Would FRAX define the high fracture risk if the patients were evaluated the day before hip fracture?

Objective: The aim of this study was to evaluate the 10-year major osteoporotic and hip fracture risks in patients with a recent hip fracture. Material and Methods: The study population comprised 58 patients (32 male and 26 female, mean age 79.1 years) with a recent hip fracture. A bedside questionnaire including fracture risk assessment tool (FRAX®) variables and fall frequency was administered to the patients. The FRAX® 10-year major osteoporotic and hip fracture risks were calculated. Statistical analyses were performed to compare different age groups (60–69 years, 70–79 years, and ≥80 years). Results: The mean 10-year major osteoporotic and hip fracture risks were 13.9% and 78%, respectively. If the National Osteoporosis Foundation guidelines were taken into account according to major osteoporotic and hip fracture risks using FRAX® the day before the fracture, treatment would not be initiated in 75.8% and 18.9% of patients, respectively. There were significant differences between the age groups according to the 10-year major osteoporotic and hip fracture probability and fall frequency (p<0.001, p<0.001, and p=0.005, respectively). Conclusion: In our study group, the FRAX® 10-year major osteoporotic fracture probability had an underestimation in younger patients with a history of frequent falling and did not seem to improve the definition of high-risk patients. The 10-year probability of hip fracture by the FRAXObjective: The aim of this study was to evaluate the 10-year major osteoporotic and hip fracture risks in patients with a recent hip fracture. Material and Methods: The study population comprised 58 patients (32 male and 26 female, mean age 79.1 years) with a recent hip fracture. A bedside questionnaire including fracture risk assessment tool (FRAX®) variables and fall frequency was administered to the patients. The FRAX® 10-year major osteoporotic and hip fracture risks were calculated. Statistical analyses were performed to compare different age groups (60–69 years, 70–79 years, and ≥80 years). Results: The mean 10-year major osteoporotic and hip fracture risks were 13.9% and 78%, respectively. If the National Osteoporosis Foundation guidelines were taken into account according to major osteoporotic and hip fracture risks using FRAX® the day before the fracture, treatment would not be initiated in 75.8% and 18.9% of patients, respectively. There were significant differences between the age groups according to the 10-year major osteoporotic and hip fracture probability and fall frequency (p<0.001, p<0.001, and p=0.005, respectively). Conclusion: In our study group, the FRAX® 10-year major osteoporotic fracture probability had an underestimation in younger patients with a history of frequent falling and did not seem to improve the definition of high-risk patients. The 10-year probability of hip fracture by the FRAX® tool can classify populations at risk more effectively. tool can classify populations at risk more effectively. © 2015 by Turkish Society of Physical Medicine and Rehabilitation

The association of calcaneal spur length and clinical and functional parameters in plantar fasciitis

Introduction: Plantar fasciitis (PF)is the most common cause of plantar heel pain. Despite many treatment alternatives for heel spur, the association of calcaneal spur size with clinical and functional parameters is inconclusive. The objective of this study to investigate the correlation of calcaneal spur length with clinical findings and functional status documented with Foot Function Index in patients with plantar fasciitis. Methods: We performed power analysis for the sample size estimation. 87 patients with PF were scrutinized to reach the estimated patient number 75. Computer-aided linear measurements were done for spur length from tip to base in milimeters. Perceived pain intensity was evaluated by visual analog scale (VAS). Patients were asked to rate the pain experienced on a 10-cm VAS. Foot function index was applied to the patients to evaluate pain, disability and activity limitation of the patients. Results: Of the 75 participants, 24 were males (32%) and 51 were females (68%). The mean age was 47 ± 10 years (range 30-65 years). The mean calcaneal spur length was 3.86 ± 3.36 mm (range between 0 and 12.2). Calcaneal spur length was significantly correlated with age (p = 0.003), BMI (p = 0.029), symptom duration, (p = 0.001) VAS (p = 0.003), and FFI total score (p < 0.001). Discussion: Our study demonstrated that length of the calcaneal spur is significantly correlated with age, BMI, symptom duration, perceived pain, FFI pain and disability subscores, and FFI total scores. Conclusion: The size of the calcaneal spur is an important parameter correlated with pain and functional scores in PF. © 2015 IJS Publishing Group Limited

ACTA OTORHINOLARYNGOLOGICA ITALICA

I cleft laringei e laringotracheali sono rare malformazioni congenite dellalbero laringo-tracheo-bronchiale. La sintomatologia associata va dalla blanda tosse allaspirazione e alla cianosi. I cleft di tipo I e II possono essere tenuti sotto osservazione senza intervenire chirurgicamente, mentre i tipi III e IV richiedono un approccio chirurgico anteriore o laterocervicale. Presentiamo il caso di un neonato di 3 mesi affetto da cleft laringotracheale di tipo III, deceduto in corso di revisione chirurgica dopo un approccio in laringofissura anteriore. Nel presente lavoro discutiamo, alla luce della letteratura, le difficoltà diagnostiche, le modalità di trattamento e le tecniche anestesiologiche relative a questa rara patologia

Malaria and Dengue mosquito vectors from Lao PDR show a lack of the rdl mutant allele responsible for cyclodiene insecticide resistance

The gamma-aminobutyric acid (GABA) receptor, RDL, plays important roles in neuronal signalling and is the target of highly effective insecticides. A mutation in RDL, commonly A296S, underlies resistance to several insecticides such as cyclodienes. Even though the use of cyclodienes has been banned, the occurrence of mutations substituting A296 is notably high in mosquitoes from several countries. Here we report a survey investigating the prevalence of the Rdl mutant allele in mosquitoes from Laos, a country where mosquito-borne diseases such as malaria and dengue fever are health concerns. Anopheles and Aedes mosquitoes were collected from twelve provinces in Laos. Adult bioassays on Ae. aegypti (Linnaeus) (Diptera: Culicidae) and Ae. albopictus (Skuse) showed that all the populations tested were susceptible to dieldrin (4%) following WHO protocols. Exon 7 from a total of 791 mosquitoes was sequenced to identify the amino acid encoded for at 296 of RDL. Only one of these mosquitoes, Anopheles maculatus rampae (Diptera: Culicidae) from Attapeu, carried the mutant allele being heterozygous for A296S. We therefore found a general lack of the Rdl mutant allele indicating that mosquitoes from Laos are not exposed to insecticides that act on the GABA receptor compared to mosquitoes in several other countries. Identifying the prevalence of the Rdl mutation may help inform the potential use of alternative insecticides that act on the GABA receptor should there be a need to replace pyrethroids in order to prevent/manage resistance

Can environment or allergy explain international variation in prevalence of wheeze in childhood?

Asthma prevalence in children varies substantially around the world, but the contribution of known risk factors to this international variation is uncertain. The International Study of Asthma and Allergies in Childhood (ISAAC) Phase Two studied 8–12 year old children in 30 centres worldwide with parent-completed symptom and risk factor questionnaires and aeroallergen skin prick testing. We used multilevel logistic regression modelling to investigate the effect of adjustment for individual and ecological risk factors on the between-centre variation in prevalence of recent wheeze. Adjustment for single individual-level risk factors changed the centre-level variation from a reduction of up to 8.4% (and 8.5% for atopy) to an increase of up to 6.8%. Modelling the 11 most influential environmental factors among all children simultaneously, the centre-level variation changed little overall (2.4% increase). Modelling only factors that decreased the variance, the 6 most influential factors (synthetic and feather quilt, mother’s smoking, heating stoves, dampness and foam pillows) in combination resulted in a 21% reduction in variance. Ecological (centre-level) risk factors generally explained higher proportions of the variation than did individual risk factors. Single environmental factors and aeroallergen sensitisation measured at the individual (child) level did not explain much of the between-centre variation in wheeze prevalence

Effectiveness of a multidimensional approach for prevention of ventilator-associated pneumonia in 11 adult intensive care units from 10 cities of Turkey: Findings of the International Nosocomial Infection Control Consortium (INICC)

Purpose: To evaluate the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach on the reduction of ventilator-associated pneumonia (VAP) in adult patients hospitalized in 11 intensive care units (ICUs), from 10 hospitals, members of the INICC, in 10 cities of Turkey. Methods: A prospective active before-after surveillance study was conducted to determine the effect of the INICC multidimensional approach in the VAP rate. The study was divided into two phases. In phase 1, active prospective surveillance of VAP was conducted using the definitions of the Centers for Disease Control and Prevention National Health Safety Network, and the INICC methods. In phase 2, we implemented the multidimensional approach for VAP. The INICC multidimensional approach included the following measures: (1) bundle of infection control interventions, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback of VAP rates, and (6) performance feedback of infection control practices. We compared the rates of VAP obtained in each phase. A time series analysis was performed to assess the impact of our approach. Results: In phase 1, we recorded 2,376 mechanical ventilator (MV)-days, and in phase 2, after implementing the multidimensional approach, we recorded 28,181 MV-days. The rate of VAP was 31.14 per 1,000 MV-days during phase 1, and 16.82 per 1,000 MV-days during phase 2, amounting to a 46 % VAP rate reduction (RR, 0.54; 95 % CI, 0.42-0.7; P value, 0.0001.) Conclusions: The INICC multidimensional approach was associated with a significant reduction in the VAP rate in these adult ICUs of Turkey. © 2013 Springer-Verlag Berlin Heidelberg