Biomedical subjects

M Arad

Publications and source records attributed to M Arad.

41 records · Page 3Linked to original sources

PubMedDate not supplied

Meperidine analgesia and delirium in aged hip fracture patients.

Delirium is quite frequent in elderly patients who sustain hip fractures. The use of Meperidine by physicians, unaware of the possible emergence of delirium in elderly patients, is very popular. We have retrospectively examined the incidence of delirium in 181 consecutive patients admitted to the orthogeriatric ward with hip fractures. We used the confusion assessment method to establish the presence of delirium in all patients. A database search was conducted to identify which patients were treated by Meperidine, or Morphine, prior to delirium onset. We identified 92 cases, 44 of whom were treated by Meperidine alone, and the other 48 treated by Morphine alone. Delirium was diagnosed in 13 (27.1%) Morphine treated patients as compared with 19 (43.2%) treated by Meperidine (P<0.001). Age, cognitive status and opiate use were associated with perioperative delirium. A subset regression analysis showed that exposure to Meperidine was significantly associated with delirium (odds ratio 2.5, P<0.01), in contrast with Morphine. Our results confirm the association between exposure to Meperidine and delirium, suggesting that this drug should be withdrawn in elderly hip fractured patients undergoing surgery, and substituted by low dose Morphine analgesia. Reducing the incidence of delirium, by adopting such an approach, may result in a significant potential of savings in direct costs, related to treatment of delirium in this population.

Journal Article↗

PubMedDate not supplied

The unfavorable nature of preoperative delirium in elderly hip fractured patients.

The onset of delirium is frequent in elderly patients who sustain hip fractures. The purpose of this study was to characterize different patterns of preoperative and postoperative delirium, to study factors associated with preoperative delirium and to evaluate the possible different outcome of these patients. This retrospective study comprised 281 elderly patients with hip fractures undergoing surgical fixation. Data collection included age, sex, length of stay, type of fracture, cognitive status by mini mental state examination (MMSE), assessment of possible delirium by the confusion assessment method (CAM) and functional outcome assessed by functional independence measure (FIM). A database search was conducted to identify whether delirium onset occurred prior to or following surgery. About 31% of the total sample developed delirium. Delirious patients tended to be more disabled (P = 0.03) and cognitively impaired (P = 0.018), compared with non-delirious patients. Most delirious cases (53%) had their onset in the preoperative period. Patients with preoperative delirium were older (P = 0.03), had a lower prefracture mobility (P < 0.01), impaired cognition (P = 0.04) and showed an adverse functional outcome in terms of FIM score. Regression analysis showed that prefracture dementia, prefracture mobility and low MMSE scores were strongly associated with higher probability of having preoperative delirium, with no additional effect of other variables. It is concluded that preoperative delirium should be viewed as a separate entity with unfavorable nature and adverse outcome. Careful preventive measures and better treating strategies should be employed to avoid this clinical condition.

Aged↗

PubMedDate not supplied

Brain and atrial natriuretic peptides in patients with ischemic heart disease with and without heart failure.

The objective of the study was the evaluation of natriuretic peptides in ischemic heart disease. Atrial and brain peptides (ANP, BNP) were elevated in patients with ischemic heart failure, as compared with patients with angina without over failure, and controls (p < 0.01). BNP/ANP ratio was higher in NYHA class IV than in class III patients (2.67 +/- 0.87 vs. 1.52 +/- 0.59, respectively). Patients in the angina group, in whom elevated BNP or ANP was found, had subclinical systolic or diastolic dysfunction. There was inverse correlation between BNP, ANP and the left-ventricular ejection fraction (each r = 0.78, p < 0.001). We conclude that BNP is elevated as a result of myocardial dysfunction, but not of ischemia and seems to be a better index of disease stage and prognosis than ANP.

Adult↗

PubMedDate not supplied

Principles of respiratory protection.

This review describes the various types of respiratory protective devices used in Israel during the Persian Gulf war, and summarizes the relevant physiological concepts of respiratory protection. Physiological principles of modern devices with powered air supply are discussed in detail. Our experience may be useful in the evaluation of new respirators and in finding solutions for problematic subpopulations.

Adult↗

PubMedDate not supplied

Physiological assessment of the passive children's hood.

The physiological effect of the "passive children's hood" (PCH) was studied in 24 children: 8 toddlers (3-4.5 years old), 8 pre-school pupils (4.5-6 years) and 8 first- and second-grade pupils (6-8 years). This device consists of a children's gas mask and a transparent PVC (polyvinyl chloride plastic) covering (hood). Inspiratory CO2 and O2 (FiCO2 and FiO2, respectively), temperature and humidity were monitored at 10-min intervals while the children were occupied with sedentary activities (playing and watching TV) in a sealed room. Ambient temperature and relative humidity were approximately 27 degrees C and 75% respectively. In the PCH space the temperature was 2 degrees C higher and humidity was near saturation at the end of exposure. FiCO2 in 12 children exceeded 2%, which is the upper acceptable limit according to industrial standards. In four of them FiCO2 was greater than 4% and FiO2 less than 16%. Twenty-two children tolerated the PCH for 92 +/- 35 min (range 24-133 min) with no physiological complications. A significant correlation was found between childrens' age and tolerance time (r = 0.47, P less than 0.025). We conclude that children whose masks are not well adjusted may be exposed to rebreathing CO2-enriched air.

Age Factors↗