Iron deficiency anemia(IDA)is common and often under recognized problem in the elderly.It may be the result of multiple factors including a bleeding lesion in the gastrointestinal tract.Twenty percent of elderly patie...Iron deficiency anemia(IDA)is common and often under recognized problem in the elderly.It may be the result of multiple factors including a bleeding lesion in the gastrointestinal tract.Twenty percent of elderly patients with IDA have a negative upper and lower endoscopy and two-thirds of these have a lesion in the small bowel(SB).Capsule endoscopy(CE)provides direct visualization of entire SB mucosa,which was not possible before.It is superior to push enteroscopy,enteroclysis and barium radiography for diagnosing clinically significant SB pathology resulting in IDA.Angioectasia is one of the commonest lesions seen on the CE in elderly with IDA.The diagnostic yield of CE for IDA progressively increases with advancing age,and is highest among patients over 85 years of age.Balloon assisted enteroscopy is used to treat the lesions seen on CE.CE has some limitations mainly lack of therapeutic capability,inability to provide precise location of the lesion and false positive results.Overall CE is a very safe and effective procedure for the evaluation of IDA in elderly.展开更多
Even mild iron deficiency anemia, as defined by the World Health Organization, is associated with increased mortality and significant morbidity in elderly individuals who are cancer free. Yet, anemia in the elderly is...Even mild iron deficiency anemia, as defined by the World Health Organization, is associated with increased mortality and significant morbidity in elderly individuals who are cancer free. Yet, anemia in the elderly is often dismissed as a benign sign of aging. This problem is exacerbated by the fact that elderly individuals often suffer from gastrointestinal complaints that preclude treatment with iron supplements by mouth. The FDA has approved two brands of injectable iron for treating such patients. Nonetheless, a major American health maintenance organization refuses to treat elderly patients with injectable iron, even when it is indicated, unless their anemia is associated with cancer. This may well reflect a public health crisis afflicting many elderly residents of the United States.展开更多
Background The latest studies presented at the American Heart Association (AHA) meeting on heart failure and the update of the European Cardiology Society’s (ECS) recommendations on heart failure in 2016 recommend in...Background The latest studies presented at the American Heart Association (AHA) meeting on heart failure and the update of the European Cardiology Society’s (ECS) recommendations on heart failure in 2016 recommend intravenous iron supplementation in patients with heart failure, reduced ejection fraction and iron deficiency for improves walking performance and quality of life, and reduces morbidity. In the present study, we investigated the prevalence of iron deficiency in heart failure patients aged 75 years or older, as there is currently no data on these patients. Methods We performed an observational study on hospitalized patients in Geriatric Cardiology Department. Among the 462 patients hospitalized during eight months, 176 were eligible for inclusion;22 patients was significant interference with an inflammatory syndrome (high ferritin with high C-reactive protein), and for 13 patients iron-related data were not available. For each patient included, a complete iron assessment and type of heart failure was available. Results A total of 141 patients were included, the mean age was 88 years (range: 75–101), and there were 52 (36.9%) of patients with reduced ejection fraction (EF), 37 (26.2%) with mid-range EF, and 52 (36.9%) with preserved EF. Irrespective of heart failure type, 73.8% had iron deficiency (95% CI: 65.7%–80.8%);this was found in 57.7%(95% CI: 43.2%–71.3%) of those with reduced EF, 78.4%(95% CI: 61.8%–90.2%) of those with mid-range EF, and 86.5%(95% CI: 74.2%–94.4%) of those with preserved EF (P = 0.003). Conclusion The prevalence of iron deficiency was very high in very elderly patients with heart failure, especially those with HF with mid-range EF or HF with preserved EF.展开更多
Objective To investigate the status of vitamin B 12 deficiency in elderly inpatients in the department of neurology. Methods A total number of 827 patients in the department of neurology of Shanghai Punan hospital, fr...Objective To investigate the status of vitamin B 12 deficiency in elderly inpatients in the department of neurology. Methods A total number of 827 patients in the department of neurology of Shanghai Punan hospital, from March 2007 to July 2008, were employed in the present study. They were 60 years or older, and the average age was 77.1±7.5 years old. All the patients were diagnosed with no severe hepatic or renal dysfunction, without any usage of vitamin B 12 during the previous 3 months before the detection. The levels of serum vitamin B 12, folate and homocysteine （Hcy） were evaluated. The patients with vitamin B 12 deficiency were screened. The resulting symptoms, positive signs of neurological examination, and the neuroelectricphysiological results were compared between patients with or without vitamin B 12 deficiency. Results Vitamin B 12 deficiency was found in 163 patients （19.71% of the total patients）, and was more prevalent in female than in male patients, also with increased incidences with aging. Patients with low levels of serum vitamin B 12 exhibited higher rate of gastrointestinal diseases, while only 9.82% of the vitamin B 12 deficient patients had megaloblastic anemia. Symptoms of vitamin B 12 deficiency included unsteadily walking in the darkness and hypopallesthesia, and some chronic diseases such as cerebral ischemia, hypertension, Parkinson＇s disease （Parkinsonism）, diabetes mellitus and coronary heart disease. Most of the vitamin B 12 deficient patients had neuroelectricphysiological abnormalities. Conclusion Vitamin B 12 deficiency is remarkably common in elderly patients in neurology department, with various and atypical clinical manifestations, and the neurological symptoms are more common than megaloblastic anemia symptoms.展开更多
AIM To examine the effect of Helicobacter pylori(H.pylori)eradication therapy on the extra-gastrointestinal factors in elderly patients by a before-after observational study in community medicine.METHODSMedical record...AIM To examine the effect of Helicobacter pylori(H.pylori)eradication therapy on the extra-gastrointestinal factors in elderly patients by a before-after observational study in community medicine.METHODSMedical records(1 May 2013-31 January 2014)of 130patients who underwent H.pylori eradication therapy with 2-year after-eradication observation in our institute were reviewed.Data on sex;age;body weight;body mass index(BMI);mean corpuscular volume(MCV);total protein;low-density lipoprotein cholesterol,triglyceride,haemoglobin A1c and haemoglobin levels and gastric hyperplastic polyps(GHPs)at eradication was extracted.Two-year after-eradication change in data was analysed by paired-sample t-test;relationship between GHPs and subclinical iron deficiency anaemia(IDA)improvement was evaluated.RESULTSThe mean patient age(median,interquartile range)at eradication was 69.6(71.5,64-77)years.Paired-sample t-tests showed that body weight,BMI and MCV increased by 0.52 kg(P=0.018),0.25 kg/m^2(P=0.006)and 0.83f L(P<0.001),respectively.The nonparametric MannWhitney test showed no significant difference in the change rate of MCV after eradication between the groups with and without GHPs(P=0.892).CONCLUSIONH.pylori eradication therapy prevented weight loss and subclinical IDA in elderly individuals.GHPs were not associated with subclinical IDA.展开更多
Objective： To observe the clinical effects of ZHAO＇s thunder-fire moxibustion in the treatment of insomnia in heart-spleen deficiency. Methods： 70 patients were randomly divided into two groups, 35 cases in the tre...Objective： To observe the clinical effects of ZHAO＇s thunder-fire moxibustion in the treatment of insomnia in heart-spleen deficiency. Methods： 70 patients were randomly divided into two groups, 35 cases in the treatment group, managed by thunder-fire moxibustion and acupuncture, 35 cases in the control group, managed by single acupuncture treatment. Results： The results showed cure in 8 cases, remarkable effect in 15 cases, effect in 10 cases, failure in 2 cases and the total effective rate in 91.4% in the treatment group, and cure in 4 cases, remarkable effect in 11 cases, effect in 11 cases, failure in 9 cases, and the total effective rate in 74.2% in the control group. The difference is statistically significant in comparison of the total effective rates between the two groups （P 〈 0.05）. Conclusion： Thunder-fire moxibustion gives a better therapeutic effect in the acupuncture treatment of insomnia in heart-spleen deficiency.展开更多
Objective： To observe the clinical efficacy of acupuncture combined with Shen Zao An Shen Tang for insomnia due to deficiency of the heart and spleen, investigate the law of treating insomnia based on syndrome differ...Objective： To observe the clinical efficacy of acupuncture combined with Shen Zao An Shen Tang for insomnia due to deficiency of the heart and spleen, investigate the law of treating insomnia based on syndrome differentiation, and thus provide evidence for treatment based on differentiation of insomnia in traditional Chinese medicine. Methods： A total of 62 cases with insomnia due to deficiency of the heart and spleen were randomized into a combined acupuncture and Chinese herbal formula group and a Western medication group, 31 cases in each group. Acupuncture and self-made Shen Zao An Shen Tang were employed in the former, while Estazolam was used in the latter. After a 28-day treatment, the clinical efficacy, sleep efficiency, sleep dysfunction rating scale （SDRS） and adverse reactions in the two groups were observed and compared. Results： The total effective rate in the combined acupuncture and Chinese herb formula group was 96.8%, versus 74.2% in the Western medication group, showing a statistically significant difference （P〈0.05）. After treatment, the sleep efficiency ratios in both groups were significantly increased （P〈O.01, P〈0.05）, and there was a between-group statistically significant difference （P〈0.05）. Also, the SDRS scores in both groups were decreased （P〈0.01, P〈0.01） and there was a between-group statistically significant difference （P〈0.01）. In addition, the adverse reaction rate in the combined acupuncture and Chinese herb formula group was significantly lower than that in the Western medication group （P〈0.05）. Conclusion： Combining acupuncture and Chinese herb formula can obtain a substantial clinical efficacy for insomnia due to deficiency of the heart and spleen and improve the patients＇ sleep quality. Compared with Estazolam, it is better in effect and less in adverse reactions.展开更多
文摘Iron deficiency anemia(IDA)is common and often under recognized problem in the elderly.It may be the result of multiple factors including a bleeding lesion in the gastrointestinal tract.Twenty percent of elderly patients with IDA have a negative upper and lower endoscopy and two-thirds of these have a lesion in the small bowel(SB).Capsule endoscopy(CE)provides direct visualization of entire SB mucosa,which was not possible before.It is superior to push enteroscopy,enteroclysis and barium radiography for diagnosing clinically significant SB pathology resulting in IDA.Angioectasia is one of the commonest lesions seen on the CE in elderly with IDA.The diagnostic yield of CE for IDA progressively increases with advancing age,and is highest among patients over 85 years of age.Balloon assisted enteroscopy is used to treat the lesions seen on CE.CE has some limitations mainly lack of therapeutic capability,inability to provide precise location of the lesion and false positive results.Overall CE is a very safe and effective procedure for the evaluation of IDA in elderly.
文摘Even mild iron deficiency anemia, as defined by the World Health Organization, is associated with increased mortality and significant morbidity in elderly individuals who are cancer free. Yet, anemia in the elderly is often dismissed as a benign sign of aging. This problem is exacerbated by the fact that elderly individuals often suffer from gastrointestinal complaints that preclude treatment with iron supplements by mouth. The FDA has approved two brands of injectable iron for treating such patients. Nonetheless, a major American health maintenance organization refuses to treat elderly patients with injectable iron, even when it is indicated, unless their anemia is associated with cancer. This may well reflect a public health crisis afflicting many elderly residents of the United States.
文摘Background The latest studies presented at the American Heart Association (AHA) meeting on heart failure and the update of the European Cardiology Society’s (ECS) recommendations on heart failure in 2016 recommend intravenous iron supplementation in patients with heart failure, reduced ejection fraction and iron deficiency for improves walking performance and quality of life, and reduces morbidity. In the present study, we investigated the prevalence of iron deficiency in heart failure patients aged 75 years or older, as there is currently no data on these patients. Methods We performed an observational study on hospitalized patients in Geriatric Cardiology Department. Among the 462 patients hospitalized during eight months, 176 were eligible for inclusion;22 patients was significant interference with an inflammatory syndrome (high ferritin with high C-reactive protein), and for 13 patients iron-related data were not available. For each patient included, a complete iron assessment and type of heart failure was available. Results A total of 141 patients were included, the mean age was 88 years (range: 75–101), and there were 52 (36.9%) of patients with reduced ejection fraction (EF), 37 (26.2%) with mid-range EF, and 52 (36.9%) with preserved EF. Irrespective of heart failure type, 73.8% had iron deficiency (95% CI: 65.7%–80.8%);this was found in 57.7%(95% CI: 43.2%–71.3%) of those with reduced EF, 78.4%(95% CI: 61.8%–90.2%) of those with mid-range EF, and 86.5%(95% CI: 74.2%–94.4%) of those with preserved EF (P = 0.003). Conclusion The prevalence of iron deficiency was very high in very elderly patients with heart failure, especially those with HF with mid-range EF or HF with preserved EF.
基金supported by the grant from Shanghai Pudong New District Science and Technology Committee (No. PKJ2008-Y09)Shanghai Pudong New District Social Development Bureau (No. PDRd2006-09)
文摘Objective To investigate the status of vitamin B 12 deficiency in elderly inpatients in the department of neurology. Methods A total number of 827 patients in the department of neurology of Shanghai Punan hospital, from March 2007 to July 2008, were employed in the present study. They were 60 years or older, and the average age was 77.1±7.5 years old. All the patients were diagnosed with no severe hepatic or renal dysfunction, without any usage of vitamin B 12 during the previous 3 months before the detection. The levels of serum vitamin B 12, folate and homocysteine （Hcy） were evaluated. The patients with vitamin B 12 deficiency were screened. The resulting symptoms, positive signs of neurological examination, and the neuroelectricphysiological results were compared between patients with or without vitamin B 12 deficiency. Results Vitamin B 12 deficiency was found in 163 patients （19.71% of the total patients）, and was more prevalent in female than in male patients, also with increased incidences with aging. Patients with low levels of serum vitamin B 12 exhibited higher rate of gastrointestinal diseases, while only 9.82% of the vitamin B 12 deficient patients had megaloblastic anemia. Symptoms of vitamin B 12 deficiency included unsteadily walking in the darkness and hypopallesthesia, and some chronic diseases such as cerebral ischemia, hypertension, Parkinson＇s disease （Parkinsonism）, diabetes mellitus and coronary heart disease. Most of the vitamin B 12 deficient patients had neuroelectricphysiological abnormalities. Conclusion Vitamin B 12 deficiency is remarkably common in elderly patients in neurology department, with various and atypical clinical manifestations, and the neurological symptoms are more common than megaloblastic anemia symptoms.
文摘AIM To examine the effect of Helicobacter pylori(H.pylori)eradication therapy on the extra-gastrointestinal factors in elderly patients by a before-after observational study in community medicine.METHODSMedical records(1 May 2013-31 January 2014)of 130patients who underwent H.pylori eradication therapy with 2-year after-eradication observation in our institute were reviewed.Data on sex;age;body weight;body mass index(BMI);mean corpuscular volume(MCV);total protein;low-density lipoprotein cholesterol,triglyceride,haemoglobin A1c and haemoglobin levels and gastric hyperplastic polyps(GHPs)at eradication was extracted.Two-year after-eradication change in data was analysed by paired-sample t-test;relationship between GHPs and subclinical iron deficiency anaemia(IDA)improvement was evaluated.RESULTSThe mean patient age(median,interquartile range)at eradication was 69.6(71.5,64-77)years.Paired-sample t-tests showed that body weight,BMI and MCV increased by 0.52 kg(P=0.018),0.25 kg/m^2(P=0.006)and 0.83f L(P<0.001),respectively.The nonparametric MannWhitney test showed no significant difference in the change rate of MCV after eradication between the groups with and without GHPs(P=0.892).CONCLUSIONH.pylori eradication therapy prevented weight loss and subclinical IDA in elderly individuals.GHPs were not associated with subclinical IDA.
文摘Objective： To observe the clinical effects of ZHAO＇s thunder-fire moxibustion in the treatment of insomnia in heart-spleen deficiency. Methods： 70 patients were randomly divided into two groups, 35 cases in the treatment group, managed by thunder-fire moxibustion and acupuncture, 35 cases in the control group, managed by single acupuncture treatment. Results： The results showed cure in 8 cases, remarkable effect in 15 cases, effect in 10 cases, failure in 2 cases and the total effective rate in 91.4% in the treatment group, and cure in 4 cases, remarkable effect in 11 cases, effect in 11 cases, failure in 9 cases, and the total effective rate in 74.2% in the control group. The difference is statistically significant in comparison of the total effective rates between the two groups （P 〈 0.05）. Conclusion： Thunder-fire moxibustion gives a better therapeutic effect in the acupuncture treatment of insomnia in heart-spleen deficiency.
基金supported by Heilongjiang Administration of Traditional Chinese Medicine(No.ZHY12-Z030)
文摘Objective： To observe the clinical efficacy of acupuncture combined with Shen Zao An Shen Tang for insomnia due to deficiency of the heart and spleen, investigate the law of treating insomnia based on syndrome differentiation, and thus provide evidence for treatment based on differentiation of insomnia in traditional Chinese medicine. Methods： A total of 62 cases with insomnia due to deficiency of the heart and spleen were randomized into a combined acupuncture and Chinese herbal formula group and a Western medication group, 31 cases in each group. Acupuncture and self-made Shen Zao An Shen Tang were employed in the former, while Estazolam was used in the latter. After a 28-day treatment, the clinical efficacy, sleep efficiency, sleep dysfunction rating scale （SDRS） and adverse reactions in the two groups were observed and compared. Results： The total effective rate in the combined acupuncture and Chinese herb formula group was 96.8%, versus 74.2% in the Western medication group, showing a statistically significant difference （P〈0.05）. After treatment, the sleep efficiency ratios in both groups were significantly increased （P〈O.01, P〈0.05）, and there was a between-group statistically significant difference （P〈0.05）. Also, the SDRS scores in both groups were decreased （P〈0.01, P〈0.01） and there was a between-group statistically significant difference （P〈0.01）. In addition, the adverse reaction rate in the combined acupuncture and Chinese herb formula group was significantly lower than that in the Western medication group （P〈0.05）. Conclusion： Combining acupuncture and Chinese herb formula can obtain a substantial clinical efficacy for insomnia due to deficiency of the heart and spleen and improve the patients＇ sleep quality. Compared with Estazolam, it is better in effect and less in adverse reactions.
