Comparison of the innovative endoscopic oropharyngeal airway and the conventional mouthpiece in elderly outpatients undergoing esophagogastroduodenoscopy under sedation: a prospective and randomized study

Background Undesirable outcomes may appear for elderly patients undergoing esophagogastroduodenoscopy (EGD) under sedation, such as hypoxia and hypotension. The aim of our study was to investigate the ability of the innovative endoscopic oropharyngeal airway to reduce the frequency of hypoxia during EGD under sedation in elderly patients. Methods In this trial, aged patients undergoing EGD were randomized into airway group and mouthpiece group. The primary outcome was the incidence of the minimum pulse oxygen saturation < 90% and minimum pulse oxygen saturation. In addition, sedation dose, recovery time, emergency management and adverse reactions were recorded. Results 360 patients completed the study (180 in each groups). The minimum pulse oxygen saturation during EGD was significantly higher in airway group (97.66 ± 2.96%) than in mouthpiece group (95.52 ± 3.84%, P < 0.001). The incidence of pulse oxygen saturation of 85–89% of airway group (5.0%, 9/180) was lower than mouthpiece group (10.6%, 19/180, P = 0.049). The endoscopy entry time in airway group was 3 (2, 4) seconds and in mouthpiece group was 5 (4, 6) (P < 0.001). Propofol total dose and awakening time were significantly lower in the airway group than in the mouthpiece group (P = 0.020 and P = 0.012, respectively). Furthermore, the incidence rate of hypotension was significantly higher in mouthpiece group (12.2%) than in airway group (5.0%) (P = 0.015). By comparison with the mouthpiece group, the satisfaction of endoscopists was higher in airway group (P = 0.012). Conclusion Elderly patients undergoing EGD, Endoscopy Protector was associated with a significantly lower incidence of hypoxia, shortened endoscopy entry time and more stable hemodynamics. Trial registration: ChiCTR, ChiCTR2000031998, 17/04/2020. http://www.chictr.org.cn/index.aspx

Handgrip Strength Weakness and Asymmetry Together are Associated with Cardiovascular Outcomes in Elderly Outpatients: A Prospective Cohort Study

Background: The evaluations of handgrip strength (HGS) weakness and asymmetry have implications for the comprehensive geriatric assessment. The aim of this study was to investigate the association of HGS weakness and asymmetry on cardiovascular outcomes in elderly outpatients. Methods: This was a prospective observational cohort study of 364 geriatrics outpatients aged ≥ 60 years, in which all participants performed HGS tests at baseline. Patients with HGS < 28 kg for men and < 18 kg for women were diagnosed as HGS weakness, and HGS ratio < 0.90 or > 1.10 were diagnosed as HGS asymmetry. Primary outcomes defined as the major adverse cardiovascular event (MACE) and composite endpoints were assessed during 21-month median follow-up.Results: Among 364 participants, 155 (42.6%) demonstrated HGS weakness, and 160 (44.0%) demonstrated HGS asymmetry. HGS weakness was associated with MACE (HR: 2.763, 95%CI: 1.217-6.272) and composite endpoints (HR: 2.842, 95%CI: 1.399-5.774). However, no significant correlation between HGS asymmetry and cardiovascular outcomes was observed. Compared with the normal and symmetric HGS group, older adults with HGS weakness and asymmetry together had a higher risk of MACE (HR: 5.229, 95%CI: 1.559-17.542) and composite endpoints (HR: 4.002, 95%CI: 1.558-10.277). Conclusion: HGS weakness and asymmetry together may increase the risk of cardiovascular outcomes in elderly outpatients. HGS asymmetry offers complementary information to HGS weakness when making a comprehensive assessment of HGS.

COVID-19 Convalescent plasma

As the coronavirus disease (COVID-19) pandemic led to a global health crisis, there were limited treatment options and no prophylactic therapies for those exposed to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Convalescent plasma is quick to implement, potentially provides benefits, and has a good safety profile. The therapeutic potential of COVID-19 convalescent plasma (CCP) is likely mediated by antibodies through direct viral neutralization and Fc-dependent functions such as a phagocytosis, complement activation, and antibody-dependent cellular cytotoxicity. In the United States, CCP became one of the most common treatments with over half million units transfused despite limited efficacy data. More than a dozen randomized trials now demonstrate that CCP does not provide benefit for those with moderate to severe disease. However, similar to other passive antibody therapies, CCP is beneficial for early disease, when provided to elderly outpatients within 72 hours after symptom onset. Only high-titer CCP should be transfused. CCP should also be considered for immunosuppressed COVID-19 patients. CCP collected in proximity, by time and location, to the patient may be more beneficial due to SARS-CoV-2 variants. Additional randomized trial data are still accruing and should be incorporated with other trial data to optimize CCP indications.

Adherence to Anti-coagulant therapy in elderly patients with Atrial fibrillation in the Kyrgyzstan

Introduction: Anticoagulant therapy can prevent adverse outcomes of Atrial fibrillation (AF), reducing the risk of stroke by 64% and death by 25%. The present study aimed to assess treatment adherence in elderly patients with non-valvular atrial fibrillation (NVAF) who were prescribed the vitamin K antagonist warfarin. Materials and methods: In the present retrospective study, we analyzed the medical records of 202 elderly outpatients with NVAF aged between 65 and 74 years (mean ± SD: 68.7 ± 10.2 years). Results: Problems associated with warfarin arose throughout the follow-up period. After 1 month of treatment, the number of patients taking warfarin had decreased to 71.3% of all patients; less than half of the patients (46%) were still taking the drug. In subsequent periods, the number continued to decrease; of all patients who had been prescribed warfarin with periodic international normalized ratio (INR) control, only 19 (9.4%) remained after 1 year. Our study revealed inadequate anticoagulation therapy in elderly patients, probably because most patients refused warfarin therapy because they could not control their INR. Moreover, significantly more rural residents than urban residents refused therapy (48 vs. 22; p < 0.05). Doctors underprescribed anticoagulants because they feared hemorrhagic complications in their patients. Conclusion: The results of the present study showed that anticoagulants were underprescribed at the outpatient stage in centers of family medicine in our country. The main drug of choice for specialists remains warfarin, which only provides adequate therapy in a small number of patients (9.4%).

There exists high ratio of, and significant overlap between, suspected dementia and suspected depression among elderly outpatients

Background Dementia and depression have emerged as two of the major mental health concerns for elderly people, which are likely to substantially affect public health in the coming decades. Both dementia and geriatric depression are associated with increased morbidity, health care utilization, and mortality. Early detection and treatment initiation are some of the best strategies to minimize the ill effects of dementia and depression on the elderly people. To this end, large-scale screening may be the first step. Methods Screening of individuals ≥65 years old was conducted in the outpatient department of a university hospital. Ascertainment of dementia 8 (AD8) and five-item Brief Symptom Rating Scale (BSRS-5) were used to screen for cognitive decline and depression, respectively. Findings: In total, 3079 elderly people completed both AD8 and BSRS-5. Patients tested positive for cognitive impairment and depression were 28.2% and 15%, respectively. However, 7% were tested positive by both AD8 and BSRS-5 and with statistical significance. Interpretation: The high ratio of suspected dementia and suspected depression suggested the needs and cost-effect of screening among the elderly outpatients. However, the statistically significant overlap implied potential bias when screening only one condition. Future screening program of geriatric mental health needs to consider this.

Regional Differences in the Diagnosis of Sarcopenia in Older People in Brazil

Introduction: Sarcopenia is a prevalent condition, and that is strongly associated with morbimortality outcomes. The optimal way to diagnose sarcopenia is currently a matter of debate. Despite evidence suggesting differences in body composition and physical performance of individuals from different regions, the diagnosis of sarcopenia in Brazil is still conducted using cutoff values established by international consensus. Therefore, the objective of this study was to establish cutoff values for appendicular muscle mass and muscle strength in a population of elderly outpatients with cardiovascular diseases from the city of São Paulo, using this data to compare populations with sarcopenia diagnosed in Brazil with individuals diagnosed using the European consensus values. Materials and Methods: This was a cross-sectional analysis including 502 older individuals from the SARCOS-Brazil study. All subjects underwent densitometry to assess muscle mass and measure strength using a manual dynamometer. The cutoff values for the SARCOS-Brazil criteria were obtained from the 25th percentile of each variable. Results and Discussion: There was no difference in the prevalence of muscle weakness using the two methods (180 patients, 35.9% of the sample). However, a difference was observed concerning low muscle mass. According to the European criteria, a total of 215 older individuals (42.8%) had low muscle mass and 123 (24.5%) according to the SARCOS-Brazil criteria. The prevalence of sarcopenia was 20.3% according to European criteria versus 13.7% according to the SARCOS-Brazil criteria. The kappa coefficient was 0.79. Conclusion: This study suggests that weakness and muscle mass can, in isolation, predict variables related to past vulnerability outcomes, as well as highlights the possibility of using regional cutoff values for the diagnosis of sarcopenia. Keywords: Sarcopenia; Aging; Muscle mass; Muscle strength