Autoimmune hepatitis treatment in the elderly: A systematic review

BACKGROUND Autoimmune hepatitis (AIH) is a rare chronic inflammatory liver disease with a high risk of progression to liver cirrhosis. The initial treatment for AIH usually includes a steroid, with or without azathioprine. AIH can present at any age;however, the most effective and safe induction treatment for AIH in the elderly remains unclear. AIM To systematically review available data on both effectiveness and safety of AIH treatments in elderly subjects. METHODS To identify studies on AIH induction treatment in elderly patients (≥ 60 years of age), an electronic research was performed (PubMed, EMBASE and Cochrane Library databases) until February 2019. Eligible studies were selected through screening of titles and abstracts, followed by full-text critical evaluation. After risk of bias assessment, data on study designs, interventions, and outcomes were extracted and reviewed. RESULTS Among the 1736 retrieved papers, 15 studies were selected. Out of them, eight studies were excluded because of a critical risk of bias. The remaining seven studies included 789 patients and out of them 239 subjects were elders. First-line treatment was a steroid either alone or in combination with azathioprine in most patients (87.6%) and only one study investigated the effect of combined steroid and mycophenolate mofetil therapy. Standard therapy was effective in inducing remission in the elderly. Moreover, treatment failure and relapses occurred less often in the elderly compared to younger people.CONCLUSION Treatment of AIH is challenging in elderly patients. This systematic review confirms the efficacy and safety of standard induction treatment for AIH in the elderly. Available evidence is insufficient to draw any conclusion on the effect of novel AIH treatments in elderly subjects.

Breakdown of Kidney and Ureteral Stones Using Extracorporeal Shock Wave Lithotripsy in Zakho City

In the present study, investigation of extracorporeal shock wave lithotripsy in Zakho City for breakdown kidney and ureteral stones has been carried out. The data were collected from the center of breakdown kidney stones in Zakho hospital. A total of 34 patients (25 male and 9 female) of ages ranged from 20 - 60 years were treated with ESWL. The patient harboring 24 renal stones and 10 ureteral stones of size ranged from 7 to 23 mm of almost patients are 8 mm and composed of calcium oxalate. The study has been conducted taking in to consideration the parameters (type, sizes, composition and location of stone as well as region and ages of patients, also power, number of shock wave and session). The results show that the number of shock wave decreases nearly exponentially with the ages of patients for calcium oxalate stone of size 8 mm under constant power 4 watt while it tends to increase according to increasing stones size for the patients of ages 20 - 30 years. The size of calcium oxalate stones decreases nearly exponentially with the patients’ ages for workers in Zakho city. Also for same size 8 mm of (calcium, phosphate, and oxalate) stones and different regions of zakho city, the number of shock waves decreases according to increasing ages of patients. Contrary to that for certain size of stones 8 mm, the number of shock wave starts to increase from uric acid to maximum value for calcium oxalate stone for the adult patients of age’s 22 up to 30 years. However for elders ages 30 - 60 years and different regions, the size of renal and ureteric stones increases from the minimum value for calcium, phosphate, oxalate to maximum value for calcium oxalate stone only. Uric acid stone requires minimum power to break, while the calcium oxalate needs maximum power to fragment due to its hardness composition. Later number of session of shock wave required for crushing each stones size increases according to increasing its size while its variation due to enhancing patients ages for calcium oxalate of size 8 mm results in nearly a decreasing exponential behavior.

Extracorporeal Shock Wave Lithotripsy Treatment for Renal and Ureteral Stones in Duhok City

The present study reports the results of extracorporeal shock-wave lithotripsy treatment for renal and ureteral stones in Duhok city. The data were collected from the center of breakdown kidney stones in Duhok hospital. There were a total of 40 patients (25 males and 15 females) aged from 20 to 60 years old. The patients harboring (23 renal and 17 ureteral) stones of size ranged from 7.5 to 20 mm. Almost stones are of average size 9 mm and composed of uric acid, calcium and cystine stones. The study has been carried out by taking into consideration the parameters (type, sizes, composition and location of stone as well as region and ages of patients, also power, number of shock wave and sessions). The results show that the stones size increases according to increasing ages of patients (male and female) for uric acid ureter stone and calcium (renal, ureter) stones. Also (renal, ureter) stone size for patients aged from 20 to 30 years old increases from the minimum value for phosphate to maximum value for cystine stones, while for patients aged from 40 to 60 years old, the minimum size is obtained for calcium oxalate and the maximum size for calcium only. On the other hand, for uric acid stones of average size 9 mm, number of shock wave and sessions as well as the power required to breakdown the stones decrease nearly exponentially according to enhancing patients’ ages. At the same time, it's found that for adult patients (20 - 30 years old), number of sessions and the power of shock wave decrease also according to increasing size of calcium and cystine stones. Contrary to that, for the same ages and renal, uretral cysteine stones number of shock wave needed to breakdown large stones will be increased.

What the Hell Am I Doing Here？ A Look at a Series of Geriatric Centers, Profile of the Institutionalized Persons and Reasons for Admission

The main objective of this study was always to know the profile of the institutionalized people in our environment, to know their reality： age, age of admission, level of dependency and evolution during their stay, years of stay, number of children, reason for admission. We use data from more than 600 patients from different residences of different backgrounds： public and private, lay and religious, rural and urban. We performed a descriptive study expressing the results in percentages with standard deviation and later evaluated the statistical significance of the differences using the student＇s t-test for the quantitative and Chi-square variables to compare qualitative variables. The results of the study are numerous and of diverse nature, because of their extension, from the general profile of the resident, to the important gender differences, attributed in principle to the different roles of each gender in the studied generations. There are also differences depending on the funding, the reason for admission or the environment. This is at the end only the beginning of a large comparative study with non-institutionalized population, in order to compare this population.

Assessment of advanced age candidates for liver transplantation warrants more caution

For patients with fulminant liver failure and end-stage liver disease,liver transplantation remains the only effective treatment.Over the years,as a result of the ageing population,the average age of liver transplant donors and recipients has increased and currently about one quarter of patients receiving transplantation in the United States are above the age of 65.Recently,a study reported that patients aged 65 years or older had lower one-year survival compared to a younger cohort.Herein,we express our opinion about this interesting publication.

CAS-Complications Rate and Relation to Risk Factors

Purpose: The aim of the study was to evaluate the risk factors for CAS with cerebral protection and the incidence of complication in patients with severe carotid stenosis. Materials and Methods: Overall, 95 consecutive patients with an average age of 64.67 years (28 - 83) (16 women (17%) and 79 men (83%)) were enrolled in the prospective monocentric study. Indication for CAS was symptomatic carotid stenosis ≥70% (n = 60 (63.16%)) or asymptomatic stenosis ≥80% (n = 35 (36.84%)) according to the NASCET criteria on DSA, which were not suitable for surgery. Results: From the selected risk factors, the most frequently found were arterial hypertension in 87 patients (91.6%), ischemic heart disease in 70 (73.7%), hyperlipidemia in 61 (64.2%), history of stroke in 43 (45.3%), diabetes mellitus in 35 (36.8%), smoking in 13 (13.7%), and age more than 75 years in 9 (9.5%). Significantly more frequent complications in elderly patients (more than the age of 75 years) were experienced: TIA (p = 0.049), early death (p = 0.049), restenosis (p = 0.04), and overall mortality (p = 0.04). Conclusion: Among the studied risk factors, only patients more than the age of 75 years were affected by the incidence of serious complications.