Predictive Strategies to Reduce the Risk of Rehospitalization with a Focus on Frail Older Adults: A Narrative Review

Frailty is a geriatric syndrome that has physical, cognitive, psychological, social, and environmental components and is characterized by a decrease in physiological reserves. Frailty is associated with several adverse health outcomes such as an increase in rehospitalization rates, falls, delirium, incontinence, dependency on daily living activities, morbidity, and mortality. Older adults may become frailer with each hospitalization; thus, it is beneficial to develop and implement preventive strategies. The present review aims to highlight the epidemiological importance of frailty in rehospitalization and to compile predictive strategies and related interventions to prevent hospitalizations. Firstly, it is important to identify pre-frail and frail older adults using an instrument with high validity and reliability, which can be a practically applicable screening tool. Comprehensive geriatric assessment-based care is an important strategy known to reduce morbidity, mortality, and rehospitalization in older adults and aims to meet the needs of frail patients with a multidisciplinary approach and intervention that includes physiological, psychological, and social domains. Moreover, effective multimorbidity management, physical activity, nutritional support, preventing cognitive frailty, avoiding polypharmacy and anticholinergic drug burden, immunization, social support, and reducing the caregiver burden are other recommended predictive strategies to prevent post-discharge rehospitalization in frail older adults

Prognostic Significance of CD44 and c-erb-B2 Protein Overexpression in Patients with Gastric Cancer

Background/Aims: The aim of the study is to evaluate the correlation between c-erb-B2 and CD44 overexpression and survival of patients with gastric cancer. Methodology: The paraffin blocks of 48 patients with gastric carcinoma were retrospectively analyzed. The pathological specimens were stained with CD44 and c-erb-B2 by immunohistochemical methods. Results: The positivity of c-erb-B2 was detected in 9 patients. In six of them, predominantly strong cytoplasmic staining was observed. The remaining three tumors were predominantly membranous stained. No correlation was found between the c-erb-B2 positivity and overall survival (OS). Seventeen specimens (35.4%) were CD44 positive, all localized in cell membrane. The median OS time of CD44 positive patients was worse than that of patients with CD44 negative (11 vs. 17 months, respectively). This difference was statistically significant (p=0.03). In 5 patients both CD44 and c-erb-B2 were detected as positive. However, there were 23 patients with both CD44 negative and c-erb-B2 negative. The median OS time for patients with both CD44 and cerb-B2 negative was better than those of patients with both CD44 and c-erb-B2 positive (37 vs. 11 months, respectively, p=0.03). The relationship between CD44 and c-erb-B2 positivities and clinicopathological factors (p>0.05). Conclusions: Our results showed that there was no correlation between c-erb-B2 positivity and OS, except for CD44. In addition, we found significant association of simultaneous positivities of c-erb-B2 and CD44 with OS of patients with gastric cancer. CD44 alone can be taken as a prognostic factor and also simultaneous overexpression of CD44 and c-erb-B2 may be used as a marker of poor prognosis

A STUDY ON EFFICACY OF HYDRATION ADMINISTERED BY SUBCUTANEOUS INFUSION IN GERIATRIC PATIENTS

Introduction: The study was conducted to investigate the effectiveness of subcutaneous infusion (Hypodermoclysis) in geriatric patients with mild and moderate dehydration

Gastric pneumatosis intestinalis associated with malignancy: An unusual case report

Pneumatosis intestinalis (PI) is an uncommon disease defined as gas-filled cysts that are found in the wall of the gastrointestinal (GI) tract. The exact causes of PI are still unclear, but it may associated with coexisting diseases, such as some GI disorders, connective tissue disease, some medication and drugs, and rarely malignancy. The most common localization is the small intestine. Gastric PI secondary to malignancy has been rarely documented. We report on a 94-year-old man with gastric PI associated with inoperable adenocarcinoma localized in the duodenum. Following the gastrojejunostomy and choledochojejunostomy bypass, his general condition improved and PI disappeared, but he died due to poor performance status and malignancy 6 mo later. We suggest that in patients presenting with PI, malignancy should be considered in the differential diagnosis

The association between polypharmacy, anticholinergic burden, comorbidities, and hospital length of stay in geriatric patients

We aimed to evaluate the association between polypharmacy, anticholinergic burden, comorbidities, and hospital length of stay in older adults. We analyzed 213 older in-patient data retrospectively. Demographic data, comorbidities, length of stay, medication use, and laboratory results at admission were extracted from electronic medical records. We used a calculator to work out Anticholinergic Burden (ACB). The use of five or more drugs was considered polypharmacy. The mean age was 78±7.3 years; 54.5% of patients were female. The mean length of stay of patients was 20.7±13.8 days. The prevalence of polypharmacy was 66.2% (n:141), and 182 (85.4%) of the patients were treated with anticholinergic medications. 52.6% had high ACB scores (ACB score 3 and more). The most used drugs with anticholinergic potential were metoprolol (40.4%) and metformin (32.4%). Polypharmacy was identified as a risk factor for the presence of high ACB with 86% sensitivity and 55% specificity. (OR 0.758 95% CI: 0.692-0.824, p: [Med-Science 2023; 12(3.000): 661-6

A RARE CAUSE OF DYSPNEA: TWO MYXOMA CASES

Myxomas are the most common types of primary cardiac tumors. Primary cardiac myxomas are typically encountered in the left atrium. Although they are generally benign on histopathological examination, they may cause cerebovascular embolism and mitral valvular obstruction due to their critical location. Myxomas are rarely asymptomatic. Here we report two myxoma cases, a 65 years old male and a 62 years old female, who were admitted to the hospital with rather different clinical presentations. The first patient had only mild dyspnea, whereas the second one presented with symptoms and signs of heart failure besides dyspnea. Albeit not included among the initial differential diagnoses, giant left atrial myxomas were detected in each patient on echocardiographic studies performed during their clinical evaluation. Masses were surgically excised and were pathologically diagnosed as myxomas. We present these two cases in order to underline the fact that although encountered rarely, cardiac myxoma should be included in the differential diagnosis of dyspnea in everyday practice

Relation of ambulatory blood pressure measurement and cognitive functions in hypertensive elderly patients

Introduction Hypertension is an important risk factor for dementia as much as the morbidity and mortality of cardiovascular disease. Sustained hypertension is also more related to that risk. The aim of the study was to determine the relationship between 24-h ambulatory blood pressure monitoring (ABPM) and cognitive functions in elderly hypertensive patients without comorbid diseases which may deteriorate cognitive functions