Background: The risk of pulmonary embolism (PE) has not been studied in older patients affected by COVID-19. We aimed to assess PE incidence and risk factors in a population of older patients ...infected with SARS-CoV-2. Methods: An ambispective, observational cohort study. A total of 305 patients ≥ 75 years old had the SARS-CoV-2 infection from March to May 2020. The incidence rate of PE was estimated as the proportion of new cases within the whole sample. Youden’s index was used to assess the cutoff point of D-dimer. To select factors associated with the risk of PE, time-to-event analyses were performed using cause-specific hazard models. Results: In total, 305 patients with a median age of 87 years (62.3% female) were studied; 67.9% were referred from nursing homes and 90.4% received any type of anticoagulation. A total of 64.9% showed frailty and 44% presented with dementia. The PE incidence was 5.6%. The cutoff value of a D-dimer level over 2.59 mg/L showed a sensitivity of 82.4% and specificity of 73.8% in discriminating a PE diagnosis. In the multivariate analysis, the factors associated with PE were previous oncological events and D-dimer levels. Conclusions: The PE incidence was 5.6%, and major risk factors for PE were oncological antecedents and increased plasma D-dimer levels.
Frailty is a clinical situation of decreased homeostatic reserve that, after a minor trigger (acute illness, fall, taking a drug...) increases the risk of an adverse event such as hospital admission, ...institutionalization, functional and/or cognitive decline, death, etc. Frailty can be understood as physical frailty, Fried's phenotype, a true geriatric syndrome that can be reversible by avoiding its progression to more advanced stages of irreversibility and dependence, and Rockwood's frailty due to accumulation of deficits, as a continuum of health or classification typology of the elderly along the frailty spectrum (healthy, robust, vulnerable, mild-moderate-severe and extreme frailty or end of life). The diagnosis of physical frailty is part of the comprehensive geriatric assessment, recommending the use of a performance test such as gait speed (<0,8m/s), Timed Up and Go (>12 s) or Short Physical Performance Battery (<10). Physical frailty is reversible by a multidisciplinary management based on three fundamental pillars: multicomponent physical exercise and resistance training, adequate protein and micronutrient intake (leucine, vitamin D, etc.) and appropriate pharmacological prescription, management of comorbidity and geriatric syndromes. Frailty is a risk factor for neurological disease progression and increased risk of adverse events in neurodegenerative diseases such as mild cognitive impairment, dementia, Parkinson's disease and cerebrovascular disease. Frailty based on the Clinical Frailty Scale or VIG-Frail shows patient typologies in relation to a greater or lesser state of fragility, being a basic prognostic tool of great utility in making diagnostic and therapeutic management decisions. It opens up a new opportunity for improvement in the management of neurological disease in the diagnosis and treatment of frailty.
La fragilidad se entiende como un situación clínica de disminución de la reserva homeostática que, ante un desencadenante (enfermedad aguda, caída, toma de un fármaco…), aumenta el riesgo de un ...evento adverso, como ingreso hospitalario, en residencia, deterioro funcional y/o cognitivo, muerte, etc. La fragilidad puede entenderse como fragilidad física, fenotipo de Fried, verdadero síndrome geriátrico, que puede ser reversible evitando su progresión a estadios más avanzados de irreversibilidad y de dependencia, y fragilidad por acúmulo de déficits de Rockwood, como
continuum
de salud o tipología de clasificación del anciano a lo largo del espectro de la fragilidad (sano, robusto, vulnerable, fragilidad leve-moderada-grave y extrema o final de vida). El diagnóstico de fragilidad física forma parte de la valoración geriátrica integral y se recomienda para su diagnóstico utilizar un test de ejecución, como velocidad de la marcha (<0,8 m/s),
Timed Up and Go
(>12 segundos) o
Short Physical Performance Battery
(<10). La fragilidad física es reversible basándose en un tratamiento multidisciplinar sobre tres pilares fundamentales: ejercicio físico multicompetente y contra resistencia, aporte adecuado de proteínas y micronutrientes (leucina, vitamina D, etc.), y adecuada prescripción farmacológica, de tratamiento de comorbilidad y de síndromes geriátricos. La fragilidad es un factor de riesgo de progresión de la enfermedad neurológica y de mayor riesgo de evento adverso tanto en enfermedades neurodegenerativas, como el deterioro cognitivo leve, la demencia o la enfermedad de Parkinson, como en la enfermedad cerebrovascular. La fragilidad a través de la
Clinical Frailty Scale
o el VIG-Frail muestra tipologías de pacientes en relación con un mayor o menor estado de fragilidad, y es una herramienta básica pronóstica de gran utilidad en la toma de decisiones de manejo diagnóstico y terapéutico. Se abre una nueva oportunidad de mejora en el manejo de la enfermedad neurológica ante el diagnóstico y el tratamiento de la fragilidad.
To analyze factors associated with mortality at 3 months and readmissions, functional and cognitive decline, anorexia and affective disorders in patients aged > 70 years surviving after hospital ...admission for SARS-CoV-2.
Patients aged > 70 years, discharged after hospitalization with COVID-19.
mortality, readmissions, functional and cognitive impairment, anorexia and mood disorder.
165 cases at 3 months after hospital discharge, 8.5% died and 20% required at least one hospital readmission. The presence of severe dependence at discharge (BI < 40) was associated at 3 months with a higher risk of mortality (OR 5.08; 95% CI 1.53-16.91) and readmissions (OR 4.53; 95% CI 1.96-10.49). The post-hospitalization functional deterioration was associated with persistence of deterioration at 3 months (OR 24.57; 95% CI 9.24-65.39), cognitive deterioration (OR 2.32; 95% CI 1.03-5.25) and affective (OR 4.40; 95% CI 1.84-10.55) CONCLUSIONS: Loss function in older people after hospitalization by COVID-19 may contribute to identify patients with a higher risk of sequelae in the short term that require closer follow-up.
Clinical guidelines recommend comprehensive multifactorial assessment and intervention to prevent falls and fractures in older populations.
A descriptive study was conducted by the Falls Study Group ...of the Spanish Geriatric Medicine Society (SEMEG) to outline which types of healthcare-specific resources were assigned for fall assessment in Spanish geriatric departments. A self-reported seven-item questionnaire was delivered from February 2019 to February 2020. Where geriatric medicine departments were not available, we tried to contact geriatricians working in those areas.
Information was obtained regarding 91 participant centers from 15 autonomous communities, 35.1% being from Catalonia and 20.8% from Madrid. A total of 21.6% reported a multidisciplinary falls unit, half of them in geriatric day hospitals. Half of them reported fall assessment as part of a general geriatric assessment in general geriatric outpatient clinics (49.5%) and, in 74.7% of cases, the assessment was based on functional tests. A total of 18.7% reported the use of biomechanical tools, such as posturography, gait-rides or accelerometers, for gait and balance analysis, and 5.5% used dual X-ray absorptiometry. A total of 34% reported research activity focused on falls or related areas. Regarding intervention strategies, 59% reported in-hospital exercise programs focused on gait and balance improvement and 79% were aware of community programs or the pathways to refer patients to these resources.
This study provides a necessary starting point for a future deep analysis. Although this study was carried out in Spain, it highlights the need to improve public health in the field of fall prevention, as well as the need, when implementing public health measures, to verify that these measures are implemented homogeneously throughout the territory. Therefore, although this analysis was at the local level, it could be useful for other countries to reproduce the model.
Las caídas son uno de los grandes síndromes geriátricos,
con una etiopatogenia multifactorial y con una
estrecha relación con la fragilidad, siendo esta relación
bidireccional. El Documento de ...Consenso sobre
Prevención de Fragilidad y Caídas aprobado por el
Consejo Interterritorial del Sistema Nacional de Salud
en 2014, propone un cribado universal de fragilidad y
riesgo de caídas, con el objetivo de intervenir en aquellos
ancianos de alto riesgo y por tanto prevenir discapacidad.
Esta revisión evalúa la relación intrínseca
entre caídas y fragilidad, describe las herramientas de
valoración del paciente que presenta caídas, incidiendo
en aquellos aspectos que detectan fragilidad y finalmente
propone intervenciones que han demostrado
reducir su impacto.
Falls are one of the classic giant geriatric syndromes
with a multifactorial etiopathogenesis and closely
related to frailty, being this relationship bidirectional.
The Consensus Document on the Prevention
of Frailty and Falls approved by the Interterritorial
Council of the National Health System in 2014 provides
recommendations for the screening of frailty
and falls in all older adults in order to develop a management
plan in high risk older adults so to prevent
disability. This review describes the intrinsic relationship
between frailty and falls, falls assessment
and screening instruments to use and detect frailty
and finally gives evidence-based recommendations
to reduce falls impact.
In this study, 160 silver-copper alloy denarii and antoniniani from the 3rd century A.D. were studied to obtain their overall chemical composition. The approach used for their characterisation is ...based on a combination of physical, chemical, and chemometric techniques. The aim is to identify and quantify major and trace elements in Roman silver-copper coins in order to assess changes in composition and to confirm the devaluation of the currency. After a first cataloguing step, μ-EDXRF and SEM-EDX techniques were performed to identify the elements on the coins’ surface. A micro-destructive sampling method was employed on a representative sample of the coins to quantify the elements present in the bulk. The powder obtained from drilling 12 coins (keeping the two categories of coins separate) was dissolved in an acidic medium; heated and sonicated to facilitate dissolution; and then analysed by ICP-AES and ICP-MS. The two currencies had different average alloy percentages; in particular, the % difference of Ag was about 8%. The other elements were found in concentrations <1 wt%. Of these, the element highest in concentration were Pb and Sn, which is in agreement with the literature. The multivariate analysis performed on the data acquired revealed two groups of coins, corresponding to the two currencies.
Adequate complementary feeding practices are important for short- and long-term child health. In industrialized countries, the formulation of several commercial baby foods (CBFs) and an increase in ...their consumption has been noticed. Aim: To update and analyze the nutritional composition of CBFs available in the Italian market. Methods: Data collection carried out in two steps (July 2018–January 2019) and updated in May–September 2021. The information on CBFs was taken from the websites of the major CBF producers available in Italy. The collected information were: Suggested initial and final age of consumption; Ingredients; Energy value; Macronutrients (protein, lipids, and carbohydrates); Fiber; Micronutrients (sodium, iron, and calcium); Presence of salt and added sugars, flavorings, and other additives. Results: Time-space for which CBFs are recommended starts too early and ends too late; protein content is adequate and even too high in some food; Amount of fats and their quality must be improved, keeping the intake of saturated fats low; Sugar content is too high in too many CBFs and salt is unnecessarily present in some of them. Finally, the texture of too many products is purée, and its use is recommended for too long, hindering the development of infants’ chewing abilities.
Objectives:
Benefits of school attendance have been debated against SARS-CoV-2 contagion risks. This study examined the trends of contagion before and after schools reopened across 26 countries in ...the European Union.
Methods:
We compared the average values of estimated
R
t
before and after school reopening, identifying any significant increase with a one-sample
t
-test. A meta-analysis and meta-regression analysis were performed to calculate the overall increase in
R
t
for countries in the EU and to search for relationships between
R
t
before schools reopened and the average increase in
R
t
afterward.
Results:
The mean reproduction number increased in 16 out of 26 countries. The maximum increase in
R
t
was reached after a mean 28 days. We found a negative relationship between the
R
t
before school reopening and its increasing after that event. By 45 days after the first day of school reopening, the overall average increase in
R
t
for the European Union was 23%.
Conclusion:
We observed a significant increase in the mean reproduction number in most European countries, a public health issue that needs strategies to contain the spread of COVID-19.
PDF
