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In our study, we examined the effect of COVID-19 vaccination on the incidence of pneumothorax in intensive care patients over age 65. COVID-19 intensive care patients that presented to our department between April 2020 and May 2021 during the COVID-19 pandemic were evaluated retrospectively. Patients were divided into two main groups, i.e., before and after the vaccination period. Patients were evaluated retrospectively for the following parameters: Gender, age, side of pneumothorax, mortality, discharge, comorbidity, and additional pleural complications. The total number of patients was 87, i.e., 66 patients before vaccination and 21 patients after vaccination. When patients in the pre- and post-vaccination period were compared, there was a significant difference in the incidence of pneumothorax between the two groups (p<0.05). Pneumothorax was less common after vaccination. When patients with pneumothorax and tube thoracostomy were evaluated according to pre- and post-vaccination mortality, mortality was significantly higher (89%) in the pre-vaccination period (p<0.05). We consider that COVID-19 vaccines used in patients aged over 65 reduced the incidence of pleural complications, especially pneumothorax. We think that mortality due to pneumothorax in patients over 65 years of age was lower during the vaccination period. In addition, we think that bilateral pneumothorax was more common in the non-vaccinated period. As a result, we think that life-threatening pneumothorax and similar complications could be reduced by increasing the number of vaccines made in the COVID-19 pandemic and spreading it around the world.Copyright © 2022, Dr. Mladen Stojanovic University Hospital. All rights reserved.
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Introduction: COVID-19 is a widespread disease having more impact on elderly as compared to younger age group. [2] Although many parameters have emerged as predictors of prognosis of COVID-19, a simple clinical score at baseline can be used for early risk stratification. NEWS2 (National Early Warning Score) is one such scoring system which was originally developed to improve detection of deterioration in acutely ill patients.[8] Therefore, the present study has been conducted to assess the effectiveness of NEWS2 in predicting critical outcomes and mortality in geriatric patients with COVID-19. Material(s) and Method(s): A cross sectional Observational study was done on 200 Geriatric patients hospitalised with confirmed COVID-19 between December 2020 to November 2022. Baseline NEWS2 score was calculated. The sensitivity, specificity, Positive Predictive Value and Negative Predictive Value were established for NEWS2 score of 5 or above. Result(s): In critical group, all 109 (100%) patients' deterioration was predicted, and in non-critical group, in 14 (15.4%) patients non deterioration was predicted while 77 (84.6%) patients' deterioration was predicted. Statistically significant association has been observed between the critical, non-critical groups and NEWS2 scale (P=0.001). Deterioration was predicted by NEWS2 scale in all the critical patients. Conclusion(s): NEWS2 score of 5 or more on admission predicts poor prognosis in geriatric patients with COVID-19 with good sensitivity and it can easily be applied for risk stratification at baseline. We recommend further studies in the Indian setting to validate this simple score and use it further in Geriatric patients with COVID-19.Copyright © 2023, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.
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Introduction: COVID-19 pandemic affected 44,696,984 people in India Geriatric (age 60 years and above) population is increasing globally. Older adults have been affected badly with COVID-19 Neutrophil lymphocyte ratio (NLR) is used in several diseases as an inflammatory marker in predicting prognosis. According to a recent study patients with severe COVID-19 are reported to have higher Neutrophil lymphocyte ratio ( NLR). In this study we aimed to assess the accuracy of Neutrophil lymphocyte ratio (NLR) as a predictor of disease severity and mortality in geriatric patients with COVID-19. Material(s) and Method(s): 200 geriatric inpatients infected with COVID-19 were included in the study. Neutrophil lymphocyte ratio (NLR) at admission was recorded. Neutrophil lymphocyte ratio (NLR) cutoff was taken 3.5. Patients were categorized into mild, moderate, severe and critical cases according to criteria given by Maharashtra Task Force. Relationship between Neutrophil lymphocyte ratio (NLR) and disease outcome was assessed. A p value < 0.05 was taken as statistically significant. Result(s): The mean age of study sample was 69.00 +/-7.09 years. A significant association was found between Neutrophil lymphocyte ratio (NLR) and disease severity (p-0.048) as well as mortality (p-0.041).Copyright © 2023, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.
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Background: Aging simulation games are established tools in undergraduate medical education aiming to provide medical students with insights into elderly patient's everyday life and raise awareness for age-related difficulties. At Leipzig University, a 90-min ageing simulation game is part of a compulsory geriatric medicine course in the fifth study year (of six). In the course of online teaching during the COVID-19 pandemic, we replaced the classroom-based simulation with an elementary online version based on four PDF documents containing audio and video links, directives for 'do it yourself' experiences and prompts for reflection. Research question: Is a simple, self-directed online ageing game able to provide students with relevant experiences and insights to enhance their understanding of elderly patients? Methods: Anonymous post-hoc survey among 277 fifthyear medical students eligible for the course in 2020. Descriptive statistical analysis and qualitative analysis of students' free-text responses regarding their main insights from the course. Result(s): Response rate was 92.4% (n=256, ;age =26 years, 60% women). 88% of the students enjoyed working on the course, and 83% perceived it as practice-orientated. 75% reported having gained new personal insights and 60% new professional knowledge. Although 92% reported an enhanced understanding of elderly patients, 85% disagreed that online simulations may generally replace realworld ageing games. PDF documents containing audio and video links directly imitating conditions (visual or hearing impairment) were rated best. Students' main insights from the course (qualitative data) most frequently referred to aspects of professional interaction with geriatric patients, knowledge about conditions/diseases, role reversal, and enhanced empathy. Conclusion(s): Very simple online ageing game equivalents can provide students with relevant insights and raise awareness for elderly patients' needs. They might be alternatively implemented into the education of health professionals where resource-intensive real-world simulations are unfeasible.
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Fecal microbiota transplantation (FMT), as an emerging therapy, can be used to treat microbiota related diseases. Progresses in donor screening, washed microbiota preparation, microbiota delivery routes, clinical administrative strategies, and long-term safety are moving FMT forward. Increasing clinical studies, especially those randomized controlled trials about ulcerative colitis and pilot real-word studies about serious inflammatory bowel disease (IBD), have been conducted. This review presents the latest findings about the efficacy, safety and methodology of FMT in treating IBD.Copyright © 2020 The Authors
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Aim: Troponin I is an important prognostic marker in critically ill patients with COVID-19, similar to cytokines and other inflammatory mediators. The aim of this study was to evaluate the predictive value of troponin I levels for mortality in geriatric patients transferred to the intensive care unit for COVID-19 pneumonia according to age group. Material(s) and Method(s): Seventy-four patients with COVID-19 pneumonia were grouped according to age (Group 1:65-74 years, Group 2: 75-84 years, and Group 3: >= 85 years) and retrospectively analyzed. Demographics, clinical findings, laboratory results upon admission to the intensive care unit, and outcomes were compared among the groups. Predictive value of troponin I levels upon admission to intensive care unit (Troponin Iicu), difference in troponin levels between general wards and intensive care unit (Troponin Idiff), C-reactive protein, ferritin, lactate dehydrogenase, neutrophil-to-lymphocyte ratio, procalcitonin, and D-dimer levels for mortality were also investigated. Result(s): The mortality rate was 74.3% for the patients overall, and increased, albeit insignificantly, with increasing age. Neither Troponin Iicu nor Troponin Idiff was predictive for mortality for any of the age groups or for the patients overall. Ferritin, lactate dehydrogenase, neutrophil-to-lymphocyte ratio, and C-reactive protein levels were predictive for mortality for patients overall (p= 0.016, p= 0.001, p= 0.013, and p < 0.001, respectively). Discussion(s): For geriatric patients, troponin I levels at the time of the first admission to the ICU are not sufficient to predict mortality alone and should be evaluated together with other parameters.Copyright © 2022, Derman Medical Publishing. All rights reserved.
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Introduction: Dermatitis herpetiformis (DH) is an autoimmune vesiculobullous disease associated with celiac enteropathy. The clinical manifestation of DH is the occurrence of a papulovesicular rash on the skin. Oral mucosal involvement in DH is very rare. This study aimed to describe the impact of COVID-19 on the acute exacerbation of oral dermatitis herpetiformis. Case Report: A 74-year-old woman was referred to the Oral Medicine Department with a chief complaint of the blisters on the skin for a week and ulcers in the oral cavity appeared two days ago. Extraoral examination revealed crusts on the neck and extremities. The lips appeared dry and desquamative. Intraoral examination revealed erosive lesions covered with a white-yellowish plaques on the right and left sides of the buccal mucosa, an ulcer with a diameter of 0.5 cm, and purpura hemorrhagic on left buccal mucosa and right lateral border of the tongue. Histopathological examination of the skin lesion revealed a subepithelial blister with eosinophils and neutrophil cells. The definitive diagnosis of dermatitis herpetiformis was made. She was given 5 mg intravenous dexamethasone, cetirizine 10 mg, and clindamycin 300 mg by the dermatologist. We gave hyaluronic acid 0.025% mouthwash for oral ulcers and petroleum jelly for the lips. The oral lesions had significant improvement after 4 weeks of treatment. Two months later, the patient experienced acute exacerbation after being infected with COVID-19 (anti-SARS-CoV-2 IgG S-RBD >40,000 AU/mL). The oral lesions healed after a month of treatment. Conclusion: COVID-19 can trigger the acute exacerbation of dermatitis herpetiformis. SARS-CoV-2 causes an immune dysregulation and hypersensitivity reaction.
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Background: With the COVID-19 pandemic since December 2019, many people around the world have been infected and affected, one of them is Indonesia. The increasing number of deaths due to COVID-19 infection that occurs in the adult to geriatric age group, especially in geriatrics who often have comorbidities. This study aims to describe the analysis of risk factors for mortality in geriatric patients infected with COVID-19 in the intensive care unit. Method(s): This study is a retrospective observational analytic Single Center study, the study was conducted by taking medical record data from geriatric patients with COVID-19 who were treated in the ICU during the period from February 1 to May 31, 2021. Result(s): Of the 52 patient medical record data, 27 patients died. In this study the mean age, weight, height, BMI and SOFA score;66 years, 70 kg, 160 cm2, 26 kg/m2, and 6. From the results of medical record data, the highest mortality was found in the group with risk factors, namely SOFA score, PaO2/FiO2 ratio, ventilator use, inotropic use, and vasopressor use. Conclusion(s): Mortality in our study was 51.9%. Risk factors that affect mortality in geriatric patients infected with COVID-19 are high SOFA scores, low PaO2/FiO2 ratios, use of ventilators, inotropes, and vasopressors. Copyright © 2022, Anka Publishers. All rights reserved.
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The last 1 year has underscored the need of a robust global public health system like never before. Both the infection itself, and the measures taken to contain it, have forced us to adopt new ways of life. Measures taken by the Indian government ranged from initial advisories on social distancing and hand hygiene to a full-fledged nationwide lockdown. The lockdown disrupted all the routine health-care activities - right from the suspension of curative outpatient department (OPD) services to preventive immunization and antenatal care services;the entire system has been affected. The problem has been especially complex for older patients due to the fact that they are at a higher risk for infection by the virtue of their age and likely to have a more severe disease due to the presence of multiple comorbidities, including but not limited to the other pandemic of diabetes that we have been witnessing over the past few decades. Resuming a health-care service for older people requiring inperson visits for OPD consultation may not be a good enough option for them. Thus, we have two major issues with geriatric population - access and utilization of health-care services. While telemedicine has been widely employed to solve the problem of access;does it really solve the issue of utilization of health-care services by a scared geriatric patient who needs a caregiver, too? In this article, we explore the impact and some of these changes, telemedicine, and other potential solutions, focusing on the health care needs of older persons and the future discourse. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
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Background: Post Covid-19 syndrome is recognized as the maintenance of disease symptoms for weeks to months after the disease has healed. It is suspected that the involvement of the ACE enzyme and IL-6 may trigger an increased risk of dementia. Method(s): This is a cohort study that is evaluating over 12 months the functional status and cognition of elderly people after hospital discharge. One group is composed of elderly people admitted to the hospital for Covid-19 and the other group is composed of elderly people hospitalized for other clinical reasons. The groups are evaluated with The Mattis (DRS), AD8, IQCODE, ADCS-ADL, PCL-C, GDS-15, FIM, COPM, CFS, FSS, mMRC and SARC-calf. We will describe the preliminary results of the first 15 patients included in the COVID-19 group on functional status, cognition, mood and quality of life. Result(s): Fifteen patients with COVID-19 were evaluated three months after hospital discharge. One was excluded due to previous mental disorder and another due to a request to be excluded from the study. We found a mean age of 67.7 +/- 7.15 years, schooling 8.7 +/- 4.7 years, 61.5% female, Charlson Comorbidity Index 1.9 +/- 1.4, 69.2% with smoking history had incomplete vaccine protection for COVID-19. Considering cognition, 15.4% of the sample had no impairment, 53.9% had mild cognitive impairment (MCI) (30.8% amnestic MCI and 23.1% non-amnesic MCI) and 30.8% had dementia. 23.1% declared their health status and quality of life as fair or poor. Median CFS was 5 (3-5), mean GDS-15 was 4.7 +/- 2.9, FSS 32.9 +/- 18.9, PCL-c 32.6 +/- 12.5, SARC-calf 3.2 +/- 4.2. All had mMRC dyspnea classified between 2 and 4. Conclusion(s): There was a high prevalence of mild cognitive impairment and dementia among patients after three months of discharge, with a predominance of mild frailty due to CFS and the presence of fatigue. It is noteworthy that a quarter of the sample reported low quality of life. Copyright © 2022 the Alzheimer's Association.
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The review is devoted to the peculiarities of the course of a new coronavirus infection (COVID-19) in elderly and senile patients. Data on the epidemiology, pathogenetic mechanisms of development, clinical manifestations, course and prognosis of the disease among geriatric patients are presented. The role of comorbid pathology in the course and prognosis of a new coronavirus infection in the elderly is shown. Recommendations for the treatment of patients with an emphasis on the need to comply with strict indications for prescribing antibacterial drugs in this category of patients are discussed. Copyright © 2022 Stavropol State Medical University. All rights reserved.
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Photobiomodulation (PBM) therapy is a therapeutic method that can produce a range of physiological effects in cells and tissues using certain wavelengths. The reparative benefits of PBM therapy include wound healing, bone regeneration, pain reduction, and the mitigation of inflammation. Advances in the development of laser instruments, including the use of high-intensity lasers in physiotherapy, have recently led to controllable photothermal and photomechanical treatments that enable therapeutic effects to be obtained without damaging tissue. The combination of PBM therapy with acupuncture may provide new perspectives for investigating the underlying therapeutic mechanisms of acupuncture and promote its widespread application.
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The aims of this study were to describe the characteristics of patients hospitalized with delta SARS-CoV-2 breakthrough infection, and to identify factors associated with pneumonia on chest Computed Tomography (CT) and mortality. The clinical records of 229 patients (105 F), with a median age of 81 (interquartile range, IQR, 73-88) years old, hospitalized between June and December 2021 after completion of the primary vaccination cycle, were retrospectively analyzed, retrieving data on comorbidities, Clinical Frailty Scale (CFS), clinical presentation and outcomes. Multimorbidity (91.7% with ≥2 chronic illnesses) and frailty (61.6% with CFS ≥ 5) were highly prevalent. CFS (OR 0.678, 95% CI 0.573-0.803, p < 0.001) and hypertension were independently associated with interstitial pneumonia. Mortality was 25.1% and unrelated with age. PaO2/FiO2 on blood gas analysis performed upon admission (OR 0.986, 95% CI 0.977-0.996, p = 0.005), and CFS (OR 1.723, 95% CI 1.152-2.576, p = 0.008) were independently associated with mortality only in subjects < 85 years old. Conversely, serum PCT levels were associated with mortality in subjects ≥ 85 years old (OR 3.088, 95% CI 1.389-6.8628, p = 0.006). In conclusion, hospitalization for COVID-19 breakthrough infection mainly involved geriatric patients, with those aged ≥ 85 more characterized by decompensation of baseline comorbidities rather than typical COVID-19 respiratory symptoms.
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Introduction: Several urogynecology conditions can be managed through telehealth visits as this is a combined surgical and medical specialty. However, geriatric patients may experience difficulty using such a modality due to the inherent ageism within the medical system. This manifests in portal developers and providers presuming the elderly's obligatory conformance to what is provided and a limited interest in this population's constraints, thus disregarding their needs when designing the interface as well as forgoing conversations on patient portals with their patients. With the COVID-19 pandemic catalyzing the digitalization of medicine, excluding the needs of this patient population risks impacting their care. Online health portal use must be optimized accordingly to improve access to geriatric urogynecology patients. Objective: To identify facilitators, concerns, technical or personal issues encountered, and the desired features of the online patient portals among geriatric urogynecology patients. Methods: This is a cross-sectional study of patients (> = 65 years of age) at an academic medical center in Northwest Ohio, where telehealth practices had been well established since early 2020. The data collection occurred between June 1-30, 2021. Two focus groups were conducted with the identified themes used to devise the anonymous survey. The questions addressed comfort with telehealth visits for urogynecology-specific conditions and the practicality of patient portals for physician visits. The promoters and deterrents were compared using the Pearson's Chi-squared test between those comfortable and uncomfortable having telehealth visits for preoperative, postoperative, and medical management. Results: A total of 205 patients completed the study (91% response rate, 225 surveys distributed). Mean age was 68.9 (SD 4.9) with 81% of participants being Caucasian and 10% being African American. Promoters of patient portal use identified included provider encouragement, enrollment on-site with concurrent education, and clarification of relevance of the telehealth to one's care (Table 1). Patients who were uncomfortable with telehealth use reported anxiety and technical issues as deterrents for using such technology. This included difficulty using the hardware, accessing the portal, and significant input needed to log on. More than half of the patients were comfortable having online visits for preoperative (51.7%), postoperative (66.3%), and medical management (73.7%) (Table 2). Up to 60.5% of the patients believed that telehealth visits were equally stressful as in-person visits, while 24.4% believed that the logistics of in-person visits were the cause of stress. Most of the patients who considered in-person visits stressful reported provider encouragement, enrollment by the hospital, and clarification of benefits as major promoters for portal use. Specific design features such as additional drop-down lists, colors, and icons in addition to an intuitive design were desired. Patients who preferred in-person visits were deterred primarily by technical and privacy concerns, anxiety, and cost of use (Figure 1). Conclusions: To improve access to care, augment the utilization of online patient portals, and combat ageism, enhancing the geriatric urogynecologic patient portal experience is vital. Investment in this population's needs includes education of patients, active enrollment, engagement by healthcare systems, and addressing technical concerns (Table Presented).