ABSTRACT
Urinary tract infection (UTI) is a very common infection among women of all ages. However, the incidence increases with older age and account for the substantial raise in morbidity, mortality and health economic costs in elderly people. Almost half of all women have suffered from at least one episode during their reproductive age, a percentage that increases to at least 60% in the postmenopausal period. UTI in elderly women can be a complex problem in terms of approach to diagnosis, treatment and prevention, because these patients often present nonspecific symptoms, resulting in the increase of morbidity and mortality in this group. It is very important to increase the epidemiological and clinical knowledge about UTI in order to help the general practitioner or specialist to make early diagnosis to prevent serious clinical complications secondary to UTI in elderly women.
ABSTRACT
The main treatment for pemphigus vulgaris are systemic corticosteroids and immunosuppressive agents, but due to adverse reactions and therapeutic failure, new drugs such as rituximab and mycophenolate mofetil have been used. In this case report are described two cases of severe pemphigus vulgaris refractory to various treatments, with resolution after use of rituximab and mycophenolate mofetil, associated with corticosteroids. A higher-than-usual dose of rituximab was employed, without the occurrence of serious adverse reactions. Mycophenolate mofetil was added as adjunctive therapy due to lack of response to azathioprine.
Subject(s)
Female , Humans , Male , Middle Aged , Antibodies, Monoclonal, Murine-Derived/therapeutic use , Immunologic Factors/therapeutic use , Immunosuppressive Agents/therapeutic use , Mycophenolic Acid/analogs & derivatives , Pemphigus/drug therapy , Adrenal Cortex Hormones/therapeutic use , Azathioprine/therapeutic use , Mycophenolic Acid/therapeutic use , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: Urinary tract infections (UTIs) in elderly patients can be a complex problem in terms of approach to diagnosis, treatment, and prevention, because the patients often present nonspecific symptoms. The epidemiological and clinical characteristics of UTI in elderly women were studied, in order to make early diagnosis and prevent serious clinical complications secondary to UTI. METHODS: This was a prospective population-based study, with elderly women, during their first medical office visit. Medical records were obtained by clinical history and physical examination in order to detect signs and symptoms of UTI and the presence of comorbidities. Clean-catch midstream urine specimens for urinary dipstick test, sediment, and culture were collected; cervical samples for conventional Pap smears were also collected. RESULTS: UTI was found in 16.55% of elderly women. The most frequent urinary symptom was foul smelling urine, in 60.6%. E. coli was responsible for 98 (76.56%) cases of significant bacteriuria; 34 (34.69%) were resistant to trimethoprim-sulfamethoxazole, and 21 (21.42%) to fluoroquinolones. Asymptomatic bacteriuria (AB) was not treated. The presence of predisposing factors demonstrated that the history of previous UTI (p < 0.001), vaginitis (p < 0.001), and diabetes (p = 0.042) increased the risk for UTI. CONCLUSION: This study confirmed the high prevalence of UTI among elderly women and its unusual clinical presentation. Diabetes, history of previous UTI, and vaginitis were shown to be predisposing factors for UTI; it is not necessary to treat AB in elderly women, even among diabetics.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Urinary Tract Infections/epidemiology , Anti-Bacterial Agents/therapeutic use , Brazil/epidemiology , Epidemiologic Methods , Independent Living , Predictive Value of Tests , Severity of Illness Index , Urinary Tract Infections/diagnosis , Urinary Tract Infections/drug therapy , Urinary Tract Infections/microbiologyABSTRACT
Estudamos a freqüência de insuficiência renal aguda (IRA) entre 240 pacientes internados com sintomas da infecçäo pelo HIV, encontrando 34 episódios em 33 pacientes (13,75). Sua freqüência foi maior nas crianças que nos demais pacientes da série (respectivamente, 34,4 por cento x 12,7 por cento, p < 0,05). O número de sobreviventes 1 mês após a instalaçäo da IRA foi baixo (5 casos, 15,2 por cento). Nenhum dos 21 doentes com quadro séptico associado sobreviveu por mais de 1 mês após o surgimento da IRA, enquanto 5 dos 12(41,7 por cento) näo sépticos ultrapassaram este período (p < 0,01), obtendo alta. Conclui-se que IRA foi importante causa de morbidade entre os pacientes com infecçäo pelo HIV, estando as crianças sob maior risco de desenvolvê-la. O prognóstico após a IRA é ruim, especialmente quando associada à sepsis