Chylous Ascites due to Mantle Cell Lymphoma

Chylous ascites is rare and results in accumulation of lymph in the abdominal cavity, due to several mechanisms. The ascitic liquid is milky because of the high concentration of triglycerides (>200 mg/dl). The higher incidence compared to the past is explained by increased survival of patients with cancer and more aggressive surgery. We describe the case of an 87-year-old man admitted to the geriatric ward due to general oedema, chylous ascites and loss of weight, explained by mantle cell lymphoma

Anticoagulant-related nephropathy : systematic review and meta-analysis

Background. The aim of this study was to report the prevalence and mortality associated with anticoagulant-related nephropathy (ARN) through a systematic review of the literature. Methods. Electronic searches were conducted in the Medline and EMBASE databases, and manual searches were performed in the reference lists of the identified studies. The studies were selected by two independent researchers, first by evaluating the titles and abstracts and then by reading the complete texts of the identified studies. Case series, cross-sectional studies, cohort studies and case–control studies reporting the prevalence and factors associated with ARN were selected. The methodological quality was assessed using the Newcastle–Ottawa scale. Meta-analyses of the prevalence of ARN and 5-year mortality using the random effects model were performed when possible. Heterogeneity was assessed using the I 2 statistic. Results. Five studies were included. Prevalence of ARN ranged from 19% to 63% among the four included cohort studies. Meta-analysis of these resulted in high heterogeneity [I 2 96%, summary effect 31%; 95% confidence interval (CI) 22–42%]. Subgroup meta-analysis yielded an ARN prevalence of 20% among studies that included patients with fewer comorbidities (I 2 12%; 95% CI 19–22%). In a direct comparison, meta-analysis of the 5-year mortality rate between anticoagulated patients who had experienced ARN and anticoagulated patients without ARN, patients with ARN were 91% more likely to die (risk ratio ¼ 1.91; 95% CI 1.22–3; I 2 87%). Risk factors for ARN that were reported in the literature included initial excessive anticoagulation, chronic kidney disease, age, diabetes, hypertension, cardiovascular disease and heart failure. Conclusions. ARN studies are scarce and heterogeneous, and present significant methodological limitations. The high prevalence of ARN reported herein suggests that this entity is underdiagnosed in clinical practice. Mortality in patients with ARN seems to be high compared with patients without this condition in observational studies

2-Pyridyl thiazoles as novel anti-Trypanosoma cruzi agents: structural design, synthesis and pharmacological evaluation

The present work reports on the synthesis, anti-Trypanosoma cruzi activities and docking studies of a novel series of 2-(pyridin-2-yl)-1,3- thiazoles derived from 2-pyridine thiosemicarbazone. The majority of these compounds are potent cruzain inhibitors and showed excellent inhibition on the trypomastigote form of the parasite, and the resulting structure-activity relationships are discussed. Together, these data present a novel series of thiazolyl hydrazones with potential effects against Chagas disease and they could be important leads in continuing development against Chagas disease

O Doente Idoso no Serviço de Urgência

Aging is a problem affecting Emergency Medicine, requiring prepared staff for special needs of older patients. We intended to understand Colour Manchester Triage and length of stay (LOS) differences to younger patients and further orientation. We conducted a retrospective, observational study, with a randomized sample of 14% of total patients admitted during a month in an Emergency department (1252 in 8872 episodes), excluding children and obstetric patients. We collected demographic data, Manchester triage, medical speciality involved, length of stay and destination. Statistical analysis was performed in SPSS ® 23.0 using qui-square, Mann-Whitney and Kruskal- Wallis tests. In our sample, 53% were female, medium age was 53,9 years old (yo), and 32,4% were 65 yo or older. Median LOS in the Emergency Department (ED) was 215 minutes. Median LOS in geriatric patients were higher than younger population (271 vs 188 minutes) (p<0.001). Priority triage was higher in older patients (p<0.001). Manchester triage attributed most patients to General Practice (30.2%), followed by Internal Medicine (25.3%). However, in geriatric population most patients were observed by Internal Medicine while younger patients were observed by General Practice (p<0.001). Older patients were more frequently admitted into ward than younger patients (p<0.001). Older patients presents higher LOS in the ED, require more immediate attention and required to be admitted in hospital ward more often. With ageing population ED will require to be adapted to their special needsCom o envelhecimento da população, prevê-se mais idosos no Serviço de Urgência (SU). Neste estudo pretendemos avaliar o tempo de estadia do Idoso num SU Polivalente, a sua triagem e orientação. Realizamos um estudo retrospetivo, e selecionamos uma amostra aleatória simples correspondendo a 14% de todos os doentes admitidos durante um mês num SU Polivalente para adultos, sendo excluída a Urgência Obstétrica, correspondendo a 1252 dos 8872 episódios. Foram recolhidos dados demográficos, triagem de Manchester, especialidades envolvidas na avaliação do doente e a demora no SU. O tratamento estatístico foi elaborado usando SPSS® versão 23, usando os testes de Qui-quadrado e os testes não paramétricos de Mann-Whitney e Kruskal-Wallis. Nesta amostra, 53% dos doentes eram do sexo feminino, com idade média de 53.9 anos, sendo que 32.4% eram idosos (≥ 65 anos). A mediana da demora no SU foi 215 minutos. As especialidades que observaram o maior número de doentes pela primeira vez foi a Medicina Geral e Familiar (MGF) em 30.2%, seguida da Medicina Interna (25.3%). A mediana do tempo de estadia do idoso no SU foi superior ao grupo não idoso (271 vs 188 minutos) (p<0.001). A atribuição de prioridade de maior severidade foi superior nos idosos (p<0.001). Nos mais jovens, a especialidade mais atribuída pela triagem foi a MGF, nos idosos a especialidade era a Medicina Interna (p<0.001). Os doentes idosos apresentaram maior probabilidade de serem internados (p<0.001). Assim, no doente idoso verificou-se uma maior demora no SU, uma triagem mais prioritária e a necessidade de cuidados mais diferenciado

O Doente Idoso no Serviço de Urgência

Resumo: Com o envelhecimento da população, prevê-se mais idosos no Serviço de Urgência (SU). Neste estudo pretendemos avaliar o tempo de estadia do Idoso num SU Polivalente, a sua triagem e orientação. Realizamos um estudo retrospetivo, e selecionamos uma amostra aleatória simples correspondendo a 14% de todos os doentes admitidos durante um mês num SU Polivalente para adultos, sendo excluída a Urgência Obstétrica, correspondendo a 1252 dos 8872 episódios. Foram recolhidos dados demográficos, triagem de Manchester, especialidades envolvidas na avaliação do doente e a demora no SU. O tratamento estatístico foi elaborado usando SPSS® versão 23, usando os testes de Qui-quadrado e os testes não paramétricos de Mann-Whitney e Kruskal-Wallis. Nesta amostra, 53% dos doentes eram do sexo feminino, com idade média de 53.9 anos, sendo que 32.4% eram idosos (&#8805; 65 anos). A mediana da demora no SU foi 215 minutos. As especialidades que observaram o maior número de doentes pela primeira vez foi a Medicina Geral e Familiar (MGF) em 30.2%, seguida da Medicina Interna (25.3%). A mediana do tempo de estadia do idoso no SU foi superior ao grupo não idoso (271 vs 188 minutos) (p<0.001). A atribuição de prioridade de maior severidade foi superior nos idosos (p<0.001). Nos mais jovens, a especialidade mais atribuída pela triagem foi a MGF, nos idosos a especialidade era a Medicina Interna (p<0.001). Os doentes idosos apresentaram maior probabilidade de serem internados (p<0.001). Assim, no doente idoso verificou-se uma maior demora no SU, uma triagem mais prioritária e a necessidade de cuidados mais diferenciados. Abstract: Aging is a problem affecting Emergency Medicine, requiring prepared staff for special needs of older patients. We intended to understand Colour Manchester Triage and length of stay (LOS) differences to younger patients and further orientation. We conducted a retrospective, observational study, with a randomized sample of 14% of total patients admitted during a month in an Emergency department (1252 in 8872 episodes), excluding children and obstetric patients. We collected demographic data, Manchester triage, medical speciality involved, length of stay and destination. Statistical analysis was performed in SPSS ® 23.0 using qui-square, Mann-Whitney and Kruskal-Wallis tests. In our sample, 53% were female, medium age was 53,9 years old (yo), and 32,4% were 65 yo or older. Median LOS in the Emergency Department (ED) was 215 minutes. Median LOS in geriatric patients were higher than younger population (271 vs 188 minutes) (p<0.001). Priority triage was higher in older patients (p<0.001). Manchester triage attributed most patients to General Practice (30.2%), followed by Internal Medicine (25.3%). However, in geriatric population most patients were observed by Internal Medicine while younger patients were observed by General Practice (p<0.001). Older patients were more frequently admitted into ward than younger patients (p<0.001). Older patients presents higher LOS in the ED, require more immediate attention and required to be admitted in hospital ward more often. With ageing population ED will require to be adapted to their special needs

Casuística de uma unidade de Ortogeriatria

A fratura do fémur está associada a importante morbimortalidade, sendo que menos de metade dos doentes regressam ao seu nível prévio de autonomia. Uma abordagem multidisciplinar permite uma reabilitação funcional imediata, bem como melhor gestão de comorbilidades, prevenção de fraturas secundárias e das quedas. Objetivos: apresentação da casuística de 3 meses de uma unidade de Ortogeriatria. Material e métodos: Descreve-se a demografia dos doentes admitidos, grau de dependência funcional, comorbilidades, intercorrências, tempo de internamento, mortalidade e destino à data de alta. O ganho de funcionalidade no internamento foi também avaliado. Resultados: De outubro/2015 a janeiro/2016 foram admitidos 66 doentes após cirurgia de fratura proximal do fémur. Média de idades foi 82,94±6,93 anos; 86% eram mulheres. O tempo de internamento foi de 7,8±4,68 dias, sendo o tempo médio para realizar cirurgia de 3±3,37 dias. Quanto ao grau de funcionalidade prévio 47% eram Katz A; à admissão 85% tinham mRankin &#8804;3. Identificaram-se várias comorbilidades em 89% dos doentes; nas intercorrências, a mais frequente foi a anemia (53%). Houve um ganho na funcionalidade relativamente à admissão na unidade de 75,8% e em relação ao estado funcional anterior ao evento de 19,7%. Setenta e um porcento dos doentes tiveram alta para o domicílio; a taxa de mortalidade foi de 1,52%. Conclusões: A unidade demonstrou eficiência no controlo das comorbilidades, reduzidas complicações e baixa mortalidade. Registou-se um ganho funcional comparando com a admissão em 3 em cada 4 doentes e em relação ao estado basal prévio em 1 em cada 5 doentes

Casuística de uma unidade de Ortogeriatria

Hip fracture is associated with important morbimortality; less than half of the patients go back to the same functional degree. A multidisciplinary approach can enable immediate functional rehabilitation, better treatment of comorbidities and prevention of secondary fractures and falls. Objectives: to describe the casuistry of an Orthogeriatrics unit in a three month period. Methods: Description of demographic variables, previous degree of dependency, comorbidities, medical or surgical occurrences, mortality and destination at discharge. The functional gain was also evaluated. Results. From October/2015 through January/2016, 66 patients were admitted to the unit, after surgical correction of proximal hip fracture. The mean age at admission was 82,94±6,93 years; 86% were women. The mean length of stay in hospital was 7,8±4,68 days; in average the patients waited 3±3,37 days to surgery. Forty-seven percent of patients were Katz A on admission; 85% had mRankin scale ≤3. Various comorbidities were identified in 89% of patients; the most frequent medical occurrence was anemia (53%). There was a gain in function in 75,8% of patients considering the time of admission and in 19,7% of patients compared to the previous functional status. Seventy-one percent of patients were discharged home; the mortality rate was 1,52%. Discussion: The Orthogeriatrics unit was efficient in controlling comorbidities, and showed a low rate of complications and mortality. Three in every four patients showed functional improvement, comparing to time of admission and 1 in every five ptients comparin with previous functionA fratura do fémur está associada a importante morbimortalidade, sendo que menos de metade dos doentes regressam ao seu nível prévio de autonomia. Uma abordagem multidisciplinar permite uma reabilitação funcional imediata, bem como melhor gestão de comorbilidades, prevenção de fraturas secundárias e das quedas. Objetivos: apresentação da casuística de 3 meses de uma unidade de Ortogeriatria. Material e métodos: Descreve-se a demografia dos doentes admitidos, grau de dependência funcional, comorbilidades, intercorrências, tempo de internamento, mortalidade e destino à data de alta. O ganho de funcionalidade no internamento foi também avaliado. Resultados: De outubro/2015 a janeiro/2016 foram admitidos 66 doentes após cirurgia de fratura proximal do fémur. Média de idades foi 82,94±6,93 anos; 86% eram mulheres. O tempo de internamento foi de 7,8±4,697 dias, sendo o tempo médio para realizar cirurgia de 3±3,374 dias. Quanto ao grau de funcionalidade prévio 47% eram Katz A; à admissão 85% tinham mRankin ≤3. Identificaram-se várias comorbilidades em 89% dos doentes; nas intercorrências, a mais frequente foi a anemia (53%). Houve um ganho na funcionalidade relativamente à admissão na unidade de 75,8% e em relação ao estado funcional anterior ao evento de 19,7%. Setenta e um porcento dos doentes tiveram alta para o domicílio; a taxa de mortalidade foi de 1,52%. Conclusões: A unidade demonstrou eficiência no controlo das comorbilidades, reduzidas complicações e baixa mortalidade. Registou-se um ganho funcional comparando com a admissão em 3 em cada 4 doentes e em relação ao estado basal prévio em 1 em cada 5 doente

Impacto de los inhibidores de SGLT2 sobre la función renal en ancianos con diabetes tipo 2 durante el primer año de tratamiento

Objetivos: Evaluar el efecto de iSGLT2 sobre la tasa de filtración glomerular estimada (TFGe) y la albuminuria en ancianos durante el primer año de tratamiento. Métodos: Estudio coorte retrospectivo que incluyó a pacientes ancianos (>65 años) con diabetes tipo 2(DM2) tratados con iSGLT2. Los datos se recogieron al inicio del tratamiento, 3, 6, 9 y 12 meses después. Resultados: Se incluyeron 115 ancianos, 48,7% varones, edad media 72,4±5,2 años, mediana de HbA1c 8,4±1,7% y de duración de la DM2 de 17±12 años. Se inició dapagliflozina en 60,9% y empagliflozina en 39,1%. Se observó una TFGe de 30-60 ml/min/1,73m2 en 21,7%, con un aumento moderado de la albuminuria en 12,2% y un aumento grave de la albuminuria en 4,3%. Durante el primer año, hubo una reducción significativa de la HbA1c (-0,32%±1,6%; p<0,038). En la TFGe no se observaron diferencias significativas al inicio del tratamiento ni al año, sin embargo, se observó una reducción no significativa en el primer semestre, seguida de un aumento significativo (71,4-84,9ml/min/1,73m2; p<0,006) en el segundo semestre. La variación de la TFGe a lo largo del año no presentó diferencias significativas entre dapagliflozina y empagliflozina, aunque en el primer semestre la empagliflozina presentó una mayor variación (p=0,021). No se ha demostrado una reducción significativa de la albuminuria(p=0,074). Conclusiones: En nuestra muestra, iSGLT2 parece preservar los efectos glucémicos, sin empeorar la función renal en una población anciana durante el primer año de tratamiento. Portanto, parece mantenerse el efecto nefroprotector en mayores de 65 años en vida real

Anticoagulant-related nephropathy : systematic review and meta-analysis

Background. The aim of this study was to report the prevalence and mortality associated with anticoagulant-related nephropathy (ARN) through a systematic review of the literature. Methods. Electronic searches were conducted in the Medline and EMBASE databases, and manual searches were performed in the reference lists of the identified studies. The studies were selected by two independent researchers, first by evaluating the titles and abstracts and then by reading the complete texts of the identified studies. Case series, cross-sectional studies, cohort studies and case–control studies reporting the prevalence and factors associated with ARN were selected. The methodological quality was assessed using the Newcastle–Ottawa scale. Meta-analyses of the prevalence of ARN and 5-year mortality using the random effects model were performed when possible. Heterogeneity was assessed using the I 2 statistic. Results. Five studies were included. Prevalence of ARN ranged from 19% to 63% among the four included cohort studies. Meta-analysis of these resulted in high heterogeneity [I 2 96%, summary effect 31%; 95% confidence interval (CI) 22–42%]. Subgroup meta-analysis yielded an ARN prevalence of 20% among studies that included patients with fewer comorbidities (I 2 12%; 95% CI 19–22%). In a direct comparison, meta-analysis of the 5-year mortality rate between anticoagulated patients who had experienced ARN and anticoagulated patients without ARN, patients with ARN were 91% more likely to die (risk ratio ¼ 1.91; 95% CI 1.22–3; I 2 87%). Risk factors for ARN that were reported in the literature included initial excessive anticoagulation, chronic kidney disease, age, diabetes, hypertension, cardiovascular disease and heart failure. Conclusions. ARN studies are scarce and heterogeneous, and present significant methodological limitations. The high prevalence of ARN reported herein suggests that this entity is underdiagnosed in clinical practice. Mortality in patients with ARN seems to be high compared with patients without this condition in observational studies

The quadruple helix-based innovation model of reference sites for active and healthy ageing in Europe: The Ageing@Coimbra case study

Challenges posed by demographic changes and population aging are key priorities for the Horizon 2020 Program of the European Commission. Aligned with the vision of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA), the development, exchange, and large-scale adoption of innovative good practices is a key element of the responses required to ensure all European citizens remain as active and healthy as possible as they age. Urged by the need of developing scalable disruptive innovation across Europe, the European Commission and the EIP on AHA created the Reference Sites; local coalition of partners that develop good practices to support AHA. Ageing@Coimbra is an example of how this can be achieved at a regional level. The consortium comprises over 70 institutions that develop innovative practices to support AHA in Portugal. Ageing@Coimbra partners support a regional network of stakeholders that build a holistic ecosystem in health and social care, taking into consideration the specificities of the territories, living environments and cultural resources (2,243,934 inhabitants, 530,423 aged 65 or plus live in the Centre Region of Portugal). Good practices in reducing the burden of brain diseases that affect cognition and memory impairment in older people and tackling social isolation in urban and rural areas are among the top priorities of Ageing@Coimbra. Profiting from the collaborative work of academia, business companies, civil society, and authorities, the quadruple helix of Ageing@Coimbra supports: early diagnosis of frailty and disease; care and cure; and active, assisted, and independent living. This paper describes, as a Community Case Study, the creation of a Reference Site of the EIP on AHA, Ageing@Coimbra, and its impact in Portugal. This Reference Site can motivate other regions to develop innovative formulas to federate stakeholders and networks, building consortia at regional level. This growing movement, across Europe, is inspired by the quadruple helix concept and by the replication of innovative good practices; creating new Reference Sites for the benefit of Citizens