Diagnostic approach of pneumonia in an elderly patient with comorbidities--case report.

Dyspnea is one of the symptoms that has a major impact on patients' health, with a negative influence on the quality of life. The main causes of dyspnea are cardiac, pulmonary and mixed (cardiac or pulmonary). There are several other causes such as metabolic conditions (acidosis), pain, neuromuscular disorders, otorhinolaryngeal disorders, anxiety, panic disorders and hyperventilation. Acute pneumonia in the elderly is a common occurrence and its incidence grows as the elderly population increases. We report the case of a 76 years old patient with a known cardiovascular condition, recently hospitalized for right pulmonary infarction. He presented to our clinic for influenced general state, rest dyspnea, fever, shiver, and productive cough in the last two days. Current medication included oral anticoagulants and triple antihypertensive treatment (responsible for his low blood pressure). Laboratory results showed a nonspecific inflammatory syndrome with leukocytosis and neutrophilia and mild normochromic normocytic anemia; D-dimers were within normal range, fibrin degradation products 1+; myocardial enzyme testing showed no alteration, and BPN (beta natriuretic peptide) was 790 pg/ml. Chest X-ray showed diffuse bilateral reticular shadows (more pronounced on the right side) and left costodiafragmatic opacification. It appears that age-related increase in morbidity and mortality in community-acquired pneumonia is not due to age per se, but to interactions between the immune system, systemic diseases and nutritional factors. Community-acquired pneumonia in the elderly is known to have a high mortality. Although the diagnosis can be easy, the physician must also investigate for less obvious causes of dyspnea such as the presence of comorbidities and fragility of the elderly patient.

[Toxic cause febrile neutropenia]. / Neutropenia febrila de cauza toxica.

Agranulocytosis is an acute disease with severe leucopenia, especially with low neutrophils, elements with an essential role in the organism's defense. It is more frequent at adult age (between 30 to 70 years of age) especially in women. We present the case of a 84 years old patient that, following passive exposure to pesticides, develops a severe neutropenia with a fast response to the administration of Methylprednisolone and granulocyte colony-stimulating factor (G-CSF-Filgrastim 48MIU/0.8mL/day, for three days). The diagnostic certainty was set by the bone marrow puncture which excluded a possible aleukemic acute leukemia or a myelodysplastic syndrome.

Self-neglect in the case of the elderly. Where are we now?

UNLABELLED: Self-neglect in an elderly person is a behavior that threatens his/her own health and safety. It is present when a person refuses to adequately feed, water, shelter, or clothe himself, refuses medication or medical care, and personal safety measures. MATERIAL AND METHOD: This is a multicentric study of self-neglect in three geriatric units from Finland, Greece and Romania The medical, social, psychological and behavioral profile analysis was based on a questionnaire; this questionnaire relied on existing studies and social, economic and medical facts in the three countries. The cognitive function, nutritional status, and the presence or absence of depression have also been assessed. RESULTS AND DISCUSSIONS: The data obtained until now support the importance of self-neglect among the elderly. The social-medical network should not only identify, diagnose, prevent, and treat the elderly affected by the phenomenon of self-neglect, but also educate the society to help them and, moreover, to prevent their marginalization.

[Five years of kidney transplantation in Iasi]. / Cinci ani de transplant renal în centrul universitar Iasi.

The activity of Renal Transplant Center Iasi started in November 2000, when we realized the first renal transplant from a live donor. Since then, 46 renal transplants were successfully realized in our center, to patients aged between 13-47 years (medium age = 30 +/- 5), M/F=27/19, 25 (56.8%) of them selected from HD, 17 (39.9%) from CAPD and 4 (8.7%) pre-emptive. Medium age of donors was 49.1 years (30-64), M/F=29/17. The donors were, in 78.3% of cases, first-degree relatives (parents, siblings). In 10 cases (21.7%) the grafts were donated by "emotionally related"donors (in most cases, spouses). An urologist-cardiovascular surgeon team, performed the transplant operations. There were no important complications during operation. We had one major vascular complication (graft artery thrombosis) in a 13 years recipient, successfully resolved after thrombectomy and stenting. Immunosuppressive therapy associated induction with monoclonal antibodies anti-Tac, cyclosporine, MMF and prednisone. Eight patients from 46 (17.39%) presented acute rejection episodes and all responded at corticosteroids. Medium values of serum creatinine were: 1.54 mg% at 1 month, 1.42 mg% at 6 months, 1.44 mg% at 1 year, 1.21 mg% at 2 years, 1.38 mg% at 3 years, 1.4 mg% at 4 years and 1.2 at 5 years. The survival of patients and donors is 100% and the survival of renal graft--97.1% (one case of chronic allograft nephropathy with lost of renal function). We also present the satisfactory evolution of the 51 renal transplanted patients addressed to our center from different other renal transplantation centers in Romania for management follow-up.