Clinical Outcomes In Elderly Patients Research Articles

Investigating the relationship between lymphocyte cells apoptosis and DNA damage and oxidative stress and therapeutic and clinical outcomes of COVID-19 elderly patients

BackgroundWhile COVID-19 has been controlled and deaths have decreased, the long-term consequences of COVID-19 remain a challenge we face today. This study was conducted to determine the relationship between the apoptosis of lymphocyte cells with DNA damage and oxidative stress and the therapeutic and clinical outcomes of elderly patients with COVID-19.MethodsThis study was conducted from April 2020 to May 2021 (the period of severe attacks of the epidemic peak of COVID-19) and September 2022 (the post-COVID-19 period). The study groups included elderly patients with COVID-19 hospitalized in the ICU and normal wards of the hospital as well as elderly patients with influenza. A polymerase chain reaction was used to check the validity of the studied diseases. The Annexin V/Propidium Iodide method was used to evaluate the level of apoptosis. Genotoxic effects and DNA damage were assessed by the comet assay method. Total antioxidant status (TAS), total oxidant status (TOS), and myeloperoxidase activity (MPO) were measured by photometric methods.ResultsThe highest level of apoptosis in peripheral blood lymphocytes and the highest level of DNA damage were observed at both times in the intubated-ICU and non-intubated-ICU groups. In all groups, there was a significant increase in peripheral blood lymphocyte apoptosis levels and DNA damage levels compared to the healthy control group (p < 0.01). The level of apoptosis and DNA damage decreased significantly in the post-COVID-19 period (p < 0.01). In the investigation of oxidative stress biomarkers, the oxidative stress index, including TOS and MPO levels, increased in patients (p < 0.01), and the TAS level decreased (p < 0.01).ConclusionIt shows that the apoptosis of lymphocyte cells, DNA damage, and oxidative stress can be effective in prognostic decisions and is a suitable predictor for diagnosing the condition of patients with viral infections such as COVID-19 and influenza.

Impact of Frailty on Outcome of Older Patients With Non-ST Elevation Acute Myocardial Infarction Who Undergo Percutaneous Coronary Intervention

IntroductionFrailty status is linked with a poorer clinical outcome and frail patients are often less revascularized even with percutaneous coronary intervention (PCI). We therefore sought to assess the impact of frailty on clinical outcome of elderly patients with non ST-elevation acute-myocardial-infarction (NSTEMI) undergoing PCI. MethodsWe prospectively enrolled 141 consecutive elderly (>75 years) patients admitted for NSTEMI. 104 patients underwent PCI (35 frail, 69 non-frail), 37 were not revascularized (22 frail, 15 non frail). ResultsFrail patients were older, less frequently male, more affected by dementia and severe left ventricular dysfunction, less treated with PCI; patients treated with PCI were younger and less affected by dementia.Thirty-day mortality rates were proportionally higher from 3% in non-frail patients treated with PCI, to 7% in non-frail not treated with PCI, 17% in frail treated with PCI, 48% in frail patients not treated with PCI (p <0.05). Similarly 6-month mortality rates were proportionally higher (12%, 29%, 37%, 71%).At multivariable analysis frail status was associated to a 6-fold increased risk of mortality at 30-days; at 6 months, frail status was associated to a 3.4-fold risk of death (p<0.01) but also PCI was associated to a lower risk of mortality (OR 0.2, p<0.01). ConclusionsIn an observational study on elderly NSTEMI patients, frail status is associated to a poorer outcome, while PCI is associated to a better long term outcome. A careful selection of patient suitable for revascularization by PCI may be useful in improving outcome of elderly frail patients with NSTEMI.

A Pharmacogenetic Panel-Based Prediction of the Clinical Outcomes in Elderly Patients with Coronary Artery Disease.

Clinical annotations for the actionable pharmacogenetic variants affecting the efficacy of cardiovascular drugs have been collected, yet their impacts on elderly patients with coronary artery disease (CAD) undergoing polypharmacy remain uncertain. We consecutively enrolled 892 elderly patients (mean age 80.7 ± 5.2) with CAD and polypharmacy. All the included patients underwent genotyping for 13 variants in 10 pharmacogenes (CYP2C19, CYP2C9, CYP4F2, CYP2D6, VKORC1, SLCO1B1, APOE, ACE, ADRB1, and MTHFR), which have the clinical annotations for 12 drugs that are commonly prescribed for patients with CAD. We found that 80.3% of the elderly CAD patients had at least one drug-gene pair associated with a therapeutical drug change. After adjusting for covariates, the number of drug-gene pairs was independently associated with a decreased risk of both major cardiovascular events (MACEs) (adjusted hazard ratio [HR]: 0.803, 95% confidence interval [CI]: 0.683-0.945, p = 0.008) and all-cause mortality (adjusted HR: 0.848, 95% CI: 0.722-0.996, p = 0.045), but also with an increased risk of adverse drug reactions (ADRs) (adjusted HR: 1.170, 95% CI: 1.030-1.329, p = 0.016). The Kaplan-Meier survival curves showed that compared to patients without a drug-gene pair, a significantly lower risk of MACEs could be observed in patients with a drug-gene pair during a 4-year follow-up (HR: 0.556, 95% CI: 0.325-0.951, p = 0.013). In conclusion, the carrier status of the actionable drug-gene pair is predictive for the clinical outcomes in elderly patients with CAD and polypharmacy. Implementing early or preemptive pharmacogenetic panel-guided polypharmacy holds the potential to enhance clinical outcomes for these patients.

Clinical outcomes in elderly patients receiving agalsidase alfa treatment in the Fabry Outcome Survey

Background and objectivesTreatment with agalsidase alfa in patients with Fabry disease is most effective when initiated early in the disease course; however, the clinical benefits in elderly patients are less well established. This analysis assesses outcomes in patients aged 65 years or older from the Fabry Outcome Survey (FOS) who were treated with agalsidase alfa. MethodsFOS data were extracted for adult patients aged 65 years or older who received agalsidase alfa, had baseline data and at least 3 years of post-baseline data, and had undergone no renal transplantation and/or dialysis before treatment. The data of patients who had undergone renal transplantation and/or dialysis during follow-up were excluded from estimated glomerular filtration rate (eGFR) analysis after the date of the renal transplantation and/or dialysis. Adult patients were stratified into two groups: those who started treatment before 65 years of age and who were still being treated when aged 65 years or older (group A), and those who started treatment when aged 65 years or older (group B). Mean annual changes in left ventricular mass index (LVMI), eGFR and proteinuria were assessed in group A (before and after the age of 65 years to understand if there was an age-related effect once patients turned 65 years of age) and in group B. ResultsEstimated mean (standard error [SE]) annual changes in LVMI were 0.46 (0.26) g/m2.7 and 0.21 (0.42) g/m2.7 in patients in group A when they were younger than 65 years and when they were aged 65 years or older, respectively, and 0.12 (0.65) g/m2.7 in patients in group B. For eGFR, mean (SE) annual changes were 0.83 (2.12) mL/min/1.73 m2 and 2.64 (2.18) mL/min/1.73 m2 in patients in group A when they were younger than 65 years and when they were aged 65 years or older, respectively, and 2.31 (1.44) mL/min/1.73 m2 in patients in group B. Proteinuria remained relatively stable in both subgroups of group A (before and after the age of 65 years) and group B. ConclusionsContinuation and initiation of agalsidase alfa treatment in patients aged 65 years or older with Fabry disease were associated with stabilization of proteinuria and minimal increases in cardiac (LVMI) and renal (eGFR) outcomes.

Impact of nutritional support on immunity, nutrition, inflammation, and outcomes in elderly gastric cancer patients after surgery.

Postoperative rehabilitation of elderly patients with gastric cancer has always been the focus of clinical attention. Whether the intervention by a full-course nutritional support team can have a positive impact on the postoperative immune function, nutritional status, inflammatory response, and clinical outcomes of this special population has not yet been fully verified. To evaluate the impact of full-course nutritional support on postoperative comprehensive symptoms in elderly patients with gastric cancer. This is a retrospective study, including 60 elderly gastric cancer patients aged 70 years and above, divided into a nutritional support group and a control group. The nutritional support group received full postoperative nutritional support, including individualized meal formulation, and intravenous and parenteral nutrition supplementation, and was regularly evaluated and adjusted by a professional nutrition team. The control group received routine postoperative care. After intervention, the proportion of CD4+ lymphocytes (25.3% ± 3.1% vs 21.8% ± 2.9%, P < 0.05) and the level of immunoglobulin G (12.5 G/L ± 2.3 G/L vs 10.2 G/L ± 1.8 G/L, P < 0.01) were significantly higher in the nutritional support group than in the control group; the changes in body weight (-0.5 kg ± 0.8 kg vs -1.8 kg ± 0.9 kg, P < 0.05) and body mass index (-0.2 ± 0.3 vs -0.7 ± 0.4, P < 0.05) were less significant in the nutritional support group than in the control group; and the level of C-reactive protein (1.2 mg/L ± 0.4 mg/L vs 2.5 mg/L ± 0.6 mg/L, P < 0.01) and WBC count (7.2 × 109/L ± 1.5 × 109/L vs 9.8 × 109/L ± 2.0 × 109/L, P < 0.01) were significantly lower in the nutritional support group than in the control group. In addition, patients in the nutritional support group had a shorter hospital stay (10.3 d ± 2.1 d vs 14.8 d ± 3.6 d, P < 0.05) and lower incidence of infection (15% vs 35%, P < 0.05) in those of the control group. The intervention by the nutritional support team has a positive impact on postoperative immune function, nutritional status, inflammatory response, and clinical outcomes in elderly patients with gastric cancer.

Clinical significance of preoperative nutritional status in elderly gastric cancer patients undergoing radical gastrectomy: A single-center retrospective study.

The population of elderly patients with gastric cancer is increasing, which is a major public health issue in China. Malnutrition is one of the greatest risk factors for adverse clinical outcomes in elderly patients with gastric cancer. To investigate the preoperative nutritional status and its association with delayed discharge of elderly gastric cancer patients following radical gastrectomy. A total of 783 patients aged 65 years and older harboring gastric adenocarcinoma and following radical gastrectomy were retrospectively analyzed from the prospectively collected database of Zhongshan Hospital of Fudan University between January 2018 and May 2020. The overall rate of malnutrition was 31.8%. The incidence of postoperative complications was significantly higher in the malnourished group compared to the well-nourished group (P < 0.001). Nutritional characteristics in the malnourished group, including body mass index, prognostic nutritional index (PNI), albumin, prealbumin, and hemoglobin, were all significantly lower than those in the well-nourished group. The percentage of patients who received postoperative total nutrient admixture was lower in the malnourished group compared to the well-nourished group (22.1% vs 33.5%, P = 0.001). Age ≥ 70 years (HR = 1.216, 95%CI: 1.048-1.411), PNI < 44.5 (HR = 1.792, 95%CI: 1.058-3.032), operation time ≥ 160 minutes (HR = 1.431, 95%CI: 1.237-1.656), and postoperative complications grade III or higher (HR = 2.191, 95%CI: 1.604-2.991) were all recognized as independent risk factors associated with delayed discharge. Malnutrition is relatively common in elderly patients undergoing gastrectomy. Low PNI is an independent risk factor associated with delay discharge. More strategies are needed to improve the clinical outcome of these patients.

Prognostic utility of paraspinal muscle index in elderly patients with community-acquired pneumonia.

This study investigated the associations between paraspinal muscle measurements on chest computed tomography and clinical outcomes of elderly patients with community-acquired pneumonia (CAP). This single-center, retrospective, observational study analyzed elderly patients (≥65 years) with CAP hospitalized through an emergency department between March 2020 and December 2022. We collected their baseline characteristics and laboratory data at the time of admission. The paraspinal muscle index and attenuation were calculated at the level of the 12th thoracic vertebra using chest computed tomography taken within 48 hours before or after admission. Univariable and multivariable logistic regression analyses were conducted to evaluate the association between paraspinal muscle measurements and 28-day mortality. Receiver operating characteristic (ROC) curve and area under the curve (AUC) analyses were used to evaluate the prognostic predictive power. Of the 338 enrolled patients, 60 (17.8%) died within 28 days after admission. A high paraspinal muscle index was associated with low 28-day mortality in elderly patients with CAP (adjusted odds ratio, 0.994; 95% confidence interval, 0.992-0.997). The area under the ROC curve for the muscle index was 0.75, which outperformed the pneumonia severity index and the CURB-65 (confusion, urea, respiratory rate, blood pressure, age ≥65 years) metric, both of which showed an AUC of 0.64 in predicting mortality. A high paraspinal muscle index was associated with low 28-day mortality in patients aged 65 years or older with CAP.

Impact analysis of conservative therapy on clinical outcomes in elderly patients with gallstones.

Impact analysis of conservative therapy on clinical outcomes in elderly patients with gallstones.

Stemless RSA shows good short-term radiological stability and clinical outcomes in elderly patients

BackgroundThe main goal of this study was to investigate the influence of patient age on humeral implant fixation in stemless reverse shoulder arthroplasty (RSA). The secondary goals were to investigate the influence on the occurrence of complications and on clinical outcomes. MethodsWe performed a retrospective multicenter study, including a series of patients operated on for stemless RSA. All patients were reviewed at a minimum of 2 years, with clinical and radiographic evaluation. The primary endpoint was the occurrence of migration of the humeral implant at the final follow-up. Secondary endpoints were clinical scores, occurrence of postoperative complications, need for revision surgery, and radiographic changes. Each patient ≥70 year old was matched on gender and body mass index,with a patient < 70 year old on a 1:1 basis. ResultsForty-five patients aged ≥70 years were included and matched, with 45 patients aged <70 years, giving a total of 90 patients (54.4% men) with the mean age being 68.5 ± 7.9 years. There was no difference between the 2 groups in terms of surgical modalities. There was no correlation between age and clinical outcomes. Three migrations of the humeral implant occurred, none leading to a revision, without any influence of age (P = 1.0). We found no correlation between patient age and the occurrence of a postoperative complication (P = 1.0), reoperation (P = 1.0) or any of the other radiographic parameters assessed. ConclusionThis study reported the stability of stemless RSA implants in elderly patients. Clinical outcomes, complication, and revision rates were not affected by age either.

Group-Based Trajectory Modeling of Fluid Balance in Elderly Patients with Acute Ischemic Stroke: Analysis from Multicenter ICUs.

Acute ischemic stroke (AIS) significantly contributes to severe disability and mortality among the elderly. This study aims to explore the association between longitudinal fluid balance (FB) trajectories and clinical outcomes in elderly patients with AIS. Our hypothesis posits the existence of multiple latent trajectories of FB in patients with AIS during the initial 7days following ICU admission. Patients (age ≥ 65years) with AIS and continuous FB records were identified from two large databases. Group-based trajectory modeling identified latent groups with similar 7-day FB trajectories. Subsequently, multivariable logistic and quasi-Poisson regression were employed to evaluate the relationship between trajectory groups and outcomes. Additionally, nonlinear associations between maximum fluid overload (FO) and outcomes were analyzed using restricted cubic spline models. To further validate our findings, subgroup and sensitivity analysis were conducted. A total of 1146 eligible patients were included in this study, revealing three trajectory patterns were identified: low FB (84.8%), decreasing FB (7.2%), and high FB (7.9%). High FB emerged as an independent risk factor for in-hospital mortality. Compared with those without FO, patients with FO had a 1.57-fold increased risk of hospital mortality (adjusted odd ratio (OR) 1.57, 95% confidence interval (CI) 1.08-2.27), 2.37-fold increased risk of adverse kidney event (adjusted OR 2.37, 95%CI 1.56-3.59), and 1.33-fold increased risk of prolonged ICU stay (adjusted incidence rate ratio (IRR) 1.33, 95%CI 1.19-1.48). The risk of hospital mortality and adverse kidney event increased linearly with rising maximum FO (P for non-linearity = 0.263 and 0.563, respectively). Daily FB trajectories were associated with adverse outcomes in elderly patients with AIS. Regular assessment of daily fluid status and restriction of FO are crucial for the recovery of critically ill patients.

Clinical Outcomes in Elderly Patients with Chronic Subdural Hematoma: Validation of Irrigation Assignment Based on Hematoma Characteristics.

The number of elderly patients with chronic subdural hematomas (CSDH) is increasing worldwide; however, there is limited data regarding the clinical outcomes in this population. Our therapeutic method using burr hole evacuation for CSDH is based on the hematoma characteristics, using simple drainage for single-layer lesions and drainage with irrigation for multiple-layer lesions. This study aimed to compare the postoperative outcomes of elderly and younger patients, identify the predictors of outcomes in elderly patients, and verify the validity of our therapeutic methods. In total, we included 214 patients who underwent burr hole evacuation between April 2018 and March 2022. Baseline characteristics, hematoma characteristics, recurrence, and clinical outcomes were compared between the elderly and younger patients. Overall, 96 elderly patients (44.9%) were included in the study, and more elderly patients underwent antithrombotic therapy than younger patients (33.3% vs. 19.5%, p = 0.027). Moreover, elderly patients had significantly fewer favorable outcomes than younger patients (70.8% vs. 91.5%; p < 0.001); however, this was not significant after adjusting for the baseline modified Rankin Scale (mRS). Similarly, elderly patients had higher recurrence rates than younger patients (10.4% vs. 2.5%; p = 0.021). However, the baseline mRS score was the only predictor of unfavorable outcomes. In conclusion, although the clinical outcomes of elderly patients were comparable to those of younger patients, the higher rate of preoperative antithrombotic therapy in elderly patients may result in a higher rate of recurrence requiring a long-term follow-up.

Long-term clinical outcomes in elderly patients with chronic total occlusion and type 2 diabetes: the impact of coronary collateralization following successful recanalization

Background and purpose: Chronic total occlusion (CTO) lesions commonly affect elderly patients, especially those with type 2 diabetes mellitus (T2DM), often associated with coronary collaterals (CC). However, it remains unclear whether CC influences the prognosis of CTO. This retrospective single-center study aimed to evaluate the prognostic relevance of CC in elderly patients with T2DM after successful revascularization for CTO. Methods: We analyzed data from 416 patients diagnosed with CTO who underwent successful revascularization between January 2013 and January 2017. Patients were categorized into two groups: the Non-T2DM group and T2DM group. Subgroup analyses were performed based on the status of CC. The primary outcome was the occurrence of major adverse cardiac events (MACE) during the follow-up period, with the secondary outcomes including all-cause mortality, cardiac death, and repeat revascularization. Results: CC did not significantly impact clinical endpoints in the overall elderly patient population. However, we observed a lower incidence of MACE, cardiac death, all-cause mortality, and repeat revascularization in the Non-T2DM group compared to the T2DM group. In patients without T2DM, poor-CC was associated with higher rates of all-cause mortality (9% vs. 18%, P = 0.041), an increased risk of cardiac death (5% vs. 12%, P = 0.042), and a greater incidence of MACE (15% vs. 28%, P = 0.031), whereas no such associations were observed in T2DM patients. Furthermore, in multivariate Cox analysis, T2DM emerged as an independent factor influencing the time to MACE (adjusted hazard ratio [HR]:1.847, 95% confidence interval [95% CI]: 1.215–2.810, P = 0.004) and repeat revascularization (adjusted HR: 2.093, 95% CI: 1.310–3.344, P = 0.002) in elderly CTO patients, rather than coronary collateralization. Notably, regardless of the quality of CC, elderly patients with T2DM exhibited a poorer prognosis. Conclusions: Elderly patients without T2DM derived greater long-term survival benefits from successful revascularization of CTO compared to those with T2DM. Additionally, good collateralization was associated with a decreased risk of adverse clinical outcomes specifically in Non-T2DM patients.

Patience is key: Association of surgical timing with clinical outcomes in elderly patients with sigmoid volvulus

BackgroundCurrent guidelines for sigmoid volvulus recommend endoscopy as a first line of treatment for decompression, followed by colectomy as early as possible. Timing of the latter varies greatly. This study compared early (≤2 days) versus delayed (>2 days) sigmoid colectomy. Methods2016–2019 NRD database was queried to identify patients aged ≥65 years admitted for sigmoid volvulus who underwent sequential endoscopic decompression and sigmoid colectomy. Outcomes included mortality, complications, hospital length of stay, readmissions, and hospital costs. Results842 patients were included, of which 409 (48.6 ​%) underwent delayed sigmoid colectomy. Delayed sigmoid colectomy was associated with reduced cardiac complications (1.1 ​% vs 0.0 ​%, p ​= ​0.045), reduced ostomy rate (38.3 ​% vs 29.4 ​%, p ​= ​0.013), an increased overall length of stay (12 days vs 8 days, p ​< ​0.001) and increased overall costs (27,764 dollar vs. 24,472 dollar, p ​< ​0.001). ConclusionIn geriatric patient with sigmoid volvulus, delayed surgical resection after decompression is associated with reduced cardiac complications and reduced ostomy rate, while increasing overall hospital length of stay and costs.

Nitroglycerin use and adverse clinical outcomes in elderly patients with acute coronary syndrome

ObjectiveThe primary care for acute coronary syndrome (ACS) includes the administration of nitroglycerin (GTN). This study aimed to investigate the association between the use of GTN before percutaneous coronary intervention...

Influence of high-flow nasal cannulae on clinical outcomes in elderly patients with acute respiratory failure: a prognostic risk factor analysis.

To explore the clinical effects of high-flow nasal cannulae (HFNC) in elderly patients with acute respiratory failure (ARF) and analyze prognostic factors following oxygen therapy. We enrolled 200 ARF patients between January 2022 and June 2023, dividing them into an observation group (n=125) treated with HFNC, and a control group (n=75) receiving conventional oxygen therapy. We compared vital signs before and after treatment and categorized patients into good and poor prognosis groups to analyze demographic data and prognostic factors. Post-treatment, both groups showed improved vital signs, with the observation group experiencing significantly greater improvements (P<0.05). However, the observation group had a higher incidence of complications compared to controls (P=0.001). Patients with a history of endotracheal intubation or high APACHE II scores were more prevalent in the poor prognosis group (both P<0.05). Logistic regression identified the APACHE II score as a risk factor for poor prognosis, while HFNC emerged as a protective factor. HFNC is a safe and effective therapy that improves vital signs and alleviates hypoxia in elderly ARF patients. The APACHE II score and type of oxygen therapy are significant prognostic factors, with HFNC offering a protective effect.

Sarcopenia and risk of malnutrition as risk factors for complications from COVID-19

Purpose: This study aimed to associate nutritional and sarcopenia risk with clinical outcomes in elderly patients with COVID-19. Methods: This is a longitudinal retrospective cohort study. Hospitalized elderly individuals diagnosed with COVID-19 were included in the study. Nutritional risk was assessed using the Malnutrition Universal Screening Tool (MUST), and Sarcopenia risk was assessed using the SARC-F. Associations were assessed throughmultivariable logistic models. Results: In total, 127 patients (mean age: 71.25 ±8.06 years) were followed up until the clinical outcome. Sarcopenia risk was diagnosed in 63.8% of the sample, whereas nutritional risk was observed in 72%. Hospitalization in the intensive care unit (ICU) was required in 48.8% of the sample, 38.6% required mechanicalventilation, and 32.3% died. Elderly individuals with sarcopenia risk were more likely to be hospitalized inICUs (OR: 5.62; 95%CI: 2.2-14.3), require mechanical ventilation (OR: 4.0; 95% CI: 1.5-10.2), and die (OR: 5.06; 95% CI: 1.7-14.2). The risk of malnutrition assessed through MUST was an important risk factor for death (OR = 30.15; 95% CI: 3.6-245.8; p&lt;0.01). Conclusion: Sarcopenia risk was a risk factor for death, hospitalization in ICU, and mechanical ventilation, while nutritional risk was a risk factor for death.

Evaluating the Safety and Outcomes of Oesophagogastroduodenoscopy in Elderly Patients Presenting With Acute Upper Gastrointestinal Bleeding.

In the absence of evidence-based guidelines regarding the safety and appropriateness of emergency endoscopy in elderly, co-morbid and frail patients, we aimed to find clinical outcomes in elderly patients who have undergone gastroscopy following an acute upper gastrointestinal bleeding (UGIB). We carried out a retrospective observational study of patients aged 70 years and older who had undergone emergency oesophagogastroduodenoscopy (OGD) at the Royal Sussex County Hospital, Brighton, United Kingdom, between May 2020 and January 2022. Data collected for analysis included Glasgow-Blatchford score, age, gender, endoscopic findings, endoscopic treatments, immediate complications, 90-day complications, 30-day and 90-day survival, length of hospital stay and re-bleeding. A total of 248 study participants were categorised into two groups: age 70-79 years (n=102) and ≥80 years (n=146). Melaena (n=226, 91%, p=0.0001) was the commonest indication for emergency OGD in both groups, with the majority of patients presenting with a Glasgow-Blatchford score of ≥1 (n=200, 80.6%, p=0.2). Endoscopy findings were normal in 26.4% (n=27) of those 70-79 years and 32% (n=47) of those ≥80 years (p=0.01). Duodenal ulcer, oesophagitis and gastric ulcer were the commonest abnormal findings(n=50,20%; n=29,11.7%; and n=28,11.3%, respectively). Of the participants,93.8% (n=212) had no immediate complications. Bleeding and hypotension occurred in 2.7% (n=6) and 2% (n=5) of patients, respectively. At 90 days post-procedure, 83.3% (n=85) of those 70-79 years and 67.8% (n=99) of those ≥80 years had survived (p=0.180). We conclude that OGD is largely a safe procedure in older adults with acute UGIB; however, the high proportion of OGDs with normal findings reinforces the importance of careful selection of patients.

Is diaphragm ultrasound better than rapid shallow breathing index for predicting weaning in critically ill elderly patients?

Prolonged weaning is associated with worse clinical outcomes in elderly patients. Beside traditional rapid shallow breathing index (RSBI), diaphragm ultrasound is a promising technique to evaluate the weaning process. We aimed to perform diaphragm ultrasonography for predicting the weaning process and its relation with frailty in the critically ill elderly population. We enrolled thirthy-two patients over 65 years of age who were mechanically ventilated for at least 48 hours. Thickness of diaphragm and excursion were evaluated within 48 h of intubation and during spontaneous breathing trial (SBT). Clinical parameters, frailty, diaphragm ultrasound results were compared according to the weaning status. Mean age (standard deviation) was 79.3 ± 7.9 years, and 18 (56.3%) patients were classified as weaning failure. Diaphragmatic excursion during SBT was the only statistically significant parameter associated with weaning failure [2.37 cm (0.67) vs 1.43 cm (0.15), p= 0.0359]. There was no statistically significant difference regarding RSBI between the groups [70.5 (46) vs 127.5 (80), p= 0.09]. Baseline thickness of diaphragm and excursion at SBT were moderately correlated with frailty. Ultrasound can be used to show diaphragm dysfunction in the elderly frail population, and a multifactorial approach to the extubation process may include ultrasound instead of using traditional RSBI alone.

Clinical outcomes in elderly patients with infections caused by NDM-producing Klebsiella pneumoniae: results from a real-life retrospective single center study in an endemic area.

Real-life outcomes data for elderly patients with infections caused by Klebsiella pneumoniae producing New Delhi metallo-beta-lactamase (NDM-Kp) are lacking. We conducted a retrospective cohort study enrolling 33 consecutive adult patients (mean age 77.4years; 48.5% males; mean Charlson Comorbidity Index-CCI 5.9) hospitalized for NDM-Kp infections during a 24-month period in an Italian highly endemic area. 78.8% were admitted to Internal Medicine ward. 45.4% of patients had bloodstream infections (BSI), 39.4% urinary tract infections (UTI) without BSI, 9.1% respiratory tract infections and 6.1% intra-abdominal infections. 93.9% had rectal colonization.Adequate definitive antibiotic therapy (mainly represented by aztreonam plus ceftazidime/avibactam) was provided to 36.4% of cases. Mean age and CCI of patients adequately treated were significantly lower than those inadequately treated (71.2 vs 80.9years, p = 0.041, and 4.6 vs 6.7, p = 0.040, respectively). Patients adequately treated had a mean hospitalization length significantly higher (28 vs 15days, p = 0.016). The overall 30-day survival rate of patients adequately and inadequately treated was 83.3% and 57.1%, respectively: this difference was not statistically significant. Mean age and CCI of 22 patients who survived at 30days were lower than those of 11 patients who died (73.7 vs 84.8years, p = 0.003, and 5.3 vs 7.2, p = 0.049, respectively). Twelve survivors received an inadequate therapy: 8/12 had UTI. Six of nine patients inadequately treated who died within 30days, died before microbiological diagnosis. Our study provides real-life data on outcomes of elderly and multimorbid patients hospitalized for infections caused by NDM-Kp. Further studies with larger sample size are warranted.

Application of cement-augmented pedicle screws in elderly patients with spinal tuberculosis and severe osteoporosis: a preliminary study.

Surgical management of elderly patients with spinal tuberculosis and severe osteoporosis is challenging. Cement-augmented pedicle screws (CAPS) have been specifically designed for elderly patients with osteoporotic spines. Herein, we investigated the feasibility of CAPS applied in elderly patients with spinal tuberculosis and severe osteoporosis. We retrospectively analyzed data of patients with spinal tuberculosis and severe osteoporosis between January 2017 and January 2021. Surgical data, including surgical duration and intraoperative blood loss, were recorded. Radiological parameters, such as correction of regional kyphotic angle and screw loosening, were also evaluated. Additionally, visual analog scores (VAS) and Oswestry disability index (ODI) were used to evaluate back pain and functional recovery, respectively. Erythrocyte sedimentation (ESR) and C-reactive protein (CRP) concentrations were detected to assess tuberculosis activity. The presence of complications and fusion rate was also assessed. A total of 15 patients were included in this study. The surgical duration was 263.0 ± 56.2min, with an average blood loss of 378.7 ± 237.0ml. The correction of regional kyphotic angle was 12.4° ± 15.0°, and it was well maintained until the final follow-up. The mean VAS decreased from 6.0 ± 1.2 points to 0.5 ± 0.6 points, and ODI reduced from 37.8% ± 7.6% to 8.3% ± 2.8% (P < 0.01). At the final follow-up, ESR and CRP levels were within normal range. Bony fusion occurred in all patients, with an average fusion duration of 8.8 ± 1.5months. No cases of pedicle screw pullout, screw loosening, or pseudoarthrosis occurred. Tuberculosis recurrence and dissemination were not observed during the follow-ups. CAPS fixation is an effective and safe technique to achieve solid fixation and favorable clinical outcomes in elderly patients with spinal tuberculosis and severe osteoporosis.