SP - Other medical conditions

Introduction Critical Illness Acquired weakness (ICU-Acquired Weakness (ICU-AW)) is an umbrella term used to describe Critical Illness Myopathy (CIM) and Critical Illness Polyneuropathy (CIP). The condition exerts high prevalence in the elderly admitted in the ICU and is associated with deteriorating patient outcomes, namely mortality and morbidity. The prevalence of the syndrome is highly variable in the current literature hindering our ability to objectively quantify the scale of the problem. Moreover, several preventative methods and treatment for ICU-AW as a result of sarcopenia have been proposed in literature with some of them providing favorable outcomes.

Our Objectives main objectives are: 1. Evaluate the prevalence of ICU-AW in the elderly through a systematic review 2. Explore the treatment options currently available

Methods We conducted a systematic review using the PubMed, Embase and Cochrane databases to explore the current studies available on the diagnosis of ICU-AW syndromes. Cochrane’s Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was our template.

Results Overall, twenty-one studies (1544 patients) were included. The minimum reported prevalence is 20%, whereas the maximum is 76%. The overall median prevalence was 52% (Q1: 32% and Q3: 61%) with an interquartile range (IQR) of 29%. The highest IQR was found in studies using clinical examination (IQR=37%) whereas the lowest in studies using electrophysiological assessment (IQR= 21%). Moreover, several preventative measures for ICU-AW were identified and analyzed namely: nutritional alterations (high protein dies), glucose control, early mobilization, neuromuscular electrical stimulation and the ABCDEF bundle.

Conclusion The variability in the diagnostic modalities used to measure the syndrome as well as the inconsistency in the diagnostic parameters within each modality prevent us from objectively quantifying the prevalence of ICU-AW. With regards to treatment early mobilization protocols offer promising evidence. Reference: Vanhorebeek, Latronico, Van den Berghe G. ICU-acquired weakness. Intensive Care Med. 2020;46(4):637-53.

Introduction

Perioperative geriatrics is an emerging specialty with immense importance to all medical and surgical specialties. Only a small number of papers have been published on the topic. A bibliometric analysis is used to identify themes and trends in current research and practice. Objectives To identify and describe research topics relating to perioperative geriatrics.

Methods

Thompson Reuters Web of Science indexing database was searched for all manuscripts relating to perioperative geriatrics. Of these, the top 100 were subcategorised into manuscript type, age, theme, specialty, journal and citation rate.

Results

The highest cited article was by Bhandari et al with 294 citations. The highest citation rate was achieved by Partridge et al, 23.75 citations/year. Across the series, the mean number of citations was 50.41 (range 294-12). The highest number of manuscripts were published between 2010-19 (n=55), with 70% of manuscripts published in journals with impact factor < 5. The specialty with the highest number of publications was orthopaedics (n=36), followed by cardio-thoracics (n=15). Most articles focussed on surgical management of geriatrics patients, followed by anaesthetic management.

Conclusion

This is the first bibliometric analysis of the top 100 most cited papers in perioperative geriatrics. Only 395 papers were returned, indicating that this needs to be further researched as a topic. Key themes identified were surgical management and anaesthetic treatment. Key Words Bibliometric analysis, literature review, geriatrics, perioperative

Pancreatic cancer represents one of the most prothrombotic neoplasms secondary to high tumoral expression of tissue factor, cytokine release, activation of leukocytes and hypofibrinolysis. Studies have shown that the incidence of thrombotic complications can reach up to 36%.

We present a case of an 84-year-old male patient who was admitted onto the Geriatrics ward with a 3-day history of sudden-onset dyspnoea, productive cough, pallor, and general malaise. Admission blood revealed microcytic anaemia (Hb 91 g/L), neutrophilic leukocytosis (WCC 29.9 x 10^9/L, Neut 26.9 x10^9/L) and elevated C-reactive protein (211 mg/L). Despite high clinical suspicion of pneumonia, chest X-ray did not demonstrate any pathology.

On day 2 of admission, D-dimer was requested, and the critical result of 3500 ng/mL was noted. Patient was immediately commenced on anticoagulation therapy and urgent CT-PA demonstrated the presence of a pulmonary embolus in a posterior sub-segmental artery of the right lower lobe.

On day 3, patient manifested left-sided lower limb weakness along with reduced sensation to light touch up to the left knee. Patient did not demonstrate cortical symptoms. Urgent CT-Head revealed hypodensity in the right parietal region suggestive of acute ischaemic infarction.

On day 5, patient reported pain and swelling of the left calf. Physical examination rendered high suspicion of left deep vein thrombosis with calf circumferential difference of 4cm (Left 34cm, Right 30cm) and significant tenderness on palpation. In light of three consecutive thromboembolic events within 5-day course of admission, suspicion of cancer-associated thrombosis was established. Urgent CT-AP was conducted, 5cm carcinoma at the tail of the pancreas with extensive hepatic, splenic and adrenal metastatic disease. The following case warrants attention from the clinicians as unprovoked pulmonary embolism should prompt investigation for potential underlying malignancy.

Furthermore, it highlights the malignancy-induced hypercoagulability and risk of cancer-associated thrombosis, particularly in the context of pancreatic carcinoma.