Characteristics and pharmacological treatment options of delirium patients treated at Sanglah Central General Hospital

Delirium is a syndrome characterized by disturbances of consciousness and cognition that occur acutely and fluctuate. Delirium can be caused by general medical conditions, drug users, sensory disturbances, polypharmacy, etc. The etiology of delirium is diverse and non-specific. The preference of pharmacological therapy in delirium is still a debate. Descriptive research with the retrospective cross-sectional method, using secondary data in medical records at the Sanglah Central General Hospital Denpasar for the period January 1, 2020, to December 31, 2020. Patients who were consulted were 166 people, with sex 57 people (34.3%) and 109 women (65.7%). The incidence of delirium in adults (20-59 years old) and elderly (age 60 years) is the highest with 51.2% and 45.1% respectively. One-third of 45 people (37.2%) had overlapping dementia. Most of the 142 people (85.5%) were experiencing significant life stress. The most common type of delirium was hyperactive delirium (74%). The underlying disease of delirium varies such as the cause of infection (24.1%), intracranial process (19%), malignancy 18.1%, cardiovascular (10.1%), endocrine disorders,(7.8%), kidney disorders (6%), and others in small percentages.

Mối liên quan giữa một số đặc điểm lâm sàng, tổn thương phổi trên X-quang và kết cục lâm sàng ở bệnh nhân Covid-19

TÓM TẮT Đặt vấn đề: Bệnh COVID-19 gây ra bởi vi rút SARS-CoV-2 hiện nay là một đại dịch toàn cầu gây ảnh hưởng lớn đến hơn 200 quốc gia trên thế giới. Mức độ nặng của bệnh lý nhu mô phổi được coi là một yếu tố nguy cơ liên quan đến kết cục tử vong, bác sĩ nhận biết được điều này sẽ cải thiện sự phân tầng nguy cơ và điều chỉnh cường độ chăm sóc, đặc biệt là những bệnh nhân có nguy cơ cao. Phương pháp: Nghiên cứu hồi cứu 220 bệnh nhân COVID-19 được cách ly và điều trị tại Trung tâm hồi sức tích cực người bệnh COVID-19 trực thuộc Bệnh viện Trung ương Huế tại TP HCM Kết quả: Chúng tôi đã lấy ngẫu nhiên 110 bệnh nhân sống và 110 bệnh nhân tử vong (TV). Tổn thương trên X-quang ở nhóm tử vong trung vị TSS là 8 (8 - 8) và gặp gần như hoàn toàn mức độ nặng 109 (49,5%), nhóm sống trung vị TSS là 6 (4 - 7), và gặp phần lớn là mức độ vừa 68 (30,9%), sự khác biệt rất có ý nghĩa thống kê với p < 0,000001 và p < 0,0001. Tổn thương trên X-quang thường phối hợp và gặp theo thứ tự sau: tổn thương kẽ 212 (96,4%), kính mờ 205 (93,2%), nốt mờ 140 (63,6%), đông đặc 103 (46,8%), tổn thương dạng nốt mờ ở nhóm TV 96 (43,6%) cao hơn hẳn nhóm sống 44 (20%) với p < 0.0001. Vị trí tổn thương gặp ở nhóm TV là lan tỏa 2 phế trường bệnh nhân, trong khi ở nhóm sống gặp ở cả ở ngoại vi 58 (26,4%) và lan tỏa 52 (23,6%), không gặp tổn thương ở quanh rốn phổi ở cả hai nhóm với p < 0,0001. Kết luận: Nghiên cứu đầu tiên ở Việt Nam chỉ ra rằng điểm TSS cao, tổn thương lan tỏa trên X-quang và tuổi cao tăng nguy cơ tử vong do COVID-19. ABSTRACT RELATIONSHIP BETWEEN CLINICAL SYMPTOMS, CHEST X-RAY ABNORMALITIES AND OUTCOME IN PATIENTS WITH COVID-19 Background: COVID-19 caused by SARS-CoV-2 virus is an unprecedented global pandemic affecting more than 200 countries worldwide. The severity of parenchymal lung disease is considered as a major risk factor for mortality. Therefore, it is important to improve its recognition by clinicians, henceits risk stratification and intensity adjustment of care, especially in high - risk patients. Methods: A retrospective study was conducted on 220 COVID-19 patients who were treated at the COVID-19 Intensive Care Center Unit run by Hue Central Hospital in Ho Chi Minh City. Results: We randomly selected 110 patients who had recovered (R) and 110 who died (D) from COVID-19. The radiographic lesion in the D group median TSS was 8 (8 - 8) and had almost complete severity 109 (49.5%) and median recovery group TSS was 6 (4 - 7), and most of them were moderate 68 (30.9%) with p < 0.00001 and p < 0.0001. Lesions on X - ray are often combined and occurred in the following order: interstitial lesions 212 (96.4%), ground - glass opacity 205 (93.2%), blurred nodules 140 (63.6%), consolidation 103 (46.8%), nodular lesions in the D group 96 (43.6%) were significantly higher than in the recovery group 44 (20%) with p < 0.0001. The location of the lesions seen in the D group was diffuse to 2 lung fields patients, while in the recovery group it was found in both peripheral 58 (26.4%) and diffuse 52 (23.6%), not found lesions around the hilum in both groups with p < 0.0001. Conclusions: This study demonstrates for the first time in Vietnam that a high TSS score, diffuse radiographic involvement, and elderly age increase the risk of death in patients with COVID-19. Keywords: Clinical symptoms, chest X-ray, TSS, outcome, COVID-19

Outcomes of soft-tissue sarcoma in nonagenarians

Aims Current literature suggests that survival outcomes and local recurrence rates of primary soft-tissue sarcoma diagnosed in the very elderly age range, (over 90 years), are comparable with those in patients diagnosed under the age of 75 years. Our aim is to quantify these outcomes with a view to rationalizing management and follow-up for very elderly patients. Methods Retrospective access to our prospectively maintained oncology database yielded a cohort of 48 patients across 23 years with a median follow-up of 12 months (0 to 78) and mean age at diagnosis of 92 years (90 to 99). Overall, 42 of 48 of 48 patients (87.5%) were managed surgically with either limb salvage or amputation. Results A lower overall local recurrence rate (LRR) was seen with primary amputations compared with limb salvage (p > 0.050). The LRR was comparable between free (R0), microscopically (R1), and macroscopically positive (R2) resection margins in the limb salvage group. Amputation was also associated with longer survival times (p < 0.050). Overall median survival time was limited to 20 months (0 to 80). Conclusion Early and aggressive treatment with appropriate oncological surgery confers the lowest LRR and a survival advantage versus conservative treatment in this cohort of patients. With limited survival, follow-up can be rationalized on a patient-by-patient basis using alternative means, such as GP, local oncology, and/or patient-led follow-up. Cite this article: Bone Joint J 2022;104-B(1):177–182.

Histological examination of cranial synchondroses as functionally significant elements in the cranial osteopathic concept

Introduction. In recent decades, medical science has accumulated convincing evidence of the fact that the normal activity of a human brain depends on the functional integration of its vascular system, a circulation system of cerebrospinal fluid and biomechanical features of a skull, forming a single structural and functional system.The aim of the study is to research the histological structure of functionally significant cranial synchondroses in the middle and elderly age group, to find possible points of osteopathic influence application in their structure. Materials and methods. The study was performed on cadaver material of 27 persons (7 men — 26 %, 20 women — 74 %) who died at the age from 49 to 66 years (57,5±5,3 years) from various somatic pathologies, but had no history of craniocerebral injuries with fractures of osseous structures. Small bone fragments with sutures of interest/synchondroses (spheno-occipital synchondrosis, petro-jugular synchondrosis, sphenopetrosal synchondrosis) were subjected to standard histological processing followed by microscopy.Results. Evaluating histological specimens of spheno-occipital synchondrosis, we observed the similar pattern: highly mineralized tissues at the edges of the bodies of the sphenoid and occipital bones were connected without elements of cartilagi-nous or connective tissue. In all cases, no fibrous or nerve tissue elements were found during the in situ immunohistochemical reactions. Reactions with the CD34 antibody mark multiple vessels of the Volkmann's or Haversian canals. Evaluating histological specimens of petro-jugular and sphenopetrosal synchondroses, we found the presence of cartilage tissue in the suture in the form of small islands of various sizes (from 20 to 120 microns) with signs of degeneration and a small number of remained chondrocytes. When evaluating specimens with immunohistochemical reactions with antibodies against the S100 protein, no elements of the nervous tissue were detected.Conclusion. Spheno-occipital synchondrosis has a temporary nature. With age, its cartilaginous tissue is replaced by osseous one. According to the histological structure, sphenobasilar synchondrosis demonstrates the complete absence of a cartilaginous component in the middle and elderly age groups. Petro-jugular and sphenopetrosal synchondroses retain the cartilaginous component in their suture throughout lifetime. During histological examination of the petro-jugular and sphenopetrosal synchondroses, the cartilaginous component is represented by variety of small islands. In all synchondroses, there is an absence of vascular and nervous components. At the same time, we revealed the presence of a prominent vascular bed in the bone tissue. The fact requires emphasizing the importance of liquid potency and elastic component in cartilaginous and osseous tissues as an application point for osteopathic techniques.

Prevalence of Self-Neglect and Associated Factors Among Disability Elderly in China

Purpose: To assess the prevalence of self-neglect and associated factors among disability elderly(age≥65 years) in China.Patients and methods: Patients aged 65 years or above were enrolled from two communities in Shenyang,China. A convenience sample of 230 disability elderly responded to the questionnaire survey. The data were collected by a series of questionnaires consisting of socio-economic and demographic characteristics, Barthel Index(BI), Elder Self-Neglect Assessment(ESNA), Geriatric Depression Scale-Short Form(GDS-SF), Multidimensional Scale of Perceived Social Support(MSPSS), and Mini-Mental State Examination(MMSE). Kruskal-Wallis test or Mann-Whitney U test was used to examine the differences of self-neglect among different demographic characteristics as appropriate.Multiple linear regression model was performed to identify which factors were independent predictors of self-neglect.Results: An overall self-neglect rate of 86.0% was registered. The study reveals that disability elderly's self-neglect correlates positively with the degree of disability and depressive symptoms. On the contrary, monthly income and perceived social support were negatively associated with self-neglect.Conclusion: In this study, the prevalence of self-neglect is high among disability elderly. Lower monthly income, decreased physical functioning, depressive symptoms, and poor perceived social support were contributing factors for self-neglect among disability elderly.

Psychological Problem in Geriatric Age Group

The proper definition of geriatrics is not easy to define. It can be said it is the health care / medical care provided to the elderly age group people of the society. Old/elderly is also preferred over the geriatric term but is not that precise, sixty-five years is said to be the age group coming into the geriatric group, but some of the people do not need any medical care until the age of seventy- seventy years. Biological or physiological impairment, as well as socioeconomic circumstances, can affect functional status. Their functional ability determines the elderly's capacity to stay at home. Doctors should reasonably expect to care for an increasing number of elderly people with complex medical and psychosocial issues. As a result of these challenges and issues, difficult ethical dilemmas may arise. As a result, practitioners should be aware of ethical difficulties that arise frequently when caring for older patients. Poor patient-clinician communication can lead to ethical difficulties; as a result, we present practical guidelines for better communication. People were more likely to develop physical disabilities, despair, and cognitive impairment as they got older, especially those in the 80-89 age bracket. Current data for India's old provide a foreshadowing of a new challenges if programme managers and policymakers do not take prompt action in this area. There is a need to raise awareness of the medical and socioeconomic difficulties that India's elderly confronts and initiatives for improving their quality of life.

Anaemia - a common syndrome in old age

Anaemia is a common syndrome in the elderly (age>65 years), combined with changes and diseases characteristic of ageing. There are currently nearly 500 million (7%) adults over the age of 65 in the world. According to statistics, there are about 15 million older people with anaemia in the European Union. This number is likely to increase in the coming years due to the ageing population in Western societies.1 The acute anaemic syndrome is dominated by symptoms of decreased circulatory volume, such as dizziness, syncope and hypotension. While in the chronic course, anaemia can be asymptomatic and be detected accidentally in a laboratory test. Suspicious signs are a reduced ability to carry oxygen, such as general weakness, fatigue and shortness of breath, for which age changes are often blamed. Worsening of concomitant conditions such as angina, heart failure, CKD and chronic obstructive pulmonary disease has been observed. Older people with anaemia of any degree have a deteriorating quality of life due to significantly higher morbidity and mortality. The purpose of this review is to summarize the most common etiological causes of anaemia in the elderly, clinical consequences, and guidelines for diagnosis.

The algorithm of decision-making in administration of anticoagulant therapy due to COVID‑19. Review

There is a hypothesis that on its late complicated stages, coronavirus disease of 2019 (COVID‑19) represents an endothelial disease. According to Peter’s Libbi data (2020), the endothelial monolayer measures up to 7000 m2 in surface area. The endothelial functions include anticoagulant, antiplatelet, anti‑inflammatory, vasomotion, and structure. The aim of the review was to figure out COVID‑19 logistics from the standpoint of its pathogenesis, in particular its thrombotic complications, to summarize data on the choice of an anticoagulant, its dose and duration of use. COVID‑19 is a new disease with the lack of evidence‑based data, however, its per‑syndrome analysis results in conclusion that the most part of acute and post‑COVID complications refer to thromboembolic ones. According to the recommendations of the European Society of Cardiology on diagnostic and treatment of thromboembolism, the need for thromboembolism prevention is defined in case of respiratory failure, installed intravenous catheters, infection (specifically pneumonia), bed rest, elderly age, etc. The adherence to evidence‑based recommendations will allow one to administer rational anticoagulation therapy without harm to a patient. It concerns both patients, who are on anticoagulant therapy at hospital admission, and those who requires its new administration. The following questions are mostly frequent arising in doctors: How one should manage a patient with active bleeding, or platelet levels < 25 · 109/ L, or with congenital abnormality of coagulation? What types of blood chemistry should be considered when administering anticoagulant? What therapy should be administered at discharge? Compliance with clear anticoagulation algorithms will prevent thromboembolic complications, further damage to organs and systems, and significant bleeding.

Correction and prevention of lumbosacral osteochondrosis in elderly women based on the use of exercise complexes in water

The study is devoted to identifying the effectiveness of exercise complexes in water for the correction and prevention of lumbosacral osteochondrosis in elderly women, which was proven and expressed in a significant improvement in systolic blood pressure, the Stange and Gencha test, spinal mobility in the Tomayer test and the Schober test, lateral flexion of the spine to the left and right, maintaining stability of balance in the Romberg test, quality of life. Keywords: elderly age, osteochondrosis, exercises in water.