Prescription of oral anticoagulation in geriatric patients with atrial fibrillation / Prescripción de anticoagulación oral en el paciente geriátrico con fibrilación auricular.

Objective: To determine the prevalence of prescription of oral anticoagulation in patients aged > 60 years with nonvalvular atrial fibrillation (NVAF). Methods: Observational, cross-sectional, retrospective study based on a review of the clinical ­histories of patients aged >60 years diagnosed with NVAF from July 1 to September 30, 2019 and seen at the outpatient clinic (cardiology, internal medicine, geriatrics) of a secondary-level hospital in Queretaro, Mexico. Clinical profile and oral anticoagulant treatment were analyzed. Results: The study population comprised 300 patients (mean age, 77.2±8.3 years; 53.3% women; 81% attended in cardiology). Of these, 91% had a high thromboembolic risk, 22.7% a high bleeding risk, and 1.7% contraindications for anticoagulation. Comorbidity was frequent. As for therapy, 82.7% were taking direct oral anticoagulants (DOAC), 11.0% vitamin K antagonists (VKA), and 6.3% no anticoagulant treatment. Anticoagulant therapy was inappropriate in 29.3% of patients, mainly because DOAC were prescribed without adjusting for age, weight, or serum creatinine and administered without indication according to thromboembolic risk. Only 39.4% of patients taking VKA were within the therapeutic range. Of all patients receiving DOAC, 48.0% were taking rivaroxaban, mainly at 20 mg/d (73.1%). Conclusions: Thromboembolic risk is high in geriatric patients with NVAF. Anticoagulation is contraindicated in <2% of patients. Oral anticoagulants are prescribed inappropriately in three out of ten patients.

Objetivo: Determinar la prevalencia de prescripción de anticoagulación oral en pacientes > 60 años con fibrilación auricular no valvular (FANV). Métodos: Estudio observacional, transversal, retrospectivo en el que se revisaron los expedientes de pacientes > 60 años que acudieron a la consulta externa de especialidades (cardiología, medicina interna, geriatría) de un hospital de segundo nivel de atención en Querétaro, México, con el diagnóstico de FANV del 1 de julio al 30 de septiembre de 2019. Se analizaron el perfil clínico y el tratamiento anticoagulante. Resultados: Se incluyeron 300 pacientes (edad media: 77.2 ± 8.3 años; 53.3% mujeres; 81.0% atendidos en cardiología). El 91% presentaban un riesgo tromboembólico elevado, el 22.7% un riesgo hemorrágico elevado y el 1.7% contraindicaciones para la anticoagulación. La presencia de comorbilidades fue frecuente. El 82.7% estaban tomando anticoagulantes orales de acción directa (ACOD), el 11.0% antagonistas de la vitamina K (AVK), y el 6.3% no estaban tomando ningún tratamiento anticoagulante. El 29.3% de los pacientes estaban tomando anticoagulantes orales de manera inadecuada, siendo las dos principales causas la prescripción de dosis de ACOD no ajustada a edad, peso y nivel de creatinina y la administración de ACOD sin indicación de acuerdo con el riesgo tromboembólico. De los pacientes que tomaban AVK, solo el 39.4% presentaban una anticoagulación en rango terapéutico. De los tratados con ACOD, el 48.0% tomaban rivaroxabán, principalmente con una dosis de 20 mg/día (73.1%). Conclusiones: El riesgo tromboembólico en pacientes geriátricos con FANV es elevado. En menos del 2% existe una contraindicación para la anticoagulación. En tres de cada diez pacientes se prescriben de manera inadecuada los anticoagulantes orales.

Handgrip strength predicts functional decline at discharge in hospitalized male elderly: a hospital cohort study.

Functional decline after hospitalization is a common adverse outcome in elderly. An easy to use, reproducible and accurate tool to identify those at risk would aid focusing interventions in those at higher risk. Handgrip strength has been shown to predict adverse outcomes in other settings. The aim of this study was to determine if handgrip strength measured upon admission to an acute care facility would predict functional decline (either incident or worsening of preexisting) at discharge among older Mexican, stratified by gender. In addition, cutoff points as a function of specificity would be determined. A cohort study was conducted in two hospitals in Mexico City. The primary endpoint was functional decline on discharge, defined as a 30-point reduction in the Barthel Index score from that of the baseline score. Handgrip strength along with other variables was measured at initial assessment, including: instrumental activities of daily living, cognition, depressive symptoms, delirium, hospitalization length and quality of life. All analyses were stratified by gender. Logistic regression to test independent association between handgrip strength and functional decline was performed, along with estimation of handgrip strength test values (specificity, sensitivity, area under the curve, etc.). A total of 223 patients admitted to an acute care facility between 2007 and 2009 were recruited. A total of 55 patients (24.7%) had functional decline, 23.46% in male and 25.6% in women. Multivariate analysis showed that only males with low handgrip strength had an increased risk of functional decline at discharge (OR 0.88, 95% CI 0.79-0.98, p = 0.01), with a specificity of 91.3% and a cutoff point of 20.65 kg for handgrip strength. Females had not a significant association between handgrip strength and functional decline. Measurement of handgrip strength on admission to acute care facilities may identify male elderly patients at risk of having functional decline, and intervene consequently.

Phytoplankton and periphyton in ponds with Nile tilapia (Oreochromis niloticus) and bocachico (Prochilodus magdalenae) / Fitoplancton y perifiton en estanques con tilapia nilótica (Oreochromis niloticus) y bocachico (Prochilodus magdalenae) / Fitoplâncton e perifiton em viveiros com tilapia nilotica (Oreochromis niloticus) e bocachico (Prochilodus magdalenae)

Background: phytoplankton is considered the most important community in the aquatic food chain. As the basis of the food chain, periphyton offers possibilities for further optimization of extensive aquaculture ponds, although in-depth research on its effects on phytoplankton is necessary. Objective: a test was conducted to assess periphyton effects on phytoplankton concentration (org/L) and Shannon Weaver algae diversity index (DI). Methods: 18 earthen ponds (90 m²) under extensive polyculture conditions and low stocking density (2 kg/m² at the end of the culture) were used. Fish density was 2.6 Nile tilapia/m² and 0.7 bocachico/m2. Treatments consisted in the inclusion or absence of substrate (polyethylene pipes) for periphyton attachment (B1 for substrate presence and B2 for substrate absence) combined with three feeding strategies: no balanced feed offered (A1), 20% crude protein feed (A2), and 25% crude protein feed (A3). The combination of substrate levels and feeding strategies resulted in six treatments. Each treatment was replicated there times using a randomized complete block design for a six-month experimental period. Data were analyzed using a repeated-measure ANOVA in which time appears as a third factor (monthly samplings). Results: an interaction between factor B and time was found (P < 0.05), suggesting that the DI was significantly higher in ponds with substrate (B1) at given times (times 3, 4, 5 and 6). A significant interaction was also found between factors A*B*time (P < 0.05) for the concentration of organisms; resulting in a higher concentration of organisms in treatments that included substrate for periphyton attachment. Conclusion: periphyton had a positive influence on phytoplankton development, which is why stimulating periphyton attachment on an artificial substrate is a good way of improving a pond's primary production.

Antecedentes: se considera que la comunidad fitoplanctónica es la más importante en la cadena alimenticia acuática. El perifiton, como base de la cadena alimenticia, ofrece posibilidades que optimizarían el uso de los insumos utilizados en sistemas extensivos, pero es necesario investigar a fondo sus efectos sobre el fitoplancton. Objetivo: evaluar el efecto del perifiton sobre la concentración (org/L) y el índice de diversidad algal Shannon Weaver (DI) del fitoplancton. Métodos: se realizó un ensayo en 18 estanques en tierra, de 90 m², bajo condiciones de policultivo de baja densidad de siembra (buscando alcanzar máximo 2 Kg/m² al final del cultivo) con 2,6 tilapias y 0,7 bocachicos/m². Los tratamientos consistieron en la inclusión o no de sustrato (tubos de polietileno) para perifiton (B1: presencia de sustrato; B2: ausencia de sustrato), bajo tres estrategias alimentarias: sin alimento balanceado, alimento con 20% proteína bruta (PB) y alimento con 25% de PB, denominadas A1, A2 y A3, respectivamente. La combinación de los tres niveles de A con los dos niveles de B resultó en seis tratamientos, cada uno con tres réplicas. Para la asignación de tratamientos a cada unidad se usó un diseño completamente al azar. Los datos fueron analizados usando un ANOVA con medidas repetidas, donde aparece el tiempo como un tercer factor (muestreos mensuales). Resultados: hubo una significativa interacción entre el factor B y el tiempo (P < 0.05), mostrando que en algunos tiempos específicos (3, 4, 5 y 6), el DI fue significativamente más alto en estanques con sustrato (B1). También se encontró interacción entre los factores A*B*tiempo (P < 0.05) para la concentración de organismos, mostrando una mayor concentración para los tratamientos con sustrato para perifiton. Conclusión: el perifiton tuvo una influencia positiva sobre el desarrollo del fitoplancton. Por esta razón, estimular la fijación de perifiton sobre un sustrato artificial es una buena forma para mejorar la productividad primaria del estanque.

Antecedentes: considera-se que a comunidade fitoplanctônica é a mais importante na cadeia alimentar aquática. O perifíton, como base da cadeia alimentar, oferece possibilidades para melhorar o uso dos insumos correntemente utilizados nos sistemas extensivos, mas precisa se pesquisar bem acerca de seus efeitos sobre o fitoplâncton. Objetivo: avaliar o efeito do perifíton sobre a concentração (org/L) e o índice de diversidade Shannon Weaver (DI) do fitoplâncton. Métodos: realizou-se um teste em 18 viveiros, de 90 m² sob condições de policultivo de baixa densidade de estoque (procurando alcançar no máximo 2 Kg/m² no final da safra) com 2,6 tilápias e 0,7 bocachicos por m² respectivamente. Os tratamentos consistiram na inclusão ou não de substrato (canos de polietileno) para perifíton (B1 presença de substrato, B2 ausência de substrato), sob três estratégias alimentarias: sem alimento balanceado, alimento com 20% de proteína bruta (PB) e alimento com 25% de PB, denominados A1, A2 e A3, respectivamente. A combinação dos três níveis de A, com os dois níveis de B resultou em seis tratamentos, cada um com três replicas. Na designação dos tratamentos para cada unidade experimental usou-se um desenho completamente ao acaso. Os dados foram analisados usando ANOVA com medidas repetidas, onde aparece o tempo como o terceiro fator (amostras mensais). Resultados: houve uma significativa interação entre o fator B e o tempo (P < 0.05), demonstrando que em alguns tempos específicos (3, 4, 5 e 6), o DI foi significativamente maior em viveiros com substrato (B1). Também se encontrou interação entre os fatores A*B*tempo (P < 0.05) para a concentração de organismos, apresentando maior concentração para os tratamentos com substrato para perifíton. Conclusão: o perifíton teve uma influencia positiva sobre o desenvolvimento do fitoplâncton. Por esta razão, estimular a fixação do perifíton sobre um substrato artificial é uma boa maneira para melhorar a produtividade primaria do viveiro.