Objectives: Sleep disturbance in the elderly is associated with cognitive decline. Sleep quality is known to deteriorate with age, and prospective studies seldom have examined the relationship between sleep quality and cognitive function. This study investigates the relationship between early sleep quality and cognitive function based on six-year follow-up data of community individuals older than 60 years. Methods: The participants included 622 community elderly people older than 60 years from Jinju-Si. The final analysis comprised 322 elderly people. Pittsburgh sleep quality index (PSQI) and the Korean version of Consortium to Establish a Registry for Alzheimer’s Disease (CERAD-K) were used to assess early sleep quality and cognitive function after six years. Multiple linear regression analysis was performed to investigate the association between early sleep quality and cognitive function in the elderly. Results: Early sleep quality (PSQI) was significantly associated with the results of the digit span test, clock drawing test (clox 1), and word recall test after six years. Sleep quality (PSQI) decreased significantly after six years, and lower quality of sleep (PSQI) score was associated with higher digit span test score (β = -0.167, p = 0.026) and higher clock drawing test score (β = -0.157, p = 0.031). Lower quality of sleep (PSQI) score was associated with higher word recall test (β = -0.140, p = 0.039). Conclusion The digit span test, word recall test, and clock drawing task (CLOX 1) shown to be significantly associated to sleep quality can be performed fast and easily in clinical practice. It is important to assess early cognitive function in the elderly with poor sleep quality, and further studies could suggest that these tests may be useful screening tests for early dementia in elderly with poor sleep quality.

Background: American Society for Bone and Mineral Research recommend the use of intramedullary reconstruction of full length-nail for atypical subtrochanteric femoral fracture (ASFF). However, there is no study on the incidence of the ipsilateral femoral fracture after index operation of ASFF, and full-length nail has disadvantage as iatrogenic fracture and leg length discrepancy (LLD). The aim of this study was to investigate the incidence of ipsilateral secondary fracture after using partial-length nail, and to compare the outcomes on surgery of ASFF between partial length-nails and full length-nails. Methods: Forty-five consecutive fractures with ASFFs which had undergone intramedullary fixation using cephalomedullary nail between 2011 and 2018 were enrolled. The 45 cases were grouped based on nail length into the partial-length nail group (n=26) and the full-length nail group (n=19). Ipsilateral secondary fracture, time to union, intra-operative iatrogenic fracture, metal failure, LLD, operative duration, and post-operative 24-hr blood loss were investigated. Results: There was no ipsilateral secondary fracture after index operation. There were no statistically significant differences between the partial-length nail and full-length nail groups in the time to union, LLD, and post-operative 24-hr blood loss (P=0.427, 0.478, and 0.228, respectively). Operative duration showed statistically significant difference between 2 groups (P=0.034). Metal failure were occurred in 1 (3%) case of the partial-length nail group and 2 (10%) cases of the full-length nail group. Iatrogenic fractures during nail insertion occurred in 2 (7%) cases of the partial-length-nail group and 3 cases (15%) of the full-length nail group. Conclusions Although large scale studies are required, our study indicate that full-length nails are not usually required for the treatment of ASFF.

BACKGROUND: There have been a number of studies on mitral valve replacement and repeated percutaneous mitral balloon valvotomy for mitral valve restenosis after percutaneous mitral balloon valvotomy. However, studies on mitral valve repair for these patients are rare. In this study, we analyzed postoperative outcomes of mitral valve repair for mitral valve restenosis after percutaneous mitral balloon valvotomy. METHODS: In this study, we assessed 15 patients (mean age, 47.7+/-9.7 years; 11 female and 4 male) who underwent mitral valve repair between August 2008 and March 2013 for symptomatic mitral valve restenosis after percutaneous mitral balloon valvotomy. The mean interval between the initial percutaneous mitral balloon valvotomy and the mitral valve repair was 13.5+/-7 years. The mean preoperative Wilkins score was 9.4+/-2.6. RESULTS: The mean mitral valve area obtained using planimetry increased from 1.16+/-0.16 cm2 to 1.62+/-0.34 cm2 (p=0.0001). The mean pressure half time obtained using Doppler ultrasound decreased from 202.4+/-58.6 ms to 152+/-50.2 ms (p=0.0001). The mean pressure gradient obtained using Doppler ultrasound decreased from 9.4+/-4.0 mmHg to 5.8+/-1.5 mmHg (p=0.0021). There were no early or late deaths. Thromboembolic events or infective endocarditis did not occur. Reoperations such as mitral valve repair or mitral valve replacement were not performed during the follow-up period (39+/-16 months). The 5-year event-free survival was 56.16% (95% confidence interval, 47.467-64.866). CONCLUSION: On the basis of these results, we could not conclude that mitral valve repair could be an alternative for patients with mitral valve restenosis after percutaneous balloon mitral valvotomy. However, some patients presented with results similar to those of mitral valve replacement. Further studies including more patients with long-term follow-up are necessary to determine the possibility of this application of mitral valve repair.
Balloon Valvuloplasty ; Disease-Free Survival ; Endocarditis ; Female ; Follow-Up Studies ; Humans ; Mitral Valve* ; Ultrasonography

Disasters complicate the management of noncommunicable diseases (NCDs) by disrupting access to and delivery of health care, including medicines. Following Typhoon Haiyan in the Philippines in November 2013, much of the health infrastructure was destroyed and health service delivery was severely affected. This left many people with NCDs vulnerable as medicines were destroyed or washed away, food was scarce, and access to medicines and drugs and quality health care was difficult.

OBJECTIVE: This paper aims to provide concise background information regarding the state of noncommunicable diseases (NCDs) and their risk factors as well as the existing efforts to address them in the Philippines in the last 25 years.

METHODS: A desk review of documents and literature review as well as analyses of available statistical data and several consultations with involved government agencies have been made to come up with summary figures and tables.

RESULTS: NCDs as well as metabolic conditions that can potentially lead to NCDs are on the rise in the last score of years. The Philippines, through the Department of Health, has been visionary in leading various projects and activities to fight NCDs over the last two decades, and its efforts are slowly paying off: the prevalence of tobacco use and that of hypertension have decreased over the last 5 years. NCD mortality (including premature deaths) and prevalence of behavioral risk factors, however, generally remain high, and the Philippines needs to accelerate whole-of-society and whole-of-government actions to sustain the gains and attain its NCD targets in the next 10 years or so.

CONCLUSION: The need to strengthen health system interventions and promote accountability of various sectors in addressing NCDs and its risk factors in the country arises. The development of a multisectoral action plan on NCD prevention and control is needed to halt the rise of NCDs in the country.

BACKGROUND: Delirium after cardiac surgery is associated with serious long-term negative outcomes and high costs. The aim of this study is to evaluate neurobehavioral, hemodynamic, and sedative characteristics of dexmedetomidine, compared with the current postoperative sedative protocol (remifentanil) in patients undergoing open heart surgery with cardiopulmonary bypass (CPB). METHODS: One hundred and forty two eligible patients who underwent cardiac surgery on CPB between April 2012 and March 2013 were randomly divided into two groups. Patients received either dexmedetomidine (range, 0.2 to 0.8 microg/kg/hr; n=67) or remifentanil (range, 1,000 to 2,500 microg/hr, n=75). The primary end point was the prevalence of delirium estimated daily via the confusion assessment method for intensive care. RESULTS: When the delirium incidence was compared with the dexmedetomidine group (6 of 67 patients, 8.96%) and the remifentanil group (17 of 75 patients, 22.67%) it was found to be significantly less in the dexmedetomidine group (p<0.05). There were no statistically significant differences between two groups in the extubation time, ICU stay, total hospital stay, and other postoperative complications including hemodynamic side effects. CONCLUSION: This preliminary study suggests that dexmedetomidine as a postoperative sedative agent is associated with significantly lower rates of delirium after cardiac surgery.
Adult* ; Cardiopulmonary Bypass* ; Delirium* ; Dexmedetomidine* ; Hemodynamics ; Humans ; Incidence ; Critical Care ; Length of Stay ; Postoperative Care ; Postoperative Complications ; Prevalence ; Thoracic Surgery*

Here, we present a rare case of cardiac parasitic infection found in an adult female patient who had the symptoms of dyspnea upon exertion. She was diagnosed with a double-chambered right ventricle due to infundibular hypertrophy confirmed by transthoracic echocardiography and cardiac computed tomography. We performed surgery of infundibulectomy around the pulmonary valve. In the end, histopathological findings of the resected infundibular muscle demonstrated trichinellosis, a type of roundworm infection.
Adult ; Dyspnea ; Echocardiography ; Female ; Heart Ventricles* ; Humans ; Hypertrophy ; Pulmonary Valve ; Trichinellosis*

OBJECTIVES: To compare the incidence of osteoporosis and the related factors among fracture sites in above 50 year-old patients with fractures caused by low-energy trauma. MATERIALS AND METHODS: Seven hundred and fourteen patients with fracture from low energy trauma were evaluated retrospectively. By the Dual-energy x-ray absorptionmetry, we measured bone mineral density (BMD) at lumbar spine and proximal femur, and compared the incidence of osteoporosis, age, sex, body mass index (BMI), previous fracture history, past osteoporosis medication history according to each fracture sites. RESULTS: BMD was decreased according to increasing age with statistical significance (P<0.001). Sex has no significant difference according to fracture site (P=0.141). Average age of patients with osteoporotic fracture was 73.8, 72.8, 66.3, 73.4, 78.3 years old according to fracture site as T-spine, L-spine, distal radius, proximal humerus and proximal femur, respectively. There was significant difference among groups (P<0.001). Average BMI related with osteoporotic fracture site was 22.9 kg/m2, 22.7 kg/m2, 23.4 kg/m2, 23.0 kg/m2, 21.7 kg/m2, respectively and it showed significant difference among groups (P<0.001). Average bone mass and T-score related with osteoporotic fracture site was 0.587 g/cm2 (-3.5), 0.614 g/cm2 (-3.1), 0.647 g/cm2 (-2.6), 0.597 g/cm2 (-3.1), 0.554 g/cm2 (-3.5), with significant difference among groups (P<0.001). Previous fracture history had no significant difference among groups (P=0.078). Previous osteoporosis medication history had significant difference among the groups (P<0.001). CONCLUSIONS: In low-energy traumatic fracture, age, BMI and previous osteoporosis medication history are significantly related factors with BMD and osteoporotic fracture. Early diagnosis of osteoporosis and osteoporotic medication use is effective for decrease incidence of low-energy osteoporotic fracture.
Body Mass Index ; Bone Density ; Early Diagnosis ; Femur ; Humans ; Humerus ; Incidence ; Middle Aged ; Osteoporosis ; Osteoporotic Fractures ; Radius ; Retrospective Studies ; Spine

A 55-year-old woman who had a history of percutaneous vertebroplasty was referred to our institution with sudden onset of chest pain. Computed tomography (CT) scan demonstrated a long, linear, highly-attenuated segment in the right side of the heart and fragmented pieces in the right pulmonary artery. The CT scan and echocardiogram revealed no pericardial effusion or hemopericardium. Based on these findings, we performed surgery through right anterolateral thoracotomy without cardiac arrest. As a result, we safely removed the foreign body. This approach may be a feasible and effective procedure for selected cases.
Bone Cements ; Chest Pain ; Female ; Foreign Bodies ; Heart ; Heart Arrest ; Humans ; Middle Aged ; Pericardial Effusion ; Pulmonary Artery ; Thoracotomy ; Vertebroplasty

BACKGROUND: Reoperation of cardiac surgery via median sternotomy can be associated with significant complications. Thoracotomy is expected to reduce the risk of reoperation and to enhance the surgical outcomes. We retrospectively analyzed two operative approaches (thoracotomy vs. sternotomy) in cardiac reoperation. MATERIALS AND METHODS: From September 2007 to December 2010, 35 patients who required reoperation of the mitral valvular disease following previous median sternotomy were included. Average age of patients was 45.8+/-15.4 years (range, 14 to 76 years) and male-to-female was 23:12. Interval period between primary operation and reoperation was 135.8+/-105.6 months (range, 3.3 to 384.9 months). RESULTS: Comparative analysis was done dividing the patient group into two groups that are thoracotomy group (22 patients) and sternotomy group (13 patients). Thoracotomy group was significantly lower in operative time (415.2+/-90.3 vs. 497.5+/-148.0, p<0.05), bleeding control time (108.0+/-29.5 vs. 146.4+/-66.8, p<0.05) and chest tube drainage (287.5+/-211.5 mL vs. 557.3+/-365.5 mL, p<0.05) compared to sternotomy group. CONCLUSION: The thoracotomy approach is superior to sternotomy in some variables, and it is considered as a valid alternative to repeat median sternotomy in patients who underwent a previous median sternotomy.
Chest Tubes ; Drainage ; Hemorrhage ; Humans ; Operative Time ; Reoperation ; Retrospective Studies ; Sternotomy ; Thoracic Surgery ; Thoracotomy