Outcome of elderly patients admitted in a polyvalent intensive care unit

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serological hallmark of this disease is a highly disease-specific auto-antibody, antimitochondrial antibody. The diagnosis of primary biliarycirrhosis should be suspected in the setting of chronic cholestasis afterexclusion of other causes of liver diseases. The authors present the caseof a 85-year-old woman, who was referred to the Internal MedicineOutpatient Department for study of an elevation on the alkalinephosphatase, gamma-glutamyltransferase and a slight elevation ofaminotransferases found on two routine laboratory evaluations. Shereferred fatigue and pruritus, which exacerbated at night, and had adaughter with Hashimoto's thyroiditis. The physical examination wasnormal. Further evaluation revealed positive anti-mitochondrial AMA,anti-nuclear antibodies ANA, anti-Sp100 and anti-PML as well asincreased levels of immunoglobulin M. Noninvasive imaging study ofthe liver and biliary tree was normal. The patient refused to do a liverbiopsy. She was given UDCA in a dose of 15 mg/kg/day and wasreevaluated after six months with an improvement of the liverbiochemical tests and pruritus. In this case we review the associationof positive anti-Sp100 with older age and its primary biliary cirrhosisspecificity and the frequent coexistence of anti-Sp100 and anti-PML inprimary biliary cirrhosis patients.

doi:10.1016/j.ejim.2013.08.642

ID: 569The use of NSAIDS in internal medicine — Between benefitsand safetyF. Marc, D.M. Farcas, D. Petrisor, C. Moldovan, O. Burta

Internal Medicine, Municipal Hospital, Faculty of Medicine and Pharmacy,Oradea, Romania

Introduction: NSAIDS are largely used in patients with differentdiseases, but as people grow old, they havemultiple co-morbidities andthus the side-effects occur more frequently. Objective: to assess thepresence of the NSAID side-effects (nonselective and COX-2 selective)in patients admitted in an internal medicine department.Material andmethod: Our study consisted in a prospective study in patientsadmitted in the Department of internal medicine during 2012. Thepatients were chronic users of NSAIDS and we evaluated if thesymptoms at admission or during hospitalization were caused byNSAIDS.We also compared the side effects of nonselective and selectiveNSAIDS. Results:During 2012, from a total of 2123 of patients admittedin our department, 376 (213 women and 163 men) had symptomsconsidered to be NSAID side-effects. The gastrointestinal side-effectswere: antral erosive-erythemathous gastritis (63%), duodenal ulcers(24%), and gastric ulcers (13%)— allHelicobacter pylori negative. Amongduodenal ulcers, 45% had the first manifestation, hematemesis. After weruled out the other causes of liver injury (hepatocytolysis and/orcholestasis),we found toxic NSAIDS-induced hepatitis in 5% of all causesof hepatitis. The cardiovascular side-effects have been: edema (33%),hypertension (37%), worsening of heart failure (18%), andworsening ofischemic heart disease (12%). Nonselective NSAIDSwere responsible for77% of gastrointestinal side-effects and the other 23% were caused byCOX-2 selective. Reversibly, nonselective drugs generated 45% of thecardiovascular side-effects while COX 2 produced 55% of them. Thesymptoms were aggravated if patients used NSAIDS and Aspirin,NSAIDS and Methotrexate or 2 different NSAIDS. Conclusions: TheNSAIDS are more and more used in clinical practice in patients withmultiple comorbidities. Careful monitoring is required especially for oldpeople. Nonselective NSAIDS produce predominantly GI symptoms,while COX-2 selective drugs generate predominantly CV symptoms.

doi:10.1016/j.ejim.2013.08.643

ID: 572Outcome of elderly patients admitted in a polyvalentintensive care unitP. Ferreiraa, H. Costab, D. Faria e Maiab, A. Magrob, M. Henriquesb,A. Langnerb, M. Rochaa, C. PaivaaaInternal Medicine, Divino Espírito Santo Hospital, Ponta Delgada,Azores, PortugalbIntensive Medicine, Divino Espírito Santo Hospital, Ponta Delgada,Azores, Portugal

There are clinical and ethical dilemmas, and economical problemswith regard to the admission of very elderly patients in Intensive CareUnits. The weighting of the their prognosis based on age, their co-morbidities and severity of current illness is essential to the decision ofadmission to highly differentiated care. Objective: The authorsintended with this retrospective study to identify and characterizepatients admitted to an Intensive Care Unit (ICU) over the age of 65,with regard to their pathologies, degree of dependence prior toadmission, severity scores (SAPS II, APACHE II) at 24 h admission,mortality, morbidity and outcome at 6-month.Methods:We studied allpatients admitted between July 2011 and June 2012 (1 year) aged over65 years, with a total of 157 cases. Results: Of these 59.2% are men and40.8% are women, with an average age of 73 and 76 years, respectively.The average time of hospitalization was 8 days. The most commonpathologies were: arterial hypertension (55.5%), diabetes mellitus(37.8%) and heart failure (29.5%). The majority of patient correspondedto 4–7 points of Charlson comorbidity index. 41.7% were admitted inICU for respiratory insufficiency needing mechanical ventilation.Infectious complications occurred at 62.8% of patients during ICU stay.The overall mortality rate stood at 13.4% during the stay in the unit and28% in men and 22% in women in the six months after discharge. 36patients (23%) were older than 80 years. Of these, 6 patients (16.7%)died in ICU and 21 (70%) died within 6 months after discharge, whichmean that 86.7% of elderly patients died in 6months.Mortality adjustedfor severity indexes and morbidity/dependency after discharge werealso studied. Conclusion/discussion: Althoughmortality was very highin very elderly patients, the clinical judgment, with discussion amongprofessionals involved, should prevail in the decision to accept thesepatients in the ICU, taking into account a forecast of acceptable qualityof life and cost-efficiency of care, respecting the limits of life.

doi:10.1016/j.ejim.2013.08.644

ID: 583Descriptive profile from interconsultation cases from generalsurgery service (GSS) target to internal medicine (IM)S. Romero, G. Ruiz, M. Escobar, R. Aranda, F. Gomez

Intern Medicine, Hospital Universitario de Puerto Real, Puerto Real, Cádiz,Spain

Objective: Identify patient profile hospitalized in the GSS whowereinvolved on interconsultation target to IMduringfivemonths, aswell astheir nature and main reason for consultation. Methods: Descriptiveretrospective chart study from interconsultation cases, target to IMfrom GSS during five months. Review from interconsultation databasethe IM Clinic Management Unit. Studied variables: number ofinterconsultation cases, basic patient profile, and nature and reasonfor consultation.Results: 29 inter consultation caseswere included. Agewas between 60 and 90 (14 men/15 women). Nature: ordinary 18(62.07%), 6 preferential (20.69%) and urgent 5 (17.24%). Reason forconsultation: therapeutic tackle 6 (20.69%), dyspnea and patienttransference 4 (13.79%) respectively, sepsis 3 (10.35%), HTN and CVA2 (6.89%) respectively. Miscellany: diagnosis, discomfort, diarrhea,

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