RESUMEN
BACKGROUND/OBJECTIVES: Malnutrition is an established risk factor for adverse clinical outcomes. Our aim was to assess nutritional status among geriatric trauma patients. SUBJECTS/METHODS: We enrolled 169 consecutive patients (⩾70 years) admitted to the Geriatric Traumatology Centre (University Hospital Zurich, Switzerland). On admission to acute care, nutritional status was assessed with the mini nutritional assessment (score<17=malnourished (M), ⩽23.5=at risk of malnutrition (ARM), >23.5=normal). At the same examination, we assessed mental (Geriatric Depression Scale; GDS) and cognitive function (Mini-Mental State Examination; MMSE), frailty status (Fried Scale), and number of comorbidities and medications. Further, discharge destination was documented. All analyses were adjusted for age and gender. RESULTS: A total of 7.1% of patients were malnourished and 49.1% were ARM. Patients with reduced mental health (GDS⩾5: 30.5 vs 11.5%; P=0.004), impaired cognitive function (MMSE⩽26: 23.6±0.5 vs 26.0±0.6; P=0.004), prevalent frailty (32.5 vs 8%; P<0.001), more comorbidities (2.3±0.1 vs 1.3±0.2; P<0.0001) and medications (5.6±0.3 vs 3.4±0.4; P<0.0001) were more likely to have an impaired nutritional status (M+ARM). Further, M+ARM patients were twice as likely to be discharged to destinations different to home (odds ratio=2.08; confidence interval 1.07-4.05). CONCLUSIONS: In this consecutive sample of geriatric trauma patients, 56.2% had an M+ARM upon admission to acute care, which was associated with indicators of worse physical, mental and cognitive health and predicted a more than twofold greater odds of being discharged to a destination other than home.
Asunto(s)
Fragilidad/epidemiología , Evaluación Geriátrica , Desnutrición/epidemiología , Estado Nutricional , Heridas y Lesiones/epidemiología , Actividades Cotidianas , Anciano , Cognición , Comorbilidad , Estudios Transversales , Femenino , Fuerza de la Mano , Humanos , Vida Independiente , Modelos Logísticos , Masculino , Desnutrición/diagnóstico , Evaluación Nutricional , Prevalencia , Estudios Prospectivos , Factores de Riesgo , SuizaRESUMEN
Opioids for non cancer pain control are controversial. The evaluation of the pain relief, changes in quality of life and complications due to long term infusion of opioids in the lumbar subarachnoid space in 11 patients with non cancer pain were the goals of this study. Patients were previously treated with drugs and surgical procedures, without significant pain relief. Patients were asked to compare pain characteristics and daily life activities before and after this treatment. The long term spinal opioids through implantable pumps for non-oncologic pain produced pain relief but did not improve the quality of life in the majority of the cases.
Asunto(s)
Analgésicos Opioides/uso terapéutico , Dolor/tratamiento farmacológico , Adulto , Anciano , Enfermedad Crónica , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The use of opioids for treatment of non-malignant pain is controversial. The evaluation of pain relief and of the quality of life of 11 severely incapacitated chronic non-cancer pain patients treated with long term intrathecal infusion of opioids trought implantable pumps was performed. The mean duration of pain complaints was 5.3 years. The mean pain intensity was 8.6. In 7 patients, pain episodes lasted at least 6 hours daily. The mean duration of the therapy was 19.6 months. After the treatment the mean pain score became 3.9. In only 1 patient, the duration of pain episodes was still longer than 6 hours. Quality of life improved in 36.36% of the cases. The long term spinal opioids through implantable pumps for non-malignant pains results in pain relief but not necessarily improves the quality of life.
Asunto(s)
Analgésicos Opioides/administración & dosificación , Morfina/administración & dosificación , Dolor/tratamiento farmacológico , Calidad de Vida , Adulto , Anciano , Analgésicos Opioides/uso terapéutico , Enfermedad Crónica , Humanos , Persona de Mediana Edad , Morfina/uso terapéutico , Resultado del TratamientoAsunto(s)
Trombosis de las Arterias Carótidas/diagnóstico por imagen , Trombosis de las Arterias Carótidas/cirugía , Endarterectomía , Velocidad del Flujo Sanguíneo/fisiología , Arteria Carótida Externa/diagnóstico por imagen , Arteria Carótida Externa/cirugía , Arteria Carótida Interna/diagnóstico por imagen , Arteria Carótida Interna/cirugía , Estudios de Seguimiento , Humanos , Complicaciones Posoperatorias/diagnóstico por imagen , UltrasonografíaRESUMEN
An algorithm of the fluorescent microscopy data analysis enabled to assess the coefficient of the diffusion permeability of the microvessels' walls for substances with small molecular mass (sodium fluorescent). A short-term application of hydrogen peroxide increased relative values of the coefficient. The effect of the oxygen free radicals on the permeability seems to be associated with structural disorder of the glycocalix in intercellular contacts of the microvessels' endothelium.