Tuberculosis in elderly in the Czech Republic.

INTRODUCTION: The incidence of tuberculosis (TB) in the Czech Republic (CR) is decreasing since 1960s. (1965: 76.9; 1975: 60.4; 1985: 45.2; 1995: 17.7; 2005: 9.9; 2015: 4.9 per 100, 000 population). In 2017 men accounted for over than 70% of cases. People aged over 75 years are most frequently affected. Elderly patients tend to develop more of extrapulmonary and atypical manifestation of the disease, the diagnosis of TB can be difficult and consequently overlooked. Multimorbid seniors are suffering from chronic illnesses, malignancies and autoimmune diseases, which translate into higher degree of immunosuppression and add to the generally described process of immunosenescence. Furthermore, therapy of TB in the elderly is challenging because of the increased drug resistance and higher incidence of adverse drug reactions. This article reviews the epidemiology of TB in the CR, immunological aspects, clinical characteristics, diagnosis, management, prevention of TB infection and presents two clinical cases in hospitalized aging adults in the CR. CASE PRESENTATION: We present a case of a 79 year old female suffering from chronic obstructive pulmonary disease (COPD), who was repeatedly hospitalized for acute exacerbations of COPD and was consequently diagnosed with TB. Patient developed manifestation of treatment toxicity and drug interactions due to comorbidities and other medications. Secondly, we present a case of a 70 year old male, a lifelong smoker, who was initially admitted for collapsing. TB developed via the endogenic route from a Ghons complex in association with a slowly progressing bronchogenic carcinoma. CONCLUSION: Diagnosis and management of TB in the elderly person can be challenging. Age-related factors increase the risk of TB reactivation as well as enhance susceptibility to TB infection. In elderly population we find accumulation of risk factors for developing TB (malnutrition, low socio economic status, smoking and alcoholism). The people most at risk among elderly include fragile institutionalized seniors whose incidence of TB is 2-3 times higher than those living at home. Because the number of seniors is growing and the incidence of TB in this subpopulation is increasing, detailed knowledge of the epidemiological features of TB in this group is needed to optimize healthcare services.

Falls in anaemic and non-anaemic hospitalized elderly patients in 2012-2016 - mutual relationships.

Although falls are more prevalent as ageing proceeds, it cannot be assumed that they happen due to ageing alone. The retrospective cohort study of data was targeted to make an analysis of prevalence of falls in anaemic patients in comparison to the non-anaemic elderly admitted to the acute geriatric department and evaluation of pertinent influence of age, gender and immobility on occurrence of falls. During the considered period of four years (2012-2016) the authors treated 9 363 elderly patients aged 79,9±8,6 years (in the majority of them 65+ years). Among them there were 8 809 non-anaemic and subgroup of 551 old anaemic patients (aged 81±7 years) with decreased haemoglobin (<110 g/l). Falls at hospital admission in average was present in 1 766 non-anaemic persons (20%) in comparison to 380 falls among anaemic patients (68,6%). Prevalence in anaemic subgroup is statistically significant higher (p<0,005). Also relation between falls and age, ADL and MMSE test and mobility is highly statistically significant (p<0,001). Meaningfully higher is occurrence of repeated falls in the anaemic subgroup in comparison to the non-anaemic one (41,2 vs 1,7%). The occurrence of falls in female gender in comparison to men is statistically significant higher in non-anaemic patients, not in anaemic group. Authors emphasize that anaemia appears to us as significant risk factor for falls in the elderly.

Pulmonary embolism in the hospitalized patients 65+ in relation to presence of diabetes in 2007-2015.

The aim was to compare an occurrence of acute PE in hospitalized patients 65+ years old with diabetes mellitus (DM) with those without any DM. It was a retrospective analysis of data collected in documentation of patients who were hospitalized at the geriatric department in the years 2007-2015. In this period we had 11 947 patients of an average age of 79,9±8,5 years (min - 65, max - 103 years). Out of this number there were 4 069 diabetics. Acute PE was found in 344 patients of an average age 80,3±7,4 years. 121 of them died (35,3%) and 223 survived (64,7%). From total patients 88 were diabetics with PE. Mortality on PE did not influence the presence of DM. She was the same in both groups of patients (p=NS) - with and without DM. RESULTS: Prevalence PE in the hospitalized 65+ years old was 2,9%. Mortality of PE among all the hospitalized 65+ was 1,0%. Higher prevalence of PE was found in non-diabetics - 3,2%, as compared to the diabetics - 2,3% (p<0,025). The average age of patients with diabetes both with and without PE was lower as compared to the non-diabetics (p<0,01). Among risk factors we found significantly more frequently obesity in the diabetics as compared to the non-diabetics both surviving (p<0,001) and those who died (p<0,05). The most important risk factor of PE was in all the patient's immobility. One risk factor appeared in the set of survivors more frequently in the non-diabetics as compared to the diabetics (p<0,05). Simultaneous occurrence of three risk factors appeared more frequently in the surviving diabetics (p<0,001) as compared to the non-diabetics. Although overall presence of risk factors was higher in the diabetics, PE prevalence in the DM patients was lower as compared to the non-diabetics. The immobility in general was the most important risk factor for PE occurrence, in the diabetics then also obesity.

Geriatric giants--contemporary occurrence in 12,210 in-patients.

OBJECTIVES: With advancing age, the degree of dependency and occurrence of great geriatric syndromes (GS), also referred to as geriatric giants, grow substantially. DESIGN: The prospective cohort study was aimed at conducting an analysis and comparison of geriatric syndromes (geriatric giants) among different age groups at admission to the acute geriatric department. SETTING, PARTICIPANTS: Between 1995 and 2012, we had altogether 12,210 elderly patients at an average age of 80.5 ± 7.0 y (range 65-103 y) hospitalised at the Department of Geriatrics. We divided the patient set into three different age subgroups (65-74 y; 75-84 y and ≥85 y; e.g. 21.4%; 47.9% and 30.7%) and compared the results among them. RESULTS: 3,787 persons (31.0%) were without any GS. The growing tendency of the occurrence of all geriatric syndromes in combinations with increased age (p<0.001) is obvious. Their occurrence in the above mentioned different age sets was examined in relation to individual geriatric syndromes and sex (female and male), namely falls 22.0%, 27.8%, 39.9% and 20.5%, 27.0%, 36.1%; immobility 26.4%, 29.3%, 42.5% and 30.3%, 30.1% and 39.2%; incontinence 38.4%, 50.6%, 69.5% and 38.2%, 47.4%, 61.8 %; dementia and cognitive impairment 13.4%, 23.4%, 38.1% and 15.8%, 24.3%, 33.2% respectively. Age cut-off for geriatric syndromes occurrence based on ROC analysis is 83.5-84.5 y for females and 78.5-82.5 y for males. CONCLUSION: The occurrence of geriatric giants increasing with age and female gender is of crucial importance not only for individuals and families but also for demands on costs of health and social care in oncoming decades (Tab. 6, Fig. 3, Ref. 52).

Deceased elderly in-patients with pulmonary embolism.

UNLABELLED: Pulmonary embolism (PE) in the elderly is an immediate threat of life. Especially in old age clinical signs of PE are non-specific and could be both underestimated and overestimated. AIM OF THE STUDY: The retrospective long-term study was aimed at conducting an analysis and comparison of pertinent influence of age, gender and immobility on occurrence of PE and sudden death. PATIENTS AND METHOD: Between 1995 and 2012 years we had altogether 12,746 elderly patients of an average age 80.6 ± 7.0 y (range 65-103 y) hospitalized at the Department of Geriatrics. All in-patients 65+ y were randomly admitted for internal hospitalization from the catchment area of Brno city (100,000 inhabitants). The subject of our interest was to study the documentation of deaths (including autopsy findings), which was caused by PE. Out of this number there were 8,540 women (66.3 %) and 4,206 men (33.7 %). Among all hospitalized patients PE in 700 cases (5.5 % of all admitted patients) was shown in a medical report. Among them there were 424 survivors (60.6 %; 134 men and 290 women). CONCLUSION: The high occurrence of PE (particularly silent form) has crucial importance in the elderly mortality. Our recommendations would like to emphasize the need of no underestimation of this fact and to carry out preventive measures in all age groups (including the "oldest old" and frail persons) (Tab. 3, Ref. 41).

Occurrence of pulmonary embolism among 260 in-patients of acute geriatric department aged 65+ years in 2005-2010.

UNLABELLED: Pulmonary embolism (PE) is after myocardial infarction and cerebrovascular events the third most frequent cardiovascular cause of death. Simultaneously it belongs to at least often correctly diagnosed cardiovascular diseases. THE AIM OF THE STUDY: The retrospective analysis of the database of inpatients with the target assess the clinical course of PE according to prevalence, mortality, average duration of stay, risk factors, used diagnostic methods and kinds of therapy. Another aim of the study was a comparison of the data among the survivors and deceased persons. Patient's set and method: between 2005 and 2010 years we had altogether 6,323 elderly patients of an average age 80.7 +/- 6.9 y. (range 65-103 y.) treated at the Department of Geriatrics. Out of this number there were 4,163 women (66%) and 2,160 men (34%). We evaluated the course of PE in 260 cases of mean age 79.8 +/- 7.2 y. (165 women and 95 men). For the verification of the diagnosis of PE we used following usual procedures (anamnesis, clinical examination, ECG, X-ray, labs etc.) also ECHO-cardiography, perfusion scan or helical CT of lungs. Eighty per cent of the deceased had an autopsy. In the set of in-patients with PE 89 died (34.2%) and 171 survived (65.8%) with anticoagulant treatment. RESULTS: Prevalence of PE was 4.1% per year among all the hospitalized elderly in-patients (> or = 65 y.). Mortality among all the admitted patients to our department was 1.4%. Its occurrence was increasing with age to 81 y. and thereafter slightly decreasing. In one third of the deceased PE was an occasional finding in autopsy without any previous clinical signs. Mortality in the non-symptomatic group with PE in autopsy was significantly higher (chi2 = 57,293; p < 0.001). We didn't find any significant gender difference in prevalence of mortality according to gender structure of the set with PE. In 14 cases PE clinically demonstrated as sudden death. We determined the age significant difference between survivors and the deceased--79.1 +/- 7.1 y. vs. 81.3 +/- 7.0 (t = 1.997; p < 0.05). Average duration of hospital stay was significantly different between both groups: the deceased 9.2 +/- 9.6 vs. 12.4 +/- 7.4 in survivors (t = 4.256, p = 0.01). Risk factors were assessed and compared between both groups: the deceased and survivors. We found the most important risk factors in the group of the deceased immobility (p < 0.001) heart failure (p < 0.005) and stroke (p < 0.01). On the contrary in the survivor group there were more frequent risk factors obesity (p < 0.025); deep venous thrombosis (p < 0.025) and tumors (p < 0.05). Previous operations and traumas in the last month did not show any significant difference between both groups. Used treatment methods were evaluated, too. In the group of those who died multi-morbidity, often frailty and geriatric giants predominated even if the anticoagulant therapy was used comparably in both groups (survivors and the deceased). CONCLUSION: We would like to emphasize the need to think permanently in elderly persons with present risk factors of the possibility of PE and also the requirement of correctly assessed diagnosis and starting therapeutic procedures as soon as possible.

GAD antibodies in T1D and LADA--relations to age, BMI, c-peptide, IA-2 and HLA-DRB1*03 and DRB1*04 alleles.

The determination of GADA may be useful for clinical classification of diabetes mellitus (DM) in clinically unclear cases. This GADA positivity may persist in any diabetics Type 1 Diabetes Mellitus (T1D) with an onset in adulthood and Late Autoimmune Diabetes of Adults (LADA) many years after appearance of DM. The study was aimed at comparing the levels of GADA between both diabetic subsets with their clinical parameters, age of onset DM, period of insulin need, body mass index, HbA1C, fasting and postprandial C-peptide, risky HLA-DRB1* alleles, occurrence of micro- and macrovascular diabetic complications. Further analysis of GADA titers in different time consequences to the development of DM and relations to IA-2 were made. In the study, we included 130 diabetics with an onset of diabetes (T1D or LADA) 35+ y. who were hospitalized and afterwards long-term observed in the diabetological outpatient department. Out of this number there were 62 men and 68 women of the average age 65.5 +/- 14.0 y. (range 35-93 y.). 54 were assessed as the T1D patients and 76 as the LADA ones. Patients of the T1D subgroup were GADA positive 22 times and of the LADA subgroup 21 times. LADA 2 patients that were GADA negative were more obese than GADA positive LADA diabetics (p < 0.01). Also postprandial C-peptide was higher in LADA patients GADA negative (p < 0.05). Other clinical characteristics were without statistically significant differences. We found in our diabetic patients a relation between alleles HLA-DRB1*03 and particularly combination with HLA-DRB1*04 with positive GADA levels. In the GADA negative group obesity, coronary heart disease, hypertension, syndrome of diabetic foot and dyslipidaemia appeared more frequently (OR = 2.8; 3.1; 6.2 and 2.4). We found no significant differences in observed parameters--comparison GADA positivity and negativity according to the duration of DM. GADA positive were even 10 y. duration 16 times and after 20 y. even 6 times. Recent DM had positive GADA in 11 cases and 13 cases of recent DM had GADA negative. IA-2 antibodies were positive (> 1.0 U/ml) 18 times altogether and always with positive GADA, but only 7 times in recent DM. The presence of elevated GADA identifies patients unequivocally suitable for early insulin therapy. Our observations and experiences confirm that GADA can be found increased after more than 10-20 years duration of DM, although in decreasing trend.

[Seniors and cardiovascular medications]. / Seniori a kardiovaskulárni medikace.

Authors analyze the situation in the therapy of cardiovascular diseases--unsatisfactory situation especially from the dyslipidaemia point of view. Different groups of medications are discussed and their risks for elderly patients. Angiotensin converting enzyme blockers and their influence on the endothelial dysfunction, but the risk of hyperpotassemia are showed. The risk of gastrointestinal bleeding during the treatment with antiagregants and anticoagulants, the risk of bradycardia in beta-blockade, possible interactions with other medications lowering the heart rate are discussed. Attention is paid to calcium channel blockers, diuretics and digoxin. The table containing possible clinical symptoms of unwanted side effect of most frequently used cardiovascular medications in elderly is added as the conclusion of the article.

[Internal medicine and cognitive decline in seniors]. / Faktory ovlivnující vznik a prubeh kognitivních poruch u senioru.

Authors show the situation in diagnostics and treatment of cognitive deterioration in elderly. There are stressed chronic diseases influencing significantly influencing the development of dementia. Adequate treatment of these diseases was proved as a factor delaying the cognitive decline. The relationship between different groups of medications and cognitive performance are discussed. The importance of nutrition of elderly and possible microelements deficits are mentioned--specially group B vitamines, polyunsaturated fatty acids etc. Special part of the article show the importance of physical and psychical activities from the cognition point of view. Depression is discussed as a potentiating factor of dementia development. The table of recommendations to preventive, prophylactical and diagnostic measures how to improve the management of cognitive deterioration in elderly.

Type 1 diabetes and LADA--occurrence of HLA-DRB1 *03 and DRB1 *04 alleles in two age different groups of diabetics.

Type 1 Diabetes Mellitus (T1D) with an onset in adulthood and Late Autoimmune Diabetes of Adults (LADA) are connected with autoimmune insulitis (associated with islet cell autoantibodies) and the specific high-risk HLA class II genotype. The study was aimed at analyzing time and clinical characteristics of the diabetics with an onset of the disease after 35 y. (T1D and LADA). Main target of the study was to assess possible role of the old age onset and compare it with diabetics with the onset in the middle age (incl. analyzing HLA-DRB1 genotype). In the study, we included 103 diabetics with an onset of autoimmune diabetes at 35+ y. who were hospitalized and afterwards long-term observed in the diabetological outpatient department. 46 men and 57 women of the average age 65.7 +/- 13.8 y. (range 35-93 y.) were out of this number. 41 were assessed as the T1D patients and 61 as the LADA ones. As a control group we used 99 healthy individuals. Patients of the T1D subgroup developed diabetes in the age of 50.8 +/- 15.1 y. and of the LADA subgroup in the age of 52.6 +/- 12.8 y. Its duration in the time of this study was 10.7 +/- 11.6 y.; respectively 5.3 +/- 7.1 y. Fasting and postprandial C-peptide levels were statistically higher (p < 0.01) in the LADA subgroup vs. T1D. Obesity 1st and 2nd grade were present together only in 12.6%. BMI was not statistically significantly different between both groups. We found in our diabetic patients the predisposition alleles HLA-DRB1*03, HLA-DRB1*04 and particularly their combination. The occurrence of these HLA alleles is significantly higher in T1D patients in comparison to control groups (p = 0.01, OR = 4.0). In our study, the occurrence of the susceptible HLA-DRB1*03 and HLA-DRB1*04 alleles in T1D patients is higher than in LADA. The presence of these alleles identifies patients of high risk and requirement of insulin therapy. Since risk alleles are similarly present in middle and old age, environmental factors probably play similar role in these onsets of autoimmune diabetes.

Radical surgery for pancreatic malignancy in the elderly.

BACKGROUND: Improving life expectancy is associated with increasing incidence of pancreatic cancer. We reviewed morbidity and mortality in patients aged 65 years and older undergoing curative intent surgery in two centers in the Czech Republic. METHODS: Data were retrieved by retrospective analysis of the medical records over the period 2000-2007. In total, 60 patients were included. The mean age was 71 years (median 70 years; range 65-85 years). Most patients (43, 72%) underwent hemipancreatoduodenectomy, combined in 4 with portomesenterial vessel resection. Twelve patients (20%) had distal pancreatectomy and 5 patients (8%) total pancreatectomy. RESULTS: Overall morbidity was 28%. Only 10 patients (18%) developed serious surgical complications in terms of pancreatic leak (5, 8%), biliary leak (2, 3%), and intra-abdominal inflammatory collection (4, 7%). Four patients (6.6%) died within 30 days. The 1-year survival was 62.8%. CONCLUSION: We can conclude that age per se is not a contraindication to surgery. Patient's overall general condition, co-existing co-morbidities, and ability to get over with any potential complications are more important. and IAP.

Anemia in elderly an important diagnostic and therapeutic problem in geriatric medicine.

Although anemia is more prevalent as aging proceeds, it cannot be assumed that it happens due to aging alone. The biggest prevalence of anemia is in the oldest old who are hospitalized. An analysis of occurrence and charactertistics of anemia in the elderly 65+ y. admitted to acute geriatric department. During the period of two years the authors treated 2282 elderly patients aged 65+ y. Out of them a subgroup of 246 old anemic patients with hemoglobin <110 g/I (aged 81+/- 7.2 y.) was selected. The prevalence of anemic patients among all the acutely admitted seniors ranged between 7.1% and 20% (from 65 y. to 100 y.). All the data of these anemic patients (both clinical and laboratory) were collected and analyzed. Hemoglobin by hospital admission in average was 93.4 g/l +/- 12.9; below 80 g/l in 56 cases. The authors found anemic persons living lonely in the community more frequently (p = 0.005) than in elderly people living with somebody or in an institution. No significant gender differences in the occurrence of anemia were observed. MCV (Microtic Cell Volume) was normal in 73% of patients; below 80 fl in 23% and above 100 fl in 4% of all anemic patients. Low iron level though was present in 192-times (78%). Low zinc level was together in this anemic patient set present in 222 cases (90.2%). During hospitalization the status was as follows: worsened 18-times; stationary 160-times and significantly improved 68-times. Anemia in the elderly is often caused by a benign disease and, in fact, may simply be a marker of a chronic illness. It may be, however, a presenting sign of a serious disease, including cancer. The authors point out some aspects, risks and pitfalls of anemia in the elderly following their own experiences concerning anemia as a chronic disease.

Insulin treatment in diabetics 75+ years: experiences and results in outpatient care.

Diabetes mellitus (DM) has a crucial impact on personal and social health. In the very old age it significantly affects also the social status of the individual. In the elderly 75+ y. DM occurs often in the domain of multi-morbidity and can conduce to incurrence and development of serious disability, which can significantly influence further therapeutic procedures. The study was aimed at analyzing the situation connected with the DM development, duration, insulin therapy period and overall approach in persons 75+ y. at 8 diabetological outpatient clinics of the Brno city. In the study we included 337 older diabetics 75+ y. who were long-term observed in the above mentioned diabetological outpatient clinics. There were 129 men and 208 women of the average age 79,3+/-4,9 y. (range 75-97 y.) out of this number. DM in patients of our set was detected in the age of 59,9+/-12,9 y. Its duration in the time of this study was 18,8+/-12,9 y. and the insulin therapy duration was 8,0+/-7,3 y. Good mobility was present in 303 persons (89,7%); 73 diabetics suffered from serious cognitive impairment - almost as to beginning dementia (22%). 159 seniors altogether had urinary incontinence, i.e. 47%. Within the study we analyzed such questions as: who applies insulin in the elderly; with whom he or she lives (24% of them are totally alone); how many times per day insulin is applied; which kind of insulin is used and whether there are hypoglycemias. We also took into consideration, if the senior owns a portable glucometer and who helps him or her with self-monitoring. Permanent insulin therapy represents in old age the kind of treatment which is very demanding for the old diabetic as well as for the nursing staff and the patient's close environment. A geriatric patient faces a long-term threat of decompensation of his/ her functional status and therefore he/she requires specific modification of the specialist's approach when deciding on the regimen and therapeutic measures.

[Drug consumption and risks of polypharmacotherapy in elderly population]. / Spotreba léciv v seniorské populaci a rizika polyfarmakoterapie ve stárí.

BACKGROUND: One of our previous studies was aimed at the consumption of prescribed drugs by the elderly population. The average per day number of drugs was 4.6 (maximum 13). Existence of freely obtainable drugs with massive advertisements brings a question, how many of those drugs it is necessary to add in order to estimate probability of interaction and undesirable drug effects. In order to achieve valid information, students of the sixth year of General medicine program during their practical course at general practitioners were asked to interview randomly selected senior patients. They asked on the number, type, and price of freely obtainable drugs which they use. Data were evaluated from interviews accomplished during academic years 2001/2002 and 2004/2005. METHODS AND RESULTS: Our cohort included 252 men and 148 women with average age of 78.7 years. Average number of freely obtainable drugs was 2.26 at the beginning and 2.32 at the end of study. Only 34% of questioned did not buy any of those drugs at all or only exceptionally, 66% reported buying once a month or weekly. 44% of seniors buy analgetics, 58% buy vitamins, 37% food supplements, 36% non steroid antirheumatics, 46% cold prevention drugs, 30% anti-constipation drugs. Contrary to our expectation, positive correlation between the sums given for the personal participation on the drug costs and that given for freely obtainable drugs was found. It is not possible to expect, that polymorbidic patient with several prescribed drugs would buy less of freely obtainable drugs even due to the financial requirements. CONCLUSIONS: Freely obtainable drugs, many of them composites, can represent significant source of interactions and undesirable drug effects. They can also significantly modulate compliance of the senior. The high percentage of seniors buying freely obtainable drugs requires aimed questions on the pharmacological history.

[Aging eye--its specific features and diseases]. / Stárnoucí oko--jeho specifika a choroby.

Practically oriented overview of the anatomical and physiological changes in the eye during aging is presented together with the description of diseases typical for the advanced age. The growing number of patients with eye diseases of advanced age and the comparatively low awareness of this fact within the medical community brought us to the publishing of the presented overview. It is necessary to increase the understanding of geriatric problems among ophthalmologists as well as to enhance the awareness of the age related changes in the eye during ageing among the physicians--non-ophthalmologists (namely among the general practitioners, internists, geriatrists) who treat seniors for other diseases. Namely they can meet in their everyday praxis the problems of drug interaction and the general and ophthalmologic side effects of various types of treatment. The use of ophthalmologic drugs (e.g. anti-glaucoma remedies) is connected with undesirable effects on the organism in any age and namely in elderly patients.

[Specific features of hematopoiesis and hemostasis in advanced age]. / Specifické rysy krvetvorby a hemostázy ve vyssím veku.

The ageing process affects also haematopoiesis and haemostasis and these changes can have a far reaching effect on other organ systems and their function. The authors decided therefore to present a review on involutional changes on the formation and function of blood elements and the system of blood clotting. The review is divided into description of changes in the bone marrow and explanation of hitherto known facts on the pathophysiological background of these changes. Furthermore the authors deal with changes in the peripheral blood stream and their mutual relations with administered drugs, diseases under way, reactions to external stimuli such as immunization etc. In the second part of the review the authors describe changes of haemocoagulation, emphasize the tendency of hypercoagulation and the mutual relationship of the development of atherosclerotic changes and hypercoagulation trends and their pathophysiological background. Attention is paid to thromboembolic disease and its increasing risk in elderly patients incl. the possible late manifestation of congenital defects of coagulation inhibitors. The authors mention also the influence of lifestyle and dietary factors on the coagulation activity in old age. They analyze in detail possibilities and pitfalls of prophylaxis of thromboembolic disease in elderly patients and the risks of haemorrhagic complications of different operations.

[Pain in elderly patients and aspects of its therapy]. / Bolest u nemocného vyssího veku a aspekty její lécby.

Treatment of pain in elderly patients can meet with diagnostic problems, namely in those with cognitive disorders, as well as with problems concerning pharmacokinetic and pharmacodynamics brought about by the advanced age. Our article presents an overview on the basic differences in the diagnostics and treatment of pain, on the therapeutic risks, and on other interrelations, which have to be considered in the therapy of elderly patients. The review is supplemented with results of our examination on the rate of analgesic treatment, spectrum of analgesics in use in the population of patients older than 75 years. About one quarter of the population use analgesics regularly, the order of most frequently prescribed analgesics is: ibuprofen 38%, diclophenac 24%, tiaprophenic acid 14%, tramadol 8%, indometacine 4%. Included were also data concerning the quality of life of patients with pain and information about the relations among patients and the curing personnel where obtained by our own inquiry. Patients concluded that pain was better tolerated at home, administration of drugs in tablets revealed to be most satisfactory, all information, namely from medial doctors, were welcome. Treatment of pain improved the quality of life in 1/3 of patients; one half of them considered it as successful. Personnel also asked for better professional information, though they had good of knowledge on the evaluation and documentation of pain and the principles of pharmacological treatment. Failure of treatment evokes in 69% of the personnel the feeling of impotency, in 41% affection of unsatisfactoriness, in 20% a tension, in 13% feeling of failing, in 18% depression and frustration. Reconciled with failure is 6% of the curing personnel.

The influence of new scientific information on the treatment of elderly patients in general practice.

UNLABELLED: It has been proven that with an increasing number of diseases elderly patients are treated by an increasing number of drugs despite the fact that treatment of elderly persons should be as simple as possible. Simpler dosage of (fewer?) drugs may contribute to a good cooperation on the part of patients, as well as to a lower incidence of undesirable effects and drug interactions. Sticking to established medication schemes is another feature observed in practice, which interferes with the introduction of novelties. The aim of this study was to investigate the actual situation of medication of elderly patients treated by general practitioners in this country. Between 1996 and 1998, a random group of 1481 patients aged older than 75 was studied in cooperation with general practitioners. A detailed history was obtained and physical examination was performed, signs of depression were assessed, Barthel's test of everyday activities, and IADL (activities of daily living) and MMSE (Mini Mental State Examination) tests were applied. A unified "Protocol on Examination" was used in which three questions were concerned with medication--the kinds of drugs taken by the patient, their names and dosage, and whether any hypnotics were taken. The five most frequently prescribed groups include vasodilators (62% patients), cardiotonics (39%), analgetics (41%) and Ca-antagonists (25%). The dynamics of the prescription were remarkable--a significant decrease of the use of analgetics and cardiotonics was observed in comparison with a significant increase in the use of ACE inhibitors. The number of drugs administered is as follows: while only 1.3% patients took no drugs, 1.6% patients took more than 13 drugs. 61% patients rank among the categories taking 4-5 or 6-8 kinds of drugs. On the whole, general practitioners tend to prescribe medicaments in doses one tablet per day. CONCLUSIONS: The results suggest that, even nowadays, elderly patients are treated with a rather high number of medicaments. In contrast, the dosage of one tablet a day decreases the total number of the tablets taken. A significant influence of new scientific information was visible in the prescription habits of general practitioners. Be that as it may, in elderly patients, the simplest possible medication should continue to be aimed at.

[Cardiotoxicity of antineoplastic therapy]. / Kardiotoxicita protinádorové lécby.

Cardiotoxicity is a serious complication of anti-tumorous treatment. Cytostatics can cause a number of undesirable side-effects such as arrhythmias, angina pectoris, acute myocardial infarction, sudden death, cardiac failure. The probably most serious cardiotoxicity is chronic cardiac failure after treatment with anthracyclines. Interest in the diagnosis, monitoring and treatment of cardiotoxicity revealed new findings of cardiac complications after various cytostatics, high-dosage chemotherapy and transplantation of haematopoietic cells. Prospective paediatric studies provided evidence of the serious character of late cardiotoxicity of anthracyclines. The authors review the most frequent cardiac complications of anti-tumorous treatment. They emphasize in particular the toxicity of anthracyclines and its possible prevention.

[Warning signs preceding the development of septic shock in patients with neutropenia treated for hematologic malignancies]. / Varovné príznaky predcházející rozvoj septického soku u neutropenických nemocných lécených pro hematologické malignity.

BACKGROUND: In patients with haematological malignities infectious complications take a very rapid course, and in particular during the period of neutropenia, they are not necessarily manifested by a clear symptomatology. Frequently they may be manifested only by an elevated temperature and general deterioration of the condition. The onset of shock then can be rapid and surprising. The objective of the work was to identify clinical and laboratory signs warning against the possible development of septic shock. METHODS AND RESULTS: The investigation comprised a total of 38 patients hospitalised due to infectious complications at the intensive care unit because of general deterioration of the condition. 18 developed septic shock (group S), the remaining 20 (group N) achieved during hospitalisation at the ICU a stabilised condition. In both groups the laboratory values and clinical condition were followed up for 2-3 days prior to deterioration of the condition. Risk factors for development of septic shock in the group of investigated patients were: unusual weakness, heart rate above 95/min. beyond the temperature peak, hypoalbuminaemia, mucositis, hypokalaemia, presence of a central venous catheter and administration of parenteral nutrition.