Elderly Research Articles

Importance of timely diagnosis and intervention in uterine artery pseudoaneurysm caused by hysteroscopic surgery

This manuscript explores the case on the occurrence of uterine artery pseudoaneurysm (UAP) during hysteroscopy endometrial polypectomy and the subsequent successful treatment via uterine artery embolization (UAE). Moreover, we focus on the management and treatment options for UAP in patients of advanced maternal age. A pseudoaneurysm is an extraluminal blood collection with a disrupted flow that communicates with the parent vessel via a defect in the arterial wall. The reported case involved a 48-year-old primiparous woman who developed a UAP after uterine polyp removal. The study enhances the understanding of UAP, a rare but potentially life-threatening condition, by providing a detailed and well-documented account of the comprehensive case presentation, effective use of medical imaging techniques for diagnosis, successful postoperative patient management following UAE, and practical clinical recommendations for clinicians managing similar cases. Overall, this study highlights the importance of considering UAP as a differential diagnosis in patients with abnormal vaginal bleeding following hysteroscopic surgery. Additionally, this manuscript recommends that clinicians with a high index of suspicion for UAP promptly request ultrasonography and computed tomography to facilitate early diagnosis. UAE is suggested as a primary treatment due to its effectiveness and safety, particularly in facilities capable of avoiding hysterectomy.

Prevalence and correlates of frailty among older people with and without HIV in rural Uganda.

The relationship between HIV and frailty, a predictor of poor outcomes in the face of stressors, remains unknown in older people in sub-Saharan Africa. We analysed data from the Quality of Life and Ageing with HIV in Rural Uganda cohort study to estimate the prevalence and correlates of frailty among older people with HIV (PWH) on long-term antiretroviral therapy and among age and sex-similar HIV-uninfected comparators. Frailty was defined as a self-report of 3 or 4 (and pre-frailty as 1 or 2) of the following phenotypic variables: weight loss, exhaustion, low activity, and slowness. We estimated the prevalence of frailty and pre-frailty and fitted logistic regression models to estimate the association between HIV and frailty, adjusting for sociodemographic factors, depression, and other comorbidities. We enrolled 599 participants (49% women) with a mean age of 58 years. PWH had a similar prevalence of frailty (8.1% vs. 10.9%, p=0.24) but a lower prevalence of pre-frailty (54.2% vs. 63.2%, p=0.03) compared with their HIV-uninfected comparators. In multivariable regression models, people with depression (AOR 7.52 [95% CI: 3.67-15.40], p<0.001) and those with ≥1 comorbidities (AOR 3.15 [95% CI: 1.71-3.82], p<0.001) were more likely to be frail. HIV serostatus was not significantly associated with frailty (AOR 0.71 [95% CI: 0.37-1.34], p=0.29). Older PWH had a similar prevalence of frailty as those without HIV. These findings call for additional study of the factors that contribute to the robustness of older PWH in sub-Saharan Africa.

The Influence of Fear of Falling on Cognitive-Motor Interference in Walking in Older Adults

Objectives: Fear of falling (FOF) is common among older people and may impact normal walking in this population. This study aimed to determine the effect of FOF on cognitive-motor interference in walking among older adults. Methods: Ninety older adults with the ability to walk 20 meters and without cognitive disorder participated in this study. Three groups of high FOF, low FOF, and no FOF were identified using the fall efficacy scale-international (FES-I). The cognitive-motor interference was determined for the completion time of three functional movements, namely forward walking (FW), timed up and go (TUG), and obstacle crossing (OC), as well as the correct answer rate in verbal fluency (VF) and mental tracking (MT) tasks. The difference in outcomes between the groups was determined using multivariate analysis of variance (MANOVA). The Pearson correlation coefficients determined the association between FES-I and cognitive-motor interference in subjects with FOF. Results: Dual-task cognitive performance measures, including MT + TUG, VF + OC, and MT + OC, significantly differed between the high FOF and no FOF groups (P&lt;0.05). MT + TUG, VF + OC, and MT + OC also showed significant differences between the high FOF and low FOF groups (P&lt;0.05). Other cognitive-motor interference measures were not significantly different between the groups. The FES-I showed a positive correlation with MT + TUG (r=0.76, P=0.001), VF + OC (r=0.72, P=0.001), and MT + OC (r=0.65, P=0.001) in individuals with FOF. Discussion: The results indicate that FOF may impair cognitive performance during dual tasks in older adults. Future studies may be needed to investigate whether reduced FOF has the advantage of dual-task improvement in older people.

Spirituality, forgiveness and self-esteem throughout adulthood in France

PurposeIt appears that spirituality, forgiveness, and self-esteem are important values which transcend human actions. This transversal study aims to observe spirituality, forgiveness, and self-esteem during aging. MethodsA quantitative protocol was conducted with 206 participants divided into two groups: younger adults (M = 23.05 years old) and older people (M = 73.09 years old). Three tests measured spirituality, forgiveness and self-esteem. Principal resultsResults showed that older people have higher scores than younger adults in spirituality (peace dimension), forgiveness (transcendence and emotional factors) and self-esteem. Moreover, all dimensions of spirituality (peace, mean, faith) were correlated with the transcendence and emotional factors of forgiveness and with self-esteem during aging. Major conclusionIt seems that with age, individuals have a better self-esteem linked to more pronounced spiritual needs (sense of peace, meaning of life, faith) and manage to forgive more unconditionally with less resentment than younger people.

Association between malnutrition-inflammation score (MIS) and quality of life in elderly hemodyalisis patients.

The malnutrition-inflammation process is one of the main causes of morbidity and mortality in patients with chronic kidney disease (CKD), influencing quality of life. The aim of this study was to identify the inflammatory and nutritional status of elderly hemodialysis (HD) and its association with quality of life. This study was carried out in health services in three different cities. The Malnutrition-Inflammation Score (MIS) was used to assess the inflammatory and nutritional status, with anthropometric measurements, protein status, lean mass and function. The quality of life was assessed using KDQOL-SFTM. Data were analyzed using multivariate analysis and the Poisson model to evaluate the factors that increased the risk of developing malnutrition and inflammation. The MIS identified a 52.2% prevalence of malnutrition and inflammation in the population. In univariate analysis, most KDQOL-SFTM domains presented higher scores for nourished elderly. Anthropometric measures associated with muscle mass and functionality were lower in the malnourished elderly. Multivariate modeling revealed a higher nutritional risk of 50.6% for women and older age, since with each additional year of life the risk of malnutrition increased by 2.4% and by 0.4% with each additional month on HD. Greater arm muscle circumference (AMC) and higher serum albumin were factors for reducing malnutrition by 4.6% and 34.7%, respectively. Higher serum albumin and preserved AMC have been shown to be good indicators of better nutritional status. Higher MIS was associated with poorer quality of life, older age, lower income and education, longer time on dialysis, and presence of comorbidities.

Nutritional therapy among adult patients with severe burns: A retrospective observational study.

The objective of this study was to examine the effects of nutritional therapy in adult patients with severe burns. Sixty adult patients with severe burns were enrolled. Data on nutritional intake through enteral nutrition (EN) or parenteral nutrition (PN) on days 7, 14, 21, and 28 post-injury were collected. Patients were divided into target and non-target groups according to whether their energy or protein intake reached the target. Age, length of ventilation, and total bilirubin (TBIL), albumin (ALB), prealbumin (pALB), and C-reactive protein (CRP) concentrations of patients were recorded. The percentage of protein targets with protein delivery was lower than that of energy target with energy delivery. The ratio of PN protein to total protein was lower than that of PN energy to total energy on days 7, 14, 21, and 28 (p<0.001, p<0.001, p=0.001, and p=0.003, respectively). Compared to the non-target group on day 21, the target group was younger, had lower TBIL on day 7, higher ALB and pALB on day 21, and lower CRP on day 14 (p=0.025, p=0.021, p=0.028, p=0.029, and p=0.049, respectively). Multivariate logistic regression analysis showed that older age and longer ventilation were independent risk factors in patients who did not meet the nutritional target on day 21 (p=0.026 and p=0.043, respectively). The protein intake of adult patients with severe burns was low. Compared to the non-target group, the target group had better laboratory test results. Older age and longer ventilation were independent risk factors for patients not meeting the nutritional target.

Evaluation of Lower Limb Angular Acceleration in Healthy and Hallux Valgus Young and Older Women During Gait

Objectives: To comprehend the kinematic effects of hallux valgus (HV) deformity on young and older people, we assessed the angular acceleration of the joints in the lower limbs of these women. Methods: Forty-eight women in two groups, young adults (20-30 years old) and older adults (50-60 years old), participated in this study (12 healthy and 12 with HV). We used an inertial measurement unit (IMU)-based motion capture system to measure the kinematics of motion. Biomechanical variables were assessed at an ideal speed during gait (stance and swing phases). All modules were calibrated in advance and then attached to the right thigh, shank, and foot. Results: The results showed that in the young group, angular acceleration was significantly different during gait in all planes of the ankle joint, the sagittal plane of the knee joint, and the horizontal and frontal planes of the hip joint. In the older group, it was significantly different in the sagittal plane of the ankle and knee and the sagittal and frontal planes of the hip joint. Discussion: It appears that the angular acceleration of the lower limb joints was affected by HV, especially in the young group. Additionally, the angular acceleration of the knee joint was less affected in both groups.

Metabolic Complications Associated with Use of Integrase Strand Transfer Inhibitors (InSTI) for the Treatment of HIV-1 Infection: Focus on Weight Changes, Lipids, Glucose and Bone Metabolism.

This review aims to summarize recently published peer reviewed papers on the influence of treatment with Integrase Strand Transfer Inhibitors (InSTI) in people with HIV (HIV) on metabolic health, including weight gain, lipid parameters, glucose homeostasis, and bone health. InSTI have a mild/moderate effect on weight gain in both antiretroviral (ART) naïve and ART experienced PWH, which is more pronounced in certain groups (i.e. women, people of Black African ethnicity, those with lower socioeconomic status, and older people). The effect on weight is also driven by other components of the ART regimen as well as previous exposure to certain ART. InSTI have a relatively safe profile in terms of lipid parameters and bone health, compared to other ART classes, although some studies suggest a greater risk of insulin resistance and diabetes in PWH using InSTI, especially 2nd generation InSTI. While there is some evidence suggesting a negative impact of InSTI on some aspects of metabolic health (weight gain and glucose homeostasis), they remain the preferred treatment option for most PWH, due to their high efficacy and tolerability. However, an individualised approach to ART choice in PWH should be used in order to avoid negative outcomes in populations at higher risks of metabolic complications.

Factors Associated with Occupational Performance in Older People with Stroke

Objectives: Occupational performance occurs in a dynamic interaction between the people, their occupations, and context. Stroke could affect the individual’s occupational performance, which is the basis of social life. This study aimed to investigate the factors affecting stroke patients’ occupational performance. Methods: In this descriptive-analytic study, 55 people with stroke participated. The patients completed the Canadian occupational performance measure (COPM), Barthel index, Brunnstrom stage, Montreal cognitive assessment, and a demographic questionnaire. Results: The results showed a significant correlation between occupational satisfaction and performance with cognition, the activities of daily living (ADL), and the severity of impairment in the upper and lower extremities (P &lt;0.01). The results of linear regression show that cognition level could significantly predict occupational performance (R= 0.83, P &lt;0.01) and satisfaction (R= 0.81, P &lt;0.01) after stroke. Discussion: Results show that the cognitive level could predict occupational performance in patients with stroke. Performing daily living activities and lower limb impairment could predict satisfaction with occupational performance. Therefore, it is recommended that therapists consider the cognition in stroke patients through a proper therapeutic plan to prevent participation restrictions.

Structural equation modeling: exploring relationships of body mass index, waist circumference, and hypertension in elderly

Waist circumference (WC) measurements in the elderly are uncommon and erratic. Furthermore, its correlation to hypertension has received less attention in Indonesia. This study attempted to investigate direct and indirect risk factors for high blood pressure in the elderly using structural equation modeling (SEM). A cross-sectional study was conducted in Surakarta, Central Java, Indonesia. The 297 elderly aged ≥60 is eager to take part. The path model of factors associated with blood pressure was analyzed using Stata 13. Male (b=-0.43; 95% CI=-5.67 to 4.81; p=0.872), age (b=0.52; 95% CI=0.12 to 0.93; p=0.012), and WC (b=0.35; 95% CI=0.17 to 0.53; p&amp;lt;0.001) directly affected systolic blood pressure (SBP). Male (b=1.83; 95% CI=-1.17 to 4.82; p=0.231), age (b=-0.03; 95% CI=-0.26 to 0.20; p=0.790), BMI (b=0.40; 95% CI=-0.03 to 0.83; p=0.067), and WC (b=0.04; 95% CI=-0.09 to 0.16; p=0.571) directly affected diastolic blood pressure (DBP). Increasing age, body mass index (BMI), and waist circumference (WC) are the important variables that influence blood pressure in older people. This study supports the evidence that body composition and weight control are necessary to prevent and control blood pressure in the elderly.

Risk factors for incisional hernia after open abdominal aortic aneurysm repair: a systematic review and meta-analysis.

The incidence of incisional hernia (IH) after an open abdominal aortic aneurysm (AAA) repair can reach up to 35%, contributing to long-term morbidity. Individual studies have been limited in identifying modifiable risk factors for IH after an open AAA repair. This meta-analysis aims to review all the risk factors for IH after an open AAA repair. We searched Cochrane Central, Embase, PubMed, MEDLINE, and Web of Science databases for original studies. Risk factors assessed were age, sex, comorbidities, surgical incision, blood loss, and surgical site infection (SSI). Data analysis was done using RStudio 4.1.2. We computed Relative Risk (RR) for dichotomous outcomes and Mean differences (MD) with 95% Confidence Interval (CI) for continuous outcomes. P-values less than 0.05 were considered statistically significant. Ten studies met the inclusion criteria among 1,795 screened articles. Among those ten studies, there were a total of 1,806 patients of which 341 patients developed IH. Older age (Mean 69.6-70.7 years, MD 1.39 years, CI [1.12-1.66], P < 0.01), midline vertical incision (RR 1.55, CI [1.06-2.25], P = 0.02) and increased intraoperative blood loss (MD 429.8ml, CI [234.8- 624.8], P < 0.01) were associated with an increased incidence of IH. Surgical site infection (SSI) was noted as a risk factor for IH after open AAA repair (RR 2.36, CI [1.31-4.24], P = 0.004). No statistically significant association was found between the incidence of IH and sex (RR 1.0, CI [0.8-1.14], P = 0.98), smoking (RR 1.01, CI [0.93-1.09], P = 0.88), diabetes (RR 1.38, CI [0.85-2.25], P = 0.19), and chronic kidney disease (RR 1.55, CI [0.47-5.09], P = 0.46). This meta-analysis shows that age, midline vertical incision, intraoperative blood loss, and SSI are risk factors for IH after open AAA repair.

Undetected and undiagnosed comorbidity in patients with obesity undergoing bariatric surgery-Results from the Berlin Bariatric Cohort study.

The quality of general obesity management before bariatric surgery (BS) is rarely investigated. Inadequate information regarding undetected and undiagnosed comorbidities (UUCs) in individuals with obesity may influence the penetration, risks, and outcomes of BS. We conducted a cohort study involving a pre-specified medical check-up in a cooperation between a BS department and an outpatient medical centre. A total of 1068 patients (74.4% women) were enrolled in the study. The mean age was 42.1 years (standard deviation [SD] 11.9) and the mean body mass index (BMI) was 46.1 (SD 6.91). The onset of obesity occurred in 11.4% of patients during childhood, 47.2% during schooltime/adolescence, 41.4% in adulthood. Gender differences were observed: men had higher BMI, systolic blood pressure, and impaired metabolic state (including diabetes, dyslipidemia, and liver disease with p-values <.001 for all). Women had lower haemoglobin levels, impaired iron status, lower albumin levels (p < .001), and increased C-reactive protein levels (p < .05). The prevalence of UUC conditions (percentage of cases) was as follows: arterial hypertension, 53%; decreased cystatin C clearance, 57%; dyslipidemia, 41%; fatty liver, 40%; iron deficiency, 37%; diabetes mellitus, 34%; vitamin D deficiency, 32%; chronic pain syndrome, 23%; liver fibrosis, 12%; obstructive sleep apnea, 10%; and vitamin deficiencies (vitamin B12, folic acid, vitamin K1) <10%. Undiagnosed hypertension was more prevalent in younger women, and nutritional deficits were associated with high BMI in both genders. Older age and high BMI were associated with undiagnosed diabetes and decreased glomerular filtration rate in both genders, and with liver fibrosis in men. UUC are highly prevalent in individuals undergoing BS. A refined assessment is recommended to improve health conditions and outcome in these candidates.

Unconventional Remedies for Squamous Cell Carcinoma: A Journey into Alternative Treatments.

Squamous cell carcinoma (SCC) is the second most common form of skin cancer and is typically found on sun-exposed skin. Risk factors include ultraviolet radiation exposure, older age, fairer complexion, smoking, and immunosuppression. SCC is a slow-growing tumor with the possibility of metastasis if not treated. The clinical presentation can range from a dry, scaly erythematous patch or plaque to a firm hyperkeratotic papule, plaque, or nodule, depending on the histological type via biopsy. The first-line therapies for SCC removal are standard excision and Mohs microscopic surgery; however, there are novel and alternative non-surgical options being considered for the treatment of SCC. This review summarizes the current guidelines for treating low-risk and high-risk SCC and discusses rare, experimental, and anecdotal non-surgical treatments for SCC in the literature.

Efficacy and safety of gene therapy with onasemnogene abeparvovec in children with spinal muscular atrophy in the D-A-CH-region: a population-based observational study

Real-world data on gene addition therapy (GAT) with onasemnogene abeparvovec (OA), including all age groups and with or without symptoms of the disease before treatment are needed to provide families with evidence-based advice and realistic therapeutic goals. Aim of this study is therefore a population-based analysis of all patients with SMA treated with OA across Germany, Austria and Switzerland (D-A-CH). This observational study included individuals with Spinal Muscular Atrophy (SMA) treated with OA in 29 specialized neuromuscular centers in the D-A-CH-region. A standardized data set including WHO gross motor milestones, SMA validated motor assessments, need for nutritional and respiratory support, and adverse events was collected using the SMArtCARE registry and the Swiss-Reg-NMD. Outcome data were analyzed using a prespecified statistical analysis plan including potential predictors such as age at GAT, SMN2 copy number, past treatment, and symptom status. 343 individuals with SMA (46% male, 54% female) with a mean age at OA of 14.0 months (range 0-90, IQR 20.0 months) were included in the analysis. 79 (23%) patients were clinically presymptomatic at the time of treatment. 172 (50%) patients received SMN2 splice-modifying drugs prior to GAT (risdiplam: n=16, nusinersen: n=154, both: n=2). Functional motor improvement correlated with lower age at GAT, with the best motor outcome in those younger than 6 weeks, carrying 3 SMN2 copies, and being clinically presymptomatic at time of treatment. The likelihood of requiring ventilation or nutritional support showed a significantly increase with older age at the time of GAT and remained stable thereafter. Pre-treatment had no effect on disease trajectories. Liver-related adverse events occurred significantly less frequently up to 8 months of age. All other adverse events showed an even distribution across all age and weight groups. Overall, motor, respiratory, and nutritional outcome were dependent on timing of GAT and initial symptom status. It was best in presymptomatic children treated within the first six weeks of life, but functional motor scores also increased significantly after treatment in all age groups up to 24 months. Additionally, OA was best tolerated when administered at a young age. Our study therefore highlights the need for SMA newborn screening and immediate treatment to achieve the best possible benefit-risk ratio. The SMArtCARE and Swiss-Reg-NMD registries are funded by different sources (see acknowledgements).

Recovery capital profiles among a heterogeneous sample of individuals in recovery from alcohol problems.

Recovery capital (RC) is a framework for conceptualizing the resources individuals use to support alcohol and other drug recovery across social, physical, human, and cultural domains. The goal of this study was to identify subgroups of individuals in recovery with distinct combinations of RC across domains and characteristics of individuals with unique RC patterns. Latent profile analyses investigated patterns in both within-domain amount and variability of RC across each of the four domains using the Multidimensional Inventory of Recovery Capital, a theoretically and psychometrically sound RC measure. The sample included U.S. participants closely reflecting 2020 Census demographics (n = 482, 49% female, 38% racial/ethnic minority, Mage = 42.57) identifying as having resolved a prior problem with alcohol (alone or with other drugs). Latent profile analyses distinguished four RC profiles: Low/Inconsistent (23%), Moderate/Consistent (43%), Moderate/Inconsistent (12%), and High/Consistent (22%). Females and individuals who were unemployed, nonabstinent, and had greater alcohol problem severity were more likely to belong to the Low/Inconsistent profile. Individuals in unassisted recovery were more likely to belong to the Moderate/Inconsistent profile. Older age and more time in recovery were associated with High/Consistent profile membership. Race/ethnicity was not associated with profile membership. These person-oriented analyses elucidate complex patterns of resources that individuals utilize during recovery and individual characteristics underpinning differences across RC patterns. The empirically derived subgroups in this heterogeneous sample highlight multiple combinations of resources that individuals leverage to achieve recovery and indicate characteristics of individuals who may need greater amounts and/or consistency of RC to continue sustaining recovery. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Factors associated with receipt of systemic anticancer treatment for locally advanced or metastatic urothelial carcinoma in England: a population-based study

IntroductionSystemic anticancer therapy for locally advanced or metastatic urothelial carcinoma (la/mUC) is associated with efficacy benefits, including longer overall survival (OS), but many patients remain untreated. This observational, real-world, national study aimed to investigate factors associated with receiving systemic anticancer therapy for la/mUC in England. Patients and MethodsAdults diagnosed with la/mUC between 2013 and 2019 were identified in the National Cancer Registration Dataset and followed until March 2021. Healthcare and comorbidity data were obtained from Hospital Episode Statistics Admitted Patient Care and Outpatient datasets. Treatment data were obtained from the Systemic Anti-Cancer Therapy dataset. Factors associated with treatment were identified using multivariable logistic regression. OS from la/mUC diagnosis was estimated using Kaplan–Meier methodology. ResultsOf 16,610 patients diagnosed with la/mUC, 5,191 (31%) received systemic anticancer therapy; 4,700 (91%) received platinum-based chemotherapy. Only 18% of patients were cisplatin ineligible. Patients were significantly less likely to receive treatment if they were female, cisplatin ineligible, older, or diagnosed before 2018; had laUC, an Eastern Cooperative Oncology Group performance status >1, or greater comorbidity; or resided outside London or in income-deprived areas. Median OS (95% CI) from diagnosis in treated vs. untreated patients was 19.9 (19.4–20.6) vs. 5.8 (5.6–6.0) months, respectively. Limitations include retrospective analysis of data not initially collected for research purposes. ConclusionFrom 2013 to 2019, ≈70% of patients with la/mUC in England were untreated, which is high given the availability of effective treatments. Reasons for undertreatment should be addressed. Given the evolving treatment landscape, analysis of more recent data would be informative. MicroabstractThis study investigated systemic anticancer treatment for patients diagnosed with advanced urothelial carcinoma in England between 2013 and 2019. Of 16,610 patients, 31% received treatment. Various factors were associated with not receiving treatment, including female sex, older age, worse performance status, greater comorbidity, and resident in income-deprived areas. Median overall survival in treated vs. untreated patients was 19.9 vs. 5.8 months.

Changes in Skeletal Muscle Mass in the First 3 Months Following Gastrointestinal Cancer Surgery: A Prospective Study.

Surgical resection is the primary treatment for gastrointestinal (GI) cancers, but postoperative skeletal muscle loss (SML) is common and linked to poor prognosis. This study aims to identify patterns of muscle change, examine its association with quality of life (QoL), and explore predictors of SML in the first 3 months. A prospective cohort study was conducted on patients newly diagnosed with GI cancer and undergoing surgery in China between September 2021 and May 2022. Skeletal muscle mass (SMM) and QoL were assessed at admission, 7 days, 1 month, and 3 months post-surgery. Demographic, clinical data, and biomarkers were collected. Missing data were imputed using multiple imputation. Data were analyzed using growth mixture modelling, bivariate analyses, and logistic regression. A total of 483 patients completed baseline assessment. Of the 242 patients with complete muscle assessments, 92% experienced SML. Three distinct patterns of muscle change were identified: 57% had normal preoperative SMM with mild postoperative SML, 16% had low preoperative SMM with moderate SML, and 27% had normal preoperative mass but severe postoperative SML. Moderate/severe SML was associated with more postoperative complications, poorer health, and higher symptom burden. Independent predictors included advanced age, preoperative sarcopenia, advanced cancer stage, and low prognostic nutrition index (PNI ≤ 45). The results did not change when using imputed values. Although SML is prevalent, patterns of muscle change are heterogeneous among patients. Advanced age, preoperative sarcopenia, advanced cancer stage, and cancer-related inflammation are predictors for moderate/severe SML, highlighting the need for early detection and management.

A Scoping Review on Vestibulopathy After Microsurgical Resection of Vestibular Schwannoma—The Forgotten Symptom

BACKGROUND AND OBJECTIVES: Although half of patients with vestibular schwannoma (VS) experience some form of vestibular dysfunction, it is rarely the most prominent symptom. The effect of VS resection on preexisting vestibulopathy remains poorly understood. Our objective was to perform a scoping review to elucidate the incidence and role of postoperative vestibulopathy after microsurgery (MS) as it relates to long-term quality of life (QOL) and predictors of recovery and to identify optimal management of vestibulopathy as a presenting symptom. METHODS: Studies were identified using the PubMed database published in the English language peer-reviewed recent literature (2000-2023) using MeSH and tiab terms, and additional studies identified from a secondary review of reference lists. RESULTS: Thirty-one articles were selected and reviewed. The literature quotes a wide range for the incidence of postoperative vestibulopathy after MS (4%-100%). Persistent vertigo universally demonstrates a strong negative effect on long-term QOL. Potential predictors of poor vestibular compensation include sex, advanced age, and tumor size. Few studies examine postoperative vertigo compared with preoperative baseline. Studies are inconsistent and variable in their use of measurement tools to assess vestibulopathy and QOL. Improvement in baseline vestibulopathy can be seen in long-term post-MS, particularly in patients with severe or disabling vertigo, although outcomes relative to other treatment modalities are otherwise similar. CONCLUSION: Further understanding of predictors and comparative management strategies for vestibulopathy would be valuable in addressing an important negative influence on QOL in patients with VS. Prospective studies factoring preoperative baseline and using standardized measurement tools are needed.

Paternal, Maternal, and Familial Factors as Predictors of Sturge–Weber Syndrome Neurological Outcome

Objectives: To identify potential risk factors influencing Sturge–Weber Syndrome (SWS) and neurological outcomes in individuals with SWS and port-wine birthmarks from paternal, maternal, and familial factors. Methods: This study follows a retrospective cross-sectional design. Clinical visits took place at the Kennedy Krieger Institute, a tertiary care center. Participants were individuals with SWS or port-wine birthmarks. Results: Higher paternal age at conception was associated with a range of cognitive dysfunctions in offspring with SWS brain involvement. Indeed, paternal age was associated with low intelligence quotient (n = 25, P = .004), strokes or stroke-like episodes (n = 34, P = .030), gross and/or fine motor delay (n = 34, P = .036), delays in ability to perform activities of daily living (n = 30, P = .012), and delayed learning compared to peers (n = 31, P = .027). Furthermore, paternal age was correlated with worse cognitive outcomes, as measured by cognitive Neuroscore (r s = 0.575, P &lt; .001, n = 32). When maternal thyroid disease and hypertension were present during pregnancy, offspring were more likely to experience low intelligence quotient (n = 30, P = .041) and regression of any abilities (n = 37, P = .045), respectively. Logistic regression confirmed the association between paternal age and severe cognitive Neuroscore (β = .580, P = .033, odds ratio: 1.79, 95% confidence interval: 1.05–3.04), even when controlling for the effects of seizures and strokes or stroke-like episodes. Conclusions: Prenatal factors were associated with neurological symptoms in subjects with SWS. Older paternal age, in particular, may predict worse neurocognitive outcomes. Further research is needed in larger cohorts to determine the value of the identified prenatal factors as prognostic tools. Likewise, animal models may be used to determine the impact of prenatal factors on the severity of outcome.

Investigating the Relationship between Nurses' Attitudes about Old Age and Age Discrimination in Caring for Older People Hospitalized in Kashan Hospitals In 2022

Investigating the Relationship between Nurses' Attitudes about Old Age and Age Discrimination in Caring for Older People Hospitalized in Kashan Hospitals In 2022