[Prise en charge de l'iléostomie à haut débit chez les personnes âgées : une revue systématique de cas et de séries de cas]. / High-output ileostomy management in older adults: A systematic review of case reports and case series.

The aim was to perform a systematic review of cases published in the literature to describe the management of high-output ileostomy (HOI) in older adults. A literature search was performed in PubMed©, and Scopus© for all publications up to March 1st, 2023. Case reports and/or case series reporting data from older adults on HOI management were included. Publication year, country, sex, age, aetiology of the stomy, time from ileostomy to HOI, daily volume threshold, Treatment regimen, and effectiveness were extracted. In total, 428 studies were identified, of which 9 (describing 10 cases) were included in this review. The mean age was 69.9 ± 4.7 years. The most frequent aetiology of ileostomy was occlusion. The daily volume considered to be excessive ranged from 1 to 2 litres per 24-hour period. The main side effects of HOI were dehydration, acute renal failure, and weight loss. Loperamide was the most frequently used drug. Most studies reported that non-pharmacological therapies were also used. No death was reported in any of the studies. In all, ileostomy exposes older individuals to complications. Medical therapy with loperamide coupled with rehydration seems to be efficacious in the medium term. Multidisciplinary management is advisable, in order to increase the chances of achieving ostomy reversal as early as possible, when indicated.

Longitudinal follow-up of mixed connective tissue disease and overlapping autoimmune diseases of childhood onset in the Afro-descendant population of the French West Indies.

INTRODUCTION: Overlap autoimmune syndromes (OAS) and mixed connective tissue disease (MCTD) are rare in children. We performed a retrospective, longitudinal and descriptive study of Afro-Caribbean patients from the French West Indies followed for MCTD and OAS to describe their characteristics and outcomes during childhood. METHODS: Retrospective study from January 2000 to 2023. Listings of patients were obtained from multiple sources: computerized hospital archives and national hospital-based surveillance system, registry of pediatricians and adult specialists in internal medicine and the national registry for rare diseases. MCTD was defined according to Kasukawa's criteria. OAS was defined as overlapping features of systemic lupus erythematosus (SLE), systemic sclerosis (SSc), and dermatomyositis/autoimmune myositis (DM/AM). RESULTS: Sixteen patients were included over a 23-year period (10 MCTD and 6 OAS). The incidence was 0.23 per 100,000 children-years. The mean age at diagnosis was 11.9 years old (2.4-17) with median follow up of 7.9 years (2.1-19.6). SLE phenotype was present in the highest, followed by SSc and DM/AM. Patients had an average of three flares during childhood (1-7). A quarter (25%) had symptomatic pulmonary arterial hypertension (PAH). Ninety-four percent received steroids during follow-up and 88% required a corticosteroid-sparing therapy. Three patients (19%) developed SLE after more than 10y of follow-up. There were no death and no chronic organ failure. CONCLUSION: This is the largest pediatric cohort of MCTD and OAS in Afro-descendant patients treated in a country with a high standard of care. The clinical evolution did not differ between MCTD and OAS. The main complication was PAH, more frequent in our cohort.

Description and outcomes of Afro-Caribbean children treated for multisystem inflammatory syndrome in the French West Indies.

Introduction: Several studies have reported a higher frequency and greater morbidity and mortality of multisystem inflammatory syndrome in children (MIS-C) of black African descent. Objectives: We aimed to describe the clinical, laboratory and echocardiographic characteristics as well as outcomes of children with MIS-C requiring admission to a pediatric intensive care unit (PICU) in the French West Indies (FWI), where the majority of the population is Afro-Caribbean. Methods: Ambidirectional observational cohort study between April 1, 2020 and August 31, 2022. Children (age ≤18 years) with MIS-C and organ failure were included. Every patient was monitored and treated following the same protocol, with repeated biological tests, echocardiography, intravenous steroids and polyvalent immunoglobulins. The primary outcomes were clinical, laboratory and echocardiography characteristics. Results: Forty children (median age 7 years, range: 5-11) were included. The majority (77 %) were included prospectively. Thirty-five (87 %) had gastrointestinal symptoms, 30 (75 %) presented initial heart failure (with persisting diastolic dysfunction at day 7) and 18 (45 %) had pericarditis. Sixteen (40 %) were in cardiogenic shock and required inotropic support. Median duration of inotropic support and hospitalization in PICU were respectively 4 and 5 days. The evolution curves of the inflammatory variables matched after treatment. The clinical outcomes were favorable. The Delta variant was associated with the highest incidence of MIS-C. Conclusion: This is the first description of MIS-C course among children of Afro-Caribbean descent. The outcomes were good, without any death or cardiac sequelae. Our work does not support an ethnic susceptibility for severity of MIS-C in Afro-Caribbean population.

Impact of Previous Continuous Positive Airway Pressure Use on Noninvasive Ventilation Adherence and Quality in Obesity Hypoventilation Syndrome: A Pragmatic Single-Center Cross-Sectional Study in Martinique.

There is a strong relationship between obstructive sleep apnea (OSA) and obesity hypoventilation syndrome (OHS). When OHS is combined with severe OSA, treatment consists of continuous positive airway pressure (CPAP), followed by noninvasive ventilation (NIV) in the case of CPAP failure. Currently, the impact of a previous use of CPAP on the quality of NIV is unknown. We conducted a cross-sectional study with OHS patients, to assess the quality of NIV according to previous CPAP use. We included 75 patients with OHS on NIV (65 women, 87%). Among these, 40 patients (53.3%) who had had prior CPAP (CPAP+ group) were compared to the remaining 35 patients (46.7%) (CPAP- group). Key characteristics were comparable between the CPAP+ and the CPAP- groups: age at diagnosis of OHS was 67 ± 3 vs. 66 ± 4 years (p = 0.8), age at inclusion was 73 ± 15 vs. 69 ± 15 years (p = 0.29), number of comorbidities was 3.7 ± 1.2 vs. 3.3 ± 1.5, the Charlson index was 5.1 ± 2 vs. 4.6 ± 1.8, and BMI was 41.6 ± 7.6 kg/m2 vs. 41.2 ± 8.2, respectively, all p > 0.05. Follow-up length was greater in CPAP+ vs. CPAP- patients (5.6 ± 4.2 vs. 2.9 ± 2.9 years, p = 0.001). The quality of NIV based on daily adherence, pressure support, apnea-hypopnea index (AHI) and leaks was similar in both groups. Reduced adherence (less than 4 h daily) was found in 10 CPAP+ patients (25%) versus 7 CPAP- patients (20%), p = 0.80. NIV efficacy was also similar. This study found no difference in the quality of NIV or in adherence between patients who had had prior CPAP and those who had not. Previous CPAP does not appear to improve the quality of NIV.

Juvenile Dermatomyositis in Afro-Caribbean children: a cohort study in the French West Indies.

INTRODUCTION: The epidemiology of Juvenile Dermatomyositis (JDM) in non-Caucasian population is poorly described. We performed a study of patients followed up in the French West Indies for JDM. We aimed to describe clinical and biological specificities during childhood. METHODS: Retrospective study covering the period from Januarys 2000-2023. Listings of patients were obtained from multiple sources, namely computerized hospital archives, registry of referent pediatricians and adult specialists in internal medicine and the French National Registry for rare diseases. JDM and organ involvement were defined according to the international ILAR criteria. RESULTS: Twenty-one patients were included over a 23 year-period. Median age at onset was 8.1 years (Range: 2.5-13.9) with a median follow up of 8 years (Range: 2-19). Two-thirds (14/21) had dysphagia at onset and 33% had respiratory involvement. Thirteen had specific autoantibodies (58%), most frequently anti-Mi-2. The median number of flares during childhood was three (1-9). During childhood, 76% had calcinosis lesions. Clinical evolution seemed to be more aggressive for boys than girls (respectively 4.2 versus 2.2 flares (p = 0.04) and 50% vs 18% needing more than one background therapy, p = 0.03). CONCLUSION: This retrospective study is the largest cohort of pediatric patients of Afro-Caribbean and Black African descent treated for JDM in a high-income health system, and the first to describe the incidence and immunological profile in a population of African descent. They had higher rate of calcinosis and similar respiratory involvement. Overall outcomes during childhood were similar to North America and European countries.

Frequency and Distribution of Broncho-Alveolar Fungi in Lung Diseases in Martinique.

The microbiota refers to all the microorganisms living in and on the human body; its fungal component is known as the mycobiota. The molecular component (mycobiome) has been linked to certain pulmonary diseases. Morphological fungal examination is still common practice and makes it possible to isolate fungi on direct examination or after sample culture. This study aimed to identify fungi via the genus colonising the respiratory tract in our environment and to evaluate the relationship between identified fungi and underlying diseases. We performed a retrospective study of patients who underwent bronchofiberoscopy and mycological analysis of fluid collected by broncho-alveolar lavage at our centre over a period of 5 years. During the study period, 1588 samples from 1547 patients were analysed (50.7% male, mean age 63.7 ± 14.8 years). Among the 1588 samples, 213 (13.4%) were positive on direct examination, and 1282 (80.8%) were positive after culture. The average number of species detected per sample was 1.4 ± 1.1. For patients with positive fungus, the median was two (ranging from one to seven). At least three fungal species were isolated in 14.4% of samples (17.9% of positive cultures), and at least two were isolated in 41.2% of samples (51.1% of positive cultures). Sterile mycelium was observed in 671 samples (42.28%), while Candida was identified in 607 samples (38.25%), and Geotrichum was identified in 271 samples (17.08%). Moulds were more frequently associated with bronchiectasis, while yeasts were associated with infectious pneumonia. Both moulds and yeasts were less frequent in diffuse interstitial lung disease, and yeast was less frequently present in chronic cough. Although overall, sterile mycelium and Candida were most frequently observed regardless of the underlying disease, there was nonetheless significant variability in the fungal genera between diseases. Fungal spores are highly prevalent in respiratory samples in Martinique. The species present in the samples varied according to the underlying respiratory disease.

Thoracic Endometriosis Syndrome (TES) in Martinique, a French West Indies Island.

INTRODUCTION: Endometriosis is a female disease that affects 5-10% of women of childbearing age, with predominantly pelvic manifestations. It is currently declared as a public health priority in France. Thoracic endometriosis syndrome (TES) is the most common extra-pelvic manifestation. OBJECTIVE: The objective of this study was to describe the epidemiological and clinical characteristics, and outcomes of patients with TES in Martinique. PATIENTS AND METHODS: We performed a descriptive, retrospective study including all patients managed at the University Hospital of Martinique for TES between 1 January 2004 and 31 December 2020. RESULTS: During the study period, we identified 479 cases of pneumothorax, of which 212 were women (44%). Sixty-three patients (30% of all female pneumothorax) were catamenial pneumothorax (CP) including 49 pneumothoraxes alone (78% of catamenial pneumothorax) and 14 hemopneumothorax (22% of catamenial pneumothorax). There were 71 cases of TES, including 49 pneumothoraxes (69%), 14 hemopneumothoraxes (20%) and 8 hemothorax (11%). The annual incidence of TES was 1.1 cases/100,000 inhabitants. The prevalence of TES was 1.2/1000 women aged from 15 to 45 years and the annual incidence of TES for this group was 6.9/100,000. The annual incidence of CP was 1 case/100,000 inhabitants. The average age at diagnosis was 36 ± 6 years. Eight patients (11%) had no prior diagnosis of pelvic endometriosis (PE). The mean age at pelvic endometriosis diagnosis was 29 ± 6 years. The mean time from symptom onset to diagnosis was 24 ± 50 weeks, and 53 ± 123 days from diagnosis to surgery. Thirty-two patients (47%) had prior abdominopelvic surgery. Seventeen patients (24%) presented other extra-pelvic localizations. When it came to management, 69/71 patients (97%) underwent surgery. Diaphragmatic nodules or perforations were found in 68/69 patients (98.5%). Histological confirmation was obtained in 55/65 patients who underwent resection (84.6%). Forty-four patients (62%) experienced recurrence. The mean time from the initial treatment to recurrence was 20 ± 33 months. The recurrence rate was 16/19 (84.2%) in patients who received medical therapy only, 11/17 (64.7%) in patients treated by surgery alone, and 17/31 (51.8%) in patients treated with surgery and medical therapy (p = 0.03). CONCLUSIONS: We observed a very high incidence of TES in Martinique. The factors associated with this high incidence in this specific geographical area remain to be elucidated. The frequency of recurrence was lower in patients who received both hormone therapy and surgery.

Short Physical Performance Battery and Study of Osteoporotic Fractures Index in the Exploration of Frailty Among Older People in Cameroon.

Objectives: To investigate the relationship between the Short Physical Performance Battery (SPPB) and the Study of Osteoporotic Fractures (SOF) index. Methods: We present data from a cross-sectional survey conducted in Cameroon. Frailty was defined as an SOF index > 0. The sensitivity and specificity of the SPPB were investigated. Principal component analysis (PCA) was performed to assess the contribution of each subtest of the SPPB to the relationship with the SOF. Results: Among 403 people included (49.6% women), average age of 67.1 (±6.2) years, 35.7% were frail according to the SOF. After determining the best SPPB threshold for diagnosing frailty (threshold = 9, Se = 88.9%, Sp = 74.9%), 47.9% were frail according to the SPPB. The first dimension of PCA explained 55.8% of the variability in the data. Among the subtests of the SPPB, the chair stand test item was the component most associated with the SOF index. Conclusion: Despite the overlap between the SOF and the SPPB, our results suggest that a negative result on the five chair-stands test alone would be sufficient to suspect physical frailty.

Overall survival of patients with thyroid cancer in Martinique (2008-2018).

BACKGROUND: Thyroid cancer (TC) overall survival at 5 years was estimated at 97% in mainland France over 2010-2015. Its prognosis is known to be affected by patient age, tumor histology, size, and extension. This study aims to describe overall survival of thyroid cancer patients diagnosed between 2008 and 2018 in Martinique. METHODS: We included in this retrospective analytical study all patients who were diagnosed with thyroid cancer. An overall survival analysis at 1, 3 and 5 years of thyroid cancer patients diagnosed in Martinique from 2008 to 2018 was conducted. Prognostic factors associated with survival have been identified. Stage at diagnosis and patterns of care among thyroid cancer patients were analyzed. RESULTS: A total of 323 thyroid cancer patients were registered between 2008 and 2018. Papillary carcinomas represented 83% of diagnoses. Local stage or locally advanced invasion was found in 264 (88%) patients. 221 Multidisciplinary Teams reports files were reviewed. The overall survival observed in this population is 97% [93-99] at 1 year, 93% [88-97] at 3 years and 91% [85-95] at 5 years. Anaplastic, poorly differentiated and medullar tumors had lower survival rates at 5 years (39% [13-65]) compared to papillary tumors (93% [89-96]). We found that metastatic stage at diagnosis (HR = 3.1[1.3-7.6]; p = 0.01) and tumor size > 3 cm (HR = 2.7 [1.1-6.3]) were independent prognostic factors for OS in our population. CONCLUSIONS: The survival rates of thyroid cancer in Martinique are comparable to those observed in France.

Tools for assessing social isolation and feelings of loneliness in older adults: a systematic review.

Older adults who are socially isolated or who feel lonely have a higher risk of morbidity and mortality. It is important to be able to assess them with efficient tools. The objective was to describe tools for assessing feelings of loneliness (FoL) and social isolation (SI) in older adults, and to estimate their prevalence. A systematic review was conducted including 18 studies. For FoL, the most frequently used tool was the UCLA Loneliness Scale. For SI, the most frequently used tool was the Lubben Social Network Scale. The median prevalences of FoL and SI were 24.1% and 42.5%, respectively. Both of these constructs will become more prominent in the coming decades; therefore, there is a need to identify the best tools.

Drug storage, polypharmacy and frailty syndrome in older people: an observational study.

Introduction: the increasing prevalence of polypharmacy in the older population could lead to inappropriate storage of medicines at home. Since polypharmacy is associated with frailty, the main objective of the Karukera Study of Aging - Drug Storage (KASADS) study was to investigate the association between drug storage and frailty. If such an association exists, drug storage could be a simple tool for the identification of medication vulnerability by non-medical staff in the elderly. Methods: observational, cross-sectional study in community-dwelling older adults (>65 years old). Drug storage was defined as any drug in excess compared to a medical prescription, any unused and/or expired drug, or any drug without a medical prescription. Frailty was measured with the Study of Osteoporotic Fractures (SOF) scale, and polypharmacy was defined as a prescription of at least 5 drugs. Bivariate and multivariate analyses were performed to study the associations between drugs storage, frailty, and polypharmacy. Results: during the study period (01/10/2019 to 15/03/2020), 115 elderly people were interviewed in their own homes. The average age was 76.0 ± 7.8 years old. Seventy-two percent of the participants met the criteria for polypharmacy and 30.4% were prefrail/frail. They stored an average of 14.7 ± 18.2 boxes. Drug storage was associated with polypharmacy (17.5 boxes versus 10.0; p=0.031) but not with frailty (15.6 versus 14.3; p=0.724). In multivariate analysis, drug storage was associated with not having a school degree (OR: 1.78; 95%CI: 1.13-2.79), suffering from dyslipidemia (OR: 2.00; 95% CI: 1.28-3.17) and suffering from cognitive disorders evaluated by the Mini Mental State Examination (MMSE) score (OR: 1.10; 95%CI: 1.02-1.17). Conclusion: drug storage was not significantly associated with frailty. Nevertheless, it was associated with polypharmacy and other medical outcomes, and could therefore represent a new area for research in geriatrics and pharmacy.

Profiles of Elderly Patients with Obesity Hypoventilation Syndrome in Martinique: A Single-Center Study.

Obesity hypoventilation syndrome (OHS) is a form of chronic respiratory insufficiency related to obesity that affects young and old people. Age appears to be associated with poorer response to treatment by nighttime ventilation. This study aimed to describe the characteristics of elderly subjects (>65 years) with OHS compared to younger patients, with a view to adapting therapy in older individuals. We conducted a retrospective study comparing socio-demographic, clinical, functional characteristics as well as treatment and outcomes between young (<65 years) and older (65 years and older) individuals with OHS at the University Hospital of Martinique. We included 143 patients (114 women), of whom 82 were 65 years or older (57%). Charlson index was higher in the older group. Patients in ≥65 years group were less frequently obese, but more frequently had diabetes mellitus, cardiac arrythmia and arterial hypertension compared to younger patients. There was no difference in the circumstances of diagnosis or arterial blood gas at diagnosis. At follow up, partial pressure of carbon dioxide (pCO2) was higher in ≥65 years group. Despite comparable NIV settings, apart from lower expiratory positive airway pressure (EPAP) with higher apnea-hypopnea index (AHI), patients in the ≥65-year-old group remained more frequently hypercapnic. In conclusion, over half (57%) of patients with OHS in our cohort were aged over 65 years. Older patients developed OHS at lower BMI levels than their younger counterparts, and more frequently, had comorbidities such as diabetes, hypertension and cardiac arrhythmia. Increased Charlson index, lower BMI and female sex were independent factors associated with OHS in the elderly.

Predictors of Nursing Home Entry within 36 Months after Hospitalization via the Emergency Department among Persons Aged 75 Years or Older.

OBJECTIVE: We aimed to identify risk factors for nursing home (NH) entry 36 months after hospitalization via the emergency department (ED) in a population of patients aged 75 years or older. METHODS: This was a prospective multicentre cohort. Patients were recruited from the emergency departments (EDs) of nine hospitals. Subjects had been hospitalised in a medical ward in the same hospital as the ED to which they were initially admitted. Subjects who experienced NH entry prior to ED admission were excluded. NH entry has been defined as the incident admission either into an NH or other long-term care facility within the follow-up period. Variables from a comprehensive geriatric assessment of patients were entered into a Cox model with competing risks to predict NH entry during 3 years of follow-up. RESULTS: Among 1306 patients included in the SAFES cohort, 218 (16.7%) who were already in an NH were excluded. The remaining 1088 patients included in the analysis were aged 84 ± 6 years on average. During 3 years of follow-up, 340 (31.3%) entered an NH. The independent risk factors for NH entry were that they: living alone (Hazard ratio (HR) 2.00, had a 95% confidence interval (CI) 1.59-2.54, p < 0.0001), could not independently perform activities of daily living (HR 1.81, 95% CI 1.24-2.64, p = 0.002), and had balance disorders (HR 1.37, 95% CI 1.09-1.73, p = 0.007), dementia syndrome (HR 1.80, 95% CI 1.42-2.29, p < 0.0001) and a risk of pressure ulcers (HR 1.42, 95% CI 1.10-1.82, p = 0.006). CONCLUSION: The majority of the risk factors for NH entry within 3 years after emergency hospitalization are amenable to intervention strategies. It is therefore reasonable to imagine that targeting these features of frailty could delay or prevent NH entry and improve the quality of life of these individuals before and after NH entry.

Epidemiology, characteristics, treatments, and outcomes of adult-onset Still's disease in Afro-Caribbeans: Results from a population-based study in Martinique, French West Indies.

OBJECTIVES: To describe the epidemiology, characteristics, response to initial treatment, and outcomes of Adult-Onset Still's disease (AOSD) in the Afro-Caribbean population of Martinique with free and easy access to specialised care. METHODS: We conducted a retrospective study from 2004 to 2022 in the island of Martinique, French West-Indies which total population was 354 800 in 2021. Patients were identified from multiple sources including standardised databases. To be included, patients had to be residents of the island and fulfilled Yamaguchi and/or Fautrel's criteria for AOSD, or have a compatible disease course, without a diagnosis of cancer, auto-immune disease or another auto-inflammatory disorder. Date of diagnosis, clinical and biological characteristics, treatments, and outcomes were collected. RESULTS: The prevalence was 7.6/100 000 inhabitants in 2021. The mean incidence was 0.4/100 000 during study period. Thirty-three patients (70.6% females) with a median follow-up of 35 months [7.5 to 119] were included. Twenty-six patients (78.8%) had a systemic pattern. Patients with a systemic monocyclic pattern had significantly more polyarticular involvement than patients with systemic polycyclic pattern (p = 0.016). Pulmonary involvement occurred in 51.5% of patients at diagnosis and systemic Pouchot score has been identified as an independent predictive factor for pulmonary involvement; OR of 3.29 [CI 95% 1.20; 9.01]. At first flare, all patients but one received oral glucocorticoids, 11 patients (32.4%) received intravenous glucocorticoids pulse and 12 patients (33%) received anti-IL1 therapy. Nineteen patients (57%) relapsed in a median time of 9 months [6 to 12] Three patients (9%) developed hemophagocytosis lymphohistiocytosis, fatal in 1 case. All deceased patients (n = 4, 11.76%) belonged to the systemic polycyclic pattern, with an event-free survival of 13.6 months [IQR 5.7; 29.5] CONCLUSION: AOSD in the Afro-Caribbean population of Martinique shares some similarities with other ethnic groups, but exhibit differences, such as a high proportion of lung involvement. Comparative studies are needed to confirm these results.

Trends in Scientific Publications for the French West Indies and the Dominican Republic from 1990 through 2019: Infectious Diseases.

OBJECTIVE: The French West Indies (FWI) and the Dominican Republic (DR) are also, by virtue of their geographical positions, exposed to infectious diseases. The objective of this study was to describe trends in scientific publication for the FWI and the DR using bibliometric analysis, to describe existing international collaborations for each site, and to identify directions for potential collaboration between the 2 sites. METHODOLOGY: Using data (publications from 1990-2019) from the Web of Science and PubMed databases, a bibliometric analysis was performed. Three bibliometric indicators were used: quantitative, performance, and organization-specific. RESULTS: There were 3599 articles published in the indicated span of time, with at least 1 author affiliated with either the FWI (N = 2552) or the DR (N = 1047). Journals ranked in the first quartile, which represent the highest quality journals in each Journal Citation Record category, were the most strongly represented, (38% for the FWI and 50.32% for the DR). In terms of the FWI publications, authors from mainland France were the primary collaborators (1754, 35%); for publications from the DR, the US provided the largest number of collaborators (898; 43%). The infectious disease category predominated, with 2 clusters emerging: arbovirus infections (FWI) and HIV infection (DR). CONCLUSION: This study is one of the first to perform a bibliometric analysis of the 30-year scientific output of the FWI and the DR. Both sites published articles about infectious diseases, indicating that this might be a strong area for future collaborations.

Hypomagnesemia Is Associated with Excessive Daytime Sleepiness, but Not Insomnia, in Older Adults.

The aim of this study was to investigate associations between serum magnesium levels with insomnia and excessive daytime sleepiness (EDS) in older adults. A total of 938 older outpatients were included in the study. Hypomagnesemia was defined as serum magnesium concentration below <1.6 mg/dL. Patients were divided into two groups: hypomagnesemia and normomagnesia (1.6-2.6 mg/dL). The Epworth Sleepiness Scale was implemented and scores of ≥11 points were categorized as EDS. The Insomnia Severity Index was implemented and scores of ≥8 indicated insomnia. The mean age was 81.1 ± 7.6 years. While the presence of EDS, hypertension, diabetes mellitus, and coronary artery disease were more common in the hypomagnesemia group than the normomagnesia group, Parkinson's disease was less common (p < 0.05). Hemoglobin and HDL cholesterol were lower, whereas HbA1c, triglyceride, and number of drugs used were higher in the hypomagnesemia group compared to the normomagnesia group (p < 0.05). In both univariate analysis and multivariate analysis adjusted for gender, age and all confounders, there were significant associations between hypomagnesemia and EDS [odds ratio (OR):1.7; 95% confidence interval (CI): 1.6-2.6, and OR: 1.9; 95%CI: 1.2-3.3, respectively (p < 0.05)]. There was no significant relationship between hypomagnesemia and insomnia (p > 0.05). The present study identified an association between hypomagnesemia and EDS in older adults. Therefore, it may be prudent to consider hypomagnesemia when evaluating older adults with EDS and vice versa.

Comparison of mortality and hospitalizations of older adults living in residential care facilities versus nursing homes or the community. A systematic review.

Residential care facility may provide a transition between living at home and a nursing home for dependent older people or an alternative to nursing homes. The objective of this review was to compare mortality and hospitalizations of older adults living in residential care facilities with those living in nursing homes or in the community. We searched Medline, Scopus and Web of Science from inception to December 2022. Fifteen cohort studies with 6 months to 10 years of follow-up were included. The unadjusted relative risk (RR) of mortality was superior in nursing homes than in residential care facilities in 6 of 7 studies (from 1.3 to 1.68). Conversely, the unadjusted relative risk of hospitalizations was higher in residential care facilities in 6 studies (from 1.3 to 3.37). Studies conducted on persons with dementia found mixed results, the only study adjusted for co-morbidities observing no difference on these two endpoints. Compared with home, unadjusted relative risks were higher in residential care facilities for mortality in 4 studies (from 1.34 à 10.1) and hospitalizations in 3 studies (from 1.12 to 1.62). Conversely, the only study that followed older adults initially living at home over a 10-year period found a reduced risk of heavy hospital use (RR = 0.68) for those who temporarily resided in a residential care facilities. There is insufficient evidence to determine whether residential care facilities might be an alternative to nursing homes for older people with similar clinical characteristics (co-morbidities and dementia). Nevertheless, given the high rate of hospitalizations observed in residential care facilities, the medical needs of residents should be better explored.

Factors Associated with the Efficiency of Home Non-Invasive Ventilation in Patients with Obesity-Hypoventilation Syndrome in Martinique.

Obesity-hypoventilation syndrome (OHS) is a respiratory complication of obesity characterized by chronic hypercapnic respiratory failure. It is often associated with several comorbidities and is treated by positive airway pressure (PAP) therapy. This study aimed to identify factors associated with persistent hypercapnia in patients receiving home non-invasive ventilation (NIV). We performed a retrospective study including patients with documented OHS. In total, 143 patients were included (79.7% women, age 67 ± 15.5 years, body mass index 41.6 ± 8.3 kg/m2). After 4.6 ± 4.0 years of follow-up, 72 patients (50.3%) remained hypercapnic. In bivariable analysis, clinical data showed no difference in follow-up duration, number of comorbidities, comorbidities, or circumstance of discovery. Patients with persistent hypercapnia on NIV were generally older, with lower BMI and more comorbidities. (5.5 ± 1.8 versus 4.4 ± 2.1, p = 0.001), female sex (87.5% versus 71.8%), was treated by NIV (100% versus 90.1%, p < 0.01), had lower FVC (56.7 ± 17.2 versus 63.6 ± 18% of theoretical value, p = 0.04), lower TLC (69.1 ± 15.3 versus 74.5 ± 14.6% of theoretical value, p = 0.07), lower RV (88.4 ± 27.1 versus 102.5 ± 29.4% of theoretical value, p = 0.02), higher pCO2 at diagnosis (59.7 ± 11.7 versus 54.6 ± 10.1 mmHg, p = 0.01) and lower pH (7.38 ± 0.03 versus 7.40 ± 0.04, p = 0.007), higher pressure support (12.6 ± 2.6 versus 11.5 ± 2.4 cmH2O, p = 0.04) and lower EPAP (8.2 ± 1.9 versus 9 ± 2.0 cmH2O, p = 0.06). There was no difference in non-intentional leaks and daily use between patients between both groups. By multivariable analysis, sex, BMI, pCO2 at diagnosis, and TLC were independent risk factors for persistent hypercapnia on home NIV. In individuals with OHS, persistent hypercapnia on home NIV therapy is frequent. Sex, BMI, pCO2 at diagnosis, and TLC were all associated with an increased risk of persistent hypercapnia in persons treated with home NIV.

Early Discharge, Outpatient Evaluation, and Home Management of Acute Respiratory Failure from COVID-19 in Martinique.

A worldwide pandemic of viral infection due to SARS-CoV-2 (and its resultant disease, COVID-19) has been ongoing since 2019. Martinique was affected by a major wave in summer 2021, with saturation of the health system forcing the implementation of home care management. We conducted a retrospective, observational study that included patients treated in the KOVIDHOM 972 program. We included adult patients with SARS-CoV2 hypoxemic pneumonia and requiring 4 L per minute or less of oxygen. In total, 418 were discharged to home with oxygen therapy after hospitalization for SARS-CoV-2 hypoxemic acute pneumonia, and 416 were analyzed. Half (50.2%) were women. Mean age was 58.8 ± 13.0 years. Time from onset of symptoms to hospitalization was 9.1 ± 3.5 days, and average length of stay was 10.5 ± 7.4 days. Maximum oxygen flow during hospitalization was 6.9 ± 4.5 L/min in patients who did not require intensive care. Average oxygen flow at discharge was 1.8 ± 07 L/min. At 30 days after discharge, the readmission rate was 0.5% (95% CI: 0-1.18), and the death rate was 0.5% (95% CI 0-1.18). Our study shows a very low rate of readmission or death in COVID-19 patients discharged to home with oxygen therapy. These results highlight the possibility of safe home care in carefully selected patients. Such programs could be useful in pandemic or wide-scale emergency situations.

The Obesity Paradox and Mortality in Older Adults: A Systematic Review.

"Obesity paradox" describes the counterintuitive finding that aged overweight and obese people with a particular disease may have better outcomes than their normal weight or underweight counterparts. This systematic review was performed to summarize the publications related to the obesity paradox in older adults, to gain an in-depth understanding of this phenomenon. PubMed©, Embase©, and Scopus© were used to perform literature search for all publications up to 20 March 2022. Studies were included if they reported data from older adults on the relation between BMI and mortality. The following article types were excluded from the study: reviews, editorials, correspondence, and case reports and case series. Publication year, study setting, medical condition, study design, sample size, age, and outcome(s) were extracted. This review has been registered with PROSPERO (no. CRD42021289015). Overall, 2226 studies were identified, of which 58 were included in this systematic review. In all, 20 of the 58 studies included in this review did not find any evidence of an obesity paradox. Of these 20 studies, 16 involved patients with no specific medical condition, 1 involved patients with chronic diseases, and 2 involved patients with type 2 diabetes mellitus. Seven out of the nine studies that looked at short-term mortality found evidence of the obesity paradox. Of the 28 studies that examined longer-term mortality, 15 found evidence of the obesity paradox. In the studies that were conducted in people with a particular medical condition (n = 24), the obesity paradox appeared in 18 cases. Our work supports the existence of an obesity paradox, especially when comorbidities or acute medical problems are present. These findings should help guide strategies for nutritional counselling in older populations.