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Biomedical subjects

M S Pathy

Publications and source records attributed to M S Pathy.

At least 37 records · Page 2Linked to original sources
PubMed1988

Can old people on oral anticoagulants be safely managed as out-patients?

Of 62 patients (mean age 75, range 65-92 years) referred to an out-patient anticoagulant clinic specifically for those aged 65 years or more, treatment was considered unsafe in only one patient and was discontinued. Minor bleeding which did not require a significant change in management was recorded on 25 (7%) of 381 clinic visits and one major haemorrhage occurred requiring emergency hospital admission. Anticoagulation was maintained within the therapeutic range on 284 (75%) visits. The results confirm that with appropriate out-patient care and supervision, the risks of oral anticoagulant therapy in the elderly need be no greater than in younger patients.

Administration, Oral↗
PubMed1988

Markers of the nutritional status in acutely ill elderly patients.

We recorded anthropometric and laboratory data in 98 sick old people on admission to a high-dependency unit. The measurement of triceps skinfold thickness and arm muscle area was feasible even in very ill people, while measurement of the body mass index was difficult and sometimes unreliable. Anthropometric measurements indicated that our study group was better nourished than a local population, with just 3 subjects (3%) being fat depleted and a further 4 (5%) being protein depleted. Serum albumin was the laboratory variable that correlated best with anthropometric parameters. However, it was low in 47% of the subjects, indicating that its lower reference value needs to be redefined in this select group.

Acute Disease↗
PubMed1988

A geriatric high dependency unit--an innovation in the care of the acutely ill elderly patient?

A geriatric High Dependency Unit has been in operation at Cardiff Royal Infirmary for the past 7 years to provide "special-care" for acutely ill elderly people requiring careful bedside monitoring and intensive nursing and medical treatment. The background to the unit, its present functioning and the results of a prospective study of 432 consecutive admissions are described. The unit offers more appropriate and better continuity of hospital care for many very ill geriatric patients and may be a satisfactory alternative to admission to coronary or intensive care units where resources are not freely available.

Acute Disease↗
PubMed1987

Double-blind randomised trial of intravenous glycerol in acute stroke.

The effects of intravenous glycerol in elderly patients with recent onset of acute ischaemic stroke were evaluated in a double-blind randomised controlled trial. 173 patients received either 500 ml of a 10% solution of glycerol in physiological saline or 500 ml of physiological saline administered intravenously over 4 h daily for 6 consecutive days. The number of deaths within the first week was 10 (12%) in the glycerol group versus 26 (30%) in the controls. Subsequent mortality up to 12 months was similar in the two groups and a survival analysis confirmed a beneficial effect of treatment (p less than 0.02). The neurological and functional recovery of survivors, their length of hospital stay, and the proportion able to return to live in their own home were similar in the two groups. The improvement in survival time with glycerol was achieved without serious adverse effects and without an increase in the proportion of survivors with severe residual disability.

Acute Disease↗
PubMed1987

Acute myocardial infarction: diagnostic difficulties and outcome in advanced old age.

The diagnostic features and outcome of acute myocardial infarction in 100 very elderly (aged 85 years or more) hospitalized patients are reviewed and compared with those in a group of younger elderly (aged 65-84 years). The diagnostic triad of chest pain, sequential ECG changes and raised cardiac enzymes was present in only 24 very elderly patients and in 27 the diagnosis was not initially suspected. Presenting symptoms were often atypical and characteristic ECG changes could not be demonstrated in 25 patients. Very elderly patients had a higher mortality during the first few days in hospital, despite no greater incidence of cardiac failure and similar infarct size to the younger patients. Subsequent in-hospital mortality was similar in both groups. A higher index of suspicion of myocardial infarction in acutely ill very elderly patients should lead to earlier diagnosis, more appropriate management and may improve immediate prognosis.

Aged↗
PubMed1987

The memory clinic. A new approach to the detection of early dementia.

Dementia is commonly diagnosed at a time of major domestic breakdown, when symptoms are severe and family and community patience has been eroded. In order to encourage early referral and identification of patients with treatable conditions, a Memory Clinic is held at the University Hospital in Cardiff. The clinic provides a service for general practitioners, patients and carers, offering a multidisciplinary assessment, early diagnosis, and the planning of an individual 'care package' for each patient. It also has an important educational function and acts as a valuable research resource. A review of 100 consecutive patients recently referred found that 44 had Alzheimer-type dementia and 14 had a probable vascular component to their dementia. This latter group of patients were younger, more likely to be male and had a shorter duration of symptoms. One-third of patients were not dementing, and presenting symptoms in 19 of these dramatically improved with appropriate management, particularly of depression. 43 patients had other previously unrecognised, but treatable, medical conditions. Thus, early diagnosis enables the development of a clear plan for care, existing drug treatment can be rationalised, and appropriate treatment started at a stage when it is potentially of most value.

Aged↗
PubMed1986

Atrial fibrillation and stroke in elderly hospitalized patients.

Of 4100 consecutive admissions to the Department of Geriatric Medicine, 414 patients (10.1%) were identified as having atrial fibrillation (AF); 138 (33%) had transient AF and 276 (67%) had constant AF. In the constant group, 41.7% of patients had had a stroke compared with 26.8% in the transient group (P less than 0.01). A random sample of 200 patients in sinus rhythm from the 4100 admissions had a stroke prevalence of 19%. This study suggests that constant AF has a greater association with stroke than transient AF.

Aged↗
PubMed1986

Changing presentation of myocardial infarction with increasing old age.

The symptoms associated with acute myocardial infarction in a series of 777 elderly hospitalized patients are reviewed. Their ages ranged from 65 to 100, with a mean of 76.0 years. The spectrum of presentation changed significantly with increasing age. Chest pain or discomfort were less frequently reported, although present in the majority of patients up to 85 years. Syncope, stroke, and acute confusion became more common and were often the sole presenting symptom. Shortness of breath, although the most frequently reported symptom in the absence of chest pain, was equally common at all ages. Thus, in patients aged 85 years or over, "atypical" presentation of myocardial infarction became the rule, and in the very old the clinician must be prepared to screen for the diagnosis in most acutely ill patients.

Aged↗
PubMed1986

A double-blind controlled study of chlormethiazole and triazolam as hypnotics in the elderly.

This study compared the hypnotic efficacy and the psychometric effects of treatment with either chlormethiazole or triazolam for 9 weeks in elderly patients with sleep disturbance. Chlormethiazole and triazolam were found to be similarly effective in short-term use. However, evidence of sustained hypnotic efficacy throughout the 9 weeks of treatment was obtained for chlormethiazole but not for triazolam. There were daytime withdrawal effects with triazolam, but none with chlormethiazole.

Aged↗
PubMed1986

Plasma electrolytes in elderly patients taking fixed combination diuretics.

Plasma potassium and sodium concentrations were measured in a group of elderly patients taking maintenance thiazide diuretic therapy alone, with a potassium supplement or in combination with a potassium sparing diuretic. Fixed dose combinations of a thiazide and potassium sparing diuretic did not significantly reduce the prevalence of hypokalaemia and the combination of amiloride-hydrochlorothiazide was associated with a disproportionate number of cases of hyponatraemia. The desirability of the current widespread use of fixed dose combination diuretics over less expensive single agents is questioned.

Aged↗
PubMed1986

Clinical and psychometric evaluation of two doses of loprazolam and placebo in geriatric patients.

A double-blind, parallel group, randomized trial was carried out to compare the hypnotic efficacy, tolerance and psychometric effects of two doses of loprazolam and placebo in 89 elderly hospital in-patients. All had disturbed sleep patterns, which were not the result of serious psychiatric or physical illness and, after a 1 or 2 day single-blind placebo baseline period, they received either 0.5 mg or 1.0 mg loprazolam or placebo administered double-blind for 5 days. The sleep of patients in all three treatment groups, as measured by patient self-rating scales, substantially improved during the study, with loprazolam being superior to placebo for measures of sleep latency, satisfaction with sleep, number of nocturnal awakenings and feeling refreshed on waking. Differences in hypnotic efficacy between the 0.5 mg and 1.0 mg loprazolam groups were not significant. The incidence of side-effects was low and, although there was a significant relationship with loprazolam treatment, this was not dose-related. Performance tests for residual effects (critical flicker fusion threshold and choice reaction time) showed no difference between the placebo and active treatment groups, suggesting that loprazolam, even in a dose of 1.0 mg, is unlikely to produce hangover effects. It is concluded that the findings confirm that loprazolam is an effective and well-tolerated hypnotic in the elderly and that a 0.5 mg dose would be an appropriate initial dose for older patients.

Aged↗
PubMed1985

Cardiac arrests in a geriatric unit.

The outcome of cardio-pulmonary resuscitation within an acute geriatric unit was studied in 95 patients (mean age 77 years, range 65-90) who were involved in 106 consecutive cardio-respiratory arrest calls. In 58 patients (61%), initial resuscitation was unsuccessful and a further 21 (22%) died later in hospital. Fourteen patients (15%) were alive 3 months after hospital discharge, a success rate comparable to that of published series in younger patients. The probability of successful resuscitation was greater in patients in the High-dependency Unit, and ventricular fibrillation and a short duration of arrest were confirmed as good prognostic factors. Age had no influence on outcome. Although subjective levels of psychological and physical disability of survivors at 3 months were low, their domestic and social life was often excessively restricted. Selective, but positive, use of cardio-pulmonary resuscitation within acute geriatric units will benefit a significant minority of patients, but there is also a need for further measures to reduce unnecessary disability in long-term survivors.

Aged↗
PubMed1985

Requests for hypnotic drugs and placebo response in elderly hospital in-patients.

Requests for night sedation and the use of placebo as first line drug management were studied prospectively in 1174 consecutive elderly hospital in-patients. Of the 390 (33.2%) patients requesting sleeping pills in hospital, 37 were subsequently satisfied without the prescription of additional medication. A further 216 patients were entirely satisfied with a placebo capsule during all of their hospital stay. An 'active' hypnotic drug was required by only 137 patients, many of whom were noisy and disturbing other patients in the ward. Most of the active hypnotic drugs prescribed to elderly hospital patients are unnecessary and a majority of those requesting hypnotics consistently respond to placebo. There remains a need for greater education of patients, nurses and doctors in the non-pharmacological management of sleep disorders.

Aged↗
PubMed1983

Colorectal carcinoma in the elderly: a geriatric and surgical practice compared.

Two hundred and eighty-eight patients with colorectal cancer over the age of 65 years admitted to either the geriatric unit or a surgical unit have been compared. Significant differences in presentation and outcome were found and are discussed. Despite adverse factors, acceptable results were obtained for surgical treatment in the geriatric group.

Aged↗