Asymptomatic Elderly Woman Research Articles

The data and the reality: urine cultures and emergency medicine physicians.

The IDSA has published guidelines for the treatment of urinary tract infections, recommending limiting treatment to symptomatic patients and pregnant females. Our objective is to elucidate current practice patterns among emergency physicians (EPs) in treating positive urine cultures in various clinical situations. This study employed a cross-sectional design utilizing a questionnaire addressing nine common scenarios encountered by EPs in the follow-up of a positive urine culture. The questionnaire was conducted using RedCap and distributed via email to current and former physicians and residents across our hospital network. Demographic information included years of training and practice setting. For each of nine clinical scenarios, Physicians were asked if they would treat with antibiotics. Results were then analyzed by tabulating percentage of responses and 95% confidence intervals. Of 120 respondents, 40.8% worked in academic centers with emergency medicine residencies, 37.5% in large community hospitals, and 20.67% in small community hospitals. Responses came from 14 residents, 33 attendings < 5years out of training, 23 attendings 5-9years out of training, 37 attendings 10-20years out of training, and 13 attendings > 20 beyond training. Asymptomatic young women were treated by 34.2% (95% CI 25.91-43.46%) while asymptomatic elderly women were treated by 50% (95% CI 40.79-59.21%) of EPs. All EPs (95% CI 96.13-100%) chose to treat a symptomatic male and 99.2% (95% CI 94.77-99.96%) chose to treat an asymptomatic pregnant female. Elderly females after a fall were treated by 63.3% (95% CI 54-71.8%) of EPs while elderly males with confusion and a fall were treated by 96.7% (95% CI 91.18-98.93%). Asymptomatic males with a chronic Foley catheter were treated by 28.2% (95% CI 20.67-37.4%) of EPs and 46.7% (95%CI 37.59-55.97%) would treat an asymptomatic middle-aged female with diabetes. Finally, 92.5% (95% CI 85.85-96.3%) of EPs chose to treat an asymptomatic kidney transplant patient. EPs in varied training stages and practice settings have significant practice variation in the treatment of positive urine cultures, particularly in the geriatric population, often prescribing antibiotics to patients where clear, specific and data-driven IDSA guidelines suggest treatment is unnecessary and potentially harmful.

Relationship between high sodium and low PUFA intake and carotid atherosclerosis in elderly women.

Several biologically active molecules including nutrients can affect the vascular endothelium which becomes dysfunctional and, as a consequence, predisposes to atherosclerosis. However, the impact of the intake of sodium and polyunsaturated fatty acids on carotid atherosclerosis in a population of elderly women has scarcely been studied. Our aim was to investigate the association between carotid intima-media thickness and atherosclerotic plaque and nutrient intake in asymptomatic elderly women. Carotid atherosclerosis was determined by duplex ultrasound in 108 elderly women. Dietary intake was assessed by a combination of a 24-hour recall and a 7-day food record. A physical examination and laboratory tests were performed. We found an association between the C-IMT and polyunsaturated fatty acid (negative, B = -0.014; p = 0.03; CI -0.027/-0.001) and sodium (positive, r = 0.16; P = 0.09) intake. When linoleic acid was added to the multivariable regression analysis instead of polyunsaturated fatty acids, C-IMT was associated with linoleic acid (B = -0.017; p = 0.02; CI -0.032/-0.003). In normotensive women we found a positive association between the C-IMT and sodium intake. The atherosclerotic plaque prevalence increased with the increase in sodium intake (66% vs 90% Tertile I vs Tertile III; p = 0.02). Iin conclusion, A low salt diet to a level of about 1.5 g/d and a polyunsaturated fatty acid intake of >9 g/d were found to be associate with a low atherosclerotic plaque prevalence in an elderly female population. Sodium and polyunsaturated fatty acids-mediated functional changes of the carotid endothelium may be implicated in atherosclerosis development.

Vitreous asteroid hyalosis prolapse into the anterior chamber simulating iris metastasis

Two asymptomatic elderly women who underwent cataract extraction 7 or more years previously and with intraocular lens placement presented with a linear bead-like white multinodular mass in the inferior angle simulating iris metastasis versus large inflammatory precipitates. There was no iris infiltration. In the first case, the posterior lens capsule was intact and there was no evidence of gelatinous vitreous in the anterior chamber, whereas in the second case, the capsule was open and there was gelatinous vitreous prolapse. In both cases, there was asteroid hyalosis in the vitreous. Both patients were diagnosed with prolapsed vitreous asteroid hyalosis into the anterior chamber and managed with observation. Vitreous asteroid hyalosis can prolapse into the anterior chamber of pseudophakic elderly patients with or without capsular opening and can simulate an intraocular tumor.

Myocardial perfusion defects and coronary risk factors in symptomatic and asymptomatic elderly women

We investigated the relation between risk factors of coronary artery disease (CAD) and myocardial ischemia detected by (201)Tl SPECT in elderly women. 306 women aged >or=75 yr (79.1 +/- 3.6 yr) who underwent pharmacologic (201)Tl SPECT for suspected CAD based on symptoms or CAD risk factors were included. Coronary risk factors were evaluated by medical records, and included diabetes mellitus (DM), hypertension, hypercholesterolemia, cigarette smoking, greater age (>or=80 yr), and obesity. Summed stress score (SSS), summed rest score (SRS), and summed difference score (SDS) were calculated based on stress and redistribution SPECT images for semi-quantification. The symptomatic group (n = 110) had a 34.5% perfusion defect rate. The asymptomatic group (n = 196) had a significantly lower perfusion defect rate of 16.8%. However, this significantly increased to 29.4% and 22.0% in the presence of diabetes mellitus (DM) and hypertension, respectively. In addition, the summed stress score of asymptomatic patients (12.4 +/- 6.0) was not lower but comparable to that of symptomatic patients (10.0 +/- 6.0). In elderly women suspected of CAD, pharmacologic perfusion imaging can be used to identify myocardial ischemia in patients with angina as well as asymptomatic subjects with concurrent DM or hypertension.

Vaginal hyperpigmentation due to ochronosis

Background Ochronosis is a manifestation of alkaptonuria, a rare metabolic disorder. It results in the accumulation of pigment in connective tissues. After several years, ochronosis may produce a distinctive form of degenerative arthritis. Case Vaginal ochronosis was diagnosed in an asymptomatic elderly woman with vaginal hyperpigmentation and severe degenerative arthritis. Conclusion Vaginal hyperpigmentation is a rare clinical finding that necessitates biopsy.

El «síndrome» de obstrucción medioventricular con aneurisma apical en la miocardiopatía hipertrófica: presentación de un caso

We report an 81-year-old woman with hypertrophic cardiomyopathy, midventricular obstruction and associated apical aneurysm partially dyskinetic. At admission she showed a lateral acute myocardial infarction with sustained episodes of uniform ventricular tachycardia and subtle cardiac physical findings. Old apical infarction was suggested by resting thallium defects in the absence of obstructive coronary disease. The ECG revealed persistent ST elevation in the anteroapical leads without Q waves at discharge. This case report represents a rare example, in a previously asymptomatic elderly woman, of a distinct syndrome within the wide clinical spectrum of hypertrophic cardiomyopathy.

Clinical Pearls: Large Pulmonary Arteries in an Asymptomatic Elderly Woman

Clinical Pearls: Large Pulmonary Arteries in an Asymptomatic Elderly Woman

Ophthalmoscopic and Cardiac Abnormalities in an Asymptomatic Elderly Woman

Ophthalmoscopic and Cardiac Abnormalities in an Asymptomatic Elderly Woman

An echocardiographic assessment of asymptomatic elderly women with radiological cardiac enlargement

To determine the significance of increased cardiothoracic ratio in elderly women without hypertension, symptoms or signs of cardiac disease, echocardiographic measurements from 22 elderly women (mean age 75.1 ± 3.9 years) with increased cardiothoracic ratio (mean ratio 0.59 ± 0.04), were compared with those from 21 women (mean age 75.3 ± 5.6 years) with normal cardiothoracic ratio using M-mode, cross-sectional and Doppler echocardiography. Subjects with increased cardiothoracic ratio had greater left ventricular end diastolic dimension and volume, and greater right ventricular diastolic dimension ( P < 0.05). There was no difference in all other cardiac dimensions, nor in the ejection fraction and fractional shortening. Thirty-three to sixty-four percent of subjects in both groups had increased thickness of the septum and left ventricular posterior wall. Regurgitation at one or more valves on Doppler examination occurred in 91% of subjects with abnormal and 86% of subjects with normal cardiothoracic ratio. Compared to a group of 43 healthy young female subjects (mean age 27.9 ± 6.3 years), elderly subjects had thicker interventricular septum and left ventricular posterior wall, increased left atrial and aortic root size, greater mitral valve A:E ratio, and higher frequency of valvular regurgitation detected by Doppler. The ejection fractions in elderly and young subjects, however, were similar. It is concluded that, in the majority of cases, increased cardiothoracic ratio in asymptomatic normotensive elderly women with normal physical examination and electrocardiogram is unlikely to represent cardiac pathology. Age-related differences in echocardiographic measurements observed in this study are in agreement with other studies, and emphasizes the importance of using age-related reference ranges in assessing cardiac dimension and function in the elderly.

Multiple Pulmonary Nodules in an Asymptomatic Elderly Woman

1985;87;823-824 Chest David W. Kamp and Richard Kern Elderly Woman Multiple Pulmonary Nodules in an Asymptomatic http://chestjournal.chestpubs.org/content/87/6/823.citation can be found online on the World Wide Web at: The online version of this article, along with updated information and services ) ISSN:0012-3692 http://chestjournal.chestpubs.org/site/misc/reprints.xhtml ( without the prior written permission of the copyright holder. reserved. No part of this article or PDF may be reproduced or distributed Chest Physicians, 3300 Dundee Road, Northbrook, IL 60062. All rights of been published monthly since 1935. Copyright1985by the American College is the official journal of the American College of Chest Physicians. It has Chest