Chronic constipation (CC) is a common disorder in the elderly population globally and is associated with comorbidities and negative implications on the quality of life. Constipation prevalence varies in different studies, primarily owing to the nonuniformity of the diagnostic criteria. However, 15%–30% of individuals aged >60 years are diagnosed with CC. Primary care physicians are the main healthcare providers that manage constipation in elderly patients in parallel with increased population aging and increased prevalence of constipation. Physical inactivity, polypharmacy, chronic medical conditions, rectal hyposensitivity, and defecatory disorders all play a role in the pathogenesis of CC in elderly patients. Detailed anamnesis, particularly history related to chronic medication use, with digital rectal examination may assist in identifying constipation causes. Additionally, blood tests and colonoscopy may identify organic causes of CC. Physiologic tests (i.e., anorectal manometry, colonic transit time with radiopaque markers, and defecography) can evaluate the physiologic function of the colon, rectum, and anus. However, generally, there are several causes of constipation in older patients, and an individualized approach is recommended. Treatment of chronic idiopathic constipation is empiric, based on the stepwise approach. Lifestyle advice, adjustment of chronic medications, and prescription of laxatives are the first steps of management. Several laxatives are available, and the treatment is evolving in the last decade. Biofeedback is an effective therapy especially for defecatory disorders. This review aimed to summarize the most updated knowledge for primary care physicians in the approach and management of CC in elderly patients.
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Background This study aims to examine the association between alcohol consumption and the risk of pre- or type 2 diabetes mellitus (T2DM) by alcohol-induced flushing response in Korean male adults, particularly based on their body mass index (BMI).
Methods This study selected 1,030 (158 non-drinkers, 364 flushers, and 508 non-flushers) male adults who had medical checkups. A logistic regression analysis was used to compare the association between alcohol consumption and the risk of pre- or T2DM.
Results In both the normal-weight group (BMI <23 kg/m2) and the overweight group (BMI ≥23 kg/m2 and <25 kg/ m2), the flushers had a higher risk of pre- or T2DM (odds ratio, 95% confidence interval) when consuming more than 8 drinks of alcohol per week than the non-drinkers (normal-weight group: 3.43, 1.06–11.07; overweight group: 4.94, 1.56–15.67). But in the non-flushers among the normal-weight group and the overweight group, there was no significant difference compared to non-drinkers regarding the risk of pre- or T2DM. Obese flushers had a significantly higher risk of pre- or T2DM when consuming more than 4 drinks of alcohol per week than the non-drinkers (>4 and ≤8 drinks: 2.64, 1.10–6.36; >8 drinks: 2.42, 1.11–5.27). However, obese non-flushers had only a significant higher risk of pre- or T2DM when consuming more than 8 drinks of alcohol per week than the non-drinkers (2.72, 1.39–5.30)
Conclusion These results suggest that obese flushers have an increased risk of developing pre- or T2DM even with less alcohol consumption.
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Background Dengue infection is the most common mosquito-borne disease in Indonesia. Dengue incidence during pregnancy increases with its prevalence among women of reproductive ages. It potentially causes serious maternal and neonatal morbidity and mortality; however, its impact during a period of disease outbreak has not been described. We aimed to assess the outcomes of pregnancies affected by dengue infection during an outbreak in an endemic area of Indonesia.
Methods We conducted a prospective observational study at Sanglah General Hospital, Bali, Indonesia from April 2016 to April 2017. All pregnant women with clinical symptoms of dengue infection who tested positive for dengue nonstructural protein 1-antigen or anti-dengue immunoglobulin M were included in the study. Clinical features and hematological and biochemical parameters were documented to assess their relationship with maternal and neonatal outcomes.
Results Our study population consisted of 41 pregnant women. Most were multigravida (58.5%). Dengue infection without warning signs was observed in 31.7% of the cases, while 53.7% had dengue infection with warning signs, and 14.6% had dengue shock syndrome/severe dengue infection. Most pregnancies were in the third trimester (78%); five cases (12.2%) suffered clinical complications. Preterm delivery was observed in seven cases (17.1%). Most patients (75.6%) decided to seek medical treatment at a critical phase of dengue infection (days 3–6).
Conclusion The high incidence of associated morbidity and mortality should warrant clinicians in endemic regions to consider diagnoses of dengue infection when treating pregnant women with clinical signs and symptoms. Patients should be treated at centers with adequate resources for monitoring and emergency procedures. A more intensive study is needed in the future aiming to make a more comprehensive guideline.
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Background Sarcopenia is an important health problem, the risk factors of which a few studies have reported on. The purpose of this study was to evaluate the correlation between sarcopenia and the ratio of total energy intake to basal metabolic rate (BMR) as well as physical activity, and determine whether the relationship was different between younger and older age groups using data from the 2008–2011 Korea National Health and Nutrition Examination Survey.
Methods We analyzed 16,313 subjects older than 19 years who had dual energy X-ray absorptiometry data. Sarcopenia was defined as an appendicular lean mass/weight (%) ratio of 1 standard deviation below the sex-specific mean value for a younger reference group, and BMR was calculated using the Harris–Benedict equation. A chi-squared test and logistic regression analyses were performed to evaluate the factors associated with sarcopenia.
Results In this study, 15.2% of males and 15.4% of females had sarcopenia. Energy intake/BMR as well as physical activity was negatively related to sarcopenia risk. In stratified analysis by age and sex, strength exercises showed an inverse association with sarcopenia only in males under the age of 50 years (odds ratio, 0.577; P<0.0001), whereas higher energy intake/BMR was negatively associated with sarcopenia in each age and sex group.
Conclusion Our findings suggest that adequate energy intake is important to prevent sarcopenia regardless of whether one exercises.
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Background Osteoporosis is characterized by a decrease in bone mineral density (BMD) and increased risk of fragility fractures. Serum iron level may interact with bone health status. This study investigated the correlations of BMD with serum iron level, hemoglobin level, and total iron-binding capacity (TIBC).
Methods We performed a retrospective analysis of data from the medical records of premenopausal women in South Korea. The women’s BMDs and the Z scores of the BMDs were verified using dual-energy X-ray absorption. The participants were stratified into quartiles for analyses of the associations of BMD with serum iron level, TIBC, and hemoglobin level.
Results A simple linear regression analysis revealed associations of changes in BMD with iron level (β=-0.001, standard error [SE]=0.001, P<0.001), hemoglobin level (β=0.015, SE=0.003, P<0.001), and TIBC (β=0.001, SE=0.001, P<0.001). This pattern was also observed in a multiple linear regression analysis. A multivariate logistic regression analysis of iron level and TIBC for low BMD revealed odds ratios of 1.005 (P<0.001) and 0.995 (P<0.001), respectively.
Conclusion This study demonstrated clear relationships of changes in BMD with serum iron level and TIBC, and thus confirms the usefulness of these markers in the clinical evaluation of iron storage and BMD in younger women.
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Background Few studies have been conducted in Korea on concordance regarding chronic diseases and lifestyle factors among couples. We, therefore, evaluated spousal concordance regarding lifestyle factors and chronic diseases among Korean couples.
Methods A total 1,040 participants (520 couples) who visited family physicians were recruited from 22 hospitals. All participants were aged ≥40 years. Participants completed questionnaires on smoking, drinking, physical activity, and irregular eating habits, including skipping breakfast. We estimated the spousal concordance regarding lifestyle factors and chronic diseases using McNemar tests and logistic regression analysis.
Results The concordance rate was high among couples who shared unhealthy behaviors, such as low physical activity, irregular diet, and skipping breakfast (P<0.05). When cardiovascular risk factors such as overweight (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.14–2.63), hypertension (OR, 1.88; 95% CI, 1.23–2.86), or hyperlipidemia (OR, 2.41; 95% CI, 1.60–3.64) were prevalent among husbands, the odds that their wives also had the same risk factors at the same time was significantly high. The odds of being depressed when the spouse was depressed were also significantly high in both men (OR, 5.54; 95% CI, 2.19–13.96) and women (OR, 4.52; 95% CI, 1.77–11.53).
Conclusion There was a high level of concordance regarding lifestyle factors among couples, which could lead to an increase in the prevalence of chronic diseases among couples. In addition, if a spouse has depression, the odds of their partner also having depression was high.
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Methods We conducted a nationwide cross-sectional study based on the diabetes and hypertension study of the Medical Research Network of the Consortium of Thai Medical Schools. Adult T2DM patients from 831 public hospitals in Thailand were evaluated. The serum uric acid level was categorized into five groups based on quintiles (<4.4, 4.4–5.3, 5.3–6.2, 6.2–7.3, and >7.3 mg/dL). A multivariate logistic regression model was used to assess the independent association between serum uric acid level and peripheral neuropathy.
Results In total, 7,511 T2DM patients with available data about serum uric acid levels were included in the analysis. The mean age of the participants was 61.7±10.9 years, and approximately 35.6% were men. The prevalence rate of peripheral neuropathy was 3.0%. Moreover, the prevalence rates of peripheral neuropathy stratified according to uric acid levels <4.4, 4.4–5.3, 5.3–6.2, 6.2–7.3, and >7.3 mg/dL were 2.5%, 2.8%, 2.4%, 2.5%, and 4.7%, respectively. A serum uric acid level ≥7.3 mg/dL was found to be associated with an increase in odds ratio (1.54; 95% confidence interval, 1.02–2.32) for peripheral neuropathy compared with a serum uric acid level <4.4 mg/dL.
Conclusion Serum uric acid level is independently associated with peripheral neuropathy in T2DM patients, and elevated serum uric acid levels should be considered a risk factor for diabetic peripheral neuropathy in clinical practice.
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Background No previous studies have assessed the psychometric properties of the 36-item version of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) in the Persian language of Iran. This study was designed and conducted to evaluate the validity and reliability of the Persian version using a sample of persons with multiple sclerosis in Ahvaz, Iran.
Methods The methodological study was conducted in two stages: First, the 36 items of the original WHODAS 2.0 were translated to create a Persian version, after which the translation validity and psychometric properties were tested. The factor structure of the instrument was also tested using exploratory and confirmatory factor analyses.
Results The intraclass correlation coefficients were very good to excellent, varying between 0.82 and 0.99 for the six domains, and all domains had Cronbach’s α reliability values of above 0.70. For construct validity, results showed negative and strong correlation between the total score of WHODAS 2.0 and the Multiple Sclerosis Quality of Life-54. Exploratory factor analysis divided the Persian version of WHODAS 2.0 into seven factors for multiple sclerosis patients.
Conclusion The results of this study indicate that the Persian version of WHODAS 2.0 is a valid and reliable instrument to study the disabilities of people with multiple sclerosis.
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Olfactory impairment occurs in patients with Alzheimer’s disease, and olfactory function tests are performed for the diagnosis of Alzheimer’s disease. However, the diagnosis and patient status are not currently outlined for vascular dementia, and many physicians do not consider concurrent vascular dementia in patients complaining of olfactory dysfunction. Here, we report a case of vascular dementia with no symptoms of dementia other than olfactory dysfunction. This case suggested that the olfactory function test is helpful not only for the diagnosis of Alzheimer’s disease but also for the early diagnosis of vascular dementia.
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