Search Results (12)

Vertebral fragility fractures (VFF) pose a challenge for appropriate care. The aim of this study was to develop consensus recommendations for the management of VFF in older people from a multidisciplinary approach. Specialists in osteoporosis belonging to different scientific societies reviewed the main clinical practice guidelines published in Spain in 2014. Thirty-five recommendations for the management of VFF were evaluated by seven experts using an anonymous survey. Consensus was defined as 80% of responses of 8 (agree) and 9 (strongly agree) on a Likert scale. Consensus was achieved in 22 recommendations (62.8%). The experts agreed on the need for anamnesis, clinical assessment, and laboratory tests, including erythrocyte sedimentation rate, proteinography, and the assessment of levels of calcium, vitamin D, alkaline phosphatase, and thyroid-stimulating hormone. Optional tests, such as bone turnover markers (BTMs), magnetic resonance imaging, bone scintigraphy, or using a fracture risk assessment tool (FRAX^®), did not achieve an agreed consensus. Also, there was consensus regarding the administration of calcium/vitamin D supplements, the withdrawal of toxic habits, and personalized physical exercise. Participants agreed on the administration of teriparatide for 24 months and then a switch to denosumab or bisphosphonates in patients at high risk of fracture. Specialists in osteoporosis, primary care physicians, and geriatricians should be involved in the follow-up of patients with VFF. Although there was multidisciplinary agreement on diagnostic tests and non-pharmacological and pharmacological treatment in frail older people, therapeutic objectives should be individualized for every patient. In addition to the specific recommendations, close collaboration between the geriatrician and the primary care physician is essential for the optimal chronic management of frail patients with fragility fractures. Full article

Recombinant human epidermal growth factor (EGF) has been used to treat adult diabetic foot ulcers and pediatric burns by facilitating wound healing and epithelization, especially for elderly patients. Several formulation types of EGF from different expression hosts are clinically available, such as intralesional injection and topical application. On the other hand, no study has compared the in vivo efficacy of EGF products directly in terms of tissue regeneration and wound healing activity. The present study compared two commercial products, Heberprot-P75^® and Easyef^®, in terms of their tissue regeneration activity in adult zebrafish and the developmental speed of zebrafish embryos. Fluorescence spectroscopy showed that the two EGF products had different Trp fluorescence emission spectra: Easyef^® showed a wavelength of maximum fluorescence (WMF) of 337 nm with weak fluorescence intensity (FI), while Heberprot-P75^® showed WMF of 349 nm with a 4.1 times stronger FI than that of Easyef^®. The WMF of Heberprot-P75^® was quenched by adding singlet oxygen in ozonated oil, while the WMF of Easyef^® was not quenched. Treatment with Heberprot-P75^® induced greater embryo development speed with a higher survival rate after exposure to EGF in water and microinjection into embryos. Under normal diet (ND) consumption, Heberprot-P75^® showed a 1.4 times higher tail fin regeneration activity than Easyef^® during seven days from the intraperitoneal injection (10 μL, 50 μg/mL) after amputating the tail fin. Under ND consumption and diabetic condition caused by streptozotocin (STZ) treatment, Heberprot-P75^® showed 2.1 times higher tail fin regeneration activity than Easyef^® from the same injection and amputation protocol. Under a high-cholesterol diet (HCD) alone, Heberprot-P75^® showed 1.2 times higher tail fin regeneration activity than the Easyef^® group and PBS group from the same injection and amputation. Under diabetic conditions (STZ-injected) and HCD consumption, the Heberprot-P75^® group showed 1.7 and 1.5 times higher tail fin regeneration activity than the Easyef^® group and PBS group, respectively, with a distinct and clean regeneration pattern. In contrast, the Easyef^® group and PBS group showed ambiguous regeneration patterns with a severe fissure of the tail fin, which is a typical symptom of a diabetic foot. In conclusion, Heberprot-P75^® and Easyef^® have different Trp fluorescence properties in terms of the WMF and fluorescence quenching. Treatment of Heberprot-P75^® induced a greater developmental speed of zebrafish embryos in both water exposure and microinjection. Heberprot-P75^® induced significantly higher wound healing and tissue regeneration activity than Easyef^® and PBS in the presence or absence of diabetic conditions and cholesterol supplementation. Full article

There is a lack of data from developing countries on the link between physical activity (PA) on health outcomes. This study examines the association between the level of PA and sarcopenia, cardiovascular risk factors (i.e., dyslipidemia, type 2 diabetes (T2D), and cardiovascular diseases), and the health-related quality of life (HRQoL) among elderly people, in community dwellings in Lebanon. In this cross-sectional, observational study, body composition, levels of PA, and the HRQoL of 243 elderly people living in community dwellings, are obtained. The participants are then categorized based on a PA cut-off point of 600 metabolic equivalent task minutes per week (MET-min/week). In our sample, the prevalence of physical inactivity, defined as performing less than 600 MET-min/week, is 51.44% (125/243 participants).They displayed a higher prevalence of sarcopenia (36.0% vs. 18.6%), T2D (39.6% vs. 21.1%), as well as a lower physical (65.67 ± 20.72 vs. 75.08 ± 17.29) and mental (67.58 ± 21.51 vs. 76.95 ± 17.16) HRQoL. On the other hand, regression analysis shows that an increased rate of PA to ≥600 MET-min/week is associated with a lower risk of T2D (OR = 0.43, 95% CI: 0.22–0.84, p = 0.013) and sarcopenia (OR= 0.40, 95% CI: 0.22–0.73, p = 0.003) by 60%, and higher scores of the physical (β = −7.65; −11.87, −3.43, p = 0.0004) and mental (β = −8.47; −13.08, −3.85, p = 0.0004) HRQoL by nearly eight points. Our results show a high prevalence of physical inactivity in Lebanese adults over the age of 60; however, an adequate level of PA among this population seemed to be associated with a lower risk of sarcopenia and T2D, as well as a better HRQoL. However, future longitudinal studies are still needed to clarify if intervention based on increasing levels of PA can determine improvement in these clinical outcomes. If this is shown to be the case, it emphasizes the importance of implementing strategies to increase physical activity within this population. Full article

Background: We examined the effect of power training on habitual, intervention and total physical activity (PA) levels in older adults with type 2 diabetes and their relationship to metabolic control. Materials and Methods: 103 adults with type 2 diabetes were randomized to receive supervised power training or sham exercise three times/week for 12 months. Habitual, intervention, and total PA, as well as insulin resistance (HOMA2-IR) and glycosylated hemoglobin (HbA1c), were measured. Results: Participants were aged 67.9 ± 5.5 yrs, with well-controlled diabetes (HbA1c = 7.1%) and higher than average habitual PA levels compared to healthy peers. Habitual PA did not change significantly over 12 months (p = 0.74), and there was no effect of group assignment on change over time in habitual PA over 0–6 (p = 0.16) or 0–6–12 months (p = 0.51). By contrast, intervention PA, leg press tonnage and total PA increased over both 6- and 12-month timepoints (p = 0.0001), and these changes were significantly greater in the power training compared to the sham exercise group across timepoints (p = 0.0001). However, there were no associations between changes in any PA measures over time and changes in metabolic profile. Conclusion: Structured high-intensity power training may be an effective strategy to enhance overall PA in this high-risk cohort. Full article

Background. Epidemiological data report that male hypogonadism may play a role in cognitive impairment in elderly. However, the effect of testosterone replacement therapy (TRT) on cognitive abilities in this cluster of patients has not been well established. Methods. PubMed/MEDLINE, Google Scholar, Cochrane Library, and Web of Science were searched by using free text words and medical subject headings terms related with “male hypogonadism”, “late-onset hypogonadism”, elderly, cognition, “mild cognitive impairment”, memory, “testosterone replacement therapy” used in various combinations according to the specific clinical questions. Original articles, reviews, and randomized controlled trials written in English were selected. Results. A long-term TRT could improve specific cognitive functions, such as verbal and spatial memory, cognitive flexibility, and physical vitality. However, randomized controlled trials do not provide positive results, and in most of the cases TRT might not induce beneficial effects on cognitive function in elderly men. Discussion and conclusions. Since the lengthening of life expectancy, the prevalence rate of cognitive decline in elderly men is expected to increase remarkably over the next decade with considerable healthcare and economical concerns. Therefore, this remains a relevant clinical topic and further investigations are needed for clarifying the role of TRT especially in elderly men with hypogonadism. Full article

The aim of this study was to investigate factors associated with sarcopenia among elderly patients with poorly controlled diabetes mellitus (DM). We retrospectively analyzed 41 patients with type 2 DM, aged ≥65 years who required diabetes education hospitalization. Patients were classified into two groups according to the presence or absence of a weakened hand grip, and clinical characteristics were compared. Patients with a weakened hand grip (n = 21) scored worse on a mini-mental state examination (24.3 vs. 26.5, p = 0.04), showed a higher prevalence of diabetic peripheral neuropathy (76% vs. 40%, p = 0.03), and had a higher serum phosphorus concentration (3.8 vs. 3.3 mg/dL, p < 0.01) compared to those without a weakened hand grip (n = 20). The serum phosphorus concentration was inversely correlated to hand grip strength (r = −0.501, p < 0.001) among the total of 41 patients. This inverse association was also confirmed after adjusting the effects of estimated glomerular filtration rate, age, and glycated hemoglobin. Thus, cognitive impairment, diabetic peripheral neuropathy, and high serum phosphorus concentrations are associated with hand grip weakness in elderly patients with type 2 DM. Full article

An imbalance of regeneration and destruction of the extracellular matrix due to a plethora of chemo- and cytokines, elevated matrix metalloproteinases, bacterial contamination and repetitive painless tissue damage can lead the chronicity of a wound, especially in diabetic foot ulcers (DFU). Along general lines, wound healing and cancer development are similar. Therefore chronic wounds prepare a breeding ground for cancer development. Several characteristics such as increase in size, verrucous everted margins and contact bleeding are suspicious for malignant growth in a chronic wound. While previously the term Marjolin’s ulcer was attributed to a malignant tumor in (burn) scars, it is nowadays used for every malignant tumor in chronic wounds. Furthermore, chronic ulcers in diabetic feet are susceptible for malignant transformation. We describe two cases of squamous cell carcinoma in patients with DFU—a 71 year-old woman and a 67 year old man. Both received total tumor excision and split-skin grafts with good short-time results. Full article

Hypothesis: Anti-diabetic drugs modulate p-21 activated kinase (PAK) signaling. Introduction: Type 2 diabetes mellitus (T2DM) is a chronic inflammatory disease associated with increased cancer risk. PAK signaling is implicated in cellular homeostasis when regulated, and cancer when unrestrained. Recent reports provided a role for PAK signaling in glucose homeostasis, but the role of PAKs in the pathogenesis of T2DM is unknown. Here, we performed a mini-meta-analysis to explore if anti-diabetic drugs modify PAK signaling pathways, and provide insight regarding modulation of these pathways, to potentially reduce diabetes-associated cancer risk. Methods: PAK interacting partners in T2DM were identified using the online STRING database. Correlation studies were performed via systematic literature review to understand the effect of anti-diabetic drugs on PAK signaling. A mini-meta-analysis correlated multiple clinical studies and revealed the overall clinical response rate and percentage of adverse events in piogliazone (n = 53) and metformin (n = 91) treated patients with PAK-associated diseases. Results: A total of 30 PAK interacting partners were identified (10: reduced beta-cell mass; 10: beta-cell dysfunction; 10: obesity-insulin resistance), which were highly associated with Wnt, and G-protein signaling. The anti-diabetic drug metformin activated signaling pathways upstream; whereas pioglitazone inhibited pathways downstream of PAK. Overall, clinical response upon pioglitazone treatment was 53%. Seventy-nine percent of pioglitazone and 75% of metformin treated patients had adverse events. Pioglitazone reduced molecular-PAK biomarkers of proliferation (Ki67 and CyclinD1), and metformin had the opposite effect. Conclusions: PAK signaling in T2DM likely involves Wnt and G-protein signaling, which may be altered by the anti-diabetic drugs metformin and pioglitazone. Apart from the therapeutic limitations of adverse events, pioglitazone may be promising in chemoprevention. However long-term multi-centered studies, which initiate pioglitazone treatment early will be required to fully assess the full potential of these drugs. Full article

The role of fasting glucose, insulin levels, and C-peptide in coronary heart disease (CHD) in non-diabetic individuals remains uncertain. We examined the association between fasting glucose, insulin and C-peptide with the long-term incidence of CHD in Japanese-American men. In 1980–1982, from a random sample of the Honolulu Heart Program men (n = 1378), aged 61–81 years, data on several CHD and metabolic risk factors were obtained to examine the relation of fasting glucose, insulin and C-peptide to 19-year CHD incidence. Age-adjusted incidence of CHD increased with increasing quintiles of glucose, insulin and C-peptide. Age-adjusted CHD rates in the glucose quintiles were 11.9, 11.6, 14.4, 18.1 and 24.1 per 1000 person-years (trend p < 0.001). In individual Cox models (lowest quintiles of glucose, insulin and C-peptide as reference) the relative risks (95% confidence interval) of CHD incidence for the glucose quintiles adjusting for age, smoking, hypertension, cholesterol, physical activity, and body mass index, were 0.9 (0.6–1.4), 1.2 (0.8–1.8), 1.4 (0.9–2.2), and 1.7 (1.1–2.6), respectively (trend p = 0.004). Insulin and C-peptide were not significantly associated with CHD on multivariate analysis. Fasting glucose remained the only significant predictor of increased CHD risk (p = 0.003) in a model combining all 3 metabolic variables. In this cohort, only fasting glucose independently predicts long-term incidence of CHD. Age-adjusted insulin and C-peptide levels were associated with CHD incidence, but after adjustment for other risk factors, do not independently predict CHD. Full article

Previous studies have shown that walking is associated with increased longevity and a reduced risk of cardiovascular and age-related diseases. Whether walking benefits individuals with diabetes who are at high risk of coronary heart disease (CHD) remains to be determined. The objective of this study is to examine the association between walking and risk of CHD among elderly men with and without diabetes. Walking data was assessed in 2732 men aged 71 to 93 years participating in the Honolulu Heart Program from 1991–1993. Study participants were initially without disabilities and free of prevalent CHD. Men were then followed for incident CHD for up to 7 years. For men with diabetes who walked <0.25 miles/day, the age-adjusted incidence of CHD was significantly higher than in men without diabetes (27.1 vs. 12.7/1000 person years, p = 0.026). In contrast when distance walked was >1.5 miles/day, incidence of CHD was similar in men with and without diabetes (12.2 vs. 9.1/1000 person-years, p = 0.46). While risk of CHD declined significantly with increasing walking distance in men with diabetes after age and risk factor adjustment (p = 0.043, p = 0.025), associations in those without diabetes were weaker (p = 0.070, p = 0.10). These findings suggest that among elderly men with diabetes who are capable of physical activity, walking reduces CHD risk to levels similar to when diabetes is absent. Walking is an easy, safe and accessible form of physical activity that may have marked health benefits for elderly men with diabetes. Full article

In 2010, approximately 79 million Americans had prediabetes and about 50 percent of those individuals were 65 years and older. The most effective diabetes prevention method in prediabetic adults is lifestyle modification. However, despite the benefits of lifestyle change, diabetes prevalence continues to increase. Maintaining a regular exercise routine and a healthy eating plan may be difficult because of the negative emotional barriers (i.e., stress, mood) that a prediabetic individual faces. This is particularly evident in older individuals when you combine that with decreases in mobility and geriatric syndromes. A potential treatment for these emotional barriers is a natural supplement called 5-aminolevulinic acid (5-ALA). In the current study, the group included 154 participants, both men and women, ranging between the ages of 41 to 71 years old. The study design was a double-blind, randomized parallel-group study. The Psychosocial Depressive Symptoms Questionnaire (PDS) and the Perceived Stress Scale (PSS) were used to examine the effect of two doses of 5-ALA (15 mg and 50 mg) on various components of mood (i.e., hopefulness, loneliness, and motivation) and coping ability. Using SAS software, an ordered logistic regression model was used to analyze the association between the dose groups (control, 15 mg, and 50 mg) and the responses to the two questionnaires, the PDS and PSS, used in this study. An integrative literature review, using the PubMed database, searched for studies on the relationship between 5-ALA administration and mood and coping ability. Our literature review resulted in zero published articles. Next, we found that the intake of 5-ALA was significantly associated with improved coping ability (p = 0.004) and improved self-perception of effort spent (p = 0.002). Finally, we found a significant dose-dependent relationship for the association of 5-ALA intake on measures of effort (p = 0.003), loneliness (p = 0.006), and coping ability (p = 0.003). The 50 mg dose was more effective than the 15 mg dose in improving these measures. In conclusion, after 12 weeks of taking 5-ALA, we found significant improvements in self-perception of effort spent, loneliness, and coping ability in prediabetic middle age and older adults. Improved mood and coping ability may allow prediabetic individuals to overcome the emotional obstacles preventing them from maintaining a healthy lifestyle and ultimately, help them to avoid the development of diabetes. Full article

Among the elderly, obesity is paradoxically associated with a lower mortality risk. Thus, this study describes fitness levels by Body Mass Index (BMI) category and the associations of high-sensitivity C-reactive protein (hs-CRP) and Vitamin D levels with muscle strength, in community-dwelling older adults. A cross-sectional study, with 1338 subjects having mean age of 78.3 years, were assessed in anthropometrics, muscle strength, and cardiorespiratory fitness. In a sub-sample, blood samples were collected and objective markers of inflammation were provided: high-sensitivity C-reactive protein (hs-CRP) and Vitamin D (25(OH) D). Obese women (BMI ≥ 30.0 kg/m²) showed significantly better results for grip strength than normal weight group (BMI between 18.5–24.9 kg/m²): 22.3 (7.0) vs. 20.0 (6.8); p = 0.002. After adjustment, higher levels of hs-CRP were an independent predictor of lower levels of grip strength (β = −0.213, 95% CI: −0.424; −0.002) and Vitamin D levels were positively associated with higher levels of muscle strength (β = 0.098, 95% CI: 0.008–0.189). The multivariate analysis found a significant and positive association between 25(OH) D and grip strength: (β = 0.098, 95% CI: 0.008–0.189). A positive pattern of higher levels of absolute strength among obese older subjects could have an important impact on morbidity and mortality risk, through the inverse association with acute inflammation and an increase in Vitamin D profile. Full article