An under-diagnosed geriatric syndrome: sleep disorders among older adults.

Introduction: Sleep disorders are commonly under-diagnosed in the geriatric population. We aimed to determine the prevalence of sleep problems among older adults admitted to the geriatrics out-patient clinic. Methods: Two hundred and three patients (136 female) older than 75 years of age were included in the study. Patients underwent comprehensive geriatric assessment, including identification of sleep problems using the Sleep Disturbance Scale, Rapid eye movement (REM) sleep behavior disorder (RBD) Single-Question Screen questionnaire (RBD1Q) and The Johns Hopkins Restless Leg Syndrome Severity Scale. Demographic and clinical data including age, sex, medications, comorbid diseases, body mass index and functional scores was noted. Results: The mean age of the patients was 80.92\ub14.3 years. 35.5% of the patients had findings of REM-SBD and 32.5% of the patients had restless legs syndrome. Ninety-seven percent of the patients answered \u2018yes\u2019 to at least one of the sleep disturbance scale questions. There was no significant difference between male and female groups. Conclusion: We observed that sleep disorders were common among older adults. For this reason, the course and quality of sleep should be examined in all patients as a routine part of comprehensive geriatric assessment

Mucosa-associated lymphoid tissue lymphoma of the duodenum together with multiple intra-abdominal thromboses and hepatitis C virus infection: a case report

Mucosa associated lymphoid tissue MALT lymphoma is a low grade malignancy that arises most commonly from the gastric mucosa. Small intestinal involvement is very rare. The causative relationship between Helicobacter pylori and the gastric MALT lymphoma is a well known issue, but recently there are several data suggesting the role of hepatitis C virus (HCV) infection in the pathogenesis of lymphoma including MALT lymphoma. Herein we present a rare case of duodenal MALT lymphoma with multiple intra-abdominal thromboses together with HCV infection that was confirmed by real-time polymerase chain reaction detecting HCV-RNA within the peripheral blood mononuclear cells

Nutritional risk in hospitalized patients: impact of nutritional status on serum prealbumin

OBJECTIVE: Poor recognition and monitoring of nutritional status is the most important cause of malnutrition in hospitalized patients. The aim of this study was to assess the nutritional status of a group of patients and compare the results with their serum prealbumin levels. METHODS: Ninety-seven patients admitted consecutively to the hospital were enrolled in the study. The risk of malnutrition was assessed according to anthropometric data and the Subjective Global Assessment and Nutrition Risk Screening 2002 tools. The nutritional statuses of the patients were compared with their age, gender, body mass index, medical history, weight loss and routine biochemical analyses, including prealbumin and length of hospital stay. RESULTS: According to the Nutrition Risk Screening 2002, 57% of the patients were malnourished or at risk of malnutrition, correlating well with the Subjective Global Assessment (pOBJETIVO: Falha no reconhecimento e acompanhamento do estado nutricional é a razão mais importante da desnutrição em pacientes hospitalizados. Este estudo objetivou avaliar o estado nutricional dos pacientes e comparar os resultados com os níveis séricos de pré-albumina. MÉTODOS: Foram incluídos 97 pacientes no estudo, internados consecutivamente. O risco de desnutrição foi avaliado de acordo com dados antropométricos e com a Avaliação Subjetiva Global e Triagem de Risco Nutricional 2002. Os estados nutricionais dos pacientes foram comparados com suas idades, sexo, índice de massa corporal, histórico médico, perda de peso e análises bioquímicas, incluindo pré-albumina e tempo de permanência hospitalar. RESULTADOS: De acordo com o Triagem de Risco Nutricional 2002, 57% dos pacientes estavam desnutridos ou em risco de desnutrição, apresentando boa correlação com o Avaliação Subjetiva Global (p<0,001, r=0,700). A análise multivariada mostrou correlações positivas entre desnutrição e idade, perda de peso, malignidade e proteína reativa-C (p=0,046, p=0,001, p=0,04 e p=0,002). Um escore ³3 no Triagem de Risco Nutricional 2002 foi associado à internação prolongada (p<0,001). Houve correlação entre pré-albumina sérica e o estado nutricional, independente do número de doenças crônicas e biomarcadores de inflamação (p=0,01). A sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e valor diagnóstico da pré-albumina na avaliação do risco de desnutrição foram de 94%, 32%, 0,67, 0,78 e 69, respectivamente. Após sete dias de suporte nutricional, o risco de desnutrição caiu em 12% (p<0,001) e os níveis séricos de pré-albumina aumentaram em 20% (p=0,003). CONCLUSÃO: Ao invés de refletir o estado nutricional global do paciente, níveis séricos baixos de séricos de pré-albumina podem ser vistos como um sinal de maior risco de desnutrição, exigindo uma avaliação nutricional mais extensa. A análise sérica de pré-albumina pode ser usada para o monitoramento de pacientes recebendo suporte nutricional

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries