Summary
Guidance is provided in an international setting on the assessment and specific treatment of postmenopausal women at low, high and very high risk of fragility fractures.
Introduction
The ...International Osteoporosis Foundation and European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis published guidance for the diagnosis and management of osteoporosis in 2019. This manuscript seeks to apply this in an international setting, taking additional account of further categorisation of increased risk of fracture, which may inform choice of therapeutic approach.
Methods
Clinical perspective and updated literature search.
Results
The following areas are reviewed: categorisation of fracture risk and general pharmacological management of osteoporosis.
Conclusions
A platform is provided on which specific guidelines can be developed for national use to characterise fracture risk and direct interventions.
Summary
This systematic review summarizes the effect of combined exercise and nutrition intervention on muscle mass and muscle function. A total of 37 RCTs were identified. Results indicate that ...physical exercise has a positive impact on muscle mass and muscle function in subjects aged 65 years and older. However, any interactive effect of dietary supplementation appears to be limited.
Introduction
In 2013, Denison et al. conducted a systematic review including 17 randomized controlled trials (RCTs) to explore the effect of combined exercise and nutrition intervention to improve muscle mass, muscle strength, or physical performance in older people. They concluded that further studies were needed to provide evidence upon which public health and clinical recommendations could be based. The purpose of the present work was to update the prior systematic review and include studies published up to October 2015.
Methods
Using the electronic databases MEDLINE and EMBASE, we identified RCTs which assessed the combined effect of exercise training and nutritional supplementation on muscle strength, muscle mass, or physical performance in subjects aged 60 years and over. Study selection and data extraction were performed by two independent reviewers.
Results
The search strategy identified 21 additional RCTs giving a total of 37 RCTs. Studies were heterogeneous in terms of protocols for physical exercise and dietary supplementation (proteins, essential amino acids, creatine, β-hydroxy-β-methylbuthyrate, vitamin D, multi-nutrients, or other). In 79% of the studies (27/34 RCTs), muscle mass increased with exercise but an additional effect of nutrition was only found in 8 RCTs (23.5%). Muscle strength increased in 82.8% of the studies (29/35 RCTs) following exercise intervention, and dietary supplementation showed additional benefits in only a small number of studies (8/35 RCTS, 22.8%). Finally, the majority of studies showed an increase of physical performance following exercise intervention (26/28 RCTs, 92.8%) but interaction with nutrition supplementation was only found in 14.3% of these studies (4/28 RCTs).
Conclusion
Physical exercise has a positive impact on muscle mass and muscle function in healthy subjects aged 60 years and older. The biggest effect of exercise intervention, of any type, has been seen on physical performance (gait speed, chair rising test, balance, SPPB test, etc.). We observed huge variations in regard to the dietary supplementation protocols. Based on the included studies, mainly performed on well-nourished subjects, the interactive effect of dietary supplementation on muscle function appears limited.
The article ‘Algorithm for the management of patients at low, high and very high risk of osteoporotic fractures’,written by J. A. Kanis, was originally published Online First without Open Access. ...After publication in volume #, issue # and page #-#, the author decided to opt for Open Choice and to make the article an Open Access publication.
Seizures and their consequences contribute to the burden of epilepsy because they can cause health loss (premature mortality and residual disability). Data on the burden of epilepsy are needed for ...health-care planning and resource allocation. The aim of this study was to quantify health loss due to epilepsy by age, sex, year, and location using data from the Global Burden of Diseases, Injuries, and Risk Factors Study.
We assessed the burden of epilepsy in 195 countries and territories from 1990 to 2016. Burden was measured as deaths, prevalence, and disability-adjusted life-years (DALYs; a summary measure of health loss defined by the sum of years of life lost YLLs for premature mortality and years lived with disability), by age, sex, year, location, and Socio-demographic Index (SDI; a compound measure of income per capita, education, and fertility). Vital registrations and verbal autopsies provided information about deaths, and data on the prevalence and severity of epilepsy largely came from population representative surveys. All estimates were calculated with 95% uncertainty intervals (UIs).
In 2016, there were 45·9 million (95% UI 39·9–54·6) patients with all-active epilepsy (both idiopathic and secondary epilepsy globally; age-standardised prevalence 621·5 per 100 000 population; 540·1–737·0). Of these patients, 24·0 million (20·4–27·7) had active idiopathic epilepsy (prevalence 326·7 per 100 000 population; 278·4–378·1). Prevalence of active epilepsy increased with age, with peaks at 5–9 years (374·8 280·1–490·0) and at older than 80 years of age (545·1 444·2–652·0). Age-standardised prevalence of active idiopathic epilepsy was 329·3 per 100 000 population (280·3–381·2) in men and 318·9 per 100 000 population (271·1–369·4) in women, and was similar among SDI quintiles. Global age-standardised mortality rates of idiopathic epilepsy were 1·74 per 100 000 population (1·64–1·87; 1·40 per 100 000 population 1·23–1·54 for women and 2·09 per 100 000 population 1·96–2·25 for men). Age-standardised DALYs were 182·6 per 100 000 population (149·0–223·5; 163·6 per 100 000 population 130·6–204·3 for women and 201·2 per 100 000 population 166·9–241·4 for men). The higher DALY rates in men were due to higher YLL rates compared with women. Between 1990 and 2016, there was a non-significant 6·0% (−4·0 to 16·7) change in the age-standardised prevalence of idiopathic epilepsy, but a significant decrease in age-standardised mortality rates (24·5% 10·8 to 31·8) and age-standardised DALY rates (19·4% 9·0 to 27·6). A third of the difference in age-standardised DALY rates between low and high SDI quintile countries was due to the greater severity of epilepsy in low-income settings, and two-thirds were due to a higher YLL rate in low SDI countries.
Despite the decrease in the disease burden from 1990 to 2016, epilepsy is still an important cause of disability and mortality. Standardised collection of data on epilepsy in population representative surveys will strengthen the estimates, particularly in countries for which we currently have no or sparse data and if additional data is collected on severity, causes, and treatment. Sizeable gains in reducing the burden of epilepsy might be expected from improved access to existing treatments in low-income countries and from the development of new effective drugs worldwide.
Bill & Melinda Gates Foundation.
Introduction Le syndrome de Sheehan (SS)est une affection devenue rare dans les pays développés, elle reste assez fréquente dans notre contexte, surtout quand les accouchements ont lieu à domicile. ...Nous rapportons le cas d‘une patiente qui présente ce syndrome découvert dans un contexte particulier. Observation B.S, 35 ans, a été admise en réanimation pour coma compliquant un état de choc septico-hémorragique sur abcès intra-utérin. Devant les hypoglycémies et hypotensions refractaires au traitement et les signes d‘hypothyroidie, la cortisolémie faite était a 3,8 ug/dl, la TSH a 0,49 uui/ml, T4 l a 1,15 pmol/l, T3l a 0,7 pmol/l. La patiente a été mise sous HSHC puis levothyroxine (dose progressive) après évaluation se son état cardiaque. transférée au service, une reevaluation note un accouchement hémorragique a domicile avec aménorrhée secondaire et signes en faveur d‘hypothyroïdie depuis 8 ans. À l’examen une pâleur manifeste, un aspect bouffi, un visage poupin, une dépilation axillo-pubienne, un diabète insipide ayant régressé spontanément. Au reste du bilan : Estradiol : 15 pg/ml, FSH : 5,4mUI/ml, LH : 2,07 mUI/ml. La TDM cérébrale faite dans le contexte d‘urgence a révélé une arachnoidocele. Discussion Le SS est une affection ischémique rare de l‘antéhypophyse avec insuffisance plus ou moins complète survenant apres d‘hémorragie obstétricale. La découverte dans le cadre d‘insuffisance surrenalienne aigue est exceptionnelle ! L‘atteinte post hypophysaire associee est non usuelle, peu d‘études ont étudié cet axe chez cette population probablement en raison de l‘atteinte partielle parfois non évidente (diminution de la capacité de concentration d‘urines) prouvée par certaines études.
Chylothorax is a possible complication of intrathoracic surgery. The diagnosis of postoperative chylothorax is easy; however, the treatment can cause problems of management because of the lack of ...consensus. In children, the most common causes of postoperative chylothorax are the cures for congenital heart diseases. We report the case of a two-year-old child, presenting with a chylothorax following surgery of the ductus arteriosus. Our case illustrates the treatment that must first include medical measures without delaying the surgery. The risk is the installation of nutritional and immune deficiency.
Acute meningitis has a high case-fatality rate and survivors can have severe lifelong disability. We aimed to provide a comprehensive assessment of the levels and trends of global meningitis burden ...that could help to guide introduction, continuation, and ongoing development of vaccines and treatment programmes.
The Global Burden of Diseases, Injuries, and Risk Factors (GBD) 2016 study estimated meningitis burden due to one of four types of cause: pneumococcal, meningococcal, Haemophilus influenzae type b, and a residual category of other causes. Cause-specific mortality estimates were generated via cause of death ensemble modelling of vital registration and verbal autopsy data that were subject to standardised data processing algorithms. Deaths were multiplied by the GBD standard life expectancy at age of death to estimate years of life lost, the mortality component of disability-adjusted life-years (DALYs). A systematic analysis of relevant publications and hospital and claims data was used to estimate meningitis incidence via a Bayesian meta-regression tool. Meningitis deaths and cases were split between causes with meta-regressions of aetiological proportions of mortality and incidence, respectively. Probabilities of long-term impairment by cause of meningitis were applied to survivors and used to estimate years of life lived with disability (YLDs). We assessed the relationship between burden metrics and Socio-demographic Index (SDI), a composite measure of development based on fertility, income, and education.
Global meningitis deaths decreased by 21·0% from 1990 to 2016, from 403 012 (95% uncertainty interval UI 319 426–458 514) to 318 400 (265 218–408 705). Incident cases globally increased from 2·50 million (95% UI 2·19–2·91) in 1990 to 2·82 million (2·46–3·31) in 2016. Meningitis mortality and incidence were closely related to SDI. The highest mortality rates and incidence rates were found in the peri-Sahelian countries that comprise the African meningitis belt, with six of the ten countries with the largest number of cases and deaths being located within this region. Haemophilus influenzae type b was the most common cause of incident meningitis in 1990, at 780 070 cases (95% UI 613 585–978 219) globally, but decreased the most (–49·1%) to become the least common cause in 2016, with 397 297 cases (291 076–533 662). Meningococcus was the leading cause of meningitis mortality in 1990 (192 833 deaths 95% UI 153 358–221 503 globally), whereas other meningitis was the leading cause for both deaths (136 423 112 682–178 022) and incident cases (1·25 million 1·06–1·49) in 2016. Pneumococcus caused the largest number of YLDs (634 458 444 787–839 749) in 2016, owing to its more severe long-term effects on survivors. Globally in 2016, 1·48 million (1·04—1·96) YLDs were due to meningitis compared with 21·87 million (18·20—28·28) DALYs, indicating that the contribution of mortality to meningitis burden is far greater than the contribution of disabling outcomes.
Meningitis burden remains high and progress lags substantially behind that of other vaccine-preventable diseases. Particular attention should be given to developing vaccines with broader coverage against the causes of meningitis, making these vaccines affordable in the most affected countries, improving vaccine uptake, improving access to low-cost diagnostics and therapeutics, and improving support for disabled survivors. Substantial uncertainty remains around pathogenic causes and risk factors for meningitis. Ongoing, active cause-specific surveillance of meningitis is crucial to continue and to improve monitoring of meningitis burdens and trends throughout the world.
Bill & Melinda Gates Foundation.
The spinal curvature irregularity index (SCII) is a quantitative measure of the irregularity of the spinal curvature. We evaluated the predictive ability of SCII to identify subjects with vertebral ...fractures (VF).
Vertebral heights were measured by quantitative vertebral morphometry in 461 Lebanese women 20-89 years of age and VFs were ascertained by the grade 1 Eastell method. SCII scores were log-transformed and expressed as Z-SCII, the number of standard deviations above or below the mean ln(SCII) of young patients without VF. Univariate and multivariate binary logistic regression models were used to identify clinical predictors of VF.
Women with a higher SCII were more likely to have prevalent VF. A higher SCII was associated with a greater prevalence of VF within each category of femoral neck BMD (normal, osteopenia, osteoporosis). In univariate analysis, predictors of VF included Z-SCII (odds ratio, OR: 2.21, 95% CI: 1.80-2.71) and femoral neck T-score (OR: 1.35, 95% CI: 1.12-1.63). In multivariate analysis, predictors of VF were: Z-SCII (OR: 1.54, 95% CI: 1.02-2.32), femoral neck T-score (OR: 1.41, 95% CI: 1.11-1.78) and age(3) (OR: 1.40, 95% CI 1.10-1.82). At a cutoff SCII of 9.5%, the sensitivity and specificity of SCII for VF were 71 and 64% respectively, and higher SCII cutoffs identified VFs with greater specificity.
The SCII is a robust, simple and independent indicator of the presence of VFs.
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