Malnutrition among patients admitted to the subacute geriatric ward during the COVID-19 pandemic era: A cross-sectional study in a tertiary hospital in Malaysia.

BACKGROUND: Acute illness and hospitalisation detriment the nutritional status of older patients. This study aimed to describe the prevalence of malnutrition, characteristics and in-hospital outcomes associated with malnutrition, and nutritional management among patients who were admitted to the Subacute Geriatric Ward. METHODS: This is a retrospective study of older patients (age ≥ 60) who were admitted to the Subacute Geriatric Ward of Kuala Lumpur Hospital from 1 March 2021 to 31 May 2021. Malnutrition was identified using the Mini Nutritional Assessment-Short Form (MNA-SF). The in-hospital outcomes evaluated were hospital-associated complications, namely delirium, functional decline, incontinence, inpatient falls, inpatient pressure injuries, hospital-acquired infection, institutionalisation, and inpatient mortality. RESULTS: Seventy-three patients were included (mean age 74.7, female 58.9%), of which 28 (38.4%) and 27 (37.0%) were malnourished and at risk of malnutrition, respectively. Poorer nutritional status was associated with increased age, comorbidity burden, frailty, immobility, impaired basic activities of daily living, history of falls, cognitive impairment, incontinence, and arthritis. About 71.2% and 60.3% of patients were offered dietitian review and oral nutritional supplements, respectively. The in-hospital outcome rates were higher among malnourished patients, but the differences were not statistically significant. However, multiple hospital-associated complications were more common with poorer nutritional status (p = 0.018). CONCLUSION: Hospital malnutrition is prevalent among older patients, and unidentified malnutrition is not justified due to its association with multiple adverse outcomes.

Integration of a vertebral fracture identification service into a fracture liaison service: a quality improvement project.

Integration of a vertebral fracture identification service into a Fracture Liaison Service is possible. Almost one-fifth of computerised tomography scans performed identified an individual with a fracture. This increase in workload needs to be considered by any FLS that wants to utilise such a service. INTRODUCTION: This service improvement project aimed to improve detection of incidental vertebral fractures on routine imaging. It embedded a vertebral fracture identification service (Optasia Medical, OM) on routine computerised tomography (CT) scans performed in this hospital as part of its Fracture Liaison Service (FLS). METHODS: The service was integrated into the hospital's CT workstream. Scans of patients aged ≥ 50 years for 3 months were prospectively retrieved, alongside their clinical history and the CT report. Fractures were identified via OM's machine learning algorithm and cross-checked by the OM radiologist. Fractures identified were then added as an addendum to the original CT report and the hospital FLS informed. The FLS made recommendations based on an agreed algorithm. RESULTS: In total, 4461 patients with CT scans were retrieved over the 3-month period of which 850 patients had vertebra fractures identified (19.1%). Only 49% had the fractures described on hospital radiology report. On average, 61 patients were identified each week with a median of two fractures. Thirty-six percent were identified by the FLS for further action and recommendations were made to either primary care or the community osteoporosis team within 3 months of fracture detection. Of the 64% not identified for further action, almost half was because the CT was part of cancer assessment or treatment. The remaining were due to a combination of only ≤ 2 mild fractures; already known to a bone health specialist; in the terminal stages of any chronic illness; significant dependency for activities of daily living; or a life expectancy of less than 12 months CONCLUSION: It was feasible to integrate a commercial vertebral fracture identification service into the daily working of a FLS. There was a significant increase in workload which needs to be considered by any future FLS planning to incorporate such a service into their clinical practice.

'See-saw' expression of microRNA-198 and FSTL1 from a single transcript in wound healing.

Post-transcriptional switches are flexible effectors of dynamic changes in gene expression. Here we report a new post-transcriptional switch that dictates the spatiotemporal and mutually exclusive expression of two alternative gene products from a single transcript. Expression of primate-specific exonic microRNA-198 (miR-198), located in the 3'-untranslated region of follistatin-like 1 (FSTL1) messenger RNA, switches to expression of the linked open reading frame of FSTL1 upon wounding in a human ex vivo organ culture system. We show that binding of a KH-type splicing regulatory protein (KSRP, also known as KHSRP) to the primary transcript determines the fate of the transcript and is essential for the processing of miR-198: transforming growth factor-ß signalling switches off miR-198 expression by downregulating KSRP, and promotes FSTL1 protein expression. We also show that FSTL1 expression promotes keratinocyte migration, whereas miR-198 expression has the opposite effect by targeting and inhibiting DIAPH1, PLAU and LAMC2. A clear inverse correlation between the expression pattern of FSTL1 (pro-migratory) and miR-198 (anti-migratory) highlights the importance of this regulatory switch in controlling context-specific gene expression to orchestrate wound re-epithelialization. The deleterious effect of failure of this switch is apparent in non-healing chronic diabetic ulcers, in which expression of miR-198 persists, FSTL1 is absent, and keratinocyte migration, re-epithelialization and wound healing all fail to occur.

Tailing propensity in the ultraviolet disinfection of trickling filter and activated sludge wastewater treatment processes.

In this paper, the effect of suspended flocs on the tailing of ultraviolet (UV) disinfection kinetics of secondary effluents was examined. To achieve this goal, final effluents produced in two processes for treating wastewater; namely, a trickling filter system and an activated sludge system, were collected and their UV disinfection were compared. Tailing of the UV dose response curve was controlled by the fraction of flocs that are both culturable and UV-resistant, referred to as the 'tailing propensity'. Using this parameter, the contribution of various floc size fractions in reducing the UV disinfection efficiency of wastewater samples was quantified. Activated sludge flocs larger than 125 µm exhibited as much as 35 times greater tailing propensity than smaller flocs in the range of 20-25 µm. Within a fixed size range, the tailing propensity of flocs generated in the trickling filter system was 3 to 8 times higher than that of activated sludge flocs, and this difference increased with the floc size. A mathematical model was developed to predict the UV disinfection of secondary effluents from suspended particle size distribution data. The model showed good agreement with experimental results.

A benchmark for Monte Carlo simulations in gamma-ray spectrometry Part II: True coincidence summing correction factors.

The goal of this study is to provide a benchmark for the use of Monte Carlo simulation when applied to coincidence summing corrections. The examples are based on simple geometries: two types of germanium detectors and four kinds of sources, to mimic eight typical measurement conditions. The coincidence corrective factors are computed for four radionuclides. The exercise input files and calculation results with practical recommendations are made available for new users on a dedicated webpage.

Activity standardization of 60Co and 106Ru/106Rh by means of the TDCR method and the importance of the beta spectrum.

Atomic and nuclear data represent an important input for the accuracy of primary activity measurements based on liquid scintillation. In particular, the reliability of ß-spectrum computation has been investigated for several years through experimental and theoretical studies providing solid evidence for the need to consider the atomic effects. In the present study, the activity standardization of two ß-emitting radionuclides (60Co, 106Ru/106Rh) was carried out by means of the 4πß-γ coincidence and Triple-to-Double Coincidence Ratio (TDCR) methods. The comparison between the activity concentrations given by both primary techniques presents new evidence that a better agreement is obtained when the exchange and screening effects are included in the ß-spectra implemented in the model of light emission for TDCR measurements. A new development of a stochastic model based on Geant4 simulations for TDCR calculations is also presented.

Mapping the Posterior Ledge and Optic Foramen in Orbital Floor Blowout Fractures.

Background The posterior ledge (PL) is a vital structure that supports the implant posteriorly during orbital floor reconstruction. This study describes a technique for mapping the PL in relation to the infraorbital margin (IM) in patients with orbital floor blowout fractures. This study establishes the location of the optic foramen in relation to the PL. Methods Facial computed tomography (FCT) scans of 67 consecutive patients with isolated orbital floor blowout fractures were analyzed using Osirix. Planes of reference for orbital fractures, a standardized technique for performing measurements on FCT, was used. Viewed coronally, the orbit was divided into seven equal sagittal slices (L1 laterally to L7 medially) with reference to the midorbital plane. The distances of PL from IM and location of optic foramen were determined. Results The greatest distance to PL is found at L5 (median: 30.1 mm, range: 13.5-37.1 mm). The median and ranges for each slice are as follows: L1 (median: 0.0 mm, range: 0.0-19.9 mm), L2 (median: 0.0 mm, range: 0.0-21.5 mm), L3 (median: 15.8 mm, range: 0.0-31.7 mm), L4 (median: 26.1 mm, range: 0.0-34.0 mm), L5 (median: 30.1 mm, range: 13.5-37.1 mm), L6 (median: 29.0 mm, range: 0.0-36.3 mm), L7 (median: 20.8 mm, range: 0.0-39.2 mm). The median distance of the optic foramen from IM is 43.7 mm (range: 37.0- 49.1) at L7. Conclusion Distance to PL from IM increases medially until the L5 before decreasing. A reference map of the PL in relation to the IM and optic foramen is generated. The optic foramen is located in close proximity to the PL at the medial orbital floor. This aids in preoperative planning and intraoperative dissection.

[Epidemiological and clinical aspects of atrial fibrillation at the cardiology department of kati university hospital]. / Aspects epidemiologique et clinique de la fibrillation auriculaire au service de cardiologie du chu de kati.

Atrial fibrillation is the most frequent permanent rhythm disorder.Theaim of this work was to determine the epidemiological and clinical aspects of atrial fibrillation cases hospitalized in the cardiology department of the University Hospital of Kati. MATERIALS AND METHODS: We carried out a descriptive retrospective study, from January 2018 to December 2019.Patients of all ages and both sexes with clinical and EKG atrial fibrillation admitted to the department during the study period were included in the study.The variables studiedwere: socio-demographic characteristics, clinical signs, classification of atrial fibrillation, and comorbidities associated. RESULTS: A total of 52 patients were included in the studyof 203 cases hospitalized in the department, with a hospital prevalence of 25.61%, the female sex was predominant 69.23%. The main reason for consultation was heart failure syndrome (46.15%).Arterial hypertension (55.76%) was the mostassociatedcomorbidity. Permanent atrial fibrillation accounted for 63.46% of cases . CONCLUSION: Atrial fibrillation is the most frequent arrhythmia in our environment, preventive measures must be put in place for early detection and better management of comorbiditiesassociatedwith atrial fibrillation.

La fibrillation auriculaire est le trouble du rythme le plus fréquent. Le but de ce travail était de déterminer les aspects épidémiologiques et cliniques de la fibrillation atriale dans le service de cardiologie du CHU de Kati. MATÉRIELS ET MÉTHODES: Il s'agit d'une étude rétrospective descriptive menée de janvier 2018 à décembre 2019. Ont été inclus dans cette étude les patients de tout âge et des deux sexes ayant présenté une fibrillation atriale sur des critères cliniques et électrocardiographiques, admis dans le service pendant la période d'étude. Les variables étudiées étaient : les caractéristiques sociodémographiques, les signes cliniques et électriques, et les comorbidités associées. RÉSULTATS: Au total 52 patients ont été inclus dans l'étude sur 203 cas hospitalisés dans le service soit une prévalence hospitalière de 25,61%, le sexe féminin a été prédominant 69,23%. Le principal motif de consultation était le syndrome d'insuffisance cardiaque (46,15%). L'hypertension artérielle (55,76%) a été la comorbidité la plus associée. La fibrillation atriale permanente représentait 63,46% des cas. CONCLUSION: La fibrillation atriale est l'arythmie la plus fréquente dans notre milieu, des mesures préventives doivent être mise en place pour une détection précoce et une meilleure prise en charge des comorbidités associées.

[Epidemiology of Covid-19 and high blood pressure association at Mali'shospital]. / Epidemiologie de l'association Covid-19 et hypertension arterielle a l'hopital du Mali.

INTRODUCTION: High blood pressure is a major cardiovascular risk factor. Patients with cardiovascular risk factors are at risk of developing COVID-19. The objective of this study was to determine epidemiology of Covid-19 infected in patients with high blood pressure. PATIENTS AND METHOD: Descriptive cross-sectional study from April 2020 to June 2020 about patients hospitalized for Covid 19 by PCR diagnosis at the Hopital du Mali Bamako and having high blood pressure. Admission registry and patient charts were used to collect data. RESULTS: We collected 78 out of 484 in patients which mean hospital frequency of 16.11%. The mean age was 55.21 +/- 14.61 years. Sex ratio M / F was 1.36. Patients were followed for high blood pressure in 59% of cases. Medical history was ischemic heart disease in 2.6% and dilated cardiomyopathy in 2.6%. Main functional signs were cough in 41.02% and lost of taste in 11.53%. High blood pressure on admission was grade 2 in 37.2% and grade 3 in 3.8%. Treatments received were calcium channel blockers 41.02%, inhibitors of the reninangiotensinaldosterone system 16.66% and combinations 15.38%. Hospital mortality was 10.3%. There was no statistically significant difference in mortality between known hypertensive patients and de novo hypertensive patients. There was also no statistically significant difference in mortality by grade of hypertension. CONCLUSION: High blood pressure can be associated to Covid 19. Treatment is based on calcium channel blockers and reninangiotensinaldosterone system inhibitors. It has an impact on the prognosis of the disease with significant mortality.

INTRODUCTION: L'hypertension artérielle (HTA) est un facteur de risque cardiovasculaire majeur. Dans la littérature elle est fréquemment retrouvée chez les patients atteints de la COVID-19.L'objectif de cette étude est de décrire l'épidémiologie de cette association chez les patients hospitalisés pour Covid-19. PATIENTS ET MÉTHODE: L'Etude est transversale et descriptive ; elle a été réalisée sur la période du 1erAvril 2020 au 30 Juin 2020. Elle a concerné les patients hospitalisés pour Covid 19 avec un test PCR positif à l'hôpital du Mali de Bamako et ayant une HTA. Les registres d'admission et les dossiers des patients ont servi pour la collecte des données. RÉSULTATS: Nous avons colligé 78 sur 484 patients hospitalisés soit une fréquence de 16,11%. L'âge moyen était de 55,21 +/- 14,61 ans. Le sex ratio H/F était de 1,36.Les patients étaient suivis pour HTA dans 59% des cas. Les antécédents médicaux étaient la cardiopathie ischémique chez 2,6% et la cardiomyopathie dilatée chez 2,6%. Les principaux signes fonctionnels étaient la toux chez 41,02% et l'agueusie chez 11,53%. L'HTA à l'admission était de grade 2 dans 37,2% des cas et de grade 3 dans 3,8% des cas. Les traitements reçus étaient les inhibiteurs calciques 41,02%, les inhibiteurs du système rénine angiotensine aldostérone 16,66% et les associations 15,38%. La mortalité hospitalière était de 10,3%. Il n'y avait pas de différence statistiquement significative concernant la mortalité entre les patients connus hypertendus et les patients hypertendus de novo. Il n'y avait pas non plus de différence statistiquement significative concernant la mortalité selon le grade de l'HTA. CONCLUSION: l'HTA peut être associée au Covid 19. Le traitement est basé sur les inhibiteurs calciques et sur les inhibiteurs du système rénine angiotensine aldostérone. Elle a un impact sur le pronostic de la maladie avec une mortalité importante.