Sarcopenia as a Little-Recognized Comorbidity of Type II Diabetes Mellitus: A Review of the Diagnosis and Treatment.

BACKGROUND: Type II diabetes mellitus (T2DM) is one of the most widespread metabolic diseases worldwide, with a significant impact on morbi-mortality. Sarcopenia has a high risk in this population (two times more risk) and a high impact at the functional level, especially in older adults. In addition, it poses enormous challenges in the diagnosis, prevention, and treatment of this disease concomitantly. The objective is to review the current knowledge on the state of muscle mass and the pathogenesis, diagnosis, and treatment of sarcopenia in people with T2DM. METHODS: A bibliographic search was conducted in the PubMed-Medline databases for articles from 2015 with previously defined terms. RESULTS: A loss of muscle mass in older diabetic patients who are malnourished or at risk of malnutrition has a proven negative impact on their autonomy and is closely related to the risk of sarcopenia as a high-impact disease, and also with frailty, as an associated multidimensional syndrome. Notably, we found that malnutrition and protein deficiency are often underdiagnosed in obese and overweight T2DM patients. Biochemical markers could help in the future with approaches to managing T2DM and sarcopenia concomitantly. The four essential elements which form the basis of care for patients with diabetes and sarcopenia are pharmacological treatment, nutrition management, regular physical exercise, and correct daily regime. CONCLUSIONS: The increasing prevalence of sarcopenia among older patients with T2DM has significant negative impacts on quality of life and is a public health concern. Effective diagnosis and management require a multidisciplinary approach involving pharmacological treatment, nutrition, exercise, and correct daily regime, with future research needed to understand the underlying mechanisms and improve diagnostic and treatment strategies.

[Results of a home rehabilitation program after hospitalization in patients with hip fracture]. / Resultados de un programa de rehabilitación domiciliaria tras hospitalización en pacientes con fractura de cadera.

INTRODUCTION: Hip fracture is one of the most frequent disabling injuries, presenting serious complications during the acute and subacute phase. Rehabilitation at home, after hospital discharge, allows rapid functional recovery. The objective of this study is to evaluate the possible usefulness of a home rehabilitation program in patients with hip fracture integrated in a Hospital at Home Unit. METHODS: Retrospective study that consecutively included patients accepted for home rehabilitation treatment between September 9, 2019 and December 31, 2021 in the Hospital at Home Unit of the Hospital Universitario de la Ribera, Alzira, Valencia. Demographic, clinical, functional and quality of care variables were collected. RESULTS: Two hundred twenty-four subjects were included. The mean age was 84.6 (SD 7.7) years, with 66% women and 34% men, with 32% of patients diagnosed with dementia in one of its degrees of severity. The mean hospital stay was 8.4 (SD 4.1) days and 6.5 (5.3) days in the Hospital at Home Unit rehabilitation program. 90% of the patients included in the program reached the therapeutic goal outlined during hospital admission. CONCLUSIONS: The home rehabilitation of patients with hip fracture contributes to a functional recovery of the patient in a shorter time. Further studies are necessary to confirm the results obtained.

Resultados de un programa de rehabilitación domiciliaria tras hospitalización en pacientes con fractura de cadera / Results of a home rehabilitation program after hospitalization in patients with hip fracture

Introducción: La fractura de cadera es una de las lesiones incapacitantes más frecuentes, presentando complicaciones graves durante la fase aguda y subaguda. La rehabilitación en el domicilio, tras el alta hospitalaria, permite una rápida recuperación funcional. El objetivo de este estudio es evaluar la posible utilidad de un programa domiciliario de rehabilitación en pacientes con fractura de cadera integrado en la una unidad de hospitalización a domicilio. Métodos: Estudio retrospectivo que incluyó consecutivamente a los pacientes aceptados para tratamiento rehabilitador domiciliario entre el 9 de septiembre del 2019 y el 31 de diciembre del 2021en la Unidad de hospitalización a domicilio del Hospital Universitario de la Ribera, Alzira, Valencia. Se recogieron variables demográficas, clínicas, funcionales y de calidad asistencial. Resultados: Se incluyeron 224 sujetos. La edad media fue de 84,6 (DT 7,7) años, con un 66% de mujeres, estando un 32% de pacientes diagnosticados de demencia en alguno de sus grados de severidad. La estancia media en el hospital fue de 8,4 (DT 4,1) días y de 6,5 (5,3) días en el programa rehabilitador de la unidad de hospitalización a domicilio. El 90% de los pacientes incluidos en el programa alcanzaron el objetivo terapéutico trazado durante el ingreso hospitalario. Conclusiones: La rehabilitación domiciliaria de pacientes con fractura de cadera contribuye a una recuperación funcional del paciente en un menor tiempo. Son necesarios más estudios para confirmar los resultados obtenidos. (AU)

Introduction: Hip fracture is one of the most frequent disabling injuries, presenting serious complications during the acute and subacute phase. Rehabilitation at home, after hospital discharge, allows rapid functional recovery. The objective of this study is to evaluate the possible usefulness of a home rehabilitation program in patients with hip fracture integrated in a Hospital at Home Unit. Methods: Retrospective study that consecutively included patients accepted for home rehabilitation treatment between September 9, 2019 and December 31, 2021 in the Hospital at Home Unit of the Hospital Universitario de la Ribera, Alzira, Valencia. Demographic, clinical, functional and quality of care variables were collected. Results: Two hundred twenty-four subjects were included. The mean age was 84.6 (SD 7.7) years, with 66% women and 34% men, with 32% of patients diagnosed with dementia in one of its degrees of severity. The mean hospital stay was 8.4 (SD 4.1) days and 6.5 (5.3) days in the Hospital at Home Unit rehabilitation program. 90% of the patients included in the program reached the therapeutic goal outlined during hospital admission. Conclusions: The home rehabilitation of patients with hip fracture contributes to a functional recovery of the patient in a shorter time. Further studies are necessary to confirm the results obtained. (AU)

Colitis por citomegalovirus en paciente anciano inmunocompetente / Cytomegalovirus colitis in an immunocompetent elderly patient

La afectación del tracto gastrointestinal por citomegalovirus es una entidad que se suele dar en pacientes inmunocomprometidos, no obstante es más raro verlo en pacientes inmunocompetentes. La edad media recogida en una serie de casos es de 68 años y los síntomas acompañantes son diarrea (76%), dolor abdominal (52%) y hematoquecia o melena (27%). A continuación describimos el caso de un paciente de 85 años sin ningún estado inmunocomprometido que se identificase que desarrolló una colitis por CMV

Gastrointestinal tract involvement due to cytomegalovirus infection is a condition that usually occurs in immunocompromised patients, but is uncommon in immunocompetent patients. In a review of 33 cases, the median age was 68 years, and the accompanying symptoms were diarrhoea (76%), abdominal pain (52%), and haematochezia, or melena (27%). The case is presented of ctyomegalovirus colitis in an 85 year-old man with no previously identified immunocompromised states

Síndrome de Guillain-Barré tipo AMAN en paciente octogenario / Variant AMAN of the Guillain-Barré syndrome in an octogenarian patient

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Síndrome de Ekbom: reporte de un caso en un paciente anciano / Ekbom's syndrome: case report of an older patient

El síndrome de Ekbom, también conocido como delirio de parasitosis, consiste en la creencia de estar infestado por insectos u organismos vivientes que recorren el cuerpo de quien lo padece sin que haya evidencia de ello. Las quejas suelen estar centradas en esta idea de parasitación, no obstante también se puede acompañar de ansiedad o depresión. Este trastorno puede ser sin patología médica asociada (primario) o con patología orgánica asociada (secundario). Se presenta el caso de un varón de 81 años que presenta un cuadro compatible con este síndrome, así como la respuesta al tratamiento con antipsicóticos y antidepresivos

Ekbom's syndrome, also known as delusional parasitosis, consists of the belief of being infested with insects or living organisms which crawl through the body when there is no evidence of such infestation. Complaints are usually focused on this idea of parasitization; however it can also be accompanied by anxiety or depression. This condition can be primary (with no associated disorders) or secondary (with associated organic diseases). We present the case of an 81 year-old man with this syndrome, and his response to treatment with antipsychotics and antidepressants

[Cytomegalovirus colitis in an immunocompetent elderly patient]. / Colitis por citomegalovirus en paciente anciano inmunocompetente.

Gastrointestinal tract involvement due to cytomegalovirus infection is a condition that usually occurs in immunocompromised patients, but is uncommon in immunocompetent patients. In a review of 33 cases, the median age was 68 years, and the accompanying symptoms were diarrhoea (76%), abdominal pain (52%), and haematochezia, or melena (27%). The case is presented of ctyomegalovirus colitis in an 85 year-old man with no previously identified immunocompromised states.

Síndrome de leucoencefalopatía posterior reversible en un paciente con enfermedad de Parkinson y sintomatología inicial psiquiátrica: una presentación clínica compleja / Posterior reversible leukoencephalopathy syndrome in a patient with Parkinson’s disease and initial psychiatric symptoms: a complex clinical presentation

Introducción. La relevancia del fármaco inmunosupresor tacrolimús en la prevención del rechazo y la enfermedad de injerto contra huésped en pacientes trasplantados es indiscutible. Sin embargo, con frecuencia, el tacrolimús presenta efectos neurotóxicos, incluyendo cuadros graves, como el síndrome de leucoencefalopatía posterior reversible. Caso clínico. Varón de 75 años, con antecedentes de trasplante renal hace cinco años, en tratamiento con tacrolimús y micofenolato, y de enfermedad de Parkinson avanzada, en tratamiento con varios agonistas dopaminérgicos. Acudió a urgencias por un cuadro de una semana de evolución consistente en alucinaciones visuales, delirios, ánimo expansivo, confusión y cefalea. La exploración psicogeriátrica por focos mostró como primera opción diagnóstica una psicosis secundaria a agonistas dopaminérgicos, sin excluir otras causas yatrógenas a pesar de encontrarse el tacrolimús en el rango terapéutico (8,3 ng/mL). Se realizaron una tomografía computarizada craneal, que no mostró hallazgos significativos, y una resonancia magnética, en la que se visualizó un edema parietooccipital bilateral, hallazgo compatible con un síndrome de leucoencefalopatía posterior reversible. Durante el ingreso se sustituyó el tacrolimús por everolimús y se ajustó la medicación dopaminérgica, con lo que se produjo de forma rápida una remisión completa del cuadro. Conclusiones. El diagnóstico de síndrome de leucoencefalopatía posterior reversible debe considerarse en los pacientes con antecedentes de trasplante de órgano en tratamiento con fármacos inmunosupresores que presentan un cuadro de instauración aguda con síntomas neurológicos o psiquiátricos

Introduction. The relevance of the immunosuppressive drug tacrolimus in the prevention of rejection and graft-versushost disease in transplanted patients is beyond all doubt. However, tacrolimus often has neurotoxic effects, including severe conditions such as posterior reversible leukoencephalopathy syndrome. Case report. A 75-year-old male who had undergone a kidney transplantation five years earlier, for which he was receiving treatment with tacrolimus and mycophenolate. He also had advanced Parkinson’s disease, treated with several dopamine agonists. The patient visited the emergency department after a week-long history of visual hallucinations, delirium, expansive mood, confusion and headache. The focal psychogeriatric examination revealed psychosis secondary to dopaminergic agonists as the first diagnostic option, without excluding other possible iatrogenic causes despite the tacrolimus being within the therapeutic range (8.3 ng/mL). Both cranial computed tomography, which did not show any significant findings, and a magnetic resonance scan, in which a bilateral parietooccipital oedema was observed, were performed, this latter finding being compatible with posterior reversible leukoencephalopathy syndrome. While the patient was in hospital, tacrolimus was replaced by everolimus, and the dopaminergic medication was adjusted, resulting in a swift and full remission of the clinical signs and symptoms. Conclusions. The diagnosis of posterior reversible leukoencephalopathy syndrome should be considered in patients with a history of organ transplantation treated with immunosuppressive drugs who have an acute onset condition with neurological or psychiatric symptoms

Catatonía de origen multifactorial: a propósito de un caso / Catatonia of multifactorial origin: A case report

La catatonia es un síndrome neuropsiquiátrico conformado por síntomas en la esfera psicomotora, conductual, cognitiva, afectiva y disautonómica. Frecuentemente, pasa desapercibido o es confundido con otros trastornos, lo que conduce a su infradiagnóstico. A pesar de su etiología múltiple y de la frecuente superposición de causas en un mismo paciente, de manera errónea se suele asumir un origen psiquiátrico. Se presenta el caso de un varón de 54 años con antecedentes de trastorno bipolar tipo 1 con alta sospecha de catatonía, en el que se identificaron múltiples condiciones médicas subyacentes además de una descompensación afectiva. El tratamiento precoz sintomático con altas dosis de lorazepam y la corrección de las múltiples causas médicas resultó clave para la resolución completa del cuadro en una semana

Catatonia is a neuropsychiatric syndrome consisting of symptoms in the psychomotor, behavioral, cognitive, affective and disautonomic area. It often goes unnoticed or is confused with other disorders, which leads to its underdiagnosis. Despite its multiple etiology and the frequent overlapping of causes in the same patient, a psychiatric origin is usually assumed in the wrong way. We present the case of a 54-year-old male with a history of bipolar disorder type 1 with a probable catatonia, in which multiple underlying medical conditions were identified in addition to an affective decompensation. Early symptomatic treatment with high doses of lorazepam and the correction of the multiple medical causes was the key to the complete resolution of the condition in a week

Rendimiento pronóstico de mortalidad a corto plazo del fragmento N-terminal del propéptido natriurético cerebral en ancianos con infección en el servicio de urgencias / Usefulness of the N-terminal pro brain natriuretic peptide as short-term prognostic factor for mortality in the elderly patients with infection seen in emergency departments

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Mortalidad y neumonía adquirida en la comunidad en el paciente anciano / Mortality in elderly patients with community-acquired pneumonia

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