Outcomes after laparoscopic cholecystectomy in patients older than 80 years: two-years follow-up.

BACKGROUND: The laparoscopic cholecystectomy is the treatment of choice for patients with benign biliary disease. It is necessary to evaluate survival after laparoscopic cholecystectomy in patients over 80 years old to determine whether the long-term mortality rate is higher than the reported recurrence rate. If so, this age group could benefit from a more conservative approach, such as antibiotic treatment or cholecystostomy. Therefore, the aim of this study was to evaluate the factors associated with 2 years survival after laparoscopic cholecystectomy in patients over 80 years old. METHODS: We conducted a retrospective observational cohort study. We included all patients over 80 years old who underwent laparoscopic cholecystectomy. Survival analysis was conducted using the Kaplan‒Meier method. Cox regression analysis was implemented to determine potential factors associated with mortality at 24 months. RESULTS: A total of 144 patients were included in the study, of whom 37 (25.69%) died at the two-year follow-up. Survival curves were compared for different ASA groups, showing a higher proportion of survivors at two years among patients classified as ASA 1-2 at 87.50% compared to ASA 3-4 at 63.75% (p = 0.001). An ASA score of 3-4 was identified as a statistically significant factor associated with mortality, indicating a higher risk (HR: 2.71, CI95%:1.20-6.14). CONCLUSIONS: ASA 3-4 patients may benefit from conservative management due to their higher risk of mortality at 2 years and a lower probability of disease recurrence.

Oral health and self-rated health in community-dwelling older adults in Colombia.

BACKGROUND: The relationship between oral health and specific health conditions, such as cardiovascular disease or cognitive impairment, has been extensively studied. However, the effect of oral health status on self-rated health has not been assessed. This could be relevant in older people considering that poor self-rated health status and oral diseases are highly prevalent in this population. The aim of this study was to determine the association between different parameters of oral health and self-rated health status (SRHS) in Colombian community-dwelling older adults. METHODS: This is a secondary analysis of the SABE-Colombia study performed in 2015. The dependent variable was defined as the SRHS status assessed by the question "Compared with other people, your age: Do you consider your health status to be better, equal, or worse?" We considered four independent variables: total edentulism considering the high prevalence in older people, the GOHAI score to assess self-rated oral health, and the use of fixed and removable dental prostheses as potential modifiers of oral health. An adjusted ordinal logistic regression was performed by each independent variable. RESULTS: After the exclusion of missing data, 17,945 persons were included in the final analysis. A total of 10.6% reported worse SRHS, 37.6% reported equal SRHS, and 51.6% reported better SRHS. The worse SRHS group was older and had a higher proportion of dependence, cognitive impairment, and depressive symptoms. The frequency of total edentulism and the lower mean score of GOHAI were significant in the worse SHRS group. An ordinal logistic regression for each independent variable was performed, finding that edentulism increases the probability of worse SHRS, while the GOHAI and use of removable or fixed dental prostheses increase the probability of better SRHS. CONCLUSION: We found an association between total edentulism, GOHAI Index, the use of dental prostheses (both removable and fixed), and self-rated health status, showing the relevance of oral health status to self-rated health status independent of comorbidities and geriatric syndromes. This result supports the inclusion of oral health evaluation in comprehensive geriatric assessment.

Clinical value of Hospital Admission Risk Profile (HARP) and the Identification of Seniors at Risk (ISAR) scales to predict hospital-associated functional decline in an acute geriatric unit in Colombia.

Background: Older adults admitted to a hospital for acute illness are at higher risk of hospital-associated functional decline during stays and after discharge. Objective: This study aimed to assess the calibration and discriminative abilities of the Hospital Admission Risk Profile (HARP) and the Identification of Seniors at Risk (ISAR) scales as predictors of hospital-associated functional decline at discharge in a cohort of patients older than age 65 receiving management in an acute geriatric care unit in Colombia. Methods: This study is an external validation of ISAR and HARP prediction models in a cohort of patients over 65 years managed in an acute geriatric care unit. The study included patients with Barthel index measured at admission and discharge. The evaluation discriminate ability and calibration, two fundamental aspects of the scales. Results: Of 833 patients evaluated, 363 (43.6%) presented hospital-associated functional decline at discharge. The HARP underestimated the risk of hospital-associated functional decline for patients in low- and intermediate-risk categories (relation between observed/expected events (ROE) 1.82 and 1.51, respectively). The HARP overestimated the risk of hospital-associated functional decline for patients in the high-risk category (ROE 0.91). The ISAR underestimated the risk of hospital-associated functional decline for patients in low- and high-risk categories (ROE 1.59 and 1.11). Both scales showed poor discriminative ability, with an area under the curve (AUC) between 0.55 and 0.60. Conclusions: This study found that HARP and ISAR scales have limited discriminative ability to predict HAFD at discharge. The HARP and ISAR scales should be used cautiously in the Colombian population since they underestimate the risk of hospital-associated functional decline and have low discriminative ability.

Antecedentes: los adultos mayores ingresados en un hospital por una enfermedad aguda tienen un mayor riesgo de deterioro functional hospitalario durante su estancia y después del alta. Objetivo: este estudio tuvo como objetivo evaluar las capacidades de calibración y discriminación de las escalas Hospital Admission Risk Profile (HARP) e Identification of Seniors at Risk (ISAR) como predictores de deterioro funcional hospitalario al alta en una cohorte de pacientes mayores de 65 años que recibieron manejo en una unidad geriátrica de agudos en Colombia. Métodos: este estudio es una validación externa de los modelos de predicción ISAR y HARP en una cohorte de pacientes mayores de 65 años atendidos en una unidad geriátrica de agudos. El estudio incluyó pacientes con índice de Barthel medido al ingreso y al alta y la evaluación de la capacidad de discriminación y calibración, dos aspectos fundamentales para esta medición. Resultados: de 833 pacientes evaluados, 363 (43.6%) presentaron deterioro funcional hospitalario al momento del alta. La escala HARP subestimó el riesgo de deterioro funcional hospitalario para los pacientes en las categorías de riesgo bajo e intermedio (relación entre eventos observados /esperados (ROE) 1.82 y 1.51, respectivamente). El HARP sobrestimó el riesgo de deterioro funcional hospitalario para pacientes en la categoría de alto riesgo (ROE 0.91). El ISAR subestimó el riesgo de deterioro hospitalario para pacientes en categorías de bajo y alto riesgo (ROE 1.59 y 1.11). Ambas escalas mostraron una pobre capacidad de discriminación, con un área bajo la curva (AUC) entre 0.55 y 0.60. Conclusiones: este estudio encontró que las escalas HARP e ISAR tienen una capacidad de discriminación limitada para predecir deterioro funcional hospitalario al alta. Las escalas HARP e ISAR deben usarse con cautela en la población colombiana ya que subestiman el riesgo de deterioro funcional hospitalario y tienen baja capacidad de discriminación.

A new non-invasive index for the prediction of endotracheal intubation in patients with SARS COVID-19 infection, in the emergency department, pilot study.

BACKGROUND: In the current context of the SARS COVID-19 pandemic, where the main cause of death is respiratory failure, and since early recognition would allow timely measures to be implemented and probably improve outcomes, it is important to have tools that allow the emergency room to predict quickly and without the use of large resources which will need invasive mechanical ventilation. This study proposes using a new predictive index of noninvasive characteristics, based on the relationship between oxygenation and work of breathing measured by ultrasound-assessed diaphragmatic function, for the need for invasive mechanical ventilation in patients with SARS-COV2 infection who are admitted to the emergency department. METHODS: A prospective predictive cohort study was performed, collecting all patients admitted to the emergency room with respiratory failure (not severe or in imminent respiratory arrest) and a confirmed diagnosis of SARS-CoV-2 pneumonia. Diaphragmatic excursion measurements were taken within the first 24 h after admission to the department. The relationship between diaphragmatic excursion and SAFI was calculated, establishing the ultrasound diaphragmatic excursion So2/FiO2 index (U.D.E.S.I). The index's performance was determined by analysis of sensitivity, specificity, and area under the curve (AUC). RESULTS: This pilot study analyzed the first 100 patients enrolled and found in-hospital mortality of 19%, all patients who died required mechanical ventilation, the right index showed a specificity of 82.4% with a sensitivity of 76.9%, likewise for the left index an overall specificity of 90.5% with a sensitivity of 65.3% was found. The ideal cut-off point for the right index is 1.485, and for the left index, the threshold point was 1.856. AUC of the right index is 0.798 (0.676-0.920) and of the left index 0.793 (0.674-0.911), when comparing them no significant differences were found between these values p = 0.871. CONCLUSION: The relationship of So2/FiO2 and diaphragm excursion measured by both right and left ultrasound could predict the need for mechanical ventilation of the patient with COVID-19 pneumonia in the emergency room and could constitute a valuable tool since it uses noninvasive parameters and is easily applicable at the patient's bedside. However, a more extensive study is needed to validate these preliminary results.

Características de las lesiones retinianas en pacientes con diagnóstico de Toxoplasmosis ocular que acuden a un centro de referencia en oftalmología en Paraguay

Introducción: La toxoplasmosis es una enfermedad parasitaria, en América Latina la prevalencia es relativamente alta, se sabe que la enfermedad no solo es la causa más frecuente de uveítis posterior, sino también la causa principal de la uveítis en sí misma. En Paraguay no se dispone de datos epidemiológicos publicados sobre la misma. Objetivo: Determinar las características de las lesiones retinianas en pacientes con diagnóstico de Toxoplasmosis ocular. Metodología: El presente estudio es observacional, descriptivo, de corte transversal, temporalmente retrospectivo, con muestreo no probabilístico de casos consecutivos. Se enfocó en pacientes con diagnóstico de Toxoplasmosis que acudieron al servicio de Oftalmología del Hospital de Clínicas, durante el periodo de junio de 2020 a febrero 2022. Resultados: Se observó un 54,3 % de mujeres, una media de 30,62 +/- 12,96 años y un 62,8 % de procedencia urbana. El 88,3 % de los casos fueron unilaterales, la mitad de episodios primarios, el 93,6 % casos agudos, y el 97,9 % tuvo un mecanismo de trasmisión adquirido. La mayoría se presentó como Panuveítis, las localizaciones más frecuentes de las lesiones retinocoroideas fueron el Polo posterior (extramacular) y la periferia. El principal abordaje terapéutico fue el tratamiento con Trimetoprim Sulfametoxazol y corticoides sistémicos, la duración del tratamiento fue de 6,51 +/- 1,52 semanas, y las principales complicaciones fueron la Vitritis residual y la Hipertensión ocular. Discusión: La toxoplasmosis ocular es una causa importante de morbilidad visual. Se hace fundamental la prevención de la infección por este parásito mediante medidas higiénico-sanitarias, así como el diagnóstico y tratamiento precoz de los pacientes infectados, de tal manera a disminuir las complicaciones asociadas a esta patología.

Introduction: Toxoplasmosis is a parasitic disease, in Latin America the prevalence is relatively high, it is known that the disease is not only the most frequent cause of posterior uveitis, but also the main cause of uveitis itself. In Paraguay there are no published epidemiological data on it. Objective: To determine the characteristics of retinal lesions in patients diagnosed with ocular Toxoplasmosis. Methods: This study is observational, descriptive, cross-sectional, temporally retrospective, with non-probabilistic sampling of consecutive cases. It focused on patients diagnosed with Toxoplasmosis who attended the Ophthalmology service of the Hospital de Clínicas, during the period from June 2020 to February 2022. Results: 54.3% of women were observed, an average of 30.62 +/ - 12.96 years old and 62.8% of urban origin. 88.3% of the cases were unilateral, half were primary episodes, 93.6% acute cases, and 97.9% had an acquired transmission mechanism. Most presented as panuveitis, the most frequent locations of retinochoroidal lesions were the posterior pole (extramacular) and the periphery. The main therapeutic approach was treatment with trimethoprim sulfamethoxazole and systemic corticosteroids, the duration of treatment was 6.51 +/- 1.52 weeks, and the main complications were residual vitritis and ocular hypertension. Discussion: Ocular toxoplasmosis is an important cause of visual morbidity. It is essential to prevent infection by this parasite through hygienic-sanitary measures, as well as early diagnosis and treatment of infected patients, in order to reduce the complications associated with this pathology.

Comparación de Latanoprostene bunod 0,024 % y Latanoprost 0,005 % en glaucoma de ángulo abierto e hipertensión ocular

Introducción: El glaucoma es la principal causa de ceguera irreversible en el mundo. La prevalencia mundial de glaucoma en personas de 40 a 80 años se estima en un 3,5 %. Objetivo: Comparar el efecto reductor de la PIO de Latanoprostene bunod (LBN) al 0,024% con Latanoprost al 0,005 % en sujetos con glaucoma de ángulo abierto (GAA) o hipertensión ocular (HTO). Metodología: Ensayo observacional de estudio de cohorte prospectivo. Resultados: Fue realizado en 28 pacientes (56 ojos) quienes fueron aleatorizados en 2 grupos paralelos (28 ojos por grupo), el grupo Latanoprost y el grupo LBN. En el grupo LBN la media de la PIO antes del tratamiento fue de 25,3 ± 6,6 mmHg y la media de la PIO luego de 1 mes de tratamiento fue de 16,5 ± 4,9 mmHg (p<0,05). En el grupo Latanoprost la media de la PIO antes del tratamiento fue de 23,6 ± 3,6 mmHg y la media de la PIO luego de 1 mes de tratamiento con Latanoprost al 0,005% fue de 15,3 ± 2,4 mmHg (p<0,05). Sin embargo, al comparar las PIOs luego de 1 mes de tratamiento con LBN 0,024% y Latanoprost 0,005% se objetiva que la diferencia en reducción de la presión intraocular entre estos dos fármacos no fue significativa (p= 0,238). Discusión: Las prostaglandinas tópicas, con su potente efecto hipotensor ocular son una importante opción de tratamiento para el glaucoma. La reducción de la PIO es la esperada con ambos medicamentos, sin embargo, no existen diferencias significativas entre ambas luego de 1 mes de uso. Con respecto a los efectos secundarios, en el grupo LBN se encontró más efectos adversos oculares.

Introduction: Glaucoma is the main cause of irreversible blindness worldwide. The global prevalence of glaucoma in people aged 40 to 80 years is estimated at 3.5%. Objective: To compare the intraocular pressure (IOP) lowering effect of 0.024% Latanoprostene bunod (LBN) with 0.005% Latanoprost in subjects with open-angle glaucoma (OAG) or ocular hypertension (OHT). Methods: Observational trial of prospective cohort study. Results: It was performed in 28 patients (56 eyes) who were randomized into 2 parallel groups (28 eyes per group), the Latanoprost group and the Latanoprostene bunod (LBN) group. In the LBN group, the mean intraocular pressure before treatment was 25.3 ± 6.6 mmHg and the mean intraocular pressure after 1 month of treatment was 16.5 ± 4.9 mmHg (p<0,05). In the Latanoprost group, the mean intraocular pressure before treatment was 23.6 ± 3.6 mmHg and the mean intraocular pressure after 1 month of treatment with 0.005% Latanoprost was 15.3 ± 2.4 mmHg (p<0,05). However, when comparing the IOPs to the 1-month treatment with Latanoprostene bunod 0.024% and Latanoprost 0.005%, it is observed, through ANOVA, that the difference in intraocular pressure reduction between these two drugs is not significant (p= 0,238). Discussion: Topical prostaglandins, with their potent ocular hypotensive effect (resulting from increased uveoscleral outflow), are an important treatment option for glaucoma. The IOP reduction is as expected with both drugs, however, there are no significant differences between the two. In the LBN group, more drug-related ocular adverse effects were found after 1 month of use.

Clinical value of Hospital Admission Risk Profile (HARP) and the Identification of Seniors at Risk (ISAR) scales to predict hospital-associated functional decline in an acute geriatric unit in Colombia

Background: Older adults admitted to a hospital for acute illness are at higher risk of hospital-associated functional decline during stays and after discharge. Objective: This study aimed to assess the calibration and discriminative abilities of the Hospital Admission Risk Profile (HARP) and the Identification of Seniors at Risk (ISAR) scales as predictors of hospital-associated functional decline at discharge in a cohort of patients older than age 65 receiving management in an acute geriatric care unit in Colombia. Methods: This study is an external validation of ISAR and HARP prediction models in a cohort of patients over 65 years managed in an acute geriatric care unit. The study included patients with Barthel index measured at admission and discharge. The evaluation discriminate ability and calibration, two fundamental aspects of the scales. Results: Of 833 patients evaluated, 363 (43.6%) presented hospital-associated functional decline at discharge. The HARP underestimated the risk of hospital-associated functional decline for patients in low- and intermediate-risk categories (relation between observed/expected events (ROE) 1.82 and 1.51, respectively). The HARP overestimated the risk of hospital-associated functional decline for patients in the high-risk category (ROE 0.91). The ISAR underestimated the risk of hospital-associated functional decline for patients in low- and high-risk categories (ROE 1.59 and 1.11). Both scales showed poor discriminative ability, with an area under the curve (AUC) between 0.55 and 0.60. Conclusions: This study found that HARP and ISAR scales have limited discriminative ability to predict HAFD at discharge. The HARP and ISAR scales should be used cautiously in the Colombian population since they underestimate the risk of hospital-associated functional decline and have low discriminative ability.

Antecedentes: los adultos mayores ingresados en un hospital por una enfermedad aguda tienen un mayor riesgo de deterioro functional hospitalario durante su estancia y después del alta. Objetivo: este estudio tuvo como objetivo evaluar las capacidades de calibración y discriminación de las escalas Hospital Admission Risk Profile (HARP) e Identification of Seniors at Risk (ISAR) como predictores de deterioro funcional hospitalario al alta en una cohorte de pacientes mayores de 65 años que recibieron manejo en una unidad geriátrica de agudos en Colombia. Métodos: este estudio es una validación externa de los modelos de predicción ISAR y HARP en una cohorte de pacientes mayores de 65 años atendidos en una unidad geriátrica de agudos. El estudio incluyó pacientes con índice de Barthel medido al ingreso y al alta y la evaluación de la capacidad de discriminación y calibración, dos aspectos fundamentales para esta medición. Resultados: de 833 pacientes evaluados, 363 (43.6%) presentaron deterioro funcional hospitalario al momento del alta. La escala HARP subestimó el riesgo de deterioro funcional hospitalario para los pacientes en las categorías de riesgo bajo e intermedio (relación entre eventos observados /esperados (ROE) 1.82 y 1.51, respectivamente). El HARP sobrestimó el riesgo de deterioro funcional hospitalario para pacientes en la categoría de alto riesgo (ROE 0.91). El ISAR subestimó el riesgo de deterioro hospitalario para pacientes en categorías de bajo y alto riesgo (ROE 1.59 y 1.11). Ambas escalas mostraron una pobre capacidad de discriminación, con un área bajo la curva (AUC) entre 0.55 y 0.60. Conclusiones: este estudio encontró que las escalas HARP e ISAR tienen una capacidad de discriminación limitada para predecir deterioro funcional hospitalario al alta. Las escalas HARP e ISAR deben usarse con cautela en la población colombiana ya que subestiman el riesgo de deterioro funcional hospitalario y tienen baja capacidad de discriminación.

Protocol of the MOVI-ageing randomized controlled trial: a home-based e-Health intervention of cognitively demanding exercise for the improvement of cardiorespiratory fitness and cognitive function in older individuals.

Objective: To describe the protocol of the MOVI-ageing randomized controlled trial, a home-based eHealth intervention of cognitive-demanding exercise for older adults, in improving global cognitive function and basic cognitive functions, cardiorespiratory fitness, and muscle fitness. Methods: This randomized controlled trial will include participants identified in the social centers of Cuenca and Talavera de la Reina who agree to participate and provide informed consent. Adults aged 60-80 years of both genders retired regardless of the reason for retirement, who do not meet frailty criteria according to Fried criteria, and without cognitive impairment will be invited to participate. This study will be developed in two phases: (i) a 12-week randomized efficacy/feasibility trial and (ii) a large-scale implementation randomized trial phase with a 12-week follow-up following similar procedures. In addition, a qualitative study on barriers to and facilitators of the implementation of the physical exercise intervention using eHealth for older people will be conducted. Participants will have access to a platform including videos of cognitively demanding physical exercise. The participants will be remotely and off-line guided through the physical exercise intervention, and the research team will be able to check the degree of compliance with the program and its correct execution. The participants will receive feedback on their compliance with the routines and reinforcement messages. Implications: The implementations of the findings and their inclusion in guidelines may directly impact in older people's life, and relatives, through the prevention of morbidity and the reduction of years lost to disability. These benefits may be reflected in the reduction of economic expenditure by reducing the demand for social and health care services. Ethics: The Clinical Research Ethics Committee of the 'Virgen de la Luz' Hospital in Cuenca approved the study protocol (registration number: 2022/PI3222). In addition, this protocol was previously registered in Clinicaltrials.gov (Number: NCT05928078).

Nutrition-Focused Care for Community-Living Adults: Healthcare Utilization and Economic Benefits.

OBJECTIVES: We assessed the impact of a recently reported nutritional quality improvement program (QIP) on healthcare resource utilization and costs for older, community-living adults in Bogotá, Colombia. METHODS: The study included 618 community-dwelling, older adults (> 60 years) who were at risk or malnourished and receiving outpatient clinical care. The intervention was a QIP that emphasized nutritional screening, dietary education, lifestyle counseling, 60-day consumption of oral nutritional supplements, and 90-day follow-up. For economic modeling, we performed 90-day budget impact and cost-effectiveness analyses from a Colombian third-party payer perspective. The base-case analysis quantified mean healthcare resource use in the QIP study population. Analysis was based on mean input values (deterministic) and distributions of input parameters (probabilistic). As the deterministic analysis provided a simple point estimate, the cost-effectiveness analysis focused on the probabilistic results informed by 1000 iterations of a Monte-Carlo simulation. RESULTS: Results showed that the total use of healthcare resources over 90 days was significantly reduced by > 40% (hospitalizations were reduced by approximately 80%, emergency department visits by > 60%, and outpatient clinical visits by nearly 40%; P < .001). Based on economic modeling, total cost savings of $129 740 or per-patient cost savings of $210 over 90 days could be attributed to the use of nutritional QIP strategies. Total cost savings equated to nearly twice the initial investment for QIP intervention; that is, the per-dollar return on investment was $1.82. CONCLUSIONS: For older adults living in the community in Colombia, the use of our nutritional QIP improved health outcomes while lowering costs of healthcare and was thus cost-effective.

Effect of multicomponent exercise in cognitive impairment: a systematic review and meta-analysis.

BACKGROUND: Multicomponent physical exercise is the most recommended type of physical intervention in older adults. Experimental data suggest the relevance of the muscle-brain axis and the relationship between muscle contraction and release of brain-derived neurotrophic factor, however, the impact of this relationship on cognition remains unclear, especially in people with diagnosis of cognitive impairment. This study assesses the effect of multicomponent physical exercise on global cognition in people with mild cognitive impairment or dementia. METHODS: Randomized controlled trials published until January 2021 were searched across three electronic databases (PubMed, Scopus, and Cochrane Database). Data about exercises included in the multicomponent intervention (endurance, strength, balance, or flexibility), the inclusion of aerobic exercise, and the change in global cognition were extracted. The effect size was represented as a standardized mean difference. Risk of bias was assessed by the RoB2 tool. RESULTS: A total of 8 studies were included. The overall effect size suggested an effect of multicomponent exercise on global cognition. However, the subgroup analysis showed an effect only when aerobic exercise was included in the intervention. No effect when mild cognitive impairment and dementia were assessed separately was found. CONCLUSION: This study suggests that multicomponent physical exercise could have an effect on global cognition in people with mild cognitive impairment or dementia only when aerobic exercise is included in the intervention. Our results support the inclusion of structured physical exercise programs in the management of people with cognitive impairment.

A nutritionally focused program for community-living older adults resulted in improved health and well-being.

OBJECTIVES: Among older adults, malnutrition is common and is associated with increased risk for impaired health and functionality, conditions further associated with poorer quality of life. In this study of community-living older adults, our objective was to quantify outcome changes following identification and treatment of malnutrition or its risk. DESIGN: Our intervention was a nutritional quality improvement program (QIP). The nutritional QIP included: (i) education of participants about the importance of complete and balanced macro- and micronutrient intake plus physical exercise, (ii) nutritional intervention with dietary counseling; and (iii) provision of oral nutritional supplements (ONS) for daily intake over 60 days. Follow-up measurements took place 30 days after ONS treatment ended, i.e., 90 days after start of intervention. SETTING AND PARTICIPANTS: We recruited 618 transitional-care, chronically ill, older adults (>60 years) with malnutrition/risk (per Mini Nutrition Assessment-Short Form, MNA-SF) from the outpatient clinic of Hospital Universitario San Ignacio, in Bogotá, Colombia. METHODS: For pre-post comparisons, we examined cognition (Mini-Mental State Exam, MMSE), physical abilities (Barthel Activities of Daily Living, ADL; Short Physical Performance Battery, SPPB), affective disorder status (Global Depression Scale, GDS), and quality of life (QoL; EuroQoL-5D-3L, EQ-5D-3L; EuroQoL-Visual Analog Scale, EQ-VAS). RESULTS: Participants were mean age 74.1 ± 8.7 y, female majority (69.4%), and had an average of 2.6 comorbidities with cardiovascular and respiratory diseases predominant (28.5%). QIP-based nutritional intervention led to significant improvements in cognitive (MMSE) and physical functions (ADL and SPPB), affective disorder status (GDS), and health-related quality of life (EQ-VAS); all differences (P < 0.001). Self-reported QoL (EQ-5D-3L) also improved. CONCLUSIONS AND IMPLICATIONS: Over 90 days, the nutritional QIP led to improvements in all measured outcomes, thus highlighting the importance of addressing malnutrition or its risk among community-living older adults. From a patient's perspective, maintaining mental and physical function are important and further linked with quality of life. BRIEF SUMMARY: For older, community-living adults, nutrition care can improve health and well-being outcomes. Care includes screening for malnutrition risk, dietary and exercise counseling, and daily nutritional supplements when needed. GOV IDENTIFIER: NCT04042987.

Use of a nutrition-focused quality improvement program for community-living older adults at malnutrition risk is associated with better nutritional outcomes.

BACKGROUND & AIMS: Among older adults, malnutrition or its risk is common and is associated with increased morbidity and mortality plus increased need for healthcare utilization. We aimed to identify and treat malnutrition risk among older adults who received care at an outpatient clinic after a recent hospitalization and/or for management of a chronic disease. METHODS: From the outpatient clinic of Hospital Universitario San Ignacio, Bogotá, Colombia, we recruited older adults (>60 years) with malnutrition or its risk according to the Mini Nutritional Assessment-Short Form (MNA-SF). Patients were excluded if they had dementia or were not expected to live 90 days or more. Intervention was a nutrition-focused quality improvement program (QIP) including: i) education of patients and caregivers about the health importance of complete and balanced macro- and micronutrient intake plus physical exercise; and ii) nutritional intervention with dietary counseling and provision of oral nutritional supplements (ONS) for daily intake. To assess the effect of our intervention, we collected nutritional outcome data pre- and post-participation of patients in the nutrition-focused QIP. For pre-post comparisons, we used MNA-SF scores and calf circumference (a proxy for leg muscle mass) measures along with nutrition-related anthropometric determinations of body weight and body mass index (BMI). The ONS treatment phase was 60 days, with follow-up measurements up to 30 days after ONS treatment ended (90 days after intervention start). RESULTS: Of 677 enrolled patients, 618 completed the QIP, while 565 had complete anthropometric data. Patients had a mean age of 74.1 ± 8.7 years, an average of 2.6 comorbidities, included a high proportion of females (69.4%), with medium socioeconomic status (76%). After QIP intervention, 324 (52.4%) patients had improvement in nutritional outcomes; improvement was significant in all four measures (P-values < 0.001). Higher ONS adherence was associated with the highest improvement in nutritional status. CONCLUSIONS: For community-living older adults receiving outpatient care, comprehensive nutritional care offered via a nutrition-focused QIP was associated with significant improvements in indicators of nutritional status (MNA-SF scores and calf circumference) and maintenance or improvements in nutrition-related anthropometric measures (body weight and BMI). GOV IDENTIFIER: NCT04042987.

Preclinical Studies and Drug Combination of Low-Cost Molecules for Chagas Disease.

Chagas disease is caused by the protozoan Trypanosoma cruzi (T. cruzi). It remains the major parasitic disease in Latin America and is spreading worldwide, affecting over 10 million people. Hundreds of new compounds with trypanosomicidal action have been identified from different sources such as synthetic or natural molecules, but they have been deficient in several stages of drug development (toxicology, scaling-up, and pharmacokinetics). Previously, we described a series of compounds with simple structures, low cost, and environmentally friendly production with potent trypanosomicidal activity in vitro and in vivo. These molecules are from three different families: thiazolidenehydrazines, diarylideneketones, and steroids. From this collection, we explored their capacity to inhibit the triosephosphate isomerase and cruzipain of T. cruzi. Then, the mechanism of action was explored using NMR metabolomics and computational molecular dynamics. Moreover, the mechanism of death was studied by flow cytometry. Consequently, five compounds, 314, 793, 1018, 1019, and 1260, were pre-clinically studied and their pharmacologic profiles indicated low unspecific toxicity. Interestingly, synergetic effects of diarylideneketones 793 plus 1018 and 793 plus 1019 were evidenced in vitro and in vivo. In vivo, the combination of compounds 793 plus 1018 induced a reduction of more than 90% of the peak of parasitemia in the acute murine model of Chagas disease.

Solid Oxide Cell Electrode Nanocomposites Fabricated by Inkjet Printing Infiltration of Ceria Scaffolds.

The enhancement of solid oxide cell (SOC) oxygen electrode performance through the generation of nanocomposite electrodes via infiltration using wet-chemistry processes has been widely studied in recent years. An efficient oxygen electrode consists of a porous backbone and an active catalyst, which should provide ionic conductivity, high catalytic activity and electronic conductivity. Inkjet printing is a versatile additive manufacturing technique, which can be used for reliable and homogeneous functionalization of SOC electrodes via infiltration for either small- or large-area devices. In this study, we implemented the utilization of an inkjet printer for the automatic functionalization of different gadolinium-doped ceria scaffolds, via infiltration with ethanol:water-based La1-xSrxCo1-yFeyO3-δ (LSCF) ink. Scaffolds based on commercial and mesoporous Gd-doped ceria (CGO) powders were used to demonstrate the versatility of inkjet printing as an infiltration technique. Using yttrium-stabilized zirconia (YSZ) commercial electrolytes, symmetrical LSCF/LSCF-CGO/YSZ/LSCF-CGO/LSCF cells were fabricated via infiltration and characterized by SEM-EDX, XRD and EIS. Microstructural analysis demonstrated the feasibility and reproducibility of the process. Electrochemical characterization lead to an ASR value of ≈1.2 Ω cm2 at 750 °C, in the case of nanosized rare earth-doped ceria scaffolds, with the electrode contributing ≈0.18 Ω cm2. These results demonstrate the feasibility of inkjet printing as an infiltration technique for SOC fabrication.

In-hospital complications in an acute care geriatric unit / [Complicaciones intrahospitalarias en una unidad geriátrica de agudos].

Introduction: In-hospital complications frequently occur in hospitalized people over 65 worsening their clinical outcomes. There are, however, few studies on the factors associated with in-hospital complications in elderly patient care. Objective: To evaluate factors associated with in-hospital complications in a geriatric acute care unit in Bogotá, Colombia. Materials and methods: We conducted an analytical, observational, retrospective study in a cohort of 1,657 patients over 65 years of age who received care in the geriatric unit of a high complexity hospital in Bogotá, Colombia. The dependent variable was in-hospital complications and the independent variables, the degree of functional dependence on admission, dementia, nutritional status, social support, comorbidity, and polypharmacy. We used Poisson's linear regression model to identify associated variables. Results: The bivariate analysis showed that functional dependence (PR=2.092, p≤0.001) and malnutrition (PR=2.850, p≤0.001) were associated with a higher rate of hospital-acquired infection. In the multivariate analysis, functional dependence (PR=1.931, p=0.003) and malnutrition (PR=2.502, p=0.002) remained independent factors for in-hospital complications. Conclusion: In acute care centers, integral assessment at admission to identify functional dependence and malnutrition predicts in-hospital complications.

Introducción. Las complicaciones hospitalarias ocurren con gran frecuencia en personas mayores de 65 años hospitalizadas y conllevan peores resultados clínicos. Son pocos los estudios sobre los factores asociados con las complicaciones hospitalarias en la atención de adultos mayores. Objetivo. Evaluar los factores asociados con las complicaciones hospitalarias en una unidad geriátrica de agudos en Bogotá, Colombia. Materiales y métodos. Se hizo un estudio observacional analítico basado en una cohorte retrospectiva que incluyó 1.657 pacientes mayores de 65 años atendidos en una unidad de hospitalización en Bogotá, Colombia. La variable dependiente fueron las complicaciones hospitalarias y, las independientes, la dependencia funcional, la demencia, el estado nutricional, el soporte social, las comorbilidades y la polifarmacia. Se utilizó el modelo de regresión lineal de Poisson para determinar las variables asociadas. Resultados. En el análisis bivariado se encontró que la dependencia funcional (razón de prevalencia, RP=2,092; p≤0,001) y la malnutrición (RP=2,850; p≤0,001) eran factores asociados con una mayor tasa de complicaciones hospitalarias. En el análisis multivariado aparecían como factores independientes (dependencia funcional: RP=1,931 y p=0,003; malnutrición: RP=2,502 y p=0,002). Conclusión. El hacer una evaluación integral que permita determinar la dependencia funcional y la malnutrición en el momento de ingreso en las unidades de hospitalización, permitiría predecir complicaciones hospitalarias.

Complicaciones hospitalarias en una unidad geriátrica de agudos / In-hospital complications in an acute care geriatric unit

Resumen | Introducción. Las complicaciones hospitalarias ocurren con gran frecuencia en personas mayores de 65 años hospitalizadas y conllevan peores resultados clínicos. Son pocos los estudios sobre los factores asociados con las complicaciones hospitalarias en la atención de adultos mayores. Objetivo. Evaluar los factores asociados con las complicaciones hospitalarias en una unidad geriátrica de agudos en Bogotá, Colombia. Materiales y métodos. Se hizo un estudio observacional analítico basado en una cohorte retrospectiva que incluyó 1.657 pacientes mayores de 65 años atendidos en una unidad de hospitalización en Bogotá, Colombia. La variable dependiente fueron las complicaciones hospitalarias y, las independientes, la dependencia funcional, la demencia, el estado nutricional, el soporte social, las comorbilidades y la polifarmacia. Se utilizó el modelo de regresión lineal de Poisson para determinar las variables asociadas. Resultados. En el análisis bivariado se encontró que la dependencia funcional (razón de prevalencia, RP=2,092; p≤0,001) y la malnutrición (RP=2,850; p≤0,001) eran factores asociados con una mayor tasa de complicaciones hospitalarias. En el análisis multivariado aparecían como factores independientes (dependencia funcional: RP=1,931 y p=0,003; malnutrición: RP=2,502 y p=0,002). Conclusión. El hacer una evaluación integral que permita determinar la dependencia funcional y la malnutrición en el momento de ingreso en las unidades de hospitalización, permitiría predecir complicaciones hospitalarias.

Abstract | Introduction: In-hospital complications frequently occur in hospitalized people over 65 worsening their clinical outcomes. There are, however, few studies on the factors associated with in-hospital complications in elderly patient care. Objective: To evaluate factors associated with in-hospital complications in a geriatric acute care unit in Bogotá, Colombia. Materials and methods: We conducted an analytical, observational, retrospective study in a cohort of 1,657 patients over 65 years of age who received care in the geriatric unit of a high complexity hospital in Bogotá, Colombia. The dependent variable was in-hospital complications and the independent variables, the degree of functional dependence on admission, dementia, nutritional status, social support, comorbidity, and polypharmacy. We used Poisson's linear regression model to identify associated variables. Results: The bivariate analysis showed that functional dependence (PR=2.092, p≤0.001) and malnutrition (PR=2.850, p≤0.001) were associated with a higher rate of hospital-acquired infection. In the multivariate analysis, functional dependence (PR=1.931, p=0.003) and malnutrition (PR=2.502, p=0.002) remained independent factors for in-hospital complications. Conclusion: In acute care centers, integral assessment at admission to identify functional dependence and malnutrition predicts in-hospital complications.

Body mass index, performance on activities of daily living and cognition: analysis in two different populations.

BACKGROUND: With this study, we aim to determine the associations of the different categories of the body mass index (BMI) with activities of daily living (ADL) and cognitive performance in two different populations living in the community; Colombian and South Korean older adults. METHODS: We performed a cross-sectional analysis of two surveys separately; The Survey on Health, Well-Being, and Aging in Colombia (SABE) (n = 23,343) and the Korean Longitudinal Study of aging (KLoSA) (n = 4556). Participants older than 50 years were selected from rural and urban areas achieving a representative sample. Here we investigated the association between BMI categories with function using zero-inflated negative binomial regressions, and with cognition using logistic regression models. RESULTS: After adjustment, in Colombia, underweight was associated with an impaired score on the Mini-mental State Examination (MMSE) and worse performance in the instrumental activities of daily living (IADL). Also, being overweight was associated with a better score on the MMSE and the IADL. For both outcomes education level significantly influenced the predictions. In South Korea, there were no significant associations for cognition, IADL, or basic activities of daily living (BADL). CONCLUSIONS: In the Colombian population, underweight, was associated with reduced cognitive performance and daily functioning. Additionally, being overweight but not obese was associated with better cognition and daily functioning. In South Korea, there were no significant associations between BMI and cognition, IADL, or BADL.

Association of Malnutrition with Functional and Cognitive Trajectories in People Living with Dementia: A Five-Year Follow-Up Study.

BACKGROUND: In dementia, functional status depends on multiple factors in addition to cognition. Nutritional status is a potentially modifiable factor related to homeostasis and proper functioning of body systems and may contribute to cognitive and functional decline. OBJECTIVE: This paper aims to analyze the association of malnutrition with the course of cognitive and functional decline in people living with dementia. METHODS: This is an analysis of a longitudinal cohort study, the Dementia Study of Western Norway. Data of 202 patients diagnosed with mild dementia were analyzed; Alzheimer's disease (AD) (n = 103), Lewy body dementia (LBD) (n = 74), and other dementias (OD) (n = 25). Cognition was assessed with the Mini-Mental State Examination and functional decline through the activities of daily living included in the Rapid Disability Rating Scale. The Global Leadership Initiative on Malnutrition Index was used to determine nutritional status. Associations of nutritional status with cognitive and functional decline were evaluated through adjusted linear mixed models. RESULTS: At baseline, the prevalence of general malnutrition was 28.7%; 17.3% were classified as moderate malnutrition and 11.38% as severe malnutrition (there were no significant differences between AD and LBD). Malnutrition at diagnosis and over follow-up was a significant predictor of functional-decline, but not of cognitive decline. CONCLUSION: According to our results malnutrition was associated with faster functional loss but, not cognitive decline in older adults with dementia. A more comprehensive dementia approach including nutritional assessments could improve prognosis.

Delirium prevalence in a Colombian hospital, association with geriatric syndromes and complications during hospitalization.

BACKGROUND: The aim of this paper is to describe the prevalence of Delirium and the factors associated with its presentation and complications identified in a geriatric unit in Colombia. MATERIAL AND METHODS: This is a retrospective observational study that included all patients admitted consecutively for two years in a geriatric unit of a hospital in Bogotá, Colombia. We assessed delirium prevalence with the Confusion Assessment Method (CAM). The independent variables were age, sex, functional impairment (Barthel<90), malnutrition (MNA<12), pressure ulcers at admission, state of the social support network, number of comorbidities, polypharmacy (5 or more drugs), complications such as ICU requirement, hospital stay, in-hospital functional impairment and mortality were also evaluated. As an exclusion criterion: not having CAM registered in the medical record, all the patients had this information. RESULTS: We studied 1599 subjects with a mean age of 86 years (IQR 9). Delirium prevalence was 51.03%. Delirium was associated with a higher rate of: pressure ulcers on admission [OR 3.76 (CI 2.60-5.43 p<0.001)], functional impairment [OR 2.38 (CI 1.79-3.16 p<0.001)], malnutrition [OR 2.06 (CI 1.56-2.73 p<0.001)], and infection [OR 1.46 (CI 1.17-1.82 p<0.001)]. Moreover delirium has a higher association with mortality [OR 2.80 (1.03-7.54 p=0.042)], in-hospital functional decline [OR 1.82 (1.41-2.36 p<0.001)], and longer hospital stay [OR 1.04 (1.04-1.09 p=0.006)]; independently of age, sex, pressure ulcers on admission, functional impairment, malnutrition, dementia, infection and limited social network. CONCLUSION: Our study suggests that infectious diseases and geriatric syndromes such as, functional dependence, pressure ulcers, malnutrition or major cognitive impairment are independently associated with the presence of delirium on admission. Additionally, the presence of delirium is independently associated during hospitalization with complications, longer hospital stay, functional impairment and mortality.