Minocycline induced lupus with yellow colored chylous exudative pleural effusion.

Ninety years old male was admitted to hospital due to breathlessness. The prominent findings were extensive blue-grey skin pigmentation and large left chylothorax. Drug induced lupus was diagnosed due to either minocycline chronic treatment or no alternative illness to explain his sub-acute disease. Minocycline therapy was stopped with gradual improvement of pleural effusion and skin discoloration. This case is the first presentation of minocycline induced lupus with chylothorax.

The Charlson Comorbidity Index (CCI) as a Mortality Predictor after Surgery in Elderly Patients.

The increasing range of surgery in elderly patients reflects the changing demography where in the next 10 years one quarter of the population will be 65 years of age or older. There is presently no consensus concerning the optimal predictive markers for postoperative morbidity and mortality after surgery in older patients with an appreciation that physical frailty is more important than chronological age. In this retrospective analysis, we have compared the impact of age and the calculated preoperative Charlson Comorbidity Index (CCI) on early (30-day) and late (one-year) mortality in a group of patients >75 years of age dividing them into an "older old" cohort (75-84 years of age, Group A) and an "oldest old" group (≥85 years of age, Group B). Increased age was associated with a higher death rate after emergency surgery, with late deaths after elective surgery exceeding those after emergency operations. A higher mean CCI was noted in both age groups in early nonsurvivors after both elective and emergency surgery with a more significant effect of the preoperative CCI than chronological age for the prediction of late postoperative death for both groups after elective and emergency operations. Although the CCI was not designed to predict perioperative mortality in surgical cohorts, it correlates with a greater risk than age for perioperative death in the elderly.

Differential impact of some risk factors on trochanteric and cervical hip fractures.

AIM: To investigate the potential distinct risk factors associated with trochanteric and cervical hip fractures. METHODS: Elderly patients aged 65 years and older (n = 1161) were admitted to the orthopedic department with hip fractures during the years 2006-2011. Demographic and clinical data, as well as routine blood tests, were retrieved from the patient electronic medical records. RESULTS: Approximately 58% of patients had trochanteric fractures and 42% had cervical fractures. Women were more likely to have trochanteric fractures than men (P = 0.002). Female sex, frailty, falls, diabetes and subnormal calcium, as well as subnormal hemoglobin levels, were significant risk factors for trochanteric fractures (OR 1.39, P = 0.0202, OR 1.36, P = 0.0166, OR 1.49, P = 0.0015, OR 1.33, P = 0.0343, OR 0.68, P = 0.0054, OR 0.70, P = 0.0036, respectively). Patients with Parkinson's disease were at a lower risk for trochanteric fractures (OR 0.6, P = 0.007). CONCLUSION: As there are some differences between risk factors for trochanteric and cervical hip fractures, there is a need for further studies in order to understand the etiology of fractures and to be able to carry out effective preventive efforts.

Organizing pneumonia and non-necrotizing granulomata on transbronchial biopsy: coexistence or bronchiolitis obliterans organizing pneumonia secondary to Mycobacterium kansasii disease.

Mycobacterium kansasii disease was diagnosed in an 85-year-old woman admitted to the hospital for cough and gradually worsening breathlessness. Transbronchial biopsy indicated either non-necrotizing granulomata or bronchiolitis obliterans organizing pneumonia (BOOP). She was cured with combined therapy of specific anti-mycobacterial medications and systemic steroids. To our knowledge, this is the first report of M. kansasii non-tuberculous mycobacterium disease with a BOOP-like pattern on lung biopsy.

[The approach to chronic pain management in the elderly].

Chronic pain is a common, yet frequently overlooked and undertreated complaint among older patients. It may result in an impairment of the function and quality of life of these patients. Chronic pain is a syndrome, which influences and is influenced by many potential factors (physiological psychological and social), all of which require treatment to achieve an optimal clinical outcome. Effective management of chronic pain in this population is attainable, if properly recognized and treated. Reasons for inadequate pain control by clinicians include lack of training, inadequate pain assessment and reluctance to prescribe opiates. The approach to pain assessment and management is often different and more complex for older patients than for younger ones. In older people, a host of factors can impede assessment and drug management, including multiple medical problems and many potential sources of pain, sensory impairment, depression, disability and impaired cognitive function. In addition, pharmacokinetics and pharmacodynamics unique to the geriatric population make this group vulnerable to adverse medication effects. By using appropriate pharmacological combined with non-pharmacological treatment, it is often possible to improve function ability to a greater extent than the severity of pain reduced.

Fever of unknown origin in older adults.

Evaluation of elderly patients who have fever of unknown origin (FUO) requires a different perspective from that needed for young patients. Differential diagnosis often varies with age, and presentation of the disease frequently is nonspecific and symptoms difficult to interpret. Noninfectious diseases are the most frequent cause of FUO in the elderly and temporal arteritis the most frequent specific cause. Tuberculosis is the most common infectious disease associated with FUO in elderly patients. FUO often is associated with treatable conditions in the elderly. Therefore, intensive, accelerated evaluation is necessary, as the lack of physiologic reserve makes this population vulnerable to irreversible changes and functional deterioration.

Profile and prognosis of febrile elderly patients with bacteremic urinary tract infection.

OBJECTIVE: To describe the profile of elderly patients with bacteremic urinary tract infections (UTI) and correlate clinical and laboratory findings with the outcome in order to identify independent predictors of mortality. METHODS: This retrospective study took place in a large community-based, geriatric hospital and included 191 patients aged 75-105 years with urine and blood cultures simultaneously positive for bacterial organisms. Records were analysed for demographic information, clinical and laboratory data over a 29 month period. Mortality was assessed and was correlated with these findings. RESULTS: Most of the patients (80.1%) had community-acquired infection. Gram-negative organisms accounted for 87.6% of bacterial isolates, with Escherichia coli accounting for 46.1% of cases. Non-Escherichia coli Gram-negative organisms were highly resistant to two common urinary tract antibiotics (gentamicin and ceftriaxone). Patients with chronic urinary catheter had Gram-negative bacteria significantly less sensitive to ciprofloxacin, gentamycin, ampicillin and ceftriaxon than patients without catheter (p<0.05). In-hospital mortality was 33%. Multiple logistic regression analysis revealed that mortality was significantly related to the number of underlying diagnoses (p<0.0203), cognitive status (p<0.0003), length of hospitalization (p<0.0397), low level of serum albumin (p<0.0021), high neutrophil count (p<0.0001) and high level of lactate dehydrogenase (p<0.0351). Fatality was not associated with advanced age in the very old. CONCLUSION: Bacteremic UTI in the elderly has a high mortality rate. In frail elderly patients with age-associated multiple severe underlying disorders and cognitive impairment, early recognition of bacteremic UTI and prompt, appropriate treatment are critical in reducing the mortality.

A "fishy remedy": an unusual transmission of Vibrio vulnificus infection.

This case report describes a unique transmission of Vibrio vulnificus infection. A 38-year-old woman with recurrent cellulitis and chronic ulcer on her leg developed necrotizing cellulitis and sepsis caused by V. vulnificus. Meticulous history investigation revealed the link to contaminated fish blood that had been applied on the ulcer by a traditional healer. Through this case, it may be stressed that a traditional remedy can sometimes be harmful and life-threatening.

Risk factors for recurrence of Clostridium difficile-associated diarrhea in the elderly.

Risk factors that influence the recurrence of nosocomial Clostridium difficile-associated diarrhea (CDAD) were determined in an 18-month follow-up study in a subacute geriatric department. A case-control study was conducted, comparing 43 patients with recurrent C. difficile-associated diarrhea (RCDAD) (case patients) with 38 patients who had only 1 episode of CDAD (control patients). The mean age of patients was 81.6 +/- 7.2 y (range 64-95 y). All cases with CDAD were receiving antibiotic therapy. RCDAD occurred in 53.1% of patients. Risk factors for RCDAD included fecal incontinence (p < or = 0.04), longer duration of fever from admission until first episode of CDAD (p < or = 0.02) and H2-antagonist treatment (p < or = 0.02). This study shows that RCDAD is a common clinical event in elderly hospitalized patients and may be predictable in some groups of patients.