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En los últimos años se ha incrementado la frecuencia de intervenciones quirúrgicas en la población geriátrica y este está asociado a una morbimortalidad alta. Ante esta realidad, indicadores validados y protocolos para el cuido especializado pre, trans y post quirúrgico del paciente adulto mayor (PAM) están siendo desarrollados para mejorar los resultados de las intervenciones. Los PAM poseen características particulares que los hacen uno de los grupos etáreos de salud más delicados, razón por la cual la atención de sus afecciones deben ser de abordaje multidisciplinarios y la prevención debe jugar un papel fundamental.El protocolo de tratamiento conocido como fast track (FT, por sus siglas en inglés), también conocido como recuperación postquirúrgica mejorada “ERAS” (según sus siglas en inglés: Enhanced Recovery After Surgery), es seguido con el fin de mejorar los resultados de las intervencionesen el paciente quirúrgico en los periodos pre-quirúrgico, transquirúrgico y post-quirúrgico. Mediante esta revisión se pretende repasar el tema del protocolo ERAS de un punto de vista fisiológico y funcional y además, destacar porque se puede aplicar de manera segura y ventajosa al PAM. Adicionalmente, repasar las características del PAM y las necesidades de atención especializada de valoración y seguimiento como paciente quirúrgico.

El paciente adulto mayor es un paciente delicado, cuyos problemas médicos deben ser abordados de manera multidisciplinaria. El protocolo de tratamiento conocido como recuperación postquirúrgica mejorada o “ERAS” (por sus siglas en inglés: Enhanced Recovery After Surgery) y fasttrack (FT, por sus siglas en inglés), es un protocolo que se aplica al paciente en los periodos pre, trans y post-quirúrgico, con el fin de mejorar los resultados de las intervenciones a que son sometidos. En el presente trabajo se hace una comparación entre la aplicación del protocolo ERAS y el cuido convencional (CC) en poblaciones con edad promedio igual o mayor a 60 años, que fueron sometidos a cirugía gastrointestinal con técnica laparoscópica, abierta o mixta. El análisis está basado en 16 estudios de casos controles, publicados y seleccionados de las bases de datos PubMed y EBSCOhost. Se midieron las variables estancia hospitalaria, readmisión en 30 días, y complicaciones reportadas. Para determinar si existía un efecto del uso del protocolo sobre las variables seleccionadas se realizó una prueba de T de Student y estadística descriptiva. La edad promedio (desviación estándar, (SD)); 66.7 (4.34) años no se encontró diferencia significativa entre el grupo ERAS y el grupo de CC. El procedimiento quirúrgico abarcado en los estudios fueron cirugías colorrectales en su mayoría, sin diferencia significativa en eltipo de abordaje (laparoscópico, abierto o mixto). Se observó una mejoría significativa (P

Background: Late-onset Alzheimer's disease (LOAD) represents a growing health burden. Previous studies suggest that blood metabolite levels influence risk of LOAD., Objective: We used a genetics-based study design which may overcome limitations of other epidemiological studies to assess the influence of metabolite levels on LOAD risk., Methods: We applied Mendelian randomization (MR) to evaluate bi-directional causal effects using summary statistics from the largest genome-wide association studies (GWAS) of 249 blood metabolites (n = 115,082) and GWAS of LOAD (ncase = 21,982, ncontrol = 41,944)., Results: MR analysis of metabolites as exposures revealed a negative association of genetically-predicted glutamine levels with LOAD (Odds Ratio (OR) = 0.83, 95% CI = 0.73, 0.92) that was consistent in multiple sensitivity analyses. We also identified a positive association of genetically-predicted free cholesterol levels in small LDL (OR = 1.79, 95% CI = 1.36, 2.22) on LOAD. Using genetically-predicted LOAD as the exposure, we identified associations with phospholipids to total lipids ratio in large LDL (OR = 0.96, 95% CI = 0.94, 0.98), but not with glutamine, suggesting that the relationship between glutamine and LOAD is unidirectional., Conclusions: Our findings support previous evidence that higher circulating levels of glutamine may be a target for protection against LOAD.

Background: Data on antibody kinetics are limited among individuals previously infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). From a cohort of healthcare personnel and other frontline workers in 6 US states, we assessed antibody waning after messenger RNA (mRNA) dose 2 and response to dose 3 according to SARS-CoV-2 infection history., Methods: Participants submitted sera every 3 months, after SARS-CoV-2 infection, and after each mRNA vaccine dose. Sera were tested for antibodies and reported as area under the serial dilution curve (AUC). Changes in AUC values over time were compared using a linear mixed model., Results: Analysis included 388 participants who received dose 3 by November 2021. There were 3 comparison groups: vaccine only with no known prior SARS-CoV-2 infection (n = 224); infection prior to dose 1 (n = 123); and infection after dose 2 and before dose 3 (n = 41). The interval from dose 2 and dose 3 was approximately 8 months. After dose 3, antibody levels rose 2.5-fold (95% confidence interval [CI] = 2.2-3.0) in group 2 and 2.9-fold (95% CI = 2.6-3.3) in group 1. Those infected within 90 days before dose 3 (and median 233 days [interquartile range, 213-246] after dose 2) did not increase significantly after dose 3., Conclusions: A third dose of mRNA vaccine typically elicited a robust humoral immune response among those with primary vaccination regardless of SARS-CoV-2 infection >3 months prior to boosting. Those with infection <3 months prior to boosting did not have a significant increase in antibody concentrations in response to a booster., Competing Interests: Potential conflicts of interest. A. L. N. reports research funding from Pfizer and Vir Biotechnology for unrelated studies. A. J. C.-M. reports Federal Emergency Management Agency grants (EMW-2019-FP-00526, EMW-2019-FP-00517, and EMW-2017-FP-00860) and State of Florida Appropriation 2369A and 2369A. M. G. reports grants or contracts unrelated to this work from the CDC–Abt Associates, CDC, CDC–VUMC, CDC–Westat and a role as co-chair of the Infectious Diseases and Immunization Committee, Texas Pediatric Society, Texas Chapter of the American Academy of Pediatrics. A. A. L. reports grants or contracts from Mercy C.A.R.E.S., National Heart Lung and Blood Institute, and the US Environmental Protection Agency and a leadership or fiduciary role with the Arizona Asthma Coalition. R. S. and J. L. U. report patents planned, issued, or pending (serological assays for SARS-CoV-2). All other authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Peroxisome proliferator-activated receptor-γ2 gene Pro12Ala allele polymorphism ( PPARG2 Pro12Ala; rs1801282) has been linked to both cancer risk and dietary factors. We conducted the first systematic literature review of studies published before December 2020 using the PubMed database to summarize the current evidence on whether dietary factors for cancer may differ by individuals carrying C (common) and/or G (minor) alleles of the PPARG2 Pro12Ala allele polymorphism. The inclusion criteria were observational studies that investigated the association between food or nutrient consumption and risk of incident cancer stratified by PPARG2 Pro12Ala allele polymorphism. From 3815 identified abstracts, nine articles (18,268 participants and 4780 cancer cases) covering three cancer sites (i.e., colon/rectum, prostate, and breast) were included. CG/GG allele carriers were more impacted by dietary factors than CC allele carriers. High levels of protective factors (e.g., carotenoids and prudent dietary patterns) were associated with a lower cancer risk, and high levels of risk factors (e.g., alcohol and refined grains) were associated with a higher cancer risk. In contrast, both CG/GG and CC allele carriers were similarly impacted by dietary fats, well-known PPAR-γ agonists. These findings highlight the complex relation between PPARG2 Pro12Ala allele polymorphism, dietary factors, and cancer risk, which warrant further investigation.