Elderly Male Patients Research Articles

Mitochondrial Dysfunction Contributes to Aging-Related Atrial Fibrillation.

The incidence of atrial fibrillation (AF) increases with age, and telomere length gradually shortens with age. However, whether telomere length is related to AF is still inconclusive, and the exact mechanism by which aging causes the increased incidence of AF is still unclear. We hypothesize that telomere length is correlated with aging-related AF and that mitochondrial dysfunction plays a role in this. This research recruited 96 elderly male patients with AF who were admitted to the Second Medical Center of Chinese PLA General Hospital from April to October 2018. After matching by age and gender, 96 non-AF elderly male patients who were admitted to the hospital for physical examination during the same period were selected as controls. Anthropometric, clinical, and laboratory analyses were performed on all subjects. The mitochondrial membrane potential (MMP) of peripheral blood leukocytes was detected as the indicator of mitochondrial function. Compared with the control group, the leukocyte telomere length (LTL) was significantly shorter (P < 0.001), and the level of PGC-1α in serum was significantly lower in AF patients. Additionally, in subjects without any other diseases, the AF patients had lower MMP when compared with the control. Multivariate logistic regression confirmed that LTL (OR 0.365; 95% CI 0.235-0.568; P < 0.001) and serum PGC-1α (OR 0.993; 95% CI 0.988-0.997; P = 0.002) were inversely associated with the presence of AF. In addition, ROC analysis indicated the potential diagnostic value of LTL and serum PGC-1α with AUC values of 0.734 and 0.633, respectively. This research concludes that LTL and serum PGC-1α are inversely correlated with the occurrence of aging-related AF and that mitochondrial dysfunction plays a role in this.

Testosterone target therapy: focus on immune response, controversies and clinical implications in patients with COVID-19 infection.

The pandemic acute respiratory syndrome coronavirus 2 (SARS-CoV-2) named COVID-19 is causing a severe health emergency, and an individual’s hormonal milieu may play an important role in both susceptibility to infection and severity of clinical course. We analyzed the role of testosterone in the immune response, and we hypothesized possible mechanisms to explain the high incidence of COVID-19 infection and a worse clinical course in elderly male patients. Testosterone may impair the immune response, and this effect could explain the greater susceptibility of men to infection. Transmembrane serine protease 2 (TMPRSS2) plays a crucial role in the entry of the virus into the respiratory epithelial cells, leading to COVID-19 disease. It is crucial to emphasize that testosterone levels and chemical castration (e.g. by androgen deprivation therapy for prostate cancer) may have contrasting roles in the phases of COVID-19 infection. Whereas low testosterone levels may be protective against the initial susceptibility (due to a restoration of immunological functions and a block of TMPRSS2), low testosterone may stimulate a worse clinical course in the advanced COVID-19 infection as it could exacerbate or activate the cytokine storm. If testosterone levels play these different roles, it is necessary to carefully identify patients for any indicated testosterone manipulation.

Mortality Profile of Critical Patients in Medical Intensive Care Unit of Government Medical College of Central India

Introduction: Mortality rate is always very high in Intensive Care Units (ICU) even with the best possible set ups, we should try to cater the need of the society according to the disease burden so that better care can be provided. Aim: To estimate the prevalence of various medical disease mortality profile of critically ill patients admitted in Medical Intensive Care Unit (MICU) of our institution. Materials and Methods: This was a retrospective observational study done at MICU of Bundelkhand Medical College and Hospital Sagar, Madhya Pradesh, India for a duration of one year (1st January 2019 to 31st December 2019). Data was retrieved from Medical Records Department (MRD) and total data of 349 deaths were registered. Disease was classified based upon ICD 10 (International Statistical classification of Diseases and related health problems) Score. Results: A total of 349 deaths occurred in MICU during the period of one year at the institution, out of which male deaths were 55.9% and Female deaths were 44.1%. MICU deaths occurred in higher numbers in males with Male: Female ratio of 1.2:1. This difference in ratio of male and female mortality was not statistically significant (p-value &gt;0.05). Mean age of males at time of death was 58.4±16.3 years whereas mean age of females were 55.2±19.7 years. This difference in mortality with age and gender was not statistically significant (p-value &gt;0.05). In present study, most common systemic causes of mortality were cardiovascular (29.8%), followed by respiratory (17.5%), renal (16.5%) and cerebrovascular diseases (13.8%). Mortality was documented in 276 (79%) individuals within duration of seven days of admission, whereas mortality in 46 (13.1%) and 27 (7.7%) cases were documented within 8 to 14 days and &gt;14 days, respectively. The present study documented no statistically significant association between length of stay and age of patients (p-value &gt;0.05). Conclusion: Cardiovascular diseases are the most common causes leading to mortality especially in elderly male patients. Also, higher number of deaths is reported within seven days of admission signifying severity of illness at the time of admission.

Causative Agents of Urinary Tract Infections in Elderly Men with Benign Prostatic Hyperplasia: a Microbiological Evaluation.

Benign prostatic hyperplasia is an important risk factor for urinary tract infections. In this study, the causative agents of urinary tract infections were isolated from urine samples of benign prostatic hyperplasia patients aged 65 and older. Bacteremia risk and the patterns of antibiotic resistance were investigated to guide clinicians in empirical antibiotic treatment. Between 2015 and 2019, cultures of bacteria and yeast were made from urine samples from 655 patients with benign prostatic hyperplasia. The patients were divided into three groups based on age: 65 - 74, 75 - 84, and ≥ 85. The identification and antibiotic susceptibility tests of microorganisms were performed using the BD Phoenix (Becton Dickinson, USA) and the VITEK®2 Compact (bioMérieux, France) automated systems, as well as traditional methods. Microbial growth was detected in 24% of the patients. No significant differences were found concerning age (p = 0.15). The most commonly isolated microorganism was Escherichia coli (47.8%), followed by Klebsiella pneumoniae (22%), Enterococcus faecalis (8.8%), Pseudomonas aeruginosa (5.7%), and Candida albicans (4.4%). Escherichia coli showed no resistance to carbapenems. On the other hand, resistance values of 1% for amikacin, 5% for fosfomycin, 11% for nitrofurantoin, 13% for piperacillin/tazobactam, and 24% for gentamicin were detected. Resistance value for trimethoprim/sulfamethoxazole, ciprofloxacin, ceftazidime, ceftriaxone, cefixime, cefuroxime, and ampicillin were more than 50%. Also, bacterial growth occurred in 9% of blood culture samples made simultaneously with urine culture from 55 patients. High resistance rates to some antibiotics frequently used in empirical antibiotic treatment of urinary tract infections have reached alarming levels in elderly male patients with benign prostatic hyperplasia. Therefore, identifying resistance patterns is important to contribute to rational antibiotic use policies. In addition, the risk of Candida-related urinary tract infections and bacteremia should be considered in these patients.

Elderly male patient with gastrocolic fistula following severe acute necrotising pancreatitis

A 60-year-old male patient presented to the Emergency Room (ER) with a history of diarrhoea with abdominal pain for 2 weeks and weight loss of 3 kg over 1 month,...

Case of an elderly male breast cancer patient in whom X chromosome was analyzed

Case of an elderly male breast cancer patient in whom X chromosome was analyzed

Differences in perioperative cardiovascular outcomes in elderly male and female patients undergoing intra-abdominal surgery: a retrospective cohort study.

ObjectivePerioperative cardiovascular events constitute the majority of complications in noncardiac surgery. Older and female patients have been less investigated. We aimed to evaluate differences in perioperative cardiovascular outcomes by age and sex.MethodsWe enrolled 1079 patients (57.5 ± 17.0 years, 42.6% women) undergoing intra-abdominal surgery from July 2007 to June 2008 and compared occurrence of perioperative cardiac events by age (≥65 vs. <65 years) and sex. Multivariable logistic regression was used to investigate associations between age, sex, and outcomes.ResultsAge ≥65 years was associated with perioperative myocardial infarction (MI) (odds ratio [OR] 2.9, 95% confidence interval [CI]: 1.3–6.6) and total cardiovascular events (OR 2.4, 95% CI: 1.3–4.2). Age ≥65 years was associated with higher perioperative MI risks in men (OR 4.7, 95% CI: 1.3–17.6) than in women (OR 3.1, 95% CI: 1.2–8.3). Advanced age was associated with heart failure in women (OR 13.9, 95% CI: 1.7–110.5). Female sex was a risk factor for heart failure in elderly patients (OR 4.2, 95% CI: 1.1–15.7).ConclusionsAdvanced age appeared to be associated with increased perioperative cardiac risk but differed by sex. Tailored strategies should be considered with respect to the patient’s sex.

Selection of AVP-Shortage Patients as Candidates for Low-Dose Oral Desmopressin Administration.

ObjectiveWe herein attempted to select male patients with an elevated nocturnal urinary frequency possibly due to a shortage of AVP. These patients may be good candidates for low-dose oral desmopressin administration.Patients and MethodsSerum and spot urine osmolality, electrolytes, serum creatinine, casual blood glucose, plasma brain natriuretic polypeptide (BNP), and plasma AVP were measured at the same time in 97 elderly male patients with urinary symptoms under free water drinking.ResultsA binary plot of plasma AVP and serum osmolality indicated a region at which patients had relatively lower AVP considering higher serum osmolality. It was tentatively named the desmopressin region. Twenty out of 97 (20.6%) patients were in the desmopressin region. Daily urine output did not exceed 3 L in any patient. Urine osmolality was slightly lower in patients in the desmopressin region. No significant differences were observed in urine volume, urinary frequency, or urination questionnaire scores between both groups.ConclusionAVP-shortage patients may be selected for treatment with oral desmopressin based on measurements of serum osmolality and plasma AVP.

Gastroduodenal Fistula or Double Pylorus

Gastroduodenal fistula (GDF) or double pylorus (DP), also called double-channel pylorus, is a rare condition seen in 0.001%–0.4% of upper gastrointestinal endoscopies. The condition is characterized by the presence of two openings from the gastric antrum to the duodenum, which may be congenital or acquired. Acquired DP is usually an uncommon complication of peptic ulcer that erodes and creates a fistula between the duodenal bulb and the prepyloric antrum. We report a case of elderly male patient who was evaluated for the complaints of upper gastrointestinal bleed and was found to have peptic ulcer disease with GDF.

Review on Acute Relapse of Spinal Cord Infarction: A Case Report

Objective: To present a case of relapsed spinal cord infarction (SCI) as an acute spinal emergency in an in-patient elderly male patient. Methods: This report presents a case of an in-patient 84 years-old man who was admitted due to acute paraparesis with urge incontinence and sudden worsening after initial improvement. To assess his condition, spine magnetic resonance was performed Results: The spine magnetic resonance confirmed relapse of spinal cord infarction, which also involved the medullar conus. Conclusion: This case report presents a very rare event that is poorly described in literature. A strict follow up of risk factors and regular neurological evaluations during ihospitalization are recommended, especially in older patients.

Posterior sternoclavicular joint dislocation, a rare but "dangerous" injury.

A 17 years of age male patient presented with pain and movement restriction of right upper-extremity after a fall from his bicycle. On examination local swelling, tenderness, and depression of the medial end of the clavicle were present. Any attempt of shoulder movement was causing excruciating pain in this area. There was no other apparent injury and apart from the above-mentioned symptoms and clinical findings, all patients' vital signs were normal. No prominent fracture or other pathology were noticed on X-rays. The clinical findings were compatible with an injury of the sternoclavicular joint; a posterior sternoclavicular joint (SCJ) dislocation in particular. Posterior dislocation of the SCJ can be associated with injuries of the structures that lie behind the manubrium resulting in life threatening complications such as neurovascular, tracheal and oesophageal injuries. Therefor prompt diagnosis and treatment is required. Based on the clinical findings, a computed tomography (CT) was performed and the clinical suspicion was confirmed (A,B). The dislocation was reduced under general anesthesia by closed means, followed by arm immobilization.

STABİL KORONER ARTER HASTALIĞI OLAN YAŞLI ERKEKLERDE RUTİN İNFLAMATUAR MARKERLER VE EJEKSİYON FRAKSİYONU ARASINDAKİ İLİŞKİ

Purpose: New inflammatory markers have recently been proposed for chronic inflammatory diseases. Inflammation plays an important role in the pathogenesis of stable coronary artery disease(SCAD). The aim of our study was to evaluate hematological parameters in elderly male patients with SCAD.&#x0D; Material and Methods: Between March 2015 and August 2019, 131 male patients over 65 years of age who had exertion angina for 3 months and had 3 vascular disease on coronary angiography and had an ejection fraction (EF) of less than 55% on transthoracic echocardiogram were included in the study group 1. A total of 117 male patients over 65 years of age who had exertion angina more than 3 months and 3-vessel disease on coronary angiography and whose EF was above 55% on transthoracic echocardiogram were included in the study. Data of elderly male patients were recorded from the patient files of the institution. The data of the two study groups were compared.&#x0D; Results: In group 1, Red Cell Distribution Width (RDW), Mean Platelet Volume (MPV)/Platelet (P) and RDW/P values were significantly higher than group 2 (p

EFFECTIVENESS OF KEGEL’S EXERCISES IN ELDERLY MALE AND FEMALE WITH URINARY INCONTINENCE

Objective: to determine the effectiveness of Kegel exercises in elderly male and female patients with stress urinary incontinence. Methodology: A quasi experimental study was conducted at In Department of urology of Shaheed Mohtarma Benazir Bhutto medical university, Chandka medical college Larkana Sindh from January 2017 to June 2019. The non-probability convenient sampling technique was used for sample selection. The n=43 patient with the age above 55 years was included in the study. Patient with neurological, cognitive and male with prostate problem were excluded from the study. Both male and female were received intervention of Kegel exercise (KE) for three months and 3-4 time/day. The urinary distress inventory (UDI) and Incontinence impact questionnaire was used for urinary distress and quality of life. The data was obtained at baseline, at 6th week and after 12th week. The mean±SD, n(%), Mean difference (MD), p-value (p&lt;0.05) and effect size (Cohen’s d &amp; partial eta square was use to describe the data. For within group analysis Repeated Measure ANOVA was used and for between the groups analysis independent t-test was used. SPSS ver 21 was used for data analysis. Results: The mean age of the study participants was 64.97±9.36 year. Within group analysis showed large significant improvement in both, males and females (p&lt;0.05). However, between group differences showed significant improvement with larger effect size in males as compared to females (p&lt;0.05). Conclusion: Kegel exercises are effective therapy for urinary incontinence in both genders. But Kegel exercises are more effective in males for urinary incontinence in improving urinary distress and quality of life. Keywords: Geriatric population, Kegel exercises, Urinary incontinence

Successful outcome of a severe COVID-19 patient with multiple co-morbidities: a case report

Patients with severe form of corona virus disease 2019 (COVID-19) with multiple co-morbidities can be treated successfully. We report a case of COVID-19 pneumonia complicated by acute respiratory distress syndrome (ARDS), occurring in an elderly male patient with (co-morbid )diabetes mellitus, hypertension, chronic kidney disease and obstructive sleep apnea. This case is reported to emphasize that managing severe COVID-19 patient with multi-disciplinary approach, keeping in mind each of the co-morbidities, can result a fourable outcome.&#x0D; Birdem Med J 2020; 10, COVID Supplement: 127-130

Piceatannol Attenuates Testosterone-Induced Benign Prostatic Hyperplasia in Rats by Modulation of Nrf2/HO-1/NFκB Axis.

Benign prostatic hyperplasia (BPH) is a serious illness affecting middle-aged and elderly male patients. It is a complication of several diseases including metabolic syndrome. BPH has been associated with inflammation and increased oxidative stress in prostatic tissues. Piceatannol (PIC) is an active natural polyhydroxylated stilbene found in many plants. It has profound anti-inflammatory as well as antioxidant activities. However, it suffers relatively poor pharmacokinetic properties. Nanoformulation is an acknowledged approach to improve PIC bioavailability. The goal was to evaluate the ability of PIC in preventing testosterone-induced benign prostatic hyperplasia in rats. PIC was prepared in a self-nanoemulsifying drug delivery system (SNEDDS). Animals were placed into seven groups: 1) control (vehicle), 2) PIC SNEDDS (20 mg/kg), 3) testosterone (3 mg/kg), 4) testosterone + PIC SNEDDS (5 mg/kg), 5) testosterone + PIC (10 mg/kg), 6) testosterone + PIC SNEDDS (20 mg/kg) and 7) testosterone + finasteride (5 mg/kg). Testosterone was injected SC while PIC SNEDDS and finasteride were given orally. All treatments were given once daily, 5 days/week for four consecutive weeks. PIC administration ameliorated increased prostate weights and indices in addition to histopathological alterations. Further it inhibited accumulation of lipid peroxidation, depletion of glutathione (GSH) and exhaustion of catalase (CAT). PIC SNEDDS exhibited anti-proliferative activities as demonstrated by the inhibition of cyclin D1 protein expression and Bcl2 mRNA expression in addition to enhancement of Bax mRNA expression and caspase-3 content. Immunohistochemically, PIC SNEDDS protected against the testosterone-induced increased expression of tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), cyclooxygenase-2 (COX-2), inducible nitric oxide synthase (iNOS), nuclear factor kappa B (NFκB) and also offered protection against the decline in Nrf2 expression. Further, a significant enhancement of Nfe212 and Homx1 mRNA expression was detected in PIC SNEDDS-treated animals in comparison to the testosterone group. Conclusively, PIC prepared in SNEDDS protects against experimentally induced BPH via modulation of, at least partly, Nrf2/HO-1/NFκB axis.

Sex-dependent immune response and lethality of COVID-19.

COVID-19 has spread to all countries around the world after it was first discovered in Wuhan of China at the end of 2019. It is caused by a novel coronavirus called SARS-CoV-2 with much semblance to SARS-CoV including the sequence homology and disease symptoms. It is reported to be more infectious than SARS-CoV due to higher binding affinities between its spike protein and the ACE2 receptor on cell surface. Despite this, its case fatality rate is much lower compared with that of SARS-CoV although it varies in different countries. However, the case fatality rate increases steadily with age and it is reported to be the highest in aged COVID-19 male patients in almost all countries. Consistent with these, females have higher antiviral immune responses. Males and females are different in inflammatory response and aberrantly hyperactive cytokines are the main lethal causes of COVID-19. Interestingly, the gene encoding the ACE2 receptor protein and some genes encoding the immune regulatory proteins such as TLR7 are located on X chromosome which is subject to X chromosome inactivation and sex hormone regulation. These may account for some sex-dependent immune responses and lethality observed in COVID-19 patients. In general, children are less likely to be infected with SARS-CoV-2 and only less than 1% of pediatric COVID-19 patients may die of COVID-19. However, the most severe pediatric cases become multisystem inflammatory syndrome that is similar to Kawasiki disease with features of viral infection. Since most infected kids were boys in China, there may be sex-dependent immune response in pediatric COVID-19 cases as well.

A Case Report: Rare Presentation of Intracranial Hemorrhage post Guillain Barré Syndrome

Background: Guillain Barre Syndrome (GBS) is an autoimmune disease where antibodies attack the myelin sheath of peripheral nerves. The hallmark of the disease includes symmetrical quadriparesis, respiratory distress, and failure with subsequent need for mechanical ventilation. Most cases occur after a viral or bacterial infection. Other causes, such as intracranial hemorrhage, also exist, and several case studies report an association between these two pathologies. Case Report: In this report, we present the case of an elderly male patient with intracranial (IC) bleeding post-GBS. The patient was admitted to the hospital for dyspnea and diagnosed with pneumonia. When he started complaining of progressive bilateral ascending paralysis of his lower extremities, we performed a lumbar puncture, and he was diagnosed with GBS. We started him on intravenous immune globulins (IVIGs) immediately, but his weakness progressed to include his respiratory muscles, and he required mechanical ventilatory support with Intensive Care Unit (ICU) admission. We extubated him after two weeks, but he needed to be reintubated 24 hours later for a severely decreased level of consciousness. An urgent computed tomography scan of the brain showed IC bleeding. The patient developed a septic shock due to his pneumonia, which was refractory to antibiotics and vasopressors. He passed away a few weeks after that. Conclusion: Our case represents a unique type of association between IC hemorrhages and GBS, where the bleeding occurred several days after, as opposed to before GBS. It also reinforces the correlation between GBS and Intracranial bleeding and stresses the importance of having a high index of suspicion when facing either pathology since both have similar symptoms that may overlap or mask each other.

Case report of metastatic presence of lingual lymph nodes in carcinoma alveolus of mandible

Lingual node metastasis is seen most commonly in carcinoma of tongue and carcinoma floor of mouth. Literature elicits about such cases, but rarely reported is lingual node metastasis in Squamous cell carcinoma of alveolus. Our case report is an elderly male patient with Squamous cell carcinoma of alveolus. Management included hemi-mandibulectomy because of the extension. Metastatic lingual node was found during the surgery as it is rare finding so is this case report presented to reappraise the literature. Keywords: Squamous Cell Carcinoma, Neck Dissection, Lymphatics, Lingual Node, Metastasis

Low-intensity pulsed ultrasound is frequently used to treat fractures after osteosynthesis in elderly patients: A study using open data from the national database of health insurance claims of Japan

BackgroundThe national database of health insurance claims of Japan (NDB) includes almost all health insurance claims in Japan. Currently, we have many cases of geriatric fracture in Japan, probably due to an increase of the elderly population. The increase of geriatric fractures may influence the use of low-intensity pulsed ultrasound (LIPUS), which is used to accelerate the fracture repair process. The present state of LIPUS treatments was analyzed using the large dataset of the NDB. MethodsThe open data from the NDB that were used included receipts from April 2015 to March 2016. The total numbers of fracture treatments were counted as the sum of the claim items that were involved in fracture treatments. Two types of the insurance claim items for LIPUS treatments were counted separately: those used for delayed or non-union fractures; and those used for fractures within two weeks after osteosynthesis. Additionally, the ratio of the LIPUS treatments per the fracture treatments was calculated. ResultsIn female patients, the number of LIPUS treatments for fractures early after osteosynthesis showed a large peak in the senile generation. Additionally, the ratio of LIPUS treatments early after osteosynthesis to all osteosynthesis treatments tended to increase with age in both males and females, while the ratio of the LIPUS treatments for delayed or non-union fractures to all fracture treatments decreased with age. ConclusionsLIPUS treatments were frequently used to treat fractures early after osteosynthesis in elderly patients, probably due to the large number of fractures in the elderly population. Additionally, the ratio of LIPUS treatments early after osteosynthesis was high in both elderly female and elderly male patients, suggesting that there is a demand for early fracture repair.

Acute Abdomen – Rare Cause, Accurate Diagnosis, Simple Solution

Jejunal diverticulitis is a rare disease with higher prevalence among patients between 60 and 70 years and slightly more common in men. They are false diverticula located predominantly on the mesenteric side of the bowel but 10% develop complications which result in major surgery and high overall mortality. Authors report a case of a 63-year-old patient who presented to our department with small bowel perforation. Patient was taken to the operating room where he underwent exploratory laparotomy; intra-operatively a perforated jejunal diverticula with thickened adjacent mesentery and fibrinous debris was found. The surgical option was segmental enterectomy of 20cm, 15cm apart from the angle of Treitz. Perforation of jejunal diverticula should be considered in the differential diagnosis in elderly male patients presenting with an acute abdomen at the emergency department. The diagnosis is challenging and bowel resection with primary anastomosis is the treatment of choice. Although the disease is extremely rare it is important to be aware of the mortality rates associated with delay in the diagnosis and intervention.