Fluorine is a double edged sword as its higher levels are linked with dental/skeletal fluorosis while its deficiency is associated with dental caries.¹ Skeletal fluorosis may remain asymptomatic or may present with myeloradiculopathy secondary to cord compression and nerve root involvement. Neurological complication including quadriparesis is a rare complication of endemic fluorosis. Since the changes of dental and skeletal fluorosis are irreversible, prevention is the mainstay of controlling the disease.

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Background: Sarcopenia is the loss of skeletal muscle mass and strength or/and performance that occurs in concert with biological aging. Objectives: To evaluate both myostatin (MST) and vitamin D₃ receptor (VDR) genes expression in Egyptian adults with their relation to each other and muscle state. Methods: Two groups were involved; group A of sarcopenic patients and group B of non-sarcopenic subjects. Multiplex quantitative RT-PCR for MST and VDR mRNA in the peripheral lymphocytes of sarcopenic and non-sarcopenic (control) groups subjects was done. Results: There was an inverse relationship between expression of myostatin and vitamin D3 receptor genes (r = -0.345, P = 0.014). Both MSTN and VDR showed a significant positive and negative association with muscle state respectively (p<0.001). Conclusion: The reciprocal MSTN and VDR expression reflect their role in the regulation of muscle state, which opens a new challenge for them as preventive and therapeutic targets for sarcopenia.

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Objective: As not many studies have been done on the topic of advance directives in Malaysia and it has yet to gain awareness among our population, we realised the need for a study to be done not only to delineate the prevalence and preference but also to raise the level of awareness. Methods: In 2015, we carried out a descriptive, cross-sectional study that targeted elderly population residing in six nursing homes and two senior activity centres in Muar. Muar a.k.a "Bandar Di Raja" is a town geographically located in the north-west region of Johor state. Data was collected through a 14 item structured questionnaire which was divided into two sections; socio-demographic profile, prevalence and preference of advance directives. Results: The response rate for this study was 50% where a total of 70 respondents out of the 150 residents participated. Non-participation was due to the exclusion criteria. 11.4% of the respondents had heard of advance directives, but none so far have an advance directive. Among the respondents, 70% of them are open to the concept of having an advance directive. For the remaining 30% that were against the use of advance directives, 38.1% of them prefer to have decisions done by the doctors. With regards to the recording of advance directives, the verbal promise was the most favored option chosen. As for the preferences for end-of-life treatment, the majority (51%) opted for comfort care with only pain medication. Conclusion: The prevalence of advance directives in Malaysia is progressing at an extremely slow pace, but it also showed that the elderly population are receptive to the concept of an advance directive. To promote the advancement of advance directives, the level of public awareness needs to be raised through primary care centres and awareness campaigns.

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Introduction: This study aimed to translate and culturally adapt the Activities-Specific Balance Confidence (ABC-M) Scale for use in Maharashtra, India and to assess its usability on elderly. The ABC Scale is a 16-item questionnaire. Each item is rated from 0% (no confidence) to 100% (complete confidence). Elderly respondents are asked to rate their confidence that they will lose their balance or become unsteady in the course of daily activities. Method: The methodological procedure of translation and cultural adaptation by WHO was followed: Forward translation, expert panel back-translation, pre-testing and cognitive interviewing, and final version Results: The process of translation and cultural adaptation was considered adequate. The procedure resulted in simple grammatical modifications for the items and 20 subjects were examined for the pre-test. Conclusions: The study resulted in successful translation and adaptation of the ABC scale in Marathi (ABC-M).

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This paper examines methodological issues concerning the measurement of semantic memory impairment in dementia of the Alzheimer's type. Fifteen mildly demented (aged 62-72 yrs, mean=68.40 yrs, SD=3.68 yrs.) and ten moderately demented patients(aged 6580 yrs, mean=69.50 yrs, SD=4.28 yrs) screened on the basis of Hindi version of Mini-Mental status examination, Hindi version of Wechsler memory scale, Mattis Dementia scale and NINCDS-ADRDA criteria and fifteen matched control subjects (aged 60-72 yrs, mean=64.00 yrs, SD= 3.11 yrs) performed a picture naming task which was classified into living and manmade categories. Results reveal that mildly and moderately demented patients show a differential pattern of impairment of specific categories of semantic knowledge. Pictorial stimuli about eight categories, four of which belonging to living and remaining four belonging to the manmade group were random presented one by one and subject were required to name them. Results indicate that picture naming for manmade objects are higher than that of living objects for both mildly and moderately demented patients. These results support the category and modality specific model of Warrington and the hybrid model of Chartkow and Bub which indicate that encoding functional attribute always effects the man made category which is less impaired. It also indicates that there is a "category effect", meaning that Alzheimer Dementia preferentially affects concepts dealing with living things and abstract concepts compared to non living objects.

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The purpose of this study is to project life expectancies (LEs) by sexes and ethnic groups for Malaysia. The secondary data of LE by sex and ethnic groups for Malaysia were extracted from the Department of Statistics, Government of Malaysia. The exponential growth model was employed to fulfill the objective. Projections of LEs for male and female of Malaysia by ethnicity were estimated by using exponential growth model for the years 2014-2050. The study investigated that the LEs for male and female of Malaysia by ethnicity are showing increasing trend. Results revealed that LEs for the female is greater than that of the male for each ethnic group. The projected LEs for male and female of Malaysia in 2050 would be 79.13 and 84.05 years, respectively. The population of Malaysia will tend to live long. The Government should have clear information about the number of elderly population ensuring their healthy environment.

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Objective: To study the frequency of macrovascular and microvascular complications in elderly with type 2 diabetes mellitus and its correlation with major cardiovascular risk factors. Research Design and Methods: 64 patients attending outpatient clinic who fulfilled the inclusion criteria of age more than 60 years with type 2 diabetes were studied during one year. Vascular complications and their risk factors were identified using a standardized questionnaire, blood and urine analysis. Results: The mean age of the patients was 67.62 ± 5.05 years. Middle age onset diabetes was seen in 43.75% of the study group, while 56.25% had elderly onset diabetes. The most prevalent cardiovascular risk factor was dyslipidemia (75.00%) followed by hypertension (71.87%), smoking (37.50%) and obesity (34.37%). Coronary artery disease, cerebrovascular disease and peripheral vascular disease were seen in 17.19%, 17.19% and 12.50% respectively, while diabetic retinopathy, diabetic nephropathy and neuropathy was seen in 31.25%, 25.00% and 28.13% respectively. 45.31% had no vascular complications. As compared to elderly onset diabetes those with middle age onset diabetes had higher mean HbA1C levels(8.94% vs 7.96%) and more prevalence of obesity (42.86% vs 27.78%), dyslipidemia (85.71% vs 66.67%), macro vascular (39.29% vs 25.00%) and micro vascular complications (50.00% vs 33.33%). Conclusion: The longer duration of diabetes and presence of multiple cardiovascular risk factors in elderly with type 2 diabetes mellitus makes them susceptible to vascular complications thereby increasing morbidity and mortality. Moreover, middle age and elderly onset diabetes appear to be two distinct groups with a difference in burden of cardiovascular risk factors and vascular complications. Future studies of diabetes in elderly may need to consider such difference while defining the treatment goals for this group.

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