1,721,025 research outputs found
Chronic gout in the elderly
No full textGout is the most common cause of inflammatory arthritis in men over 40 years old; it is a debilitating disease and, if untreated, can result in a chronic progressive disease, including tophaceous gout. In the elderly it represents a special issue, with notable clinical and therapeutic differences from the classical form with a systemic involvement. The burden of the disease increases particularly in the very old people, in whom arthritis, impaired gait and eyesight problems may enhance the related disability. Chronic gout moreover could aggravate heart and kidney disease and increase overall mortality and organ-related damage. Early diagnosis and appropriate treatment are important goals for the clinician that should to rely on the cooperation of specialists working together through the methodology of comprehensive geriatric assessment. The aim of the present review was to analyze chronic gout in old people in terms of epidemiology, pathophysiology, risk factors, clinical approach, and current treatmen
Tophaceous gout in the elderly: a clinical case review
No full textGout is the most common cause of arthritis in the elderly. Its incidence among older people has risen worldwide due to an increase in risk factors such as renal diseases, metabolic syndrome, and a diet rich in purines. In older age, tophaceous gout may affect different joints from its classical presentation, due to other concomitant musculoskeletal diseases, but specific data on its epidemiology and clinical aspects in the elderly are limited to a few case reports. The present review focuses on the distinctive aspects of tophaceous gout in the elderly, revisiting all our clinical cases seen from 1990 to December 2011. Our findings indicate that: tophaceous gout can affect several joints in the elderly, including some unusual sites; its incidence is similar in both genders in the elderly even if the latency period between its initial diagnosis and the onset of tophi is higher in men; and vertebral localizations are rising and often solitary. The components of metabolic syndrome are the most common medical conditions associated with tophaceous gout. In conclusion, tophaceous gout in the elderly may be a growing medical problem and cause of disability in years, partly because of the new sites involve
A rare case of sepsis due to Corynebacterium macginleyi from central venous catheter in an elderly woman
No full textCorynebacterium macginleyi is a gram positive rod that causes especially ocular infections: since now only six elderly cases of extraocular infection are described. A 76 years old bedridden woman with a central venous catheter was hospitalized for 10 days of persistent fever. She was treated before with vancomicin and then with imipenem. The clinical conditions improved and the patient was discharged after two weeks of hospitalization. Among recognised risk factors for this infection the advanced age, indwelling devices and immunosuppression seem the most important. On the other hand, the antibiotics of choice are glycopeptides while the association of another antibiotic is recommended in our opinion only in severe clinical manifestatio
A case of hypocalcemia
No full textHypocalcemia is a common disorder in the elderly,
affecting 10% of the elderly population as a whole, 18% of
those in hospital and 36% of those in long-term care [1, 2].
Many conditions can lead to hypocalcemia in adults young
and old, e.g. primary hypoparathyroidism, chronic renal
failure, gastrointestinal diseases (such as celiac disease or
Crohn’s disease), drugs (particularly diuretics, bisphosphonates
and antiepileptics), acute pancreatitis and thyroid
surgery. Rare causes of hypocalcemia include isolated
vitamin 1.25(OH)D3 deficiency or vitamin 1.25(OH)D3
resistance. Another, often neglected cause of hypocalcemia
relating to functional parathyroid deficiency is hypomagnesemia. Considering the important role of magnesium in a normal
health status, and the potentially serious consequences
of hypomagnesemia, clinicians need to identify and treat
this condition as soon as possible, thus avoiding serious
risks for the patient, particularly in the elderl
A case of naturally evolving gout in an elderly man
No full textGout is a common disorder in adults that can lead to severe organ decline, disability and impaired quality of life due to the formation of periarticular tophi. We report a case of massive tophaceous gout in a 78-year-old man with a 16-year-long history of untreated disease. The patient gradually became disabled, his renal function deteriorated, and he finally died of sepsis. Our case demonstrates that chronic gout not only affects the joints, but is also associated with organ function decline and can, even nowadays, lead to death
Gender differences in upper and lower limb strength response to 8 weeks of resistance training
No full textProphylactic or therapeutic doses of heparins for COVID-19 infection? A retrospective study
Full text linkBackground: Coronavirus disease 19 (COVID-19) is a global outbreak. COVID-19 patients seem to have relevant coagulative abnormalities, even if they are not typical of disseminated intravascular coagulopathy (DIC) of the kind seen in septicaemia. Therefore, anticoagulant therapy with heparins is increasing in interest for a clinical approach to these patients, particularly if older. Studies comparing if prophylactic doses are more effective than therapeutic ones are still missing. Methods: Data were collected in the Geriatric Section of the Dolo Hospital, ULSS 3 “Serenissima”, Venice from 31st March to 01st May 2020. Heparins (calciparin, fondaparinux, enoxaparine) were divided into prophylactic or therapeutic doses. People previously treated with oral anticoagulants were removed. Vital status was assessed using administrative data. Cox’s regression analysis, adjusted for potential confounders, was used for assessing the strength of the association between heparins and mortality. The data were reported as hazard ratio (HR) with 95% confidence intervals (CIs). Results: 81 older people (mean age 84.1 years; females = 61.9%) were included. No significant differences in terms of demographic and clinical characteristics emerged between people treated with prophylactic or therapeutic doses, including age, gender, X-rays findings or severity of disease. Therapeutic doses were not associated to a better survival rate (HR 1.06; 95% CI 0.47–2.60; p = 0.89), even after adjusting for 15 confounders related to mortality (HR 0.89; 95% CI 0.30–2.71; p = 0.84). Conclusions: Our paper indicates that in older people affected by COVID-19 there is no justification for using therapeutic doses instead of prophylactic ones, having a similar impact on mortality risk. © 2020, Springer Nature Switzerland AG
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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