Delirium prevalence in a Colombian hospital,association with geriatric syndromes and complications during hospitalization

BackgroundThe aim of this paper is to describe the prevalence of Delirium and the factors associated with its presentation and complications identified in a geriatric unit in Colombia.Material and methodsThis is a retrospective observational study that included all patients admitted consecutively for two years in a geriatric unit of a hospital in Bogotá, Colombia. We assessed delirium prevalence with the Confusion Assessment Method (CAM). The independent variables were age, sex, functional impairment (Barthel < 90), malnutrition (MNA < 12), pressure ulcers at admission, state of the social support network, number of comorbidities, polypharmacy (5 or more drugs), complications such as ICU requirement, hospital stay, in-hospital functional impairment and mortality were also evaluated. As an exclusion criterion: not having CAM registered in the medical record, all the patients had this information.ResultsWe studied 1599 subjects with a mean age of 86 years (IQR 9). Delirium prevalence was 51.03%. Delirium was associated with a higher rate of: pressure ulcers on admission [OR 3.76 (CI 2.60–5.43 p < 0.001)], functional impairment [OR 2.38 (CI 1.79–3.16 p < 0.001)], malnutrition [OR 2.06 (CI 1.56–2.73 p < 0.001)], and infection [OR 1.46 (CI 1.17–1.82 p < 0.001)]. Moreover delirium has a higher association with mortality [OR 2.80 (1.03–7.54 p = 0.042)], in-hospital functional decline [OR 1.82 (1.41–2.36 p < 0.001)], and longer hospital stay [OR 1.04 (1.04–1.09 p = 0.006)]; independently of age, sex, pressure ulcers on admission, functional impairment, malnutrition, dementia, infection and limited social network.ConclusionOur study suggests that infectious diseases and geriatric syndromes such as, functional dependence, pressure ulcers, malnutrition or major cognitive impairment are independently associated with the presence of delirium on admission. Additionally, the presence of delirium is independently associated during hospitalization with complications, longer hospital stay, functional impairment and mortality.     

S-allyl cysteine prevents CCl4-induced acute liver injury in rats

Aged garlic extract (AGE) possesses multiple biological activities. We evaluated the protective effect of S-allyl cysteine (SAC), one of the organosulfur compounds of AGE, against carbon tetrachloride (CCl₄)-induced acute liver injury in rats. SAC was administrated intraperitoneally (50–200 mg/kg). SAC significantly suppressed the increases of plasma ALT and LDH levels. SAC also attenuated histological liver damage. CCl₄ administration induced lipid peroxidation accompanied by increases in the plasma malondialdehyde and hepatic 4-hydroxy-2-nonenal levels, and SAC dose-dependently attenuated these increases. The hepatic total level of hydroxyoctadecadienoic acid (HODE), a new oxidative stress biomarker, was closely correlated with the amount of liver damage. These results suggest that SAC decreased CCl₄-induced liver injury by attenuation of oxidative stress, and may be a better therapeutic tool for chronic liver disease.     

内脂素对老年大鼠脑组织损伤和炎症反应的影响分析

摘要 目的：探讨与分析内脂素对老年大鼠脑组织损伤和炎症反应的影响。方法：10个月龄老年健康雄性Sprague-Dawley(SD)大鼠60只随机平分为两组-对照组与内脂素组,内脂素组给予腹腔注射重组人内脂素200 μg/次,对照组均给予等量蒸馏水灌胃,2次/w,连续给药4 w。对比两组给药前、给药第2 w、给药第4 w的逃避潜伏期、血清白介素(Interleukin,IL)-6与C-反应蛋白(C-reactive protein,CRP)含量,及给药第4 w的线粒体超氧化物歧化酶(Superoxide dismutase,SOD)与谷胱甘肽过氧化物酶(Glutathione peroxidase,GSH-Px)活性、海马与皮层区神经元凋亡率。结果：所有大鼠在实验期间均出现典型的绕池壁现象。两组给药前逃避潜伏期、血清IL-6与CRP含量对比差异无统计学意义(P>0.05),给药后两组第2 w、给药第4 w的逃避潜伏期、血清IL-6与CRP含量均降低(P<0.05),且内脂素组给药第2 w、给药第4 w的上述指标低于对照组,对比均有统计学意义(P<0.05);内脂素组给药第4 w的线粒体SOD、GSH-Px活性高于对照组,海马与皮层区神经元凋亡率低于对照组,经对比差异有统计学意义(P<0.05)。结论：内脂素在老年大鼠的应用能缓解脑组织损伤,抑制炎症反应,有利于清除过量的自由基,降低神经元的凋亡率。     

腰麻硬膜外联合麻醉在老年下肢手术中的临床观察

目的:比较罗哌卡因、左旋布比卡因和布比卡因在老年患者下肢手术腰麻—硬膜外联合麻醉(combined spinal epidural anesthesia,CSEA)应用中的麻醉效果.方法:60例拟行下肢手术的老年患者随机分为罗哌卡因组、左旋布比卡因组和布比卡因组,每组各15例,均采用CSEA麻醉方法.比较各组感觉、运动麻醉阻滞情况,以及血流动力学变化.结果:罗哌卡因组麻醉效果不及其他两组,而布比卡因组与左旋布比卡因组间比较麻醉效果差异不明显;与其他两组比较,罗哌卡因组麻醉起效时间及最大运动阻滞时间均显著延长,而阻滞恢复时间明显缩短(P＜0.05或0.01),且Bromage评分及麻醉满意率低于布比卡因组(P＜0.05);罗哌卡因组与左旋布比卡因组患者循环系统稳定性优于布比卡因组.结论:腰麻—硬膜外联合麻醉中罗哌卡因、左旋布比卡因和布比卡因对于老年患者下肢手术均有较好的麻醉效果,其中罗哌卡因、左旋布比卡因对于心血管影响较小.     

手术创伤对成年鼠和老年鼠海马区GFAP、S100β表达的影响

目的 探讨肝部分切除术对成年鼠和老年鼠海马区胶质纤维酸性蛋白(GFAP)、S100β表达的影响.方法 雄性成年SD大鼠和老年SD大鼠分别随机分为老年对照组、麻醉组和手术组以及成年对照组、麻醉组和手术组.手术组行肝部分切除术.实验鼠在术后1、3、7d行Morris水迷宫后,处死实验鼠取海马行免疫组化检测.结果 GFAP在成年鼠和老年鼠基础水平有统计学差异(P=0.039,P=0.002).当增加的GFAP阳性细胞在成年鼠术后第3d(P=0.09)恢复后,老年鼠GFAP阳性细胞在术后第3d(P＜0.001)仍然明显增加,在术后第7d(P=0.823)恢复.S100β与GFAP变化趋势相同.结论 手术创伤引起成年鼠和老年鼠海马区GFAP、S100β可逆性表达增多,与成年鼠相比,老年鼠GFAP、S100β表达上调更加明显,持续时间更长.     

Efectividad de la vacuna antigripal en la prevención de la gripe en personas mayores de 65 años

IntroductionInfluenza is one of the diseases with the greatest epidemiological impact and of maximum relevance in the management of health services. The flu vaccine can have great variability each season, so our objective was to find out the effectiveness of the flu vaccine for the 2017/2018 season for the prevention of severe cases of flu in people over 65 years of age in a 385-bed acute general hospital.Material and methodStudy of cases and controls. All hospitalized patients with laboratory-confirmed influenza older than 65 years during the 2017/2018 season were included. Those who met the criteria for a severe case of influenza were considered cases. Those who did not meet the severity criteria were considered controls. Factors associated with the development of severe influenza were calculated.ResultsThe median age was 68 years (SD 91.87). The attack rate was 0.23 per hundred inhabitants and the vaccine effectiveness was 38%. The vaccinated and unvaccinated groups were different in terms of age (p < 0.0481). Vaccination status against severe influenza was found to be an independent protective factor (OR = 0.840; 0.746-0.913).ConclusionsThe effectiveness of influenza vaccination provided greater protection against infection and reduced the severity of influenza in older hospitalized patients. These findings should be taken into account to improve vaccination strategies and achieve better vaccination coverage in the population at risk.     

人参皂甙对老龄大鼠Meynert核TrkB mRNA表达的影响

目的探讨人参皂甙对老龄大鼠Meynert核(NBM)神经元TrkB mRNA表达的影响.方法选40只雌性Wistar大鼠随机分为3组:青年组(3-5月龄)、老龄组(24-27月龄)及给药组(24-27月龄).给药组大鼠自18月始饲以人参皂甙至24-27月龄.对各组NBM神经元进行原位杂交组织化学法染色,采用图象分析法测定各组平均灰度值并作t检验.结果老龄组大鼠NBM神经元TrkB mRNA表达显著低于青年组,而给药组较老龄组大鼠表达增多.结论人参皂甙对NBM神经元TrkB mRNA表达有促进作用,本结果为人参皂甙抗脑衰老及AD的临床治疗提供了形态学依据.     

Can antioxidant’s reactive oxygen species (ROS) scavenging capacity contribute to aged seed recovery? Contrasting effect of melatonin,ascorbate and glutathione on germination ability of aged maize seeds

It is well known that antioxidants such as AA (reduced ascorbate), glutathione (GSH) (reduced glutathione) and melatonin can delay seed ageing. Can they recover aged seed? Artificial aged maize seeds were obtained and their reduced germination rate (GR) and high lipid peroxidation were recorded. Exogenous melatonin was applied on these aged seeds and enhanced GR was observed. However, treatment with other antioxidants such as AA, GSH or DMTU (dimethyl thiourea) did not significantly improve or even reduce the GR of aged seeds. In addition, melatonin improved germination ability of theses aged seeds can be significantly impaired by DDC (diethyldithiocarbamic acid, a specific inhibitor of superoxide dismutase or superoxide dismutase (SOD)) and ATZ (aminotriazol, a specific inhibitor of catalase or CAT). In a further study, we found that melatonin but not other antioxidants (AA, GSH and DMTU) significantly induced CAT and SOD activities of aged seeds after imbibition. Accordingly, melatonin significantly reduced lipid peroxidation in aged seeds than that of other antioxidants. Taken together, these data suggest that melatonin induced antioxidant enzyme but not its direct reactive oxygen species (ROS) scavenging capacity contributing to recovery of aged maize seeds.     

Socio-medical condition and oral functional status in an older institutionalised population

Objectives: To investigate the association between the general medical condition, the socio-economic status, and some factors related to the functional status of the stomatognathic system. Design: A survey in an elderly population. Subjects: 257 older adults, with a mean age of 83.7 years. Setting: Residential homes for the elderly. Intervention: Examination of the medical records on the overall health and the drugs consumed, a structured interview on the socio-economic status, the complaints for xerostomia, the subjective chewing difficulties, and a clinical evaluation of the number of natural teeth and the number of posterior occluding pairs of teeth contacts (premolars and molars). Results: Multiple pathology and polypharmacy were recorded. 25% of the residents had no occluding posterior tooth contact (natural or prosthetic) and 62% were edentulous. 43% of the residents reported complaints for xerostomia, and 46% for chewing difficulties when eating specific food types. Xerostomic feelings and chewing problems were not related to age. Chewing difficulties were not related to the number of natural teeth, but to the number of posterior occluding teeth contacts, natural or prosthetic (less than two). From all medical conditions examined, only the psychiatric disorders were significantly related to dental status (p<0.05). Moreover, the number of remaining natural teeth was related to socio-economic status, while the number of posterior occluding teeth contacts was also inversely related to the duration of institutionalisation (p<0.05). Conclusions: Psychiatric disorders, low socio-economic status and increased duration of institutionalisation were most closely related to poor dental status. The presence of more than two posterior occluding teeth contacts, natural or prosthetic, benefit the very old patient in terms of reduced subjective chewing difficulty. A formal oral care delivery system for the institutionalised elderly, and particularly for those suffering from psychiatric disorders, is imperative.     

Orexin-1受体参与调节老年大鼠异氟醚麻醉苏醒延迟

目的:探索orexin能神经系统是否参与调节老年大鼠异氟醚麻醉觉醒延迟及其具体机制。方法:选择雄性SD大鼠,将其分为老年大鼠组(n=6,20月龄,体重600~800g)和青年大鼠组(n=6,3~4月龄,体重230~250 g)。采用翻正反射恢复时间作为麻醉觉醒时间,记录异氟醚麻醉下老年大鼠和青年大鼠各自的麻醉觉醒时间;通过免疫荧光染色和细胞计数确定老年大鼠和青年大鼠神经元数目,放射免疫法检测两组大鼠血浆orexin-A含量;Western blot检测老年大鼠和青年大鼠orexin-1和-2受体含量。结果:老年大鼠异氟醚麻醉觉醒时间明显长于青年大鼠(P0.05);老年大鼠orexin能神经元的数目与青年大鼠相比差异无统计学意义(P0.05),但其血浆orexin-A含量显著高于青年大鼠(P0.05);老年大鼠orexin-1受体在蛋白质表达中明显低于青年大鼠(P0.05),而orexin-2受体的表达与青年大鼠相比差异无统计学意义(P0.05)。结论:在老龄化过程中,虽然血浆中orexin-A含量代偿性增加,但是由于全脑中orexin-1受体含量的减少,使其并不能充分发挥促觉醒作用,这可能是导致老年人麻醉苏醒延迟的原因之一。