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PURPOSE: Sagittal synostosis is the most common isolated craniosynostosis. Surgical treatment of this synostosis has been extensively described in the global literature, with promising outcomes when it is performed in the first 12 months of life. However, in some cases, patients older than 12 months arrive at the craniofacial center with this synostosis. A comprehensive study on efficacy and perioperative outcomes has yet to be fully explored in this population. This systematic review and meta-analysis aimed to assess the available evidence of surgical outcomes for the treatment of sagittal synostosis among older patients to analyze the efficacy and safety of synostosis surgery in this unique population. METHODS: PubMed, Embase, and Scopus were searched for studies published from inception to March 2024 reporting surgical outcomes of synostosis surgery in older patients (> 12 months) with isolated sagittal synostosis. The main outcome was the reoperation rate, with secondary endpoints including transfusion rates, aesthetic outcomes, and surgical complications. RESULTS: Nine studies were included in the final analysis. The pooled proportion of the reoperation rate was 1%. The rate of excellent aesthetic results was 95%. The need for transfusion associated with the procedures was 86%, and finally, surgical complications attained a pooled ratio of 2%, indicating minimal morbidity associated with the surgical repair. CONCLUSION: Sagittal synostosis surgery is a safe and effective procedure to perform in older patients; this meta-analysis suggests that open surgery confers a significant rate of excellent aesthetic results with a low reoperation rate and minimal complications associated with the intervention. Future research with direct comparisons among different techniques will validate the findings of this study, which will all contribute to the rigor of synostosis management.
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Craniossinostoses , Humanos , Craniossinostoses/cirurgia , Lactente , Resultado do Tratamento , Pré-Escolar , Procedimentos de Cirurgia Plástica/métodos , Procedimentos de Cirurgia Plástica/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Reoperação/estatística & dados numéricos , Reoperação/métodosRESUMO
Population aging represents a critical issue for global cancer care, notably in low- and middle-income countries (LMIC). Latin America is a large region composed of 21 countries with notable diversity in both human development and access to quality healthcare. Thus, it is necessary to understand how care for older individuals is being delivered in such large and diverse regions of the world. This review describes the recent advances made in Mexico, Brazil, and Chile, focusing on the creation and implementation of educational, research, and clinical activities in geriatric oncology. These initiatives intend to change healthcare professionals' perceptions about the care for older adults and to improve the way older patients are being treated.
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Neoplasias , Humanos , Idoso , América Latina/epidemiologia , Neoplasias/terapia , Oncologia , México , EnvelhecimentoRESUMO
AIM: To assess the relationship of the presence of sarcopenia and malnutrition with unfavorable clinical outcomes: prolonged length of hospital stay (LOS), readmission, and one-year mortality in older patients with type 2 diabetes (T2D). METHODS: Were included 319 patients with ≥ 60 years of age with T2D hospitalized at a university hospital in Southern Brazil. Sarcopenia was diagnosed according to handgrip strength (HGS), calf circumference (CC), and the timed up and go (TUG) walking test, and malnutrition according to the subjective global assessment (SGA) and the mini nutritional assessment long form (MNA-LF). Multivariate analyses, adjusted for confounders, were performed to assess the association of sarcopenia and malnutrition with clinical outcomes. One-year survival was compared using Kaplan-Meier analysis. RESULTS: The association between sarcopenia and malnutrition increased by 2.42 times (95 %CI 1.35-4.36) the probability of LOS ≥ 14 days and by 2.01 times (95 %CI 1.09-3.72) the risk of one-year mortality. Older patients with malnutrition and sarcopenia have a higher risk of one-year mortality (log-rank p < 0.05) compared with well-nourished patients without sarcopenia. CONCLUSION: In older patients with type 2 diabetes, those with sarcopenia, and malnutrition have higher odds of prolonged hospitalization and risk of mortality within one year after hospital discharge.
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Diabetes Mellitus Tipo 2 , Desnutrição , Sarcopenia , Humanos , Idoso , Sarcopenia/diagnóstico , Hospitalização , Diabetes Mellitus Tipo 2/complicações , Estado Nutricional , Força da Mão , Estudos Prospectivos , Desnutrição/complicações , Desnutrição/diagnóstico , Avaliação NutricionalRESUMO
The treatment of older patients with Hodgkin lymphoma (HL) remains a challenge. We sought to identify the treatment patterns and outcomes in older HL patients included in the Brazilian HL registry (NCT02589548). A total of 136 patients with HIV-negative classic HL, aged ≥ 60 years, diagnosed between 2009 and 2018, were analyzed. The median age was 66 years old (60-90), 72% had advanced disease, 62% had a high IPS, and 49% had a nodular sclerosis subtype. Median follow-up was 64 months for alive patients. ABVD was the front-line treatment in 96% of patients. Twenty-one patients (15%) died during front-line treatment. The 5-year PFS and 5-year OS rates were 55% and 59%, respectively. The 5-year OS rates in localized and advanced disease were 81% and 51% (p=0.013). Lung toxicity developed in 11% of the patients treated with ABVD. Bleomycin was administered for > 2 cycles in 65% of patients. Compared with 2009-2014, there was a decrease in the use of bleomycin for > 2 cycles in 2015-2018 (88% × 45%, p<0.0001). The impact of socioeconomic status (SES) on outcomes was studied in patients treated with ABVD. After adjusting for potential confounders, lower SES remained independently associated with poorer survival (HR 2.22 [1.14-4.31] for OS and HR 2.84 [1.48-5.45] for PFS). Treatment outcomes were inferior to those observed in developed countries. These inferior outcomes were due to an excess of deaths during front-line treatment and the excessive use of bleomycin. SES was an independent factor for shorter survival.
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Doença de Hodgkin , Idoso , Humanos , Pessoa de Meia-Idade , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bleomicina/uso terapêutico , Brasil/epidemiologia , Dacarbazina/uso terapêutico , Doxorrubicina/uso terapêutico , Doença de Hodgkin/tratamento farmacológico , Doença de Hodgkin/epidemiologia , Estadiamento de Neoplasias , Estudos Prospectivos , Sistema de Registros , Resultado do Tratamento , Vimblastina/uso terapêutico , Idoso de 80 Anos ou mais , Estudos Clínicos como AssuntoRESUMO
Resumen Objetivo: Describir las características clínicas y los resultados operatorios y a siete años del reemplazo valvular aórtico en una cohorte de pacientes mayores de 80 años. Materiales y métodos: Estudio descriptivo retrospectivo de 75 pacientes consecutivos mayores de 80 años, intervenidos de reemplazo valvular aórtico exclusivo entre 2007 y 2019 en el Hospital Guillermo Grant Benavente. Se estudian sus características demográficas, clínicas, ecocardiográficas, riesgo operatorio, cirugías, complicaciones y mortalidad operatoria y supervivencia alejada hasta el 15 de marzo 2021. Resultados: La edad media de la cohorte fue 83,05 ± 2,9 años (rango 80-95) y 43 pacientes eran mujeres (57,3%). La lesión valvular predominante fue la estenosis aórtica (89,3%). 10 pacientes tenían enfermedad coronaria asociada (13,3%) y 2 endocarditis activa. El riesgo de mortalidad operatoria calculado por EuroSCORE aditivo, logístico, II y STS score fue 7,58 ± 1,8; 9,88 ± 6,5%; 3,72 ± 3,5% y 4,27 ± 3,2%, respectivamente. Se utilizó prótesis biológica en 70 (92%) pacientes. Hubo 29 complicaciones operatorias y fallecieron 11 (14,7%) pacientes. El seguimiento promedio fue 7,1 años (rango 2-14), durante el cual fallecen 28 pacientes. La supervivencia a uno, tres y cinco años fue 82, 76, 66 y 48% respectivamente. Conclusiones: La cirugía de reemplazo valvular aórtico en octogenarios en nuestro medio es un procedimiento poco frecuente. La mortalidad observada fue mayor que la estimada por las escalas de riesgo. El reemplazo valvular quirúrgico es una alternativa de tratamiento de la enfermedad de la válvula aórtica en pacientes seleccionados. Se deben evaluar estrategias para mejorar los resultados.
Abstract Objective: To describe the clinical characteristics and operative and 7-year results of aortic valve replacement in a cohort of patients older than 80 years. Materials and methods: Retrospective descriptive study of 75 consecutive patients older than 80 years of age who underwent exclusive aortic valve replacement between 2007 and 2019 at the Guillermo Grant Benavente Hospital. Demographic, clinical, echocardiographic characteristics, operative risk, surgeries, complications and operative mortality and long-term survival until March 15, 2021 are studied. Results: The mean age of the cohort was 83.05 ± 2.9 years (range 80-95) and 43 patients were women (57.3%). The predominant valve lesion was aortic stenosis (89.3%). Ten patients had an associated coronary artery disease (13.3%) and 2 had active endocarditis. The risk of operative mortality calculated by EuroSCORE additive, logistic, II and STS score was 7.58 ± 1.8; 9.88 ± 6.5%; 3.72 ± 3.5% and 4.27 ± 3.2%, respectively. A biological prosthesis was used in 70 (92%) patients. There were 31 operative complications and 11 (14.7%) patients died. The mean follow-up was 7.1 years (range 2-14), during which 28 patients died. Survival at 1, 3, and 5 years was 82, 76, 66 and 48%, respectively. Conclusions: Aortic valve replacement surgery in octogenarians in our setting is a rare procedure. The observed mortality was higher than that estimated by the risk scales. Surgical valve replacement is an alternative treatment for aortic valve disease in selected patients. Strategies to improve results should be evaluated.
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BACKGROUND: Breast cancer (BC) prevalence steadily increases in older patients but their treatment is based on the geriatric evaluations of comorbidities and potential benefits proved in clinical trials with younger patients. The lack of better decision-making tools urges to promote the search for new prognostic markers. The association between inflammation, aging and cancer may be crucial for better treatment selection. We sought to analyze its impact on the survival of older BC patients, evaluating the interaction with age and comorbidities. METHODS: We evaluated the relationship between inflammatory biomarkers at BC diagnosis (circulating blood cell counts and inflammatory indexes) and BC-related and not related mortality rate, evaluating the influence of comorbidities and age through the competitive risks assessment. RESULTS: We analyzed 148 consecutive BC patients aged ≥ 70 years old, diagnosed with BC and regional lymph node metastases. After the median follow-up of 51.5 months, 59 patients died (28 due to breast cancer progression and 31 because of other causes). Increased levels of circulating monocytes, neutrophils and neutrophil-to-lymphocytes ratio and decreased level of eosinophils and eosinophil multiple by neutrophils-to-lymphocytes ratio were associated with higher probability of BC-related death but not with death related to other causes. CONCLUSION: Our data suggest a role of inflammatory parameters as a possible prognostic tool in therapeutic decision-making process in older patients with BC, as increased level of inflammation was associated with cancer-specific mortality. Prospective studies may give the possibility of refining the geriatric evaluation for BC treatment in elderly.
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Neoplasias da Mama , Idoso , Mama/patologia , Neoplasias da Mama/patologia , Feminino , Humanos , Inflamação/patologia , Prognóstico , Estudos ProspectivosRESUMO
We retrospectively reviewed the data from patients ≥ 70 years old treated between January 2012 and January 2017. Axillary staging was scarcely used in the therapeutic algorithm but arm lymphedema was significantly associated to axillar dissection (p=0.04) and regional nodal irradiation (p = 0.02). Aggressive management of axilla did not provide relevant information for deciding chemotherapy but added morbidity.
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Neoplasias da Mama , Idoso , Axila/patologia , Neoplasias da Mama/patologia , Dissecação , Feminino , Humanos , Excisão de Linfonodo , Linfonodos/patologia , Estadiamento de Neoplasias , Estudos Retrospectivos , Biópsia de Linfonodo SentinelaRESUMO
La disfagia es la alteración de la seguridad y eficacia del proceso deglutorio que dificulta el correcto paso del alimento/saliva desde la boca hacia el estómago, lo que aumenta la probabilidad de desnutrición, deshidratación y aspiración pulmonar con un consiguiente empeoramiento del pronóstico[1]. Los cambios en el acto de tragar relacionados con la edad se llaman presbifagia[6], un cuadro altamente prevalente afectando entre 13-30% de las personas mayores autovalentes, e incrementando considerablemente, en contexto de hospitalización, al 30-47% por causas adicionales[7]: mecánicas, neurológicas o iatrogénicas, que potencian las complicaciones o desestabilizan el equilibrio deglutorio. Recientemente la disfagia se considera un síndrome geriátrico[6], lo que conlleva desafíos para el equipo multidisciplinario respecto de prevenir y disminuir efectos adversos[8]. El conflicto principal, es que para el equipo hospitalario resulta un desafío detectar a personas mayores con riesgo aspirativo, por lo que no son identificados a tiempo[68]. El objetivo de este artículo es exponer un esquema multidisciplinario de detección de riesgo aspirativo en contexto de hospitalización de la "Unidad Especializada de Cuidado en persona Mayor" (UCAM) de Clínica Las Condes, para lo cual, primero se revisa literatura asociada a disfagia, clasificación reciente, consecuencias, métodos de evaluación recomendados y condiciones específicas, asociadas a riesgo aspirativo y segundo, se definen dos vías junto con Geriatría, Enfermería y Nutrición: 1) Se definen criterios de derivación fonoaudiológica oportunos para evaluación clínica de la deglución, y 2) Método precoz de pesquizaje y evaluación multidisciplinario de disfagia orofaríngea y riesgo aspiratorio.
Dysphagia is the alteration of the safety and efficacy of the swallowing process that prevents the correct transit of food/saliva from the mouth to the stomach, which increases malnutrition, dehydration and pulmonary aspiration and patient's bad prognosis[1]. The changes in the act of swallowing related to age are called presbyophagy[6]. A highly prevalent affect of self-worthy elderly people (between 13-30%), and increasing considerably in hospitalization context (30-47%) for additional causes[7]: mechanical, neurological or iatrogenic, which increases complications or destabilizes swallowing balance. Recently dysphagia it is considered a geriatric syndrome[6], that challenges the multidisciplinary team regarding prevention and reduction of adverse effects related to hospitalization units of elderly people[8]. One of the main tasks of the healthcare team is the early detection of elderly people with aspiration risk. The objective of this article is present a multidisciplinary protocol of EP with dysphagia in the context of hospitalization in the "Specialized care unit for the elderly" (SCUE) of Clínica Las Condes. Initially, literature associated with oropharyngeal dysphagia (OD), recent classification, consequences, recommended evaluation methods and specific conditions associated with were reviewed. Accordingly, two routes are defined with SCUE'team, Speech language pathologist, Geriatrics, Nursing and Nutrition. 1) opportune referral criteria of Speech language pathologist for clinical swallowing evaluation and 2) Early multidisciplinary screening and evaluation method of OD and aspiration risk.
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Humanos , Idoso , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/terapia , Hospitalização , Transtornos de Deglutição/classificação , Transtornos de Deglutição/fisiopatologia , Diagnóstico PrecoceRESUMO
Earlier age at onset is one characteristic of hereditary cancer syndromes, so most studies of genetic testing have focused on young patients with cancer. However, recent studies of multigene panel tests in unselected cancer populations have detected a considerable proportion of older patients with germline pathogenic variants (PVs) in cancer susceptibility genes. As the number of older patients with cancer continues to rise, clinicians should be aware of genetic/genomic cancer risk assessment (GCRA) criteria in both young and older adults. Identifying individuals with a germline PV in a cancer susceptibility gene may be important for precision therapy of current cancers and screening and prevention of new primary cancers, as well as cascade testing to identify high cancer risks for family members. Typically, hereditary predisposition germline genetic testing has been recommended for patients with early onset cancers and/or a family history of cancer. However, more recently international guidelines recommend testing for potential therapeutic intervention regardless of age for some tumors frequently seen in older patients, such as epithelial ovarian, pancreatic, and metastatic prostate and breast cancers. GCRA in older patients may present challenges including: clonal hematopoiesis (CH) confounding test interpretation, ethical aspects (autonomy, nonmaleficence, beneficence), patient health status, comorbidities, as well as lack of insurance coverage. These factors should be considered during genetic counseling and when considering cancer screening and risk reduction procedures. This manuscript reviews available data on common hereditary cancer syndromes in older patients and provides tools to help providers perform GCRA in this population.
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Neoplasias da Mama , Síndromes Neoplásicas Hereditárias , Idoso , Neoplasias da Mama/genética , Aconselhamento Genético , Predisposição Genética para Doença , Testes Genéticos , Humanos , Masculino , Síndromes Neoplásicas Hereditárias/genéticaRESUMO
INTRODUCTION: An increase in the number of cancer cases is expected in the near future. Breast cancer (BC) mortality rates increase with age even when adjusted for other variables. Here we analyzed BC disease-free survival (BCDFS) and BC specific survival (BCSS) in the El Alamo III BC registry of GEICAM Spanish Breast Cancer Group. MATERIALS AND METHODS: El Alamo III is a retrospective registry of BC patients diagnosed between 1998 and 2001. Patients with stage I-III invasive BC of age groups 55-64 years (y), 70-74 years and ≥ 75 years were included. Patients and tumors characteristics, treatments and recurrences and deaths were analyzed. RESULTS: 4343 patients were included within the following age intervals: 2288 (55-64 years), 960 (70-74 years), and 1095 (≥ 75 years). Older patients (≥ 70 years) were diagnosed with more advanced tumors (stage III) than younger patients (21.5% versus 13.4%, p < 0.0001). Mastectomies were performed more on older patients and they received less chemotherapy than younger patients (66.6% versus 43.1%, p < 0.00001 and 30.8% versus 71.6%, p < 0.0001, respectively). With a median follow-up of 5.9 years, 17.7% patients had BCDFS events in the younger group and 19.8% in the older group (p < 0.0001). A decrease in BCSS was also observed in older patients, either when analyzing patients ≥ 70y (p < 0.0001) and when differentiating by the two older groups (p < 0.0001). CONCLUSIONS: Our study suggests that older BC patients have worse outcomes what can be a consequence of receiving inadequate adjuvant treatments. Specific trials for these patients are warranted to allow us to treat them with the same scientific rigor than younger patients.
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Neoplasias da Mama/mortalidade , Sistema de Registros/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Neoplasias da Mama/química , Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Sobreviventes de Câncer , Causas de Morte , Quimioterapia Adjuvante/estatística & dados numéricos , Intervalo Livre de Doença , Feminino , Humanos , Mastectomia/estatística & dados numéricos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Espanha/epidemiologia , Análise de SobrevidaRESUMO
OBJECTIVES: An increase in life expectancy is predicted for the general population and, by 2050, about one billion people will be older than 65 years. The Global Cancer Incidence, Mortality and Prevalence database estimates that 1.2 million people of this age will have cancer; this number represents 58% of new cases in the American population. This represents a challenge for diagnosis and treatment, given that some older people have multiple comorbidities and disabilities. MATERIALS AND METHODS: This was a retrospective descriptive study of 204 patients aged 65 years and over. All had a solid tumor that was diagnosed in a private hospital from January 2015 to December 2017. RESULTS: The median age was 72.2 years; the most frequent age group (48.5% of patients) was 65-75 years, and only a small percentage (4.4%) were aged > 85 years. The most common type of cancer was lung cancer (22.5%), followed by colorectal and urinary cancer. Most patients received cancer treatment after the disease diagnosis. CONCLUSION: There are no epidemiological studies of the older oncology population in Mexico. We believe it is necessary to perform larger studies to understand this population and to undertake actions to facilitate greater attention to patient diagnosis, treatment, and alleviation.
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INTRODUCTION AND AIMS: The growing elderly population and wide use of capsule endoscopy have led to a higher number of procedures in those patients. The aim of the present study was to assess the usefulness of capsule endoscopy in older patients. MATERIALS AND METHODS: All consecutive patients undergoing capsule endoscopy at our center within the time frame of 2004-2016 were classified as older (≥75 years of age) and younger. Findings and diagnostic yield were comparatively assessed. RESULTS: Of 2311 patients (mean age: 59.5 ± 19.23 years, 44.48% male), 648 were in the older group and 1663 in the younger group. Gastric transit time was shorter in the older patients (p=0.001), whereas small bowel transit time was shorter in the younger patients (p<0.001). Overall diagnostic yield in the elderly was higher (50.66% vs. 41.19%, p<0.001). Obscure gastrointestinal bleeding was the most frequent indication for capsule endoscopy in the elderly (90.4% vs. 53.77%, p<0.001), achieving a higher diagnostic yield than in the younger population (51.47% vs. 42.76%, p=0.002), whereas Crohn's disease, suspected or known neoplasms/polyps, malabsorption syndrome, and abdominal pain were the indications in the younger patient group. Such indications were rare in the older group. Vascular lesions and active bleeding were more frequently diagnosed in the older patients, whereas ulcers/erosions and mucosal atrophy were more common in the younger patients (p<0.001). CONCLUSIONS: Capsule endoscopy achieved a higher overall diagnostic yield in the elderly patients. Obscure gastrointestinal bleeding indication for capsule endoscopy was much more frequent in the advanced-age group and had a higher diagnostic yield.
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Endoscopia por Cápsula/estatística & dados numéricos , Gastroenteropatias/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Feminino , Gastroenteropatias/diagnóstico , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/diagnóstico por imagem , Trânsito Gastrointestinal , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
Las bacteremias por microorganismos del genero Campylobacter son poco comunes en nuestro medio, debido a su baja incidencia y son escasos los reportes en la literatura. El siguiente reporte describe un caso de bacteremia por la especie Campylobacter fetus subespecie fetus, en un paciente de edad avanzada, quien presentó manifestaciones neurológicas que inicialmente desviaron el diagnóstico oportuno. Finalmente el paciente resuelve la infección tras el tratamiento antibiótico, sin complicaciones. Es de interés mencionar la presencia de este microorganismo como causante de diversas patologías en pacientes con inmunosupresión, considerándose un patógeno oportunista, del cual no está bien definida su patogénesis ni la fuente de exposición o los factores de riesgo en estos pacientes. Igualmente, es importante la vigilancia activa de este microorganismo ya que por su complicada recuperación, altas exigencias nutricionales y su crecimiento lento, dificulta su aislamiento y diagnóstico en el laboratorio de microbiología.
The bacteremias by microorganism of genera Campylobacter are uncommon in our medium, because of its low incidence and few reports in the literature. The report describe a bacteremia by Campylobacter fetus, a gram negative rod, spiral shape, in an older patient who presented initial neurogycal manifestations that shifted the timely diagnosis. Finally, the patient solves the infection after the antibiotic treatment, uncomplicated. It`s important to say that, this microorganism is the cause of different pathologies in patients with inmunosuppression considering as opportunistic pathogen. It`s pathogenesis source of exposure and risk factor in these patients has not yet been defined. Also, it is important the active surveillance in these microorganism, due to its complicated recovery, high nutritional requirements and slow growth. As described above is the reason because of its difficult isolation and diagnosis in the laboratory of microbiologic.
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Humanos , Feminino , Idoso de 80 Anos ou mais , Campylobacter fetus , Bacteriemia , Bactérias , Colômbia , Serviços de Vigilância Epidemiológica , Bactérias Gram-NegativasRESUMO
Background Advances in the treatment of HIV infection have enabled better control of the disease, allowing patients to enjoy a longer life expectancy. However, the ageing of patients leads to an increased prevalence of cardiovascular disease. Various studies have found that pharmaceutical care results in better control of cardiovascular risk factors. Objective To measure the impact of pharmaceutical care on cardiovascular risk in patients older than 50 years receiving combination antiretroviral therapy. Setting Outpatient pharmacy service of a tertiary hospital, Spain. Methods A pre/post-intervention quasi-experimental clinical study was conducted in which health education and pharmacist interventions to reduce cardiovascular risk factors were carried out in a single patient cohort using the Dader method of pharmacotherapy, with a 12-month follow-up period per patient. Patients included were older than 50 years, with moderate/elevated cardiovascular risk. Data were obtained from patient clinical histories, dispensing records and patient interviews, and were subjected to statistical analysis. Main outcome measure Cardiovascular risk estimated by SCORE and REGICOR equations. Results Forty-two patients completed the study. Of these, 93 % were men, with an average age of 57 years and 15 years since diagnosis of HIV. A reduction was observed in the mean values (baseline vs. 12 months) of the following cardiovascular risk factors: systolic blood pressure (P = 0.009), diastolic blood pressure (P = 0.010), total cholesterol (P = 0.006), low-density lipoprotein cholesterol (LDL-c; P = 0.039), triglycerides (P = 0.010) and total cholesterol/high-density lipoprotein cholesterol (HDL-c; P < 0.001). An increase in HDL-c (P = 0.037) was also observed. The average cardiovascular risk estimated by the SCORE instrument was reduced from 7.6 % at the beginning of the study to 6.4 % after 12 months (P = 0.039). The risk estimate according to REGICOR also decreased (P = 0.002). Over the 12-month period, 6.3 ± 3.4 interventions were carried out per patient. Quantitative ineffectiveness was the most prevalent negative outcome associated with medication throughout the study, and noncompliance was the most frequent cause. Interventions on health education were the most common, followed by interventions on improving adherence. Conclusion Pharmaceutical care, delivered as a combination of health education and pharmacotherapy follow-up to outpatients at a tertiary hospital, had a positive impact on cardiovascular risk in patients older than 50 years receiving combination antiretroviral therapy.
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Antirretrovirais/uso terapêutico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Serviço de Farmácia Hospitalar/métodos , Fatores Etários , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Ambulatório Hospitalar , Fatores de RiscoRESUMO
Purpose: Demographic changes make it necessary to improve communication with older patients and design gender sensitive health promotion. The present article aimed to explore how general practitioners see old age and what role gender may play in their representations of aging. It also looked whether the gender of the older patients played a role for how general practitioners treated them. Methods: Episodic interviews were conducted with 17 women and 17 men who worked as general practitioners in Romania. Thematic coding was used to analyze data. Results: Findings showed that general practitioners saw old age as negative no matter their gender. Older patients were perceived as difficult and mostly older women were given as negative examples to illustrate treatment non-adherence and psychological or social problems related to aging. Conclusion: Negative aging views combined with a (de)gendering of aging patients may lead to maintain negative aging stereotypes and gender inequality in old age. Implications for preventing this from happening are discussed.
Propósito: Los cambios demográficos hacen necesario mejorar la comunicación con pacientes mayores y diseñar promoción de la salud sensible al género. El presente artículo explora cómo médicos generales perciben la adultez mayor y qué rol puede jugar el género en sus representaciones sobre el envejecimiento. También examina si el género de los pacientes mayores jugó un rol en la forma en la que los médicos generales los trataron. Métodos: Se llevaron a cabo entrevistas episódicas con 17 mujeres y 17 hombres que trabajaron como médicos generales en Rumanía. Se usó codificación temática para analizar los datos. Resultados: Los hallazgos mostraron que los médicos generales ven la adultez mayor como negativa sin importar el género. Se percibió a los pacientes mayores como difíciles y se mencionó principalmente a mujeres como ejemplos negativos para ilustrar falta de adherencia al tratamiento y problemas psicológicos y sociales relacionados con el envejecimiento. Conclusión: Ejemplos de envejecimiento negativo combinados con una invisibilización del género de los pacientes puede guiar hacia el mantenimiento de estereotipos negativos sobre el envejecimiento y la desigualdad de género en la adultez mayor. Se discuten implicaciones para prevenir que esto pase.
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AIM: The optimal treatment in older persons with metastatic colorectal cancer (mCRC) is complicated by a lack of general agreement. The aim of this study was to evaluate the activity of bevacizumab plus capecitabine combination in elderly mCRC patients who were not suitable for chemotherapy with irinotecan and oxaliplatin-containing regimens. MATERIALS AND METHODS: Seventy years and older patients with metastatic colorectal carcinoma were included in this retrospective study. Bevacizumab was administered at a dose of 7.5 mg/kg on day 1 as an intravenous (IV) infusion over 30-90 min every 21 days, and capecitabine was prescribed at 1000 mg/m(2) twice daily on days 1-14 of the same 21-day schedule. RESULTS: Eighty-two consecutive patients (47 men, 35 women) were included in the study. The mean age was 75.5 (SD 3.9, range 70-87). Half of the patients were older than 75 years. There were 55 patients (67.1 %) with a good Eastern Cooperative Oncology Group (ECOG) performance status (PS: 0-1) and the remaining 27 patients (32.9 %) had a poor ECOG performance status (PS: 2). With a median follow-up period of 18.5 months, the median progression-free survival (PFS) was 10 months (95 % CI, 7.8-12.1) and the median OS was 25 months (95 % CI, 18.6-31.3). The main toxicities recorded were non-hematological. Thirty-one patients (37 %) experienced grade 3/4 adverse events, the most common being hand-foot syndrome (9.8 %). No fatal toxicity resulting from this regimen was recorded. CONCLUSIONS: Considering the toxicity profile and survival outcomes, the combination regimen of capecitabine and bevacizumab is a potentially feasible treatment option in elderly mCRC patients.
Assuntos
Adenocarcinoma/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bevacizumab/administração & dosagem , Capecitabina/administração & dosagem , Neoplasias Colorretais/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/mortalidade , Intervalo Livre de Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Estudos RetrospectivosRESUMO
Objetivo: Comunicar los resultados clínico-radiológicos del tratamiento de las fracturas de húmero distal con prótesis total de codo en pacientes >65 años. Materiales y Métodos: Estudio retrospectivo en dos centros quirúrgicos. Criterios de inclusión: pacientes con fractura de húmero distal, >65 años, operados con prótesis total de Coonrad-Morrey y seguimiento >1 año. Se incluyeron 21 pacientes (20 mujeres), edad promedio: 79 años. Según la clasificación AO, 13 C3, siete C2 y una A2. Todos fueron operados sin desinserción del aparato extensor. Seguimiento promedio: 40 meses. Resultados: La flexo-extensión fue de 123-17°, arco de movilidad de 106° (80% con respecto al lado sano). Dolor según la escala analógica visual: 1 punto. El puntaje de la Clínica Mayo promedio fue 83: resultado excelente (8 pacientes), bueno (11 pacientes), regular (1 caso) y malo (1 caso). El puntaje DASH promedio fue de 24. No hubo aflojamientos en 13 pacientes. Se produjeron nueve complicaciones: dos pacientes fueron operados nuevamente por desgaste del polietileno, uno operado otra vez al mes de la cirugía para la recolocación del perno de ensamble, dos parestesias del nervio cubital, una falsa vía intraoperatoria, un hematoma de la herida que necesitó de un colgajo braquial y dos aflojamientos protésicos. Conclusiones: El tratamiento de las fracturas de húmero distal con prótesis total de codo en pacientes >65 años puede ofrecer una opción terapéutica razonable, pero las indicaciones deben limitarse a fracturas complejas donde la fijación interna puede ser precaria, en pacientes con osteoporosis y con baja demanda funcional.
Objective: To report the clinical-functional results of humeral distal fracture treatment with total elbow prosthesis in patients older than 65 years. Methods: Retrospective study performed in two surgical centers. Inclusion criteria: patients with humeral distal fractures, >65 years, operated on with Coonrad-Morrey prostheses, and with a follow-up >1 year. Twenty-one patients were included (20 women) with an average age of 79 years. According to AO classification: 13 type C3 fractures, 7 C2 and 1 A2. All patients were operated on without disinsertion of the extensor mechanism. Average follow-up: 40 months. Results: Flexion-extension: 123-17°, with a total arc of mobility of 106° (80% of the contralateral side). Pain according to visual analogue scale was 1. The Mayo Clinic score was 83 points, results were excellent (8 patients), good (11 patients), regular (one case) and bad (one case). Average DASH score was 24 points. No loosening of the implants was evidenced in 13 patients. Nine complications were reported: 2 reoperations for polyethylene wear, one early decoupling of the prosthesis, 2 ulnar nerve paresthesia, one patient presented a false intraoperative via, one hematoma that needed a local flap and 2 loosening of the prosthesis. Conclusions: Treatment of humeral distal fractures with total elbow arthroplasty in patients older than 65 years may be a good therapeutic option, but indications must be limited to patients with complex fractures, bad bone quality, with osteoporosis and low functional demands.
Assuntos
Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Articulação do Cotovelo/cirurgia , Artroplastia de Substituição do Cotovelo/métodos , Fraturas do Úmero/cirurgiaRESUMO
Introducción: la extensión de las indicaciones del tratamiento anticoagulante oral y el incremento en la edad de los pacientes que requieren de este tratamiento, posibilitaron cambios en su uso y control sin disminuir su eficacia, por lo que se considera una terapéutica de beneficio para el adulto mayor. Objetivos: describir el comportamiento del control del tratamiento anticoagulante oral en población geriátrica con enfermedad tromboembólica venosa. Métodos: estudio descriptivo, analítico, en 76 pacientes (60-85 años) atendidos por consulta especializada en el Instituto Nacional de Angiología y Cirugía Vascular un en un periodo de dos años. Se evaluó el grado de control de la anticoagulación y se determinó la frecuencia de eventos hemorrágicos y otras complicaciones. Resultados: hubo buen control de la anticoagulación oral durante los dos años en pacientes mayores y menores de 60 años. No se encontraron diferencias estadísticamente significativa entre ambos grupos. Se observó un mayor índice de eventos hemorrágicos menores en la muestra estudiada. Conclusiones: el control del tratamiento anticoagulante oral en el adulto mayor tiene un comportamiento similar en ambos grupos de edades estudiados, por lo que dicho tratamiento se debe utilizar en todas las indicaciones si se tiene en cuenta la relación riesgo-beneficio(AU)
Introduction: the scope of the oral anticoagulant treatment indications and the older age of patients in need of this treatment favored changes in its use and control without reducing its efficacy, so this is considered beneficial therapeutics for the elderly. Objective: to describe the behavior of the control of oral anticoagulant treatment in the elderly population with thromboembolic venous disease. Methods: a descriptive and analytical study of 76 patients (60 to 85 years) seen at the specialized service of the National Institute of Angiology and Vascular Surgery in two years. The level of control of anticoagulation was evaluated, the frequency of hemorrhagic events and other complications were determined. Results: good control of the oral anticoagulant treatment was reached during the 2 year-period in younger than and over 60 years-old patients. No significant statistical difference was found when comparing the two groups. A higher index of slight hemorrhagic events was found in the study sample Conclusions: the control of the oral anticoagulant treatment in the older adult behaved similarly to that of the patient younger than 60 years, so the above mentioned treatment should be used in all the indications if the risk-benefit ratio is considered(AU)
Assuntos
Humanos , Idoso , Trombose Venosa/tratamento farmacológico , Anticoagulantes/uso terapêutico , Epidemiologia DescritivaRESUMO
Graças à melhoria global das condições de saúde e de vida, a população mundial está envelhecendo. Aproximadamente 60% da incidência de câncer ocorre em adultos de 65 anos ou mais. O câncer é um importante problema de saúde na população idosa. Oncologia geriátrica é definido pela abordagem multidimensional e multidisciplinar dos idosos portadores de câncer. A avaliação geriátrica ampla (AGA) foi desenvolvida para avaliar individualmente o estado de saúde dos pacientes idosos e é a ferramenta mais adequada para detectar os problemas funcionais nestes pacientes. O objetivo deste estudo, através de uma revisão da literatura, foi analisar o impacto da AGA em pacientes idosos com câncer. Resultados: A AGA pode detectar vários problemas sub ou não diagnosticados em pacientes com câncer. Alguns estudos sugerem que os critérios utilizados pela AGA são preditores de morbidade e mortalidade e podem influenciar as decisões do tratamento oncológico, tendo um impacto positivo no prognóstico dos pacientes com esta doença. Conclusões: Avaliação geriátrica ampla é um importante instrumento que pode ajudar a definir o prognóstico e influenciar na decisão e resultado do tratamento do idoso com câncer.