BackgroundNosocomial infections are extremely common in the elderly and may be related to ageing of the immune system. The Immune Risk Phenotype (IRP), which predicts shorter survival in elderly patients, has not been evaluated as a possible risk factor for nosocomial infection. Our aim was to assess the prevalence of nosocomial infections in elderly in-patients and to investigate potential relationships between nosocomial infections and the immunophenotype, including IRP parameters.ResultsWe included 252 consecutive in-patients aged 70 years or over (mean age, 85 ± 6.2 years), between 2006 and 2008. Among them, 97 experienced nosocomial infections, yielding a prevalence rate of 38.5% (95% confidence interval, 32.5-44.5). The main infection sites were the respiratory tract (21%) and urinary tract (17.1%) When we compared immunological parameters including cell counts determined by flow cytometry in the groups with and without nosocomial infections, we found that the group with nosocomial infections had significantly lower values for the CD4/CD8 ratio and naive CD8 and CD4 T-cell counts and higher counts of memory CD8 T-cells with a significant increase in CD28-negative CD8-T cells. Neither cytomegalovirus status (positive in 193/246 patients) nor presence of the IRP was associated with nosocomial infections. However, nosocomial pneumonia was significantly more common among IRP-positive patients than IRP-negative patients (17/60 versus 28/180; p = 0.036).ConclusionImmunological parameters that are easy to determine in everyday practice and known to be associated with immune system ageing and shorter survival in the elderly are also associated with an elevated risk of nosocomial pneumonia in the relatively short term.
Transvaginal evisceration of the intra-abdominal organs is a rare emergency event. In this paper, we discuss the case of a 97-year-old female who presented to the emergency department due to abdominal pain and a large prolapse with visible extrusion of the small bowel per vagina. Past surgical history was significant for a total abdominal hysterectomy and surgical repair for pelvic organ prolapse; both performed more than 15 years prior to the patient's current presentation. The eviscerated bowel was initially reduced through a vaginal vault defect into the abdominal cavity. A lower midline laparotomy was undertaken for further assessment, and the vault defect was closed by transabdominal repair with no evident compromise to bowel function. We suggest that a multidisciplinary approach to prompt examination and management by gynaecology and general surgery is vital in reducing the risk of morbidity and mortality.
Cancer antigen 125 (also known as carbohydrate antigen 125 or CA 125) is an antigen first identified by Bast et al. Although much research has been done to understand the molecular structure of CA 125, its function remains a source of much speculation. At present, CA 125 is most commonly used in the diagnosis of epithelial non-mucinous ovarian cancers, and in monitoring their response to treatment. Following surgical resection, CA 125 levels are expected to half within 10 days and it is therefore a useful tool for assessing response to treatment as well. We present a case of incidental finding of rasied CA125, followed by the literature review to discuss a better understanding of the factors that lead to CA 125 production, its mechanisms of action, and the nature and functions of its subspecies may help in improving its use as a standalone diagnostic tool.
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