Nevin Manimala

Arch Osteoporos. 2021 Jun 19;16(1):97. doi: 10.1007/s11657-021-00937-2.

ABSTRACT

We used data from NHANES to explore the associations between serum folate and grip strength, and found that high levels of serum folate were associated with increased grip strength among females rather than males. It is recommended to maintain a proper level of serum folate, especially in women.

PURPOSE: Associations and dose-response relationships between serum total folate, 5-methyltetrahydrofolate, and grip strength in general adults were unknown. Thus, we conducted this analysis for further exploration.

METHODS: Data from the National Health and Nutrition Examination Survey (NHANES) database of 2011-2014 cycle were used. The independent variables including serum total folate, combined total folate (total folate plus Mefox), and 5-methyltetrahydrofolate. The dependent variable was BMI-corrected grip strength. Linear regression and the restricted cubic splines were used in our analyses.

RESULTS: A total of 9079 adults aged over 20 years were included. In multivariate-adjusted model 2, compared with quartile (Q) 1, grip strength increased in Q3 of combined total folate and total folate, and the weighted β values with 95% confidence intervals (CIs) of grip strength were 0.06 (0.01, 0.12) and 0.06 (0.00, 0.10) for combined total folate and total folate, respectively. In the stratified analysis by gender, positive relationships between combined total folate, total folate, and 5-methyltetrahydrofolate and grip strength were found only in females, with β (95% CIs) of 0.07 (0.02, 0.12), 0.07 (0.03, 0.12), and 0.09 (0.05, 0.13) for combined total folate, total folate, and 5-methyltetrahydrofolate in Q4, respectively. Non-linear positive dose-response relationships between serum folate and grip strength were also found only in females, not in males.

CONCLUSION: Our study suggested a positive association between serum folate and grip strength, while this positive association was only found in females; besides, the dose-response relationships were in a non-linear trend. Thus, it is recommended to maintain a proper serum folate level to keep better muscle strength, especially for women.

PMID:34148134 | DOI:10.1007/s11657-021-00937-2

Int J Legal Med. 2021 Jun 19. doi: 10.1007/s00414-021-02635-7. Online ahead of print.

ABSTRACT

The estimation of the time since death is an important task in forensic medicine that mainly relies on body cooling in the early post-mortem period. The rectum has been traditionally used to determine the central core temperature after death, though the external auditory canal has been proposed as an alternative site by several authors. The objective of this study was to assess the ability of four body temperature-based methods (Henssge’s rectal nomogram, Henssge’s brain nomogram, and Baccino’s both interval and global formulae based on ear temperature) to estimate the post-mortem interval (PMI). PMI calculations were carried out based on ear and rectal temperature measurements performed with a reference metal probe on 100 inpatient bodies with an average PMI of 4.5 ± 2.5 h. For practical purposes, ear temperature measurements were applied to Henssge’s brain nomogram. All methods could be applied to 81 cases, since high body temperatures prevented the rectal nomogram method from being used in most of the remaining cases. The actual PMI was within the time interval (95% CI) provided by the rectal nomogram method in 72.8% of cases, and in 63.0% to 76.5% of cases when using ear temperature-based methods. The proportions of adequate estimates did not differ statistically between the different methods. When the methods failed to provide a reliable time interval, all except the brain nomogram tended to underestimate the PMI. Similar results were obtained in the subgroup of normothermic patients at the time of death (n = 63), confirming that the PMI calculations had not been biased by the inclusion of patients with thermoregulation disorders. Our findings are in accordance with the published literature which suggests that ear temperature-based methods are as reliable as those based on rectal temperature for estimating the early PMI and that they may be used as quick, simple, and non-invasive methods at the scene, although caution should be taken in interpreting their results given their high error rates. However, further research including field studies is recommended to confirm their practical relevance in forensic casework.

PMID:34148133 | DOI:10.1007/s00414-021-02635-7

Arch Osteoporos. 2021 Jun 19;16(1):99. doi: 10.1007/s11657-021-00963-0.

ABSTRACT

There is limited evidence from 11 randomised controlled trials on the effect of rehabilitation interventions which incorporate outdoor mobility on ambulatory ability and/or self-efficacy after hip fracture. Outdoor mobility should be central (not peripheral) to future intervention studies targeting improvements in ambulatory ability.

PURPOSE: Determine the extent to which outdoor mobility is incorporated into rehabilitation interventions after hip fracture. Synthesise the evidence for the effectiveness of these interventions on ambulatory ability and falls-related self-efficacy.

METHODS: Systematic search of MEDLINE, Embase, PsychInfo, CINAHL, PEDro and OpenGrey for published and unpublished randomised controlled trials (RCTs) of community-based rehabilitation interventions incorporating outdoor mobility after hip fracture from database inception to January 2021. Exclusion of protocols, pilot/feasibility studies, secondary analyses of RCTs, nonrandomised and non-English language studies. Duplicate screening for eligibility, risk of bias, and data extraction sample. Random effects meta-analysis. Statistical heterogeneity with inconsistency-value (I²).

RESULTS: RCTs (n = 11) provided limited detail on target or achieved outdoor mobility intervention components. There was conflicting evidence from 2 RCTs for the effect on outdoor walking ability at 1-3 months (risk difference 0.19; 95% confidence intervals (CI): 0.21, 0.58; I² = 92%), no effect on walking endurance at intervention end (standardised mean difference 0.05; 95% CI: – 0.26, 0.35; I² = 36%); and suggestive (CI crosses null) of a small effect on self-efficacy at 1-3 months (standardised mean difference 0.25; 95% CI: – 0.29, 0.78; I² = 87%) compared with routine care/sham intervention.

CONCLUSION: It was not possible to attribute any benefit observed to an outdoor mobility intervention component due to poor reporting of target or achieved outdoor mobility and/or quality of the underlying evidence. Given the low proportion of patients recovering outdoor mobility after hip fracture, future research on interventions with outdoor mobility as a central component is warranted.

TRIAL REGISTRATION: PROSPERO registration: CRD42021236541.

PMID:34148132 | DOI:10.1007/s11657-021-00963-0

Eur J Appl Physiol. 2021 Jun 19. doi: 10.1007/s00421-021-04744-y. Online ahead of print.

ABSTRACT

PURPOSE: This study investigated the effect of 5 days of heat acclimation training on neuromuscular function, intestinal damage, and 20 km cycling (20TT) performance in the heat.

METHODS: Eight recreationally trained males completed two 5-day training blocks (cycling 60 min day^-1 at 50% peak power output) in a counter-balanced, cross-over design, with a 20TT completed before and after each block. Training was conducted in hot (HA: 34.9 ± 0.7 °C, 53 ± 4% relative humidity) or temperate (CON: 22.2 ± 2.6 °C, 65 ± 8% relative humidity) environment. All 20TTs were completed in the heat (35.1 ± 0.5 °C, 51 ± 4% relative humidity). Neuromuscular assessment of knee extensors (5 × 5 s maximum voluntary contraction; MVC) was completed before and after each 20TT and on the first and last days of each training block.

RESULTS: MVC torque was statistically higher after 5 days of HA training compared to CON (mean difference = 14 N m [95% confidence interval; 6, 23]; p < 0.001; d = 0.77). However, 20TT performance after 5 days of HA training was not statistically different to CON, with a between-conditions mean difference in the completion time of 68 s [95% confidence interval; – 9, 145] (p = 0.076; d = 0.35).

CONCLUSION: Short-term heat acclimation training may increase knee extensor strength without changes in central fatigue or intestinal damage. Nevertheless, it is insufficient to improve 20 km self-paced cycling performance in the heat compared to workload-matched training in a temperate environment. These data suggest that recreationally trained athletes gain no worthwhile performance advantage from short-term heat-training before competing in the heat.

PMID:34148124 | DOI:10.1007/s00421-021-04744-y

Acta Diabetol. 2021 Jun 20. doi: 10.1007/s00592-021-01759-x. Online ahead of print.

ABSTRACT

AIM: The study is aimed to detect the expression of serum Sirtuin 6 (SIRT6) with different severities and urinary albumin creatinine ratios (UACR) in type 2 diabetes mellitus (T2DM) patients, thus exploring the association of SIRT6 together with glycolipid metabolism and urinary protein in the cross-sectional study.

METHODS: T2DM patients (313 cases), pre-diabetic patients (102 cases), and healthy volunteers (100 cases) were selected. T2DM patients were divided into the normal albuminuria (103 cases, UACR < 30 mg/g), micro-albuminuria (106 cases, UACR 30-300 mg/g), and large amount of albuminuria group (104 cases, UACR > 300 mg/g) based on different UACR levels. The medical history was asked, biochemical indicators were detected, hematuria samples were taken, serum SIRT6 levels were detected, and detailed statistical analysis was conducted.

RESULTS: FPG, 2 h-PG, HOMA-IR, HbA1c, and LDL-C increased, while ISI and HDL-C decreased with the aggravation of diabetic status (P < 0.05). HbA1c, UACR, TNFα, HIF1α, and SIRT6 increased with UACR in T2DM patients (P < 0.05). Correlation analysis demonstrated that SIRT6 was significantly positively correlated with glycolipid metabolism in the whole samples, and correlated with UACR, TNFα, and HIF1α in T2DM patients (P < 0.05). Ridge regression analysis showed that SIRT6 was a risk factor for both glycolipid metabolism and urinary protein (P < 0.05).

CONCLUSION: SIRT6 increases with biomarkers in glycolipid metabolism and urinary protein in different severities of diabetes and UACR, which is expected to be a potential biomarker for early prediction and diagnosis related to glycolipid metabolism disorders and related nephropathy. Trial number: ChiCTR2000039808.

PMID:34148121 | DOI:10.1007/s00592-021-01759-x

Arch Microbiol. 2021 Jun 19. doi: 10.1007/s00203-021-02445-w. Online ahead of print.

ABSTRACT

In this study, the relationships of integron 1 element, formaldehyde dehydrogenase, and orfF genes with the level of formaldehyde resistance of isolated E. coli were investigated. E. coli bacteria were isolated from apparently healthy and colibacillosis-affected broilers of Fars Province, Iran. Formaldehyde resistance level and the presence of genetic markers were measured using MIC, and PCR tests, respectively. The prevalence of integron 1 element, orfF, and formaldehyde dehydrogenase genes in E. coli isolates were 61%, 8%, and 94%, respectively. In addition, according to our cut off definition, 15% and 85% of isolates were resistant and sensitive to formaldehyde, respectively. None of the genes had a statistically significant relationship with the formaldehyde resistance; however, the isolates containing integron 1 were significantly more sensitive to formaldehyde in the MIC test than those without integron 1. Integron 1 gene cassette could carry some bacterial surface proteins and porins with different roles in bacterial cells. Formaldehyde could also interfere with the protein functions by alkylating and cross-linking, and this compound would affect bacterial cell surface proteins in advance. Through an increase in the cell surface proteins, the presence of integron 1 gene cassette might make E. coli more sensitive to formaldehyde. As integron 1 was always involved in increasing bacterial resistance to antibiotics and disinfectants such as QACs, this is the first report of bacterial induction of sensitivity to a disinfectant through integron 1. Finally, integron 1 does not always add an advantage to E. coli bacteria, and it could be assumed as a cause of vulnerability to formaldehyde.

PMID:34148112 | DOI:10.1007/s00203-021-02445-w

Egypt J Immunol. 2021 Jan;28(1):33-45.

ABSTRACT

Some studies reported a high prevalence of ischemic stroke in hepatitis C virus patients, other several studies have suggested that hepatitis C virus (HCV) may act as a trigger for autoimmune diseases and autoantibodies including Anti-Neutrophil Cytoplasmic Antibody (ANCA) which predispose to vasculitis. Because vasculitis is a risk factor for ischemic stroke, we investigated the association of the hepatitis C virus with ANCA in first-ever ischemic stroke patients. This study included 67 Egyptian patients with first-ever ischemic stroke. These patients were clinically examined and investigated for HCV infection by chemiluminescence & Real Time-PCR, and ANCA antibodies by ELISA. Forty-two patients (62.7%) had HCV infection. Twenty-nine (43.2%) of them were cytoplasmic- Antineutrophil Cytoplasmic Antibodies (c-ANCA) positive, while none was perinuclear- Antineutrophil Cytoplasmic Antibodies (p-ANCA) positive. Comparison between c-ANCA positive and ANCA negative patients showed that 82.8% and 47.4% had anti-HCV antibody, respectively, with P-value 0.003. The c-ANCA level correlated significantly with age, and HCV antibody level. No statistically significant difference was found in both the consciousness and stroke severity between the negative and positive c- ANCA patients. However, patients with positive c-ANCA had smaller and multiple cerebral infarctions with P-value 0.002 and 0.01 respectively. Multiple regression analysis showed that the number and size of cerebral infarctions were independent predictors of c-ANCA positivity with P value 0.02, and 0.03 respectively. In conclusion, c-ANCA level correlates with HCV antibody and may predispose to ischemic stroke by a possible ANCA associated vasculitis.

PMID:34147052

Egypt J Immunol. 2021 Jan;28(1):1-11.

ABSTRACT

There is evidence consistent with the hypothesis that genetic, inflammatory and immune mechanisms are involved in the pathogenesis of AD. The aim of this study is to assess the relationship between Apolipoprotein E (Apo E), serum levels of inflammatory markers, and cognitive functions among elderly patients with Alzheimer’s disease (AD) and Mild cognitive impairment (MCI) compared to elderly with normal cognitive function. 88 participants (≥60 years) from Ain Shams University Hospital were enrolled. They were divided into 3 groups: Group A (32 elderly patients with AD), Group B (32 elderly patients with MCI) and Group C (24 controls with normal cognitive function). All participants were subjected to comprehensive geriatric assessment, Apo E genotyping, measurement of C-reactive protein (CRP) and Alpha-1-antichymotrypsin (ACT), by PCR-RFLP, ELIZA and semi-quantitative method respectively. The most common variant of Apo E gene was E3/E3 being more frequent in healthy control group (HC) than the other two groups and the least common variant was E4/E4 detected only in the AD group. ApoE4 allele was associated with 40.6% of AD patients (where 31.4% were heterozygous and 8.6 % homozygous) and 17.1% of MCI patients, whereas ApoE2 was more prevalent in the control group (P<0.05). A significant difference was observed when Mini mental status Examination (MMSE) score in different Apo E alleles was compared (P<0.01). The highest score was associated with (E2/E3) allele whereas, the lowest score was associated with (E4/E4) allele. Regarding inflammatory markers; CRP levels showed a statistically significant difference between the 3 groups and were higher in the AD group than the other 2 groups. (P<0.01). There was no statistically significant difference between the 3 groups as regard ACT level (P>0.05). Carriers of at least one E4 allele showed great risk to develop AD when combined with high CRP serum levels (OR = 36; CI: 11.4-113.7; P< 0.01). In conclusion, Apo E together with CRP may be a useful tool to predict Alzheimer’s disease.

PMID:34147049

Sleep Med. 2021 May 24;84:127-133. doi: 10.1016/j.sleep.2021.05.009. Online ahead of print.

ABSTRACT

INTRODUCTION: Polysomnography is the recommended method for the diagnosis of obstructive sleep apnea (OSA); however, it is expensive, uncomfortable, and inaccessible. Alternative diagnostic methods are necessary, and Nocturnal Oximetry (NO) has proven to be reliable. Nevertheless, there have been doubts about its accuracy in patients with a history of hypoxia. Hence, the objective of this study was to evaluate the performance of NO in patients with neuromuscular diseases (NMD).

METHOD: This was a cross-sectional study in patients with NMD suspected of having OSA. We performed a statistical analysis using Spearman’s correlation coefficients (SCCs). We used the value of the area under the ROC curve (AUCROC), just as we calculated the sensitivities (Sens) and specificities (Spec) for the chosen variables.

RESULTS: The sample comprised 41 patients; 51.2% with muscular dystrophies and 48.8% with motor neuron diseases, with a predominance of men (63.4%). Median age was 42 (19.7-55) years, body mass index (BMI) was 27.9 (23.8-32) kg/m2, forced vital capacity was 67% (54%-76.5%), and maximum inspiratory pressure was-60 cmH2O (-87.5 to -50). The prevalence of OSA was 75.7%. We analyzed and selected the best four oximetric variables with the following performance in identifying the apnea/hypopnea index >5/h, ODI3/2, cutoff>5/h, AUCROC 0.919, Sens 82.3%, Spec 91.7%; ODI3/5, cutoff>11.2/h, AUCROC 0.904, Sens 82.3%, Spec 87.5%; ODI4/5, cutoff>6.02, AUCROC 0.839, Sens 70.6%, Spec 91.6%, and ODI5/5, cutoff>0.87/h, AUCROC 0.870, Sens 94.1%, and Spec 70.8%.

CONCLUSION: NO can be used as a diagnostic tool for OSA, even in patients with neuromuscular diseases and potentially hypoxic diseases.

PMID:34147027 | DOI:10.1016/j.sleep.2021.05.009

J Clin Anesth. 2021 Jun 16;74:110375. doi: 10.1016/j.jclinane.2021.110375. Online ahead of print.

ABSTRACT

STUDY OBJECTIVE: Assess for a relationship between immediate preoperative glucose concentrations and postoperative complications.

DESIGN: Retrospective cohort study.

SETTING: Single large, tertiary care academic medical center.

PATIENTS: A five-year registry of all patients at our hospital who had a glucose concentration (plasma, serum, or venous/capillary/arterial whole blood) measured up to 6 h prior to a non-emergent surgery.

INTERVENTIONS: The glucose registry was cross-referenced with a database from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). We applied an outcomes review to the subset of patients for whom we had data from both registries (n = 1774).

MEASUREMENTS: Preoperative glucose concentration in the full population as well as the subgroups of patients with or without diabetes were correlated with adverse postsurgical outcomes using 1) univariable analysis and 2) full multivariable analysis correcting for 27 clinical factors available from the ACS NSQIP database. Logistic regression analysis was performed using glucose level either as a continuous variable or as a categorical variable according to the following classifications: mild (≥140 mg/dL; ≥7.8 mmol/L), moderate (≥180 mg/dL; ≥10 mmol/L), or severe (≥250 mg/dL; ≥13.9 mmol/L) hyperglycemia. A third analysis was performed correcting for 7 clinically important factors (age, BMI, predicted duration of procedure, sex, CKD stage, hypoalbuminemia, and diabetic status) identified by anesthesiologists and surgeons as immediately available and important for decision making.

MAIN RESULTS: Univariable analysis of all patients and the subgroups of patients without diabetes or with diabetes showed that immediate preoperative mild or moderate hyperglycemia correlates with postoperative complications. Statistical significance was lost in most groups using full multivariable analysis, but not when correcting for the 7 factors available immediately preoperatively. However, for all patients with diabetes, moderate hyperglycemia (≥180 mg/dL; ≥10 mmol/L) continued to significantly correlate with complications even in the full multivariable analysis [odds ratio (OR) 1.79; 95% Confidence Intervals (CI) 1.10, 2.92], and with readmission/reoperation within 30 days [OR 1.93; 95% CI 1.18, 3.13].

CONCLUSIONS: Preoperative hyperglycemia within 6 h of surgery is a marker of adverse postoperative outcomes. Among patients with diabetes in our study, a preoperative glucose level ≥ 180 mg/dL (≥10 mmol/L) independently correlates with risk of postoperative complications and readmission/reoperation. These results should encourage future work to determine whether addressing immediate preoperative hyperglycemia can improve complication rates, or simply serves as a marker of higher risk.

PMID:34147016 | DOI:10.1016/j.jclinane.2021.110375