martes, 4 de abril de 2017

Combo de geriatría / Geriatric combo

Abril 2, 2017. No. 2647

El impacto de la evaluación prequirúrgica geriátrica en los resultados postoperatorios en pacientes de edad avanzada sometidos a cirugía programada: una revisión sistemática.
The impact of pre-operative comprehensive geriatric assessment on postoperative outcomes in older patients undergoing scheduled surgery: a systematic review.
Anaesthesia. 2014 Jan;69 Suppl 1:8-16. doi: 10.1111/anae.12494.
Comprehensive geriatric assessment is an established clinical approach. It reduces mortality and improves the physical wellbeing of older people in the community or hospitalised for medical reasons. Pre-operative comprehensive geriatric assessment seems a plausible method for reducing adverse postoperative outcomes. The objectives of this systematic review and narrative synthesis are to describe how pre-operative comprehensive geriatric assessment has been used in surgical patients and to examine the impact of comprehensive geriatric assessment on postoperative outcomes in older patients undergoing scheduled surgery. We searched MEDLINE, EMBASE and Web of Science from 1980 to 2013 (week 26). We included five studies: two randomised controlled trials and three before-and-after intervention quasi-experimental studies. Patient populations, interventions and outcome measures varied between studies. Both the randomised trials showed benefit on postoperative outcomes, including medical complications. Two of the before-and-after studies reported a positive impact on postoperative length of stay and other outcomes. The heterogeneity of study methods, populations, interventions and outcomes precluded meta-analysis. Based on this narrative synthesis, pre-operative comprehensive geriatric assessment is likely to have a positive impact on postoperative outcomes in older patients undergoing elective surgery, but further definitive research is required. Clinical services providing pre-operative comprehensive geriatric assessment for older surgical patients should be considered.

Controversias en anestesia para cirugía no cardiaca en el anciano
Controversies in anaesthesia for noncardiac surgery in older adults.
Br J Anaesth. 2015 Dec;115 Suppl 2:ii15-25. doi: 10.1093/bja/aev396.
As the population of the world is rapidly ageing, the amount of surgery being performed in older patients is also increasing. Special attention is required for the anaesthetic and perioperative management of these patients. The clinical and non-clinical issues specific to older surgical patients are reviewed, with a special emphasis on areas of debate related to anaesthesia care in this group. These issues include the role of frailty and disability in preoperative assessment, choice of anaesthesia technique for hip fracture, postoperative delirium, and approaches to shared decision-making before surgical procedures.
KEYWORDS: ageing; anaesthesia; frail elderly; geriatric anaesthesia; hip fracture

Sarcopenia y síndrome de fragilidad
Sarcopenia and the syndrome of frailty
Ajay Kumar Gupta1, Siddhartha Mishra
Egypt J Intern Med 28:133-139
Sarcopenia is the process of loss of body mass, specifically the musculoskeletal tissue, with age, which ultimately leads to a syndrome of clinical entity poorly defined as frailty. It is probably as old as humanity itself. Functionally, frailty is described as a syndrome characterized by a progressive decrease in the body's reserve and declining resistance to stressors, possibly because of declining capacity of multiple physiologic systems resulting in higher vulnerability morbidity and mortality. Ayurveda also mentions morbidity occurring with advancing age and various options for its management. Elixirs are recommended in Ayurveda, popularly called 'rasayana', for recovery from the symptoms of frailty. Worldwide, because of the wide demographic profile, the process of ageing exerts its effects on geriatric populations at different ages. Europeans were the first to paraphrase the word frailty for the ageing process. With better medical care and nutrition, a substantial subset of populations survives longer than 60 years or longer worldwide. The most relevant aspect of the recognition of syndrome of frailty is that the process is, to some extent, reversible, provided that adequate attention is paid and a timely intervention is performed for the needy subset of population, which is likely to improve the quality of life markedly, besides resulting in an increased life span.

Sarcopenia en falla cardiaca. Mecanismos y estrategias de manejo
Sarcopenia in heart failure: mechanisms and therapeutic strategies.
J Geriatr Cardiol. 2016 Jul;13(7):615-24. doi: 10.11909/j.issn.1671-5411.2016.07.004.
Chronic heart failure (CHF) is a highly prevalent condition among the elderly and is associated with considerable morbidity, institutionalization and mortality. In its advanced stages, CHF is often accompanied by the loss of muscle mass and strength. Sarcopenia is a geriatric syndrome that has been actively studied in recent years due to its association with a wide range of adverse health outcomes. The goal of this review is to discuss the relationship between CHF and sarcopenia, with a focus on shared pathophysiological pathways and treatments. Malnutrition, systemic inflammation, endocrine imbalances, and oxidative stress appear to connect sarcopenia and CHF. At the muscular level, alterations of the ubiquitin proteasome system, myostatin signaling, and apoptosis have been described in both sarcopenia and CHF and could play a role in the loss of muscle mass and function. Possible therapeutic strategies to impede the progression of muscle wasting in CHF patients include protein and vitamin D supplementation, structured physical exercise, and the administration of angiotensin-converting enzyme inhibitors and β-blockers. Hormonal supplementation with growth hormone, testosterone, and ghrelin is also discussed as a potential treatment.
KEYWORDS: Ghrelin; Muscle loss; Protein supplementation; Vitamin D
Inflamación y fragilidad en el anciano. Revisión sistemática y meta-análisis
Inflammation and frailty in the elderly: A systematic review and meta-analysis.
Ageing Res Rev. 2016 Nov;31:1-8. doi: 10.1016/j.arr.2016.08.006. Epub 2016 Aug 31.
The pathogenesis of frailty and the role of inflammation is poorly understood. We examined the evidence considering the relationship between inflammation and frailty through a systematic review and meta-analysis. A systematic literature search of papers providing data on inflammatory biomarkers and frailty was carried out in major electronic databases from inception until May 2016. From 1856 initial hits, 35 studies (32 cross-sectional studies n=3232 frail, n=11,483 pre-frail and n=8522 robust, and 563 pre-frail+robust; 3 longitudinal studies n=3402 participants without frailty at baseline) were meta-analyzed. Cross-sectional studies reported that compared to 6757 robust participants, both 1698 frail (SMD=1.00, 95%CI: 0.40-1.61) and 8568 pre-frail (SMD=0.33, 95%CI: 0.04-0.62) participants had significantly higher levels of C-reactive protein (CRP). Frailty (n=1057; SMD=1.12, 95%CI: 0.27-2.13) and pre-frailty (n=4467; SMD=0.56, 95%CI: 0.00-1.11) were associated with higher serum levels of interleukin-6 compared to people who were robust (n=2392). Frailty and pre-frailty were also significantly associated with elevated white blood cell and fibrinogen levels. In three longitudinal studies, higher serum CRP (OR=1.06, 95%CI: 0.78-1.44,) and IL-6 (OR=1.19, 95%CI: 0.87-1.62) were not associated with frailty. In conclusion, frailty and pre-frailty are associated with higher inflammatory parameters and in particular CRP and IL-6. Further longitudinal studies are needed.
KEYWORDS: Aging; C-Reactive protein; Frailty; Inflammation; Interleukin-6; Pre-frailty

Genes asociados con la enfermedad de Alzheimer. Revisión y estado actual
Genes associated with Alzheimer's disease: an overview and current status.
Clin Interv Aging. 2016 May 17;11:665-81. doi: 10.2147/CIA.S105769. eCollection 2016.
Alzheimer's disease (AD) is a progressive, neurodegenerative disease and the most common form of dementia in elderly people. It is an emerging public health problem that poses a huge societal burden. Linkage analysis was the first milestone in unraveling the mutations in APP, PSEN1, and PSEN2 that cause early-onset AD, followed by the discovery of apolipoprotein E-ε4 allele as the only one genetic risk factor for late-onset AD. Genome-wide association studies have revolutionized genetic research and have identified over 20 genetic loci associated with late-onset AD. Recently, next-generation sequencing technologies have enabled the identification of rare disease variants, including unmasking small mutations with intermediate risk of AD in PLD3, TREM2, UNC5C, AKAP9, and ADAM10. This review provides an overview of the genetic basis of AD and the relationship between these risk genes and the neuropathologic features of AD. An understanding of genetic mechanisms underlying AD pathogenesis and the potentially implicated pathways will lead to the development of novel treatment for this devastating disease.
KEYWORDS: Alzheimer's disease; amyloid precursor protein; biological pathways; genome-wide association studies; neuropathology; presenilin 1; presenilin 2

Libro de Geriatría
Book on Geriatrics
Edited by Craig S. Atwood, ISBN 978-953-51-0080-5, 246 pages, Publisher: InTech, Chapters published February 24, 2012 under CC BY 3.0 license
DOI: 10.5772/1893
With the baby boomer generation reaching 65 years of age, attention in the medical field is turning to how best to meet the needs of this rapidly approaching, large population of geriatric individuals. Geriatric healthcare by nature is multi-dimensional, involving medical, educational, social, cultural, religious and economic factors. The chapters in this book illustrate the complex interplay of these factors in the development, management and treatment of geriatric patients, and begin by examining sarcopenia, cognitive decline and dysphagia as important factors involved in frailty syndrome. This is followed by strategies to increase healthspan and lifespan, such as exercise, nutrition and immunization, as well as how physical, psychological and socio-cultural changes impact learning in the elderly. The final chapters of the book examine end of life issues for geriatric patients, including effective advocacy by patients and families for responsive care, attitudes toward autonomy and legal instruments, and the cost effectiveness of new health care technologies and services.

MOJ Gerontology & Geriatrics
Journal of Geriatric Oncology

Journal of the American Geriatrics Society
Revista / Journal

Curso sobre Anestesia en Trasplantes, Cirugía abdominal, Plástica, Oftalmología y Otorrinolaringología.
Committee for European Education in Anaesthesiology (CEEA) 
y el Colegio de Anestesiólogos de León A.C.
Abril 7-9, 2017, León Guanajuato, México

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