Lower urinary tract symptoms in females can be due to various factors. Most of the time it is due to simple urinary tract infection and lower urinary tract pathology such as urethral stricture, meatal stenosis, bladder stones, underactive detrusor, and primary bladder neck obstruction. Commonly found neurologic causes among females are detrusor–external sphincter dyssynergia, associated with various brain and spine diseases and diabetic neuropathy. Labial fusion is a rare cause of female voiding difficulty. We herein present two elderly postmenopausal diabetic female patients who had nearly total urethral occlusion due to labial fusion. After thorough history taking and local genitourinary examination, the patients were operated. Treatment included surgical correction followed by the local application of 1% estrogen ointment. Both patients were symptom-free after the procedure. Thus, with a correct diagnosis followed by simple operative procedure, we can treat such patients successfully.

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Introduction: Fragility hip fractures in nonagenarian patients pose a great challenge in management. To the best of our knowledge, no study has previously evaluated the outcomes and risk factors for mortality after hip fractures in this subgroup of population from the Indian subcontinent. Materials and Methods: A retrospective observational study was performed on nonagenarian patients (aged ≥90) who underwent surgery for hip fractures between March 2016 and March 2019. The patients were divided into two groups: “survivor group” (Group A) and “mortality group” (Group B). The demographic data, type of fracture, side of fractured limb, preinjury ambulatory status, American Society of Anesthesiologists (ASA) status, comorbidities, time interval from injury to surgery, operative time, length of hospital stay, and postoperative ambulatory status were recorded from hospital medical records and were studied between the two groups. The follow-up duration of the study was 1 year. Results: Thirty-four patients were included in the study. Both the groups had 17 patients each. Cardiac dysfunction was the most common cause of mortality. The time interval from injury to surgery (odds ratio [OR] = 11.2), gender (OR = 0.23) and postoperative mobility status (OR = 0.07) were found to be significantly different between the two groups. No significant difference in ASA grade, comorbidities, fracture type, preinjury ambulatory status, operative time, and length of hospital stay was seen between the two groups. Conclusions: Risk factors for mortality after hip fracture surgery in the nonagenarian population are male gender, delay in surgery (>3 days) and poor ambulatory status in the postoperative period. Hence, the aim for such patients with hip fractures should be to perform an early surgery and encourage an early ambulation.

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Background: The hand is the most active and important part of the upper extremity with complex functional biomechanics and anatomy. The decline in hand grip strength and dexterity with age can adversely affect functional activities. Task-oriented training (TOT) is a treatment approach focused on functional activities of daily life. Aim: To investigate the effect of TOT on hand dexterity, grip strength, and hand function in the geriatric population. Subjects and Methods: Sixteen institutionalized geriatric participants were recruited based on the inclusion and exclusion criteria and assigned to Group A experimental group (nine participants) who received TOT for 4 weeks, 3 days/week along with routine activities and Group B control group (seven participants) who were involved in routine activities only. Gross dexterity was assessed using the box and block test, fine dexterity with nine-hole peg board, hand grip strength with hand dynamometer, and hand function with the Michigan hand outcome questionnaire. The statistical analysis with Student's t-test was performed using the SPSS software. The significance level kept as P ≤ 0.05. Results: The analysis expressed significant improvement in gross and fine hand dexterity and grip strength among the experimental group. The hand function did not reveal a statistically significant change. Conclusion: A 4-week TOT program is an effective measure to improve gross and fine dexterity, and muscle grip strength in the geriatric population. For improvement in hand function, a longer training may be required.

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Context: Adaptation needs of senior citizens are not well explored in research, especially among people living in old age homes situated in developing countries like India. Aim: The aim of the study was to understand the needs and concerns of senior citizens living in old age homes and its effect on their adaptation. Subjects and Methods: Using the purposive sampling method, fifteen residents of an old age home and their three caregivers were interviewed to describe their views and experiences. The tools used were the Montreal Cognitive Assessment and an in-depth interview schedule. Statistical Analysis: Qualitative data were analyzed using Atlas ti. 7 for identifying major themes and subthemes. Results: The results showed that the major needs and concerns of senior citizens were unmet medical needs, difficulty to handle negative attitudes of staff, difficulty to adapt with new environment and culture, and emotional issues. Conclusion: Findings indicate the importance of addressing the adaptation needs of the elderly living in old age homes.

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Older people are complex and have a higher absolute risk of diabetes-related complications and thus should be a target group for diabetes and geriatric nursing intervention. Patients with diabetes also have poor knowledge and understanding of the condition and self-management skills. Management of older people with diabetes should be individualized. Comprehensive geriatric assessment takes into account medical, psychosocial, and functional considerations. Many of the presenting complaints of older people are multifactorial. The reliability and objectivity of the history should also be considered. Other aspects of management include dentition, nutritional status, swallowing, medications, physical activity, fall prevention, palliative care, and support services as well as pressure injuries in dependent older people. Finally, with the current COVID-19 pandemic, the approach for service delivery may also need adjustments to take into account infection prevention and control measures, such as the use of virtual consultations.

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Objective: The objective of the study was to assess the levels of neutralizing antibody after COVID vaccination in the elderly and compare it with that of the younger persons. The study also aimed at determining the association between the age, sex, and comorbidities and levels of neutralizing antibodies in the young and the old. Subjects and Methods: This was a single-center, cross-sectional, analytical study, conducted in the General Medicine Unit of ACS Medical College, Chennai, from August 2021 to October 2021. Forty-five elderly persons aged 60 years and above and 103 young adults aged 18 years and above and <60 years who were vaccinated with either COVISHIELD or COVAXIN were randomly selected to participate in this study. A detailed history regarding vaccination status, vaccination type, comorbidities, and breakthrough infection was obtained. Blood samples were collected from the participants to analyze the levels of neutralizing antibodies developed after COVID vaccination. Results: The mean age of the older participants was 66.13 ± 5.3 years and the mean age of the younger participants was 36.48 ± 10.9 years. The median level of neutralizing antibody in the younger participants was 97.4% (interquartile range [IQR]: 96.4%–98.0%) and in the older participants was 97.1% (IQR: 93.1%–97.6%). There was a significant difference in the neutralizing antibody level between the younger and the older participants (P = 0.033). There was no significant difference in the neutralizing antibody levels after two doses of either of the two vaccines among both the groups of participants. There was no significant association between the neutralizing antibody titer and sex and comorbidities in both the groups of participants. Five young and two old participants had breakthrough infections after vaccination. The antibody level was higher in persons with breakthrough infection than in those with no breakthrough infection in both the study groups. Conclusion: There was a significant difference in the neutralizing antibody level between the younger and the older participants after COVID vaccination. No significant difference existed in neutralizing antibody response with respect to the type of vaccine in both the study groups. There was no significant association between sex, comorbid status, and neutralizing antibody levels in both the groups.

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Background and Objectives: Altered mental status (AMS) is a challenging diagnosis in elderly patients and has a wide range of etiologies. The aim of this study was to know the clinical and etiological profile in the elderly, so that physicians will be better aware of AMS backgrounds and reducing morbidity and mortality rates among the patients. Materials and Methods: This was a prospective observational study conducted at the emergency department (ED) and medical intensive care unit (MICU) of a tertiary care hospital in South India from November 1, 2019, to October 31, 2020. Patients aged 65 years and older who presented to the ED and MICU with AMS were included in this study. They were evaluated clinically and necessary investigations were done to know the etiologies. Results: Among 100 elderly patients, 64% belonged to young old (age group of 65–74 years), 30% belonged to old (age group of 75–84 years), and 6% belonged to oldest old (>85 years). Sixty-one percent were male and 39% were female. The most common cause for AMS in elderly was primary neurological cause (40%, cerebrovascular accident was most common cause). The other causes were metabolic encephalopathy (29%, hyponatremia being most common) followed by multifactorial causes (24%). Infections and hypertensive encephalopathy were noted in 6% and 1% respectively. The common comorbidities found were hypertension (71%) and type 2 diabetes mellitus (50%), and 28% had diabetes mellitus and hypertension, whereas 25% had multiple comorbidities. Conclusion: The elderly patients who present with AMS must be screened for the above etiologies. This study helps the physicians to have an idea regarding common causes of AMS in elderly patients at presentation, hence appropriate management approach thus helps in reducing morbidity and mortality.

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Chronic obstructive pulmonary disease (COPD) is a common respiratory disease in older adults. The increasing prevalence and disease burden in older adults comes with added challenges of coexisting disease condition. Frailty is an important geriatric syndrome associated with worse clinical outcomes in older adults. COPD and frailty share many common and interrelated risk factors, the presence of one condition worsening the course of other and vice versa. It is important to understand their relation, which can help in management. The continued and supervised pulmonary rehabilitation program has a vital role in the management of COPD and frail patients, providing a better quality of life.

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Introduction: Depression in the elderly can have a different pathophysiology and clinical profile, and studies have shown pathological changes in the brain on radio imaging. The present study aimed to find out the association of white matter hyperintensities (WMH) on magnetic resonance imaging (MRI) with the severity of illness and cognition in elderly depressed patients. Methodology: This cross-sectional study included 68 elderly (>60 years of age) depressed patients who had undergone MRI at a tertiary care center, and based on the severity of WMH, they were divided into two groups: no or slight WMH group and moderate or severe WMH group. The severity of depression was assessed using the Hamilton Depression Rating Scale (HAM-D) scale, and neuropsychological assessments were made for testing attention, concentration and executive function. Results: HAM-D scores were found significantly higher in patients with moderate-to-severe WMH groups (22.6 ± 5.2) compared to those with no or slight WMH (16.3 ± 4.2). The cognitive performance evaluated by backward digit span test, Trail making Test A and B, and Color Stroop test was significantly poor in the moderate-to-severe WMH group. Conclusion: Elderly depressed patients having a greater WMH had more severe depression and poor cognitive performance, especially psychomotor and executive functioning. WMH could be a potential marker for the severity of illness and cognition in depression in elderly persons.

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Introduction: The twenty-first century has shown a boost in the geriatric population. Looking at the trends, this group of population is expected to outnumber the other population groups, therefore has become one of the focus points for researchers these days. As the age of an individual increase, due to slowed metabolism and other biological reasons, the physical activity levels and body functioning tends to get affected, thereby also affecting their motor skills. This age group is also an age group which tends to face changes in psychological conditions. The kind of environment which they live in and their social status are also one of contributing factors to such changes in their lives and also how their perception of life and quality of life (QOL). Maintaining a good QOL has therefore become an important issue in the geriatric population so that they can lead a better life until senescence. QOL according to the World Health Organization depends on different factors and has been measured through four domains. The four domains include the physical state, psychological domain, social domain, and environmental domain. Aim: This article aims at studying the effect of the gender of an individual on the QOL, and what steps can be taken to improve the perception of life among the population by improvements in the QOL by assessing all the four domains of a group of 100 individuals, both male and female of 60 years and above through online survey. Materials and Methods: A standardized questionnaire developed by the WHO was adopted to measure the scores obtained by both males and females in the different domains. Data obtained through this survey were tested and validated, and a comparison between the QOL scores of males and females was done using appropriate statistical tests. Results: Results showed no significant difference in the scores of males and females. Conclusion: It was concluded that the gender of an individual does not influence the QOL.

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Parkinsonism is a clinical syndrome characterized by bradykinesia, rigidity, and tremor. Many causes have been identified for secondary parkinsonism. Among them, hypocalcemia due to hypoparathyroidism is one of the rarer causes. Here, we emphasized a patient presented with reversible secondary parkinsonism caused by hypocalcemia due to iatrogenic hypoparathyroidism following thyroidectomy. A 56-year-old female diagnosed with hypothyroidism and parkinsonism was admitted following a lower respiratory tract infection. She had undergone a total thyroidectomy 10 years ago, following which there were intermittent episodes of hypocalcemia. The patient was found to have hypocalcemia, hypophosphatemia, and low parathyroid hormone level. The noncontrast computed tomography of the brain showed diffuse brain calcification with a predilection to basal ganglia. Her diagnosis was refined as parkinsonism due to cerebral calcification secondary to iatrogenic hypoparathyroidism. This case emphasized the importance of evaluating treatable secondary causes of parkinsonism at diagnosis.

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Background: Antrochoanal polyps (ACPs) are benign polypoidal mass originating from the maxillary sinus and they extend into the choana. The etiopathogenesis of ACP is not clear. These are found more commonly in children and young adults. ACP is almost always unilateral and common symptoms include nasal obstruction and nasal discharge. These lesions are extremely rare in the older adult age group. Materials and Methods: This is a retrospective study of 14 cases of ACPs managed between June 2017 and July 2022. Detailed clinical presentations, investigations, and treatment with surgical interventions for ACPs were studied. Results: Out of 14 cases of older adult patients with ACPs, there are 8 (57.14%) cases with a polyp on the left side and 6 (42.85%) cases on the right side of the nasal cavity. The most common symptom was constant and unilateral nasal obstruction in 12 (85.71%) patients, followed by purulent nasal discharge in 7 (50%) cases, clear rhinorrhea in 5 (35.71%) cases, facial pain in 4 (28.57%) cases, snoring in 3 (21.42%) cases, sneezing in 3 (21.42%) cases, and halitosis in 2 (14.28%) cases. Conclusion: ACPs are uncommon in the older adult age group. Diagnostic nasal endoscopy and computed tomography scans are important tools for the diagnosis of ACP. Functional endoscopic sinus surgery and power instrumentation are helpful for the complete removal of ACPs and are considered extremely safe procedures. Clinicians and otolaryngologists are often not aware of the prevalence of ACPs among the older adult age group.

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