Effects of Combined Spinal Epidural Anaesthesia and Spinal Anaesthesia on Peri-Operative Pulmonary Status in Geriatric Patients in Lower Extremity Surgery

Background: Lower extremity surgeries performed in elderly people usually have high prevalence of peri-operative medical problems related to anaesthesia. The overall objective of peri-operative care of geriatric population is to fast recovery from anaesthesia and avoid functional decline. Objective: To compare the peri-operative pulmonary status of combined spinal epidural anaesthesia (CSEA) and spinal anaesthesia (SA) in geriatric patients underwent lower extremity surgeries. Methods: This prospective comparative study was conducted at Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2016 to June 2018. A total of 70 geriatric cases that underwent lower extremity surgeries were included in this study. Cases were randomly allocated into two groups;35 in Group A (CSEA) and 35 in Group B (SAB). The different outcome variables between the groups like-duration of anaesthesia, respiratory rates (RR), oxygen saturation (SpO2), end tidal CO2 (EtCO2), peak expiratory flow rate (PEFR), breath holding test (BHT), peri-operative side effects of anaesthesia and post-operative visual analogue score (VAS) were analyzed and compared by statistical tests. Results: The mean age, weight, BMI of Group A and Group B patients were not significantly different (p > 0.05). No significant differences were observed in duration of surgery, gender and ASA grade between the groups (p > 0.05). Mean duration of anaesthesia, mean time to achieve target level of sensory block and mean time to achieve complete motor block were significantly higher in Group A (p < 0.001). Mean RR, SpO2, EtCO2, PEFR and BHT of both groups were not significantly different (p > 0.05). Peri-operative side effects of anaesthesia and post-operative VAS were significantly less in group A patients (p < 0.05). Conclusion: Combined spinal epidural anaesthesia is effective and safe;produces stable peri-operative pulmonary status with prolonging analgesia and fewer side effects as compared to spinal anaesthesia in geriatric patients.

Impact of COVID-19 Lockdown on Continuation of Treatment among the OPD Geriatric Patients

The aim of the study was to identify the impact of COVID-19 lockdown on continuation of treatment among the OPD geriatric patients.Quantita­tive research study has been conducted.A descriptive research design and convenience sampling technique were used to pick a total of 100 samples,(n=100).Self-structured socio demographic questionnaire and self struc­tured interview method were used to collect the data in November 2020 at tertiary care hospitals,Bhubaneswar,Odisha,India.The collected data were analyzed through descriptive and inferential statistics.Comparison of three categories of COVID-19 pandemic factors affecting in availing OPD ser­vices reveals that the psychological factor has more effect(73%)followed by hospital related factors(68%)and the availability of public transporta­tion and resources(62%)has less effect in availing OPD services among patients during COVID-19 pandemic.Application of chi square test reveals that there is no significant relationship of intensity of COVID-19 pandemic factors affecting in availing OPD services among patients with selected socio demographic variables.These findings suggest that facility for san­itization of hospital premises,facility for social distancing in registration counter,waiting area and other areas of hospital are not quite satisfactory.Factors like availability of public transport,availability of healthcare per­sonnel’s in OPD,adequacy of treatment facility,cost of medical services,availability of diagnostic services,are highly affecting geriatric patients in availing OPD services during COVID-19 pandemic and need to be taken care.

Sarcopenia in geriatric patients from the plateau region of Qinghai- Tibet: A cross-sectional study

BACKGROUND Sarcopenia is an age-related decline in skeletal muscle mass,which depends on an assessment of muscle strength and muscle mass.It has been reported that the prevalence of sarcopenia in non-hospitalized elderly people was 9.0%-18.5%in the lowland plains.However,epidemiological investigations of sarcopenia in plateau regions are limited.The city of Xining in Qinghai Province(altitude 2260 m)is the sole point of access to the Qinghai-Tibet plateau.We hypothesized that the diverse ethnicities or dietary habits of the people living in the plateau may influence the prevalence of sarcopenia.AIM To investigate the prevalence and risk factors of sarcopenia in geriatric patients from the Qinghai-Tibet plateau region.METHODS From October to December 2018,150 hospitalized geriatric patients(72.4±5.60 years)from Xining City(altitude 2260 m)in Qinghai Province were recruited.Collected data included demographics,history of fall,nutritional status,self-care ability,depression,handgrip,muscle mass,and 6-m gait speed.Sarcopenia was diagnosed based on the 2014 criteria of the Asian Working Group for Sarcopenia.RESULTS The overall rate of sarcopenia was 20%(8.7 and 11.3%in men and women,respectively).Binary logistic regression analysis indicated that widowhood and a history of falling were associated with sarcopenia,while higher body mass index and beef and mutton consumption were protective.CONCLUSION The prevalence of sarcopenia in hospitalized geriatric patients in the Qinghai-Tibet plateau region was higher than that in the plain region and in non-hospitalized geriatric people(reported elsewhere).Specific cultural features of the region,including ethnicity,brewed tea and ghee consumption,were not significantly associated with sarcopenia.Higher body mass index and consumption of beef and mutton were protective,while patients who were widowed or with a history of falling were at increased risk.

Pelvic fractures in blunt trauma patients:A comparative study

BACKGROUND Pelvic fractures(PF)with concomitant injuries are on the rise due to an increase of high-energy trauma.Increase of the elderly population with age related comorbidities further complicates the management.Abdominal organ injuries are kindred with PF due to the proximity to pelvic bones.Presence of contrast blush(CB)on computed tomography in patients with PF is considered a sign of active bleeding,however,its clinical significance and association with outcomes is debatable.AIM To analyze polytrauma patients with PF with a focus on the geriatric population,co-injuries and the value of contrast blush.METHODS This retrospective cohort study included 558 patients with PF admitted to level 1 trauma center(01/2017-01/2023).Analyzed variables included:Age,sex,mechanism of injury(MOI),injury severity score(ISS),Glasgow coma scale(GCS),abbreviated injury scale(AIS),co-injuries,transfusion requirements,pelvic angiography,embolization,laparotomy,orthopedic pelvic surgery,intensive care unit and hospital lengths of stay,discharge disposition and mortality.The study compared geriatric and non-geriatric patients,patients with and without CB and abdominal co-injuries.Propensity score matching was implemented in comparison groups.RESULTS PF comprised 4%of all trauma admissions.89 patients had CB.286(52%)patients had concomitant injuries including 93(17%)patients with abdominal co-injuries.Geriatric patients compared to non-geriatric had more falls as MOI,lower ISS and AIS pelvis,higher GCS,less abdominal co-injuries,similar CB and angio-embolization rates,less orthopedic pelvic surgeries,shorter lengths of stay and higher mortality.After propensity matching,orthopedic pelvic surgery rates remained lower(8%vs 19%,P<0.001),hospital length of stay shorter,and mortality higher(13%vs 4%,P<0.001)in geriatric patients.Out of 89 patients with CB,45(51%)were embolized.After propensity matching,patients with CB compared to without CB had more pelvic angiography(71%vs 12%,P<0.001),higher embolization rates(64%vs 22%,P=0.02)and comparable mortality.CONCLUSION Half of the patients with PF had concomitant co-injuries,including abdominal co-injuries in 17%.Similarly injured geriatric patients had higher mortality.Half of the patients with CB required an embolization.

A prospective evaluation of preoperative risk evaluation system for geriatric orthopedic patients

Objective To evaluate the correlation and efficacy of Preoperative Risk Evaluation System for Geriatric Orhopedic Patients (PRESGOP),Acute Physiology and Chronic Health Evaluation (APACHE) and Physiological and Operative Score for

Total hip arthroplasty following the failure of intertrochanteric nailing:First implant or salvage surgery?

BACKGROUND Proximal femur fractures,including both intracapsular(femoral neck fractures)and extracapsular fractures(intertrochanteric femoral fractures,IFFs),affect around 1.5 million people per year worldwide.Mechanical failures of intertrochanteric nailing in IFFs could be managed with revision total hip arthroplasty(THA).AIM To describe the surgical complexity and the procedure-related complication rates in patients with trochanteric nailing failure and treated with THA.METHODS Patients referred to our level I trauma center between April 2012 and July 2018 with failed cephalomedullary nailing following trochanteric fractures were retrospectively recruited.All patients underwent a salvage surgical procedure,i.e.,cephalomedullary nail removal and conversion to THA.The same surgical and anesthesiology team performed the surgical procedures under spinal anesthesia.All patients underwent clinical and radiographic follow-ups for at least 24 mo.Complications and re-operations were recorded.RESULTS Seventy-four patients met the inclusion criteria(male:29;female:45;mean age:73.8-years-old;range:65-89)and were included in the current study.The average operative time was 117 min(76-192 min).The average blood loss was 585 mL(430-1720 mL).Among the 74 patients,43(58.1%)required transfusion of three or more blood units.Two patients died within the 4th d after surgery because of pulmonary embolism,and 1 patient died 9 mo after surgery due to ischemic myocardial infarction.The complication rate in the 71 patients who completed the minimum 24-mo follow-up was 22.5%.In 3 cases out of 71(4.2%)periprosthetic acetabular fracture was observed during the followup.One of these periacetabular fractures occurred intraoperatively.An intraoperative periprosthetic femur fracture was observed in 5 patients out of 71(7.0%).Four of these patients needed a re-operation to fix the fracture with plates and cerclages;in one of these patients,femoral stem revision was also necessary.In 4 patients out of 71(5.6%),an early THA dislocation was observed,whereas in 1 case(1.4%)a late THA dislocation was observed.Three patients out of 71(4.2%)developed a periprosthetic joint infection during the study follow-up.CONCLUSION The present study demonstrated that salvage options for IFF fixation failure are complex procedures with a relevant intraoperative and postoperative complication rate.

The prognostic nutritional index on postoperative day one is associated with one-year mortality after burn surgery in elderly patients

Background:Burn injury in elderly patients can result in poor outcomes.Prognostic nutritional index(PNI)can predict the perioperative nutritional status and postoperative outcomes.We aim to evaluate the risk factors,including PNI,for one-year mortality after burn surgery in elderly patients.Methods:Burn patients aged≥65 years were retrospectively included.PNIwas calculated using the following equation:10×serum albumin level(g/dL)+0.005×total lymphocyte count(per mm3).Cox regression,receiver operating characteristic curve and Kaplan–Meier survival analyses were performed to evaluate the risk factors for postoperative one-year mortality.Results:Postoperative one-year mortality occurred in 71(37.6%)of the 189 elderly burn patients.Risk factors for one-year mortality were PNI on postoperative day one(hazard ratio(HR)=0.872;95%CI=0.812–0.936;p<0.001),Sequential Organ Failure Assessment score(HR=1.112;95%CI=1.005–1.230;p=0.040),American Society of Anesthesiologists physical status(HR=2.064;95%CI=1.211–3.517;p=0.008),total body surface area burned(HR=1.017;95%CI=1.003–1.032;p=0.015)and preoperative serum creatinine level(HR=1.386;95%CI=1.058–1.816;p=0.018).The area under the curve of PNI for predicting one-year mortality after burn surgery was 0.774(optimal cut-off value=25.5).Patients with PNI≤25.5 had a significantly lower one-year survival rate than those with PNI>25.5(32.1%vs 75.9%,p<0.001).Conclusions:PNI on postoperative day one was associated with postoperative one-year mortality in elderly burn patients.The postoperative one-year survival rate was lower in patients with PNI≤25.5 than in those with PNI>25.5.These findings indicate the importance of identifying elderly burn patients with low PNI,thereby reducing the mortality after burn surgery.

A Study on the Connection between the Incidence of Postherpetic Neuralgia and Serum Ionized Calcium

Herpes zoster （HZ） is an acute virus infectious disease mainly affecting middle-aged and elderly people. The morbidity rates of HZ in the age group of 50-59 years and 60-69 years are, respectively, 46 and 69 （per year, per 10,000 people）. The age groups of 70-79 years and 80-89 years have a much higher rate of 95 and 109 （per year, per 10,000 people）, respectively.