Caracterización del asma grave no controlada en adultos mayores de 60 años / Characterization of Severe Uncontrolled Asthma in Adults Older Than 60 Years

Introducción: Los pacientes mayores de 60 años suelen tener un asma más grave, menos controlada y peor función pulmonar que los jóvenes. Objetivo: Caracterizar a los pacientes mayores de 60 años con asma grave no controlada. Métodos: Se realizó un estudio observacional descriptivo, prospectivo y transversal en el Hospital Neumológico Benéfico Jurídico en el período comprendido entre enero del 2020 y enero del 2021. Resultados: Edad predominante 60-69 años (76,5 por ciento). Mujeres (61,8 por ciento). Antecedentes familiares de asma o alergia (64,7 por ciento). Asma de larga evolución (85,3 por ciento). Asma asociada a obesidad y mal control (55,9 por ciento). Reversibilidad del VEF1 (volumen espiratorio forzado en el primer segundo) después de la aplicación del broncodilatador (26,5 por ciento). Adherencia al tratamiento (61,8 por ciento). El riesgo futuro de resultados adversos fue bajo en el 58,8 por ciento, es el principal factor, el mal control actual en el 100 por ciento. Conclusiones: El asma grave no controlada en mayores de 60 años es más frecuente en el sexo femenino, los pacientes suelen tener antecedentes familiares de asma o alergia, presentar asma de larga evolución, obesidad asociada al mal control, disminución de la reversibilidad del VEF1 con la aplicación del broncodilatador, mala adherencia al tratamiento y el mal control actual como riesgo futuro de la enfermedad(AU)

Introduction: Patients older than 60 years tend to have more severe, less controlled asthma and worse lung function than younger people. Objective: To characterize patients older than 60 years with severe uncontrolled asthma. Methods: A descriptive, prospective and cross-sectional observational study was carried out at Benéfico Jurídico Pneumological Hospital from January 2020 to January 2021. Results: The age group 60-69 years (76.5percent) predominated. Women also predominated (61.8percent), as well as family history of asthma or allergy (64.7percent), and long-standing asthma (85.3percent). Asthma associated with obesity and poor control was 55.9percent. The reversibility of the forced expiratory volume in the first second (FEV1) after the application of the bronchodilator was 26.5percent. The adherence to treatment was 61.8percent. The future risk of adverse results was low (58.8percent), which is the main factor, the current poor control in 100percent. Conclusions: Severe uncontrolled asthma in people over 60 years of age is more frequent in women, patients usually have family history of asthma or allergy, there is long-term asthma. It was observed that obesity is associated with poor control, the decreased FEV1 reversibility with the application of the bronchodilator, poor adherence to treatment and poor current control as a future risk of the disease(AU)

Two-staged hybrid ablation versus thoracoscopic epicardial ablation for long-standing persistent atrial fibrillation: Mid-long term result of a randomized controlled trial / 中国胸心血管外科临床杂志

@#Objective    To evaluate the efficacy of hybrid ablation through compared with thoracoscopic epicardial ablation. Methods    In this study, 108 patients with all long-standing persistent atrial fibrillation (LSPAF) received thoracoscopic epicardial ablation (TEA) after enrollment. There were 82 males and 26 females at age of 56.5±9.4 years. After blanking-period, patients off antiarrhythmic therapy with sinus rhythm were divided into a hybrid ablation (HA) group (50 patients) and a TEA group (58 patients). Only patients in the HA group received catheter ablation after randomization subsequently. In at least two-year observation period, cardiovascular risk factors were observed in all groups’ patients. Results    The mean follow-up duration was 17.3-41.8 (26.9±6.1) months and there was no significant difference between two groups [8.2-40.6 (27.5±5.7) months in the HA group and 17.3-41.8 (26.4±6.7) months in the TEA group]. The off antiarrhythmic agents (AADs) sinus rhythm rate was significantly higher in the HA group than that in the TEA group at the time of postoperative 6, 12, 24 and 36 months ［96.0%, 90.0%, 83.7%, 83.7% versus 79.3%, 75.9%, 67.3%, 63.1%, HR=0.415 (95%CI 0.206-0.923)]. Conclusion    We can conclude that the efficacy of two-staged hybrid ablation for LSPAF is superior to thoracoscopic epicardial ablation alone. Patients can obtain benefit from a supplemental radiofrequency catheter ablation after blanking-period of surgical ablation, instead of those without a supplemental ablation.

Clinical characteristics, residual beta-cell function and pancreatic auto-antibodies in Thai people with long-standing type 1 diabetes mellitus / Journal of the ASEAN Federation of Endocrine Societies

@#Objectives. To describe the characteristics of long-standing T1DM in Thai patients and assess residual beta-cell function with status of pancreatic autoantibodies. Methodology. This is a cross-sectional study of Thai subjects with T1DM and disease duration ≥ 25 years seen at the Theptarin Hospital. Random plasma C-peptide and pancreatic auto-antibodies (Anti-GAD, Anti-IA2, and Anti-ZnT8) were measured. Patients who developed complications were compared with those who remained free of complications. Results. A total of 20 patients (males 65%, mean age 49.4±12.0 years, BMI 22.5±3.1 kg/m2, A1C 7.9±1.6%) with diabetes duration of 31.9±5.1 years were studied. Half of the participants remained free from any diabetic complications while the proportions reporting retinopathy, nephropathy, and neuropathy were 40%, 30%, and 15%, respectively. HDL cholesterol was significantly higher and triglyceride concentration significantly lower in patients who were free from diabetic nephropathy but not in those who were free from other complications. The prevalence rates of anti-GAD, anti- IA2, and anti-ZnT8 were 65%, 20%, and 10%, respectively. None of the patients who tested negative for both anti-GAD and anti-IA2 was positive for anti-ZnT8. Residual beta-cell function based on detectable random plasma C-peptide (≥ 0.1 ng/mL) and MMTT was found in only 3 patients (15%). There was no relationship between residual beta-cell function and protective effects of diabetic complications. Conclusion. Endogenous insulin secretion persists in some patients with long-standing T1DM and half of longstanding T1DM in Thai patients showed no diabetic complications. HDL cholesterol was significantly higher and triglyceride concentration significantly lower in patients who were free from diabetic nephropathy

Hybrid minimally invasive surgical and transcatheter ablation for long-standing persistent atrial fibrillation / 中华胸心血管外科杂志

Objective To explore the application and effectiveness of one-staged or two-staged hybrid minimally invasive surgical and transcatheter ablation for long-standing persistent atrial fibrillation(LSPAF).Methods From Jun 2015 to Dec 2017,a cohort of 56 patients[18 female,mean age of(59.1 ±6.9) years] with long-standing persistent atrial fibrillation underwent one-staged(30 cases) or two-staged(26 cases) hybrid minimally invasive surgical and transcatheter ablation.Mean AF duration was(5.9 ± 3.0) years.Mean left atrial diameter was(45.4 ± 4.2) mm.Mean CHA2DS2-VASc score was 2.3 ± 1.2.Fourteen cases had a history of prior catheter ablation.All patients underwent continuous 24-hour or 48-hour holter monitoring at 3 months,6 months,1 year and yearly thereafter.Results All patients successfully underwent one-staged or two-staged hybrid minimally invasive surgical and transcatheter ablation.During ablation,LSPAF was terminated in 80.0％ (24/30) with one-staged hybrid ablation and 84.6％ (22/26) with two-staged hybrid ablation.At a mean follow-up of(20.3 ± 8.2) months,89.3％ (50/56) patients maintained sinus rhythm.Among them,86.7％ (26/30) patients with one-staged hybrid ablation maintained sinus rhythm,and 92.3％ (50/56) patients with two-staged hybrid ablation maintained sinus rhythm.Six patients with recurrent AF continued to receive warfarin and amiodarone drug therapy.No death or cerebrovascular events occurred.No patient required permanent pacemaker implantation.Conclusion One-staged or two-staged hybrid minimally invasive surgical and transcatheter ablation could be safely and effectively applied to the treatment of LSPAF.The early and midterm outcomes were satisfactory.

Observations on the Activation of Chronic Compensated Hydrocephalus in Adult Patients / 대한신경손상학회지

OBJECTIVE: There is a broad spectrum of compensated hydrocephalus. Various terms such as long-standing overt ventriculomegaly in adult (LOVA) has been coined, however, even such terms leave diverse aspect of this condition out of account. We have experienced compensated hydrocephalus cases which were considered to be activated after a long time period of quiescent state, and tried to compare their clinical characteristics with the relatively well described entity of LOVA. METHODS: We conducted a retrospective review of 206 patients who underwent ventriculoperitoneal shunt (VPS) between February 2001 and May 2012. Of these, 6 patients had chronic compensated hydrocephalus. The clinical and radiological characteristics are evaluated. RESULTS: Definite triventriculomegaly was observed in two patients. Macrocephaly was observed in two cases, one with aqueductal stenosis (AS), the other with unknown status of aqueduct. All of the cases with triventriculomegaly were normocephalic. Spinal causes were thought as aggravating factor in two. Two endoscopic third ventriculostomy and eight VPS were performed in five patients. Four patients responded well but one took a very complicated course. CONCLUSION: The relationships between macrocephaly, triventriculomegaly, and AS suggested in other studies were inconsistent. Blockage or narrowing of cerebrospinal fluid pathways were observed at various sites. Disturbances of spinal arachnoid pathways were related to the activation in some cases. Treatment is to be tailored individually considering various reigniting event. It is suggested that this entity is to be evaluated for better nomenclature reflecting diverse aspects of this condition. Further study is needed to elucidate underlying pathophysiology and effective management.

Long-Standing Intermittent Exotropia Diagnosed in Patients Older than 16 Years of Age

PURPOSE: To evaluate clinical features and binocular function of long-standing intermittent exotropia detected for the first time in patients older than 16 years of age. METHODS: We retrospectively evaluated adult exotropic patients older than 16 years of age who were first diagnosed between March 2001 and February 2010. A total of 73 patients with exotropia who had not undergone ophthalmologic management for at least 10 years were included in the present study. RESULTS: The mean age was 29.47 +/- 12.13 years and 42 (57.5%) patients were male. The mean angle of deviation was 40.68 +/- 17.75 prism diopter (PD); 46.58% of patients were between 30 to 50 PD and 26% were over 55 PD. Out Of 64 the intermittent exotropic patients, 17 patients had poor fusion at distance. Abnormal findings in binocular function such as poor stereoacuity, suppression at distance, reduced binocular visual acuity at distance, diplopia, panoramic vision, anomalous retinal correspondence, and accommodative spasms were observed. All 20 patients received surgery. Postoperatively, 59.90% of the patients showed improvement in near stereoacuity, and 78.57% improved in suppression at distance. CONCLUSIONS: According to the present study, exotropia may cause subjective and objective deteriorations in motor/sensory function without appropriate medical or surgical intervention during childhood. In addition, the potential for improvement in binocular function after surgery was demonstrated even in adults. Therefore, we recommend surgical treatment for untreated, long-standing exotropia in adults.

The Role of Bone Cement Augmentation in the Treatment of Chronic Symptomatic Osteoporotic Compression Fracture

OBJECTIVE: Bone cement augmentation procedures such as percutaneous vertebroplasty and balloon kyphoplasty have been shown to be effective treatment for acute or subacute osteoporotic vertebral compression fractures. The purpose of this study was to determine the efficacy of bone cement augmentation procedures for long standing osteoporotic vertebral compression fracture with late vertebral collapse and persistent back pain. METHODS: Among 278 single level osteoporotic vertebral compression fractures that were treated by vertebral augmentation procedures at our institute, 18 consecutive patients were included in this study. Study inclusion was limited to initially, minimal compression fractures, but showing a poor prognosis due to late vertebral collapse, intravertebral vacuum clefts and continuous back pain despite conservative treatment for more than one year. The subjects included three men and 15 women. The mean age was 70.7 with a range from 64 to 85 years of age. After postural reduction for two days, bone cement augmentation procedures following intraoperative pressure reduction were performed. Imaging and clinical findings, including the level of the vertebra involved, vertebral height restoration, injected cement volume, local kyphosis, clinical outcome and complications were analyzed. RESULTS: The mean follow-up period after bone cement augmentation procedures was 14.3 months (range 12-27 months). The mean injected cement volume was 4.1 mL (range 2.4-5.9 mL). The unipedicular approach was possible in 15 patients. The mean pain score (visual analogue scale) prior to surgery was 7.1, which decreased to 3.1 at 7 days after the procedure. The pain relief was maintained at the final follow up. The kyphotic angle improved significantly from 21.2 +/- 4.9degrees before surgery to 10.4 +/- 3.8degrees after surgery. The fraction of vertebral height increased from 30% to 60% after bone cement augmentation, and the restored vertebral height was maintained at the final follow up. There were no serious complications related to cement leakage. CONCLUSION: In the management of even long-standing osteoporotic vertebral compression fracture for over one year, bone cement augmentation procedures following postural reduction were considered safe and effective treatment in cases of non-healing evidence.

Long-standing Adult Horizontal Strabismus with Early Childhood Onset

Management of infantile and early childhood onset strabismus should be completed during early childhood to gain better binocular function and vision. The author experienced 38 adult patients who had horizontal strabismus without any adequate treatment lasting over 14 years with onset before 6 years of age. They showed large angle of deviation and deep amblyopia. After surgery, stereopsis was never developed in all of the 14 congenital strabismic patients, whereas 30% of the 24 patients with acquired onset showed gross stereopsis. There was abnormal muscular contracture requiring adjustable stutre. All of the patients showed abnormal character psychologically. This study revealed that the lunger the duration of misalignment, the greater the chance of deep amblyopia large angle of deviation, abnormal sensory and motor adaptation, psychological influence, and ahnormal muscular contracture. Therefore early initiation of therapy during early childhood should be emphasized.

Long-standing Adult Horizontal Strabismus with Early Childhood Onset

Management of infantile and early childhood onset strabismus should be completed during early childhood to gain better binocular function and vision. The author experiencep 38 adult patients who had horizontal strabismus without any adequate treatment lasting over 14 years with onset before 6 years of age. They showed large angle of deviation and deep amblyopia. After surgery, stereopsis was never developed in all of the 14 congenital strabismic patients, whereas 30% of the 24 patients with acquired onset showed gross stereopsis. There was abnormal muscular contracture requiring adjustable stutre. All of the patients showed abnormal character psychologically. This study revealed that the longer the duration of misalignment, the greater the chance of deep amblyopia, large angle of deviation, abnormal sensory and motor adaptation, psychological influence, and abnormal muscular contracture. Therefore early initiation of therapy during early childhood should be emphasized.