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Objective: Probable sarcopenia is a predictor of functional limitation in older adults. However, whether standard thresholds recommended by guides, or population-specific thresholds better predict impairment in functionality is an issue that needs to be enlightened. We aimed to study the associations of probable sarcopenia identified by the use of EWGSOP2 and population-specific thresholds with deterioration in functionality at follow-up and give prevalences of probable sarcopenia with different thresholds in older outpatients admitted to a tertiary health center. Methods: In this retrospective, longitudinal follow-up study, we assessed handgrip strength (HGS) at the admission with a Jamar hand-dynamometer and diagnosed probable sarcopenia with standard and population-specific thresholds, i.e., 27 kg/16 kg, and 35 kg/20 kg in males/females, respectively. We evaluated activities of daily living (ADL) and instrumental ADL (IADL), with Katz and Lawton scales, at the admission and follow-up. To study whether probable sarcopenia was a predictor of impaired functionality, we defined two models for Cox regression analysis. We performed adjustments for age, sex, and nutritional status (assessed by Mini-Nutritional Assessment-Short Form) in Model 1 and defined Model 2 by adding low gait speed and frailty to the variables in Model 1. Results: Among a total of 1970 patients, 195 had follow-up of median 560 days. The mean age was 75.5 ± 5.5, and 142 (72.8%) were female. In the basal evaluation, the prevalences of probable sarcopenia defined by the standard cut-offs and by population-specific cut-offs were 8.7% and 35.4%, respectively. In univariate analyses (Kaplan–Meier log-rank test), probable sarcopenia by population-specific cut-offs, but not EWGSOP2-cut-offs, was associated with deteriorations in both ADL (p = 0.04) and IADL (p < 0.001). In multivariate analyses, only the probable sarcopenia identified by population-specific cut-offs was independently associated with impairment in IADL in both models [HR (95%CI) = 1.88 (1.07–3.30), and 1.9 (1.04–3.6); for Model 1 and Model 2, respectively)]. Conclusion: Our findings suggested that the definition of probable sarcopenia identified by not standard, but population-specific thresholds more reliably predicted longitudinal deterioration of functionality in older outpatients. This finding might be considered as evidence supporting the use of population-specific cut-offs when the concern is sarcopenia diagnosis. [ABSTRACT FROM AUTHOR]

Copyright of Contemporary Islamic Studiens Magazine is the property of Republic of Iraq Ministry of Higher Education & Scientific Research (MOHESR) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

ObjectivesPatients with laboratory or clinical manifestations suggestive of antiphospholipid syndrome (APS) but not fulfilling the classification criteria constitute a clinical challenge. This study aims to compare non-criteria APS (NC-APS) with definite APS in terms of clinical manifestations, therapies, and outcomes.MethodsA systematic review of observational studies comparing definite and NC-APS was performed searching four electronic databases. Data on clinical manifestations, therapies and clinical outcomes was extracted.ResultsSixteen studies, assessing a total of 3,798 participants, were included. Seven out of 10 studies found no significant difference in the prevalence of arterial or venous thrombosis between definite and NC-APS, with two studies on seronegative APS also finding no difference in thrombosis recurrence. Seven out of 12 studies found no significant difference in the prevalence of obstetric manifestations between groups, with the remaining exhibiting conflicting results. In 9 studies comparing treatment frequency in obstetric patients, all but one described similar treatment frequency, with the percentage of NC-APS treated during pregnancy ranging from 26% to 100%. In 10 studies comparing pregnancy outcomes of NC-APS versus definite APS, 7 found similar successful pregnancies/live births. Additionally, 5 studies described improvement of live births in both groups with treatment, with three signalling aspirin monotherapy as efficacious as combination therapy in NC-APS.ConclusionThis review hints at an absence of marked differences in most evaluated parameters between definite and NC-APS, emphasizing the value of a more active follow-up of these patients. The low-quality available evidence highlights the need for well-defined NC-APS populations in future studies.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero, identifier CRD42020210674.

The decrease in social distance together with the normalization period as of June 1, 2020 in our country caused an increase in the number of COVID 19 patients. Our aim was to compare the demographic features, clinical courses and outcomes of confirmed and probable coronavirus disease 2019 (COVID-19) patients admitted to our intensive care unit (ICU) during the normalization period. Critically ill 128 COVID-19 patients between June 1 - December 2, 2020 were analyzed retrospectively. The mean age was 69.7±15.5y (61.7% male). Sixty-one patients (47.7%) were confirmed. Dyspnea (75.0%) was the most common symptom and hypertension (71.1%) was the most common comorbidity. The mean Acute Physiology and Chronic Health Evaluation System (APACHE II) score; Glasgow Coma Score (GCS); Sequential Organ Failure Assessment (SOFA) scores on ICU admission were 17.4 ± 8.2, 12.3 ± 3.9 and 5.9 ± 3.4, respectively. 101 patients (78.1%) received low flow oxygen, 48 had high flow oxygen therapy (37.5%) and 59 (46.1%) had invasive mechanical ventilation. 53 patients (41.4%) had vasopressor therapy and 30 (23.4%) patients had renal replacement therapy (RRT) due to acute kidney injury (AKI). Confirmed patients were more tachypneic (p=0.005) and more hypoxemic than probable patients (p

(1) Background: The diagnosis of invasive aspergillosis (IA) in an intensive care unit (ICU)remains a challenge and the COVID-19 epidemic makes it even harder. Here, we evaluated AspergillusPCR input to help classifying IA in SARS-CoV-2-infected patients. (2) Methods: 45 COVID-19 patients were prospectively monitored twice weekly for Aspergillus markers and anti-Aspergillus serology. We evaluated the concordance between (I) Aspergillus PCR and culture in respiratory samples, and (II)blood PCR and serum galactomannan. Patients were classified as putative/proven/colonized using AspICU algorithm and two other methods. (3) Results: The concordance of techniques applied on respiratory and blood samples was moderate (kappa=0.58 and kappa=0.63, respectively), with ahigher sensitivity of PCR. According to AspICU, 9/45 patients were classified as putative IA. When incorporating PCR results, 15 were putative IA because they met all criteria, probably with a lack of specificity in the context of COVID-19. Using a modified AspICU algorithm, eight patients were classified as colonized and seven as putative IA. (4) Conclusion: An appreciation of the fungal burden using PCR and Aspergillus serology was added to propose a modified AspICU algorithm. This proof of concept seemed relevant, as it was in agreement with the outcome of patients, but will need validation in larger cohorts. [ABSTRACT FROM AUTHOR]

Background: Cefoperazone/sulbactam is a broad-spectrum antibacterial agent. Drug-induced immune hemolytic anemia is a rare but serious condition, and reactive thrombocytosis is caused by processes extrinsic to the megakaryocyte. Limited data are available for cefoperazone/sulbactam-associated hemolytic anemia and reactive thrombocytosis.Case presentation: We report the case of a 60-year-old woman undergoing surgical excision of the left atrial myxoma, who presented with hemolytic anemia and thrombocytosis following cefoperazone/sulbactam administration for lung infection. The duration of cefoperazone/sulbactam therapy was 8 days. Blood analysis showed markedly decreased hemoglobin, hematocrit, and red blood cell levels, with elevated lactate dehydrogenase, indirect bilirubin, platelets, and reticulocytes. Furthermore, the direct antiglobulin test was positive for anti-C3 and a diagnosis of hemolytic anemia and reactive thrombocytosis was made. Then, cefoperazone/sulbactam was discontinued and red blood cell transfusion was performed for 3 days. After 1 week, the patient’s condition improved, and she was discharged.Conclusion: This is the first suspected case report of immune hemolytic anemia and reactive thrombocytosis related to cefoperazone/sulbactam. Caution should be taken for this reaction in patients undergoing cefoperazone/sulbactam therapy.

Background: Cefoperazone/sulbactam is a broad-spectrum antibacterial agent. Drug-induced immune hemolytic anemia is a rare but serious condition, and reactive thrombocytosis is caused by processes extrinsic to the megakaryocyte. Limited data are available for cefoperazone/sulbactam-associated hemolytic anemia and reactive thrombocytosis. Case presentation: We report the case of a 60-year-old woman undergoing surgical excision of the left atrial myxoma, who presented with hemolytic anemia and thrombocytosis following cefoperazone/sulbactam administration for lung infection. The duration of cefoperazone/sulbactam therapy was 8 days. Blood analysis showed markedly decreased hemoglobin, hematocrit, and red blood cell levels, with elevated lactate dehydrogenase, indirect bilirubin, platelets, and reticulocytes. Furthermore, the direct antiglobulin test was positive for anti-C3 and a diagnosis of hemolytic anemia and reactive thrombocytosis was made. Then, cefoperazone/sulbactam was discontinued and red blood cell transfusion was performed for 3 days. After 1 week, the patient's condition improved, and she was discharged. Conclusion: This is the first suspected case report of immune hemolytic anemia and reactive thrombocytosis related to cefoperazone/sulbactam. Caution should be taken for this reaction in patients undergoing cefoperazone/sulbactam therapy. [ABSTRACT FROM AUTHOR]

This paper examined the possible breading space of tsetse flies in Ikom Local Governement Area and it's environs in Cross River State, Nigeria, using remote sensing and geographic information system techniques. The study used supervised classification techniques with maximum likelihood algorithms to classify the satellite imagery in to four categories as vegetation-agriculture, water bodies, built-up lands, and other land uses and digitized all the rivers on the imagery as polylines. A buffer operation of 1km away from the digitized area was done; an overlaid analysis was carried out on the buffered operation and the classified image, so as to analyze the probability of breeding of the tsetse flies on each parcel of land. The study grouped the possible breeding sites of the tsetse flies into three; most probable, moderately probable and less probable breeding space. Result of the findings reveals that 48.496 Hectares (24.64 %) is most probable for tsetse flies to breed on, 107.54 hectares (54.24 %) is moderately probable, and 42.231 Hectares (21.3 %) is less probable. Based on the findings of the study it's apparent that Ikom Local Governement Area and it's environs provide a good breeding space and habitat for tsetse flies, it becomes imperative for all stakeholders in the control and eradication of tsetse flies, to work towards its total eradication in the area. [ABSTRACT FROM AUTHOR]

(1) Background: The diagnosis of invasive aspergillosis (IA) in an intensive care unit (ICU) remains a challenge and the COVID-19 epidemic makes it even harder. Here, we evaluated Aspergillus PCR input to help classifying IA in SARS-CoV-2-infected patients. (2) Methods: 45 COVID-19 patients were prospectively monitored twice weekly for Aspergillus markers and anti-Aspergillus serology. We evaluated the concordance between (I) Aspergillus PCR and culture in respiratory samples, and (II) blood PCR and serum galactomannan. Patients were classified as putative/proven/colonized using AspICU algorithm and two other methods. (3) Results: The concordance of techniques applied on respiratory and blood samples was moderate (kappa = 0.58 and kappa = 0.63, respectively), with a higher sensitivity of PCR. According to AspICU, 9/45 patients were classified as putative IA. When incorporating PCR results, 15 were putative IA because they met all criteria, probably with a lack of specificity in the context of COVID-19. Using a modified AspICU algorithm, eight patients were classified as colonized and seven as putative IA. (4) Conclusion: An appreciation of the fungal burden using PCR and Aspergillus serology was added to propose a modified AspICU algorithm. This proof of concept seemed relevant, as it was in agreement with the outcome of patients, but will need validation in larger cohorts.

This paper tries to investigate the policy tools supporting New Technology-Based Firms (NTBFs). Given this aim, after reviewing background research regarding policy tools in Iran and other countries, the policy tools applied in other countries are compared with those applied in Iran and the gap between probable and preferred future situations was investigated in the framework of financial, administrative, information and regulatory policy tools by using paired T-Test and descriptive survey. The components of preferred policy tools are ranked by Freedman test. Research findings indicate that the widest and the narrowest gaps are in financial and information policy tools. The most preferred policy tools include joint ventures, joint R&D, issuing or buying stocks, companies' guarantees to receive aids, networking, grants, loans, incubators' development, creating a proper legal environment, training (managerial/technical) for companies, HR development, awards and bonuses, tax incentives, tax exemptions and consultancy service provision for the companies. [ABSTRACT FROM AUTHOR]

The redefinition of neuropathic pain as "pain arising as a direct consequence of a lesion or disease affecting the somatosensory system," which was suggested by the International Association for the Study of Pain (IASP) Special Interest Group on Neuropathic Pain (NeuPSIG) in 2008, has been widely accepted. In contrast, the proposed grading system of possible, probable, and definite neuropathic pain from 2008 has been used to a lesser extent. Here, we report a citation analysis of the original NeuPSIG grading paper of 2008, followed by an analysis of its use by an expert panel and recommendations for an improved grading system. As of February, 2015, 608 eligible articles in Scopus cited the paper, 414 of which cited the neuropathic pain definition. Of 220 clinical studies citing the paper, 56 had used the grading system. The percentage using the grading system increased from 5% in 2009 to 30% in 2014. Obstacles to a wider use of the grading system were identified, including (1) questions about the relative significance of confirmatory tests, (2) the role of screening tools, and (3) uncertainties about what is considered a neuroanatomically plausible pain distribution. Here, we present a revised grading system with an adjusted order, better reflecting clinical practice, improvements in the specifications, and a word of caution that even the "definite" level of neuropathic pain does not always indicate causality. In addition, we add a table illustrating the area of pain and sensory abnormalities in common neuropathic pain conditions and propose areas for further research. [ABSTRACT FROM AUTHOR]

The present pilot study compared the effects of cognitive and non-cognitive approaches on the development of Japanese learners' knowledge about the different degrees of sureness attached to certain, probable, and possible items. The results showed that the cognitive approach group outperformed the non-cognitive approach and control groups in writing and comparison judgment tests, and that both the cognitive and non-cognitive approach groups performed better than the control group in the categorization judgment test. These results suggest that the cognitive approach with 3D image content through computers can promote L2 language learning because it may have made the target structures more salient and also enabled the participants to connect spatial concepts with different degrees of sureness attached to the certain, probable, and possible items, thereby facilitating deep processing of form-meaning pairings. [ABSTRACT FROM AUTHOR]

Objectives This study aimed to determine the characteristics and significance of a probable diagnostic entity for primary headache disorder (PHD). Background A diagnosis of probable primary headache disorder (PPHD) is given when a patient's headache fulfills all but one criteria of the third beta edition of the international classification of headache disorder (ICHD-3β). Despite the uncertainty regarding this diagnosis, the inclusion of a probable diagnosis entity in this manual may aid in the accurate classification of headache disorders and allow effective treatment strategies to be started at the patient's initial visit. Methods This cross-sectional multicenter registry study assessed first-visit patients with complaints of headaches who presented at the outpatient clinics of 11 neurologists in Korea. The classification of a headache disorder was made according to the criteria of the ICHD-3 β by each investigator based on the initial evaluation of the patient or by a consensus meeting for uncertain cases. The rates of a probable diagnosis among PPHD patients were assessed and the clinical characteristics of these patients were compared with those of patients with a diagnosis of definite primary headache disorder (DPHD). Results A total of 1429 patients were diagnosed with PHD, and 305 (21.3%) of these patients had PPHD. The proportions of PPHD differed among the subtypes of DPHD as follows: migraines (16.1%), tension-type headaches (TTH; 33%), trigeminal autonomic cephalalgia (TAC; 40.9%), and other PHD (14%, P < .001). Patients with PPHD had less severe headache intensity than patients with DPHD (5.8 ± 2.2 vs 6.5 ± 2.1, respectively, P < .001) as well as a shorter duration of headache from onset (median: 1 vs 4 months, respectively, P < .001). The most common criteria missing for a definite diagnosis in the PPHD patients were total frequency (52.1%), duration of attack (14.4%), and accompanying symptoms (13.1%). Conclusions A probable diagnosis was given to 21.3% of the first-visit PHD patients due to incomplete or atypical presentations of the headaches. The incorporation of a probable diagnosis into the ICHD-3 β may be useful for reducing the diagnoses of unspecified headaches. [ABSTRACT FROM AUTHOR]

Islamic law introduced some do's and don'ts and morals to ensure community coherence and spread love between individuals. This research highlights the probable among people and shows what the consequent effects on the individual and society. We collected the Ayat on that subject to extract its significance.

An adverse drug reaction is a causal relationship between a drug and an event. Alcohol consumption remains a huge threat to the global health. A seizure is an event accompanied with loss of motor activity and alterations in the patients EEG. Phenytoin is one of the most commonly employed anti-seizure medications. Manifestations of chronic phenytoin use may induce phenytoin toxicity and psychosis. Here we report a case of a 45 year old male patient with probable phenytoin induced psychosis while being treated for seizures in the in-patient ward. The long term use of phenytoin may manifest psychotic symptoms in certain population. There is a definite need of more evidence in this field and proper diagnostic and management approaches. [ABSTRACT FROM AUTHOR]

To assess the value of clinical definitions for human granulocytic anaplasmosis (HGA) epidemiological, clinical and laboratory findings in 50 adult patients with proven HGA ( Anaplasma phagocytophilum isolated from blood, and/or positive PCR result, and/or seroconversion or ≥4−fold change in serum IFA antibody titres to A. phagocytophilum ) and 46 patients with probable HGA (demonstration of serum antibodies to A. phagocytophilum in titres ≥1:256) were compared. Patients with proven HGA were older (55 versus 43.5 years; p = 0.001), were more often treated with doxycycline (31/50, 62% versus 11/46, 23.9%; p < 0.001), more frequently reported chills (40/50, 80% versus 17/46, 36.9%; p < 0.001), myalgia (37/50, 74% versus 21/46, 45.7%; p = 0.005) and cough (10/50, 20% versus 2/46, 4.4%; p = 0.02), and had more often abnormal laboratory findings such as thrombocytopenia (45/50, 90% versus 22/46, 47.8%; p < 0.001), abnormal liver function test results (45/50, 87% versus 22/46, 47.8%; p < 0.001), leukopenia (38/50, 76% versus 21/46, 45.7%; p = 0.002) and elevated serum CRP concentration (48/50, 96% versus 31/46, 67.4%; p < 0.001). The dissimilarities imply that in some patients fulfilling criteria for probable HGA the signs and symptoms most likely are not the result of a recent infection with A. phagocytophilum and indicate that clinical definitions used in the present study have a distinctive value. [ABSTRACT FROM AUTHOR]

This study deals with the place of Cicero’s Academics in the Middle Ages. It focuses on the case study of John Salisbury who is one the few medieval philosopher to claim to be an Academic (Academicus). We first examine the progress of the medieval reception of Academics and individuate John’s ciceronian corpus. We conclude from this analysis that he probably did not have a direct access to the Academics. But, relying on some other ciceronian works, he was able to build a new form of skepticism, both ciceronian and christian.

Defining qualified reasoning as reasoning containing such loose qualifying words as 'probably,' 'usually,' 'probable, 'likely,' 'ceteris paribus,' and 'primafacie, Ennis argues that typical cases of qualified reasoning, though they might be good arguments, are deductively invalid, implying that such arguments fail soundness standards. He considers and rejects several possible alternative ways of viewing such cases, ending with a proposal for applying qualified soundness standards, which requires employment of sufficient background knowledge, sensitivity, experience and understanding of the situation. All of this takes place as part of the process, introduced elsewhere, of successively applying different legitimate sets of standards until one is found that is satisfied, or none is found, the latter calling for rejection of the argument, the former calling for its acceptance.

Se realizó un estudio descriptivo para conocer la prevalencia de deterioro cognoscitivo de un grupo de pacientes de edad avanzada, pertenecientes a 3 consultorios médicos del Policlínico Docente "Ana Betancourt". El universo del estudio estuvo integrado por el total de pacientes mayores de 60 años (303). El deterioro cognoscitivo se evidenció en 49 de ellos, con una prevalencia estimada de 17,4 % . Se diagnosticaron 41 con síndrome demencial con un tiempo de evolución promedio de 2 años. El 53,7 % de los pacientes con síndrome demencial mostraron probable demencia en la enfermedad de Alzheimer de inicio tardío, el 26,8 % mostró una probable demencia vascular, mientras que el 19,5 % exhibió una probable demencia mixta. El grado de deterioro cognoscitivo mostró relación con el probable diagnóstico causal del síndrome demencial, y resultó mayor el grado de deterioro mental en los adultos mayores que sufren de probable demencia en la enfermedad de Alzheimer de inicio tardío.A descriptive study was conducted aimed at knowing the prevalence of cognoscitive deterioration in a group of aged patients from 3 family physicians' offices of "Ana Betancourt" Teaching Polyclinic. All the patients over 60 (303) entered into the study. Cognoscitive deterioration was observed in 49 of them with an estimated prevalence of 17,4 %. 41 were diagnosed demential syndrome with an average time of evolution of 2 years. 53.7 % of the patients with demential syndrome showed probable dementia in late onset Alzheimer's disease. 26,8 % presented a possible vascular dementia, whereas 19,5 % exhibited a probable mixed dementia.The degree of cognoscitive deterioration had a relation with the probable diagnosis causing demential syndrome. The mental deterioration degree proved to be higher in the elderly suffering from probable dementia in late onset Alzheimer's disease.

The classification criteria for antiphospholipid syndrome (APS) generate discussion, with a growing impression that certain patients not fulfilling these criteria might be inadequately excluded from the classification. Nonetheless, these "non-criteria" patients are heterogeneously defined across different publications. We reviewed the "non-criteria" APS subgroups depicted in the literature and attempted to organize these subsets in a nomenclature proposal that could be used for research purposes. We established four potential patient profiles, grouped under the broad term "non-criteria APS": (A) "Seronegative APS": patients fulfilling clinical criteria, plus "non-criteria" manifestations, with persistently negative antiphospholipid antibodies (aPL); (B) "Clinical non-criteria APS": patients with "non-criteria" manifestations, plus aPL positivity fulfilling the classification criteria; (C) "Incomplete laboratory APS": patients fulfilling clinical criteria, plus positive aPL, but not fulfilling the classification criteria (low titer aPL); and (D) "Laboratory non-criteria APS": patients fulfilling clinical criteria, with negative or low titer criteria aPL, plus positive "non-criteria" aPL. This categorization could allow for a more homogeneous research approach to APS, enabling more sustained and universal conclusions. • "Non-criteria" antiphospholipid syndrome (APS) is heterogeneously described across the literature. • We describe four subsets: "Seronegative APS", "Clinical non-criteria APS", "Incomplete laboratory APS", and "Laboratory non-criteria APS". • This nomenclature aims to allow for a more uniform research approach to APS. [ABSTRACT FROM AUTHOR]

How is it possible to recover the dialogue’s intellectual function? What is it that is learned by its reader? We shall try to settle the question by resorting to Carlo Sigonio’s treatise De dialogo. We shall afterwards refer to Cicero, Sigonio’s model. By so doing, we shall put the emphasis on the idea of the probable, starting from two acceptations, one aristotelian and the other carneadian, acceptations which are combined into Cicero’s use of the term. The idea of the term will allow to determine the reader’s due practice : to practice freedom of judgment by suspending the intellectual boundaries issuing from systems.