scholarly journals Hypotermia in the elderly

2012 ◽  
pp. 47-51
Author(s):  
Gianpaolo Bragagni ◽  
Anna Alberti ◽  
Giuliano Castelli ◽  
Federico Lari
Keyword(s):  
Sinus Bradycardia ◽  
Clinical Manifestations ◽  
The Elderly ◽  
Temporal Region ◽  
Respiratory Condition ◽  
Mild Anemia ◽  
Elevated Liver Enzymes ◽  
Electrocardiographic Changes ◽  
Ecg Alterations ◽  
Time Of Admission

IntroductionAn 88-year-old woman suffered a cerebrovascular accident and was found on the floor of her cold house.Materials and methodsAt the time of admission to our division, the patient was unresponsive with a rectal temperature of 28 °C, blood pressure of 120/80 mmHg, and a heart rate of 40 bpm. The cerebral CT revealed a hypodense lesion in the temporal region. The ECG showed sinus bradycardia, prolonged PR and QTc intervals, and a classic “J” (Osborn) wave that was most pronounced in the lateral and inferior leads. The patient presented a low respiratory rate, hypoventilation, severe acidosis (both respiratory and metabolic), hyperkalemia, elevated liver enzymes, mild anemia, hyporeflexia, and sluggish pupil responses.ResultsDuring rewarming with thermic blanket and heated intravenous fluids, the respiratory condition improved, and the ECG alterations disappeared. Twenty-four hours later, however, the patient died suddenly due to cardiac asystole.DiscussionThis report analyses the effects of hypothermia and its clinical manifestations and provides a brief discussion of the electrophysiologic mechanisms underlying Osborn waves and the other electrocardiographic changes associated with hypothermia.

scholarly journals ANALISIS PEMERIKSAAN LABORATORIUM PADA KASUS LEPTOSPIROSIS DISERTAI ABSES HATI AMOEBA

2021 ◽  
Vol 3 (3) ◽  
pp. 131-139
Author(s):  
Donaliazarti Donaliazarti
Keyword(s):  
Liver Abscess ◽  
Clinical Manifestations ◽  
Abdominal Ultrasound ◽  
Amoebic Liver Abscess ◽  
Personal Hygiene ◽  
Serological Examination ◽  
Mild Anemia ◽  
Prolonged Aptt ◽  
The Right ◽  
Time Of Admission

Leptospirosis is a disease caused by spirochaeta microorganism of the genus Leptospira, while the amoebic liver abscess is an extraintestinal complication by Entamoeba Histolytica. Both diseases occurred in a 45-year-old man with poor personal hygiene and environment sanitation. Amoebic liver abscess was found to be a coincidence that was thought to have existed before the patient developed leptospirosis so that the two diseases caused overlapping clinical manifestations in the patient, but the acute symptoms experienced by the patient at the time of admission were more likely to be caused by his leptospirosis. Patient complained of high fever, yellowing of the skin and eyes, urinating like concentrated tea, stiffness in both legs, nausea, vomiting and heartburn. On physical examination found febrile, tachycardia, icteric on skin and sclera, ciliary injection, and hepatomegaly. Laboratory tests showed mild anemia with normocytic normochromic features, leukocytosis with neutrophilia shift to the right, thrombocytosis, increased ESR, prolonged APTT, hyperbilirubinemia, elevated SGOT SGPT, ALP and GGT enzymes, hypoalbuminemia, hyperglobulinemia, and bilirubinuria. Microscopic examination with negative staining of urine samples found Leptospira. Abdominal ultrasound examination showed a solitary space occupying lesion (SOL) in the right lobe of the liver and on serological examination showed positive antiamoeba. Based on the above, this patient was diagnosed as having coincident leptospirosis with amoebic liver abscess.

Polymyalgia Rheumatica - a Disease of the Elderly

2018 ◽  
Vol 69 (1) ◽  
pp. 152-154
Author(s):  
Vasilica Cristescu ◽  
Aurelia Romila ◽  
Luana Andreea Macovei
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Polymyalgia Rheumatica ◽  
Temporal Arteritis ◽  
Viral Infections ◽  
Clinical Manifestations ◽  
The Elderly ◽  
Clinical Aspects ◽  
Immune Disorder ◽  
Markers Of Inflammation

Polymyalgia rheumatica is a disease that occurs mostly in the elderly and is rarely seen in patients less than 50 years of age. Polymyalgia rheumatica is a vasculitis, which manifests itself as an inflammatory disease of the vascular wall that can affect any type of blood vessel, regardless of its size. It has been considered a form of giant cell arteritis, involving primarily large and medium arteries and to a lesser extent the arterioles. Clinical manifestations are caused by the generic pathogenic process and depend on the characteristics of the damaged organ. PMR is a senescence-related immune disorder. It has been defined as a stand-alone condition and a syndrome referred to as rheumatic polyarteritis with manifestations of giant cell arteritis (especially in cases of Horton�s disease and temporal arteritis) which are commonly associated with polymyalgia. The clinical presentation is clearly dominated by the painful girdle syndrome, with a feeling of general discomfort. Polymyalgia and temporal arteritis may coexist or be consecutive to each other in the same patient, as in most of our patients. The present study describes 3 cases of polymyalgia rheumatica, admitted to the Clinic of Rheumatology of Sf. Apostol Andrei Hospital, Galati. The cases were compared with the literature. Two clinical aspects (polymyalgia rheumatica and/or Horton�s disease) and the relationship between them were also considered. Polymyalgia rheumatica is currently thought to have a multifactorial etiology, in which the following factors play a role: genetic factors or hereditary predisposition (some individuals are more prone to this disease), immune factors and viral infections (triggers of the disease). Other risk factors of polymyalgia rheumatica include age over 50 years and the association with giant cell arteritis. The characteristic feature of the disease is girdle pain, with intense stiffness of at least one hour�s duration. Markers of inflammation, erythrocyte sedimentation rate and C-reactive protein are almost always increased at the onset of the disease. Diseases that can mimic the clinical picture of polymyalgia rheumatica are neoplasia, infections, metabolic disorders of the bone and endocrine diseases.

scholarly journals Myocardial amyloidosis following multiple myeloma in a 38-year-old female patient: A case report

Open Medicine ◽  
2020 ◽  
Vol 15 (1) ◽  
pp. 396-402
Author(s):  
Qisi Zhang ◽  
Yingli Qiao ◽  
Dongmei Yan ◽  
Yuhui Deng ◽  
Mengyang Zhang ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Plasma Cells ◽  
Laboratory Data ◽  
Young Patients ◽  
Clinical Manifestations ◽  
The Elderly ◽  
First Episode ◽  
Rapid Progression ◽  
Congo Red Staining ◽  
Impaired Cardiac Function

AbstractMultiple myeloma (MM) is an immunoglobulin-producing tumor of plasma cells, which occurs commonly in the elderly. The incidence of myocardial amyloidosis with MM is extremely low and early clinical manifestations are nonspecific. The diversity of clinical manifestations and first episode symptoms often cause misdiagnosis in young patients with myocardial amyloidosis following MM. In this study, we analyzed the clinical data of a young woman with MM and impaired cardiac function combined with echocardiography, electrocardiography (ECG), laboratory data, cell Congo Red staining, and other manifestations to diagnose amyloidosis. Considering the rapid progression, short survival, and poor prognosis in most patients, a clear, definitive, and timely diagnosis is essential for the treatment of patients with MM complicated with myocardial amyloidosis.

DEVELOPMENT OF A MODEL FOR ASSESSMENT OF THE CONDITION OF PATIENTS WITH DISEASES OF THE SPINE BASED ON THE METHOD OF MULTI-CRITERIAL SELECTION OF ALTERNATIVES

2021 ◽  
pp. 115-121
Author(s):  
Екатерина Ивановна Новикова ◽  
Евгений Николаевич Коровин
Keyword(s):  
Information Technologies ◽  
Clinical Manifestations ◽  
Human Perception ◽  
The Elderly ◽  
Modern Medicine ◽  
Great Accuracy ◽  
Spinal Diseases ◽  
Gradual Introduction ◽  
The Russian Federation ◽  
Selection Of

Современная медицина имеет два приоритетных направления развития. Первое направление - это создание новейших лекарственных препаратов, а также разработка вакцин против новых вирусов. Второе направление - повсеместное и поэтапное внедрение в медицину информационных технологий. С болью в спине могут столкнуться люди не только пожилого возраста, но и подростки и даже грудные дети. Боль эта может быть вызвана многими причинами: как усталостью, так и всевозможными заболеваниями, которые могли развиться со временем или быть от рождения. По данным статистики ВОЗ, 80% населения страдает клиническими проявлениями остеохондроза позвоночника. В Российской Федерации большая часть амбулаторного приема неврологов и ортопедов занимают болезни позвоночника. Зачастую эксперту сложно однозначно оценить объект по некоторому критерию, возникают сомнения и поиски усредненной оценки. Но нередко затруднения в точном определении значения возникают не из-за недостатка опыта, а как раз, наоборот, из-за интуитивного понимания размытости оценки. Излишняя точность понятия может привести к потере части наилучших альтернатив или неправильному их ранжированию, если таковое применяется. Поэтому возникает необходимость разработки все более гибких по отношению к человеческому восприятию информации методов, позволяющих учитывать неопределенность все в большем количестве измерений. Целью данной работы является изучение методов, позволяющих с большой точностью определить заболевание позвоночника по некоторым жалобам пациента. Задачами работы являются выбор методов для просчета альтернатив, выбор критериев для альтернатив, и собственно, сами расчеты по выбранным методам Modern medicine has two priority areas of development. The first direction is the creation of the latest drugs, as well as the development of vaccines against new viruses. The second direction is the widespread and gradual introduction of information technologies into medicine. Back pain can be experienced not only by the elderly, but also by adolescents and even infants. This pain can be caused by many reasons: both fatigue and all kinds of diseases that could develop over time or be from birth. According to WHO statistics, 80% of the population suffers from clinical manifestations of osteochondrosis of the spine. In the Russian Federation, most of the outpatient visits to neurologists and orthopedists are spinal diseases. It is often difficult for an expert to unambiguously evaluate an object according to some criterion; doubts arise and searches for an average assessment. But often difficulties in accurately determining the meaning arise not because of a lack of experience, but, on the contrary, because of the intuitive understanding of the fuzziness of the assessment. Excessive precision of the concept can lead to the loss of some of the best alternatives or their incorrect ranking, if applicable. Therefore, there is a need to develop more and more flexible methods in relation to human perception of information, allowing to take into account the uncertainty in more and more dimensions. The aim of this work is to study methods that allow to determine with great accuracy the disease of the spine based on some of the patient's complaints. The tasks of the work are the choice of methods for calculating alternatives, the choice of criteria for alternatives, and, in fact, the calculations themselves according to the selected methods

scholarly journals Acute Pancreatitis Mimicking ST-Segment Elevation Myocardial Infarction

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Akanksha Agrawal ◽  
Nuzhat Sayyida ◽  
Jorge Luis Penalver ◽  
Mary R. Ziccardi
Keyword(s):  
Acute Pancreatitis ◽  
Sinus Bradycardia ◽  
Fluid Collection ◽  
Uncinate Process ◽  
Heart Catheterization ◽  
St Segment Elevation ◽  
Computed Tomographic ◽  
St Segment ◽  
Electrocardiographic Changes ◽  
Artery Disease

Introduction. Electrocardiographic changes imitating myocardial ischemia have been occasionally reported in patients with intra-abdominal pathology including acute pancreatitis. Case Report. A 60-year-old man with no past medical history presented to the emergency department (ED) after a syncopal episode. In ED, his vitals were stable. His ECG showed sinus bradycardia at 53 beats per minute, peaked T waves, 1 mm ST-segment elevation in leads II, III, and aVF, and 2 mm ST elevation in V3 as shown in the figures. With the concern for STEMI, he was taken for left heart catheterization (LHC) emergently, showing nonobstructive coronary artery disease (CAD). His laboratory workup was remarkable for lipase of 25,304 IU/l (normal level 8–78 IU/l). His liver function test and triglyceride level were normal. Troponin was <0.01 ng/ml. A computed tomographic exam of the abdomen revealed acute interstitial pancreatitis with a small discrete fluid collection in the uncinate process. He was treated with aggressive intravenous fluid resuscitation and was discharged on day 3. Discussion. Intra-abdominal pathologies like acute pancreatitis can lead to transient ECG changes mimicking STEMI. It is important to use ECG clues, echocardiographic findings, and clinical judgement to avoid cardiac catheterization, contrast exposure, and associated health care costs.

scholarly journals OPTIMIZATION OF DSME THROUGH INCREASED KNOWLEDGE OF PREVENTION OF COMPLICATIONS AND DIABETES EMERGENCIES IN WONOREJO VILLAGE

2021 ◽  
Vol 3 (1) ◽  
pp. 29
Author(s):  
Ari Pebru Nurlaily ◽  
Meri Oktariani ◽  
Anestasia Pangestu Mei Tyas
Keyword(s):  
Access To Health Care ◽  
Diabetes Complications ◽  
Clinical Manifestations ◽  
The Elderly ◽  
Health Care Facilities ◽  
Basic Knowledge ◽  
Foot Care ◽  
Healthy Elderly ◽  
Access To Health ◽  
Prevention Of Diabetes

Background: Many elderly convey blood sugar often up and down due to lack of attention to their diet. The condition became urgent because the elderly had previously died from complications accompanied by diabetic ulcers. In the posyandu area of wonorejo healthy elderly, DM disease is one of the diseases that are quite widely suffered by its citizens. Objective: The DSME education program for cadres and the elderly at Posyandu Wonorejo aims to increase knowledge and prevent diabetes complications. Method: This DSME program was conducted in four sessions, namely, session 1 discussing basic knowledge about DM (definition, etiology, classification, etiology, clinical manifestations, diagnosis, prevention, treatment, complications), session 2 discussing DM management including nutrition/diet arrangements, and physical activities/exercises that can be done, session 3 discussing foot care and stress management; and session 4 discusses the prevention of chronic and acute complications, and the patient's access to health care facilities. Results: There was an increase in knowledge and prevention of diabetes complications up to 93,75% after this activity was conducted.. Conclusion: The program is optimally implemented.

scholarly journals Propéptido natriurético tipo B N-terminal en adultos mayores ecuatorianos

2020 ◽  
Vol 4 (1) ◽  
pp. 9
Author(s):  
Rubí Eliana Bermello Zamora ◽  
Yury Jordano Sanclemente Núñez ◽  
Ivón Howland Álvarez
Keyword(s):  
Heart Failure ◽  
Healthcare Expenditure ◽  
Clinical Manifestations ◽  
Clinical Importance ◽  
The Elderly ◽  
Comprehensive Health Care ◽  
Palabras Clave ◽  
Insuficiencia Cardiaca ◽  
Comprehensive Health ◽  
Severity Of The Disease

  La insuficiencia cardiaca (IC) es un trastorno progresivo y letal que constituye la primera causa de ingreso hospitalario en las personas mayores de 65 años. Se ha demostrado la utilidad del NT-proBNP para su diagnóstico; sin embargo, los valores de estos marcadores difieren según las características de los pacientes y la severidad de la enfermedad. El objetivo de este estudio consistió en determinar la utilidad de la medición de NT-proBNP para diagnosticar el riesgo de padecer IC en adultos mayores. Se realizaron análisis de NT-proBNP, creatinina, urea, hemoglobina, glucosa y sodio en 47 muestras sanguíneas de pacientes de un centro gerontológico de Manabí en el periodo octubre a diciembre 2017. Se analizaron los valores y la posible asociación a otras enfermedades. Se compararon los valores de variables demográficas, analíticas y clínicas. Se analizaron las manifestaciones clínicas y antecedentes patológicos personales asociados al riesgo de IC. El valor NT-proBNP se asoció con la presencia de anemia, creatinina mayor de 2 mg/dL e hiponatremia. La edad media de los pacientes fue de 79 años, de predominio masculino, con comorbilidad asociada y cierto grado de dependencia, aunque la edad no fue un factor que influyó en la probabilidad de tener elevación en el valor plasmático de NT-proBNP y por lo tanto del riesgo latente de padecer o no IC. El valor de NT-proBNP mostró ser un analito complementario de gran importancia clínica para la evaluación y el cuidado integral de salud del anciano.   Palabras clave: NT-proBNP, insuficiencia cardiaca, adultos mayores.   Abstract Heart failure (HF) is a progressive and lethal disorder that constitutes the first cause of hospital admission in people over 65 years of age and represents just over 2% of national healthcare expenditure. The usefulness of NT-proBNP for its diagnosis has been demonstrated, however, the values of these markers differ according to the characteristics of the patients and the severity of the disease. The objective of this study is to determine the NT-proBNP usefullness to diagnose risk of HF in older adults. NT-proBNP, creatinine, urea, hemoglobin, glucose and sodium were analyzed in 47 blood samples of patients from the gerontological center from October to December 2017. The values and the possible association to other diseases were analyzed. The values of demographic, analytical and clinical variables were compared. The clinical manifestations and personal pathological background associated with the risk of HF were analyzed. The NT-proBNP value was associated with the presence of anemia, creatinine greater than 2 mg/dL and hyponatremia. The average age of the patients was 79 years, predominantly male, with associated comorbidity and a certain degree of dependence, although age was not a factor that influenced the probability of having an elevated plasma NT-proBNP value and therefore both of the latent risk of suffering or not IC. The value of NT-proBNP was shown to be a complementary analyte of great clinical importance for the evaluation and comprehensive health care of the elderly.   Keywords: NT-proBNP, heart failure, elderly.

scholarly journals Clinical manifestations of chronic subdural hematoma in the elderly: Literature Review

2021 ◽  
Author(s):  
Gabriela Ferreira Kalkmann ◽  
Carlos Umberto Pereira ◽  
Francisco de Assis Pereira ◽  
Débora Moura da Paixão Oliveira ◽  
Nicollas Nunes Rabelo
Keyword(s):  
Early Diagnosis ◽  
Literature Review ◽  
Subdural Hematoma ◽  
Elderly Population ◽  
Clinical Presentation ◽  
Clinical Manifestations ◽  
Chronic Subdural Hematoma ◽  
Signs And Symptoms ◽  
The Elderly ◽  
Study Results

Introduction: The clinical manifestations of chronic subdural hematoma (CSDH) are often confused with other medical entities in the elderly, making their early diagnosis difficult or difficult. Early diagnosis is important, since its prognosis is directly associated with the preoperative neurological state, thus resulting in a worse vital and functional prognosis. Objectives: Report through a literature review the clinical manifestations of CSDH in the elderly population. Methods: Literature review, with the search terms: “Signs and Symptoms”, “Chronic Subdural Hematoma”, Aged, Diagnosis and Prognosis. In which PubMed, Lilacs, Scielo, Cochrane and TripDataBase data platforms were used. The inclusion criteria were: original studies published in any language. Articles in which full reading was prevented were excluded. With the application of the inclusion and exclusion criteria, 110 articles were included in the study. Results: Clinical presentation depends on the location, volume of the hematoma, rapid growth, the location of the CSDH, whether unilateral or bilateral, and the clinical conditions of the patient. Because the forms of clinical presentation of CSDH are variable, it is necessary that health professionals linked to the elderly (geriatrician, psychiatrist, general practitioner) have knowledge of this clinical entity. Conclusions: The recognition of classic forms as well as the identification of risk factors in the elderly favors the timely diagnosis and treatment of CSDH in the elderly population.

scholarly journals Clinical and laboratory findings in elderly with Community-Acquired Pneumonia in Babol, northern Iran – 2017-2019

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Saleh Habibi ◽  
Arefeh Babazadeh ◽  
Soheil Ebrahimpour ◽  
Parisa Sabbagh ◽  
Mehran Shokri
Keyword(s):  
Older Adults ◽  
Age Groups ◽  
Clinical Manifestations ◽  
Gastrointestinal Symptoms ◽  
Vital Signs ◽  
The Elderly ◽  
Community Acquired Pneumonia ◽  
Northern Iran ◽  
Laboratory Findings ◽  
Cross Sectional

Abstract Morbidity and mortality are higher in older adults with community-acquired pneumonia (CAP) than in other age groups. Also, CAP in older adults has various clinical manifestations with other. A higher mortality rate in the elderly with CAP may contribute to a delay in management. Consequently, the purpose of this study was to investigate the clinical and laboratory manifestations of CAP in the elderly. This cross-sectional study was conducted on 221 elderly patients with CAP who were admitted to Ayatollah Rouhani Hospital, in Babol, northern of Iran, in 2017-2019. Patient outcomes included 170 cases that recovered from CAP, and 51 cases that died of complications. Patients were evaluated in terms of their clinical and laboratory manifestations. The most common symptoms of pneumonia were cough (79.6%), sputum (73.8%), weakness (72.9%), fever (56%), dyspnea (46.2%). The most frequent underlying disease was ischemic heart disease (43.9%). In our study, clinical and laboratory characteristics in older patients with CAP were evaluated and compared with other studies confirming past findings, but there were differences in some cases, such as vital signs, gastrointestinal symptoms, and disturbance of the level of consciousness. Therefore, it recommends carefully taking the patients’ initial histories and accurately recording their clinical and laboratory symptoms.

Liver Histology in Short Telomere Syndrome: A Case Report and Review of the Literature

2021 ◽  
pp. 106689692110541
Author(s):  
Lixia Bai ◽  
Charles Rohrer ◽  
Yongjun Liu
Keyword(s):  
Liver Disease ◽  
Bone Marrow Failure ◽  
Correct Diagnosis ◽  
Clinical Manifestations ◽  
Liver Histology ◽  
Telomere Maintenance ◽  
Short Telomere ◽  
Ductular Reaction ◽  
Elevated Liver Enzymes ◽  
Tract Infections

Short telomere syndrome (STS) encompasses a broad family of genetically inherited conditions caused by various mutations in telomerase and other telomere maintenance genes, resulting in premature telomere shortening. STS involves a variety of clinical manifestations, including dyskeratosis congenita, premature achromotrichia, bone marrow failure, immunodeficiency, pulmonary fibrosis and liver disease. Liver histopathologic features in STS patients have not been well characterized. We report a 46-year-old male patient who presented for dyspnea. The patient had a complicated medical history significant for immune thrombocytopenic purpura and splenectomy, recurrent respiratory tract infections, pneumonia, primary immunodeficiency, and severe hepatopulmonary syndrome. He and his brother both developed gray hair by their late 20s. He had a long history of intermittently elevated liver enzymes starting at age 33. These clinical manifestations prompted an evaluation for a possible telomere biology disorder, which revealed the telomere length was critically short and fell at or below the first percentile for age, supporting the diagnosis. The liver biopsy showed marked portal inflammation with interface hepatitis, ductular reaction and frequent foci of lobular inflammation with focal hepatocyte dropout. Hepatocytes around the portal tracts demonstrated ballooning degeneration and occasional Mallory-Denk bodies. A trichrome stain highlighted bridging fibrosis. A literature review shows liver histology is available in only a small number of STS patients, demonstrating a variety of morphologic features. Our case and others suggest liver disease associated with STS exhibits a spectrum of histopathology. Being aware of these features is important for establishing the correct diagnosis of STS which is under recognized.

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