PubMed Health⌕ Search

Biomedical subjects

Joseph Grinblat

Publications and source records attributed to Joseph Grinblat.

11 recordsLinked to original sources
PubMed2006

Seasonal changes in orthostatic hypotension among elderly admitted patients.

BACKGROUND AND AIMS: Orthostatic hypotension (OH) is a common finding among older patients. It has been shown that blood pressure (BP) is lower in summer than in winter. The aim of this study was to examine whether OH varies between seasons in the elderly population. METHODS: Five hundred and two inpatients (241 males, 261 females) of mean age 81.6 years were included in the study; 253 were studied in summer and 166 in winter. Orthostatic tests were performed 3 times daily, 30 minutes after meals. Orthostatic hypotension was defined as a decrease of at least 20 mmHg in systolic BP and/or 10 mmHg in diastolic BP upon assuming an upright posture at least twice during the day. RESULTS: OH was documented in 107 patients (34.8%). Initial BP did not differ between seasons (147.6 +/- 24.6 / 72.6 +/- 14.5 mmHg in summer, 146.7 +/- 23.4 / 71.5 +/- 13.4 mmHg in winter). However, the orthostatic drop in BP in the morning was greater in summer (-8.4 / -2.8 mmHg vs -4.3 / +0.2 mmHg in winter; p < 0.05). OH was also more prevalent in summer than in winter (37.9 vs 27.1%; p = 0.02). After adjustment for all confounders, the risk of experiencing OH in summer was 64% higher than in winter [adjusted odds ratio (OR) 1.64 [95% Confidence Interval (CI) 1.03-2.61]. CONCLUSIONS: The prevalence of OH is higher in summer than winter. Thus, more attention should be paid to the diagnosis of OH in summer.

Aged↗
PubMed2006

Influence of orthostatic hypotension on mortality among patients discharged from an acute geriatric ward.

BACKGROUND: Orthostatic hypotension (OH) is a common finding among older patients. The impact of OH on mortality is unknown. OBJECTIVE: To study the long-term effect of OH on total and cardiovascular mortality. PATIENTS AND METHODS: A total of 471 inpatients (227 males and 244 females), with a mean age of 81.5 years who were hospitalized in an acute geriatric ward between the years 1999 and 2000 were included in the study. Orthostatic tests were performed 3 times during the day on all patients near the time of discharge. Orthostatic hypotension was 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 at least twice during the day. Patients were followed until August 31, 2004. Mortality data were taken from death certificates. RESULTS: One hundred and sixty-one patients (34.2%) experienced OH at least twice. Orthostatic hypotension had no effect on all cause and cause specific mortality. Over a follow-up of 3.47+/-1.87 years 249 patients (52.8%) had died 83 of whom (33.3%) had OH. Age-adjusted mortality rates in those with and without OH were 13.4 and 15.7 per 100 person-years, respectively. Cox proportional hazards model analysis demonstrated that male gender, age, diabetes mellitus, and congestive heart failure increased and high body mass index decreased total mortality. CONCLUSIONS: Orthostatic hypotension is relatively common in elderly patients discharged from acute geriatric wards, but has no impact on vascular and nonvascular mortality.

Adrenergic beta-Antagonists↗
PubMed2004

Can functional status, after rehabilitation, independently predict long-term mortality of hip-fractured elderly patients?

BACKGROUND AND AIMS: Hip fractures are one of the most serious causes of functional impairment and death in the elderly. The aim of this study was to evaluate prospectively the predictive value of functional performance, after rehabilitation, of hip fracture on long-term mortality in community-dwelling patients. METHODS: One hundred and seventy-one patients aged 60 years and over, admitted to a geriatric rehabilitation day unit after inpatient rehabilitation, were followed for up to 4 years. Main outcome measures were Functional Independent Measure (FIM), Timed Get Up and Go test (GUAG), cognitive status using the Mini-Mental State Examination on admission, and mortality during the follow-up period. Kaplan-Meier analysis was carried out on survival curves. RESULTS: All 24 deceased patients performed the GUAG test in > 20 seconds. Although approaching significance, the survival curves were not statistically different between patients performing the test in < or = 20 and those performing it in > 20 seconds (p = 0.08). Survival curves were significantly higher in patients with a FIM score of > or = 90 (p = 0.004), no cardio-cerebrovascular (CCV) diseases (p = 0.001) and no diabetes mellitus (p = 0.01). There were no differences in survival according to age, gender, educational level, marital status, surgical vs conservative treatment, and cognition. A multivariate analysis including FIM score, CCV diseases and diabetes mellitus, demonstrated that only CCV disease was an independent variable for survival (p = 0.02). CONCLUSIONS: Performance, as evidenced by FIM scores after rehabilitation for hip fracture, may provide additional useful information on long-term survival. However, since functional status after rehabilitation is not an independent risk factor for long-term mortality, its predictive value must be interpreted in view of the comorbidities, mainly CCV diseases, which are more important to the risk of mortality than the event of hip fracture itself.

Aged↗
PubMed2003

Pectoralis major rupture in elderly patients: a clinical study of 13 patients.

The purpose of this study was to analyze and describe circumstances and clinical aspects of pectoralis major rupture in elderly patients compared with younger patients. Eleven patients were nursing home residents and two were community residents. All had severe pain with a large pectoral ecchymosis extending to the lateral chest wall and arm. Twelve patients experienced substantial blood loss (average, 2.3 g/dL hemoglobin), which resulted in hemodynamic decompensation in two of the patients, necessitating a blood transfusion. The most probable mechanism of injury was indirect, caused by a brisk tearing movement applied to stiff, atrophic muscle during commonly used nursing procedures for transferring, positioning, and dressing the patients. The authors suspect this injury to be more common than reported. Although surgical repair is not required in the elderly, a proper diagnosis is imperative because the injury has a severe clinical impact necessitating care and followup.

Aged↗
PubMed2002

Orthostatic hypotension in acute geriatric ward: is it a consistent finding?

BACKGROUND: Orthostatic hypotension (OH) is a common finding among older patients. We designed a study to examine the prevalence and consistency of OH during the day. METHODS: A total of 502 inpatients (241 men and 261 women) with a mean age of 81.6 years were included in the study. Orthostatic tests were performed 3 times during the day, 30 minutes after meals. In 13 patients only 2 sets of measurements were obtained, and they were omitted from some of the calculations. Orthostatic hypotension was defined as a fall of at least 20 mm Hg in systolic blood pressure and/or 10 mm Hg in diastolic blood pressure on assuming an upright posture. RESULTS: Three hundred thirty-two (67.9%) of 489 patients experienced OH at least once during the day. Of these, 170 patients (34.8% of the 489) had OH at least twice (persistent OH) and 162 patients (33.1%) experienced OH only once (variable OH). Diastolic OH was more prevalent than systolic OH (57.3% vs 43.4%; P<.001). The intraindividual consistency of OH was low (kappa = 0.2). Orthostatic hypotension was observed less frequently during the evening than during the morning and afternoon (P<.05 vs morning and P =.003 vs afternoon). The difference between meals' constituents (light vs heavy meals) did not affect the prevalence of OH. CONCLUSIONS: Orthostatic hypotension is very common in the elderly, and diastolic OH is more common than systolic OH. The prevalence of OH is the lowest during the evening, and meals do not increase the prevalence of OH. The intraindividual consistency of OH during the day is poor. Thus, in elderly patients, more attention should be paid to diastolic OH and the diagnosis should be based on repeated measurements.

Acute Disease↗
PubMed2002

Brain abscess complicating cerebral infarct.

PRESENTATION: We report a case of a 68-year-old man who suffered ischemic strokes in the left middle cerebral artery territory and three months later, following urosepsis, developed a cerebral abscess in the infarcted area. DISCUSSION: A literature search found only eight other cases. We discuss herein the common clinical aspects of brain abscess complicating strokes, the co-existent diseases, and point out the possibility of underreporting this rare but treatable complication. CONCLUSION: Cerebral abscess should be suspected in patients with a previous brain infarction or haemorrhage, who develop bacteremia and impaired consciousness without a clear explanation to their condition. Advanced age, and medical conditions known adversely to affect immunological competence reinforce the clinical suspicion.

Aged↗
PubMedDate not supplied

Diarrhea in elderly patients due to Clostridium difficile associated with Salmonella and Shigella infection.

Clostridium difficile is the main cause of nosocomial diarrhea mainly in elderly hospitalized patients and in nursing homes, but less common in the community. We report three elderly patients living in the community, one frail and two in reasonable good health who recently developed diarrhea due to C. difficile associated with Salmonella group C in two cases and Shigella flexneri in the other. The association with Shigella has not previously been reported and there have only been a few cases with Salmonella. These findings may be important due to the possibility that diarrhea caused by C. difficile associated with other enteric bacteria may be more prevalent than expected in the aging population, thus necessitating awareness and consequently appropriate treatment and follow-up.

Aged↗
PubMedDate not supplied

Pectoralis major rupture in the elderly: clinical and sonographic findings.

We describe clinical and sonographic features of pectoralis major rupture in the elderly, which is relatively rare and unknown. Patients presented with a large pectoral ecchymosis extending to the axilla, chest wall, breast and arm. The pectoral area was sensitive, sometimes with a visible and palpable defect in the axilla. Ultrasound examination showed a large hypoechoic, well-circumscribed structure representing a hematoma within the pectoralis major muscle, partially replacing the normal echo muscle pattern. Ultrasonography is a useful, low cost diagnostic tool, and is recommended in the investigation of pectoralis major rupture in the elderly.

Aged↗
PubMedDate not supplied

Different C-reactive protein kinetics in post-operative hip-fractured geriatric patients with and without complications.

BACKGROUND: Hip fracture is a frequent injury in the elderly, and is associated with a high incidence of functional impairment, complications and mortality. OBJECTIVE: To determine kinetics of C-reactive protein (CRP), fibrinogen and erythrocyte sedimentation rate (ESR) in hip-fractured patients over a 1-month post-operative period; to examine the relationship of these parameters to cognition, operation type, post-operational complications, functional level 1 month post-operatively and 6-month mortality. METHODS AND SUBJECTS: 32 aged patients operated on for hip fracture were prospectively followed-up for 6 months. Fracture, type of operation and anesthetic risk were recorded. Cognition was evaluated by the Mini-Mental State Examination and pre-fracture functional level evaluated by the Katz Index of ADL. Follow-up included complications, mortality and functional outcome. CRP, fibrinogen and ESR were assessed during the first 10 h post-fracture; 48-60 h, and 7 and 30 days post-operatively, respectively. RESULTS: Only CRP kinetics were found to differ in patients with complications vs. those without, as a group (p = 0.006), and in patients suffering infections, delirium and cardiovascular complication vs. patients with no complications (p = 0.06, 0.03, 0.02, respectively). Mean (+/-SEM) CRP 48-60 h post-operatively was 20.9 +/- 2.1 and 13.1 +/- 1.6 mg/dl in complicated and uncomplicated patients, respectively (p = 0.002). The mean CRP 48-60 h post-operatively was highly correlated with the CRP area under the curve, R = 0.88 (p < 0.001). A cut-off level of 15 mg/dl for CRP, 48- 60 h post-operatively, was calculated for patients with complications (sensitivity 93%, specificity 65%, p = 0.003). CRP, fibrinogen and ESR were not related to fracture or type of operation, cognition, anesthetic risk, 1-month post-operative functioning and 6-month mortality. CONCLUSIONS: CRP measurement in elderly patients operated for hip fracture may be valuable in assessing and monitoring complications.

Aged↗
PubMedDate not supplied

Uncontrolled crying: characteristics and differences from normative crying.

BACKGROUND: Uncontrolled crying (UC) is a prevalent poststroke phenomenon of elderly patients, socially disabling and interfering with rehabilitation. There are many differences in opinions and nonclarity in the literature relating to UC. OBJECTIVE: To examine two basic questions regarding UC that have as yet not been experimentally studied: typical situations where UC occurs and how UC differs from normative crying (NC). METHODS: Crying episodes of elderly patients suffering from poststroke UC were documented. From 235 crying documented episodes, instructions for further follow-up documentation were received. According to these instructions, 1,098 crying episodes were documented. Using the 'truncated pyramid' model developed during this study, 47 crying situations typical of poststroke UC processed into seven categories were identified. Based on these findings, we compared UC and NC. RESULTS: UC and NC were found to differ in all tested variables: crying situations, content areas of crying situations, crying frequency, crying frequency of men as compared with that of women, and crying frequency when alone as compared with the crying frequency in the presence of others. CONCLUSIONS: UC should be approached as an entity totally different from NC within a wide range of variables. The study's findings assist in understanding UC, the reasons for its disabling effect, and the need for exploring ways to aid elderly patients suffering from poststroke UC. The situations typical of UC and their categories found in this study may serve as additional clinical and research means for these purposes.

Affective Symptoms↗