Extreme Age Research Articles

Multi-modal profiling of peripheral blood cells across the human lifespan reveals distinct immune cell signatures of aging and longevity.

Age-related changes in immune cell composition and functionality are associated with multimorbidity and mortality. However, many centenarians delay the onset of aging-related disease suggesting the presence of elite immunity that remains highly functional at extreme old age. To identify immune-specific patterns of aging and extreme human longevity, we analyzed novel single cell profiles from the peripheral blood mononuclear cells (PBMCs) of a random sample of 7 centenarians (mean age 106) and publicly available single cell RNA-sequencing (scRNA-seq) datasets that included an additional 7 centenarians as well as 52 people at younger ages (20-89 years). The analysis confirmed known shifts in the ratio of lymphocytes to myeloid cells, and noncytotoxic to cytotoxic cell distributions with aging, but also identified significant shifts from CD4+ T cell to B cell populations in centenarians suggesting a history of exposure to natural and environmental immunogens. We validated several of these findings using flow cytometry analysis of the same samples. Our transcriptional analysis identified cell type signatures specific to exceptional longevity that included genes with age-related changes (e.g., increased expression of STK17A, a gene known to be involved in DNA damage response) as well as genes expressed uniquely in centenarians' PBMCs (e.g., S100A4, part of the S100 protein family studied in age-related disease and connected to longevity and metabolic regulation). Collectively, these data suggest that centenarians harbor unique, highly functional immune systems that have successfully adapted to a history of insults allowing for the achievement of exceptional longevity. TK, SM, PS, GM, SA, TP are supported by NIH-NIAUH2AG064704 and U19AG023122. MM and PS are supported by NIHNIA Pepper center: P30 AG031679-10. This project is supported by the Flow Cytometry Core Facility at BUSM. FCCF is funded by the NIH Instrumentation grant: S10 OD021587.

Knowledge Attitude and Practice on Infection Prevention and Control of Healthcare Workers During Covid-19 In A Tertiary Hospital

Health care workers are the first to be on the front lines of the epidemic. Increased infection and mortality rates among health care workers will paralyze a country's response to the COVID-19 epidemic, and it will certainly have a significant long-term impact on health care delivery, especially in health systems that are already struggling with workforce shortages due to lack of skilled personnel, skilled labor migration, and geographic location. Assessing IPC knowledge, attitude, and practice remains important in determining the level of compliance with IPC measures.It is in this context that our study aims to assess the knowledge, attitude, and practice of health care workers at Befelatanana University Hospital. Our population was predominantly female (n= 60; 57%) with a sex ratio of 0.76. The average age was 28 years with an extreme age of 21 and 57 years. More than a third of the staff interviewed were residents (n=42; 39.62%), followed by nurses and midwives. More than half had less than 5 years of work experience (n=60; 56.82%) and more than half also reported no training in ICC (n=63; 59%). The majority of health workers (n=103; 97.17%) had previous contact with a suspected and confirmed case (Covid-19). Of the health workers (n=69; 65.09%) contracted Covid-19 of which (n=62; 59%) were confirmed cases and (n=7; 6%) were suspected cases Our study revealed that more than one third of the participants had insufficient knowledge of hand hygiene (34.91%), almost half of the participants (42.45%) had insufficient knowledge of wearing PPE, insufficient knowledge of donning (35.85%), insufficient knowledge of removal (42.45%). We noted the non-compliance of IPC measures in their practices: the majority reported using surgical masks for more than 4 hours, very few CHWs (n=17; 21%) changed their masks every 8 hours and 29 (36%) . Only 37.71% (n=40) of participants performed a leak test on their FFP2 masks.The majority of staff (98.11%) reported using the gowns; half of the staff (53.17%) did not wash the cloth gowns. We found noncompliance in the use of face shields: 95.3% discarded face shields and 88.7%. We identified factors associated with contamination of healthcare workers, namely midwives/nurses, physicians, residents, and specialty residents, lack of knowledge of hand washing with alcohol-based disinfectant, lack of knowledge of the indication for gowns as universal precautions. Knowledge and skill deficiencies in terms of IPC during Covid- 19 was observed in our study. Thus, establishing a national IPC program and strengthening the training of health workers remains crucial to implement IPC measures at all levels of the health structure in order to reduce the spread of infection either before or during an outbreak . This allows each health worker to be better prepared for a potential outbreak.

Edukasi Bahaya dan Pencegahan Preeklampsia Pada Kehamilan

Background: There are many risk factors that influence the occurrence of preeclampsia, such as primigravida, hyperplacentosis, extreme maternal age (less than 20 years and more than 35 years), a family history of preeclampsia or eclampsia, kidney disease, diabetes mellitus, chronic hypertension already suffered before pregnancy superimposed preeclampsia and obesity. This devotion aims to overcome the problem of possible low knowledge about the dangers and ways of preventing preeclampsia. The implementation method of conducting education and evaluating pregnant women the extent of knowledge and awareness of the dangers of preeclampsia and prevention that can be done during pregnancy, preparation for childbirth to the puerperium. Results: From the results of the pretest analysis, more mothers do not know about Preeclampsia during pregnancy, dangers and how to prevent it, but after being given education on the dangers and how to prevent preeclampsia, the posttest results show that almost all mothers understand about preeclampsia during pregnancy, dangers and how to prevent it. Conclusion: Counseling participants, namely pregnant women who attend the activity, can understand the importance of knowing the dangers of preeclampsia and how to prevent it and are willing to regularly control blood pressure and urine protein regularly.

Close Quarters: Dealing with Difference in the (Post-)Soviet Realm

Close QuartersDealing with Difference in the (Post-)Soviet Realm Maike Lehmann (bio) Adrienne Edgar and Benjamin Frommer, eds., Intermarriage from Central Europe to Central Asia: Mixed Families in the Age of Extremes. 344 pp. Lincoln: University of Nebraska Press, 2020. ISBN-13 978-1496202116. $75.00. Jeff Sahadeo, Voices from the Soviet Edge: Southern Migrants in Leningrad and Moscow. 273 pp. Ithaca, NY: Cornell University Press, 2019. ISBN-13 978-1501738203. $46.95. Rustamjon Urinboyev, Migration and Hybrid Political Regimes: Navigating the Legal Landscape. 186 pp. Oakland: University of California Press, 2021. ISBN-13 978-0520971257 (Open Access e-book). The kommunalka as a living arrangement particular to the Soviet Union appeals to researchers as much as it fascinates people who first come across this space with its complex rules and relationships. Its challenge to Western notions of private and public, the coexistence of fierce territoriality and intimate relationships in cramped quarters, which could elicit the whole range of emotions between inhabitants who often hailed from wildly diverging backgrounds and did not live together by choice, has turned the kommunalka into an allegory for the whole Soviet Union.1 As a metaphor, it has also been popular with scholars working on the multiethnic character of [End Page 391] the Soviet Union.2 Very much like the kommunalka, which accommodated people of all classes in apartments taken from the former imperial elite, the USSR came to be in a mostly involuntary fashion. But it afforded all its inhabitants a national home within the borders of the former empire—room to foster national culture and local support for the socialist project. With rooms in the kommunalka often contested and cramped, sometimes further divided by curtains and makeshift walls, they lend themselves easily to a comparison with the disputed borders of national territories between and within republics. In recent years, however, the kommunalka metaphor has been called into question, because it usually called attention to the aspect of territoriality and conflict when reflecting on the multiethnic layout of the Soviet Union, thereby reinforcing the boundaries drawn by the Soviet state and implicitly treating the different rooms as homogeneous while often foregrounding conflict.3 There are solid grounds for this approach. But what happens when we extend the kommunalka metaphor to include forays into how cohabitation and boundary crossing worked out? What were the rules and relationships here? And what did this kommunalka mean to its (former) inhabitants? ________ The three publications under review here address such issues in different ways and for different groups. While the article collection edited by Adrienne Edgar and Benjamin Frommer brings together contributions dealing with intermarriage from Central Europe to Central Asia from the late 19th to the early 21st centuries, the monographs by Sahadeo and Urinboyev explore the experiences of migrants from the (post-)Soviet South to (post-)Soviet Moscow and Leningrad. While the diversity in contexts and perspectives is immediately apparent from the lineup of Edgar's and Frommer's volume, Sahadeo's and Urinboyev's shared focus might suggest the possibility of a long-term perspective on migration across the 1991 divide. After all, a recurring assumption is that the tectonic shifts of the political and social [End Page 392] landscape upon the implosion of the Soviet Union might have brought undercurrents to the surface that previously remained hidden, not the least by the rather idealistic picture of a multiethnic Soviet family painted by official discourse. While for the economic and social sphere, the fundamental change of the 1990s is recognized, the multiethnic makeup of the (post-) Soviet space is often talked about in terms of continuity. The enduring image of the Soviet Union as a breaker of nations is time and again linked to the xenophobic profiling at work in Russia today. The possibility of a long-term perspective could be also expected from certain features the two monographs share: Sahadeo and Urinboyev approach their subjects in large part through interviews (besides contemporary sources in Sahadeo's case and multisited field work in Moscow and the Ferghana Valley, spanning participant observation and exchanges on social media, in Urinboyev's); they focus on their subject's agency while analyzing living situations and everyday experiences...

Prolactinomas in adolescent and elderly patients-A comparative long-term analysis.

Prolactinomas represent the most common type of secreting pituitary adenomas, yet are rarely encountered in adolescent-onset (AO; i.e. <18 years) or elderly-onset (EO; i.e. ≥65 years) cohorts. As a result, it is not clear whether long-term strategies should be focused differently at both age extremes when comparing their therapeutic outcomes. We aimed at investigating long-term endocrinological outcomes, looking for differences between the two cohorts and evaluating the dependence on continued dopamine agonist (DA) therapy. Retrospective cross-sectional comparative study analyzing prolactinoma patients with a follow-up of ≥4 years. Clinical, radiological and biochemical characteristics were assessed at diagnosis and last follow-up. Longitudinal endocrinological outcomes between groups of extreme ages (i.e. AO and EO) and middle age (i.e. ≥18 years to 65 years) were compared. Independent risk factors for long-term dependence on DAs were calculated. Follow-up at ≥4 years was recorded for 108 prolactinoma patients; 10 patients with AO and 10 patients with EO. Compared to AO patients, EO patients were predominantly men (p = 0.003), and presented with significantly higher prolactin (PRL) levels (p = 0.05) and higher body mass index (p = 0.03). We noted a significant positive correlation between patients' PRL values and their age (r = 0.5, p = 0.03) or BMI (r = 0.6, p = 0.03). After a median follow-up of 115 months, remission was noted in 87 (83%) patients; 9 (90%) in AO patients, and 7 (70%) in EO patients (p = 0.58). Continuation of DAs was required in 4 patients (40%) with AO and 7 patients (70%) with EO (p = 0.37). Patients with elderly-onset were an independent predictor of long-term dependence on DAs (HR 2.8, 95% CI 1.1-7.2, p = 0.03). Long-term control of hyperprolactinemia and hypogonadism does not differ between members of the AO and EO cohorts, and can be attained by the majority of patients. However, adjuvant DAs are often required, independent of the age of onset. Considering the clinical significance of persistent DA therapy for the control of hyperprolactinemia in many patients at both extremes of age, long-term monitoring may become recommended, in particular in patients with elderly-onset.

Response of extreme environmental aging on the novel Moringa stenopetala husk fiber/epoxy composites: Understanding the characteristics and thermokinetic behavior

AbstractThe increasing use of composite components in various engineering disciplines necessitates detailed comprehension of their operation. When subjected to adverse environmental circumstances, such as variable humid surroundings and UV radiations, the structural and mechanical characteristics of the composites can deteriorate. Additionally, using these composite materials for structural applications such as rooftop buildings or household properties may reduce lifespan. In this study, the static and dynamic mechanical properties and the stability of novel lignocellulosic Moringa stenopetala (MS) husk fiber‐based epoxy composites exposed to various environmental factors were assessed. These harsh conditions were picked to imitate those encountered outside and influence the longevity of these composites. The obtained fiber from the husk was examined for its physiological, structural, and thermal characteristics. Using the Broido, Kissinger, Flynn‐Wall‐Ozawa (FWO), Coats‐Redfern and Kissinger‐Akahira‐Sunose (KAS) isoconventional models, the thermal degradation kinetics of the fibers were investigated. KAS method results in the best‐fitted curve and shows maximum activation energy of 175.13 KJ/mol. After husk fiber assessment, composite materials were fabricated using a Hand layup method, and their static and dynamic mechanical properties, water uptake rate, and contact angle analysis with surface energy behavior under various environmental aging circumstances were studied. In comparison to the composites “as developed,” the findings indicate that the mechanical characteristics of husk fiber‐based epoxy composites are significantly reduced by humidity and UV aging. Overall, the development of thermoset composites for structural applications can utilize husk fiber. Furthermore, after curing the water and UV‐aged composites, qualities can be recovered.

Four Elegies

Four Elegies

Time trends, projections, and spatial distribution of low birthweight in Australia, 2009-2030: Evidence from the National Perinatal Data Collection.

Infants with low birthweight (LBW, birthweight <2500 g) have increased in many high-resource countries over the past two decades. This study aimed to investigate the time trends, projections, and spatial distribution of LBW in Australia, 2009-2030. We used standard aggregate data on 3 346 808 births from 2009 to 2019 from Australia's National Perinatal Data Collection. Bayesian linear regression model was used to estimate the trends in the prevalence of LBW in Australia. Wefound that the prevalence of LBW was 6.18% in 2009, which has increased to 6.64% in 2019 (average annual rate of change, AARC=+0.76%). If the national trend remains the same, the projected prevalence of LBW in Australia will increase to 7.34% (95% uncertainty interval, UI=6.99, 7.68) in 2030. Observing AARC across different subpopulations, the trend of LBW was stable among Indigenous mothers, whereas it increased among non-Indigenous mothers (AARC=+0.81%). There is also an increase among the most disadvantaged mothers (AARC=+1.08%), birthing people in either of two extreme age groups (AARC=+1.99% and +1.53% for <20 years and ≥40 years, respectively), and mothers who smoked during pregnancy (AARC=+1.52%). Spatiotemporal maps showed that some of the Statistical Area level 3 (SA3) in Northern Territory and Queensland had consistently higher prevalence for LBW than the national average from 2014 to 2019. Overall, the prevalence of LBW has increased in Australia during 2009-2019; however, the trends vary across different subpopulations. If trends persist, Australia will not achieve the Sustainable Development Goals (SDGs) target of a 30% reduction in LBW by 2030. Centering and supporting the most vulnerable subpopulations is vital to progress the SDGs and improves perinatal and infant health in Australia.

Living in an Age of Extremes

Living in an Age of Extremes

The Status Epilepticus in Adults: Results from a Tertiary Care Teaching Hospital in Karachi, Pakistan

Background: Status epilepticus is one of the common neurological emergencies associated healthcare costs, morbidity and mortality worldwide. The prevalence is more in extreme ages, in adults as well as in children. However, it can occur at any age. Aim: The aim of this study was to determine the possible causes and outcomes of status epilepticus in adults. Method: Across-sectional study was conducted in the department of Neurology, at Jinnah Postgraduate Medical College, Karachi during January 2015 to March 2016. All patients of either gender between 18-60 years of age diagnosed for status epilepticus, presented within 24 hours of their first episode of status epilepticus were included in the study. Patients were examined for the assessment of nature, type and presence or absence of precipitating factors (noncompliance, systemic infection, head trauma and central nervous system infections). Data was entered and analyzed by using SPSS version 19.0. Results: A total number of 241 patients were recruited. We observed that the patients with no previous history of epilepsy 41(17%) had central nervous system infections, followed by head trauma 27(11%), systemic infections 22(9%) and 3(1.2%) were stroke. In patients who were known case of epilepsy 70(29.0%) patients were found non-compliant to Anti-Epiliptic Drug while 30(12.4%) patients were found to have hyponatremia. In 48(19.9%) patients no obvious cause was found. Conclusion: Status epilepticus is not common in our setup and predominant type is convulsive status and none of our patients have non convulsive status. Most common precipitating factor was infections followed by trauma. Further studies of bigger dimension are needed to substantiate these findings. Bangladesh Journal of Medical Science Vol. 22 No. 01 January’23 Page : 128-134

Presentation, Treatment, and Complications of Acute Dehydration in Hyperemesis Gravidarum

Hyperemesis gravidarum (HG), a condition affecting a group of pregnant women, poses a complex clinical situation marked by persistent vomiting, dehydration, and weight loss. The prevalence rate of HG ranges from 0.5% to 2%, which means it carries risks for both the health of the mother and the developing fetus throughout pregnancy. The multifaceted etiology of HG involves hormonal factors, genetic predisposition, and other potential contributors. This review explores the key findings, clinical manifestations, and management strategies associated with HG. Identifiable risk factors, including prior HG history, multiple gestations, and extreme maternal age, contribute to its development. Hormonal factors, including increased levels of gonadotropin (hCG) and dysfunction in the thyroid, play a role in its development. Clinically, HG is marked by severe vomiting, dehydration, electrolyte imbalances, and notable weight loss. Timely and comprehensive management is paramount, necessitating a multidisciplinary approach involving intravenous fluids, antiemetic medications, nutritional support, and psychological counseling. In conclusion, HG underscores the unique healthcare needs of pregnant women, emphasizing the importance of addressing these needs promptly and comprehensively to safeguard both maternal and fetal well-being. This review sheds light on the intricate nature of HG, highlighting the significance of tailored interventions and continuous care throughout pregnancy to mitigate complications and ensure safe outcomes.

A Rare Case of Anti-N-Methyl-D-Aspartate Receptor Encephalitis in an Infant Presenting with Regression and Movement Disorder.

A Rare Case of Anti-N-Methyl-D-Aspartate Receptor Encephalitis in an Infant Presenting with Regression and Movement Disorder.

Do the Dictatorships Ever End? Historians and Publishers under the Dictatorship in the Kingdom of Yugoslavia

The theme of the paper are the ways in which the dictatorship of King Alexander influenced the politics of history, the educational system, historians, publishers of historical literature, and publishers in general in the late 1920s and early 1930s in the Kingdom of Yugoslavia. In order to put this first dictatorship in the Yugoslav area in a diachronic perspective, I will analyze the presence of certain types of continuities and discontinuities. I will also show the trajectories of historians and publishers during King Alexanderʼs dictatorship and other dictatorships which followed in the 20th century’s Age of Extremes. Moreover, all these dictatorships inevitably referred to each other. I will also explore the contemporary attitude toward the first dictatorship in the Yugoslav area, the attitude which was shaped by the stance toward Serbo-Croatian conflicts and Yugoslavism as a whole. All this contributed to the constant presence of this dictatorship in the ongoing symbolic struggles over the interpretation of national history.

Epidemiological, clinical and ethnological particularities of puerperal psychosis in Toamasina, Madagascar

Introduction: A descriptive retrospective study in the Psychiatry service of the Analankininina University Hospital Center of Toamasina Madagascar was conducted from January 1st to December 31st, 2018 to know the epidemiological, clinical and ethnological particularities of puerperal psychosis affecting women hospitalized in this service. Methodology and results: Women presenting mental disorders corresponding to the diagnostic of puerperal psychosis coded F.53 from the Tenth version of the International Classification of Diseases of the WHO were included. Then, among the 451 patients hospitalized at the Toamasina Psychiatry Service, 27 women presented puerperal psychosis. The average age was 25 years with extreme ages of 18 and 34 years. The age between 20 to 24 years was the most affected. According to the level of education, 55.55% of patients attended secondary school and 29.62% had a school break in primary level. They were housewives in 51.85% of cases, married in 59.25%. Obstetrically, 59.25% of patients are primiparous, delivered vaginally in 92.59% and by caesarean surgery in 7.40 % of cases. They had full-term births in 92.59% of cases and premature births in 7.40%. Psychiatrically, no family past of mental troubles was reported in 88.88% of the patients while 7.40 % have had it with first-degree relatives. Furthermore, no personal history of psychosis was found in 74.07% of the patients, while 22.22% had a history of psychosis and 3.70% a history of bipolar disorders. A traumatic experience of childbirth was reported in 22.22% of patients, while 18.51% reported traumatic previous pregnancies and/or deliveries. Marital conflicts (14.81%) and financial difficulties (11, 11%) were the most present stressors. Clinically, puerperal psychosis appeared on average within 8 to 14 days postpartum in 37% of cases. The most presented clinical signs were insomnia (81.48%), delusional state (59.25%), behavioral dissociation (51.85%), anorexia and weight loss (44. 44%) and psychomotor agitation (37.03%). Polymorphic thema of delusions were the most observed in 44.44% of cases. Brief delusional psychoses were the most reported (51.85%), followed by depressive states (25.92%) and schizophrenic troubles (14.81%). Conclusion: Psychological preparation and support for women during pregnancy, childbirth and postpartum are importants. It is suggested that the population would be concious of the existence of appropriate psychiatric care and specific place in Toamasina to treat puerperal psychosis.

Corrélation entre l’utilisation d’une tige remplissante et le syndrome d’implantation du ciment chez les personnes âgées ostéoporotiques souffrant d’une fracture du col du fémur traitée par arthroplastie de hanche cimentée : une étude cas-témoin rétrospective chez 128 patients

BackgroundBone cement implantation syndrome (BCIS) is a serious and potentially fatal complication especially in patients with osteoporotic femoral neck fracture (OFNF) undergoing cemented hip arthroplasty (CHA). Recent studies showed that the shape-closed femoral stem profile could lead to a significant increase of the intramedullary pressure during cementation and prosthesis insertion. This study aimed to 1) correlate the use of shaped-closed femoral stem and other perioperative risk factors with severe grade of BCIS (grade 2 or 3: BCIS gr2/3, and 2) identify the prevalence of BCIS in the elderly patients with OFNF and treated with CHA. HypothesisLarge wedge-shaped (or “shape-closed”) femoral stem design would significantly associate with BCIS gr2/3 in the elderly patients who sustained OFNF and underwent CHA. Patients and methodsA total of 128 OFNF patients, who aged over 75 years and underwent CHA were retrospectively reviewed and then allocated into 2 groups: SC Group (use shape-closed femoral stem, n=40) and FC Group (use force-closed femoral stem, n=88). BCIS was grading in all patients according to Donaldson classification. Perioperative data between the patients with BCIS-gr2/3 and those with BCIS grade 0 or 1 (BCIS-gr0/1) were compared. Multiple logistic regression analysis was used to identify predictive factors for BCIS-gr2/3. ResultsThe prevalence of overall BCIS and BCIS-gr2/3 was 32.8 % (n=42) and 6.2 % (n=8), respectively. The total in-hospital and 1-year mortality rates were 2.3 % and 4.7 %, respectively. The major perioperative complication in patients with BCIS-gr2/3 was significantly higher compared to those in patients with BCIS-gr0/1 (62.5 % vs. 10.0 %, p=0.001). Multivariate analysis showed that age >90 years (OR 9.4, 95 % CI: 1.4-62.9, p=0.02), preinjury Parker mobility score <4 (OR=48.8; 95 % 2.7-897.2, p=0.008) and shape-closed femoral stem used (OR=19.1; 95 %CI, 1.8–204.5, p=0.01) were the significant independent predictors for BCIS-gr2/3 in these patients. ConclusionBCIS in OFNF patients undergoing CHA is common and associates with a high major perioperative complication rate. Our initial hypothesis is validated as the patients at risk for BCIS-gr2/3 are those whose CHA procedures use a shape-closed femoral stem design and with extreme age, and having poor preinjury ambulatory status. Therefore, we recommended using cementless stem as the first option in OFNF. However, if CHA is needed, strict guideline for cement insertion should be followed with force-closed stem application to avoid the risk of BCIS-gr2/3. Level of evidenceIII; Retrospective case-control study.

MOSAIC CHROMOSOMAL ALTERATIONS AND LONGEVITY

Abstract Mosaic chromosomal alterations (mCAs) are structural alterations that are associated with mortality, age, cancer, cardiovascular disease, and diverse infections. The distribution of mCAs in long-lived subjects and individuals with familial longevity is not well described. We applied MOsaic CHromosomal Alteration (MoChA) caller on genome-wide genotype samples of 2025 centenarians, their siblings, and offspring and 273 unrelated controls from the New England Centenarian Study (NECS) and 3642 subjects with familial longevity and 920 controls from the Long-Life Family Study (LLFS). MoChA utilizes a Hidden Markov Model to detect mCA-induced deviations in allelic balance at heterozygous sites with Log R Ratio and B-allele frequency (BAF) with phased genotype information. We analyzed somatic mCAs in samples with genome-wide BAF phase concordance less than 0.51, LOD score greater than 10, and estimated cell fraction less than 50%. The results in the two studies showed that autosomal mCAs spanning over 100 kbase pairs increase with older age until approximately 102 years. However, the prevalence of the subjects with mCAs tends to plateau after that age, suggesting that the accumulation of mCAs is less prevalent in long-lived subjects. We also found that offspring and siblings of centenarians accumulate less autosomal mCAs (fixed-effect meta-analysis for NECS and LLFS: RR=0.78, p=0.033) compared to unrelated controls. In addition, consistent with results from other studies, mCAs are associated with increased risk for mortality (HR=1.08, p=0.02) and sex (Male RR=1.37, p=4.15e-05), and impact incident events of cancer, dementia, diabetes, and cardiovascular diseases even at extreme old ages.

382: EHRLICHIOSIS-INDUCED MYOCARDITIS

Introduction: Myocarditis caused by Ehrlichiosis is a rare manifestation. The following case emphasizes the significance of early detection and its treatment. Description: A previously healthy 77-year-old female presented with a two-day history of generalized weakness and altered mental status. On arrival, she had a fever of 101.5°F, a heart rate of 110 beats per minute, a respiratory rate of 26 breaths per minute, a blood pressure of 80/70 mmHg, and an oxygen saturation of 92% on low-flow nasal cannula oxygen therapy. She was disoriented without a focal neurologic deficit, and the remainder of the examination was unremarkable. Laboratory evaluation revealed leukocytosis at 22000 /mm3, thrombocytopenia at 34000 /mm3, troponins at 6300 ng/mL, creatinine of 3.0 mg/dL, and mild transaminitis. Her hepatitis panel, toxicology screen, urine, and blood cultures were negative. A lumbar puncture was not performed because of thrombocytopenia. Her pan-computed tomography (CT) scans were also unremarkable. Echocardiography revealed severe diffuse hypokinesia with a left ventricle ejection fraction of 20%. Cardiac catheterization was deferred due to renal dysfunction. Her empiric antibiotics regimen was de-escalated to doxycycline after peripheral smear, and a PCR test confirmed Ehrlichiosis. Her symptoms improved, and she was discharged to inpatient rehabilitation. An echocardiogram in 6 months showed an improved ejection fraction of 45%. Discussion: Ehrlichiosis usually manifests with symptoms of fever, myalgias, and malaise mimicking influenza-like illness. However, severe sequelae are more traditionally encountered at extreme ages. Myocarditis is a rare and fatal occurrence. The pathogenic mechanism driving cardiac involvement is still partially understood. It may cause cardiac damage or produce immunosuppression and inflammatory cell dysfunction, leading to nonspecific myocyte damage. We believe our patient had ehrlichiosis-related myocarditis, as evidenced by peripheral smear testing, profoundly raised cardiac enzymes, new-onset congestive heart failure, and recovery of cardiac function after treatment. In endemic locations, especially during the summer, it is prudent to keep suspicion of ehrlichiosis-associated myocarditis.

Impact of COVID-19 pandemic on medication use in the older Italian population.

This study aims to analyse the impact of the pandemic on the amount of use and new medication dispensation for chronic diseases in the Italian population aged 65years and older (almost 14 million inhabitants). The "Pharmaceutical Prescriptions database", which gathers data on medications, reimbursed by the National Health Service and dispensed by community pharmacies, was employed. Data were analysed as amount of use (defined daily dose-DDD per 1000 inhabitants); variation in DDD between 2020 and 2019 was calculated for the 30 categories with major consumption in 2020. Trends in prevalence and incidence of dispensations between 2020 and 2019 were calculated for four categories: antidiabetics, antihypertensives, antidepressants and drugs for respiratory diseases. All medications showed a negative variation in DDD/1000 inhabitants between 2020 and 2019 except for anticoagulants (+ 5%). The percentage variation ranged from -27.7% for antibiotics to -6.4% for antipsychotics in 85 + year-old persons, but increased for most classes in the youngest (65-69years). On the other hand, a decrease of the dispensation incidence of antidiabetics, antihypertensives, antidepressants and drugs for pulmonary disease was high, especially in the two extreme age groups, the youngest and the oldest one. Great variation in medication use between 2020 and 2019 was observed probably reflecting the low rate of infectious diseases due to the widespread use of protective devices and self-isolation, reduced healthcare access because of the lockdowns and the fear of going to hospital, and the reduction of screening and diagnostics due to health-care system overload.

PREVALENCE, RISK FACTOR AND MANAGEMENT OF ANEMIA WITH PREGNANCY AMONG WOMEN ATTENDING ANTENATAL CARE CLINIC IN WAD MADANI TEACHING HOSPITAL

Background Anaemia in pregnancy is defined as haemoglobin concentration less than 11.0 g/dl. Globally, anaemia affects half a billion women of reproductive age. Anaemia during pregnancy is a public health problem especially in developing countries and is associated with adverse outcomes in pregnancy Objective To study the prevalence, risk factors and management of anemia with Pregnancy among women attending antenatal care clinic in Wad Madani Teaching Hospital (October 2021 to March 2022). MethodsAprospective descriptive cross sectional hospital based study was conducted in Wad Medani Teaching Hospital ANC clinic during the period from October 2021 to March 2022 and covered all pregnant women in antenatal period . Data collected, prepared, entered and analyzed using SPSS version 25.0. Results This study covered 353 participants (pregnant women). Concerning the anaemia characteristics, the study showed that the prevalence of anaemia was 162 (45.9%), and 11 (6.8%) had severe anaemia, 42 (25.9%) moderate, and 109 (67.3%) mild anaemia. All anaemic patients received a dietary intake correction advice, 79 (48.8%) iron supplementation and only 10 (6.2%) received blood transfusion. The analysis found that the prevalence of anaemia was significantly higher among pregnant women with extreme ages (less 20 years and above 40 years), lower education, rural residence, higher parity, third trimester, irregular antenatal care visits, and with positive history of anaemia with p values &lt; 0.05. Conclusion and recommendationOur study concludes that the occurrence of anemia among pregnant women is high and should not be ignored, and the associated factors must be taken into consideration, to improve the prevention and management policies of this serious problem among pregnant women in Sudan.

Assessment Clinical Association of Thyroid Function in Women of Reproductive Age Group with Abnormal Uterine Bleeding

Background: Abnormal Uterine Bleeding occurs when the frequency and quantity of menstrual bleeding in females is significantly altered. It is the most prevalent clinical presentation in gynecology, affecting more than 20% of the female population, and is characterized by variations from normal menstruation in terms of irregularity in periods, frequency, duration of blood flow, amount of blood loss, and cyclicity. Thyroid hormones had significant effects on the female reproductive system, such as delayed puberty, infertility, premature menopause, recurrent abortions, and AUB. The AUB is significantly associated with thyroid secretions, and any patient who complains of AUB or irregular menstruation must have thyrotoxicosis ruled out. Objectives: This study was conducted at the Department of Obstetrics and Gynecology, Nishtar Hospital, Multan, Pakistan, (2021-22) in order to evaluate the clinical association between thyroid function and AUB in women of different reproductive age groups. Methods: This cross-sectional study was conducted in the outpatient department of Obstetrics &amp; Gynecology, Nishtar Hospital, Multan, from 1st December 2021 to 31st May 2022. 320 patients participated in the study and were examined clinic-pathologically and were allocated into three groups based on their thyroid profile (euthyroid, hyperthyroid and hypothyroid, respectively) and further predisposition risk factors were recorded and analyzed. Results: It was discovered that extreme age groups of adolescence and pre-menopause phase significantly (p&lt;0.05) increased the incidence of AUB. The incidence of AUB was also elevated (p&lt;0.05) among patients with an abnormal BMI, women with multiple pregnancies, and married women. The menstrual bleeding pattern was also studied in females, with polymenorrhea (131/320) being the most prevalent (p&lt;0.05), followed by menorrhagia (79/320), metrorrhagia (59/320), oligomenorrhea (42/320), and amenorrhea (9/320) having a significantly lower incidence (p&lt;0.05). The incidence rate of thyroid disorders was 28.12% (90/320), with hypothyroidism affecting 77(24.06%) and hyperthyroidism affecting 13(4.06%) patients (p&lt;0.05). Practical implication: AUB is significantly associated (p&lt;0.05) with thyroid hormones, therefore for early diagnosis of the underlying etiology and treatment of the patients by preventing hysterectomy and other serious surgical interventions, all patients presenting to OPD clinics with the complaint of AUB or irregular menstruation must be ruled out for a thyroid profile in the first instance. Conclusion: It was concluded that thyroid disorders directly affected the BMI, fertility and menstrual cycle of gynecology patients and increased the incidence of AUB along with the medical and gynecological complications. Keywords: Amenorrhea; Hyperthyroidism; Hypothyroidism; Polymenorrhea; Thyrotoxicosis.