SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Geriatric patients, though they may present many of the dermatological problems occurring throughout adult life, show a greater incidence of the degenerative skin changes consequent on sun exposure in the form of collagen degeneration, solar keratoses, keratoacanthoma and skin cancer. The benign, precancerous and malignant skin tumours, the various types of eczema, senile pruritus and certain other conditions will be discussed.
Klebsiella pneumoniae (KPN) infections pose heightened risks in the geriatric population due to weakened immunity, prevalent comorbidities, potential exposure in long-term care settings, and increased likelihood of antibiotic resistance (ABR). The study focused on the prevalence and antibiotic resistance of KPN infections, the presence of ABR genes in KPN, and the genomic characterization of KPN obtained from geriatric patients in Chattogram. A total of 543 specimens were collected from four hospitals in Chattogram, along with demographic data from hospital records. Genomic DNA was extracted from multi-drug-resistant (MDR) KPN, and the presence of ABR genes, blaTEM-1, sul-1, aadB, blaNDM-1, blaSHV-11, and phoE was identified. To characterize the KPN genomes, two MDR KPN isolates were subjected to whole-genome sequencing (WGS), and the data were analyzed using bioinformatics tools to identify genomic determinants of ABR. KPN exhibited high resistance to ceftazidime (96%), cefuroxime (92%), and cefixime (83%), but sensitivity to colistin (79%) and amikacin (75%). MDR KPN was mostly detected in sputum (36%) and urine (27%) specimens, where the prevalence of ABR genes, blaTEM-1, sul1, aadB, blaNDM-1, and blaSHV-11 were 28.2%, 17%, 6.17%, 56%, and 48% of these strains, respectively. These genomes exhibited distinct profiles for sequence types, ST420 and ST277 in Kpn007 and Kpn016, respectively, and ABR genes (qnrS1, blaCTX-M-15, and blaSHV-27), virulence factors (ybt, iuc1, iro1), and contained both K (K20, K46) and O antigens (O1, O3b). MDR KPN in the geriatric population poses a serious health concern due to their increased vulnerability to infections and limited treatment options, requiring careful management.IMPORTANCEMultidrug resistance (MDR) and the hypervirulence nature of Klebsiella pneumoniae (KPN) in geriatric patients pose a critical health concern in nosocomial infections worldwide and result in high clinical complexity and mortality. The study investigated the factors for KPN infections and analyzed antimicrobial resistance profiles. More than 60% of Klebsiella pneumoniae isolates from geriatric patients were resistant to third- and fourth-generation cephalosporins, and most isolates carried blaNDM-1 and blaSHV-11 genes. Analyzing whole genomes of two KPNs, Kpn007 (ST277) was identified as a hypervirulent strain with aerobactin and yersinia siderophores, contributing to virulence, and Kpn016 (ST420) carried fluoroquinolone (qnrS1), ESBL (blaCTX-M-15 and blaSHV-27) resistance. Both genomes contained K antigens (K20 and K46) and O antigens (O1 and O3b).
Forty geriatric patients from the psychiatric ward of a state hospital were enrolled in a 12 week double-blind comparative study of the concentrate forms of thioridazine and haloperidol. The objective of the study was to assess the efficacy and safety of these drugs in the treatment of psychosis associated with organic brain syndrome in the elderly. Two types of patients comprised the population, those who had been hospitalized most of their adult lives and those who had not entered the hospital until late in life. Although both drugs produced significant improvement in these patients' symptoms, the improvement with thioridazine tended to be greater than that with haloperidol in most ratings. A plateau effect was seen with haloperidol in contrast to a steady improvement seen with thioridazine. The safety of both drugs was confirmed. Geriatric patients who display both psychotic and OBS symptomatology were found to respond quite well to both drugs, regardless of their previous psychiatric history, but a somewhat more dramatic response was seen with thioridazine.
The discovery of diastematomyelia in a geriatric patient is a rare occurrence. A 76-year-old woman with this entity was not diagnosed until she developed superimposed motor neuron disease.
The nutrition of geriatric patients should observe the following characteristics of advanced age: diminished calorie requirement, impaired glucose tolerance, tendency to elevated serum cholesterin and triglyceride levels, increased requirements for protein of high biological value, absence of thirst and reduced total body water. Considering these metabolic changes recommendations for an adequate nutrition of senescent people are discussed.
Bulk laxatives have been said to have a good effect in normalizing both hard and loose stools in geriatric patients as concluded from some open studies. In a double-blind study Vi-Siblin, Lunelax and placebo were compared in the six weeks treatment of 29 patients (8 patients on Vi-Siblin, 8 patients on Lunelax, 13 patients on placebo). Two weeks prior to the study and the two last weeks of the study defecation frequency, consistency of stools and the use of additional laxatives were registered by the personnel. Results showed no significant differences between groups or between substances. From this controlled double-blind study it is not possible to draw any definite conclusions regarding the efficacy of bulk laxatives on geriatric patients.
Tiapride, a new drug of the anisamides' family, offers not only a major effectiveness on physical disease in alcoholism, but also on behavioral or affective disorder such agitation, hostility, impulsivity in alcoholic or in geriatric patients; this particular effectiveness is presented through the study of a sample of 15 alcoholic and geriatric patients.
In a survey of the health needs of White and Coloured geriatric patients discharged from hospital it was found that community services were not effectively utilized to meet existing needs. While the White elderly suffered less financial hardship and had better access to medical care, they complained of more symptoms, more loneliness and more depression than their Coloured counterparts.
Pathological orthostatic heart rate and systolic blood pressure responses are common in geriatric patients in long-term in-patient care. The distribution of these pathological types of response differs markedly from that of earlier investigated patients (2), with a higher prevalence of asympathicotonic and vasovagal responses and a lower prevalence of sympathicotonic responses in this material.
Monoamine oxidase (MAO) activity has previously been found to be high both in brain and in platelets in patients with Alzheimer's disease and low in patients with cycloid psychosis and suicidal behaviour and/or ethanol abuse. To establish if there is a correlation between brain and platelet MAO activities in patients without psychic disease, blood samples from patients in a geriatric ward were collected before death and from 4 different parts of the brain at autopsy. The MAO activities in platelets and brain were then estimated with different substrates. No correlation between the MAO activities in the two tissues was, however, found, regardless of the substrate used.
The urine sediment of 12 geriatric patients with indwelling catheters was quantified by the glutaraldehyde-cytocentrifuge method prior to, during and after a clinical trial of methenamine hippurate (MH), 2 g x 3 daily given for 34 days as the sole therapeutic agent for the urinary tract infection. The median leukocyte concentration in the urine of these patients was 100 cells/microliter (Q1 - Q3 50-350), i.e. tenfold higher than the upper normal limits reported in healthy probands. The median bacteriuria in the control period was 12 x 10(5) bacteria/ml urine, interquartile range 10-60 x 10(5) bacteria/ml and extreme individual values 300-500 x 10(5) bacteria/ml. Hematuria, defined as greater than or equal to 24 erythrocytes/microliter urine, was not prominent and could not be correlated with MH treatment, nor with catheter changes. The reported observations suggest that short-term high-dose treatment with MH as sole therapeutic agent reduced pyruria and bacteriuria in the group of patients studied.
A significant improvement in the protein metabolism of twelve malnourished geriatric patients was achieved during a three-week daily supplement of the hospital diet with 9 g essential amino acids (8 classic essential amino acids plus histidine). This was especially evident in the doubled serum concentration of pre-albumin and retinol-binding-protein which may be regarded as highly sensitive parameters of protein metabolism. There was a significant increase of total protein and hemoglobin into the lowest normal range. The immunoglobulins IgG, IgA and IgM, however, remained unchanged for the entire observation period.
This paper deals with the specialised therapeutic needs regarding immediate care, parenteral nutrition and surgery in burned geriatric patients according to the experience gained in the treatment of these patients at the Burns Treatment Division of the Department of Dermatology (I) of the University of Vienna.
In a four-week study, a comparison was made of oxazepam, flurazepam and chloral hydrate as hypnotic sedatives in 17 geriatric patients. Each drug was given alone for six nights, with a two-night placebo interval following each phase. Each patient completed an additional placebo phase (up to six nights) before each drug phase. The number of awakenings per night and the sleep latency (time required to fall asleep) were determined from the patients' reports and from the reports of a nurse-observer. Only for oxazepam was the number of patient-reported awakenings per night significantly less than for placebo, although with both oxazepam and flurazepam the awakenings were fewer than with chloral hydrate. According to the patient-reports, sleep latency was significantly lower with flurazepam than with placebo; for oxazepam and chloral hydrate the latencies were not significantly different from those for flurazepam or placebo. Only for oxazepam were the patients' ratings of sleep quality significantly greater than for placebo. The objective assessment of sleep by the nurse-observer usually confirmed the patients' assessments. Morning drowsiness was the most common side effect, reported equally for placebo and for the active drugs. Drowsiness during the day was reported less frequently for oxazepam than for flurazepam, chloral hydrate or placebo. It is concluded that oxazepam is safe and efficacious for the short-term management of insomnia in the elderly.
A review of the literature and a study conducted at a state hospital indicated that valid psychologic test results on geriatric patients are often difficult to obtain. Reasons most frequently offered by psychometricians for inconclusive or incomplete findings were the patient's uncooperativeness, unavailability, or severity of physical/mental dysfunction. A need was apparent for alternate assessment instruments for measuring current and potential levels of functioning in the elderly. In the investigation, attention was focused on the following areas: 1) studies in which the more traditional measurements were used, 2) articles stressing the need for caution in using the traditional techniques, and 3) studies in which behavioral rating scales and checklists were used as the evaluative devices. A large number of checklists and behavioral rating scales were found to be relevant and applicable to an institutional setting. Five were selected and are reviewed in depth.
The results of a 3-month trial with an ergot alkaloid preparation (Hydergine) in 16 geriatric patients showed that, in accordance with a previously proposed working hypothesis, the improvement induced by the drug in electroencephalographic age-related changes was accompanied by clinical improvement in patients with similarly age-related mental deterioration.
Favorable clinic experiences with an anaesthetic involving rohypnol (flunitrazepam) and fentanyl led to an investigation of the haemodynamic effect of this procedure in a group of 9 geriatric patients, aged from 86 to 95 years. Anaesthesia was induced with 0.5 mg rohypnol and 0.1 to 0.2 mg fentanyl depending on the narcotic effect of rohypnol, intubation was performed under relaxation with suxamethonium and long term relaxation was achieved with pancuronium. The patients were normoventilated with nitrous oxide/oxygen. The individual values of the changes in cardiac output and total peripheral resistance showed a great variation. There was a significant correlation between the relative changes in mean arterial pressure and total peripheral resistance (r = 0.69, p less than 0.05) but no correlation between mean arterial pressure and cardiac output (r = 0.09). This indicates that the pronounced drop in arterial pressure which occurred in 4 patients can be explained by a decrease in total peripheral resistance. Careful dosage of the drugs, in particular of fentanyl, and knowledge of adequate measures to treat a decrease in blood pressure if it occurs, appears to be a prerequisite for the use of this type of anaesthesia in poor risk patients.
An evaluation has been made of the clinical and laboratory effects of short-term (34 days), high-dose (2g x 3 daily) treatment with methenamine hippurate (MH) of 14 geriatric patients with an indwelling catheter and clinical features of urinary tract infection. During MH treatment the number of catheter changes was halved, each catheter remaining in situ for an average of 12.0 days as compared to 6.2 days in the pre-treatment control period and 5.2 days in the post-treatment control period; the difference is significant (p = 0.008; Friedman two-way analysis of variance). Urine pH was reduced (pH 7.0--6.5--7.0; p = 0.01) and the standard bicarbonate in blood was slightly elevated (24.1--25.7--25.0 mmol/l; p= 0.008) during the MH treatment period, when compared to pre- and post-treatment control periods. It is suggested that MH treatment reduced the complications associated with indwelling catheters due to reduction in urine pH, bacteriuria, and pyuria. Blockage of catheters is thought to be due to intraluminal salt precipitations with trapping of clumps, and is primarily not correlated with urine viscosity.