Search

ZusammenfassungDurch den in Deutschland herrschenden demografischen Wandel verschiebt sich die Alterspyramide immer mehr nach oben. Als älter gilt laut WHO ein Mensch zwischen dem 61. und dem 75. Lebensjahr. Als alt werden Menschen ab 76 Jahren bezeichnet. Für die Beantwortung der Frage, ob und in welchem Ausmaß ein alter Patient aufgrund seiner Komorbiditäten thoraxchirurgisch operabel ist, gibt es bislang keine systematische Klassifizierung. In den meisten Fällen scheint für diese Entscheidung die Erfahrung und Einschätzung des Operateurs ausschlaggebend zu sein. Patienten und Methoden Die Datenanalyse erfolgte im Zeitraum von 01. 2016–01. 2018 anhand der Daten des Deutschen Thoraxregisters (Projekt-ID:2017–03), das unter der Schirmherrschaft der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI) und der Deutschen Gesellschaft für Thoraxchirurgie (DGT) aufgebaut wurde. Insgesamt wurden 1357 Patienten eingeschlossen, von denen 658 ein histologisch nachgewiesenes Lungenkarzinom im Stadium I-II hatten. Diese wurden in drei Gruppen unterteilt; Gruppe I ( 75 Jahre).Wir konnten zeigen, dass Gruppe III, die der > 75-jährigen Patienten, im Wesentlichen keine erhöhten postoperativen Komplikationsraten hatten (Alle = 48,00 %; Gr. I = 40,90 %; Gr. II = 53,00 %; Gr. III = 52,90 %) und sogar bei einigen speziellen Komplikationen besser abschnitt, als die Gruppe der 65 bis ≤ 75-jährigen Patienten. (z. B. postoperative Pneumonie Gruppe II = 19,20 %, Gruppe III = 12,90 %).Die Mortalität lag bei den Patienten der Gruppen I–III, die in Zentren des Deutschen Thoraxregisters operiert wurden (Alle = 1,70 %, Gr. I = 1,90 %; Gr. II = 1,70 %; Gr. III = 1,30 %), insgesamt niedriger als im bundesdeutschen Durchschnitt (Alle = 1,99 %; Gr. I = 1,23 %; Gr. II = 2,18 %; Gr. III = 3,78 %). Insbesondere die alten Patienten der Gruppe III wiesen hierbei den größten Unterschied auf.Weiterhin konnten wir feststellen, dass im Gegensatz zu anderen deutschen Zentren und Kliniken, der größte Teil der anatomischen Resektionen in den Zentren des Deutschen Thoraxregisters minimalinvasiv per VATS (Video-assisted Thoracoscopic Surgery) durchgeführt wurde. Diskussion Auf Grundlage dieser Erhebungen stellte sich uns die Frage, ob die alten Patienten der Gruppe III (> 75jährigen) in Deutschland in der Regel einer leitliniengerechten Therapie zugeführt wurden. Zwar gibt es eine Selektion der Patienten in Gruppe III in den Zentren des Deutschen Thoraxregisters, dennoch ist unser Appell, dass nach Abwägung der individuellen Risiken und nach objektiven Kriterien auch diese Patientengruppe deutschlandweit der onkologischen Therapie der Wahl (Goldstandard) zugeführt werden sollte. Hierunter verstehen wir unbedingt die anatomische Resektion mit einem minimal invasiven Zugang per VATS. Das Risiko einer postoperativen Komplikation auf Grund des Alters darf nicht die alleinige Entscheidungsgrundlage gegen eine Resektion sein.

BACKGROUND Lack of clinical management of old patients in the emergency department. QUESTION How can we manage old patients in the emergency department more effectively, medically and economically? METHODS Evaluation of current selection and screening methods and recommendations for old patients in the emergency department. Acute inpatient treatment needs, presence of dysfunction in at least two core areas and assessment of advance care needs are examined. RESULT The identification of old patients in the emergency department as geriatric patients alone shows no control potential. Combining the three test criteria of acute inpatient need for treatment, the presence of dysfunction in at least two core areas and the assessment of advance care needs generates four old patient types that have interesting control potential: the medical traumatology patient, the acute geriatric patient, the rehabilitative geriatric patient, and the ambulatory patient. DISCUSSION in addition to identifying geriatric patients, screening should map acute inpatient treatment needs, assessment of dysfunction, and analysis of advance care needs to define clinically steerable old patients.

Calcified aortic stenosis has become the most common form of acquired valvular heart disease in very old patients. Despite this fact, a majority of these patients were turned down by surgery owing to a risk of mortality > 10 % in patients older than 90 years. In recent years, transcatheter aortic valve implantation (TAVI) has emerged as a therapeutic option for severe aortic stenosis. However, there is a paucity of data regarding the outcomes of TAVI in patients older than 100 years. We present the oldest patient who has undergone successful TAVI reported in the current literature.

Objective: In the current pandemic of COVID-19 the health care workers are working with social scientist to assist the government policy makers to slow the spread of this disease. These studies are focusing on different social aspects of the disease. A few studies are conducted on the behavior changes in community in response to this pandemic. Study Design: Cross Sectional Survey. Setting: Urology Outpatients Department of Four Hospitals. Period: May 2020. Material & Methods: YouGov behavior change Performa was used for the survey with a 4 points scale from "Not at all" to "Drastic Change". Results: Total 285 patients were included in this study. Among these 191 patients were male while 94 were female. The age range was 50-68 years. Among 285 patients 159 an education level above primary. Among these 285 patients 234 patients (82.1%) belong to urban area while 51 patients (17.9%) belongs to rural area. Regarding change in behavior, 168 patients responded that there is no change, 56 showed a little change, 32 showed significant change and 28 showed drastic change in the habit of hand washing. In change in travel habit 128 mentioned not at all, 84 said a little change, 53 showed significant change and 20 said drastic change. In work from home 120 mentioned not at all, 88 said a little change, 57 showed significant change and 20 said drastic change. In piling of food and medicine 164 mentioned not at all, 96 said a little change and 25 showed significant change while there was no drastic change. In elderly and child care160 mentioned not at all, 68 said a little change and 57 showed significant change while there was no drastic change. In social distancing 160 mentioned not at all, 72 said a little change, 24 showed significant change and 29 said drastic change. In use of face mask 124 mentioned not at all, 132 said a little change, 24 showed significant change and 05 said drastic change. Conclusion: As there is no vaccine for this disease and treatment plans are also under trial so the role of preventive measures increases. The most important preventive measures are wearing of face masks, social distancing and avoidance of unnecessary traveling. As, at present, we can only decrease the spread of disease by adopting preventive measures.

The aim is to assess the frequency of falls and intrinsic fall risk factors in patients requiring pacemakers. Methodology. The research was conducted from November 2020 to February 2021. Participated patients were hospitalized at the LUHS hospital Kauno Klinikos Department of Cardiology and required heart pacemaker implantation. Total 82 patients participated in the study. The questionnaire was composed by the authors of the research. The study was obtained by the Bioethics Permit of the Medical Academy of LUHS (No. BEC-SL (B) -42). Results. Almost half of the patients fell (45.1%) at least once a year. Elderly patients (65 years and older) are more likely to experience falls than patients under 65 years of age p=0,006. Elderly patients are more often exposed to various internal risk factors of falls: urination at night (82,9 %), weakness (82,9 %), dizziness (76,8 %). Perceived decreased leg muscle strength was found in both women and men (69.6% and 52.8%, respectively, p = 0.002). Patients older than 65 years and therefore

Актуальність. У статті подано ретроспективний аналіз причин, що призводять до негативних результатів хірургічного лікування людей літнього віку з грижами міжхребцевих дисків на рівні поперекового відділу хребта. Мета. Визначення причин негативних результатів хірургічного лікування гриж міжхребцевих дисків у людей літнього і старечого віку порівняно з молодими пацієнтами, що дозволить у подальшому вибрати правильну хірургічну тактику та запобігти виникненню ускладнень. Матеріали та методи. Проведено ретроспективний аналіз хірургічного лікування гриж міжхребцевих дисків поперекового відділу хребта у 170 пацієнтів. Група молодих людей становила 92 пацієнти, група осіб літнього і старечого віку (60 років і старше) — 78 пацієнтів. Першу операцію з приводу грижі міжхребцевого диска було проведено у термін від 3 місяців до 7 років до дослідження в різних лікувальних закладах України. Результати. Рецидив грижі диска на тому самому рівні виявлено у 61 % молодих пацієнтів і майже в 4 рази рідше (14,1 %) у старших. Грижа диска на суміжному рівні виявлена також частіше у молодих пацієнтів (10,0 %), ніж у старшої вікової категорії (3,8 %). Цей факт автори пов’язують з тим, що з віком міжхребцевий диск більш дегідратований, а висота міжтілового проміжку значно зменшується, тоді як у молодих людей об’єм матеріалу диска значний, що збільшує ризик утворення нових секвестрів. Висновки. Результати проведеної роботи вказують на те, що причини повторних оперативних хірургічних втручань з приводу гриж міжхребцевих дисків залежать від віку пацієнта; найчастішою причиною повторних оперативних втручань у старших пацієнтів є нестабільність на оперованому та суміжному рівнях, що спонукає хірургів до більш широкого застосування стабілізуючих оперативних втручань та більш детального передопераційного планування щодо вибору рівня стабілізації; у старшої вікової категорії переважають процеси стенозування, отже, у них необхідно застосовувати більш широку декомпресію.

Introduction Several psychiatric and somatic medications are assumed to improve COVID-19-symptoms. These include antidepressants, antipsychotics, and anticonvulsants as well as anticoagulants, statins, and renin-angiotensin-aldosterone-system (RAAS)-inhibitors for somatic comorbid conditions. All these agents may reduce the hyperinflammatory response to SARS/CoV-2 or the related negative cardio-cerebrovascular outcomes. Methods In a retrospective longitudinal, multi-center inpatient study, we sought to explore the influence of psychiatric medications on COVID-19, comprising the period from diagnosing SARS/CoV-2-infection via PCR (nasopharyngeal swab) up to the next 21 days. Ninety-six psychiatric inpatients (mean age [SD] 65.5 (20.1), 54% females) were included. The primary outcome was the COVID-19-duration. Secondary outcomes included symptom severity and the presence of residual symptoms. Results COVID-19-related symptoms emerged in 60 (62.5%) patients, lasting 6.5 days on average. Six (6.3%) 56–95 years old patients died from or with COVID-19. COVID-19-duration and residual symptom-presence (n=22, 18%) were not significantly related to any substance. Respiratory and neuro-psychiatric symptom-load was significantly and negatively related to prescription of antidepressants and anticoagulants, respectively. Fatigue was negatively and positively related to RAAS-inhibitors and proton-pump-inhibitors, respectively. These significant relationships disappeared with p-value adjustment owed to multiple testing. The mean total psychiatric burden was not worsened across the study. Discussion None of the tested medications was significantly associated with the COVID-19-duration and -severity up to the end of post-diagnosing week 3. However, there were a few biologically plausible and promising relationships with antidepressants, anticoagulants, and RAAS-inhibitors before p-value adjustment. These should encourage larger and prospective studies to re-evaluate the influence of somatic and psychiatric routine medications on COVID-19-related health outcomes.

BACKGROUND Acute promyelocytic leukemia (APL) is uncommon among subjects aged ≥ 70 years and the better therapeutic strategy represents an unmet clinical need. MATERIALS AND METHODS This prompted us to explore our real-life data on a retrospective cohort of 45 older APL patients (≥ 70 years) consecutively diagnosed at eight different hematologic institutions in Latium, Italy, from July 1991 to May 2019. RESULTS Two patients (4.4%) died from early hemorrhagic complications before treatment could begin. Twenty-two patients (51.1%) (Group A) were enrolled or treated according to standard clinical protocols, while 21 (48.8%) (Group B) received an ATRA-based personalized approach due to poor performance status. Morphologic complete remission (CR) after induction therapy was achieved in 33 patients (76.7%) with 100% of patients in Group A and 52.3% in Group B (p

Background The latest guidelines recommended that common bile duct stones (CBDSs) should be removed, preferably endoscopically, regardless of the presence of symptoms or complications. However, the removal of CBDSs may not be feasible in very old patients or those with co-morbidities. In these cases, it is important to understand the risk factors for the development of CBDSs-related complications to decide whether or not to treat high-risk patients. Herein, we aimed to identify the risk factors for the development of complications after the diagnosis of CBDSs. Methods The medical records of patients with CBDSs between October 2005 and September 2019 were retrospectively analyzed. All patients with radiologically-diagnosed CBDSs, including those who received treatment and those who did not, were analyzed. Results A total of 634 patients were included and 95 (15.0%) patients had CBDS-related complications during the mean follow-up period of 32.6 months. Forty-four (6.9%) high-risk patients remained asymptomatic and did not receive treatment during the follow-up period. In multivariate analyses, size of CBDSs ≥ 5 mm and no treatment within 30 days were independent risk factors for the development of complications. The spontaneous passage of CBDSs was proved radiologically in 9 out of 81 (11.1%) patients within 30 days. Conclusions It is recommended treating CBDSs within 30 days from the diagnosis, even in high-risk patients, especially if the size is larger than 5 mm.

Increasing data suggests that chronic low-grade inflammation plays an important role on development of sarcopenia. The present study was designed to identify the association between fibrinogen, fibrin degradation products (FDP) and sarcopenia risk in hospitalized old patients.A total of 437 patients were enrolled in this cross-sectional study (148 with sarcopenia and 289 without sarcopenia). Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia (AWGS) 2019 criteria. Body composition, grip strength and gait speed were performed to participants. Fibrinogen, FDP levels were measured. Logistic regression analyses were carried out to assess the association between fibrinogen and sarcopenia, between FDP and sarcopenia, respectively.Compared to non-sarcopenic patients, fibrinogen and FDP levels were found to be higher in the sarcopenic group (3.07 g/L vs 2.79 g/L, 1.75 μg/mL vs 1.00 μg/mL, respectively, p 0.05). Multiple linear regression analysis showed a significant negative association between fibrinogen and gait speed (β: -0.164, p = 0.008), and muscle strength (β: -0.231, p 0.001). Multivariable logistic regression analysis showed that fibrinogen and FDP were independently associated with sarcopenia (odds ratio 1.32 [95% confidence interval 1.03, 1.70], p = 0.009; odds ratio 1.07 [95% confidence interval 1.01, 1.19], p = 0.049, respectively). ROC curve revealed that the cutoff values of fibrinogen and FDP to predict sarcopenia risk were 2.54 g/L and 1.15 μg/mL, respectively.In hospitalized old patients, serum fibrinogen and FDP levels are elevated in sarcopenia patients than those without sarcopenia. Fibrinogen and FDP are associated with sarcopenia in a concentration-dependent manner.

Aim. To evaluate the results of surgical treatment in older patients with lumbar spinal stenosis.Materials and methods. The study is based on the results of a comprehensive examination and surgical treatment of 20 patients who were hospitalized in the neurosurgery department of the SI NMC “Shifobakhsh” in the Department of Neurosurgery and Combined Trauma of the ATSMU with stenosis of the lumbar spine with various options for the clinical course. Assessment of the neurological status in degenerative spinal disease was conducted using a visual analog scale (VAS.)Results. When comparing subgroups, it was noted that decompressive interventions show the best results for lumbar spinal stenosis in the older age group.Conclusion. The use of differentiated microsurgical decompression techniques in older patients with degenerative lateral and central spinal canal stenosis provides an improvement in quality of life.

Background Occurrence at a young age is known to be associated with unique clinical features in colorectal cancer (CRC). However, the genomic differences between young and old patients with CRC are not well elucidated and, to the best of our knowledge, have never been investigated in a Chinese population. Methods Tumor tissue samples from 29 young (age ≤50 years) and 46 old (age >50 years) patients with CRC were collected. Targeted sequencing of 808 cancer‐related genes was conducted to characterize the genomic landscape for Chinese CRC. Results Overall, mutational profiles exhibited notable differences between the two groups. In particular, APC and PIK3CA mutations were more frequently observed in old patients (p = 0.009 and p = 0.012, respectively), while SMAD4 mutations tended to occur in young patients (p = 0.054). Mutation loci distributions of KRAS in the young cohort differed from those in the old cohort, and a higher frequency of KRAS codon 12 mutations was potentially associated with a young age (p = 0.076). The frequencies of clinically actionable alterations were analyzed by defined age categories, which unveiled a distinctive targeted genomic profile in the young group. Furthermore, among patients with mismatch repair‐proficient (pMMR) CRC, tumor mutation burden (TMB) was positively correlated with age (Pearson's r = 0.306, p = 0.011), and genomic alterations associated with high TMB in young patients differentiated from those in old patients. Conclusions These findings revealed different molecular characterization between young and old Chinese patients with CRC, which may provide novel insights for the personalized treatment of CRC., This is the first NGS study to compare genomic profiles between young and old Chinese cohorts with CRC. The results demonstrated that young patients with CRC presented with some unique molecular features. Moreover, the comprehensive investigation of clinically actionable mutations and TMB will contribute to the improvement of personalized therapy and clinical management in CRC.

Background: Hematologic malignancies are of diverse incidence, prognosis, and etiology. Dhaka medical college hospital (DMCH) is a tertiary level hospital and dealing with patients attending from all over the country. We have analyzed data of patients present with hematological malignancy in our Out Patient Department (OPD). As Hematology Dept DMCH deal with patients referred from all over the country, its OPD data represents the picture of whole country. Methods: This is a retro-spective study of OPD patients with hematological malignancy in the department of Hematology of DMCH from January 2018 to December 2018. The diseases were diagnosed on the basis of bone marrow morphology or histopathology (Lymphoma) and or immunophenotyping & molecular genetics. Results: Total 5747 patients were treated in 2018 with the complaints related to hematological malignancy of which 4599 (80%) were old patients and 1148 (20%) were new patients. Among all the treated patients 1420 (24.7%) were female and 4327 (75.3%) were male. Among 1148 new cases 37 were AL(3%), 386 were ALL (34%), 265 were AML(23%), 32 were CLL (3%), 126 were CML (11%), 40 were HL (3%), 18 were MDS (1%), 76 were MM (7%), 168 were NHL (15%). Data shows variation in total number of new patients per month- 83 in January (7.23%), 96 in February (8.36%), 140 in March (12.20%), 98 in April (8.54%), 94 in May (8.19), 89 in June (7.75%), 98 in July (8.54%), 66 in August (5.75%), 99 in September (8.62%), 103 in October (8.97%), 98 in November (8.54%), 84 in December (7.31%) But it does not show any statistical significant frequencies of diseases according to months. Conclusion: We deal a lot of patients with hematological malignancy each year in DMCH. A good portion of them are of ALL because of monthly maintenance of ALL protocols. Analysis of new cases shows ALL, AML, NHL is most common three diseases encounter in OPD. OPD patients’ inflow does not show any significant monthly variation for any of the diseases.

This is the first Western study presenting short-term results on patients older than 80 years affected by gastric cancer and treated with laparoscopic distal gastrectomy. A multicentre prospective database on patients suffering from distal gastric cancer with age of ≥ 80 undergone to distal gastrectomy was analysed retrospectively. End points were length of hospital stay (LoS) after surgery, and times to stool passage and solid diet initiation, as well as postoperative complications. Univariate analysis of the differences between “laparoscopic” and “open” groups was performed with non-parametric tests. Forty-six patients (median age: 83 years, median CCI: 5) undergone to distal gastrectomy were analysed. Seventeen out 46 patients (36.9%) underwent laparoscopic distal gastrectomy and extended lymphadenectomy was achieved in 25 cases (25/46, 54.3%). Median number of removed and examined nodes was higher in laparoscopic than in open group. Median LoS was significantly lower in the laparoscopic group (8 vs. 11 days). Complications occurred in 12 patients (26.1%): no significant differences between the two groups. There was a significant difference between the two surgical approaches in term of times for stool passage. Laparoscopic approach seems to reduce the effect of the surgical trauma without compromising lymphadenectomy also in octogenarian patients with distal gastric cancer.

Burr hole evacuation (BHE) of symptomatic chronic subdural hematoma (CSH) carries significant morbidity and mortality in the elderly because they are a fragile population. As military neurosurgeons, we perform a simplified technique under local anesthesia using a manual craniotome. We present the case of an 85-year-old woman suffering from a right-sided CSH causing confusion and severe left-sided hemiparesis. After the procedure, the patient presented immediate neurological improvement. Performing manual BHE of symptomatic CSH under local anesthesia is safe, and it is of great interest for very old patients or in case of strained resources, thus we think that this technique should be taught to every young neurosurgery resident.

Purpose Surgical resection of intracranial meningiomas in patients that are 80 years old and older, i.e. very old patients, is increasingly considered. Meningiomas with a largest diameter of at least 5 cm—‘giant meningiomas’—form a distinct entity, and their surgical resection is considered more difficult and prone to complications. Here, we evaluated functional outcome, morbidity and mortality, and the prognostic value of tumor size in very old patients who underwent resection of giant supratentorial meningiomas. Methods We retrospectively reviewed clinical and radiological data, functional performance (Karnofsky Performance Score), histopathological diagnosis and complications of very old patients who underwent surgery of a supratentorial meningioma at the Helsinki University Hospital between 2010 and 2018. Results We identified 76 very old patients, including 28 with a giant meningioma. Patients with a giant meningioma suffered from major complications more commonly than those with a non-giant meningioma (36% vs. 17%, p = 0.06), particularly from postoperative intracranial hemorrhages (ICH). At the 1-year follow-up, functional performance and mortality rate were comparable between patients with giant meningiomas and those with non-giant meningiomas. An exceptionally high rate of giant meningiomas were diagnosed as atypical meningiomas (WHO II) at an (11 out of 28 cases). Conclusions Giant meningioma surgery entails a high complication rate in frail, very old patients. The prevention of postoperative ICH in this specific patient group is of utmost importance. An atypical histopathology was notably frequent among very old patients with a giant meningioma, which should be taken into account when planning the surgical strategy.

Objective:To explore and understand young people’s perspectives of fixed orthodontic treatment. In particular, understanding how young people perceived and experienced having a fixed appliance and how their experiences can change during their treatment.Design:Qualitative study carried out longitudinally.Setting:In-depth qualitative interviews carried out in participants’ homes, video diaries recorded by participants when and where they wish.Participants:Fifteen patients aged 10–15 years undergoing NHS fixed appliance treatment.Methods:Data were collected by in-depth interviews and video diaries throughout the participants’ course of orthodontic treatment. Data were analysed using thematic analysis.Results:Young people’s friends, family and social media influenced how young people felt about the appearance of their teeth. Young people can perceive negative social judgements are made about them based on the appearance of their teeth; however, the appearance of the brace was not a concern. For some of the young people, the presence of the brace formed a rite of passage throughout adolescence. Pain and discomfort caused by fixed appliances was expected and tolerated and felt normal with time.Conclusion:Young people’s perceptions about appearance are influenced by people around them and social media. The physical feeling of the brace was normalised, although it did affect young people’s lives.

Aim: To explore the effect of socioeconomic status on frequency of dental caries among patients with maloccluded teeth. Methodology: Analytical cross-sectional study was conducted at Dental hospital of Institute of dentistry, CMH, Lahore Medical College, Lahore. Sample size was calculated as 330. Data was collected using purposive sampling technique. Patients of both genders between the ages of 3 to 11 years with maloccluded teeth were included. Result: According to Modified Kuppuswamy socioeconomic scale rating, gender wise comparison was conducted using chi-square test. Out of 330 participants, 28 males and 17 females were between scores of 25-29, i.e. the upper class. 91 males and 105 females were between scores of 16-25, being in upper middle class. 40 males and 45 females were scored between 5-10, being in lower middle class while 1 male and 3 females were scored

Aim: To determine patients’ perception of services rendered in a high volume Nigerian primary eye care center. Methods: ex post facto research design was used. Participants' socio-demographic profile was obtained using a pretested questionnaire. Data analysis was by SPSS version 20.0. Results: Of the 303 patients (156, 51.6% first timers; 147, 48.5% were old patients), 153(50.5%) were males and 150 (49.5%) were females. The age range was 13 years to 94 years with a mean of 53.8+17.05 years. Overall satisfaction with care was 98.3% with waiting time constituting the highest level of dissatisfaction (22.5%). Conclusion: The high patronage of this eye center can be linked to the high level of satisfaction of the patients.

This examination expected to efficiently survey distributed exploration written works to distinguish and assess the viability of Conventional Physiotherapy (CP) training on progress in muscle quality in moderately aged and old female people analyzed as having Osteoarthritis (OA) of the knee. Different information bases having articles distributed somewhere in the range of 2000 and 2016, for example, - PubMed, Web of Science, ProQuest, CINAHL, &Ebscohost are deliberately looked for articles identified with knee OA. Just unmistakable, meta-systematic and interventional investigation articles are held. Generally, impact size with 95% “confidence intervals (CIs)” is utilized to survey the quality of connection among intercessions and development in muscle quality between old OA of knee patients, by utilizing an arbitrary impacts model. Heterogeneity was likewise assessed. Nine exploratory investigations were chosen and remembered for the audit, out of 4 are randomized controlled preliminaries & remaining are pseudo-randomized controlled preliminaries. The surveys deliberating drug co-mediations are prohibited. Normalized impact sizes with 95% CIs are determined from pre-mediation and post-intercession methods for CP preparing gathering and other mediation or no-mediation gathering. Accordingly, the valuable effect of CP preparing in developing muscle-quality in OA patients didn't get affirmed. This discovery suggests that next investigations following thorough approach are needed to infer complete proof to affirm the gainful impacts of CP preparing on progress in muscle quality between old patients experiencing OA of the knee.

AIM: To observe and characterize imaging features of macular and optic disc areas in less than 60-year-old patients with early primary open angle glaucoma (POAG) by optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA), and to evaluate the diagnostic value of OCT and OCTA. METHODS: Totally 15 patients (23 eyes) with early POAG as observation group and 30 health people (30 eyes) as normal control group were enrolled in this cross-sectional study. OCTA-based superficial macula vessel density, superficial macula perfusion density, superficial optic disc vessel density, superficial optic disc perfusion density and spectral domain OCT (SD-OCT)-based macular area thickness, ganglion cell complex (GCC) thickness and retinal nerve fiber layer (RNFL) thickness were measured in the two groups. Independent t-test and receiver operating characteristic curve were used for analysis. Area under the receiver operating characteristic curves (AUROC) were used to measure the diagnostic utility. RESULTS: Among all the parameters, the optimal diagnostic utility parameter was the superficial vessel density in the macular area (except the center of the macula), and the AUROC reached 0.98. The diagnostic utility of macular area perfusion density (except the center of the macula) was similar to that of superficial vessel density in the macular area, and the AUROC was above 0.97. Followed by the diagnostic utility of vessel density in the optic disc area, the best parameter was the inner ring of the vessel density, and its AUROC reached 0.97. The diagnostic utility of perfusion density in the optic disc area was slightly lower than that of vessel density in the optic disc area. The best parameter was the central optic disc perfusion density, and its AUROC was 0.95. The SD-OCT-based diagnostic utility parameters were generally lower than that mentioned above, the top three parameters were the inferior RNFL thickness (AUROC=0.919), the superior (AUROC=0.919) and the inferior GCC thickness (AUROC=0.9077). CONCLUSION: The OCT-based diagnostic utility parameters are generally lower than the OCTA-based diagnostic utility parameters. OCTA has an important clinical application value in diagnosis and evaluation for less than 60-year-old patients with early POAG.

Zusammenfassung Hintergrund Die Symptomatik der chronischen Rhinitis in der alten und sehr alten Bevölkerung kann aus der isolierten Schleimhauthyperplasie der unteren Nasenmuscheln resultieren. Als eine zielführende Therapie kommt eine Muschelplastik in Betracht. Bedenken bestehen hinsichtlich des oftmals reduzierten Allgemeinzustands, der häufig erhöhten Neigung zur Epistaxis, vor allem bei der Verwendung von Antikoagulanzien, und der Komorbiditäten wie der arteriellen Hypertonie. Hinzu kommt die Problematik der verzögerten Heilung. Ziel In der vorliegenden Studie sollten die Ergebnisse einer Muschelplastik, die in der Gruppe der alten bzw. sehr alten Patienten erzielt wurden, mit den Ergebnissen in der Gruppe der jungen Individuen verglichen werden. Material und Methoden Die Krankenakten von insgesamt 130 Patienten, die in drei Altersgruppen eingeteilt wurden: 82 Patienten 18–59 Jahre (M = 33,8; SD = 10,2); 30 Patienten 60–74 Jahre (M = 66,0; SD = 3,7) und 18 Patienten 75 + Jahre (M = 85,3; SD = 6,5) wurden einer Analyse unterzogen. Die Befragung der Patienten in Bezug auf die Intensität ihrer Symptome erfolgte direkt prä- und einen Monat postoperativ. Zur Beurteilung wurde der Sinonasal Outcome Test (SNOT-20) eingesetzt. Die Dauer der Heilung und die Zufriedenheitswerte der Patienten wurden ebenfalls notiert. Ergebnisse Es zeigte sich eine vergleichbare Verbesserung des Nasendurchflusses, der Rhinorrhoe und des Postnasal-Drip-Syndroms bei den alten und sehr alten Patienten sowie den jungen Probanden. Die Funktion des Geruchssinns verbesserte sich dagegen in einem höheren Maß in der Gruppe der jungen Patienten. Die postoperative Heilung dauerte länger bei den alten und sehr alten Patienten als bei den jungen Probanden. Fazit Einige klinische Ergebnisparameter waren bei den alten und sehr alten Patienten signifikant schlechter als bei den jungen Probanden.

Aim: Through advances in technology and medicine, life expectancy is longer than before. The area covered by elderly people in the population pyramid has been changing over the years. Emergency departments are often used by elderly patients. It increases the density and fullness in already-crowded departments. In this study, we aimed to examine characteristics of the admissions of old-old people through the EDs and we wanted to discuss the precautions and regulations that might be taken in order to improve the quality of care and management. Methodology: This study was carried out cross-sectionally and retrospectively in the one-year period between 01.01.2017-31.12.2017 in a department of emergency medicine. Patients' age, gender, the hours of admissions to the emergency department, the month of admissions, reasons for admissions, diagnoses, consultations, final status, the place of hospitalization, the name of the hospitalization department and the number of readmissions in a one-year period were recorded in the study form. The study data were analyzed with SPSS for Windows 22.0. P < 0.05 was considered statistically significant. Results: 4331 of these patients were included in the study. The mean age of the patients was 85.25 ± 3.90 and 60.5% of them were female. According to the months, the first three of the admission months were December, November and October (9.7%, 9.6%, 9.2% respectively). The most common admission was in the 08: 00-15: 59 time zone with 47%, followed by 41.8% with the 16: 00-23: 59 time zone.4331 patients included in the study admitted to the emergency department 12.988 times during the study period. 46.2% of the patients admitted to the department once, 53.8% of them admitted 2 times and more. The discharge rate of patients who were admitted only once was 84.2% and the rate was 88.4% for twice and more admissions. Conclusion: The existence and increasing number of this population should not be forgotten in changes to be made in emergency departments and other parts of the health system. Efforts should be made to improve the quality of care and to train staff to manage these patients more quickly and safely.

Introducción: La obesidad en niños y adolescentes es un problema de salud pública que puede pasar desapercibido, si no se caracteriza de manera temprana en centros de atención primaria.Objetivo: Determinar la prevalencia de sobrepeso y obesidad en niños de 5 a 10 años que asistieron a la consulta externa de pediatría, en un centro de atención primaria en Bogotá, entre los años 2017 y 2018.Metodología: Estudio de corte transversal. Se incluyeron todos los pacientes entre 5 y 10 años que asistieron al consultorio de pediatría del Clinicentro Calle 80. Se realizó muestreo consecutivo estricto. Los participantes fueron pesados y tallados y se calculó el índice de masa corporal. Se aplicó una encuesta para registrar factores de riesgo asociados al sobrepeso y a la obesidad.Resultados: Se incluyeron 300 pacientes, 148 niñas (49.33%) y 152 niños (50.66%). La mediana de edad fue de 7 años. El 70% de ambos sexos tuvo un peso adecuado para la edad, el 14.86% de las niñas y el 12.5% de los niños tenían sobrepeso y el 7.43% de las niñas y el 5.25% de los niños, obesidad.Conclusión: Se encontró una prevalencia importante de obesidad entre los menores evaluados; hallazgo con implicaciones clínicas importantes dadas las consecuencias que el sobrepeso y la obesidad acarrean en la población pediátrica y posteriormente en la edad adulta, ocasionando elevados gastos al sistema de salud. El diseño e implementación de estrategias que regulen la calidad de la alimentación y la actividad física deben constituir uno de los insumos más importantes en el desarrollo de políticas para la infancia en Colombia.

Purpose Frailty is a common condition among critically ill patients. Usually evaluated in a mixed population of medical, cardiac and surgical patients, we aimed to assess the impact of frailty on short- and long-term mortality exclusively in critically ill older medical patients. Materials and methods We included 285 patients aged≥70 years admitted to ICU (2009–2017). Comorbidities, severity scores, treatment intensity and complications were recorded. Pre-hospital frailty, measured by Clinical Frailty Scale (CFS), was defined as a score ≥ 5 according to this scale. Results Prevalence of frailty (CFS ≥ 5) of 18.6%. Frail patients were more likely to be female (64.2% vs. 35.6%, p

Background To identify the capsule enlargement index after femtosecond laser-assisted anterior capsulorhexis in 2–6-year-old children who underwent congenital cataract surgery. Methods In this prospective case series study, femtosecond laser-assisted anterior capsulorhexis was performed in patients with congenital cataract, aged 2–6 years. The actual achieved capsulorhexis diameters were measured with Digimizer version 4.2.6. Correlation coefficient (r) and multiple linear regression analysis were used to evaluate the variables that could potentially influence anterior capsulorhexis enlargement index (E). Results This prospective study enrolled 28 eyes of 22 patients with congenital cataract. The mean age of the patients at surgery was 4.67 years ±1.54 (standard deviation [SD]). “E” of the 28 cases was 1.211 ± 0.039 (SD). Correlation analysis showed that “E” correlated significantly with the anterior chamber depth (ACD) (r = − 0.469, p = 0.021) and axial length (AL) (r = 0.452, p = 0.027). The following formula was developed by using multivariable linear regression analysis: Predicted E = 1.177–0.052 × ACD + 0.009 × AL, R2 = 0.346 (F = 4.396, p = 0.046). Conclusions The anterior capsulorhexis enlargement index and its calculation formula could help to set up an accurate programmed capsulorhexis diameter for femtosecond laser-assisted congenital cataract surgery in children aged 2–6 years. Thus, an appropriate actual capsulorhexis diameter could be achieved.

This research was conducted on 12 old patients of both sexes at the Prince Rashid military hospital between July 2003 and July 2004. Under spinal anaesthetic, an open reduction for a femur fracture neck was performed using only 1ml plane bupivacaine 0.5 percent at the L2-L3 intervertebral regions.

Background Percutaneous transluminal angioplasty (PTA) improves limb salvage rates in patients with severe lower extremity arterial disease (LEAD). It remains unknown whether PTA can be safely performed to the older LEAD patients. Purpose We investigated the effect of age ≥85 vs Methods We analyzed 222 LEAD patients from our previous retrospective cohort study between 2013 and 2018. All patients received percutaneous transluminal angioplasty. Study outcomes were in-hospital mortality and 1-year all-cause mortality and major adverse limb events (MALEs). Results The study included 222 patients aged 74±11 years (54% male), and 12.6% had acute limb ischemia. The older group had significantly higher rates of in-hospital (17.8 vs. 5.1%, P=0.009) and all-cause mortality (37.8% vs. 19.2%, P=0.016), but MALEs were not different significantly (8.9% vs. 16.9%, P=0.247). In multivariate logistic regression analyses, age ≥85 years was not associated with the increased risks of the study outcomes after we adjusted for potential confounders. The risk factors associated with 1-year all-cause mortality was the presence of acute limb ischemia (adjusted HR: 2.978, 95% CI: 1.502–5.905, P=0.002) and Rutherfold stages (adjusted HR: 2.135, 95% CI: 1.248–3.652, P=0.005). Conclusion Compared with the patients aged less than 85 years, the LEAD patients aged more than 85 years had favorable risks of mortality after receiving PTA, and the incident MALEs were not significantly different. Funding Acknowledgement Type of funding sources: None. Study outcomes in LEAD patients

Introduction: Nasal nitric oxide (nNO) is extremely low in individuals with primary ciliary dyskinesia (PCD) and is recommended as part of early workup. We investigated the results of a former study whether tidal breathing sampling for a few seconds and vacuum sampling was as discriminative between PCD and healthy controls (HC) as conventional tidal breathing sampling (cTB-nNO) for 20–30s. Methods: We performed very rapid sampling of tidal breathing for 4 s (TB-nNO4sec) and vacuum sampling with applied negative pressure (TB-nNOvac; negative pressure was applied by pinching the sampling tube) for Results: We included 5 patients with PCD, median (IQR) age of 1.2 (0.3-4.1) years and 13 HC, 3.4 (1.3–4.4) years and 8 patients with cystic fibrosis (CF) as a disease control group, 2.4 (0.4–2.9) years. Measured nNO values with TB-nNO4sec and TB-nNOvac showed similar and comparable results to cTB-nNO measurements (HC4sec: p = 0.11, HCvac: p = 0.87, PCD4sec: p = 0.56, PCDvac: p = 0.23, CF4sec: p = 0.38, CFvac: p = 0.06). Conclusion: TB-nNO4sec and TB-nNOvac were comparable to cTB-nNO. TB-nNO4sec and TB-nNOvac requires only a few seconds of probe-in-nose time and is feasible for preschool kids and infants (0-5 years). Rapid TB-nNO sampling needs standardization and further investigations. Keywords: Primary ciliary dyskinesia · Nasal nitric oxide · Rare lung diseases · Pediatrics · Cystic fibrosis

INTRODUCTION Outcomes in old patients with upper gastrointestinal bleeding (UGIB) have been scarcely studied. Our aim was to compare very old individuals (>80 years old) with younger patients with UGIB, and to identify risk factors for the main outcomes. METHODS A single-centre prospectively collected database was analysed. Descriptive, inferential and multivariate logistic regression models were performed. Main clinical outcomes were in-hospital and delayed 6-month mortality. RESULTS 698 patients were included, 143 very old and 555 aged

Mini-Percutaneous Nephrolithotomy (M-PCNL) and Retrograde Intrarenal Surgery (RIRS) are commonly used methods in treatment of kidney stones. The aim of our study is to compare the efficacy and safety of M-PCNL and RIRS in kidney stone treatment over 50 years old patients. A total of 125 patients, 65 of whom had RIRS, and 60 of whom had M-PCNL, were included in the study. Age, gender, BMI (Body-Mass Index), ASA (American Society of Anesthesiology) scores of the patients; stone size, stone location, operation side, ESWL history, HU (Hounsfield Unit) values, hospital stay durations, SFR, complication rates according to Clavien modification system, postoperative hemoglobin loss, postoperative transfusion rates, and patients who needed a secondary operation were recorded. SFR values were calculated in the postoperative third and sixth months. The data between the two groups had similar characteristics in terms of age, gender, BMI, HU, stone size, operation side, stone location, ESWL history, operation time, postoperative transfusion rate, postoperative Clavien complications ( p > 0.05). When the ASA categories were evaluated, the mean ASA scores, ASA I, and ASA II data had similar characteristics in both groups ( p > 0.05). When the ASA 3 scores were evaluated, the number of ASA III patients in the RIRS group was statistically significantly higher ( p

Dear Editor,The need for exercise has been emphasised in both young and old patients with rheumatic diseases [1–3]. However, the same thing obviously applies to healthy young people if they do not ...

Introduction It is well recognised that cleft lip and/or palate carries an increased risk of developing dental caries. This article describes a service evaluation that was undertaken at the South Thames cleft service to analyse whether the five-year-old cohort of patients attending the clinic were following preventative advice as well as whether they were registered with a general dental practitioner and attending for regular recall. Methods A total of 96 patients were assessed. Data from a 24-month period were collected retrospectively using a data collection sheet. Results The vast majority (92%) of the patients included in this service evaluation were registered with a general dentist. Despite this, 40% had a decayed/missing/filled teeth score of >0, only 73% were having fluoride varnish applied regularly and 79% were using toothpaste containing the recommended fluoride content. More than half (57%) of the patients had developmental defects of enamel. Conclusions There needs to be increased emphasis on following national prevention guidelines given that this group of patients is known to be at a higher risk of dental caries. Parents and carers must be made aware of the requirement for shared care between general dental practitioners and secondary care.

A study on waiting time of patients in outpatient department was conducted in this hospital of northern India, with an aim to assess the services of outpatient department & suggests new ways to improve the health care system through research. A 100 respondents were chosen randomly from a pool of patients who visit the various OPD. The data was collected through questionnaire and interview. Results: The study revealed 62 were male and 38 were female, 26 were below age 30 yrs & 40 were between age 30-50 yrs and 34 were above 51 yrs of age. The majority were married 76%. The 55% were local and 45% were from out station. The 37% were new registration and 63% were old patients. The majority (95) had spent less than 30 min at the registration and 49% has consultation time more than 30 min. The time spent in laboratory and radiodiagnosis for more than 30 min by 12% and 29% respectively. The various factors like overlaps of round & OPD time, transportation time of sample and preparation time in radiology has been pointed out as major problem area. Conclusion: Queuing method, advanced simulations & real time waiting system will be immensely helpful to provide efficient & appropriate health care. Keywords: OPD, Waiting time, Simulation, Screening, Queuing method.

The authors report a high prevalence of delirium in COVID-19 old patients admitted in an academic hospital. During the recent COVID-19 period, delirium was present in 38% of old patients admitted with delirium at the COVID ward of the Erasmus MC University Medical Center of Rotterdam. We do not know in which patients COVID-19 can cause delirium; however, considering the high prevalence of delirium in COVID-19 old patients and the potential serious consequences, attention is needed in order to reduce disability and mortality in this vulnerable category of patients.

The aim of this study was to compare the outcome of nonagenarians (≥ 90 years) with that of younger ( 90 years) patients undergoing transcatheter aortic valve implantation (TAVI) in current practice.Data are collected from the German Aortic Valve Registry (GARY), which was designed to evaluate current practice in the invasive treatment of patients with aortic valve diseases in Germany. Data were analyzed regarding procedural outcome, 30-day, and 1-year outcomes of nonagenarians in comparison to that of younger patients.Between 2011 and 2015, 2436/33,051 (7.3%) nonagenarians underwent TAVI and were included in GARY. Nonagenarians were significantly more often male (45.2% vs. 40.0%, p 0.001), frail (38.7% vs. 34.7%, p 0.001), and had higher EuroSCORE scores than younger patient group (23.2% vs. 17.0%). Nonagenarians were significantly less often treated via transapical access (16.3% vs. 22.3%, p 0.001). Procedure was performed significantly less often in general anesthesia (58.2% vs. 60.7%, p = 0.02) in nonagenarians, while necessity of pacemaker implantation was significantly higher in nonagenarians (27.2% vs. 24.8%, p 0.001). The incidence of other typical postprocedural complications such as severe bleeding events and vascular complications were comparable between groups. However, 30-day (5.2% vs. 3.9%) and 1-year (22.7% vs. 17.7%) mortality rates were significantly higher among nonagenarians and age ≥ 90 years could be identified as an isolated risk factor for mortality.TAVI is a highly standardized procedure that can be performed safely with high procedural success even in very old patients. Although mortality is significantly higher in these patients-most probably due to the intrinsic higher risk profile of the very old patients-the results are still acceptable. To optimize outcome, especially elderly patients seem to profit from a procedure under local anesthesia or conscious sedation, to minimize the rate of postoperative delirium and the length of stay and to facilitate early mobilization.

Background: The epidemiology of aortic stenosis (AS) in older patients admitted to non-cardiologic acute hospital wards and the effect of AS on mid-term survival are incompletely reported. In a cohort of very old patients admitted to an acute geriatric unit (AGU), we aimed to assess: (1) the prevalence of newly and previously diagnosed AS; and (2) the association between AS severity and patients’ 6-month mortality. Methods: The patients consecutively admitted in two AGU rooms from February 2016 to February 2018 were assessed with echocardiography and AS severity was defined according to standard criteria. We assessed frailty using a 34-item Frailty Index (34-FI), which was operationalized using health variable information, and the Clinical Frailty Scale (CFS). Vital status at 6months was extracted from Regional Register of Birth and Death. Results: Two hundred and three patients (mean age 84.5 ± 6.0 SD, female gender 56.1%) were included. Of these, 57 (28.1%) had AS, mild in 9 (4.5%), moderate in 32 (16.1%) and severe in 16 (8.1%). A new diagnosis of AS was obtained in 42 (73.7%) patients, of whom 33 (78.6%) had moderate or severe AS. At 6months, 61 (28.9%) patients died. In multiple regression models, after adjusting for covariates, frailty, as assessed with both FI and CFS, was independent predictor of 6-month mortality whereas AS was not. Conclusions: Among older patients admitted to non-cardiologic acute hospital wards, AS was common and frequently underdiagnosed. The severity of AS was not associated with increased 6-month mortality, whereas frailty was the most important predictor.

We examined 66 patients 17–55 years old with decompensated form of dental abrasion, who had applied to the hospital “Dental Forte” with various types of complaints of discomfort in the TMJ. They were divided into several groups: 1 st — 17–25 years old, 2 nd — 25–35 years old, 3 rd — 35–45 years old, 4 th — 45–55 years old patients. It was established, that the age of 25–35 is specific for significant indication of dysfunctions in the TMJ. By the age of 35–45 years the number of complaints of discomfort in the TMJ increases. There is also increase in the diversity of complaints, and decrease in their allocation in percentage terms. The number of complaints and their diversity in patients of 45–55 years old remained, complaints of one type of pain decreased, but the number of complaints about “pain” associated with chewing, headache, crunch, etc. increased.

Background and Aims: Laparoscopic sleeve gastrectomy (LSG) among older obese subjects (>60 years of age) has recently gained popularity because of the population aging. We performed a meta-analysis...

Objectives: Health status is associated with socioeconomic status (SES) of the individuals. The aim of this study was to identify any link between the SES and influenza-like illness (ILI). Materials and Methods: This observational case-control study was done on 18–70 years old patients presented with ILI (cases) at tertiary care hospital of western India. Controls were selected from demographically matched elective surgery patients except the SES. SES was evaluated as per the Modified B G Prasad 2017 scale and participants were further classified in lower SES (per capita income