Loneliness among Elderly Population

Background: Old age or elderly is the final stage of the normal life span. The elderly population is facing many health problems such as physical, mental, psychological & social etc. Factors like loneliness, low self-esteem, social isolation, quality of life and several others negatively affect elderly population and increase the risk of various health problems in elderly people. Aim: This study aims to assess loneliness among elderly population and to examine possible correlations with associated demographic, social and health factors. Methods: A cross sectional study was conducted, in which 200 elderly from Sirmour participated and the subjects were selected using total enumeration sampling technique. For the data collection the UCLA loneliness 20-item scale was used as well as a questionnaire with questions about demographic, social and health factors and the data was analyzed using descriptive and inferential statistics in SPSS. Results: Present study results reveals 127(63.5%) of elderly has mild level of loneliness, 44(22.0%) of them has moderate level of loneliness whereas 29(14.5%) has severe level of loneliness and no significant association was found between the level of loneliness & demographic variable. Conclusion: Results show that no significant association is present between the loneliness with demographic variable. Keywords: Loneliness, UCLA Scale.

Ethical considerations of age-based allocation of intensive care treatments amid the COVID-19 outbreak

With the COVID-19 outbreak severely overwhelming healthcare systems worldwide, countries must decide on allocation criteria for scarce intensive care resources such as ventilators, leaving some without life-saving treatment. Groups such as the Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) have suggested using age as allocation criteria, prioritizing the young over the elderly. In judging the morality of such criteria, different ethical frameworks must be applied. From a utilitarian perspective, age-based allocation ensures “the greatest good” – that those with greater “therapeutic success” or “quality-of-life” get access to intensive treatment. However, age poorly predicts prognostic outcomes, and quality-of-life measures are inherently value-laden. From a contractarian view, a morally justifiable action is one made in ignorance of one’s own stake in the outcome. In this lens, age-based allocation is justified since it maximizes the most life-years for the most people. However, it relies on the same flawed assumptions as utilitarianism. From a prioritarian view, age-based allocation ensures that the rights of the young to live out a “normal life span” are respected. However, such judgements ignore the positive experiences of later life and cannot be made on a patient’s behalf. Through a deontological lens, age-based allocation is discriminatory as it views elderly people as means to an end rather than individual agents. Ultimately, the rationing criteria a society uses reflects its values, with age limitations implicitly devaluating the elderly. Therefore, allocation guidelines should deemphasize age in favor of more predictive and less discriminatory measures like multimorbidity or frailty.

Gynecological and psycho-sexual aspects of women with history of anorectal malformations

Purpose Women with anorectal malformation (ARM) are expected to have a normal life span, therefore, gynecological and psycho-sexual issues are also important. Aim of the study was to assess these aspects in adult females with history of ARM. Methods Thirty-seven women from two ARM referral centers, aged ≥ 16, were identified. Gynecologic visit, cervicovaginal swab, pelvic ultrasound, FSH, LH, prolactin, progesterone, 17–β–estradiol, DHEAS, testosterone, TSH during follicular and luteal phases, and administration of FSFI questionnaire to screen the female sexual functioning were performed. Data were compared with six controls. Results Nineteen patients, mean age 21.7 (16–45), participated to the study. Associated anomalies, mostly affecting limbs, vertebrae and genitalia, were present in 57.8% of cases. Mullerian anomalies were retrieved in 36.8%. Hormones’ levels were normal. Concerning sexual functioning, four women (21%) reported dyspareunia or impossible penetration, four did not answer the FSFI questionnaire due to lack of confidence about their sexuality, and three scored lower than the cut-off value for female sexual function. Conclusion This study confirms the importance of a multidisciplinary long-term follow-up for ARM patients, including a careful study of the reproductive tract to detect and treat those conditions that could affect the fertility. Moreover, an appropriate psychological support should be provided.

Generation and identification of a conditional knockout allele for the PSMD11 gene in mice

Background Our previous study have shown that the PSMD11 protein was an important survival factor for cancer cells except for its key role in regulation of assembly and activity of the 26S proteasome. To further investigate the role of PSMD11 in carcinogenesis, we constructed a conditional exon 5 floxed allele of PSMD11 (PSMD11flx) in mice. Results It was found that homozygous PSMD11 flx/flx mice showed normal and exhibited a normal life span and fertility, and showed roughly equivalent expression of PSMD11 in various tissues, suggesting that the floxed allele maintained the wild-type function. Cre recombinase could induce efficient knockout of the floxed PSMD11 allele both in vitro and in vivo. Mice with constitutive single allele deletion of PSMD11 derived from intercrossing between PSMD11flx/flx and CMV-Cre mice were all viable and fertile, and showed apparent growth retardation, suggesting that PSMD11 played a significant role in the development of mice pre- or postnatally. No whole-body PSMD11 deficient embryos (PSMD11−/−) were identified in E7.5–8.5 embryos in uteros, indicating that double allele knockout of PSMD11 leads to early embryonic lethality. To avoid embryonic lethality produced by whole-body PSMD11 deletion, we further developed conditional PSMD11 global knockout mice with genotype Flp;FSF-R26CAG − CreERT2/+; PSMD11flx/flx, and demonstrated that PSMD11 could be depleted in a temporal and tissue-specific manner. Meanwhile, it was found that depletion of PSMD11 could induce massive apoptosis in MEFs. Conclusions In summary, our data demonstrated that we have successfully generated a conditional knockout allele of PSMD11 in mice, and found that PSMD11 played a key role in early and postnatal development in mice, the PSMD11 flx/flx mice will be an invaluable tool to explore the functions of PSMD11 in development and diseases.

Glial activation in prion diseases is strictly nonautonomous and requires neuronal PrPSc

Although prion infections cause cognitive impairment and neuronal death, transcriptional and translational profiling shows progressive derangement within glia but surprisingly little changes within neurons. Here we expressed PrPC selectively in neurons, astrocytes or oligodendrocytes of mice. After prion infection, both astrocyte and neuron-restricted PrPC expression led to copious brain accumulation of PrPSc. As expected, neuron-restricted expression was associated with typical prion disease. However, mice with astrocyte-restricted PrPC expression experienced a normal life span, did not develop clinical disease, and did not show astro- or microgliosis. Besides confirming that PrPSc is innocuous to PrPC-deficient neurons, these results show that astrocyte-born PrPSc does not activate the extreme neuroinflammation that accompanies the onset of prion disease and precedes any molecular changes of neurons. This points to a nonautonomous mechanism by which prion-infected neurons instruct astrocytes and microglia to acquire a specific cellular state that, in turn, drives neural dysfunction.

Insulation Performance Analysis of Field Aged and New MV XLPE Cables Using Various Diagnostic Techniques

Cross-linked polyethylene (XLPE) cables are widely used in the distribution and transmission networks of power systems. The insulation materials of these cables are stressed by the over voltages and are also exposed to various environmental conditions. This leads the power cables to degrade during their normal life span. Therefore, it would be advantageous for the power utilities to acquire the cable’s insulation condition frequently during their operation. In this paper, experimental studies were carried out on short sections of field aged as well as un-aged medium voltage (MV) XLPE cables to investigate the insulation condition using non-destructive diagnostic techniques such as Dissipation Factor (DF), Isothermal Relaxation Current (IRC), and Partial Discharge (PD) characteristics at 60Hz. From this set of experiments, different parameters will be used to analyze the dielectric response and the insulation condition. Finally, the results show how the VLF dissipation factor works efficiently to assess cable aging.

Pyloric perforation in situs inversus totalis and Ladd’s band with dextrocardia: a collection of rare anomalies and associated operative challenge

Situs inversus totalis with dextrocardia is a rare entity where the liver and gall bladder are on the left side and the spleen on the right. It is an autosomal recessive mode of inheritance and the patients are usually asymptomatic with a normal life span. Ladd’s band on the other hand is a fibrous band of peritoneum lying over the duodenum to the caecum, which usually presents as intestinal malrotation and is most commonly diagnosed and treated with Ladd’s procedure in infancy itself. Asymptomatic adult cases presenting later in life are rarely seen. Here we present a case of a 22-year-old male who presented with symptoms of perforation peritonitis and was diagnosed on clinical and radiological examination to have situs inversus. Intra-operative findings later revealed presence of a Ladd’s band too.

Widespread organ tolerance to Xist loss and X reactivation except under chronic stress in the gut

Long thought to be dispensable after establishing X chromosome inactivation (XCI), Xist RNA is now known to also maintain the inactive X (Xi). To what extent somatic X reactivation causes physiological abnormalities is an active area of inquiry. Here, we use multiple mouse models to investigate in vivo consequences. First, when Xist is deleted systemically in post-XCI embryonic cells using the Meox2-Cre driver, female pups exhibit no morbidity or mortality despite partial X reactivation. Second, when Xist is conditionally deleted in epithelial cells using Keratin14-Cre or in B cells using CD19-Cre, female mice have a normal life span without obvious illness. Third, when Xist is deleted in gut using Villin-Cre, female mice remain healthy despite significant X–autosome dosage imbalance. Finally, when the gut is acutely stressed by azoxymethane/dextran sulfate (AOM/DSS) exposure, both Xist-deleted and wild-type mice develop gastrointestinal tumors. Intriguingly, however, under prolonged stress, mutant mice develop larger tumors and have a higher tumor burden. The effect is female specific. Altogether, these observations reveal a surprising systemic tolerance to Xist loss but importantly reveal that Xist and XCI are protective to females during chronic stress.

Success and Challenges in the Management of Chronic Myeloid Leukemia

Chronic myeloid leukemia (CML) is one of the most common myeloproliferative neoplasms characterized by the presence of Philadelphia chromosome, that is, t(9:22), a reciprocal translocation between long arms of chromosomes 9 and 22. In its natural course CML has three phases, that is, chronic phase, accelerated phase, and blast crises phase. Peripheral blood shows marked leukocytosis and left shift. Diagnosis is confirmed by demonstration of specific molecular abnormality by polymerase chain reaction (PCR), fluorescence in situ hybridization (FISH) method or cytogenetics. The drug of choice is tyrosine kinase inhibitor (TKI); imatinib. Other TKIs are dasatinib and nilotinib. Most patients respond and have almost normal life span. However, challenges remain. At present the drug is prescribed for lifelong. Recent studies have shown that the drug may be stopped in certain groups of which around 50% remain in long term remission (operational cure). However, around 20% did not respond and showed resistance. Research is in progress to find out the mechanism of resistance and newer therapeutic modalities or agents.