The case of a patient of 80 years old with epilepsy and neurocognitive disorders

Background. Epilepsy is a very widespread disease in the world. It is one of the most common neurological diseases of old age. However, older age is also associated with multi-morbidity and cognitive decline. This will result in a decrease or loss of the possibility of being independent of other people in the scope of basic everyday activities such as: moving, nutrition, sphincter control and maintaining personal hygiene. Disorders occurring in such a wide range in people with dementia often translate into disability in everyday life. Improving the quality of life of patients consists primarily in maintaining autonomy in self-service for as long as possible. Therefore, one of the most important elements of improving the quality of life of an elderly person is the early detection of neurocognitive disorders, rehabilitation of the patient and performing prescribed screening tests. Case report. A 80- year-old patient admitted to the Clinic of Geriatric in urgent matter due to dizziness and falls. Patient living with family, dependent in daily life, financially self-sustaining. Patient takes medicines from different groups due to multiple diseases. Patient's symptoms: dizziness and frequent falls. Because of the last complain, consulted in the department of emergency medicine, head tomography was conducted. The test showed no signs of fresh bleeding. The patient suffers from epilepsy. Patient has condition after treatment of subdural hematoma, in the state after heart attacks in 2001, 2003, 2004. In 2003 coronary angioplasty was performed. Patient is also suffering from hypertension, type 2 diabetes and chronic kidney disease. No use of drugs, alcohol and cigarettes. Result. The risk of functional limitations increases with the number of diseases present and is particularly large in people over 80 years of age. Multiple diseases is a serious problem in rehabilitation, therefore geriatric rehabilitation should be carried out on many levels. A comprehensive geriatric assessment helps diagnose the problem and develop a plan to improve the patient's quality of life. In addition, vitamin supplementation should be implemented in the elderly. Also medications used by the elderly and behavioral changes should be controlled. Patients should follow the recommendations of health care workers and attend both laboratory and neuropsychological monitoring tests

Challenges of modern medicine – a case study of a patient with ALS after age 60

Background. Amyotrophic lateral sclerosis is a degenerative disease of the nervous system, neurodegenerative cerebral cortex, pad and spinal cord due to damage to the upper and lower motor neurons, with progressive course, various symptoms with varying intensity and duration (from several months to even 10 years), extremely unfavorable prognosis. As an incurable and progressive disease, due to the deterioration of mobility it leads to complete stopping of muscles, including respiratory ones, with the intellectual ability of the patients fully preserved Case report. A 65-year-old patient was hospitalized in Geriatrics Clinic in University Hospital A. Jurasza in Bydgoszcz. Patient with shortness of breath, present paradoxical chest movement, impaired chest mobility, present whirring, wheezing during auscultation examination. The patient was admitted to the ward because of pneumonia. Amyotrophic lateral sclerosis, chronic respiratory failure, hypertension, and hyperthyroidism were diagnosed. In the medical history she had swallowing problems, abdominal pain, insufficient cough reflex, dysphagia, increased body temperature, difficulty falling asleep, depressed mood. The patient did not consent to a tracheotomy for aspiration of secretions from the respiratory tract. The patient required suctioning of excessively accumulating secretions in the mouth. The patient was patted. Patient's skin without pathological changes. During the night, the patient requires non-invasive mechanical ventilation - BIPAP respirator. Patient under the care of the Palliative Medicine Clinic. Patient fed an industrial diet (Isosource Protein) for PEG (percutaneous endoscopic gastrostomy) - self-service. Results. Although the disease is incurable, many of its symptoms can be alleviated, and the goal of therapy should be to improve the quality of life and maintain patient independence for as long as possible. SLA patients and their relatives often experience depression, feelings of despair and anxiety. Therefore, psychological help is recommended for patients and their relatives. The continuous development of medicine remains a hope for this disease. There is a need to continue research into the search for an effective cure for amyotrophic lateral sclerosis

Case report of a patient with acute renal failure and cardiovascular disease after 65 years of age

Introduction. Acute kidney injury (AKI) is a clinical syndrome with high mortality. It is a clinical syndrome consisting in rapid impairment of kidney function. The result is retention of metabolic products in the body and the inability to maintain normal water-electrolyte and acid-base homeostasis. Chronic heart failure is a significant clinical, economic and social problem, and despite the continuous development of medicine, the incidence of this disease is still increasing. A weakened inefficient heart is not able to supply the organs with the right amount of blood, oxygen and nutrients. The effect is fast fatigue, weakness of muscle strength and dizziness. Kidney and cardiovascular diseases affect each other and increase their course, which worsens the patient's condition. Periodic monitoring of renal function in patients with cardiovascular disease is very important because it has been proven that the occurrence of kidney disease in these patients increases the risk of death. Case report. Patient, 78 years old, hospitalized many times in the Geriatrics Clinic, Cardiology Clinic, Nephrology Clinic due to shortness of breath, chronic myocardial insufficiency, edema of the lower limbs. The degree of independence is limited, the patient walks with assistance, lives with a family / significant other. Main ailments of the patient: increasing swelling of the lower limbs, left foot pain, nausea, vomiting, palpitations, effortlessness and rest dyspnea without stenocardial complaints. Comorbidities: Type 2 insulin-dependent diabetes mellitus (with unspecified complications), obesity, generalized atherosclerosis, hypertension, chronic NYHA type II heart failure. Cardiac defect in the form of mitral and tricuspid regurgitation, pulmonary hypertension, paroxysmal atrial fibrillation, myocardial infarction. The patient was qualified for hemodialysis treatment, then returned to conservative treatment, followed a strict diet. The applied treatment improved the general condition of the patient and was discharged from the hospital in a stable general condition. Results. Frequent and regular examination of a patient's condition with cardiac-renal syndrome, disease progression and ability to tolerate treatment can be helpful in treating and prolonging the patient's life. It is important to monitor kidney function in people with cardiovascular disease

The case of myelodysplastic syndrome after 65 years old

Background. The etiology of MDS syndromes (myelodysplastic syndromes) is unknown. MDS is a disease of the elderly, mostly affects people over 50 years of age. Elderly patients with MDS are diagnosed at an earlier stage of the disease compared to younger people. Therapeutic options in MDS include treatment with high-dose chemotherapy with / without hematopoietic stem cell transplantation, treatment with low-dose chemotherapy, supportive care and symptomatic treatment. Transfusion of RBC (Red Blood Cells) concentrate and platelet concentrate is used in the majority of patients with MDS and it is the only form of therapy recommended for both patients with good and bad prognosis. Case report. A 77-year-old patient repeatedly hospitalized in the Clinic of Geriatrics for symptomatic anemia in myelodysplastic syndrome. Independent patient in the field of self-care, living alone. Patient take many medicines from different groups. Patient with multidisease. Symptoms of the patient: weakness, depressed mood, reduced tolerance of physical exercise, dizziness, palpitations associated with slight physical effort, symptoms of gastrointestinal bleeding, stenocardial complaints in 2017. A bone marrow biopsy was performed - in the myelogram MDS was diagnosed with features of low-grade triplicate dysplasia. Patient repeatedly hospitalized for transfusion of Irradiated Leukocyte-Depleted RBC Concentrate (since the beginning of 2018 11 times - average 1 x / month). From October 2012 to November 2018, a total of 49 Irradiated Leukocyte-Depleted RBC Concentrates units were transfused, reducing only the symptoms of the disease. Results. A careful assessment of the functional status, ability to tolerate treatment, disease progression and overall health can be helpful in determining treatment. To improve access to treatment, emphasis should be placed on oral drug therapies that can be easily administered on an outpatient basis to minimize transfusion. Palliative care and environmental care are important aspects of improving the health and quality of life of MDS patients

Assessment of knowledge about body postural defects among parents

Introduction: Postural defects became in recent decades significant problem, both medical and social. Many examinations show that faulty posture affect about 60-80 per cent of children. The rapid development of technology has led to limiting of physical activity which manifests itself by massive occurrence of faulty posture. Therefore it is extremely important to increase the parents knowledge and awareness of the prevention and correction of faulty posture as well as benefit from physical activity. Aim: The aim of the present study was estimation parents knowledge about faulty posture and verification who knows more – parents who have children with correct posture or these who have children with postural defects as well as parents who encourage children to exercise or these who don’t do this. Materials and methods: A survey was conducted in a group of 60 parents. First group: 30 parents of children attending The Postural Defect Clinic, second group: 30 parents of children attending School Complex No. 8 in Bydgoszcz. The original questionnaire was used for the study. Questionnaire to the estimation of parents knowledge consisted of 19 questions: metric questions and knowledge test. The results were analyzed statistically (p<0,05). Results: Parents who enroll children for extra sports are more knowledgeable than parents who do not. Parents whose children have postural problems have no higher knowledge than parents whose children have a correct posture. Parents with higher education have more knowledge about posture defects. Conclusion: Parents knowledge on the prevention and correction of faulty posture is sufficient (mean: 56 per cent correct answers). Nowadays, knowledge should be at a higher level by looking at the frequency of postural defects

Usefulness of the Polish versions of the Montreal Cognitive Assessment 7.2 and the Mini-Mental State Examination as screening instruments for the detection of mild neurocognitive disorder

Introduction. Screening tests are a key step in the diagnosis of dementia and should therefore be highly sensitive to the detection of mild neurocognitive disorders (NCD). The Mini Mental State Examination (MMSE) is the most commonly used screening method. The Montreal Cognitive Assessment (MoCA) is a newer and less well-known screening tool, which has none of the limitations of the MMSE.Aim. The aim of this study was to analyse the reliability of the Polish versions of MoCA 7.2 vs MMSE in the detection of mild NCD among people aged over 60.Material and methods. The study was carried out at the Department and Clinic of Geriatrics from September 2014 to March 2017. The study included 281 participants, 91 of whom were assigned to the group without NCD. The other 190 had been diagnosed with mild NCD.Results. In the analysis of the ROC curve of the MoCA 7.2 results, the AUC was 0.925 (p &lt; 0.001). The optimal cut-off point for mild NCD was 23/24 points, with sensitivity and specificity of 83.2% and 79.1%. In the ROC curve of MMSE results, the AUC was 0.847 (p &lt; 0.001). The optimal cut-off point for mild NCD was 27/28 points, with sensitivity and specificity of 75.8% and 66.7%. The difference between AUC MoCA 7.2 and MMSE was 0.078 (p = 0.036).Conclusions. MoCA 7.2 detects mild NCD with more sensitivity than MMSE. We recommend using the cut-off point for MoCA of 23/24 points, because this is characterised by a higher sensitivity than the previously recommended cut-off point of 25/26 points. For the MMSE, the recommended cut-off point should be 27/28, which gives greater diagnostic accuracy than the previously recommended 25/26 points