Bacteriuria was very common in elderly patients with diabetes. The observed trends in risk factors, clinical profile, laboratory profile, causative organism patterns, and antimicrobial susceptibilities will help to add the growing literature on this topic.
An 85 year old woman was admitted in our care with a diagnosis of systemic hypertension and cerebrovascular attack (ischemic) with right sided hemiplegia. On reviewing the history, the relatives gave a history of anorexia, constipation and cold intolerance for 6 months. There was a history of inadequate oral intake following the untimely death of her daughter a few weeks prior to her admission in this hospital. On admission, there was an indwelling urinary catheter and nasogastric tube in situ.Patient was drowsy, responding to commands intermittently, afebrile with a heart rate of 54/minute and a blood pressure of 140/90 mmHg. General examination was unremarkable except for dry tongue, coarse skin, pallor and puffiness of face. Neurological examination showed signs of right sided hemiparesis with bilateral extensor plantars. Other system examination was unremarkable.Complete blood count revealed an Hb of 9.4 mg/dl with neutrophilic leukocytosis. ESR was 60 mm at the end of first hour. Basal metabolic profile was within normal limits while serum sodium was 109 mEq/L. 2D Echo was normal except for grade 1 diastolic dysfunction. MRI brain revealed diffuse brain atrophy and periventricular leucomalacia. Thyroid profile revealed low serum T3 (0.43 ng/ml; ref. range 0.6-1.81), T4 (0.51ng/dl; ref. range 3.2-12.6) and a high serum TSH (60 IU/ml). Hyponatremia correction was done and thyroid hormone replacement was initiated. Within a few days of care, her general medical condition and neurological condition improved remarkably but indwelling urinary catheter ABSTRACTPurple Urine Bag Syndrome (PUBS) is a unique disease entity characterised by purple discoloration of urine secondary to recurrent urinary tract infections with indigo and indirubin producing bacteria and is predominantly seen in constipated, chronically debilitated and catheterised women with alkaline urine. This syndrome indicates underlying recurrent urinary tract infections (UTIs) associated with higher incidence of mortality and morbidity than urinary tract infection alone without this occurrence. This article is about an elderly hypothyroid woman with PUBS and reviews the need to be aware of this entity.
Background: Anthracyclines are extensively used in the treatment of breast cancer. However, these therapeutic agents are responsible for chemotherapy-induced cardiotoxicity. Aim of this study was to assess the effect of use of prophylactic nebivolol for the prevention of anthracycline-induced cardiotoxicity in breast cancer patients.Methods: This was a prospective, randomized, single-blind, and placebo-controlled trial involving 80 participants with breast cancer, scheduled to undergo chemotherapy with doxorubicin. Patients were randomly divided into two groups: the nebivolol group (n=40) to receive nebivolol 5 mg daily and the placebo group (n=40) to receive placebo. All patients were evaluated with baseline Electrocardiogram (ECG) and echocardiography prior to treatment, and at the 6-month follow-up. Echocardiography included 2D echocardiography, colour doppler and tissue doppler imaging.Results: The study groups had comparable baseline echocardiographic variables. At the 6-month echocardiographic follow-up, there were no changes of statistical significance in any 2D echocardiographic variables in either group. However, there were minimal reductions of 0.4% in left ventricular ejection fraction in the nebivolol group (62.2±4.4% to 61.9±4.2%, p=0.75) and 1.6% in the placebo group (62.8±3.6% to 61.8±3.2%, p=0.18). Doppler examinations also did not reveal any statistically significant changes in variables such as peak A velocity, peak E velocity, E/A ratio, isovolumic relaxation time, and isovolemic contraction time in either group.Conclusions: Prophylactic use of nebivolol treatment may possess cardioprotective properties against anthracycline-induced cardiotoxicity in breast cancer patients although not statistically significant in this study.
BACKGROUND Heart Failure (HF) is a leading cause of hospitalisation and death across the globe. An idea about predictors of mortality can help physician in patient prognosis as well as decision making about the type and intensity of care of hospitalised patients. The aim of the present study is to identify clinical factors that predict mortality at one year post discharge in HF patients. MATERIALS AND METHODS A single centre observational study included 327 patients with HF. Patient mortality at one year follow up was identified and was correlated with various clinical factors including gender, anaemia, renal malfunction, ejection fraction <40% and NYHA class IV. Cox regression analysis was applied to identify relative risk of each clinical factor. RESULTS The one year post discharge mortality rate was 8.2%. NYHA Class IV, EF <40% and male gender were identified as strong predictors of mortality while anaemia and renal malfunction were reported as moderate predictors of mortality. CONCLUSION The study further confirms the significant mortality rates in HF patients even at one year follow up. We suggest that patients at high risk such as those with NYHA class IV, EF <40% and male gender be treated with more intensive treatment plans.
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