Empleo de antibióticos en cirugía electiva en el adulto mayor / Antibiotic Use for Elective Surgery in the Older Adult

Introducción: Los pacientes quirúrgicos geriátricos tienen afectación funcional y enfermedades asociadas, lo cual aumenta su riesgo quirúrgico con la edad. Objetivo: Determinar el comportamiento del uso de los antibióticos en pacientes geriátricos que requieren cirugía electiva atendidos en el Hospital Vladimir Ilich Lenin del 2018 al 2022. Métodos: Se realizó un estudio descriptivo, observacional, analítico y transversal a pacientes intervenidos por cirugía electiva con tratamiento con antibiótico. Los datos se obtuvieron de las historias clínicas y la entrevista aplicada. Se analizaron variables como edad, sexo, enfermedades asociadas, diagnóstico preoperatorio, tiempo quirúrgico, complicaciones, evolución, filtrado glomerular y dosis antibiótica perioperatoria. Resultados: El empleo de antibióticos fue más utilizado en los grupos de edades de 60 a 64 años y el sexo femenino; las comorbilidades que predominaron fueron la diabetes mellitus, la hipertensión arterial y la cardiopatía isquémica. Los motivos de consulta más frecuentes fueron por litiasis vesicular y por hernias dentro del grupo ASA I de la American Society of Anesthesiologists. Los antibióticos fundamentales fueron con dosis ajustada. Conclusiones: Se necesita de un trabajo diferenciado en cuanto a la atención al adulto mayor. La utilización de un protocolo o algoritmo de trabajo es necesario en la práctica diaria, sobre todo ante la necesidad de una cirugía electiva(AU)

Introduction: Geriatric surgical patients have functional impairment and associated diseases, which increases their surgical risk with age. Objective: To determine the behavior of antibiotic use in geriatric patients requiring elective surgery attended at Hospital Vladimir Ilich Lenin Hospital from 2018 to 2022. Methods: A descriptive, observational, analytical and cross-sectional study was conducted on patients undergoing elective surgery with antibiotic treatment. The data were obtained from medical records and the applied interview. The analyzed variables included age, sex, associated diseases, preoperative diagnosis, surgical time, complications, evolution, glomerular filtration and perioperative antibiotic dose. Results: Antibiotic use was more frequent in the age group 60 to 64 years and in the female sex; the most frequent comorbidities were diabetes mellitus, arterial hypertension and ischemic heart disease. The most frequent reasons for consultation were vesicular lithiasis and hernias within the ASA I group of the American Society of Anesthesiologists. The fundamental antibiotics were adjusted by doses. Conclusions: An individualized work is needed in terms of care of the older adult. The use of a working protocol or algorithm is necessary in daily practice, especially when elective surgery is required(AU)

Flexible New Dosage Forms Containing Carvedilol for the Treatment of Patients with Cardiovascular Disorders: Development, Stability, Palatability, and Microbiological Studies.

The development of formulations adapted to the patient's age is a challenge in the pharmaceutical industry. Pediatric and geriatric patients may have difficulties in swallowing oral medications when an adequate formulation is not available. Carvedilol is a poorly water-soluble drug used to treat cardiovascular problems; it is commercialized in several countries only as solid oral formulations, which are often manipulated at the point of administration to treat pediatric or geriatric patients. The purpose of this work was to obtain a new dosage form of Carvedilol using safe excipients, suitable for administration to pediatric and geriatric patients. To improve the solubility of Carvedilol, the effect of several factors was analyzed and optimized. Subsequently, to improve the physical stability of the formulations, two preparation methods were analyzed by adding HPMC. In "method 1," HPMC was dissolved in buffer and incorporated into a mixture of Carvedilol-PEG 400, while in "method 2," Carvedilol was solubilized in buffer containing PEG 400, and then, HPMC was added. Finally, microbiological tests were performed to the stable formulations. The factors "pH value" and "concentration of PEG" affected the solubility of Carvedilol. A formulation containing Carvedilol (3 mg/mL), pH=3, PEG 400 (15% v/v), and HPMC (0.25% w/v) prepared by method 2 was stable for 180 days at 4 °C while those containing Carvedilol (5 mg/mL), pH=3, PEG 400 (27% v/v), and HPMC (0.5% w/v), prepared by method 2, were stable for 180 days at 4 and 25°C. These oral liquid formulations were physicochemical and microbiologically stable for 6 months.

Potentially inappropriate prescriptions in geriatric patients hospitalized in the internal medicine department of a referral hospital in Mexico.

BACKGROUND: Potentially inappropriate prescription (PIP) constitutes a risk for the development of adverse effects of a drug that outweigh its benefits, which can be considered inappropriate medication use. OBJECTIVE: To describe the prevalence of PIP in geriatric patients hospitalized at the internal medicine department of a referral hospital in Mexico. MATERIAL AND METHODS: Cross-sectional, descriptive design, with simple allocation of medical records from patients older than 65 years hospitalized between January 2016 and August 2017. The STOPP/START criteria were applied to identify the number of PIPs, the number of prescribed medications, number and type of comorbidities, as well as days of hospital stay. RESULTS: A prevalence of PIP of 73.3% was identified, with main comorbidities being hypertension and type 2 diabetes mellitus. A total of 1,885 prescribed medications were quantified; mean hospital stay was 6.3 days. CONCLUSIONS: A high prevalence of PIP was identified in hospitalized geriatric patients, hence the importance of applying the STOPP/START criteria and of the role of the pharmacist for validating the prescription prior to drug administration.

ANTECEDENTES: Una prescripción potencialmente inapropiada (PPI) constituye un riesgo de presentar efectos adversos por un fármaco que superan los beneficios de este, pudiendo considerarse como uso inadecuado de medicamentos. OBJETIVO: Describir la prevalencia de prescripciones potencialmente inapropiadas en pacientes geriátricos hospitalizados en el servicio de medicina interna de un hospital de referencia en México. MATERIAL Y MÉTODOS: Diseño descriptivo transversal, con asignación simple de expedientes clínicos de pacientes hospitalizados mayores de 65 años, entre enero de 2016 y agosto de 2017. Se aplicaron los criterios STOPP y START para identificar el número de PPI, cantidad de medicamentos prescritos, presencia, cantidad y tipo de comorbilidades, así como días de estancia hospitalaria. RESULTADOS: Se encontró una prevalencia de 73.3 % de PPI y las principales comorbilidades fueron hipertensión arterial y diabetes mellitus tipo 2. Se cuantificaron 1885 medicamentos prescritos; la estancia hospitalaria media fue de 6.3 días. CONCLUSIONES: Se identificó alta prevalencia de PPI en los pacientes geriátricos hospitalizados, de ahí la importancia de aplicar los criterios STOPP y START y del papel del farmacéutico en la validación de la prescripción antes de la administración de medicamentos.

Prescripciones potencialmente inapropiadas en pacientes geriátricos hospitalizados en el servicio de medicina interna en un hospital de referencia en México / Potentially inappropriate prescriptions in geriatric patients hospitalized in the internal medicine department of a referral hospital in Mexico

Resumen Antecedentes: Una prescripción potencialmente inapropiada (PPI) constituye un riesgo de presentar efectos adversos por un fármaco que superan los beneficios de este, pudiendo considerarse como uso inadecuado de medicamentos. Objetivo: Describir la prevalencia de prescripciones potencialmente inapropiadas en pacientes geriátricos hospitalizados en el servicio de medicina interna de un hospital de referencia en México. Material y métodos: Diseño descriptivo transversal, con asignación simple de expedientes clínicos de pacientes hospitalizados mayores de 65 años, entre enero de 2016 y agosto de 2017. Se aplicaron los criterios STOPP y START para identificar el número de PPI, cantidad de medicamentos prescritos, presencia, cantidad y tipo de comorbilidades, así como días de estancia hospitalaria. Resultados: Se encontró una prevalencia de 73.3 % de PPI y las principales comorbilidades fueron hipertensión arterial y diabetes mellitus tipo 2. Se cuantificaron 1885 medicamentos prescritos; la estancia hospitalaria media fue de 6.3 días. Conclusiones: Se identificó alta prevalencia de PPI en los pacientes geriátricos hospitalizados, de ahí la importancia de aplicar los criterios STOPP y START y del papel del farmacéutico en la validación de la prescripción antes de la administración de medicamentos.

Abstract Background: Potentially inappropriate prescription (PIP) constitutes a risk for the development of adverse effects of a drug that outweigh its benefits, which can be considered inappropriate medication use. Objective: To describe the prevalence of PIP in geriatric patients hospitalized at the internal medicine department of a referral hospital in Mexico. Material and methods: Cross-sectional, descriptive design, with simple allocation of medical records from patients older than 65 years hospitalized between January 2016 and August 2017. The STOPP/START criteria were applied to identify the number of PIPs, the number of prescribed medications, number and type of comorbidities, as well as days of hospital stay. Results: A prevalence of PIP of 73.3% was identified, with main comorbidities being hypertension and type 2 diabetes mellitus. A total of 1,885 prescribed medications were quantified; mean hospital stay was 6.3 days. Conclusions: A high prevalence of PIP was identified in hospitalized geriatric patients, hence the importance of applying the STOPP/START criteria and of the role of the pharmacist for validating the prescription prior to drug administration.

Effect of ABO blood groups on length of hospital stay according to age in Covid-19 patients

Abstract Introduction Coronavirus Disease 2019 (COVID-19) is a novel viral disease with person-to-person transmission that has spread to many countries since the end of 2019. Although many unknowns were resolved within a year and the vaccine is available, it is still a major global health problem. Objective COVID-19 infection may present with a considerably wide spectrum of severity and host factors play a significant role in determining the course of the disease. One of these factors is blood groups. Based on previous experience, it is believed that the ABO blood group type affects prognosis, treatment response and length of stay in the hospital. In this study, our aim was to evaluate whether the blood group had an effect on the length of the hospital stay. To the best of our knowledge, no previous studies have assessed the effect of ABO blood groups, as well as age, on the length of the hospital stay in these settings. Methods In this retrospective cohort study, 969 patients admitted to our hospital between March 15, 2020 and May 15, 2020 were evaluated. The patients were divided into 4 groups according to ABO blood groups. The effect of the ABO blood group by age on the course of the disease, need for intensive care, duration of hospitalization and mortality in patients with COVID-19 infection, especially in geriatric patients, was evaluated. Results Of all the patients, 9.1% required admission to the intensive care unit (ICU), of whom 83% died. The average length of ICU stay was 11 days (0 - 59). The observed mortality rates in blood groups A, B, AB and 0 were 86.4%, 93.3%, 80.0% and 70.8%, respectively, indicating similar death rates in all ABO blood types. When the Rh phenotype was taken into consideration, no significant changes in results were seen. Conclusion As a result, we could not observe a significant relationship between blood groups and clinical outcomes in this study, which included a sample of Turkish patients with COVID-19.

Effect of ABO blood groups on length of hospital stay according to age in Covid-19 patients.

INTRODUCTION: Coronavirus Disease 2019 (COVID-19) is a novel viral disease with person-to-person transmission that has spread to many countries since the end of 2019. Although many unknowns were resolved within a year and the vaccine is available, it is still a major global health problem. OBJECTIVE: COVID-19 infection may present with a considerably wide spectrum of severity and host factors play a significant role in determining the course of the disease. One of these factors is blood groups. Based on previous experience, it is believed that the ABO blood group type affects prognosis, treatment response and length of stay in the hospital. In this study, our aim was to evaluate whether the blood group had an effect on the length of the hospital stay. To the best of our knowledge, no previous studies have assessed the effect of ABO blood groups, as well as age, on the length of the hospital stay in these settings. METHODS: In this retrospective cohort study, 969 patients admitted to our hospital between March 15, 2020 and May 15, 2020 were evaluated. The patients were divided into 4 groups according to ABO blood groups. The effect of the ABO blood group by age on the course of the disease, need for intensive care, duration of hospitalization and mortality in patients with COVID-19 infection, especially in geriatric patients, was evaluated. RESULTS: Of all the patients, 9.1% required admission to the intensive care unit (ICU), of whom 83% died. The average length of ICU stay was 11 days (0 - 59). The observed mortality rates in blood groups A, B, AB and 0 were 86.4%, 93.3%, 80.0% and 70.8%, respectively, indicating similar death rates in all ABO blood types. When the Rh phenotype was taken into consideration, no significant changes in results were seen. CONCLUSION: As a result, we could not observe a significant relationship between blood groups and clinical outcomes in this study, which included a sample of Turkish patients with COVID-19.

Caracterización de pacientes geriátricos con ventilación mecánica invasiva en cuidados intensivos / Characterization and evolution of the geriatric patient with invasive mechanical ventilation in intensive care unit

Introducción: La ventilación mecánica invasiva en pacientes geriátricos ingresados en las unidades de cuidados intensivos, es frecuente y tiene una letalidad elevada. Objetivos: Caracterizar a los pacientes geriátricos con ventilación mecánica invasiva y su evolución en la unidad de cuidados intensivos. Métodos: Se realizó un estudio descriptivo, en 149 pacientes geriátricos ingresados en la sala de cuidados intensivos. Las variables estudiadas fueron: edad, sexo, antecedentes patológicos personales, índices APACHE II y SOFA, perfil diagnóstico, diagnóstico al ingreso, aplicación de traqueostomía, tiempo de ventilación mecánica, estado al egreso y complicaciones. Se emplearon como medidas las frecuencias porcentajes; se evaluó la posible asociación entre las variables. Resultados: Predominó la edad de 70 a 79 años (44,9 por ciento) y el sexo masculino (53,7 por ciento). La mortalidad fue de 40,9 por ciento y se asoció a: valores elevados de los índices APACHE II y SOFA, pacientes quirúrgicos y tiempo de ventilación mecánica mayor de 7 días. Las complicaciones más frecuentes fueron: el síndrome de disfunción múltiple de órganos (23,4 por ciento), la neumonía asociada a la ventilación (22,8 por ciento) y la insuficiencia renal aguda (22,1 por ciento). Conclusiones: Los pacientes se caracterizan por el predomino del sexo masculino, edad menor de 80 años y presencia de enfermedades crónicas; el diagnóstico al ingreso más relevante, es el posoperatorio de afecciones quirúrgicas urgentes; la mortalidad se asociada al sexo femenino, al perfil quirúrgico, la gravedad de la enfermedad y el tiempo de ventilación mecánica. Las complicaciones se relacionan con la sepsis(AU)

Introduction: Invasive mechanical ventilation in geriatric patients admitted to intensive care units, is frequent and has a high lethality. Objectives: To characterize geriatric patients with invasive mechanical ventilation and their evolution in the intensive care unit. Methods: A descriptive study was carried out in 149 geriatric patients admitted to the intensive care unit. The variables studied were: age, sex, personal pathological history, APACHE II and SOFA indices, diagnostic profile, diagnosis on admission, application of tracheostomy, time of mechanical ventilation, status at discharge and complications. Percentage and frequencies were used as measurements; the possible association between the variables was evaluated. Results: The age of 70 to 79 years (44.9 percent) and the male sex (53,7 percent) predominated. Mortality was 40,9 percent and was associated with: elevated APACHE II and SOFA indices, surgical patients, and mechanical ventilation time greater than 7 days. The most frequent complications were: multiple organ dysfunction syndrome (23,4 percent), ventilator-associated pneumonia (22,8 percent) and acute renal failure (22,1 percent). Conclusions: The characteristics were: age less than 80 years, most were male sex, history of chronic diseases and in the diagnosis at admission, urgent surgical conditions. Mortality was associated with female sex, surgical profile, severity of the disease, and time on mechanical ventilation. Complications were related to sepsis (AU)

Clinical manifestations and factors associated with mortality from COVID-19 in older adults: Retrospective population-based study with 9807 older Brazilian COVID-19 patients.

AIM: Older adults are the main risk group for coronavirus disease 2019 (COVID-19). This study aimed to describe the clinical manifestations and factors associated with mortality from COVID-19 among older adults in Brazil. METHODS: A cross-sectional observational study was carried out with data from 9807 cases of COVID-19 among older adults in the state of Alagoas, Brazil. We determined the case fatality rate between age groups and clinical factors associated with mortality. RESULTS: A total of 52.5% (n = 5145) were women, and with an average age of 70.21 ± 8.37 years. The fatality rate was 11.9%, with a higher rate in men (14.4%) compared with women (9.8%). The fatality rate increased with age. The most common manifestations were fever (n = 4926; 50.2%), cough (n = 5737; 58.5%), headache (n = 1980; 20.2%) and fatigue (n = 2022; 20.6%). The most prevalent comorbidities were diabetes (n = 1528; 5.6%), cardiovascular disease (n = 1528; 15.6%) and systemic arterial hypertension (n = 597; 6.1%). The factors associated with mortality were male sex (OR 1.54), age ≥75 years (OR 2.40), dyspnea (OR 2.92), diabetes (OR 2.33), hypertension (OR 1.53) and chronic kidney disease (OR 2.02). CONCLUSIONS: The profile and the risk factors evidenced show the need to adopt mechanisms to protect the elderly population.

Revisión teórica de los factores de riesgos asociados a hemorragia digestivas altas en pacientes geriátricos / Theoretical review of risk factors associated with high digestive hemorrhage in geriatric patients

La hemorragia digestiva alta aguda (HDAA) es la emergencia gastrointestinal más frecuente. En los ancianos se asocia con tasas de internación, morbilidad y mortalidad más elevadas que en las personas jóvenes, probablemente por la prevalencia más elevada de múltiples comorbilidades, como las enfermedades pulmonares y cardiovasculares. Objetivo: Describir los fundamentos teóricos de los factores de riesgos asociados a hemorragia digestivas altas. Metodología: Documental, descriptiva. Resultados: diversos estudios demuestran que los factores de riesgos asociados a las hemorragias digestivas altas son: la úlcera péptica gastroduodenal y várices esofágicas, complicaciones graves con alto riesgo de mortalidad en pacientes de edades avanzadas, por lo que se debe actuar con rapidez, eficacia y efectividad. Conclusión: la bibliografía consultada revela: que a pesar de los avances de la tecnología y de la farmacología, la tasa de mortalidad global por hemorragia digestiva alta no ha mejorado. Esta realidad se explica por el aumento significativo en la edad de los pacientes que hoy ingresan a los servicios de urgencias con esta complicación. En la HDAA es fundamental intentar identificar y tratar la fuente del sangrado, para lo cual resulta esencial la endoscopia temprana(AU)

Acute upper gastrointestinal bleeding (HDAA) is the most frequent gastrointestinal emergency. In the elderly, it is associated with higher hospitalization, morbidity and mortality rates than in young people, probably due to the higher prevalence of multiple comorbidities, such as pulmonary and cardiovascular diseases. Objective: To describe the theoretical foundations of the risk factors associated with upper gastrointestinal bleeding. Methodology: Documentary, descriptive. Results: various studies show that the risk factors associated with upper gastrointestinal bleeding are, gastroduodenal peptic ulcer and esophageal varices, serious complications with a high risk of mortality in elderly patients, therefore, it is necessary to act quickly, efficiently and effectiveness. Conclusion: the bibliography consulted reveals: that despite advances in technology and pharmacology, the overall mortality rate from upper gastrointestinal bleeding has not improved. This reality is explained by the significant increase in the age of patients who today enter the emergency services with this complication. In HDAA it is essential to try to identify and treat the source of the bleeding, for which early endoscopy is essential(AU)

Geriatric patients: compliance issues and ways of its optimization

The aim of the study is to increase the effectiveness of diseases treatment in elderly patients. The work is based on the study of the nature and the role of compliance disorders, optimizing the effectiveness with the use of therapeutic complex of pharmacotherapy associated with psychotherapeutic component. As a result of the analysis of morbidity in elderly age and the nature of compliance in elderly patients, an optimal therapeutic complex was proposed, which consists of rational pharmacological load and psychotherapeutic intervention, aimed at informing a patient about the disease, methods of its treatment, as well as at creating an effective therapeutic alliance which provides proper medical care and prevents self-treatment in such patients.

Relationship between Nutritional Status and Gastrointestinal Symptoms in Geriatric Patients with End-Stage Renal Disease on Dialysis.

Gastrointestinal symptoms (GIS) are common in patients with end-stage renal disease (ESRD) and are associated with nutritional risks resulting from low food intake. Little is known about the relationship between GIS and malnutrition in geriatric patients with ESRD. The main objective of this study was to determine the relationship between nutritional status and severity of GIS in geriatric patients on dialysis therapy. Clinically-stable geriatric patients (older than 60 years old) who were dialysis outpatients were included in this cross-sectional study. The severity of GIS was assessed using the Gastrointestinal Symptoms Questionnaire (GSQ, short version), with patients classified into three groups: mild, moderate, and severe. Nutritional status was evaluated with the Malnutrition Inflammation Score (MIS), anthropometric assessment, biochemical parameters, and bioelectrical impedance. Descriptive statistics were used and differences between groups were analyzed with ANOVA and Kruskal Wallis, with a p < 0.05 considered to indicate significance. Fifty patients completed the study; the median age was 67 years old. Twenty-three patients were on hemodialysis (HD) and 27 were on peritoneal dialysis (PD). No significant differences were found according to dialysis modality, presence of diabetes, or gender. Ninety percent of patients had at least one GIS. Poorer nutritional status (evaluated by MIS) was related to a higher severity of GIS. There were no significant differences with other nutritional parameters. Our study showed a high prevalence of GIS in geriatric patients. There were no differences in observed GIS values that were attributed to dialysis modality, gender, or presence of type 2 diabetes mellitus (DM2). Severe GIS values were associated with poorer nutritional status determined by MIS, however, there was no association with anthropometry, biochemical values, or bioimpedance vector analysis.

Adherencia al tratamiento anticoagulante oral por enfermedad tromboembólica venosa en adultos mayores / Adherence to the oral anticoagulant treatment for venous tromboembolic disease in older adults

Introducción: Los adultos mayores son más propensos a presentar inestabilidad en los niveles de anticoagulación y efectos adversos, donde pudiera influir la no adherencia al tratamiento.Objetivo: Determinar el comportamiento de la adherencia al tratamiento anticoagulante oral por enfermedad tromboembólica venosa en los adultos mayores.Métodos: Estudio descriptivo retrospectivo-prospectivo en 42 adultos mayores bajo tratamiento anticoagulante oral de junio a diciembre de 2014. Se analizaron variables sociodemográficas, enfermedades crónicas asociadas, dosis, grado de control, frecuencia de cumplimiento, complicaciones, tiempo en rango terapéutico, adherencia al tratamiento y factores que influyen en la adherencia.Resultados: El 71,4 por ciento de los casos presentó elevada adherencia al tratamiento. El tiempo en rango terapéutico de la población en estudio fue de 55,1 por ciento.Conclusiones: En los pacientes adultos mayores estudiados prevaleció la alta adherencia al tratamiento anticoagulante oral aunque predominó en ellos el inadecuado control de la anticoagulación(AU)

Introduction: Older adults are often more prone to present unbalanced levels of anticoagulation and adverse effects, and this condition could be influenced by non-adherence to treatment.Objective: To characterize the behavior of adherence to oral anticoagulant therapy for venous thromboembolic disease in older adults.Methods: A descriptive, retrospective-prospective study was conducted in 42 old people under oral anticoagulant treatment from June to December 2014. It analyzed sociodemographic variables, associated chronic diseases, doses, level of control, frequency of control, complications, length of time in therapeutic status, adherence to treatment and factors that affect it.Results: In 71.4 percent of patients, the percentage of adherence to treatment was high. The length of time in therapeutic status of the study population was 55.1 percent.Conclusions: The studied older patients showed high margin of adherence to oral anticoagulant therapy, although inadequate control of anticoagulation was also predominant(AU)

Adherencia al tratamiento anticoagulante oral por enfermedad tromboembólica venosa en adultos mayores / Adherence to the oral anticoagulant treatment for venous tromboembolic disease in older adults

Introducción: Los adultos mayores son más propensos a presentar inestabilidad en los niveles de anticoagulación y efectos adversos, donde pudiera influir la no adherencia al tratamiento. Objetivo: Determinar el comportamiento de la adherencia al tratamiento anticoagulante oral por enfermedad tromboembólica venosa en los adultos mayores. Métodos: Estudio descriptivo retrospectivo-prospectivo en 42 adultos mayores bajo tratamiento anticoagulante oral de junio a diciembre de 2014. Se analizaron variables sociodemográficas, enfermedades crónicas asociadas, dosis, grado de control, frecuencia de cumplimiento, complicaciones, tiempo en rango terapéutico, adherencia al tratamiento y factores que influyen en la adherencia. Resultados: El 71,4 por ciento de los casos presentó elevada adherencia al tratamiento. El tiempo en rango terapéutico de la población en estudio fue de 55,1 por ciento. Conclusiones: En los pacientes adultos mayores estudiados prevaleció la alta adherencia al tratamiento anticoagulante oral aunque predominó en ellos el inadecuado control de la anticoagulación(AU)

Introduction: Older adults are often more prone to present unbalanced levels of anticoagulation and adverse effects, and this condition could be influenced by non-adherence to treatment. Objective: To characterize the behavior of adherence to oral anticoagulant therapy for venous thromboembolic disease in older adults. Methods: A descriptive, retrospective-prospective study was conducted in 42 old people under oral anticoagulant treatment from June to December 2014. It analyzed sociodemographic variables, associated chronic diseases, doses, level of control, frequency of control, complications, length of time in therapeutic status, adherence to treatment and factors that affect it. Results: In 71.4 percent of patients, the percentage of adherence to treatment was high. The length of time in therapeutic status of the study population was 55.1 percent. Conclusions: The studied older patients showed high margin of adherence to oral anticoagulant therapy, although inadequate control of anticoagulation was also predominant(AU)

Complications of Liver Resection in Geriatric Patients

Abstract: Introduction and aims. Liver resection is the treatment of choice for many primary and secondary liver diseases. Most studies in the elderly have reported resection of primary and secondary liver tumors, especially hepatocellular carcinoma and colorectal metastatic cancer. However, over the last two decades, hepatectomy has become safe and is now performed in the older population, implying a paradigm shift in the approach to these patients. Material and methods. We retrospectively evaluated the risk factors for postoperative complications in patients over 65 years of age in comparison with those under 65 years of age after liver resection (n = 360). The set comprised 127 patients older than 65 years (35%) and 233 patients younger than 65 years (65%). Results. In patients younger than 65 years, there was a significantly higher incidence of benign liver tumors (P = 0.0073); in those older than 65 years, there was a significantly higher incidence of metastasis of colorectal carcinoma to the liver (0.0058). In patients older tan 65 years, there were significantly more postoperative cardiovascular complications (P = 0.0028). Applying multivariate analysis, we did not identify any independent risk factors for postoperative complications. The 12-month survival was not significantly different (younger versus older patients), and the 5-year survival was significantly worse in older patients (P = 0.0454). Conclusion. In the case of liver resection, age should not be a contraindication. An individualized approach to the patient and multidisciplinary postoperative care are the important issues.

Aspectos clínico-epidemiológicos de pacientes geriátricos con pie diabético / Clinical and epidemiological aspects of geriatric patients with diabetc foot

Introducción: en el mundo, actualmente se estima que padecen de diabetes mellitus alrededor de 285 millones de personas y de ellas el 15 por ciento sufre de pie diabético. Las principales complicaciones tardías son de patogenia vascular y metabólica; las úlceras en las extremidades inferiores, en especial en el pie, resultan una de las complicaciones más frecuentes. Objetivo: caracterizar a los pacientes geriátricos con pie diabético, según diferentes variables clínico-epidemiológicas. Métodos: estudio descriptivo en 106 pacientes geriátricos con pie diabético, que fueron tratados en el Hospital Dr. Mario Muñoz Monroy de Matanzas entre septiembre de 2010 y marzo de 2012. Se confeccionó una planilla de recolección de datos que se completó a partir de las historias clínicas de los pacientes incluidos en el estudio. Las variables estudiadas fueron: edad sexo, factores de riesgo, enfermedades asociadas, color de la piel, tipo de pie diabético según la clasificación de Mc Cook, y estado de convivencia. Resultados: la población más afectada fue la de 60-64 años (26,4 por ciento). Predominó el sexo masculino (54,5 por ciento). Prevalecieron los pacientes con un elevado tiempo de evolución de la diabetes, entre 11 y 20 años (66,9 por ciento). El pie diabético isquémico resultó el de mayor frecuencia de aparición (52,8 por ciento). Los pacientes de color de piel negra tuvieron menor afectación (10,3 por ciento) que los de piel blanca. Los gerontes que vivían solos evidenciaron mayor cantidad de amputaciones (de 11 amputados, 7 vivían solos). El tabaquismo como factor de riesgo se presentó en el 66 por ciento de los pacientes y la hipertensión arterial como enfermedad asociada en el 81,1 por ciento. Conclusión: llegar a la edad geriátrica representa una mayor preocupación para los pacientes diabéticos, pues en esta etapa aparece con más frecuencia el pie diabético. El sexo masculino, la hipertensión arterial, el tabaquismo, ser blanco o mestizo,...(AU)

Introduction: globally, 285 million people are estimated to suffer diabetes mellitus and 15 percent of them suffer from diabetic foot. The major late complications are vascular and metabolic pathogenesis; ulcers in the lower limbs, especially in foot, are one of the most frequent complications.Objective: characterize geriatric patients suffering from diabetic foot according to different clinical and epidemiological variables. Methods: a descriptive study in 106 elderly patients with diabetic foot was conducted from September 2010 to March 2012. These patients were treated at Dr. Mario Muñoz Monroy hospital in Matanzas. A form for data collection was designed to be completed from the patients´s medical records included in the study. The variables studied were: age sex, risk factors, associated diseases, skin color, type of diabetic foot as rated by Mc Cook, and state of coexistence. Results: population aging 60-64 years were the most affected (26.4 percent). There was male predominance (54.5 percent). Patients with high duration of diabetes (11 and 20 years) (66.9 percent) prevailed. The ischemic diabetic foot had the highest frequency of occurrence (52.8 percent). black skinned patients were less affected (10.3 percent) than white skinned ones. The elderly people living alone showed higher number of amputations (out of 11 amputees, 8 were living alone). Smoking as a risk factor occurred in 66 percent of patients and hypertension as associated disease in 81.1 percent. Conclusions: reaching geriatric age represents a major concern for diabetic patients, because at this stage diabetic foot appears more frequently. Male gender, hypertension, smoking, white or mixed race and living alone, are elements to assess this entity prognosis(AU)

Aspectos clínico-epidemiológicos de pacientes geriátricos con pie diabético / Clinical and epidemiological aspects of geriatric patients with diabetc foot

INTRODUCCIÓN: en el mundo, actualmente se estima que padecen de diabetes mellitus alrededor de 285 millones de personas y de ellas el 15 % sufre de pie diabético. Las principales complicaciones tardías son de patogenia vascular y metabólica; las úlceras en las extremidades inferiores, en especial en el pie, resultan una de las complicaciones más frecuentes. OBJETIVO: caracterizar a los pacientes geriátricos con pie diabético, según diferentes variables clínico-epidemiológicas. MÉTODOS: estudio descriptivo en 106 pacientes geriátricos con pie diabético, que fueron tratados en el Hospital "Dr. Mario Muñoz Monroy" de Matanzas entre septiembre de 2010 y marzo de 2012. Se confeccionó una planilla de recolección de datos que se completó a partir de las historias clínicas de los pacientes incluidos en el estudio. Las variables estudiadas fueron: edad sexo, factores de riesgo, enfermedades asociadas, color de la piel, tipo de pie diabético según la clasificación de Mc Cook, y estado de convivencia. RESULTADOS: la población más afectada fue la de 60-64 años (26,4 %). Predominó el sexo masculino (54,5 %). Prevalecieron los pacientes con un elevado tiempo de evolución de la diabetes, entre 11 y 20 años (66,9 %). El pie diabético isquémico resultó el de mayor frecuencia de aparición (52,8 %). Los pacientes de color de piel negra tuvieron menor afectación (10,3 %) que los de piel blanca. Los gerontes que vivían solos evidenciaron mayor cantidad de amputaciones (de 11 amputados, 7 vivían solos). El tabaquismo como factor de riesgo se presentó en el 66 % de los pacientes y la hipertensión arterial como enfermedad asociada en el 81,1 %. CONCLUSIÓN: llegar a la edad geriátrica representa una mayor preocupación para los pacientes diabéticos, pues en esta etapa aparece con más frecuencia el pie diabético. El sexo masculino, la hipertensión arterial, el tabaquismo, ser blanco o mestizo, así como vivir solo, constituyen elementos a valorar en el pronóstico de esta entidad.

INTRODUCTION: globally, 285 million people are estimated to suffer diabetes mellitus and 15% of them suffer from diabetic foot. The major late complications are vascular and metabolic pathogenesis; ulcers in the lower limbs, especially in foot, are one of the most frequent complications. OBJECTIVE: characterize geriatric patients suffering from diabetic foot according to different clinical and epidemiological variables. METHODS: a descriptive study in 106 elderly patients with diabetic foot was conducted from September 2010 to March 2012. These patients were treated at Dr. Mario Muñoz Monroy hospital in Matanzas. A form for data collection was designed to be completed from the patients´s medical records included in the study. The variables studied were: age sex, risk factors, associated diseases, skin color, type of diabetic foot as rated by Mc Cook, and state of coexistence. RESULTS: population aging 60-64 years were the most affected (26.4 %). There was male predominance (54.5 %). Patients with high duration of diabetes (11 and 20 years) (66.9 %) prevailed. The ischemic diabetic foot had the highest frequency of occurrence (52.8 %). black skinned patients were less affected (10.3 %) than white skinned ones. The elderly people living alone showed higher number of amputations (out of 11 amputees, 8 were living alone). Smoking as a risk factor occurred in 66% of patients and hypertension as associated disease in 81.1 %. CONCLUSIONS: reaching geriatric age represents a major concern for diabetic patients, because at this stage diabetic foot appears more frequently. Male gender, hypertension, smoking, white or mixed race and living alone, are elements to assess this entity prognosis.

Colecistectomía videolaparoscópica en ancianos para prevenir la urgencia / Videolaparoscopy cholecystectomy in elderlies to prevent an emergency

Introduccion: con el aumento de la expectativa de vida, cada vez es mayor el número de ancianos que necesitan ser intervenidos quirúrgicamente por afecciones de la vesícula biliar. La cirugía de urgencia en esta entidad, con el alto índice de morbilidad y mortalidad que tiene, solo se previene si se les interviene de forma electiva. Objetivo: evaluar los resultados de la colecistectomía vieolaparoscopica en los pacientes de 60 años o más, para prevenir la urgencia. Metodos: se realizó un estudio prospectivo, descriptivo, de corte transversal a todos los pacientes de la tercera edad, a quienes se les realizaron colecistectomïas violaparoscóica en el perïódo de febrero 2005 a febrero 2010. Se analizaron variables preoperatorias, intraoperatorias y posoperatorias. Se utilizacion la clasificación de la American Society of Anestesiologist, para evaluación preoperatoria anestésica. Resultados: de un total de 919 ...

Introduction: with the increasing life expectancy, the figure of elderlies needing be operated on due to gall bladder affections es higher. In this entity, the emergency surgery with the high rate of morbility and mortality only is prevented if they are operated on in elective way. Objective: to assess the results of the videolaparoscopy cholecystectomy in patients aged 60 or more to prevent the emergency. Methods: a cross-sectional, descriptive and prospective study was conducted in all third age patients who underwent videolaparoscopy cholecystectomy from February 2005 to February, 2010. The preoperative, intraoperative and postoperative variables were analyzed. The classification or the American Society of Anesthesiologist was used for the anesthetic preoperative assessment. Results: from a total of 919...

Drug related problems associated with the psychoactive drugs used on geriatric, hospitalized patients

A prospective study was carried out, to identify the drug related problems and to prevent or to solve the negative outcomes associated with medication of the geriatric patients that consumed psychoactive drugs, who were hospitalized. The study was carried out according to the DADER Method of Pharmacotherapy Monitoring, adapted to the Hospital's environment and the theoretical rationale of the Third Consent of Granada was assumed, for the considerations related to the drug related problems and the negative outcomes associated with medication. Thirty five patients were included whose ages ranged between the 60 and 90 years. Thirty six negative associated outcomes were identified, in 34 patients that represented 97.14% incidence. A prevalence of the negative outcomes associated with the necessity was observed, followed by those associated with the security. The inadequate drug uses was the drug related problem that prevailed in the sample. The psychoactive drugs that were related with these results were mainly the anxiolytics, meprobamate and the neuroleptics. Some 82.35% of the interventions were accepted, achieving resolution of 47.06% of the negative outcomes associated with medication.

Foi realizada uma pesquisa de intervenção, prospectiva, a fim de identificar problemas relacionados aos medicamentos e evitar ou resolver resultados negativos daí decorrentes, em pacientes idosos que faziam uso de medicamentos psicotrópicos e que foram internados. O estudo foi realizado de acordo com o método DADER para o acompanhamento farmacoterapêutico e assumiram-se os pressupostos teóricos do III Consenso de Granada, as considerações relacionadas com os problemas dos fármacos e os resultados negativos associados à medicação. Foram incluídos 35 pacientes com idades entre 60 e 90 anos. Trinta e seis RM foram identificados em 34 pacientes representando incidência de 97,14% e a prevalência foi observada para os resultados negativos associados com a necessidade, seguidos por aqueles relacionados à segurança. O uso indevido de fármacos foi os problema mais frequente na amostra. Os psicofármacos mais implicados foram os ansiolíticos, meprobamato e neurolépticos. Das intervenções, 82,35% foram aceitas, alcançando 47,06% de resolução dos resultados negativos associados à medicação.

Oral health status in geriatric diabetics / Condições de saúde bucal em pacientes diabéticos geriátricos

OBJECTIVE: To determine if any difference exists in the oral health status between geriatric patients with diabetes mellitus and the normal population. SUBJECTS AND METHODS: The oral health status of 100 metabolically controlled geriatric diabetic patients attending the Diabetes Clinic of the Manipal Hospital, were prospectively assessed over six months and compared with that of 50 non-diabetic acting as controls. RESULTS: The mean duration of diabetes was 100.5±85.1 months. The degree of hyposalivation between the two groups was statistically significant (p < 0.05). No significant difference was observed in the taste, burning mouth sensation, angular cheilitis, glossitis, and stomatitis status of the two groups and no pathgnomonic lesions or alterations could be observed in relation to the disease. CONCLUSION: It was concluded that, with adequate metabolic control, the oral health status of a diabetic may not be significantly different from that of a non-diabetic except for xerostomia.

OBJETIVO: Avaliar possíveis diferenças na saúde bucal de pacientes geriátricos com diabetes mellitus em comparação a uma população normal. CASUÍSTICA E MÉTODO: A condição de saúde bucal de 100 pacientes geriátricos diabéticos, metabolicamente controlados, atendidos na Clínica de Diabetes do Hospital Manipal foram avaliados prospectivamente durante seis meses e comparados com 50 pacientes geriátricos não diabéticos (grupo controle). RESULTADOS: A duração média do diabetes foi 100 m5 +- 85,1 meses. O grau de hiposalivação entre os dois grupos foi estatisticamente significante (p < 0,05). Não foram encontradas diferenças significativas no paladar, sensação de queimação bucal, queilite angular, glossite e estomatites entre os dois grupos. Não foram observadas lesões patognômicas ou alterações relacionadas ao diabetes. CONCLUSÃO: Concluiu-se que, com controle metabólico adequado, as condições bucais de pacientes diabéticos geriátricos pode não ser significativamente diferente das de um não diabético, com exceção da xerostomia.