Adherence to CPAP therapy for sleep apnea in patients aged over 70 years old

Purpose Adherence to continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA) syndrome has not been established in patients over 70 years of age, whereas several studies have reported adherence below that age. This trial was designed to address this evidence gap. Methods Consecutive senior (> 70 years) patients with OSA, mean respiratory event index (REI) 34/h, body mass index (BMI) 31 kg/m2, and junior (< 50 years) patients (REI 37/h, BMI 31 kg/m2) were included. Results At year follow-up among 72 senior patients (35 women) and 71 junior patients (17 women), there was no difference in the percentage of patients abandoning CPAP (senior 47% vs. junior 43%) or in CPAP daily use (4:53 ± 2:44 hh:min vs. 4:23 ± 3:00 hh:min). Conclusions CPAP adherence in senior patients with OSA was not poorer than that of a younger group of OSA patients. Advanced age should not be an obstacle to CPAP initiation.

Pars-plana-Vitrektomie bei proliferativer diabetischer Retinopathie: Unterschiede zwischen jüngeren und älteren Patienten

<b>Background:</b> Proliferative diabetic retinopathy (PDR) is one of the most common cause of vision loss in diabetic patients, and the incidence age of PDR patients gradually gets younger. This study aims to compare the characteristics of PDR and outcomes following vitrectomy in young and senior patients. <b>Methods:</b> This is a retrospective case series study. Data of 116 eyes of 92 patients who underwent vitrectomy for PDR from February 2012 to February 2017 were reviewed, which were divided into young and senior patient groups. All patients were followed up for 24 months at least. <b>Results:</b> There were 62.1% of eyes with tractional retinal detachment secondary to PDR in the young patient group, while only 12.1% of eyes in the senior patient group with this surgery indication. (<i>P</i> &#x3c; 0.001) The best corrected visual acuity increased in 41 eyes (70.7%), stable in 9 eyes (15.5%), and decreased in 8 eyes (13.8%) in young patients at the final follow-up. And it increased in 47 eyes (81.0%), stable in 2 eyes (3.4%), and decreased in 9 eyes (15.5%) in senior patients (<i>P</i> = 0.085). Postoperative complications mainly included recurrent vitreous hemorrhage (24.1%), retinal detachment (3.4%), neovascular glaucoma (NVG) (27.6%) and nuclear sclerosis (53.4%) in young patients, and it was 19.0, 0.0, 1.7 and 3.4% in senior patients respectively. <b>Summary:</b> PDR of young patients is more severe than that of senior patients, and vitrectomy is an effective and safe method for PDR treatment. NVG is a main and severe complication besides nuclear sclerosis in young patients, and the incidence of NVG is higher compared to that in senior patients.

An Experimental Education Project for Consultations of Older Adults during the Pandemic and Healthcare Lockdown

Objective: To develop a mentor-supervised, interprofessional, geriatric telemedicine experiential education project in response to the COVID-19 pandemic. Method: Medical and pharmacy students collaborated via remote consultations to address the coexistence of multimorbidity and polypharmacy in geriatric patients. In-depth interviews of students and patients as well as Likert scale-based telephonic survey were performed for a comprehensive evaluation of the project’s significance. Results: To date, 49 consultations have been conducted. Remote consultations performed by medical and pharmacy students working collaboratively were beneficial for both students, participants. Conclusions and Practice Implications: This experimental education project provided students with authentic challenges while simultaneously delivering care to the older adults who are susceptible to disruption of care associated with the pandemic. Further development and expanded implementation of such approaches may be a post-pandemic practice to provide more accessible care for senior patients while incorporating interprofessional education.

Neurologic Manifestations of COVID-19 Disease in Children and Adults

SARS-CoV-2 has kept the world on tenterhooks for half a year. In this short time, millions of data and clinical findings have been collected, the amount of which astonishes even the scientific community. But the majority of them concern adult patients. Knowledge about the clinical course, complications and therapy of COVID-19 in children and adolescents, on the other hand, has been limited to date [2]. And the data that have been collected internationally illustrate once again that "children are not small adults." This is because the incidence of infection in this age group appears to differ, in some cases markedly, from that of elderly and senior patients.

NON-TRADITIONAL VIEW ON TRADITIONAL RISK FACTORS OF CARDIOVASCULAR DISEASES IN SENIORS

В статье раскрываются малоизвестные врачебному сообществу научные данные о традиционных факторах сердечно-сосудистого риска применительно к социальной группе пожилых, старых людей и долгожителей. Рассматриваются связанные с метаболизмом признаки старения организма. Оцениваются особенности показателей липидного спектра, уровня мочевой кислоты, мочевины, креатинина, факторов системы свертывания крови. Приводятся данные о характере стенозирования коронарных артерий у пожилых и старых пациентов с ИБС; о взаимосвязи ИБС и жировой дегенерации печени; об особенностях липидного спектра у больных старших возрастных групп с различными заболеваниями сердца; о различных психологических особенностях и поведенческих типах личности стареющих людей, имеющих кардиологическую патологию. Обращается внимание на «профилактический парадокс», который наблюдается у мужчин 60 лет и старше с различными формами ИБС, когда влияние «традиционных» факторов риска на увеличение смертности от сердечнососудистых заболеваний практически нивелируется, а в качестве прогностически неблагоприятных факторов значимую роль играют низкий уровень холестерина ЛПВП, пониженный уровень апо- А 1, увеличение соотношения апо- В /апо- А 1 и низкая физическая активность. Дополнительную ценность обзору придает факт, что в современной литературе, как отечественной так и зарубежной, имеется незначительное количество публикаций, посвященных особенностям факторов риска развития кардиологических заболеваний у людей старших возрастных групп, а также у пациентов, чей возраст превышает 100 лет. The article reveals little-known scientific data on the traditional risk factors of cardiovascular diseases in relation to social groups of the elderly, old people and centenarians. Some of metabolism associated signs of ageing are considering. In the article some biochemical markers in seniors are evaluated (lipids, fibrinogen, uric acid etc.). Some particularities about atherosclerotic lesions of coronary arteries in seniors are discovering, as well as relationships between coronary heart disease (CHD) and fatty liver degeneration. One more topic of the article is the lipid spectrum characteristics in senior patients with different types of heart diseases and psychological features and behavioral personality types of the seniors with cardiovascular pathology. Special attention payed on so-called preventive paradox in men older than 60 years with different forms of CHD, when the influence of traditional risk factors is critically decreased, and as important prognostic factors low levels of high-density lipoprotein cholesterol, reduced APO-A1, an increasing of APO-B/APO-A1 ratio and low physical activity play a significant role.

Surgical Treatment of a Symptomatic Diaphyseal Tibiofibular Synostosis in a Professional Rugby Player: A Case Report and Literature Review

Context: Diaphyseal tibiofibular synostosis (DTS) is a rare pathology with unknown origin especially occurring in intensive sport athletes. No therapeutic guideline has been well established in the literature. Case Presentation: A rare case of DTS in a 26-year-old professional rugby player has been described. A 5-month exhaustive conservative treatment including physiotherapy and oral medication has been achieved but failed. Management and Outcomes: Following the conservative treatment failure, the DTS has been widely removed including the adjacent interosseous membrane, and the patient could return to competition at the same level after 5 months of convalescence. No recurrence has been revealed at a 35-month follow-up at least. Conclusion: In accordance with the literature data and even if the pathophysiology remains obscure, resection of DTS seems to be the adapted treatment to allow and to reduce professional athletes’ recovery time at the same sport level. The resection including a part of the tibiofibular interosseous membrane could avoid the occurrence of recurrence. Conservative treatment should be reserved for senior patients with a low sport activity.

Bridging the Telemedicine Gap Among Seniors During the COVID-19 Pandemic

At the onset of the COVID-19 pandemic, many senior patients in the USC-Keck Family Medicine clinics were limited or lacking in telemedicine participation. Three factors contributed: lack of video-enabled devices, technological literacy, and/or absence of Wi-Fi connectivity. We addressed the first 2 of these factors. Via phone contact, 9 patients agreed to receive donated Android or Apple devices and to trial instruction manuals for use. Donated equipment and instructions were prepared and delivered in accordance with pandemic guidelines. Follow-up calls indicated that 4 participants were able to set up their devices and 3 of whom had connected with their providers. The remaining 5 participants had not set up their devices by the end of the follow-up period, had difficulty with device setup, accessing applications necessary for telemedicine, or had limited access to Wi-Fi. This project highlights some telemedicine barriers that senior patients may overcome with the additional support of care providers.