Background

Musculoskeletal disorders are common problems that affect the elderly. They severely restrict mobility and dexterity, resulting in early retirement from work, lower levels of well-being, and reduced ability to participate in society. With the increase in life expectancy, the older populations are dreaming of active, painless, and independent lives in the face of functional limitations that are the result of various comorbidities with age progression.

Main text

The aim of the study is to highlight aging changes in the musculoskeletal system, risk factors that may have a negative impact on musculoskeletal, as well as strategies to optimize musculoskeletal health in the elderly. A narrative review was conducted through a series of literature searches in the database MEDLINE/PubMed focusing on musculoskeletal health. The search terms used were “muscle building,” “bone building,” “osteoporosis,” “osteopenia,” “sarcopenia,” “osteosarcopenia,” “fractures,” “falls,” “functional ability,” “nutrition,” “diet,” “obesity,” “comorbidity,” and “medication.” Data extraction was carried out by the investigators using a standardized data collection form with subsequent discussion among the authors. Peer-reviewed observational controlled and non-controlled studies (case–control and cohort studies) were selected. The data collected in the selected articles were all related to musculoskeletal health.

Conclusion

Many of the changes in the musculoskeletal system result more from disuse than from simple aging. Less than 10% of the Egyptian population participate in regular exercise, and the most sedentary group is older than 50 years of age. Long-term regular exercises may reduce the loss of bone and muscle mass and prevent age-associated increases in body fat.

Summary

Despite the wide availability of a wide variety of approved osteoporosis medications and DXA scan centers in Egypt, only a minority of patients at high risk of sustaining a fragility fracture receive treatment, even after their first fracture. Such big “treatment gap” leaves the most high-risk individuals unprotected against fragility fractures. This study provides a benchmark to monitor national trends in osteoporosis management and service uptake.

Purpose

To assess the treatment gap among men and postmenopausal women presenting with a fragility fracture, and to analyze the characteristics and fracture risks of the patients presenting with an index fragility fracture.

Methods

This was a multi-center, cross-sectional, observational study. Both men and postmenopausal women, admitted with an osteoporotic fracture (whether major osteoporosis or hip fracture), were consecutively recruited for this work. The fracture risk was assessed based on their FRAX calculation prior to the index fracture. All the patients were assessed for their falls and sarcopenia risks. Blood tests for bone profile as well as DXA scan were offered to all the patients.

Results

Two hundred and thirty-six patients presenting with fragility fractures were included in this work. 70.8% were women and 29.2% were men. Mean age was 70.1 (SD = 9.2) years. Ten-year probability of fracture (without BMD) was high in 65.9% of the postmenopausal women and 40.3% of the men. 82.1% of the postmenopausal women and 100% in men identified to be eligible for osteoporosis therapy did not receive any form of osteoporosis therapy. FRAX score correlated significantly with bone mineral density assessment at both hip and spine. Falls, sarcopenia, and functional disability showed significant relation to the fracture risk.

Conclusions

There is a large treatment gap in Egyptian older adults. The recent guidelines for osteoporosis management in Egypt endorsed fracture centric approach to identify people at risk. The gap appears to be related to a low rate of osteoporosis diagnosis and lack of patient education.

I would like to inform you that your above referred manuscript submitted to International Journal of Chemical and Biochemical Science (IJCBS) (http://iscientific.org/Journal.html) published by International Scientific Organization has been accepted for publication in current issue. Article indexing with Scopus and all other websites is an automated process and beyond the control of IJCBS. All indexing websites recheck quality of all articles and journal cannot grantee indexing of all articles. Article processing charges paid to journal are non-refundable as these are charged to pay expenses of journal management staff. Please note, it will be finally published only after confirmation of Article Processing Charges (APC) payment.

Background

Regarding risk stratification of intermediate-risk pulmonary embolism, data are still not sufficient. Transthoracic echocardiography parameters may be useful in risk evaluation in those patients. Some novel echocardiographic indices mainly tricuspid regurgitation peak gradient (TRPG), pulmonary artery acceleration time, and tricuspid annulus plane systolic excursion (TAPSE) were evaluated showing that they may be used for risk stratification of normotensive cases with acute pulmonary embolism (APE).

Results

The studied cases were subdivided into two classes:

Class I with intermediate-low-risk pulmonary embolism included 32 patients (53.3%) and class II with intermediate high-risk pulmonary embolism involved 28 cases (46.7%). Dyspnea, tachypnea, troponin level, RVD, RVD/LVD, TR velocity, and TRPG/TAPSE were statistically higher in cases of class II than that of class I (p < 0.001). On the other …

Background: Cardiac surgeries induce many inflammatory responses with remarkable clinical implications. Tryptophan (Trp) is a precursor for serotonin, melatonin and kynurenine (Kyn). Plasma kynurenic acid (Kyna) and Kyn concentrations are thought to be related to the severity of inflammation. Plasma Trp/Kyn ratio is used to measure inflammatory cytokine activity.

Methods: We performed the current longitudinal study in a tertiary care center and included 62 patients divided into two groups; group A (on-pump CABG patients) and group B (off-pump CABG patients). Plasma Trp and Kyn were measured using the high-performance liquid chromatography (HPLC) technique. Serum interlukin-6 (IL-6) and white blood cells (WBCs) were measured using ELISA and routine blood count, respectively.

Results: The present study revealed that the intraoperative levels of plasma Kyn, IL-6 and WBCs were significantly increased while the plasma Trp/Kyn ratio was significantly decreased in both the groups; however, the changes were more significant in the on-pump CABG group. Moreover, the levels in both the groups returned to preoperative levels 72 h postoperative. Our study has shown that WBCs is positively correlated with IL-6, but has negative correlation with Trp/Kyn ratio.

Conclusions: Kyn and Trp/Kyn ratio might be utilized as markers of the severity of inflammation in major surgery. In addition, off-pump CABG might be more preferable than on-pump CABG regarding stress and release of inflammatory markers.

Background & Objectives: platelet indices are widely available and relatively cheap platelet parameters. The critical objective of this study is to assess the reliability of platelet indices as biomarkers for diagnosis and prognosis in adult thrombocytopenic patients.

Methods: A retrospective case-control study, including 81 immune thrombocytopenia (ITP) cases, 50 aplastic anemia (AA) cases, and 150 participants as a control group. This study included patients admitted from 2016 to 2021 to the Clinical Hematology Unit, Department of Internal Medicine, University Hospital. The collected data included Socio-demographic information, clinical data, laboratory data, and an assessment of the therapeutic response in the studied groups.

Results:For the diagnosis of adult thrombocytopenic patients, platelet distribution width (PDW) showed the best diagnostic accuracy (85% for ITP and 91.9% for AA) at cutoff points of 14.9% and 17.2%, respectively. This was followed by mean platelet volume (MPV) with diagnostic accuracies of 77% for ITP and 89.3% for AA at a cutoff point of 9.4 fl. Platelet large cell ratio (PLCR) demonstrated insignificant accuracy in diagnosing either ITP or AA. Conclusion Platelet indices can play a crucial influence in the diagnosis, not the prognosis, of adult thrombocytopenia.

Keywords: immune thrombocytopenic purpura, aplastic anemia, mean platelet volume; platelet distribution width, platelet large cell ratio

Ethical approval number:(IRB No:17101645).

Clinical trial ID: NCT05116033

https://classic.clinicaltrials.gov/ct2/show/NCT05116033