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See related editorial by Moody et al. [ABSTRACT FROM AUTHOR]

Data and clinical guidelines on the management of osteoporosis in nonagenarians are lacking. The aim of this study was to assess the characteristics of osteoporosis management and identify any gaps or trends in a cohort of nonagenarians who were newly diagnosed with osteoporosis during an inpatient admission. A retrospective analysis of nonagenarians admitted to the medicine department of a tertiary hospital who were newly diagnosed with osteoporosis based on extracted ICD-10 codes. Baseline demographics, frailty based on the clinical frailty scale, comorbidities, initiation, compliance and adverse effects on osteoporosis medication were analysed. Mean age of the study group was 93.0 ± 2.5 years. There was a high prevalence of frailty (71.7%), cognitive impairment (34.2%) and recurrent falls (30.0%). 82.5% were started on osteoporosis treatment with denosumab (43.4%) being the most prescribed, followed by alendronate (41.4%). Cognitive impairment and male gender were associated with less likelihood of being on osteoporosis treatment on multivariate analysis. Having a previous fracture was associated with a higher likelihood of being on osteoporosis treatment. There was a discontinuation rate of 49.5% with a mean time to discontinuation of 26.3 ± 22.9 months. There was a high rate of osteoporosis treatment in nonagenarians with osteoporosis. The presence of previous fractures was associated with initiation of osteoporosis medications, whereas frailty and falls had no impact on treatment decisions. Cognitive impairment and males were associated with a lower rate of initiation of osteoporosis medication. [ABSTRACT FROM AUTHOR]

The article presents the discussion on telehealth services rapidly expanding during the COVID-19 pandemic. Topics include identifying any trends in telemedicine usage in an integrated general hospital predicting future usage and development of telehealth; and including the age, gender, specialty visit, mode of teleconsultation, subsidy class and subsidy diagnosis code.

Atrial fibrillation (AF) is common in older adults. CHA2DS2-VASC (congestive heart failure, hypertension, age ≥75 (doubled), diabetes mellitus, prior stroke or transient ischemic attack (doubled), vascular disease, age 65–74, female) and HASBLED(Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly) are the most established risk stratification tools in assessing suitability for anticoagulation in AF. However, there are no established screening tools for geriatric syndromes on anticoagulation risks in older adults. This study examined the association of anticoagulation prescription with geriatric syndromes. Older adults 65 years and above admitted to a tertiary hospital with atrial fibrillation and CHA2DS2-VASC score ≥ 2. Data on demographics, function (modified Barthel's Index (MBI)), cognition (mini-cog), frailty (Edmonton Frail Scale (EFS) and FRAIL), geriatric syndromes (EFS), sarcopenia (SARC-F), HASBLED and CHA2DS2-VASC were collected. 150 patients aged 65 and above (mean age 79.4 ± 7.1 years) with AF were recruited. 101 (67%) participants were anticoagulated, in univariate analysis comparing those who were anticoagulated with those who were not, age (OR 0.94; 95% CI 0.89−0.99), chronic kidney disease (OR 0.39; 95% CI 0.19−0.80), frailty (OR 0.77; 95% CI 0.60−0.98) and functional status by Barthel's Index (OR 0.75; 95% CI 0.57−0.97) were significantly associated with anticoagulation prescription. In multivariate analysis, age (OR 0.93; 95% CI 0.88−0.99) and CKD (OR 0.35; 95% CI 0.16−0.76) remained significant. There was no significant difference in CHA2DS2-VASC, HASBLED, MBI or falls between the groups. Age and CKD were significantly associated with anticoagulation prescription in patients with AF. Further studies on the impact of geriatric syndromes on anticoagulation prescription and outcomes in older adults are needed with specific guidelines for patients with geriatric syndromes and AF. [ABSTRACT FROM AUTHOR]

• There is lack of consensus on measurement of muscle mass in obese pre-frail older adults. • body mass index (BMI)-adjusted appendicular skeletal muscle mass in pre-frail obese older adult is associated with poor quality of life, poor physical function and inflammation. There is lack of consensus on measurement of muscle mass and quality in obese older adults. We aim to evaluate the association of four muscle mass indices (appendicular skeletal muscle mass (ASM) over height2(ASMIht), ASM/weight (ASMwt), ASM/body fat percentage (ASMbfp)and ASM/body mass index (BMI) ASMIbmi) with physical function and inflammation in pre-frail obese older adults. Cross-sectional study of 407 community dwelling pre-frail older adults. Data on demographics, cognition, and physical function(gait speed, handgrip strength (HGS) and Short Physical Performance Battery (SPPB) test), body composition and inflammation biomarkers were collected. Participants were analysed based on BMI tertiles(T1 lowest,T3 highest). The mean age was 72.67 years, mean BMI 25.42 kg/m2 and 59.5 % were females. Participants in T3 had a mean BMI of 30.75 kg/m2, younger with lower education levels, multimorbidity, polypharmacy and lower prevalence of sarcopenia. In BMI T3, ASMIbmi was significantly associated with EQ-5D index (β 0.53, 95 % CI 0.04 to 1.03, p = 0.033),HGS (β 5.28, 95 % CI 0.27 to 10.29, p = 0.039), SPPB (β 2.19, 95 % CI 0.47 to 3.91, p = 0.013) and IL-6 (β -4.13, 95 % CI -7.46 to -0.81, p = 0.017). ASMIwt was associated with EQ-5D index (β 0.17, 95 % CI 0.02 – 0.33, p = 0.047). ASMbfp was associated with HGS (β 6.97, 95 % CI 0.051 to 13.92, p = 0.049). There was significant association of HGS with all muscle mass indices in BMI T2, and A S Mbfp in BMI T1. ASMIbmi was significantly associated with SPPB, HGS, EQ-5D index and IL-6 in BMI T3. ASMbfp was associated with HGS in all the tertiles. Our results need further validation at population level. [ABSTRACT FROM AUTHOR]

• The association between gout and cognitive impairment is unclear. • Our study found that gout at midlife was associated with a lower risk of cognitive impairment in late life. • This risk was reduced in a stepwise manner with either longer duration of gout or lower age at first diagnosis of gout. • Uric acid may have neuroprotective effects on cognition which warrant further study. The association between gout and risk of cognitive impairment or dementia is not well established. We examined the relationship between having gout at midlife and the risk of developing cognitive impairment later on. We used data of 16,948 participants from the population-based Singapore Chinese Health Study cohort. Participants were recruited from 1993 to 1998 at mean age of 53 years and re-contacted for three follow-up interviews: 1999 to 2004 for follow-up 1, 2006 to 2010 for follow-up 2, and 2014 to 2016 for follow-up 3. History of physician-diagnosed gout was self-reported at follow-up 1 and follow-up 2, while cognitive function was assessed with the Singapore modified Mini-Mental State Examination during follow-up 3, when participants had a mean age of 73.2 years. Gout was reported by 1281 (7.6%) participants at either follow-up 1 or 2, and 2243 (14.4%) had cognitive impairment at follow-up 3. A history of gout was associated with reduced risk of cognitive impairment (OR 0.78, 95% CI 0.65–0.93). This risk was reduced in a stepwise manner with either increased duration of gout or lower age at first diagnosis of gout (P trend <0.001). Compared to those without gout, those with gout for ≥20 years (OR 0.56, 95% CI 0.39–0.80) and those with age of onset of gout <50 years old (OR 0.59, 95% CI 0.37–0.94) had a lower risk of developing cognitive impairment. A young age of onset or a long history of gout was associated with reduced risk of cognitive impairment in late life. [ABSTRACT FROM AUTHOR]

The article discusses the COVID-19 outbreak has placed immense pressure on national healthcare systems globally, to increase bed capacity, protect healthcare workers and care for vulnerable groups. Topics include older adults face barriers to the adoption of telehealth services such as cost, trust of technology, design aod user interface challenges; and the COVID-19 pandemic has in fact led to greater uptake of telehealth services for older adults.

Objectives With an aging population and increase in multimorbidity, the importance of screening for frailty and sarcopenia has become a public health priority. Several tools to do so exist. This study aimed to examine whether the SARC-F and Edmonton frail screening tools are useful in clinical practice to identify at-risk patients for negative health outcomes who would benefit from intervention. Design This is a cross-sectional study of patients attending medical specialist outpatient clinics at the National University Hospital, Singapore from May 2015 to February 2016. Measurements Frailty and sarcopenia were identified using the Edmonton Frail Scale and SARC-F questionnaires, respectively. Other clinically relevant data including basic demographics, presence of caregiver, number of follow-ups, medications and hospital readmissions in the past 1 year, Charlson comorbidity index, and modified Barthel index were collected from chart review. Results A total of 115 patients 65 years old and older were screened. Of the sample, 44.3% (n = 51) of patients were sarcopenic, whereas 27.0% (n = 31) were classified as frail; 23.5% (n = 27) were both frail and sarcopenic; and 87.1% of frail patients were sarcopenic, whereas 47.1% of sarcopenic patients were frail. Sarcopenia and frailty were associated with a higher Charlson comorbidity index, higher likelihood of requiring a caregiver, more medical specialty follow-ups, polypharmacy, more than 2 hospital admissions within a year, a higher number of falls and falls with serious consequences. This affected their perceived health status with 50.0% of robust patients rating their health excellent compared with 19.6% of sarcopenic patients ( P < .001), 9.7% of frail patients ( P < .001) and sarcopenic and frail patients scoring the lowest with 3.7% (P < .001). Conclusions The prevalence of frailty and sarcopenia among older adults attending medical outpatient clinic is high. Both syndromes are predictors of recurrent hospital admissions, polypharmacy, multiple medical clinic appointments, higher rate of falls, and falls with serious consequences. Early identification of older adults at risk of adverse health outcomes would aid in instituting timely intervention to reduce healthcare burden and improve quality of life. [ABSTRACT FROM AUTHOR]

A commentary is presented that explores strategies to limit the impact of coronavirus disease 2019 in long-term care facilities (LTCFs). Topics discussed include the status of LTCFs in Singapore and the importance of COVID vaccination and COVID vaccination rates. New strategies for dealing with the infection are also offered.

The binding properties of [RuL(mip)] {where L is 1,10-phenanthroline (phen) or 4,7-dimethyl-1,10-phenanthrollne (4,7-dmp) and mip is 2′-(3″,4″-methylenedioxyphenyl)imidazo[4′,5′- f][1,10]phenanthroline} with regard to the triplex RNA poly(U)·poly(A)*poly(U) were investigated using various biophysical techniques and quantum chemistry calculations. In comparison with [Ru(4,7-dmp)(mip)], remarkably higher binding affinity of [Ru(phen)(mip)] for the triplex RNA poly(U)·poly(A)*poly(U) was achieved by changing the ancillary ligands. The stabilization of the Hoogsteen-base-paired third strand was improved by about 10.9 °C by [Ru(phen)(mip)] against 6.6 °C by [Ru(4,7-dmp)(mip)]. To the best of our knowledge, [Ru(phen)(mip)] is the first metal complex able to raise the third-strand stabilization of poly(U)·poly(A)*poly(U) from 37.5 to 48.4 °C. The results reveal that the ancillary ligands have an important effect on third-strand stabilization of the triplex RNA poly(U)·poly(A)*poly(U) when metal complexes contain the same intercalative ligands. [ABSTRACT FROM AUTHOR]

The binding properties of [Ru(bpy)2(H2IIP)]2+ ( 1) {bpy=2,2′-bipyridine, H2IIP=2-(indole-3-yl)-imidazolo[4,5- f][1,10]phenanthroline} with calf thymus DNA (CT-DNA) and yeast tRNA have been investigated comparatively by different spectroscopic and viscosity measurements. The results suggest that the affinity of complex 1 binding with yeast tRNA is stronger than that of complex 1 binding with CT-DNA, and complex 1 is a better enantioselective binder to yeast tRNA than to CT-DNA. The toxicity of complex 1 was concentration dependent, and HL-60 cells are more sensitive to complex 1 than Hep-G2 cells; complex 1 could induce Hep-G2 cell apoptosis. [ABSTRACT FROM AUTHOR]

Abstract: A new Ru(II) complex [Ru(phen)2(mdpz)]2+ (phen=1,10-phenanthroline, mdpz=7,7′-methylenedioxyphenyl-dipyrido-[3,2-a:2′,3′-c]phenazine) has been synthesized and characterized in detail by elemental analysis, mass spectrometry and 1H NMR spectroscopy. The interaction of the complex with calf thymus DNA was investigated by spectroscopic and viscosity measurements. The results suggest that the complex binds to DNA via an intercalative mode and serves as a molecular “light switch” for DNA. Moreover, the complex has been found to promote the photocleavage of plasmid DNA pBR322 under irradiation at 365nm. The mechanism studies reveal that singlet oxygen (1O2) plays a significant role in the photocleavage. [Copyright &y& Elsevier]

Abstract: A new polypyridyl ligand tbtc {tbtc=4,5,9,14-tetraaza-benzo[b]triphenylene-11-carboxylic acid methyl ester} and its complexes [Ru(phen)2(tbtc)]2+ (1) (phen=1,10-phenanthroline) and [Ru(2,9-dmp)2(tbtc)]2+ (2) (2,9-dmp=2,9-dimethyl-1,10-phenanthroline) were synthesized and characterized by element analysis, MS, and 1H NMR. The DNA binding properties of both complexes to calf thymus DNA (CT-DNA) were investigated by different spectrophotometric methods and viscosity measurements. The results suggest that both complexes bind to DNA via an intercalative mode, and the DNA binding affinity of complex 1 is much greater than that of complex 2. This difference in binding affinity probably was caused by the different ancillary ligands. Also, when irradiated at 365nm, complex 1 was found to be a more-effective DNA-cleaving agent than complex 2. [Copyright &y& Elsevier]

Abstract: The new polypyridyl ligand MIP {MIP=2-(2,3-methylenedioxyphenyl)imidazo[4,5-f]1,10-phenanthroline} and its ruthenium(II) complexes [Ru(phen)2(MIP)]2+ (1) (phen=1,10-phenanthroline) and [Ru(dmp)2(MIP)]2+ (2) (dmp=2,9-dimethyl-1,10-phenanthroline) were synthesized and characterized by elemental analysis, MS and 1H NMR spectroscopy. The DNA-binding properties of the two complexes to calf-thymus DNA (CT-DNA) were investigated by different spectrophotometric methods and viscosity measurements, as well as equilibrium dialysis and circular dichroism spectroscopy. The results suggest that complex 1 binds to CT-DNA through intercalation, and complex 2 binds to CT-DNA via a partial intercalative mode. This difference in binding mode probably is caused by the different ancillary ligands. Also, when irradiated at 400nm, complex 1 was found to be a more-effective DNA-cleaving agent than complex 2. [Copyright &y& Elsevier]

Abstract: New ligand 2-(4′-biphenyl)imidazo[4,5-f][1,10]phenanthroline (BPIP) and its complexes [Ru(bpy)2(BPIP)]2+ (1) (bpy=2,2′-bipyridine) and [Ru(phen)2(BPIP)]2+ (2) (phen=1,10-phenanthroline) have been synthesized and characterized by mass spectroscopy, 1H NMR and cyclic voltammetry. The interaction of two Ru(II) complexes with calf thymus DNA (CT-DNA) was investigated by spectroscopic and viscosity measurements. Results indicate that both complexes bind to DNA via an intercalative mode and the DNA-binding affinity of complex 2 is much greater than that of complex 1. Furthermore, when irradiated at 365nm, both complexes have also been found to promote the photocleavage of plasmid pBR 322 DNA. [Copyright &y& Elsevier]

Abstract: New mixed polypyridyl {NMIP=2′-(2″-nitro-3″,4″-methylenedioxyphenyl)imidazo-[4′,5′-f][1,10]-phenanthroline, dmb=4,4′-dimethyl-2,2′-bipyridine, bpy=2,2′-bipyridine} ruthenium(II) complexes [Ru(dmb)2(NMIP)]2+ (1) and [Ru(bpy)2(NMIP)]2+ (2) have been synthesized and characterized. The binding of these complexes to calf thymus DNA (CT-DNA) has been investigated with spectroscopic methods, viscosity and electrophoresis measurements. The experimental results indicate that both complexes could bind to DNA via partial intercalation from the minor/major groove. In addition, both complexes have been found to promote the single-stranded cleavage of plasmid pBR 322 DNA upon irradiation. Under comparable experimental conditions compared with [Ru(phen)2(NMIP)]2+, during the course of the dialysis at intervals of time, the CD signals of both complexes started from none, increased to the maximum magnitude, then no longer changed, and the activity of effective DNA cleavage dependence upon concentration degree lies in the following order: [Ru(phen)2NMIP]2+ >complex 2 >complex 1. [Copyright &y& Elsevier]

Abstract: A novel polypyridyl ligand 2-(4′-benzyloxyphenyl)imidazo[4,5-f][1,10]phenanthroline (BPIP) and its complex [Ru(bpy)2(BPIP)]2+ (1) (bpy=2,2′-bipyridine) and (2) [Ru(phen)2(BPIP)]2+ (phen=1,10-phenanthroline) have been synthesized and characterized by elemental analysis, electrospray mass spectra and 1H NMR. The DNA-binding properties of the two complexes were investigated by spectroscopic and viscosity measurements. The results suggest that both complexes bind to DNA via an intercalative mode. Both complexes can enantioselectively interact with calf thymus DNA (CT-DNA) in a way. The Λ enantiomer of complex 1 is slightly predominant for binding to CT-DNA to the Δ enantiomer. Under irradiation at 365nm, both complexes have also been found to promote the photocleavage of plasmid pBR 322 DNA. Inhibitors studies suggest that singlet oxygen (1O2) and hydroxyl radical ( OH) play a significant role in the cleavage mechanism for both complexes. Moreover, the DNA-binding and photocleavage properties of both complexes were compared with that of [Ru(bpy)2(BPIP)]2+ and [Ru(phen)2(BPIP)]2+. The experimental results indicate that methene group existence or not have a significant effect on the DNA-binding and cleavage mechanism of these complexes. [Copyright &y& Elsevier]

Abstract: A new polypyridyl ligand MPPIP {MPPIP=2-(3′-phenoxyphenyl)imidazo[4,5-f]-[1,10]phenanthroline} and its ruthenium(II) complexes, [Ru(bpy)2MPPIP]2+ (1) (bpy=2,2′-bipyridine) and [Ru(phen)2MPPIP]2+ (2) (phen=1,10-phenanthroline) have been synthesized and characterized. The binding of the two complexes to calf thymus DNA (CT-DNA) has been investigated with spectrophotometric methods, viscosity measurements, as well as equilibrium dialysis and circular dichroism spectroscopy. The results suggest that both complexes bind to CT-DNA through intercalation, and enantioselectively interact with CT-DNA in a way. However, complex 2 is a much better candidate as an enantioselective binder to CT-DNA than complex 1. When irradiated at 365nm, both complexes have also been found to promote the photocleavage of plasmid pBR322 DNA. [Copyright &y& Elsevier]

Abstract: A novel ligand 2′-(2″-nitro-3″,4″-methylenedioxyphenyl)imidazo[4′,5′-f][1,10]-phenanthroline (NMIP) and its complex [Ru(phen)2(NMIP)]2+ have been synthesized and characterized by mass spectroscopy, 1H NMR and cyclic voltammetry. Binding of the complex with calf thymus DNA (CT DNA) has been investigated by spectroscopic methods, viscosity and electrophoresis measurements. The experimental results indicate that [Ru(phen)2(NMIP)]2+ binds to DNA via partial intercalative mode and the individual enantiomers of it bind to DNA in different rates. [Ru(phen)2(NMIP)]2+ has also been found to promote cleavage of plasmid pBR 322 DNA from the supercoiled Form I to the open circular Form II upon irradiation. [Copyright &y& Elsevier]

Abstract: A novel ligand 2-(4′-phenoxy-phenyl)imidazo[4,5-f][1,10]phenanthroline (PPIP) and its complexes [Ru(bpy)2(PPIP)]2+ (1) (bpy=2,2′-bipyridine) and [Ru(phen)2(PPIP)]2+ (2) (phen=1,10-phenanthroline) have been synthesized and characterized by mass spectroscopy, 1H NMR and cyclic voltammetry. The interaction of two complexes with calf thymus DNA (CT-DNA) was investigated by spectroscopic and viscosity measurements. The results suggest that both complexes bind to DNA via an intercalative mode. Both complexes have also been found to promote the photocleavage of plasmid pBR 322 DNA under irradiated. [Copyright &y& Elsevier]

Background: Gastric tumors become increasingly prevalent with advanced age but can be challenging to diagnose in older adults who may present with non-specific symptoms. Here, we report a rare case of an occult gastric tumor associated with mesenteric panniculitis that presented with recurrent falls precipitated by vertigo.Case Presentation: We describe a diagnostically challenging case of cryptogenic gastric tumor associated with mesenteric panniculitis in a 74-year-old female who presented with abdominal bloating and recurrent falls precipitated by vertigo, dehydration, acute kidney injury and electrolyte deficiencies, but had no alarm symptoms. Her symptoms resolved after laparoscopic wedge resection of the gastric tumor.Conclusions: Our case highlights that while alarm symptoms such as dysphagia, weight loss, gastrointestinal bleeding and vomiting are considered indications for endoscopy, clinicians should also maintain a high index of suspicion for gastric tumors in older patients who may present with atypical symptoms. [ABSTRACT FROM AUTHOR]

Two Ru(II) complexes, [Ru(phen) 2 (11-F-dppz)]2+ (Ru 1 , phen = 1,10-phenanthroline, 11-F-dppz = 11-fluorodipyrido[3,2- a :2′,3′- c ]phenazine) and [Ru(phen) 2 (11-CN-dppz)]2+ (Ru 2 , 11-CN-dppz = 11-cyanodipyrido[3,2- a :2′,3′- c ]phenazine), have been synthesized and characterized in this work. The binding properties of Ru 1 and Ru 2 with poly(A)•poly(U) RNA duplex have been investigated by spectroscopic methods and viscosity measurements. UV–vis absorption spectra and viscosity experiments demonstrate that the binding modes of Ru 1 and Ru 2 with poly(A)•poly(U) RNA duplex are intercalation, while the binding affinity for Ru 2 is greater than that for Ru 1. In addition, thermal denaturation studies reveal that both complexes significantly improve the stability of poly(A)•poly(U) duplex RNA. However, fluorescence titrations indicate that Ru 1 , unlike Ru 2 , can act as a molecular "light switch" for the poly(A)•poly(U) duplex RNA. The obtained results of this work indicate that the electron-withdrawing effect of substituents on the main ligands can significantly affect the binding of Ru(II) polypyridyl complexes with poly(A)•poly(U). Binding properties of [Ru(phen) 2 (11-F-dppz)]2+ (Ru 1 , phen = 1,10-phenanthroline, 11-F-dppz = 11-fluorodipyrido[3,2- a :2′,3′- c ]phenazine) and [Ru(phen) 2 (11-CN-dppz)]2+) (Ru 2 , (11-CN-dppz = 11-cyanodipyrid[3,2- a :2′,3′- c ]phenazine) toward poly(A)•poly(U) were investigated. Results indicate that the electron-withdrawing effect of substituents on the main ligands can significantly affect the binding of Ru(II) polypyridyl complexes with poly(A)•poly(U). [Display omitted] • phen = 1,10-phenanthroline, 11-F-dppz = 11-fluorodipyrido[3,2- a :2′,3′- c ]phenazine. • 11-CN-dppz = 11-cyanodipyrid[3,2- a :2′,3′- c ]phenazine. • Complexes [Ru(phen) 2 (11-R-dppz)]2+ (Ru 1 , R = F; Ru 2 , R = CN) were synthesized. • Binding properties of Ru 1 and Ru 2 with poly(A)•poly(U) were investigated. • Electron-withdrawing substituents promote the intercalation of complexes into duplex RNA. [ABSTRACT FROM AUTHOR]

Background frailty has been shown to be a better predictor of clinical outcomes than age alone across many diseases. Few studies have examined the relationship between frailty, stroke and stroke interventions such as endovascular thrombectomy (EVT). Objective we aimed to investigate the impact of frailty measured by clinical frailty scale (CFS) on clinical outcomes after EVT for acute ischemic stroke (AIS) in older patients ≥70 years. Methods in this retrospective cohort study, we included all consecutive AIS patients age ≥ 70 years receiving EVT at a single comprehensive stroke centre. Patients with CFS of 1–3 were defined as not frail, and CFS > 3 was defined as frail. The primary outcome was modified Rankin Score (mRS) at 90 days. The secondary outcomes included duration of hospitalisation, in-hospital mortality, carer requirement, successful reperfusion, symptomatic intracranial haemorrhage and haemorrhagic transformation. Results a total of 198 patients were included. The mean age was 78.1 years and 52.0% were female. Frail patients were older, more likely to be female, had more co-morbidities. CFS was significantly associated with poor functional outcome after adjustment for age, NIHSS and time to intervention (adjusted odds ratio [aOR] 1.54, 95% confidence interval [CI] 1.04–2.28, P  = 0.032). There was trend towards higher mortality rate in frail patients (frail: 18.3%; non-frail: 9.6%; P  = 0.080). There were no significant differences in other secondary outcomes except increased carer requirement post discharge in frail patients (frail: 91.6%; non-frail: 72.8%; P  = 0.002). Conclusions frailty was associated with poorer functional outcome at 90 days post-EVT in patients ≥ 70 years. [ABSTRACT FROM AUTHOR]

Abstract: A novel asymmetric bidentate ruthenium (II) complex, [Ru(bpy)2(PYNI)]2+ (bpy=2,2′-bipyridine, PYNI=2-(2′-pyridyl)naphthoimidazole), has been synthesized and characterized by elemental analysis, ES-MS (electrospray mass spectra) and 1H NMR. The electrochemical behaviors of this complex were studied by cyclic voltammetry. DNA interaction studies suggest that [Ru(bpy)2(PYNI)]2+ binds to calf thymus DNA (CT-DNA) in an intercalative mode. Interestingly, this new Ru(II) complex has also been found to promote cleavage of plasmid pBR 322 DNA from the supercoiled form I to the open circular form II upon irradiation. [Copyright &y& Elsevier]

The article presents the case of an 83-year-old male with diabetes mellitus and chronic kidney disease who was presented with left ear pain for two weeks to discuss cephalosporin (Cefepime)-related neurotoxicity. Based on magnetic resonance imaging, he has malignant otitis externa and was prescribed cefepime. He developed hyperactive delirium and his treatment was changed to meropenem. Also mentioned are the manifestations of Cefepime-related neurotoxicity like myoclonus aphasia.

Abstract: A series of furoxan-based nitric oxide-releasing chrysin derivatives were synthesized. Pharmacological assays indicated that all chrysin derivatives exhibited in vitro inhibitory activities against aldose reductase and advanced glycation end-product formation. Some chrysin derivatives were also found to increase the glucose consumption of HepG2 cells. Furthermore, the compounds released a low amount of NO in the presence of l-cysteine (range from 0.20% to 1.89%). These hybrid furoxan-based NO donor chrysin derivatives offer a mutual prodrug design concept for the development of therapeutic or preventive agents for vascular complications due to diabetes. [Copyright &y& Elsevier]

Abstract: Vascular complications are major causes of disability and death in patients with diabetes mellitus. It is often characterized by endothelial dysfunction. Studies have shown that either the loss of nitric oxide bioactivity or the decreased biosynthesis of NO is a central mechanism in endothelial dysfunction. As such, the delivery of exogenous NO is an attractive therapeutic option that has been used to slow the progress of diabetic vascular complications. In this paper, a novel group of hybrid nitric oxide-releasing chrysin derivatives was synthesized. The results indicated that all these chrysin derivatives exhibited in vitro inhibitory activities against aldose reductase and advanced glycation end-products formation. And some of them were even found to increase the glucose consumption of HepG2 cells. Furthermore, all compounds released NO upon incubation with phosphate buffer at pH 7.4. These hybrid ester NO donor prodrugs offer a potential drug design concept for the development of therapeutic or preventive agents for vascular complications due to diabetes. [Copyright &y& Elsevier]

Abstract: A novel asymmetric bidentate ligand, 2-(pyrazin-2-yl)naphthoimidazole (PZNI), and its Ru(II) complexes [Ru(bpy)2(PZNI)]2+ (1) and [Ru(phen)2(PZNI)]2+ (2) have been synthesized and characterized by elemental analysis, mass spectra, 1H NMR, and electronic spectroscopy. The electrochemical behaviors of the novel complexes were studied by cyclic voltammetry. The DNA-binding properties of the complexes were investigated by spectroscopic methods and viscosity measurements. The experimental results indicate that the complexes 1 and 2 interact with calf thymus DNA by intercalative mode via the terminal naphthyl ring into the base pairs of DNA. The two Ru(II) complexes have also been found to promote the cleavage of plasmid pBR 322 DNA from the supercoiled form I to the open circular form II upon irradiation. [Copyright &y& Elsevier]

Three novel asymmetric ligands, 3-(pyridine-2-yl)-5,6-diphenyl-as-triazine (pdtb), 3-(pyridine-2-yl)-as-triazino[5,6-f]acenaphthylene (pdta) and 3-(pyridine-2-yl)-as-triazino[5,6-f]phenanthroline (pdtp) and their cobalt(III) complexes have been synthesized and characterized. Binding of the three complexes with calf thymus DNA (CT-DNA) has been investigated by spectroscopic methods, viscosity, cyclic voltammetry, and electrophoresis measurements. The experimental results indicate that the size and shape of the intercalated ligand have a marked effect on the binding affinity of complexes to CT-DNA. Complexes 2 and 3 have also been found to promote cleavage of plasmid pBR322 DNA from the supercoiled form I to the open circular form II upon irradiation. [Copyright &y& Elsevier]