scholarly journals Age-Dependent Differences in the Rate and Symptoms of TIA Mimics in Patients Presenting With a Suspected TIA to a Neurological Emergency Room

2021 ◽  
Vol 12 ◽  
Author(s):  
Franziska Maria Ippen ◽  
Fabian Walter ◽  
Christian Hametner ◽  
Christoph Gumbinger ◽  
Simon Nagel ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Elderly Patients ◽  
Emergency Room ◽  
Facial Palsy ◽  
Tertiary Care ◽  
Age Groups ◽  
University Hospital ◽  
Sensory Impairment ◽  
Motor Weakness ◽  
Neurological Emergency

Background: Transient ischemic attack (TIA) needs further diagnostic evaluation to prevent future ischemic stroke. However, prophylaxis can be harmful in elderly if the diagnosis is wrong. We aimed at characterizing differences in TIA mimics in younger and older patients to enhance diagnostic accuracy in elderly patients.Methods: In a dedicated neurological emergency room (nER) of a tertiary care University hospital, patients with transient neurological symptoms suspicious of TIA (<24 h) were retrospectively analyzed regarding their final diagnoses and their symptoms. These parameters were compared between patients aged 18–70 and >70 years using descriptive, univariable, and multivariable statistics.Results: From November 2018 until August 2019, 386 consecutive patients were included. 271 (70%) had cardiovascular risk factors and all patients received cerebral imaging, mostly CT [376 (97%)]. There was no difference in the rate of diagnosed TIA between the age groups [85 (46%) vs. 58 (39%); p = 0.213].TIA mimics in the elderly were more often internal medicine diseases [35 (19%) vs. 7 (5%); p < 0.001] and epileptic seizures [48 (26%) vs. 24 (16%); p = 0.032] but less often migraine [2 (1%) vs. 20 (13%); p < 0.001]. The most frequent symptoms in all patients were aphasia and dysarthria [107 (28%) and 92 (24%)]. Sensory impairments were less frequent in elderly patients [23 (11%) vs. 54 (30%); p < 0.001]. Impaired consciousness and orientation were independent predictors for TIA mimics (p < 0.001) whereas facial palsy (p < 0.001) motor weakness (p < 0.001), dysarthria (p = 0.022) and sensory impairment (p < 0.001) were independent predictors of TIA.Conclusion: TIA mimics in elderly patients are more likely to be internal medicine diseases and epilepsy compared to younger patients. Excluding internal medicine diseases seems to be important in elderly patients. Facial palsy, motor weakness, dysarthria and sensory impairment are associated with TIA.

Characteristics of elderly patients attended at a psychiatry emergency room

2011 ◽  
Vol 26 (S2) ◽  
pp. 834-834 ◽  
Author(s):  
L. Prats ◽  
N. Gual ◽  
P. Lusilla ◽  
A. Gual
Keyword(s):  
Depressive Disorder ◽  
Elderly Patients ◽  
Emergency Room ◽  
Depressive Disorders ◽  
Suicide Attempts ◽  
Psychiatric Symptoms ◽  
Psychiatric Inpatient ◽  
The Elderly ◽  
University Hospital ◽  
Common Diagnosis

IntroductionThere is no general agreement on the prevalence of mental disorders in the elderly, although it is estimated that 25%. of them present psychiatric symptoms. Geriatric psychiatry is one of the most rapidly advancing fields and requires a comprehensive approach.ObjectivesTo analyse the characteristics of patients older than 65 who are attended at the psychiatry emergency room.MethodsA descriptive study was conducted among all elderly pacients seen during May 2010 at the psychiatry emergency room at Vall d’Hebron University Hospital. Clinical variables (functional status, reason to show up, medical history, diagnosis), treatment and referral at discharge were analysed.Results36 patients (44.4% men, mean age 75.3 years) were identified. Charlson comorbidity index was 2.08. Suicide attempts were the most frequent reason for admission (27.8%), followed by psychomotor agitation (16.7%), anxiety disorders (13.9%), delirium (13.9%), depression (11.1%), and behaviour disorders (8.3%). Concerning psychiatric antecedents 58.3% had depressive disorder and 40% reported somatic symptoms during the month prior to their consultation.The most common diagnosis at discharge were anxiety-depressive disorders (52.7%) and delirium (16.7%). The most widely prescribed psychotropics were antipsychotics (19.4% haloperidol, 13.9% quetiapine) followed by benzodiazepines (13.9%). Referral at discharge was: 41.7% home, 13.9% midterm psychiatric units, 27.8% acute psychiatric inpatient unit and 16.7% Internal Medicine.ConclusionsTypically, elderly patients attended at the psychiatric emergency room are diagnosed of an anxiety-depressive disorder and often present with a suicidal attempt, but only 41.7% are admitted as psychiatric inpatients.

Assessing frailty index and correlation with crp and serum albumin and clinical outcome in terms of length of hospital stay

2021 ◽  
Vol 8 (1) ◽  
pp. 15-21
Author(s):  
Shilpa Avarebeel ◽  
Akash Durgakar ◽  
Pratibha Pereira ◽  
Tandure Varsha ◽  
Mahesh Poojari ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Elderly Patients ◽  
Serum Albumin ◽  
Hospital Stay ◽  
Frailty Index ◽  
Tertiary Care ◽  
Age Groups ◽  
Length Of Hospital Stay ◽  
Care Hospital ◽  
Cross Sectional

Frailty is defined as “a clinically recognizable state of increased vulnerability, resulting from aging associated decline in reserve and function across multiple A Hospital based descriptive cross-sectional study in tertiary care hospital. Atotal of 294 patients admitted in the Medicine/Geriatric Ward, were included in stressors is compromised”. It is a robust and powerful risk factor for disability. With this background, study was conducted at a tertiary centre with objectives to assess the frailty in elderly patients and to assess the correlation of frailty with Serum Albumin and CRP physiologic systems, such that the ability to cope with every day or acute and evaluate the clinical outcome in terms of length of hospital stay. The study. Demographic details and details of known comorbidities were recorded. Cognition score of all patients were assessed using mini mental scale examination. Investigations like Serum Albumin and CRP were done. The data was analyzed using statistical software.Our results show that in hospitalized patients frailty is seen in both gender. The presence of co-morbidities worsens the frailty. 30 second chair test is very good indicator for frailty and risk of fall and we observed reduced duration in the Pre-Frail group. The cognition score decreased along with the increase in age groups. When compared with the Frailty index, it was more in the Pre-Frail group. The duration of hospital stay was more in Frail group. The mean serum albumin level is important marker to identify early frailty.Assessment of frailty in elderly patients is necessary and identifying Pre-Frailgroup is very important. 30 second chair stand test and serum albumin are very important early markers in the assessment of frailty. Cognitive function is also very important to identify early frailty. Our study shows that the length of hospital stay is more in the Frail group. Frailty is important aspect of elderly. It should be included in routine clinical assessment of all elderly patients.

scholarly journals Potentially inappropriate medication prescribed to elderly outpatients at a general medicine unit

2011 ◽  
Vol 9 (1) ◽  
pp. 18-23 ◽  
Author(s):  
Christine Grützmann Faustino ◽  
Milton de Arruda Martins ◽  
Wilson Jacob Filho
Keyword(s):  
Elderly Patients ◽  
Inappropriate Medication ◽  
Age Groups ◽  
General Medicine ◽  
University Hospital ◽  
Potentially Inappropriate Medication ◽  
Potentially Inappropriate Medications ◽  
Female Sex ◽  
The Mean ◽  
Inappropriate Medications

ABSTRACT Objective: To establish the prevalence of potentially inappropriate medications prescribed for elderly patients, to identify the most commonly involved drugs, and to investigate whether age, sex and number of medications were related with the prescription of these drugs. Methods: Prescriptions for 1,800 elderly patients (≥ 60 years) were gathered from a database. These prescriptions were written by general physicians at a tertiary level university hospital in the city of Sao Paulo, Brazil, from February to May 2008. Only one prescription per patient was considered. The prescriptions were classified according to sex and age (60-69, 70-79 and ≥ 80). The Beers criteria (2003 version) were used to evaluate potentially inappropriate medications. Results: Most of the sample comprised women (66.6%) with a mean age of 71.3 years. The mean prevalence of potentially inappropriate medication prescriptions was 37.6%. The 60-69 age group presented the highest prevalence (49.9%). The most frequently prescribed potentially inappropriate medications to women were carisoprodol, amitriptyline, and fluoxetine; amitriptyline, carisoprodol, fluoxetine and clonidine were prescribed more often to men. The female sex (p<0.001; OR=2.0) and number of medications prescribed (p<0.001) were associated with prescription of potentially inappropriate medications. The chance of having a prescription of these drugs was lower among patients aged over 80 years (OR=0.7). The mean number of prescribed medications for both sexes and all age groups was 7.1. The mean number of medications per patient was higher among females (p<0.001); this result was not age-dependent (p=0.285). Conclusion: The prevalence of potentially inappropriate medications was similar to previously reported values in the literature and was correlated with the female sex. The chance of having a potentially inappropriate medication prescription was lower among patients aged over 80 years. The chance of having a potentially inappropriate medications prescription increased proportionally with the number of medications prescribed (≥ 5).

scholarly journals Chemotherapy Treatment of Elderly Patients (≥70 Years) with Non-Small Cell Lung Cancer: A Seven-Year Retrospective Study of Real-Life Clinical Practice at Karolinska University Hospital, Sweden

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Hirsh Koyi ◽  
Gunnar Hillerdal ◽  
Olov Andersson ◽  
Karl-Gustav Kölbeck ◽  
Per Liv ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Clinical Practice ◽  
Retrospective Study ◽  
Elderly Patients ◽  
Performance Status ◽  
Age Groups ◽  
Real Life ◽  
The Elderly ◽  
University Hospital ◽  
Nsclc Patients

An increasing proportion of cancer patients are aged >65 years and many are aged >70 years. Treatment of the elderly with lung cancer has, therefore, become an important issue; so we performed a retrospective study of our patients to demonstrate how elderly patients with NSCLC are treated in real-life, clinical practice. All patients aged ≥70 years with NSCLC at our department were reviewed retrospectively. In total, 1059 patients (50.8% of all NSCLC patients). Of these patients, 243 (22.9%) received chemotherapy, 164 (70.4%) of whom were treated with a platinum doublet using carboplatin. Second- and third-line chemotherapy were given to 31.4% and 13.9% of patients, respectively. Median overall survival was 289 and 320 days for male and female patients, respectively. Patients with performance status (PS) 0 experienced significantly better survival than patients with PS1 or PS 2: 410, 314, and 204 days, respectively. Age was of less importance, with patients aged 70–79 years versus those aged ≥80 years. Treatment of elderly NSCLC patients with chemotherapy is feasible if they have a good PS and appears to prolong survival. In this study, we found no significant differences in survival either between age groups or genders.

scholarly journals Epidemiological Trends of Fungemia in Greece with a Focus on Candidemia during the Recent Financial Crisis: a 10-Year Survey in a Tertiary Care Academic Hospital and Review of Literature

2019 ◽  
Vol 64 (3) ◽  
Author(s):  
Maria Siopi ◽  
Aikaterini Tarpatzi ◽  
Eleni Kalogeropoulou ◽  
Sofia Damianidou ◽  
Alexandra Vasilakopoulou ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Financial Crisis ◽  
Tertiary Care ◽  
Incidence Rates ◽  
University Hospital ◽  
Content Type ◽  
Defined Daily Doses ◽  
Bed Days ◽  
Internal Medicine Wards ◽  
Recent Financial Crisis

ABSTRACT Updated information on the epidemiology of candidemia, particularly during severe socioeconomic events, is important for proper management of these infections. A systematic literature review on candidemia in Greece and a retrospective surveillance study were conducted in a tertiary university hospital during the years of the recent financial crisis (2009 to 2018) in order to assess changes in incidence rates, patient characteristics, species distribution, antifungal susceptibilities, and drug consumption. The average annual incidence of 429 candidemic episodes was 2.03/10,000 bed days, with 9.88 in adult intensive care units (ICUs), 1.74 in surgical wards, and 1.81 in internal medicine wards, where a significant increase was observed (1.15, 1.85, and 2.23/10,000 bed days in 2009 to 2011, 2012 to 2014, and 2015 to 2018, respectively; P = 0.004). Candida albicans was the most common species (41%), followed by Candida parapsilosis species complex [SC] (37%), Candida glabrata SC (11%), Candida tropicalis (7%), Candida krusei (1%), and other rare Candida spp. (3%). Mixed infections were found in 20/429 (4.7%) cases, while 33 (7%) cases were due to non-Candida spp. Overall, 44/311 (14%) isolates were resistant/non-wild type (WT) to the nine antifungals tested, with 23/113 (20%) C. parapsilosis SC and 2/34 (6%) C. glabrata SC isolates being resistant to fluconazole (1 panechinocandin and 2 panazole resistant). All isolates were susceptible/WT to amphotericin B and flucytosine. While the overall consumption of antifungals diminished (P = 0.02), with a mean of 17.93 defined daily doses (DDD)/100 bed days, increased micafungin use was correlated with the rise in C. parapsilosis SC (P = 0.04). A significant increase of candidemia in internal medicine wards and of C. parapsilosis SC infections was found during the years of financial crisis. Although resistance rates remain low (<14%), fluconazole-resistant C. parapsilosis SC and multidrug-resistant C. glabrata SC isolates are of major concern.

scholarly journals Study on prevalence of foreign bodies in ENT

2020 ◽  
Vol 7 ◽  
Author(s):  
Shilpi Agrawal ◽  
Haritosh K. Velankar
Keyword(s):  
Foreign Body ◽  
Emergency Room ◽  
General Anaesthesia ◽  
Foreign Bodies ◽  
Tertiary Care ◽  
Age Groups ◽  
Care Hospital ◽  
Cross Sectional ◽  
Common Location ◽  
Nose And Throat

Introduction- Foreign body is a substance that doesn’t belong to a location where it is found. Ear,nose and throat are common location for occurence of foreign bodies. It is a common problem encountered in both adults and children. Objective- 1) To analyse the different kinds of foreign bodies in ear ,nose and throat and their prevalence in different age groups. 2) To analyse the most prevalent site of foreign body among ear, nose and throat.Methods- A cross-sectional study was performed in our tertiary care hospital in Navi-mumbai. The study period was from august 2017 to august 2019. The study population were the patients who came to the out patient department and emergency room of this hospital.Result- A total of 100 patients as sample size with foreign bodies in ear, nose or throat were taken on first come basis. 62 were males and 38 were females. Of the 100 patients, 36 had foreign body in ear, 47 in nose and 17 in the throat. The foreign body was removed under local anaesthesia in 4% patients, with general anaesthesia in 30 % and with no anaesthesia at all in 66% patients. The most common age group affected was less than 10 years among both male and female patients.Conclusion- The most frequent site of foreign body occurrence was found to be nose. The most common site requiring general anaesthesia for foreign body removal was throat. Although most of the foreign bodies could be removed without any anaesthesia in the emergency room or outpatient department.

scholarly journals Headache in an emergency room in Brazil

2000 ◽  
Vol 118 (3) ◽  
pp. 58-62 ◽  
Author(s):  
Marcelo Bigal ◽  
Carlos Alberto Bordini ◽  
José Geraldo Speciali
Keyword(s):  
Primary Care ◽  
Emergency Room ◽  
Care Service ◽  
International Headache Society ◽  
Tertiary Care ◽  
Primary Headache ◽  
Tension Type Headache ◽  
University Hospital ◽  
Type Headache ◽  
The University

CONTEXT: When experiencing a headache attack, Brazilian patients usually look for a primary care service, where they are seen by general clinicians. In the town of Ribeirão Preto, these clinicians routinely refer patients to the Emergency Room of the University Hospital. OBJECTIVE: The objective of this study was to evaluate the quality of primary care by analyzing retrospectively the medical records of patients with a complaint of headache seen in this emergency room during the year of 1996. DESIGN: retrospective study. SETTIING: Emergency Room of the Universital Hospital, Ribeirão Preto, São Paulo, reference unit. PARTICIPANTS:1254 patients. The patients who sought the Emergency Room (ER) of the University Hospital of Ribeirão Preto, during the year of 1996 with a complaint of headache were studied retrospectively. MAIN MEASUREMENTS: Etiology, age, diagnosis, secondary cause, laboratory tests. RESULTS: Of the 1254 patients seen (61% women), 1190 (94.9%) were discharged after the administration of parenteral analgesics before they had spent 12 hours in the room. Only 64 (5.1%) patients remained for more than 12 hours. Of the patients who spent less than 12 hours in the room, 71.5% had migraine or tension type headache and did not require subsidiary exams for diagnosis. Of the patients who spent more than 12 hours in the room, 70.3% had secondary headaches. CONCLUSIONS: We conclude the primary care for headache is unsatisfactory in the Ribeirão Preto region. Many patients with primary headache are referred to tertiary care services, indicating the need for the dissemination of the diagnostic criteria of the International Headache Society to general practitioners.

scholarly journals Frequency of Different Ocular Conditions Leading to Ocular Morbidity in Pediatric Age Group at Dow University Hospital

2021 ◽  
Vol 37 (4) ◽  
Author(s):  
Madiha Jawaid ◽  
Mazhar-ul- Hassan ◽  
Saba Al-Khairy ◽  
Farnaz Siddiqui ◽  
Asad Azeem
Keyword(s):  
Visual Acuity ◽  
Positive Impact ◽  
Tertiary Care ◽  
Age Groups ◽  
University Hospital ◽  
P Value ◽  
Care Hospital ◽  
Cross Sectional ◽  
Ocular Abnormality ◽  
Ocular Morbidity

Purpose:  To determine the frequency of different ocular conditions leading to ocular morbidity in a tertiary care hospital. Study Design:  Descriptive cross sectional study. Place and Duration of Study:  Study was done in Dow University of medical sciences, from May 2018 to October 2018. Methods:  A total of 278 patients presenting in the eye out-patient department were included. Patients with unaided visual acuity of 6/6 in both eye and no ocular abnormality were excluded from the study. Children with congenital syndromes like Down’s syndrome, etc. leading to eye diseases were also excluded. All children underwent complete ocular examination. Data was analyzed by using SPSS version 22. Frequency and percentages were computed for gender and different ocular diseases e.g., myopia, hypermetropia, strabismus, Vernal Kerato-conjunctivitis, astigmatism, red eye, subconjunctival hemorrhage etc. Post-stratification chi-square test was applied with p-value ? 0.05. Results:  Out of 278 participants of the study, there were 154 (55.4%) males and 124 (44.6%) females. Average age of the patients was 11.15 ± 3.44 years. Myopia and red eyes were the major causes of pediatric ocular morbidity i.e. 33.81% and 26.6% respectively. Comparison between two age groups showed that Myopia was higher in children with 11 to 15 years. Myopia and astigmatism were more common in females while sub-conjunctival hemorrhage was more in males. Conclusion:  Refractive errors are the commonest cause of childhood visual impairment in our setup. Correcting these preventable diseases can have a positive impact on the performance of children at school. Key Words:  Visual acuity, Pediatric, Myopia, Hypermetropia, Kerato-conjunctivitis.

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