The influence of frailty on outcomes for older adults admitted to hospital with benign biliary disease: a single-centre, observational cohort study.

INTRODUCTION: The prevalence and complications of biliary disease increase with age. Frailty has been associated with adverse outcomes in the hospital setting. We describe the prevalence of frailty in older patients hospitalised with benign biliary disease and its association with duration of hospital stay, and 90-day and 1-year mortality. METHODS: We performed a retrospective cohort study of patients aged 75 years and over admitted with acute biliary disease between 17 September 2014 and 20 March 2017. Clinical Frailty Scale (CFS) score was recorded on admission. RESULTS: We included 200 patients with a median age of 82 (75-99) years, 60% were female; 154 (77%) were independent for personal activities of daily living (ADLs) and 99 (49.5%) for instrumental ADLs. Cholecystitis was the most common diagnosis (43%) followed by cholangitis (36%) and pancreatitis (21%). Ninety-nine patients were non frail (NF; CFS 1-4) and 101 were frail (F; CFS 5-9). Some 104 patients received medical treatment only. Surgery was more common in NF patients (11% vs F 2%), percutaneous drainage more frequently performed in F patients (15% vs NF 5%) and endoscopic cholangiopancreatography was similar in both groups (F 32% vs NF 31%). Frailty was associated with worse clinical outcomes in F vs NF: functional deconditioning (34% vs 11%), increased care level (19% vs 3%), length of stay (12 vs 7 days), 90-day mortality (8% vs 3%) and 1-year mortality (48% vs 24%). CONCLUSIONS: Half of patients in our cohort were frail and spent longer in hospital, were less likely to undergo surgery and were less likely to remain alive at 1 year after discharge.

Increased care at discharge from COVID-19: The association between pre-admission frailty and increased care needs after hospital discharge; a multicentre European observational cohort study.

BACKGROUND: The COVID-19 pandemic has placed significant pressure on health and social care. Survivors of COVID-19 may be left with substantial functional deficits requiring ongoing care. We aimed to determine whether pre-admission frailty was associated with increased care needs at discharge for patients admitted to hospital with COVID-19. METHODS: Patients were included if aged over 18 years old and admitted to hospital with COVID-19 between 27 February and 10 June 2020. The Clinical Frailty Scale (CFS) was used to assess pre-admission frailty status. Admission and discharge care levels were recorded. Data were analysed using a mixed-effects logistic regression adjusted for age, sex, smoking status, comorbidities, and admission CRP as a marker of severity of disease. RESULTS: Thirteen hospitals included patients: 1671 patients were screened, and 840 were excluded including, 521 patients who died before discharge (31.1%). Of the 831 patients who were discharged, the median age was 71 years (IQR, 58-81 years) and 369 (44.4%) were women. The median length of hospital stay was 12 days (IQR 6-24). Using the CFS, 438 (47.0%) were living with frailty (≥ CFS 5), and 193 (23.2%) required an increase in the level of care provided. Multivariable analysis showed that frailty was associated with an increase in care needs compared to patients without frailty (CFS 1-3). The adjusted odds ratios (aOR) were as follows: CFS 4, 1.99 (0.97-4.11); CFS 5, 3.77 (1.94-7.32); CFS 6, 4.04 (2.09-7.82); CFS 7, 2.16 (1.12-4.20); and CFS 8, 3.19 (1.06-9.56). CONCLUSIONS: Around a quarter of patients admitted with COVID-19 had increased care needs at discharge. Pre-admission frailty was strongly associated with the need for an increased level of care at discharge. Our results have implications for service planning and public health policy as well as a person's functional outcome, suggesting that frailty screening should be utilised for predictive modelling and early individualised discharge planning.

Predicting in-hospital mortality in older general surgical patients.

Introduction A significant number of emergency general surgical admissions occur in older patients. Clinical decision making in this group is challenging and current risk prediction tools extrapolate data from cohorts of younger patients. This is the first UK study to examine risk factors predicting in-hospital mortality in older acute surgical patients undergoing comprehensive geriatric assessment. Methods This was a prospective study of consecutive patients aged ≥75 years admitted non-electively to general surgery wards between September 2014 and February 2017 who were reviewed by an elderly medicine in-reach service. Results A total of 577 patients were included with a mean age of 82.9 years. There was a female predominance (56%). The majority were living at home alone or with carers (93%) and most were independent in basic activities of daily living (79%). Over two-thirds (69%) were mobile with no walking aids or use of a walking stick and overt here-quarters (79%) had no cognitive impairment. Seventy-seven per cent of patients were managed non-operatively. The in-hospital mortality rate was 6.9%. Female sex (p=0.031), dependence in activities of daily living (p<0.001), cognitive impairment (p<0.001) and incontinence (p<0.001) were predictors of in-hospital mortality. ASA (American Society of Anesthesiologists) grade ≥3 was also associated with increased in-hospital mortality (odds ratio: 5.3, 95% confidence interval: 2.6-10.7). Conclusions Older general surgical patients present a high level of complexity. This study highlights the predictive role of mobility, functional and cognitive impairment when assessing this population. Accurate risk stratification requires global assessment by teams experienced in care of the older patient rather than the traditional focus on co-morbidities.

Treatment of stress urinary incontinence after prostatectomy with the adjustable transobturator male system (ATOMS®) with preattached scrotal port. / Tratamiento de la incontinencia urinaria de esfuerzo tras prostatectomía con el sistema masculino transobturador ajustable (ATOMS®) con puerto escrotal premontado.

INTRODUCTION: Stress urinary incontinence (SUI) is a significant sequela of prostate cancer surgery. In this article, we present the surgical technique and safety and efficacy of the adjustable transobturator male system (ATOMS®) with preattached scrotal port. MATERIAL AND METHOD: An open prospective study was conducted at a university hospital with the main objective of changing the baseline condition after adjustment in the daily pad count and their wet weight (pad test). The secondary objectives were the quality-of-life assessment (International Consultation on Incontinence Questionnaire-Short Form [ICIQ-SF] and Incontinence Impact Questionnaire-7 [IIQ-7], baseline and after the adjustment), patient-perceived results (Patient Global Index [PGI] and Global Response Assessment [GRA] at 1 year) and assessment of complications according to Clavien-Dindo. The numerical values are expressed in median ± IQR. RESULTS: We analysed 60 consecutive patients with a follow-up of 21±22 months. The baseline pad-test was 465±450mL, and the pad-count was 5+3 pads/day. The baseline SUI was mild (11.6% of patients), moderate (25%) and severe (63.3%). The operative time was 60±25min, the hospital stay was 1±0 days, and the visual analogue scale of pain on day 1 after surgery was 0±1. The total filling was 16.5±7mL, and the number of refillings was 1±2. The pad-test and pad-count after the adjustment were 0±20mL and 0±1, respectively (both p<.0001 compared with baseline). SUI disappeared (81.7%) or remained mild (11.7%), moderate (5%) or severe (1.6%). We observed a reduction in the ICIQ-SF (p<.0001) and IIQ-7 scores (p=.0003). Both continence (p=.002) and satisfaction (p=.03) were lower in the irradiated patients. Complications occurred in 11 cases (18.6%), 8 (13.5%) of which were grade I and 3 (5.1%) of which were grade 3. The treatment satisfaction rate was 91.7%, and the patient-perceived overall improvement at 1 year was highly pronounced (PGI-I score, 1±1; GRA, 6±1). CONCLUSIONS: SUI treatment of men using third-generation ATOMS® is safe and effective in the short-term, even in patients with severe SUI. The rate of dry patients after the adjustment exceeded 80%, and the satisfaction rates exceeded 90%. The patients assessed this treatment highly positively.

Escala de la calidad del desempeño sensoriomotor de bebés de 2 a 15 meses de edad: ECDSM2-15 / The sensory-motor quality performance scale from 2-15 months

The Sensory Motor Performance Quality Scale of babies from 2 to 15 months of age, detected with delayed motor development, or at risk or with cerebral palsy, is presented and its application exemplified through a case corresponding to the sixth month the subscale.

Se presenta la Escala de la Calidad del Desempeño Sensoriomotor de bebés de 2 a 15 meses de edad, detectados con retraso del desarrollo psicomotor, o diagnosticados en riesgo o con parálisis cerebral. Se ejemplifica su aplicación a través de un caso correspondiente a la subescala del sexto mes.

Comparative study of multiport laparoscopy and umbilical laparoendoscopic single-site surgery with reusable platform for treating renal masses. / Estudio comparativo entre laparoscopia multipuerto y LESS umbilical con plataforma reutilizable en el tratamiento de las masas renales.

INTRODUCTION: Umbilical laparoendoscopic single-site (LESS) surgery is an increasingly used modality for treating renal masses. We present a prospective comparison between LESS renal surgery and conventional laparoscopy. MATERIAL AND METHOD: A comparative paired study was conducted that evaluated the surgical results and complications of patients with renal neoplasia treated with LESS surgery (n=49) or multiport laparoscopy (n=53). The LESS approach was performed with reusable material placed in the navel and double-rotation curved instruments. An additional 3.5-mm port was employed in 69.4% of the cases. We assessed demographic data, the type of technique (nephrectomy, partial nephrectomy and nephroureterectomy), surgical time, blood loss, haemoglobin, need for transfusion, number and severity of complications (Clavien-Dindo), hospital stay, histological data and prognosis. RESULTS: There were no differences in follow-up, age, sex, body mass index, preoperative haemoglobin levels or type of surgery. Conversion occurred in 2 cases (1 in each group). The surgical time was equivalent (P=.6). Intraoperative transfusion (P=.03) and blood loss (P<.0001) was lower with LESS, postoperative haemoglobin levels were higher (P<.0001) and haemostatic agents were used more frequently (P<.0001). There were no differences in the number (P=.6) or severity (P=.47) of complications. The length of stay (P<.0001), the proportion of patients with drainage (P=.04) and the number of days with drainage (P=.0004) were lower in LESS. Twenty-five percent of the lesions operated on with LESS were benign, but the mean size was similar in the 2 groups (P=.5). Tumour recurrence and/or progression were more frequent in multiport laparoscopy (P=.0013). CONCLUSIONS: Umbilical LESS surgery with reusable platform enables various surgical techniques to be performed when treating renal masses, with time consumption and safety comparable to conventional laparoscopy. The LESS approach is advantageous in terms of blood loss and hospital stay.

Prevalencia de Lengua Geográfica en Niños Chilenos de 7 a 10 Años de Edad / Prevalence of Geographic Tongue in Chilean Children between 7 and 10 Years of Age

El objetivo del estudio fue determinar la prevalencia de lengua geográfica y evaluar su asociación con el estrés emocional, irritación crónica, lengua fisurada y tipo de establecimiento educacional, en niños de 7 a 10 años de edad en la ciudad de Viña del Mar, Chile. De un total de 27.234 escolares, cursando 2 a 5 año básico, pertenecientes a colegios de la ciudad de Viña del Mar, Chile, se examinaron 436 niños.Se realizó un estudio descriptivo transversal de alumnos provenientes de tres tipos de establecimientos educacionales diferentes: particular, particular con subvención del estado de Chile y municipalizado. Las variables estudiadas fueron edad, sexo y establecimiento educacional. Adicionalmente, en los alumnos con lengua geográfica y 23 alumnos sin este diagnóstico se evaluó la presencia de lengua fisurada, irritación lingual crónica y estrés emocional. Se determinó la prevalencia mediante el cálculo de una proporción, las variables discretas se analizaron mediante Chi-cuadrado de Pearson o la prueba de Fisher y para determinar medidas de asociación con lengua geográfica se realizó regresión logística binaria, considerándose significativo un p<0,05. De los 436 niños, 23 presentaron lengua geográfica, evidenciando una prevalencia de 5,28%, con un IC 95% de 3,37% a 7,81%. No se evidenciaron diferencias respecto al sexo, edad ni tipo de establecimiento educacional. No se determinaron factores asociados a lengua geográfica. La prevalencia de LG determinada es similar a otros estudios que abarcan la misma población de rangos etarios. Al igual que en otros estudios no se pudo demostrar que el estrés emocional, irritación crónica, lengua fisurada y tipo de establecimiento educacional constituyeron factores asociados a la presencia de lengua geográfica.

The aim of this study was to determine the prevalence of geographic tongue and evaluate its association with emotional stress, chronic irritation, fissured tongue and type of educational establishment, in children between 7 and 10 years of age, in the city of Viña del Mar, Chile. From a total of 27,234 students attending 2nd through 5th grade, we examined 436 children. A descriptive study of students was carried out from three different educational institutions: private, private with state funding and public schools. The variables studied were age, sex and the educational establishment the children attended. Additionally in the students with geographic tongue and in 23 students without this diagnosis, we evaluated the presence of fissured tongue, tongue irritation and chronic emotional stress. Prevalence was determined by calculating ratio, discrete variables were analyzed using Pearson Chi-square test or Fisher, and in order to determine association measures with geographic tongue, binary logistic regression was considered significant at p <0.05. Of the 436 children, 23 had geographic tongue, showing a prevalence of 5.28% with a 95% CI 3.37% to 7.81%. No differences regarding sex, age and type of educational establishment were found. No factors associated with geographic tongue were determined. The prevalence of the LG is similar to other studies covering the same age ranges. Furthermore, and as in other works, our study did not to show that emotional stress, chronic irritation, fissured tongue and the type of educational establishment constituted factors associated with the presence of geographic tongue.

Daidzein has neuroprotective effects through ligand-binding-independent PPARγ activation.

Phytoestrogens are a group of plant-derived compounds that include mainly isoflavones like daidzein. Phytoestrogens prevent neuronal damage and improve outcome in experimental stroke; however, the mechanisms of this neuroprotective action have not been fully elucidated. In this context, it has been postulated that phytoestrogens might activate the peroxisome proliferator-activated receptor-γ (PPARγ), which exerts neuroprotective effects in several settings. The aim of this study was to determine whether the phytoestrogen daidzein elicits beneficial actions in neuronal cells by mechanisms involving activation of PPARγ. Our results show that daidzein (0.05-5 µM) decreases cell death induced by exposure to oxygen-glucose deprivation (OGD) from rat cortical neurons and that improves synaptic function, in terms of increased synaptic vesicle recycling at nerve terminals, being both effects inhibited by the PPARγ antagonist T0070907 (1 µM). In addition, this phytoestrogen activated PPARγ in neuronal cultures, as shown by an increase in PPARγ transcriptional activity. Interestingly, these effects were not due to binding to the receptor ligand site, as shown by a TR-FRET PPARγ competitive binding assay. Conversely, daidzein increased PPARγ nuclear protein levels and decreased cytosolic ones, suggesting nuclear translocation. We have used the receptor antagonist (RE) fulvestrant to study the neuroprotective participation of daidzein via estrogen receptor and at least in our model, we have discarded this pathway. These results demonstrate that the phytoestrogen daidzein has cytoprotective properties in neurons, which are due to an increase in PPARγ activity not mediated by direct binding to the receptor ligand-binding domain but likely due to post-translational modifications affecting its subcellular location and not depending to the RE and it is not additive with the agonist rosiglitazone.

Severidad clínica de la infección respiratoria aguda baja primaria por virus respiratorio sincicial grupos A y B / Severity of primary acute lower respiratory infection for RSV groups A and B

La evolución severa de la infección respiratoria aguda baja (IRAB) por VRS se observa en lactantes con y sin factores clásicos de riesgo. La gravedad puede depender del huésped, virus y/o ambiente. Nuestro objetivo fue evaluar la asociación del grupo A y B a una mayor severidad. Estudiamos lactantes previamente sanos, hospitalizados por IRAB por VRS. Comparamos severidad clínica de grupo A y B. VRS B predominó en 1994, A lo hizo entre 1995 y 1997 y entre 1999 y 2002; en 1998 la proporción de VRS A y B fue similar, apareciendo primero A y luego B. Los grupos no mostraron diferencias significativas en días de hospitalización o ingreso a UTI; el requerimiento de oxígeno fue significativamente mayor en el grupo B, con predominio de neumonías. Concluimos que la severidad de las IRAB por VRS se asocia marginalmente a VRS B, ya que este grupo presentó más neumonías puras y necesidad de oxígenoterapia.

The more severe primary acute lower respiratory tract infection (ALRI) due to RSV is seen in infants with underlying diseases but also in previously healthy infants. Severity depends on host factors, viral strain and/or environment. Our aim was to determine the association of RSV A and B with severity. We studied previously healthy infants hospitalized due to RSV ALRI. We compared the clinical severity of groups A and B. RSV B was predominant in 1994, RSV A in 1995 to 1997 and in 1999 to 2002. In 1998 the proportion of RSV A and B were similar. Both groups did not differ in hospital stay, admission to ICU or mechanical ventilation. Oxygen requirements and a diagnosis of pneumonia were more frequent in RSV group B. We conclude that severity of RSV ALRI is little associated to viral strain, RSV group B presented with more pneumonias and oxygen requirements.

[Absence of chromosomic and genotoxic damage from the radiation dose administered in scintigraphic examinations]. / Ausencia de daño cromosómico y genotóxico inducido por la dosis de radiación administrada en las exploraciones gammagráficas.

INTRODUCTION: The cytokinesis-blocked (CB) micronucleus test (MN) on irradiated human lymphocytes is normally used to evaluate chromosomal and genotoxic damage produced by various physical and chemical agents. OBJECTIVE: Determine any possible genotoxic effect induced by the different types of ionizing radiation employed in medical diagnostic radiology and nuclear medicine. MATERIAL AND METHODS: The frequency of the MN appearance was determined in CB lymphocyte cultures of a total of 4 different groups of patients: (1) in 35 supposedly healthy volunteers to establish the MN spontaneous frequency in the medium; (2) in 9 volunteers to measure the in vitro dose-response curves in order to calculate the MN frequency following X-ray irradiation and gamma radiation; (3) in 25 patients in whom a specific diagnostic and/or therapeutic procedure employing diagnostic radiology techniques involving X-ray exposure was applied, and (4) in 26 patients in whom the diagnostic procedure in question involved nuclear medicine techniques (scintiscan). RESULTS: A lineal relationship was observed between the MN frequency and the dose of ionizing radiation administered in vitro, both in X-rays and gamma radiation. A significant increase in the MN is observed after radiation is given to patients during medical diagnostic radiology examinations when compared with the control values obtained from the same patients prior to being subjected to the radiological procedure (p < 0.01). No significant MN increase is observed following exposure to radiation involved in diagnostic examinations in patients studied in Nuclear Medicine. CONCLUSION: Ionizing radiation employed in complex medical diagnostic radiology examinations produces a significant increase in the MN appearance frequency and as such indicates both radiation induced chromosomal and genotoxic damage. However, the ionizing radiation used in diagnostic nuclear medicine examinations does not induce any significant increase in MN appearance frequency.

Antimutagenic properties of bell and black peppers.

The wing Somatic Mutation And Recombination Test (SMART) in Drosophila melanogaster was used to study the modulating action of bell pepper (Capsicum annuum) and black pepper (Piper nigrum) in combination with the alkylating agent methyl methanesulfonate (MMS) and the promutagen agent ethyl carbamate (EC). Larvae trans-heterozygous for the third chromosome recessive markers multiple wing hairs (mwh) and flare-3 [flr(3)] were fed genotoxins alone or in combination with each of the two spices. Genetic changes induced in somatic cells of the wing's imaginal discs lead to the formation of mutant clones on the wing blade. Our results showed that bell pepper was effective in reducing the mutational events induced by EC and MMS and black pepper was only effective against EC. Pretreatment of 2-day-old larvae with the spices for 24 h followed by a treatment with EC and MMS was only effective in reducing mutations induced by EC. Suppression of metabolic activation or interaction with the active groups of mutagens could be mechanisms by which the spices exert their antimutagenic action.

A dose dependent anti-genotoxic effect of turmeric.

The anti-genotoxic action of turmeric was evaluated by Somatic Mutation and Recombination Test (SMART). As described in other mutagenecity tests, turmeric showed non mutagenic effects in the SMART. The well known powerful mutagen urethane was used as a model to evaluate the anti-genotoxicity of turmeric. Combined treatment of urethane and turmeric displayed, throughout all concentrations assayed, an inhibition of the genotoxic effect of urethane by turmeric. This anti-genotoxic effect was proportional to the concentrations applied. The results obtained, both in single and combined treatments indicate the suitability of the wing spot test for miming the normal intake of substances.

Determinación del grado de contaminación por microorganismos bucales de los cepillos dentales a diversos tiempos de uso / Determination of contamination level by oral microorganisms of dental brushes at different time of use

Se seleccionaron 120 alumnos de la Facultad de Odontología , U. de Chile, los que se dividieron en dos grupos: el grupo A escobilló sus dientes con cepillo dental humedecido en agua solamente y el B, con pasta dental con monofluorfosfato de Na, carbonato de Ca y carragenato de Ca. A todos los participantes al inicio de la investigación, se les entregó un cepillo nuevo. Cada grupo fue a su vez dividido en tres sub-grupos: A-1, A-2, A-3, B-1, B-2 y B-3; los sub-grupos A-1 y B-1 terminaron la experiencia a los 15 días, devolviendo sus cepillos; los sub-grupos A-2 y B-2, los entregaron a los 30 días y los sub-grupos A-3 y B-3, a los 60 días. De los 120 alumnos, sólo 82 terminaron la investigación de acuerdo a las exigencias, el resto fue retirado de la investigación. Los cepillos que los alumnos entregaban estaban protegidos de la contaminación externa y se llevaron al laboratorio de microbiología de la Facultad, para su procesamiento. Este consistió en cortar en forma aséptica las cerdas del 1/3 anterior de cada cepillo, tomar 20 de éstas y sembrarlas en un tubo con caldo thioglicolato para luego ser agitadas en el vortex mixer por 1 minuto. De cada tubo se tomaron 100 uL para ser sembrados en los siguientes medios de cultivo: agar TYCSB para el S. mutans, agar Sabureaud + Cloramfenicol para las Cándidas, el agar LBS para los l,actobacilos y agar sangre + hemina + menadiona para la flora periodontal total. Resultados: no hubo desarrollo de cándidas en ninguno de los subgrupos, los lactobacilos sólo estuvieron presentes en un solo caso del universo total de 82. El desarrollo del S. mutans fue escaso en el medio TYCSB, un caso en el sub-grupo A-1 tres en el sub-grupo A-3 y uno en el sub-grupo B-3. Con respecto al medio de agar sangre+hemina+menadiona, el desarrollo de los anaerobios totales periodontales fue positivo en 34 casos, lo que hace un 41,5 por ciento del total

An investigation into the mechanism ofL-asparaginase resistance in L5178Y murine leukemia cells.

Resistance of leukemia cells toL-asparaginase is presumed to be due to increased expression of asparagine synthetase activity by resistant cells, so they are no longer dependent on an exogenous source ofL-asparagine for growth. The mechanism by which cells acquire the ability for increased enzyme expression, however, has not been clearly defined. Evidence presented here indicates that genomic alterations in the form of translocations, gene amplification, or increased P-glycoprotein expression, do not account for the phenotypic transformation fromL-asparaginase sensitivity toL-asparaginase resistance. Instead, both sensitive and resistant L5178Y cells contain immunoreactive material detected by Western blotting with an antiserum prepared against bovine pancreatic asparagine synthetase. This suggests that the mechanism of resistance might involve modification of asparagine synthetase inL-asparaginase-resistant cells by an as-yet-unidentified mechanism or by inhibition of enzyme activity in theL-asparaginase-sensitive cells.

Glutathione status and sensitivity to GSH-reacting compounds of Escherichia coli strains deficient in glutathione metabolism and/or catalase activity.

The intracellular concentrations of total glutathione, GSSG and protein X S-SG, the total excreted glutathione concentration, and the susceptibility towards GSH-reacting compounds were assayed in strains of Escherichia coli deficient in biosynthesis and/or reduction of glutathione. A deficiency in glutathione reductase displaced the glutathione status towards the oxidized forms. This displacement was more clearly appreciated in strains additionally deficient in glutathione biosynthesis. A deficiency in catalase activity also produced an increase in the oxidation of glutathione. The most severe changes were observed in the concentrations of protein-glutathione mixed disulfides and in the amount of glutathione excreted to the medium. Increased sensitivities towards compounds known to interact with cellular GSH were observed in glutathione reductase deficient strains, although these effects were enhanced in strains additionally deficient in GSH biosynthesis.