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Kim JH, Thiruvengadam R. Hypertension in an ageing population: Diagnosis, mechanisms, collateral health risks, treatments, and clinical challenges. Ageing Res Rev 2024; 98:102344. [PMID: 38768716 DOI: 10.1016/j.arr.2024.102344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 05/07/2024] [Accepted: 05/15/2024] [Indexed: 05/22/2024]
Abstract
Ageing population is considerably increasing worldwide, which is considered to reflect an improved quality of life. However, longevity in the human lifespan has increased the burden of late-life illnesses including cancer, neurodegeneration, and cardiovascular dysfunction. Of these, hypertension is the most common condition with huge health risks, with an increased prevalence among the elderly. In this review, we outline the current guidelines for defining hypertension and examine the detailed mechanisms underlying the relationship between hypertension and ageing-related outcomes, including sodium sensitivity, arterial stiffness, endothelial dysfunction, isolated systolic hypertension, white coat effect, and orthostatic hypertension. As hypertension-related collateral health risk increases among the elderly, the available management strategies are necessary to overcome the clinical treatment challenges faced among elderly population. To improve longevity and reduce adverse health effects, potential approaches producing crucial information into new era of medicine should be considered in the prevention and treatment of hypertension among elderly population. This review provides an overview of mechanisms underlying hypertension and its related collateral health risk in elderly population, along with multiple approaches and management strategies to improve the clinical challenges among elderly population.
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Affiliation(s)
- Jin Hee Kim
- Department of Integrative Bioscience & Biotechnology, Sejong University, Seoul 05006, the Republic of Korea.
| | - Rekha Thiruvengadam
- Department of Integrative Bioscience & Biotechnology, Sejong University, Seoul 05006, the Republic of Korea
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Kontoghiorghes GJ. The Puzzle of Aspirin and Iron Deficiency: The Vital Missing Link of the Iron-Chelating Metabolites. Int J Mol Sci 2024; 25:5150. [PMID: 38791185 DOI: 10.3390/ijms25105150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 04/22/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024] Open
Abstract
Acetylsalicylic acid or aspirin is the most commonly used drug in the world and is taken daily by millions of people. There is increasing evidence that chronic administration of low-dose aspirin of about 75-100 mg/day can cause iron deficiency anaemia (IDA) in the absence of major gastric bleeding; this is found in a large number of about 20% otherwise healthy elderly (>65 years) individuals. The mechanisms of the cause of IDA in this category of individuals are still largely unknown. Evidence is presented suggesting that a likely cause of IDA in this category of aspirin users is the chelation activity and increased excretion of iron caused by aspirin chelating metabolites (ACMs). It is estimated that 90% of oral aspirin is metabolized into about 70% of the ACMs salicyluric acid, salicylic acid, 2,5-dihydroxybenzoic acid, and 2,3-dihydroxybenzoic acid. All ACMs have a high affinity for binding iron and ability to mobilize iron from different iron pools, causing an overall net increase in iron excretion and altering iron balance. Interestingly, 2,3-dihydroxybenzoic acid has been previously tested in iron-loaded thalassaemia patients, leading to substantial increases in iron excretion. The daily administration of low-dose aspirin for long-term periods is likely to enhance the overall iron excretion in small increments each time due to the combined iron mobilization effect of the ACM. In particular, IDA is likely to occur mainly in populations such as elderly vegetarian adults with meals low in iron content. Furthermore, IDA may be exacerbated by the combinations of ACM with other dietary components, which can prevent iron absorption and enhance iron excretion. Overall, aspirin is acting as a chelating pro-drug similar to dexrazoxane, and the ACM as combination chelation therapy. Iron balance, pharmacological, and other studies on the interaction of iron and aspirin, as well as ACM, are likely to shed more light on the mechanism of IDA. Similar mechanisms of iron chelation through ACM may also be implicated in patient improvements observed in cancer, neurodegenerative, and other disease categories when treated long-term with daily aspirin. In particular, the role of aspirin and ACM in iron metabolism and free radical pathology includes ferroptosis, and may identify other missing links in the therapeutic effects of aspirin in many more diseases. It is suggested that aspirin is the first non-chelating drug described to cause IDA through its ACM metabolites. The therapeutic, pharmacological, toxicological and other implications of aspirin are incomplete without taking into consideration the iron binding and other effects of the ACM.
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Affiliation(s)
- George J Kontoghiorghes
- Postgraduate Research Institute of Science, Technology, Environment and Medicine, Limassol 3021, Cyprus
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Moris V, Cristofari S, See LA, Guillier D, Zwetyenga N, Pluvy I. Randomized comparative study of negative pressure wound therapy versus compression dressing on split-thickness skin grafts of the lower limbs in an elderly population. Expert Rev Med Devices 2024:1-8. [PMID: 38712592 DOI: 10.1080/17434440.2024.2350494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/08/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION Failure to adequately secure the skin graft to the lower limbs recipient bed can result in loss of the graft. Our objective was to compare the healing of split-thickness skin grafts three weeks postoperatively, using either negative pressure wound therapy (NPWT) or conventional compression bandaging. METHODS In this multicenter randomized controlled study, patients with tissue loss ranging from 50 cm2 to 600 cm2 on the lower limbs and treated with split-thickness skin grafts were included in three French hospitals. A digital photographic evaluation was performed at 3 weeks. RESULTS During 9 years, 70 patients were included in the study and allocated to a treatment group. The grafted area was similar in both groups. Loss of graft was significantly reduced in the NPWT group with 14.6 cm2 compared to 29 cm2 in the control group (p = 0.0003). The hospital stay was also significantly reduced in the NPWT group, at 4 days versus 6.5 days in the control group (p = 0.0284). In the NPWT group, 60% reported pain compared to 22.9% in the control group (p = 0.0048). CONCLUSIONS The use of NPWT dressings improves skin graft take by reducing necrosis, improving the graft's adherence to the recipient site, and reducing hospital length-of-stay.
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Affiliation(s)
- Vivien Moris
- Service chirurgie maxillo-faciale, plastique-reconstructrice et esthétique, chirurgie de la main, CHU de Dijon, Dijon, France
| | - Sarra Cristofari
- Lipids Nutrition Cancer team NuTox UMR866, université de Bourgogne Franche-Comté, Dijon, France
| | - Leslie Ann See
- Service chirurgie maxillo-faciale, plastique-reconstructrice et esthétique, chirurgie de la main, CHU de Dijon, Dijon, France
| | - David Guillier
- Service chirurgie maxillo-faciale, plastique-reconstructrice et esthétique, chirurgie de la main, CHU de Dijon, Dijon, France
| | - Narcisse Zwetyenga
- Service de chirurgie plastique, reconstructive, esthétique, microchirurgie et régénération tissulaire, hôpital Tenon, Paris, France
| | - Isabelle Pluvy
- Service de chirurgie orthopédique, traumatologique, plastique, reconstructrice et assistance main, CHU Jean-Minjoz, Besançon cedex, France
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Guo J, Mo H, Zuo L, Zhang X. Association of physical activity and vitamin D deficiency with cognitive impairment in older adults: a population based cross-sectional analysis. Front Nutr 2024; 11:1390903. [PMID: 38751741 PMCID: PMC11095040 DOI: 10.3389/fnut.2024.1390903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 04/16/2024] [Indexed: 05/18/2024] Open
Abstract
Objectives The global aging situation is becoming increasingly critical and cognitive impairment in the elderly has become a public health burden of concern. Physical activity (PA) and vitamin D may play a key role in improving cognitive impairment. However, little studies have examined the interaction between these two. The purpose of this study was to assess the association of PA and vitamin D with cognitive impairment in older adults, as well as the interactions of PA and vitamin D. Materials and methods This study was conducted by multi-stage random sampling of elderly people ≥60 years old, and a total sample of 2,492 (1,207 male and 1,285 female, mean age of 69.41 ± 6.75 years) with complete data was included in the analysis. PA was assessed by the Global Physical Activity Questionnaire, and < 600 MET-min/week was used as the division criteria. Serum vitamin D was measured by high-performance liquid chromatography tandem mass spectrometry, and 25-hydroxyvitamin D2/D3 concentration < 20 ng/mL was used as a vitamin D deficiency criterion. Cognitive function was assessed by three subtests: the Consortium to Establish a Registry for Alzheimer's disease word learning test (CERAD-WL) for immediate and delayed learning, the Animal Fluency Test (AFT) for verbal fluency; and the Digit Symbol Substitution Test (DSST) for information processing speed and switching attention. All three subtests were scored at less than the lowest quartile of the score as a criterion for cognitive impairment. Statistical analysis was performed using SPSS for chi-square test, rank sum test, interaction analysis, subgroup analysis, and regression analysis. Results Lower level of PA is associated with higher odds of cognitive impairment (CERAD W-L: OR = 1.596, 95% CI: 1.338-1.905, p < 0.001; AFT: OR = 1.833, 95% CI: 1.534-2.190, p < 0.001; DSST: OR = 1.936, 95% CI: 1.609-2.329, p < 0.001). Vitamin D deficiency has significant effects in AFT (OR = 1.322, 95% CI: 1.103-1.584, p = 0.003) and DSST (OR = 1.619, 95% CI: 1.345-1.948, p < 0.001). After adjusted for covariates, PA and vitamin D have multiplicative interaction on AFT (OR = 0.662, 95% CI: 0.448-0.977, p = 0.038) and DSST (OR = 0.775, 95% CI: 0.363-0.868, p = 0.009). The interaction between PA and vitamin D was not significant in the CERAD W-L (OR = 0.757, 95% CI: 0.508-1.128, p = 0.172). Conclusion The results showed that lower level of PA and vitamin D deficiency were associated with higher odds of cognitive impairment in the elderly population and that there was a multiplicative interaction between PA and vitamin D on cognitive function, with a significant effect of vitamin D on cognitive impairment in high PA conditions.
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Affiliation(s)
- Jing Guo
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Department of Kinesiology, School of Physical Education (Main Campus), Zhengzhou University, Zhengzhou, Henan, China
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Hongfei Mo
- Synergetic Innovation Center of Kinesis and Health, School of Physical Education (Main Campus), Zhengzhou University, Zhengzhou, Henan, China
- Department of Children Adolescence and Woman Health, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Longfei Zuo
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Xu Zhang
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Li F, Xiong Y, Zhang Z, Liu J, Tian J, Zhang Q, Yan H, Gao J. Association of Neutrophil-to-Lymphocyte Ratio With All-Cause Mortality in the Elderly Population in China: A Retrospective Cohort Study. Asia Pac J Public Health 2024:10105395241246048. [PMID: 38600738 DOI: 10.1177/10105395241246048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Neutrophil-to-lymphocyte ratio (NLR) is an emerging systemic inflammation marker associated with disease progression and mortality in patients. However, there is limited research on the predictive value of NLR in the general population. This study aimed to investigate the relationship between NLR and all-cause mortality in an elderly Chinese population. A retrospective cohort study was conducted based on health examination in a community in Shanghai, China, between 2015 and 2020. Among 6364 participants (aged ≥ 55 years), a total of 169 (2.66%) participants died during a median follow-up period of 5.37 years. The median NLR was 1.63 (interquartile range: 1.29, 2.11). Multivariate analysis revealed that the upper 2 quartiles of NLR were positively associated with all-cause mortality (Q3 vs Q1: hazard ratio [HR] = 1.82, 95% confidence interval [CI]: 1.07-3.09; Q4 vs Q1: HR = 2.22, 95% CI: 1.34-3.68, P for trend <.001). The stratified and interaction analyses showed that age, sex, body mass index (BMI), history of diabetes, or history of hypertension did not significantly modify the association between NLR and all-cause mortality. Elevated NLR was independently associated with an increased risk of all-cause mortality in the elderly Chinese population.
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Affiliation(s)
- Fan Li
- Department of Nutrition, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yanqin Xiong
- Center of Community-Based Health Research, Fudan University, Shanghai, China
- Gumei Community Health Service Center, Shanghai, China
| | - Zhitian Zhang
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiaojiao Liu
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
| | | | - Qiongyue Zhang
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Hongmei Yan
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
- Fudan Institute for Metabolic Disease, Fudan University, Shanghai, China
- Department of Endocrinology and Metabolism, Wusong Branch of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jian Gao
- Department of Nutrition, Zhongshan Hospital, Fudan University, Shanghai, China
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Sanikommu DR, Nadeem A, Ponnusamy V. Coombs-Negative Hemolytic Anemia in an Elderly COVID-19 Patient. Cureus 2024; 16:e58589. [PMID: 38765388 PMCID: PMC11102707 DOI: 10.7759/cureus.58589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 05/22/2024] Open
Abstract
COVID-19 infections are known to cause multi-organ complications. Hematological complications like autoimmune hemolytic anemia with a positive direct antiglobulin test (DAT), are commonly encountered. However, Coombs-negative hemolytic anemia is extremely rare. We report an interesting case of an elderly female with moderate-severe acute respiratory distress syndrome in the setting of COVID-19 pneumonia-causing Coombs-negative hemolytic anemia. This patient initially presented with sudden onset abdominal pain and vomiting, found to have an incarcerated inguinal hernia with small bowel obstruction (SBO) on imaging. Additionally, labs revealed positive COVID-19 antigen test and normocytic anemia. The hospital course was complicated by worsening hemolytic anemia and thrombocytopenia requiring blood products. Extensive workup for hemolysis in this patient with no prior hematological abnormalities, was negative for DAT and other conditions associated with or causative of hemolysis. At discharge, hemolytic parameters improved and on follow-up, hemoglobin returned to baseline, and repeat hemolytic parameters were normal. This case emphasizes the importance of considering SARS-CoV-2 along with other viral infections as one of the differentials for Coombs-negative hemolytic anemia.
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Affiliation(s)
| | - Ahmed Nadeem
- Oncology, New York Medical College, Landmark Medical Center, Woonsocket, USA
| | - Vignesh Ponnusamy
- Critical Care Medicine, New York Medical College, Landmark Medical Center, Woonsocket, USA
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Barba M, Cola A, De Vicari D, Costa C, Volontè S, Frigerio M. How Old Is Too Old? Outcomes of Prolapse Native-Tissue Repair through Uterosacral Suspension in Octogenarians. Life (Basel) 2024; 14:433. [PMID: 38672705 PMCID: PMC11050946 DOI: 10.3390/life14040433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION Medical advancements are expected to lead to a substantial increase in the population of women aged 80 and older by 2050. Consequently, a significant number of individuals undergoing corrective prolapse surgery will fall into the elderly-patient category. The research indicates a notable rise in complications associated with prolapse surgery in patients older than 80, irrespective of frailty and other risk factors. Despite these challenges, the vaginal approach has been identified as the safest surgical method for pelvic organ prolapse (POP) repair in the elderly population. For this reason, we aimed to investigate the efficacy, complication rate, and functional outcomes associated with vaginal hysterectomy and an apical suspension/high uterosacral ligaments suspension as a primary technique for prolapse repair, both within a cohort of elderly patients. METHODS We retrospectively analyzed patients who underwent transvaginal hysterectomy plus an apical suspension procedure for stage ≥ II and symptomatic genital prolapse between January 2006 and December 2013. Anatomical and functional outcomes were evaluated. The Patient Global Impression of Improvement (PGI-I) score was used to evaluate subjective satisfaction after surgery. RESULTS Sixty-five patients were included in the analysis. The median age was 81.3 years. All individuals exhibited an anterior compartment prolapse stage II or higher, and the majority also a central prolapse stage II or higher. Notably, all participants reported symptoms of vaginal bulging. Over half of the population (58.6%) complained of incomplete bladder emptying. The intervention for all participants involved a vaginal hysterectomy with an apical suspension. Sixty-three patients (96.9%) and forty-four patients (67.6%) underwent a simultaneous anterior or posterior repair, respectively. Long-term complications (>30 days from surgery) were observed during follow-up, with a median duration of 23 ± 20 months. Seven (10.7%) anatomical recurrences were recorded, five (7.69%) concerning the anterior compartment, one (1.5%) the central, and three (4.6%) the posterior. Nevertheless, none of them necessitated further surgical intervention due to symptoms. Significant anatomical improvements for the anterior, central, and posterior compartments were noticed, compared to preoperative assessment (p < 0.001 for Aa and Ba, p < 0.001 for Ap and Bp, and p < 0.001 for C). PGI-I values established that 100% of patients were satisfied (PGI-I ≥ 2), with a median score of 1.12. Consequently, objective and subjective cure rates were 89.5% and 100%, respectively. CONCLUSION Vaginal hysterectomy combined with apical suspension, particularly high uterosacral ligaments suspension, is a safe and effective primary surgical approach, even in elderly patients.
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Affiliation(s)
| | | | | | | | | | - Matteo Frigerio
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (D.D.V.); (C.C.); (S.V.)
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Huan G, Heyong S. Longitudinal Invariance and Construct Validity of the Chinese Version of the Mini-Mental State Examination Across 10 Years in the Elderly Population. J Nurs Meas 2024; 32:4-17. [PMID: 37348896 DOI: 10.1891/jnm-2021-0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Background and Purpose: In this study, we investigate the longitudinal measurement invariance of the Chinese version of the mini-mental state examination (CMMSE). Methods: The factor structure and longitudinal equivalence of the CMMSE were examined by confirmatory factor analysis. Four CMMSE measurements of 13,132 participants from the China Longitudinal Health and Longevity Study between 2008 and 2018 were included. The nested model of longitudinal invariance proves the existence of strict longitudinal invariance. Results: It showed that the factor structure, factor loadings, intercept error variance, and latent factor means of the CMMSE were invariant across four measurements. Conclusion: These findings indicate that the changes in CMMSE scores can be attributed to real structural change, indicating that the CMMSE is a reliable measurement tool for the study of cognitive aging.
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Affiliation(s)
- Guo Huan
- School of Human Resources, Guangdong University of Finance and Economics, Guangzhou, China
| | - Shen Heyong
- Institute of Analytical Psychology, City University of Macau, Macau, China
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Shi J, Fang H, Ju L, Guo Q, Cao Q, Yuan X, He L. [Prevalence and trends of low body weight among elderly population aged 60 years and above in China in 2002-2015]. Wei Sheng Yan Jiu 2024; 53:173-179. [PMID: 38604950 DOI: 10.19813/j.cnki.weishengyanjiu.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
OBJECTIVE Understand the current situation and changing trends of low body weight in elderly population aged 60 years and above. METHODS Data was collected from 2002 Chinese Nutrition and Health Survey, 2010-2013 Chinese Nutrition and Health Surveillance and 2015 Chinese Adult Chronic Disease and Nutrition Surveillance. Multi-stage stratified cluster random sampling was used for all surveys or surveillance. In 2002, 27 778 samples of people aged 60 and over were taken from 132 monitoring sites in mainland China. In 2010-2013, 34 581 subjects were selected from 150 monitoring points in mainland China. In 2015, 59 576 subjects were selected from 302 monitoring points in mainland China. Questionnaires collected basic information such as gender, and date of birth, and information such as height and weight were collected through physical examination. RESULTS The prevalence of low body weight in the elderly aged 60 years and above showed a downward trend from 2002 to 2015 in China(P<0.01). The prevalence of low body weight decreased from 11.67% in 2002 to 5.19% in 2015. The prevalence of low body weight among males decreased from 11.51% in 2002 to 5.21% in 2015. The prevalence of low body weight among females decreased from 11.83% in 2002 to 5.17% in 2015. The prevalence of low body weight in the elderly aged 60 years and above showed an upward trend with age. The prevalence of low body weight in urban areas decreased from 5.85% in 2002 to 3.31% in 2015. The prevalence of low body weight in rural areas decreased from 16.25% in 2002 to 6.67% in 2015. The prevalence of low body weight in seven geographic regions of China decreased from 2002 to 2015. The prevalence of low body weight was highest in the elderly population aged 60 years and above in South China(9.49%(95%CI 8.61%-10.38%)) and lowest in North China(2.55%(95%CI 2.15%-2.95%)) in 2015. CONCLUSION The prevalence of low body weight among the elderly aged 60 years and above in China decreased from 2002 to 2015. The prevalence of low body weight increased with age. The prevalence was higher in rural areas than in urban areas, and the prevalence in South China was higher than in other geographic regions.
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Affiliation(s)
- Jiaqi Shi
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Hongyun Fang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Lahong Ju
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Qiya Guo
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Qiuye Cao
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Xiaolin Yuan
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Li He
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
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Ramien AS, Azmi AAB, Ravichandran S, Wai Li TT, Ravendran S, Kyaw Soe HH, Ravi R, Priya H, Chikkala SM, George Pallivathukal R. Oral Health-Related Quality of Life Among Non-institutionalized Elderly in Malaysia: A Teaching Hospital-Based Survey. Cureus 2024; 16:e56202. [PMID: 38618473 PMCID: PMC11016163 DOI: 10.7759/cureus.56202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2024] [Indexed: 04/16/2024] Open
Abstract
Background In Malaysia, the Geriatric Oral Health Assessment Index (GOHAI) has been recognized as a vital instrument for evaluating oral health-related quality of life among the elderly population. Its integration into the National Health and Morbidity Survey (NHMS) in 2018 demonstrates the country's dedication to understanding and addressing the unique oral health challenges faced by older individuals. The NHMS, led by the Ministry of Health Malaysia, serves as a crucial platform for identifying and addressing healthcare needs, while also working towards achieving sustainable development goals. This study aimed to provide valuable information for stakeholders and researchers by investigating the relationship between quality of life related to oral health and demographic factors, with the ultimate goal of enhancing oral healthcare for older individuals. Objective The objective of this research was to identify the variables that impact the Oral Health-Related Quality of Life (OHRQoL) of non-institutionalized elderly individuals who visit the Klinik Pergigian Manipal University College Malaysia (MUCM). By utilizing the OHRQoL, dental practitioners can gain insight into the elderly's oral health-related quality of life, which is crucial information for dental healthcare providers to effectively reach out to and cater to the elderly at the institution. Methodology A cross-sectional design was employed, utilizing a non-probability sampling method to select eligible elderly individuals at the clinic. A validated questionnaire comprising 18 items covering sociodemographic details and the Geriatric Oral Health Assessment Index (GOHAI) was distributed to individuals above 60 years via printed forms. One way ANOVA, unpaired t-test and multiple linear regression analysis were performed to analyze the data. Results The overall mean GOHAI score among non-institutionalized elderly attending Klinik Pergigian MUCM was 48.38±9.33, indicating poor OHRQoL. The psychosocial impact domain had a mean score of 19.33±5.21, surpassing the pain and discomfort domain with a score of 10.73±2.82, highlighting the significant impact of psychosocial factors on poor oral health-related quality of life. Multiple linear regression analysis revealed no significant associations between OHRQoL and factors such as ethnicity, living arrangements apart from spouse and family, or tertiary education among older individuals after adjusting for confounding variables. Conclusions This study indicates that sociodemographic aspects have minimal impact on the OHRQoL of seniors. Further examination is needed to understand the economic aspects of tooth replacement options and preventive measures in this age group. To enhance the OHRQoL of older adults, especially those not living in facilities like nursing homes or assisted living centers, tailored oral healthcare plans and strategies are crucial. Interdisciplinary collaboration among mental health professionals, geriatric experts, and oral healthcare providers is crucial for empowering both healthcare practitioners and seniors to maintain optimal oral health.
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Affiliation(s)
- Avenia Shammah Ramien
- Oral Pathology, Faculty of Dentistry, Manipal University College Malaysia, Melaka, MYS
| | - Amirul Arif Bin Azmi
- Oral Pathology, Faculty of Dentistry, Manipal University College Malaysia, Melaka, MYS
| | - Sethu Ravichandran
- Oral Pathology, Faculty of Dentistry, Manipal University College Malaysia, Melaka, MYS
| | - Trisha Thein Wai Li
- Oral Pathology, Faculty of Dentistry, Manipal University College Malaysia, Melaka, MYS
| | | | | | - Ramanathan Ravi
- Conservative Dentistry and Endodontics, Faculty of Dentistry, Manipal University College Malaysia, Melaka, MYS
| | - Harini Priya
- Oral and Maxillofacial Pathology, Manipal University College Malaysia, Melaka, MYS
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Birlutiu V, Neamtu B, Birlutiu RM. Identification of Factors Associated with Mortality in the Elderly Population with SARS-CoV-2 Infection: Results from a Longitudinal Observational Study from Romania. Pharmaceuticals (Basel) 2024; 17:202. [PMID: 38399417 PMCID: PMC10891894 DOI: 10.3390/ph17020202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/16/2024] [Accepted: 01/31/2024] [Indexed: 02/25/2024] Open
Abstract
The progression of SARS-CoV-2 infection has been linked to a hospitalization rate of 20%. The susceptibility of SARS-CoV-2 infection increases with age, resulting in severe and atypical clinical forms of the disease. The severity of SARS-CoV-2 infection in the elderly population can be attributed to several factors, including the overexpression of angiotensin-converting enzyme 2 (ACE2) receptors, immunosenescence, and alterations in the intestinal microbiota that facilitate the cytokine storm. In light of these observations, we conducted a retrospective analysis based on prospectively collected data between 23 December 2021 and 30 April 2022 (the fourth wave of SARS-CoV-2 infection). We analyzed patients aged over 60 years who were hospitalized in a county hospital in Romania. The primary objective of our study was to assess the risk factors for an unfavorable outcome, while the secondary objective was to assess the clinical and baseline characteristics of the enrolled patients. We included 287 cases with a complete electronic medical record from this available cohort of patients. We aimed to retrospectively evaluate a group of 127 patients that progressed, unfortunately, toward an unfavorable outcome versus 160 patients with a favorable outcome. We used the Combined Ordinal Scale of Severity that combines the WHO ordinal scale and the degrees of inflammation to assess the severity of the patients at the time of the initial assessment. The age group between 70 and 79 years had the highest percentage, accounting for 48.0%-61 patients, of the deceased patients. We noted statistically significant differences between groups related to other cardiovascular diseases, nutritional status, hematological diseases, other neurological/mental or digestive disorders, and other comorbidities. Regarding the nutritional status of the patients, there was a statistically significant unfavorable outcome for all the age groups and the patients with a BMI > 30 kg/m2, p = 0.004. The presence of these factors was associated with an unfavorable outcome. Our results indicate that with the presence of cough, there was a statistically significant favorable outcome in the age group over 80 years, p ≤ 0.049. In terms of the presence of dyspnea in all groups of patients, it was associated with an unfavorable outcome, p ≤ 0.001. In our study, we analyzed laboratory test results to assess the level of inflammation across various WHO categories, focusing on the outcome groups determined by the average values of specific biomarkers. Our findings show that, with the exception of IL-6, all other biomarkers tend to rise progressively with the severity of the disease. Moreover, these biomarkers are significantly higher in patients experiencing adverse outcomes. The differences among severity categories and the outcome group are highly significant (p-values < 0.001). CART algorithm revealed a specific cut-off point for the WHO ordinal scale of 4 to stand out as an important reference value for patients at a high risk of developing critical forms of COVID-19. The high death rate can be attributed to proinflammatory status, hormonal changes, nutritional and vitamin D deficiencies, comorbidities, and atypical clinical pictures.
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Affiliation(s)
- Victoria Birlutiu
- Faculty of Medicine, Lucian Blaga University of Sibiu, Str. Lucian Blaga, Nr. 2A, 550169 Sibiu, Romania; (V.B.); (B.N.)
- County Clinical Emergency Hospital, Bvd. Corneliu Coposu, Nr. 2-4, 550245 Sibiu, Romania
| | - Bogdan Neamtu
- Faculty of Medicine, Lucian Blaga University of Sibiu, Str. Lucian Blaga, Nr. 2A, 550169 Sibiu, Romania; (V.B.); (B.N.)
- Pediatric Research Department, Pediatric Clinical Hospital Sibiu, Str. Pompeiu Onofreiu, Nr. 2-4, 550166 Sibiu, Romania
| | - Rares-Mircea Birlutiu
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
- Clinical Hospital of Orthopedics, Traumatology, and Osteoarticular TB Bucharest, B-dul Ferdinand 35-37, Sector 2, 021382 Bucharest, Romania
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Matovelle P, Olivan-Blázquez B, Magallón-Botaya R, García-Sangenís A, Monfà R, Morros R, Navarro Sanmartín A, Mateos-Nozal J, Sáez Bejar C, Rodríguez Jiménez C, López Pérez E, Llor C. Antimicrobial Agent Use for Urinary Tract Infection in Long-Term Care Facilities in Spain: Results from a Retrospective Analytical Cohort Analysis. Antibiotics (Basel) 2024; 13:152. [PMID: 38391537 PMCID: PMC10885965 DOI: 10.3390/antibiotics13020152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/25/2024] [Accepted: 01/31/2024] [Indexed: 02/24/2024] Open
Abstract
Urinary tract infections (UTIs) are highly prevalent in long-term care facilities, constituting the most common infection in this setting. Our research focuses on analyzing clinical characteristics and antimicrobial prescriptions for UTIs in residents across nursing homes (NH) in Spain. This is a retrospective analytical cohort analysis using a multifaceted approach based on the normalization process theory to improve healthcare quality provided by nursing staff in 34 NHs in Spain. In this study, we present the results of the first audit including 719 UTI cases collected between February and April 2023, with an average age of 85.5 years and 74.5% being women. Cystitis and pyelonephritis presented distinct symptom patterns. Notably, 6% of asymptomatic bacteriuria cases were treated. The prevalence of dipstick usage was 83%, and that of urine culture was only 16%, raising concerns about overreliance, including in the 46 asymptomatic cases, leading to potential overdiagnosis and antibiotic overtreatment. Improved diagnostic criteria and personalized strategies are crucial for UTI management in NHs, emphasizing the need for personalized guidelines on the management of UTIs to mitigate indiscriminate antibiotic use in asymptomatic cases.
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Affiliation(s)
- Priscila Matovelle
- Geriatrics Department, Hospital San Juan de Dios, 50006 Zaragoza, Spain
- Geriatrics Department, Universidad de Zaragoza, 50009 Zaragoza, Spain
| | - Bárbara Olivan-Blázquez
- Group B21-23R, Health Research Institute of Aragon (IISA), 50009 Zaragoza, Spain
- Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS, RD21/0016/0005), 50015 Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, 50009 Zaragoza, Spain
| | - Rosa Magallón-Botaya
- Group B21-23R, Health Research Institute of Aragon (IISA), 50009 Zaragoza, Spain
- Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS, RD21/0016/0005), 50015 Zaragoza, Spain
- Medicine Department, Universidad de Zaragoza, 50009 Zaragoza, Spain
| | - Ana García-Sangenís
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, 08007 Barcelona, Spain
- Pharmacology Department, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), 08193 Bellaterra, Spain
- CIBER en Enfermedades Infecciosas Instituto Carlos III, 28029 Madrid, Spain
| | - Ramon Monfà
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, 08007 Barcelona, Spain
- Pharmacology Department, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), 08193 Bellaterra, Spain
| | - Rosa Morros
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, 08007 Barcelona, Spain
- Pharmacology Department, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), 08193 Bellaterra, Spain
- CIBER en Enfermedades Infecciosas Instituto Carlos III, 28029 Madrid, Spain
| | | | - Jesús Mateos-Nozal
- Geriatrics Department, Hospital Universitario Ramón y Cajal (IRYCIS), 28034 Madrid, Spain
| | - Carmen Sáez Bejar
- Internal Medicine Department, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria (IIS-Princesa), 28006 Madrid, Spain
- Research Institute of Princesa (IIS Princesa), 28006 Madrid, Spain
| | - Consuelo Rodríguez Jiménez
- Pharmacology Department, Complejo Hospitalario Universitario de Canarias, 38320 Santa Cruz de Tenerife, Spain
| | | | - Carl Llor
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, 08007 Barcelona, Spain
- CIBER en Enfermedades Infecciosas Instituto Carlos III, 28029 Madrid, Spain
- Institut Català de la Salut, 08038 Barcelona, Spain
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, 5230 Odense, Denmark
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13
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Toprak K, Kaplangoray M, Özen K, Koyuncu İ, Taşcanov MB, Altıparmak İH, Biçer A, Demirbağ R. Disruption of the endothelial glycocalyx layer is associated with idiopathic complete atrioventricular block in the elderly population: An observational pilot study. J Investig Med 2024; 72:233-241. [PMID: 38102740 DOI: 10.1177/10815589231222239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Idiopathic atrioventricular block (iCAVB) is the most common reason for the need for a permanent pacemaker in the elderly population. The fibrotic process that occurs in the conduction system of the heart with aging is the main pathogenesis in the development of iCAVB. However, the processes that trigger the development of iCAVB in the elderly population have not been fully elucidated. In this study, we aimed to reveal the possible relationship between the endothelial glycocalyx (EG) layer and idiopathic complete atrioventricular block. A group of 68 consecutive patients who developed iCAVB and a group of 68 healthy subjects matched for age, sex, and cardiovascular risk factors were included in the study. The groups were compared for clinical, laboratory, and levels of Syndecan-1 (SDC1), an EG layer marker. In the study, SDC1 levels were found to be significantly higher in the iCAVB group compared to the control group (23.7 ± 7.5 vs 16.7 ± 5.2; p = 0.009). In multivariable regression analysis, SDC1 was determined as an independent potential predictor for iCAVB (OR: 1.200; 95% CI: 1.119-1.287; p < 0.001). In the receiver operating characteristic curve analysis, SDC1 predicted iCAVB with 74% sensitivity and 72% specificity at the best cut-off value of 18.5 ng/mL (area under the curve: 0.777; confidence interval: 0.698-0.856; p < 0.001). Disruption of the endothelial glycolic layer may be one of the main triggering factors for the process leading to iCAVB.
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Affiliation(s)
- Kenan Toprak
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Mustafa Kaplangoray
- Department of Cardiology, Faculty of Medicine, Şeyh Edebali University, Bilecik, Turkey
| | - Kaya Özen
- Department of Cardiology, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - İsmail Koyuncu
- Department of Clinical Biochemistry, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | | | | | - Asuman Biçer
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Recep Demirbağ
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
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Pham J, Shaaya E, Rhee B, Kimata A, Ozcan EE, Pham KM, Niu T, Sullivan P, Gokaslan ZL. Gross total resection and survival outcomes in elderly patients with spinal chordoma: a SEER-based analysis. Front Oncol 2024; 13:1327330. [PMID: 38352297 PMCID: PMC10862492 DOI: 10.3389/fonc.2023.1327330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/28/2023] [Indexed: 02/16/2024] Open
Abstract
Objective The association between aggressive resection and improved survival for adult spinal chordoma patients has not been well characterized in the geriatric population. Thus, the present study aimed to elucidate the relationship between gross total resection (GTR) and survival outcomes for patients across different age groups. Methods The authors isolated all adult patients diagnosed with spinal chordoma from the 2000-2019 Surveillance, Epidemiology, and End Results database and divided patients into three surgical subgroups: no surgery, subtotal resection (STR), and GTR. Kaplan-Meier curves with a log-rank test were used to discern differences in overall survival (OS) between surgical subgroups. Univariate and multivariate analyses were used to identify prognostic factors of mortality. Results There were 771 eligible patients: 227 (29.4%) received no surgery, 267 (34.6%) received STR, and 277 (35.9%) received GTR. Patients receiving no surgery had the lowest 5-year OS (45.2%), 10-year OS (17.6%), and mean OS (72.1 months). After stratifying patients by age, our multivariate analysis demonstrated that patients receiving GTR aged 40-59 (HR=0.26, CI=0.12-0.55, p<0.001), 60-79 (HR=0.51, CI=0.32-0.82, p=0.005), and 80-99 (HR=0.14, CI=0.05-0.37, p<0.001) had a lower risk of mortality compared to patients undergoing no surgery. The frequency of receiving GTR also decreased as a function of age (16.4% [80-99 years] vs. 43.2% [20-39 years]; p<0.001), but the frequency of receiving radiotherapy was comparable across all age groups (48.3% [80-99 years] vs. 45.5% [20-39 years]; p=0.762). Conclusion GTR is associated with improved survival for middle-aged and elderly patients with spinal chordoma. Therefore, patients should not be excluded from aggressive resection on the basis of age alone. Rather, the decision to pursue surgery should be decided on an individual basis.
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Affiliation(s)
- John Pham
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, United States
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15
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AlQashqri H, Hariri N, Jadkarim RJ, Falemban AH, Alfalogy E. Screening of Geriatric Depression in Makkah, Saudi Arabia: A Pilot Study. Cureus 2024; 16:e53313. [PMID: 38435946 PMCID: PMC10906780 DOI: 10.7759/cureus.53313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 03/05/2024] Open
Abstract
OBJECTIVE There is currently limited evidence about the prevalence of depression among elderly people residing in Makkah, Saudi Arabia. This study aims to report the magnitude of depression among the older population in Makkah, Saudi Arabia, and the related risk factors. METHODS An online cross-sectional pilot survey was carried out in Makkah City, Saudi Arabia. Data were collected using an online self-administered questionnaire. RESULTS The study questionnaire was completed by 191 older people. The participants' ages varied from 60 to 88 years. 55.5% were women, 47.9% were married, and 21.5% were divorced/widowed. 46.6% had hypertension, 42.4% had diabetes, 17.3% had hypothyroidism, 7.9% had cardiovascular diseases (CVDs), and 6.3% reported psychiatric problems. 44.5% of the subjects had no depression, 23.5% had mild, 15.2% had moderate, and 16.8% had severe depression. The sample included 32% who had been classified as having major depression. Elderly participants with insomnia, cognitive diseases, and chronic diseases showed a high risk for experiencing severe depression (OR=2.74; 95% CI: 1.42-5.28),(OR=2.63; 95% CI: 1.29-5.40), and (OR=2.62; 95% CI: 1.11-6.14) respectively. CONCLUSION Depression was common among the elderly population in Makkah, particularly among those with a documented history of insomnia, cognitive diseases, and chronic diseases. Depression screening and treatment for old people in medical settings is recommended.
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Affiliation(s)
- Hamsa AlQashqri
- Community and Family Medicine, Umm Al-Qura University, Makkah, SAU
| | - Nahla Hariri
- Community Medicine, Umm Al-Qura University, Makkah, SAU
| | - Renad J Jadkarim
- Epidemiology and Public Health, Umm Al-Qura University, Makkah, SAU
| | - Alaa H Falemban
- Pharmacology and Toxicology, Umm Al-Qura University, Makkah, SAU
| | - Enas Alfalogy
- Family Medicine, Suez Canal University, Ismailia, EGY
- Family Medicine, Umm Al-Qura University, Makkah, SAU
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16
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Liaquat H, Harmouch F, Patel N, Prenatt Z, Stoltzfus J, Geme B, Martins N, Chaput K. Association of Metabolic Syndrome Components and Colonic Diverticulosis in the Very Elderly: A Tertiary Health Network Study. Cureus 2024; 16:e51610. [PMID: 38313910 PMCID: PMC10837053 DOI: 10.7759/cureus.51610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction There is scarce data about the association of metabolic syndrome (MetS) or its components with the development of colonic diverticulosis (CD) in the elderly. We aim to determine the association of MetS and its components with CD in the elderly aged ≥75 years. Methods We conducted a retrospective chart review at St. Luke's University Health Network to identify patients who underwent a colonoscopy between 2011 and 2020. We collected data on patient demographics, comorbidities, and colonoscopy findings. Statistical analyses were conducted to compute means and frequencies of patient characteristics and rates of CD, as well as to test for associations between potential risk factors and the presence of CD. Results A total of 1239 patients were included with a median age of 80 years, 57.6% females, 89.5% Caucasians, 72.9% with CD, and 66.7% having a left-sided disease. On bivariate analysis, the older age group (p=0.02), Caucasian ethnicity (p=0.01), and hypertension (p=0.04) were found to be significant risk factors for developing CD. Multivariate regression analysis showed older age group and hypertension (OR=1.47, 95% CI: 1.66-2.02, p=0.02) were major risk factors. A significant proportion of patients with left-sided disease had Caucasian ethnicity (p<0.001), while female gender, obesity, and iron deficiency anemia were also seen more frequently, although without statistical significance. Conclusion In the elderly (>75 years old), our study found hypertension to be associated with an increased risk of CD, while impaired fasting glucose (IFG) was protective. Most patients exhibited isolated left-sided diverticulosis, with pan-diverticulosis associated with higher proportions of adverse health indicators, including American Society of Anesthesiologists (ASA) score ≥3, IFG, hypertriglyceridemia, hypertension, and hypothyroidism. Further research with larger sample sizes in similar age groups is needed to expand upon these findings.
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Affiliation(s)
- Hammad Liaquat
- Gastroenterology, St. Luke's University Health Network, Bethlehem, USA
| | - Farah Harmouch
- Internal Medicine, St. Luke's University Health Network, Bethlehem, USA
| | - Nishit Patel
- Gastroenterology, St. Luke's University Health Network, Bethlehem, USA
| | - Zarian Prenatt
- Internal Medicine, St. Luke's University Health Network, Bethlehem, USA
| | - Jill Stoltzfus
- Research Institute, St. Luke's University Health Network, Bethlehem, USA
| | - Berhanu Geme
- Gastroenterology, St. Luke's University Health Network, Bethlehem, USA
| | - Noel Martins
- Gastroenterology, St. Luke's University Health Network, Bethlehem, USA
| | - Kimberly Chaput
- Gastroenterology, St. Luke's University Health Network, Bethlehem, USA
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Henwood L, Vaughn A, Narvel R, Gour R. Correction of In-Patient Severe Hypernatremia in an 81-Year-Old Female With Hypopituitarism. Cureus 2024; 16:e51474. [PMID: 38298322 PMCID: PMC10830120 DOI: 10.7759/cureus.51474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2023] [Indexed: 02/02/2024] Open
Abstract
Hypernatremia has been significantly associated with in-hospital mortality and discharge to long-term care facilities. The appropriate correction of electrolyte disturbances, especially sodium, is important to consider to prevent the addition of central nervous system disturbances, such as cerebral edema and eventual brain injury. The importance of maintaining a proper correction of hypernatremia has been well studied and used in clinical practice. Choosing to use a hypotonic solution is a key principle. It is of utmost importance to adjust the rate of correction based on the patient's symptoms, underlying etiology, and associated comorbidities. This case demonstrates how a correction formula was used and adjusted accordingly in an 81-year-old female with severe hypernatremia and metabolic encephalopathy with multiple comorbidities, including hypopituitarism. It is noteworthy to examine the correction rate, how it was calculated and delivered, and how the main cause of the hypernatremia was determined. Considering all these factors can help to properly administer any additional corrective medications, such as desmopressin (DDAVP) in a patient with diabetes insipidus (DI) secondary to hypopituitarism, or adjust the correcting rate based on signs, symptoms, and laboratory findings.
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Affiliation(s)
- Luke Henwood
- Medicine-OMS3, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Austin Vaughn
- Medicine-OMS3, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Ravish Narvel
- Internal Medicine, Ascension St. Vincent's - Riverside, Jacksonville, USA
| | - Rahil Gour
- Family Medicine, Ascension St. Vincent's - Riverside, Jacksonville, USA
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Mookerjee N, Schmalbach N, Antinori G, Thampi S, Windle-Puente D, Gilligan A, Huy H, Andrews M, Sun A, Gandhi R, Benedict W, Chang A, Sanders B, Nguyen J, Keesara MR, Aliev J, Patel A, Hughes I, Millstein I, Hunter K, Roy S. Association of Risk Factors and Comorbidities With Chronic Pain in the Elderly Population. J Prim Care Community Health 2024; 15:21501319241233463. [PMID: 38366930 PMCID: PMC10874592 DOI: 10.1177/21501319241233463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/24/2024] [Accepted: 02/01/2024] [Indexed: 02/19/2024] Open
Abstract
INTRODUCTION/OBJECTIVE Chronic pain disorders affect about 20% of adults in the United States, and it disproportionately affects individuals living in the neighborhoods of extreme socioeconomic disadvantage. In many instances, chronic pain has been noted to arise from an aggregation of multiple risk factors and events. Therefore, it is of importance to recognize the modifiable risk factors. The aim of this study was to investigate the comorbid medical conditions and risk factors associated with chronic pain disorders in patients aged 65 years and older. METHODS Our team retrospectively reviewed medical records of elderly patients (65 years and older) who were evaluated in our outpatient medicine office between July 1, 2020 and June 30, 2021 for acute problems, management of chronic medical problems, or well visits. We divided our patients into a group who suffered from chronic pain disorder, and another group who did not have chronic pain disorder. The association of variables were compared between those groups. RESULTS Of the 2431 patients, 493 (20.3%) had a chronic pain disorder. A higher frequency of females in the group with chronic pain disorder was found compared to the group without a chronic pain disorder (60.6% vs 55.2%; P = .033). The mean ages between the two groups were similar in the group with a chronic pain disorder compared to the group without (76.35 ± 7.5 year vs 76.81 ± 7.59 year; P = .228). There were significant associations of certain comorbidities in the group with a chronic pain disorder compared to the group without a chronic pain disorder, such as depression (21.9% vs 15.2%; P < .001), anxiety (27.0% vs 17.1%; P < .001), chronic obstructive pulmonary disease (8.7% vs 6.1%; P = .036), obstructive sleep apnea (16.8% vs 11.6%; P = .002), gastroesophageal reflux disease (40.8% vs 29.0%; P < .001), osteoarthritis (49.3% vs 26.1%; P < .001), other rheumatologic diseases (24.9% vs 19.4%; P = .006), and peripheral neuropathy (14.4% vs 5.3%; P < .001). CONCLUSION Female sex, depression, anxiety, chronic obstructive pulmonary disease, obstructive sleep apnea, gastroesophageal reflux disease, osteoarthritis, other rheumatologic diseases, and peripheral neuropathy were significantly associated with chronic pain disorder in elderly patients, while BMI was not associated with chronic pain disorder.
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Affiliation(s)
- Neil Mookerjee
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | | | | | | | | | - Amy Gilligan
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Ha Huy
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Megha Andrews
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Angela Sun
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Roshni Gandhi
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | | | - Austin Chang
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Ben Sanders
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Justin Nguyen
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | | | - Janet Aliev
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Aneri Patel
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Isaiah Hughes
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Ian Millstein
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Krystal Hunter
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Satyajeet Roy
- Cooper Medical School of Rowan University, Camden, NJ, USA
- Cooper University Health Care, Camden, NJ, USA
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Reddy RN, Baikunje N, Belur G, Nair N. Adenocarcinoma of the Lung Masquerading As Invasive Pulmonary Aspergillosis in an Elderly Lady: A Diagnostic Challenge. Cureus 2024; 16:e53345. [PMID: 38435947 PMCID: PMC10907549 DOI: 10.7759/cureus.53345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 03/05/2024] Open
Abstract
A 59-year-old hypertensive woman presented with a year-long history of cough, expectoration, and progressive breathlessness, recently complicated by hemoptysis and significant weight loss. Initial investigations, including a chest x-ray and contrast-enhanced computed tomography (CECT) of the thorax, suggested an infective pathology. Despite negative bacterial, fungal, and tuberculosis cultures, elevated bronchoalveolar lavage (BAL) galactomannan and serum Aspergillus-specific IgG levels led to a diagnosis of invasive pulmonary aspergillosis (IPA), and antifungal treatment commenced. The patient's initial response was positive; however, symptoms recurred three months later. Further investigations revealed adenocarcinoma, confirmed by cytology from a thoracentesis. The patient, a non-smoker, began targeted therapy with tyrosine kinase inhibitors but declined further diagnostic evaluation. Despite the poor prognosis and palliative care options, the patient opted for discharge to home care. This case underscores the complexity of diagnosing lung pathologies and the importance of considering alternative diagnoses in persistent respiratory symptoms.
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Affiliation(s)
| | | | - Giridhar Belur
- Pulmonary Medicine, KS Hegde Medical Academy, Mangaluru, IND
| | - Nandu Nair
- Pulmonary Medicine, KS Hegde Medical Academy, Mangaluru, IND
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Scharf A, Kleinke F, Michalowsky B, Rädke A, Pfitzner S, Mühlichen F, Buchholz M, van den Berg N, Hoffmann W. Sociodemographic and Clinical Characteristics of People Living with Dementia and Their Associations with Unmet Healthcare Needs: Insights from the Baseline Assessment of the InDePendent Study. J Alzheimers Dis 2024; 99:559-575. [PMID: 38669533 DOI: 10.3233/jad-231173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
Background The healthcare needs of People living with Dementia (PlwD) (such as Alzheimer's disease) are often unmet. Information about the needs of community-dwelling PlwD and their association with sociodemographic and clinical characteristics is needed to fill the knowledge gap regarding factors influencing unmet needs among PlwD and to conduct a comprehensive needs assessment to develop tailored interventions. Objective To describe sociodemographic and clinical characteristics of the InDePendent study population with particular reference to determinants of unmet needs. Methods We analyzed baseline data of the multi-centre cluster-randomized controlled trial (InDePendent) using descriptive statistics to describe patients' sociodemographic and clinical characteristics and Poisson regression models to predict unmet needs, separated by sex. Data were collected personally via face-to-face interviews. Results Most of the n = 417 participating PlwD were mild to moderately cognitively impaired, were not depressed, had an average of 10.8 diagnoses, took 6.7 medications, and had, on average, 2.4 unmet needs (62% of PlwD had at least one unmet need) measured by the Camberwell Assessment of Need for the Elderly (CANE). Low social support, a high body-mass-index, a lower education, functional impairment, and worse health status were associated with more unmet needs, regardless of sex. In women, higher unmet needs were associated with more depressive symptoms, a poor financial situation, living alone and not being recently treated by a general practitioner. In males, unmet needs increased with the number of medications taken. Conclusions PlwD had a broad array of unmet healthcare needs, indicating primary healthcare provision improvement potentials. The results underscore the significance of early assessment of patient's clinical characteristics and unmet needs as a basis for individualized gender-sensible intervention strategies.∥ClinicalTrials.gov Identifier: NCT04741932, Registered on February 5, 2021.
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Affiliation(s)
- Annelie Scharf
- Deutsches Zentum für Neurodegenerative Erkrankungen (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Fabian Kleinke
- Department of Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Bernhard Michalowsky
- Deutsches Zentum für Neurodegenerative Erkrankungen (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Anika Rädke
- Deutsches Zentum für Neurodegenerative Erkrankungen (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Stefanie Pfitzner
- Department of Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Franka Mühlichen
- Deutsches Zentum für Neurodegenerative Erkrankungen (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Maresa Buchholz
- Deutsches Zentum für Neurodegenerative Erkrankungen (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Neeltje van den Berg
- Deutsches Zentum für Neurodegenerative Erkrankungen (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Wolfgang Hoffmann
- Deutsches Zentum für Neurodegenerative Erkrankungen (DZNE), Rostock/Greifswald, Greifswald, Germany
- Department of Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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21
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Guo L, Zhu X, Zhang L, Xu Y. Physiologically based pharmacokinetic modeling of candesartan to predict the exposure in hepatic and renal impairment and elderly populations. Ther Adv Drug Saf 2023; 14:20420986231220222. [PMID: 38157240 PMCID: PMC10752084 DOI: 10.1177/20420986231220222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024] Open
Abstract
Background Candesartan cilexetil is a widely used angiotensin II receptor blocker with minimal adverse effects and high tolerability for the treatment of hypertension. Candesartan is administered orally as the prodrug candesartan cilexetil, which is wholly and swiftly converted to the active metabolite candesartan by carboxylesterase during absorption in the intestinal tract. In populations with renal or hepatic impairment, candesartan's pharmacokinetic (PK) behavior may be altered, necessitating dosage adjustments. Objectives This study was conducted to examine how the physiologically based PK (PBPK) model characterizes the PKs of candesartan in adult and geriatric populations and to predict the PKs of candesartan in elderly populations with renal and hepatic impairment. Design After developing PBPK models using the reported physicochemical properties of candesartan and clinical data, these models were validated using data from clinical investigations involving various dose ranges. Methods Comparing predicted and observed blood concentration data and PK parameters was used to assess the fit performance of the models. Results Doses should be reduced to approximately 94% of Chinese healthy adults for the Chinese healthy elderly population; approximately 92%, 68%, and 64% of that of the Chinese healthy adult dose in elderly populations with mild, moderate, and severe renal impairment, respectively; and approximately 72%, 71%, and 52% of that of the Chinese healthy adult dose in elderly populations with Child-Pugh-A, Child-Pugh-B, and Child-Pugh-C hepatic impairment, respectively. Conclusion The results suggest that the PBPK model of candesartan can be utilized to optimize dosage regimens for special populations.
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Affiliation(s)
- Lingfeng Guo
- The First Affiliated Hospital of Zhejiang University Shengzhou Branch, School of Medicine, Shengzhou, Zhejiang, China
| | - Xinyu Zhu
- The First Affiliated Hospital of Zhejiang University Shengzhou Branch, School of Medicine, Shengzhou, Zhejiang, China
| | - Lei Zhang
- Department of Pharmacy, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Yichao Xu
- Center of Clinical Pharmacology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang 310009, China
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22
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Guo L, Song B, Xiao J, Lin H, Chen J, Jian B. Predictive value of blood biomarkers in elderly patients with non-small-cell lung cancer. Biomark Med 2023; 17:1011-1019. [PMID: 38235564 DOI: 10.2217/bmm-2023-0723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Aim: Whether GRHL1 can be considered as a potential biomarker for screening non-small-cell lung cancer (NSCLC) is still uncertain. We aimed to investigate the value of circulating blood GRHL1 on detecting NSCLC in an older population. Materials & methods: Diagnostic models from 351 older patients with NSCLC were constructed to assess the predictive value of blood GRHL1 on distinguishing NSCLC. Results: We observed that GRHL1 (odds ratio: 3.25; 95% CI: 1.70-6.91; p < 0.001) maintained a strong relationship with an elevated rate of NSCLC after adequate clinical confounding factors were controlled for. Importantly, serum GRHL1 (area under the curve: 0.725; 95% CI: 0.708-0.863; p < 0.001) had a good predictive value. Conclusion: This is the first time that circulating GRHL1 has been shown to have good value for early detection of NSCLC in an elderly population.
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Affiliation(s)
- Lianghua Guo
- Department of Respiratory Medicine, Mindong Hospital Affiliated to Fujian Medical University, Fuan, 355000, China
| | - Bin Song
- Department of Respiratory Medicine, Mindong Hospital Affiliated to Fujian Medical University, Fuan, 355000, China
| | - Jianhong Xiao
- Department of Respiratory Medicine, Mindong Hospital Affiliated to Fujian Medical University, Fuan, 355000, China
| | - Hui Lin
- Department of Respiratory Medicine, Mindong Hospital Affiliated to Fujian Medical University, Fuan, 355000, China
| | - Junhua Chen
- Department of Respiratory Medicine, Mindong Hospital Affiliated to Fujian Medical University, Fuan, 355000, China
| | - Baoren Jian
- Department of Respiratory Medicine, Mindong Hospital Affiliated to Fujian Medical University, Fuan, 355000, China
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23
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Borkowski P, Nazarenko N, Mangeshkar S, Borkowska N, Singh N, Garg V, Parker M, Naser AM. Atrial Flutter in the Elderly Patient: The Growing Role of Ablation in Treatment. Cureus 2023; 15:e50096. [PMID: 38186540 PMCID: PMC10770799 DOI: 10.7759/cureus.50096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 01/09/2024] Open
Abstract
The prevalence of atrial flutter (AFL) is increasing among the elderly population, and managing this condition presents specific challenges within this demographic. As patients age, they often exhibit reduced responsiveness to conservative treatment, necessitating a more invasive approach. We present a case of a 93-year-old female who presented to the hospital with acute decompensated heart failure (ADHF) and AFL. A year prior, she was diagnosed with arrhythmia-induced cardiomyopathy. Despite recovering her ejection fraction (EF) through guideline-directed medical therapy (GDMT), her EF deteriorated again. The patient declined invasive management for her arrhythmia on multiple occasions. Managing such patients is challenging since the approach with pharmacotherapy alone often fails to maintain sinus rhythm or adequately control the ventricular rate. Growing evidence shows that invasive management, especially ablation, may be a safe and effective procedure for this patient population. Furthermore, the studies suggest that ablation may yield particular benefits for patients with simultaneous heart failure and atrial fibrillation/AFL (AF/AFL). Unfortunately, limited data exist regarding the invasive management of AFL in the elderly. Therefore, this case report aims to provide a comprehensive review of the current evidence regarding the safety and efficacy of ablation as a therapeutic option for AFL in elderly patients, with a particular focus on how patients with concomitant heart failure may benefit from ablation.
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Affiliation(s)
- Pawel Borkowski
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, USA
| | - Natalia Nazarenko
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, USA
| | - Shaunak Mangeshkar
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, USA
| | - Natalia Borkowska
- Pediatrics, Samodzielny Publiczny Zakład Opieki Zdrowotnej (SPZOZ), Krotoszyn, POL
| | - Nikita Singh
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, USA
| | - Vibhor Garg
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, USA
| | - Matthew Parker
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, USA
| | - Ahmad Moayad Naser
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, USA
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24
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K V BM, Alagesan J. A Case Series Tries to Answer Whether Exercise Positively Influences Immunosenescence. Cureus 2023; 15:e51072. [PMID: 38269239 PMCID: PMC10806379 DOI: 10.7759/cureus.51072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/25/2023] [Indexed: 01/26/2024] Open
Abstract
The immune system, the defense mechanism of the body, mainly consists of lymphocytes. The three primary subtypes of lymphocytes are natural killer cells (NK cells), bone marrow-derived lymphocytes (B-lymphocytes), and thymus-derived lymphocytes (T-lymphocytes). T-lymphocytes are mostly composed of CD (cluster of differentiation) cells, such as CD4+ and CD8+ subsets of CD cells. Immunosenescence is the term for the steady decline of the immune system with aging. There are alterations in the composition of various types of lymphocytes, especially in CD4 and CD8 T cells. The elderly are more vulnerable to infections due to immunosenescence, which raises morbidity and mortality rates. Physical exercises are believed to have the potential to alter immunosenescence and produce positive changes in immune cell composition. The extent of exercise-induced immune function changes was different in research studies owing to the differences in protocols, methodologies, testing procedures, ages, and gender compositions. The impact of an eight-week balance-based exercise intervention on immune biomarkers is investigated in this case series. In this case series, two elderly women residing in an institutional setting were exposed to an eight-week-long balanced-based supervised exercise intervention. The immunological biomarkers CD45, CD3, CD4, and CD8 were the outcome variables that were assessed. Data on the outcome variables was gathered both before and after the intervention. Using flow cytometry and single-platform technology, immune biomarkers were analyzed. Following the intervention, there was a rise in the CD45, CD3, CD4, and CD8 cell counts relative to the baseline data. The biomarkers showed only slight and statistically non-significant improvements.
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Affiliation(s)
- Binoy M K V
- Physiotherapy, Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Sciences, Chennai, IND
| | - Jagatheesan Alagesan
- Physiotherapy, Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Sciences, Chennai, IND
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25
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Okita Y, Kitamura T, Komukai S, Zha L, Komatsu M, Narii N, Murata F, Megumi M, Gon Y, Kimura Y, Kiyohara K, Sobue T, Fukuda H. Association of anticholinergic drug exposure with the risk of dementia among older adults in Japan: The LIFE Study. Int J Geriatr Psychiatry 2023; 38:e6029. [PMID: 38041399 DOI: 10.1002/gps.6029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 11/12/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVES Several studies have investigated that anticholinergic drugs cause cognitive impairment. However, the risk of dementia associated with anticholinergics has not been extensively investigated in the super-aging society of Japan. We conducted this study to assess the association between anticholinergic drugs and the risk of dementia in older adults in Japan. METHODS This nested case-control study used data from the Longevity Improvement & Fair Evidence Study, which includes claim data in Japan from 2014 to 2020. We included 66,478 cases of diagnosed dementia and 328,919 matched controls aged ≥65 years, matched by age, sex, municipality, and cohort entry year. Primary exposure was the total cumulative anticholinergic drugs prescribed from cohort entry date to event date or matched index date, which was the total standardized daily doses for each patient, calculated by adding the total dose of different types of anticholinergic drugs in each prescription, divided by the World Health Organization-defined daily dose values. Odds ratios for dementia associated with cumulative exposure to anticholinergic drugs were calculated using conditional logistic regression adjusted for confounding variables. RESULTS The mean (standard deviation) age at index date was 84.3 (6.9), and the percentage of women was 62.1%. From cohort entry date to event date or matched index date, 18.8% of the case patients and 13.7% of the controls were prescribed at least one anticholinergic drug. In the multivariable-adjusted model, individuals with anticholinergic drugs prescribed had significantly higher odds of being diagnosed with dementia (adjusted odds ratio, 1.50 [95% confidence interval, 1.47-1.54]). Among specific types of anticholinergic drugs, a significant increase in risk was observed with the use of antidepressants, antiparkinsonian drugs, antipsychotics, and bladder antimuscarinics in a fully multivariable-adjusted model. CONCLUSIONS Several types of anticholinergic drugs used by older adults in Japan are associated with an increased risk of dementia. These findings suggest that the underlying risks should be considered alongside the benefits of prescribing anticholinergic drugs to this population.
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Affiliation(s)
- Yuki Okita
- Division of Environmental Medicine and Population Sciences, Department of Social Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Sho Komukai
- Biomedical Statistics, Department of Integrated Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Ling Zha
- Division of Environmental Medicine and Population Sciences, Department of Social Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Masayo Komatsu
- Division of Environmental Medicine and Population Sciences, Department of Social Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Nobuhiro Narii
- Division of Environmental Medicine and Population Sciences, Department of Social Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Fumiko Murata
- Department of Health Care Administration and Management, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Maeda Megumi
- Department of Health Care Administration and Management, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Yasufumi Gon
- Department of Neurology, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yasuyoshi Kimura
- Department of Neurology, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Kosuke Kiyohara
- Department of Food Science, Faculty of Home Economics, Otsuma Women's University, Chiyoda-ku, Japan
| | - Tomotaka Sobue
- Division of Environmental Medicine and Population Sciences, Department of Social Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Haruhisa Fukuda
- Department of Health Care Administration and Management, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
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26
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Shiroma K, Zimmerman T, Xie B, Fleischmann KR, Rich K, Lee MK, Verma N, Jia C. Older Adults' Trust and Distrust in COVID-19 Public Health Information: Qualitative Critical Incident Study. JMIR Aging 2023; 6:e42517. [PMID: 37856774 PMCID: PMC10637349 DOI: 10.2196/42517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/19/2023] [Accepted: 10/04/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND The COVID-19 infodemic has imposed a disproportionate burden on older adults who face increased challenges in accessing and assessing public health information, but little is known about factors influencing older adults' trust in public health information during COVID-19. OBJECTIVE This study aims to identify sources that older adults turn to for trusted COVID-19 public health information and factors that influence their trust. In addition, we explore the relationship between public health information sources and trust factors. METHODS Adults aged 65 years or older (N=30; mean age 71.6, SD 5.57; range 65-84 years) were recruited using Prime Panels. Semistructured phone interviews, guided by critical incident technique, were conducted in October and November 2020. Participants were asked about their sources of COVID-19 public health information, the trustworthiness of that information, and factors influencing their trust. Interview data were examined with thematic analysis. RESULTS Mass media, known individuals, and the internet were the older adults' main sources for COVID-19 public health information. Although they used social media for entertainment and personal communication, the older adults actively avoided accessing or sharing COVID-19 information on social media. Factors influencing their trust in COVID-19 public health information included confirmation bias, personal research, resigned acceptance, and personal relevance. CONCLUSIONS These findings shed light on older adults' use of information sources and their criteria for evaluating the trustworthiness of public health information during a pandemic. They have implications for the future development of effective public health communication, policies, and interventions for older adults during health crises.
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Affiliation(s)
- Kristina Shiroma
- School of Information, The University of Texas at Austin, Austin, TX, United States
| | - Tara Zimmerman
- School of Information, The University of Texas at Austin, Austin, TX, United States
| | - Bo Xie
- School of Information, The University of Texas at Austin, Austin, TX, United States
- School of Nursing, The University of Texas at Austin, Austin, TX, United States
| | | | - Kate Rich
- School of Information, The University of Texas at Austin, Austin, TX, United States
- Department of Communication, The University of Washington, Seattle, WA, United States
| | - Min Kyung Lee
- School of Information, The University of Texas at Austin, Austin, TX, United States
| | - Nitin Verma
- School of Information, The University of Texas at Austin, Austin, TX, United States
| | - Chenyan Jia
- School of Journalism, The University of Texas at Austin, Austin, TX, United States
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27
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Celiksoz A, Kavak M, Tarlacık AO. Inflammatory Index as a Predictor of Mortality in Elderly Patients With Intracapsular Femoral Neck Fracture. Cureus 2023; 15:e46318. [PMID: 37790871 PMCID: PMC10544652 DOI: 10.7759/cureus.46318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2023] [Indexed: 10/05/2023] Open
Abstract
A femoral neck fracture is a major cause of mortality in the elderly population, and intracapsular femoral neck fractures (ICFNFs) are commonly treated with hemiarthroplasty. The 30-day mortality rate for elderly hip fracture patients ranges from 1.0% to 6.5%, and one-year mortality increases significantly to 37.3%. Identifying predictors of mortality in these patients is crucial for better management. Inflammatory indices, such as neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and monocyte-to-lymphocyte ratio (MLR), have gained popularity for assessing mortality risk in various diseases. Several studies have demonstrated the value of these indices in predicting mortality after hip fracture. The pan-inflammatory immune value (PIV), which combines hematological parameters, has been shown to predict mortality in cancer patients. However, its role in predicting mortality in ICFNF patients treated with hemiarthroplasty has yet to be explored. This study aimed to assess the association of PIV, SII, NLR, and MLR with 30-day and one-year mortality in ICFNF patients. We also investigated the impact of surgical delay time (≤24h, 24-48h, ≥48h) on these inflammatory indices and mortality. Data from 522 patients with ICFNF treated with hemiarthroplasty were retrospectively collected. We observed 30-day and one-year mortality rates of 5.24% and 21.2%, respectively. Age, gender, and American Society of Anesthesiologists (ASA) score were identified as significant predictors of mortality. Preoperative PIV, SII, NLR, and MLR were significant predictors in the evaluation of early mortality. However, postoperatively, only NLR on the third day (NLR3rd) demonstrated statistical significance. Stepwise logistic regression further confirmed NLR3rd as the most effective predictor for early mortality. For mortality occurring between 30 to 365 days, NLR3rd remained statistically significant, albeit with diminished sensitivity. No other inflammatory index demonstrated significant predictive power for mortality during this later period. Our findings suggest different inflammatory indices may have varying predictive abilities depending on the mortality period. We recommend considering NLR3rd as a valuable and reliable predictor for early mortality in ICFNF patients treated with hemiarthroplasty. Respiratory system disease and preoperative chronic obstructive pulmonary disease (COPD) were identified as risk factors for mortality in our study, in line with previous research. In conclusion, our study highlights the potential of specific inflammatory indexes, particularly NLR3rd, in predicting mortality in elderly patients with ICFNFs treated with hemiarthroplasty. Further research is needed to validate these findings and optimize risk assessment in orthopedic practice.
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Affiliation(s)
- Aytek Celiksoz
- Orthopedics and Traumatology, Eskişehir City Hospital, Eskişehir, TUR
| | - Mustafa Kavak
- Orthopedics and Traumatology, Eskişehir Osmangazi University, Eskişehir, TUR
| | - Ali Okan Tarlacık
- Orthopedics and Traumatology, Eskişehir City Hospital, Eskişehir, TUR
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28
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McWhirter A, Mahmood S, Mensah E, Nour HM, Olabintan O, Mrevlje Z. Evaluating the Safety and Outcomes of Oesophagogastroduodenoscopy in Elderly Patients Presenting With Acute Upper Gastrointestinal Bleeding. Cureus 2023; 15:e47116. [PMID: 38021747 PMCID: PMC10647938 DOI: 10.7759/cureus.47116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2023] [Indexed: 12/01/2023] Open
Abstract
AIMS In the absence of evidence-based guidelines regarding the safety and appropriateness of emergency endoscopy in elderly, co-morbid and frail patients, we aimed to find clinical outcomes in elderly patients who have undergone gastroscopy following an acute upper gastrointestinal bleeding (UGIB). METHODS We carried out a retrospective observational study of patients aged 70 years and older who had undergone emergency oesophagogastroduodenoscopy (OGD) at the Royal Sussex County Hospital, Brighton, United Kingdom, between May 2020 and January 2022. Data collected for analysis included Glasgow-Blatchford score, age, gender, endoscopic findings, endoscopic treatments, immediate complications, 90-day complications, 30-day and 90-day survival, length of hospital stay and re-bleeding. RESULTS A total of 248 study participants were categorised into two groups: age 70-79 years (n=102) and ≥80 years (n=146). Melaena (n=226, 91%, p=0.0001) was the commonest indication for emergency OGD in both groups, with the majority of patients presenting with a Glasgow-Blatchford score of ≥1 (n=200, 80.6%, p=0.2). Endoscopy findings were normal in 26.4% (n=27) of those 70-79 years and 32% (n=47) of those ≥80 years (p=0.01). Duodenal ulcer, oesophagitis and gastric ulcer were the commonest abnormal findings (n=50, 20%; n=29, 11.7%; and n=28, 11.3%, respectively). Of the participants, 93.8% (n=212) had no immediate complications. Bleeding and hypotension occurred in 2.7% (n=6) and 2% (n=5) of patients, respectively. At 90 days post-procedure, 83.3% (n=85) of those 70-79 years and 67.8% (n=99) of those ≥80 years had survived (p=0.180). CONCLUSIONS We conclude that OGD is largely a safe procedure in older adults with acute UGIB; however, the high proportion of OGDs with normal findings reinforces the importance of careful selection of patients.
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Affiliation(s)
- Alexandra McWhirter
- General Internal Medicine, Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, GBR
| | - Saba Mahmood
- General Internal Medicine, Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, GBR
| | - Ekow Mensah
- Geriatrics, Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, GBR
| | - Hussameldin M Nour
- General Surgery, Furness General Hospital, University Hospitals of Morecambe Bay NHS Foundation Trust, Brighton, GBR
| | - Olaolu Olabintan
- Gastroenterology, King's College Hospital NHS Foundation Trust, London, GBR
| | - Ziva Mrevlje
- Gastroenterology, Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, GBR
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29
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Zheng LX, Walsh EI, Sutarsa IN. Provision of health services for elderly populations in rural and remote areas in Australia: A systematic scoping review. Aust J Rural Health 2023; 31:805-825. [PMID: 37469118 DOI: 10.1111/ajr.13016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/18/2023] [Accepted: 07/03/2023] [Indexed: 07/21/2023] Open
Abstract
INTRODUCTION Although various studies have examined availability, access barriers and patient experiences of rural health services for the ageing population, no synthesis of this literature exists in Australia. OBJECTIVE The objective of this study was to examine the current literature surrounding rural service provision and to evaluate the barriers to access for older individuals and to recognise gaps in the literature. DESIGN A systematic scoping review of peer-reviewed literature from three online databases (PUBMED, SCOPUS and Web of Science). FINDINGS Thirty-two papers were included in analysis. The most prominent types of health service discussed were residential aged care (n = 12) and community health care (n = 10). More studies explored the perspectives of health personnel than the service end users. Qualitative synthesis revealed three themes associated with health service and rural ageing: access to services, health workforce experiences and end user experiences. DISCUSSION Access to health services for the elderly population is a complex issue. Promoting positive experiences for both health providers and patients is critical to assisting in healthy ageing for people living in rural and remote areas. This requires intervention on a social and institutional level. Key research gaps in the literature include the effectiveness of an integrated approach to institutional interventions, utilisation of preventative measures such as screening programs for cancer and greater identification of the health needs and perceptions among culturally diverse elderly residents. These studies are critical to promote appropriate and patient-centred care for elderly populations in rural and remote areas. CONCLUSION The review highlights the need to address availability, retention and service innovations across health services to improve access to care and health outcomes of rural elderly residents.
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Affiliation(s)
- Ling Xiao Zheng
- School of Medicine and Psychology, College of Health and Medicine, The Australian National University, Acton, Australian Capital Territory, Australia
| | - Erin I Walsh
- Population Health Exchange (PHXchange), National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Acton, Australian Capital Territory, Australia
| | - I Nyoman Sutarsa
- Rural Clinical School, School of Medicine and Psychology, The Australian National University, Acton, Australian Capital Territory, Australia
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar, Indonesia
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Dadarlat-Pop A, Molnar A, Serban A, Tomoaia R, Hagiu C, Manole S, Oprea A, Mocanu L, Picos A, Mot S. Prognostic Value of Myocardial Function Imaging Markers in Elderly Patients Undergoing Transcatheter Aortic Valve Replacement. Clin Interv Aging 2023; 18:1597-1606. [PMID: 37786426 PMCID: PMC10541530 DOI: 10.2147/cia.s413426] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/12/2023] [Indexed: 10/04/2023] Open
Abstract
Background Transcatheter aortic valve replacement (TAVR) became the leading therapeutic strategy for aortic valve replacement in older patients with severe symptomatic aortic stenosis. Echocardiographic parameters that mark the left ventricle and right ventricle reverse remodeling after the TAVR are not well established. The aim of the current study is to describe the dynamics of both left ventricle (LV) and right ventricle (RV) strain derived from speckle tracking echocardiography in elderly patients at 3-months after the TAVR procedure. Methods We enrolled 52 consecutive patients (77 ± 4.9 years old, median STS score of 3.1) who underwent transfemoral TAVR at our tertiary care center. All patients were evaluated at baseline and 3 months following TAVR. Results The LV global longitudinal strain (GLS) 3-month following TAVR was significantly improved compared with baseline values (-16 ±4.2% vs -16 ±4.2%; p < 0.001) but no significant changes in the RV GLS 3 and 6 segments model following TAVR were registered. The LV ejection fraction was significantly improved 3-months after the TAVR procedure. LV-GLS at baseline demonstrated a strong positive correlation with LV-GLS at 3 months (r = 0.69) and a moderate correlation with RV strain parameters (r = 0.38 and r = 0.56), but also a negative correlation with LVEF at follow-up (r=-0.61). Interestingly, in contrast to LVEF, none of the strain parameters correlated with age. NT-proBNP values were correlated with both LV-GLS (r = 0.37) and LVEF (r=-0.5) at baseline. However, at follow-up, baseline NT-proBNP values remained correlated only to LV-GLS at 3-months (r = 0.24), but the correlation was weak.
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Affiliation(s)
- Alexandra Dadarlat-Pop
- Cardiology Department, Heart Institute Niculae Stăncioiu, Cluj-Napoca, Romania
- Cardiology Department, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Adrian Molnar
- Cardiovascular Surgery Department, Heart Institute Niculae Stăncioiu, Cluj-Napoca, Romania
- Cardiovascular Surgery Department, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Adela Serban
- Cardiology Department, Heart Institute Niculae Stăncioiu, Cluj-Napoca, Romania
- Cardiology Department, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Raluca Tomoaia
- Cardiology Department, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Cardiology Department, Clinical Rehabilitation Hospital, Cluj-Napoca, Romania
| | - Claudia Hagiu
- Gastroenterology Department, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- “Prof. Dr. Octavian Fodor” Regional Gastroenterology-Hepatology Institute, Cluj-Napoca, Romania
| | - Simona Manole
- Radiology and Medical Imaging Department, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Radiology and Medical Imaging, Heart Institute Niculae Stăncioiu, Cluj-Napoca, Romania
| | - Alexandru Oprea
- Cardiovascular Surgery Department, Heart Institute Niculae Stăncioiu, Cluj-Napoca, Romania
- Cardiovascular Surgery Department, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Lorena Mocanu
- Cardiology Department, Heart Institute Niculae Stăncioiu, Cluj-Napoca, Romania
| | - Andrei Picos
- Department of Prevention in Dental Medicine, ‘Iuliu Hatieganu’ University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Stefan Mot
- Cardiology Department, Heart Institute Niculae Stăncioiu, Cluj-Napoca, Romania
- Cardiology Department, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Hashemi A, Nabovati P, Hashemi H, Mortazavi AG, Khabazkhoob M. Corneal densitometry and associated factors in an elderly population. Clin Exp Optom 2023:1-8. [PMID: 37674266 DOI: 10.1080/08164622.2023.2242864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
CLINICAL RELEVANCE Knowing normative corneal optical density (COD) values is important for identifying pathologic corneal changes. BACKGROUND The aim of this work is to determine the distribution and associated factors of COD in the elderly population. METHODS This report is a part of a cross-sectional population-based study conducted on the elderly population (≥60 years) of Tehran, Iran from Jan 2019 to Jan 2020. Using a multi-stage stratified random cluster sampling method, a total of 160 clusters were randomly selected from 22 districts of Tehran city. Study participants underwent a complete ocular examination including measurement of visual acuity, refraction, and slit-lamp biomicroscopy. Corneal densitometry was evaluated using the Pentacam HR. Generalized estimating equation (GEE) models were used to investigate associations of COD with study variables. RESULTS A total of 3633 eyes from 2068 individuals were analysed. Of these, 1256 (60.7%) were female, and the mean age of the individuals was 66.42 ± 5.28 (60 to 95) years. The mean entire COD was 21.96 ± 4.45 greyscale unit (GSU) (95% CI: 21.57-22.34). There was a statistically significant difference in the mean COD between the anterior, central, and posterior layers (p < 0.001); the highest and lowest average COD was related to the anterior and posterior corneal layers, respectively. The lowest and highest mean COD were observed in the 0-2 mm [17.21GSU (95% CI:16.87-17.55)], and 10-12 mm annular zones [31.4 GSU (95% CI: 30.89-31.91)], respectively (p < 0.001). According to the multiple GEE model, the COD had a statistically significant direct relationship with age, central corneal thickness, and mean keratometry, while it was significantly inversely associated with female sex, anterior chamber depth, white-to-white distance, and corneal volume. CONCLUSION These normal values of COD in the present study could be used as reference data in older adults. The associated factors of COD should be taken into account to avoid misinterpretation of physiologic changes as pathologic processes.
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Affiliation(s)
- Alireza Hashemi
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Payam Nabovati
- Rehabilitation Research Center, Department of Optometry, Iran University of Medical Sciences, Tehran, Iran
| | - Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Abol Ghasem Mortazavi
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Khabazkhoob
- Department of Basic Sciences, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Francis MA, Shaikh R, Inban P, Akuma O, Intsiful TA, Akuma CM, Lat Aung LL, Chukwuedozie VC, Francis S, Sukhoroslov M. Extensive Scalp Melanoma in an Elderly Female: A Case Report and Literature Review. Cureus 2023; 15:e45425. [PMID: 37859876 PMCID: PMC10581861 DOI: 10.7759/cureus.45425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2023] [Indexed: 10/21/2023] Open
Abstract
Scalp melanoma is a rare and aggressive form of skin cancer. Its occurrence in the elderly population poses unique challenges due to factors such as delayed diagnosis and comorbidities. We present a case of extensive scalp melanoma in an elderly female to highlight the clinical presentation, diagnostic process, treatment modalities, and outcomes. Biopsy and histopathological analysis showed the presence of dysplastic nevi arising in pigmented melanocytic nevi, with uncertain pagetoid spread of atypical melanocytes. The management involved complete excision with safety margins and immunotherapy based on melanoma guidelines. This case underscores the importance of early detection and tailored treatment strategies in managing melanoma in elderly patients.
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Affiliation(s)
- Maya A Francis
- Internal Medicine, Windsor University School of Medicine, Cayon, KNA
| | - Rahila Shaikh
- Dermatology/Internal Medicine, Saba University School of Medicine, The Bottom, BES
| | - Pugazhendi Inban
- General Medicine, Government Medical College, Omandurar, Chennai, IND
| | | | | | | | - Lynn Lat Lat Aung
- College of Medicine, MAHSA (Malaysian Allied Health Sciences Academy) University, Petaling Jaya, MYS
| | | | - Sandra Francis
- Internal Medicine, Windsor University School of Medicine, Cayon, KNA
| | - Mikhail Sukhoroslov
- Internal Medicine, S.M. Kirov Military Medical Academy, Saint Petersburg, RUS
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Mengis-Palleck CL, Tomé-Bermejo F, Piñera-Parrilla Á, Cervera-Irimia J, Gallego-Bustos J, Garzón-Márquez F, Rodríguez-Arguisjuela MG, Sanz-Aguilera S, Peiro-Garcia A, Álvarez-Galovich L. Surgical Site Infection After Polymethyl Methacrylate Pedicle Screw Augmentation in Osteoporotic Spinal Vertebrae: A Series of 537 Cases. Int J Spine Surg 2023; 17:587-597. [PMID: 37217274 PMCID: PMC10478696 DOI: 10.14444/8474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Retrospective observational study of prospectively collected outcomes. OBJECTIVE The use of transpedicular screws augmented with polymethyl methacrylate (PMMA) is an alternative for patients with osteoporotic vertebrae. To investigate whether using PMMA-augmented screws in patients undergoing elective instrumented spinal fusion (ISF) is correlated with an increased risk of infection and the long-term survival of these spinal implants after surgical site infection (SSI). METHODS We studied 537 consecutive patients who underwent ISF at some point within a 9-year period, involving a total of 2930 PMMA-augmented screws. Patients were classified into groups: (1) those whose infection was cured with irrigation, surgical debridement, and antibiotic treatment; (2) those whose infection was cured by hardware removal or replacement; and (3) those in whom treatment failed. RESULTS Twenty eight of the 537 patients (5.2%) developed SSI after ISF. An SSI developed after primary surgery in 19 patients (4.6%) and after revision surgery in 9 (7.25%). Eleven patients (39.3%) were infected with gram-positive bacteria, 7 (25%) with gram-negative bacteria, and 10 (35.7%) with multiple pathogens. By 2 years after surgery, infection had been cured in 23 patients (82.15%). Although there were no statistically significant differences in infection incidence between preoperative diagnoses (P = 0.178), the need to remove hardware for infection control was almost 80% lower in patients with degenerative disease. All screws were safely explanted while vertebral integrity was maintained. PMMA was not removed, and no recementing was done for new screws. CONCLUSIONS The success rate for treatment of deep infection after cemented spinal arthrodesis is high. Infection rate findings and the most commonly found pathogens do not differ between cemented and noncemented fusion. It does not appear that the use of PMMA in cementing vertebrae plays a pivotal role in the development of SSIs. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | - Félix Tomé-Bermejo
- Spine Department, Fundación Jiménez Díaz University Hospital, Avenida de los Reyes Católicos, Spain, Madrid
- Department of Orthopaedic Surgery and Traumatology, Villalba University General Hospital, Carretera de Alpedrete a Moralzarzal, Madrid, Spain
| | - Ángel Piñera-Parrilla
- Department of Orthopaedic Surgery and Traumatology, Cabueñes University Hospital, Los Prados, Spain, Gijón
| | - Javier Cervera-Irimia
- Department of Orthopaedic Surgery and Traumatology, Villalba University General Hospital, Carretera de Alpedrete a Moralzarzal, Madrid, Spain
| | - Jesús Gallego-Bustos
- Spine Department, Fundación Jiménez Díaz University Hospital, Avenida de los Reyes Católicos, Spain, Madrid
| | - Francisco Garzón-Márquez
- Spine Department, Fundación Jiménez Díaz University Hospital, Avenida de los Reyes Católicos, Spain, Madrid
| | | | - Sylvia Sanz-Aguilera
- Spine Department, Fundación Jiménez Díaz University Hospital, Avenida de los Reyes Católicos, Spain, Madrid
| | - Alejandro Peiro-Garcia
- Pediatric Spinal Unit, Sant Joan de Déu Barcelona Children's Hospital, Passeig de Sant Joan de Déu, Spain, Barcelona
| | - Luis Álvarez-Galovich
- Spine Department, Fundación Jiménez Díaz University Hospital, Avenida de los Reyes Católicos, Spain, Madrid
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Khanna K, Khanna R, Kumar S. Retrospection of Seldom-Known Causes and Presentations of Partial Empty Sella Syndrome. Cureus 2023; 15:e44494. [PMID: 37791188 PMCID: PMC10544456 DOI: 10.7759/cureus.44494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/31/2023] [Indexed: 10/05/2023] Open
Abstract
Pituitary gland shrinkage or flattening obscures it from view on an MRI, giving the impression that it is an empty sella. On the other hand, if some viable pituitary gland tissue is still seen on the MRI scan, a diagnosis of partial empty sella can be made. Diminished physiological and functional reserve in the elderly can result in a bad prognosis if not treated early. Therefore, there is a need to become familiar with fewer known causes and presentations of the empty sella or partial empty sella syndrome in older patients. We report a case of a 71-year-old female with multiple known ailments presenting with hypotension as the sole symptom. It urged us to investigate further and reach the root cause as partial empty sella syndrome with panhypopituitarism.
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Affiliation(s)
- Kushagra Khanna
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Rajika Khanna
- Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Udupi, IND
| | - Sunil Kumar
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
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Padhan S, Mohapatra A, Ramasamy SK, Agrawal S. Artificial Intelligence (AI) and Robotics in Elderly Healthcare: Enabling Independence and Quality of Life. Cureus 2023; 15:e42905. [PMID: 37664381 PMCID: PMC10474924 DOI: 10.7759/cureus.42905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2023] [Indexed: 09/05/2023] Open
Abstract
We are being urged to redefine aging and only use positive terminology when discussing it. It is unacceptable to use a derogatory term like "aging tsunami." This is unfortunate because it comes at a time when geriatrics is precariously balancing itself. Geriatricians are growing far too slowly to supply an adequate number of medical professionals to meet the needs of the rapidly aging senior population. The global aging population poses significant challenges for healthcare systems and providing elderly care. In recent years, artificial intelligence (AI) and robotics have emerged as promising technologies to address these challenges by enabling independence and enhancing the quality of life for older adults. This review article examines the applications of AI and robotics in elderly care, focusing on their role in promoting independence, monitoring health, helping, and enhancing social interaction. The article also discusses the ethical considerations, challenges, and future directions in implementing AI and robotics in elderly care.
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Affiliation(s)
- Srikanta Padhan
- Community and Family Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Avilash Mohapatra
- Physiotherapy, All India Institute of Medical Sciences, New Delhi, IND
| | | | - Sanjana Agrawal
- Epidemiology and Public Health, All India Institute of Medical Sciences, Raipur, Raipur, IND
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Pan XB, Wang HX, Cao YJ, Liu YY. Secular Trends in Sleep Conditions in Chinese Elderly Individuals: A National Population-Based Study. Nat Sci Sleep 2023; 15:555-566. [PMID: 37441269 PMCID: PMC10335309 DOI: 10.2147/nss.s416084] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
Purpose As one of the most rapidly aging countries in the world, the elderly population is expected to reach over 400 million in China by 2032. Many studies have suggested a positive association between sleep duration and adverse health events among elderly individuals. This study aimed to investigate the sleep conditions of Chinese elderly individuals between 2005 and 2018. Patients and methods Data for 53,013 elderly individuals were taken from five cycles of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) during 2005-2018. Sex- and age-specific means and 95% confidence intervals (95% CIs) were used to estimate sleep duration trends. Changes in sleep patterns were explored during this period. The prevalence of short and long sleep durations was assessed and age-standardized by the 2010 census. Finally, self-reported sleep quality was used to determine sleep conditions from another perspective among elderly individuals. Results The mean sleep duration decreased from 7.87 (95% CI: 7.83-7.91) to 7.29 (95% CI: 7.25-7.33) hours between 2005 and 2018. Changes in sleep duration patterns were found during the study period. The proportion of the elderly population who slept ≤6 hours increased and that of those who slept ≥9 hours decreased noticeably over the past 13 years. The age-standardized prevalence of short sleep duration increased from 32.7% (95% CI: 32.7-32.9%) to 38.4% (95% CI: 38.3-38.5%). A significant decrease was observed in the prevalence of long sleep duration. Conclusion Sleep conditions are gradually shifting toward a shorter sleep duration and poorer sleep quality among Chinese elderly individuals.
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Affiliation(s)
- Xing-Bing Pan
- Performance Appraisal Office, Children’s Hospital of Hebei Province, Shijiazhuang, People’s Republic of China
| | - Hong-Xia Wang
- Department of Obstetrics and Gynecology, The Fourth Hospital of Hebei Medical University/The Tumour Hospital of Hebei Province, Shijiazhuang, People’s Republic of China
| | - Ya-Jing Cao
- Institutes for Non-Communicable Chronic Diseases Control and Prevention, Hebei Provincial Centre for Disease Control and Prevention, Shijiazhuang, People’s Republic of China
| | - Yan-Yu Liu
- Cancer Institute, The Fourth Hospital of Hebei Medical University/The Tumour Hospital of Hebei Province, Shijiazhuang, People’s Republic of China
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Pacilio C, Rosati G, Crispo A, Bimonte S, DI Rella F, Nuzzo F, DE Laurentiis M. An Overview of the Roles of CDK4/6 Inhibitors in Metastatic Breast Cancer Elderly Patients. In Vivo 2023; 37:1445-1449. [PMID: 37369460 DOI: 10.21873/invivo.13228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023]
Abstract
Breast cancer is the most common type of cancer in women worldwide. Many studies indicate that breast cancer increases in elderly patients (≥70 years) and suggest that the higher cancer mortality in this population relative to that observed in younger women could be related to organ dysfunction, an advanced and delayed diagnosis, and other morbidities. Endocrine therapy (ET) represents the favorite treatment for patients affected by hormone receptor positive (HR+) metastatic breast cancer (MBC). Unfortunately, half of these patients are resistant to ET. In recent years, new therapeutic options, such as orally highly selective inhibitors of cyclin-dependent kinase 4 and 6 (CDK4/6), have been widely investigated in patients suffering from MBC with good outcomes. They are able to bypass resistance from hormonal therapy, by restoring hormone sensitivity and by delaying chemotherapeutic agent use. Thus, CDK4/6 inhibitors, combined with hormonal therapy, represent an alternative treatment for MBC. Unfortunately, the elderly population with MBC remains mostly excluded from clinical trials. Moreover, few data on the efficacy, safety, and short and longterm outcomes of therapies based on the combined treatment of ET and CDK4/6 inhibitors are available. This narrative review highlights the use of CDK 4/6 inhibitor-based therapy for MBC in elderly patients and suggests new therapeutic perspectives.
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Affiliation(s)
- Carmen Pacilio
- Department of Breast and Thoracic Oncology, Division of Breast Medical Oncology, Istituto Nazionale dei Tumori IRCSS "Fondazione G. Pascale", Naples, Italy
| | - Gerardo Rosati
- Medical Oncology Unit, San Carlo Hospital, Potenza, Italy
| | - Anna Crispo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori-IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Sabrina Bimonte
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori IRCCS "Fondazione Pascale", Naples, Italy
| | - Francesca DI Rella
- Department of Breast and Thoracic Oncology, Division of Breast Medical Oncology, Istituto Nazionale dei Tumori IRCSS "Fondazione G. Pascale", Naples, Italy
| | - Francesco Nuzzo
- Department of Breast and Thoracic Oncology, Division of Breast Medical Oncology, Istituto Nazionale dei Tumori IRCSS "Fondazione G. Pascale", Naples, Italy
| | - Michelino DE Laurentiis
- Department of Breast and Thoracic Oncology, Division of Breast Medical Oncology, Istituto Nazionale dei Tumori IRCSS "Fondazione G. Pascale", Naples, Italy
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Wu N, Feng M, Zhao H, Tang N, Xiong Y, Shi X, Li D, Song H, You S, Wang J, Zhang L, Ji G, Liu B. A bidirectional link between metabolic syndrome and elevation in alanine aminotransferase in elderly female: a longitudinal community study. Front Cardiovasc Med 2023; 10:1156123. [PMID: 37408651 PMCID: PMC10318155 DOI: 10.3389/fcvm.2023.1156123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/31/2023] [Indexed: 07/07/2023] Open
Abstract
Pre-obesity, as a significant risk factor for the progression of metabolic syndrome (MS), has become a prevalent public health threat globally. In this three-year longitudinal study of pre-obese women at baseline, the goal was to clarify the female-specific bidirectional relationship between the risk of MS and blood alanine aminotransferase. In this manuscript, the MS score was determined using the following equation: MS score = 2*waist/height + fasting glucose/5.6 + TG/1.7 + SBP/130-HDL/1.02 for men and 1.28 for women, which is highly related to the risk of MS. With 2,338 participants, a hierarchical nonlinear model with random effects was utilized to analyze the temporal trends of serum characteristics from 2017 to 2019. A bivariate cross-lagged panel model (CLPM) was employed to estimate the structural relations of frequently measured variables at three different time points to determine the directionality of the relationship between the risk of MS and serum characteristics. MassARRAY Analyzer 4 platforms were used to evaluate and genotype candidate SNPs. In this study, the MS score only rose with age in females; it was positively correlated with serum alanine aminotransferase (ALT) in females; the CLPM revealed that the MS score in 2017 predicted ALT in 2018 (β = 0.066, p < 0.001); and ALT in 2018 predicted an MS score in 2019 (β = 0.037, p < 0.050); both relationships were seen in females. Additionally, the MS score in elderly females with NAFLD was related to the rs295 in the lipoprotein lipase (LPL) gene (p = 0.042). Our work showed that there may be female-specific causal correlations between elevated ALT and risk of MS and that the polymorphism rs295 in LPL may serve as a marker for the prognosis of MS. The genetic roles of rs295 in the LPL gene in the onset of MS and the development of ALT in the elderly Chinese Han population are thus provided by this, offering one potential mechanism.
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Affiliation(s)
- Na Wu
- Shanghai Innovation Center of Traditional Chinese Medicine Health Service, School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Mofan Feng
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Shanghai Jiao Tong University, Shanghai, China
| | - Hanhua Zhao
- Department of Sport Science, College of Education, Zhejiang University, Hangzhou, China
| | - Nan Tang
- Shanghai Innovation Center of Traditional Chinese Medicine Health Service, School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yalan Xiong
- Shanghai Innovation Center of Traditional Chinese Medicine Health Service, School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xinyu Shi
- Shanghai Innovation Center of Traditional Chinese Medicine Health Service, School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Dong Li
- Zhangjiang Community Health Service Center of Pudong New District, Shanghai, China
| | - Hualing Song
- Shanghai Innovation Center of Traditional Chinese Medicine Health Service, School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shengfu You
- Institute of Digestive Diseases, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jianying Wang
- Shanghai Innovation Center of Traditional Chinese Medicine Health Service, School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lei Zhang
- Shanghai Innovation Center of Traditional Chinese Medicine Health Service, School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Guang Ji
- Institute of Digestive Diseases, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Baocheng Liu
- Shanghai Innovation Center of Traditional Chinese Medicine Health Service, School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Alshanberi AM. Frailty in Kingdom of Saudi Arabia-Prevalence and Management, Where Are We? Healthcare (Basel) 2023; 11:1715. [PMID: 37372833 DOI: 10.3390/healthcare11121715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
A recent report from the United Nations state that the percentage of elderly individuals in the Kingdom of Saudi Arabia (KSA) will witness a sharp increase in the next three decades (5.6% in 2017 to 23% by 2050). This situation will lead to an increased prevalence of comorbidities and hence, will require close monitoring and constant care of such individuals who are prone to suffer from complications such as arthritis, cardiovascular disorders, diabetes, neurological disorders, etc. Frailty is one such age-related phenomenon which enhances the risk of falling, functional restrictions and greater vulnerability to adverse consequences, which tend to lead to institutionalization. Such factors highlight the importance of the urgent awareness for circumventing the progression of frailty toward a compromised health status. This concise report is an attempt to sum up the relevant research articles published with regard to frailty and concomitant diseases in the last 5 years. It also sums up the research on frailty in the KSA elderly population, till date. This article reflects the opinions of an author on tackling such issues through a well-directed mechanism involving interdisciplinary transitional care and geriatric co-management.
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Affiliation(s)
- Asim Muhammed Alshanberi
- Department of Community Medicine and Pilgrims Health Care, Umm Alqura University, Makkah 24382, Saudi Arabia
- Medicine Program, Batterjee Medical College, Jeddah 21442, Saudi Arabia
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Gosai F, Espejo K, Zussman R, DeMartini S, Wilfong C. A Rare Case of Spontaneous Intussusception in an Elderly Patient. Cureus 2023; 15:e40726. [PMID: 37485156 PMCID: PMC10360450 DOI: 10.7759/cureus.40726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2023] [Indexed: 07/25/2023] Open
Abstract
Intussusception is an uncommon pathology in the adult population. Most intussusception cases result from an underlying pathological lead point, oftentimes a malignant neoplasm. We report a case of intussusception in an adult male patient who presented with abdominal pain and currant jelly diarrhea. The patient underwent laparoscopic right hemicolectomy and the biopsy of the affected colon did not show any pathological lead point. Intussusception remains an important differential diagnosis in patients presenting with abdominal pain and bloody diarrhea.
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Affiliation(s)
- Falgun Gosai
- Hospitalist, Saint Francis Medical Center, Peoria, USA
| | - Kyle Espejo
- Medicine, University of Illinois College of Medicine Peoria, Peoria, USA
| | - Rachel Zussman
- Medicine, University of Illinois College of Medicine Peoria, Peoria, USA
| | - Stephen DeMartini
- Medicine, University of Illinois College of Medicine Peoria, Peoria, USA
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Yao Q, Jiang K, Lin F, Zhu T, Khan NH, Jiang E. Pathophysiological Association of Alzheimer's Disease and Hypertension: A Clinical Concern for Elderly Population. Clin Interv Aging 2023; 18:713-728. [PMID: 37181536 PMCID: PMC10167960 DOI: 10.2147/cia.s400527] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/22/2023] [Indexed: 05/16/2023] Open
Abstract
Alzheimer's disease (AD), the most common cause of dementia and the fifth leading cause of death in the adult population has a complex pathophysiological link with hypertension (HTN). A growing volume of published literature on a parallel elevation of blood pressure (BP), amyloid plaques, and neurofibrillary tangles formation in post-middle of human brain cells has developed new, widely accepting foundations on this association. In particular, HTN in elderly life mediates cerebral blood flow dysfunction, neuronal dysfunction, and significant decline in cognitive impairment, primarily in the late-life populace, governing the onset of AD. Thus, HTN is an established risk factor for AD. Considering the impact of AD, 1.89 million deaths annually, and the failure of palliative therapies to cure AD, the scientific research community is looking to adopt integrated approaches to target early modified risk factors like HTN to reduce AD burden. The current review highlights the significance and impact of HTN-based prevention in lowering the AD burden in the elderly by providing a comprehensive overview of the physiological relationship between AD and HTN with an in-detail explanation of the role and applications of pathological biomarkers in this clinical association. The review will gain worth in presenting new insights and providing inclusive discussion on the correlation between HTN and cognitive impairment. It will increase across a wider scientific audience to expand understanding of this pathophysiological association.
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Affiliation(s)
- Qianqian Yao
- Institute of Nursing and Health, Henan University, Kaifeng, People’s Republic of China
| | - Kexin Jiang
- Institute of Nursing and Health, Henan University, Kaifeng, People’s Republic of China
| | - Fei Lin
- School of Medicine, Shangqiu Institute of Technology, Shangqiu, People’s Republic of China
| | - Tao Zhu
- Department of Geriatrics, Kaifeng Traditional Chinese Medicine Hospital, Kaifeng, People’s Republic of China
| | - Nazeer Hussain Khan
- Institute of Nursing and Health, Henan University, Kaifeng, People’s Republic of China
- Henan International Joint Laboratory for Nuclear Protein Regulation, Henan University, Kaifeng, People’s Republic of China
| | - Enshe Jiang
- Institute of Nursing and Health, Henan University, Kaifeng, People’s Republic of China
- Henan International Joint Laboratory for Nuclear Protein Regulation, Henan University, Kaifeng, People’s Republic of China
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Wadasadawala T, Patil R, Carlton J, Verma S, Umesh N, Rane P, Sarin R, Pathak R, Bajpai J, Nair N, Shet T, Kaur R. Long-term outcomes and prognostic factors in elderly patients with breast cancer: single-institutional experience. Ecancermedicalscience 2023; 17:1542. [PMID: 37377682 PMCID: PMC10292850 DOI: 10.3332/ecancer.2023.1542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction Despite advances in treatment, there is rising mortality in elderly patients with breast cancer. We aimed to conduct an audit of non-metastatic elderly breast cancer patients to understand the predictors of outcome. Methods Data collection was done from electronic medical records. All time-to-event outcomes were analysed using Kaplan-Meier method and compared using log-rank test. Univariate and multi-variate analysis of known prognostic factors was also done. Any p-value ≤0.05 was considered statistically significant. Results A total of 385 elderly (>70 years) breast cancer patients (range 70-95 years) were treated at our hospital from January 2013 to December 2016. The hormone receptor was positive in 284 (73.8%) patients; 69 (17.9%) patients had over-expression of HER2-neu, while 70 (18.2%) patients had triple-negative breast cancer. A large majority of women (N = 328, 85.9%) underwent mastectomy while only 54 (14.1%) had breast conservation surgery. Out of 134 patients who received chemotherapy, 111 patients received adjuvant, while the remaining 23 patients received neoadjuvant chemotherapy. Only 15 (21.7%) patients of the 69 HER2-neu receptor-positive patients received adjuvant trastuzumab. Adjuvant radiation was given to 194 (50.3%) women based on the type of surgery and disease stage. Adjuvant hormone therapy was planned using letrozole in 158 (55.6%) patients, while tamoxifen was prescribed in 126 (44.4%). At the median follow up of 71.7 months, the 5-year overall survival, relapse-free survival, locoregional relapse-free survival, distant disease-free survival, breast cancer-specific survival were 75.3%, 74.2%, 84.8%, 76.1% and 84.5%. Age, tumour size, presence of lymphovascular invasion (LVSI) and molecular subtype emerged as independent predictors of survival on multi-variate analysis. Conclusion The audit highlights the underutilisation of breast-conserving therapy and systemic therapy in the elderly. Increasing age and tumour size, presence of LVSI and molecular subtype were found to be strong predictors of outcome. The findings from this study will help to improve the current gaps in the management of breast cancer among the elderly.
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Affiliation(s)
- Tabassum Wadasadawala
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra 400012, India
- https://orcid.org/0000-0003-2167-420X
| | - Roshankumar Patil
- Department of Radiation Oncology, Cancer Centers of America, Nashik, Maharashtra 422011, India
- https://orcid.org/0000-0002-9025-6864
| | - Johnny Carlton
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra 400012, India
| | - Shalini Verma
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha Cancer Hospital, Varanasi, Uttar Pradesh 221010, India
| | - Namita Umesh
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra 400012, India
| | - Pallavi Rane
- Department of Statistics, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra 400012, India
| | - Rajiv Sarin
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra 400012, India
| | - Rima Pathak
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra 400012, India
| | - Jyoti Bajpai
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra 400012, India
| | - Nita Nair
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra 400012, India
| | - Tanuja Shet
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra 400012, India
| | - Ramneet Kaur
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra 400012, India
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Shetty P, N I. Is There an Association Between Pseudoexfoliation and Pterygium? An Observational Study in a Semi-arid District of South India. Cureus 2023; 15:e38631. [PMID: 37288233 PMCID: PMC10243393 DOI: 10.7759/cureus.38631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2023] [Indexed: 06/09/2023] Open
Abstract
Introduction Pseudoexfoliation (PXF) has a varied impact on the eye and has a complex relationship with pterygium and cataracts. We explored this study to estimate the proportion of PXF and its association with pterygium in cataract patients from a semi-arid district in South India. Methods This retrospective observational study was conducted at Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research, a tertiary care referral center in Kolar, India. Cataract patients attending the hospital between December 2020 and August 2022 were included based on non-probability sampling. Three hundred fifty-two patients were included based on the inclusion and exclusion criteria, and their records on demographic details and ocular examination were collected. Results Out of 352 patient records, 184 (52.27%) were males, with the mean age being 67.84 ± 13.08 years. In all, 95% of the patients were agricultural laborers exposed to sunlight and dust for more than six hours daily. It was observed that the proportion of PXF and pterygium in the study population was 28.40% (100) and 56.33% (199), respectively. The mean age of the PXF patients was 75.53 ± 6.26 years. The association of PXF with pterygium was statistically significant (p < 0.05). Conclusion PXF is one of the significant causes of complications in cataract surgery and blindness, which can be detected only in the end stages. This study draws a statistically significant association between pterygium and PXF. Identifying preclinical cases of PXF and halting its progression by avoiding risk factors such as prolonged exposure to sunlight, UV radiation, and dust should be focused on risk-prone geographical areas.
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Affiliation(s)
- Panaah Shetty
- Ophthalmology, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Inchara N
- Ophthalmology, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
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Sundaram R, Srinivasan V, Rizvana S, Saraboji K, Muthusamy KK, Murugan I, Karunanithi KP. Risk Assessment of Osteoarthritis Among Geriatric Population in Perambalur District Using the Western Ontario and McMaster Universities Arthritis Index and Katz Index of Independence in Activities of Daily Living: A Cross-Sectional Study. Cureus 2023; 15:e39323. [PMID: 37351234 PMCID: PMC10282885 DOI: 10.7759/cureus.39323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Osteoarthritis (OA) is a degenerative joint disease that occurs resulting from tear and progressive loss of articular cartilage. It is one of the leading causes of disability in elderly people. This study aims to assess the risk of OA and the ability to perform activities of daily living (ADL) independently among the geriatric population using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) scale and Katz Index of Independence in Activities of Daily Living (Katz ADL) scale, respectively. METHODS This cross-sectional study was conducted among the geriatric population in Perambalur district, Tamil Nadu from November 2022 to January 2023. Around 415 geriatric populations above 60 years of age were included by using a simple random sampling method. A semi-structured questionnaire was used to collect sociodemographic profiles, personal and medical details, OA risk (WOMAC), and ADL (Katz ADL scale). Descriptive statistics and the chi-square test were used to investigate the relationship between sociodemographic characteristics and the Katz ADL scale and the WOMAC index score for assessing OA risk. RESULTS The mean age of participants was 69.62 ± 6.86 years. The mean ± SD score for the WOMAC scale and the Katz ADL scale among the geriatric population was 20.997 ± 14.69 and 4.821 ± 2.37, respectively. The OA risk among the geriatric population using the WOMAC scale was low in 98 (23.6%), moderate in 216 (52%), and high risk in 101 (24.3%) participants. Using the Katz ADL scale, 332 (80%) participants were found to be independent and 83 (20%) were dependent. The high-risk factors for developing OA were age ≥ 70 years, female sex, living in a rural area, employment status, Muslim religion, the habit of betel nut chewing, diabetes mellitus, hypertension, thyroid diseases, family history of knee OA, history of previous surgery, and ADL, significantly associated with WOMAC (p < 0.05). CONCLUSION As per the WOMAC scale, approximately 24.3% of the geriatric population is at high risk of developing OA and 20% of them are dependent on performing ADL as assessed using the Katz ADL scale. The WOMAC and Katz ADL scales are simple questionnaire-based screening tools used to detect high-risk individuals for OA at an early stage in the geriatric population.
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Affiliation(s)
- Ramkumar Sundaram
- Department of Community Medicine, Dhanalakshmi Srinivasan Medical College & Hospital, Perambalur, IND
| | - Vijayalakshmi Srinivasan
- Department of Community Medicine, Dhanalakshmi Srinivasan Medical College & Hospital, Perambalur, IND
| | - Shagirunisha Rizvana
- Department of Community Medicine, Dhanalakshmi Srinivasan Medical College & Hospital, Perambalur, IND
| | - Kayalvizhi Saraboji
- Department of Community Medicine, Dhanalakshmi Srinivasan Medical College & Hospital, Perambalur, IND
| | - Kishore Kannan Muthusamy
- Department of Community Medicine, Dhanalakshmi Srinivasan Medical College & Hospital, Perambalur, IND
| | - Indhumathi Murugan
- Department of Community Medicine, Dhanalakshmi Srinivasan Medical College & Hospital, Perambalur, IND
| | - Keerthi Priya Karunanithi
- Department of Community Medicine, Dhanalakshmi Srinivasan Medical College & Hospital, Perambalur, IND
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Fujino K, Ureshino H, Yoshida T, Ichinohe T. Benefit of the Reduced Dose Combination of Azacitidine and Venetoclax in an Elderly Patient With Acute Myeloid Leukemia. Cureus 2023; 15:e39481. [PMID: 37362503 PMCID: PMC10290478 DOI: 10.7759/cureus.39481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
Elderly patients with acute myeloid leukemia (AML) have been found to clinically benefit from the combination of azacitidine (AZA) and venetoclax (VEN), although the safety and efficacy of the treatment in extremely elderly patients (age >85 years) have not been fully established. An 88-year-old woman diagnosed with AML was given a lower dose of AZA and VEN. She eventually developed grade 4 hypokalemia, necessitating treatment interruption. However, a lower dose of VEN was successfully continued in the subsequent cycle of treatment, resulting in complete remission. Hence, reduced AZA and VEN doses may be beneficial for extremely elderly AML patients.
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Affiliation(s)
- Keita Fujino
- Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, JPN
| | - Hiroshi Ureshino
- Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, JPN
| | - Tetsumi Yoshida
- Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, JPN
| | - Tatsuo Ichinohe
- Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, JPN
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Liu JW, Tan Y, Chen T, Qian YT, Zhang T, Ma DL. Video education improves patients' knowledge and satisfaction in treatment of solar lentigines with picosecond 755-nm alexandrite laser: A retrospective study. Front Med (Lausanne) 2023; 10:1158842. [PMID: 37409281 PMCID: PMC10319399 DOI: 10.3389/fmed.2023.1158842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 03/27/2023] [Indexed: 07/07/2023] Open
Abstract
Background Picosecond lasers are widely used in dermatologic and cosmetic practice. In clinical practice, informed consent for laser treatments is critical to ensure patients' understanding of health information. Objectives To evaluate whether video-based informed consent improves patient comprehension and satisfaction. Methods The study was performed from August 1 to November 30, 2022. Solar lentigines patients who fulfilled the inclusion criteria were included. Before October 1, 2022, traditional informed consent methods were performed. In the subsequent 2 months, a video-based informed consent was used as an adjunct to traditional consenting methods. Finally, patient comprehension of relevant knowledge about laser treatment and client satisfaction were assessed. Results A total of 106 patients were included. The mean number of correct answers in the comprehension assessment in the video-based informed consent group was significantly higher than that in the traditional informed consent group (4.4 ± 1.2 vs. 3.4 ± 1.1, p < 0.001). Compared to the traditional informed consent group, more correct answers in the video-based informed consent group were provided by older patients (3.9 ± 1.2 vs. 2.9 ± 1.1, p = 0.004) and patients with lower education levels (4.1 ± 1.1 vs. 3.0 ± 1.2, p < 0.001). The mean satisfaction score in the video-based informed consent group was significantly higher than that in the traditional informed consent (27.8 ± 5.7 vs. 24.3 ± 6.2, p = 0.003). Conclusion Video-based informed consent helps patients learn clinical literacy more effectively and improves patient satisfaction, especially in those with lower education levels and older ages.
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De Santis KK, Mergenthal L, Christianson L, Busskamp A, Vonstein C, Zeeb H. Digital Technologies for Health Promotion and Disease Prevention in Older People: Scoping Review. J Med Internet Res 2023; 25:e43542. [PMID: 36951896 PMCID: PMC10131689 DOI: 10.2196/43542] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/30/2022] [Accepted: 01/31/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Digital technologies have the potential to contribute to health promotion and disease prevention in the aging world. OBJECTIVE This study aims to identify digital technologies for health promotion and disease prevention that could be used independently by older people in nonclinical settings using a scoping review. METHODS Through database (MEDLINE, PsycINFO, CINAHL, and SCOPUS; to March 3, 2022) and manual searches (to June 14, 2022), 90 primary studies and 8 systematic reviews were included in this scoping review. The eligibility was based on the PCC (Population, Concept, and Context) criteria: (1) people aged 50 years or older (population), (2) any digital (health) technology (eg, smartphone apps, websites, virtual reality; concept), and (3) health promotion and disease prevention in daily life in nonclinical and noninstitutional settings (context). Data items included study characteristics, PCC criteria, opportunities versus challenges, and evidence gaps. Data were synthesized using descriptive statistics or narratively described by identifying common themes. RESULTS The studies were published in 2005-2022 and originated predominantly from North America and Europe. Most primary studies were nonrandomized, reported quantitative data, and investigated effectiveness or feasibility (eg, acceptance or usability) of digital technologies in older people. The participants were aged 50 years to 99 years, predominantly female, affluent (ie, with high income, education, and digital competence), and intended to use or used digital technologies for a median of 3 months independently at home or in community settings. The digital technologies included mobile or nonmobile technologies or virtual reality. The studies used "modern devices" (eg, smartphones, wearables, or gaming consoles) or modern and "older devices" (eg, computers or mobile phones). The users interacted with digital technologies via websites, emails, text messages, apps, or virtual reality. Health targets of digital technologies were mobility, mental health, nutrition, or cognition. The opportunities versus challenges of digital technologies were (1) potential health benefits versus unclear or no benefits for some outcomes, (2) monitoring of health versus ethical issues with data collection and management, (3) implications for functioning in daily life (ie, potential to prolong independent living) versus unclear application for clinical management or care, (4) tailoring of technical properties and content toward older users versus general use, (5) importance of human support for feasibility versus other factors required to improve feasibility, (6) reduction of social isolation versus access to digital technologies, and (7) improvement in digital competence versus digital divide. CONCLUSIONS Various digital technologies were independently used by people aged 50 years or older for health promotion and disease prevention. Future studies should focus on (1) more diverse populations of older people, (2) new digital technologies, (3) other (clinical and care) settings, and (4) outcome evaluation to identify factors that could enhance any health benefits of digital technologies. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/37729.
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Affiliation(s)
- Karina Karolina De Santis
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
- Leibniz-Science Campus Digital Public Health Bremen, Bremen, Germany
| | - Lea Mergenthal
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
| | - Lara Christianson
- Department of Administration, Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
| | - Annalena Busskamp
- Department Q6- Adults, Seniors, Women's and Men's Health, Health Equity, Federal Centre for Health Education, Cologne, Germany
| | - Claudia Vonstein
- Department Q6- Adults, Seniors, Women's and Men's Health, Health Equity, Federal Centre for Health Education, Cologne, Germany
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
- Leibniz-Science Campus Digital Public Health Bremen, Bremen, Germany
- Faculty 11 Human and Health Sciences, University of Bremen, Bremen, Germany
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Quinn E, Hsiao KH, Johnstone T, Gomez M, Parasuraman A, Ingleton A, Hirst N, Najjar Z, Gupta L. Protecting Older Adult Residents in Care Facilities Against Influenza and COVID-19 Using the Influenza Communication, Advice and Reporting (FluCARE) App: Prospective Cohort Mixed Methods Study. JMIR Form Res 2023; 7:e38080. [PMID: 36763638 PMCID: PMC10013678 DOI: 10.2196/38080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 11/20/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Early detection and response to influenza and COVID-19 outbreaks in aged care facilities (ACFs) are critical to minimizing health impacts. The Sydney Local Health District (SLHD) Public Health Unit (PHU) has developed and implemented a novel web-based app with integrated functions for online line listings, detection algorithms, and automatic notifications to responders, to assist ACFs in outbreak response. The goal of the Influenza Outbreak Communication, Advice and Reporting (FluCARE) app is to reduce time delays to notifications, which we hope will reduce the spread, duration, and health impacts of an influenza or COVID-19 outbreak, as well as ease workload burdens on ACF staff. OBJECTIVE The specific aims of the study were to (1) evaluate the acceptability and user satisfaction of the implementation and use of FluCARE in helping ACFs recognize, notify, and manage influenza and COVID-19 outbreaks in their facility; (2) identify the safety of FluCARE and any potential adverse outcomes of using the app; and (3) identify any perceived barriers or facilitators to the implementation and use of FluCARE from the ACF user perspective. METHODS The FluCARE app was piloted from September 2019 to December 2020 in the SLHD. Associated implementation included promotion and engagement, user training, and operational policies. Participating ACF staff were invited to complete a posttraining survey. Staff were also invited to complete a postpilot evaluation survey that included the user Mobile Application Rating Scale (uMARS) measuring app acceptance, utility, and barriers and facilitators to use. An issues log was also prospectively maintained to assess safety. Survey data were analyzed descriptively or via content analysis where appropriate. RESULTS Surveys were completed by 31 consenting users from 27 ACFs. FluCARE was rated 3.91 of 5 overall on the uMARS. Of the 31 users, 25 (80%) would definitely use FluCARE for future outbreaks, and all users agreed that the app was useful for identifying influenza and COVID-19 outbreaks at their facilities. There were no reported critical issues with incorrect or missed outbreak detection. User training, particularly online training modules, and technical support were identified as key facilitators to FluCARE use. CONCLUSIONS FluCARE is an acceptable, useful, and safe app to assist ACF staff with early detection and response to influenza and COVID-19 outbreaks. This study supports feasibility for ongoing implementation and efficacy evaluation, followed by scale-up into other health districts in New South Wales.
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Affiliation(s)
- Emma Quinn
- Public Health Unit, Sydney Local Health District, Sydney, Australia.,Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, Australia
| | - Kai Hsun Hsiao
- Public Health Unit, Sydney Local Health District, Sydney, Australia
| | - Travers Johnstone
- Public Health Unit, Sydney Local Health District, Sydney, Australia.,Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, Australia
| | - Maria Gomez
- Public Health Unit, Sydney Local Health District, Sydney, Australia
| | - Arun Parasuraman
- Public Health Unit, Sydney Local Health District, Sydney, Australia
| | - Andrew Ingleton
- Public Health Unit, Sydney Local Health District, Sydney, Australia
| | - Nicholas Hirst
- Public Health Unit, Sydney Local Health District, Sydney, Australia
| | - Zeina Najjar
- Public Health Unit, Sydney Local Health District, Sydney, Australia
| | - Leena Gupta
- Public Health Unit, Sydney Local Health District, Sydney, Australia.,Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, Australia
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Babakhanlou R, Ravandi-Kashani F. Non-intensive acute myeloid leukemia therapies for older patients. Expert Rev Hematol 2023; 16:171-180. [PMID: 36864772 DOI: 10.1080/17474086.2023.2184342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
INTRODUCTION Acute myeloid leukemia (AML) is an aggressive disease predominantly affecting the elderly population. The elderly population represents a challenging group to treat and the prognosis is generally poor with significantly worse treatment outcomes compared to the younger population. While the goal of treatment for younger fit patients is cure and includes intensive chemotherapy and stem cell transplantation, these strategies are not always feasible for elderly unfit patients due to increased frailty, co-morbidities, and, subsequently, an increased risk of treatment-related toxicity and mortality. AREAS COVERED This review will discuss both patient- and disease-related factors, outline prognostication models and summarize current treatment options, including intensive and less intensive treatment strategies and novel agents. EXPERT OPINION Although recent years have seen major advances in the development of low-intensity therapies, there is still a lack of consensus on the optimal treatment for this patient group. Because of the heterogeneity of the disease, personalizing the treatment strategy is important and curative-oriented approaches should be selected wisely, rather than following a rigid hierarchical algorithm.
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Affiliation(s)
- Rodrick Babakhanlou
- Department of Leukemia, the University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Farhad Ravandi-Kashani
- Department of Leukemia, the University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
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50
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Lagarto M, Santos A, Freitas BD, Anastácio M, Jesus S. The Overlooked Agent: Cytomegalovirus Colitis in an Immunocompetent Patient. Cureus 2023; 15:e36926. [PMID: 37128542 PMCID: PMC10148746 DOI: 10.7759/cureus.36926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 05/03/2023] Open
Abstract
Cytomegalovirus (CMV) colitis is usually associated with immunosuppressed patients, which by the classic definition are individuals who have immunosuppressed associated conditions (human immunodeficiency virus [HIV], oncology diseases, inflammatory bowel disease, transplant patients) or who are submitted to immunosuppressing therapies (for instance, corticosteroids, chemotherapeutic agents or immunomodulation therapies). In immunocompetent patients, this diagnosis tends to be often missed, leading to a delay in initiating proper management. We present a case of a 91-year-old woman that was diagnosed with CMV colitis without any identified formal immunocompromising factors. We intend to highlight the need to review the definition of an immunosuppressed individual and emphasize that CMV colitis should be considered in the differential diagnosis, especially in elderly patients and those with underlying conditions that can possibly affect their immune status, since prompt diagnosis and treatment are essential and influence the prognosis.
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Affiliation(s)
- Margarida Lagarto
- Medical Oncology, Centro Hospitalar de Lisboa Ocidental, Lisboa, PRT
| | - Ana Santos
- Internal Medicine, Centro Hospitalar de Lisboa Ocidental, Lisboa, PRT
| | - Bruno D Freitas
- Internal Medicine, Centro Hospitalar de Lisboa Ocidental, Lisboa, PRT
| | - Marta Anastácio
- Internal Medicine, Centro Hospitalar de Lisboa Ocidental, Lisboa, PRT
| | - Susana Jesus
- Internal Medicine, Centro Hospitalar de Lisboa Ocidental, Lisboa, PRT
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