Mortality predictors in a cohort of patients with COVID-19 admitted to a large tertiary hospital in the city of São Paulo, Brazil: a retrospective study.

BACKGROUND: There is discrepant information across countries regarding the natural history of patients admitted to hospitals with coronavirus disease (COVID-19), in addition to a lack of data on the scenario in Brazil. OBJECTIVE: To determine the mortality predictors in COVID-19 patients admitted to a tertiary hospital in São Paulo, Brazil. DESIGN AND SETTING: A retrospective analysis of medical records of COVID-19 patients admitted to the Hospital Central da Irmandade da Santa Casa de Misericórdia of São Paulo. METHODS: Overall, 316 patients with laboratory-confirmed COVID-19 between March 1, 2020, and July 31, 2020, were included. The analysis included the baseline characteristics, clinical progression, and outcomes. RESULTS: The mortality rate of the sample was 51.27%. Age ≥ 60 years was determined as a risk factor after multivariate logistic regression analysis. Patients with an oxygen (O2) saturation ≤ 94% upon admission accounted for 87% of the deaths (P < 0.001). Vasoactive drugs were used in 92% (P < 0.001) of patients who progressed to death, and mechanical ventilation was employed in 88% (P < 0.001) of such patients. However, patients who received corticosteroids concomitantly with mechanical ventilation had a better prognosis than those who did not. The progressive degree of pulmonary involvement observed on chest computed tomography was correlated with a worse prognosis. The presence of thrombocytopenia has been considered as a risk factor for mortality. CONCLUSION: The main predictors of in-hospital mortality after logistic regression analysis were age, O2 saturation ≤ 94% upon admission, use of vasoactive drugs, and presence of thrombocytopenia.

Potentially inappropriate medication use in hospitalized elderly patients.

OBJECTIVE: This study aimed to assess the prevalence of potentially inappropriate medication prescription in hospitalized elderly patients according to the 2019 American Geriatrics Society Beers Criteria. METHODS: This study is a prospective analysis of electronic medical records of elderly patients admitted to the Department of Medicine, Hospital Central da Irmandade da Santa Casa de Misericórdia de São Paulo, between 1 September 2020 and 30 April 2021. RESULTS: A total of 142 patients (85 women and 57 men) with a mean age of 74.5±7.3 years (65-99 years) were assessed. Of these, 108 (76.1%) were elderly (age ≥65 years and <80 years) and 34 (23.9%) long-lived (age ≥80 years). The average length of stay found in the sample was 25.3±28.7 days (between 2 and 235 days), and 102 out of the 140 patients assessed remained in the hospital for up to 29 days. Sixteen drugs considered potentially inappropriate medication were found in the patients' prescriptions, with at least one potentially inappropriate medication having been prescribed to 141 (99.3%) patients. Elderly patients had a mean of 2.57±0.94 potentially inappropriate medication prescribed versus 2.56±0.89 among long-lived patients. The most prescribed potentially inappropriate medication were as follows: regular human insulin as required (85.2%), and omeprazole (73.9%) and metoclopramide as required (61.3%). CONCLUSION: The study sample showed significant percentages of potentially inappropriate medication prescriptions for the elderly admitted to the hospital.

[Drugs and feeding tubes]. / Medicamentos e sondas de nutrição.

OBJECTIVE: Define the prevalence of drugs that are not compatible with this way of administration for inpatients in long term care facilities (LTCF), and their use in feeding tubes. METHODS: Analysis of prescriptions for LTCF inpatient who are using feeding tubes for more than 48 hours. The active ingredients, presentation and possibility of pulverizing drugs prescribed were compared to data in literature regarding the feasibility of enteral administration of drugs. RESULTS: Feeding tubes were observed in 57 patients (11.2% of the total of inpatients), mean age of 65.6 +/- 16.0 years, 32 women and 25 men. Mean number of drugs administered enterally: 5.6 +/- 2.2. Medication items in prescriptions: 316 divided into 64 drugs, with 129 items (40.8% of the total), and 23 drugs (35.4%) inappropriate for such administration. Inappropriate medications most often prescribed were: captopril, phenytoin, ranitidine, omeprazole, and B complex. Alternative presentations were found for 15 (65.2%) of the 23 drugs that were not appropriate for enteral administration CONCLUSION: Feeding tubes as a way of drug administration for LTCF have a significant risk of including prescriptions which are not compatible.

Beers AGS 2019 criteria in very old hospitalized patients.

OBJECTIVE To define the rates and types of potentially inappropriate medications (PIMs) for older adults according to the Beers AGS 2019 criteria in oldest-old patients (aged ≥80 years) hospitalized in an Internal Medicine ward. METHODS A retrospective analysis of prescriptions from medical records of oldest-old patients hospitalized in an Internal Medicine Teaching-Hospital ward using the Beers AGS 2019 criteria was performed. Data was also collected for gender, mean age, days of hospitalization, presence of feeding tube, delirium, and polypharmacy (≥5 drugs/day). The drugs listed in Table 2 of the Beers criteria were considered PIMs. RESULTS The series comprised 39 very old patients (22 men, 17 women), with a mean age of 86.3±4.7 years and hospitalization of 22.8±21.3 days. All patients were admitted via the Emergency Room. Feeding tube placement and polypharmacy occurred in 84.6% of cases and delirium in 71.8%. The prescription of a total of 16 drugs considered PIM was detected by the Beers AGS 2019 criteria (mean 1.8 ± 1.0 PIM per patient). Main prescribed PIMs were Metoclopramide "if necessary" [IN] (41.0% of cases), Omeprazole (38.5%), Regular Insulin [IN] (23.1%), Haloperidol [IN] (18.0%), Quetiapine and Amiodarone (10% each). CONCLUSION In the present series of oldest-old hospitalized patients, significant rates of PIM were found, especially for drugs prescribed as "If Necessary", thereby increasing the risk of side-effects to that of the common polypharmacy in this age group.

[Study on accidental hypothermia in institutionalized elderly]. / Estudo da hipotermia acidental em idosos institucionalizados.

OBJECTIVE: To analyze the prevalence, causes and outcome of hypothermia in institutionalized elderly. METHODS: Prospective study held from January to December, 2004 at the Hospital Geriátrico e de Convalescentes Dom Pedro II (Geriatric and Convalescent Hospital Dom Pedro II), with 483 long-term care beds. Hypothermia was diagnosed by esophageal thermometer in all patients with axillary temperature below or equal to 35 degrees C or 95 degrees F. Clinical examination and tests were used to obtain etiologic diagnosis and detect complications. Tests included: ECG, chest X-Ray, blood count, blood gas analysis, glycemia, biochemical blood tests, amylase, kidney and liver functions, urinalysis and serology for HIV, syphilis and hepatitis B. Rewarming was adopted, among other actions in the treatment protocol. RESULTS: Thirty nine cases of hypothermia were confirmed, 31 in elderly (60 years old or over), 10 men and 21 women with an average age of 76.9 years. Eighty three percent of these patients had a high degree of dependence (Katz index between 'F' and 'G'). Seventy percent of these cases had mild hypothermia (32-35 degrees C [89.6-95 degrees F]), 25.0% had moderate hypothermia (28-31.9 degrees C [82.4-89.6 degrees F]) and 5.0% had severe hypothermia (<28 degrees C [<82.4 degrees F]). Seventy three percent of these patients died (50.0% during hypothermia and 50.0% after reversal). Infections were the etiology in all cases (Pneumonia [80.0%], urinary tract infection [60.0%] and pressure ulcer [17.1%]). CONCLUSION: Hypothermia in institutionalized elderly is a serious clinical diagnosis with a high level of mortality. Prevention, early diagnosis and measures of central rewarming have collaborated for a better prognosis.

[Beer-Fick criteria and generic drugs in Brazil]. / Critérios de Beers-Fick e medicamentos genéricos no Brasil.

BACKGROUND: Determine, according to the Beer-Fick criteria, the prevalence of drugs potentially inappropriate for the elderly available as generic medication in Brazil. METHODS: Analysis of the list of generic medications issued by " Diário Oficial da União" on July/12/2004 and of the page of the National Agency for Sanitary Surveillance (ANVISA) - www.anvisa.gov.br, using the Beers-Fick criteria. RESULTS: From the list of 299 products 20 (6.7% of the total) included in the Beers-Fick criteria were analyzed, mainly in the categories of anxiolytics, platelet antiaggregants, antiallergics, anti-angina and vasodilators, antiarrythmics, antidepressants, antispasmodics, anti-hypertensive's, non steroid antinflammatories, antiulceratives and cardiac glycosides. These criteria do not include drugs such as cough suppressants, cinnarizine, diltiazem, piracetam, quinolones, xanthines, creams, ointments and ophthalmic solutions which are also present in the list of generic medication. CONCLUSION: The Beers-Fick criteria may prevent use of drugs potentially inappropriate for the elderly, however, it should be stressed that these criteria are not complete for Brazilian generic medications.

Mortality predictors in a cohort of patients with COVID-19 admitted to a large tertiary hospital in the city of São Paulo, Brazil: a retrospective study

Abstract BACKGROUND: There is discrepant information across countries regarding the natural history of patients admitted to hospitals with coronavirus disease (COVID-19), in addition to a lack of data on the scenario in Brazil. OBJECTIVE: To determine the mortality predictors in COVID-19 patients admitted to a tertiary hospital in São Paulo, Brazil. DESIGN AND SETTING: A retrospective analysis of medical records of COVID-19 patients admitted to the Hospital Central da Irmandade da Santa Casa de Misericórdia of São Paulo. METHODS: Overall, 316 patients with laboratory-confirmed COVID-19 between March 1, 2020, and July 31, 2020, were included. The analysis included the baseline characteristics, clinical progression, and outcomes. RESULTS: The mortality rate of the sample was 51.27%. Age ≥ 60 years was determined as a risk factor after multivariate logistic regression analysis. Patients with an oxygen (O2) saturation ≤ 94% upon admission accounted for 87% of the deaths (P < 0.001). Vasoactive drugs were used in 92% (P < 0.001) of patients who progressed to death, and mechanical ventilation was employed in 88% (P < 0.001) of such patients. However, patients who received corticosteroids concomitantly with mechanical ventilation had a better prognosis than those who did not. The progressive degree of pulmonary involvement observed on chest computed tomography was correlated with a worse prognosis. The presence of thrombocytopenia has been considered as a risk factor for mortality. CONCLUSION: The main predictors of in-hospital mortality after logistic regression analysis were age, O2 saturation ≤ 94% upon admission, use of vasoactive drugs, and presence of thrombocytopenia.

Anemia in elderly residents of a long-term care institution.

BACKGROUND: The Brazilian elderly population is growing exponentially, making prevention and treatment of chronic diseases a priority in this age group. Anemia in older adults is underdiagnosed, undervalued and associated with high morbimortality. OBJECTIVE: To assess the prevalence of anemia in the elderly residents of a long-term care institution and to correlate this with individual patient history, the use of polypharmacy and mortality. METHOD: A retrospective study was carried out of data extracted from medical records of patients treated in 2014 at the Hospital Geriátrico e de Convalescentes Dom Pedro II under the Preventive Actions Program. RESULTS: Data were collected from 88 female (48%) and 95 male (52%) elderly residents at a long-term care institution. Patient ages ranged from 60 to 102 years with a mean age of 76.3 years. Overall, 76 participants were diagnosed with anemia, representing 41% of the sample. Of those diagnosed, 35 were women (46%) and 41 were men (54%). CONCLUSION: Anemia in the elderly is a clinical condition associated with increased morbimortality. However, the disorder remains underdiagnosed, resulting in higher risks for older adults. The present study found 76 patients with anemia among the 183 residents at the long-term care institution. The patient profile of this population with anemia is non-smokers, male, aged between 70 and 79 years, with normochromic/normocytic anemia and taking multiple medications.

Carcinomatous encephalitis as clinical presentation of occult lung adenocarcinoma: case report.

Carcinomatous encephalitis is a rare entity, originally described by Madow and Alpers in 1951, which is characterized by tumoral spreading perivascular, without mass effect. Clinical manifestations such as hemiparesis, seizures, ataxia, speech difficulties, cerebrospinal fluid findings as well as computed tomography are nonspecific. This leads the physician to pursue more frequent diseases that could explain those manifestations--toxic, metabolic, and/or infectious encephalopathy. A magnetic resonance imaging (MRI) with gadolinium, the method of choice, presumes the diagnosis. Previous reports of this unusual form of metastatic disease have described patients with prior diagnosis of pulmonary adenocarcinoma. We present the case of carcinomatous encephalitis in a 76-year-old woman as the primary manifestation of occult pulmonary adenocarcinoma with its clinical, imaging, and anatomopathological findings.

Potentially inappropriate medication use in hospitalized elderly patients

SUMMARY OBJECTIVE: This study aimed to assess the prevalence of potentially inappropriate medication prescription in hospitalized elderly patients according to the 2019 American Geriatrics Society Beers Criteria. METHODS: This study is a prospective analysis of electronic medical records of elderly patients admitted to the Department of Medicine, Hospital Central da Irmandade da Santa Casa de Misericórdia de São Paulo, between 1 September 2020 and 30 April 2021. RESULTS: A total of 142 patients (85 women and 57 men) with a mean age of 74.5±7.3 years (65-99 years) were assessed. Of these, 108 (76.1%) were elderly (age ≥65 years and <80 years) and 34 (23.9%) long-lived (age ≥80 years). The average length of stay found in the sample was 25.3±28.7 days (between 2 and 235 days), and 102 out of the 140 patients assessed remained in the hospital for up to 29 days. Sixteen drugs considered potentially inappropriate medication were found in the patients' prescriptions, with at least one potentially inappropriate medication having been prescribed to 141 (99.3%) patients. Elderly patients had a mean of 2.57±0.94 potentially inappropriate medication prescribed versus 2.56±0.89 among long-lived patients. The most prescribed potentially inappropriate medication were as follows: regular human insulin as required (85.2%), and omeprazole (73.9%) and metoclopramide as required (61.3%). CONCLUSION: The study sample showed significant percentages of potentially inappropriate medication prescriptions for the elderly admitted to the hospital.

Compulsory notification at skilled nursing facilities.

INTRODUCTION:: Notifiable diseases (NDs) encompass conditions of high clinical severity and/or contagious. Being closed communities, long-term care facilities (LTCF) are places that deserve attention on their own, but one might be left wondering: what is the reality of NDs at Brazilian LTCFs? OBJECTIVE:: To determine the prevalence and type of NDs at large LTCF. METHOD:: Active search for NDs conducted by the Hospital Infection Control Committee (HICC) in 459 beds. Due to the low turnover of patients, the monthly list kept by the HICC on NDs was analyzed. Data were grouped into males and females, and into elderly (age ≥ 60 years) and non-elderly (age ≤ 59 years). RESULTS:: 31 diseases in 29 patients (6.9% of all inpatients - 19 males and 10 females): 23 cases of hepatitis C, five of hepatitis B, two of human immunodeficiency virus (HIV), and one case of renal tuberculosis. One patient with hepatitis B and another HIV-positive also had hepatitis C. There was no statistical significance in the comparison of the two groups with the total number of other institutionalized patients - by age and gender - for total number of NDs and cases of hepatitis C (p>0.05). CONCLUSION:: Chronic NDs and those requiring chronic treatment observed in this study suggest that Brazil needs more studies to define the dynamics of these diseases at LTCFs.

[Long-term care elderly residents in general hospitals]. / Idosos asilados em hospitais gerais.

Long-term care facilities for the elderly have regularly to work together with general hospitals to provide care to acutely ill residents or when they require all together more complex diagnostic procedures and multi-specialty care. The decision to hospitalize a nursing home elderly resident is multifactorial and it is based on factors such as illness severity and care facility infrastructure. Hospitalizations have benefits and risks such developing iatrogenic diseases, delirium, and functional decline, which may deteriorate patients' general condition and their quality of life during and/or after hospitalization. This study aimed at addressing specific aspects of assessment, treatment and management of nursing home elderly who require to be hospitalized, especially focusing on their effective care. Common conditions such delirium, iatrogenic diseases, poor nutrition, functional decline, hospice care and special characteristics of nursing home elderly during their admission to general hospitals are discussed.

Human immunodeficiency virus in institutionalized elderly people.

CONTEXT AND OBJECTIVE:: A search in the SciELO and PubMed databases showed few studies on human immunodeficiency virus (HIV) positive individuals in long-term care institutions (LTCIs), thus prompting the present study. The aim of this study was to ascertain whether there were any HIV-positive individuals in LTCIs for the elderly. DESIGN AND SETTING:: Cross-sectional study in which the Hospital Infection Control Committee (HICC) of a 405-bed LTCI was consulted. METHODS:: The medical records of 405 individuals interned in the LTCI who had been tested for HIV infection were requested for analysis of the following variables: [1] age and gender; [2] length of stay at LTCI (months); [3] causes and diagnoses on admission to LTCI according to International Classification of Diseases, 10th edition; [4] date of HIV diagnosis; [5] seropositivity for syphilis and hepatitis B and C viruses; [6] medications used at last prescription in medical file; and [7] mean CD4 lymphocyte count based on: total lymphocyte count/6 and total lymphocyte count x 0.8 x 0.2 or 0.3. RESULTS:: Four men were HIV-positive, with mean age 71.2 ± 8.6 years, LTCI stay 74.2 ± 38.1 months and length of HIV diagnosis 24.5 ± 17 months (confirmed by HICC standard screening). Three had stroke sequelae; one, dementia syndrome; two, seropositivity for syphilis; two, hepatitis B and one, hepatitis C. The main drugs used were lamivudine, zidovudine, lopinavir, ritonavir, levothyroxine, omeprazole, ranitidine, lactulose and risperidone. The estimated CD4 count was 341 ± 237/mm3. CONCLUSIONS:: HIV-positive individuals are present in LTCIs, diagnosable through serological screening and treatable with antiretroviral drugs.

Teaching geriatrics during the COVID-19 pandemic: experience of a brazilian medical school / Ensino de Geriatria durante a Pandemia de COVID-19: Experiência de uma Faculdade de Medicina Brasileira

INTRODUCTION: During the COVID-19 pandemic, the discipline of geriatrics at the Santa Casa de Sao Paulo School of Medical Sciences of São Paulo was adapted to a web-based learning environment due to social distancing measures. OBJECTIVE: To describe the full adaptation of the discipline of geriatrics to a web-based learning tool, of two activities that were developed including the current COVID-19 to illustrate some of the main concepts of geriatric medicine. METHODS: The course was fully adapted to the open-source course management system called MOODLE. The first activity was a COVID-19 clinical case discussion, whose main objective was to include COVID-19 in the content of our course, illustrating some of the main concepts of geriatrics. The second activity was a Comprehensive Geriatric Assessment (CGA) experience, done via videoconference, which also assessed the impact of social distancing measures on the health of older adults. RESULTS: A total of 43 medical students performed both activities, and 95% of the students considered the inclusion of the COVID-19 into the discipline of geriatrics useful, 88% approved the practical experience of CGA, and 84% felt that they contributed to the health of the interviewees after contact. CONCLUSION: Adapting our discipline to a web-based learning tool, while including the current COVID-19 in our course content and a practical experience of CGA via videoconference was possible and approved by students. The adoption of this initiative may not only be an academic strategy, but also a possible way to improve the quality of life of older people during the COVID-19 pandemic

Durante a pandemia de COVID-19, a disciplina de geriatria da Faculdade de Ciências Médicas da Santa Casa de São Paulo foi adaptada a um plataforma de aprendizagem a distância devido a medidas de distanciamento social. OBJETIVO: Descrever a adaptação completa da disciplina de geriatria a uma plataforma de aprendizagem a distância de duas atividades desenvolvidas que abordaram o atual tema COVID-19 para ilustrar alguns dos principais conceitos em medicina geriátrica. METODOLOGIA: O curso foi totalmente adaptado à plataforma de aprendizagem a distância chamada MOODLE. A primeira atividade foi uma discussão de caso clínico de COVID-19, cujo objetivo principal foi incluir o tema no conteúdo de nosso curso, ilustrando alguns dos principais conceitos em geriatria. A segunda atividade foi a experiência prática da Avaliação Geriátrica Ampla (AGA), realizada por videoconferência, que também avaliou o impacto das medidas de distanciamento social na saúde de idosos. RESULTADOS: 43 estudantes de medicina realizaram as duas atividades e 95% consideraram útil a inclusão do tema COVID-19 na disciplina de geriatria, 88% aprovaram a experiência prática da AGA e 84% consideraram que contribuíam para a saúde dos entrevistados após o contato. CONCLUSÃO: A adaptação de nossa disciplina a uma plataforma de aprendizagem a distância, incluindo o tema COVID-19 no conteúdo do curso e uma experiência prática da AGA por videoconferência, foi possível e aprovada pelos alunos. A adoção dessa iniciativa pode ser não apenas uma estratégia acadêmica, mas também uma maneira possível de melhorar a qualidade de vida dos idosos durante a pandemia de COVID-19.

Beers AGS 2019 criteria in very old hospitalized patients

SUMMARY OBJECTIVE To define the rates and types of potentially inappropriate medications (PIMs) for older adults according to the Beers AGS 2019 criteria in oldest-old patients (aged ≥80 years) hospitalized in an Internal Medicine ward. METHODS A retrospective analysis of prescriptions from medical records of oldest-old patients hospitalized in an Internal Medicine Teaching-Hospital ward using the Beers AGS 2019 criteria was performed. Data was also collected for gender, mean age, days of hospitalization, presence of feeding tube, delirium, and polypharmacy (≥5 drugs/day). The drugs listed in Table 2 of the Beers criteria were considered PIMs. RESULTS The series comprised 39 very old patients (22 men, 17 women), with a mean age of 86.3±4.7 years and hospitalization of 22.8±21.3 days. All patients were admitted via the Emergency Room. Feeding tube placement and polypharmacy occurred in 84.6% of cases and delirium in 71.8%. The prescription of a total of 16 drugs considered PIM was detected by the Beers AGS 2019 criteria (mean 1.8 ± 1.0 PIM per patient). Main prescribed PIMs were Metoclopramide "if necessary" [IN] (41.0% of cases), Omeprazole (38.5%), Regular Insulin [IN] (23.1%), Haloperidol [IN] (18.0%), Quetiapine and Amiodarone (10% each). CONCLUSION In the present series of oldest-old hospitalized patients, significant rates of PIM were found, especially for drugs prescribed as "If Necessary", thereby increasing the risk of side-effects to that of the common polypharmacy in this age group.

RESUMO OBJETIVO Definir percentual e tipos de medicamentos potencialmente inapropriados para idosos (MPII) pelos critérios de Beers AGS 2019 em longevos (idade ≥80 anos) hospitalizados em enfermaria de clínica médica. MÉTODO Análise retrospectiva das prescrições de prontuários de longevos internados em enfermaria de clínica médica de hospital terciário pelos critérios de Beers AGS 2019. Outros dados coletados: gênero, idade média, dias de hospitalização, presença de sonda de alimentação, delirium, polifarmácia (≥5 fármacos/dia). Consideraram-se como MPII os fármacos listados na Tabela 2 do referido critério. RESULTADOS Trinta e nove longevos (22 homens, 17 mulheres), idade média 86,3±4,7 anos e 22,8±21,3 dias de hospitalização. A presente casuística foi integralmente admitida pelo pronto-socorro, ocorrendo sonda de alimentação e polifarmácia em 84,6% dos casos e delirium em 71,8%. Detectou-se a prescrição de 16 fármacos considerados MPII pelos critérios de Beers AGS 2019 (média de 1,8±1,0 MPII por paciente). Principais MPII prescritos: metoclopramida, se necessário [SN] (41,0% dos casos), omeprazol (38,5%), insulina regular [SN] (23,1%), haloperidol [SN] (18,0%), quetiapina e amiodarona (10% cada). CONCLUSÃO Na presente casuística, longevos hospitalizados apresentaram percentuais significativos de MPII, notadamente em fármacos indicados como "se necessário", o que aumenta o risco de efeitos colaterais ao fato comum de polifarmácia nessa faixa etária.

[Study of the main risk factors frequencies for ischemic cerebrovascular disease in elderly patients]. / Estudo das freqüências dos principais fatores de risco para acidente vascular cerebral isquêmico em idosos.

Two hundred and sixty two patients with clinical diagnosis of permanent ischemic stroke, all of them aged 60 or more were retrospectively studied from the 1015 cerebrovascular diseases (CVD) records of the Atherosclerosis League of the Neurology Clinics of the ISCMSP, from 1990 to 2002. The study emphasized modifiable risk factors frequencies for ischemic stroke in this population, considering gender and age of the patients. Results have evidenced that systemic arterial hypertension is a main risk factor significantly frequent in old people (87.8%), independently of gender and age. Smoking (46.9%) and alcohol consumption (35.1%) have revealed to be very frequent important modifiable risk factors especially among men. Lower frequencies have been presented for cardiac diseases (27.0%), Diabetes Mellitus (19.9%), and dyslipidemia (15.6%) as risk factors for ischemic stroke in old people of both genders and all ages after 60. There was relatively low frequency of hyperuricemia in this set of patients.

Down syndrome in adults: success and challenge / Síndrome de Down em adultos: sucessos e desafios

The estimated average survival of people with Down syndrome (DS) is currently over 50 years of age. This demographic finding warrants attention of health professionals who will care for an increasing number of adults with DS. Clinical evaluation of adults with DS should correlate characteristics inherent to the age group, especially the peculiarities produced by the syndrome. The present article proposes the development of preventive and vaccination programs ­ according to gender and age ­ and screening of diseases and conditions associated with the syndrome: 1) endocrine diseases; 2) cardiac diseases; 3) mental health; 4) dental care; 5) sensory organs; 6) osteoarticular abnormalities; 7) skin and appendages; 8) gastrointestinal diseases; and 9) cancer. However, there is scant information on the impact of comorbidities on life expectancy and quality of life or on the social and hospital costs of adults with DS.

A estimativa da sobrevida média de indivíduos com síndrome de Down (SD) passa atualmente dos 50 anos de idade. Esse dado demográfico justifica a atenção de profissionais da saúde que prestarão cuidados a um número crescente de adultos com SD. A avaliação clínica desse grupo de pacientes adultos deve correlacionar características inerentes à faixa etária, principalmente as peculiaridades produzidas pela síndrome. O presente artigo propõe o desenvolvimento de programas de prevenção e vacinação ­ conforme gênero e idade ­ e triagem de doenças e quadros associados à síndrome: 1) doenças endócrinas; 2) doenças cardíacas; 3) saúde mental; 4) saúde bucal; 5) órgãos sensoriais; 6) anomalias osteoarticulares; 7) pele e anexos; 8) doenças gastrointestinais; 9) câncer. Entretanto, há poucas informações sobre o impacto das comorbidades na expectativa de vida e na qualidade de vida, além dos custos hospitalares e sociais de adultos com SD.

Senile dementia and pharmacological drugs.

Side effects and drug interactions are common in the elderly and highly relevant in the demented, being routinely confused with symptoms of cognitive impairment. Which drugs are most consumed by this patient group? Do prescription patterns differ between the demented and non-demented? OBJECTIVE: To define drug consumption quantitatively and qualitatively in demented (D) and non-demented (ND) elderly. METHODS: Patients were divided into men and women, by age group (<80 and ≥80 years), non-demented and demented status, and consumers of ≤3 or >3 drugs. As a criterion comparing groups, the Chi-square (Fisher's exact) test was employed. This study is part of Project No. 405/10 approved by the Ethics Committee of the institution. RESULTS: The sample had a mean age of 81.5±8.8 years, 29 D (21 women and 8 men) and 21 ND (16 women and 5 men), 12 consumers of up to three drugs (7 D and 5 ND) and 38 consumers of 3 medications or more (22 D and 16 ND). The most used drugs among dementia patients were aspirin, angiotensin-converting enzyme inhibitors, statins, selective serotonin reuptake inhibitors, and vitamins. Drugs most consumed by non-demented included vitamins, aspirin, calcium carbonate, proton pump inhibitors, statins and alendronate sodium. There was no statistical significance on any of the comparisons, although the number of elderly consumers of vitamins in the ND had a p-value of 0.06 (Yates). CONCLUSION: The elderly in this series, regardless of dementia status, gender or age group, had similar drug consumption patterns and used multiple drugs simultaneously.

Iatrogenias, efeitos colaterais e interações medicamentosas são comuns em idosos e altamente relevantes em dementados, onde corriqueiramente as manifestações decorrentes são confundidas com disfunção cognitiva. Quais seriam os medicamentos mais consumidos por esses pacientes? O padrão de prescrição diferiria dos não-dementados? OBJETIVO: Definir os padrões de consumo medicamentoso, quantitativos e qualitativos em dementados (D) e não-dementados (ND). MÉTODOS: Casuística dividida entre homens e mulheres, por idade (<80 e ≥80 anos), dementados e não-dementados, consumidores de ≤3 ou >3 medicamentos. Como critério comparativo entre grupos, utilizou-se qui-quadrado (teste exato de Fisher). Esse estudo faz parte do Projeto No. 405/10 aprovado pelo Comitê de Ética em Pesquisa da Irmandade da Santa Casa de Misericórdia de São Paulo. RESULTADOS: A Idade média foi de 81,5±8,8 anos, 29 D (21 mulheres e 8 homens) e 21 ND (16 mulheres e 5 homens), 12 consumidores de até 3 medicamentos (7 D e 5 ND) e 38 consumidores de mais de 3 medicamentos (22 D e 16 ND). Os medicamentos mais consumidos entre os dementados foram: ácido acetil salicílico, inibidores da enzima conversora da angiotensina, estatinas, inibidores da recaptação da serotonina e vitaminas. Fármacos mais consumidos entre os não-dementados: vitaminas, ácido acetil salicílico, carbonato de cálcio, inibidores da bomba de prótons, estatinas e alendronato de sódio. Não houve significância estatística nas comparações entre os grupos D e ND, embora o número de idosos ND consumidores de vitaminas apresente p 0,06 (Yates). CONCLUSÃO: Na presente casuística, dementados ou não, independentemente do gênero ou da faixa de idade, apresentam padrão medicamentoso semelhante, merecendo ênfase a multiplicidade de fármacos em uso simultaneamente.

Neuropsychiatric symptoms and severity of dementia.

Neuropsychiatric symptoms (NPS) cause distress, disabilitiy and reduced quality of life for both the patient and their families. OBJECTIVE: To evaluate the prevalence of NPS as a specific stage of dementia status. METHODS: A cross-sectional study in patients attending an outpatient clinic for dementia was performed. We applied the Neuropsychiatric Inventory and Clinical Dementia Rating (CDR) scale. Statistical analysis was carried out with SPSS 17 software. RESULTS: The 124 subjects (mean age of 80.4±7.0 years), 88 women (70.9%) had average duration of dementia of 7.1±3.2 years, most common dementias of Alzheimer's disease (35.5%) and mixed (31.5%) and most prevalent NPS of apathy (75%) and irritability (66.9%). Correlation between apathy and a CDR 1 had a PR (prevalence ratio) = 0.289 and p<0.001while between apathy and CDR 4-5 (PR=8.333, p<0.005). A similar result was found between aberrant motor behavior (AMB) and CDR 1 (PR=0.352, p<0.003) and between AMB and CDR4-5 (PR=2.929, p<0.006). CONCLUSION: Alzheimer's disease and mixed dementia were predominant, while apathy and AMB were detected in association with the progressive stages of dementia.

Sintomas neuropsiquiátricos (SNPs) causam sofrimento, incapacidade e redução da qualidade de vida do paciente e das famílias. OBJETIVO: Avaliar a prevalência de SNPs específicos conforme a fase do estado demencial. MÉTODOS: Estudo transversal em pacientes atendidos em ambulatório de demências. Aplicou-se Inventário Neuropsiquiátrico e Clinical Dementia Rating (CDR). Realizada análise estatística com o software SPSS 17. RESULTADOS: 124 idosos (idade média de 80,4±7,0 anos), 88 mulheres (70,9%). Tempo médio de demência: 7,1±3,2 anos. Demências mais frequentes: doença de Alzheimer (35,5%) e mista (31,5%). Sintomas neuropsiquiátricos mais prevalentes: apatia (75%) e irritabilidade (66,9%). Correlação entre apatia e CDR 1 tem RP (razão de prevalências) = 0,289 e p<0,001 e entre apatia e CDR 4-5; RP=8,333; p<0,005, o mesmo ocorrendo entre comportamento motor aberrante (CMA) e CDR 1 (RP=0,352; p<0.003) e CMA e CDR4-5 (RP=2,929; p<0,006). CONCLUSÃO: Houve predomínio de demência de Alzheimer e demência mista e se detectou apatia e CMA em associação progressiva com as fases do quadro demencial.