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1.
J Nutr Health Aging ; 24(7): 685-691, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32744561

RESUMO

A new coronavirus, called SARS-CoV-2, was identified in Wuhan, China, in December 2019. The SARS-CoV-2 spread very rapidly, causing a global pandemic, Coronavirus Disease 2019 (COVID-19). Older adults have higher peak of viral load and, especially those with comorbidities, had higher COVID-19-related fatality rates than younger adults. In this Perspective paper, we summarize current knowledge about SARS-CoV-2 and aging, in order to understand why older people are more affected by COVID-19. We discuss about the possibility that the so-called "immunosenescence" and "inflammaging" processes, already present in a fraction of frail older adults, could allow the immune escape of SARS-CoV-2 leading to COVID-19 serious complications. Finally, we propose to use geroscience approaches to the field of COVID-19.


Assuntos
Envelhecimento , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Geriatria , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Virologia , Idoso , Envelhecimento/imunologia , Envelhecimento/patologia , Humanos , Inflamação/imunologia , Inflamação/patologia , Pandemias
2.
J Nutr Health Aging ; 24(7): 705-707, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32744565

RESUMO

The COVID-19 pandemic, being the greatest challenge to our healthcare system for over a century, has its greatest impact on older patients. This subgroup has higher morbidity and mortality than younger age groups. Superimposed on this, the major preventative intervention resulting in social isolation has negative consequences. Prof. Bernard Isaacs described the "Geriatric Giant Symptoms" in 1965 and encouraged the development of interventions for immobility, instability, incontinence and impaired intellect/memory with careful management of these symptoms resulting in better outcomes for older patients including reduced admissions to Nursing Homes and mortality. The author's explore the impact of the current pandemic and, most particularly its aftermath on the provision of such interventions. In the context of a major economic crisis, resources for highly effective interventions such as joint replacement surgery, urological interventions, cataract surgery will be all be limited after this crisis. Moreover delayed access to day patient services with suboptimal access to assessments for conditions such as cognitive decline and falls as well as social care will likewise militate against addressing the "Geriatric Giant Symptoms". Thus the "Founding Fathers" of Geriatric Medicine including Prof Isaacs would be justifiably concerned regarding our ability to deliver interventions to address the "Geriatric Giant Symptoms". Current leaders in geriatric medicine, healthcare workers, funders and providers as well as advocacy groups must redouble their efforts to ensure gains made in management of older patients over 2 generations are not lost in the aftermath of this pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Geriatria , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Idoso , Infecções por Coronavirus/mortalidade , Assistência à Saúde , Pessoal de Saúde , Humanos , Casas de Saúde , Pneumonia Viral/mortalidade , Isolamento Social
3.
Int J Nanomedicine ; 15: 5671-5685, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32821096

RESUMO

Aim: The aim of the current work was to develop vardenafil hydrochloride (VRD)-loaded ethosome-derived invasomes as a possible transdermal system which could be used for patients suffering from pulmonary arterial hypertension. Methods: VRD-loaded ethosomes were developed at three concentrations of phosphatidylcholine (5, 10 and 15 mg/mL) and three percentages of ethanol (20%, 30% and 40%, v/v). The best achieved VRD-loaded ethosomes (ETH9) were optimized to invasomes via incorporation of terpenes (limonene, cineole and a 1:1 mixture) at three concentrations (0.5%, 1% and 2%, v/v). All systems were evaluated for vesicle size, zeta potential, drug entrapment efficiency (EE%), cumulative drug permeated percentages after 0.5hrs (Q0.5h) and 12hrs (Q12h) and steady-state flux (Jss). The optimized system (ETH9-INV8) was further characterized for morphology, histopathology and confocal laser scanning microscopy (CLSM). Physiologically based pharmacokinetic (PBPK) modeling was employed to estimate VRD pharmacokinetic parameters from the optimized transdermal system and an oral aqueous drug dispersion, in adults and geriatrics. Results: The optimized invasomal system (ETH9-INV8) was characterized with spherical vesicles (159.9 nm) possessing negative zeta potential (-20.3 mV), promising EE% (81.3%), low Q0.5h (25.4%), high Q12h (85.3%) and the largest steady-state flux (6.4 µg.cm-2h-1). Following a leave-on period of 12hrs in rats, it showed minor histopathologic changes. CLSM studies proved its ability to deeply permeate rat skin. Lower Cmax values, delayed Tmax estimates and greater AUC0-24h folds in adults and geriatrics (≈ 2.18 and 1.69, respectively) were estimated following the transdermal application of ETH9-INV8 system. Conclusion: ETH9-INV8 is a promising transdermal system for VRD.


Assuntos
Sistemas de Liberação de Medicamentos , Etanol/química , Geriatria , Modelos Biológicos , Dicloridrato de Vardenafila/administração & dosagem , Dicloridrato de Vardenafila/farmacocinética , Administração Cutânea , Animais , Lipossomos , Masculino , Microscopia Confocal , Tamanho da Partícula , Permeabilidade , Ratos Wistar , Absorção Cutânea , Eletricidade Estática
4.
Z Gerontol Geriatr ; 53(5): 382-388, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32647990

RESUMO

BACKGROUND: Even though the effects of cultural activities on active and positive ageing have been extensively examined, spatial aspects have hardly been considered by research in this field. OBJECTIVES: Instead of understanding active ageing as a result of cultural education, this article focuses on practices of (active) ageing in cultural education programs for older adults. We examined the meanings of space and spatial arrangements in which cultural education takes place and how these spatial aspects limit or enable active ageing. MATERIAL AND METHODS: The article is based on six qualitative case studies of programs for cultural education for older adults. In programs, such as a yodel seminar or a theater workshop, data were collated by participatory observation and qualitative interviews with the participants and trainers of each program. All data were analyzed using situational analysis. RESULTS: We found that the spaces where the programs took place had a special meaning to the older participants. This was mainly because these spaces where not exclusively designed for target groups of older adults. The experience of the program was not only characterized by these meanings but also by how these spaces were used within the program. Active ageing was realized through the appropriation of new spaces and specific spatial arrangements. CONCLUSION: This article shows how spatial arrangements and the experience of (active) ageing are intertwined. To foster active ageing, cultural education programs need to provide spaces which can be used accordingly. For environmental gerontology, this paper highlights the necessity to consider the symbolic dimension of spaces and environments in research.


Assuntos
Envelhecimento/psicologia , Educação/métodos , Meio Ambiente , Geriatria/educação , Vida Independente/psicologia , Comportamento Espacial , Humanos , Pesquisa Qualitativa , Meio Social
6.
J Cross Cult Gerontol ; 35(3): 273-290, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32621107

RESUMO

This study investigated the differences between Japanese and Korean college students' images of the elderly. Japan is the most aged society worldwide, while South Korea has the highest rate of aging. Japan has a more advanced elderly welfare system than Korea. The datasets included responses from 320 Japanese students (collected in 2009) and 384 Korean students (collected in 2011). A semantic difference scale of 50 pairs of items was adopted. The chi-square test and logistic regression analyses were utilized. The five most prevalent images among Korean students were generally negative, whereas the most common images among Japanese participants were mostly neutral or positive. A greater degree of talking/good memories, activities with older adults, and experience of gerontological education showed positive relationships to favorable images, whereas living with grandparents and visiting facilities for the elderly did not yield the same results. It seems that greater interaction with grandparents and other senior citizens, as well as more extensive gerontology education, improved the images of the elderly in both countries, whereas merely visiting facilities for older adults seemed insufficient. The results also suggest that living with grandparents can lead to rather negative images of older adults.


Assuntos
Ageismo/etnologia , Geriatria/educação , Percepção Social , Estereotipagem , Feminino , Humanos , Japão , Masculino , República da Coreia , Estudantes , Inquéritos e Questionários , Universidades
7.
J Biomed Inform ; 108: 103483, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32603793

RESUMO

Monitoring patients through robotics telehealth systems is an interesting scenario where patients' conditions, and their environment, are dynamic and unknown variables. We propose to improve telehealth systems' features to include the ability to serve patients with their needs, operating as human caregivers. The objective is to support the independent living of patients at home without losing the opportunity to monitor their health status. Application scenarios are several, and they spread from simple clinical assisting scenarios to an emergency one. For instance, in the case of a nursing home, the system would support in continuously monitoring the elderly patients. In contrast, in the case of an epidemic diffusion, such as COVID-19 pandemic, the system may help in all the early triage phases, significantly reducing the risk of contagion. However, the system has to let medical assistants perform actions remotely such as changing therapies or interacting with patients that need support. The paper proposes and describes a multi-agent architecture for intelligent medical care. We propose to use the beliefs-desires-intentions agent architecture, part of it is devised to be deployed in a robot. The result is an intelligent system that may allow robots the ability to select the most useful plan for unhandled situations and to communicate the choice to the physician for his validation and permission.


Assuntos
Monitorização Fisiológica/instrumentação , Robótica/tendências , Idoso , Inteligência Artificial , Sistemas Computacionais , Infecções por Coronavirus/terapia , Medicina de Emergência/instrumentação , Geriatria/instrumentação , Humanos , Infectologia/instrumentação , Informática Médica , Modelos Teóricos , Monitorização Fisiológica/métodos , Casas de Saúde , Pandemias , Pneumonia Viral/terapia , Risco , Telemedicina/instrumentação , Telemedicina/métodos
8.
Dtsch Med Wochenschr ; 145(15): 1039-1043, 2020 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-32731276

RESUMO

The pandemic due to the SARS-CoV-2 virus challenges all of us in the many areas of life. Our health systems are tested for their sustainability and load capacity. SARS-CoV-2 virus-infections will become part of our lives, but they mainly threaten vulnerable and multimorbid older adults. Older people with a frailty-syndrome are challenged not only in physical, but also psychological and social domains. Adapted caring structures are required and the pandemic will introduce important ethical discussions. As examples, distribution of limited resources, requests for more Advance Care Planning as well as balancing between infection protection versus the drawbacks of long-lasting social isolation should be named. This article therefore focuses on ethical questions for older adults in times of the SARS-CoV-2 virus pandemic.


Assuntos
Infecções por Coronavirus , Idoso Fragilizado , Avaliação Geriátrica , Pandemias , Pneumonia Viral , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Família , Fragilidade , Geriatria , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/fisiopatologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/terapia , Isolamento Social , Assistência Terminal
9.
J Am Med Dir Assoc ; 21(7): 954-957, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32674827

RESUMO

The COVID-19 pandemic's greatest impact is among older adults. Management of the situation requires a systemic response, and post-acute care (PAC) can provide an adequate mix of active treatment, management of associated geriatric syndromes and palliative care, both in the acute phase, and in post-COVID-19 recovery. In the region of Catalonia, Spain, selected PAC centers have become sites to treat older patients with COVID-19. Referrals come from the emergency department or COVID-19 wards of the acute reference hospitals, nursing homes, or private homes. We critically review the actions taken by Parc Sanitari Pere Virgili, a PAC facility in Barcelona, to manage the pandemic, including its administration, health care, communication, psychological support, and ethical frameworks. We believe that the strategies we used and the lessons we learned can be useful for other sites and countries where similar adaptation of existing facilities may be implemented.


Assuntos
Assistência Integral à Saúde/organização & administração , Infecções por Coronavirus/epidemiologia , Instalações de Saúde/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Pneumonia Viral/epidemiologia , Cuidados Semi-Intensivos/organização & administração , Centros de Atenção Terciária/organização & administração , Idoso , Infecções por Coronavirus/prevenção & controle , Feminino , Geriatria/métodos , Humanos , Masculino , Inovação Organizacional , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Pneumonia Viral/prevenção & controle , Espanha , População Urbana
10.
Geriatr Psychol Neuropsychiatr Vieil ; 18(2): 125-133, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: covidwho-611801

RESUMO

The COVID-19 epidemic that started in November in China became a national epidemic from March 16, 2020 with the declaration of population containment in order to reduce the spread of the virus in France. From March 17 to March 27, 2020, the monitoring unit of the French society of geriatrics and gerontology decided to conduct a survey to analyze the implementation of the mobilization of geriatric units, given that this epidemic had shown that it resulted in excess mortality mainly among the elderly. The survey was able to bring together the response of 34 services, nine of which were located in a high epidemic cluster zone. Dedicated acute geriatric units for patients infected with COVID-19 were present in eight facilities, only outside the cluster zones. Nine geriatric follow-up and rehabilitation services were dedicated, an additional telemedicine activity concerned 35% of the facilities, and family listening and tablet communication facilities concerned 36% of the facilities. This survey is a snapshot of an initial moment in the epidemic. It provides an opportunity to describe the context in which this epidemic occurred in terms of geriatric policy, and to assess the responsiveness and inventiveness of these services in meeting the needs of the elderly.


Assuntos
Infecções por Coronavirus/terapia , Geriatria , Unidades Hospitalares/estatística & dados numéricos , Pneumonia Viral/terapia , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/mortalidade , Feminino , França/epidemiologia , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/mortalidade , Inquéritos e Questionários , Telemedicina
11.
Geriatr Psychol Neuropsychiatr Vieil ; 18(2): 151-156, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: covidwho-611800

RESUMO

At the beginning of the Covid-19 epidemic, National forum for ethical reflection on Alzheimer's disease and neurodegenerative diseases conducted a national survey to identify the difficulties encountered by professionals working in the field of old age and autonomy, families and volunteers, and the initiatives they have implemented. Seven major difficulties were identified: the isolation induced by the prohibition of visits, the lack of protective equipment and tests, the difficulties of people with cognitive difficulties in understanding measures to avoid the spread of the epidemic, the sustainability of overwork for professionals, the concern of the families of residents, complex situations at home and difficulties in accessing care. Four initiatives are being implemented: information and training for teams, compensation for interrupted visits, consultations and exchanges between professionals, actions to benefit people living at home. The Covid-19 epidemic hit the elderly sector at a very special moment in its history, several years of effort by the sector to reinvent itself around strong values. They have been a resource during this period of crisis. An ambitious law on old age and autonomy therefore appears to be a necessity.


Assuntos
Infecções por Coronavirus/terapia , Geriatria/ética , Geriatria/tendências , Pneumonia Viral/terapia , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Técnicas de Laboratório Clínico/estatística & dados numéricos , Transtornos Cognitivos/complicações , Transtornos Cognitivos/psicologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Família , Feminino , França/epidemiologia , Acesso aos Serviços de Saúde , Humanos , Masculino , Pandemias , Educação de Pacientes como Assunto , Isolamento de Pacientes/psicologia , Autonomia Pessoal , Equipamento de Proteção Individual , Pneumonia Viral/epidemiologia , Inquéritos e Questionários
12.
Geriatr Psychol Neuropsychiatr Vieil ; 18(2): 125-133, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: covidwho-607702

RESUMO

The COVID-19 epidemic that started in November in China became a national epidemic from March 16, 2020 with the declaration of population containment in order to reduce the spread of the virus in France. From March 17 to March 27, 2020, the monitoring unit of the French society of geriatrics and gerontology decided to conduct a survey to analyze the implementation of the mobilization of geriatric units, given that this epidemic had shown that it resulted in excess mortality mainly among the elderly. The survey was able to bring together the response of 34 services, nine of which were located in a high epidemic cluster zone. Dedicated acute geriatric units for patients infected with COVID-19 were present in eight facilities, only outside the cluster zones. Nine geriatric follow-up and rehabilitation services were dedicated, an additional telemedicine activity concerned 35% of the facilities, and family listening and tablet communication facilities concerned 36% of the facilities. This survey is a snapshot of an initial moment in the epidemic. It provides an opportunity to describe the context in which this epidemic occurred in terms of geriatric policy, and to assess the responsiveness and inventiveness of these services in meeting the needs of the elderly.


Assuntos
Infecções por Coronavirus/terapia , Geriatria , Unidades Hospitalares/estatística & dados numéricos , Pneumonia Viral/terapia , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/mortalidade , Feminino , França/epidemiologia , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/mortalidade , Inquéritos e Questionários , Telemedicina
13.
Geriatr Psychol Neuropsychiatr Vieil ; 18(2): 151-156, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: covidwho-607701

RESUMO

At the beginning of the Covid-19 epidemic, National forum for ethical reflection on Alzheimer's disease and neurodegenerative diseases conducted a national survey to identify the difficulties encountered by professionals working in the field of old age and autonomy, families and volunteers, and the initiatives they have implemented. Seven major difficulties were identified: the isolation induced by the prohibition of visits, the lack of protective equipment and tests, the difficulties of people with cognitive difficulties in understanding measures to avoid the spread of the epidemic, the sustainability of overwork for professionals, the concern of the families of residents, complex situations at home and difficulties in accessing care. Four initiatives are being implemented: information and training for teams, compensation for interrupted visits, consultations and exchanges between professionals, actions to benefit people living at home. The Covid-19 epidemic hit the elderly sector at a very special moment in its history, several years of effort by the sector to reinvent itself around strong values. They have been a resource during this period of crisis. An ambitious law on old age and autonomy therefore appears to be a necessity.


Assuntos
Infecções por Coronavirus/terapia , Geriatria/ética , Geriatria/tendências , Pneumonia Viral/terapia , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Técnicas de Laboratório Clínico/estatística & dados numéricos , Transtornos Cognitivos/complicações , Transtornos Cognitivos/psicologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Família , Feminino , França/epidemiologia , Acesso aos Serviços de Saúde , Humanos , Masculino , Pandemias , Educação de Pacientes como Assunto , Isolamento de Pacientes/psicologia , Autonomia Pessoal , Equipamento de Proteção Individual , Pneumonia Viral/epidemiologia , Inquéritos e Questionários
16.
J Am Med Dir Assoc ; 21(7): 939-942, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32563752

RESUMO

The COVID-19 pandemic is devastating post-acute and long-term care (PA/LTC). As geriatricians practicing in PA/LTC and a regional academic medical center, we created this program for collaboration between academic medical centers and regional PA/LTC facilities. The mission of the Geriatric Engagement and Resource Integration in Post-Acute and Long-Term Care Facilities (GERI-PaL) program is to support optimal care of residents in PA/LTC facilities during the COVID-19 pandemic. There are 5 main components of our program: (1) Project ECHO; (2) nursing liaisons; (3) infection advisory consultation; (4) telemedicine consultation; and (5) resident social contact remote connections. Implementation of this program has had positive response from our local PA/LTC facilities. A key component of our program is our interprofessional team, which includes physicians and nursing, emergency response, and public health experts. With diverse professional backgrounds, our team members have created a new model for academic medical centers to collaborate with local PA/LTC facilities.


Assuntos
Centros Médicos Acadêmicos/organização & administração , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Instituições de Cuidados Especializados de Enfermagem/organização & administração , Idoso , Feminino , Geriatras/organização & administração , Geriatria/organização & administração , Humanos , Comunicação Interdisciplinar , Assistência de Longa Duração/organização & administração , Masculino , Casas de Saúde/organização & administração , Avaliação de Resultados em Cuidados de Saúde , Pandemias , Equipe de Assistência ao Paciente/organização & administração , Avaliação de Programas e Projetos de Saúde , Consulta Remota/organização & administração , Medição de Risco , Telemedicina/organização & administração , Estados Unidos
17.
Z Gerontol Geriatr ; 53(5): 395-400, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32548780

RESUMO

BACKGROUND: The study of housing and living spaces has always played a central role in sociogerontological research. For example, living environments are seen as essential influencing factors on the quality of life and personal well-being (or the lack of it) of older people. The study of the relationship between space and age(ing) is dominated by psychologically influenced environmental gerontological approaches and social area-oriented research. While environmental perspectives in gerontology focus in particular on perceptions, experiences and affects to identify the relationships between space and age(ing), social area-oriented research tends to focus on social inequalities and strategies of participation. OBJECTIVE: The results of ecogerontological approaches to affects and social area-oriented research on social inequalities are combined by means of a praxiological approach. A relational understanding of space and age is developed, which is able to focus on affects and is also sensitive to spatial exclusions based on social inequalities and which also have an affective component. This combination enables new insights into a gerontological designation of the relationship between space and age(ing). RESULTS AND CONCLUSION: Such a remapping of age(ing) makes it possible to formulate other research questions regarding constructions of space through age or age through space and to provide impulses for gerontological research perspectives that take the complex interplay of humans, artefacts and spatial arrangements into account and explore the consequences for individual persons and also for their living spaces.


Assuntos
Afeto , Envelhecimento/psicologia , Habitação para Idosos , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Ambiente Construído , Geriatria , Disparidades nos Níveis de Saúde , Habitação , Humanos , Fatores Socioeconômicos , Comportamento Espacial
18.
J Am Geriatr Soc ; 68(8): 1666-1670, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32557533

RESUMO

During the coronavirus disease 2019 (COVID-19) pandemic, principles from both clinical and public health ethics cue clinicians and healthcare administrators to plan alternatives for frail older adults who prefer to avoid critical care, and for when critical care is not available due to crisis triaging. This article will explore the COVID-19 Ethical Decision Making Framework, published in British Columbia (BC), Canada, to familiarize clinicians and policy makers with how ethical principles can guide systems change, in the service of frail older adults. In BC, the healthcare system has launched resources to support clinicians in proactive advance care planning discussions, and is providing enhanced supportive and palliative care options to residents of long-term care facilities. If the pandemic truly overwhelms the healthcare system, frailty, but not age alone, provides a fair and evidence-based means of triaging patients for critical care and could be included into ventilator allocation frameworks. J Am Geriatr Soc 68:1666-1670, 2020.


Assuntos
Idoso Fragilizado , Geriatria/ética , Serviços de Saúde para Idosos/ética , Pandemias/ética , Saúde Pública/ética , Planejamento Antecipado de Cuidados/ética , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Colúmbia Britânica , Tomada de Decisão Clínica/ética , Infecções por Coronavirus/terapia , Feminino , Fragilidade/terapia , Humanos , Masculino , Cuidados Paliativos/ética , Pneumonia Viral/terapia
20.
Medicine (Baltimore) ; 99(26): e20929, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590805

RESUMO

Retrospective reviewThe degree of spinal cord compression and bony spinal canal stenosis are risk factors for the occurrence of spinal cord injury (SCI) without major fracture or dislocation, but they do not affect the severity of neurological symptoms. However, whether a relatively large spinal cord for the dural sac influences the severity of symptoms in SCI cases is unknown.The purpose of this study was to verify the influence of spinal cord size relative to dural sac on the severity of paralysis in elderly patients with cervical SCI caused by minor trauma.Subjects were 50 elderly patients with SCI caused by falls on flat ground. At 72 hours after injury, neurological assessment was performed using the Japanese Orthopaedic Association (JOA) scoring system. Bony canal anteroposterior diameters (APD) at mid C5 vertebral body were measured with computed tomography. We measured dural sac and spinal cord APD at the injured level and mid C5 with magnetic resonance imaging. Spinal cord compression ratio was calculated by dividing spinal cord at the injured level by spinal cord at mid C5. As the evaluation of spinal cord size relative to the dural sac, spinal cord/dural sac ratio was calculated at the injured level and mid C5. To clarify the factors influencing the severity of paralysis, the relationships between JOA score and those parameters were examined statistically.A significant negative correlation was observed between JOA score and spinal cord/dural sac ratio at mid C5. No clear relationship was observed between JOA score and bony canal APD or spinal cord compression ratio.In elderly patients with SCI caused by minor trauma, a relatively large spinal cord for the dural sac was shown to be a factor that influences the severity of paralysis. This result can be useful for the treatment and prevention of SCI in the elderly.


Assuntos
Vértebras Cervicais/lesões , Paralisia/etiologia , Canal Vertebral/anatomia & histologia , Traumatismos da Medula Espinal/etiologia , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais/anatomia & histologia , Feminino , Geriatria/métodos , Humanos , Japão/epidemiologia , Imagem por Ressonância Magnética/métodos , Masculino , Paralisia/epidemiologia , Índice de Gravidade de Doença , Canal Vertebral/patologia , Medula Espinal/anormalidades , Medula Espinal/fisiologia , Traumatismos da Medula Espinal/classificação , Traumatismos da Medula Espinal/epidemiologia , Tomografia Computadorizada por Raios X/métodos , Ferimentos e Lesões/complicações , Ferimentos e Lesões/epidemiologia
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