Comorbidities In Elderly Patients Research Articles

Enhancing surgical outcomes in elderly gastric cancer patients: the role of comprehensive preoperative assessment and support

BackgroundAs the prevalence of gastric cancer rises in aging populations, managing surgical risks and comorbidities in elderly patients presents a unique challenge. The Comprehensive Preoperative Assessment and Support (CPAS) program, through comprehensive preoperative assessments, aims to mitigate surgical stress and improve outcomes by enhancing patient awareness and preparation. This study investigates the efficacy of a CPAS program, incorporating frailty and sarcopenia evaluations, to improve short-term outcomes in elderly gastric cancer patients.MethodsA retrospective analysis was conducted on 127 patients aged 75 or older who underwent surgery with CPAS between 2018 and August 2023, compared to 170 historical controls from 2012 to 2017. Propensity score matching balanced both groups based on age-adjusted Charlson Comorbidity Index and surgical details. The primary focus was on the impact of CPAS elements such as rehabilitation, nutrition, psychological support, oral frailty, and social support on short-term surgical outcomes.ResultsAmong 83 matched pairs, the CPAS group, despite 40.4% of patients in the CPAS group and 21.2% in the control group had an ASA-PS score of 3 or higher (P < 0.001), demonstrated significantly reduced blood loss (100 ml vs. 190 ml, P = 0.026) and lower incidence of serious complications (19.3% vs. 33.7%, P = 0.034), especially in infections and respiratory issues. Sarcopenia was identified in 38.6% of CPAS patients who received tailored support. Additionally, the median postoperative hospital stay was notably shorter in the CPAS group (10 days vs. 15 days, P < 0.001), with no in-hospital deaths. These results suggest that personalized preoperative care effectively mitigates operative stress and postoperative complications.ConclusionImplementing CPAS significantly enhances surgical safety and reduces complication rates in elderly gastric cancer patients, emphasizing the critical role of personalized preoperative care in surgical oncology for this demographic.

Dexamethasone treatment in chronic subdural hematoma - a case report

The topic of this research, chronic subdural hematoma (CSH), is one of the most common pathologies in neurosurgery, and it is more frequent in the elderly. Surgical evacuation has been widely considered the gold standard treatment. Despite the excellent outcomes, sometimes some cases require a different approach. The treatment choice depends on the general condition of the patients, as well as the clinical presentation and hematoma volume. Also, preexisting comorbidities in elderly patients, postoperative complications, and the ability to recover must be considered. Consequently, conservative treatment can be effective in carefully selected cases, and can be considered if the patient's neurological and physical conditions allow. Some drugs contribute to CSH resolution by changing the capsule membrane permeability and inhibiting the fibrinolytic and inflammatory systems. Our work is based on the efficacy of dexamethasone as a method of conservative therapy, and it was demonstrated in the case of a 91-year-old patient.

Association between Albuminuria, Glycated Hemoglobin with Comorbidities in Type 2 Diabetes Patients: Experience in Sulaimani City, Iraq

Background: Diabetes nephropathy is one of the most important complications of type 2 diabetes mellitus (T2DM). Albuminuria is an early clinical indicator for investigating diabetes nephropathy. Age, poor glycemic control, long duration of diabetes, and hypertension increase the risk of albuminuria. Objectives: To determine the relationship between albuminuria, HbA1c, and comorbidities in elderly patients with T2DM. Methods: A cross-sectional study was carried out on 136 elderly patients with T2DM at the Diabetes and Endocrine Center in Sulaimani City. Data was obtained from each patient through face-to-face interviews and laboratory tests for HbA1c, serum lipid profiles, and albumin levels in the urine. Results: Out of 136 patients, 82 elderly patients with T2DM were normoalbuminuric, 37 had microalbuminuria, and 17 had macroalbuminuria, respectively. The female gender was at greater risk of developing albuminuria (19.1% microalbuminuria and 6.6% macroalbuminuria) than the male gender (8% microalbuminuria and 5.8% macroalbuminuria). The risk factors for microalbuminuria and macroalbuminuria were poor glycemic control (HBA1c &gt;7.5) (16.9% microalbuminuria and 6.6% macroalbuminuria), long-term diabetes (5–10 years) (13.9% microalbuminuria and 5.1% macroalbuminuria), and coexisting comorbidity conditions (21.3%) microalbuminuria and 10.2% macroalbuminuria, mainly hypertension (20.5% microalbuminuria and 8.8% macroalbuminuria). Conclusion: Our findings showed that the incidence of albuminuria in elderly patients with T2DM was high in patients with poor diabetes control, a long duration of diabetes, and comorbidity conditions, particularly in patients with hypertension.

Effect of white matter hyperintensities and amyloid on neurodegenerative change and cognitive trajectory in cognitively unimpaired older adults

AbstractBackgroundOverwhelming evidence of association between amyloidosis and neurodegeneration, particularly in the hippocampus, has been reported. However, the recognition of cerebrovascular disease (CVD), the most common comorbidity in elderly patients with dementia2, as a contributor to neurodegeneration process has remained modest. The objective of this study is to investigate the contributions of amyloidosis, as measured by amyloid PET, and CVD, as reflected by white matter hyperintensity (WMH), on neurodegenerative change and how their combination impacts cognitive trajectory in cognitively unimpaired (CU) individuals.Method139 CU participants from the University of California, Davis Alzheimer’s Disease Research Center diversity cohort received at least two cognitive assessments and underwent a PET exam at baseline, and baseline and follow‐up MRI imaging (Table 1). Z‐score measures of DVR19 and SUVR20 values were used as measure of baseline amyloid beta (Aβ) burden. Baseline WMH volume was log‐transformed and regressed against intracranial volume (TCV). Four markers of neurodegeneration were used, including hippocampal volume (regressed against TCV), mean cortical GM thickness and two cognitive‐related signature region of interest (sROI), including episodic memory and executive function. We used structural equation modeling (SEM) analyses (Figure 1) to investigate associations between cognitive performance trajectories (∼6 years), including episodic memory and executive function, and baseline Aβ, baseline WMH and change in the four neurodegeneration markers.ResultSEM analysis revealed significant effects of increased baseline Aβ and greater baseline WMH on accelerated decrease in neurodegeneration marker measures in all models (Figure 2). Increased baseline amyloid and WMH, but not neurodegenerative change measures, were also associated with accelerated decline in episodic memory performance (pvalues&lt;0.05, Figure 2, panels A‐C‐E). Finally, increased baseline Aβ and accelerated decreased in cortical GM and sROI thickness were found to be associated with accelerated decline in executive function (pvalues&lt;0.05, Figure 2, panels B‐D‐F).ConclusionOur findings suggest that both CVD and amyloidosis simultaneously impact neurodegenerative change and that these pathologies are associated with cognitive trajectories, but the dynamics of these trajectory are different for executive and memory, suggesting different early path of vulnerability for these domains and emphasizing the need to thoroughly understand the interaction between amyloidosis, CVD, and neurodegeneration.

Psychocognitive dysfunction in comorbid patients in the post-COVID period

Introduction. Currently, psychopathological symptoms are noted in a third of patients with COVID-19, according to published systematic reviews. Aim. To study psychocognitive function in comorbid patients depending on the coronavirus infection caused by SARS-CoV-2.Material and methods. The observational analytical cohort study included 223 patients with AF and comorbidity (ischemic heart disease, arterial hypertension, obesity, type 2 diabetes mellitus) aged 60–74 years, who were divided into 2 groups: 1st – 123 patients without COVID –19 and 2nd – 110 patients with a history of COVID-19 and the presence of PCS. The group of patients with a history of COVID-19 was retrospectively divided into 2 groups depending on the intake of sulodexide; patients in the subgroups were comparable. The work assessed psychological disorders (anxiety and depression) and cognitive status using specialized scales «HADS» and «SPMSQ».Results. In patients with COVID-19, compared with patients from group 1, there is a more pronounced depressive syndrome (p&lt;0.001); subclinical depression in 26% of patients (p&lt;0.001) and the absence of the latter in group 1; clinically pronounced depression was found in 15% (p=0.007). At the same time, the severity of subclinical symptoms of anxiety syndrome was noted in patients without COVID-19, and clinically significant anxiety was more often observed in recovered patients, although statistical significance was not achieved. When assessing cognitive function, it was found that moderate dysfunction was observed in patients with COVID-19 significantly more often (p=0.001). In the sulodexide group, only mild cognitive dysfunction was detected (14%), and the majority of patients taking sulodexide had no cognitive dysfunction.Conclusion. Thus, in comorbid elderly patients in the post-COVID period, an increase in the number of people with psychocognitive disorders was noted. In this regard, long-term follow-up of patients who have undergone COVID-19 is necessary, both for the dynamic assessment of underlying diseases and the analysis of psychocognitive status. In addition, it should be noted that the drug sulodexide, consisting of a heparin-like fraction and dermatan sulfate, has many pharmacodynamic (anti-inflammatory, angioprotective, anticoagulant, antifibrotic) and pharmacokinetic advantages (safety, the possibility of oral administration) can effectively prevent the development of cognitive dysfunction, which requires even further in-depth research.

Identification and evaluation of cases of polypharmacy and irrational pharmacotherapy in Georgia

Abstract Background Medical practice sometimes involves the prescription of multiple medications (5 or more) at once, known as polypharmacy. Most frequently it occurs when a patient receives care from multiple doctors as a result of poly morbidity. The study aimed to identify polypharmacy cases (prescribing 5 or more than 5 medications) and irrational pharmacotherapy. Methods Polypharmacy and irrational pharmacotherapy cases in Georgia from 1 July to 30 September 2021 were evaluated using an electronic prescription system. The total number of polypharmacy was 7665, where 5 or more medications were prescribed. Out of 7665 cases, 612 (8%) were irrational pharmacotherapy that was assessed according to Beers criteria (American Geriatrics Association, 2015) and STOP/START criteria (recommendations of the Great Britain National Health Organization, NHS, 2014). Results Out of 612 cases 95 (15.6%) indicated irrational prescription (2 or more drugs) containing the same active ingredient under different trade names, which represented 1.2% of the total number of prescriptions; out of 612 cases 72% (440) and 5.9% out of a total number of cases the simultaneous appointment of drugs of the same and/or similar pharmacological group was detected. In 9.4% of cases (57) non-rational pharmacotherapy (an incompatibility of drugs) was revealed that was 0.8% of the total cases; out of 612 cases 20, or 3%, and 0.3% of the total cases showed that the prescription contained more than 2 antibiotics. Conclusions Medical polypharmacy is widespread in Georgia, especially in co-morbid elderly patients, which further increases their morbidity and mortality rates. The obtained results could be used to increase the efficiency of treatment, improve the population's health and reduce treatment costs. Key messages • The selection drug or combination of drugs is a complex process and requires justification of the appropriateness of the prescription for a particular patient. • A major goal of the best clinical practice is to optimize the use of medical preparations, improve quality of life and reduce expenses on drugs.

COMPARATIVE STUDY OF ERECTOR SPINAE PLANE BLOCK VERSUS SYSTEMIC ANALGESIA FOR INTERLOCKING NAIL IN INTERTROCHANTERIC FRACTURE OF FEMUR: A RANDOMIZED CONTROLLED INTERVENTIONAL STUDY

Objective: The geriatric population is prone to multiple comorbidities, and their fragile bones and unsteadiness make them susceptible to fractures, commonly observed in the wrist and proximal end of the femur. Internal fixation of fractures under central neuraxial block allows for early mobilization. However, the presence of comorbidities in elderly patients puts them at higher risk for anesthesia and surgery.&#x0D; Methods: To manage postoperative pain following surgery for proximal femur fracture, opioid-sparing multimodal analgesia techniques are employed. Regional anesthesia techniques such as fascia iliaca block, femoral nerve block, and quadratuslumborum block are utilized as part of a multimodal approach. Pain is subjective, and the inability to communicate does not negate the need for appropriate pain relief.&#x0D; Results: Postoperative pain, if poorly managed, can result in complications, prolonged recovery, and chronic pain with reduced quality of life. Effective pain relief enhances patient satisfaction, reduces hospital stays and costs. Inadequate pain control activates the sympathetic nervous system, increases hormonal response, and contributes to adverse events. Opioids, though common, pose risks and adverse effects.&#x0D; Conclusion: The erector spinae plane block (ESPB) is a safe and easy-to-perform technique for postoperative pain management. It involves ultrasound-guided deposition of local anesthetic, allowing effective spread. Previous studies have shown its effectiveness for thoracic pain relief. This study evaluated lumbar ESPB and compared it with systemic analgesics in terms of ease of positioning and postoperative pain control.

Relationship Between Medical Therapy, Long-Term Care Insurance, and Comorbidity in Elderly Patients With Heart Failure With Systolic Dysfunction.

Although guideline-directed medical therapy (GDMT), including β-blockers, angiotensin-converting enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARBs), and mineralocorticoid receptor antagonists (MRAs), improves survival and quality of life, most patients with heart failure with reduced (HFrEF) and mildly reduced (HFmrEF) ejection fraction are treated with inadequate medications. We investigated the prescription patterns of GDMT in elderly patients with HFrEF and HFmrEF and their characteristics, including the certification of long-term care insurance (LTCI), which represents frailty and disability.Methods and Results: This retrospective cross-sectional study analyzed 1,296 elderly patients with symptomatic HFrEF and HFmrEF with diuretic use (median age 78 years; 63.8% male; median left ventricular ejection fraction 40%). Prescription rates of GDMT were inadequate (ACEi, ARBs, β-blockers, and MRAs: 27.0%, 30.1%, 54.1%, and 41.9%, respectively). LTCI certification was independently associated with reduced prescription of all medications (ACEi/ARB: odds ratio [OR] 0.591, 95% confidence interval [CI] 0.449-0.778, P=0.001; β-blockers: OR 0.698, 95% CI 0.529-0.920, P<0.001; MRAs: OR 0.743, 95% CI 0.560-0.985, P=0.052). Patients with LTCI certification also had a high prevalence of polypharmacy and prescription of diuretics. Vulnerable patients with LTCI may be an explanation for the challenges in implementing GDMT, and communicating is required for favorable heart failure care in this population.

Outcomes of transcatheter aortic valve replacement in patients with and without amyloidosis: A nationwide analysis from the United States

BackgroundAmyloidosis is a common comorbidity in elderly patients with aortic stenosis (AS) referred for transcatheter aortic valve replacement (TAVR). This study aims to assess the impact of amyloidosis on the clinical outcomes of TAVR. MethodsThis is a retrospective study of the National Inpatient Sample database that identified adult patients (≥18 years) with AS hospitalized for TAVR from 2016 through 2020 to compare outcomes in those with versus without amyloidosis. Our primary outcome was in-hospital mortality. Secondary outcomes included procedural complications, hospital length of stay (LOS), and total costs. TAVR trends in both cohorts were also evaluated. ResultsThe total cohort included 304,710 patients with AS undergoing TAVR, of whom 410 had amyloidosis. Over the study period, TAVR trends increased significantly in patients with and without amyloidosis (both ptrend < 0.01). Patients with amyloidosis were more likely to be older males with atrial fibrillation/flutter, congestive heart failure, renal disease, and dementia compared to non-amyloidosis patients. After adjustment for baseline characteristics, patients with amyloidosis had similar odds of in-hospital mortality (adjusted odds ratio [aOR] 1.66, 95 % confidence interval [CI] 0.34–3.63), heart block (aOR 1.33, 95 % CI 0.84–2.10), permanent pacemaker insertion (aOR 0.67, 95 % CI 0.27–1.66), stroke (aOR 0.90, 95 % CI 0.32–3.13), acute kidney injury, major bleeding, blood transfusion, vascular complications, in addition to similar LOS (p = 0.21) and total costs (p = 0.18) compared to patients without amyloidosis. ConclusionIn patients with AS undergoing TAVR, comorbid amyloidosis is associated with similar in-hospital mortality and procedural complications compared to patients without amyloidosis.

Lessons Learnt from the Management of Severe COVID-19 Disease in a 93-year-old with Chronic Co-Morbidities at a Resource-constrained Centre in Nigeria – A Retrospective Single Case Study

Introduction: Severe COVID-19 infection is associated with significant mortality in the elderly. This is even more so, when the elderly patient with the disease also has multiple chronic co-morbidities, and is resident in a resource-constrained area.&#x0D; Aims/ Objectives: To outline management strategies employed, and important lessons learnt from the successful management of a case of severe COVID-19 disease in a 93-year-old with chronic co-morbidities in a resource-limited setting.&#x0D; Methods: We utilized a simple COVID-19 severity categorization algorithm on presentation, to assign the index patient to the appropriate COVID-19 disease severity class and subsequently employed patient’s serial, weekly clinical and laboratory parameters to guide a multi-specialty management protocol.&#x0D; Results: A 93-year-old man was referred to a tertiary hospital in Enugu during the second wave of the COVID-19 pandemic, with a 5-day-history of high grade fever, severe fatigue, and altered sensorium. He had been living with diabetes for 48years; recently had worsening glycemic control, and was yet to pass urine in the previous 12hours. He was also being managed conservatively for prostate carcinoma. Examination revealed signs of severe pneumonia and he was drowsy, dehydrated, and had asterixis. A diagnosis of acute kidney injury from septicemia, following community acquired pneumonia and possibly urinary tract infection was made, with COVID-19 infection as a differential. Samples were collected for laboratory investigations while he was recommended for intensive care unit admission for further care. Para-enteral broad spectrum antibiotics, intravenous fluid therapy, intranasal oxygen therapy, basal-bolus-insulin-regimen, and anti-coagulation prophylaxis were instituted. Following laboratory investigation results which included a positive COVID-19 test (clinically categorized as severe disease), severe systemic inflammation, evidence of uro-tract infection, intravascular thrombosis and severe renal impairment, the Nephrology, Infectious disease, Urology teams were invited to co-manage the patient alongside the Endocrinologists. After 27days of collaborative care, patient was discharged with resolution of his symptoms and signs.&#x0D; Conclusion: Multi-specialty collaborative care improves patients’ outcome even in the face of severe COVID-19 with associated co-morbidities in elderly patients. Severity stratification ensures life-saving timely care for severe COVID-19 disease.

EPH35 Comorbidities in Elderly Patients with Oral Corticosteroid-Dependent Asthma in South Korea

To examine the adverse effects of oral corticosteroid (OCS) on elderly asthma patients in South Korea, we aimed to estimate the prevalence and odds of potential OCS-related comorbidities in OCS-dependent asthma patients compared with patients who did not use OCS.

COVID-19'lu Yaşlı Hastalarda Komorbidite, Laboratuvar Bulguları ve Klinik Sonuçların Değerlendirilmesi

Background: In this study, we aimed to analyze the underlying diseases, laboratory findings and clinical outcomes of elderly patients infected with COVID-19. We also investigated the value of laboratory parameters in the estimation of critical cases and mortality in elderly patients. Materials and Methods: The study included 314 elderly patients aged 60 years and older who were diagnosed with COVID-19.The patients were divided into two groups according to age, as young old patients (60-74 years) and old old patients (≥75 years). Participants' age, gender, underlying diseases, laboratory findings, disease severity and survival data were obtained from hospital records. Results: The most common comorbidities in elderly patients were hypertension (57.6%), diabetes mellitus (33.8%) and cardiovascular disease (28%). Old old patients had higher rates of critical type (63.4% vs 30.8%, P&amp;lt;0.001) and death (41.9% vs 21.3%, P&amp;lt;0.001) compared to young old patients. The leukocyte count, neutrophil count, urea, creatinine, C-reactive protein (CRP), procalcitonin, ferritin, troponin T, creatine kinase-MB, prothrombin time and D-dimer values were higher in the old old group compared to the young old group. In contrast, hemoglobin and albumin values were lower in the old old group. The areas under the curve (AUC) of albumin, CRP, procalcitonin, ferritin, troponin T and prothrombin time were greater than 0.80 to predict critically elderly COVID-19 patients. Ferritin had the highest AUC for predicting death (AUC: 0.819) followed by CRP (AUC: 0.805) and procalcitonin (AUC: 0.796). Conclusions: We found higher rates of critical type and death in old old patients compared to young old patients. In addition, ferritin, CRP, and procalcitonin were strong predictors of both disease severity and mortality in COVID-19-infected elderly subjects.

Prevalence of Ocular Comorbidities in Elderly Patients with Multiple Myeloma in the US: An Analysis of 100% Medicare Sample Data during 2007-2020

Background Multiple myeloma (MM) predominantly affects older patients (median age at diagnosis 69 years [Padala SA, Barsouk A, Barsouk A, Rawla P, Vakiti A, Kolhe R, Kota V, Ajebo GH. Epidemiology, staging, and management of multiple myeloma. Medical Sciences. 2021 Jan 20;9(1):3]) in whom comorbidities are prevalent. Some anti-MM therapies can be associated with ocular toxicities and require careful attention when used among patients with pre-existing ocular comorbidities (OCs). A study found that 39% of adult (>18 years of age) MM patients had pre-existing OCs (e.g., disorders of lens, glaucoma) and the prevalence increased with age. Given the potential implication of comorbid OCs on MM treatment decisions, this study aimed to describe the annual prevalence of OCs among Medicare beneficiaries with MM during 2007-2020 in the US. Methods Using a 100% sample of Medicare claims data, beneficiaries ≥65 years with newly diagnosed MM (NDMM; defined as the first MM diagnosis after a 1-year clean period) who received up to 4 lines of systemic therapies (LOT) for MM during 2007-2020 were selected. The following cohorts were identified: NDMM patients, NDMM patients who received 1L treatment, relapsed/refractory MM (RRMM) patients who initiated 2L, 3L or 4L treatment. The index date was the date of NDMM diagnosis or LOT initiation date. Patients were required to have ≥12 months of continuous Medicare enrollment before the index date. LOT was defined based on a clinically validated adaptation of published algorithms. A non-MM general population control cohort was also selected by matching to the 1L initiator cohort by age group (i.e., 65-74, 75-84, and ≥85), sex, and race, with a randomly selected medical claim date as the index date. Patients were considered to have an OC if they had a claim with any OC ICD-9/10 diagnosis codes in the 12 months prior to index date. OCs (e.g., disorders of conjunctiva, lens, choroid, retina, glaucoma) were considered potentially MM-related disease manifestations or MM treatment-related toxicity based on published literature and clinical expert opinion. The prevalence of OCs, defined by the percent of patients with ≥1 OC among all eligible patients in a cohort, was reported by age group, sex, race, and index year. Results The median age for NDMM was 76.5 years (N=122,991). Among patients who received treatment, the median age was 75.8, 76.4, 77.0, and 77.5 years at 1L, 2L, 3L, and 4L initiation. About half of patients (49.1-51.3% across groups) were women, and 79.9-84.4% were White. The mean modified Charlson Comorbidity Index (excluding malignancy conditions) was 2.1 among NDMM and 1.9 among treated patients. Proteasome inhibitors and immunomodulatory drugs were the most used treatments in all LOTs and monoclonal antibody therapies were more commonly used in later LOTs (3.2% in 1L vs. 30.8% in 4L). The prevalence of OCs among NDMM was 60.0% (Table 1). Among treated patients, the prevalence of OCs was 58.7% at 1L initiation, compared to 55.8% in the matched general population, and even higher in RRMM patients (61.7%, 63.3%, and 64.8% prior to 2L, 3L, and 4L initiation, respectively). This trend was observed across all OC categories, among MM-related OCs, and across all age groups. The most prevalent OCs were disorders of lens (32.9% in NDMM, 33.4% in 1L initiators, and 32.3% in general population) and disorders of choroid and retina (22.9% in NDMM, 21.6% in 1L initiators, and 19.6% in general population). The prevalence of disorders of eyelid, lacrimal system, and orbit had the greatest increase from 1L (17.0%) to 4L (23.9%), followed by disorders of lens (from 33.4% in 1L to 36.8% in 4L). Women and White patients had a higher prevalence of OCs than men and minorities, respectively, in all LOTs and the prevalence increased with age. The prevalence of OCs by LOT was stable over the years (Figure 1). Conclusions Sixty percent of newly diagnosed multiple myeloma patients among US Medicare beneficiaries have an existing ocular comorbidity at diagnosis. Prevalence of OCs, especially MM and MM treatment-related OCs, is higher among patients who are treated than the general population and the prevalence increases with advancing lines of therapy. Ocular comorbidities are more prevalent among White than among African American, Asian and Hispanic patients and among women than men. Given the magnitude, ocular comorbidities should be factored into the treatment decisions for the elderly patients with MM. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Combination of ibrutinib and venetoclax followed by Chimeric Antigen Receptor T-cell therapy in the first line of treatment in an elderly patient with mantle cell lymphoma with hyperleukocytosis and mutation in the TP53 gene

Introduction. The tactics of therapy for elderly comorbid patients with mantle cell lymphoma with unfavorable prognosis factors (complex karyotype, 17p13 deletion, mutations in the TP53 gene) have not been developed. The use of intensive chemotherapy regimens and transplantation of allogeneic hematopoietic stem cells (allo-HSCT) is impossible due to severe comorbidity in elderly patients. A rational approach is the use of a combination of ibrutinib and venetoclax. As an alternative to allo-HSCT, a new option for elderly patients with poor prognostic factors is Chimeric Antigen Receptor T-cell therapy (CAR-T) cell therapy.Aim — to present the experience of using ibrutinib and venetoclax with CAR-T-cell therapy in the first line of treatment in an elderly patient with MCL with a mutation in the TP53 gene and hyperleukocytosis.Main findings. Patient M., 68 years old. The examination revealed hyperleukocytosis 978 × 109/L, anemia (55 g/L), thrombocytopenia (30 × 109/L), and splenomegaly 250 × 180 mm. According to the results of laboratory studies, the diagnosis of lymphoma from mantle cells with a complex karyotype, deletion 17p13, 13q14 and mutation p.R248W in exon 7 of the TP53 gene (VAF = 26 %) was verified. For cytoreductive purposes, two sessions of leukocytapheresis and prephase with cyclophosphamide (200 mg/m2) and dexamethasone (10 mg/m2) were performed. From day 3, therapy with ibrutinib 420 mg/day and venetoclax 100 mg/day was started. After 2 days, the leukocytes were 0.7 × 109/L, and the size of the spleen decreased, as a result of which the development of tumor lysis syndrome was noted. As a result of intensive therapy, the patient’s condition stabilized, which allowed him to resume treatment. After 7 days, the number of leukocytes was 2.5 × 109/L, neutrophils — 70 %, platelets — 90 × 109/L, hemoglobin — 95 g/L. According to immunophenotyping, the population of B-lymphocytes was 4 %. According to NGS data, the allelic load of the mutation in the TP53 gene is 0.8 %. The patient underwent anti-CD19 CAR-T-cell therapy and achieved complete remission. Three months after therapy, MRD remains-negative remission and the persistence of CAR-T cells is determined.

Analysis of the structure of drug prescriptions in patients with arterial hypertension and atrial fibrillation in conditions of comorbidity and their compliance with the STOPP/START criteria

Background. Arterial hypertension (AH) is often associated with type 2 diabetes mellitus (DM2), is one of the leading modifiable risk factors for cardiovascular disease, atrial fibrillation (AF), chronic kidney disease (CKD). Progression of renal dysfunction is a powerful predictor of the onset of AF in patients with high blood pressure. Irrational prescription of drugs is a risk factor for adverse drug reactions, which is especially important for elderly patients and leads to an increased risk of adverse clinical outcomes.Objective. To analyze the concordance of pharmacotherapy with the STOPP/START criteria in comorbid elderly patients with AH and combined DM2, CKD and AF treated in a multidisciplinary hospitals.Design and methods. Included data from medical records of 1600 patients aged ≥ 65 years with AH and/or AF admitted to multidisciplinary hospitals in Moscow from July 1, 2018 to June 30, 2019. Patients were divided into two groups — (1) AH in combination with AF (n = 822, women — 73%, median age 87 [79; 90]) and (2) control group (n = 778, women — 79,9%, median age 78 [71; 85]) Evaluation of the appointment of drugs was made according to the “STOPP/START” criteria.Results. The number of patients who were not prescribed the recommended drugs was statistically significant (p &lt; 0,001) and higher in the AH + AF group (785 people, 95,5%) compared to the control group (623 people, 80,1%). The number of patients who were prescribed potentially non-recommended drugs was similarly statistically significant (p &lt; 0,001) higher in the AH + AF group (439, 53,4%) compared to the control group (328, 42,2%). The most common START criteria were: 1. Statins with a documented history of coronary, cerebral or peripheral vascular disease (in the AH + AF group — 672, 81,8% of the number of patients in the group; in the control group — 464, 59,6%; p &lt; 0,001) 2. Clopidogrel in patients with ischemic stroke or a history of peripheral vascular disease (c respectively, 324, 39,4% and 237, 30,5%; p &lt; 0,001) 3. Warfarin/direct oral anticoagulants in AF (in the group AG + FP — 294, 35,8%). The most common STOPP criteria were: 1. Drugs that can increase constipation in chronic constipation, if there is a more suitable alternative (in the AH + AF group — 160, 19,5% of the number of patients in the group; in the control group — 47,6%; p &lt; 0,001). 2. Drugs with anticholinergic activity in chronic constipation (respectively, 111, 13,5% and 74, 9,5%; p = 0,013). 3. Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers in patients with hyperkalemia (respectively, 26, 3,2 % and 94, 12,1%; p &lt; 0,001). Similar results were obtained in the analysis of subgroups of AH + AF with concomitant DM2, CKD and without them.Conclusions. The results obtained dictate the need to optimize pharmacotherapy in elderly and very old patients with AH and comorbidities in a hospital setting. In practice, START criteria are more common than STOPP, that is, in reality, the necessary drugs are often not prescribed where they are indicated and drugs with an unfavorable safety profile are prescribed relatively rarely in elderly and senile patients.

Camara] Influencia de las comorbilidades en la decisi�n del tratamiento invasivo en ancianos con SCASEST

Introduction and objectives: The presence of comorbidities in elderly patients with non-ST-segment elevation acute coronary syndrome worsens its prognosis. The objective of the study was to analyze the impact of the burden of comorbidities in the decision of using invasive management in these patients. Methods: A total of 7211 patients > 70 years old from 11 Spanish registries were included. Individual data were analyzed in a common database. We assessed the presence of 6 comorbidities and their association with coronary angiography during admission. Results: The mean age was 79 ± 6 years and the mean CRACE score was 150 ± 21 points. A total of 1179 patients (16%) were treated conservatively. The presence of each comorbidity was associated with less invasive management (adjusted for predictive clinical variables): cerebrovascular disease (OR, 0.78; 95%CI, 0.64-0.95; P = .01), anemia (OR, 0.64; 95%CI, 0.54-0.76; P < .0001), chronic kidney disease (OR, 0.65; 95%CI, 0.56-0.75; P < .0001), peripheral arterial disease (OR, 0.79; 95%CI, 0.65-0.96; P = .02), chronic lung disease (OR, 0.85; IC95%, 0.71-0.99; P = .05), and diabetes mellitus (OR, 0.85; 95%CI, 0.74-0.98; P < .03). The increase in the number of comorbidities (comorbidity burden) was associated with a reduction in coronary angiographies GRACE score: 1 comorbidity (OR, 0.66; 95%CI, 0.54-0.81), 2 comorbidities (OR, 0.55; 95%CI, 0.45-0.69), 3 comorbidities (OR, 0.37; 95%CI, 0.29-0.47), 4 comorbidities (OR, 0.33; 95%CI, 0.24-0.45), ≥ 5 comorbidities (OR, 0.21; 95%CI, 0.12-0.36); all P values < .0001 compared to 0. Conclusions: The number of coronary angiographies performed drops as the number of comorbidities increases in elderly patients with non-ST-segment elevation acute coronary syndrome. More studies are still needed to know what the best management of these patients should be.

The Association between Comorbidities and Comorbid Injuries on Treatment Outcome in Pediatric and Elderly Patients with Injuries in Korea: An Observational Study.

We aimed to compare the characteristics and types of injuries affecting pediatric and elderly patients and to identify factors associated with treatment outcomes. We used data from the 2006–2017 Korea National Hospital Discharge Survey. The patients were divided into two groups, children (0–12 years) and elderly (≥65 years), based on their age at discharge. In total, 47,528 (11,842 children and 35,686 older adults) patients with injuries were identified. The number of deaths and the LOS were 36 (0.3%) and 7.6 days (±10.1), respectively, in the children group, and 861 (2.4%) and 18.5 days (±27.3), respectively, in the elderly group (p < 0.001). In the children group, there were increased odds for surgery among boys, Medicaid and health insurance subscribers, patients with multiple injuries, patients without a subdiagnosis, and an increasing number of hospital beds. In the elderly group, there were increased odds for surgery among women, Medicaid and health insurance subscribers, patients who died, patients with a single injury, patients with a subdiagnosis, and increasing numbers of hospital beds. Treatment outcomes could be improved by providing early diagnosis and prompt treatment in pediatric patients and by taking multilateral approaches for multiple injuries and comorbidities in elderly patients.

Medical Management of Common Comorbidities in Elderly Patients with Proximal Femur Fractures

Objectives: Provide a framework for the medical treatment of patients with proximal femur fractures. Design: Literature review and evidence based note template. Intervention: Medical management of patient undergoing operative fixation of proximal femur fracture. Main outcome measurement: Perioperative morbidity. Results and conclusions: Proximal femur fractures are common orthopaedic injuries in the geriatric population and present with morbidity and portend mortality. The current evidence suggests that most patients should be surgically managed 24-48 hours from injury in accordance with patient preferences and medical risk stratification. Doing so is likely to improve postoperative outcomes and save both patients and hospital systems financial resources. After proper history and physical examination, imaging with plain radiographs is recommended, with MRI indicated in occult fractures. There are numerous cardiovascular, cognitive, and endocrinologic comorbidities that may delay or impact surgical treatment of hip fracture patients. This review discusses informed consent, cardiovascular implantable electronic devices, anticoagulation, preoperative cardiovascular evaluation, anemia, congenital heart disease, cerebrovascular accident, hyponatremia, diabetes mellitus, end-stage renal disease, osteoporosis, COVID-19 and chronic obstructive pulmonary disease, and history of bariatric surgery. A proper understanding of how these conditions affect hip fracture patients may help orthopaedic surgeons to expedite surgery safely and effectively and may also serve as a framework in the management of other fragility fractures in patients with comorbidities. Level of Evidence: IV, systematic review Keywords: Hip Fracture, Medical co-management, Geriatrics, Fragility fracture, Osteoporosis, Comorbidity, Comorbidity management, Anesthesia, Perioperative morbidity, Cardiovascular, Cerebrovascular, Renal disease, Surgical timing. (J Ortho Business 2022; Volume 2, Issue 2

Clinical Profile and Factors Affecting Outcomes in Elderly Patients Admitted to the Medical Intensive Care Unit of a Tertiary Care Hospital.

BackgroundIn recent years, there is an increase in the proportion of the elderly population in the world. With an increase in patients' age, there is a change in the comorbidities and causes for Intensive care unit (ICU) admissions. More studies are needed to redefine healthcare delivery to elderly patients admitted to ICU.AimsThe aims are to assess the disease pattern and outcome in elderly patients admitted to the Medical ICU and to determine factors affecting the outcomes in elderly patients admitted to the Medical ICU.MethodsThis was a retrospective cross-sectional study conducted in the Medical ICU of a tertiary care hospital for six months. Patients who met inclusion and exclusion criteria were included in this study. Data collected from medical records were statistically analysed.ResultsOut of 859 newly admitted patients to the Medical ICU, 196 (22.81%) were elderly patients (age > 60 years). The mean age of elderly patients was 69.8 ± 7.65 years. The mortality rate in elderly patients aged > 60 years was 36.70%, which was higher when compared to 23.60% in patients aged ≤ 60 years, and the correlation was statistically significant (p<0.0001). Neurological disorders (42.8%) were the most common cause of admissions, followed by renal disorders (13.26%), respiratory diseases (9.7%), and infections (9.18%). Deaths due to neurological disorders were most common (43.66%) followed by renal disorders (14.08%), infections (11.26%), and respiratory diseases (7%). The mean number of comorbidities in elderly patients was 1.99 ± 1.21. The mortality rate in elderly patients with more than three comorbidities was 56.52%, which was higher when compared to 33.52% in elderly patients with comorbidities ≤3, and the correlation was statistically insignificant (p=0.1275). The mean length of ICU stay in elderly patients was 9.14 ± 6.73 days. The length of stay in ICU was prolonged in patients with more number of comorbidities, which was statistically significant (p<0.0001). The mortality rate was higher in patients with prolonged length of stay, and the correlation was statistically significant (p=0.0013).ConclusionThe insight over the proportion of older patients admitted to the ICU will enable policy-makers to plan accordingly. Mortality in elderly patients was high. Hence there is a need to redefine healthcare delivery to elderly patients in terms of triage and level of care in ICU. For better outcomes, risk categorisation can be done based on the number of comorbidities for optimal care. Exclusive geriatric intensive care units were needed for better care of elderly patients.

SYNDROM OFSENILE ASTHENIA AS A COMORBID STATE IN A MULTISPECIALITY HOSPI

Among one of age-associated diseases, the syndrome of senile asthenia is increasingly common. The massive spread of senile asthenia syndrome among elderly patients forces us to look for new approaches to the treatment and diagnosis of this syndrome and other pathologies of organs and systems. The purpose of this study is: to determine the incidence and structure of comorbid pathology in patients with senile asthenia syndrome followed by the study of the clinical significance in the development of adverse complications in this category of patients. According to a retrospective analysis of hospitalized patients with senile asthenia syndrome and various comorbid conditions, it was revealed that in the structure of chronic non-infectious diseases, arterial hypertension took the first place among cardiovascular diseases — 130 (100%). The second place among comorbid pathology was taken by chronic heart failure — 84% of cases. Ischemic heart disease was detected in 97 people (74%). Also, a significant place in the structure was taken by chronic kidney disease — 54 (41.5%), degenerative-dystrophic changes in the joints in 123 (94%) cases. Thus, in the course of the study, it was revealed that senile asthenia syndrome is highly common among comorbid elderly patients. In addition, there is a certain relationship between senile asthenia syndrome and other age-related conditions, which undoubtedly affects the life expectancy and quality of life.