Recurrent respiratory arrests - an unusual manifestion of SLE.

We report on a case of a 40-year-old female who presented with two respiratory arrests occurring a few months apart. The investigations performed in our hospital during admission showed diffuse alveolar haemorrhage of unknown aetiology. Once the correct diagnosis of systemic lupus erythematosus was made, adequate treatment was initiated. This induced remission of the disease and allowed the patient to return to her normal life.

COVID-19's natural course among ambulatory monitored outpatients.

Research objective was to detail COVID-19's natural trajectory in relation to the Czech population's viral load. Our prospective detailed daily questionnaire-based telemonitoring study evaluated COVID-19's impact among 105 outpatients. In accordance with government quarantine requirements, outpatients were divided into a cohort with two negative tests at the end of the disease (40 patients) and a cohort with a new algorithm (65 patients) following a 14-day quarantine. Median follow-up differed significantly between the 2 groups (23 days vs. 16 days). Only 6% of patients were asymptomatic during the entire telemonitoring period. Another 13% of patients were diagnosed asymptomatic, as suspected contacts, yet later developed symptoms, while the remaining 81% were diagnosed as symptomatic on average 6 days following symptom onset. Telemonitoring enabled precise symptom status chronicling. The most frequently reported complaints were fevers, respiratory issues, and anosmia. Six patients were eventually hospitalized for complications detected early after routine telemonitoring. During the extended follow-up (median 181 days), anosmia persisted in 26% of patients. 79% of patients in the new quarantine algorithm cohort reported no symptoms on day 11 compared to just 56% of patients in the two negative test cohort upon first testing negative (median-19 days). The highest viral load occurred within 0-2 days of initial symptom onset. Both the PCR viral load and two consecutive PCR negative sample realizations indicated high interindividual variability with a surprisingly fluctuating pattern among 43% of patients. No definitive COVID-19 symptoms or set of symptoms excepting anosmia (59%) and/or ageusia (47%) were identified. No preexisting medical conditions specifically foreshadowed disease trajectory in a given patient. Without a PCR negativity requirement for quarantine cessation, patients could exhibit fewer symptoms. Our study therefore highlights the urgent need for routine ambulatory patient telemedicine monitoring, early complication detection, intensive mass education connecting disease demeanor with subsequent swift diagnostics, and, notably, the need to reevaluate and modify quarantine regulations for better control of SARS-CoV-2 proliferation.

Risk factors for hospitalization among older persons.

The hospitalization of older patients involves, in addition to treating of acute illness or acute worsening of chronic disease, the risk of a number of age-specific complications. Deliria are one of the most common events at the onset of the hospital stay. As the ethiology of deliria in addition to the underlying disease we have to consider the deteriorated adaptability to environmental change. Another serious complication is the emergence of immobilization syndrome, which can start the irreversible unfavourable outcome. Infection complications with a high tendency to develop sepsis are a frequent primary cause of hospitalization, but also a frequent complication of hospitalization from originally different indications. The onset of the infection complication is usually accompanied by a slower increase of inflammatory parameters, but it does not mean slower progression of the condition. The basic problem is the choice of appropriate antibiotic treatment with regard to the high risk of Clostridium difficile selection in older age. Other risks, such as malnutrition, dehydration, thromboembolic disease are more frequent in hospitalized older patients and it is advisable to start as soon as possible with preventive measures against their occurrence. Key words: dehydration - deliria - immobilization syndrome - instability - malnutrition - respiratory infection - urinary infection.

Do the test results of cognitive function and activities of daily life of seniors correlate with the state of vitamin D supply to the organism?

INTRODUCTION: Till recently, the main effect of Vitamin D (calcitriol) was accounted for its role in regulation of calcium levels. But at the present time several other important functions of this vitamin have been unfolding in human organism, which currently ascribe to the properties of hormone. It also effects among other functions such as cognitive functions, immune system and muscle mass. In the resent past there are rising number of scientific publications on possible consequences of the long term deficit of Calcitriol, not only in the older generation. AIM: The aim of our study was to establish the relationship between the supply of Vitamin D to the organism and basic parameters of self-sufficiency, which are cognitive functions stipulated in the Mini Mental State Examination (MMSE) test and Barthels test for Activities of Daily Living (ADL) among seniors. MATERIALS AND METHODS: In our study we evaluated, 244 patients (65 men and 179 women) of average age 80,1 ± 7,4 (min. 65, max. 99) hospitalized at Department of Internal Medicine, Geriatrics, and General Practice of Faculty of Medicine, Masaryk University and Faculty Hospital Brno, from March 2012 to September 2012. The state of Vitamin D supply to the organism was evaluated with the help of serum Vitamin D total [1.25(OH)2D + 25(OH)D], the values of MMSE and ADL were taken from the third day of hospitalization till overcoming the acute stage. The characteristics of the patients were drawn with multimorbidity index CIRS - CI (cumulative Illness Rating Scale - Comorbidity Index). Furthermore, we observed the correlation of Serum Vitamin D levels to the season of the year. RESULTS:   In our patients average concentration of vitamin D levels, MMSE, and ADL was 37.9 ± 26.1 (8-142 nmol/l), 23.36 ± 6.91 (0-30 points), 80.66 ± 25.13 (0-100 points), and CIRS CI 4.7 + 1.9 points, respectively. The correlation of vitamin D serum level with MMSE was r = 0,289 (p 0.01), with ADL r = 0,292 (p 0.01), and CIRS CI r = -0.22 (p < 0.05). Using multivariation analysis proved the significance of correlations obtained, even after the exclusion of multimorbidity. There was no statistically significant correlation between seasons of the year and serum vitamin D total level. However, nonsignificant decreasing trend of serum vitamin D total level with rising age of patients was found (r = -0.149, NS). CONCLUSIONS: The values obtained for MMSE and ADL demonstrated a significant correlation with serum vitamin D total levels. Attention paid to maintain an adequate supply of serum vitamin D in the organism, helps to maintain quality bone remodeling and functioning of other processes with which it takes part. For supplementing elderly sick patients, apart from diet, it is suitable to choose partially or fully hydroxylated supplements and adequate exposure to sunlight. Key words:  ADL - cognitive function - MMSE - vitamin D.

[Severe osteoporosis - the story of chronic medication-related hyponatremia]. / Tezká osteoporóza aneb Príbeh chronické polékové hyponatremie.

The authors present a case-report of a 73 years old woman treated for arterial hypertension within past 15 years with diuretics (thiazides, amiloride and indapamide) and concomitantly with antidepressive trazodone. The patient developed severe osteoporosis after 6 years of such a treatment with multiple fractures even after minor trauma; during whole this period severe hyponatremia without adequate supplementation was documented. Most probably, there exists tight relationship of osteoporosis and hyponatremia in this patient - the authors discuss possible pathophysiological mechanisms at the level of renal tubules, osteoblasts and osteoclasts, hypopituitary-skeletal axis, syndrome of inadequate adiuretin secretion (SIADH) and possible influence of acid-base balance disturbances.

[Geriatric patient in oncology]. / Geriatrický nemocný v onkologii.

UNLABELLED: At the beginning of the article there are mentioned the stages of human life breakdown and breakdown of senior age by stages approximately corresponding to functional efficiency. Attention is paid to a specific geriatric regime respecting the differences of senior age. Article emphasizes the role of comprehensive geriatric assessment including evaluation of psychological changes and social aspects in accordance to optimal geriatric approach. Diagnostic strategy and oncology treatment in terms of prognosis and expected goals are also described. There are discussed the specifics of diseases in elderly patients in the cancer context. Present work reviews the differences between ca-lendar and biological age with possibility to segregate seniors and to avoid inadequate palliative care. Finally, the author discusses the aspects of supportive care for seniors and polypharmacotherapy with its potential risk. KEYWORDS: functional geriatric examination - palliative care - polypharmacotherapy - specific geriatric regime - supportive care - specifics of diseases in elderly patients.

Benefits and pitfalls of cardiovascular medication in seniors.

Authors analyze actual situation in treatment of cardiovascular diseases in older patients. Different groups of recommended drugs are discussed separately; possible risks for elderly patients are stressed. Angiotensin converting enzyme inhibitors-this group is widely used in older patients because of their hypotensive effect, positive influence on cardiac failure, and positive modulation of endothelial dysfunction. The risk of hyperkalemia must be considered. Antiaggregants and anticoagulants are proved as potent prophylactic treatment, but the associated risk of gastrointestinal bleeding must be weighed very carefully. Bradycardia related to ß-blockers, especially in combination with other medications lowering the heart rate must be taken into account. Otherwise, this group brings the highest profit in cardiovascular diseases as for morbidity and mortality. Attention is paid to calcium channel blockers, statins, diuretics, nitrates, and digoxin. A table listing the possible side effects and clinical symptoms of overdose by medications most frequently used in the elderly concludes the article.