impact of cytomegalovirus infection on mechanically ventilated patients in the respiratory and geriatric intensive care units

Reactivation of cytomegalovirus [CMV] has been reported in critically ill patients [especially elderly] lying in the intensive care units. So identifying such patients to treat is important. To detect the frequency of CMV infection in mechanically ventilated patients, and its correlation with patients' risk factors, and outcomes. The present study was carried out on 51 mechanically ventilated patients admitted to the Respiratory [20] and Geriatric ICU [31] of the Ain Shams University hospitals over a 3 month period. Serum CMV load was measured by real-time PCR. The overall rate of active CMV infection by RT-PCR among the studied populations was [68.6%], [77.4%] in patients of geriatric ICU versus [55%] in respiratory ICU patients. Comparison between CMV positive and negative cases showed a significant difference in the duration of mechanical ventilation and mortality rate. A statistically higher CMV load was recorded in respiratory ICU patients admitted due to exacerbation of chronic respiratory disease or stroke and developing ventilator associated pneumonia [VAP] or septic shock. Also there was a significant direct correlation between CMV load and age of the patient, duration of mechanical ventilation and duration of ICU stay CMV infection is frequent in mechanically ventilated critically ill patients especially the elderly. It is associated with poor outcomes, leads to increased mortality and morbidity in terms of increased ICU stay, longer duration of mechanical ventilation, and higher rates of nosocomial infections

Relation between smoking and cognition in egyptian elderly

In spite of numerous studies published in the past few years on the topic, the effectof smoking on Alzheimer's disease and dementia remains uncertain. Case-control studies havelargely suggested that smoking lowers the risk of AD, whereas prospective studies have shownthat smoking increases this risk or has no effect on the probability of developing AD. The aim of this study is to compare the prevalence of Smoking in elderly withcognitive impairment and elderly with non-cognitive impairment. A Case control 88 participants aged 60 years and above. They wereselected from Ain Shams University Hospital from inpatient wards and outpatient clinics. Thestudied sample was divided into 3 groups: Group A [32 elderly patients with Alzheimer's disease],Group B [32 elderly patients with Mild cognitive impairment] and Group C [24 controls withnormal cognitive function].Comprehensive geriatric assessment, including detailed history, physicalexamination, and also cognitive assessment using Montreal Cognitive Assessment [MOCA] andMini mental status examination [MMSE].As regards smoking there was a highly statistical significant difference between the 3groups as non-smokers were more prevalent in Alzheimer's diseaseand Mild cognitiveimpairment groups in comparison to control group with [p-value= 0.001]. There was a highly significant negative association between smoking and cognitiveimpairment

Homocystiene profile in elderly

Homocysteine [Hcy] is a sulfurated amino acid an elevated homocysteine level is a marker for a pathogenic process as well as a cause of pathology. It is across sectional study conducted on 91 elderly participants 60 years and older selected from geriatric outpatient clinic and geriatric inpatient departmentthey underwent comprehensive geriatric assessment, and homocysteine [Hcy] level in blood by Enzyme Immunoassay [EIA]. homocysteine not significantly related to age, sex and functional status. Also mean Hcy level is 15.4 micromol/liter. Further studies to evaluate Hcy level in elderly with different ages are recommended

Relation between frailty and common geriatric problems in elderly

There is a high prevalence of common geriatric problems [falls, urinary incontinence, visual and hearing impairment] among frail elderly leading to more disability and functional impairment. The aim of this study is to compare the prevalence of common geriatric problems between frail and non-frail elderly. A Case control study. 90 participants aged 60 years and above. They were selected from Ain Shams University Hospital from inpatient wards and outpatient clinics. The studied sample was divided into 2 groups: Group A [30 frail elderly females and 30 frail elderly males] and Group B [30 healthy elderly subjects; 15 males and 15 females]. Comprehensive geriatric assessment, including detailed history of common geriatric problems as mentioned above, physical examination, and also assessment of frailty using modified Fried criteria]. Hearing impairment, incontinence and falls were more prevalent in frail elderly with a highly difference between the two groups, with p values< [0.001,0.009,0.006] consequently, visual impairment was statistically significant in cases more than controls with p value [0.012]. There is a significant positive relationship and high prevalence of common geriatric problems especially falls, urinary incontinence, visual and hearing impairment among frail elderly

Some differences between dyspnea of cardiac origin and dyspnea of pulmonary origin in the elderly

Acute dyspnea is a common problem among elderly patients. Few studies have examined acute dyspnea in the elderly. The most common causes of dyspnea in the elderly are either of cardiac origin include heart failure, or of pulmonary origin as chronic obstructive pulmonary disease and asthma. Other causes include parenchymal lung disease, pulmonary vascular diseases, upper airway obstruction and pneumonia. In clinical practice, it is often difficult to distinguish between cardiac and pulmonary causes of dyspnea. To detect some differences between cases of cardiac dyspnea and those suffering from pulmonary dyspnea in elderly patients admitted to the departement of Geriatrics in Ain Shams University hospital. All patients admitted to the department of Geriatrics in Ain Shams University hospital with acute dyspnea as a main complaint for a period of 6 months [56 patients] were evaluated by both clinical assessment and some investigations as arterial blood gases, chest X ray, ECG, echocardiography. Accordingly determination of the cause of dyspnea was made. Comparison between the three groups i.e. cardiac, pulmonary and mixed were made regarding number, mean age, mean PO2, delirium and ICU admission. The total number of patients presented to the geriatric department during the period of the study were 361 patients, so those 56 patients represented 15% from the total admission. 37.5% of cases were suffering from dyspnea of pulmonary origin. The rest were suffering from cardiac dyspnea [26.8%], mixed type [26.8%] and [8.9%] only were suffering from dyspnea due to other causes. The highest mean age was among the mixed group. There was no statistically significant difference between the three groups regarding sex, delirium and ICU admission. The lowest mean PaO[2] was among those with mixed cardiac and pulmonary dyspnea and the highest was among the cardiac group. In the elderly it is difficult to set out points of differentiation between dyspnea of cardiac origin and that of pulmonary origin. The number of mixed cases is relatively high. It was found also that there are other confounding factors which are important in predicting mortality and morbidity should be considered when we are assessing cases of acute dyspnea in the elderly

Prevalence of asymptomatic bacteriuria among Egyptian elder persons living in the rural areas

This study detected the prevalence of asymptomatic bacteriuria among elder Egyptians living in the rural areas [Serrey Village, Qalyoubia Governorate]. Complete history taking, clinical examination, urine analysis and culture, blood glucose level and serum creatinine were performed for 86 elders. The incidence of asymptomatic bacteriuria was 24.4% and the most common organism was Klebsiella, followed by Staphylococcus and the least incidence was found for E. coli. A regular urine culture must be done for elders in rural areas