Multiple Comorbid Conditions among Middle-Aged and Elderly Hemophilia Patients: Prevalence Estimates and Implications for Future Care

Introduction. Advances in hemophilia care and treatment have led to increases in the life expectancy among hemophiliacs. As a result, persons with hemophilia are reaching an older age and experiencing various age-related health conditions never seen before in this population. Aim. To determine the prevalence of comorbidities among middle-aged and elderly hemophilia A and hemophilia B patients. Methods. Retrospective chart review among all hemophilia patients, who attended the Gulf States Hemophilia and Thrombophilia Center. Results. All patients had at least one comorbid condition other than hemophilia, and the majority had between 3 and 6 comorbidities. The most common conditions identified were chronic hepatitis C, hypertension, HIV, chronic arthropathy, and overweight/obesity. Conclusions. Since persons with comorbidities are more likely to have poorer health outcomes and require greater care in managing their health needs, caring for aging hemophiliacs is likely to pose various social and economic challenges for both patients and providers

Clinical utility of viscoelastic testing (TEG and ROTEM analyzers) in the management of old and new therapies for hemophilia

Hemophilia A and B are rare inherited bleeding disorders resulting from deficiency of coagulation factors VIII and IX respectively. In the past few decades, the field of hemophilia has witnessed pivotal management challenges and therapeutic advances. Routine coagulation and factor assays, while useful in the classification of severity and treatment monitoring in hemophilia patients, have been shown to be of limited use in managing clinical presentations and outcomes. This prompted the investigation of viscoelastic studies in hemophilia care, which have established their utility in various bleeding and thrombotic states. In this review, we will discuss and critically assess the current literature highlighting the use of viscoelastic studies in various aspects of hemophilia including the determination of clinical phenotype, management of patients with inhibitors, perioperative management, and monitoring of novel agents.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146857/1/ajh25319_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146857/2/ajh25319.pd

Predictive equations not always overestimate the resting energy expenditure in amyotrophic lateral sclerosis patients

Fil: Libere, Guillermo P.. Centro del Parque; ArgentinaFil: Guastavino, Sabrina. Centro del Parque; ArgentinaFil: Escobar, Miguel A.. Centro del Parque; ArgentinaFil: de Vito, Eduardo. Centro del Parque; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; Argentin

Valorization of toxic cyanobacteria biomass - disruption efficiency assessment and consequent bioproduct availability using different disruption techniques

The worldwide occurrence of hepatotoxic cyanobacterium Microcystis aeruginosa and accumulation of its toxin microcystin-LR, have been responsible for several human deaths and animal intoxication incidents. In recognition to its toxicity, the World Health Organization and several national governments established guideline values for this toxin in water, which gave rise to an increasing demand for microcystin′s analytical standards. These standards might be useful either as laboratory standards to apply in human and environmental risk assessment or as tools for molecular and cell biology studies. However, their availability is still limited due to constraints found in production and purification processes, which inflate the final price to values as high as 28000 €/mg. As an example of the increasing interest observed over the last years, U.S. Environmental Protection Agency has recently announced that cyanotoxins became part of its list of substances to be studied as a precursor to regulatory action between 2018 and 2020. Consequently, the optimization of this cyanobacterium cultivation and toxin purification techniques is needed to decrease the production cost of such high added-value product. In biotechnological industrial scale processes, the costs associated with downstream processing often represent more than 60 % of the overall expenses. The aim of this work is therefore to provide an insight regarding the development of a costeffective process for obtaining high-quality and affordable microcystin-LR by evaluating the efficiency of three different methodologies (microwave, freeze-thaw cycles and bead mill) on the disruption of M. aeruginosa and consequent availability of bioproducts. For that purpose, several parameters including time, power, and temperature were tested. The best conditions determined for each extraction method were the following: i) 1.5 minutes at 800 W (microwave), ii) three 12- hour cycles at -20 ºC (freeze-thaw cycles), and iii) 7 minutes using 20 % (v/v) of glass beads (bead mill). According to cell counting and intracellular organic matter release determining techniques, freeze-thaw cycles have shown to be the best disruption method presenting an overall efficiency around 97 %

Revenue management software in the hotel sector

La disponibilidad de software se ha erigido como un requisito fundamental para la aplicación de Revenue Management desde sus inicios. El gran volumen y variedad de datos requeridos para la adopción de decisiones de Revenue Management ha impulsado el desarrollo de soluciones, tanto genéricas que hemos denominado software de Revenue Management, como específicas, nombradas como herramientas de Revenue Management; en el contexto nacional e internacional. En este trabajo se analiza la evolución y la utilización de ambos tipos en función de la pertenencia o no a cadena hotelera. A nivel internacional se aprecia la difusión, en etapas tempranas de la implantación de Revenue Management, de software genérico. Centrándonos en el caso de España, actualmente se usa un mayor número de herramientas. Se identifican cinco software de Revenue Management mayoritariamente utilizados por cadenas hoteleras (EasyRMS, Synergy, Price Match, Ideas y ARMS); y 25 herramientas de apoyo (shoppers, channel managers, entre otros)que aseguran estar utilizando actualmente un elevado porcentaje de los hoteles que pertenecen a cadenas (93%) y todos los independientes (100%)The availability of software has constituted a fundamental requirement for the application of Revenue Management from its beginnings. The great volume and the variety of data required to adopt Revenue Management decisions has boosted the development of solutions in the national and international contexts that are both generic – which we have called Revenue Management software - and specific –Revenue Management tools. In this work, we analyse the evolution and the use of both types according to belonging to a hotel chain or not. At the international level, the diffusion of generic software is noted in the early stages of implementing Revenue Management. Centring on the case of Spain, more tools are currently used. Five software of Revenue Management have been identified, mainly utilised by hotel chains (EasyRMS, Synergy, Price Match, Ideas and ARMS), and 25 support tools (shoppers, channel managers, among others). The last ones are to a greater or lesser extent employed by a high percentage of the hotels that belong to chains (93%) and all those which are independent (100%

The validity and reliability of a novel mobile app to measure agility performance in the physically active youth population

Agility is a key component of physical fitness in adolescents. However, the measurement of this variable is usually complex, requiring high cost instruments and complex software. To test the validity and reliabilityof a novel iPhone app (Lap Tracker Auto-timer) to measure agility performance among adolescents.Twenty-four physically active adolescents (15.7 ± 2.3 years old) participated in two testing sessions (separated by 7 days). They performed three 4 x 10 m agility test trials measured by Photocell or the iPhone app.The correlation analysis revealed high validity (r = .92; 95% confidence interval [CI] = .88 –.95), with a standard error of the estimate of 0.56 s (p < 0.001). The coefficient of variation (CV; 0.09) and intraclass correlation coefficient (ICC; .93; 95% CI = .85 –.97) showed an acceptable reliability.This study demonstrated that the iPhone App Lap Tracker Auto-timer could be a valid, reliable and low-cost tool to evaluate agility performance in adolescents. However, more studies are required to guarantee the utility of this app

Brain SIRT1 Mediates Metabolic Homeostasis and Neuroprotection

Sirtuins are evolutionarily conserved proteins that use nicotinamide adenine dinucleotide (NAD+) as a co-substrate in their enzymatic reactions. There are seven proteins (SIRT1-7) in the human sirtuin family, among which SIRT1 is the most conserved and characterized. SIRT1 in the brain, in particular, within the hypothalamus, plays crucial roles in regulating systemic energy homeostasis and circadian rhythm. Apart from this, SIRT1 has also been found to mediate beneficial effects in neurological diseases. In this review, we will first summarize how SIRT1 in the brain relates to obesity, type 2 diabetes, and circadian synchronization, and then we discuss the neuroprotective roles of brain SIRT1 in the context of cerebral ischemia and neurodegenerative disorders

Differential gene expression profile in omental adipose tissue in women with polycystic ovary syndrome

10 pages, 2 figures, 5 tables.CONTEXT: The polycystic ovary syndrome (PCOS) is frequently associated with visceral obesity, suggesting that omental adipose tissue might play an important role in the pathogenesis of the syndrome. OBJECTIVE: The objective was to study the expression profiles of omental fat biopsy samples obtained from morbidly obese women with or without PCOS at the time of bariatric surgery. DESIGN: This was a case-control study. SETTINGS: We conducted the study in an academic hospital. PATIENTS: Eight PCOS patients and seven nonhyperandrogenic women submitted to bariatric surgery because of morbid obesity. INTERVENTIONS: Biopsy samples of omental fat were obtained during bariatric surgery. MAIN OUTCOME MEASURE: The main outcome measure was high-density oligonucleotide arrays. RESULTS: After statistical analysis, we identified changes in the expression patterns of 63 genes between PCOS and control samples. Gene classification was assessed through data mining of Gene Ontology annotations and cluster analysis of dysregulated genes between both groups. These methods highlighted abnormal expression of genes encoding certain components of several biological pathways related to insulin signaling and Wnt signaling, oxidative stress, inflammation, immune function, and lipid metabolism, as well as other genes previously related to PCOS or to the metabolic syndrome. CONCLUSION: The differences in the gene expression profiles in visceral adipose tissue of PCOS patients compared with nonhyperandrogenic women involve multiple genes related to several biological pathways, suggesting that the involvement of abdominal obesity in the pathogenesis of PCOS is more ample than previously thought and is not restricted to the induction of insulin resistance.This work was supported by PI020578, PI020741, PI050341, PI050551, RCMN C03/08, and RGDM 03/212 from Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, and Grants 08.6/0021/2003 and GR/SAL/0137/2004 from the Consejería de Educación y Cultura, Comunidad de Madrid, Spain.Peer reviewe