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Sep 2022
K Al Miraj ACorresponding author
Research Assistant, Department of Vascular Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU)Dhaka, Bangladesh.
Background Cardiovascular disease, and ischemic heart disease (IHD), is a major cause of morbidity and mortality in the very elderly patients worldwide. In the developing countries like Bangladesh it has been increasing with time. Due to life style, food habits and urbanisation. These patients represent a rapidly growing cohort presenting for percutaneous coronary intervention (PCI), now constituting more than one in five patients treated with PCI in real-world practice. Materials and Methods From July 2020 we included 152 patients with IHD purposively in Cardiology department of Bangabandhu Sheikh Mujib Medical University Dhaka, Bangladesh undergone PCI who were divided into 2 groups according to age: e” 75 years (n = 51) and <75 years (n = 101). Baseline clinical characteristics, indications for coronary intervention, in hospital outcomes were obtained. Study endpoint was Renal impairment, MI, LVF, emergency revascularization and death. Results Very elderly patients were more frequently male (86.2%) and nonsmoker at present (41.1% vs. 63.3%, p=0.003), had higher prevalence of hypertension (60.7% vs. 50.4%, p<0.13), and more often presented with NSTEMI (54.9% vs. 23.7%, p<0.001). Elderly group had higher incidence of TVD and LM disease (37.2% vs. 26.7% and 9.8% vs. 2.9%, p=0.07) and more incidence of ostial (17.6% vs.5.9%,p=0.007) and calcified lesions (31.3% vs. 14.8%, p=0.004). Procedural success (TIMI III) were high in both groups, but still lower in the elderly as compared to younger group (96% vs. 97%, p=0.65). Very elderly patients had higher incidence of post PCI bleeding, CIN, MI, LVF and death (9.8% vs.5.9%, 7.8% vs.3.9%, 5.8% vs.5.9%, 9.8% vs. 4.9% and 5.8%vs.3.9%,p=0.07), whereas emergency revascularization were higher in younger group (5.8% vs. 6.9%, p=0.07). Conclusion Very elderly patients aged ≥80 years face more vascular site complications during PCI, usually have more LM and TVD with more ostial and calcified lesions in comparison with younger group. Though procedural success is similar with younger group, they face more post PCI CIN, LVF and MI. Repeat revascularization was higher in younger group.
Mar 2021 DOI 10.14302/issn.2641-4538.jphi-21-3765
A. Weber SimonCorresponding author
Cellogic GmbH, Niedstrasse 21, 12159 Berlin, Germany
Acute post-operative delirium (POD) and long-term post-operative cognitive dysfunction (POCD) are frequent and associated with increased mortality, dependency on care giving and institutionalization rates. The POCD-related cost burden on the German long-term care insurance provides an indication for the savings potential from risk-adapted treatment schemes. Comprehensive estimates have not been assessed or published so far. A model-based cost-analysis was designed to estimate POCD-related costs in the long-term care insurance. Comprehensive analysis of inpatient operations and procedures (OPS-codes) served as the base for case number calculations, which were then used as input to the actual cost model. POCD-incidence rates were obtained from the BioCog study. Various sensitivity analyses were performed to assess uncertainty of the model results. Total POCD related annual costs in the German long-term care insurance account for approximately 1.6 billion EUR according to the base case of our analysis. Total annual costs for all POCD cases depend on surgery numbers, incidence rates, other assumptions, and uncertain input parameters. The financial burden to the long-term care insurance is substantial, even in a conservative scenario of the cost model. Variability of results stems from uncertain assumptions, POCD-incidence rates and from uncertain patient numbers who are undergoing surgery and are therefore at risk to develop POCD.
Aug 2017
Zugor VahudinCorresponding author
Department of Urology, University Hospital of Cologne, Germany
Purpose: To show the increased necessity of routine prostate biopsy in men older than 75 years and to identify markers, which reliably indicate the presence of a prostate cancer (PCa), we evaluate several different parameters from elderly patients. Methods: 196 patients over 75 years were included in the study, inclusion criteria for the biopsy were: PSA levels >4 ng/ml and/or a suspicious finding on dig ital rectal examination (DRE). The parameters analyzed included: age, prostate size, PSA levels, DRE findings, American Society of Anesthesiologists (ASA) PCa detection rate, Gleason score, clinically significant PCa detection rate and type of therapy once PCa had been detected (curative intent or palliative intent). Results: PCa was detected in N=115 patients (59%), with 84.3% of them being defined as clinically significant (p<0.05) and 60.8% (p<0.05) as high grade. Only a PSA level > 10 ng/ml with a simultaneous positive DRE finding was a marker for high-grade or significant PCa (p< 0.001) in patients >70 years. Conclusions: Our findings demonstrate that the prevalence of significant and high-grade PCa in the elderly patients is high raised (~60%). We identified two significant markers for patients over the age of 75, namely an increased high PSA level (PSA>10 ng/ml) and positive DRE. The combination of both markers indicates that the patient is suffering under a significant and high-grade PCa. In our opinion, every patient showing a combinational increase of both markers should be biopsied in order to receive an adequate therapy.
Mar 2017 DOI 10.14302/issn.2474-7785.jarh-16-1348
Srisuwan PatsriCorresponding author
Outpatient and Family Medicine Department, Phramongkutklao Hospital, Bangkok, Thailand;
Background and Objective: Cognitive stimulation training was effective in reducing risk of cognitive decline and dementia in patients with mild cognitive impairment. The present study aimed to explore factors that contribute to regular participation and practice cognitive stimulation training for elderly patients with mild cognitive impairment. Materials and Methods: Data were collected through individual face-to-face interviews with 25 elderly subjects with mild cognitive impairment, and analyzed using interpretive description method. Results: Five core themes emerged from the analysis of data: (i) program with four subthemes of “interesting session, ” “effective teaching materials,” “suitable duration and frequency” and “small group activities;” (ii) group facilitators with three subthemes of “good explanation,” “always facilitate” and “friendly personality;” (iii) homework assignments with two subthemes of “suitable content” and “can adapt in daily living;” (iv) family members with two subthemes of “supporting” and “sharing;” (v) before and after class notification. Conclusion: Increasing awareness of holistic factors including in clinic and at home should be emphasized in planning cognitive stimulation training. Having an effective program and facilitators and collaboration from family member were the keys of successful training.