Nodular mucinosis in Graves disease mimicking gouty tophi.

We report a patient who had Graves disease and recently developed subcutaneous nodules over both lower limbs. Initially, gouty tophi were suspected by the endocrinologist so he was referred to the rheumatology clinic. However, a series of studies, including soft tissue ultrasonography, magnetic resonance image, and biopsy revealed nodular mucinosis resulting from Graves dermopathy. Nodular mucinosis is an unusual form of myxedema which mimics tophaceous gout, and should be considered in patients with Graves disease presenting with subcutaneous nodules.

Predictors of functional recovery (FR) for elderly hospitalized patients in a geriatric evaluation and management unit (GEMU) in Taiwan.

Elderly patients who are hospitalized with acute illnesses frequently have adverse outcomes. To maintain functional independence, the geriatric evaluation and management unit (GEMU) was established to provide the opportunity for functional recovery (FR). This study's aim was to investigate potential prognostic factors for functional improvement in a GEMU of Taichung Veterans General Hospital, Taiwan. A total of 117 elderly patients (age, 80.0+/-6.3 years, 84.6% males) were enrolled. A comprehensive geriatric assessment and functional status evaluation, including the functional reach test (FRT) and the timed up-and-go (TUG) test, were performed. FR was defined by a greater than 10% improvement in the Barthel Index (BI) before GEMU discharge. Lower BI (44.7+/-25.2 vs. 68.7+/-34.5, p < 0.001), lower instrumental activities of daily living (IADL) scores (1.8+/-1.5 vs. 3.5+/-2.6, p < 0.001), impaired FRT (83.3% vs. 63.5%, p = 0.028), and impaired TUG test (94.4% vs. 74.6%, p = 0.008) were predictive factors for functional improvement. On multivariate logistic regression, an impaired TUG test (Odds ratio = OR = 6.18, 95% confidence interval = 95% C.I. = 1.69-22.6, p = 0.006) was an independent variable associated with FR. The results indicate that elderly hospitalized patients, even with poor physical function, could benefit from geriatric integrated care delivered by a GEMU.

First-ever ischemic stroke in Taiwanese elderly patients: predicting functional independence after a 6-month follow-up.

The incidence of ischemic stroke increases with age, and it has a great impact on patients' functional independence. The aim of this study was to analyze the clinical features, laboratory findings, and stroke subtypes in different age subgroups and identify the predictive factors for functional independence 6 months after stroke. A total of 533 patients with first-ever ischemic stroke were enrolled in this study. They were divided into two subgroups: more than 80 years old (n = 108) and less than 80 years old (n = 425). Patients aged 80 years or over had higher frequencies of heart disease and atrial fibrillation, and lower frequencies of dyslipidemia, alcohol drinking, and a family history of ischemic stroke. Significantly lower body mass index, serum albumin levels, and lipid profiles, including total cholesterol, low-density lipoprotein, and triglyceride levels, but higher severity of initial neurologic deficit, and higher rates of mortality and complications during hospitalization were noted in patients aged over 80 years. The multivariate logistic regression analysis showed that higher serum total cholesterol level, less severity of neurologic deficit at admission, and absence of a history of diabetes mellitus were predictive of functional independence 6 months after stroke.

Geriatric syndromes in elderly patients with rheumatoid arthritis.

OBJECTIVE: Geriatric syndromes (GSs), i.e. cognitive impairment, depression, fall, incontinence and malnutrition, are extensively used to highlight the unique features of common health problems in the frail elderly. Although GS is common in older RA patients, it is rarely reported earlier. We evaluate the prevalence of GS in elderly RA patients and explore the interrelationship between GS and RA. METHODS: All enrolled RA patients were categorized into elderly RA (aged > or =65 years) and younger RA (aged <65 years). A comprehensive geriatric assessment was done to determine the presence of GS. HAQ score and disease activity of RA, including 28-joint disease activity score (DAS28), were assessed. RESULTS: In total, 65 elderly and 25 younger RA patients were enrolled. The prevalence of GS in the elderly participants, especially cognitive impairment and fall, was significantly higher than that in the young. Older RA patients were more physically dependent than the young. Compared with subjects without GS, older RA patients with GS had longer disease duration, higher DAS28 scores, lower haemoglobin levels and more physical dependence. By using binary logistic regression, we found that a higher DAS28 score and a lower haemoglobin level were independent risk factors for GS. CONCLUSIONS: The prevalence of GS was higher in the elderly RA patients than that in the young. A higher DAS28 score and a lower haemoglobin level were independent risk factors for GS in older RA patients. Further study is needed to evaluate the prognostic role of GS.

A hospital-based screening study of latex allergy and latex sensitization among medical workers in Taiwan.

BACKGROUND AND PURPOSE: Natural rubber latex is the most important occupational allergen among medical workers, and remains a significant occupational health issue in Taiwan. We conducted this large-scale hospital-based screening study to understand the incidence of latex allergy and latex sensitization among medical workers in Taiwan over the past 5 years. METHODS: 1253 medical workers were enrolled in this study. Subjects were interviewed using a screening questionnaire. Skin prick testing with commercial latex extract was performed for 1139 of the subjects. RESULTS: 152 subjects (12%) had positive latex skin prick test, suggesting that they had been sensitized to latex proteins. Seventy nine subjects (6%) had immediate allergic reactions to latex products. The prevalence of contact hand dermatitis from latex gloves was 35%. The intensive care unit and medical laboratory department accounted for the highest prevalence of allergy among all hospital departments. Most subjects developed immediate latex allergy by 9000 h of total latex exposure. The prevalence of positive latex skin prick test increased with increasing duration of latex exposure. CONCLUSIONS: Latex allergy continues to be an important occupational allergy among medical workers in Taiwan. The addition of a routine screening examination in medical employees' health check-ups will help in the early identification of sensitized cases and facilitate preventive strategies.