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Biomedical subjects

J Grinblat

Publications and source records attributed to J Grinblat.

At least 19 recordsLinked to original sources
PubMed2004

Orthostatic hypotension in the elderly: are the diagnostic criteria adequate?

Orthostatic hypotension (OH) is a common finding in the elderly. OH is defined as a fall of at least 20 mmHg in systolic blood pressure (BP) and/or 10 mmHg in diastolic BP upon assuming an upright posture. Some patients exhibit a fall in BP of less than the defined OH upon standing. The aim of this study was to estimate the prevalence of BP changes not defined as OH among elderly in-patients and to assess the relationship between these changes in the morning and the occurrence of OH during the day. Postural BP measurements were performed in 502 in-patients; in the morning, early afternoon, and in the evening. We defined intermediate postural drop (ID) in BP as a decrease of 10-19 mmHg in systolic BP and/or of 5-9 mmHg in diastolic BP. We observed that OH and ID occurred in 39.2 and 18.5% of the measurements in the morning, respectively. The prevalence of OH and ID was lower in the evening than in the morning (P<0.05) and afternoon (P<0.005). Postural BP changes in the morning correlated with those occurring later in the day. Patients who had ID in the morning had a 57% probability of having OH later during the day. In conclusions, ID is prevalent in elderly in-patients. ID in the morning predicts OH later in the day. Thus, postural BP drops below the OH range may be an important finding in the geriatric population.

Aged↗
PubMed2001

Outcome of medically unstable elderly patients admitted to a geriatric ward after hip fracture.

Outcome of surgical treatment is superior to that of conservative treatment for hip fractures. Nevertheless, for a number of patients, the operation is either delayed or unfit due to their unstable medical conditions. We retrospectively reviewed patients admitted to a geriatric ward after hip fracture, and investigated complications, functional outcome and survival in different cognitive, pre-fracture functional and treatment groups. Patients hospitalized (N=78) from January 1993 to June 1999 were included (1/2 demented, 1/3 fully dependent in Basic Activities of Daily Living, and 2/5 high operative risk patients). Following stabilization, 14 subjects (17. 9%) were operated. The mean and range of surgical delay was 9+/-7.2, and 3 to 30 days, respectively. Comparison between surgical and conservative treatment groups, and cognitive and pre-fracture functional groups showed no differences in age, gender, chronic medical conditions, fracture type, reasons for surgical delay or conservative approach, complications, survival curves and laboratory results. Thirteen operated patients were in ASA I + II grades, only 1 in ASA grades III + IV (low and high operative risk, American Society of Anesthesiologists grading system) (p=0.004). Functional outcome was similar in the surgical vs the conservative group, and intracapsular vs extracapsular fractures. ASA I + II patients had a higher survival rate compared to ASA III + IV patients (p=0. 02). We conclude that after stabilization of acute medical conditions, the most important preoperative consideration is the anesthetic risk, and surgical and conservative approaches may be equally considered in selected groups of elderly, frail patients with hip fracture who are medically unstable for more than a few days.

Activities of Daily Living↗
PubMed2001

Dementia does not significantly affect complications and functional gain in elderly patients operated on for intracapsular hip fracture.

Fifty-three elderly patients with intracapsular hip fracture were hospitalized in the Department of Orthopaedics. Forty-two underwent operations: 38 hemiarthroplasty; 2 total hip replacements and 2 closed reduction interior fixation. They were followed up and assessed prospectively five times for 6 months post-fracture. Cognition was evaluated by the Mini-Mental State Examination. Pre-fracture functioning was determined by the Functional Independence Measure (FIM) and the Katz index of activities of daily living (ADL). The functional outcome was assessed by the FIM gain defined as the difference between FIM scores at 6 months and just prior to discharge. FIM gain, length of stay, complications and mortality rates were not significantly different between three cognitive groups: normal, moderately and severely demented patients. The majority of patients were independent and partially dependent in their ADL. We conclude that dementia does not significantly affect complications and functional gain in elderly patients operated on for intracapsular hip fracture if they were mobile before the fracture.

Activities of Daily Living↗
PubMed2000

Convulsions induced by metronidazole treatment for Clostridium difficile-associated disease in chronic renal failure.

Clostridium difficile-related diarrhea and colitis are common health problems, especially in elderly, frail hospitalized patients. The drug of choice is metronidazole, which can be associated, in long or high doses, with neurotoxic side effects. We report convulsions induced by short-term metronidazole therapy used in conventional doses for Clostridium difficile colitis in an elderly patient with chronic renal failure.

Aged↗
PubMed1998

Relationship between routine hematological parameters, serum IL-3, IL-6 and erythropoietin and mild anemia and degree of function in the elderly.

To investigate the influence of functioning on unexplained senile anemia, we measured commonly used hematological parameters (serum iron, transferrin, iron saturation and ferritin) in addition to specific erythropoietic factors, such as interleukin-3 (IL-3), interleukin-6 (IL-6), and erythropoietin (EPO) in 48 elderly subjects aged 65-90 years. The subjects were divided into 3 groups: 1) 17 patients with unexplained mild anemia; 2) 17 non-anemic patients with newly acquired stroke and who previously were functionally active; 3) 14 functionally active patients with no major disease who served as controls. Anemia was defined as hemoglobin (Hb) values under 12.0 g/dL. The degree of functional ability was defined and scored by the "functional independence measure" (FIM) test. Data are presented as mean values +/- SD. The results revealed a correlation between the functional state and levels of Hb, iron and transferrin with unchanged iron saturation. Patients in the mild anemia group were found to be functionally declined (FIM = 57 +/- 19.4) with the relatively lowest mean iron (75.1 +/- 17 micrograms/dL) and transferrin levels (243 +/- 42.6 micrograms/dL). The stroke group (FIM = 62 +/- 17.7) had intermediate levels of iron (85.4 +/- 20.3 micrograms/dL) and transferrin (245 +/- 45.2), and with the continuation of the declined functional state the Hb level decreased significantly (13.7 +/- 0.9 to 12.0 +/- 1.0 g/dL, p < 0.001). The highest mean values of iron (102 +/- 27.9 micrograms/dL) and transferrin (322 +/- 42.7 micrograms/dL) were found in the control group (FIM = 122.7 +/- 5.8). The ferritin levels showed an opposite trend. IL-3 values were undetectable in the anemic and control groups, and were elevated in some patients in the stroke group. The lowest IL-6 level was observed in the anemic group, and the highest in the control group. Serial IL-6 assays in the stroke group showed an upward trend. Erythropoietin levels in all groups showed no difference.

Activities of Daily Living↗
PubMed1996

Macronutrient consumption and nutritional status in a selected well-established group of elderly people in a home for the aged in Israel.

OBJECTIVE: To evaluate the distribution pattern of the main macronutrients (protein, fat, carbohydrates) and fiber in a selected well-established group of elderly people, average age above 80 years. METHOD: Dietary consumption was evaluated in a well-established group of 21 elderly people in a home for the aged by in-person interview using a food frequency questionnaire. RESULTS: Daily energy intake was 1.87 Mcal (7.8 MJ) or 29.3 kcal/kg body weight, a value which lies within the range of 1.6 to 2.0 Mcal or 25 to 30 kcal/kg, found in 12 other studies conducted on elderly people. The average percentage of energy derived from macronutrients (with an individual range) was: protein 17.5 (13-22); fat 32.9 (25-44); and carbohydrates 49.6 (35-61). Fiber intake was 8.6 g/Mcal, lower than that found in three other studies. Positive coefficients of correlation were found between protein intake and the following parameters: serum urea (r = 0.28), cholesterol (r = 0.48) and DBP (r = 0.43). CONCLUSIONS: In our small group of elderly, energy derived from protein was higher than that in most of other studies reviewed, and that from fat was higher than in half of those studies. These values were remarkably higher than the suggested values. Energy derived from carbohydrates was close to that found in other studies. Monitoring of dietary macronutrients might improve the nutritional and the physiological status of the elderly.

Aged↗
PubMed1996

Estimation of vitamin needs--riboflavin, vitamin B6 and ascorbic acid-according to blood parameters and functional-cognitive and emotional indices in a selected well-established group of elderly in a home for the aged in Israel.

OBJECTIVE: To evaluate the vitamin status and the effects of micronutrient supplementation as determined by biochemical assays and functional, cognitive and emotional tests in a selected well-established group of elderly people, average age above 80 years. METHODS: Dietary consumption was evaluated by in-person interview using a food frequency questionnaire. Medical, biochemical, nutritional, functional, cognitive and behavioral parameters were assessed in elderly subjects (n = 12) living in a home for the aged, at baseline and after 42 days of micronutrient supplementation. The same parameters were assessed in additional subjects (n = 9), at baseline only. RESULTS: In all subjects, most of the micronutrients were not supplied at an adequate level. Supplementation of micronutrients at a level of 100% RDA improved parameters related to vitamin status, the activation coefficients (AC) of GR (glutathione reductase) and AST, blood ascorbic acid concentrations, functional-cognitive evaluation values, blood pressure, pulse rate, and serum cholesterol and triglycerides levels. At baseline, the following parameters significantly correlated with vitamin intake and were used for the estimation of vitamin needs: AC of GR, Tinetti Balance Evaluation, FIM and recorded morbidity. CONCLUSIONS: On the basis of limited available data, calculation of vitamin needs based on regression lines resulted in estimates (mg/day) of: > 150 for ascorbic acid, > 3 for riboflavin, > 3 for vitamin B6. Expanding the current practice of supplementing micronutrients at a level of 100% RDA (in tablet form) that already exists in some elderly societies should be considered after a comprehensive study in a large group of elderly people.

Aged↗
PubMed1995

The importance of brain infarct size and location in predicting outcome after stroke.

Fifty-six consecutive elderly ( > or = 65 years) patients, admitted for acute stroke to a geriatric department were included in the study and underwent CT scanning. Functional status was graded according to the modified Rankin scale. Three patients had primary intra-cerebral haemorrhage, 22 deep hemispheric infarct, 17 had anterior circulation cortical infarcts, five had posterior circulation infarcts and in nine the CT scan was normal. Stroke risk factors were equally distributed among the different CT scan groups, and all three larger groups had similar rates of non-neurological major complications including death (41%). However, independence in ADL (Rankin 0-2) was observed in 72% of deep infarct survivors, but only 15% of the cortical infarct group (p = 0.00018). For the normal scan group, functional recovery was intermediate. In the cortical infarct group patients with an infarct of > or = 50 mm mean diameter (five cases) should worse functional recovery than did eight patients with small infarcts. The mean difference between pre- and post-stroke Rankin score (DR) was 3.4 for the larger infarct patients and 1.9 for the smaller infarct group (p = 0.027). Pearson correlation revealed a direct relationship between the infarction size and DR (p = 0.039). Such a relationship was not observed for the deep hemispheric group.

Activities of Daily Living↗
PubMed1993

Chromosome 20 long arm deletion in an elderly malformed man.

A 46,XY/46,XY,del(20)(q13-->q13.33) mosaicism was identified in a 68 year old man who had mild mental retardation and severe malformation of the limbs. The clinical findings of the patient are compared to those of the very few cases of 20q deletion published to date.

Abnormalities, Multiple↗
PubMed1986

Folate and vitamin B12 levels in an urban elderly population with chronic diseases. Assessment of two laboratory folate assays: microbiologic and radioassay.

Folate levels of serum and red blood cells (RBC) and vitamin B12 serum levels were investigated in 326 urban chronically ill elderly ambulatory patients and 41 healthy young control subjects. Two laboratory methods were used for investigating the folate levels, the microbiologic assay (MBA) with Lactobacillus casei and radioassay (RA). Serum and RBC samples of 326 patients were tested by the folate MBA and 270 of the same samples by the RIA methods. In the MBA 6.8% of the patients and 12.2% of controls had low levels of folate RBC (less than 200 ng/mL) and 1.8% of patients and 4.8% of controls had low serum folate levels (less than 5 ng/mL). All of the patients with the low folate levels had normal hematologic findings and no clinical symptoms of folate deficiency. In the RIA method, all of the patients and almost all of the control subjects (except one) had normal folate levels. Ten of the patients (3%) had low levels of serum vitamin B12 (less than 200 pg/mL). They were hematologically normal. They had normal Schilling tests and normal vitamin B12 dietary intake. Their RBC folate levels were normal and even somewhat higher. Forty percent of these patients had macular degeneration of the eyes. The data indicate the superiority of the RA method over the MBA and bring into question the accuracy of previous studies. The data furnish further evidence that a low vitamin B12 level in the elderly is not necessarily a true vitamin B12 deficiency and raise the possibility of an association between low B12 serum levels and macular degeneration of the eyes.

Adult↗