Medical Specialties Commons^™

The Impact Of Asymmetry In Lower Limb Muscle Strength And Power On Straight-Line Running Speed In Female Soccer Players, Dariusz Skalski, Magdalena Prończuk, Kinga Łosińska, Michał Spieszny, Maciej Kostrzewa, Piotr Aschenbrenner, Adam Maszczyk

Baltic Journal of Health and Physical Activity

The aim of this study was to investigate and determine the impact of asymmetries in muscle strength and power between the right and left lower limbs on straight-line running speed in female soccer players.30 right-footed female soccer players playing in the Ekstraliga participated in the study. The Modulus. Number formula was used to avoid negative results and to assess only the difference in relative strength and power between the lower limbs, not the dominance of one of them. A result equal to or below the threshold defined group G1 "with lower asymmetry," and a result above the threshold defined group …

Lyrical Stillness, Madhav Patel

HCA Healthcare Journal of Medicine

“Lyrical Stillness” is a poem I wrote during my radiation oncology rotation, during which I was provided the opportunity to learn more about multidisciplinary cancer care while delving deeper into radiotherapy. Cancer can be an overwhelming disease process physically, psychologically, and emotionally. Patients undergoing treatment often experience stress and anxiety with the uncertainty of their prognoses. In this poem, I describe a patient receiving radiation therapy whom I enjoyed speaking to about his favorite hobby: bird watching. During his subsequent radiation treatment sessions, I decided to play a CD of mockingbirds singing in a tropical forest, in the hopes it …

Apocrine Breast Cancer With Psammoma Bodies In A Male Patient, Alena Bashinskaya, Eric W. Baum, Michael B. Morgan

HCA Healthcare Journal of Medicine

Introduction

While male breast carcinoma is a relatively uncommon occurrence, its incidence is on the rise, potentially attributed to sporadic pathophysiological mechanisms, primarily involving hormonal imbalances. Invasive apocrine carcinoma represents a small fraction of global breast malignancies, with limited instances reported among male patients in the literature. The clinical presentation of an apocrine breast carcinoma closely resembles that of other breast cancer subtypes, as it is most often described as a solitary ulcerative nodular lesion occupying a retro-areolar region of the breast. Herein, we describe a novel case of an apocrine male breast carcinoma metastasizing to the skin, given that …

Hemophagocytic Lymphohistiocytosis In A Critically Ill Patient: A Case Report Of A Potentially Fatal Entity, Ali Khreisat, Inna Mikaella Sta Maria, Giovi Grasso-Knight, Meghan Mansour

HCA Healthcare Journal of Medicine

Background

Hemophagocytic lymphohistiocytosis (HLH) is a non-neoplastic proliferation and macrophage activation that induces cytokine-mediated bone marrow suppression and features of intense phagocytosis in the bone marrow and liver, leading to multi-organ dysfunction and ultimate failure. The diagnosis of HLH in an intensive care setting is challenging, and it is associated with high morbidity and mortality. HLH-94 is the standard protocol for treatment, consisting of dexamethasone and chemotherapy like etoposide.

Case Presentation

We present the case of a 73-year-old woman who had a prolonged hospitalization for vomiting, diarrhea, and dehydration. Her conditions were complicated by acute refractory pancytopenia on the 12th …

Evaluation Of A Patient With A Severe Systemic Inflammatory Response To Nitrofurantoin, Brigitte Vanle, Timothy Beatty

HCA Healthcare Journal of Medicine

Background

Nitrofurantoin is a prevalent antibiotic used to treat urinary tract infections. Despite nitrofurantoin’s general safety, it can cause serious side effects, including acute pulmonary toxicity, fulminant hepatitis, and severe systemic inflammatory responses, which may mimic conditions such as ischemia and infection. However, reports of acute systemic inflammatory response syndrome after nitrofurantoin ingestion are uncommon in medical literature.

Case Presentation

This case describes a severe systemic inflammatory response syndrome in an 85-year-old woman presenting with hypoxia, altered mental status, and profound leukocytosis after exposure to a single dose of nitrofurantoin.

Conclusion

Herein we report on a patient with suspected bacteremia …

Veillonella Discitis: A Rare Presentation And Review Of Literature, Akankcha Alok, Vidya Sagar Kollu, Gautam Kalyatanda

HCA Healthcare Journal of Medicine

Background

Veillonella is an anaerobic gram-negative coccus found as a commensal organism in the oral, respiratory, gastrointestinal, and genitourinary tract of humans. Rarely, it can cause serious infections by the production of lipopolysaccharide, an endotoxin. Although most Veillonella infections occur in immunocompromised individuals, we herein describe cases of Veillonella discitis, a rare presentation of Veillonella, in immunocompetent patients.

Case Presentation

The first presented case was encountered in a patient admitted at our facility. All patient data were obtained from the hospital's electronic medical record system. Thereafter, a literature search and subsequent review was done on PubMed with the MEDLINE …

Clinical Variant Of Serpentine Supravenous Hyperpigmentation Following Subcutaneous Bortezomib Injection, Madelyn Richards, Stephen E. Weis

HCA Healthcare Journal of Medicine

Introduction

Bortezomib is a reversible proteasome inhibitor that is a first-line chemotherapeutic agent for multiple myeloma. Bortezomib can be administered intravenously or subcutaneously with similar efficacy. Subcutaneous administration has fewer side effects. Many cutaneous reactions have been associated with bortezomib treatment. These include morbilliform exanthems, erythematous nodules and papules, leukocytoclastic vasculitis, Sweet syndrome, and rarely Stevens-Johnson Syndrome.

Case Presentation

This paper reports the occurrence of serpentine supravenous hyperpigmentation (SSH) after subcutaneous administration of bortezomib. SSH is a rare, characteristic cutaneous reaction that has been reported following intravenous administration of chemotherapeutic agents. Intravenous administration of bortezomib rarely results in documented cases …

Successful Treatment Of An Atypical Presentation Of Disseminated Retroperitoneal Seminoma: A Case Report, Mahmoud Abd-El-Hafez, Kylie Johnson, Joe Cates, Alosh Madala

HCA Healthcare Journal of Medicine

Background

Testicular seminoma is the most common malignant tumor of the testis. It occurs at a rate of 5 per 100 000 men, primarily between the ages of 15 to 34. While seminomas typically occur in the testis, other primary sites include the mediastinum, the retroperitoneum, or other extra-gonadal sites. Due to the curable nature of the malignancy (5-year survival rate > 95%), detection at early stages of the disease is key. This case presentation explores the delayed diagnosis and treatments of an atypical presentation of disseminated seminoma.

Case Presentation

We present the unusual case of a 56-year-old male who had …

Hemophagocytic Lymphohistiocytosis Due To Ehrlichiosis: A Case Series, Ajay Iyer, Mattias D'Anna, Shruti Verma, Thomas Pritchard, Vladimir Begilman, Himal Bajracharya, Kaveh Naemi

HCA Healthcare Journal of Medicine

Background

Hemophagocytic lymphohistiocytosis (HLH) is an immunologic syndrome characterized by excessive inflammation and tissue injury due to uncontrolled activation of the phagocytic system. The underlying mechanism is a lack of downregulation of activated macrophages and lymphocytes by natural killer and T cells. Unfortunately, the diagnosis is often delayed or missed due to the rarity of the disease, decreased awareness, and clinical picture variability. Ehrlichiosis is becoming a more prevalent tick-borne illness in endemic regions and a relatively uncommon but increasingly considered cause of HLH.

Case Presentation

We describe the cases of 2 patients diagnosed with secondary HLH as per the …

Endovascular Repair Of A Superior Mesenteric Arteriovenous Fistula And Pseudoaneurysm After A Single Gunshot Wound To The Abdomen, Robert Ringersen Iii, Michael Shockley, Sanjiv Gray, Tracy Bilski, Julio Calderin, Philip Kondylis

HCA Healthcare Journal of Medicine

Background

Traumatic arteriovenous fistulas (AVFs) are rare entities, especially when referring to visceral arterioportal AVFs. Currently, there are no large epidemiological studies looking specifically at traumatic visceral AVFs. When traumatic AVFs have been discussed in the literature, it is in the form of case reports or case series and focused on peripheral AVFs. The following case is a presentation of a traumatic arterioportal AVF and its management with an endovascular approach.

Case Presentation

A 16-year-old adolescent boy presented tachycardic and hypotensive with a single gunshot wound in his left abdomen. Multiple operations were required. His intensive care unit course was …

Investigating The Effects Of Nosocomial Clostridioides Difficile Infection Among Acute Leukemia Patients: Insights From The 2020 National Inpatient Sample, Zubair Hassan Bodla, Mariam Hashmi, Fatima Niaz, Umer Farooq, Muhammad Jahanzeb Khalil, Farhan Khalid, Kipson Charles, Christopher L. Bray

HCA Healthcare Journal of Medicine

Background

Rising nosocomial Clostridioides difficile infections pose high risks, especially for immunocompromised leukemia patients, necessitating targeted research to enhance patient care and outcomes.

The objective of this study was to investigate the impact of nosocomial Clostridioides difficile infections (CDI) on patients hospitalized with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML).

Methods

Our study was a retrospective analysis of adult patients hospitalized with a primary diagnosis of ALL or AML, using the Nationwide Inpatient Sample (NIS) database for 2020. Primary outcomes included the incidence of nosocomial CDI and all-cause inpatient mortality. Secondary outcomes included hospital length of stay, resource …

Assessment Of The European Hernia Society Classification Of Ventral Hernias And Clinical Outcomes, Oluwatunmininu A. Anwoju, Ashtyn Barrientes, Connor Hogan, Erik Askenasy, Jacob Greenberg, Keith Jerrod, Scott J. Roth, Zuhair Ali, Mike K. Liang

HCA Healthcare Journal of Medicine

Background

Ventral hernias are a common but heterogeneous disease. Communication among key stakeholders (eg, patients, clinicians, administrators, payers, and researchers) can be augmented by a widely utilized classification system. The European Hernia Society (EHS) developed an expert-opinion-based hernia classification system organized by hernia type (primary versus incisional) and size. We sought to assess what components of the EHS ventral hernia classification system were correlated to real-world clinical outcomes.

Methods

This was a multicenter cohort study. All hospitals contributing to the database were affiliated with 1 of 6 academic institutions. All adult patients who underwent ventral hernia repair over a 4-year …

Second Generation Antipsychotics And Cardiovascular Adverse Effects: Developing Evidence-Based Recommendations For Primary Care Medicine, Sana Borda, Ahn-Dao Lee, Paul F. Bell

HCA Healthcare Journal of Medicine

Background

Second-generation antipsychotic medications (SGAs) are often used by primary care physicians (PCPs) to treat multiple psychiatric diagnoses. SGAs have been connected to a number of adverse effects, including cardiovascular disease. Currently, there are no published evidence-based recommendations addressing SGAs and cardiotoxicity that are directed toward PCPs. This project aims to fill this gap.

Methods

Relevant search terms related to SGAs and cardiovascular disease were identified and then used to search databases (PubMed, PubMed Central, and AccessMedicine). Research studies obtained from the searches were narrowed to include systematic reviews and meta-analyses. The Assessment of Multiple Systematic Reviews-2 (AMSTAR-2) tool was …

Hubungan Abnormalitas Ekokardiografi Terhadap Mortalitas Pasien Terkonfirmasi Covid-19 Derajat Berat Dan Kritis Di Rsupn Dr. Cipto Mangunkusumo, Fidiaji Hiltono Santoso, Idrus Alwi, Sally A. Nasution, Cleopas Martin Rumende

Jurnal Penyakit Dalam Indonesia

Introduction. The mortality rate of COVID-19 patients in Indonesia is high with manifestations of cardiac complications. Echocardiographic evaluation can help identify cardiac functional and structural disorders associated with patient mortality. Therefore, this study aims to determine the relationship between echocardiographic abnormalities and mortality in severe and critical COVID-19 patients.

Methods. A retrospective cohort study was conducted using medical record data of severe and critical COVID-19 patients at Dr. Cipto Mangunkusumo Hospital Jakarta during March 2020 to April 2021. Subjects were selected using total sampling. Descriptive analysis was performed, presenting descriptive tables, and bivariate analysis was conducted using the …

Saatnya Memberikan Vaksin Influenza Untuk Tenaga Kesehatan, Anshari Saifuddin Hasibuan

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Pengaruh Durasi Pengobatan Dan Preferensi Pasien Kanker Stadium Akhir Terhadap Layanan Homecare Di Rumah Sakit Medistra Pada Tahun 2021-2023, Peter Brian Sutanto Putra Dr, Erfen Gustiawan Suwangto Dr, Tena Djuartina Dr, Iskandar Rahardjo Budianto Dr, C. Rinaldi A. Lesmana

Jurnal Penyakit Dalam Indonesia

Introduction. Cancer is still an enormous health problem in the world and rank second as the most common cause of mortality. End-stage cancer requires end-of-life or palliative care to improve the patient’s quality of life before death. Homecare services have become an option for providing palliative care to avoid long-term hospital stays. The study aimed to provide an overview of the treatment duration and other factors in end-stage cancer patients regarding the selection of homecare services at Medistra Hospital during the period of 2021-2023.

Methods. This study with a cross-sectional design analyzed medical records of end-stage cancer patients …

Efektivitas Vaksin Covid-19 Mrna Booster Kedua Pada Tenaga Kesehatan Di Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo Dan Faktor Yang Memengaruhinya, Siti Taqwa Fitria Lubis, Sukamto Koesnoe, Evy Yunihastuti, Hamzah Shatri, Teguh Harjono Karjadi, Kuntjoro Harimurti, Ceva Wicaksono Pitoyo, Em Yunir

Jurnal Penyakit Dalam Indonesia

Introduction. The emergence of the Omicron variant during the pandemic had an impact on the effectiveness of the COVID-19 vaccine. The spread of Omicron increased rapidly even in populations that had been vaccinated with booster doses, causing a high incidence of infection. This study aimed to determine the effectiveness and factors related to the effectiveness of the second mRNA booster vaccine as well as antibody levels after the second mRNA booster vaccine in healthcare workers at Cipto Mangunkusumo National General Hospital.

Methods. This study used a cohort design. Total sampling of 271 healthcare workers were obtained from previous …

Efek Terapeutik Analog Somatostatin Dalam Menghambat Perkembangan Autosomal Dominant Polycystic Kidney Disease, Irvin Rembrant Holleritz Sitompul, Grasella Angelika Putri, Purwita Wijaya Laksmi

Jurnal Penyakit Dalam Indonesia

Autosomal Dominant Polycystic Kidney Disease (ADPKD) is a hereditary disorder characterized by formation and progressive growth of cysts in the kidneys and other organs such as liver, spleen, and pancreas. Recent advances have led to possibilities to target the main cause of cyst growth, cAMP. Somatostatin targets cAMP and inhibits its production directly and indirectly in kidney and liver, which might potentially prevent renal and liver cyst progression in ADPKD. This report aims to evaluate the effectiveness of somatostatin analogue therapy in slowing disease progression in ADPKD patients, according to the latest evidence. A literature search was conducted on five …

Long Covid Dan Sistem Kardiovaskular, Muhadi Muhadi, Ivan Mardhi Laksmana

Jurnal Penyakit Dalam Indonesia

Even after nasopharyngeal Polymerase Chain Reaction (PCR) swab investigation revealed no COVID-19 infection, some individuals continue to have long COVID symptoms. According to a research published in 2022, 4.5 – 36.6% of patients had symptoms following a COVID-19 infection more than three months. Long COVID symptoms may impact multiple organ systems, including the cardiovascular system. Chest pain, palpitations, arrhythmia, postural orthostatic tachycardia syndrome, and other symptoms are possible appeared in long COVID. D-Dimer, echocardiography, CT scan, cMRI and other supportive test showed meaningful results. Pharmacological treatment can be given based on the concurrent diagnosis found in patients with long COVID. …

Implementation Of Patient Care Documentation Standard For Athletic Training Staff In Intercolle, Lucas Bianco, Maria Popek, Bri Durics, Christian Miles

Clinical Practice in Athletic Training

Documentation is a professional standard for all health care professions. As part of a relatively young profession, athletic trainers have had to adjust to the expectations around documentation to stay at the same level as other health care providers. Documentation is often a highly discussed topic with more and more education sessions and resources being provided by NATA, BOC and NATA Research Education Foundation. The need for Continuous Quality Improvement projects and subsequent studies has continued to grow. Projects with a focus on documentation can be completed then disseminated to determine the most effective ways to improve documentation across our …

The Use Of Primal Reflex Release Technique To Address Pain And Stress: An Exploratory Case Series, Nathan R. Reep, Sydney N. Leverett, Rebecca M. Heywood, Zachary Johnson, Alan Nasypany, James May, Scott W. Cheatham

Clinical Practice in Athletic Training

The majority of the world population is experiencing more stress after the COVID-19 pandemic. Working in an outpatient healthcare setting it can be expected that patients will present with stress in combination with other perceptions of pain related to injury. Stress alone may be the cause of pain perception especially in patients who present with no specific mechanism of injury. There is a need for a quick full-body approach to assessment and treatment while considering the stress response to injury. Therefore, the purpose of this study was to determine the immediate effects of Primal Reflex Release Technique (PRRT) Primals on …

Molecular Mechanism Governing The Plasticity Of Use-Dependent Spike Broadening In Dorsal Root Ganglion Neurons, Tyler D. Alexander, Stephen Tymanskyj, Kyle J. Kennedy, Leonard K. Kaczmarek, Manuel Covarrubias

SKMC Student Presentations and Publications

Use-dependent spike broadening (UDSB) results from inactivation of the voltage-gated K+ (Kv) channels that regulate the repolarization of the action potential. However, the specific signaling and molecular processes that modulate UDSB have remained elusive. Here, we applied an adeno-associated viral vector approach and dynamic clamping to conclusively demonstrate how multisite phosphorylation of the N-terminal inactivation domain (NTID) of the Kv3.4 channel modulates UDSB in rat dorsal root ganglion (DRG) neurons. The Kv3.4 phosphonull variant promotes slow recovery from inactivation, cumulative inactivation, and UDSB. In contrast, the Kv3.4 phosphomimic variant promotes fast recovery from inactivation and robust resistance to cumulative inactivation …

Pengetahuan Dan Persepsi Keluarga Penderita Penyakit Ginjal Tahap Akhir (Pgta) Terhadap Transplantasi Ginjal Di Rs Hasan Sadikin Bandung, Rizqa Adinda Syakira, Helni Mariani, Rizky Andhika

Jurnal Penyakit Dalam Indonesia

Introduction. Kidney transplantation is the best kidney replacement therapy for End Stage Renal Disease (ESRD) patients. The gap between the number of donors and recipients remains a problem contributing to the low rate of kidney transplantation in Indonesia. The families of ESRD patients are the most recommended donor candidates. Knowledge and perception have a crucial role in the decision to donate organs, making it important to know the knowledge and perception of ESRD patients’ families towards kidney transplantation. This study aimed to describe the knowledge and perception of families of ESRD patients undergoing dialysis at Dr. Hasan Sadikin General …

Analisis Prediktif Mutasi Egfr Pada Adenokarsinoma Paru Menggunakan Pendekatan Pembelajaran Mesin, Edwin Nugroho Njoto, Yuri Pamungkas, Atina I.W. Putri, Muhammad. Najib Haykal, Dwinka Syafira Eljatin, Edith Maria Djaputra

Jurnal Penyakit Dalam Indonesia

Introduction. Lung adenocarcinoma is a prevalent form of lung cancer, and mutations in the epidermal growth factor receptor (EGFR) gene are known to play a crucial role in its pathogenesis. This study aimed to develop a machine-learning model to predict EGFR mutations in lung adenocarcinoma patients using clinical and radiological features.

Methods. A case-control study was conducted using a dataset comprising 160 patients with lung adenocarcinoma. Several machine learning algorithms, including decision tree, linear regression, Naive Bayes, support vector machine, K-nearest neighbor, and random forest, were employed to predict EGFR mutations based on variables such as smoking status, …

Concussions In Women’S Rugby: A Timely Review Of Available Data, Shannon M. Wright

Clinical Practice in Athletic Training

Rugby is a growing full-contact sport across the world for both men and women; as a full-contact sport with no protective equipment, it has a reputation for high injury rates, including concussions. Organized men’s rugby has been established for over a century, whereas organized women’s rugby has struggled to achieve the same success over the years. With a much shorter amount of time to track injuries, women’s rugby lacks data to assess when, where, and what kinds of injuries are most common. The guiding study attempts to examine epidemiological trends for concussion in women’s rugby union and league. After pooling …

Effective Anterior Cruciate Ligament Injury Prevention Programming In Young Female Athletes: An Evidence-To-Practice Review, Janay Ward, Kina M. Ingram, Jackson Biffle, Emily E. Hildebrand, Peter Lisman

Clinical Practice in Athletic Training

Anterior cruciate ligament (ACL) injuries are common in adolescents, in particular females participating in sports requiring frequent jumping, pivoting, and rapid acceleration. Consequently, the prevention of ACL injury is a principal concern of athletic trainers and other sports medicine professionals. Neuromuscular training (NMT) programs have been effective in reducing ACL injury risk in athletic populations, though additional clarity on programmatic factors, such as exercise selection, timing, and training dosage is warranted. Therefore, the primary purpose of this evidence-to-practice review was to present which components of NMT programs have been found to be most effective in reducing ACL injury incidence in …

Wilson’S Disease Presenting As Acute Hepatitis In Pregnancy With Successful Maternal And Neonatal Outcomes: A Case Report, Paribesh Gyawali, Ranjan Regmi, Shambu Khanal, Rajan Bhandari, Shivani Gupta, Gunjan Arora

Graduate Medical Education Research Journal

Background: Wilson’s disease is a rare genetic disorder characterized by copper accumulation, leading to multi-organ symptoms. It affects between 1 in 30,000 to 1 in 100,000 individuals, with a mean age at diagnosis of 13.2 years. The diagnosis may be overlooked due to its numerous presentations, which can range from non-specific symptoms such as fever, fatigue, and behavioral changes to fulminant hepatic failure. Its clinical manifestations vary widely, making diagnosis during pregnancy particularly challenging. Wilson’s disease complicates pregnancy, as untreated cases can lead to significant morbidity and mortality; excess copper can disrupt metabolic processes and contribute to recurrent miscarriages.

Case: …

Pumping Iron, Straining Hearts: Androgen Building Cardiomyopathy In A Middle Aged Bodybuilding Enthusiast, Milan Terzic, Yash B. Patel

Graduate Medical Education Research Journal

A 46-year-old bodybuilder presenting with new onset dyspnea found to have a new onset non-ischemic cardiomyopathy (CM) attributed to exogenous trenbolone and testosterone use. Steroid cessation and guideline-directed heart failure therapy led to notable recovery in left ventricular function supported by global longitudinal strain, ejection fraction and symptomatology.

Anabolic steroid-induced CM involves multiple mechanisms including lipid disturbances, hypertrophy, reduced receptor sensitivity, and cell damage. This case emphasizes the importance of recognizing anabolic steroid misuse as a potential cause of non-ischemic cardiomyopathy in middle aged men. With prompt discontinuation of steroids, remained abstinence and early initiation of guideline-directed medical therapy, myocardial …

The Use Of Abdominal Fascial Plane Blocks For Post-Operative Analgesia In Intestinal Rehabilitation Patients – A Retrospective Comparative Study, Brittany A. Brown, Lauren E. Costello, Elizabeth C. Ternent-Recht, Trevor J. Wilke, Cale A. Kassel

Graduate Medical Education Research Journal

Background: Short gut syndrome affects both pediatric and adult patients often requiring multiple surgical procedures to improve intestinal function. Identifying methods to improve pain control and reduce opioid consumption is an important consideration for this patient population.

Methods: A retrospective chart review of 115 patients less than 12 years of age undergoing abdominal procedures between August 1, 2012, and December 31, 2019, was performed. From this group, 64 patients had a perioperative abdominal wall fascial plane block performed and were compared to 51 patients who did not have a block performed.

Results: Mean opioid use defined as morphine equivalent daily …

Perioperative Outcomes And Mortality In Liver Transplant Patients 65 And Older, Nathaniel S. Pester, Trevor J. Wilke, V K. Shostrom, Cale A. Kassel

Graduate Medical Education Research Journal

Background: The number of patients over the age of 65 awaiting liver transplantation (LT) continues to grow and an increasing number of patients will undergo liver transplantation. While age is not an absolute contraindication to liver transplantation, understanding the risks to older patients remains essential to ensure good outcomes with the limited number of grafts available.

Methods: This retrospective study included patients undergoing LT at the University of Nebraska Medical Center. A total of 421 patients were enrolled and stratified to patients under 65 years old (351 patients) and patients over 65 (70 patients). Geriatric patients were defined as aged …