Use of vitamin D supplements and vitamin D status in patients taking bisphosphonate drugs.
Explore the source record for details and available documents.
Aged↗
Biomedical subjects
T J Allain
Publications and source records attributed to T J Allain.
The implications of a growing evidence base for drug use in elderly patients. Part 4. Vitamin D and bisphosphonates for fractures and osteoporosis.
Fractures are common in elderly subjects, disabling and occasionally fatal. Their incidence increases exponentially with age, with the commonest affected sites being the wrist, vertebrae, hip and humerus. Of these, hip fractures are the most relevant in terms of morbidity and financial cost. The increase in fracture rate with age is believed to result predominantly from age-related increases in the incidence of osteoporosis and falls. This article reviews the evidence for the use of vitamin D and bisphosphonates for the prevention of bone fractures and osteoporosis in elderly patients.
Accidental Falls↗
Muscle strength and vitamin D in older people.
Explore the source record for details and available documents.
Aged↗
Amelanotic malignant melanoma disguised as a diabetic foot ulcer.
UNLABELLED: BACKGROUND/CASE REPORT A female patient with diet-controlled Type 2 diabetes mellitus, presented with disseminated malignancy. She had a 15-year history of a diabetic foot ulcer, which was subsequently found to be an amelanotic malignant melanoma. She had recently received immunosuppressive treatment for an episode of nephrotic syndrome secondary to focal segmental glomerulosclerosis. CONCLUSIONS: This case raises two important points. Firstly, whether non-healing diabetic foot ulcers should be biopsied, and secondly, whether the spread of the malignant melanoma was precipitated by immunosuppressive treatment.
Aged↗
Neuromuscular and psychomotor function in elderly subjects who fall and the relationship with vitamin D status.
Vitamin D and calcium supplementation significantly reduces the incidence of fractures. Evidence suggests vitamin D deficiency impairs neuromuscular function, causing an increase in falls and thereby fractures. The relationship between vitamin D, functional performance, and psychomotor function in elderly people who fall was examined in a prospective cross-sectional study. Patients were recruited from a falls clinic and stratified according to serum 25-hydroxyvitamin-D levels (25OHD): group 1, 25OHD < 12 microg/liter; group 2 25OHD, 12-17 microg/liter; and group 3, 25OHD > 17 microg/liter. Healthy elderly volunteers with 25OHD > 17 microg/liter comprised group 4 (n = 20/group). Measures included aggregate functional performance time (AFPT, seconds), isometric quadriceps strength (Newtons), postural sway (degrees), and choice reaction time (CRT, seconds). Serum bone biochemistry, 25OHD, and parathyroid hormone levels were measured. Patients who fell had significantly impaired functional performance, psychomotor function, and quadriceps strength compared with healthy subjects (AFPT: 51.0 s vs. 32.8 s,p < 0.05; CRT: 1.66 s vs. 0.98 s,p < 0.05; strength: 223N vs. 271N, t = 2.35, p = 0.02). Group 1 had significantly slower AFPT (66.0 s vs. 44.8 s, t = 4.15, p < 0.05) and CRT (2.37 s vs. 0.98 s, t = 3.59, p < 0.05) than groups 2 and 3. Group 1 had the greatest degree of postural sway and the weakest quadriceps strength, although this did not reach significance. Multivariate analysis revealed 25OHD as an independent variable for AFPT, CRT, and postural sway. PTH was an independent variable for muscle strength. Older people who fall have impaired functional performance, psychomotor function, and muscle strength. Within this group, those with 25OHD < 12 microg/liter are the most significantly affected.
Accidental Falls↗
Urinary iodine concentrations and thyroid function in adult Zimbabweans during a period of transition in iodine status.
BACKGROUND: In 1993 the compulsory iodization of salt was introduced in Zimbabwe, a country that was previously an area of severe iodine deficiency. OBJECTIVE: The objective of this study was to document urinary iodine excretion and biochemical thyroid function in seemingly healthy, community-dwelling adults after the introduction of iodization. DESIGN: A multistage, random sampling method was used in rural and urban settings to identify households from which the senior household member (aged >35 y) was recruited (alternating male and female recruits). Demographic data were collected for each subject and urinary and venous blood samples were taken. Urinary iodine excretion and serum thyroid hormone status (thyrotropin and total thyroxin) were evaluated according to age, sex, and area of residence. RESULTS: A total of 736 adults were recruited (253 men; mean age: 64 y). Urinary iodine concentrations were high [median (first and third quartiles): 4.41 (2.84, 6.78) micromol/L, or 560 (360, 860) microgram/L] and were significantly higher in rural areas than in urban areas [4.73 (3.07, 7.14) micromol/L, or 600 (390, 906) microgram/L, compared with 3.47 (2.05, 4.73) micromol/L, or 440 (260, 600) microgram/L; P < 0.001]. Urinary iodine excretion declined significantly with increasing age (r = -0.29, P < 0.001). Serum thyroid status suggested that the prevalence of biochemical hyperthyroidism in the study was 3%, with 13 of 415 cases in rural and 3 of 149 cases in urban subjects. CONCLUSION: This study reaffirms the need to continuously monitor iodine replacement programs to ensure efficacy.
Adult↗
Changes in growth hormone, insulin, insulinlike growth factors (IGFs), and IGF-binding protein-1 in chronic fatigue syndrome.
Chronic fatigue syndrome (CFS) is characterized by severe physical and mental fatigue of central origin. Similar clinical features may occur in disorders of the hypothalamopituitary axis. The aim of the study was to determine whether patients with CFS have abnormalities of the growth hormone/insulinlike growth factor (GH-IGF) axis basally or following hypothalamic stimulation with insulin-induced hypoglycemia. We compared levels of GH, IGF-I, IGF-II, IGF-binding protein-1 (IGFBP-1), insulin, and C-peptide in nondepressed CFS patients and normal controls. We found attenuated basal levels of IGF-I (214 +/- 17 vs. 263.4 +/- 13.4 micrograms/L, p = .036) and IGF-II (420 +/- 19.8 vs. 536 +/- 24.3 micrograms/L, p = .02) in CFS patients and a reduced GH response to hypoglycemia (peak GH; 41.9 +/- 11.5 vs. 106.0 +/- 25.6 mU/L, p = .017). Insulin levels were higher (7.6 +/- 1.0 vs. 4.3 +/- 0.8 mU/L, p = .02) and IGFBP-1 levels were lower (19.7 +/- 4.6 vs. 43.2 +/- 2.7 mg/L, p = .004) in CFS patients compared with controls. This study provides preliminary data abnormalities of the GH-IGF axis in CFS. It is not apparent whether these changes are components of a primary pathological process or are acquired secondary to behavioral aspects of CFS such as reduced physical activity.
Adult↗
Morbidity and disability in elderly Zimbabweans.
BACKGROUND: the population aged over 60 years in Zimbabwe is expanding. Despite the likely increased demand on medical services that this will bring, little is known about the health needs of this elderly population. OBJECTIVE: to record the prevalence of disability (impairment of activities of daily living), subjective morbidity (symptoms), the social circumstances and the utilization of health services in a group of elderly Zimbabweans. DESIGN: cross-sectional community survey. SETTING: a remote rural area in North Eastern Zimbabwe and two urban townships located approximately 80 km from Harare. SUBJECTS: 278 subjects (154 women, 174 rural), aged > 60 years (range 60-92) living at home. METHOD: subjects were selected by random cluster sampling. They were assessed in a structured interview and underwent physical examination including visual acuity, inspection for cataracts and assessment of mobility. RESULTS: less than 4% experienced difficulty with self-maintenance activities of daily living, but 30% had difficulty with instrumental activities. The former were all visually impaired and both visual and mobility problems contributed to the latter. Elderly people experienced many symptoms but had inadequate access to health services and used medication infrequently. Subjects were mainly self-sufficient for financial income and 60% still worked. They had declining resources with age and received little help from the social welfare department. Their health and functional abilities deteriorated with age but it was older subjects who had most difficulty getting to the clinic. Simple measures such as cataract surgery and analgesics were available only to the minority or not at all. CONCLUSIONS: this study highlights problem areas where simple, low-cost measures could make a difference to the morbidity and disability of elderly Zimbabweans.
Activities of Daily Living↗
Diet and nutritional status in elderly Zimbabweans.
BACKGROUND: nutritional studies in developing countries tend to focus on women of reproductive age and children. Little is known about the diet or nutritional status of elderly Africans. OBJECTIVE: to record the diet, anthropometric, haematological and biochemical measurements which might reflect nutrition and social factors in a group of elderly Zimbabweans. DESIGN: cross-sectional community survey. SETTING: a remote rural area in north-eastern Zimbabwe and two urban townships located approximately 80 km from Harare. SUBJECTS: 278 subjects (154 women, 174 rural), aged >60 years (range 60-92), living at home. METHOD: subjects were selected by random cluster sampling. Diet was assessed by a food frequency questionnaire. Anthropometric measurements were body mass index (BMI), waist : hip ratio (WHR), triceps and subscapular skinfold thickness (SFT). Laboratory analysis included serum albumin, calcium, haemoglobin, alkaline phosphatase (ALP), cholesterol, triglycerides, vitamin B12 and red blood cell folate levels. RESULTS: the staple diet was maize meal and vegetables; 74 (27%) ate a protein-containing meal less than once a week; 135 (49%) took milk less than once a week and 27% had serum Ca2+ < 2 mmol/l. The frequency of eating meat, milk, bread and fried food varied with income and education and declined with age. For all anthropometric measurements median values were higher in the urban area (BMI 21.1 vs 18.3, WHR 0.98 vs 0.9, triceps SFT 10 vs 6.7 mm; P < 0.001 for all) and related to the frequency of eating meat and fried food. The BMI was higher in those with more years of education. Within the rural area physical measurements were higher in a more prosperous area. Serum lipid concentrations were higher in urban residents (median cholesterol 4.4 vs 3.9 mmol/l, triglycerides 1.8 vs 1.5 mmol/l; P < 0.001 for both) and correlated with BMI, WHR and triceps SFT. Vitamin B12 concentrations were higher in urban residents, whereas folate concentrations were higher in rural residents. CONCLUSIONS: dietary patterns, anthropometric measurements and biochemical values in a group of randomly-selected elderly Zimbabweans are influenced by area of residence, age, income and educational level.
Aged↗
Hypertension management in Zimbabwe--awareness, treatment and blood pressure control. A community-based study.
OBJECTIVE: To evaluate the level of awareness of hypertension, treatment and blood pressure control in rural and urban communities in Zimbabwe. DESIGN: Community-based cross-sectional survey. SUBJECTS AND SETTING: 749 male and female heads of households aged > 34 years recruited from alternate households of randomly selected villages in two adjacent rural areas and randomly selected streets in an urban area. MAIN OUTCOME MEASURES: Blood pressure, awareness of hypertension, treatment and control for those on drug therapy. RESULTS: 250 subjects were found to have a diastolic blood pressure (DBP) > 94 mmHg or were on treatment with a DBP < 95 mmHg. Only 56 (22.4%) were on treatment. Of those not on treatment, 73.9% were not aware that they were hypertensive, while only 26.1% were aware but were untreated. Of those on treatment, control was inadequate in 24 (52.2%). CONCLUSION: Awareness is low and treatment and control of hypertension are inadequate in this population. There is an urgent need to set up a national policy for the prevention and control of hypertension in Zimbabwe. The main focus should be on prevention, as this may be more cost-effective for a developing country with limited resources.
Adult↗
Anaemia, macrocytosis, vitamin B12 and folate levels in elderly Zimbabweans.
OBJECTIVES: To establish the ranges of full blood count (FBC), vitamin B12 and folate levels and to determine the prevalence of occult haematological abnormalities in older Zimbabweans. STUDY DESIGN: Community based cross sectional survey. SUBJECTS: 278 randomly selected healthy Zimbabweans aged > 65 years. INTERVENTIONS/STUDY FACTORS: Haemoglobin level, MCV, folate, B12 alcohol consumption. RESULTS: The median Hb was males 14.0 (range 8 to 18.3), females 13.1 g/dl (7.9 to 18.1). 23% were anaemic (Hb < 13 g/dl in males, < 12 g/dl in females), 3% with microcytic and 20% with macrocytic indices. Overall 13% had low vitamin B12 and 30% had low folate levels. Folate levels were significantly lower in urban subjects and B12 levels were significantly lower in rural subjects. Fifty four subjects (21%) had an MCV > 100 fl. In this group, low folate levels were found in 22, low B12 levels in nine, excessive alcohol in eight and two subjects had elevated TSH. The MCV was higher in urban subjects. CONCLUSIONS: This study has revealed a large amount of occult haematological abnormality and interesting differences between rural and urban subjects. It focuses attention on low levels of folate, which should be preventable by simple nutritional education, as an extensive problem in the community.
Aged↗
The isoform-specific expression of the tri-iodothyronine receptor in osteoblasts and osteoclasts.
Hyperthyroidism is associated with an increase in both osteoblast and osteoclast activity. We have previously shown that, in vitro, osteoclasts do not respond directly to tri-iodothyronine to increase bone resorption but that the effect is mediated by another bone cell, probably the osteoblast. To investigate this issue further we have studied the isoform-specific expression of thyroid receptor (TR) protein in human osteoclasts derived from an osteoclastoma (giant cell tumour of bone) and the expression of TR mRNA and protein in the osteoblastic cell lines MG 63 and UMR 106. Three major TR receptor variants have been described; TR alpha 1 and TR beta are functional receptors whereas c-erbA alpha 2 is a non-functional variant. Northern blot analysis using [32P]-cDNA probes against human TR alpha 1, c-erbA alpha 2 and TR beta demonstrated specific binding of these probes to mRNA from MG 63 and UMR 106. mRNA for all three receptor variants was observed in both cell lines, in UMR 106 multiple mRNA transcripts were present for TR alpha 1 and TR beta. Immunohistochemical staining with antibodies recognizing a common TR alpha epitope and specific c-erbA alpha 2 and TR beta epitopes extended these observations by demonstrating receptor protein in both osteoblasts and osteoclasts. These findings are consistent with previous observations of TR expression in osteoblast-like-cells and are the first direct demonstration of TR in osteoclasts.
Animals↗
Abbreviated Mental Test (AMT) in the elderly: shortcoming of an adapted AMT in Zimbabwe.
OBJECTIVE: To measure the abbreviated mental test (AMT)-and to determine factors which might influence this in a group of Zimbabwean elders. DESIGN: Community based cross sectional survey. SETTING: Randomly selected households within randomly selected villages and two high-density urban areas in north eastern Zimbabwe. SUBJECTS: 278 subjects aged 60 to 92 years (124 male, 154 female). INTERVENTIONS: A questionnaire, including the AMT, was administered, at home, by trained research nurses. MAIN OUTCOME MEASURES: AMT-literacy rates, visual acuity, social and demographic information. RESULTS: 128 (46pc) scored less than seven, a level normally associated with significant mental impairment. Only one subject was actually disoriented in time and place. Multiple regression analysis confirmed that increasing age, female sex, rural evidence, lack of formal education, reduced visual acquity and not currently living with a spouse were all independent factors associated with low AMT score. CONCLUSION: It was apparent that the AMT was not a valid tool for screening for confusion in Zimbabwean elderly, since the prevalence of senile-dementia is increasing in the developing world. It is important to develop a screening test for use in Zimbabwe which is sensitive but is independent of these confounding variables.
Aged↗
Determinants of happiness and life satisfaction in elderly Zimbabweans.
OBJECTIVE: To assess determinants of happiness and life satisfaction in elderly Zimbabweans. DESIGN: Community based cross sectional survey. SETTING: Randomly selected villages and two urban areas in north eastern Zimbabwe. SUBJECTS: 278 subjects aged 60 to 92 years (124 male, 154 female). METHOD: One subject per randomly selected household was interviewed, at home, by a trained interviewer to complete a questionnaire. RESULTS: Independent determinants of happiness were: rural residence, whether children gave material support and satisfaction with financial circumstances. [Adjusted odds ratios and confidence intervals 0.25 (0.13 to 0.49), 0.45 (0.22 to 0.94) and 0.11 (0.01 to 0.87) respectively]. Independent determinants of life satisfaction were: feeling better off than their neighbours, receiving adequate respect from their children and satisfaction with financial circumstances. [Adjusted odds ratios and confidence intervals 0.73 (0.59 to 0.91), 0.13 (0.03 to 0.59) and 0.24 (0.1 to 0.61) respectively]. CONCLUSIONS: We have demonstrated that, despite physical hardship, the majority of Zimbabwean elders are happy and 50% are satisfied with their lives and we have identified independent determinants of happiness and life satisfaction in this group. Characterization of these determinants allows us to predict that social changes such as rural/urban migration, declining family support and diminishing respect from children will have a negative effect on happiness and life satisfaction in our elders. It is important that, when planning intervention programmes for the elderly, these facets of wellbeing are not neglected.
Aged↗
A histomorphometric study of bone changes in thyroid dysfunction in rats.
Clinical studies in thyrotoxicosis reveal a state of high bone turnover leading, eventually, to osteoporosis. Recently there has been concern that thyroxine (T4) treatment may have a similar effect on bone. Rat models have been used to study the effects of T4 on bone, but the majority of studies have looked at the effects of T4 after only 3 weeks of treatment. The aim of this study was to evaluate histomorphometric changes in rats after 12 weeks of thyroxine overtreatment or 12 weeks of hypothyroidism compared with untreated control animals. Animals received either T4 200 micrograms/kg per day, 0.1% propylthiouracil, or vehicle for 12 weeks. Tetracycline was administered 1 week and 3 weeks prior to killing. Iliac crest bone was used for histomorphometry. Serum T4 measurements (taken at killing) confirmed hyper- and hypothyroidism in the appropriate animal groups (between group difference p < 0.001 by ANOVA). In hyperthyroid animals there was an increase in mineral apposition rate (MAR; 0.94 vs. 0.59 microns/day, p < 0.001) and mineral formation rate (MFR/BS; 0.24 vs. 0.12 x 10(-2) micron3/micron2 per day, p < 0.001) and a slight increase in eroded surfaces (ES/BS%; 1.54 vs. 1.36, p < 0.05) compared with controls, consistent with previous in vitro and in vivo observations. In hypothyroid rats there was a marked reduction in osteoid surfaces (OS/BS%; 1.7 vs. 24.8, p < 0.001) and MAR (0.3 vs. 0.59 micrograms/day, p < 0.001), a reduction in ES/BS% (0.51 vs. 1.36, p < 0.05), and an increase in cancellous bone volume (BV/TV%; 30.29 vs. 19.6, p < 0.05), suggesting that thyroid hormones are a requirement for normal bone turnover.(ABSTRACT TRUNCATED AT 250 WORDS)
Analysis of Variance↗
A case of gram negative pericarditis in a patient with the Acquired Immunodeficiency Syndrome.
A diagnosis of pericarditis due to Escherichia coli was made in a 38 year old male patient with AIDS. The source of infection in this patient was not established. This case highlights the need to carry out a diagnostic pericardiocentesis in immunocompromised patients presenting with pericardial effusions and the importance of adequate antibiotic cover when treating such patients prior to microbiological confirmation of the causative organism.
AIDS-Related Opportunistic Infections↗
The management of diabetic ketoacidosis.
Explore the source record for details and available documents.
Blood Glucose↗
Thyroid hormones and bone.
Explore the source record for details and available documents.
Bone Density↗