Seasonal influenza in octogenarians and nonagenarians admitted to a general hospital: epidemiology, clinical presentation and prognostic factors.

OBJECTIVE: Seasonal influenza is responsible for high annual morbidity and mortality worldwide, especially in elderly patients. The aim of the study was to analyse the epidemiological, clinical and prognostic features of influenza in octogenarians and nonagenarians admitted to a general hospital, as well as risk factors associated with mortality. METHODS: Retrospective, cross-sectional, descriptive study in patients admitted and diagnosed with influenza by molecular biology in the General University Hospital of Alicante from 1 January to 31 April 2015. RESULTS: A total of 219 patients were diagnosed with influenza in the study period: 55 (25.1%) were ≤64 years-old; 77 (35.2%) were aged 65-79; 67 (30.6%) were aged 80-89 years; and 20 (9.1%) were aged ≥90 years. Most flu episodes were caused by influenza A (n=181, 82.6%). Patients aged 80 years or older had lower glomerular filtration rate (mean: 49.7 mL/min vs. 62.2 mL/min; p=0.006), a greater need for non-invasive mechanical ventilation (22% vs 9.3%; p=0.02), greater co-morbidity due to cardiac insufficiency (40.5% vs. 16.4%; p<0.001) and chronic renal disease (32.9 vs. 20%, p=0.03), and greater mortality (19% vs. 2.9%; p<0.001). In a multivariate analysis, mortality was higher in those aged 80 or over (adjusted odds ratio [ORa] 9.2, 95% confidence interval [CI] 1.65-51.1), those who had acquired the flu in a long-term care facility (ORa 11.9, 95% CI 1.06-134), and those with hyperlactataemia (ORa 1.89, 95% CI 1.20-3.00). CONCLUSIONS: Seasonal influenza is a serious problem leading to elevated mortality in octogenarian and nonagenarian patients admitted to a general hospital.

Trastorno de conducta durante el sueño REM / Behavior disorders during REM sleep

El trastorno de conducta durante la fase REM es una parasomnia caracterizada por la ausencia de atonía muscular en esta fase de sueño. Clínicamente se acompaña de movimientos bruscos y violentos de las extremidades y el tronco en relación con sueños agresivos. Se describe el caso de una paciente de 80 años de edad que presentaba conductas violentas y ensoñaciones agresivas. La clínica de la paciente y el estudio polisomnográfico efectuado con monitorización de varios músculos y videograbación confirmaron el diagnóstico. El tratamiento con clonacepam fue eficaz en la paciente, con resolución de su clínica. Dada la escasa frecuencia de este trastorno en mujeres, consideramos relevante la exposición de este caso (AU)

Behavior disorder during the REM phase of sleep is a parasomnia characterized by the lack of the atonia or muscular paralysis. Clinically, said disorder occurs with sudden and violent movements in extremities and trunk related to aggressive dreams. The case of a patient, 80, with violent behaviour and dreams is reported. Her medical profile and the polysomnographic study carried out with monitoring of some muscles and video recording confirmed the diagnosis. The treatment with clonacepam was effective, with resolution of the disorder (AU)