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With the multiple advances in the field of medicine and the resulting increase in life expectancy, the population pyramid is showing a tendency towards inversion; each day it becomes more feasible to surgically treat elderly patients. These patients represent a challenge not only because of the comorbidity that generally is associated with the elderly patient, but because of the multiple endemic physiological changes that alter and usually diminish their ability to cope with stressful situations. The elderly also experience social, economic and motivational problems during their illnesses, which should be considered during the surgical period in order to optimize the results of surgery and contribute to improve the quality of life of our patients. The approach with patients65 years of age during the perioperative period should be multifactorial. It is necessary to acknowledge the physiological changes, poly-pathology, poly-pharmaceutical, and social situation of our elderly patients since these are factors that will determine their response to, and recuperation from, the surgical treatment.

Con los múltiples avances en el campo de la medicina y el resultante aumento en la esperanza de vida y la evidente inversión de la pirámide poblacional, cada día es más frecuente el tratamiento quirúrgico en pacientes de la tercera edad. Estos pacientes representan un reto no sólo por la comorbilidad que generalmente les acompaña, sino por los múltiples cambios fisiológicos propios de la edad que alteran y habitualmente disminuyen su respuesta ante situaciones de estrés. Además, los ancianos se enfrentan durante su enfermedad con problemas de tipo social, económico y anímico, los cuales deberemos tomar en cuenta durante el perioperatorio para optimar los resultados de la cirugía y contribuir a mejorar la calidad de vida de nuestros pacientes. El abordaje del paciente quirúrgico mayor a 65 años de edad durante el perioperatorio deberá ser multifactorial. Será necesario conocer los cambios fisiológicos con los que éstos cursan y tomar en cuenta su polipatología, polifarmacia y entorno socioeconómico, factores que serán determinantes en su respuesta y recuperación al tratamiento quirúrgico.

Background The use of protease inhibitors has revolutionized the treatment of HIV infection. These agents are well tolerated, although the Federal Drug Administration (FDA) has warned U.S. doctors that protease inhibitors may precipitate hyperglycemia and diabetes (DM), based on isolated reports from physicians. Methods Sixty-one patients with HIV infection with criterion of non-DM from the onset of the protease inhibitor therapy participated in the study. Plasma glucose levels were obtained every month during a 6-month period, with a basal determination prior to protease inhibitor therapy. Results All Mexican patients enrolled in this study had the same Hispanic-American ethnic origin. Four patients (6.55%) developed hyperglycemia related with saquinavir. One had family history of DM type II. These patients were controlled with diet. Conclusions Based on present data, we believe the benefits of these drugs to patients suffering from HIV infection outweigh the various risks of taking protease inhibitors. However, physicians who use these drugs have to be on the alert for hyperglycemia in the Mexican population, while patients should know the warning symptoms of hyperglycemia and diabetes.