Anticoagulant therapy in elderly patients

The pathology of recent years is dominated by lung thromboembolism, the more worrying factor as the algorithms for prophylaxis and treatment of diseases with high embolic risk are properly applied in medical practice and perform only of 75% antithrombotic protection. The aim is to present the benefits and risks of anticoagulant treatment in elderly patients with cardiovascular disease. Anticoagulant treatment is at least as important as for the other age groups because elderly patients have combinations of cardiovascular diseases and comorbidity which have anticoagulant treatment indications. We performed a retrospective study on 781 patients over 65 years, admitted between January 1, 2009 and March 31, 2010 in Medical Clinic IV, Department of Geriatrics. Statistical study followed their distribution by age, average residence, gender, cardiovascular diseases, anti-coagulant treatment indication and methods of implementation. From 781 patients, 758 cases (97%) were hospitalized for cardiovascular disease of these, 545 (72%) received anticoagulant therapy, 152 (20%) received also antiplatelet and 61 (8%) did not receive any of these forms. Adverse effects of anticoagulation therapy were recorded at 1.5% of patients. All these patients were under chronic anticoagulation therapy with antivitamin К and required permanent or temporary interruption. Anticoagulant therapy in the elderly is under-utilized due to fear of unwanted side effects taking into consideration the problems of monitoring chronic treatment with К antivitamin at home

Pharmacoepidemiologic investigation in acute renal cholic in children

Acute renal colic is one of the most intense pains in pathology and represents a urologic and nephrologic emergency. This exploratory study was performed on 86 patients with a ages between 10 and more than 18 which completed a questionnaire consisting of some questions about intensity of acute renal colic measured with the visual analogue scale (range=0-10), associated symptoms and the drugs used to reduce pain. In summary this study shows that in most of the patients the pain semnificativelly affects the normal daily activities. Drug therapy plays an important role in pain management. Renal colic pain management consists especially in using spasmolytic drugs and their association with analgesics or anti-inflammatory drugs

Actual treatment of atrial fibrillation in the elderly

Atrial fibrillation (AFb) is a common arrhythmia in the elderly (17% of the cases) which can be precipitated by cardiac and non-cardiac factors. It can have characteristic symptoms (palpitations with rapid frequency) or it can borrow elements of low cardiac output syndrome (anginous pain, dyspnoea, fatigue, dizziness, syncope).The physical examination and ECG-cut the diagnosis. The goal of the treatment is the conversion to sinusal rhythm but the therapeutic decision should be made carefully in the elderly. The analysis of the therapeutic methods in patients aged> 65 years diagnosed with atrial fibrillation (AFb) regardless of its ethiology. We conducted a retrospective study on 704 patients (age> 65 years) hospitalized in the Geriatric Department of 4th Clinic of Internal MedicineNephrology Iasi between January 1- December 31 2009. The incidence of atrial fibrillation was followed in the study group, also the associated risk factors; trigger factors, indication of conversion to sinusal rhythm and response to the administration of anti-arrhythmic therapy. Out of 704 patients, 668 had cardiovascular damage (94%) and of these 224 patients had AFb (33.5%).From the group of patients with AFb, 156 were from rural areas, the majority being women (149 cases). The main risk factors incriminated were: hypertension (45%), dyslipidemia (38%), obesity (38%), and smoking (44%). Among the trigger factors are included: excessive physical effort and unexpected, intercurrent respiratory infections and ethanol consumption. From the types of AFb we note the predominance of fast AFb, followed by the recently installed AFb, paroxistical AFb and AFb with slow spontaneous frequency. In 54 cases was decided the chemical conversion in sinusal rhythm, with amiodarone in 44 cases (83%) and in 10 cases with Propafenone (17%). Sinusal rhythm was achieved in 48 of the 54 patients (88%). The attempt of conversion to sinusal rhythm was charged to all our patients regardless of age, but qualifying the standard criteria: normal sized cardiac cavity, EjF> 40%, no intracavitary thrombus, the AFb onset under 1 year. The conversion was carried out under protective anticoagulant therapy. The results were very good and the prevention of relapses was achieved with amiodarone, very well tolerated by patients

Specific features of clostridium difficile colitis in patients with inflammatory bowel disease

Through its specific biological, epidemiological, diagnostic and infection management features, Clostridium difficile infection (CDI) can be considered a major health concern, especially in inflammatory bowel disease (IBD) patients. In this particular infection, many IBD risk factors are triggered due to bowel inflammation, antibiotics use, microbiota changes, immunosuppressive therapy use and surgical intervention. Thus, each IBD and diarrhea patient must be tested for CDI. Clinical features show different initial infectious stages such as mild, fulminate and refractory. It has been shown that CDI presents recurrent episodes. CDI treatment consists of metronidazole, vancomycin or fidaxomicin, as well as prophylactic measures. It was recently shown that antibiotic doses must be gradually reduced in order to avoid CDI relapses. Fecal transplantation, effective in CDI management, remains controversial in CDI patients with concurrent IBD