Robotic sacrocolpopexy for the treatment of pelvic organ prolapse in elderly women: comparative analysis of safety and efficacy versus younger women.

INTRODUCTION: Pelvic organ prolapse is a condition with high prevalence in elderly women. With increasing life expectancy and a desire for improved quality of life, a rise in the frequency of surgical treatments for these women is anticipated. The aim is to compare complication, success, and satisfaction rates among elderly patients (aged >70 years) in comparison to younger women undergoing robotic sacrocolpopexy, thereby assessing the safety and efficacy of this surgery in this group of patients. METHOD: A prospective observational comparative study of 123 robotic sacrocolpopexies conducted between December 2016 and June 2022. Patients were stratified by age (cutoff point: 70 years). Baseline characteristics, type, and grade of prolapse, intra and postoperative data, complications, functional and anatomical outcomes, and satisfaction levels were collected. RESULTS: Among the 123 patients, 62.6% were under 70 years old, while 37.4% were 70 years or older, exhibiting similar baseline characteristics, prolapse grade, and type. The percentages of intraoperative (6.5%) and postoperative complications (4.4-9%) were comparable in both age groups. Furthermore, success and satisfaction rates exceeded 90%, with no significant differences between women under and over 70 years during a two-year follow-up. CONCLUSION: Robotic sacrocolpopexy is at least as effective and safe in women aged 70 years or older as in younger individuals, with no higher rates of intra and postoperative complications and similar rates of anatomical and subjective success.

Efficacy and safety of biological treatment for inflammatory bowel disease in elderly patients: Results from a GETECCU cohort.

INTRODUCTION: Biological therapies used for the treatment of inflammatory bowel disease (IBD) have shown to be effective and safe, although these results were obtained from studies involving mostly a young population, who are generally included in clinical trials. The aim of our study was to determine the efficacy and safety of the different biological treatments in the elderly population. METHODS: Multicenter study was carried out in the GETECCU group. Patients diagnosed with IBD and aged over 65 years at the time of initiating biological therapy (infliximab, adalimumab, golimumab, ustekinumab or vedolizumab) were retrospectively included. Among the patients included, clinical response was assessed after drug induction (12 weeks of treatment) and at 52 weeks. Patients' colonoscopy data in week 52 were assessment, where available. Regarding complications, development of oncological events during follow-up and infectious processes occurring during biological treatment were collected (excluding bowel infection by cytomegalovirus). RESULTS: A total of 1090 patients were included. After induction, at approximately 12-14 weeks of treatment, 419 patients (39.6%) were in clinical remission, 502 patients (47.4%) had responded without remission and 137 patients (12.9%) had no response. At 52 weeks of treatment 442 patients (57.1%) had achieved clinical remission, 249 patients had responded without remission (32.2%) and 53 patients had no response to the treatment (6.8%). Before 52 weeks, 129 patients (14.8%) had discontinued treatment due to inefficacy, this being significantly higher (p<0.0001) for Golimumab - 9 patients (37.5%) - compared to the other biological treatments analyzed. With respect to tumor development, an oncological event was observed in 74 patients (6.9%): 30 patients (8%) on infliximab, 23 (7.14%) on adalimumab, 3 (11.1%) on golimumab, 10 (6.4%) on ustekinumab, and 8 (3.8%) on vedolizumab. The incidence was significantly lower (p=0.04) for the vedolizumab group compared to other treatments. As regards infections, these occurred in 160 patients during treatment (14.9%), with no differences between the different biologicals used (p=0.61): 61 patients (19.4%) on infliximab, 39 (12.5%) on adalimumab, 5 (17.8%) on golimumab, 22 (14.1%) on ustekinumab, and 34 (16.5%) on vedolizumab. CONCLUSIONS: Biological drug therapies have response rates in elderly patients similar to those described in the general population, Golimumab was the drug that was discontinued most frequently due to inefficacy. In our experience, tumor development was more frequent in patients who used anti-TNF therapies compared to other targets, although its incidence was generally low and that this is in line with younger patients based on previous literature.

Epidemiología y calidad asistencial de las intoxicaciones agudas en el adulto mayor de 65 años en Alicante, España / Epidemiology and quality of care of acute intoxication in people over 65 years of age in Alicante, Spain

Introducción El objetivo fue estudiar la epidemiología de las intoxicaciones agudas en el servicio de urgencias (SU) de un centro de tercer nivel y analizar el grado de cumplimiento de los indicadores de calidad (IC) en pacientes ≥65 años comparado con el resto de los adultos. Material y métodos Estudio observacional y retrospectivo, se incluyeron los casos diagnosticados de intoxicación aguda de pacientes >14 años atendidos en el SU de un hospital terciario. Se recogieron las variables demográficas, tipo de tóxicos y causa de la intoxicación, 19 IC y destino, siendo la variable de resultado el grado de cumplimiento de los IC. Resultados Se registraron 1.144 casos, 10,4% (n=119) personas ≥65 años. Hubo mayor proporción de mujeres en este grupo (72,8 vs. 60,9%; p=0,015), más intoxicación accidental (37,6 vs. 25,7% p=0,006), y menos voluntaria (35,0 vs. 49,6%; p=0,003), menos intoxicación por alcohol (5 vs. 17,8%; <0,001) y ningún caso intoxicado por drogas ilegales (p<0,001). En la mayoría de los IC tenían un alto grado de cumplimento (> 85%) en personas ≥65 años como en el resto de los adultos. De todos los IC hubo diferencias en la indicación de oxigenoterapia en el caso de intoxicación por monóxido de carbono (CO) en aquellos ≥65 años (64,2 vs. 40,9%; p=0,005). Conclusiones El perfil epidemiológico de la intoxicación en personas ≥65 años es diferente al de los más jóvenes y con un cumplimiento de los IC. Dado los resultados obtenidos no consideramos que existan diferencias en la asistencia del paciente intoxicado con respecto a su edad (AU)

Introduction The objective of this study was to examine the epidemiology of acute poisonings in the emergency department (ED) of a tertiary center and to analyze the compliance level with quality indicators (QIs) in patients 65 years and older compared rest of adults. Materials and methods This was an observational and retrospective study that included diagnosed cases of acute poisoning in patients over 14 years old treated in the ED of a tertiary hospital. Demographic variables, type of toxic substances, and cause of poisoning were collected, along with 19 QIs and patient outcomes, with the main outcome variable being the degree of compliance with the QIs. Results A total of 1144 cases were recorded, with 10.4% (n=119) being patients 65 years and older. Patients 65 years and older were more likely to be female (72.8% vs. 60.9%; p=0.015), experience more accidental poisonings (37.6% vs. 25.7%; p=0.006), and fewer intentional poisonings (35.0% vs. 49.6%; p=0.003). There were fewer cases of alcohol poisoning (5% vs. 17.8%; p<0.001), and no cases of illegal drug poisoning (p<0.001) in this age group. Most QIs showed a high degree of compliance (>85%) in both patients 65 years and older and rest of adults. However, there were differences in the indication of oxygen therapy in cases of carbon monoxide poisoning (64.2% vs. 40.9%; p=0.005). Conclusions The epidemiological profile of poisoning in patients 65 years and older differs from that of adult patients, with a similar degree of compliance with QIs. Based on the results obtained, there does not appear to be significant differences in the management of poisoned patients based on their age (AU)

Relevancia del estudio genético de la amiloidosis cardíaca por transtiretina en el anciano / Importance of genetic study in elderly patients with transthyretin cardiac amyloidosis

Antecedentes y objetivo La amiloidosis cardiaca por transtiretina (AC-ATTR) es una enfermedad prevalente con la edad. Se recomienda realizar sistemáticamente un estudio genético incluso en los pacientes más añosos. Nuestro objetivo ha sido realizar un análisis de la prevalencia de amiloidosis por transtiretina hereditaria (ATTRv) en ancianos (≥75años) con AC-ATTR y sus implicaciones. Pacientes y método Estudio observacional retrospectivo de la cohorte de pacientes ancianos con AC-ATTR diagnosticados de acuerdo con el protocolo internacional. Analizamos los resultados de la secuenciación del gen TTR, las características diferenciales y sus implicaciones clínicas. Resultados Entre 2016 y 2022 se diagnosticaron 130 pacientes ancianos (89% cohorte) con AC-ATTR (85% varones). En 8 pacientes de los 123 con estudio genético se identificó una variante patogénica en TTR (6,5%), iniciándose tratamiento específico en 4 sujetos (50%). El estudio familiar identificó otro caso y 6 portadores asintomáticos. No hubo diferencias significativas entre características basales ni en los eventos clínicos. Conclusiones La prevalencia de ATTRv en ancianos con AC-ATTR fue del 6,5%, sin observarse características diferenciales que permitan guiar una indicación selectiva del análisis genético (AU)

Background and objective Cardiac transthyretin amyloidosis (CA-ATTR) is a prevalent disease with age. Genetic study is recommended, even in eldest patients. We aim to analyze the prevalence of hereditary transthyretin amyloidosis (ATTRv) in elderly patients (≥75years) with CA-ATTR and its implications. Patients and methodology Retrospective observational study of the cohort of elderly patients with CA-ATTR diagnosed according to the international recommended protocol. We analyze the results of sequencing TTR gene, the differential characteristics and their clinical implications. Results Between 2016 and 2022, 130 elderly patients (89% cohort) were diagnosed with CA-ATTR (85% male). In 8 of the 123 patients with a genetic study, a pathogenic variant in TTR was identified (6.5%), initiating specific treatment in 4 subjects (50%). The family study identified another case and 6 asymptomatic carriers. There were no significant differences between baseline characteristics or in clinical events. Conclusions The prevalence of ATTRv in elderly patients with CA-ATTR was 6.5% without observing differential characteristics that allow guiding a selective indication of genetic analysis (AU)

Recomendaciones del Grupo de Psoriasis de la Academia Española de Dermatología y Venereología sobre el manejo del paciente de edad avanzada con psoriasis en placas moderada-grave / Moderate to Severe Psoriasis in Older Adults: Recommendations on Management from the Psoriasis Working Group of the Spanish Academy of Dermatology and Venereology (AEDV)

El abordaje terapéutico de pacientes de edad avanzada con psoriasis en placas moderada-grave es complejo debido, entre otros factores, a las comorbilidades asociadas, la polimedicación y la inmunosenescencia propias de este grupo de edad. En el presente documento se recogen 17 recomendaciones para el manejo de la psoriasis moderada-grave en pacientes de edad avanzada (>65 años). Estas recomendaciones han sido propuestas por un comité científico de 6 dermatólogos a partir de una revisión de la literatura científica y consensuadas entre 51 miembros del Grupo de Psoriasis de la Academia Española de Dermatología y Venereología mediante dos rondas de consulta Delphi. En los pacientes con psoriasis moderada-grave de edad avanzada, estas recomendaciones pueden mejorar su manejo, resultados y pronóstico. (AU)

Managing moderate to severe psoriasis in older adults is complex due to factors characteristic of the later years of life, such as associated comorbidity, polypharmacy, and immunosenescence. This consensus statement discusses 17 recommendations for managing treatment for moderate to severe psoriasis in patients older than 65 years. The recommendations were proposed by a committee of 6 dermatologists who reviewed the literature. Fifty-one members of the Psoriasis Working Group of the Spanish Academy of Dermatology and Venereology (AEDV) then applied the Delphi process in 2 rounds to reach consensus on which principles to adopt. The recommendations can help to improve management, outcomes, and prognosis for older adults with moderate to severe psoriasis. (AU)

[Translated article] Moderate to Severe Psoriasis in Older Adults: Recommendations on Management From the Psoriasis Working Group of the Spanish Academy of Dermatology and Venereology (AEDV) / Recomendaciones del Grupo de Psoriasis de la Academia Española de Dermatología y Venereología sobre el manejo del paciente de edad avanzada con psoriasis en placas moderada-grave

El abordaje terapéutico de pacientes de edad avanzada con psoriasis en placas moderada-grave es complejo debido, entre otros factores, a las comorbilidades asociadas, la polimedicación y la inmunosenescencia propias de este grupo de edad. En el presente documento se recogen 17 recomendaciones para el manejo de la psoriasis moderada-grave en pacientes de edad avanzada (>65 años). Estas recomendaciones han sido propuestas por un comité científico de 6 dermatólogos a partir de una revisión de la literatura científica y consensuadas entre 51 miembros del Grupo de Psoriasis de la Academia Española de Dermatología y Venereología mediante dos rondas de consulta Delphi. En los pacientes con psoriasis moderada-grave de edad avanzada, estas recomendaciones pueden mejorar su manejo, resultados y pronóstico. (AU)

Managing moderate to severe psoriasis in older adults is complex due to factors characteristic of the later years of life, such as associated comorbidity, polypharmacy, and immunosenescence. This consensus statement discusses 17 recommendations for managing treatment for moderate to severe psoriasis in patients older than 65 years. The recommendations were proposed by a committee of 6 dermatologists who reviewed the literature. Fifty-one members of the Psoriasis Working Group of the Spanish Academy of Dermatology and Venereology (AEDV) then applied the Delphi process in 2 rounds to reach consensus on which principles to adopt. The recommendations can help to improve management, outcomes, and prognosis for older adults with moderate to severe psoriasis. (AU)

Análisis de factores de riesgo de vaciamiento gástrico lento tras la duodenopancreatectomía cefálica / Study of risk factors for delayed gastric emptying after partial pancreatoduodenectomy

Introducción: El vaciamiento gástrico lento (VGL) es una de las complicaciones más frecuentes tras la duodenopancreatectomía cefálica. El objetivo del actual estudio es analizar los factores de riesgo de su aparición. Métodos: Análisis de factores de riesgo de VGL sobre una base de datos prospectiva de 390 pacientes intervenidos entre 2013 y 2021. Se realizó un estudio retrospectivo comparativo entre pacientes con y sin VGL y posteriormente un estudio de factores de riesgo de VGL mediante modelos de regresión logística univariante y multivariante. Resultados: La incidencia de VGL en el global de la serie fue del 28%. Un 63% de los pacientes presentaron alguna complicación y la mortalidad postoperatoria fue del 3,1%. Se evidenció que la edad mediana (73 años vs. 68 años, p<0,001) y la creatinina preoperatorias (75 vs. 68.5, p<0,001) eran superiores en el grupo VGL. El estudio de factores de riesgo evidenció que la edad superior a 60 años (p=0,002) y la fístula pancreática (p<0,001) eran factores de riesgo de VGL. Conclusiones: La presencia de fístula pancreática se confirma como factores de riesgo de VGL tras la duodenopancreatectomía. Además, se demuestra que la edad superior a 60 años es un factor de riesgo de VGL. (AU)

Introduction: Delayed gastric emptying is one of the most frequent complications after pancreatoduodenectomy. Methods: We performed an analysis of risk factors for delayed gastric emptying on a prospective database of 390 patients operated on between 2013 and 2021. A comparative retrospective study was carried out between patients with and without delayed gastric emptying and subsequently a study of risk factors for delayed gastric emptying using univariate and multivariate logistic regression models. Results: The incidence of delayed gastric emptying in the overall series was 28%. The morbidity of the group was 63% and postoperative mortality was 3.1%. Focusing in delayed gastric emptying, it was shown that the median age (73 years vs. 68 years, p<0.001) and preoperative creatinine (75 vs. 65.5, p<0.001) were higher in the group with this complication. The study of risk factors showed that age over 60 years (p=0.002) and pancreatic fistula (p<0.001) were risk factors for delayed gastric emptying. Conclusions: The presence of pancreatic fistula is confirmed as risk factor for slow gastric emptying after pancreaticoduodenectomy. In addition, age over 60 years is shown to be a risk factor for slow gastric emptying. (AU)

Indicaciones e histología de 489 orquiectomías analizadas según la edad del paciente / Indications and histology of 489 orchiectomies analyzed by patient age

Objetivo Evaluar indicaciones e histología de nuestra serie de orquiectomías, analizando los resultados dependiendo de la edad del paciente. Métodos Estudio de las orquiectomías realizadas en nuestro centro entre 2005 y 2020 a pacientes mayores de 18 años. Evaluamos: datos demográficos, indicaciones, histología y efectividad del diagnóstico ecográfico según 3 grupos de edad. Resultados Se realizaron 489 orquiectomías, 364 (74%) en los pacientes entre 18-50 años (grupo A), 59 (12%) entre los pacientes de 51-70 años (grupo B) y 66 (13,4%) en mayores de 70 años (grupo C). En el grupo A, 284 (78%) orquiectomías fueron indicadas por sospecha tumoral, 261/284 (91,9%) fueron neoplasias malignas, 253 (89%) germinales. La ecografía testicular tuvo un valor predictivo positivo (VPP) para tumor testicular maligno del 90%. En el grupo B, 34 (57%) orquiectomías fueron indicadas por sospecha tumoral y 25/34 (73,5%) presentaron neoplasias malignas. La ecografía tuvo un VPP para malignidad del 68%. En el grupo C, la orquiepididimitis fue la causa más frecuente de orquiectomía con 30 casos (45,5%). Entre las 20 orquiectomías por sospecha de tumor (30,3%), se encontró malignidad en 6. La ecografía tuvo un VPP para malignidad del 31%. Conclusión En menores de 70 años la indicación principal de orquiectomía fue la sospecha tumoral y en mayores, la orquiepididimitis. Los tumores germinales fueron la histología más frecuente en los menores de 70 años; en los mayores la malignidad fue infrecuente. Con la edad, disminuyó el VPP de la ecografía testicular para neoplasia maligna. En los mayores de 50 años se debería mejorar el proceso diagnóstico antes de indicar orquiectomía por sospecha tumoral (AU)

Objective To evaluate the indications and histology of our series of orchiectomies, analysing the results by patient's age. Methods We included the orchiectomies realized in our hospital between 2005 and 2020 in patients older than 18 years. We estimated demographic data, indications, histology and effectiveness of testicular ultrasound by three groups of age. Results We included 489 orchiectomies, which 364 (74%) belonged to group A (patients between 18-50 years), 59 (12%) to group B (50-70 years) and 66 (14%) to group C (older than 70 years). In group A, 284 (78%) orchiectomies were indicated due to malignancy suspect. In 91.9% cases (261) malign neoplasm was confirmed at final histology and 253 (89%) were germinal cells. Testicular ultrasound had a positive predictive value (PPV) of 90% in this group. In group B, 34 (57%) orchiectomies were indicated because of malignancy suspect. At final histologic analysis, 25/34 (73.5%) confirmed malign neoplasm. Ultrasound had a PPV of 68%. In group C, orchiepididymitis was the main cause of testicular removal with 30 cases (45,5%). From the 20 cases (30.3%) with suspicion of malignancy, only 6 had confirmed malign histology. Testicular ultrasound PPV for malignancy was 31%. Conclusion In patients younger than 70 years the main orchiectomy's indication was suspect of malignancy and in older than 70, testicular inflammation. The germinal neoplasm was the predominant histology in younger than 70 years. In older than that, malignancy was infrequent. The positive predictive value of testicular ultrasound for malignancy decreased with patient's age. In patients older than 50 years proper image diagnosis to assess malignancy should be considered before orchiectomy is done (AU)

Importance of genetic study in elderly patients with transthyretin cardiac amyloidosis. / Relevancia del estudio genético de la amiloidosis cardíaca por transtiretina en el anciano.

BACKGROUND AND OBJECTIVE: Cardiac transthyretin amyloidosis (CA-ATTR) is a prevalent disease with age. Genetic study is recommended, even in eldest patients. We aim to analyze the prevalence of hereditary transthyretin amyloidosis (ATTRv) in elderly patients (≥75years) with CA-ATTR and its implications. PATIENTS AND METHODOLOGY: Retrospective observational study of the cohort of elderly patients with CA-ATTR diagnosed according to the international recommended protocol. We analyze the results of sequencing TTR gene, the differential characteristics and their clinical implications. RESULTS: Between 2016 and 2022, 130 elderly patients (89% cohort) were diagnosed with CA-ATTR (85% male). In 8 of the 123 patients with a genetic study, a pathogenic variant in TTR was identified (6.5%), initiating specific treatment in 4 subjects (50%). The family study identified another case and 6 asymptomatic carriers. There were no significant differences between baseline characteristics or in clinical events. CONCLUSIONS: The prevalence of ATTRv in elderly patients with CA-ATTR was 6.5% without observing differential characteristics that allow guiding a selective indication of genetic analysis.

Assessment of long-term cognitive dysfunction in older patients who undergo heart surgery / Deterioro cognitivo a largo plazo tras cirugía cardiaca en pacientes de edad avanzada

Introduction: Older patients are more likely to have cognitive dysfunction, and a great pro-portion of patients undergone surgical procedures are older adults. Postoperative cognitivedysfunction (POCD) has been shown as a consistent complication after major surgical proceduressuch as heart surgery.Aim: To determine the presence of long-term POCD in ≥65-year-old patients undergoing coro-nary artery bypass grafting and aortic valve replacement, and to establish related risk factors.Methods: We prospectively and sequentially included 44 patients with coronary disease andaortic stenosis scheduled for heart surgery. Follow-up of all patients was standardized anda neurocognitive evaluation were performed preoperatively and at 1, 6 and 12 months aftersurgery.Results: Patients experienced a significantly postoperative cognitive dysfunction (33.5%, 63.4%and 38.9% at 1, 6 and 12 months, respectively) from baseline (20.5%). Patient-associated aspectssuch as age (p < 0.01), history of smoking (p < 0.01), arterial hypertension (p = 0.022), diabetesmellitus (p = 0.024), heart failure (p = 0.036) and preoperative cognitive dysfunction (p < 0.01),and surgery-associated aspects such as EuroSCORE (p < 0.01) and operation time (p < 0.01) wereidentified as related risk factors. Conclusions: Older patients who underwent heart surgery had long-term POCD. Both patient-and surgery-related risk factors were established as related risk factors. These findings suggestthat the prevalence of cognitive dysfunction after cardiac surgery in older patients could berelated to a possible progression to dementia. In addition, many of the risk factors identifiedmay be modifiable but in practice, these patients are not attended to for their possible cognitiveimpairment.(AU)

Introducción: Los pacientes de edad avanzada tienen más riesgo de sufrir deterioro cognitivo, yson cada vez más frecuentemente sometidos a una cirugía. El deterioro cognitivo posquirúrgico(DCP) tras cirugía cardiaca se ha mostrado como una complicación importante.Objetivos: Determinar la presencia del DCP a largo plazo en pacientes ≥ 65 a˜nos intervenidosde derivación coronaria y reemplazo de válvula aórtica, y establecer los factores de riesgorelacionados.Métodos: Se realizó un estudio en el que se incluyeron de forma prospectiva y secuen-cial 44 pacientes con enfermedad coronaria y estenosis aórtica programados para cirugía. Elseguimiento fue estandarizado y se realizaron evaluaciones neuropsicológicas preoperatoria-mente a los 1, 6 y 12 meses postoperatorios.Resultados: Se observó la presencia de un DCP significativo (33,5, 63,4 y 38,9% a 1, 6 y 12 meses,respectivamente) respecto al nivel basal (20,5%). Se identificaron como factores de riesgo varia-bles asociadas al paciente como la edad (p < 0,01), el tabaquismo (p < 0,01), la hipertensiónarterial (p = 0,022), la diabetes mellitus (p = 0,024), la insuficiencia cardiaca (p = 0,036) y el dete-rioro cognitivo preoperatorio (p < 0,01), y variables quirúrgicas como el EuroSCORE (p < 0,01) yel tiempo de intervención (p < 0,01).Conclusiones: Los pacientes de edad avanzada sometidos a cirugía cardiaca presentaron DCP alargo plazo. Variables asociadas al paciente y quirúrgicas se mostraron como factores de riesgo,muchas de ellas modificables. Estos hallazgos sugieren que la presencia de DCP en pacientes demás edad podría suponer mayor riesgo de evolución a demencia. En la práctica clínica habitualno es evaluado el rendimiento cognitivo.(AU)

Assessment of long-term cognitive dysfunction in older patients who undergo heart surgery.

INTRODUCTION: Older patients are more likely to have cognitive dysfunction, and a great proportion of patients undergone surgical procedures are older adults. Postoperative cognitive dysfunction (POCD) has been shown as a consistent complication after major surgical procedures such as heart surgery. AIM: To determine the presence of long-term POCD in ≥65-year-old patients undergoing coronary artery bypass grafting and aortic valve replacement, and to establish related risk factors. METHODS: We prospectively and sequentially included 44 patients with coronary disease and aortic stenosis scheduled for heart surgery. Follow-up of all patients was standardized and a neurocognitive evaluation were performed preoperatively and at 1, 6 and 12 months after surgery. RESULTS: Patients experienced a significantly postoperative cognitive dysfunction (33.5%, 63.4% and 38.9% at 1, 6 and 12 months, respectively) from baseline (20.5%). Patient-associated aspects such as age (p<0.01), history of smoking (p<0.01), arterial hypertension (p=0.022), diabetes mellitus (p=0.024), heart failure (p=0.036) and preoperative cognitive dysfunction (p<0.01), and surgery-associated aspects such as EuroSCORE (p<0.01) and operation time (p<0.01) were identified as related risk factors. CONCLUSIONS: Older patients who underwent heart surgery had long-term POCD. Both patient- and surgery-related risk factors were established as related risk factors. These findings suggest that the prevalence of cognitive dysfunction after cardiac surgery in older patients could be related to a possible progression to dementia. In addition, many of the risk factors identified may be modifiable but in practice, these patients are not attended to for their possible cognitive impairment.

Prevalence of sarcopenia in patients older than 75 years admitted for hip fracture.

BACKGROUND: Hip fracture in the population aged 75 years and older is one of the most disabling pathologies. Likewise, disease related malnutrition (DRM) and sarcopenia are two frequent diagnoses in this age group, whose prevalence may be increased in patients with hip fracture. AIMS: To determine the prevalence of malnutrition and/or sarcopenia in patients admitted for hip fracture and evaluate the existence of malnutrition related to disease and sarcopenia, and the differences between the sarcopenic and non-sarcopenic group. METHODS: 186 patients aged 75 years or over, hospitalised for hip fracture from March 2018 to June 2019 were included. Demographic, nutritional and biochemical variables were collected. Nutritional screening was carried out with the Mini-Nutritional Assessment (MNA), the presence of DRM was established with The Global Leadership Initiative on Malnutrition (GLIM) criteria. For sarcopenia screening, the Strength, Assistance with walking, Rising from a chair, Climbing stairs and Falls (SARC-F) was used and the diagnosis of sarcopenia was made using the criteria from the European Working Group on Sarcopenia in Older People (EWGSOP) reviewed in 2019 (EWGSOP2). Muscle strength was determined by hand-grip strength, body composition by measurement of bioelectrical impedance. RESULTS: The mean age was 86.2 years, most of the patients were women (81.7%). 37.1% of patients were at nutritional risk (MNA 17-23.5) and 16.7% were malnourished (MNA < 17). 72.4% of women and 79.4% of men, were diagnosed with DRM. 77.6% of the women and 73.5% of the men had low muscle strength. The appendicular muscle mass index was below the cut-off points for sarcopenia in 72.4% of the women and 79.4% of the men. Patients with sarcopenia had a lower body mass index, older age, poorer previous functional status and higher disease burden. The relationship between weight loss and hand grip strength (HGS) was significant (p = 0.007). CONCLUSIONS: 53.8% of patients admitted for hip fracture present malnutrition or are at risk after screening with MNA. Sarcopenia and DRM affects at least three out of four patients older than 75 years admitted for hip fracture. Older age, worse functional status, lower body mass index and high number of comorbidities, are associated with these two entities. There is a relationship between DRM and sarcopenia.

Hypoalbuminemia and advanced age are risk factors for delayed gastric emptying after pancreaticoduodenectomy / La hipoalbuminemia y la edad avanzada son factores de riesgo de vaciamiento gástrico lento tras duodenopancreatectomía cefálica

Background: delayed gastric emptying (DGE) is one of the most common complications after pancreatoduodenectomy. It could be related to some baseline patient-related characteristics. This study aims to assess the predictive factors associated to DGE in the cohort of patients included in the PAUDA clinical trial. Methods: this study was a retrospective analysis based on the 80 patients included in a randomized clinical trial conducted and published by our group. A descriptive analysis and a bivariate regression model were carried out. Some factors were further scrutinized for associations using the Pearson correlation coefficient and, finally, a multiple regression model using a stepwise selection of variables was conducted. Results: DGE was diagnosed in 36 (45 %) out of 80 patients (DGE group). The number of patients older than 60 years old in the DGE group was greater than in the group without DGE (32 vs 28 patients, p = 0.009]. Likewise, the number of patients with a preoperative albumin < 35 g/L (18 vs 11 patients, p = 0.036); preoperative bilirubin > 200 µmol/L (14 vs 8 patients, p = 0.039); postoperative haemorrhage (7 vs 1 patients, p = 0.011); postoperative intraabdominal abscess (12 vs 5 patients, p = 0.017); and postoperative biliary fistula (5 vs 0 patients, p = 0.011), was also greater in the DGE group. Two risk factors were associated with DGE: the patient's age at the time of surgery and preoperative hypoalbuminemia (serum albumin concentration ≤ 35g/L). Conclusions: the patient's age at the time of surgery and the preoperative nutritional status are independent risk factors to the development of DGE after pancreatoduodenectomy. (AU)

Introducción: el vaciamiento gástrico lento (VGL) es una complicación frecuente tras la duodenopancreatectomía cefálica (DPC) y puede relacionarse con algunas características basales del paciente. El objetivo es evaluar los factores predictivos de VGL en la cohorte de pacientes incluidos en el ensayo clínico aleatorizado PAUDA. Métodos: se realizó un análisis retrospectivo basado en los 80 pacientes incluidos en el ensayo PAUDA. Se realizaron un análisis descriptivo y un modelo de regresión bivariante. Posteriormente, algunos factores se examinaron mediante el coeficiente de correlación de Pearson y, finalmente, se llevó a cabo un modelo de regresión multivariante. Resultados: se diagnosticó VGL en 36 (45 %) pacientes. El número de pacientes mayores de 60 años en el grupo VGL fue mayor que en el grupo sin VGL (p = 0,009). El número de pacientes con albúmina preoperatoria < 35 g/L (p = 0,036); bilirrubina preoperatoria > 200 µmol/L (p = 0,039); hemorragia (p = 0,011); absceso intraabdominal (p = 0,017); y fístula biliar (p = 0,011), fue mayor en el grupo VGL. Dos factores de riesgo se asociaron con el VGL: la edad del paciente y la hipoalbuminemia preoperatoria. Conclusiones: la edad del paciente en el momento de la cirugía y el estado nutricional preoperatorio son factores de riesgo independientes de VGL tras DPC. (AU)

Moderate to Severe Psoriasis in Older Adults: Recommendations on Management from the Psoriasis Working Group of the Spanish Academy of Dermatology and Venereology (AEDV). / Recomendaciones del Grupo de Psoriasis de la Academia Española de Dermatología y Venereología sobre el manejo del paciente de edad avanzada con psoriasis en placas moderada-grave.

Managing moderate to severe psoriasis in older adults is complex due to factors characteristic of the later years of life, such as associated comorbidity, polypharmacy, and immunosenescence. This consensus statement discusses 17 recommendations for managing treatment for moderate to severe psoriasis in patients older than 65 years. The recommendations were proposed by a committee of 6 dermatologists who reviewed the literature. Fifty-one members of the Psoriasis Working Group of the Spanish Academy of Dermatology and Venereology (AEDV) then applied the Delphi process in 2 rounds to reach consensus on which principles to adopt. The recommendations can help to improve management, outcomes, and prognosis for older adults with moderate to severe psoriasis.

Hypoalbuminemia and advanced age are risk factors for delayed gastric emptying after pancreaticoduodenectomy.

Introduction: Background: delayed gastric emptying (DGE) is one of the most common complications after pancreatoduodenectomy. It could be related to some baseline patient-related characteristics. This study aims to assess the predictive factors associated to DGE in the cohort of patients included in the PAUDA clinical trial. Methods: this study was a retrospective analysis based on the 80 patients included in a randomized clinical trial conducted and published by our group. A descriptive analysis and a bivariate regression model were carried out. Some factors were further scrutinized for associations using the Pearson correlation coefficient and, finally, a multiple regression model using a stepwise selection of variables was conducted. Results: DGE was diagnosed in 36 (45 %) out of 80 patients (DGE group). The number of patients older than 60 years old in the DGE group was greater than in the group without DGE (32 vs 28 patients, p = 0.009]. Likewise, the number of patients with a preoperative albumin < 35 g/L (18 vs 11 patients, p = 0.036); preoperative bilirubin > 200 µmol/L (14 vs 8 patients, p = 0.039); postoperative haemorrhage (7 vs 1 patients, p = 0.011); postoperative intraabdominal abscess (12 vs 5 patients, p = 0.017); and postoperative biliary fistula (5 vs 0 patients, p = 0.011), was also greater in the DGE group. Two risk factors were associated with DGE: the patient's age at the time of surgery and preoperative hypoalbuminemia (serum albumin concentration ≤ 35g/L). Conclusions: the patient's age at the time of surgery and the preoperative nutritional status are independent risk factors to the development of DGE after pancreatoduodenectomy.

Introducción: Introducción: el vaciamiento gástrico lento (VGL) es una complicación frecuente tras la duodenopancreatectomía cefálica (DPC) y puede relacionarse con algunas características basales del paciente. El objetivo es evaluar los factores predictivos de VGL en la cohorte de pacientes incluidos en el ensayo clínico aleatorizado PAUDA. Métodos: se realizó un análisis retrospectivo basado en los 80 pacientes incluidos en el ensayo PAUDA. Se realizaron un análisis descriptivo y un modelo de regresión bivariante. Posteriormente, algunos factores se examinaron mediante el coeficiente de correlación de Pearson y, finalmente, se llevó a cabo un modelo de regresión multivariante. Resultados: se diagnosticó VGL en 36 (45 %) pacientes. El número de pacientes mayores de 60 años en el grupo VGL fue mayor que en el grupo sin VGL (p = 0,009). El número de pacientes con albúmina preoperatoria < 35 g/L (p = 0,036); bilirrubina preoperatoria > 200 µmol/L (p = 0,039); hemorragia (p = 0,011); absceso intraabdominal (p = 0,017); y fístula biliar (p = 0,011), fue mayor en el grupo VGL. Dos factores de riesgo se asociaron con el VGL: la edad del paciente y la hipoalbuminemia preoperatoria. Conclusiones: la edad del paciente en el momento de la cirugía y el estado nutricional preoperatorio son factores de riesgo independientes de VGL tras DPC.

Prevalence of transthyretin cardiac amyloidosis in elderly patients diagnosed with heart failure / Prevalencia de amiloidosis cardiaca por transtirretina en pacientes de edad avanzada con diagnóstico de insuficiencia cardiaca

Objective: There is increased interest in studying ATTR-CA, a pathology that primarily affects patients of geriatric age and is frequently underdiagnosed. We aim to establish the prevalence of ATTR-CA in a cohort of patients with a history of HFpEF and to describe its characteristics. Methods: We conducted a prospective observational study. Patients ≥75 years, clinical history of HFpEF, atrial dilation ≥34ml/m2 and left ventricular wall thickening >13mm, were included. Demographic and analytical parameters were collected, and a comprehensive geriatric assessment was performed, along with a transthoracic echocardiogram and cardiac scintigraphy. Finally, telephone follow-up was carried out at 6 and 12 months. Results: 50 patients were recruited, mean age 86±6 years, 54% women. Age and functional class (I–II vs. III–IV) were factors associated with presenting with ATTR-CA. Patients with positive scintigraphy had a median time to admission of 5.2 months (confidence interval [CI] 95% 0–10.9), while in those with negative scintigraphy, it was 12.2 months (95% CI 11.7–12.8); log-rank: p=0.064. Patients with positive scintigraphy had a median time to the combined endpoint (death and readmission) of 1.9 months (95% CI 0–6.1), and patients with negative scintigraphy of 11.9 months (95% CI 11.7–12); log-rank: p=0.027. Conclusions: ATTR-CA appears to be a prevalent etiology in elderly patients within the spectrum of HFpEF. Patients with a diagnosis of ATTR-CA had a shorter time to admission for HF and the combined event of death and admission than patients with a negative result on scintigraphy. (AU)

Objetivo: Existe un interés creciente por el estudio de AC-TTR, siendo esta una patología que afecta fundamentalmente a pacientes de edad avanzada y que es frecuentemente infradiagnosticada. Nuestro objetivo fue establecer la prevalencia de AC-TTR en una cohorte de pacientes con historia de ICFEp y describir sus características. Métodos: Estudio observacional prospectivo. Se incluyeron pacientes ≥75 años, con historia clínica de ICFEp, dilatación auricular ≥34ml/m2 y engrosamiento de la pared del ventrículo izquierdo >13mm. Se recogieron datos analíticos y demográficos, así como de la valoración geriátrica integral y se realizó un ecocardiograma transtorácico y una gammagrafía cardiaca. Finalmente se realizó seguimiento telefónico a los 6 y 12 meses. Resultados: Se incluyó a 50 pacientes, edad media 86±6 años, 54% mujeres. La edad y la clase funcional NYHA (I-II vs. III-IV) se asociaron con mayor riesgo de presentar AC-TTR. Los pacientes con gammagrafía positiva tuvieron una mediana de tiempo al ingreso de 5,2 meses (intervalo de confianza [IC] 95% 0-10,9), frente a aquellos con gammagrafía negativa que fue de 12,2 meses (IC 95% 11,7-12,8); log-rank: p=0,064. Los pacientes con gammagrafía positiva presentaron una mediana de tiempo al evento combinado (muerte y reingreso) de 1,9 meses (IC 95% 0-6,1), mientras que en aquellos con resultado negativo fue de 11,9 meses (IC 95% 11,7-12); log-rank: p=0.027. Conclusiones: La AC-TTR supone una etiología prevalente de insuficiencia cardiaca, dentro del espectro de la ICFEp, en pacientes de edad avanzada. Los individuos con diagnóstico de AC-TTR presentaron un menor tiempo al ingreso por insuficiencia cardiaca y al evento combinado de muerte y reingreso frente a aquellos pacientes con resultado negativo en la gammagrafía. (AU)

Study of risk factors for delayed gastric emptying after partial pancretoduodenectomy.

INTRODUCTION: Delayed gastric emptying is one of the most frequent complications after pancreatoduodenectomy. METHODS: We performed an analysis of risk factors for delayed gastric emptying on a prospective database of 390 patients operated on between 2013 and 2021. A comparative retrospective study was carried out between patients with and without delayed gastric emptying and subsequently a study of risk factors for delayed gastric emptying using univariate and multivariate logistic regression models. RESULTS: The incidence of delayed gastric emptying in the overall series was 28%. The morbidity of the group was 63%, and postoperative mortality was 3.1%. Focusing on delayed gastric emptying, the median age (73 years vs 68 years, P < 0.001) and preoperative creatinine (75 vs 65.5, P < 0.001) were higher in the group with this complication. The study of risk factors showed that age over 60 years (P = 0.002) and pancreatic fistula (P < 0.001) were risk factors for delayed gastric emptying. CONCLUSION: The presence of pancreatic fistula is confirmed as a risk factor for slow gastric emptying after pancreaticoduodenectomy. In addition, age over 60 years is shown to be a risk factor for slow gastric emptying.

Prevalence of transthyretin cardiac amyloidosis in elderly patients diagnosed with heart failure.

OBJECTIVE: There is increased interest in studying ATTR-CA, a pathology that primarily affects patients of geriatric age and is frequently underdiagnosed. We aim to establish the prevalence of ATTR-CA in a cohort of patients with a history of HFpEF and to describe its characteristics. METHODS: We conducted a prospective observational study. Patients ≥75 years, clinical history of HFpEF, atrial dilation ≥34ml/m2 and left ventricular wall thickening >13mm, were included. Demographic and analytical parameters were collected, and a comprehensive geriatric assessment was performed, along with a transthoracic echocardiogram and cardiac scintigraphy. Finally, telephone follow-up was carried out at 6 and 12 months. RESULTS: 50 patients were recruited, mean age 86±6 years, 54% women. Age and functional class (I-II vs. III-IV) were factors associated with presenting with ATTR-CA. Patients with positive scintigraphy had a median time to admission of 5.2 months (confidence interval [CI] 95% 0-10.9), while in those with negative scintigraphy, it was 12.2 months (95% CI 11.7-12.8); log-rank: p=0.064. Patients with positive scintigraphy had a median time to the combined endpoint (death and readmission) of 1.9 months (95% CI 0-6.1), and patients with negative scintigraphy of 11.9 months (95% CI 11.7-12); log-rank: p=0.027. CONCLUSIONS: ATTR-CA appears to be a prevalent etiology in elderly patients within the spectrum of HFpEF. Patients with a diagnosis of ATTR-CA had a shorter time to admission for HF and the combined event of death and admission than patients with a negative result on scintigraphy.

Indications and histology of 489 orchiectomies analyzed by patient age.

OBJECTIVE: To evaluate the indications and histology of our series of orchiectomies, analysing the results by patient's age. METHODS: We included the orchiectomies realized in our hospital between 2005 and 2020 in patients older than 18 years. We estimated demographic data, indications, histology and effectiveness of testicular ultrasound by three groups of age. RESULTS: We included 489 orchiectomies, which 364 (74%) belonged to Group A (patients between 18-50 years), 59 (12%) to Group B (50-70 years) and 66 (14%) to Group C (older than 70 years). In Group A, 284 (78%) orchiectomies were indicated due to malignancy suspect. In 91.9% cases (261) malign neoplasm was confirmed at final histology and 253 (89%) were germinal cells. Testicular ultrasound had a positive predictive value (PPV) of 90% in this group. In Group B, 34 (57%) orchiectomies were indicated because of malignancy suspect. At final histologic analysis, 25/34 (73.5%) confirmed malign neoplasm. Ultrasound had a PPV of 68%. In Group C, orchiepididymitis was the main cause of testicular removal with 30 cases (45,5%). From the 20 cases (30.3%) with suspicion of malignancy, only 6 had confirmed malign histology. Testicular ultrasound PPV for malignancy was 31%. CONCLUSION: In patients younger than 70 years the main orchiectomy's indication was suspect of malignancy and in older than 70, testicular inflammation. The germinal neoplasm was the predominant histology in younger than 70 years. In older than that, malignancy was infrequent. The positive predictive value of testicular ultrasound for malignancy decreased with patient's age. In patients older than 50 years proper image diagnosis to assess malignancy should be considered before orchiectomy is done.

Enfermedad pélvica inflamatoria en una paciente de 70 años: reporte de caso / Pelvic inflammatory disease in a 70-year-old patient. Case report

Resumen ANTECEDENTES: El absceso tubo-ovárico, como parte de la enfermedad pélvica inflamatoria, tiene características distintas en pacientes posmenopáusicas que en mujeres más jóvenes. CASO CLÍNICO: Paciente de 68 años, con antecedentes de cinco embarazos, tres partos y dos cesáreas, con vida sexual activa, diabetes mellitus tipo 2 e hipertensión arterial crónica, en control. Acudió a consulta debido a un dolor agudo en la fosa iliaca izquierda, con irradiación a la fosa iliaca derecha, acompañado de vómitos; esto disminuyó la toma pautada de antiinflamatorios no esteroideos y de los antibióticos. Con base en los reportes clínicos y de imagen se decidió la laparotomía exploradora en la que hubo hallazgos de: absceso pélvico multiseptado originado en el anexo derecho, con drenaje de material purulento de 250 cc. Se encontraron, además: síndrome adherencial severo, adenitis mesentérica, afectación del apéndice cecal con procesos inflamatorios reactivos y despulimiento del colon sigmoides, con sangrado de 500 cc. CONCLUSIONES: La enfermedad pélvica inflamatoria asociada con un absceso tubo-ovárico en una paciente posmenopáusica no es frecuente, quizá por ello a veces es infradiagosticada, lo que conduce a un aumento de la morbilidad y mortalidad.

Abstract BACKGROUND: Tubo-ovarian abscess as part of pelvic inflammatory disease has different characteristics in postmenopausal patients than in younger women. CLINICAL CASE: A 68-year-old woman with a history of five pregnancies, three deliveries and two caesarean sections, with an active sexual life, type 2 diabetes mellitus and chronic arterial hypertension under control. She presented with severe pain in the left iliac fossa with radiation to the right iliac fossa, accompanied by vomiting, which reduced the prescribed intake of non-steroidal anti-inflammatory drugs and antibiotics. Based on the clinical and imaging findings, an exploratory laparotomy was performed, which revealed the following: multiseptal pelvic abscess originating from the right adnexa with drainage of 250 cc of purulent material. There were also findings of: severe adhesive syndrome, mesenteric adenitis, involvement of the cecal appendix with reactive inflammatory processes, and sigmoid colon depulpation with bleeding of 500 cc. CONCLUSIONS: Pelvic inflammatory disease associated with a tubo-ovarian abscess in a postmenopausal patient is uncommon, perhaps because of this it is sometimes underdiagnosed, leading to increased morbidity and mortality.