Ioana Dana Alexa

Incidence of chemotherapy discontinuation and characteristics of elderly patients with non-small cell lung cancer treated with platinum-based doublets

Aim of the study To compare patients characteristics, clinical data, and rates of chemotherapy discontinuation in advanced NSCLC (non-small cell lung cancer) patients treated with platinum-based association chemotherapy (elderly vs. younger counterparts). To evaluate if there are certain factors that can predict discontinuation of chemotherapy. Material and methods A retrospective analysis of all cases of advanced NSCLC treated with either cisplatin-gemcitabine or cisplatin-vinorelbine at the Regional Institute of Oncology Iaşi between January 2012 and December 2013 was performed. Patients were divided into two groups: over 70 years old and under 70 years old. Patients characteristics and clinical data (including whether or not the patient discontinued treatment) were recorded for each case. Results The elderly patients had more comorbidities (p = 0.003), were prescribed a larger number of pills (p = 0.02), and had longer periods of hospitalisation (p = 0.005). No difference in toxicity was noted between the two groups. Five patients chose to discontinue chemotherapy in the elderly group. Only two patients made the same choice (p = 0.02) in the younger group. Correlation analysis revealed that refusal of further chemotherapy was associated with the length of hospital stay, number of pills per day, and smoking status. Conclusions Geriatricians should minimise iatrogeny and polypharmacy by optimising long-term treatment. This will increase the chance that elderly patients will not discontinue chemotherapy. Hospital stay should be reduced to a minimum. As life span increases so does the number of elderly patients with cancer; it is vital to understand and prevent the causes of chemotherapy discontinuation in order to achieve optimal therapeutic results.

TELEMON — A Complex System for Real Time Telemonitoring of Chronic Patients and Elderly People

This paper presents a project that has as main goal researches, design and implementation of an electronicinformatics- telecom and scalable system, that allows the automatic, complex and real time telemonitoring, everywhere and every time (at home, in hospitals, at work, etc.), using several communication paths, of (mobile) persons with chronic illnesses, of elderly people, of those having high medical risk and of those with neuro-locomotor disabilities. The monitored features are electrophysiological (vital) signs, signals for domotics (home surveillance, access control in a certain area), and the systems also performs automatic image analysis of the movements of the subjects.

Techniques of determining arterial stiffness in clinical practice

With the aging of population, assessment of total vascular risk is very important, because old age is associated with multiple risks. More specifically, arterial stiffness has been recognized as a measure of biological ageing. Pulse wave velocity (PWV) is not a direct measure of stiffness, it is a measurement of the velocity of the pressure pulse, and is related with stiffness and is influenced by pressure. Brachial-ankle PWV (ba PWV) has been confirmed to increase in conditions with cardiovascular factors such as ageing, hypertension, diabetes, chronic kidney disease. Measurement of this parameter is easy and has a good reproducibility. As an alternative, to measure direct the stiffness, was developed Cardio-Ankle Vascular Index (CAVI). CAVI reflects stiffness of the artery from the origin of aorta to ankle region. Several clinical and experimental studies have shown that CAVI is not correlated with blood pressure from the moment of determination, unlike PWV. CAVI evolves with age and reflects the severity of coronary disease, also is increased in early atherosclerotic disease than does ba PWV. Assessment of arterial stiffness could allow further risk stratification of high-risk individuals and can assist in the early detection of arteriosclerosis.

Is the Singh Index useful for evaluating osteoporosis

The Singh Index was proposed by Singh and Nagath in 1970 to evaluate the degree of osteoporosis. The aim of this study was to appreciate the value SI in current practice. Method. We performed an analysis on 129 antero-posterior plain radiographies of proximal femurs without fractures or arthrosis, obtained during a period of three years. Four observers (orthopedists) analyzed these radiographies and classified each image into one of the six Singh categories. After a period of three months, the radiographies were reexamined by the same observers. In order to evaluate the value of the Singh Index, variability inter- and intra-observers was measured. These parameters evaluate the proportion of identical readings for the same set of radiographies for 2 different observers (interobservability) and the proportion of identical readings for the same observer at two different readings (intraobservability). The results were evaluated with the aid of statistic interpretation (kappa value). In the second stage of the evaluation, the relevance of the Singh index was assessed using dual energy X-ray absorptiometry (DXA). Results. For assessing interobservability, the four observers were grouped in pairs, resulting six possible pairs. Kappa was measured for each pair, and the final result represented an average of the kappa value. For interobservability, kappa value was 0.15. In order to determine intraobservability, we took into account the number of identical readings for the same observer at two different moments. The procedure for calculating kappa was similar. Mean kappa value for intraobservability was 0.19. According to the scale proposed by Landis and Koch, these figures suggest slight agreement (0.00 – 0.20). When comparing the results obtained by DXA with those by the Singh index, a significant discrepancy was also noticed. Conclusions. Based on these findings, we believe that the Singh Index, as proposed by the author, has a reduced significance and utility.

Sarcopenia and the importance of biochemical determinations in the hospitalised older adults

Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength. It is the major pathway leading to physical frailty, an important geriatric syndrome and an important problem in the elderly population. There are multiple factors leading to sarcopenia and frailty and for preventing them is important to determine the biochemical factors involved. We conducted a study on 143 elderly patients hospitalized during a nine months period. Demographic data were collected and biochemical parameters were determined. Sarcopenia was determined through muscle mass and muscle strength. The average age of the persons included in the study was 77.13 ± 6.30 years, without differences between gender distributions. To assess the relationship between the biochemical parameters and the presence of sarcopenia, the patients were divided into two groups: the group with sarcopenia and the group without sarcopenia. The analysis of the relationships between the presence of sarcopenia and the biochemical parameters determined within the study group, revealed that sarcopenia is correlated with blood glucose (p = 0.002, r = − 0.266), creatinine (p=0.010, r= −0.221) and also creatinine clearance (p=0.017, r=0.207). Biochemical determinations are important in determining sarcopenia and frailty and are of high importance before establishing any measure of treatment or prevention.

Home blood pressure monitoring — One step towards reducing defensive medicine

Hypertension is one of the major risk factors for developing cardiovascular diseases such as heart failure, stroke, coronary heart disease, and renal failure, and one of the most frequent reasons for access to medical care. In elderly patients, hypertension is usually associated with several concomitant diseases, which leads to polypharmacy, iatrogeny, repeated hospitalizations and un-necessary consultations. Defensive medicine is defined as the ordering of treatments, tests, and procedures for the purpose of protecting the doctor from criticism rather than diagnosing or treating the patient. Our case presentation illustrates defensive medicine applied to an elderly female patient with high blood pressure. What should have been the methods to prevent the delaying of treatment for the main problems (high blood pressure and atrial fibrillation)? A better medical surveillance and monitoring should have been the answer. Use of blood pressure telemonitoring technique might help in improving blood pressure control and adherence, helping the quantification and definition of the psychological trait of the hypertensive patient and preventing defensive medicine expressed by un-necessary hospitalization and interdisciplinary consults.