[Show abstract][Hide abstract] ABSTRACT: To compare patient's characteristics, clinical data, and rates of chemotherapy discontinuation in advanced NSCLC (non-small cell lung cancer) patients treated with platinum-based association chemotherapy (elderly vs. younger counterparts). To evaluate if there are certain factors that can predict discontinuation of chemotherapy.
A retrospective analysis of all cases of advanced NSCLC treated with either cisplatin-gemcitabine or cisplatin-vinorelbine at the Regional Institute of Oncology Iaşi between January 2012 and December 2013 was performed. Patients were divided into two groups: over 70 years old and under 70 years old. Patient's characteristics and clinical data (including whether or not the patient discontinued treatment) were recorded for each case.
The elderly patients had more comorbidities (p = 0.003), were prescribed a larger number of pills (p = 0.02), and had longer periods of hospitalisation (p = 0.005). No difference in toxicity was noted between the two groups. Five patients chose to discontinue chemotherapy in the elderly group. Only two patients made the same choice (p = 0.02) in the younger group. Correlation analysis revealed that refusal of further chemotherapy was associated with the length of hospital stay, number of pills per day, and smoking status.
Geriatricians should minimise iatrogeny and polypharmacy by optimising long-term treatment. This will increase the chance that elderly patients will not discontinue chemotherapy. Hospital stay should be reduced to a minimum. As life span increases so does the number of elderly patients with cancer; it is vital to understand and prevent the causes of chemotherapy discontinuation in order to achieve optimal therapeutic results.
[Show abstract][Hide abstract] ABSTRACT: Hypoalbuminemia is considered an independent predictor of mortality, especially in elderly patients. It is common in patients with congestive heart failure, when is due to several mechanisms: increased volume of distribution, significant stasis in the mesenteric circulation and altered protein metabolism in the liver. These alterations are even more pregnant when tricuspid regurgitation is associated or aggravated by different risk factors (recent infections, anemia, hyperthyroidism). We present the case of an elderly patient with severe hypoproteinemia and important hypoalbuminemia associated with congestive heart failure and aggravation of tricuspid regurgitation. The differential diagnosis concluded that hypoalbuminemia was influenced by tricuspid regurgitation as it enhanced liver dysfunction and enteral protein absorption due to increased stasis in mesenteric system. On the other hand, hypoalbuminemia contributed to the progression of heart failure by favoring myocardial edema, volume overload, and diuretic resistance. This is why correct management of this situation should include removal of subclinical excess of fluid and renutrition. A multidisciplinary approach is needed in order to achieve a good control of the symptoms and a significant improvement of quality of life.
[Show abstract][Hide abstract] ABSTRACT: Aim:
The present study aims to evaluate whether ascorbic acid (AA) and curcumin, two substances with redox properties, have similar effects on different models of pain in mice.
Materials and methods:
This study included a total of 28 mice that were divided into four groups. One group (AA) received intraperitoneally 500 mg/kg b.w. AA for 21 days and the 2-nd group (curcumin) received 120 mg/kg b.w. curcumin by gastric gavage for two weeks. Other two groups serve as control and received vehicle in a dose--time manner similar to that of the treated groups. The pain models (oro-facial formalin induced pain, paw formalin induced pain and visceral pain) were performed 24 h after the last dose.
When compared with control groups, curcumin significantly decreases pain perception in oro-facial (p = 0.01 1-st phase, p = 0.002 2-nd phase) and paw formalin induced pain (p = 0.04 1-st and 2-nd phase) while AA stimulates pain perception in acid acetic induced visceral pain (p = 0.05) and increases oro-facial inflammatory pain induced by formalin ( p = 0.02) but demonstrates analgesic effects on paw formalin induced pain (p = 0.003 1-st phase, p = 0.01 2-nd phase).
ROS production is important in pain modulation. Structures involved in the process of pain have different antioxidant defense capacities. Curcumin and AA are able to modulate pain perception, but beside their antioxidant capacities, there are other mechanisms involved.
[Show abstract][Hide abstract] ABSTRACT: Ageing is inevitably associated with a decline in physiologic reserves. Frailty results from reaching a threshold of decline across multiple organ systems. By consequence, it is associated with a high vulnerability and reduced ability to maintain homeostasis. This vulnerability is not only age-related, but also related to disability and comorbidity, as illustrated by three clinical cases. Sarcopenia, which is defined as age-related loss of muscle mass, is considered to be a central manifestation of frailty. In addition to being highly prevalent in elderly population, frailty also exerts a substantial impact on quality of life. As it is extremely challenging by defying conventional medication and involving new therapeutically approaches, frailty fully qualifies as a new geriatric syndrome.
[Show abstract][Hide abstract] ABSTRACT: Schizophrenia as severe mental disorder is characterized
by a disintegration of the process of thinking and of emotional
responsiveness whereas the underlying mechanisms of
schizophrenia are complex and still discussed. The objective of this
study is to find out if patients with schizophrenia and their healthy
first-degree relatives have abnormal autonomic nervous
system (ANS) activity by measuring cardiac indices as QT
variability index (QTVI). Moreover, it is useful to study if ANS
dysfunction could play an important role in schizophrenia and if
abnormal functioning could be retrieved by patients' healthy first
degree relatives. Also, a parallel experiment monitored QTVI in
healthy controls before, during and after a new complex stress test
named Mannheim Multicomponent Stress Test (MMST). As QT
variability analysis results were not significantly different during
MMST versus normal state, we concluded that short-term stress
has no fundamental impact on ECG morphology in healthy
subjects. However, patients with schizophrenia revealed an
increased QTVI that indicates structural changes of ECG
morphology in those patients. These findings were obviously
independent from the findings regarding to healthy subjects under
stress and healthy subjects (basic measurement of 30min).
IEEE 4th International Conference E-Health and Bioengineering – ”EHB 2013”, IASI, Romania; 11/2013
[Show abstract][Hide abstract] ABSTRACT: A complex goal in biomedical information technology today is the design and implementation of telemedicine and e-health solutions, which provide (chronic) patients and elderly people services that can enhance their quality of life.
We used wireless sensor network technology, low-power integrated embedded systems and wireless communications, which have enabled us the design of low-cost, miniature, precise and intelligent physiological sensor modules. These modules are capable of measuring, processing, communicating one or more physiological parameters, and can be integrated into a wireless personal area network (WPAN).
We have designed, deployed, produced and tested both hardware and software medical sensors for WPAN, dedicated to vital signs acquisition, processing and transmitting, as well as the whole telemedical system for these physiologic parameters monitoring in real time.
This paper is dedicated to the most complex Romanian telemedical pilot project, TELEMON, that has as goals the design and implementation of a system for automatic and complex telemonitoring, everywhere and every time, in (almost) real time, of the vital signs of persons with chronic illnesses, of elderly people, of those having high medical risk and of those living in isolated regions. The final objective of this pilot project is to enable personalized telemedical services, and to act as a basis for a public service for telemedical procedures in Romania and abroad.
[Show abstract][Hide abstract] ABSTRACT: When assessing an acute coronary syndrome (ACS) by means of high serum levels of creatine kinase (CK) and its MB fraction (CK-MB), one must keep in mind that there are several other causes for an increase of these markers, such as myocarditis, pericarditis, heart failure, severe aortic stenosis, stroke, renal failure, malignant hyperthermia, Reye syndrome, polymyositis, and borreliosis (1). Also, there are cases when CK-MB is falsely increased due to certain abnormalities that occur in the CK isoenzymes. One such example is the formation of the so-called macro-creatine kinase complexes (macro-CK) that give a false increase of the CK-MB fraction. We report two clinical cases where macro-CK was the cause of apparent increase in serum CK and CK-MB: in a 79-year old male with a history of coronary disease and a 82-year old female with permanent atrial fibrillation.
[Show abstract][Hide abstract] ABSTRACT: Therapeutic adherence represents the extent to which the patient's behavior follows medical recommendations. It is a complex process that strongly influences the quality of life of the each and everyone. We performed a retrospective study that included 126 very old patients (≥ 80 years old). Patients' data were recorded in a database that contained demographic and clinical data and information about patient's current medication. Information about therapeutical adherence was collected for each person by way of a questionnaire, which consisted in verifying their knowledge about their diet and medication and comparing it with information from past medical records or family members. We found several factors that influence adherence to treatment: living in the urban area, the number of pills prescribed by the general practitioner and a strong familial and financial support. Fighting non-adherence should rely upon two complementary directions: the multidisciplinary medical approach and the telemonitoring and e-health systems.
E-Health and Bioengineering Conference (EHB), 2013; 01/2013
[Show abstract][Hide abstract] ABSTRACT: Introduction
We evaluated effects of diabetes mellitus on cognitive function in non-demented older patients.
We included 537 older patients with diabetes mellitus consequently admitted to our departments. Age range: 65 - 95 years, mean 80; 73% women, 27% men. Three age groups were considered: young-old (65-74 years), old-old (75-84 years), very-old (>84). We excluded patients with past medical history of stroke, dementia, depression (score of >/=8 on the Short version of Geriatric Depression Scale). Cognitive function was evaluated using MMSE, Clock-drawing Test, Five Words Test and Stroop Test (score >42 normal). HbA1c assessed long-term response to anti-diabetic treatment (>7% -abnormal).
Irrespective of age-group, past medical history of diabetes mellitus >10 years correlated with higher prevalence of mild cognitive impairment (correlation coefficient r=0.86). Very-old group had better scores on cognitive tests, but maximum glucose levels were lower, possibly due to selection effect. Significant difference was noticed between scores on Five Words Test and Stroop Test in patients with HbA1c >10% as compared to those with HbA1c < 7% (p<0.005) irrespective of age-group and gender.
Poor control of diabetes mellitus is a significant risk factor for cognitive impairment in elderly. Moreover, diabetes mellitus itself makes these patients prone to cognitive impairment possibly due to macro- and microvascular complications of this metabolic disease. A systematic screening of cognitive function needs to be performed in elderly diabetics to establish an early diagnosis of cognitive impairment and start adequate and timed therapy to slow down progression of cognitive disorder.
- DOI: http://dx.doi.org/10.1016/j.eurger.2012.07.360
8th Congress of the EUGMS, Brussels, 26th-28th September 2012, Brussels, Belgium; 09/2012
[Show abstract][Hide abstract] ABSTRACT: Introduction
Falls are frequently encountered in older people and often may be caused by orthostatic hypotension that has several etiologic factors. Objective of the research was to apply a postural exercise program in older patients aiming at reducing postural hypotension that was not due to side effects of medicines.
We included 416 patients, age range 65–85, divided into two age-matched groups, both presenting postural hypotension: Study Group - 195 subjects that followed specific postural exercises program and Control Group - 221 subjects without this program. Exercises were performed 15 minutes three times daily for one month. We excluded patients with cognitive impairment, on medication that could induce postural hypotension, with severe heart conditions, severe joint diseases and stroke sequelae that could interfere with program.
At inclusion t-test for independent samples showed significant orthostatic reduction in Systolic blood pressure for both Study and Control Group: t= –4.370; statistical significance p<0.001; confidence level 95%; confidence interval: –8.2148 and –3.1886. After 30 days of postural exercises program we noticed a significant reduction in Systolic blood pressure difference between orthostatic and recumbent position in Study Group patients (t-test for paired samples: t= –3.270, p<0.005), but not in Control Group (t=1,526, p=0.171). Moreover, incidence of falls was significantly lower (p<0.001) in Study Group as compared to Control. Study Group subjects tolerated better standing and walking.
The program could act by re-training carotid sinus baroreceptors through a postural stimulation and this could reduce the risk of falls in older patients.
8th Congress of the EUGMS, Brussels, 26th-28th September 2012, Brussels, Belgium; 09/2012
[Show abstract][Hide abstract] ABSTRACT: This paper presents a Romanian telemedical project that has as goals researches, design and implementation of an electronic-informatics-telecom
and scalable system, that allows the automatic and complex telemonitoring, everywhere and every time (at home, in hospitals,
at work, of mobile subject, etc), in (almost) real time, of the vital signs of persons with chronic illnesses, of elderly
people, of those having high medical risk and of those with neuro-locomotor disabilities. The main objective of this pilot
project is to enable personalized medical teleservices delivery and patient safety enhancement based on an earlier diagnosis,
and to act as basis for a public service for telemedical procedures.
Keywordstelemedicine-biomedical equipment-biomedical signal analysis-wireless personal area network-falldetection
[Show abstract][Hide abstract] ABSTRACT: The current common goal in medical information technology to-day is the design and implementation of telemedicine solutions, which provide to patients services that enhance their quality of life. Advances in wireless sensor network technology, the overall miniaturization of their associated hard-ware low-power integrated circuits and wireless communications have enabled the design of low-cost, miniature, and intelligent physiological sensor modules with applications in the medical industry. These modules are capable of mea-suring, processing, communicating one or more physiological parameters, and can be integrated into a wireless personal area network. This paper is dedi-cated to the most complex Romanian telemedical pilot project, TELEMON, which has as goals design and implementation of an electronic-informatics-telecommunications system, that allows the automatic and complex telemoni-toring, everywhere and every time, in (almost) real time, of the vital signs of persons with chronic illnesses, of elderly people, of those having high medical risk and of those living in isolated regions. The final objective of this pilot project is to enable personalized medical teleservices delivery, and to act as a basis for a public service for telemedical procedures in Romania and abroad.
[Show abstract][Hide abstract] ABSTRACT: Right heart infective endocarditis in an elderly patient with no previous known risk factors is a very rare situation (even if subacute infective endocarditis has the same chance of occurrence at either a young person, or an elderly patient). We present the case of a 75-years old patient, with no previous cardiac history, addressed to our clinic with nonspecific septic symptoms associated with an edematous syndrome. The patient was treated for right heart valve infective endocarditis; a particularity may be the fact not all Duke criteria were respected. Iatrogeny was involved, our patient having administered a 7-day antibiotic treatment before hospital addressing. The therapeutic probe was positive: excellent evolution under treatment. Few cases of infective endocarditis of the tricuspid valve were reported worldwide, in which the source of infection was unknown in about 80% of cases. In two pediatric cases reported, tricuspid endocarditis was caused by Staphylococcus aureus septicemia following upper respiratory infection. This may also occur in adult cases. Further investigations should be carried out in the future to elucidate the source of infection. Isolated right-sided endocarditis should be included in the differential diagnosis of patients with febrile syndrome, respiratory symptoms and predisposing disease, even when they do not have a pacemaker and are not intravenous-drug users (IVDU).
[Show abstract][Hide abstract] ABSTRACT: This paper presents the most complex Romanian telemedical project, TELEMON, that has as goals researches, design and implementation of an electronic-informatics-telecom and scalable system, that allows the automatic and complex telemonitoring, everywhere and every time (at home, in hospitals, at work, of mobile subject, etc), in (almost) real time, of the vital signs of persons with chronic illnesses, of elderly people, of those having high medical risk and of those with neuro-locomotor disabilities. The main objective of this pilot project is to enable personalized medical teleservices delivery and patient safety enhancement based on an earlier diagnosis, and to act as basis for a public service for telemedical procedures.