Number of medications and polypharmacy are associated with frailty in older adults: results from the Midlife in the United States study

ObjectivesThe current study aimed to examine the association between the number of medications, polypharmacy, and frailty in community-dwelling older adults. In addition, the cutoff score for the number of medications related with frailty in this sample was determined.MethodsA cross-sectional analysis was performed using data of 328 individual aged between 65 and 85 years from the Midlife in the United States (MIDUS 2): Biomarker Project, 2004–2009, a multisite longitudinal study, for 328 individuals aged between 65 and 85 years. All the participants were categorized into two groups based on the number of medications used: no polypharmacy (n = 206) and polypharmacy (n = 122). The polypharmacy was defined as having 5 or more medication per day. Frailty status was measured using a modified form of Fried frailty phenotype through the presences of the following indicators include low physical activity; exhaustion; weight loss; slow gait speed and muscle weakness. Participants were categorized into three different groups based on total score: 0 as robust, 1 to 2 as prefrail, 3 or more as frail. The relationship between no. of medications, polypharmacy, and frailty was examined using a multinomial logistic regression model. The model was adjusted for age, sex, BMI, and no. of chronic conditions. Receiver operator characteristics and area under the curve were used to determine the cutoff number of medications.ResultsNumber of medications, and polypharmacy were associated with being frail (relative risk ratio [RRR]: 1.30; 95% confidence interval [CI]: [1.12, 1.50], p = 0.001), (RRR: 4.77; 95% CI [1.69, 13.4], p = 0.003), respectively. Number of medications with cutoff 6 medication or more was associated with being in frail category with sensitivity of 62% and specificity of 73%.ConclusionPolypharmacy was shown to be significantly related to frailty. A cutoff score of 6 or more medications distinguished frail from non-frail. Addressing polypharmacy in the older population might ameliorate the impact of physical frailty

STATIC STANDING BALANCE AND STRENGTH MEASUREMENTS BEFORE AND AFTER TWO DIFFERENT GROUP EXERCISE INTERVENTIONS IN INDEPENDENT LIVING OLDER ADULTS

Purpose: The aims of this dissertation were to examine, in older adults: 1) the test-retest reliability of static standing balance performance using an accelerometer and lower extremity strength performance using a uniaxial load cell device; 2) the validity of balance and strength measurements at baseline with different mobility measurements; and 3) the effect of two different exercise programs on standing balance and lower extremity muscle strength. Participants: Thirty-eight participants were enrolled in the reliability testing (89% female, mean age 76 ± 7 years), and a total of 131 subjects (85% female, mean age 80 ± 8 years) were enrolled in the experimental study. Methods: For the balance assessment, an accelerometer was used to collect acceleration data in the anterior-posterior and medial-lateral directions for different standing balance conditions. In addition, lower extremity muscle strength measurements were assessed with a portable load cell for three consecutive trials. Clinical measures of mobility were concurrently tested. Test-retest reliability was assessed over two testing visits occurring one week apart, using the intraclass correlation coefficient. Spearman’s rank correlation coefficient was used to test convergent validity at baseline for the whole sample. A linear mixed model was used to examine the effect of the “On the Move” and standard of care group exercise programs on standing balance and lower extremity muscle strength. Results: Both balance and muscle strength performance showed good to excellent test-retest reliability using the accelerometer and uniaxial load cell device, respectively. The balance and measures were most strongly correlated with the Short Physical Performance Battery, and the strength measures with the repeated chair stands test. Both exercise interventions resulted in a significant change in both balance accelerometry measures and lower extremity muscle strength when compared to a waitlist control group, but did not differ from each other. Conclusion: The dual-axis accelerometer and uniaxial-load cell provide a reliable method for testing standing balance and lower extremity muscle strength, respectively in older adults living independently in the community. Participation in either group exercise intervention would result in improvement in both standing balance and lower extremity strength as compared to not receiving any exercise

National and regional prevalence rates of hypertension in Saudi Arabia: A descriptive analysis using the national survey data

BackgroundLimited studies have examined the prevalence of hypertension (HTN) at the national and regional levels in Saudi Arabia. Therefore, this study aimed to examine the national and regional prevalence of HTN in the Saudi population.MethodsThis study used the data from household health survey carried out by the General Authority for Statistics in 2017. It included 24,012 households representing the Saudi population across all 13 administrative regions. The diagnosis of HTN was confirmed by a self-reported history of a physician diagnosed HTN.ResultsThe prevalence of HTN was 9.2% among Saudi population aged 15 years and older. It was relatively higher in women (10.0%) than in men (8.5%). The prevalence of HTN increased with advancing age (aged 65 years and older), accounting for 55.3% in women and 48.0% in men; its prevalence was relatively low among the younger age group, accounting for 0.1% in those aged 15–19 years. A large difference was found in the prevalence of HTN between regions, ranging from 6.0% in Najran region to 10.0% in Makkah region.ConclusionThis study reported the national and regional prevalence of HTN among Saudi adults using a representative sample with large variations in the prevalence rates according to age, sex, and regions. Older age, men, and Makkah region had higher prevalence of HTN. Our findings will help determine the etiological factors, identify the priorities for healthcare, and generate initiatives for policymakers, and develop preventive and therapeutic strategies for HTN

Low-Level Laser Therapy for Diabetic Dermopathy in Patients With Type 2 Diabetes: A Placebo-Controlled Pilot Study

Introduction: Diabetic dermopathy (DD) is the most common cutaneous diabetes marker. Few studies have targeted DD using low-level laser therapy (LLLT). This pilot study aimed to evaluate the effect of LLLT on DD in patients with type 2 diabetes (T2D).Methods: 12 patients with T2D (9 men, 3 women) and bilateral DD were enrolled in this placebo-controlled pilot study, and their ages ranged 50-65 years. One side was subjected to LLLT, three sessions weekly for one month (LLLT side), while the other side received the same treatment protocol with a laser device switched off as a placebo (placebo side). All patients were instructed to receive skincare for both sides, such as debridement, antibiotic creams, and dressings with betadine solution. The diameter of DD lesion and the cutaneous blood flow of the knees and ankles sites were assessed before and after one month at the end of the intervention.Results: At the baseline, no significant differences existed between LLLT and placebo sides in the DD and skin blood flow at the knee and ankle sites (P > 0.05). Post-intervention, a significant improvement occurred in DD diameter and the skin blood flow of the knee and ankle sites in the LLLT side (P < 0.05), while the placebo side showed a significant improvement only in DD diameter (P < 0.05) and non-significant changes in skin blood flow (P > 0.05). Comparing both sides, all measures significantly favored LLLT.Conclusion: The findings of this study indicate that LLLT has beneficial effects on decreasing DD in T2D patients. Also, it was approved that the short term of LLLT is a safe modality to control DD in T2D patients

A techno-economic-environmental assessment of a hybrid-renewable pumped hydropower energy storage system: a case study of Saudi Arabia

The depletion of valuable resources like oil and natural gas and the growth of greenhouse gas emissions have led governments worldwide (e.g. Saudi Arabia) to prioritise renewable energy sources. However, designing and implementing such sources are subject to sensitive technical, economical, and environmental factors. The current study aims to accurately design each component of a hybrid renewable energy system consisting of photovoltaic/wind turbines/pumped hydropower energy storage relying on the development of a multi-objective optimisation model. To increase the robustness of the model outcomes, objectives include incorporating a head loss factor into the model, considering a capacity factor as the main metric for energy storage design, and conducting a techno-economic environmental assessment considering greenhouse emission credit. Three algorithms (non-dominated sorting, reference direction-based, and two-archive evolutionary) are developed, and a comparative analysis with Saudia Arabia as a case study is carried out. The results show that considering a combination of solar and wind energy in a hybrid renewable energy system could cover up to 93% of total demand, with a maximum pumped hydro capacity factor of 27%. This combination is much better than using solar or wind alone (i.e. 62% and 70%, respectively) at a capacity factor of pumped hydro of 18%. The levelised cost of energy for the proposed system ranges between 0.07 and 0.22 $/kWh, largely influenced by proposed Saudia Arabia government subsidies. Regarding environmental assessment, the total amount of greenhouse gas emissions generated annually from all proposed systems is between 2.4 and 11 million tonnes

Design and performance assessment of a pumped hydro power energy storage connected to a hybrid system of photovoltaics and wind turbines

Worldwide, the overdependence on conventional power plants for electricity generation has been one of the most significant economic and environmental challenges. Renewable energy sources have become the most viable option to overcoming this issue. Recently, a hybrid renewable energy system consisting of wind turbines and photovoltaics combined with a pumped hydroelectric energy storage system has received considerable interest. However, neglecting crucial parameters, such as head losses and evaporation rate, might reduce the accuracy of the total simulation performance, resulting in an underestimation of the correct size of each component. This study investigates this issue by proposing a robust approach with a strategy to establish the ideal pipe design through an in-depth techno-economic assessment. A comparative analysis between two different scenarios in which one considers head loss and the other does not is carried out. A wide range of proposed system configurations has been thoroughly investigated. The essential performance indicators employed for designing the proposed system are the renewable energy fraction and the loss of renewable energy, and the results reveal that these two indicators have improved by approximately 8.6% and 3%, respectively. The most significant annual variation between the two scenarios regarding the total demand satisfied by the proposed system and the amount of renewable energy loss is 218.23 GWh and 89.39 GWh, respectively. The pipe efficiency at the pumping and generating modes, which is determined through a sensitivity analysis, ranges between 91-99% and 76–95%, respectively. These findings could assist designers in making initial assumptions about such parameters with reasonable confidence

Examining the impacts of 12 weeks of low to moderate-intensity aerobic exercise on depression status in patients with systolic congestive heart failure - A randomized controlled study

OBJECTIVES: Psychiatric depression disorder is common in patients with systolic congestive heart failure (HF), and both conditions share underlying pathophysiological mechanisms. The incidence rate of depression disorder has clearly increased with the increase in HF manifestations in recent decades. Depression disorder is considered an independent predisposing factor for hospitalization, disturbed functional performance, and high rates of morbidity and mortality in HF patients. This randomized controlled study was designed to examine the impacts of low- to moderate-intensity aerobic exercise training on depression status in patients with systolic congestive HF. METHODS: A total of 46 systolic congestive HF patients with depression (40-60 years of age) were randomized to receive twelve weeks of mild- to moderate-intensity aerobic exercise plus standard medical treatment (exercise group) or standard medical treatment without any exercise intervention (control group). Depression status was examined using the validated Patient Health Questionnaire-9 (PHQ9) pre- and post-intervention at the end of the study program. RESULTS: No significant differences were observed between the exercise and control groups in demographic data or clinical characteristics (p40.05). Both study groups showed a significant reduction in depression status at the end of the 12-week intervention (po0.05). The comparison between the mean values of the depression scores showed significant differences between the two groups after 6 and 12 weeks of the intervention, indicating a greater reduction in depression scores in the exercise group than in the control group (po0.05). CONCLUSIONS: Twelve weeks of a low- to moderate-intensity aerobic exercise program was safe and effective for reducing depression severity in patients with systolic congestive HF. Low- to moderate-intensity aerobic training should be recommended for cardiac patients, particularly those with HF-related depression

Reclassifying variations of unknown significance in diseases affecting Saudi Arabia’s population reveal new associations

Introduction: Physicians face diagnostic dilemmas upon reports indicating disease variants of unknown significance (VUS). The most puzzling cases are patients with rare diseases, where finding another matched genotype and phenotype to associate their results is challenging. This study aims to prove the value of updating patient files with new classifications, potentially leading to better assessment and prevention.Methodology: We recruited retrospective phenotypic and genotypic data from King Saud Medical City, Riyadh, Kingdom of Saudi Arabia. Between September 2020 and December 2021, 1,080 patients’ genetic profiles were tested in a College of American Pathologists accredited laboratory. We excluded all confirmed pathogenic variants, likely pathogenic variants and copy number variations. Finally, we further reclassified 194 VUS using different local and global databases, employing in silico prediction to justify the phenotype–genotype association.Results: Of the 194 VUS, 90 remained VUS, and the other 104 were reclassified as follows: 16 pathogenic, 49 likely pathogenic, nine benign, and 30 likely benign. Moreover, most of these variants had never been observed in other local or international databases.Conclusion: Reclassifying the VUS adds value to understanding the causality of the phenotype if it has been reported in another family or population. The healthcare system should establish guidelines for re-evaluating VUS, and upgrading VUS should reflect on individual/family risks and management strategies

Prospect of genetic disorders in Saudi Arabia

Introduction: Rare diseases (RDs) create a massive burden for governments and families because sufferers of these diseases are required to undergo long-term treatment or rehabilitation to maintain a normal life. In Saudi Arabia (SA), the prevalence of RDs is high as a result of cultural and socio-economic factors. This study, however, aims to shed light on the genetic component of the prevalence of RDs in SA.Methodology: A retrospective study was conducted between September 2020 and December 2021 at King Saud Medical City, a tertiary hospital of the Ministry of Health (MOH), SA. A total of 1080 individuals with 544 potentially relevant variants were included. The index was 738, and the samples were tested in a commercialized laboratory using different molecular techniques, including next-generation sequencing.Result: A total of 867 molecular genetics tests were conducted on 738 probands. These tests included 610 exome sequencing (ES) tests, four genome sequencing (GS) tests, 82 molecular panels, 106 single nucleotide polymorphism (SNP) array, four methylation studies, 58 single-gene studies and three mitochondrial genome sequencing tests. The diagnostic yield among molecular genetics studies was 41.8% in ES, 24% in panels, 12% in SNP array and 24% in single gene studies. The majority of the identified potential variants (68%) were single nucleotide variants (SNV). Other ascertained variants included frameshift (11%), deletion (10%), duplication (5%), splicing (9%), in-frame deletion (3%) and indels (1%). The rate of positive consanguinity was 56%, and the autosomal recessive accounted for 54%. We found a significant correlation between the ES detection rate and positive consanguinity. We illustrated the presence of rare treatable conditions in DNAJC12, SLC19A3, and ALDH7A1, and the presence of the founder effect variant in SKIC2. Neurodevelopmental disorders were the main phenotype for which genetics studies were required (35.7%).Conclusion: This is the sixth-largest local study reporting next-generation sequencing. The results indicate the influence of consanguineous marriages on genetic disease and the burden it causes for the Kingdom of SA. This study highlights the need to enrich our society’s knowledge of genetic disorders. We recommend utilising ES as a first-tier test to establish genetic diagnosis in a highly consanguineous population

Functional imaging of cognition in an old-old population: A case for portable functional near-infrared spectroscopy

In this study, functional near-infrared spectroscopy (fNIRS) was used to record brain activa- tion during cognitive testing in older individuals (88±6yo; N = 19) living in residential care communities. This population, which is often associated with loss of personal independence due to physical or cognitive decline associated with aging, is also often under-represented in neuroscience research because of a limited means to participate in studies which often take place in large urban or university centers. In this study, we demonstrate the feasibility and initial results using a portable 8-source by 4-detector fNIRS system to measure brain activity from participants within residential care community centers. Using fNIRS, brain sig- nals were recorded during a series of computerized cognitive tests, including a Symbol Digit Coding test (SDC), Stroop Test (ST), and Shifting Attention Test (SAT). The SDC and SAT elicited greater activity in the left middle frontal region of interest. Three components of the ST produced increases in the right middle frontal and superior frontal, and left superior frontal regions. An association between advanced age and increased activation in the right middle frontal region was observed during the incongruent ST. Although none of the partici- pants had clinical dementia based on the short portable mental status questionnaire, the group performance was slightly below age-normed values on these cognitive tests. These results demonstrate the capability for obtaining functional neuroimaging measures in resi- dential settings, which ultimately may aid in prognosis and care related to dementia in older adults