Infarction In Elderly Patients Research Articles

Risk factors, Clinical presentation and In-hospital Outcome of Acute Myocardial Infarction in Elderly Patients

Background: Coronary artery disease (CAD) is the leading cause of mortality, morbidity in the developed and developing country. Ageing is important risk factor for coronary artery disease. The role of conventional cardiovascular risk factors in older persons is incompletely understood because only fragmentary and inadequate data are available in most instance and manifestations of acute myocardial infarction are generally believed to be atypical in the elderly. The aim of the study was to find out the clinical presentation, common risk factors and In-hospital Outcome of Acute Myocardial Infarction in Elderly Patients. Methods: An observational study in tertiary level hospital. Study protocol was approved by ethical review committee of Sir Salimullah Medical College & Mitford Hospital, Dhaka. Sample was selected from the population by purposive sampling technique. Detail demographic data were collected from the subject and recorded in structured case report form. Researcher makes contact with patient and patients caregiver, and describe them about study aim-objective, and then informed consent was taken. All collected questionnaire checked very carefully to identify the error in the data. Data processing work were consisting of registration of schedules, editing, coding and computerization, preparation of dummy tables, analysis and matching data. Result: In this series, the maximum number of patients (57.0%) was between 60-69 years age group, with mean value 67.21 ± 9.05 years. Out of 100 cases (62%) cases were male and (38%) were female (Figure 1). Male – female ratio was 1.63:1. Large numbers of respondents came from urban area (58%). Among the patients the poor class (44%) comprising the major percentage of the myocardial infarction patients. In this study majority (58%) of the patients had sedentary lifestyle before the onset of myocardial infarction. Among all the risk factors hypertension was the most common risk factor, present in 62% cases; next common risk factors were Diabetes mellitus 56%, dyslipidemia 32%, obesity 22%, smoking 40%. In this study majority of patients (56%) presented with shortness of breath as predominant symptoms. Besides typical chest pain others important atypical symptoms were atypical chest pain (31%), upper abdominal pain (18%), giddiness (4%) and confusional state (3%). In this study many of the patients had developed acute LVF (34%), arrhythmia (17%), cardiogenic shock (8%). Conclusion: We concluded that the manifestations of AMI are more subtle in the elderly, with different risk factors. The elderly subjects are under thrombolysed and have higher complication rate. Bangladesh J Medicine 2024; 35(1): 9-14

Clinical Manifestation of Acute Myocardial Infarction in Elderly Patients

Myocardial Infarction is one of the most common causes of mortality and morbidity among the elderly patients. Also, it is known for wide range of clinical presentations other than chest pain. Yet, a large number of patients may have atypical or no symptoms. As an indication of a cardiac problem, resulting in a delay in seeking medical care the absence of typical chest pain and the vagueness of symptoms might not be recognized. The absence of typical chest pain and the vagueness of symptoms might not be recognized. This cross sectional observational study was carried out among 50 patients >60 years of either sex with acute myocardial infarction in the Department of Medicine and CCU of Dhaka Medical College Hospital, Dhaka, from January 2018 to July 2018. Then consent was taken. History taking and physical examination were done in a predesigned data collection sheet. Then required investigation like ECG, cardiac enzymes and relevant laboratory investigations was done. After collecting all available information statistical analysis was done using SPSS for windows version 20. Result was expressed as frequency, percentage, mean (±SD), range, p-value. Among the 50 patients diagnosed as having AMI, 14 (28%) patients presented with atypical presentation to the hospital. Atypically presenting AMI Patients were mostly ae group 60-69 years (50%). Among all patients 29 (58%) were male and 21(42%) were female. 14 (28%) patients had no complaints of chest pain, out of which, dyspnea and epigastric pain (28.6%) are the commonest. Atypical presentation is found in 38.1% of female elderly patients and 20.7% of male patients (p=0.002). Commonest risk factor, found in this study was hypertension (66%) of the patients included in the study. Next common was Diabetes Mellitus (64%), hypercholesterolemia (56%) and smoking (28%). 13 Patients with Diabetes presented with atypical symptoms among atypical group (p=0.008). Most of the patients with atypical symptoms (78%) presented lately more than 12 hours compared to patients with typical symptom. Mortality rate was higher among the patient presented with atypical symptoms (42.3%) than among the patients presented with typical chest pain (27.7%). 28% patient with atypical chest pain was found to have inferior MI and mortality was highest among those with inferior MI and atypical symptoms. This study showed that even though chest pain was the most common presentation in elderly AMI patients, they were also found to have atypical presentations like dyspnea, vomiting, sweating and epigastric pain. This signifies the need of examining physicians to meticulously identify acute myocardial infarction in elderly for successful and immediate treatment. Accurate diagnosis of ACS could reduce hospital mortality and morbidity. Bangladesh Med J. 2022 May; 51(2): 13-20

Long term follow-up of patent foramen closure due to embolic infarction in elderly patients

Abstract Background In patients < 60 years (yrs) with crytogenic embolism associated with a patent foramen ovale (PFO) guidelines recommend interventional closure based on several randomized studies. There is no recommendation for elderly patients, although they seem to carry a similar risk for recurrent events. There are only scarce data on early and particularly late outcome. Methods We therefore retrospectively analyzed the up to 10 years outcome (median 4,2 yrs) in 444 consecutive patients (female, male) according to age at PFO closure. Results From 444 patients in our study population, 155 were >60 years of age (mean age 66,7 (IQR 63,1-71,74), 45% females. Older patients had higher prevalence of cardiovascular risk factors like hypertension, hyperlipidemia and diabetes (p< 0,01 for all vs. younger patients) while smoking was more prevalent in younger patients (p<0,01). No difference in procedural success and periinterventional complications was observed between the two age groups. During follow up of median 4,2 years (5 patients lost to FU) event rate of recurrent stroke, atrial fibrillation and acute myocardial infarction did not differ between older and younger patients. Conclusions Long term outcome was independent of age despite higher CV risk factors burden and supports PFO closure in elderly patients.

Risk Factors, Clinical Profile and Outcome of Acute Myocardial Infarction in Elderly Patients

Background: Coronary heart disease is the leading cause of death among elderly patients. Although, chest pain is the most common presentation of acute myocardial infarction (AMI) in elderly patients, there can be of predominance of other ischemic symptoms such as giddiness, dyspnoea, vomiting, sweating and epigastric pain in the absence of chest pain. Objective: To assess the risk factors, various symptoms, complications, prognosis and outcome of elderly patients with acute myocardial Infarction (AMI). Methods: This is a prospective study was carried out at Dept. of Cardiology, Shaheed Tajuddin Ahmad Medical College Hospital, Gazipur, Bangladesh from January to July 2022. Seventy (70) elderly patients admitted to STAMCH with the diagnosis of acute myocardial infarction and patients satisfying the inclusion criteria were included in the study. Results: Among the seventy patients the majority of the patients belonged to the age group 60-69 years. Twenty percent of the patients presented without chest pain. The atypical presentations included dyspnoea, giddiness, vomiting, sweating and epigastric pain. Mortality rate was 20%. Conclusions: Even though chest pain is the most common presentation in elderly AMI patients, atypical symptoms such as shortness of breath, giddiness, vomiting, sweating and epigastric pain without chest pain are much more common. This signifies the need of examining physicians to identify meticulously for acute myocardial infarction in elderly though they may not present typically.

Application of machine learning model to predict lacunar cerebral infarction in elderly patients with femoral neck fracture before surgery

BackgroundFemoral neck fracture and lacunar cerebral infarction (LCI) are the most common diseases in the elderly. When LCI patients undergo a series of traumas such as surgery, their postoperative recovery results are often poor. Moreover, few studies have explored the relationship between LCI and femoral neck fracture in the elderly. Therefore, this study will develop a ML (machine learning)-based model to predict LCI before surgery in elderly patients with a femoral neck fracture.MethodsProfessional medical staff retrospectively collected the data of 161 patients with unilateral femoral neck fracture who underwent surgery in the Second Affiliated Hospital of Wenzhou Medical University database from January 1, 2015, to January 1, 2020. Patients were divided into two groups based on LCI (diagnosis based on cranial CT image): the LCI group and the non-LCI group. Preoperative clinical characteristics and preoperative laboratory data were collected for all patients. Features were selected by univariate and multivariate logistic regression analysis, with age, white blood cell (WBC), prealbumin, aspartate aminotransferase (AST), total protein, globulin, serum creatinine (Scr), blood urea nitrogen (Bun)/Scr, lactate dehydrogenase (LDH), serum sodium and fibrinogen as the features of the ML model. Five machine learning algorithms, Logistic regression (LR), Gradient Boosting Machine (GBM), Extreme Gradient Boosting (XGBoost), Random Forest (RF), and Decision tree (DT), were used in combination with preoperative clinical characteristics and laboratory data to establish a predictive model of LCI in patients with a femoral neck fracture. Furthermore, indices like the area under the receiver operating characteristic (AUROC), sensitivity, specificity, and accuracy were calculated to test the models’ performance.ResultsThe AUROC of 5 ML models ranged from 0.76 to 0.95. It turned out that the RF model demonstrated the highest performance in predicting LCI for femoral neck fracture patients before surgery, whose AUROC was 0.95, sensitivity 1.00, specificity 0.81, and accuracy 0.90 in validation sets. Furthermore, the top 4 high-ranking variables in the RF model were prealbumin, fibrinogen, globulin and Scr, in descending order of importance.ConclusionIn this study, 5 ML models were developed and validated for patients with femoral neck fracture to predict preoperative LCI. RF model provides an excellent predictive value with an AUROC of 0.95. Clinicians can better conduct multidisciplinary perioperative management for patients with femoral neck fractures through this model and accelerate the postoperative recovery of patients.

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The purpose of this study was to perform a comparative analysis of mortality and rehabilitation rates with three-year follow-up in patients with acute myocardial infarction in different age groups and to analyze the correlations of the above mentioned indicators with comorbid diseases. The results of our study show that coronary angioplasty is associated with the reduction of mortality in the elderly population compared with the conservative treatment at a three-year follow-up (25.9%; 70.1%). However, re-hospitalizations were comparable in the group of patients undergoing coronary angioplasty and in the group of conservative treatment (41.4%; 44.3%). It should be mentioned that in both groups, the average age of patients and the frequency of comorbid diseases were comparable. The treatment of myocardial infarction in elderly patients has a problematic approach, due to the difficulties of diagnosis, the presence of comorbid diseases, and the high likelihood of drug side effects. Numerous studies have shown that cardiac catheterization in case of acute myocardial infarction may be associated with high mortality in the elderly population. Although international guidelines recommend a routine invasive treatment approach, our study included elderly patients with myocardial infarction aged 75 years and older, for whom the effectiveness of an interventional approach was proven with long-term follow-up. Routine invasive intervention reduces mortality in elderly patients with myocardial infarction during a three-year follow-up. The results of the study confirm that the implementation of an interventional approach should not be selective in elderly patients. It should be mentioned that the age of a patient should not be a contraindication for a routine invasive intervention. A comprehensive clinical assessment of the condition of patients may have a more decisive role for choosing the tactics of conservative or interventional treatment in case of elderly patients with myocardial infarction.

Toll-Like Receptors/TNF-α Pathway Crosstalk and Impact on Different Sites of Recurrent Myocardial Infarction in Elderly Patients.

Background Recurrent myocardial infarction is associated with increased mortality. Risk and predictive factors of recurrent myocardial infarction in elderly patients after coronary stenting are not well known. This research sought to investigate the effects of proinflammatory cytokines and toll-like receptor on recurrent myocardial infarction after coronary stenting in elderly patients. Methods We measured the levels of toll-like receptor 2 (TLR2), toll-like receptor 3 (TLR3), toll-like receptor 4 (TLR4), tumor necrosis factor-α (TNF-α), soluble tumor necrosis factor-α receptor-1 (sTNFR-1), soluble tumor necrosis factor-α receptor-2 (sTNFR-2), endothelial progenitor cells (EPCs), and vascular endothelial growth factor (VEGF) in elderly patients with recurrent myocardial infarction and assessed the changes of proinflammatory cytokines and toll-like receptors in elderly patients with recurrent myocardial infarction after coronary stenting. Results Levels of TLR2, TLR3, TLR4, TNF-α, sTNFR-1, and sTNFR-2 were remarkably increased (P < 0.001), and EPCs and VEGF were remarkably lowered (P < 0.001) in the elderly patients with recurrent myocardial infarction after coronary stent implantation. Increased expressions of proinflammatory cytokines and toll-like receptors induced recurrent myocardial infarction after coronary stenting. Elevated expressions of proinflammatory cytokines and toll-like receptors may be used to identify elderly patients who have an increased risk of developing recurrent myocardial infarction after coronary stenting. Conclusion The increase levels of proinflammatory cytokines and toll-like receptors were associated with recurrent myocardial infarction after coronary stenting. Increased expressions of proinflammatory cytokines and toll-like receptors may be clinically useful biomarkers for predicting recurrent myocardial infarction in the elderly patients after coronary stent implantation.

Prevalence of COVID-19 related factors among medical and emergency and critical care nursing students during COVID-19 pandemic outbreak

In recent years, there has been increasing interest in the frailty as a prognostic factor of acute myocardial infarction in elderly patients. Frailty is an important prognostic marker of frequent complications, readmission to hospital, high hospital mortality and major cardiovascular events in elderly patients with acute myocardial infarction. This category of persons is often not allowed to undergo invasive interventions and are often excluded from the recommended treatment, and they tolerate cardiac surgery worse, recovery from illness is slower, functionality decreases, then disability and death develop. The present review aims to investigate the impact of frailty on management of elderly patients with acute myocardial infarction (AMI). To analyze the literature, we searched for information on this issue in PubMed / MEDLINE, PMC, Web of Science, Scopus, The Сochrane[AA1] [П2] Library. The search depth was 15 years: from 2006 to 2021. One of the important factors in improving clinical outcomes, improving the quality of life in elderly patients with acute myocardial infarction is the early detection of frailty. Frailty assessment is a valuable tool for risk stratification that can be helpful to clinicians in deciding the optimal pathway for management and treatment strategies. Risk prediction is also important for deciding secondary prevention and cardiac rehabilitation measures in the elderly with acute myocardial infarction. Key words: acute myocardial infarction, advanced age, frailty, prognosis, risk assessment

Frailty in elderly patients with acute myocardial infarction

In recent years, there has been increasing interest in the frailty as a prognostic factor of acute myocardial infarction in elderly patients. Frailty is an important prognostic marker of frequent complications, readmission to hospital, high hospital mortality and major cardiovascular events in elderly patients with acute myocardial infarction. This category of persons is often not allowed to undergo invasive interventions and are often excluded from the recommended treatment, and they tolerate cardiac surgery worse, recovery from illness is slower, functionality decreases, then disability and death develop. The present review aims to investigate the impact of frailty on management of elderly patients with acute myocardial infarction (AMI). To analyze the literature, we searched for information on this issue in PubMed / MEDLINE, PMC, Web of Science, Scopus, The Сocrane Library. The search depth was 15 years: from 2006 to 2021. One of the important factors in improving clinical outcomes, improving the quality of life in elderly patients with acute myocardial infarction is the early detection of frailty. Frailty assessment is a valuable tool for risk stratification that can be helpful to clinicians in deciding the optimal pathway for management and treatment strategies. Risk prediction is also important for deciding secondary prevention and cardiac rehabilitation measures in the elderly with acute myocardial infarction.

Lower Body Temperature Independently Predicts Delayed Cerebral Infarction in the Elderly With Ruptured Intracranial Aneurysm.

Purpose: To assess the correlation between admission body temperature and delayed cerebral infarction in elderly patients with ruptured intracranial aneurysm (IA).Methods: Patients with ruptured IA diagnosed between 2012 and 2020 were retrospectively analyzed. Patients were divided into a non-infarction and an infarction group based on the presence of cerebral infarction after treatment. The demographic and clinical information of the patients was gathered. Outcomes at the 3-month follow-up were assessed using the modified Rankin Scale. Correlation between admission body temperature and cerebral infarction was assessed using Spearman's rank correlation coefficient. A receiver operating characteristic (ROC) curve was used to assess the specificity and sensitivity of admission body temperature to predict cerebral infarction.Results: A total of 426 patients (142 men and 284 women) with ruptured IA were enrolled. Elderly patients with cerebral infarction (12.4%) had a lower body temperature at admission (p < 0.001), higher prevalence of hypertension and diabetes (p = 0.051 and p = 0.092, respectively), and higher rate of poor outcomes (p < 0.001). Admission body temperature was independently associated with cerebral infarction (odds ratio [OR] = 5.469, p < 0.001); however, hypertension (OR = 0.542, p = 0.056), diabetes (OR = 0.750, p = 0.465), and aneurysm size (OR = 0.959, p = 0.060) showed no association. An inverse correlation between admission body temperature and the incidence of cerebral infarction was observed (Spearman's r =−0.195, p < 0.001). An admission body temperature of 36.6°C was able to distinguish infarction and non-infarction patients. The area under the ROC curve was 0.669 (specificity, 64.15%; sensitivity, 81.50%; p < 0.001).Conclusions: Lower body temperature at admission (≤36.6°C) is an independent predictor of delayed cerebral infarction in elderly patients who have undergone treatment for ruptured IA. Therefore, it could be a risk factor for adverse outcomes of IA.

Comparison of six decision aid rules for diagnosis of acute myocardial infarction in elderly patients presenting to the emergency department with acute chest pain.

This study aimed to evaluate the accuracy and effectiveness of different strategies for the diagnosis of acute myocardial infarction (AMI) in the elderly in real-life clinical practice. Patients older than 70 years presenting to the emergency department with chest pain were included. The performance of six decision aid rules (T-MACS, HEART, EDACS, TIMI, GRACE, and ADAPT) and solo troponin T strategy for diagnosing AMI was evaluated by calculating sensitivity, specificity, odds ratios, negative and positive predictive values. A total of 250 patients, with a mean age of 78.5 years, were enrolled. Forty-eight patients (19.2 %) had an acute myocardial infarction in a 30 day follow-up period. The sensitivity for ruling-out AMI was 100 % for T-MACS, HEART, and ADAPT; 97.9 % for EDACS, 93.8 % for TIMI, and 81.3 % for GRACE and solo TnT strategy. For ruling-in AMI, the specificity was 97.5 % for T-MACS, 95 % for TIMI, 83.2 % for HEART, 81.7 % for GRACE, and 46 % for ADAPT. T-MACS decision aid had the best performance for rule-out and rule-in diagnostics of AMI. Risk stratification of patients with suspected acute coronary syndrome based on decision aid rules can be used in real-life practice, even in the population of the elderly (Tab. 6, Fig. 1, Ref. 17).

729 Clinical profile and management of acute myocardial infarction in elderly patients

Abstract Aims The management of acute myocardial infarction (AMI) in elderly patients is often challenging for their peculiar clinical profile and the limited clinical evidence available. This represents a major unmet need in cardiovascular medicine, given the progressive ageing of population in western Countries. To investigate the clinical characteristics of elderly patients with AMI at a single tertiary university hospital. Methods and results The EMIR is an ongoing registry including elderly patients (≥75 years) consecutively referred to a single tertiary centre with diagnosis of acute myocardial Infarction with indication for coronary angiography. A total of 760 patients were enrolled to date, 39.6% were female, while mean age was 80 ± 4 years. Most patients had a NSTEMI, while 28% had a STEMI. Time from symptoms’ onset to presentation was 9.4 ± 14.6 for STEMI and 26.5 ± 30.4. Percutaneous coronary intervention (PCI) was performed in 64% of cases. Concomitant PCI of a non-target lesion (NTL) was performed within the same procedure in 8.8% of cases. A staged PCI of NTL was performed in 14% of cases. An elective surgical revascularization was performed after PCI of the IRA in 2.1% of cases. Altogether, a complete revascularization was achieved in 43% of cases before discharge. No evidence of critical coronary stenoses (CCS) was reported in 12.1% of cases, more frequently in females (18%) than in males (8.3%). Patients with no CCS were younger (P = 0.007), more frequently female (P &amp;lt; 0.001), had lower LV-EF (P = 0.002) and a longer time from symptoms’ onset to presentation (P = 0.008). Atrial fibrillation (AF) was present in 17.4% of patients, although only 12.1% of patients had any knowledge of carrying AF. Among patients with AF, 16.7% had no CCS, while the remaining had a formal indication to a combined antiplatelet/anticoagulant treatment. Conclusions Elderly patients with AMI are a specific population, posing peculiar clinical needs and demanding dedicated clinical management protocols.

Leukocyte telomere length and serum polyunsaturated fatty acids, dietary habits, cardiovascular risk factors and features of myocardial infarction in elderly patients

BackgroundTelomeres are non-coding sequences at the end of eukaryote chromosomes, which in complex with associated proteins serve to protect subtelomeric DNA. Telomeres shorten with each cell division, are regarded as a biomarker for aging and have also been suggested to play a role in atherosclerosis and cardiovascular disease (CVD). The aim of the present study was to explore the associations between leukocyte telomere length and serum polyunsaturated fatty acids, diet, cardiovascular risk factors and features of myocardial infarction (MI) in elderly patients.MethodsThe material is based upon the first 299 included patients in the OMEMI trial, where patients aged 70–82 years of age are randomized to receive omega-3 supplements or corn oil (placebo) after MI. Patients were included 2–8 weeks after the index MI. DNA was extracted from whole blood, and leukocyte telomere length (LTL) was analyzed by qPCR and reported as a number relative to a reference gene. Serum long chain polyunsaturated fatty acid (LCPUFA) content was analyzed by gas chromatography. Diet was evaluated with the validated SmartDiet food frequency questionnaire. Medical records, patient interviews and clinical examination provided previous medical history and anthropometric data. Non-parametric statistical tests were used.ResultsMedian (25, 75 percentile) LTL was 0.55 (0.42, 0.72). Patients had a median age of 75 years, 70.2% were male and 45.2% used omega-3 supplements. There was a weak, but significant correlation between LTL and linoleic acid (r = 0.139, p = 0.017), but not with other LCPUFAs. There was a trend towards longer telomeres with a healthier diet, but this did not reach statistical significance (p = 0.073). No associations were found between LTL and CVD risk factors or features of MI.ConclusionsIn our population of elderly with a recent myocardial infarction LTL was associated with linoleic acid concentrations, but not with other LCPUFAs. Patients with a healthy diet tended to have longer telomeres. The limited associations may be due to age and the narrow age-span in our population. Further studies, designed to detect longitudinal changes should be performed to explore the role of telomeres in cardiovascular aging.Trial registrationClinical trials no. NCT01841944, registration date April 29, 2013.

Relationship between hemoglobin level and the prognosis of cerebral infraction in elderly patients aged 75 years and over

Objective To investigate the relationship between hemoglobin levels and prognosis of cerebral infarction in elderly patients aged 75 years and over. Methods A retrospective analysis of 238 elderly patients (≥75 years old) with cerebral infarction admitted into our hospital from January 2016 to June 2018 was performed. The age, gender, serum creatinine and risk factors for stroke (hypertension, diabetes, dyslipidemia, homocysteine, atrial fibrillation, smoking, drinking), coronary heart disease, previous stroke history, tumor history, National Institutes of Health Stroke Scale (NIHSS) score, hemoglobin, hematocrit and other basic data were recorded. The patients were divided into the group with good prognosis (mRS score ≤ 2) and the group with poor prognosis (mRS score > 2). The relationship between hemoglobin levels and the prognosis of cerebral infarction in elderly patients were analyzed. Results After 6 months of follow-up, 124 (52.1%, 124/238) stroke patients had a good prognosis, and 114 (47.9%, 114/238) patients had a poor prognosis, including 21 deaths. Anemia at admission (OR=2.433, 95%CI: 1.213-4.591, P=0.011), new-onset anemia after hospitalization (OR=2.615, 95%CI: 1.333-6.521, P=0.043) and the low level of minimum hemoglobin during hospitalization (OR=0.847, 95%CI: 0.671-0.971, P=0.038) were independent risk factors for poor prognosis in elderly stroke patients aged ≥75 years. New-onset anemia after hospitalization (OR=1.015, 95%CI: 1.002-1.027, P=0.022), the low level of minimum hemoglobin during hospitalization (OR=0.801, 95%CI: 0.654-0.981, P=0.027), the decrement of hemoglobin ≥20 g/L (OR=1.342, 95%CI: 1.011-1.763, P=0.000) at reexamination were independent risk factors for the mortality in elderly patients with cerebral infarction. Conclusions Anemia at admission, new-onset anemia after hospitalization, and the low level of minimum hemoglobin during hospitalization are independent predictors for poor prognosis in cerebral infarction patients aged ≥75 years. The decrement of hemoglobin ≥20 g/L after admission is an independent predictor for high mortality in elderly patients with cerebral infarction. Key words: Brain infarction; Hemoglobinometry

PISIoT: A Machine Learning and IoT-Based Smart Health Platform for Overweight and Obesity Control

Overweight and obesity are affecting productivity and quality of life worldwide. The Internet of Things (IoT) makes it possible to interconnect, detect, identify, and process data between objects or services to fulfill a common objective. The main advantages of IoT in healthcare are the monitoring, analysis, diagnosis, and control of conditions such as overweight and obesity and the generation of recommendations to prevent them. However, the objects used in the IoT have limited resources, so it has become necessary to consider other alternatives to analyze the data generated from monitoring, analysis, diagnosis, control, and the generation of recommendations, such as machine learning. This work presents PISIoT: a machine learning and IoT-based smart health platform for the prevention, detection, treatment, and control of overweight and obesity, and other associated conditions or health problems. Weka API and the J48 machine learning algorithm were used to identify critical variables and classify patients, while Apache Mahout and RuleML were used to generate medical recommendations. Finally, to validate the PISIoT platform, we present a case study on the prevention of myocardial infarction in elderly patients with obesity by monitoring biomedical variables.

Identification of acute myocardial infarction in elderly patients using optimized highly sensitive troponin I thresholds

Purpose: Established diagnostic thresholds for high-sensitivity cardiac troponins (hs-cTn) might not apply for elderly patients as they are elevated irrespective of the presence of an acute myocardial infarction (AMI). Aim of the present study was to investigate hs-cTnI in elderly patients with suspected AMI and to calculate optimized diagnostic cutoffs.Material and methods: Data from a prospective multi-centre study and from a second independent prospective single-centre cohort study were analysed. A number of 2903 patients were eligible for further analysis. Patients > 70 years were classified as elderly. hs-cTnI was measured upon admission.Results: Around 34.7% of 2903 patients were classified as elderly. Around 22.5% of elderly patients were finally diagnosed with AMI. Elderly patients had higher hs-cTnI levels at admission irrespective of the final diagnosis (p < 0.001). According to the AUROC, hs-cTnI was a strong marker for detection of AMI in elderly patients. Application of the 99th percentile cutoffs showed a substantially lower specificity in elderly. By using optimized thresholds, specificity was improved to levels as in younger patients in both cohorts but accompanied with a decrease in sensitivity.Conclusions: hs-cTnI levels have a lower specificity for detecting AMI in elderly patients. This lower specificity can be improved by using hs-cTnI thresholds optimized for elderly patients.

Effect of Comprehensive Cerebral Protection Program on Cerebral Oxygen Metabolism and Vascular Endothelial Function in Elderly Patients with Acute Cerebral Infarction

We aimed to explore the effect of comprehensive cerebral protection on cerebral oxygen metabolism and vascular endothelial function in elderly patients with acute cerebral infarction. A total of 168 elderly patients with acute cerebral infarction treated in The First Affiliated Hospital of Nanchang University, China from January 2016 to January 2018 were selected. The patients were divided into a control group and an observation group using random number method, n=84. Patients in the observation group were given comprehensive cerebral protection treatment, and patients in the control group were treated with conventional standardized treatments. The changes of cerebral oxygen metabolism, hemorheology and vascular endothelial function before and after treatment were compared between the two groups. After treatment, oxygen content in arteries and internal jugular veins (Da-vO2), ofoxygen uptake fraction (OEF), Oxygen saturation (SpO2), nitric oxide (NO) were increased in both groups in comparison to before treatment, jugular venous oxygen saturation (SjvO2), brain oxygen uptake rate (ERO2), endothelin (ET), intracranial pressure (ICP), whole blood viscosity, plasma viscosity, reduced viscosity of whole blood, and hematocrit were decreased. However, the changes in the observation group were larger than those in the control group, the difference was statistically significant (P<0.05). The treatment of cerebral infarction in elderly patients with acute cerebral infarction can effectively improve the cerebral oxygen metabolism and vascular endothelial function and improve the blood rheology, which has important clinical value.

A comparative efficacy of 7.5 lakh units versus 1.5 million units of streptokinase in acute myocardial infarction in elderly patients

A comparative efficacy of 7.5 lakh units versus 1.5 million units of streptokinase in acute myocardial infarction in elderly patients

Influencing factors of cerebral infarction in elderly patients with hypertensive intracerebral hemorrhage after hematoma clearance

Objective To investigate the influencing factors of cerebral infarction in elderly patients with hypertensive intracerebral hemorrhage after hematoma clearance. Methods A total of 197 elderly patients with hypertensive intracerebral hemorrhage were selected and treated with craniotomy hematoma removal and decompression of bone flap. Cerebral infarction was checked by craniocerebral CT after operation.Univariate and multivariate Logistic regression analysis was used to identify the independent risk factors for cerebral infarction. Results The incidence of cerebral infarction after hematoma clearance in hypertensive intracerebral hemorrhage was 26.90%(53/197). There was no significant difference in the incidence of cerebral infarction after hematoma clearance in hypertensive intracerebral hemorrhage on gender and age (P>0.05), while the differences were statistically significant in diabetes(χ2=7.986), hypertension history(χ2=10.399), hematoma volume(χ2=10.396), edema(χ2=12.436), systolic blood pressure(χ2=12.128), diastolic blood pressure(χ2=13.040) and GCS score(χ2=3.940) (all P 35 ml(β=2.361, OR=3.890, 95%CI=1.792-5.132), area of brain edema (> 65 cm3) (β=2.471, OR=4.321, 95%CI=1.879-5.487), systolic pressure (> 150 mm Hg, 1 mmHg=0.133 kPa) (β=2.073, OR=3.172, 95%CI=1.428-4.768), diastolic pressure (> 90 mm Hg) (β=1.715, OR=2.498, 95%CI=1.276-3.451)and GCS score < 8(β=2.592, OR=4.871, 95%CI=1.974-5.798)were independent risk factors for cerebral infarction after hematoma clearance in hypertensive intracerebral hemorrhage. Conclusion Elderly patients with cerebral infarction after hematoma clearance in hypertensive intracerebral hemorrhage is affected by diabetes mellitus, hypertension, hematoma volume, edema, systolic blood pressure, diastolic blood pressure and other factors. Early intervention on these factors may effectively reduce the incidence of cerebral infarction. Key words: Hypertensive cerebral hemorrhage; Hematoma; Cerebral infarction; The elderly; Influencing factors

Study on the risk factors for hemorrhagic transformation of the different subtypes of acute cerebral infarction in elderly patients

Objective To investigate the risk factors for hemorrhagic transformation(HT)of different subtypes of acute cerebral infarction in elderly patients. Methods A total of 415 elderly hospitalized patients aged ≥60 years with acute cerebral infarction were selected from a hospital in Changsha from January 2014 to December 2016 for the study.Among them, 56 had hemorrhagic transformation(observation group)and 359 had no hemorrhage transformation(control group). The general demographic information, past medical history, physical examination and laboratory indicators, cranial CT/MRI examination, admission treatment and the National Institutes of Health Stroke Scale(NIHSS)score on admission were analyzed and compared between two different subtypes.Multivariate Logistic regression was used to analyze the influencing factors for HT of different subtypes of acute cerebral infarction in elderly patients. Results The incidence of HT was 26.61%(29/109)for large-artery atherothrombosis, 47.50%(19/40)for cardiac embolism and 3.12%(8/257)for small-artery occlusion with a statistically significant differences among the three subtypes(χ2=77.923, P=0.000). The incidence of HT was 0%(0/7)for unknown type, and 0%(0/2)for other types.Multivariate logistic regression showed that female was the protective factor(OR=0.171, 95%CI: 0.037-0.790), but high level of glycated haemoglobin A1c(HbA1c)and large infarct size were the risk factors(OR=5.949 and 20.619, 95%CI: 1.199-29.509 and 2.869-148.207)for HT due to large-artery atherothrombosis.A high score of NIHSS and high level of matrix metalloproteinase-9(MMP-9)were the risk factors for HT due to cardioembolism(OR=20.254 and 91.200, 95%CI: 1.605-255.625 and 4.044-2056.710, respectively). A high level of homocysteine(Hcy)and large infarct size were the risk factors for HT due to small-artery occlusion(OR=10.231 and 15.251, 95%CI: 1.202-87.108 and 3.371-68.995, respectively). Conclusions The incidence of HT due to cardioembolism is the highest.Influencing factors for HT due to different subtypes of acute cerebral infarction are different in the elderly.It is important for clinicians to know that gender, HbA1c levels and infarct size are associated with HT due to large-artery atherothrombosis, NIHSS score on admission and MMP-9 concentration associated with HT due to cardioembolism, and Hcy level and infarct size associated with HT due to small-artery occlusion. Key words: Brain infarction; Cerebral hemorrhage; Factor analysis, statistical