Deceased elderly in-patients with pulmonary embolism.

UNLABELLED: Pulmonary embolism (PE) in the elderly is an immediate threat of life. Especially in old age clinical signs of PE are non-specific and could be both underestimated and overestimated. AIM OF THE STUDY: The retrospective long-term study was aimed at conducting an analysis and comparison of pertinent influence of age, gender and immobility on occurrence of PE and sudden death. PATIENTS AND METHOD: Between 1995 and 2012 years we had altogether 12,746 elderly patients of an average age 80.6 ± 7.0 y (range 65-103 y) hospitalized at the Department of Geriatrics. All in-patients 65+ y were randomly admitted for internal hospitalization from the catchment area of Brno city (100,000 inhabitants). The subject of our interest was to study the documentation of deaths (including autopsy findings), which was caused by PE. Out of this number there were 8,540 women (66.3 %) and 4,206 men (33.7 %). Among all hospitalized patients PE in 700 cases (5.5 % of all admitted patients) was shown in a medical report. Among them there were 424 survivors (60.6 %; 134 men and 290 women). CONCLUSION: The high occurrence of PE (particularly silent form) has crucial importance in the elderly mortality. Our recommendations would like to emphasize the need of no underestimation of this fact and to carry out preventive measures in all age groups (including the "oldest old" and frail persons) (Tab. 3, Ref. 41).

GAD antibodies in T1D and LADA--relations to age, BMI, c-peptide, IA-2 and HLA-DRB1*03 and DRB1*04 alleles.

The determination of GADA may be useful for clinical classification of diabetes mellitus (DM) in clinically unclear cases. This GADA positivity may persist in any diabetics Type 1 Diabetes Mellitus (T1D) with an onset in adulthood and Late Autoimmune Diabetes of Adults (LADA) many years after appearance of DM. The study was aimed at comparing the levels of GADA between both diabetic subsets with their clinical parameters, age of onset DM, period of insulin need, body mass index, HbA1C, fasting and postprandial C-peptide, risky HLA-DRB1* alleles, occurrence of micro- and macrovascular diabetic complications. Further analysis of GADA titers in different time consequences to the development of DM and relations to IA-2 were made. In the study, we included 130 diabetics with an onset of diabetes (T1D or LADA) 35+ y. who were hospitalized and afterwards long-term observed in the diabetological outpatient department. Out of this number there were 62 men and 68 women of the average age 65.5 +/- 14.0 y. (range 35-93 y.). 54 were assessed as the T1D patients and 76 as the LADA ones. Patients of the T1D subgroup were GADA positive 22 times and of the LADA subgroup 21 times. LADA 2 patients that were GADA negative were more obese than GADA positive LADA diabetics (p < 0.01). Also postprandial C-peptide was higher in LADA patients GADA negative (p < 0.05). Other clinical characteristics were without statistically significant differences. We found in our diabetic patients a relation between alleles HLA-DRB1*03 and particularly combination with HLA-DRB1*04 with positive GADA levels. In the GADA negative group obesity, coronary heart disease, hypertension, syndrome of diabetic foot and dyslipidaemia appeared more frequently (OR = 2.8; 3.1; 6.2 and 2.4). We found no significant differences in observed parameters--comparison GADA positivity and negativity according to the duration of DM. GADA positive were even 10 y. duration 16 times and after 20 y. even 6 times. Recent DM had positive GADA in 11 cases and 13 cases of recent DM had GADA negative. IA-2 antibodies were positive (> 1.0 U/ml) 18 times altogether and always with positive GADA, but only 7 times in recent DM. The presence of elevated GADA identifies patients unequivocally suitable for early insulin therapy. Our observations and experiences confirm that GADA can be found increased after more than 10-20 years duration of DM, although in decreasing trend.