Sacubitril/Valsartan is a novel Angiotensin Receptor Blocker-Neprilysin Inhibitor (ARNI) approved for the treatment of patients with NYHA class II-IV Heart failure with reduced ejection fraction (HFrEF). Hypotension, renal dysfunction, upper respiratory tract infections and angioedema are the common adverse effects reported with sacubitril/valsartan. Here, we report the first case of chronic non-resolving diarrhoea refractory to conventional therapy in an elderly female on sacubitril-valsartan treatment, which posed a diagnostic challenge. The case highlights the importance of suspecting novel drugs being sparsely used in the elderly population as the aetiology of new symptoms, and conducting a therapeutic de-challenge even in the face of apparently low causality scores.

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Purpose: To study the relation between the performance of older persons in Delhi on individual components of MMSE and years spent on formal education. Material and methods: Random subjects above sixty years, attending out-patient clinics of Department of Medicine or Senior Citizen Clinic between November 2014-April 2016 were included in this study and approved by Institutional Ethical Committee after they consented. Patients with acute infectious conditions were excluded. Participants were assessed using a pre-designed MMSE. Frequency tables for all components were constructed. To evaluate the relationship between gender and MMSE as well as educational status and MMSE, the t-test was used. Linear regression models were developed using MMSE as an outcome variable, and exposure variables were added in blocks. Results: 100 subjects were included in this cross-sectional assessment. >90% of people were oriented to space and were able to repeat and recall all three objects. The mean MMSE score was 24.92 (±5.8). Males had a higher score than women. Education status affected fields like serial deduction, obeying a 3 stage command, writing, drawing and responding to a written command due to which only 50% of people scored well in these parameters. Conclusion: Age and education are critical factors in understanding the inconsistencies in MMSE execution. Subjects who spent more years in formal education performed better than the subjects with low education. The low educational levels increase the probability of misclassifying the ordinary subjects as cognitively impaired. Since the memory area of the MMSE is less influenced by training, it might be utilized alongside other tests in populaces with low instruction.

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Objective-Clinical trials and observational studies have provided good evidence that early glycemic control leads to a reduction in complications and improved survival in diabetics. However, elevated risk of mortality has been reported at both the lower and upper ends of long-term glucose levels. Fear of hypoglycemia has been a significant factor in suboptimal glycemic control. In this retrospective analysis we aimed to identify the incidence of hypoglycemia and their precipitating factors in elderly diabetics on good glycemic control. Material and methods- Ninety seven elderly diabetic patients attending the cardiology Out-Patients Department of a super speciality private sector hospital from 1 December 2017 to 30 November 2018 were studied retrospectively. Their demographic profile, co-morbidities and pharmacological profile were recorded. Incidence of hypoglycemic episodes and their precipitating factor were then analyzed. Result-Mean age was 71.7± 6.3 years, and 64 (66%) were male. Mean duration of diabetes was 7.3± 1.3 years. All patients had type II diabetes mellitus. Mean fasting and random capillary blood glucose levels were 116.5 ±8.7 mg/dl and 169.5±13.5mg/dl, respectively. Mean HbAlc levels of the study population was 6.8±1.14. Over the study period, 23 (23.7%) patients experienced 39 episodes of any level of hypoglycemia. HbAlc Levels in the hypoglycemia group were not significantly different from those in no-hyperglycemia group (6.85±1.13 vs. 6.63±1.04). Mean random plasma glucose values were slightly higher in no-hypoglycemia group (170.9±14.5 vs 164.9±14.9), but the difference did not reach the statistical significance. There was a markedly significant difference in mean fasting plasma glucose values between hypoglycemia and no-hypoglycemia group (101.8±8.9 vs 116.5±12.7). Sulphonylurea and insulin use was more frequent in patients experiencing hypoglycemia (9.6% and 52.2% respectively) as compared with no-hypoglycemia group (33.8% and 39.1% respectively). The most common preceding event was either skipping a meal in 12(30.8%) patients or an unplanned change in diet in 23% patients. Conclusion- Patients with longstanding diabetes and loss of warning symptoms have increased risk of severe hypoglycaemic episodes. Risk of the hypoglycemic episode is better correlated with fasting plasma glucose levels and glycemic variability rather than with HbAlc Level. Sulphonylurea drug use was the only group associated with a statistically significant risk of hypoglycemia. Skipping of a meal or a sudden change in the diet and alteration in antidiabetic drug regimen are the most important precipitating factors for hypoglycemia.

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Objective: This study aimed to report the fear of falling and assess its associations with several fall-related characteristics and functional fitness parameters among older adults living in the rest home. Methods: Seventy-eight older adults aged between 65-94 years were included in the study. History of falling and the number of risk factors for falling were recorded. Fear of falling was evaluated with The Falls Efficacy Scale- International. Functional fitness was assessed with Senior Fitness Test, including tests for the functional measurement of strength, flexibility, aerobic endurance and dynamic balance. Result: The mean age of participants was 78.46±7.16 years. There were correlations exist between fear of falling and number of fall risk factors, dynamic balance, upper body flexibility and aerobic endurance (p<0.05). Multiple linear regression analysis showed that the parameters with the highest determinants of fear of falling were the dynamic balance and history of falling (p<0.05). Conclusions: In our study, history of falling, number of fall risk factors, flexibility for the upper body, aerobic endurance and dynamic balance were parameters related to fear of falling among older adults, but the most influential factors in fear of falling were dynamic balance and history of falling.

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Full text not available  [PDF]