Diagnosis In Elderly Patients Research Articles

Epidemiological aspects, clinical management and short-term outcomes in elderly patients diagnosed with acute heart failure in the emergency department in Spain: results of the EDEN-34 study

ObjectiveTo estimate the incidence of acute heart failure (AHF) diagnosis in elderly patients in emergency departments (ED), diagnostic confirmation in hospitalized patients, and short-term adverse events. MethodsAll patients aged ≥65 years attended in 52 Spanish EDs during 1 week were included and those diagnosed with AHF were selected. In hospitalized patients, those diagnosed with AHF at discharge were collected. As adverse events, in-hospital and 30-day mortality, and combined adverse event (death or hospitalization) at 30 days post-discharge were collected. Adjusted odds ratios (OR) for association of demographic variables, baseline status and constants at ED arrival with mortality and 30-day post-discharge adverse event were calculated. ResultsWe included 1,155 patients with AHF (annual incidence: 26.5 per 1000 inhabitants ≥65 years, 95% CI: 25.0–28.1). In 86% the diagnosis of AHF was known at discharge. Overall 30-day mortality was 10.7% and in-hospital mortality was 7.9%, and the combined event in 15.6%. In-hospital and 30-day mortality was associated with arterial hypotension (adjusted OR: 74.0, 95% CI: 5.39–1015. and 42.6, 3.74–485, respectively and hypoxemia (2.14, 1.27–3.61; and 1.87, 1.19–2.93) on arrival at the ED and requiring assistance with ambulation (2.24, 1.04–4.83; and 2.48, 1.27–4.86) and age (per 10-year increment; 1.54, 1.04–2.29; and 1.60, 1.13–2.28). The combined post-discharge adverse event was not associated with any characteristic. ConclusionsAHF is a frequent diagnosis in elderly patients consulting in the ED. The functional impairment, age, hypotension and hypoxemia are the factors most associated with mortality.

Aspectos epidemiológicos y de manejo clínico relativos a las neumonías diagnosticadas en urgencias en pacientes mayores en España: resultados del estudio EDEN-29

ObjectivesTo estimate the incidence of pneumonia diagnosis in elderly patients in Spanish emergency departments (ED), need for hospitalization, adverse events and predictive capacity of biomarkers commonly used in the ED. MethodsPatients ≥65 years with pneumonia seen in 52 Spanish EDs were included. We recorded in-hospital and 30-day mortality as adverse events, as well as intensive care unit (ICU) admission among hospitalized patients. Association of 10 predefined variables with adverse events was calculated and expressed as odds ratio (OR) with 95% confidence interval (CI), as well as predictive capacity of 5 commonly used biomarkers in the ED (leukocytes, hemoglobin, C-reactive protein, glucose, creatinine) was investigated using area under the receiver operating characteristic curve (AUC-ROC). Results591 patients with pneumonia attended in the ED were included (annual incidence of 18.4 per 1,000 inhabitants). A total of 78% were hospitalized. Overall, 30-day mortality was 14.2% and in-hospital mortality was 12.9%. Functional dependency was associated with both events (OR=4.453, 95%CI=2.361-8.400; and OR=3.497, 95%CI=1.578- 7.750, respectively) as well as severe comorbidity (2.344, 1.363-4.030, and 2.463, 1.252-4.846, respectively). Admission to the ICU during hospitalization occurred in 3.5%, with no associated factors. The predictive capacity of biomarkers was only moderate for creatinine for ICU admission (AUC-ROC=0.702, 95%CI=0.536-0.869) and for leukocytes for post-discharge adverse event (0.669, 0.540-0.798). ConclusionsPneumonia is a frequent diagnosis in elderly patients consulting in the ED. Their functional dependence and comorbidity is the most frequent factor associated with adverse events. The biomarkers analyzed do not have a good predictive ability to predict adverse events.

Perforated jejunal diverticulitis a rare cause of acute abdomen type of article: case report

Jejunal diverticulosis are false diverticula which is characterized by herniation of mucosa and submucosa through muscular layer of bowel; their perforation is rare but potentially a life-threatening condition that can present as peritonitis. In this case report, a 75-year lady presented to the emergency department with complaints of generalized pain in the abdomen with multiple episodes of vomiting and signs of peritonitis. Radiological evaluation, X-ray of abdomen suggestive of pneumoperitoneum, raising suspicion of a bowel perforation. The patient was immediately resuscitated and promptly managed by surgical intervention. Intraoperatively, multiple jejunal diverticular perforations identified and managed by resection and anastomosis of affected jejunal segment. This case report outscores presentation, early diagnosis and surgical intervention in such rare and challenging cases for better outcomes. The purpose of this case report is to highlight the clinical presentation, diagnostic work up, surgical intervention and postoperative outcomes in jejunal diverticular perforation as a differential diagnosis in elderly patient with acute abdominal pain and to discuss the current management strategies based on the latest research findings.

Eczema and its treatment in older adults

Eczema encompass awide range of dermatoses that can affect elderly patients in particular. Common differential diagnoses in elderly patients include asteatotic eczema, late-onset atopic dermatitis, allergic contact dermatitis, early phases of mycosis fungoides, eczematous and pruriginous variants of premonitory bullous pemphigoid, as well as eczematized scabies and post-scabietic eczema. Given the partly overlapping clinical presentations, accurate diagnosis plays acrucial role in the management of these conditions. Therapeutic options depend on the underlying disease and necessitate an individualized approach. This review presents relevant types of eczema in older adults together with diagnostic and therapeutic approaches. In addition to confirming the diagnosis and selecting the appropriate treatment, aspects relevant to the care of older patients should be incorporated into the tailored therapeutic approach.

Wrist-worn arrhythmia monitoring devices are well accepted for long-term rhythm assessment by the elderly

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): This study was funded by PulseOn Oy. Background Wearable devices such as patch ECG monitors and wrist-worn intermittent ECG devices have recently emerged to fill the gap between Holter monitors and implantable loop recorders in diagnosing paroxysmal cardiac arrhythmias. Unlike patch ECG, wrist-worn devices require active participation of the patient, for example, for taking the ECG recordings. The incidence of cardiac arrhythmias increases with age, so it is important that the devices are easy enough to use also for older people. Purpose We evaluated the usability of a wrist-worn arrhythmia monitoring device among elderly. The device is exclusively targeted for health care providers to be handed out to patients for planned monitoring period instead of being targeted directly to consumers. Another purpose was to obtain feedback on the comfortability of wearing the device and possible skin irritation caused by continuous wearing. Methods We recruited 200 subjects of at least 65 years of age (average 71, range 65-92) with no previous atrial fibrillation diagnosis through a newspaper advertisement. The subjects came for a visit in a local cardiac clinic where they received a short introduction for using the wrist device. The monitoring period was defined as two weeks. The participants were instructed to take four scheduled ECG measurements daily and every time they had arrhythmia symptoms or if the continuous photoplethysmography-based rhythm monitoring of the device detected irregular rhythm and notified the user. The subjects had to recharge the device once during the monitoring period using the accompanied charging dock. The subjects were instructed to keep a diary on the device usage. The subjects also filled a feedback questionnaire regarding device usability at the end of the monitoring period. Results On a scale of 1 to 5, the overall easiness of using the device obtained an average score of 4.4 (standard deviation 0.7), the easiness of taking the ECG recordings 4.7 (std 0.6), and the easiness of device charging 4.8 (std 0.6). All except one study subject were capable of using the device in the correct way for the whole monitoring period. Average score for the device causing skin irritation was 1.6 (std 1.0) when score 1 was considered ‘no irritation’. However, one subject had to stop using the device prematurely due to skin irritation. Three of the previously undiagnosed subjects had paroxysmal AF episode during the monitoring period and another eleven subjects had other atrial tachycardia events. Conclusion Based on the obtained feedback, the studied wrist-worn arrhythmia monitor was found easy to use and was well received by the study participants. The studied wrist-worn monitoring device seems thus suitable for arrhythmia diagnosis in elderly patients. A wearable device, being immediately available at the wrist for taking ECG measurements, additionally provides the benefit of being able to record also short-lasting atrial tachycardia episodes.

Alternative skeletal muscle index for sarcopenia diagnosis in elderly patients with type 2 diabetes mellitus: A pilot study.

To determine an alternative skeletal muscle index (a-SMI), easy diagnosis of sarcopenia in elderly patients with type 2 diabetes mellitus (T2DM). This cross-sectional study included 223 inpatients with T2DM (100 males, age range 60-89; 123 females, age range 60-87). Screening for grip strength and gait speed, measuring SMI by dual-energy X-ray absorptiometry (d-SMI) for sarcopenia diagnosis, according to the Asian Working Group for Sarcopenia (AWGS) 2019 consensus. The a-SMI was established by binary logistic regression analysis with positive screening population. To assess the conformance of the new diagnostic approach with the AWGS 2019. Sarcopenia was present in 36.3% of the study population. 59 had normal d-SMI and 81 had low d-SMI in screening patients with probable sarcopenia. In univariate analyses for all positive screening population, body mass index (BMI), 25-hydroxyvitamin D (25 - (OH) VitD), high density lipoprotein cholesterol (HDL-C), hypertension (HTN), and gender were correlates of d-SMI. Binary logistic regression analysis revealed that male (B = 2.463, 95%CI: 3.640 ~ 37.883, p = 0.000), HTN (B = 1.404, 95%CI: 1.599 ~ 10.371, p = 0.003), BMI (B = -0.344, 95%CI: 0.598 ~ 0.839, p = 0.000), 25-(OH) VitD (B = -0.058, 95%CI: 0.907 ~ 0.982, p = 0.004) were independent factors for d-SMI detection. Based on the extracted four correlates, the a-SMI was determined. The area under receiver operating characteristic (ROC) curve was 0.842, sensitivity and specificity for the new diagnostic approach were 84.0% and 84.5%. In a statistical measure of agreement between the AWGS 2019 and the new diagnostic approach, the kappa coefficient was 0.669 (p < 0.001). The a-SMI - based on gender, obesity status, 25-(OH) VitD, and HTN history - can be used in the absence of the d-SMI to supplement the algorithm for sarcopenia diagnosis in elderly patients with T2DM.

Diverse limbic comorbidities cause limbic and temporal atrophy in lewy body disease

BackgroundIn contrast to Alzheimer's disease (AD)-related pathology, the influence of comorbid limbic-predominant age-related TDP-43 encephalopathy neuropathological change (LATE-NC) or argyrophilic grains (AG) on structural imaging in Lewy body disease (LBD) has seldom been evaluated. ObjectiveThis study aimed to investigate whether non-AD limbic comorbidities, including LATE-NC and AG, cause cortical atrophy in LBD. MethodsSeventeen patients with pathologically confirmed LBD with lower Braak neurofibrillary tangle stage (<IV) and 10 healthy controls (HC) were included. Based on the presence of comorbid LATE-NC or AG, LBD patients were subdivided into nine patients with these proteinopathies (mixed LBD [mLBD]) and eight without (pure LBD [pLBD]). In addition to clinical feature evaluation, gray matter atrophy on voxel-based morphometry was compared between the two LBD and HC groups. ResultsThe mean age at antemortem magnetic resonance imaging of the mLBD patients was higher than that of the pLBD patients (84.3 ± 3.9 vs. 76.5 ± 10.5; p = .046). Irrespective of the presence or absence of comorbid LATE-NC or AG, all patients were clinically diagnosed with probable dementia with Lewy bodies or Parkinson's disease with dementia, respectively. Compared to the pLBD group, the mLBD group showed more conspicuous cortical atrophy of the bilateral hippocampus, amygdala, and temporal pole. ConclusionsNon-AD limbic comorbidities, including LATE-NC and AG, are associated with limbic and temporal atrophy in older patients with LBD. Therefore, the possibility of non-AD limbic comorbidities should be considered in the diagnosis of elderly patients with dementia with clinical symptoms of LBD and medial temporal atrophy.

Cholesterol granuloma in the choroid plexus of a cat

BackgroundThis case report describes the clinical presentation, magnetic resonance imaging (MRI) as well as the histopathological findings in an elderly cat with an intracranial cholesterol granuloma.Case presentationAn 11.5-year-old, male neutered cat was presented at the emergency service with deteriorating behavioral changes including aggression, and progressive generalized ataxia. Magnetic resonance imaging (MRI) of the brain revealed a large, well demarcated, inhomogeneous and contrast enhancing mass in the lateral ventricles with marked mass effect. Due to a poor clinical prognosis, the cat was euthanized. Histological examination identified the mass as a bilateral cholesterol granuloma in the choroid plexus of the lateral ventricles.ConclusionsAlthough plexus cholesterol granulomas are rarely seen in cats, they should be considered as a differential diagnosis in elderly patients with neurological signs such as behavioral changes.

An unusual case of subacute small bowel obstruction - Gallstone ileus.

Introduction and importanceGallstone ileus is caused by an impaction of one or more gallstones within the gastrointestinal tract, leading to mechanical intestinal obstruction. It is a rare complication of cholelithiasis leading to the formation of a cholecystoenteric fistula and is associated with high mortality rates. We report a case of atypical subacute small bowel obstruction due to gallstone ileus.Presentation of caseAn 82-year-old man, with previously diagnosed cholelithiasis, presented with abdominal pain and vomiting for nine days. The contracted gallbladder with distended bowel loops was visualized on abdominal ultrasound. Computed tomography of the abdomen and pelvis revealed dilated loops of the small intestine with a gallstone in the proximal ileum, causing intestinal obstruction with pneumobilia, suggesting gallstone ileus with cholecystoduodenal fistula. The patient underwent an emergency laparotomy and enterolithotomy to remove the impacting gallstone. The cholecystoduodenal fistula was left undisturbed due to the significant risk of duodenal injury. The patient had an uneventful postoperative recovery.ConclusionGallstone ileus almost always requires surgical management. However, performing an interval biliary surgery is based on the clinical judgment of the surgeon. In our case, the patient's clinical status determined the treatment in which an enterotomy with stone extraction alone was largely sufficient, and has supported the literature. Gallstone ileus is an important differential diagnosis in elderly patients with gallstone disease, untreated or undiagnosed, presenting with features of small bowel obstruction.

The optimal oral body temperature cutoff and other factors predictive of sepsis diagnosis in elderly patients.

INTRODUCTION:The aim of this study was to identify the optimal oral temperature cut-off value and other factors predictive of sepsis in elderly patients presenting to emergency department.METHODS:A hospital-based retrospective study was performed on all elderly patients who presented to the Adult Emergency Department at King Abdulaziz Medical City in Riyadh (January to December 31, 2018).RESULTS:Of total of 13,856 patients, 2170 (15.7%) were diagnosed with sepsis. The associated area under the curve estimate was 0.73, 95% confidence interval (CI) 0.72–0.74. Body temperature ≥37.3 was found as optimal cut-point with sensitivity = 50.97% and specificity = 87.22% and 82.39% of patients with sepsis will be correctly classified using this cut-off. An increase of 1° in body temperature was associated with an odds ratio of 9.95 (95% CI 8.95–11.06, P < 0.0001). Those aged ≥100 years having 11.12 (95% CI 2.29–20.88, P < 0.0001) times the likelihood for sepsis diagnosis compared with those aged 60–69 years. People admitted in weather such as winter, spring, or autumn were more likely to develop sepsis than people admitted in summer.CONCLUSION:The risk factors of sepsis such as age, temperature, and seasonal variation inform important evidence-based decisions. The hospitals dealing with sepsis patients should assess older patients for other severe illnesses or co-morbid that might lead to sepsis if left untreated. Therefore, older patients need to be prioritized over younger patients. The body temperature of patients admitted to hospitals needs to be monitored critically and it is important to consider seasonal fluctuations while managing cases of sepsis and allocating resources. Our findings suggest that clinicians should explore the possibility of sepsis in elderly patients admitted to emergency units with oral temperature ≥37.3°C. Risk factors for sepsis reported in this study could inform evidence-based decisions.

Immune thrombocytopenia in the elderly: immunosenescent and clinical diversity.

Immune thrombocytopenia in the elderly: immunosenescent and clinical diversity.

Deep-Learning-Based Color Doppler Ultrasound Image Feature in the Diagnosis of Elderly Patients with Chronic Heart Failure Complicated with Sarcopenia.

The neural network algorithm of deep learning was applied to optimize and improve color Doppler ultrasound images, which was used for the research on elderly patients with chronic heart failure (CHF) complicated with sarcopenia, so as to analyze the effect of the deep-learning-based color Doppler ultrasound image on the diagnosis of CHF. 259 patients were selected randomly in this study, who were admitted to hospital from October 2017 to March 2020 and were diagnosed with sarcopenia. Then, all of them underwent cardiac ultrasound examination and were divided into two groups according to whether deep learning technology was used for image processing or not. A group of routine unprocessed images was set as the control group, and the images processed by deep learning were set as the experimental group. The results of color Doppler images before and after processing were analyzed and compared; that is, the processed images of the experimental group were clearer and had higher resolution than the unprocessed images of the control group, with the peak signal-to-noise ratio (PSNR) = 20 and structural similarity index measure (SSIM) = 0.09; the similarity between the final diagnosis results and the examination results of the experimental group (93.5%) was higher than that of the control group (87.0%), and the comparison was statistically significant (P < 0.05); among all the patients diagnosed with sarcopenia, 88.9% were also eventually diagnosed with CHF and only a small part of them were diagnosed with other diseases, with statistical significance (P < 0.05). In conclusion, deep learning technology had certain application value in processing color Doppler ultrasound images. Although there was no obvious difference between the color Doppler ultrasound images before and after processing, they could all make a better diagnosis. Moreover, the research results showed the correlation between CHF and sarcopenia.

Percutaneous Kyphoplasty Guided by CT Images Based on SEPB Algorithm in the Treatment of Elderly Osteoporotic Thoracolumbar Vertebral Compression Fractures

The paper uses the SEPB algorithm to explore the value of X-ray and CT diagnosis in elderly patients with osteoporotic lumbar compressive fractures, while observing percutaneous kyphoplasty (PKP) in the treatment of elderly osteoporotic compression fractures with clinical efficacy. 38 elderly patients with fractured osteoporotic compression fractures who came to our hospital for treatment were included. All patients were diagnosed by X-ray and CT, the clinical data of all patients were analyzed, the imaging findings related to X-ray and CT diagnosis were clarified, and the diagnostic coincidence rate was analyzed. At the same time, PKP treatment was applied for clinical efficacy and Imaging analysis. And, follow-up was conducted for 2 months after operation. The results showed that compared with the X-ray diagnosis, the accuracy of CT diagnosis was 88.89% (32/38), and the difference between the groups was significant ( P &lt; 0.05 ). 35 cases of low back pain disappeared after operation, and 3 cases of pain were significantly reduced without bone cement leakage. Postoperative imaging examination showed no space occupied in the spinal canal, and kyphosis deformity was significantly improved. The average height of the anterior vertebral column after injury was significantly increased ( P &lt; 0.05 ). The Cobb angle returned to normal level, which was statistically significant compared with that before the operation ( P &lt; 0.05 ). In conclusion, in the diagnosis of elderly patients with osteoporotic lumbar compression fractures, the coincidence rate of CT diagnosis is better than that of X-ray diagnosis. Therefore, the application rate of CT diagnostic methods in diagnosis is higher, which provides an effective basis for clinical diagnosis and treatment. PKP surgery is less invasive, safe, and has good clinical efficacy. It can quickly relieve pain and effectively restore the height of injured vertebrae. It is an ideal treatment method for elderly osteoporotic thoracolumbar vertebral compression fractures.

Yoğun bakımda yatan yaşlı hastada sepsis seyrinde gelişen hemofagositik sendrom ve DRESS sendromu birlikteliği

Sepsis is one of the leading causes of mortality in intensive care units. Its mortality increases, &#x0D; especially with the high number of comorbidities and immunosuppression. Hemophagocytic syndrome &#x0D; is an uncontrolled cytokine storm that develops in the course of increased inflammatory conditions &#x0D; such as sepsis. The clinical picture is very wide; because of nonspecific symptoms. For this reason; to &#x0D; diagnose hemophagocytic syndrome, it must be kept in mind. Mortality in hemophagocytic syndrome &#x0D; is especially high in intensive care patients. Drug reaction with eosinophilia and systemic symptoms &#x0D; syndrome is a rare, infrequent drug reaction. The clinical picture is heterogeneous and symptoms may &#x0D; be prolonged despite discontinuation of the drug. Overlap of different diagnoses in elderly patients; In &#x0D; the presence of multiple drug use and chronic diseases, clinical management is difficult and early &#x0D; initiation of effective treatment can be delayed. In this case report; a 66-year-old male patient who &#x0D; underwent nephrostomy due to bilateral hydronephrosis and who developed sepsis and HPS in the &#x0D; follow-up after hospitalization with high fever and complicated with drug reaction with eosinophilia and &#x0D; systemic symptoms syndrome during treatment is presented.

Differential diagnosis of acute traumatic hip pain in the elderly

Elderly patients who present with an inability to weight bear following a fall, with normal radiographs, should be appropriately investigated to rule out an occult hip fracture (OHF). We aim to identify both the range and incidence of the differential diagnosis of acute traumatic hip pain in a large series of patients investigated for OHF. A retrospective analysis of consecutive patients investigated for an OHF with magnetic resonance imaging (MRI) was performed. Dedicated musculo- skeletal radiologists reported the MRI scans. All diagnoses including hip fractures, other fractures and soft tissue injuries were recorded. Case notes were reviewed for all patients to identify subsequent complications, management and outcomes. A total of 157 patients fulfilled the inclusion criteria. 52 (33%) patients had a fracture of the proximal femur. The majority of patients with proximal femoral fractures required surgical intervention. 9 patients who had fractures of the greater trochanter of the femur without fracture extension across the femoral neck were managed non-operatively. 40 (25%) patients had fractures of the pelvis, with a combined pubic rami and sacral fracture occurring frequently. The most common diagnosis was a soft tissue injury alone that was seen in 60 (38%) patients imaged. Injuries to the gluteal muscle group, iliopsaos complex and trochanteric bursa were most prevalent. All patients with soft tissue injuries or fractures of the pelvis were successfully managed non-operatively. This study highlights a wide range of differential diagnoses in elderly patients presenting with acute traumatic hip pain. The proximal femur was fractured in 33% of patients imaged for OHFs in our series. The most common diagnosis was a soft tissue injury around the hip and pelvis ; these injuries can be successfully managed without surgery.

Statin-induced toxic rhabdomyolysis with hepatocellular jaundice in the elderly

Adverse drug reactions (ADRs) are a common cause of hospitalization, increased morbidity and mortality in the elderly. ADRs are difficult to diagnose in the elderly as they often present with nonspecific symptoms such as fatigue, falls, cognitive decline, and constipation. Statins are generally well-tolerated drugs used in the secondary prevention of coronary artery disease. We report a 75-year-old lady who developed jaundice and became bedbound due to statin-induced hepatitis and acute rhabdomyolysis causing proximal myopathy following initiation of atorvastatin 40 mg for the management of coronary artery disease. She had rapid clinical improvement with discontinuation of statin therapy and supportive management. ADR must be considered a part of differential diagnosis in elderly patients during the evaluation of illnesses. In the elderly initiated on statins, it is essential to differentiate benign muscle pain from severe muscle injury with biochemical abnormalities. Prompt discontinuation of statins will lead to rapid improvement and prevent further worsening.

An unusual case of type II spontaneous gallbladder perforation presenting as a right iliac fossa mass.

Spontaneous gallbladder perforation (GBP) is a very rare clinical condition which is mostly associated with calculous cholecystitis. Neoplastic growths at ampulla of Vater usually present with progressive symptoms and are rarely associated with GBP. Type II GBP presents as a localized collection and abscess formation at the site of the perforation, but unusual presentation can be found. Definitive diagnosis in elderly patients presenting with a mass in the right iliac fossa (RIF) region could be quite difficult due to the wide range of potential pathologies of the different anatomical organs present there. Here we discuss an unusual presentation of GBP secondary to periampullary growth presenting as a RIF mass. An 84-year-old female presented with a history of right side lower abdominal pain and fullness for a period of about a month. She also complained of dyspeptic symptoms for roughly the same duration. She underwent contrast enhanced computed tomography (CECT) of the abdomen as an initial investigation which revealed a collection in the RIF region from GBP, and a periampullary growth causing complete obstruction of the biliary tract. Ultrasound guided drainage of RIF collection followed by Endoscopic Retrograde Cholangio-Pancreaticogrphy (ERCP) and stenting of the common bile duct (CBD) was arranged as palliative treatment, since patient was unfit for major therapeutic intervention, i.e. pancreatico-duodenectomy. This case illustrates the importance of cross-sectional imaging in the evaluation of patients with RIF masses, especially when they are not in the typical age for appendicular masses, and also highlights the variety of unusual pathologies that could possibly give rise to such mass lesions.

S2290 Venous and Arterial Thromboembolism: Unusual Harbinger of Ulcerative Colitis in a 64-Year-Old

INTRODUCTION: Arterial and venous thromboembolic events are known extraintestinal manifestations of inflammatory bowel disease (IBD). Since elderly patients with IBD require tailored treatment strategies, establishing the initial diagnosis and assessing the etiology of future symptoms are critical. We present a 64-year-old male who underwent left iliofemoral vein and artery thrombectomy for phlegmasia with subsequent diagnosis of severe active ulcerative colitis. CASE DESCRIPTION/METHODS: A 64-year-old otherwise healthy white male presented with a 3-month history of abdominal pain, hematochezia, 20 lb unintentional weight loss, and left lower extremity pain. He quit smoking one year prior to presentation and denied family history of IBD or colon cancer. Vital signs were stable and physical exam revealed left leg swelling and tenderness, cyanosis of the left great toe, and positive fecal occult blood test. Labs showed mild normocytic anemia and elevated fecal calprotectin. The abdominal CT showed thrombosis of the left femoral vein, right sided subsegmental pulmonary embolus, distal abdominal aorta mural thrombus, and left iliac artery occlusion (Figure 1). Anticoagulation was not initiated given concerns for lower gastrointestinal bleed. An Inferior Vena Cava filter was placed the following day with stenting of the left common and external iliac arteries, and thrombectomy of the left common femoral, superficial femoral, and external iliac veins. A colonoscopy showed severe inflammation from the rectum to the descending colon (Figure 2). Colonic biopsies showed active chronic colitis with cryptitis and crypt abscesses consistent with ulcerative colitis (UC). Patient was started on steroids, discharged on hospital day 5, and readmitted 5 days later for right leg pain. The Doppler ultrasound showed an occlusive acute Deep Vein Thrombosis (DVT) of the right posterior-tibial vein, nonocclusive DVT of the right common femoral, superficial femoral, and popliteal veins, and occlusion of right proximal superficial femoral artery. He was started on heparin drip, switched to apixaban on hospital day 5, and discharged on hospital day 8. DISCUSSION: The risk of venous thromboembolism is quite high in elderly adults with UC. The literature suggests that thrombosis and hypercoagulability are features of IBD involved in the occurrence of thromboembolic events. Therefore, it is imperative to consider IBD as a differential diagnosis in elderly patients presenting with unprovoked thromboembolism and gastrointestinal bleeding.Figure 1.: Mural thrombus of the distal abdominal aorta and high-grade left iliac artery occlusion.Figure 2.: Colitis up to the descending colon.

Bilateral sakroileiti taklit eden multiple yetmezlik kırığı

The aim of this case report was to represent a case with multiple insufficiency fractures detected in an elderly female patient who was referred to our clinic for the differential diagnosis of bilateral sacroiliitis. A 71-year-old female patient was admitted to our outpatient clinic with the complaint of low back pain and also pain in her both hips and groin. On assessment of her musculoskeletal system, she had limited range of motion for low back and also had bilateral painful hip rotations. Bilateral Faber, Mennel and sacroiliac compression tests were positive. In her laboratory examination, 25-hydroxy-Dvit level was 3 ng/ml and parathormone level was 70 pg/ml. In consistent with physical examination pelvic radiograph revealed bilateral subchondral sclerosis in the sacroiliac joint, narrowing in the coxafemoral joint space, irregularity in symphisis pubis. Sacroiliac magnetic resonance imaging showed diffuse hypointense signal on T1-weighted images and hyperintense signal change on STIR images in the periarticular surfaces of bilateral sacroiliac joints and also fracture lines were detected on T1-weighted images. Subsequently, multiple insufficiency fracture lines were detected on the anterior face of the sacrum, bilateral iliac bones and the pubic ramus on the sacroiliac computed tomography. The patient was diagnosed with multiple insufficiency fractures due to vitamin D deficiency. Vitamin D was replaced and conservative treatment was planned. In conclusion, insufficiency fractures should be considered in differential diagnosis in elderly patients who present with low back pain and who have joint changes that may mimic sacroiliitis in imaging.

Validation of encephalapp stroop for minimal hepatic encephalopathy diagnosis in elderly patients with cirrhosis: a multi-center study

Validation of encephalapp stroop for minimal hepatic encephalopathy diagnosis in elderly patients with cirrhosis: a multi-center study