Clinical frailty scale and mortality in COVID-19: A systematic review and dose-response meta-analysis.

INTRODUCTION: National Institute for Health and Care Excellence (NICE) endorsed clinical frailty scale (CFS) to help with decision-making. However, this recommendation lacks an evidence basis and is controversial. This meta-analysis aims to quantify the dose-response relationship between CFS and mortality in COVID-19 patients, with a goal of supplementing the evidence of its use. METHODS: We performed a systematic literature search from several electronic databases up until 8 September 2020. We searched for studies investigating COVID-19 patients and reported both (1) CFS and its distribution (2) CFS and its association with mortality. The outcome of interest was mortality, defined as clinically validated death or non-survivor. The odds ratio (ORs) will be reported per 1% increase in CFS. The potential for a non-linear relationship based on ORs of each quantitative CFS was examined using restricted cubic splines with a three-knots model. RESULTS: There were a total of 3817 patients from seven studies. Mean age was 80.3 (SD 8.2), and 53% (48-58%) were males. The pooled prevalence for CFS 1-3 was 34% (32-36%), CFS 4-6 was 42% (40-45%), and CFS 7-9 was 23% (21-25%). Each 1-point increase in CFS was associated with 12% increase in mortality (OR 1.12 (1.04, 1.20), p = 0.003; I2: 77.3%). The dose-response relationship was linear (Pnon-linearity=0.116). The funnel-plot analysis was asymmetrical; Trim-and-fill analysis by the imputation of two studies on the left side resulted in OR of 1.10 [1.03, 1.19]. CONCLUSION: This meta-analysis showed that increase in CFS was associated with increase in mortality in a linear fashion.

The Addition of Active Stretching to Balance Strategy Exercise is the Most Effective as a Home-Based Exercise Program in Improving the Balance of the Elderly.

Background: The decreased balance in the elderly increases the risk of falling. An effective type of exercise is needed to improve balance for the elderly. Aims: The purpose of this study was to determine the difference in the effectiveness of adding active stretching with dynamic stretching to balance strategy exercise as a home-based exercise program in improving the balance for the elderly. Participants and Methods: This research was a randomized control trial. The participants were 36 elderly selected based on the inclusion and exclusion criteria, divided into three groups. Group 1 was given dynamic stretching exercises to balance strategy exercises, Group 2 was assigned active stretching exercises to balance strategy exercise, and Group 3 was given balance strategy exercise only as a control group. Each group was given different exercises three times a week for 6 weeks. The balance ability of the elderly is measured using a Berg balance scale (BBS). Results: The mean difference scores of BBS before and after exercise with paired sample t-test increased in both groups with P < 0.05. It means that all groups had a significant impact, where the highest different score is in Group 2. The one-way ANOVA test showed a significant difference in the average posttest BBS value between the groups. Furthermore, the data were analyzed by the LSD post hoc test, where the results showed that all groups have significant differences against other groups (P < 0.05), with the best group being Group 2. Conclusion: According to the results, the addition of active stretching exercise to the balance strategy exercise as a home-based exercise program is the most effective in improving balance for the elderly.

Factors Related to the Severity of Delirium in the Elderly Patients With Infection.

Objective: Delirium is a common neuropsychiatric syndrome in the elderly characterized by concurrent impairments in cognition and behavior. Infection is one of the most important risk factors for delirium. The objective of this study is to elaborate the factors related to the severity of delirium in the elderly patients with infection. Method: An observational study on the relationship of several clinical parameters and the severity of delirium in elderly patients (more than 60 years) with infection was conducted at Geriatric Inpatient Ward, Sanglah Hospital. Delirium was defined by the Memorial Delirium Assessment Scale (MDAS). Charlson Age Comorbidity Index (CACI) scores were calculated as proposed by Charlson et al. Infection was confirmed by clinical, laboratory, and radiographic findings. Results: During 3 months, there were 60 elderly patients (35 men and 25 women) who were hospitalized with infection and delirium. In all, 33 (55.0%), 16 (26.7%), and 11 (18.3%) patients had pneumonia, urinary tract infection, and other infections, respectively, and 44 out of 60 (73.3%) patients had sepsis. There was no significant difference found in MDAS score between male and female patients and among different types of infection, but patients with sepsis had higher MDAS score significantly compared with patients without sepsis (19.48 ± 3.72 vs. 15.88 ± 2.82; p < .001). This study revealed that of several clinical parameters, only CACI (R = .533; p < .001), blood urea nitrogen (BUN; R = .230; p = .040), and interleukin 6 (IL-6) levels (R = .499; p < .001) were correlated with MDAS score significantly. By multiple linear regression test, CACI, IL-6, and sepsis have significant role, meanwhile, BUN has no role, on the severity of delirium. Conclusions: The CACI score, IL-6 levels, and sepsis have strong relationship with the severity of delirium, but BUN only has weak role in the severity of delirium in the elderly patients with infection.

Bone marrow-derived stem cells as an adjunctive treatment for acute myocardial infarction: a systematic review and meta-analysis.

AIM: to confirm the beneficial effect of BMCs therapy over placebo in AMI patients with inclusion only to the randomized double blind placebo-controlled trials. METHODS: we searched multiple database (MEDLINE, CENTRAL, CINAHL) through January 2011 for randomized, double-blind, placebo-controlled trials evaluating the efficacy and safety of BMCs for the treatment of AMI. We subsequently performed a random-effect meta-analysis to assess the eligible studies included related to the primary outcomes (mean LVEF, LVESV, and LVEDV changes from baseline) and secondary outcomes (all-cause mortality, recurrent MI, rehospitalization for HF). RESULTS: ten RCTs (total=906 patients) were included. BMCs therapy was proven superior to placebo regarding mean LVEF change (2.07%; 95% CI, 0.55% to 3.59%; [I2=57%; p=0.008]), LVESV (5.52 mL; 95% CI, -7.68 mL to -3.36 mL; [I2=16%; p<0.00001]), and LVEDV (3.08 mL; 95% CI, -5.57 mL to -0.58 mL; [I2=23%, p=0.02]) from baseline. BMCs therapy showed no difference with regards to mortality events when compared to placebo (OR 1.01; 95% CI, 0.35 to 2.94; [I2=0%; p=0.98]), but exerts protective effects toward recurrent MI (OR 0.45; 95% CI, 0.09 to 2.16; [I2=8%; p=0.32]) and rehospitalization for HF (OR 0.39; 95% CI, 0.08 to 1.85; [I2=0%; p=0.24]). All outcomes were sustained for a long period of time (up to 5 years). CONCLUSION: the resulting meta-analysis concluded that BMCs therapy consistently improves cardiac performance parameters (LVEF, LVESV, and LVEDV) when compared to placebo, even after the establishment of primary intervention. It is also safe to use and prevents the development of recurrent MI and HF.

Cut-off of anthropometry measurement and nutritional status among elderly outpatient in Indonesia: multi-centre study.

AIM: To obtain the cut-off value of anthropometric measurements and nutritional status of elderly in Indonesia. METHODS: A multicentre-cross sectional study was performed at 9 hospitals in Indonesia. The data collected comprises of samples characteristics, anthropometric measurements (weight, height, trisep, bisep, subscapular, suprailiac, and circumference of the hip, waist, arm, calf, and thigh), albumin value, MNA score and ADL Index of Barthel. RESULTS: A total of 702 subjects were collected. The average value of serum albumin is 4.28 g/dl, with 98% subjects had normal serum albumin (> 3.5 g/dl). The mean MNA score and BMI was 23.07 and 22.54 respectively. Most of subjects (56.70%) had risk of malnutrition based on MNA score, and 45.01% had normal nutritional status based on body mass index. Average value of several anthropometric measures (weight, stature, and body mass index; sub-scapular and supra-iliac skinfolds; thigh, calf, mid-arm, and waist circumferences) in various age groups in both groups of women and men were obtained. Cut-off values of various anthropometric indicators were also analyzed in this study with MNA as a gold standard. CONCLUSION: This study showed age related anthropometric measurement differences in both men and women aged 60 years and older.

Clinical applications of stem cell therapy for regenerating the heart.

An immediate reperfusion therapy after acute myocardial infarction (AMI) is a prerequisite to prevent further cardiac damage and minimize ventricular remodelling. Although a rigorous and sophisticated set of therapeutic procedure has been applied in the disease management, mortality rate has yet unchanged during the last twenty years. This fact necessitates an alternative or adjuvant therapy that is critically safe and capable of repairing the injured vascular as well as regenerating the infarcted myocardium without omitting the ethical considerations. Stem cell therapy could be the answer. It has gained major basic and clinical research interest, ever since its discovered potential to repair the injured vascular in 1997. Multiple cell types across lineages have been shown to be able to transdifferentiate into mature functioning cardiomyocytes either in vitro through similar phenotypical and genotypical characteristics or in vivo by regenerating the infarcted myocardium and improve contractile function. Although the exact repairing mechanisms are still in a major debate, numerous clinical trials have demonstrated favorable effects toward the use of autologous stem cells in AMI patients with considerably low side effects. Despite the relatively novel discovery, stem cell therapy offers a promising prospect to confer a better protection, prevent later complications, and perhaps reduce the mortality among patients with ischemic heart disease. This ultimate outcome would likely be achieved through a stringent and coordinated of either basic and clinical research.

Age and homocystein were risk factor for peripheral arterial disease in elderly with type 2 diabetes mellitus.

AIM: to find out the magnitude of risk of some traditional and non-traditional risk factors for PAD event in the elderly with Type 2 diabetes mellitus (T2DM) patients. METHODS: a case-control study involved 40 subjects of each arms (case and control group) at Geriatric Outpatient Clinic Sanglah Hospital, Denpasar, Bali, Indonesia was conducted. RESULTS: the study showed that compared to patients without PAD, patients with PAD had higher age (70.7 vs. 65.0 years; p<0.001), lower waist circumference (82.7 vs. 91.3 cm; p=0.019), lower triglyceride levels (127.8 vs. 173.9 mg/dl; p=0.016), and higher homocystein levels (13.4 vs. 11.5 mmol/L, p=0.023); while other variables revealed no any significantly difference between two groups. Although no any significant difference, subjects with PAD tend to do exercise less prevalent, consumed anti-hyperlipidemic and anti-thrombotic more frequent compared to subjects without PAD. High age (70-80 years) has risk 7.4 time than those lower age (60-69 years), and high homocystein level (> or =11 mmol/L) has risk 2.5 time than those with lower level to develop PAD. By multivariate analysis (logistic regression), only age has a role in PAD event, while homocystein tend to be risk factor for PAD event. CONCLUSIONS: some traditional risk factors and non-traditional risk factors unproved as risk factors for PAD event in the elderly with type 2 diabetes. Older age and homocystein level were risk factors for PAD event in the elderly with type 2 diabetes subjects.