An assessment of functional limitations and its relation to morbidity pattern among the elderly residing in urban area, Kerala, India

Background: Ageing is an inevitable process and a person aged 60 years or above is often referred to as ‘elderly’. Older age is characterized by emergence of several complex health states that tend to occur only later in life and that do not fall into discrete disease categories. These are commonly called as geriatric syndromes. The aim of the study was to estimate the prevalence of functional limitations among the elderly and to determine the association between functional limitations and morbidity pattern among the elderly residing in urban area in Ernakulam district, Kerala.Methods: A community-based cross-sectional study was carried out among 302 elderly participants by using cluster sampling technique in two urban areas of Ernakulam. The structured questionnaire included socio-demographic details, diagnosed morbidities and modified Barthel index to assess functional limitations.Results: The overall prevalence of functional limitations was 22.4% among the elderly. Functional limitations were significantly associated with acid peptic diseases, constipation, kidney disorder, urinary tract infection, arthritis/joint pain, visual impairment, senile deafness and edentulous mouth.Conclusions: In our study 22.4% of the elderly had some form of functional limitations in terms of difficulties in performing basic ADL. Association of functional limitations and different type of morbidities were found in acid peptic diseases, constipation, kidney disorder, urinary tract infection, arthritis/joint pain, visual impairment, senile deafness showed statistically significant. Individuals who had edentulous mouth was also found to be statistically significant.

A Novel Mutation c.841C>T in COPA Syndrome of an 11-Year-Old Boy: A Case Report and Short Literature Review

COPA syndrome is a rare autosomal dominant disorder with auto-immune and auto-inflammatory abnormalities. This disease is caused by mutations of COPα, a protein that functions in the retrograde transport from the Golgi to the ER. Here we report the first COPA case of an 11-year-old boy with c.841C>T, p.R281W mutation. The arginine at position 281 was located in a highly evolutionary-conserved region. Immunosuppressive drugs and corticosteroids might not improve the long-term outcome of COPA patients. For patients with pulmonary disease, polyarthritis and/or kidney disorder, and suspected of COPA, genetic analysis should be conducted promptly for early diagnosis.

EFFICACY OF SEVELAMER CARBONATE IN COMBINATION WITH EDIBLE SOURCES IN HYPERPHOSPHATEMIA CONDITION ASSOCIATED WITH CHRONIC KIDNEY DISORDER

Objective: The main objective of the study was to discover a suitable dietary source of plant origin which can be recommended alongside the medication in case of hyperphosphatemia. Methods: The 2 plant samples chow chow (Sechiumedule) and bitter gourd (Momordica carantia) and two seed samples-Flax seeds (Linumusitatissimum) and Chia seeds (Salvia hispanica) were selected for the study. The samples were extracted using methanol. The filtrate obtained was used for dialysis studies under different conditions. Inorganic phosphate was estimated in each of the conditions. Results: The study indicated perturbation in the absorption of phosphate with the selected plant samples as talked about in the following study. The extreme concentration of phosphate among the four diverse picked plant sources was seen in bitter gourd, which was found to be 0.4686 µmoles/ml. A minimal measure of 0.0693 µmoles/ml of phosphate was found in chia seeds. Chow chow ended up being the best one in hyperphosphatemia condition as the amount of phosphate removed by it along with the drug, sevelamer carbonate, was calculated to be the maximum (0.0561 µmoles). It was followed by chia seeds (0.0429 µmoles) and flax seeds (0.0420 µmoles). Conclusion: The present study concentrates on the impact of various samples of plant extraction that can act on the phosphate absorption in the intestine by the procedure of dialysis.

Risk factors associated with mortality in COVID-19 patients: a retrospective case control study

Background: COVID-19, a novel disease, appeared in December 2019 in China and rapidly spread across the world. This study aimed to investigate and find out the factors responsible for death of COVID patients by comparing with recovered patients. Methodology: A retrospective, case control study was conducted from August 2020 to October 2020 in three hospitals of Poonch division, AJK. Total 192 patients who have been admitted in a hospital with symptoms of COVID-19 and positive PCR test, including 152 recovered from the infection and 40 died, were enrolled in the study. Data of age, gender, occupation, body weight, temperature, diabetic status, hypertension, cardiovascular disease, lungs disorder, kidney disorder, tuberculosis, cancer and smoking was collected for all patients and entered in a datasheet. Different factors were than compared statistically between recovered and dead patients. Results: Died patients had significantly higher age (P=0.000) and body temperature (P=0.000) as compared to recovered patients. Heart disorder, lungs disorder, older age, diabetes and hypertension were found to be significant risk factors of the death in COVID-90 patients. Mortality rate was found to be significantly higher in patients with heart disorder (P=0.000; OR=5.07), lungs disorder (P=0.000; OR=4.0), older age (P=0.000; OR=3.44), diabetes (P=0.001; OR=2.49) and hypertension (P=0.024; OR=1.84) as compared to the COVID-19 patients without these factors. Mortality rate was also higher for the patients with smoking and some kidney disorder but not significant (P=0.170 and 0.191 respectively). Among the died patients, 39 (97.5%) had 1 (2.5%) or more than one of the risk factors were present while 1 patient had no obvious risk factor.Conclusion: The study concludes that heart disorder, lungs disorder, older age, diabetes and hypertension are significant risk factors of the death in COVID-90 patients. More the risk factors accumulate in a person, higher will be the risk of death.

Bilateral Vesicoureteral Reflux in Congenital Nephrotic Syndrome

: Congenital nephrotic syndrome (CNS) is a rare genetic kidney disorder. Different associations between CNS and other organ anomalies have been reported previously. However, urologic abnormalities are not common. This case report can show the association of CNS as a genetic disorder with other abnormalities with a genetic basis. However, the association with urinary abnormalities is rare. We have reported a 25-day-old male newborn, who was referred to our hospital with generalized edema. During the initial evaluation, CNS was diagnosed. The baby, then four months old, was admitted to the hospital with high fever and poor feeding, and a diagnosis of febrile urinary tract infection was made. A voiding cystouretrography was performed that revealed bilateral high-grade vesicoureteral reflux. According to our findings in this case and the genetic basis of CNS and urinary tract anomalies, we recommend the investigation of the urinary tract in CNS patients if indicated.

Factors Associated with Mortality in COVID-19 Patients: A Systematic Review and Meta-Analysis

Background: The current study aimed to identify effective factors on the death among COVID-19 patients. Methods: All articles published in the period Jan 1, 2020, to Mar 23, 2020, written in English and reporting factors associated with COVID-19 mortality were reviewed. The random-effects model with 95% CI was used to calculate the pooled Odds Ratio (OR) and Hazard Ratio (HR). Data were analyzed using Stata ver.11.0. Results: The older age OR: 1.21(1.10-1.33) and male gender OR: 1.41(1.04-1.89) were most prone to death due to COVID-19. The Comorbidity with some chronic diseases such as Diabetes type2 OR: 2.42(1.06-5.52), Hypertension OR: 2.54(1.21-5.32), Kidney disorder OR: 2.61(1.22-5.60), Respiratory disorder 3.09 (1.39-6.88) and Heart diseases OR: 4.37 (1.13-16.90) can increase the risk of COVID19 mortality. Conclusion: Infection with COVID-19 is associated with substantial mortality mainly in older patients with comorbidities. We found the significant effect of age, gender and comorbidities such as Diabetes Mellitus, Hypertension, Kidney disorders and Heart diseases on the risk of death in patients with COVID-19. The factors associated with mortality found in this research can help to recognize patients with COVID-19 who are at higher risk of a poor prognosis. Monitoring these factors can serve to give early warning for the appropriate interventions.

Thyroid Parameters and Kidney Disorder in Type 2 Diabetes: Results from the METAL Study

Objective. Diabetic kidney disease is one of the most common microvascular complications of diabetes mellitus. We aimed to analyze the association of thyroid parameters with kidney disorders, especially in euthyroid participants. Methods. The data were obtained from a cross-sectional study, the METAL study. Thyroid parameters, including thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4), triiodothyronine (T3), thyroxin (T4), thyroid peroxidase antibody (TPOAb), and thyroglobulin antibody (TgAb), of 4136 participants with type 2 diabetes were measured. Two structure parameters of thyroid homeostasis, including the sum activity of step-up deiodinases (SPINA-GD) and thyroid secretory capacity (SPINA-GT), and two pituitary thyrotropic function indices, including Jostel’s TSH index (TSHI) and the thyrotroph thyroid hormone resistance index (TTSI), were also calculated. Kidney disorders were described according to the presence of reduced estimated glomerular filtration rate (eGFR) and/or higher urinary albumin to creatinine ratio (UACR). Results. The prevalence of kidney disorders increased with decreasing FT3 or T3 and increasing FT4 or T4 quartile levels (all P<0.05). After full adjustment, linear regression showed that UACR levels were negatively associated with FT3 and T3 (P<0.001). In addition, eGFR was positively associated with FT3 and T3 and was negatively associated with TSH and FT4 levels and TgAb positivity (all P<0.05). By using binary logistic regression, higher TSH and FT4 and lower FT3 and T3 were associated with kidney disorders (all P<0.05). Similar results were seen in sensitivity analyses, which were performed in 3035 euthyroid diabetic participants; however, TSH was no longer related to them. The area under the receiver operating characteristic curve (AUROC) of lower FT3 for existing kidney disorder was greater than that for any other thyroid hormones (all P<0.001). The cutoff value of FT3 for reduced eGFR was 4.39 pmol/L. Regarding thyroid homeostasis parameters, SPINA-GD was negatively associated with three statuses of kidney disorders, and TSHI and TTSI were positively associated with reduced eGFR (all P<0.05). Conclusions. Among patients with type 2 diabetes, elevated TSH and FT4 (or T4), lower FT3 (or T3), TgAb positivity, lower SPINA-GD, and higher TSHI and TTSI were associated with kidney disorders. The lower FT3, even within the normal range (<4.38 pmol/L), may be the factor most related to reduced eGFR compared with other thyroid hormones in diabetic patients.