Respective Age Groups Research Articles

The risk of recurrence in women with venous thromboembolism while using estrogens: a prospective cohort study

The optimal duration of anticoagulation for women who had venous thromboembolism (VTE) associated with estrogen use is unknown. To test the hypothesis that women who had a first VTE while using estrogens have a low risk of recurrence. A Prospective cohort study of 630 women (333 estrogen users, 297 non-users) with a first VTE, who were followed for an average of 69 months after anticoagulation withdrawal. Women with a previous or secondary VTE, coagulation inhibitor deficiency, lupus anticoagulant, cancer, pregnancy, requirement of long-term antithrombotic therapy or homozygosity or double heterozygosity for factor V Leiden and/or the G20210A prothrombin mutation were excluded. The endpoint was objectively documented symptomatic recurrent VTE. VTE recurred in 22 (7%) estrogen users and in 49 (17%) non-users. After 1, 2 and 5 years, the cumulative probability of recurrence was 1% (95% confidence interval [CI], 0-2), 1% (95% CI, 0-2) and 6% (95% CI, 3-9) among estrogen users and 5% (95% CI, 2-7), 9% (95% CI, 6-13) and 17% (95% CI, 12-22) among non-users. Compared with non-users, estrogen users had an adjusted relative risk (RR) of recurrent VTE of 0.4 (95% CI, 0.2-0.8). Compared with non-users in the respective age groups, the RR of recurrence was 0.4 (95% CI, 0.2-0.8) among estrogen-containing-contraceptive users and 0.7 (95% CI, 0.3-1.5) among women using estrogen-containing menopausal hormone therapy. Women who had their first VTE while using estrogens have a low risk of recurrent VTE. These women might not benefit from extended anticoagulant therapy.

Understanding the Profile of Tuberculosis and Human Immunodeficiency Virus Coinfection: Insights from Expanded HIV Surveillance at a Tuberculosis Facility in Durban, South Africa.

Background. Expanded HIV surveillance in TB patients forms part of the World Health Organization framework for strategic collaborative activity. Surveillance helps understand the epidemiology of the local dual epidemic and enables design of a tailored response to these challenges. Methods. We conducted an observational, cross-sectional study of anonymous unlinked HIV testing for 741 consecutive TB suspects attending an urban TB facility during a seven-week period in 2008. Results. A total of 512 patients were found to have TB. The mean age was 35.7 years, and 63% were male. The prevalence of HIV was 72.2% (95% CI: 68.2–75.9) in all TB cases, 69.8% (95% CI: 65.3–74.2) in pulmonary tuberculosis (PTB), 81.6% (95% CI: 72.9–90.3) in extrapulmonary disease, and 66.8% (95% CI: 60.7–72.9) in those without TB disease. HIV prevalence in TB patients was higher in females than males and in younger age groups (18–29 years). The sex ratio of PTB patients correlated with the sex ratio of the prevalence of HIV in the respective age groups (P < 0.05). Conclusion. The use of a rapid HIV test performed on sputum anonymously provides an opportunity for HIV surveillance in this high-burdened setting, which has the potential to lend valuable insight into the coepidemics.

The Risk Of Recurrence In Women With Venous Thromboembolism While Using Estrogens: A Prospective Observational Cohort Study

▪ ObjectiveBecause of the high recurrence risk, guidelines recommend indefinite anticoagulation in women with a first unprovoked proximal deep-vein thrombosis (DVT) and/or pulmonary embolism (PE). The optimal duration of anticoagulation in women who had venous thromboembolism (VTE) while using estrogens is unknown. We therefore compared the risk of recurrent VTE between women who used estrogens at the time of first VTE and women who did not. MethodsThis analysis was performed within the frame of the Austrian Study on Recurrent Venous Thromboembolism (AUREC), an on-going prospective observational study. Patients with a first objectively confirmed DVT of the leg and/or PE who had received anticoagulants for 3 to 18 months were included. Exclusion criteria were: age < 18 years; VTE associated with surgery, trauma, cancer or pregnancy; long-term anticoagulation; natural inhibitor deficiency; lupus anticoagulant; homozygosity or double heterozygosity for factor V Leiden and/or the prothrombin mutation. Women were advised to refrain from further estrogen use and were excluded in case of non-adherence. The study end point was recurrent symptomatic DVT and/or PE verified by imaging. The local ethics committee approved the study and all patients gave written informed consent. ResultsWe followed 630 women (mean age 46 +/- 17 years) who had been treated with oral anticoagulants for 7 (+/- 3) months for an average of 69 (+/- 52) months. Recurrent VTE was recorded in 71 patients (11%). Recurrent VTE occurred in 22 (7%) of 333 estrogen users and in 49 (17%) of 297 non-users. After 1, 2 and 5 years, the cumulative probability of recurrence was 1% (95% CI 0-2), 1% (95% CI 0-2) and 6% (95% CI 3-9) among estrogen users and 5% (95% CI 2-7), 9% (95% CI 6-13) and 17% (95% CI 12-22) among non-users, respectively (p < 0.001, Figure). Compared to non-users, estrogen users had a relative risk (RR) of recurrent VTE of 0.4 (95% CI 0.2-0.8) after adjustment for age, site of first VTE and factor V Leiden carrier status. Compared to non-users in the respective age groups, the RR of recurrent VTE was 0.4 (95% CI 0.2-0.8) among estrogen containing contraceptive users and was 0.7 (95% CI 0.3-1.5) among women using estrogen containing hormone replacement therapy. [Display omitted] ConclusionWomen who had their first VTE while using estrogens have a low risk of recurrent VTE. The recurrence risk is particularly low in estrogen containing contraceptive users. We therefore propose that these women should receive anticoagulant therapy for no longer than 3 months. Disclosures:No relevant conflicts of interest to declare.

The development of the Tuebingen Cushing's disease quality of life inventory (Tuebingen CD‐25). Part II: normative data from 1784 healthy people

In Volume 76 Issue 6 of Clinical Endocrinology, the amount of impaired patients reported was incorrect in comparison with the general population. The affected portions of the article should read as follows: The Tuebingen CD-25 scores (means, standard deviations) as well as the 95·0% and 84·0% thresholds for the respective subdomains from the healthy controls are listed in Table 2 for female and Table 3 for male patients and the respective age groups. Figure 1 demonstrates the percentages of patients who are slightly or severely impaired in their HRQoL compared with the healthy controls. A slight impairment was found in 14·3% of the patients concerning depressive symptoms, 20·6% sexual activity, 15·9% environment, 25·4% eating behaviour, 23·8% bodily restrictions, 14·3% cognitive functions and 15·9% regarding the overall score of the Tuebingen CD-25. Forty-six per cent of the patients reported severe impairment in the Depression scale, 41·3% in the Sexual Activity scale, 49·2% concerning their Environment, 39·7% in the Eating Behavior scale, 52·4% regarding Bodily Restrictions and 65·1% in the Cognition scale. Sixty-six per cent of the Cushing's disease patients presented with severe impairment in the Total Score of the Tuebingen CD-25. Overall, only 17·5% of the CD patients had HRQoL scores who were similar to those of the healthy population. Impairment was found in the same frequency in all scales of the Tuebingen CD-25 [χ2 (5) = 8·96, P = 0·111], pointing to the fact that all HRQoL domains are impaired to a similar degree. After allocation of each CD patient in the categories not impaired and impaired, we aimed to examine gender differences. We found highly significant gender differences concerning depressive symptoms [χ2 (1) = 14·6, P < 0·001], environment [χ2 (1) = 8·4, P < 0·01], eating behaviour (χ2 [1] = 4·8, P < 0·05), bodily restrictions [χ2 (1) = 6·9, P < 0·01] and cognition [χ2 (1) = 5·0, P < 0·05], female patients reporting impairment by far more frequently than male patients (Fig. 1). No significant gender differences in the degree of impairment could be observed in the HRQoL domains Sexual Activity (P > 0·05). Tables 2 and 3 as well as Fig. 1 were also affected by incorrect data, and the correct versions are as follows: The authors apologise for the errors.

Validation of an Oral Health–Related Quality of Life Measure for Cambodian Children

This study aimed to determine the impact of dental caries in terms of Oral Health-Related Quality of Life (OHRQoL) for Cambodian children. The Child Perceptions Questionnaires (CPQ) were cross-culturally adapted and validated for the Cambodian population using a sample of 430 Cambodian children. The participants had a high caries burden, with a mean number of decayed-missing-and-filled deciduous tooth surfaces (dmfs) of 8.8 (SD = 11.1) and a mean DMFS of 3.7 (SD = 5.5) for the permanent dentition. Two in 5 children had at least one pulpally involved tooth. There was a significant difference in mean CPQ8-10 and CPQ11-14 scores by caries experience and by global item response for the respective age-groups, with those in the more severe caries categories scoring higher. Similar gradients were apparent with the CPQ11-14 in the 8- to 10-year age-group. The differences in OHRQoL scores by caries experience demonstrate the construct validity of the CPQ11-14 for the 8- to 14-year age-group.

Seroepidemiology of diphtheria and tetanus among children and young adults in Tajikistan: Nationwide population-based survey, 2010

BackgroundTajikistan had a major diphtheria outbreak (∼10,000 cases) in the 1990s, which was controlled after nationwide immunization campaigns with diphtheria-tetanus toxoid in 1995 and 1996. Since 2000, only 52 diphtheria cases have been reported. However, in coverage surveys conducted in 2000 and 2005, diphtheria-tetanus-pertussis vaccine coverage was lower than administratively reported estimates raising concerns about potential immunity gaps. To further assess population immunity to diphtheria in Tajikistan, diphtheria antibody testing was included in a large-scale nationwide serosurvey for vaccine-preventable diseases conducted in connection with a poliomyelitis outbreak in 2010. In addition, the serosurvey provided an opportunity to assess population immunity to tetanus. MethodsResidents of all regions of Tajikistan aged 1–24 years were included in the serosurvey implemented during September–October 2010. Participants were selected through stratified cluster sampling. Specimens were tested for diphtheria antibodies using a Vero cell neutralization assay and for tetanus antibodies using an anti-tetanus IgG ELISA. Antibody concentrations ≥0.1IU/mL were considered seropositive. ResultsOverall, 51.4% (95% CI, 47.1%–55.6%) of participants were seropositive for diphtheria and 78.9% (95% CI, 74.7%–82.5%) were seropositive for tetanus. The lowest percentages of seropositivity for both diseases were observed among persons aged 10–19 years: diphtheria seropositivity was 37.1% (95% CI, 31.0%–43.7%) among 10–14 year-olds, and 35.3% (95% CI, 29.9%–41.1%) among 15–19 year-olds; tetanus seropositivity in respective age groups was 65.3% (95% CI, 58.4%–71.6%) and 70.1% (95% CI, 64.5%–75.2%). ConclusionsPopulation immunity for diphtheria in Tajikistan is low, particularly among 10–19 year-olds. Population immunity to tetanus is generally higher than for diphtheria, but is suboptimal among 10–19 year-olds. These findings highlight the need to improve routine immunization service delivery, and support a one-time supplementary immunization campaign with diphtheria-tetanus toxoid among birth cohorts aged 1–19 years in 2010 (3–21 years in 2012) to close immunity gaps and prevent diphtheria outbreaks.

Time trends in dietary fat intake in a sample of German children and adolescents between 2000 and 2010: not quantity, but quality is the issue

Dietary fat intake in childhood may influence the risk for developing chronic diseases. The objective of the present study was to examine secular trends in the parameters of fat intake between 2000 and 2010 in a sample of German children and adolescents (n 808) participating in the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study. Dietary data from 4380 3 d weighed dietary records were analysed using repeated-measures regression to determine time trends in fat quantity, i.e. the intake of total fat, and in fat quality, i.e. the ratios of SFA, MUFA and PUFA. In young children (2-3 years) and in adolescents (13-18 years), total fat intake remained stable over time, but decreased by 0·08 % of total energy (%E) per year in 4-12-year-old children. In 2010, median fat intake was at the upper end of the recommendations. SFA intake decreased slightly in 2-3- and 4-12-year-old children by 0·09 and 0·05 %E per year, respectively. MUFA and PUFA intakes remained stable in all the age groups except in adolescents. Here, PUFA intake decreased initially, but increased between 2005 and 2010. In 2010, only between 3 and 18 % of the respective age groups had an intake of SFA or PUFA within the recommendations. In conclusion, fat quantity and quality did not change substantially between 2000 and 2010. Fat quality, in particular, needs to be improved, since a large percentage of our sample did not meet the recommended intakes for SFA and PUFA.

Osteochondritis Dissecans of the Knee: Outcomes after Arthroscopic Abrasion Chondroplasty and Loose Body Removal (SS-53)

Osteochondritis Dissecans of the Knee: Outcomes after Arthroscopic Abrasion Chondroplasty and Loose Body Removal (SS-53)

Blood pressure in Afghan male immigrants to Denmark

Immigration from a Third-World society to a Western society can be associated with higher blood pressure and salt sensitivity. We therefore tested whether immigrants from Afghanistan to Denmark compared with non-immigrant Danes exhibit a (i) higher 24-h ambulatory blood pressure (24-h ABP) and (ii) blunted renin response to a change in salt intake. Twenty-four-hour ABP was measured in 40 men of Afghan (Afghans) and 40 men of Danish (Danes) origin. Each group was divided into young (20-30years, n=20) and middle aged (40-60years, n=20). A 3-day low (70mmol per 24-h) and a 3-day high (250mmol per 24-h) salt intake were in addition instituted in subgroups of the young groups (n=18). Young and middle-aged Afghans exhibited a lower 24-h mean arterial pressure (24-h MAP) than the same respective age groups of Danes (83±1 versus 90±1mm Hg, P<0·05, and 89±2 versus 100±1mm Hg, P<0·05). 24-h ABP did not change in any of the young groups during increased salt intake, whereas the Danes exhibited a greater decrease in plasma renin activity (PRA) (P<0·05). Plasma noradrenaline (PNA ) was significantly higher among the young Afghans. Afghan immigrants to Denmark exhibit a lower 24-h ABP than Danes. In young Afghans, PRA is less sensitive to changes in salt intake, while PNA is higher and may reflect their lower systolic blood pressure and/or arterial pulse pressure. Whether these hormonal differences can explain the lower 24-h ABP in Afghans should be further explored.

Abstract 149: Utilization and Costs of Hospitalization among Adolescents and Young Adults with Congenital Heart Disease in California

Background: Congenital heart disease (CHD) often requires intensive surgeries and care, especially in the early years of a CHD patient. However, it is not well understood how their health care utilization and costs vary as CHD patients transition into young adulthood. Objective: We aim to identify the utilization patterns of hospitalization by age among CHD patients 10-29 years old and to measure the associated costs as compared with the general population in California. Methods: We utilized the California State Inpatient Database (SID) and the Healthcare Cost and Utilization Project (HCUP) Cost-to-Charge Ratio Files 2005-2009. By merging the two datasets, we obtained data on about 97% of all hospital discharge records in California including principal and secondary diagnoses, principal and secondary procedures, admission and discharge status, basic patient demographics, total charges, imputed total costs, and length of stay (LOS). Hospital discharges of CHD patients were identified by one or more principal or secondary ICD-9 diagnosis codes of 745.xx, 746.xx, or 747.xx. Utilization and cost patterns were compared to the general population by 5-year age groups (10-14, 15-19, 20-24, and 25-29). We then conducted a multivariate linear regression with the CHD population to understand how age and other factors influence costs of hospitalization per stay. Results: The average hospitalization costs per stay among CHD patients remain 2-3 times as high as that of the general population across all age groups ($21-31k vs. $7k-12k). However, the total hospitalization costs of the CHD population monotonically decrease as patients with CHD age into adulthood: in 2005-2009, the total costs were $75m in the 10-14 group, $74m in the 15-19 group, $50m in the 20-24 group and $48m in the 25-29 group, which represented 3.8%, 1.7%, 0.8%, 0.7% of the total costs in the general population of the respective age group. The decline in total costs by age among the CHD population manifested in both decreasing numbers of hospitalizations and lower costs per stay. Other observed trends include increasing fraction of admissions from the emergency department (ED), decreasing fraction of surgery-related hospitalizations, and shorter LOS as CHD population age into adulthood. Regression results within the CHD population 10-29 years old (n=9680) suggest that costs per stay were positively associated with LOS (+$2674, p&lt;.001) and were negatively associated with being 25-29 years old (-$3240, p&lt;.001), being female (-$1935, p&lt;.001), having no surgeries (-$16758, p&lt;.001) or other procedures performed ($21396, p&lt;.001), and being admitted from the ED (-$3638, p&lt;.001). Conclusion: The CHD population incurs lower hospitalization costs as they age into young adulthood.

Epstein-barr Virus Antibodies Response for Zhuang NPC Patients of Different Ages

Objective To evaluate the relationship between ages and the Rta/IgG,VCA/IgA,VCA/IgG and Zta/IgG values and positive rate of the Epstein-Barr virus(EBV) antibodies in Zhuang NPC patients at different ages in west Guangxi.Methods Serum samples obtained from140 patients with nasopharyngeal carcinoma(NPC) and from 280 healthy people were examined for the EBV antibodies including Rta/IgG,VCA/IgA,VCA/IgG and Zta/IgG by the enzyme-linked immnunosorbent assay(ELISA).The positive rates and antibody levels of the NPC patients at different ages were analyzed statistically.Results Significant difference in VCA/IgA values and positive rates was found in the NPC patients at different ages(P0.05).There was significant difference in the positive rates of Rta/IgG and VCA/IgA between the patients and healthy people above 50 years old(P0.05).But no significant difference in the positive rates of Zta/IgG was found between them(P0.05).Conclusion The serum levels and positive rates of EB virus antibodies(Rta/IgG,VCA/IgA and Zta/IgG) fluctuate with different ages.Different positive critical values of EBV antibodies for respective age groups should be set to facilitate NPC diagnosis and high-risk screening.

T2 Values of Posterior Horns of Knee Menisci in Asymptomatic Subjects

PurposeThe magnetic resonance (MR) T2 value of cartilage is a reliable indicator of tissue properties and therefore may be used as an objective diagnostic tool in early meniscal degeneration. The purpose of this study was to investigate age, gender, location, and zonal differences in MR T2 value of the posterior horns of knee menisci in asymptomatic subjects.MethodsSixty asymptomatic volunteers (30 men and 30 women) were enrolled and divided into three different age groups: 20–34, 35–49 and 50–70 years. The inclusion criteria were BMI<30 kg/cm2 , normalized Western Ontario and McMaster Universities (WOMAC) pain score of zero, and no evidence of meniscal and ligamentous abnormalities on routine knee MR imaging. The T2 values were measured on images acquired with a T2-weighted fat-suppressed turbo spin-echo sequence at 3T.ResultsThe mean T2 values in both medial and lateral menisci for the 20–34, 35–49, and 50–70 age groups were 9.94 msec±0.94, 10.73 msec±1.55, and 12.36 msec±2.27, respectively, for women and 9.17 msec±0.74, 9.64 msec±0.67, and 10.95 msec±1.33, respectively, for men. The T2 values were significantly higher in the 50–70 age group than the 20–34 age group (P<0.001) and in women than in men (P = 0.001, 0.004, and 0.049 for each respective age group). T2 values were significantly higher in medial menisci than in lateral menisci only in women age 50–70 (3.33 msec, P = 0.006) and in the white zone and red/white zone of the 50–70 and 35–49 age groups than that of the 20–34 age group (2.47, 1.02; 2.77, 1.16 msec, respectively, all P<0.01).ConclusionThe MR T2 values of the posterior meniscal horns increase with increasing age in women and are higher in women than in men. The age-related rise of T2 values appears to be more severe in medial menisci than in lateral menisci. Differences exist in the white zone and red/white zone.

THE EFFECT OF ABORTION LEGALIZATION ON CHILDBEARING BY UNWED TEENAGERS IN FUTURE COHORTS

This article examines the long‐term impact of legalized abortion on childbearing by unwed teenagers in the United States. I find that the 1970 legalization of abortion in the repeal states led to about a 6% reduction in unwed childbearing rates for white women aged 15–20 who were born in these states immediately after abortion became legal. I find a larger long‐term impact for African‐American women of the same ages: a 7.5%–13% reduction in unwed childbearing. My estimates are smaller and not as precise for the effect of Roe v. Wade. This outcome is not surprising given that I am able to estimate only a potential lower bound of the effect on unwed childbearing rates. On the other hand, when I estimated a Difference‐in‐Difference regression for the non‐repeal states assuming that there was no national trend that affected the childbearing behavior of the treatment age groups and their respective control age groups separately, I found that the true effect of Roe v. Wade on childbearing by unwed teenagers was about an 11% and 3% reductions for white and African‐American teenagers, respectively. (JEL J13, I18)

Abstract TP187: Risk of Subarachnoid Hemorrhage among Patients Infected with Human Immunodeficiency Virus

Background: In the current literature, subarachnoid hemorrhage data among patients with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) is limited to case reports. Objective: To compare the incidence and relative risk of subarachnoid hemorrhage (SAH) in patients with AIDS to those who are HIV negative, on a national level. Method: The Nationwide Inpatient Sample (NIS 2002-2010) was used to identify and all patients presenting with the primary diagnosis of SAH in the United States between 2002 and 2009. Among this cohort, we identified the patients with HIV/AIDS and those who were HIV negative and further stratified them based on gender and age: 13-24 years, 25-34 years, 35-44 years, 45-54 years and 55+ years. We obtained the number of people living with AIDS in the United States population from the Centers for Disease Control and Prevention (CDC) for 2002 according to the same age groups. Using the 2000 United States census information we identified the number of people in the general population and subtracted the AIDS cases within the respective age group. The relative risk of developing a SAH in patients with AIDS versus the HIV negative patients was also obtained between 2002 and 2009. Result: The age adjusted annual incidence of SAH was 62.3 per 100,000 and 20.2 per 100,000 among HIV/AIDS positive persons and HIV negative persons. The age adjusted annual relative risk for SAH among the HIV/AIDS positive persons was 3 (95% confidence interval 2.4 to 3.8). HIV positive women had higher incidence of SAH when compared to HIV positive males except for the 13-24 year old group. The SAH rate ratio decreased with each increasing decade when compared with HIV negative patients: 13-24 years (25), 25-34 years (8.6), 35-44 years (3), 45-54 years (2.4) and 55+ years (1.6). The 7 year incidence rate of SAH in HIV positive men between 13-24 years was 29 times more than in HIV negative men; similarly, the incidence of SAH among HIV positive women was 18 times that of HIV negative women. Conclusion: HIV/AIDS positive persons, particular young individuals, appear to have an increased risk of developing SAH.

Inappropriateness of prostate cancer screening by PSA in young Algerian farmers

Introduction: It is not yet established, in Algeria, a consensus on the use of prostate specific antigen (PSA) for the screening of prostate cancer (PCA) while some doctors speculate and recommend a serum-PSA assay to the young men. The objective is to assess the prevalence of PSA by age in young farmers. Methods: This study was undergone on 403 farmers, exposed to the risk of pesticides, aged between 30 - 70 years and living in rural areas of Saida (Western Algeria), during the period 2006 to 2012. The values of the PSA were collected during PCA screening and compared by statistical tests that revealed significant difference. Results: It was found that 15.6% of patients were under the age of 40 years. The total PSA (TPSA) increases with age and varies from 1 to 2 ng/ml for the respective age groups of 30 - 39 and 60 - 69 years. Approximately, 16.6% of men (or 1/6), who underwent PSA assay were under the age of 40 years. Conclusion: According to the recommendations of Algerian associations of cancer, men younger than 50 years may not be candidates for screening by PSA.

The Effects of 4-Weeks of Plyometric Training on Reactive Strength Index and Leg Stiffness in Male Youths

Although previous pediatric research has reported performance improvements in muscular power, agility, speed, and rate-of-force development after exposure to plyometric training, the effects on reactive strength index (RSI) and leg stiffness remain unclear. One hundred and twenty-nine boys from 3 different age groups (9, 12, and 15 years) participated and were divided into either an experimental (EXP) or control (CON) group within their respective age groups. The EXP groups followed a twice-weekly, 4-week plyometric training program, whereas the CON groups participated in their normal physical education lessons. Preintervention and postintervention measures were collected for RSI (during maximal hopping) and leg stiffness (during submaximal hopping). Both 12- and 15-year-old EXP groups made significant improvements in both absolute and relative leg stiffness (p < 0.05). The 9-year-old EXP group and CON groups for all ages did not make significant changes in leg stiffness. The 12-year-old EXP cohort also made significant improvements in RSI (p < 0.05). Both 15- and 9-year-old EXP cohorts, and CON groups for all ages, failed to show any significant improvements in RSI. The study concludes that improvements in RSI and leg stiffness after a 4-week plyometric training program are age dependent during childhood.

Aptidão cardiorrespiratória de uma amostra regional brasileira distribuída em diferentes tabelas

Most classification tables of cardiorespiratory fitness (CRF) used in clinical practice are international and have not been validated for the Brazilian population. That can result in important discrepancies when that classification is extrapolated to our population. To assess the use of major CRF tables available in a Brazilian population sample of the Central High Plan of the state of Rio Grande do Sul (RS). This study assessed the retrospective data of 2,930 individuals, living in 36 cities of the Central High Plan of the state of RS, and considered the following: presence of risk factors for cardiovascular disease and estimated maximum oxygen consumption (VO2peak) values obtained through exercise test with Bruce protocol. To classify CRF, the individuals were distributed according to sex, inserted in their respective age groups in the Cooper, American Heart Association (AHA) and Universidade Federal de São Paulo (Unifesp) tables, and classified according to their VO2peak. Women had lower VO2peak values as compared with those of men (23.5 ± 8.5 vs. 31.7 ± 10.8 mL.kg-1.min-1, p < 0.001). Considering both sexes, VO2peak showed an inverse and moderate correlation with age (R = -0.48, p < 0.001). An important discrepancy in the CRF classification levels was observed between the tables, ranging from 49% (Cooper x AHA) to 75% (Unifesp x AHA). Our findings indicate important discrepancy in the CRF classification levels of the tables assessed. Future studies could assess whether international tables could be used for the Brazilian population and populations of different regions of Brazil.

Prevalence of fluorosis and identification of fluoride endemic areas in Manur block of Tirunelveli District, Tamil Nadu, South India

Prevalence of fluorosis is mainly due to the consumption of more fluoride through drinking water. It is necessary to identify the fluoride endemic areas to adopt remedial measures for the people under the risk of fluorosis. The objectives of this study were to identify the exact location of fluoride endemic areas in Manur block of Tirunelveli District and to estimate fluoride exposure level through drinking water for different age groups. Identification of fluoride endemic areas was performed through Isopleth and Google earth mapping techniques. Fluoride level in drinking water samples was estimated by fluoride ion selective electrode method. A systematic clinical survey conducted in 19 villages of Manur block revealed the rate of prevalence of fluorosis. From this study, it has been found that Alavanthankulam, Melapilliyarkulam, Keezhapilliyarkulam, Nadupilliyarkulam, Keezhathenkalam and Papankulam are the fluoride endemic villages, where the fluoride level in drinking water is above 1 mg/l. Consumption of maximum fluoride exposure levels of 0.30 mg/kg/day for infants, 0.27 mg/kg/day for children and 0.15 mg/kg/day for adults were found among the respective age group people residing in high fluoride endemic area. As compared with adequate intake level of fluoride of 0.01 mg/kg/day for infants and 0.05 mg/kg/day for other age groups, the health risk due to excess fluoride intake to the people of Alavanthankulam and nearby areas has become evident. Hence the people of these areas are advised to consume drinking water with optimal fluoride to avoid further fluorosis risks.

Glandular resection and central embedding in hypospadias repair—a novel modification of the Barcat technique

PurposeUrethrocutaneous fistula and urethral or meatal stricture, to date, remain the commonest complications of hypospadias repair, with increased tissue tension being a major cause of failure. We developed a novel technique comprising glandular resection and central embedding of the neourethra to specifically address this critical issue. We report the results of the first 112 procedures, of which 7 cases were a secondary hypospadias repair. Materials and MethodsAll patients who underwent hypospadias repair using the glandular resection and central embedding technique over a period of 10 years were included into this retrospective single-surgeon case series. An independent third-party observer carried out follow-up examinations including urometric evaluation. ResultsThe median follow-up was 37 months (range, 7-147 months). In the group of primary hypospadias repair, urethrocutaneous fistulas were observed in 4%, all requiring surgical revision, and meatal or urethral stricture were observed in 4% of the patients, treated either surgically or by dilatation. In 98% of the patients, the neomeatus was located at the tip of the glans. A cosmetically impeccable slitlike appearance of the meatus was achieved in 84%, and a cosmetically acceptable oval shape was achieved in 10% of the patients. Both maximum and average urinary flow rates were within the standard ranges for the respective age groups in 93.7% and 96%, respectively. There was no significant residual urine in 92% of the patients. In the group of secondary hypospadias repairs, both cosmetic and functional results were similar, and no complications were noted. ConclusionsGlandular resection and central embedding is a promising expansion of the repertoire of Barcat modifications. It allows safe embedding of the neourethra and glandular closure without detrimental tension. The cosmetic and functional results are encouraging.

Age and gender differences of endothelial function in 4739 healthy adults: the HUNT3 Fitness Study

Endothelial dysfunction is an important marker for prognosis in patients with coronary heart disease. However, there are no reference values for endothelial function in a healthy population. Our aim was to determine the distribution of flow-mediated dilation (FMD) values by gender and age in healthy adults. FMD was measured by ultrasound during reactive hyperaemia in the brachial artery of 4739 adults aged 20-89 years, who were free from self-reported cardiovascular or pulmonary disease. Differences in FMD across age and gender were analysed by multiple linear regression. Total mean ± SD FMD was 4.8 ± 4.2%, with corresponding estimates of 4.3 ± 3.9% for men and 5.3 ± 4.5% for women (p < 0.001). In total, 17% had FMD ≤0%, indicating endothelial dysfunction. FMD decreased with increasing age in both genders up to 70 years for men and 80 for women (p < 0.001). In women, age-related decline in FMD was steepest after age 45; in men, a steady decline after age 30. In men 80 years and older, FMD was higher than in men aged 50-79 years. The distribution of FMD in this study is representative of the respective age and gender groups of a healthy population and may be a useful reference for future studies. The high proportion of endothelial dysfunction came as a surprise. Its age and gender distribution suggest that FMD ≤0% precedes cardiovascular disease and that it may be a powerful non-invasive biomarker for identifying high-risk individuals.