Depression in the elderly as a significant clinical problem

Introduction: Depression is a very common mental disorder among older people. It limits life activity and interests. It causes difficulties in making decisions or actions. It introduces somatic and emotional changes, which in older people becomes a problem on a large scale. Diagnosis of depressive disorders has very high clinical value.Depression is often associated with chronic diseases that often accompany the elderly. Material and Methods: The paper reviews literature using the EBSCO and Google Scholar databases. Articles have been analyzed using the keywords depression, depression of the elderly, care for the elderly, treatment of depression, diagnosis of depression, clinical symptoms. The article presents depression as a problem among older people, its symptoms, treatment and care for such people. Results: Treatment of depressive disorders is based on pharmacology and psychotherapy. Care and the presence of loved ones are very important. Commitment to physical activity improves emotional balance. Conclusions: Depression in older people creates a problem in terms of diagnosis and clinical aspect. Depression reduces the quality of life, which means that older people cannot perform basic life activities on their own. Reduces motivation and interest in the environment. Correct diagnosis enables quick implementation of treatment that will allow you to recover. Key words: depression, treatment, care, old age, diagnosis, epidemiology, SSRI, NSRI, helplin

Sexual dysfunction in elderly men and women

Background: The aging process of the body is inexorable and affects all areas of geriatric patient's life, including the quality of his sex life. In this case, however, also psychological and environmental problems must be taken into account in the case of diagnostics. The sexuality of elderly patients has been neglected by the medical community for many years, and even recognized by some doctors as unnecessary or bad. Currently, there is a slow change in this position, also due to the patients themselves who are looking for help in specific situations. Material and methods: Analysis of available literature, articles in the Google Scholar and PubMed database using keywords: Sexuality, Geriatrics, Dysfunctions Results: Statistics on the sexuality of the elderly give a clear picture of how great a problem this sphere of life is. The main risk factors for sexual dysfunction of the above-mentioned patients include, among others, abnormal lifestyle and urinary tract infections. In the patients' lifestyle the most important aetiological factors are incorrect diet or lack of physical activity. Men of all ages are exposed to problems, however, in the epidemiology of this dysfunction, a drastic jump after the age of 50 is noticed. It is connected with the weakening of the function of the nervous system and microcirculation in the urinary tract and the reduction of the number of hormones responsible for the functioning of sexual organs. In women, this menopause is the period that most destructively affects the quality of sexual life. Here, as in the case of men, a reduced amount of hormones has a negative effect, among others, by a reduced sexual desire or the presence of pain during intercourse. In the treatment of the above-mentioned disorders, mainly pharmacology has the largest field of action. In the treatment of sexual dysfunction, we mainly use 2 compounds and these are sildenafil and tadalafil. Conclusions: Human sexuality, especially in the case of older people, can not be a neglected subject, and dysfunctions and problems of patients treated like any other. The need to integrate interdisciplinary mode in dealing with this type of problems is more necessary. All this is connected with the fact that there is a definite deficit in publications and research on this subject, which creates a wide range of possibilities for the medical community

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

The spectral and temporal properties of fiddler crab photoreceptors in the context of predator avoidance

The ability to detect and effectively escape from predators is critical to an animal's survival, and the ability to do so effectively depends on its sensory system. Vision is the dominant if not sole sensory system fiddler crabs use for predator avoidance. In this thesis I investigate the photoreceptor properties of two fiddler crab species, Uca vomeris and Uca dampieri, and their escape behaviour under field conditions with the aim to further our knowledge of how these crabs use visual information to organise their escape behaviour. In an attempt to elucidate the spectral sensitivities of the crabs' photoreceptors, intracellular electrophysiological recordings were performed and are presented in Chapter 2. Temporal resolution of their visual system was investigated using both intracellular recordings and electroretinograms (ERGs) and presented in Chapter 3. The following two chapters present the results of behavioural experiments into the effect of the predator's elevation in the crabs' visual field on two stages of the crabs' predator avoidance response: the run home stage (Chapter 4) and the burrow descent stage (Chapter 5). I found that both species of fiddler crabs have a UV-sensitive photopigment, plus one or two photopigments with a peak sensitivity in the blue part of the spectrum (400-500 nm). Their temporal resolution, measured as critical flicker fusion frequency (CFF), was similar to other non-flying animals at around 70 Hz. When measured as integration time and time-to-peak, however, their temporal resolution was very high, comparable even to flying animals. The behavioural experiments revealed that at the run home stage, the crabs perceive objects changing in elevation as most dangerous. Additionally, when far from the burrow they respond earlier to objects appearing low in the visual field, whereas when close to their burrow, such as at the stage of the burrow descent, they are more sensitive to objects that are seen high in the visual field. These investigations into the visual system and into predator avoidance behaviours of fiddler crabs move us closer to establishing them as a model system where we understand the first stage of sensory processing, which in turn will allow us to investigate how further neural processing leads to the functional behavioural output that can be observed in the field

Evaluation of CRC-Metastatic Hepatic Lesion Chemoembolization with Irinotecan-Loaded Microspheres, According to the Site of Embolization

With the chemembolization of colorectal-cancer (CRC)-metastatic hepatic lesions by irinotecan-loaded microspheres, most researchers recommend slow embolizate delivery at the lobar-artery level to the entire liver parenchyma without obtaining visible stasis. An association has been reported between postoperatively visible embolizate stasis and lesion response to treatment. Possibly, in some cases, more selective administration might give greater benefit, particularly with previous systemic chemotherapy failure. Objective: Treatment response evaluation after chemoembolization of CRC-metastatic liver lesions with irinotecan-loaded microspheres, according to a hepatic-artery branch level of administration. Patients and methods: The analysis included 54 patients (24 females, 30 males) with large (median diameter > 5 cm) CRC-metastatic liver lesions, who underwent 196 chemoembolization procedures (mean 3.63 per patient) with irinotecan (100 mg)-loaded microspheres. Patients were divided into two groups according to initial embolizate-administration branch level: Group A (n = 26): at the segmental or subsegmental-vessel level; Group B (n = 28): at the lobar-branch level. Treatment response was assessed by computed-tomography (mRECIST criteria); overall survival (OS) and progression-free survival (PFS) were calculated using the Kaplan–Meier method and adverse effects were assessed according to the Common Terminology Criteria for Adverse Events (CTCAE; version 5.0). Results: There were statistically significant differences in the occurrence of partial response (PR): higher in Group A (42.3%) than Group B (17.9%) (p = 0.039) and occurrence of stable disease (SD): lower (p = 0.025) in Group A (11.5%) than Group B (39.4%). However, occurrence of disease progression (PD) was similar: Group A: 42.3%; Group B: 42.9% (p = 0.93). Patients in Group A presented with more favorable PFS (p = 0.029) and OS (p = 0.039) than Group B. Median survival times: Group A: 15.2 months; Group B: 13.1 months. There was no significant difference in complication incidence between groups (Group A: seven complications; Group B: six complications; p = 0.863). Conclusion: Superselective chemoembolizate administration to vessels supplying large CRC-metastatic liver lesions gave better response to treatment and extended patient survival time, without significantly increasing complication risk

Genesis and classification of the soils developed from the sediments of the former Oleszek mill pond basin (the Chełmińskie Lakeland, N Poland) / Geneza i pozycja systematyczna gleb wykształconych z osadów niecki dawnego stawu młyńskiego Oleszek (Pojezierze Chełmińskie)

Budowa i funkcjonowanie młynów wodnych znacznie wpłynęły na przekształcenie środowiska przyrodniczego w ich otoczeniu, przede wszystkim na zmiany rzeźby terenu i warunków wodnych. Obszar badañ obejmuje nieckę dawnego stawu młyńskiego Oleszek w okolicach wsi Borówno, w zachodniej części Pojezierza Chełmińskiego, około 20 km na północny wschód od Torunia. Celem badañ było określenie genezy gleb wykształconych z osadów zakumulowanych w niecce dawnego stawu młyńskiego Oleszek. Pięć profili glebowych w transekcie o długości około 550 m zlokalizowanym wzdłuż Strugi Rychnowskiej stanowiącej oś podłużną niecki. Wszystkie przeanalizowane gleby zbudowane są z osadów wypełniających nieckę dawnego stawu młyńskiego. Gleby w opisywanej niecce powstały w wyniku wielu nakładających się procesów, takich jak: proces mułotwórczy, aluwialny, koluwialny oraz glejowy. Dwa z analizowanych profili glebowych (profile 3 i 4) spełniaj¹ kryteria wydzielania gleb organicznych limnowych typowych (Systematyka gleb Polski 2011). Jako pozycję systematyczną kolejnych dwóch gleb (profile 2 i 5) zaproponowano gleby mułowate. W związku z problemami klasyfikacyjnymi dotyczącymi tego typu gleb, przy opracowaniu aktualizacji Systematyki gleb Polski należałoby wprowadzić w typie gleb glejowych podtyp gleb mułowatych lub mułowato-glejowych, obejmuj¹cy gleby wytworzone z mineralno-organicznych utworów aluwialno-mułowych. Cztery wymienione powyżej profile zostały zaklasyfikowane jako Histosols (3 i 4) i Gleysols (2 i 5) według klasyfikacji WRB (2014). Jednostki glebowe wykształcone z osadów aluwialnych (mady wg SgP 2011 lub Fluvic Phaeozems wg WRB 2014) występują w proksymalnej części stawu (cofce)