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PubMed1997

[Hypervitaminosis D in institutionalized elderly in Buenos Aires].

Several studies have shown that vitamin D (Vit. D) deficiency in elderly people enhances bone mass loss. Most of these studies have been carried out in areas of low solar irradiation. In order to establish Vit. D circulating levels in elderly people in our community (34 degrees S) and their relationship with bone metabolism, 34 men and 33 women were studied at the end of the summer. These subjects, all residents of nursing homes, had a mean age of 81.9 + 8.1 years (range 69-99). Calcemia, parathyroid hormone (PTH and 25-hydroxyvitamin D (25(HO)D) were measured in serum and bone markers in serum and urine. Bone densitometry (BMD) of cortical and trabecular bone in the forearm (distal third of the radius (R33%) and ultradistal (RUD), respectively) were performed using X-ray absorptiometry. We found: 1) Low serum 25(HO)D (14.4 + 1.7 ng/ml) at summer's end. 40.5% showed levels < 10 ng/ml. 2) Secondary hyperparathyroidism (PTH: 169.4 + 30.9 pg/ml), 3) Hypocalcemia was observed in 34.5% of elderly people, 4) increased bone turnover in the subpopulation with hypovitaminosis D. 5) The serum levels of 25(HO)D correlated with BMD R33% (r = 0.55, n = 54, P < 0.001), with BMD RUD (r = 0.50, n = 54, P < 0.001) and with PTH (r = -0.44, n = 42, P < 0.01). A deficiency of Vit.D was found in our population of elderly people, probably due to diminished epidermic production of its precursors and/or to scant exposure to sunlight in the elderly. The decrease is associated to age. The positive correlation of 25(HO)D with bone mass (cortical and trabecular bone) underscores its importance for the preservation of bone mass. Hyperparathyroidism, triggered by Vit. D deficit, enhances bone loss.

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PubMedDate not supplied

[The parameters of the immune function in the evolution of HIV-1 infection in institutionalized children in Romania].

OBJECTIVE: To describe the evolution of HIV-1 + horizontal infected children nursed in closed community. METHOD: The biological status of 26 HIV-1 + children nursed in Iaşi Orphanage was assessed in dynamic during April. 1993-Feb. 1994. The income age ranged among 1 month-3 years. RESULTS: The following progressive stages could be drawn accordingly to the biological status parameters dynamic: stage 1 ("oligosymptomatic"), stage 2 ("multiform, medium or severe symptomatology"), and stage 3 ("severe immunodepression, with predominant infectious symptomatology, waves evolution"). These stages could not be assimilated to the currently CDC or WHO classifications. The following thresholds of the immunologically parameters separate the stages 1 and 2, and respective stages 2 and 3: CD4% lymphocytes (27% respective 20%); absolute CD4+ lymphocytes (1150/microliter respective 700 + 750/microliter), CD4/CD8 ratio (0.75 respective 0.45), beta 2-microglobulin (1.5 mg/1000 respective 2.5 mg/ 1000). Lymphocytes lacking the markers CD4, CD8, CD19, CD3, ranging between 15 + 20% were also detected by flow-cytometry; these cells could be attributed to the immature subpopulations (typically for dystrophy) or to down-regulation of membrane expression of some markers. Also, a dichotomy in the distribution of the CD2/CD3 surface markers was recorded in the case of lymphocytes. CONCLUSIONS: Immunological features demarcate this epidemiological group versus the current described models for the HIV-1 + child.

Biomarkers↗
PubMed1997

[Zinc status evaluation in an elderly institutionalized population].

Elderly people is at high nutritional risk for zinc, specially marginal deficit, which could contribute to complications of chronic diseases and undernutrition. The aim of study was to know the zinc status of 83 elderly people (older than 60), from both sexes, living in geriatric home. Zinc serum levels, alkaline phosphatase serum levels; albumin serum levels, energy, proteins and zinc dietary intake and gustative sensitivity were determined. Results expressed as mean +/- DS are the following: serum zinc: 90.89 +/- 19.0 micrograms/dl, alkaline phosphatase: 125.41 +/- 24.2 IU/L, albumin serum: 3.9 +/- 0.76 g/dl energy intake: 1643 +/- 309.9 Kcal/day, protein intake: 59.96 +/- 13.2 g/day, zinc intake 7.9 +/- 3.0 mg/day, only energy and zinc intake were deficient. 18.1% had zinc values under 70 micrograms/dl. There was 54% of positive responses to the taste acuity tests. This results qualify this group as at risk, specially for zinc nutritional.

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PubMed1993

Time until institutionalization and death in patients with dementia. Role of caregiver training and risk factors.

OBJECTIVE: To determine which variables best predict prognosis--time to nursing home admission (NHA) and death--in patients with dementia. DESIGN: Survival analysis employing the Cox proportional hazards model with the use of risk variables pertaining to dementia severity and its rate of progression and caregiver functioning. SETTING: Patients and their caregivers participating in a controlled intervention study of training for caregivers in home management of dementia. PARTICIPANTS: Patients with mild Diagnostic and Statistical Manual of Mental Disorders, Third Edition--defined dementia (N = 91; 68 patients with Alzheimer-type dementia, 20 with vascular dementia, and three with other types) and their caregivers. FOLLOW-UP: All subjects had repeated assessments in the first year to determine rates of change and thereafter annually to determine the date of NHA and/or death. RISK VARIABLES: (1) Caregiver training; (2) dementia severity at index assessment; (3) caregiver stress, neuroticism, and socialization; (4) changes in patients and caregivers during the first 12 months; and (5) patient characteristics. RESULTS: By 5 years' follow-up, 76% of patients had entered a nursing home and 42% had died. Dementia severity and rate of deterioration ("how far" and "how fast") and caregiver psychological morbidity significantly influenced rates of NHA and death. Training of caregivers was significantly associated with delayed NHA and reduced mortality. Greater patient age, non-Alzheimer's dementia, and, unexpectedly, greater caregiver psychological morbidity were associated with shorter survival to death. CONCLUSIONS: Both severity ("how far") and rate of deterioration ("how fast") influence time to NHA and death. Caregiver training may have important ameliorating effects on the prognosis of dementia.

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