Effects of a Physical Exercise Program on the Physical Capacities of Older Adults: A Quasi-Experimental Study.

Purpose: To measure the effects of an exercise program on the physical capacities of older adults such as strength, flexibility, balance, and aerobic capacity. Patients and Methods: This was a quasi-experimental study on a population of 5550 older adults and a sample of 4830 participants in an active aging program designed by the Municipal Health Secretary. The exercise program lasted 12 months, and pre-and post-program intervention measures were recorded using the senior fitness test. Results: Most participants were women (92.4%) and their mean age was 70.7 years (standard deviation, 7.3 years; range, 60-97 years). All areas showed significant differences before and after the program in terms of the participants' physical capabilities (p < 0.05), muscular strength and flexibility had a more significant mean difference and a large effect (>0.80), except for aerobic capacity, which had a small effect. Conclusion: The present study revealed that a supervised physical exercise program at the community level has positive effects on the physical capacities of coordination, balance, flexibility, strength, and aerobic capacity, which are essential components for a better functional capacity at this stage of life, with improvements that encompassed the improved self-perception of their health status, a reduction of overweight and obesity. The reinforcement of these programs is recommended, consequently, promoting pre-sport games and sports championships among the elderly population, as a public health strategy.

Condiciones de salud asociadas a discapacidad en adultos mayores de un programa de actividad física / Health conditions associated to disability in older adults attending a physical activity program

Introducción: Existe la tendencia mundial del aumento de población adulta mayor. Colombia no es un país ajeno a esta situación. Objetivo: Determinar las condiciones crónicas de salud asociadas al desarrollo de discapacidad en adultos mayores de la ciudad de Santiago de Cali, Colombia. Métodos: Estudio transversal en el que participaron 322 adultos mayores, seleccionados con muestreo aleatorio estratificado proporcional. Se aplicó la Encuesta de Salud, Bienestar y Envejecimiento Colombia, en su sección 8, y el WHODAS 2.0, versión de 36 preguntas. Resultados: El 90,4 por ciento de los participantes en el estudio eran mujeres, la mediana de edad fue de 70 años. La media de discapacidad global fue de 9,39 ± 10,2 puntos. La movilidad obtuvo la mayor puntuación 13,80 ± 17,79 (escala de 0-100 puntos) y las de menor puntuación fueron AVD-trabajo remunerado y participación (2,240 ± 11,15 puntos). La hipertensión arterial fue el padecimiento con mayor prevalencia. Los adultos que han sufrido embolias reportaron el mayor nivel de discapacidad (18,395), seguido de los que manifestaron haber tenido algún tipo de alteración mental (14,15 por ciento ). El dominio con mayor significancia estadística fue la participación, más afectada en los adultos con diabetes, ataques al corazón, embolia cerebral, artritis, osteoporosis y cataratas. Conclusiones: Hubo presencia de enfermedades crónicas en los sistemas cardiovascular, pulmonar y músculo-esquelético, aunque se reportaron niveles bajos discapacidad. Las actividades de la vida diaria más complejas son las que primero presentan dificultad; además, la movilidad es crucial para el funcionamiento de los adultos mayores(AU)

Introduction: Increase in the number of older adults is a current worldwide tendency. Colombia is not an exception. Objective: Determine the chronic health conditions associated to the development of disability in older adults from the city of Santiago de Cali, Colombia. Methods: A cross-sectional study was conducted of 322 older adults selected by proportional stratified random sampling. Data were obtained with the survey Health, Wellbeing and Aging Colombia, section 8, and the tool WHODAS 2.0, 36-item version. Results: Of the participants in the study, 90.4 percent were women; mean age was 70 years. Mean global disability was 9.39 ± 10.2 points. Mobility obtained the highest score (13.80 ± 17.79 on a 0-100 scale), whereas the lowest ranking variables were ADL - paid work and participation (2.240 ± 11.15 points). Arterial hypertension was the most common condition. Patients who had had embolisms reported the highest level of disability (18.395), followed by those reporting having had some sort of mental disorder (14.15 percent). The domain with the greatest statistical significance was participation, which was more affected in adults with diabetes, heart attacks, cerebral embolism, arthritis, osteoporosis and cataract. Conclusions: A presence was observed of chronic diseases of the cardiovascular, respiratory and musculoskeletal systems, though low disability levels were reported. The most complex activities of daily living are the first to present difficulty. On the other hand, mobility is crucial for the functioning of older adults(AU)

Characterization of dance-based protocols used in rehabilitation - A systematic review.

OBJECTIVE: To describe the use of dance-based intervention protocols as a rehabilitation proposal. METHOD: Papers containing protocols used in adult patients and written in Spanish, English, and Portuguese were collected using the following keywords: Physical Therapy; Dance Therapy; Rehabilitation; and Clinical Trial Protocol. The PUBMED, MEDLINE, LILACS, BVS ScienceDirect, PEDro, OTseeker, The Cochrane Library (Cochrane Central Register of Controlled Trials), and Scopus databases were used for the collection of information to define the type of dance, the established protocol, pathologies, and the population involved. RESULTS: 70 studies met the eligibility criteria, all of which presented a dance protocol. This was used in the rehabilitation of pathologies covering the neuromuscular, musculoskeletal, and cardiovascular systems, as well as in a healthy population. Positive results were the main outcome measure. DISCUSSION: Dance is an innovative intervention strategy for patients with comorbidities or underlying pathologies as well as for those in good health. It offers, without limitations, a field of applicability through the use of a dancing style as a rehabilitation process, generating significant changes in the physical, mental, and social skills of the individual.

Hypertension attenuates the prognostic value of coronary artery calcification scoring in low-risk patients.

OBJECTIVES: In outpatients with suspected ischaemic symptoms, we investigated the impact of risk factor profile on the prognostic value of coronary artery calcium scoring (CACS) and CT coronary angiography (CTCA). METHODS: 772 consecutive patients underwent CACS and CTCA; 52 patients (6.7%) with significant coronary artery lesions underwent revascularisation within 60 days and were excluded. 720 remaining patients were followed up for 38.1±17.4 months. RESULTS: Late presentation (after 60 days) major adverse cardiovascular events (MACEs) were recorded in 27 patients (3.8%). Hypertension was strongly associated with adverse outcomes (unadjusted HR 6.5 (2.9 to 14), p<0.001), and hypertensive patients had double the prevalence of non-calcified plaque versus normotensive individuals (30.2% vs 14.3%, p<0.001). Adjusting for confounders, severe stenosis at CTCA was predictive of MACE for normotensive and hypertensive patients (HR 9.6 (2.8 to 43.1), p<0.001, and HR 6.2 (2.4 to 16.1), p<0.001, respectively). CACS alone was not predictive of MACE throughout the cohort (HR 1.001 (0.9997 to 1.001), p=0.36) and when adjusting for confounders, a cut-off of CACS>400 predicted MACE in normotensive individuals (HR 10.6 (2.41 to 49.3), p<0.001) but not in hypertensive individuals (HR 1.3 (0.5 to 3.6), p=0.56). Zero calcium score did not mitigate the risk of MACE (HR 0.84 (0.39 to 1.8), p=0.65) and 13/27 patients (48.1%) who suffered MACE had a 0 calcium score; all had hypertension. CONCLUSIONS: In low-risk patients with stable cardiovascular symptoms, CTCA provides important additive prognostic information over CACS, and CACS (including CACS>400) underestimated cardiovascular risk in patients with hypertension. This may relate to the increased prevalence of non-calcified plaque in these individuals.

Cell-Based Therapy for Canavan Disease Using Human iPSC-Derived NPCs and OPCs.

Canavan disease (CD) is a fatal leukodystrophy caused by mutation of the aspartoacylase (ASPA) gene, which leads to deficiency in ASPA activity, accumulation of the substrate N-acetyl-L-aspartate (NAA), demyelination, and spongy degeneration of the brain. There is neither a cure nor a standard treatment for this disease. In this study, human induced pluripotent stem cell (iPSC)-based cell therapy is developed for CD. A functional ASPA gene is introduced into patient iPSC-derived neural progenitor cells (iNPCs) or oligodendrocyte progenitor cells (iOPCs) via lentiviral transduction or TALEN-mediated genetic engineering to generate ASPA iNPC or ASPA iOPC. After stereotactic transplantation into a CD (Nur7) mouse model, the engrafted cells are able to rescue major pathological features of CD, including deficient ASPA activity, elevated NAA levels, extensive vacuolation, defective myelination, and motor function deficits, in a robust and sustainable manner. Moreover, the transplanted mice exhibit much prolonged survival. These genetically engineered patient iPSC-derived cellular products are promising cell therapies for CD. This study has the potential to bring effective cell therapies, for the first time, to Canavan disease children who have no treatment options. The approach established in this study can also benefit many other children who have deadly genetic diseases that have no cure.

Gastrointestinal obstruction secondary to enteral nutrition bezoar: A case report.

BACKGROUND: Post-operative enteral nutrition via gastric or jejunal feeding tubes is a common and standard practice in managing the critically ill or post-surgical patient. It has its own set of complications, including obstruction, abscess formation, necrosis, and pancreatitis. We present here a case of small bowel obstruction caused by enteral nutrition bezoar. It is the second recorded incidence of this complication after pancreaticoduodenectomy in the medical literature. CASE SUMMARY: The 70-year-old female presented to our institution for a pancreaticoduodenectomy (Whipple's procedure) for pancreatic adenocarcinoma. On day 5 post-operative, having failed to progress and developing symptoms of small bowel obstruction, she underwent a computed tomography scan, which showed features of mechanical small bowel obstruction. Following this, she underwent an emergency laparotomy and small bowel decompression. The recovery was long and protracted but, ultimately, she was discharged home. A literature search of reports from 1966-2020 was conducted in the MEDLINE database. We identified eight articles describing a total of 14 cases of small bowel obstruction secondary to enteral feed bezoar. Of those 14 cases, all but 4 occurred after upper gastrointestinal surgery; all but 1 case required further surgical intervention for deteriorating clinical picture. The postulated causes for this include pH changes, a reduction in pancreatic enzymes and gastric motility, and the use of opioid medication. CONCLUSION: Enteral feed bezoar is a complication of enteral feeding. Despite rare incidence, it can cause significant morbidity and potential mortality.

Modelo de gestión sostenible en la atención comunitaria del adulto mayor / Sustainable management model for community care of the elderly

Introducción: el envejecimiento es un proceso progresivo, heterogéneo, multisistémico, multidimensional; con tendencia al aumento a nivel global asociado a la longevidad y conversión de la pirámide poblacional, en efecto el municipio de Santiago de Cali propende por una cultura de envejecimiento contemplando acciones integrales orientadas a la promoción, protección y desarrollo de potencialidades de los adultos mayores. Objetivo: formular una propuesta de gestión en intervención integral sostenible en el tiempo, para la atención comunitaria del adulto mayor basado en la política de envejecimiento y vejez; articulado con los proyectos, planes y estrategias establecidos para el fomento de una longevidad activa y saludable. Métodos: se presenta un estudio de caso dónde se propone el diseño de un modelo de gestión integral basado en estrategias diagnosticas preliminares, desarrollo y promoción de elementos que contemplan la actividad física, deporte y recreación. Resultados: se efectúa un diagnóstico evidenciando la intervención y articulación de diferentes actores que convergen en la formulación e implementación de estrategias, a partir del análisis de acciones, basado en un modelo metodológico a corto, mediano y largo plazo; estableciendo a su vez planes y programas con procesos sostenibles en el tiempo, que proporcionen herramientas a las necesidades presentes en el contexto. Conclusiones: se deben generar modelos de gestión que estructuren procesos que optimicen el recurso territorial y continuidad de las acciones en pro del envejecimiento activo de la administración municipal(AU)

Introduction: aging is a progressive, heterogeneous, multisystemic, multidimensional process with a tendency toward a worldwide increase associated to longevity and inversion of the population pyramid. In the municipality of Santiago de Cali an aging culture is fostered which incorporates comprehensive actions aimed at the promotion, protection and development of the potential capacities of the elderly. Objective: develop a proposal for comprehensive intervention management sustainable in time for community care of the elderly based on the aging and old age policy and articulated with the projects, plans and strategies set up to promote active, healthy longevity. Methods: a case study is presented in which a design is proposed for a comprehensive management model based on preliminary diagnostic strategies and the development and promotion of elements such as physical activity, sports and recreation. Results: a diagnosis is conducted which makes evident the intervention and articulation of different actors converging on the formulation and implementation of strategies starting from the analysis of actions and based on a short-, medium- and long-term methodological model. Plans and programs are also set up which incorporate processes sustainable in time providing tools to address the current needs in this context. Conclusions: management models should be developed which structure processes optimizing the territorial resources and the continuity of actions implemented by the municipal(AU) administration to foster active aging.

Inconsistency in aortic stenosis severity between CT and echocardiography: prevalence and insights into mechanistic differences using computational fluid dynamics.

Objectives: The aims of this study were to evaluate the inconsistency of aortic stenosis (AS) severity between CT aortic valve area (CT-AVA) and echocardiographic Doppler parameters, and to investigate potential underlying mechanisms using computational fluid dynamics (CFD). Methods: A total of 450 consecutive eligible patients undergoing transcatheter AV implantation assessment underwent CT cardiac angiography (CTCA) following echocardiography. CT-AVA derived by direct planimetry and echocardiographic parameters were used to assess severity. CFD simulation was performed in 46 CTCA cases to evaluate velocity profiles. Results: A CT-AVA>1 cm2 was present in 23% of patients with echocardiographic peak velocity≥4 m/s (r=-0.33) and in 15% patients with mean Doppler gradient≥40 mm Hg (r=-0.39). Patients with inconsistent severity grading between CT and echocardiography had higher stroke volume index (43 vs 38 mL/m2, p<0.003) and left ventricular outflow tract (LVOT) flow rate (235 vs 192 cm3/s, p<0.001). CFD simulation revealed high flow, either in isolation (p=0.01), or when associated with a skewed velocity profile (p=0.007), as the main cause for inconsistency between CT and echocardiography. Conclusion: Severe AS by Doppler criteria may be associated with a CT-AVA>1 cm2 in up to a quarter of patients. CFD demonstrates that haemodynamic severity may be exaggerated on Doppler analysis due to high LVOT flow rates, with or without skewed velocity profiles, across the valve orifice. These factors should be considered before making a firm diagnosis of severe AS and evaluation with CT can be helpful.

'Porcelain aorta': a proposed definition and classification of ascending aortic calcification.

Introduction: 'Porcelain aorta' is listed in the second consensus document of the Valve Academic Research Consortium as a risk factor in aortic valve replacement. However, the extent of circumferential involvement is poorly defined with great variability in reported incidence. We present a simple, reproducible classification to describe the extent of aortic calcification and thus appropriately define 'porcelain aorta', aiding clinical decision-making and registry data collection. Methods: 175 consecutive CT aortograms were reviewed. The aorta was divided into three sections, and each section divided into quadrants. These were individually scored using a 5-point scale (0-no calcification, 5-complete contiguous calcification).Results for each quadrant were summated for each segment to provide an indication of the distribution of calcification. Results: Only one patient (0.6%) had a 'true' porcelain aorta, defined as contiguous calcification across all quadrants at any aortic level. Intraobserver and interobserver variation was excellent for the ascending aorta (K=0.85-0.88 and 0.81-0.96, respectively) while the interobserver variation in the transverse arch was good at 0.75. Conclusions: Our data suggest the incidence of 'true' porcelain aorta may be significantly lower than reported in the literature. The predominance of calcification within the anterior wall of the proximal ascending aorta and the superior wall of the transverse arch may be clinically important. Application of this quick, simple and reproducible grading system, with no requirement for advanced software, may provide a tool to support accurate assessment of focal aortic calcification and its relationship to subsequent procedural risk.

Clinical outcomes when applying NICE guidance for the investigation of recent-onset chest pain to a rapid-access chest pain clinic population.

OBJECTIVE: To describe the clinical outcomes of patients for whom National Institute for Health and Care Excellence (NICE) recent-onset chest pain guidance would not have recommended further investigation, compared with those of patients where further investigation would have been recommended. METHODS: 557 consecutive patients with recent-onset chest pain attending rapid-access chest pain clinics (RACPC) in two district general hospitals over a 9-month period were retrospectively reviewed. Likelihood of coronary artery disease (CAD) was calculated according to NICE-defined modified Diamond-Forrester criteria. Patients were categorised into those for whom NICE guidelines recommend (NICE-Y) and do not recommend (NICE-N) further investigation. Main outcome measures were subsequent diagnosis of significant CAD and major adverse cardiac events (MACE) at 6 months. RESULTS: 187/557 (33.6%) patients comprised NICE-Y group, with 370/557 (66.4%) in NICE-N group. 360/370 (97.3%) of NICE-N group would have been excluded from further investigation due to non-anginal chest pain. Of 92/557 (16.5%) patients subsequently diagnosed with significant CAD, 35/557 (9.5%) were from NICE-N group versus 57/557 (30.5%, p<0.0001) from NICE-Y group. Of 11 patients experiencing at least one MACE, 7/557 (1.9%) were from NICE-N group, versus 4/557 (2.1%, p=1.000) from NICE-Y group. CONCLUSIONS: The rigid application of NICE chest pain guidance to a RACPC population may result in up to two-thirds of patients being excluded from further cardiac investigation. Potentially, up to 10% of these patients may subsequently be diagnosed with significant CAD, with up to 2% potentially experiencing a major adverse cardiac event.

Genomic era diagnosis and management of hereditary and sporadic colon cancer.

The morbidity and mortality attributable to heritable and sporadic carcinomas of the colon are substantial and affect children and adults alike. Despite current colonoscopy screening recommendations colorectal adenocarcinoma (CRC) still accounts for almost 140000 cancer cases yearly. Familial adenomatous polyposis (FAP) is a colon cancer predisposition due to alterations in the adenomatous polyposis coli gene, which is mutated in most CRC. Since the beginning of the genomic era next-generation sequencing analyses of CRC continue to improve our understanding of the genetics of tumorigenesis and promise to expand our ability to identify and treat this disease. Advances in genome sequence analysis have facilitated the molecular diagnosis of individuals with FAP, which enables initiation of appropriate monitoring and timely intervention. Genome sequencing also has potential clinical impact for individuals with sporadic forms of CRC, providing means for molecular diagnosis of CRC tumor type, data guiding selection of tumor targeted therapies, and pharmacogenomic profiles specifying patient specific drug tolerances. There is even a potential role for genomic sequencing in surveillance for recurrence, and early detection, of CRC. We review strategies for diagnostic assessment and management of FAP and sporadic CRC in the current genomic era, with emphasis on the current, and potential for future, impact of genome sequencing on the clinical care of these conditions.

Distance from the growth plate and Its relation to the outcome of unicameral bone cyst treatment.

BACKGROUND: Interventions to treat unicameral bone cysts vary. Nonetheless, regardless of the intervention modality, the outcome is not certain. The purpose of this study was to determine if the distance between the growth plate and the cyst can be used to predict the outcome of the treatment. METHODS AND MATERIALS: Retrospectively, we assessed the outcome of 39 interventions in nineteen children that were performed between 1994 and 2003. Seventeen different modalities of treatment were employed. There were three female and sixteen male patients. The average age was 8 years. Nine cysts were in the greater trochanter area, three were in the femoral capital area and seven were in the proximal humerus. According to the cyst's distance from the growth plate, at the intervention time, there were 18 cases within less than 2 cm and 21 cases of more than 2 cm. RESULTS: Complete healing was achieved in 10 children (employing seven different modalities). In nine of them, the cysts were more than 2 cm away from the growth plate. In one child, the cyst was within less than 2 cm of the growth plate, however, treatment here involved epiphyseodesis. DISCUSSION: This study confirmed that, regardless of intervention modality, complete healing was not achievable in those cysts that are within less than 2 cm of an active growth plate. Complete healing was possible in those cysts that are more than 2 cm away from the growth plate. CONCLUSION: The 2-cm distance from the growth plate could be used as a predictor of treatment outcome of unicameral bone cysts.

Care, autonomy and nurse education.

Paternalism in medicine is giving way to consumerism. When doctors sneeze, nurses catch cold. Consumerism is having an equal affect on nursing. For example, patient autonomy is currently in vogue. A greater emphasis on the needs and wishes of patients is a much needed correction to the times when medical and nursing staff rode roughshod over those in their care. However, the danger is that we go too far and undermine the personal and professional integrity of nurses.

The medico-legal aspects of the injuries of the skull

Points out the significance of noting the details of fractures of the skull in the living by Clinicians, and by the Pathologist in the dead, as it will throw much light on the nature of weapon used and the method of infliction of injury to the head. At the same time, the reasons for the variation encountered in the type of injury to skull and the related pertinent aspects are briefly discussed. For medico-legal purposes, to diagnose the presence of a fracture is not enough; accurate description is essential and this aspect is emphasized by appropriate illustrations. (AU)

Chlorinated hydrocarbon pesticide residues in human fat in Trinidad, with statistical survey of acute poisoning

In order to assess the trend in the body load of chlorinated hydrocarbon residues in Trinidad, during 1972 and 1973, samples of fat were taken during routine forensic post mortems in non-poisoning cases of all ages at the General Hospital, Port-of-Spain. The levels of two main pesticides DDT and Dieldrin were found to be far lower than the toxic levels. No marked differences were observed in levels throughout Trinidad. Trinidad and Tobago compares favourably with other countries in which similar surveys have been done. A brief account of the statistics of the forencic post mortems with reference to deaths due to acute poisoning is given as encountered at the General Hospital, Port-of-Spain, which receives cases from all over the country