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Biomedical subjects

Yitshal N Berner

Publications and source records attributed to Yitshal N Berner.

At least 19 recordsLinked to original sources
PubMed2006

Infection-related hypoglycemia in institutionalized demented patients: a comparative study of diabetic and nondiabetic patients.

Hypoglycemia is common in elderly community dwelling patients and may accompany episodes of acute infection. We analyzed the interrelations of clinical variables with infection-related hypoglycemia (IRH) and its outcome in institutionalized demented elderly patients, with and without diabetes mellitus (DM). This is a retrospective cohort study involving residents of a large long term-care facility. We measured demographic, clinical, functional, nutritional and cognitive data as well as blood counts and chemistry analysis. We identified 65 elderly patients with IRH and compared data of 33 diabetic patients with 32 nondiabetic patients. Mean age of patients was 77.7 years and mean Mini-Mental score of 1.8. Diabetic patients were younger, more cognitively impaired, had a lower functional score (nonsignificant differences), but presented with more comorbidities, compared with nondiabetics (p=0.004). Mean blood glucose levels in diabetics and nondiabetics were 53.2 and 54.3 mg/dl, respectively. Only 22% of the patients showed clinical signs indicating hypoglycemia. Multivariate analysis showed that, in groups, comorbidity and functional status, creatinine, albumin, C-reactive protein (CRP) and total cholesterol were all associated with IRH. During a 6 months period, 58% (38/65) of the patients died, out of whom 47% (18/38) died within one month following the documentation of IRH. There were no statistically significant differences in short and late mortality rates between patients with and without DM. we conclude that asymptomatic IRH in institutionalized demented elderly is frequently associated with common respiratory and urinary infections, in both diabetic and nondiabetic patients. IRH seems to indicate a poor general health status rather than being the cause of death. Blood glucose needs to be screened in this population during common infections, also in nondiabetics, to identify patients at high risk.

Aged↗
PubMed2006

Drug use in a geriatric long-term care setting: comparison between newly admitted and institutionalised patients.

BACKGROUND AND OBJECTIVE: Advanced age, co-morbid diseases, functional dependence and frailty are associated with polypharmacy and overall high health expenditures. Polypharmacy is commonly defined as the concomitant ingestion of four or more medications, particularly in community-dwelling patients, but the number of drugs being taken by institutionalised and hospitalised patients may be as high as ten. The aim of this study was to compare drug use in newly admitted patients (AP) to a geriatric medical centre for long-term care (LTC) with that of institutionalised patients (IP) at the centre. METHODS: A cross-sectional study was conducted, between January 2001 and December 2002, in 324 functionally dependent and cognitively impaired elderly patients (> or = 65 years of age), consisting of 167 IP (127 females, 40 males) staying at the centre for > or = 3 months and 157 (117 females, 40 males) consecutive new admissions for LTC. All patients underwent a comprehensive geriatric assessment, which included a structured medical history, history of drug use, physical examination and functional and cognitive examinations. Overall drug use, drug categories and the basis of use (regular and/or as needed) were compared between the two groups of patients. The pattern of drug use was defined as use of drugs either on a 'regular' basis or on an 'as needed' basis at any time during the 3 weeks preceding the comprehensive geriatric assessment. RESULTS: IPs were younger, more dependent, more cognitively impaired, had more co-morbidity and had nonsignificantly higher overall drug use than APs. APs used drugs mainly on a 'regular' basis. All of the IPs and most (97%) of the APs were taking drugs according to regular regimens. However, advanced age in IPs was associated with lower overall drug use, predominantly of medications taken on a 'regular' basis, and higher use of drugs taken on an 'as needed' basis, whereas in APs, advanced age was associated with higher use of both types of medications. CONCLUSION: IPs used more drugs on an 'as needed' basis, probably because of closer medical supervision of these patients than those in the community. Better knowledge of the patient's medical condition and treatment, together with better monitoring in the community through patient caregiver instruction, on the one hand, and computerisation of medical data accessible to all healthcare providers, on the other hand, might reduce drug use on a regular basis and, consequently, the costly and adverse effects of polypharmacy.

Aged↗
PubMed2005

Antiepileptic drug use and the occurrence of pressure ulcers among bedridden institutionalized elderly patients: a retrospective chart review.

BACKGROUND: Phenytoin (PH) is indicated primarily for the control of grand mal and psychomotor seizures. However, topical PH has been used for the treatment of various types of ulcers, including pressure ulcers. OBJECTIVE: The aim of this study was to investigate the possibility of a relationship between the use of oral PH and the prevalence of pressure ulcers among bedridden institutionalized elderly patients. METHODS: This retrospective chart review was conducted in a state-run urban geriatric medical center in Israel and involved long-term bedridden institutionalized patients who were receiving chronic antiepileptic medication during the 7-year period between January 1996 and December 2003. The prevalence of pressure ulcers in patients who received treatment with PH alone or in combination with other antiepileptic drugs was compared with that in patients who received antiepileptic agents other than PH. RESULTS: The study analyzed data from the medical charts of 153 patients, 72 of whom received PH alone or in combination with other antiepileptic drugs, and 81 of whom received antiepileptic agents other than PH. Patients' mean (SD) age was 78.5 (7.2) years; 106 (69.3%) were women. All patients were totally dependent with respect to activities of daily living (mean Katz score, 2.0 [2.0]) and had severe cognitive decline (mean Mini-Mental State Examination score, 3.5 [3.3]). Pressure ulcers occurred in 9.7% of PH recipients and 27.2% of non-PH recipients (P = 0.006; chi2 = 7.55). In PH recipients, 85.7% of pressure ulcers were of mild to moderate severity (stage I or II), compared with 59.1% of ulcers in non-PH recipients; the difference between groups was not statistically significant. Four (18.2%) non-PH recipients and no PH recipients had stage IV pressure ulcers. In the PH group, 71.4% of patients had a pressure ulcer in only 1 anatomic location, compared with 22.7% of the non-PH group (P = 0.023; chi2 = 5.13); 28.6% of PH recipients and 63.6% of non-PH recipients had pressure ulcers in 2 or 3 anatomic locations; and 3 (13.6%) non-PH recipients and no PH recipients had pressure ulcers in > or = 4 areas. CONCLUSIONS: In the long-term bedridden institutionalized patients studied, those who received PH had lower rates of pressure ulcers, as well as less severe ulcers. PH may be a useful anticonvulsive agent in frail elderly patients, who are at risk for the development of pressure ulcers.

Activities of Daily Living↗
PubMed2004

Energy restriction controls aging through neuroendocrine signal transduction.

Since the work of McCay in 1935, demonstrating the effect of energy restricted diet on the lifespan of rats, many studies have confirmed these findings in different species. Several mechanisms have been suggested, including among others, growth retardation, diminished apoptosis, decreased oxidative damage, altered glucose utilization, changes in gene expression, enhanced stress responsiveness and hormesis. There is some evidence that energy restriction (ER) exerts important metabolic effects on the aging process and longevity through intra- and intercellular signal transduction transmitters, with several signaling pathways mediating its beneficial action.

Aging↗
PubMed2004

Homocysteine effect on protein degradation rates.

OBJECTIVES: To show the effect of homocysteine (Hcy) on the degradation rates of proteins. DESIGN AND METHODS: Degradation rates of short-lived proteins in neutrophils were measured in in vivo human model of elevated plasma Hcy and lower vitamin status and in animal model of Hcy added in vitro to rat neutrophils. RESULTS: In the human study, we found significant coefficients of correlation between plasma total homocysteine (tHcy) and the degradation rates of 21 protein fractions. In the animal model, Hcy significantly increased degradation rates of 57 protein fractions. CONCLUSIONS: The increase in protein degradation rates, induced by Hcy, may provide a clue to our understanding of the mechanism of Hcy detrimental effects. Hcy may amplify the specific effect of cellular solutes on protein conformation, thereby monitor protein degradation rates to control enzyme activity. Consequently, the cell may lose its ability to maintain an efficient control of some crucial metabolic pathways, possibly leading to atherogenesis.

Aged↗
PubMed2004

[Vestibular function, falls and hip fracture in elderly--a relationship study].

BACKGROUND: Falling is the main reason for which people over 70 arrive at emergency rooms. Over 90% of hip fractures occur as a direct result of falling. PURPOSE: To examine the relationship between the function of the vestibular system and hip fractures following falls in elderly. SUBJECTS AND METHODS: The research group (n = 84) undergone hip surgery as a result of a fall and were then hospitalized in a rehabilitative geriatric care unit at the Meir Hospital in Kfar Sava. The control group (n = 85)--without any history of a hip fracture and living in a retirement home. Four clinical tests were given to each examinee in order to locate any impairment of the vestibular system. Three of the clinical examinations concentrated on testing the VOR while the fourth test was especially used to locate BPPV (Benign Paroxysmal Positional Vertigo). Sociodemographic status and medical history were taken. RESULTS: A significant difference was found between the two groups (those with a hip fracture and those without any hip fracture) with regard to the functioning of the VOR, age, endocrine disease and medications for treating diabetic. However, there was no significant difference found in the appearance of the BPPV. CONCLUSIONS: It is important to locate the elderly who are at risk of falling in nursing homes and the community at large by performing the four simple clinical tests. Correct diagnosis and early treatment of the vestibular impairment in elderly patient can prevent the next fall.

Accidental Falls↗
PubMed2004

[Fever and its decrement in acute stroke].

Management of body temperature is considered crucial in the management of acute stroke patients. Hyperthermia exacerbates ischaemic neuronal injury and physiological dysfunction. Hypothermia has been suggested as the "gold standard" for neuroprotection to which new pharmacological therapies should be compared. This article reviews the literature on the predictive role of admission body temperature on the outcomes of patients with stroke. We also examined the derived effect of using hypothermic procedures and antipyretic agents as a treatment measure in acute stroke patients for improving outcomes. Immediate effective treatment of the fever, while simultaneously evaluating its origin, is found to be crucial in the acute stroke for improving outcomes. The hypothermic effect of acetaminophen as a preventive measure for all patients requires further evaluation.

Acute Disease↗
PubMed2003

Hyperhomocysteinemia and vitamin score: correlations with silent brain ischemic lesions and brain atrophy.

Elevated fasting plasma total homocysteine concentration (tHcy) and lower vitamin status are associated with atherosclerotic states. Silent brain ischemic lesions and brain atrophy, prevailing in the elderly, are affected by tHcy and vitamin status. The study was performed on 56 outpatients who had undergone brain computed tomography (CT) before the onset of the study. According to brain CT evaluation, three groups were set: minor brain ischemia, brain atrophy and control. Brain CT, tHcy, plasma pyridoxal phosphate (PLP), vitamin B(12), folic acid and cognitive and functional capacities were measured or evaluated in all of the subjects. Plasma vitamin score for three vitamins was calculated. In subjects with minor brain ischemic lesions (n = 21), tHcy was higher by 5.6 microM, whereas vitamin score and cognitive function were lower than in controls (n = 24). In subjects with brain atrophy (n = 11), plasma PLP and cognitive function were lower. Particular attention should be paid to tHcy monitoring, vitamin status assessment and brain impairment evaluation.

Aged↗
PubMed2003

Assessment tools for nutritional status in the elderly.

Nutritional assessment in the elderly consists of many different tests--clinical, biochemical and anthropometric. However, objective markers of nutritional assessment often do not reflect physiologic, physical, cognitive and emotional function. Moreover, nutritional assessment using objective markers is more complicated in the older subject because metabolic changes, among others, affect some of the routine biochemical test results, and the reference values of the anthropometric measures are not always age-adjusted. In addition, it is possible that functional impairment may occur at a subclinical level and precede a measurable alteration in body composition, i.e., there may be clearly defined alterations in muscle function at a time when significant changes in body composition could not be detected. Malnutrition or nutritional deficiency is a continuum that starts with an individual's inadequate intake (that, in fact, does not meet his or her needs) and progresses through a series of functional changes that precede any changes in body composition. At present there is no gold standard for evaluating nutritional status. The relationship between nutritional status and functional capacities apparently is the simplest, but also the most reliable index of malnutrition. The extent of dependency and disability has a considerable impact on nutritional status and vice versa.

Aged↗
PubMed2003

Is the treatment of hyperlipidemia as secondary prevention adequate in different age groups in Israel?

BACKGROUND: Treatment of hyperlipidemia is important for secondary prevention in patients suffering from coronary heart disease. It has been proven that "young elderly" (patients aged 65-75 years) can benefit from the treatment at least as much as younger patients. OBJECTIVE: To assess the adequacy of treatment as part of secondary prevention in "young elderly" and younger patients. METHODS: In this prospective study, 389 patients discharged from the hospital with the diagnosis of coronary heart disease were divided according to age groups. Data were collected regarding lipid profile examinations, dietary and drug therapy, and results of lipid profiles. RESULTS: Less than one-third of the patients achieved target low density lipoprotein levels. More patients in the older age group achieved the treatment goals. The goals were achieved despite the fact that the percentage of patients treated with lipid-lowering drugs was lower in the older age group. CONCLUSION: The percentage of patients treated for hyperlipidemia as part of a secondary prevention plan in Israel is similar to that in other developed countries. The fact that more "young elderly" patients achieve adequate lipid profiles compared to younger patients indicates that there is no age discrimination towards this patient group. The finding that less than one-third of the patients reach the treatment goals should prompt physicians to treat hyperlipidemia more aggressively.

Adult↗
PubMed2002

Outcome of West Nile fever in older adults.

OBJECTIVES: To determine the effect of clinical presentation and cognitive changes on the postdischarge outcome in older adult patients with West Nile fever (WNF). DESIGN: Retrospective, cohort analysis. SETTING: Meir Hospital located in the center of Israel in the Sharon region. PARTICIPANTS: Thirty-two patients aged 65 and older hospitalized during a WNF outbreak. MEASUREMENTS: All patients' charts were analyzed retrospectively with special emphasis on their cognitive and functional state. A follow-up examination of patients with functional decline at discharge was performed after 3 months. RESULTS: A change in consciousness, rather than in cognition, predicted the outcome. The death rate was 22% (7/32); all fatal cases were aged 78 and older. Similarly, the functional decline and residual damage appeared only in the older age group (>or=75). Eighty-eight percent of the survivors returned to their premorbid function. In contrast to other viral infections, chronic conditions in the subjects had no effect on the outcome. CONCLUSIONS: In older adults, WNF carries a high death rate, but the outcome is favorable for the survivors.

Age Factors↗
PubMed2002

[Cognitive assessment in geriatric rehabilitation].

Geriatric rehabilitation is a prolonged and expensive process. There is a need to evaluate the rehabilitation potential because of the increasing number of elderly in the population and limited resources. Cognition is one of the components of occupational performance and its evaluation is a crucial part of comprehensive geriatric assessment. Cognitive evaluation is one of the predictors of function among elderly in the community and also assists in predicting their rehabilitation potential during hospitalization. High prevalence of cognitive decline with aging and the difficulties in its early assessment during hospitalization emphasizes the utmost importance of this evaluation in predicting the functional prognosis of the patient. This article reviews the main common tools for cognitive evaluation, which are in use clinically, and also used in research, for geriatric rehabilitation in Israel. These were compared with the principles of dynamic cognitive assessment. We aim to assess the need to add dynamic diagnostic tools to supplement those in common use. This will assist in providing an optimal mechanism for cognitive evaluation during geriatric rehabilitation.

Adult↗
PubMed2002

[Sexuality in aging].

During aging, impairment in many physiological functions is manifested. This is exhibited in sexual functioning, which is an intricate interaction involving a number of systems: endocrinal, motor, sensor, physical and sensual. Sexual activity is a component of the well-being of the individual, while sexuality is part of self-identity at any age. Sexual activity is a primary base to human relations, and it is a basic right of every person in society. Sexuality and sexual activity are considered to be part of youth, hence, the combination of sexuality and aging is considered strange. In many instances, sexual activity in the elderly is considered exceptional and possibly requiring certain intervention of the society establishment. Recent technological advances enable sexual activity, despite physiological and even anatomical shortcomings. Knowledge of the changes in sexual activity with aging, as well as having open communication on the subject, are the best tools for maintaining sexual activity with appropriate limitation during aging. The purpose of this short review is to present the different aspects of sexuality and sexual activity in aging.

Aged↗
PubMedDate not supplied

Hypodermoclysis (subcutaneous infusion) effective mode of treatment of dehydration in long-term care patients.

Dehydration is associated with morbidity and mortality in frail elderly patients. Intravenous fluid administration in these patients is sometimes hard, especially in agitated patients. The purpose of this study was to review of 57 long-termed care patients received hypodermoclysis infusion on 118 different occasions during the 9 months. Data collection included: demographic data, functional and mental status, indication hypodermoclysis, duration of the infusion, type of solution, laboratory data, adverse effects, and outcome. The main reasons for initiation of the hypodermoclysis were either dehydration (64%) or febrile illness (21%). The average duration of infusions was 15.9 days and average daily volume was 1161 ml per day. After hydration by hypodermoclysis, in 77% of the patients, clinical improvement occurred manifested as general improvement (88%), cognitive status improvement (84%), and improved oral intake (81%). During the course of the study, failure of the treatment was observed in 12% of the patients, mortality of 11% was observed. Nobody developed signs of fluid overload. Local complications were reported in 12% of patients: local swelling (6/57), complain of local pain at site (3/57) and local inflammation (2/57). Hypodermoclysis is a safe, effective and suitable alternative to intravenous re-hydration in long-term care patients.

Aged↗
PubMedDate not supplied

Triple task Clock Completion Test (CCT) as a predictor of functional outcome in geriatric rehabilitation.

Cognitive status is considered as a predictor of the rehabilitation outcome. The triple task Clock Completion Test (CCT), which evaluates visuospatial skill, has been demonstrated to be a sensitive predictor of functional capacity. The objective of the study was to test the predictive validity of the CCT for assessing functional outcome in geriatric rehabilitation. Functional evaluation using the Functional Independence Measure (FIM) and cognitive evaluation using the Mini Mental State Examination (MMSE) as well as the CCT, were performed in 77 elderly patients (35 men, 42 women, median age 81.5 years) on admission and discharge. Significant positive coefficients of correlation were found between the admission and discharge CCT scores, and negative coefficients, between CCT and FIM scores, both on admission and discharge. CCT and MMSE scores correlated significantly just on admission. The MMSE and the FIM scores were significantly higher among those who succeeded than in those who failed on the CCT in the task of setting the hour on admission and discharge, whereas in the task of reading the hour, just on admission. The triple task CCT is a sensitive tool for identifying cognitive impairment affecting the executive functions and an important functional outcome predictor.

Activities of Daily Living↗