Physical and Functional Clinical Profile of Older Adults in Specialized Geriatric Rehabilitation Care Services in Saguenay-Québec: A Retrospective Study at La Baie Hospital.

Musculoskeletal disorders, cardiovascular and neurological diseases were the most commonly debilitating conditions and risk factors associated with pain, mobility limitations, increased risk of falls and disability. Studies barely address the profile of older adults in care within a specialized geriatric rehabilitation service (SGRS) to provide subsidies for new actions within the public healthcare to reduce falls and improve management in health investments. This study aimed to establish a clinical physical and functional profile of the patients with neuromusculoskeletal and cognitive disorders and fallers in interventions within SGRS. From a retrospective study design, 127 medical records were compiled and analyzed to determine the physical and functional profile of older adults and differences according to sex, age groups and the benefits for local physical therapy intervention. The users were between 76 and 85 years of age, with diverse clinical diagnoses and debilitating conditions and impairments. A higher proportion presented gait and balance impairments and had two or more falls in 12 months. A significant effect for advanced age was observed. Overall, real benefits were reported with intervention for functional improvement, although the absence of a control group. These results have direct implications for a better understanding of a local SGRS and provide subsidies for developing new approaches for the assessment and treatment of older adults with high a risk of falls in order to reduce costs for the public health system.

Prevention of Post-operative Delirium in the Elderly Using Pharmacological Agents.

INTRODUCTION: Post-operative delirium (POD) is a serious surgical complication that can cause significant morbidity and mortality. It is associated with prolonged hospital stay, delayed admission to rehabilitation programs, persistent cognitive deficits, marked health-care costs, and more. The pathophysiology is multi-factorial and not completely understood, which complicates the optimal management. Non-pharmacological measures have been the mainstay of treatment, but there has been an ongoing interest in the medical literature on the prevention of post-operative delirium using medications. The purpose of this review is to critically analyze the current evidence on pharmacological prevention of POD. METHODS: A literature review was conducted using PubMed and Embase databases, using the following search terms: delirium, anti-psychotics, cholinesterase inhibitors, and statins. RESULTS: A total of 1,152 articles were screened and 25 articles were reviewed. Fourteen articles found a reduced incidence of post-operative delirium using pharmacological agents: eight with antipsychotics, two with statins, one with melatonin, one with dexamethasone, one with gabapentin, and one with diazepam. However, study designs, methodological issues, or authors' interpretations raise questions on these conclusions. CONCLUSIONS: Further double-blinded randomized clinical trials should be conducted before administering pharmacological agents to reduce POD in a non-research setting.

Ultra-fast analysis of anatoxin-A using laser diode thermal desorption-atmospheric pressure chemical ionization-tandem mass spectrometry: validation and resolution from phenylalanine.

A novel approach for the analysis of the cyanobacterial toxin, anatoxin-a (ANA-a), in an environmentally relevant matrix, using laser diode thermal desorption-atmospheric pressure chemical ionization-tandem mass spectrometry (LDTD-APCI-MS/MS) is presented. The ultra-fast analysis time (15 s/sample) provided by the LDTD-APCI interface is strengthened by its ability to remove interference from phenylalanine (PHE), an isobaric interference in ANA-a analysis by MS/MS. Thus the LDTD-APCI interface avoids the time consuming steps of derivatization, chromatographic separation or solid-phase extraction prior to analysis. Method development and instrumental parameter optimizations were focused toward signal enhancement of ANA-a, and signal removal of a PHE interference as high as 500 µg/L. External calibration in a complex matrix gave detection and quantification limit values of 1 and 3 µg/L respectively, as well as good linearity (R(2) > 0.999) over nearly two orders of magnitude. Internal calibration with clomiphene (CLO) is possible and method performance was similar to that obtained by external calibration. This work demonstrated the utility of the LDTD-APCI source for ultra-fast detection and quantification of ANA-a in environmental aqueous matrices, and confirmed its ability to suppress the interference of PHE without sample preparation or chromatographic separation.

Laser diode thermal desorption-positive mode atmospheric pressure chemical ionization tandem mass spectrometry for the ultra-fast quantification of a pharmaceutical compound in human plasma.

An ultra-fast, reliable and sensitive analytical method enabling high-throughput quantitative analysis of pharmaceutical compounds in human plasma is described. The quantitative work was performed on one of our compound currently under clinical trial by employing a deuterated internal standard (IS). Plasma samples were treated on solid phase micro-extraction (SPME) plates prior their analysis by laser diode thermal desorption and atmospheric pressure chemical ionization coupled to tandem mass spectrometry (LDTD/APCI-MS/MS) in positive mode. The sample analysis run time was 10s as compared to the 7 min obtained for the validated LC-MS/MS method. The limit of quantification (LOQ) of the method was estimated at 1 ng/mL. The calibration graphs were linear with a regression coefficient R(2) > 0.997. The data of the partial validation show that LDTD/APCI-MS/MS assay was highly reproducible and selective. In addition, the deviations for intra and inter assay accuracy and precision data were within 15% at all quality control levels. The LDTD/APCI-MS/MS method was successfully applied to the analysis of clinical samples and the data obtained were consistent with those found with a validated LC-MS/MS assay. This work demonstrates that LDTD/APCI-MS/MS could be used for the ultra-fast and reliable quantitative analysis of pharmaceutical compounds in human plasma without using the separation step commonly associated with the LC-MS/MS assay.

High-throughput quantitation of seven sulfonamide residues in dairy milk using laser diode thermal desorption-negative mode atmospheric pressure chemical ionization tandem mass spectrometry.

Sulfonamides are antibiotic compounds widely used in the dairy industry. Their presence in diary milk poses a risk to public health and may also contribute to the spread of antibiotic resistance in bacteria. Sulfonamide residues in dairy milk were quantified by tandem mass spectrometry (MS/MS) using a novel ionization source based on laser diode thermal desorption-negative mode atmospheric pressure chemical ionization (LDTD-APCI(-)). Seven sulfonamides spiked in milk were extracted with acetonitrile, which yielded high recoveries (77.5-101.5%). Calibration curves in the matrix showed good linearity (0.9977 >or= R(2) >or= 0.9658) over the dynamic range (1.6-500 microg L(-1)), and limits of quantitation were between 2 and 14 microg L(-1), lower than or of the same magnitude as maximum residue criteria set by several regulatory agencies (10-100 ng L(-1)). In addition, the run time using the LDTD-MS/MS system was 30 s per sample, as compared to actual methods running from 7 to 84 min for the same sulfonamide residue compounds, which gave the method the high screening throughput capacity necessary for monitoring milk production.

Membrane permeation continuous-flow isotope ratio mass spectrometry for on-line carbon isotope ratio determination.

Gaseous membrane permeation (MP) technologies have been combined with continuous-flow isotope ratio mass spectrometry for on-line delta13C measurements. The experimental setup of membrane permeation-gas chromatography/combustion/isotope ratio mass spectrometry (MP-GC/C/IRMS) quantitatively traps gas streams in membrane permeation experiments under steady-state conditions and performs on-line gas transfer into a GC/C/IRMS system. A commercial polydimethylsiloxane (PDMS) membrane sheet was used for the experiments. Laboratory tests using CO2 demonstrate that the whole process does not fractionate the C isotopes of CO2. Moreover, the delta13C values of CO2 permeated on-line give the same isotopic results as off-line static dual-inlet IRMS delta13C measurements. Formaldehyde generated from aqueous formaldehyde solutions has also been used as the feed gas for permeation experiments and on-line delta13C determination. The feed-formaldehyde delta13C value was pre-determined by sampling the headspace of the thermostated aqueous formaldehyde solution. Comparison of the results obtained by headspace with those from direct aqueous formaldehyde injection confirms that the headspace sampling does not generate isotopic fractionation, but the permeated formaldehyde analyzed on-line yields a 13C enrichment relative to the feed delta13C value, the isotopic fractionation being 1.0026 +/- 0.0003. The delta13C values have been normalized using an adapted two-point isotopic calibration for delta13C values ranging from -42 to -10 per thousand. The MP-GC/C/IRMS system allows the delta13C determination of formaldehyde without chemical derivatization or additional analytical imprecision.

Improved detection of sugar addition to maple syrup using malic acid as internal standard and in 13C isotope ratio mass spectrometry (IRMS).

Stable carbon isotope ratio mass spectrometry (delta13C IRMS) was used to detect maple syrup adulteration by exogenous sugar addition (beet and cane sugar). Malic acid present in maple syrup is proposed as an isotopic internal standard to improve actual adulteration detection levels. A lead precipitation method has been modified to isolate quantitatively malic acid from maple syrup using preparative reversed-phase liquid chromatography. The stable carbon isotopic ratio of malic acid isolated from this procedure shows an excellent accuracy and repeatability of 0.01 and 0.1 per thousand respectively, confirming that the modified lead precipitation method is an isotopic fractionation-free process. A new approach is proposed to detect adulteration based on the correlation existing between the delta13Cmalic acid and the delta13Csugars-delta13Cmalic acid (r = 0.704). This technique has been tested on a set of 56 authentic maple syrup samples. Additionally, authentic samples were spiked with exogeneous sugars. The mean theoretical detection level was statistically lowered using this technique in comparison with the usual two-standard deviation approach, especially when maple syrup is adulterated with beet sugar : 24 +/- 12% of adulteration detection versus 48 +/- 20% (t-test, p = 7.3 x 10-15). The method was also applied to published data for pineapple juices and honey with the same improvement.

Investigation of the competitive rate of derivatization of several secondary amines with phenylisocyanate (PHI), hexamethylene-1,6-diisocyanate (HDI), 4,4'-methylenebis(phenyl isocyanate) (MDI) and toluene diisocyanate (TDI) in liquid medium.

The stabilization of the isocyanate (NCO) groups during workplace sampling is necessary for their subsequent laboratory analysis. Most derivatization reagents are secondary amines. By carrying out a test in which two secondary amines are added to an isocyanate, the relative rates of these reactions can be evaluated. This evaluation is known for a monoisocyanate, phenylisocyanate (PHI), but is being developed for diisocyanates. This study deals with the relative reactivity (RR) of four diisocyanates: hexamethylene 1,6-diisocyanate (HDI), 4,4'-methylenebis(phenyl isocyanate) (MDI), and the ortho and para isomers of toluene diisocyanate (TDI) in addition to PHI, with four secondary amines: 1-(2-methoxyphenyl)piperazine (MOPIP), 9-(N-methylaminomethyl)anthracene (MAMA), 1-(9-anthracenylmethyl)piperazine (MAP), and dibutylamine (DBA). These competitive derivatization reactions are studied in three reaction solvents, namely acetonitrile, toluene, and acetonitrile doped with water (1% v/v). The results show that the order of reactivity, which doesn't change with the isocyanate as well as with the solvent used, is the following: DBA > MAP > MOPIP > MAMA. The relative difference in reactivity is a function of both the isocyanate and the solvent used. Hindered aromatic diisocyanates (TDI and MDI) show a greater difference in reactivity with the derivatization agents. These differences in reactivity are also modified by the solvent used. For example, larger differences are observed in acetonitrile than in toluene, but the introduction of water to acetonitrile, which does not affect the reaction yield, makes these differences smaller.