Anemia is common among elderly and is associated with increased morbidity and mortality in this vulnerable age group. Anaemia hampers functional capacity and cognition, increases risk for frequent falls, frailty, dementia, hospitalization, mortality and mobility and ultimately affects the quality of life. Anemia in elderly is divided in three major types: nutritional deficiency, anemia of chronic disease including chronic renal disease and unexplained anemia. A high index of suspicion is required to manage anemia in elders. The symptoms (easy fatigue, decrease appetite, pallor) are usually taken as consequences of advance age. The onset of signs and symptoms are insidious and elders adjust their routine activities to the remaining physical capabilities and physiological adaptations. Anemia may present as worsening of associated disorder like worsening congestive heart failure, cognitive impairment, dizziness and apathy. The evaluation of anemia in elderly involves complete history including dietary, medical illness and medication history and through physical examination to detect any sign suggestive of etiology followed by further investigations accordingly. The treatment of anemia depends on its etiology and severity. In severe anemia, red cell transfusion is required along with treatment of underlying etiology. In unexplained anemia, erythropoietin replacement in higher dose than usual may be needed due to blunted response to erythropoietin. Anabolic steroid supplementation is also beneficial in elderly with anemia.
Introduction: Rheumatological manifestations (RM) are very common in human immunodeficiency virus (HIV)-infected patients. The aim of this study was to determine the clinical spectrum of musculoskeletal involvement and relationship with the Centers for Disease Control and Prevention (CDC) stage and CD4? cells and other factors. Methods: A cross-sectional study was conducted involving 75 patients of over 18 years of either sex with confirmed HIV status attending a tertiary care hospital in north India in one calendar year. Baseline demographic details, relevant history including duration of combination antiretroviral therapy (cART), RM, joints involved, CD4 cell count, and biochemical parameters were evaluated. Results: Of 75 patients, 54 were male and 21 were female (mean age 33.15 ± 5.00 years, range 21-48 years). Most common RM was arthralgia (26.67%), followed by myalgia (18.67%), and arthritis (13.33%). Keratoderma blennorrhagicum (1.33%), tendo-achilles tendinitis (2.67%), and plantar fasciitis (2.67%) were other manifestations. Spondyloarthritis (SpA) was seen in 8% patients (undifferentiated SpA 4%, reactive arthritis 2.67%, psoriatic arthritis 1.67%). HIVassociated arthritis was seen in 2.67% while septic arthritis, rheumatoid arthritis, vasculitis, and diffuse infiltrative lymphocytic syndrome were seen in one patient (1.33%) each. The mean duration of disease in patients with RM was significantly less than patients without RM (p \ 0.01). The erythrocyte sedimentation rate in patients with RM was significantly higher than in patients without RM (p \ 0.05). Mean CD4 ? cells were also significantly lower in patients with RM as compared to patients without RM (p \ 0.05). Significantly fewer patients on cART had RM in comparison to patients not on cART (p \ 0.001). Of 35 patients with RM, 25 were in CDC stage IV. Conclusion: RM are common in HIV-infected patients. HIV arthralgia, myalgia, and undifferentiated SpA are the common manifestations. RM were associated with low CD4 counts. Most of the cases with RM were in CDC stage IV.
Background: To ascertain the prevalence of Hepatitis C infection among patients visiting a tertiary care center in Jaipur, Rajasthan.Methods: An observation analytic study was done at a tertiary care center affiliated to Medical College with retrospective analysis of the hospital data of two calendar years. During this period HCV infection screening (anti-HCV) was offered to every suspected patient admitted in hospital and every pregnant women visiting antenatal care clinic.Results: The study prevalence of HCV infection was 0.05% (13/25311). The prevalence was more in female (0.03%) than male (0.02%). The study prevalence of anti-HCV among pregnant female was 0.02% (3/16224). Maximum positive cases (4/13, 30.77% positive cases) were in the age group of 21-30 years (sexually active group) and >50 years age group while minimum positivity was found in children (00 case, 0-20 years age).Conclusions: In this study, prevalence of HCV infection was 0.05%. The study prevalence of HCV among pregnant females was 0.02%. Maximum positive cases (4/13, 30.77% positive cases) were in the age group of >50 years and 21-30 years. This study aids in view to strengthen proper screening for HCV infection to reduce HCV related morbidity and mortality
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