Clinical and subclinical arteriosclerotic disease in octagenarians with hip fracture. A case-control study.

BACKGROUND AND OBJECTIVES: Evaluate clinical and subclinical arteriosclerotic disease in older patients with hip fracture compared with patients without fracture in order to increase knowledge about the relation between both diseases in older individuals. PATIENTS AND METHODS: Age- and sex-matched case-control study of octogenarians with and without recent hip fracture. Vascular risk factors, subclinical vascular diseases (assessed by carotid plaques, carotid intima media thickness and arterial stiffness) as well as cardiovascular diseases were analyzed. Univariate and multivariate logistic models were used to estimate odds ratios (OR) with their 95% confidence intervals (CI) to assess the association of the arteriosclerosis and hip fracture. RESULTS: We analyzed 95 patients per group with a median age of 82 [79-87] years of whom 77.9% were female. Patients in both groups have elevated rates of vascular disease (25%) without differences between them. Patients with hip fracture had higher subclinical arteriosclerotic alterations with higher percentage of carotid plaques (OR 3.25 [1.06-9.97]) compared with the control group. CONCLUSIONS: Older patients with hip fracture had significantly higher presence of subclinical alterations but not increase on rate of cardiovascular arteriosclerotic disease compared with those without hip fracture.

Clinical characteristics and outcome of patients aged over 80 years with covid-19.

ABSTRACT: To investigate the clinical characteristics and outcome of octogenarians with covid-19.This is a observational, retrospective, descriptive study.Consecutive patients aged >80 years who were admitted for covid-19 pneumonia during a 6 weeks period (March 20-April 30, 2020).Illness severity on admission was classified according to World Health Organization (WHO) criteria: mild, moderate, severe, and critical. Data collected included demographics, presenting symptoms, radiological and laboratory findings, comorbidities, functional status, treatment, and clinical outcome.There were 159 patients (52.2% women) with a median age of 85.99 (IQR: 80-98). The median Barthel index was 90 (40-100) and Charlson index was 5 (5-6). Most common presenting symptoms were fever, dyspnea, and cough. Patients had mild (8.2%), moderate (52.2%), or severe (39.6%) illness according to WHO criteria. A bilateral pulmonary involvement was seen in 86% of patients. Laboratory analysis revealed increased serum concentrations of inflammatory parameters (C-reactive protein, ferritin, lactate dehydrogenase, and D-dimer) with an abnormal lymphocyte count [0.88 × 109/L (0.5)]. Treatments included corticosteroids in 37%, and biological therapies in 17.6%. Fifty three (33.3%) patients died during hospitalization, with a median time from admission to death of 3 (IQR 1-6) days. Mortality was higher in men (55%). Deceased patients had a significantly higher frequency of dyspnea, increased inflammatory parameters, and illness severity compared to survivors.One-third of octogenarians with covid-19 died during hospitalization and most had bilateral lung involvement. A further knowledge of the characteristics and outcome of this population may assist clinicians in the decision-making process in these patients.

Seguimiento telemático a los pacientes con fracturas por fragilidad / Telematic follow-up of patients with fragility fractures

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Localised granulomatosis with polyangiitis in an older patient with rheumatoid arthritis.

New onset of granulomatosis with polyangiitis (GPA) occurring in patients previously diagnosed with rheumatoid arthritis (RA) is very uncommon. In older individuals, this condition is associated with high mortality, especially in those with renal involvement. We describe the first case of GPA in a patient older than 65 years diagnosed with RA without exposure to biologic disease-modifying anti-rheumatic drugs, presenting with pulmonary nodules due to a limited form of anti-neutrophil cytoplasmic antibody-negative GPA.

Manejo de la sepsis grave y el shock séptico en un servicio de urgencias de un hospital urbano de tercer nivel. Oportunidades de mejora / Management of severe sepsis and septic shock in a tertiary care urban hospital emergency department: opportunities for improvement

Objetivos: Describir las características del manejo inicial de la sepsis grave y el shock séptico (SS) en un servicio de urgencias hospitalario (SUH) en el que no existe una identificación específica en el triaje. Determinar cuáles serían las oportunidades de mejora. Método: Diseño de cohortes prospectivo de marzo de 2014 a marzo de 2015. Se incluyó el primer paciente del día de estudio que fue atendido en el SUH por un cuadro compatible con SS. Se registró el nivel de triaje asignado (mediante el Modelo Andorrano de Triaje -MAT-) y las variables clínico epidemiológicas primarias. Se realizó seguimiento del paciente durante el ingreso hasta el alta. Resultados: Se incluyeron 50 pacientes con SS (35 varones, edad media 65 años), 35 fueron clasificados como nivel 1-2 del MAT y 15 como nivel 3. Los pacientes clasificados inicialmente como nivel 1-2, en comparación con los de nivel 3, presentaban una frecuencia cardiaca de 110 frente a 90 latidos por minuto (p = 0,003) y una frecuencia respiratoria de 27 frente a 18 respiraciones por minuto (p = 0,001). La diferencia entre la hora de llegada y la hora de entrada al box (nivel 1-2: 18 minutos; nivel 3: 117 minutos, p = 0,002), así como entre la hora de llegada y la primera dosis de antibiótico (nivel 1-2: 85 minutos, nivel 3: 231 minutos, p = 0,001 fue significativamente menor en los pacientes clasificados como nivel 1-2). Conclusiones: La atención médica a los pacientes con SS en un SUH sin identificación específica es susceptible de mejora en cuanto al diagnóstico precoz y a la adhesión a las guías de manejo terapéutico inicial (AU)

Objectives: To describe the characteristics of early management of severe sepsis and septic shock in a hospital emergency department that does not have a specific triage category to identify patients in these states. To determine opportunities for improvement. Methods: Prospective cohort study from March 2014 to March 2015. On each day during the study period, we included the first patient with signs compatible with septic shock. We recorded the severity level assigned according to the Andorran Triage Model and the main clinical and epidemiological variables. Patients were followed until hospital discharge. Results: Fifty patients (35 men) with septic shock (mean age 65 years) were included. Thirty-five were at triage level 1 or 2 and 15 were at level 3. Patients initially classified as level 1-2 had significantly higher heart rates than level 3 patients (mean 110 vs 90 bpm, respectively; P=.003) and respiratory rates (mean 27 vs 18 breaths per minute; P=.001). Patients classified as level 1-2 also had significantly shorter care times than level 3 patients: time from arrival to examination room entry, 18 vs 117 minutes, respectively (P=.002); time from arrival to the first antibiotic dose (85 vs 231 minutes (P=.001). Conclusions: Medical care for patients with septic shock in this emergency department needs to improve in terms of earlier diagnosis and better compliance with guidelines for initial therapeutic management (AU)

[Management of severe sepsis and septic shock in a tertiary care urban hospital emergency department: opportunities for improvement]. / Manejo de la sepsis grave y el shock séptico en un servicio de urgencias de un hospital urbano de tercer nivel. Oportunidades de mejora.

OBJECTIVES: To describe the characteristics of early management of severe sepsis and septic shock in a hospital emergency department that does not have a specific triage category to identify patients in these states. To determine opportunities for improvement. MATERIAL AND METHODS: Prospective cohort study from March 2014 to March 2015. On each day during the study period, we included the first patient with signs compatible with septic shock. We recorded the severity level assigned according to the Andorran Triage Model and the main clinical and epidemiological variables. Patients were followed until hospital discharge. RESULTS: Fifty patients (35 men) with septic shock (mean age 65 years) were included. Thirty-five were at triage level 1 or 2 and 15 were at level 3. Patients initially classified as level 1-2 had significantly higher heart rates than level 3 patients (mean 110 vs 90 bpm, respectively; P=.003) and respiratory rates (mean 27 vs 18 breaths per minute; P=.001). Patients classified as level 1-2 also had significantly shorter care times than level 3 patients: time from arrival to examination room entry, 18 vs 117 minutes, respectively (P=.002); time from arrival to the first antibiotic dose (85 vs 231 minutes (P=.001). CONCLUSION: Medical care for patients with septic shock in this emergency department needs to improve in terms of earlier diagnosis and better compliance with guidelines for initial therapeutic management.

OBJETIVO: Describir las características del manejo inicial de la sepsis grave y el shock séptico (SS) en un servicio de urgencias hospitalario (SUH) en el que no existe una identificación específica en el triaje. Determinar cuáles serían las oportunidades de mejora. METODO: Diseño de cohortes prospectivo de marzo de 2014 a marzo de 2015. Se incluyó el primer paciente del día de estudio que fue atendido en el SUH por un cuadro compatible con SS. Se registró el nivel de triaje asignado (mediante el Modelo Andorrano de Triaje ­MAT­) y las variables clínico epidemiológicas primarias. Se realizó seguimiento del paciente durante el ingreso hasta el alta. RESULTADOS: Se incluyeron 50 pacientes con SS (35 varones, edad media 65 años), 35 fueron clasificados como nivel 1-2 del MAT y 15 como nivel 3. Los pacientes clasificados inicialmente como nivel 1-2, en comparación con los de nivel 3, presentaban una frecuencia cardiaca de 110 frente a 90 latidos por minuto (p = 0,003) y una frecuencia respiratoria de 27 frente a 18 respiraciones por minuto (p = 0,001). La diferencia entre la hora de llegada y la hora de entrada al box (nivel 1-2: 18 minutos; nivel 3: 117 minutos, p = 0,002), así como entre la hora de llegada y la primera dosis de antibiótico (nivel 1-2: 85 minutos, nivel 3: 231 minutos, p = 0,001 fue significativamente menor en los pacientes clasificados como nivel 1-2). CONCLUSIONES: La atención médica a los pacientes con SS en un SUH sin identificación específica es susceptible de mejora en cuanto al diagnóstico precoz y a la adhesión a las guías de manejo terapéutico inicial.