Purpose
To assess the prevalence of urgent hospitalization due to adverse drug reactions (ADRs) in patients aged ≥65 years, to compare the in-hospital mortality rates between patients admitted for ...ADRs and those admitted for other causes, and to describe the ADRs, the used and suspected drugs, and the drug-reaction associations.
Methods
A cross-sectional study was conducted by using the institutional database of the Pharmacovigilance Programme of Bellvitge University Hospital, a 750-bed tertiary care hospital, with information corresponding to a 7-year period. ADR-related admissions of patients aged ≥65 years prospectively identified through a systematic daily review of all admission diagnosis were reviewed.
Results
ADRs were suspected to be the main reason for urgent admission in 1976 out of 60,263 patients aged ≥65 years (prevalence of ADR-related hospitalization 3.3 % 95 % CI 3.1–3.4 %). The crude in-hospital mortality rate was 10.2 % in patients with ADR-related admission and 9 % in patients admitted for other causes (
p
= 0.077). Most patients (86 %) were exposed to polypharmacy, and a drug-drug interaction was suspected in 49 % of cases. The most frequent drug-reaction associations were acute renal failure related to renin-angiotensin system inhibitors, gastrointestinal bleeding caused by antithrombotics and/or non-steroidal anti-inflammatories, and intracranial bleeding induced by vitamin K antagonists.
Conclusions
One out of every 30 urgent admissions of patients aged ≥65 years is ADR-related. These ADRs can be as serious and life-threatening as any other acute pathology that merits urgent hospital admission. Most cases involve patients exposed to polypharmacy and result from well-known reactions of a few commonly used drugs.
Distinct DNA methylomes of newborns and centenarians Heyn, Holger; Li, Ning; Ferreira, Humberto J. ...
Proceedings of the National Academy of Sciences - PNAS,
06/2012, Letnik:
109, Številka:
26
Journal Article
Recenzirano
Odprti dostop
Human aging cannot be fully understood in terms of the constrained genetic setting. Epigenetic drift is an alternative means of explaining age-associated alterations. To address this issue, we ...performed whole-genome bisulfite sequencing (WGBS) of newborn and centenarian genomes. The centenarian DNA had a lower DNA methylation content and a reduced correlation in the methylation status of neighboring cytosine—phosphate—guanine (CpGs) throughout the genome in comparison with the more homogeneously methylated newborn DNA. The more hypomethylated CpGs observed in the centenarian DNA compared with the neonate covered all genomic compartments, such as promoters, exonic, intronic, and intergenic regions. For regulatory regions, the most hypomethylated sequences in the centenarian DNA were present mainly at CpG-poor promoters and in tissue-specific genes, whereas a greater level of DNA methylation was observed in CpG island promoters. We extended the study to a larger cohort of newborn and nonagenarian samples using a 450,000 CpG-site DNA methylation microarray that reinforced the observation of more hypomethylated DNA sequences in the advanced age group. WGBS and 450,000 analyses of middle-age individuals demonstrated DNA methylomes in the crossroad between the newborn and the nonagenarian/centenarian groups. Our study constitutes a unique DNA methylation analysis of the extreme points of human life at a single-nucleotide resolution level.
Abstract Background The Readmission Risk score (RR score) has been considered useful to predict Medicare/Medicaid patients' likelihood of 30-day hospital readmission for heart failure (HF). To our ...knowledge, the accuracy of this prediction model has not been independently validated in other clinical circumstances in Europe. Methods From July 2013 to December 2014, all patients who survived to a first admission due to decompensated HF at our tertiary care teaching hospital were retrospectively included in the study. The RR score was calculated in all patients to predict future 30 and 90-day unplanned all-cause readmissions. Results A total of 679 patients were included, of them, 52 patients (7.6%) were readmitted by any cause within 30 days after discharge, and 98 (14.4%) within 90 days. When compared, the average RR scores for patients readmitted was significantly higher to those who did not, either within 30 days (22.7 vs. 20.1) or 90 days (22.7 vs. 20.1) of discharge. The 30-day C-statistic was 0.649 (95% CI 0.574–0.723) and the 90-day 0.621 (95% CI 0.560–0.681). There was a significant increase in readmission percentages at 30 and 90 days with respect to increasing quartiles of RR score. Conclusion Our results only support a modest applicability of this predictive model in patients at 30 and 90 days, after a first hospitalization for decompensated HF. Probably, the fact that our readmission rate in patients firstly admitted due to HF was very low, generated a bias in the study, discouraging the use of this score in the de novo HF patients.
Abstract Background Multimorbidity is associated with higher mortality, increased disability, a decline in functional status and a lower quality of life. The objective of the study is to explore ...patterns of multimorbidity in an elderly population. Methods 328 community inhabitants aged 85 years were included. Socio-demographic variables and data from the global geriatric assessment were evaluated. Information on the presence of sixteen common chronic conditions was collected: hypertension, diabetes mellitus, dyslipidemia, ischemic cardiomyopathy, heart failure, stroke, chronic obstructive pulmonary disease, (COPD), atrial fibrillation, peripheral arterial disease, Parkinson's disease, cancer, dementia, anemia, chronic kidney disease (CKD), visual impairment and deafness. Hierarchical cluster analysis was performed. Results The rate of multimorbidity (> 1 disease) was 95.1%. Men had a higher percentage of COPD and malignancy. Four main clusters were identified. The highest value of the bivariate correlation matrix was that between heart failure and visual impairment. These two diseases were included in a cluster with atrial fibrillation, CKD, heart failure, stroke, high blood pressure and diabetes mellitus. Conclusions The large majority of oldest old subjects had multimorbidity. The results confirm the non-random co-occurrence of certain diseases in this age group.
The prevalence of transthyretin‐associated amyloidosis cardiomyopathy (ATTR‐CM) has grown because of newer non‐invasive diagnosis tools. Detecting the presence of extra‐cardiac ATTR manifestations ...such as musculoskeletal pathologies considered ‘red flags’, when there is minimal or non‐cardiac clinical involvement is primordial to carry out an early diagnosis. The aim of this systematic review is to examine the prevalence of musculoskeletal, ATTR‐deposition‐related co‐morbidities in patients already diagnosed with ATTR‐CM, specifically carpal tunnel syndrome, ruptured biceps tendon, spinal stenosis, and trigger finger. We performed a systematic review using PRISMA guidelines. Inclusion criteria were all studies in English and Spanish language and participants had to be patients diagnosed with ATTR‐CM, by any diagnostic method, with the musculoskeletal co‐morbidities subject of this review. The quality of the studies was based on the Risk of Bias Tool. This systematic review included 22 studies for final analysis. Carpal tunnel syndrome is reported in 21 studies, brachial biceps tendon rupture is reported in three, and spinal stenosis in eight studies. No articles that accomplished all the inclusion criteria for trigger finger were found. Regarding to the quality of the studies, all of them were categorized as being of high and moderate quality. The frequent association between ATTR‐CM and carpal tunnel syndrome, ruptured biceps tendon, and lumbar spinal is confirmed, and the onset of these co‐morbidities usually precedes the diagnosis of by years. This association defines them as red flags that should be search proactively due to the current treatment possibilities and the severity of the presentation of cardiac amyloidosis.
Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are two chronic diseases with the greatest adverse impact on the general population, and early detection of their decompensation is ...an important objective. However, very few diagnostic models have achieved adequate diagnostic performance. The aim of this trial was to develop diagnostic models of decompensated heart failure or COPD exacerbation with machine learning techniques based on physiological parameters. A total of 135 patients hospitalized for decompensated heart failure and/or COPD exacerbation were recruited. Each patient underwent three evaluations: one in the decompensated phase (during hospital admission) and two more consecutively in the compensated phase (at home, 30 days after discharge). In each evaluation, heart rate (HR) and oxygen saturation (Ox) were recorded continuously (with a pulse oximeter) during a period of walking for 6 min, followed by a recovery period of 4 min. To develop the diagnostic models, predictive characteristics related to HR and Ox were initially selected through classification algorithms. Potential predictors included age, sex and baseline disease (heart failure or COPD). Next, diagnostic classification models (compensated vs. decompensated phase) were developed through different machine learning techniques. The diagnostic performance of the developed models was evaluated according to sensitivity (S), specificity (E) and accuracy (A). Data from 22 patients with decompensated heart failure, 25 with COPD exacerbation and 13 with both decompensated pathologies were included in the analyses. Of the 96 characteristics of HR and Ox initially evaluated, 19 were selected. Age, sex and baseline disease did not provide greater discriminative power to the models. The techniques with S and E values above 80% were the logistic regression (S: 80.83%; E: 86.25%; A: 83.61%) and support vector machine (S: 81.67%; E: 85%; A: 82.78%) techniques. The diagnostic models developed achieved good diagnostic performance for decompensated HF or COPD exacerbation. To our knowledge, this study is the first to report diagnostic models of decompensation potentially applicable to both COPD and HF patients. However, these results are preliminary and warrant further investigation to be confirmed.
Dependence for basic activities of the daily living (ADL) relates to adverse outcomes in elderly acute heart failure (AHF) patients.
We evaluated patients ≥75years admitted because of AHF, divided ...according to preadmission Barthel Index (BI) category: severe (BI 0–60), moderate (BI 61–90) and slight dependence or independence for basic ADL (BI 91–100). We compared their baseline characteristics and used logistic regression models to determine whether a BI≤60 confers higher one-year mortality risk.
We included 2195 patients, mean age 83years; 57% women, Charlson Index 3, 65% with preserved left ventricular ejection fraction. Their median preadmission BI was 90 (65–100); 21.7% had BI≤60. Patients with BI≤60 were older, more often females, with higher comorbid and cognitive burden and more likely to be institutionalized. 560 patients (26%) died within the follow-up period. A preadmission BI≤60 was significantly associated with higher risk of 12-month mortality (HR 1.42, 95% CI 1.14–1.77) together with male sex (1.27, 1.04–1.54), valve disease (1.49, 1.20–1.83), worse preadmission NYHA class (1.44, 1.20–1.73), stage IV chronic kidney disease (1.70, 1.35–2.15), pulmonary edema (1.33, 1.01–1.76), no family support (1.47, 1.06–2.06), and higher Charlson Comorbidity Index (1.09, CI 1.05–1.13) and Pfeiffer cognitive screening questionnaire scores (1.10, 1.05–1.14).
Among elderly AHF patients, the presence of severe (BI≤60) preadmission dependence for basic ADL confers a significant and independent risk of one-year post-discharge mortality.
The aim of this study is to determine prevalence and risk factors of Cognitive Impairment (CI) and its association with Type 2 Diabetes Mellitus (T2DM) in subjects aged 65 years and above. ...Additionally, we attempt to provide a cognitive profile for T2DM group.
A cross-sectional analytical study to assess CI was carried out. We evaluated a sample of community-dwelling residents from Chile. All participants underwent a general interview, lifestyle questionnaires and a comprehensive neuropsychological battery. Regression analyses were performed to evaluate risk of CI with T2DM and influencing factors. Results between groups in the different domains of the neuropsychological assessment were compared by Student's
-tests and MANOVA.
Among all 358 subjects, overall T2DM prevalence were 17.3%. The prevalence of CI was higher in T2DM group compared to the healthy participants (30.7%,
< 0.001). The risk of CI was 2.8 times higher in older people with T2DM compared to older people without the diagnosis. Multiple regression analysis, adjusted for age and gender, demonstrated that age, education, presence of dyslipidemia, and T2DM duration were the predictor variables significantly associated with CI. T2DM group performed worse on global cognitive performance, attention, language, verbal memory, visual memory, visual constructional ability, and executive function. After adjusting for significant covariates from multiple regression analysis, a relationship between "cognition" and T2DM is still observed. Amnesic multi-domain impairment was the specific cognitive identified pattern for T2DM group.
The present study confirms the high prevalence of CI with T2DM among Chilean older adults in a community-based population. T2DM is significantly associated with a higher risk of CI, and age, education, presence of dyslipidemia, and duration of T2DM are risk factors. T2DM patients with CI are impaired in multiple cognitive domains, even after adjusting covariables, resulting in an amnesic multi-domain cognitive profile.
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