Cognitive decline among older adults who developed acute coronary syndrome during hospitalization for non-cardiac illness

Background: Atypical presentations of acute coronary syndrome (ACS) delay its recognition and treatment in the elderly patients. Functional decline and delirium which are common to the elderly during hospitalization, leads to cognitive impairment and poor health outcomes. Steps taken for its prevention is usually not considered the top priority by the cardiologist. The present study was conducted to identify cognitive decline among elderly patients who developed ACS during hospitalization for noncardiac illness and their outcome. Materials and Methods: Three hundred and ten elderly patients above 60 years of age with ACS were included from June 26, 2020 to October 13, 2020. Subjects were divided into those admitted primarily due to an ACS (Group I, n = 94) and those developing ACS following admission for noncardiac illness (Group II, n = 216). Co-morbidities, medications, investigations, management, clinical outcome, and Montreal Cognitive Assessment scale were compared between the two groups at the time of admission, after 30 days and after 6 months. Results: Majority of the subjects were admitted due to acute kidney injury (27.1%) in Group II and had a non-ST elevation ACS (90.2%). Optimum management was given to a lesser extent due to the clinical condition of these patients. Poor clinical outcome, cognitive impairment during hospitalization and cognitive decline during follow-up was more in Group II. Conclusion: Clinicians must be vigilant for the development of cognitive impairment and cognitive decline when an elderly patient is admitted to the hospital, as early detection and optimum management provides better clinical and cognitive outcome.

The pancreas and tuberculosis: a diagnostic challenge.

Pancreatic tuberculosis is often mistaken for malignancy and can pose a diagnostic challenge. A high degree of suspicion is necessary to diagnose this condition which responds well to anti-tuberculosis treatment (ATT). Fine-needle aspiration cytology helps to differentiate malignancy from treatable conditions like tuberculosis. Records of four patients treated for pancreatic tuberculosis between 1997 and 2006 were studied. All patients had a pancreatic mass which was suspected to be malignant at imaging. The diagnosis of tuberculosis was established by FNAC in one case and after laparotomy in one; two had tuberculosis of other systems. All showed good response to ATT which included resolution of the pancreatic mass over mean follow up of 2 years. We suggest that all inoperable masses of the pancreas should be subjected to FNAC to rule out treatable conditions like pancreatic tuberculosis.

Management of anorectal melanomas: a 10-year review.

BACKGROUND: Anorectal melanoma (AM) is a rare tumour with poor prognosis. The primary modality of treatment for AM is surgery. However, the choice of operation is controversial. Historically, radical operations like abdominoperineal excision of rectum (APER) with or without inguinal lymph node dissection were preferred. However, as no stage-specific survival advantage has been seen with APER later studies have recommended wide local excision (WLE) as the preferred treatment where negative margins can be achieved. The aim of our study was to review our results. METHODS: Inpatient and outpatient charts of all patients treated for AM between 1996 and 2005 were reviewed. Patient characteristics, clinical presentation, evaluation, staging, treatment, complications and followup were studied. Patients were followed up to assess disease free and overall survival according to the stage of disease and the surgical procedure performed. RESULTS: 17 patients were treated for AM between 1996 and 2005. At presentation 4 (23%) had metastatic and 1 (6%) had inoperable disease. 12 patients (71%) had operative therapy of which 10 had APER and two had WLE. 82% of these patients were followed up for a mean duration of 8 months (range 3-30 months) and their overall and disease free survival compared. The stage specific disease free and overall survival for patients who underwent APER was 8 months and 13 months for stage I and 7 months and 10 months for stage II respectively. The disease free survival and overall survival for patients who underwent WLE, both for stage I disease, was 10 months and 27 months respectively. CONCLUSION: Despite surgical resection and emergence of various forms of adjuvant therapy, the overall prognosis of anorectal melanoma remains dismal. From a review of literature and our own experience, though limited, we conclude that WLE be recommended where negative margins can be achieved and where this is technically feasible. APER should be reserved for large tumours where WLE is not technically possible.

Adult idiopathic ileosigmoid intussusception prolapsing per rectum.

Ileosigmoid intussusception can lead to ischemia and necrosis of either the ileum or sigmoid colon. Ileosigmoid intussusception as a mass prolapsing per rectum in an adult has not been previously reported. We report a 50-year-old man with such a presentation. He recovered uneventfully after subtotal colectomy.

Pancreatic metastasis from renal cell carcinoma 16 years after nephrectomy: a case report and review of the literature.

Two percent of all malignant pancreatic tumors are metastases from other primaries, with small cell lung cancer, colorectal cancer, breast cancer and hematological neoplasms being the commonest. Renal cell carcinoma (RCC) metastasizing to the pancreas is rare and occurs in 2.8% of patients with metastatic RCC. However, RCC is the most common primary leading to solitary pancreatic metastasis. Metastases often present many years after nephrectomy for primary RCC (median time of 8 years) and should therefore be looked for on surveillance or when patients present with upper abdominal symptoms. Complete surgical resection when possible offers the best chance for cure.