Visualizing Frailty: Exploring Radiographical Measures of Frailty in Trauma Patients

Purpose: This study assessed the relationship of core muscle sarcopenia, myosteatosis, and L1 attenuation to the 5-factor modified frailty index (mFI-5), discharge disposition, and post-admission complications in orthopedic and general trauma patients. It was hypothesized that reduced sarcopenia, L1 attenuation, and increased myosteatosis is associated with higher mFI-5 scores (≥ 0.3), discharge into care, and increased post-admission complications.Methods: This prospective cohort study was performed at a Level 1 trauma center. Patients were surveyed and metrics of the mFI-5 were used. Frail was categorized as a mFI-5 score ≥ 0.3. Recent abdominal computed tomography (CT) scans were used to extract radiographical information of total psoas cross-sectional area, psoas myosteatosis, and L1 vertebrae attenuation.Results: There were 140 patients who consented to the study, of which 83 had available abdomen and pelvis CT scans. The mean age was 43.19 (± 17.36), and 65% were male (n = 52). When comparing the frail (16%, n = 13) and not frail (84%, n = 70) patients, there was a significant difference in mean psoas myosteatosis (p < 0.0001) and the attenuation of the L1 vertebrae (p < 0.001). On multivariate analysis when accounting for age, myosteatosis of the psoas muscles was predictive of an mFI-5 score ≥ 0.3.Conclusion: The findings suggest that myosteatosis and L1 attenuation are associated with frailty indices (mFI-5) after traumatic injury. Future studies are needed to prospectively assess the validity of both radiographical and index-based markers of frailty in predicting post-traumatic complications, mortality, and hospital utilization.

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Comparison of Sarcopenia with Modified Frailty Index as a Predictor of Adverse Outcomes in Critically Ill Elderly Patients

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i32b31763 ◽

2021 ◽

pp. 200-206

Author(s):

Shrirang Bhurchandi ◽

Sachin Agrawal ◽

Sunil Kumar ◽

Sourya Acharya

Keyword(s):

Elderly Patients ◽

Critically Ill ◽

Health Care Cost ◽

Frailty Index ◽

The Elderly ◽

Time Frame ◽

Adverse Outcomes ◽

Cross Sectional ◽

Parametric Data ◽

Modified Frailty Index

Background: Ageing is a global fact affecting both developed and developing countries.It brings out various catabolic changes in body resulting in frailty(i.e. the person is not able to with stand minor stresses of the environment, due to reduced reserves in psychologicalreserve of several organ system).Thus causing a great burden of disease, dependence & health care cost. Sarcopenia is the leading component for frailty in the elderly population, but very few studies have been done in India for correlating frailty with sarcopenia. Aim: To compare sarcopenia with modified frailty index (MFI) as a predictor of adverse outcomes in critically ill elderly patients. Methodology: Cross-sectional study will be performed on all the critically ill geriatric subjects/patients coming to all the ICU's of AVBRH, Sawangi (M), Wardha who will satisfy various inclusion and exclusion criteria for selection and all standard parametric & non-parametric data will be assessed by using standard descriptive & inferential statistics. Expected Results: In our study, we are anticipating that the Modified frailty index to be a better predictor of adverse outcomes in terms of mortality as compared to sarcopenia in the critically ill elderly patients. Also, we are anticipating that sarcopenia to be the most important contributor of frailty in critically ill elderly patients and the prevalence of frailty will be high in critically ill elderly patients. Limitation: Due to limited time frame & resources we will not be able to follow up the patients.

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Frailty in Caregivers and Its Relationship with Psychological Stress and Resilience: A Cross-Sectional Study Based on the Deficit Accumulation Model

Journal of Frailty & Aging ◽

10.14283/jfa.2021.29 ◽

2021 ◽

pp. 1-8

Author(s):

M. F.S. Bersani ◽

F.S. Bersani ◽

F. Sciancalepore ◽

M. Salzillo ◽

M. Cesari ◽

...

Keyword(s):

Psychological Stress ◽

Frailty Index ◽

Cross Sectional Study ◽

Sectional Study ◽

Deficit Accumulation ◽

Cross Sectional ◽

Accumulation Model ◽

Emotional Strain ◽

Relationship Of ◽

The Relationship

Background: Studies increasingly suggest that chronic exposure to psychological stress can lead to health deterioration and accelerated ageing, thus possibly contributing to the development of frailty. Recent approaches based on the deficit accumulation model measure frailty on a continuous grading through the “Frailty Index” (FI), i.e. a macroscopic indicator of biological senescence and functional status. OBJECTIVES: The study aimed at testing the relationship of FI with caregiving, psychological stress, and psychological resilience. DESIGN: Cross-sectional study, with case-control and correlational analyses. PARTICIPANTS: Caregivers of patients with dementia (n=64), i.e. individuals a priori considered to be exposed to prolonged psychosocial stressors, and matched controls (n=64) were enrolled. MEASUREMENTS: The two groups were compared using a 38-item FI condensing biological, clinical, and functional assessments. Within caregivers, the association of FI with Perceived Stress Scale (PSS) and Brief Resilience Scale (BRS) was tested. RESULTS: Caregivers had higher FI than controls (F=8.308, p=0.005). FI was associated directly with PSS (r=0.660, p<0.001) and inversely with BRS (r=-0.637, p<0.001). Findings remained significant after adjusting for certain confounding variables, after excluding from the FI the conditions directly related to psychological stress, and when the analyses were performed separately among participants older and younger than 65 years. CONCLUSIONS: The results provide insight on the relationship of frailty with caregiving, psychological stress, and resilience, with potential implications for the clinical management of individuals exposed to chronic emotional strain.

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Evaluation of Reduction Accuracy of Suture-Button and Screw Fixation Techniques for Syndesmotic Injuries

Foot & Ankle International ◽

10.1177/1071100716661221 ◽

2016 ◽

Vol 37 (12) ◽

pp. 1317-1325 ◽

Cited By ~ 32

Author(s):

Onur Kocadal ◽

Mehmet Yucel ◽

Murad Pepe ◽

Ertugrul Aksahin ◽

Cem Nuri Aktekin

Keyword(s):

Screw Fixation ◽

Ct Scans ◽

Functional Evaluation ◽

Level Of Evidence ◽

Cross Sectional ◽

Suture Button ◽

Fixation Group ◽

Significant Difference ◽

The Mean

Background: Among the most important predictors of functional results of treatment of syndesmotic injuries is the accurate restoration of the syndesmotic space. The purpose of this study was to investigate the reduction performance of screw fixation and suture-button techniques using images obtained from computed tomography (CT) scans. Methods: Patients at or below 65 years who were treated with screw or suture-button fixation for syndesmotic injuries accompanying ankle fractures between January 2012 and March 2015 were retrospectively reviewed in our regional trauma unit. A total of 52 patients were included in the present study. Fixation was performed with syndesmotic screws in 26 patients and suture-button fixation in 26 patients. The patients were divided into 2 groups according to the fixation methods. Postoperative CT scans were used for radiologic evaluation. Four parameters (anteroposterior reduction, rotational reduction, the cross-sectional syndesmotic area, and the distal tibiofibular volumes) were taken into consideration for the radiologic assessment. Functional evaluation of patients was done using the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale at the final follow-up. The mean follow-up period was 16.7 ± 11.0 months, and the mean age was 44.1 ± 13.2. Results: There was a statistically significant decrease in the degree of fibular rotation ( P = .03) and an increase in the upper syndesmotic area ( P = .006) compared with the contralateral limb in the screw fixation group. In the suture-button fixation group, there was a statistically significant increase in the lower syndesmotic area ( P = .02) and distal tibiofibular volumes ( P = .04) compared with the contralateral limbs. The mean AOFAS scores were 88.4 ± 9.2 and 86.1 ± 14.0 in the suture-button fixation and screw fixation group, respectively. There was no statistically significant difference in the functional ankle joint scores between the groups. Conclusion: Although the functional outcomes were similar, the restoration of the fibular rotation in the treatment of syndesmotic injuries by screw fixation was troublesome and the volume of the distal tibiofibular space increased with the suture-button fixation technique. Level of Evidence: Level III, retrospective comparative study.

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Normal levels of inflammatory markers in treated patients with familial hypercholesterolaemia: a cross-sectional study

JRSM Cardiovascular Disease ◽

10.1258/cvd.2012.012011 ◽

2012 ◽

Vol 1 (3) ◽

pp. 1-9 ◽

Cited By ~ 2

Author(s):

Mary Seed ◽

D John Betteridge ◽

Jackie Cooper ◽

Muriel Caslake ◽

Paul N Durrington ◽

...

Keyword(s):

Familial Hypercholesterolaemia ◽

Univariate Analysis ◽

Cross Sectional Study ◽

Risk Markers ◽

Sectional Study ◽

Cross Sectional ◽

Lipoprotein A ◽

Significant Difference ◽

Heterozygous Familial Hypercholesterolaemia ◽

Relationship Of

Objective To assess the relationship of levels of inflammatory risk markers to presence of clinical coronary artery disease (CAD) in patients with treated heterozygous familial hypercholesterolaemia. Design A cross-sectional study of patients on the Simon Broome Familial Hyperlipidaemia Register. Setting Six hospital outpatient clinics in the UK. Participants A total of 211 men and 199 women with heterozygous familial hypercholesterolaemia. Main outcome measures Analysis of conventional risk factors and concentrations of high-sensitivity C-reactive protein (hsCRP), lipoprotein (a), serum intercellular adhesion molecule (sICAM), interIeukin-6 (IL-6) and lipoprotein-associated phospholipase A2 (LpPLA2) mass. Results CAD was present in 104 men and in 55 women; the mean ages of onset were 43.1 and 46.5 years, respectively. On univariate analysis there was a positive relationship of CAD with age, male sex, smoking, IL-6 and sICAM, and an inverse relationship with low-density lipoprotein (LDL) and LpPLA2. On multivariate analysis, age, smoking, low LDL and low LpPLA2 were associated with CAD. When LpPLA2 values were adjusted for apoB and aspirin usage, there was no significant difference between those with and without CAD. Only age and smoking were independently associated with CAD in men, and IL-6 and lipoprotein(a) in women. Conclusions Although on univariate analysis inflammatory marker levels were associated with CAD in these patients, the majority of the associations, including that for hsCRP, disappeared when corrected for smoking and apoB. This may be because atherosclerotic plaques in these statin-treated patients were quiescent or an effect of aspirin usage. In this observational study newer risk markers were not usefully associated with the presence or absence of symptomatic CAD.

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TOMOGRAPHIC MORPHOLOGICAL STUDY OF THE CRANIUM AND ITS CORRELATION WITH CRANIAL HALO USE IN ADULTS

Acta Ortopédica Brasileira ◽

10.1590/1413-785220172501168033 ◽

2017 ◽

Vol 25 (1) ◽

pp. 11-14

Author(s):

TIAGO FERREIRA DE ALMEIDA ◽

HOMAR TOLEDO CHARAFEDDINE ◽

FERNANDO FLORES DE ARAÚJO ◽

ALEXANDRE FOGAÇA CRISTANTE ◽

RAPHAEL MARTUS MARCON ◽

...

Keyword(s):

Computed Tomography ◽

Morphological Study ◽

Descriptive Analysis ◽

Parietal Bone ◽

Frontal Bone ◽

Ct Scans ◽

Level Of Evidence ◽

Cross Sectional ◽

Significant Difference ◽

Parietal Bones

ABSTRACT Objective: To evaluate using tomographic study the thickness of the cranial board at the insertions points of the cranial halo pins in adults Methods: This is a retrospective, cross-sectional, descriptive analysis of Computed Tomography (CT) scans of adult patients' crania. The study included adults between 20 and 50 years without cranial abnormalities. We excluded any exam with cranial abnormalities Results: We analyzed 50 CT scans, including 27 men and 23 women, at the original insertion points and alternative points (1 and 2 cm above the frontal and parietal bones). The average values were 7.4333 mm in the frontal bone and 6.0290 mm in the parietal bone Conclusion: There was no statistically significant difference between the classical and alternative points, making room for alternative fixings and safer introduction of the pins, if necessary. Level of Evidence II, Retrospective Study.

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Study of Asssociation of Concha Bullosa with Rhinosinusitis

Bengal Journal of Otolaryngology and Head Neck Surgery ◽

10.47210/bjohns.2016.v24i3.87 ◽

2016 ◽

Vol 24 (3) ◽

pp. 111-116

Author(s):

Shrikrishna B H ◽

Jyothi A C

Keyword(s):

Chronic Rhinosinusitis ◽

Ct Scans ◽

Radiological Assessment ◽

Concha Bullosa ◽

Cross Sectional ◽

Relationship Of ◽

The Relationship ◽

Strength Of Association ◽

Larger Sample

Introduction There are several studies with contradictory findings about the role of concha bullosa with predisposition to rhinosinusitis. This study was conducted to assess the relationship of osteomeatal unit blockage with concha bullosa. Materials and method A cross-sectional observational study by radiological assessment of prevalence of chronic rhinosinusitis and blockage of ipsilateral osteomeatal unit was done on 100 cases of concha bullosa detected on computed tomography to determine the prevalence of chronic rhinosinusitis in subjects with concha bullosa and to examine the latter’s relationship to osteomeatal unit blockage, which is a precursor for rhinosinusitis. Result One hundred cases of concha bullosa were studied in a total of 87 CT scan films depicting concha bullosa. Some CT scans showed unilateral concha bullosa while few scans showed bilateral concha bullosa. Ipsilateral rhinosinusitis was found in only 31% of the sides in scans of subjects with concha bullosa. Of the total 100 concha bullosae studied, extensive type was the commonest followed by bulbous and lamellar variety. Discussion Although rhinosinusitis was more predominant in the extensive type of concha bullosa compared to other types, it was statistically not significant and there was no statistically significant association between any type of concha bullosa with ipsilateral rhinosinusitis either in right side or left side. Conclusion This study has found no statistically significant association between any type of concha bullosa with rhinosinusitis. A bigger study with larger sample size is required to better assess the strength of association between concha bullosa and rhinosinusitis.

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Correlation of serum uric acid with renal function parameters in preeclampsia.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.12.4267 ◽

2020 ◽

Vol 27 (12) ◽

pp. 2703-2707

Author(s):

Muddasir Zia ◽

Rukhshan Khurshid ◽

Uzma Jabbar ◽

Adnan Riaz ◽

Roohi Jabbar ◽

...

Keyword(s):

Renal Function ◽

Uric Acid ◽

Serum Creatinine ◽

Serum Uric Acid ◽

Cross Sectional Study ◽

Urinary Protein ◽

Estimation Of Parameters ◽

Cross Sectional ◽

Significant Difference ◽

Relationship Of

Objectives: Study was designed to find out the Correlation of serum uric acid with renal function parameters in Preeclampsia. Study Design: Cross Sectional study. Setting: Sir Ganga Ram Hospital Lahore. Period: July 2016 to July 2017. Material & Methods: Level of serum uric acid, serum creatinine and blood urea of 40 Preeclamptic women and 30 gestation-matched normotensive controls were estimated. Their Demographic and clinical characteristics were noted. The blood sample was analyzed for biochemical parameters, blood urea, serum uric acid, serum creatinine and urinary protein. Result: Mean age and gestational age of women was 25 weeks with BMI 29 Kg/m2. Level of serum uric acid and blood urea and serum creatinine were increased, but significant difference only observed with serum uric acid and blood urea with marked proteinuria. An inverse relationship of serum uric acid with urinary protein was observed. A direct relationship, of serum uric acid with serum creatinine was observed. Conclusion: it is concluded that estimation of parameters of renal function of preeclamptic women are important along with hyperuicaemia.

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Ekspresi Caspase-3 sebagai Petanda Apoptosis Makrofag Lesi Kulit Penderita Kusta Tipe Pausibasiler dan Multibasiler

Pustaka Kesehatan ◽

10.19184/pk.v7i1.17588 ◽

2020 ◽

Vol 7 (1) ◽

pp. 27

Author(s):

Anggun P Yuniaswan ◽

Santoso Basuki ◽

Delya Widasmara

Keyword(s):

Caspase 3 ◽

Pearson Correlation ◽

Punch Biopsy ◽

Cross Sectional Study ◽

Cross Sectional ◽

Significant Difference ◽

Coefficient Corrélation ◽

Pearson Correlation Test ◽

Elimination Mechanism ◽

Relationship Of

Macrophage and Schwann cells are target cell on leprosy disease, where apoptotic is assumed as one of elimination mechanism of macrophage previously infected by M.leprae. Several study showed various result in apoptotic on leprosy disease. Apoptotic level can be evaluated by observing caspase-3 activity, an executioner caspase on cell death. This study is aimed to observe the relationship of caspase-3 expression with paucibacillary and multibacillary types of leprosy. We used observational analytic and cross sectional study with consecutive sampling method. The subject was leprosy patient which had been diagnosed on dermatovenereology division outpatient clinic Saiful Anwar Hospital, and fullfilled the inclusion-exclusion criteria. Total subject was 19 persons (11 multibacillary and 8 paucibacillary). Sampling was taken with punch biopsy on skin lession, followed by immunohistochemical staining with caspase-3 antibody, and caspase-3 expression was measured by ImmunoRatio method. Comparation test revealed significant difference (p<0.05%) between caspase-3 expression mean on paucibacillary patient (84.46%) compared to multibacillary patient (65.39%). Pearson correlation test revealed caspase-3 expression tend to be higher in paucibacillary patient than multibacillary (coefficient correlation -0.759). In conclusion, there is a significance relationship between caspase-3 expression with leprosy type.

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Relationship of circulating total bilirubin, UDP-glucuronosyltransferases 1A1 and the development of non-alcoholic fatty liver disease: a cross-sectional study

BMC Gastroenterology ◽

10.1186/s12876-021-02088-7 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Xuefeng Ma ◽

Xu Zheng ◽

Shousheng Liu ◽

Likun Zhuang ◽

Mengke Wang ◽

...

Keyword(s):

Total Bilirubin ◽

Cross Sectional Study ◽

Liver Fat ◽

Control Group ◽

Chinese Han ◽

Cross Sectional ◽

Alcoholic Fatty Liver ◽

Significant Difference ◽

Fat Fraction ◽

Relationship Of

Abstract Background This study aimed to investigate the correlation of circulating total bilirubin (TB) and UGT1A1 with NAFLD in Chinese Han population. Methods 172 adults were enrolled from the Qingdao Municipal Hospital from May 2019 to October 2020. All individuals were examined with MRI-PDFF and divided into no steatosis, mild steatosis, moderate steatosis, and severe steatosis groups according to the MRI-PDFF values. The biochemical indexes and UGT1A1 were measured. Results There was no significant difference of circulating TB and UGT1A1 levels between NAFLD group and controls. In the moderate steatosis and severe steatosis groups, the circulating TB levels were higher than that in control group (all P < 0.05). In addition, circulating TB levels were weak positively associated with liver fat fraction in NAFLD patients (ρ = 0.205, P = 0.001). There was no significant correlation between circulating UGT1A1 levels with liver fat fraction in patients with NAFLD (ρ = 0.080, P = 0.179), but positively correlation was found in patients with severe steatosis (ρ = 0.305, P = 0.026). Conclusions The circulating TB levels were significant high in patients with moderate and severe steatosis. Circulating TB levels were weakly associated with liver fat fraction in patients with NAFLD, and the circulating UGT1A1 levels were positively correlated with liver fat fraction in NAFLD patients with severe steatosis. Trial registration: ChiCTR, ChiCTR1900022744. Registered 24 April 2019 – Retrospectively registered, http://www.chictr.org.cn/edit.aspx?pid=38304&htm=4.

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3 Safely landing a resuscitative endovascular balloon occlusion of the aorta (REBOA) device in zone one

Journal of the Royal Army Medical Corps ◽

10.1136/jramc-2018-000959.3 ◽

2018 ◽

Vol 164 (3) ◽

pp. 224.3-225

Author(s):

O Jefferson ◽

JJ Morrison

Keyword(s):

Traumatic Injury ◽

Emergency Situation ◽

Balloon Occlusion ◽

Trauma Patients ◽

Height Range ◽

Fixed Distance ◽

Significant Difference ◽

Insertion Algorithm ◽

Study Population ◽

Endovascular Balloon Occlusion

BackgroundNon-compressible torso haemorrhage is a leading cause of potentially preventable death following trauma. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is a technique to temporise haemorrhage. Areas for potential inflation have been characterised as zones I – III. Placement superior to zone I may cause harm. Fluoroscopy, used to confirm position, is often unavailable. The literature shows disagreement about whether a fixed insertion distance would be safe. Some papers advocate using a multi-variable insertion formula.MethodsThree cohorts of patients underwent retrospective analysis of their aortic morphometry. The patients had undergone CT imaging of their torsos when they presented to one of three centres following serious traumatic injury. Aortic reconstructions were performed and measurements taken. Virtual balloons were inserted to both fixed distances and distances calculated using previously reported formulae.ResultsThe study population consisted of trauma patients presenting to Camp Bastion, Afghanistan [n=177]; St Mary’s Hospital, London, UK [n=100]; Wilford Hall Hospital, Texas, US [n=88]. When compared, the 3 cohorts were sufficiently similar for combined analysis (n=365). The two fixed insertion distances (444 mm and 418 mm) each conveyed virtual balloon placement accuracies of 98.4% (359/365). The placements proximal to Zone I occurred in those patients with the smallest 2% of torso heights. The 2 formulae for calculating zone I insertion length each conveyed accuracy of 99.7% (364/365). Statistical analysis found no significant difference between formulaic and fixed insertion distance accuracies (p=0.07).ConclusionFixed distance insertion is more practical in an emergency situation; formulae conveyed no greater accuracy. Fixed distances may not suit a minority of patients who are in the extreme of a population’s height range. These findings support the trial of a zone I fixed distance insertion algorithm.

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