Fourth Decade Of Life Research Articles

Perfil epidemiológico de los ingresos involuntarios en el Servicio de Psiquiatría del Hospital Universitario de Gran Canaria Doctor Negrín

IntroductionInvoluntary admissions due to mental disorders occur with relative regularity in hospital admission units in our country. This work will study the socio-demographic and clinical characteristics found in relation to this type of patients, in order to have more information, both clinical and legal, with which to work and perform a better function, administration of resources and development of necessary skills in these situations. Material and methodsRetrospective descriptive observational study, in which different variables will be analyzed, previously selected, present in the population of psychiatric patients involuntarily admitted to the Doctor Negrín Hospital in a period of 2 years, 2019 and 2020, thus determining, the degree of prevalence of each of them. ResultsAmong the variables most associated with involuntary admission are, being a man, in the fourth decade of life, single, without children, or employment, with a diagnosis of major psychotic or affective disorder who has most likely abandoned treatment. DiscussionIt would be advisable to carry out a special follow-up of patients who meet the profile described above in order to minimize involuntary occurrence. It is necessary to develop educational, follow-up and adherence programs within the reach of the population of psychiatric patients in order to minimize the need for involuntary admissions in our environment.

In Reply to the Letter to Editor Regarding “Case Series and Systematic Review of Electronic Scooter Crashes and Severe Traumatic Brain Injury”

Jugular foramen schwannomas are rare. To our knowledge only a small number of series including a large number of patients have been reported. We aimed to analyse the clinical characteristics, surgical approaches, and outcome of patients undergoing treatment for jugular foramen schwannomas via a retrospective analysis of departmental records. Data for 28 patients treated for jugular foramen schwannomas in the Department of Neurosurgery at our tertiary level referral institution between January 2001 and December 2010 were analysed. Most patients were in the fourth decade of life, with the duration of symptoms ranging from 1 month to 13 years. A skull base approach was used in every surgically treated patient. Of the 19 patients for whom radiological follow-up were available, complete tumor excision was achieved in 17 patients. Follow-up ranged from 3 months to 59 months (mean, 32 months). One patient died and three had permanent morbidity in the form of facial nerve palsy. Jugular foramen schwannomas are best treated by total surgical resection. Partial resection is appropriate for tumors with adhesions to the brainstem and in medically unfit patients. Subsequent radiosurgery can be used for small residual tumors.

A Case Report on Neuro-Retinitis

Neuroretinitis is an inflammation of the neural retina and optic nerve. It was originally described by Leber in 1916 as a "stellate maculopathy," but this definition was challenged by Don Gass in 1977, citing that disc oedema precedes macular exudates. Subsequently, Gass confirmed optic disc leakage by fluorescein angiography and suggested the term "neuro retinitis." More recent retinal and optic nerve imaging has supported Gass' description. The condition was renamed Leber’s idiopathic stellate neuroretinitis. Neuroretinitis is characterized by an optic disc vasculature inflammation with fluid exudation into the peripapillary retina. The lipid-rich component of the exudate is further able to penetrate the outer plexiform layer, creating what is clinically seen as a macular star pattern. Only the aqueous phase is then able to pass through the external limiting membrane to accumulate beneath the neurosensory retina. Neuroretinitis is a type of optic neuropathy characterized by an acute unilateral visual loss in the setting of optic disc swelling accompanied by hard exudates characteristically arranged in a star shape around the fovea. It is classified as one form of optic neuritis, the other forms being the more common retrobulbar neuritis and papillitis. Funduscopically, neuroretinitis is often confused with hypertensive, renal and infiltrative retinopathies as well as with papillitis, papilledema, anterior ischemic optic neuropathy and retinal vein occlusion. It is an entity that physicians, paediatricians and neurologists are poorly exposed to since the diagnosis and management are almost exclusively performed by the ophthalmologist. Pathogenesis and aetiology of neuroretinitis are distinctly different from other funduscopic ally-resembling conditions often encountered by neurologists during their training and clinical practice; further, these have different principles of management and prognosis. The prognosis for visual recovery is reported to be excellent, although not uniform. It affects persons of all ages, more often in the third and fourth decades of life, with no gender predilection. Visual acuity at the time of initial examination ranges from 6/6 to light perception (PL). It can manifest either due to systemic infections, autoimmune diseases or as idiopathic.

A large-cohort study of 2971 cases of epulis: focusing on risk factors associated with recurrence

BackgroundTo analyze the clinicopathological features of different histological subtypes of epulis, and evaluate the risk factors associated with recurrence.Materials and methodsA retrospective study including 2971 patients was performed. The patients’ sex, age, location, size, histological subtypes, recurrence information, oral hygiene habits, periodontitis symptoms and smoking history were retrieved from the patient medical records and follow-up information.ResultsAmong the 2971 cases, focal fibrous hyperplasia (FFH) was the most common lesion (60.92%), followed by peripheral ossifying fibroma (POF) (29.32%), pyogenic granuloma (PG) (8.08%) and peripheral giant cell granuloma (PGCG) (1.68%). The peak incidence of epulis was in the third and fourth decade of life, with a mean age of 45.55 years. Female predominance was found in all types of lesions with a female to male ratio of 1.71:1. PG had the highest recurrence rate (17.18%), followed by POF (12.98%), FFH (9.55%) and PGCG (8.82%). Histological subtypes were significantly correlated with the recurrence of epulis (P = 0.013). Regular supportive periodontal therapy (P = 0.050) had a negative correlation with recurrence, whereas symptoms of periodontitis (P < 0.001) had a positive correlation with the recurrence of epulis.ConclusionsControlling the periodontal inflammation and regular supportive periodontal therapy might help reduce the recurrence of epulis.

Clinical profile and demographic distribution of pigment dispersion syndrome: An electronic medical record-driven big data analytics from an eye care network in India

Objectives: The purpose of this study was to describe the demographics and clinical profile of pigment dispersion syndrome (PDS) in patients presenting to a multi-tier ophthalmology hospital network in India. Material and Methods: This cross-sectional hospital-based study included 2,961,706 new patients presenting between August 2010 and September 2021. Patients with a clinical diagnosis of PDS in at least one eye were included as cases. The data were collected using an electronic medical record system. Results: Overall, 403 (0.014%) patients were diagnosed with PDS. Three fourth of the patients were male (75.43%) and 91.81% had bilateral affliction. The most common age group at presentation was during the fourth decade of life with 100 (24.81%) patients. In the 773 eyes, 443 (57.31%) eyes had mild or no visual impairment (&lt;20/70) and blindness (&gt;20/400) in 81 (10.48%) eyes. Krukenberg spindle was seen in 445 (57.57%) eyes and iris transillumination defects in 33 (4.27%) eyes. About a third of the eyes, 241 (31.18%) eyes had an intraocular pressure (IOP) &gt;21 mm of Hg at presentation. Three hundred and twenty-eight (42.43%) eyes were on more than one anti-glaucoma medication. YAG peripheral iridotomy was documented in 100 (12.94%) eyes. In the 46 (5.95%) eyes that required a glaucoma related surgical intervention, combined surgery was performed in 30 (3.88%) eyes and trabeculectomy in 16 (2.07%) eyes. Conclusion: PDS is more common in males presenting during the fourth decade of life and is predominantly bilateral. A third of the eyes have raised IOP and a tenth of them are affected with blindness at presentation.

Clinical Profile and Demographic Distribution of Acanthamoeba Keratitis: An Electronic Medical Record-Driven Data Analytics from an Eye Care Network in India

ABSTRACT Objective To describe the clinical profile of patients presented with Acanthamoeba keratitis (AK) to a multi-tier ophthalmology hospital network in India. Methods This cross-sectional hospital-based study included 1945339 new patients registering between September 2016 and May 2022. Patients with clinically confirmed diagnosis of AK in one or both eyes were included in the study. All the relevant data were documented using an electronic medical record (EMR) system. Results A total of 245 (0.013%) patients were diagnosed with AK and majority were male (62.86%) with unilateral (99.59%) affliction. The most common age group was during the fourth decade of life, 65 (26.53%) patients and predominantly were adults (95.51%). The prevalence of the infection was higher in patients from a lower socioeconomic status (43.27%) from rural geography (52.24%) and in agriculture-related work (28.16%). The most common inciting factor was injury with vegetative matter (8.98%), dust (7.76%) and contact lens wear (4.49%). The majority of the eyes had blindness (20/400 to 20/1200) in 116 (47.15%) eyes with a presenting visual acuity (logMAR) of 2.14 ± 1.04. Among the surgical interventions, therapeutic keratoplasty was performed in 41 (16.67%) eyes, penetrating keratoplasty in 22 (8.94%) eyes, and evisceration in 2 (0.81%) eyes. Conclusion AK more commonly affects males presenting during the fourth decade of life from lower socio-economic status and is predominantly unilateral. A fourth of the affected eyes underwent keratoplasty and the majority had significant visual impairment at presentation.

STUDY ON CLINICAL PROFILE OF ACUTE PANCREATITIS FROM A TERTIARY CARE TEACHING INSTITUTE OF WESTERN UTTAR PRADESH

Objective: The objective of this study was to study the clinical profile of subjects diagnosed and managed for acute pancreatitis at a tertiary care teaching institute of western Uttar Pradesh. Methods: All the cases diagnosed and managed for acute pancreatitis at the study place and during the study time formed the study population. All the cases were followed up till the outcome of the case. A detailed pro forma was designed to capture relevant details of study subjects. Results: Underlying cause of the clinical condition was noted as alcoholic in nature by majority (80%) of the study subjects. In ten patients (16.7%) reason for the pancreatitis could not be ascertained despite extensive evaluation. Common complications of the clinical condition were noted as pleural effusion (n=12, 20%), followed by ascites (n=9, 15%) and acute fluid collection (n=5, 8.3%). Morality was seen among two patients (3.3%). Conclusion: In this region of the western Uttar Pradesh, alcohol is the most frequent cause of acute pancreatitis. Males are more likely to get the condition, and it typically manifests in the fourth decade of life. Biochemical and radiological results supplement the primary clinical diagnosis.

Osteomalacia in Adults: A Practical Insight for Clinicians.

The term osteomalacia (OM) refers to a series of processes characterized by altered mineralization of the skeleton, which can be caused by various disorders of mineral metabolism. OM can be genetically determined or occur due to acquired disorders, among which the nutritional origin is particularly relevant, due to its wide epidemiological extension and its nature as a preventable disease. Among the hereditary diseases associated with OM, the most relevant is X-linked hypophosphatemia (XLH), which manifests in childhood, although its consequences persist into adulthood where it can acquire specific clinical characteristics, and, although rare, there are XLH cases that reach the third or fourth decade of life without a diagnosis. Some forms of OM present very subtle initial manifestations which cause both considerable diagnosis and treatment delay. On occasions, the presence of osteopenia and fragility fractures leads to an erroneous diagnosis of osteoporosis, which may imply the prescription of antiresorptive drugs (i.e., bisphosphonates or denosumab) with catastrophic consequences for OM bone. On the other hand, some radiological features of OM can be confused with those of axial spondyloarthritis and lead to erroneous diagnoses. The current prevalence of OM is not known and is very likely that its incidence is much higher than previously thought. Moreover, OM explains part of the therapeutic failures that occur in patients diagnosed with other bone diseases. Therefore, it is essential that clinicians who treat adult skeletal diseases take into account the considerations provided in this practical review when focusing on the diagnosis and treatment of their patients with bone diseases.

Unruptured Sinus of Valsalva Aneurysm Coexisting with Ventricular Septal Defect

Unruptured sinus of valsalva aneursym is an incidental, relatively rare finding on cardiac imaging and is often found in association with other cardiac defects with ventricular septal defect as the commonest. It presents a diagnostic challenge on transthoracic echocardiography in coexistence with ventricular septal defect in adulthood, mimicking other cardiac defects. Unruptured sinus of valsalva aneurysm coexisting with ventricular septal defect usually presents with symptoms of rupture—a surgical emergency in the third and fourth decade of life. We report a case of a 24-year-old single mother referred to the Cardiology Clinic of the University of Nigeria Teaching Hospital with 5 months symptoms of heart failure. Investigations showed cardiomegaly, prominent pulmonary conus, and upper lobe vessel diversion on chest x-ray. There were bigeminal premature ventricular contractions, left atrial abnormality, biventricular hypertrophy with a right strain on electrocardiogram, and bidirectional membranous ventricular septal defect with right sinus of valsalva aneurysm on transthoracic echocardiography.

Comparative study between corticosteroid injection and ultrasound therapy in treatment of lateral epicondylitis of humerus

Tennis elbow or lateral epicondylitis is a condition in which the outer part of the elbow becomes sore and tender. The forearm muscles and tendons become damaged from overuse - repeating the same strenuous motions again and again. This leads to inflammation, pain and tenderness on the outside of the elbow.Any activity, including playing tennis, which involves the repetitive use of the extensor muscles of the forearm can cause acute or chronic tendinitis of the tendinous insertion of these muscles at the lateral epicondyle of the elbow. It is a common pathology of both athletes and non-athletes affecting 1 to 3% population at large. Tennis elbow is seldom observed in subjects under the age of 25 years and black people are apparently affected less frequently than the whites. Tennis elbow has been reported to be four times more common in the fourth decades of life. Currently available conservative treatment methods include acupuncture, ultrasound therapy, steroid injection, counter force bracing, cross friction massaging. Some of these treatment modalities have no scientific basis. The most successful non operative treatment consists of avoidance of overuse counterforce bracing to relieve the insertion of extensor tendons, steroid injection into the affected area and stretching exercises.

TO EVALUATE THE FUNCTIONAL OUTCOME OF VOLAR PLATING IN DISTAL END RADIUS FRACTURES

Introduction: Most frequent bone injuries seen in orthopaedic practice is distal end radius fractures.[1] It occurs most frequently in adult patients after the fourth decade of life and comprises around 10% to 20% of all the fractures attended as emergencies.[2] The causes of the injury are fall on outstretched hand/work related accidents/car accidents/sports injuries. The importance of fixation of the distal radius (DR) fractures have evolved over the past two decades. Cast immobilization was the initial method, followed by K-wire fixation and then internal fixation with a variety of plates.[4] After using a variety of the available volar locking plates to fix intra-articular fractures, a significant improvement in wrist function was observed. In addition, surgical technique has improved, resulting in less disfigurement. The purpose of this study was to evaluate the outcome of a fracture of the distal radius (DR) treated surgically by ORIF (open reduction and internal fixation) with a volar plate, and to prospectively follow the degree of recovery of wrist range of motion and patient functional outcomes. Result: The present study was conducted on patients presenting with fracture of the distal end of radius, who were treated with open reduction and internal fixation with volar plating. The results of the study are summarized as below: ? Majority of the patients were in age group 21-30 and 31-40 years with a mean age of 35.90 ± 12.21 years. The youngest patient was 18 years old and oldest one was 58 years old. ? Majority of the patients were males. ? In majority of the patients, left side involvement was seen in comparison to right side involvement. ? Coronary artery disease, diabetes mellitus type-2 and hypertension were seen in 1 patient each in our study. Rest of the patients had no comorbidities. The reason for not having significant comorbidities was that majority of the patients in our study were young. ? All these patients underwent open reduction and internal fixation with volar plating. Majority of the patients (77.4%) achieved fracture union within 1-2 months, while 19.4% achieved it within 3 months. 1 patient (3.2%) was able to achieve the union within a month of surgical intervention. The fracture union was achieved in a short time. The wrist function was assessed using Gartland and Werley score. The mean Gartland and Werley score showed significant improvement from 1 month to 6 months in all the patients. ? At 6 months, 87.1% patients had excellent outcome and 12.9% patients had good outcome. ? Complications were seen in 4 patients. Of them 1 patient complained of complex regional pain syndrome and 3 patients complained of wrist stiffness Conclusion: We found that open reduction and internal fixation with volar plating provided excellent to good wrist outcome in patients with distal end radius fractures with minimal complications. Volar plating provides stable fixation for early mobilization, leading to early resumption to pre-trauma functional level. Although we obtained excellent to good results with open reduction and internal fixation with volar plating in distal end radius fractures, the results cannot be extrapolated to the general population as the sample size was small. Hence, we recommend that large multi- centric studies be performed before generalizing the results.

Gestational Antibioma of the Breast: A Rare Case Presentation

Breast is an important organ of the female human body. It is composed of skin, subcutaneous tissue and breast tissue. Mastitis is defined as inflammation of the breast tissue. It is painful with high fever, chills and red, tender, hot, and swollen areas of the breast. The causes are mainly inflammatory or infectious. Staphylococcus aureus is the most common bacteria involved in this condition. If left under-treated or untreated, infective mastitis can lead to breast abscess or septicemia. Management of breast abscess consists of aspiration or mini incision and drainage in combination with appropriate antibiotic therapy. An antibioma is defined as a hard edematous swelling consisting of sterile pus following treatment of an abscess with long-term antibiotics. The established treatment for antibioma is to surgically incise and drain it like an abscess under analgesics and antimicrobial therapy. Breast infection is most commonly associated with lactation with an incidence rate of 10 percent to 33 percent women. Lactational mastitis has an incidence rate of 2-3 percent of lactating women with 5-11 percent of these patients developing into an abscess. The mean age of incidence is 32 years. On the other hand, non-lactating breast abscesses has a peak incidence in the fourth decade of life. But this condition is rare during gestation with only a few reported cases in literature. We present one such rare case of gestational antibioma in second trimester.

Mycetoma: Management for the First Contact Doctor

Mycetoma is a chronic infection of the skin and underlying tissues caused by fungi or bacteria. It is endemic to tropical regions, mainly affecting men, peasants, between the third and fourth decade of life. The clinical picture is characterized by increased volume, deformity of the anatomical area, and fistulas that drain a stringy exudate with the presence of "pimples." The diagnosis and determination of the etiological agent is carried out by direct analysis and culture of the secretion.

Temporomandibular disorders and their impact on the development of the overloading changes within temporomandibular joints.

The study material included a group of 386 patients, both sexes, aged 20 to 46 years, who came for prosthetic treatment due to symptoms of TMD. Ultrasound examination of the temporomandibular joints supplemented the clinical diagnosis of TMD in all the subjects. Axis I of the DC/TMD were used. Group I included 116 women and 89 men, group II consisted of 102 women and 79 men. Pathological morphological changes in the temporomandibular joints were found in all the examined patients. The changes in soft tissue structures were significantly increased in group II, but numerous pathomorphological changes were also present in the group of patients with the muscle form of TMD. The results of the conducted studies with the use of USG temporomandibular joints revealed numerous pathomorphological changes within the temporomandibular joints. This indicates the usefulness of the USG examination in additional diagnostic tests in the group of patients with TMD.

Auricular Perichondritis: Clinical Search in a District Level Hospital

Background: Perichondritis refers to an inflammation of the perichondrium, a layer of connective tissue which surrounds cartilage. Auricular perichondritis, the commonest form, involves the pinna due to infection of a traumatic or surgical wound or the deep spread of superficial inflammation. This type of disease often leads to residual deformity, and its incidence in our experience seems to be increasing.&#x0D; Objectives: The present study was conducted to determine the predisposing factors, pathogenic organisms, interventions and residual deformities of the disease in a peripheral medical college hospital.&#x0D; Methods: This was a prospective study which was conducted in the Department of Otolaryngology – Head &amp; Neck Surgery, Pabna Medical College Hospital, Pabna from January 2017 to June 2018. Follow up was for six months ending with assessment of pinna deformity. Data was analyzed using SPSS for windows version 22.&#x0D; Results: Patients were from 15- 75 years of age (range 60 years) with male predominance and peak in the fourth decade of life. The most common predisposing factors were trauma from motor vehicle accidents (30%) followed by high ear piercing (22%). Pseudomonas aeruginosa (48%) followed by Staphylococcus aureus (20%) were the most common organisms. Patients were treated with intravenous antibiotics but 76% also required surgical intervention. 68% developed residual deformities of the pinna with 50% being total and 18% being partial.&#x0D; Conclusion: Auricular perichondritis is a frightening disease which requires early management. As Pseudomonas aeruginosa is the most common organism, antipseudomonal antibiotics should be started as early as possible. Despite medical and surgical intervention, residual deformities may ensue.&#x0D; Bangladesh J Otorhinolaryngol 2022; 28(2): 165-170

Evolving epidemiology and chemical analysis of urinary stones

Background: Renal stones are a painful urological disorder resulting from the combined influence of epidemiological, biochemical and genetic risk factors. A high recurrence risk has been reported for renal stones, and 0.6%–3.2% cases may progress to end stage renal disease. Modern lifestyle, sedentary habits and unhealthy dietary practices are primary promoters of the stone boom in this millennium. Aims and Objectives: The aim of the present study is to evaluate the percentage of the stone type according to chemical composition and their association with epidemiological factors like sex and age. A retrospective analysis of the chemical composition of the stone samples received was done. Material and Methods: Stones samples were processed by Stone Analysis Set (BIOLABO S A, France). Qualitative chemical analysis was done for calcium, phosphorus, ammonium ion, oxalate, cystine, magnesium, carbonate and uric acid. Results: Type of renal stone and its incidence with age and sex have been evaluated. The total number of patients reporting to the hospital with renal stones was 123. Of these, 69.11% were male and 30.89% were female, with a male to female ratio of 2.23:1. The maximum occurrence was in the third and fourth decade of life. On analysis, 72.35% of total stones comprised calcium oxalate and 23.57% of nonoxalate (phosphate, magnesium, carbonate, ammonium ion) stones, whereas uric acid was positive in 4.06%. Conclusion: The occurrence of renal stones according to epidemiological factors such as age and sex in our study are similar to those reported in studies from developed countries. The data on urinary stones indicate that 98% were located in the upper urinary tract. Oxalate stones represent the main form of urolithiasis, affecting males more than females. The most important cause studied for renal stone formation is metabolic disturbances, but the genetic factors associated with the occurrence and recurrence of stone and mineral homeostasis of ions in kidney of stone formers should be further evaluated.

Complex Repair of Anomalous Left Coronary Artery From the Pulmonary Artery in a 55-Year-Old Patient.

Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a congenital malformation that classically presents within the first year of life. Few patients survive into adulthood, and initial presentation after the fourth decade of life is rare. We describe a 55-year-old woman who presented after cardiac arrest. She initially refused surgery and underwent automated implantable cardioverter defibrillator placement, followed later by surgical repair involving reimplantation of the left coronary artery to the aorta and pulmonary artery reconstruction using interposition grafts. We report this late presentation of ALCAPA and successful surgical management.

Scapular Osteosarcoma Treated by Scapulectomy with or Without Scapular Allograft: A Retrospective Case Series.

Osteosarcoma of the scapula is extremely rare. Hence, there is no consensus regarding its optimal management. In this study, we report the demographics, characteristic features, and outcomes of scapulectomy with or without scapular allograft reconstruction in a series of patients with primary scapular osteosarcoma. Twelve patients with primary scapular osteosarcoma who were treated by scapulectomy with or without scapular allograft reconstruction (five and seven patients, respectively) were included. The allograft was fixed in place using a dacron tape without a plate or screw. The function of the shoulder was evaluated using the Musculoskeletal Tumor Society (MSTS) score for the upper extremity and Toronto Extremity Salvage Score (TESS). The study population included seven (58.3%) males and five (41.7%) females with a mean age of 30 ± 8.2years. The histologic type of the tumor was osteoblastic in the majority of patients (n = 8, 66.7%). At an average follow-up of 6.5 ± 2.3years, only one local recurrence (8.3%) occurred in our patients that coincided with lung metastasis. The mean MSTS score was 78.7 ± 3.8% and 66.2 ± 4% in patients with and without scapular allograft, respectively (P = 0.006).‏ The mean TESS was 78.6 ± 5.6 and 68.4 ± 2.4 in patients with and without scapular allograft, respectively (P = 0.005).‏ The overall 5-year survival of the patients was 85.7%. ‏ Osteosarcoma of scapula more frequently occurs in the fourth decade of life, mainly presented with a sclerotic radiologic appearance. Patients with scapular allograft impaction after scapulectomy have better functional outcomes compared to those without boney reconstruction.

Grip strength values and cut-off points based on over 200,000 adults of the German National Cohort - a comparison to the EWGSOP2 cut-off points.

The European Working Group on Sarcopenia in Older People (EWGSOP) updated in 2018 the cut-off points for low grip strength to assess sarcopenia based on pooled data from 12 British studies. Comparison of the EWGSOP2 cut-off points for low grip strength to those derived from a large German sample. We assessed the grip strength distribution across age and derived low grip strength cut-off points for men and women (peak mean -2.5 × SD) based on 200,389 German National Cohort (NAKO) participants aged 19-75years. In 1,012 Cooperative Health Research in the Region of Augsburg (KORA)-Age participants aged 65-93years, we calculated the age-standardised prevalence of low grip strength and time-dependent sensitivity and specificity for all-cause mortality. Grip strength increased in the third and fourth decade of life and declined afterwards. Calculated cut-off points for low grip strength were 29kg for men and 18kg for women. In KORA-Age, the age-standardised prevalence of low grip strength was 1.5× higher for NAKO-derived (17.7%) compared to EWGSOP2 (11.7%) cut-off points. NAKO-derived cut-off points yielded a higher sensitivity and lower specificity for all-cause mortality. Cut-off points for low grip strength from German population-based data were 2kg higher than the EWGSOP2 cut-off points. Higher cut-off points increase the sensitivity, thereby suggesting an intervention for more patients at risk, while other individuals might receive additional diagnostics/treatment without the urgent need. Research on the effectiveness of intervention in patients with low grip strength defined by different cut-off points is needed.

Aneurisma de apêndice atrial esquerdo: um achado radiográfico acidental - relato de caso

Left atrial appendage aneurysm is an extremely rare condition. It usually oc-curs together with changes in the mitral valve and manifests itself with cardiac arrhythmias or thromboembolisms, most commonly between the second and fourth decade of life. It can be asymptomatic, and the diagnosis is made by ob-serving radiographic changes, such as the prominence of the left cardiac bor-der. Due to the complications that can occur, surgery for resection is recommended. The present study reports a case of an infant who was seen in con-sultation for a cough complaint two months ago. An investigation was initiated which diagnosed an aneurysm of the left atrial appendage. Therefore, it is shown that although it is more common between the second and fourth decades of life, the left atrial appendage aneurysm may also be present in children.