The effect of oral and parenteral vitamin D supplementation in the elderly: a prospective, double-blinded, randomized, placebo-controlled study

Hypovitaminosis D in the elderly causes falls and fractures as a result of impaired neuromuscular functions and also may be a reason for nonspecific musculosceletal pain. The aim of this study is to investigate the benefits of a single dose per os or parenterally administrated vitamin D on increasing the quality of life and functional mobility and decreasing the pain in the elderly. The community-dwelling elderly subjects over 65?years age were included in the study. The subjects were given 300.000?IU Vitamin D via per os and parenteral route and assessed after 4?weeks. The serum creatinine, calcium, phosphorous, ALT, ALP, 24-h urine calcium excretion, PTH, and vitamin D levels, as well as VAS (visual analog scale) for pain assessment, functional mobility with TUG (timed up and go test) and quality of life with SF-36 before and after the treatment were evaluated. The serum vitamin D levels were measured by the RIA method. The subjects were divided into four groups each consisting of 30 subjects. The 1st group took i.m. vitamin D, the 2nd group took i.m. placebo, the 3rd group took p.o. vitamin D, and the 4th group took p.o. placebo. The mean age of all the participants was 70.1?±?4.3?years. There was no difference in the age and gender between the groups (P?>?0.05). After treatment, the PTH level of first group was decreased (P?=?0.0001) and the vitamin D level increased (P?=?0.0001) significantly. In the third group, the PTH level of first group was decreased (P?=?0.0001) and the vitamin D level increased (P?=?0.004) and the 24-h calcium excretion in urine (P?=?0.015) increased significantly. When the pain, the functional mobility, and the quality of life were evaluated, in the first group, the TUG (P?=?0.0001) and the VAS (P?=?0.0001) decreased significantly, whereas the SF-36 subtitles: physical functioning (P?=?0.0001), role physical (0.006), bodily pain (P?=?0.0001), general health (P?=?0.007), social functioning (P?=?0.05), and mental health (P?=?0.048) increased significantly. In group two, the VAS (P?=?0.001) decreased, the role physical (P?=?0.009), and role emotional (P?=?0.034) increased significantly; In group three, the TUG (P?=?0.0001) and the VAS (P?=?0.002) decreased, whereas the physical function (P?=?0.0001) and role physical (0.001) increased significantly; In group four, the VAS (P?=?0.007) decreased significantly. The megadose vitamin D administration increases quality of life, decreases pain, and improves functional mobility via po or im route in the elderly.     

Effects of montelukast on the healing of ischemic colon anastomoses

Background

The aim of this study was to examine whether treatment with montelukast, a selective leukotriene antagonist, would affect anastomotic healing in a reperfused colon rat model with remote ischemia/reperfusion injury.

Methods

Rats (n = 12 per group) were intraperitoneally administered normal saline or 10 mg/kg montelukast sodium 60 minutes before and for 5 days after surgery. Ischemia was induced for 45 minutes through superior mesenteric artery occlusion. A left colon anastomosis was made. Blood and perianastomotic tissue samples were obtained on postoperative day 5.

Results

Mean anastomotic bursting pressures of the control and montelukast groups were 159.17 ± 29.99 and 216.67 ± 26.40, respectively (P < .001). Compared with saline, montelukast treatment increased the mean tissue hydroxyproline level (2.46 ± .30 vs 3.61 ± .33 μmol/L) and decreased tissue caspase-3 activity (36.06 ± 5.72 vs 21.78 ± 3.87) and malondialdehyde levels (3.43 ± .34 vs 2.29 ± .34 nmol/g) (P < .001 for all). Other plasma markers of injury also showed differences.

Conclusions

Montelukast prevented ischemia/reperfusion-induced damage in a rat model of colonic anastomotic wound healing.     

Effects of Preoperative Iron Deficiency on Transfusion Requirements in Liver Transplantation Recipients: A Prospective Observational Study

The aims of this study were to determine the frequency of preoperative iron deficiency in adult living donor liver transplantation patients and to investigate its relationship with the need for intraoperative transfusion. Between September 1, 2011, and June 1, 2012, 103 patients scheduled for liver transplantation were included in this prospective study. Patients were divided into 2 groups according to baseline iron status: an iron-deficient group and a non deficient (normal iron profile) group. Iron deficiency was assessed on the basis of several parameters, including transferrin saturation, levels of ferritin, soluble transferrin receptor, C-reactive protein, and peripheral blood smear. Preoperative iron deficiency was diagnosed in 62 patients. Preoperative iron deficiency was associated with low preoperative hemoglobin levels (P = .01) and a high rate of intraoperative transfusion (P < .0001). Preoperative iron deficiency is prognostic factor for predicting intraoperative transfusion requirements. These findings have important implications for transfusion practices for liver transplant recipients.     

The Effects of Hyperbaric Oxygen Therapy on Colonic Anastomosis in Rats With Peritonitis

The aim of this study is to investigate the healing effect of hyperbaric oxygen (HBO) on colonic anastomoses in the presence of experimentally induced peritonitis. Thirty-two rats were allocated randomly into short-term anastomosis (STA), short-term anastomosis + HBO treatment (STA+HBO), long-term anastomosis (LTA), and long-term anastomosis + HBO (LTA+HBO) treatment groups. The STA and LTA groups were administered fluid resuscitation and antibiotics for 3 and 7 days, respectively, whereas the HBO treatment groups received additional HBO therapy for 3 and 7 days, respectively. The rats were reoperated on the third and the seventh days of anostomoses for evaluation. The bursting pressures in STA+HBO and LTA+HBO therapy groups were significantly higher than those in groups with anastomoses alone (p <. 001 and p <. 01). HBO therapy did not affect the fibrotic index neither in STA nor in LTA groups (p >. 05 for both); however, it was significantly higher in LTA+HBO group than that in STA+HBO group (p <. 05). The hydroxyproline level was significantly higher in LTA group than in STA group (p <. 05), yet HBO therapy did not affect the hydroxyproline levels in STA or LTA groups (p >. 05 for both). It is concluded that hyperbaric oxygen treatment has positive effects on colonic anastomotic healing in case of peritonitis.     

Visceral Adipose Tissue Quantification Using Lunar Prodigy

A dual-energy X-ray absorptiometry (DXA) application to measure visceral adipose tissue (VAT) in the android region of a total body DXA scan has recently been developed. This new application, CoreScan, has been validated on the Lunar iDXA (GE Healthcare, Madison, WI) densitometer against volumetric computed tomography. The geometric assumptions underlying the CoreScan model are the same on the Prodigy (GE Healthcare, Madison, WI) densitometer. However, differences between the peak X-ray voltage and detector array configurations may lead to differences in VAT quantification. The purpose of this study was to evaluate the agreement of Prodigy and iDXA CoreScan values and to characterize differences in VAT precision between the instruments. Data from volunteers with paired Prodigy and iDXA measurements were used to define empirical adjustments to the VAT algorithm parameters (n = 59) and validate performance on Prodigy (n = 62). Prodigy VAT measurements were highly correlated to iDXA (r = 0.984). The mean of the Prodigy-iDXA VAT volume differences was ?13.8 cm³ with a 95% confidence interval of ?45 to +17 cm³. The Bland-Altman 95% limits of agreement for the 2 methods were ?252 to +224 cm³. Measurement of short-term precision showed that measurement error variance on iDXA was smaller (p < 0.01) than Prodigy (coefficient of variance: 7.3% vs 9.8%). Precision results are in agreement with previous reports on the differences between Prodigy and iDXA for body composition measures. Prodigy and iDXA measures of VAT are similar, but the lower precision of the Prodigy may require investigators to target larger changes in VAT.     

A rare cause of mechanical bowel obstruction: mesh migration

The use of mesh has become the gold standard in hernia operations recently due to advantages such as lower recurrence rates, lower post-surgical pain and earlier return to work. Plug mesh application, first described by Robins and Rutkow [Robbins AW, Rutkow IM (1993) The mesh-plug hernioplasty. Surg Clin North Am 73:501–512], is a popular method of hernia repair. Although rare, there may be complications of surgery using plug mesh. This report presents a case of mechanic bowel obstruction due to mesh migration, 3 years after a left inguinal hernia repair with plug mesh method.     

Driving and off‐road impairments underlying failure on road testing in Parkinson's disease

Parkinson's disease (PD) affects driving ability. We aimed to determine the most critical impairments in specific road skills and in clinical characteristics leading to failure on a road test in PD. In this cross‐sectional study, certified driving assessment experts evaluated specific driving skills in 104 active, licensed drivers with PD using a standardized, on‐road checklist and issued a global decision of pass/fail. Participants also completed an off‐road evaluation assessing demographic features, disease characteristics, motor function, vision, and cognition. The most important driving skills and off‐road predictors of the pass/fail outcome were identified using multivariate stepwise regression analyses. Eighty‐six (65%) passed and 36 (35%) failed the on‐road driving evaluation. Persons who failed performed worse on all on‐road items. When adjusted for age and gender, poor performances on lateral positioning at low speed, speed adaptations at high speed, and left turning maneuvers yielded the best model that determined the pass/fail decision (R² = 0.56). The fail group performed poorer on all motor, visual, and cognitive tests. Measures of visual scanning, motor severity, PD subtype, visual acuity, executive functions, and divided attention were independent predictors of pass/fail decisions in the multivariate model (R² = 0.60). Our study demonstrated that failure on a road test in PD is determined by impairments in specific driving skills and associated with deficits in motor, visual, executive, and visuospatial functions. These findings point to specific driving and off‐road impairments that can be targeted in multimodal rehabilitation programs for drivers with PD. © 2013 International Parkinson and Movement Disorder Society