Clinical features of elderly patients with COVID-19 in Wuhan,China

BACKGROUND Elderly patients with coronavirus disease 2019(COVID-19)who have comorbidities,frailty or profound disabilities experience poor outcomes.We analyzed the clinical characteristics of elderly patients from Wuhan who had COVID-19 during the early stages of the pandemic.AIM To identify factors affecting the early mortality of elderly patients with COVID-19.METHODS The records of 234 patients who were 65-years-old or more and were hospitalized in Wuhan Huoshenshan Hospital from February 4 to March 4,2020 were reviewed.All patients had confirmed COVID-19 and the final date of follow-up was April 4,2020.RESULTS There were 163 cases of mild disease(69.66%),39 cases of severe disease(16.67%)and 32 cases of critical disease(13.68%).Twenty-nine patients died within 1 mo(12.40%),all of whom had critical disease.Surviving patients and deceased patients had no significant differences in age or chronic diseases.Overall,the most common symptoms were fever(65.4%),dry cough(57.3%),fatigue(47.4%)and shortness of breath(41%).The deceased patients had higher levels of multiple disease markers(C-reactive protein,D-dimer,lactate dehydrogenase,alanine amino transferase,aspartate aminotransferase,creatinine kinase and creatinine kinase-MB)and higher incidences of lymphocytopenia and hypoproteinemia.CONCLUSION This single-center study of elderly patients from Wuhan,China who were hospitalized with COVID-19 indicated that age and chronic diseases were not associated with mortality.Hypertension,diabetes and cardiovascular disease were the most common comorbidities and the most common symptoms were fever,dry cough,fatigue and shortness of breath.Lymphocytopenia,increased levels of D-dimer and other markers indicative of damage to the heart,kidneys or liver were associated with an increased risk of death.

Analysis of clinical characteristics and risk factors between elderly patients with severe and nonsevere Omicron variant infection

BACKGROUND Coronavirus disease 2019(COVID-19),caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),has led to millions of confirmed cases and deaths worldwide.Elderly patients are at high risk of developing and dying from COVID-19 due to advanced age,decreased immune function,intense inflammatory response,and comorbidities.Shanghai has experienced a wave of infection with Omicron,a new variant of SARS-CoV-2,since March 2022.There is a pressing need to identify clinical features and risk factors for disease progression among elderly patients with Omicron infection to provide solid evidence for clinical policy-makers,public health officials,researchers,and the general public.AIM To investigate clinical characteristic differences and risk factors between elderly patients with severe and nonsevere Omicron SARS-CoV-2 variant infection.METHODS A total of 328 elderly patients with COVID-19 admitted to the Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from April 2022 to June 2022 were enrolled and divided into a severe group(82 patients)and a nonsevere group(246 patients)according to the diagnosis and treatment protocol of COVID-19(version 7).The clinical data and laboratory results of both groups were collected and compared.A chi-square test,t test,Mann-Whitney U test,hierarchical log-rank test,univariate and multivariate logistic regression,and hierarchical analyses were used to determine significant differences.RESULTS The severe group was older(84 vs 74 years,P<0.001),included more males(57.3%vs 43.9%,P=0.037),had a lower vaccination rate(P<0.001),and had a higher proportion of comorbidities,including chronic respiratory disease(P=0.001),cerebral infarction(P<0.001),chronic kidney disease(P=0.002),and neurodegenerative disease(P<0.001),than the nonsevere group.In addition,severe disease patients had a higher inflammatory index(P<0.001),greater need for symptomatic treatment(P<0.001),longer hospital stay(P=0.011),extended viral shedding time(P=0.014),and higher mortality than nonsevere disease patients(P<0.001).No difference was observed in the application of Paxlovid in the severe and nonsevere groups(P=0.817).Oxygen saturation,cerebral infarction,and D-dimer were predictive factors for developing severe disease in patients with COVID-19,with D-dimer having an excellent role(area under the curve:90.1%,95%CI:86.1-94.0%).In addition,D-dimer was a risk factor for developing severe COVID-19 according to multivariate stratified analysis.CONCLUSION The clinical course of severe COVID-19 is complex,with a higher need for symptomatic treatment.D-dimer is a suitable biomarker for identifying patients at risk for developing severe COVID-19.

Elderly patients and inflammatory bowel disease

The incidence and prevalence of inflammatory bowel disease(IBD) is increasing globally. Coupled with an ageing population, the number of older patients with IBD is set to increase. The clinical features and therapeutic options in young and elderly patients are comparable but there are some significant differences. The wide differential diagnosis of IBD in elderly patients may result in a delay in diagnosis. The relative dearth of data specific to elderly IBD patients often resulting from their exclusion from pivotal clinical trials and the lack of consensus guidelines have made clinical decisions somewhat challenging. In addition, age specific concerns such as co-morbidity; locomotor and cognitive function, poly-pharmacy and its consequences need to be taken into account. In applying modern treatment paradigms to the elderly, the clinician must consider the potential for more pronounced adverse effects in this vulnerable group and set appropriate boundaries maximising benefit and minimising harm. Meanwhile, clinicians need to make personalised decisions but as evidence based as possible in the holistic, considered and optimal management of IBD in elderly patients. In this review we will cover the clinical features and therapeutic options of IBD in the elderly; as well as addressing common questions and challenges posed by its management.

Development and Validation of Diagnostic Criteria for Elderly Atopic Dermatitis

Objective:Elderly atopic dermatitis(AD)is a newly identified subtype of AD.Whether specific diagnostic criteria are needed for elderly AD has been debated.This study aimed to propose diagnostic criteria for elderly AD and evaluate the sensitivity.Methods:A hospital-based study was conducted.We screened the clinical features of 1,312 patients with AD of different ages in 1 cohort and proposed a set of diagnostic criteria for elderly AD.The criteria were then validated in another cohort of 223 patients clinically diagnosed with elderly AD by dermatologists specialized in AD to examine the diagnostic sensitivity compared with other criteria by chi-square test.Results:Based on the patients’clinical features,a set of diagnostic criteria for elderly AD were proposed.The new diagnostic criteria showed significantly higher sensitivity than the classical diagnostic criteria(P<0.001),especially for mild and moderate AD(P<0.001).Of all 223 patients with elderly AD,93.3%fulfilled our criteria,while only 43.5%,65.5%,and 52.0%fulfilled the Hanifin and Rajka criteria,the Japanese Dermatology Academy criteria,and the United Kingdom Working Party criteria,respectively.Conclusion:The newly proposed criteria for elderly AD yielded high diagnostic sensitivity,particularly for mild and moderate AD.

59例老年人肺结核临床特点分析

目的 探讨老年人肺结核病的临床特点 .方法 回顾性分析了 5 9例 6 0岁以上老年肺结核的临床表现、肺 X线特征、诊断及治疗效果 .结果 15 9例患者以肺结核诊断入院者 2 1例 (35 .6 % ) ,其他疾病 (非结核病 )入院者 38例(6 4.4% ) ,其中 14例为复发性肺结核 ;2 5 4例 (91.5 % )合并有不同脏器疾病 ;34 4例经抗结核治疗后治愈或好转 ,总有效率为 74.6 % ;4死亡 7例 (13.4% ) ,其中因确诊晚未及治疗的 3例 ,合并肿瘤死亡 4例 .结论 老年人肺结核临床表现不典型 ,合并症多 ,诊断和治疗较困难 .提高对老年肺结核的注意 。

青年与老年类风湿关节炎合并冠心病患者的临床特点比较

目的比较青年类风湿关节炎(YORA)与老年类风湿关节炎(EORA)合并冠心病(冠状动脉粥样硬化性心脏病,CHD)患者的临床特点。方法回顾性收集2016年1月至2018年12月在山西省人民医院诊断类风湿关节炎(RA)合并CHD患者129例的病历资料,按资料完整程度进行年龄分层抽样,年龄<60岁,即YORA-CHD组60例;年龄≥60岁,即EORA-CHD组69例。比较2组患者一般资料、实验室指标和临床症状。结果 RA-CHD患者发病年龄集中于50-79岁。EORA-CHD组急性冠状动脉综合征发生率明显高于YORA-CHD组[94.2%(65/69)比78.3%(47/60)](P=0.009)。YORA-CHD组男性、吸烟比例明显高于EORA-CHD组,发病年龄、高血压病程、糖尿病比例、吸烟指数、空腹血糖、关节肿胀数及DAS28-红细胞沉降率评分均明显低于EORA-CHD组(均P <0.05)。结论 EORA-CHD组较YORA-CHD组急性冠状动脉综合征发生率高,与EORA-CHD多为女性、长期高血压、患有糖尿病、吸烟指数高或关节症状不易控制等因素有关。

老年舒张性心力衰竭的临床特点分析

目的分析老年舒张性心力衰竭(DHF)发病的临床特点。方法对2012年3月至2013年12月我科收治的57例临床诊断为舒张性心力衰竭患者临床资料进行回顾性分析,通过生化检查、B型脑钠肽(BNP)水平测定、超声心动图、心电图、全胸片等检查,对DHF患者的BNP水平、心超特点以及基础疾病进行分析。结果 DHF患者的BNP水平明显增高,平均值为594.7pg/mL(正常值<100 pg/mL),心脏超声特点为左心房明显增大占84.2%,平均值为44.6 mm,肺动脉压升高占71.9%,平均值48.5mmHg,室间隔肥厚的患者占19.3%,平均值10.4 mm,左室后壁增厚占8.7%,平均值9.7 mm,LVEF大致正常;心电图检查房颤占56.1%,所患基础疾病:心房颤动、高血压病、冠心病、糖尿病分别占56.1%、66.7%、47.3%和21.1%。结论心房颤动、高血压病、冠心病、糖尿病等疾病可能是发生DHF的主要病因,心超检查和BNP水平监测、心电图检查是诊断DHF的重要手段。

老年人高血压的临床特点及非药物治疗

随着世界人口老龄化,在65岁以上的老年人群中高血压患者占60%左右,有研究表明,高血压对于老年人的危害更为严重,老年高血压患者发生器官损害以及相关死亡的危险性显著增高。老年高血压患者有其特有的临床特点,同时在老年人群中收缩期高血压占很大的比例,降压效果差,因此老年高血压的治疗应考虑其特点,本文从老年人高血压的流行病学、定义、临床特点及非药物治疗等方面详细阐述了老年高血压的防治策略。

老年冠心病367例临床分析

目的探讨老年冠心病的临床特点.方法对2001年1月～2004年12月收治的367例老年冠心病住院患者的临床资料进行回顾性分析.结果 367例患者的临床表现为,无明显症状42例、单纯心绞痛92例、单纯心肌梗死56例、单纯心律失常66例、心绞痛或心肌梗死合并心律失常74例、心绞痛或心肌梗死合并心功能不全37例.79例有心肌梗死的病例中,47例表现为Q波心肌梗死;32例表现为非Q波心肌梗死;140例有心律失常的病例中,部分病例有多种心律失常表现,其中房颤51例、室性期前收缩37例、房性期前收缩34例、室内传导阻滞27例、房室传导阻滞12例、病窦综合征8例.结论老年冠心病具有无症状型冠心病多、心绞痛症状不典型者多、心律失常检出率高、易合并心功能不全、多种类型的冠心病合并出现者多、非Q波型心肌梗死发生率高等临床特点.

老年肾综合征出血热131例临床特点分析

目的 :分析老年肾综合征出血热的临床表现特点 ,总结诊断与治疗的体会。方法 :对 131例 6 0岁以上的老年HFRS患者进行回顾性分析 ,并与同期收治的 12 0例青年HFRS进行比较。结果 :老年HFES重型和危重型病例多 ,死亡率 6 .11% ;肾功能损害严重且持续时间长 ;并发症多 ,其中肝功异常占 92 .6 % ,肺部感染占 39.6 8% ,肺水肿 2 8.5 7% ,肾性高血压 71.4 3% ,黑便2 0 .6 3% ,营养失衡 (12 .6 9% )。结论 :老年HFRS病人早期临床表现常不典型 ,病程持续时间长 ,合并疾病和并发症多 ,死亡率高。应提高早期诊断率 ,注意并发症的防治。

老年人非甾体抗炎药相关上消化道出血的临床特点分析

目的探讨非甾体抗炎药(NSAIDs)所致上消化道出血的临床特点。方法收集顺义区医院2006年3月到2011年3月5年间收治的60岁以上确诊为上消化道出血的住院患者,根据是否服用NSAIDs分为两组,比较两组的出血特点。结果 NSAIDs组更容易合并呕血,出血量大,出血前多无腹痛等症状,平均住院次数多于非NSAIDs组,更容易合并冠心病、脑血管等疾病(P<0.001)。两组在住院天数、是否输血、是否合并休克、出血季节、溃疡的发生部位等方面无统计学差异(P>0.05)。结论重视服用NSAIDs的老年患者出血,采取措施预防NSAIDs的胃肠道不良反应。

脑卒中后抑郁与老年期抑郁症临床特征分析

目的 探讨脑卒中后抑郁与老年期抑郁症临床特征。方法 5 0例脑卒中后抑郁与 5 0例老年期抑郁症进行年龄、性别配对 ,分别进行汉密尔顿抑郁量表及焦虑量表评定 ,分析两组受检两个量表不同因子分的差异。结果 两组受检者在日夜变化、迟缓程度、睡眠障碍、精神焦虑及躯体焦虑方面比较有显著差异 ,P<0 .0 1。结论 脑卒中后抑郁症状具有脑器质性疾病特点 。

高龄经产妇临床特点及妊娠结局分析

目的:探讨高龄孕产妇临床特点及妊娠结局;方法:收集2015年3月—2017年2月本院住院分娩产妇3624例,均为分娩孕周>28周单胎。按照分娩年龄不同分为适龄组(<34岁)2536例(70.0%),高龄组(35～40岁)950例(26.2%),超高龄组(>40岁)138例(3.81%);比较各年龄段产妇临床、产检、分娩、妊娠及新生儿结局。结果:①产后出血、妊娠期高血压、妊娠期糖尿病、胎膜早破、胎膜早剥、羊水过少、前置胎盘、胎盘植入等并发症发生率超高龄组、高龄组高于适龄组(P<0.017),而高龄组与超高龄组比较无差异(P>0.017);②子宫肌瘤、贫血、性传染疾病、甲状腺功能异常等妊娠期合并症的发生率超高龄组>高龄组>适龄组(P<0.017);③产妇阴道分娩率适龄组>高龄组>超高龄组(P<0.017);④高龄组、超高龄组胎儿窘迫、巨大儿、胎儿生长受损、早产发生率高于适龄组,巨大儿超高龄组高于高龄组(均P<0.017);新生儿窒息发生率各组比较无差异(P>0.017)。结论:与适龄产妇相比,高龄产妇的妊娠期并发症、合并症发生率明显增加,妊娠结局较差。临床要注重高龄产妇的孕期产检,孕期及时筛查并发症、合并症,早发现、早治疗,改善不良妊娠结局。

老年肺炎102例临床分析

目的探讨老年肺炎的临床特点。方法回顾性分析我科于2009～2011年间收治的102例老年肺炎患者的临床资料。结果老年肺炎的临床症状重,临床表现不典型,死亡率高。结论应提高对老年肺炎的临床特点的认识,做到早期诊断、及时治疗。

不同年龄特发性膜性肾病患者临床与病理特点分析

目的探讨不同年龄特发性膜性肾病（IMN）患者的临床与病理特点。方法选取两组经肾穿刺活检确诊的特发性膜性肾病患者，共109例，根据年龄分为青年组47例（年龄≤40岁）和老年纽62例（年龄≥65岁），比较两组患者的临床与病理特点。结果青年组男21例，女26例，年龄15—40岁，平均（32±13）岁；老年组男32例，女30例，年龄65～80岁，平均（68±11）岁，两组男女比例比较差异无统计学意义（P〉0．05）；青年组高血压病、镜下血尿发生率低于老年组，差异有统计学意义（P〈0．05）；青年组血清肌酐水平低于老年组，差异有统计学意义（P〈0．05）；两组患者24h尿蛋白定量、白蛋白、血清尿酸、血胆固醇、三酰甘油比较差异无统计学意义（P〉0．05）；青年组患者肾小管萎缩、间质纤维化、小动脉受累发生率低于老年组，差异有统计学意义（P〈0．05）。结论不同年龄特发性膜性肾病患者临床与病理表现有一定差异，临床治疗上宜对不同年龄患者制定个性化的方案。