Prevalence and patterns of multimorbidity among elderly people in rural Bangladesh: a cross-sectional study

Data on multimorbidity among the elderly people in Bangladesh are lacking. This paper reports the prevalence and distribution patterns of multimorbidity among the elderly people in rural Bangladesh. This cross-sectional study was conducted among persons aged > or = 60 years in Matlab, Bangladesh. Information on their demographics and literacy was collected through interview in the home. Information about their assets was obtained from a surveillance database. Physicians conducted clinical examinations at a local health centre. Two physicians diagnosed medical conditions, and two senior geriatricians then evaluated the same separately. Multimorbidity was defined as suffering from two or more of nine chronic medical conditions, such as arthritis, stroke, obesity, signs of thyroid hypofunction, obstructive pulmonary symptoms, symptoms of heart failure, impaired vision, hearing impairment, and high blood pressure. The overall prevalence of multimorbidity among the study population was 53.8%, and it was significantly higher among women, illiterates, persons who were single, and persons in the non-poorest quintile. In multivariable logistic regression analyses, female sex and belonging to the non-poorest quintile were independently associated with an increased odds ratio of multimorbidity. The results suggest that the prevalence of multimorbidity is high among the elderly people in rural Bangladesh. Women and the non-poorest group of the elderly people are more likely than men and the poorest people to be affected by multimorbidity. The study sheds new light on the need of primary care for the elderly people with multimorbidity in rural Bangladesh.     

Fluoxetine versus placebo in depressed alcoholics: a 1-year follow-up study

The authors conducted a first study to evaluate the long-term efficacy of fluoxetine for decreasing the depressive symptoms and the drinking of patients with comorbid major depressive disorder and alcohol dependence. This study consisted of a 1-year naturalistic follow-up of 31 patients who previously had completed a 3-month double-blind, placebo-controlled study of fluoxetine in depressed alcoholics. The fluoxetine group continued to demonstrate less depressive symptoms and less drinking than the placebo group at the 1-year follow-up evaluation. The results of the 1-year follow-up evaluation suggest persistent efficacy for fluoxetine for treating the depressive symptoms and the drinking of depressed alcoholics.     

Morphometric and immunohistochemical characterization of the intimal layer throughout the arterial system of elderly humans

The purpose of the present study was to obtain insight into the natural development of adaptive intimal thickening and atherosclerosis in the arterial tree of human species. The morphometry and composition of the intimal layer were studied in the arterial system of elderly individuals. Post mortem, a total of 703 arterial segments were dissected from 24 subjects (age 81.9 ± 9.9 years). From each subject, segments were dissected from 31 different arteries. Area stenosis [(plaque area/vessel area) × 100%] was determined in each segment. By (immuno)histochemistry, lipid content and the presence of inflammatory cells (macrophages) were assessed in the coronary, common carotid, brachial, radial and internal iliac arteries. Adaptive intimal thickening or advanced atherosclerosis was observed in all studied artery types. Area stenosis was highest in the coronary arteries (median, 30%) and lowest in the arteries supplying the brain (median, ≤ 7%). Plaques hiding a lipid‐rich core and plaques with macrophage infiltration were observed in all five selected artery types. In summary, the present observation demonstrates that intimal thickening is a systemic process involving most artery types. Within elderly humans, features of advanced atherosclerotic disease, a lipid‐rich core and macrophages, can be observed in the intimal layer of artery types that are recognised for their relation with clinical syndroms as well as artery types that remain clinically silent.     

Occurrence of perfluorinated compounds (PFCs) in drinking water of North Rhine-Westphalia,Germany and new approach to assess drinking water contamination by shorter-chained C4–C7 PFCs

After detection of perfluorooctanoate (PFOA) in drinking water at concentrations up to 0.64 μg/l in Arnsberg, Sauerland, Germany, the German Drinking Water Commission (TWK) assessed perfluorinated compounds (PFCs) in drinking water and set for the first time worldwide in June 2006 a health-based guide value for safe lifelong exposure at 0.3 μg/l (sum of PFOA and perfluorooctanesulfonate, PFOS). PFOA and PFOS can be effectively removed from drinking water by percolation over granular activated carbon. Additionally, recent EU-regulations require phasing out use of PFOS and ask to voluntarily reduce the one of PFOA. New and shorter-chained PFCs (C4–C7) and their mixtures are being introduced as replacements. We assume that some of these “new” compounds could be main contributors to total PFC levels in drinking water in future, especially since short-chained PFCs are difficult to remove from drinking water by common treatment techniques and also by filtration over activated carbon. The aims of the study were to summarize the data from the regularly measured PFC levels in drinking water and in the drinking water resources in North Rhine-Westphalia (NRW) for the sampling period 2008–2009, to give an overview on the general approach to assess PFC mixtures and to assess short-chained PFCs by using toxicokinetic instead of (sub)chronic data. No general increase of substitutes for PFOS and PFOA in wastewater and surface water was detected. Present findings of short-chained PFC in drinking waters in NRW were due to extended analysis and caused by other impacts. Additionally, several PFC contamination incidents in drinking water resources (groundwater and rivers) have been reported in NRW. The new approach to assess short-chained PFCs is based on a ranking of their estimated half-lives for elimination from the human body. Accordingly, we consider the following provisional health-related indication values (HRIV) as safe in drinking water for lifelong exposure: perfluorobutanoate (PFBA) 7 μg/l, perfluoropentanoate (PFPA) 3 μg/l, perfluorohexanoate (PFHxA) 1 μg/l, perfluoroheptanoate (PFHpA) 0.3 μg/l, perfluorobutanesulfonate (PFBS) 3 μg/l, perfluoropentanesulfonate (PFPS) 1 μg/l, perfluorohexanesulfonate (PFHxS) 0.3 μg/l and perfluoroheptanesulfonate (PFHpS) 0.3 μg/l. For all PFCs the long-term lowest maximal quality goal (general precautionary value, PV_g) in drinking water is set to −0.1 μg/l.     

The Prognostic Value of Prothrombin Time in Predicting Survival after Major Trauma: a Prospective Analysis of 1,351 Patients from the German Trauma Registry

Background: Early assessment of the individual trauma load in major trauma patients is difficult. A simple and reliable prognostic factor already available in the emergency room would help the emergency physician to make appropriate therapeutic decisions, e. g., when and how to operate on major fractures. The aim of the study was to evaluate the prognostic value of prothrombin time (PT). Patients and Methods: The German Trauma Registry is a prospective, standardized and anonymous documentation of severely injured patients. 3,814 patients were included in the registry. 1,351 patients with an Injury Severity Score (ISS) h 16 and complete data for specific variables (PT, Trauma Score + Injury Severity Score [TRISS], survival until discharge) were included in the study. The PT was measured on the patient's arrival in the emergeny room. Three different analyses were performed. 1. According to clinical judgment, three groups of patients were compared (PT S 60%, PT 40-59%, PT < 40%). A univariate analysis compared therapeutic interventions and outcome variables between the three groups. 2. A receiver-operator-characteristic (ROC) curve analysis compared the performance of PT with the prognostic standard TRISS. 3. A multivariate logistic regression was performed in order to evaluate PT as an independent prognostic variable. Results: PT values showed a good inverse correlation with the severity of injury and the level of therapeutic interventions. The ROC analysis as well as the regression revealed PT as a significant prognostic factor although it showed a slightly worse performance compared to TRISS. Conclusions: As PT, in contrast to TRISS, is readily available already in the emergency room, it can be used as a screening variable for the assessment of a patient's trauma load and thereby help in the decision-making for further operative treatment of major trauma patients.     

Lymphocytic Hypophysitis Masking a Suprasellar Germinoma in a 12-year-old Girl<197>A Case Report

Case history, light and electron microscopic findings of a case of a lymphocytic hypophysitis in coincidence with a suprasellar germinoma in a 12-year-old girl are reported. The girl presented with a long time case history of diabetes insipidus and subsequent panhypopituitarism. Two years after the diagnosis of diabetes insipidus magnetic resonance imaging (MRI) showed a tumorous enlargement of the sellar content and pituitary stalk. A transnasal exploration was initially performed and revealed a lymphocytic hypophysitis. Light microscopy showed a dense infiltration of mature lymphocytes and plasma cells in the interstitium of the anterior pituitary gland. The stalk area could not be exposed to exclude a germinoma. One year later the lesion relapsed despite dexamethason therapy and a second operation by another neurosurgeon had to be performed. Light microscopy showed lymphocytic infiltrates, fibrosis and necrosis. The diagnosis was a lymphocytic hypophysitis again. Though transcranially exposed only pituitary tissue was removed. No infundibular mass became visible at surgery as shown by MRI. The girl developed five months later multiple cerebral lesions, which revealed to be a germinoma. Lymphocytic hypophysitis in children is very rare and a coincedence with a germinoma has not been described from histopathological aspect until now. The origin of the pituitary infiltration is discussed.     

Contrasting effects of convective flow on catheter ablation lesion size: cryo versus radiofrequency energy

Background: Cryoablation has now become an alternative to treat many cardiac arrhythmias, and may be the treatment of choice in some patient populations. We compared the effects of convective flow on large-tip cryo and radiofrequency (RF) lesions dimensions.
Methods: Cryoablation and RF ablation were performed on porcine heart sections in a saline bath with varying directed flow rates. Cryoablation was performed for 4 minutes on 50 tissue pieces with tip temperature controlled at −80°C. RF ablation was performed on 50 tissue pieces for 60 seconds at 60°C tip temperature. The pieces were placed in culture media for 24 hours, and then sectioned, stained, and measured.
Results: Cryoablation and RF lesion sizes varied significantly with flow such that higher flow rates produced smaller cryoablation lesions and larger RF lesions (mean cryoablation volumes: 854 ± 402, 808 ± 217, 781 ± 217, 359 ± 114, and 292 ± 117 mm³, and mean RF volumes: 211 ± 35, 304 ± 79, 439 ± 125, 525 ± 187, and 597 ± 126 mm³ for 0, 1, 2, 3, and 5L/min flow rates, respectively, P < 0.0005). Trabeculated pieces had larger cryoablation lesions and smaller RF lesions than nontrabeculated ones at higher flow rate (P < 0.005). Cryoablation lesion volume increased as the time to reach −80°C decreased (r²= 0.72).
Conclusion: In contrast to RF ablation, cryoablation lesion size is smaller at high flow rates, and larger at low flow rates due to the warming effects of local convective flow. The effects of high flow are reduced in areas of trabeculation, and the time to reach −80°C predicts cryoablation lesion size.