RESUMO
PURPOSE: To examine the sex differences in the relationship of metabolic syndrome (MetS) criteria with arthritis and symptomatic arthritis among Mexican American older adults aged ≥ 65 without self-reported arthritis at baseline over 23-years of follow-up. METHODS: Participants (N = 1447) were from the Hispanic Established Population for the Epidemiologic Study of the Elderly (1993/94-2016). Measures included MetS criteria, arthritis defined as self-reported physician-diagnosed arthritis, socio-demographics, morbidities, depressive symptoms, pain on weight-bearing, cognitive and physical function, handgrip strength, mobility, and activities of daily living (ADLs) limitations. Symptomatic arthritis was defined as self-reported arthritis and having ≥ 1 of the following: pain, mobility limitation, or limited ADLs. RESULTS: At baseline, the mean age was 72.6 years and 730 (50.5%) of our participants were females. Female participants with 2 and 3 MetS criteria had greater odds of arthritis [odds ratio (OR) = 1.77, 95% Confidence Interval (Cl) = 1.28-2.45 and OR = 2.68, 95% CI = 1.69-4.27, respectively) and symptomatic arthritis (OR = 1.74, 95% Cl = 1.24-2.44 and OR = 3.27, 95% CI = 2.04-5.26, respectively) after controlling for covariates. Male participants with 2 and 3 MetS criteria had greater odds of arthritis (OR = 1.65, 95% Cl = 1.14-2.39 and OR = 2.52, 95% CI = 1.51-4.19, respectively) and symptomatic arthritis (OR = 1.93, 95% Cl = 1.30-2.86 and OR = 2.98, 95% CI = 1.62-5.47, respectively) after controlling for covariates. Both females and males with pain on weight-bearing had greater odds of arthritis than those without pain. CONCLUSIONS: At 23-years of follow-up, Mexican American older adults with MetS have an increased risk of arthritis and symptomatic arthritis. Early MetS screening and management may reduce arthritis in this population at high risk of disability.
RESUMO
Bleeding ectopic varices is an uncommon but life-threatening complication of portal hypertension that requires a high clinical index of suspicion for early diagnosis and management. Transjugular intrahepatic portosystemic shunt is a safe and effective treatment option for bleeding ectopic varices. However, due to a high re-bleeding rate despite a patent shunt and reduced portosystemic gradient, adjunctive measures directed at embolization of the varices should be attempted. Herein, we report a case of bleeding omental varices after traumatic injury in a cirrhotic patient presenting with hemoperitoneum and hemorrhagic shock.
RESUMO
The COVID-19 pandemic has placed an unprecedented burden on health care systems and economies around the globe. Clinical evidences demonstrate that SARS-CoV-2 infection produces detrimental levels of pro-inflammatory cytokines and chemokines that can lead to acute respiratory distress syndrome (ARDS) and significant systemic organ damage. Currently, there is no definitive therapy for COVID-19 or associated complications, and with the hope of a safe and effective vaccine in the distant future, the search for an answer is paramount. Mesenchymal stem cells (MSCs) provide a viable option due to their immunomodulatory effects and tissue repair and regeneration abilities. Studies have demonstrated that compassionate use of MSCs can reduce symptoms associated with SARS-CoV-2 infection, eliminate fluid buildup, and act as a regenerative technique for alveolar damage; all in a safe and effective way. With multiple autologous sources available for MSCs, each with their own respective limitations, allogenic umbilical cord (UC) and/or UC-derived Wharton's jelly (WJ) seem to be best positioned source to harvest MSCs to treat COVID-19 and associated symptoms. As an allogenic source, UC is readily available, easily obtainable, and is rich in immunomodulatory and regenerative factors. In this manuscript, we reviewed the current evidences and explored the potential therapeutic use of allogenic UC and/or WJ-derived MSCs for the treatment of COVID-19. Although, preliminary preclinical and clinical studies indicate that their use is safe and potentially effective, more multi-center, randomized, controlled trials are needed to adequately assess the safety and efficacy of UC and/or WJ-derived MSCs for the treatment of COVID-19.
