Hypertension in elderly Egyptians

Global census studies reveal that the elderly are the most rapidly growing population group in both industrialized and less industrialized nations. During 1991 and 1992, three major interventional trials dealt with hypertension in older subjects and the value of antihypertensive treatment in the elderly. These were the American Systolic Hypertension in the Elderly Program [SHEP], the Swedish Trial in Old Patients with Hypertension [STOP-Hypertension], and the British Medical Research Council Trial on treatment of hypertension in older adults. All three trials showed that therapy for hypertension in the elderly reduces the risk of stroke and cardiovascular events. In 1993 evidence from the Egyptian Hypertension Project highlighted hypertension as a national public health problem that must be addressed. Guidelines for primary prevention among all sectors of the community are discussed

Confirmatory Evaluation of the Modified Medical Research Council Questionnaire for Assessment of Dyspnea in Patients with Chronic Obstructive Pulmonary Disease in Portugal

Introduction: The Modified British Medical Research Council Questionnaire is considered an adequate and simple measure of breathlessness in chronic obstructive pulmonary disease. It is widely used in clinical practice in Portugal, but it still lacks confirmatory evaluation for the Portuguese setting. The aim of this study was to perform a cultural adaptation and validation of the Modified British Medical Research Council Questionnaire so that its most suitable version can be made available to researchers and clinicians in Portugal.Material and Methods: We performed a cross-sectional descriptive study involving patients with chronic obstructive pulmonary disease aged 40 years or older. We applied the Modified British Medical Research Council Questionnaire and the previously validated Portuguese-language version of the clinical questionnaire for chronic obstructive pulmonary disease between January and June 2019. We determined the agreement between the two questionnaires with kappa agreement, with a 95% confidence interval, and we used Spearman correlation to find a correlation between two scores.Results: The study included 65 patients managed in a hospital pulmonology clinic (aged 68 ± 7 years; with predicted FEV1 of 49.86% ± 16.5%). The Modified British Medical Research Council scale correlated significantly with all the domains and the overall score of the clinical questionnaire for chronic obstructive pulmonary disease (0.46 < r < 0.68; p < 0.001). In bilingual patients, interclass correlation coefficient was 0.912 (p < 0.001).Discussion: Our study showed that the Portuguese-language version of the Modified British Medical Research Council Questionnaire is feasible and externally valid when compared with a traditional and previously validated instrument.Conclusion: The Portuguese version of the Modified British Medical Research Council Questionnaire is a valid instrument for measurement of breathlessness in chronic obstructive pulmonary disease.

Sensory outcomes after repair of median and ulnar nerve with nerve graft

Background: Peripheral nerve injuries in upper extremities are common. These injuries have significant impact on patient’s life. Appropriate treatment is important for patients to regain functional recovery.Methods: Study conducted on patients treated on Department of Plastic and Reconstructive surgery from January 2018 to May 2019. Study was done to evaluate the sensory recovery of median and ulnar nerve in the forearm after defects were repair by autologous nerve graft. Evaluation was performed in 24 patients. Rating of sensibility was presented by British medical research council scale. Satisfactory sensory recovery was defined as MRC grading S3+ and S4.Results: We evaluate the result of median and ulnar nerve reconstruction as regards to factors affecting functionally the result of operation, which are age, injury level, graft level, and denervation time. Median nerve grafting done in 14 patients and sensory recovery S4 achieved in 2 patients (14%), S3+ in 4 patients (29%). Ulnar nerve grafting done in 10 patients and sensory recovery S4 achieved in 2 patients (20%), S3+ in 2 patients (20%). There was not statistically significant difference in sensory recovery of median and ulnar nerve. There was not statistically significant difference by age, level of injury, graft length, denervation time.Conclusions: There was no significant difference in sensory recovery of median and ulnar nerves. Mode of injury influences results. Results were comparatively better in younger patients and in patients who had undergone repair within shorter time.

Prevalensi Penyakit Paru Obstruktif Kronik Pada Penyapu Jalan Raya di Jakarta

Latar Belakang: PPOK adalah penyakit yang penting di seluruh dunia baik di negara maju maupun berkembang. Penyapu jalan raya terpajan oleh partikel debu, bioaerosol dan berbagai gas berbahaya. Penelitian ini mengevaluasi prevalensi PPOK pada penyapu jalan raya di Jakarta Metode : Penelitian potong lintang pada 153 subjek penyapu jalan raya di Jakarta, berusia lebih dari 40 tahun dengan masa kerja lebih dari 2 tahun. Pengumpulan subjek menggunakan metode cluster sampling berdasarkan lokasi kerja daerah kotamadya di Jakarta. Diagnosis PPOK berdasarkan kuesioner COPD Assessment Test (CAT), The Modified British Medical Research Council (mMRC), pemeriksaan spirometri berdasarkan Pneumobile Project Indonesia dan dilakukan uji bronkodilator bila didapatkan hasil obstruktif. Hasil : Prevalens PPOK pada penyapu jalan raya di Jakarta adalah 10 dari 153 subjek (6,5%). Enam subjek laki-laki (60%), tidak menggunakan masker (80%), bekerja lebih dari 10 tahun (70%), perokok (60%) dan indeks massa tubuh ≤25 kg/m2 (80%). Terdapat hubungan yang bermakna secara statistik antara usia dan PPOK (p<0,05). Kesimpulan : Prevalens PPOK pada penyapu jalan raya di Jakarta adalah 6,5%. Terdapat hubungan bermakna secara statistik antara usia dan PPOK.

Factors associated with failed ulnar nerve fascicle to biceps motor branch transfer: a case control study

We sought to identify predictors of failed ulnar nerve fascicle (to flexor carpi ulnaris) to biceps motor branch transfer. A retrospective review of adult brachial plexus patients treated with flexor carpi ulnaris to biceps transfer with a minimum 1-year follow-up was performed. Failure, defined as modified British Medical Research Council grade <3 elbow flexion was compared with randomly selected controls (M ≥ 4−). Ninety-one patients, of which 80% regained >M3 flexion met criteria. Eighteen failures and 18 controls, with similar follow-up (20 vs 23 months) were evaluated. Preoperative flexor carpi ulnaris weakness (M < 5) was significantly more common in failures (78% vs 33%). The rate of flexor carpi ulnaris recovery after operation was significantly higher in controls (86% vs 7%). Increased failure risk can be expected with impaired preoperative flexor carpi ulnaris function. The challenge is how to identify which patients will regain near normal flexor carpi ulnaris strength as excellent outcomes can be obtained. Level of evidence: III

Doble fijación para la rotura de bíceps distal: Descripción de la técnica y evaluación de resultados

Introducción La ruptura del bíceps distal es una lesión infrecuente producida por la aplicación de una carga excéntrica sobre el codo flexionado. El objetivo de este trabajo es analizar nuestros resultados para la reinserción del bíceps distal mediante la técnica de doble fijación con botón de anclaje cortical y tornillo interferencial de biotenodesis a través de una incisión anterior única, con una casuística mayor a la presentada con anterioridad. Material y Método Entre agosto de 2008 y agosto de 2015, se intervino 24 casos de rotura del bíceps distal tratados quirúrgicamente por vía anterior limitada. Los 22 últimos casos consecutivos fueron tratados con doble fijación utilizando botón extracortical y tornillo de biotenodesis, y son el grupo de estudio de este artículo. Todos eran hombres, con una mediana de edad de 39,5 años (rango 22–59). Los pacientes fueron evaluados con el Cuestionario DASH y la valoración Subjetiva/Objetiva de Andrews y Carson, la fuerza de flexión y supinación se controló con la escala del British Medical Research Council modificada por Mackinnon y Dellon (M0-M5). Resultados El valor promedio del cuestionario DASH fue de 1,7 (0 - 31,6) y el de Andrews y Carson, de 197,5 (135–200), con 20 resultados excelentes, 1 bueno y 1 regular. Todos consiguieron una fuerza M5 para la flexión y la supinación de antebrazo. El tiempo promedio de seguimiento fue de 17,5 meses (10–38). En tres pacientes se registraron complicaciones, todos con una recuperación total. Conclusión La técnica descrita demostró ser segura y eficaz, con resultados satisfactorios y baja tasa de complicaciones. Nivel de Evidencia: IV. Serie de Casos.

Results of nerve grafting in radial nerve injuries occurring proximal to the humerus, including those within the posterior cord

OBJECT Results of radial nerve grafting are largely unknown for lesions of the radial nerve that occur proximal to the humerus, including those within the posterior cord. METHODS The authors describe 13 patients with proximal radial nerve injuries who were surgically treated and then followed for at least 24 months. The patients’ average age was 26 years and the average time between accident and surgery was 6 months. Sural nerve graft length averaged 12 cm. Recovery was scored according to the British Medical Research Council (BMRC) scale, which ranges from M0 to M5 (normal muscle strength). RESULTS After grafting, all 7 patients with an elbow extension palsy recovered elbow extension, scoring M4. Six of the 13 recovered M4 wrist extension, 6 had M3, and 1 had M2. Thumb and finger extension was scored M4 in 3 patients, M3 in 2, M2 in 2, and M0 in 6. CONCLUSIONS The authors consider levels of strength of M4 for elbow and wrist extension and M3 for thumb and finger extension to be good results. Based on these criteria, overall good results were obtained in only 5 of the 13 patients. In proximal radial nerve lesions, the authors now advocate combining nerve grafts with nerve or tendon transfers to reconstruct wrist, thumb, and finger extension.

RADIAL NERVE LACERATIONS — THE OUTCOME OF END-TO-END REPAIRS IN PENETRATING TRAUMA

Due to its mostly motor content, repair of the radial nerve is considered to yield favourable results. This is despite the fact that there are limited studies looking at the outcomes of end-to-end repair secondary to sharp penetrating trauma. We retrospectively reviewed the outcome of a series of repaired level 2 and level 3 radial nerves following penetrating stab injuries. Twenty-seven cases with adequate follow-up were included. All the patients underwent direct end-to-end repair. We evaluated the motor recovery of the target muscles using the British Medical Research Council (MRC) grading system. Wrist extension recovered in 93% of cases at a mean of six months. Finger extension recovered in 74% and thumb extension in 52% of cases within the follow-up period. We conclude that end-to-end repair is possible in the majority of level 2 and level 3 radial nerve lacerations secondary to penetrating stab injuries. Acceptable results can be expected.

Prevalência de sinais e sintomas respiratórios em população residente próxima a uma fábrica de cimento, Cezarina, Goiás, 2011

Introdução: Durante a fabricação do cimento há emissões de poluentes variados conhecidos por terem efeitos tóxicos à saúde humana, sobretudo no que se refere à saúde respiratória. A pesquisa de sinais e sintomas respiratórios é um importante meio de se conhecer os possíveis efeitos dessa poluição em populações residentes em áreas próximas às fábricas de cimento.Métodos: Estudo epidemiológico descritivo transversal de base populacional realizado em Cezarina, Goiás. A amostragem foi aleatória probabilística por conglomerados. O instrumento utilizado foi baseado no questionário do British Medical Research Council para a pesquisa de sinais e sintomas respiratórios. A análise estatística foi feita no programa Statistical Package for the Social Sciences(SPSS) versão 20.0.Resultados: A amostra foi composta, em sua maioria, por mulheres (60,9%; p<0,001). A fábrica de cimento foi o local de trabalho de 11,1% da amostra. A prevalência de tosse foi de 23,1% (p<0,001), expectoração 22,8% (p<0,001), falta de ar 29,3% (p<0,001) e chiado no peito 17,9% (p=0,014). Tabagismo foi referido por 16,6% dos entrevistados.Conclusão:Não houve associação dos sintomas respiratórios com o local de moradia. O tabagismo apresentou associação com todos os sintomas respiratórios pesquisados.