ABSTRACT
Musculoskeletal pain is a common and debilitating symptom in older adults. However, its importance is often underestimated. In this review article, we discuss its proper evaluation and management. Pain evaluation includes detailed history taking, physical examination, imaging, and laboratory investigations. Management of musculoskeletal pain requires a multidomain approach including nonpharmacological, pharmacological, and surgical modalities. A step-wise approach recommended by the World Health Organization can be used for pain management. Common musculoskeletal conditions causing pain are osteoarthritis, low?back pain, gout, pseudogout, rheumatoid arthritis, polymyalgia rheumatica, and fibromyalgia.
ABSTRACT
Orthostatic hypotension (OH) is defined as a drop of >20 mm Hg of systolic or >10 mm Hg of diastolic blood pressure (BP) within 3 min of standing from lying position. It is a common geriatric syndrome caused by impaired orthostatic response of BP. Its clinical manifestation can range from dizziness to syncope. It is a common cause of recurrent falls and fracture in older adults. Its etiology ranges from neurological causes such as Parkinson and diabetes to hypovolemia. Drugs, especially cardiovascular drugs are also frequently identified as the cause of OH. The management of OH is primarily nonpharmacological including medication review, dietary, and lifestyle modifications. However, in partially responsive or resistant cases, medications such as fludrocortisone, midodrine, droxidopa, etc., are also used.
ABSTRACT
Visceral malignancies often present as cutaneous lesion and are an important clue towards the diagnosis. Authors report a case of a 64 years old male, who presented to us with right hemiparesis and multiple purple-red skin lesions. Systematic evaluation, thorough history and histological examination of the skin lesion showing the characteristic lesion lead to a final diagnosis of Renal Cell Carcinoma. Although in the history and physical examination there was no sign of Renal Cell Carcinoma, but eventually the case turned out to be an extensively spread cancer. This kind of Cutaneous lesions in a case of RCC is a rare phenomenon and has not been frequently mentioned in the previous literature, thus this case reminds us about the importance of a detailed clinical look out in each and every patient and various clues to make a correct and timely diagnosis of systemic diseases. The list of visceral malignancies causing cutaneous metastasis is quite long and requires a battery of test to diagnose the same.