BackgroundThe effect of geriatric events (GEs) on outcomes of acute coronary syndrome (ACS) admissions is poorly understood. We evaluated the prevalence and impact of GEs on clinical outcomes and resource utilization of older patients admitted with ACS. MethodsUsing the 2018 National (Nationwide) Inpatient Sample, we analyzed all elective hospitalizations for ACS in older adults (age ≥ 65 years) and a younger reference group (age 55-64). Nationally-weighted descriptive statistics were generated for GEs based on ACS subtypes. Multivariate logistic regression models controlling for comorbidities, frailty, patient procedure, and hospital-level variables were used to estimate the association of age with GEs and GEs with outcomes. ResultsOut of 403,760 admissions analyzed, 71.9% occurred in older adults (≥65 years). The overall rate of any GE in older adults with ACS was 3.4%. With advancing age, the number of GEs was found to significantly increase (p<0.001). After adjustments, having any GE was found to have a significant impact on mortality (adjusted
Family members regularly mistreat the elderly who rely on them because they lack financial stability and believe that seeking aid will exacerbate their predicament. Elder abuse studies conducted in the last two years indicate that an increased number of elderly citizens have been abused since the COVID-19 outbreak, and many of them did not receive assistance from agencies responding to abuse because they did not report any incidents and did not have access to a phone, even if they desired it. Researchers think that an increase in elder maltreatment is being fuelled, in part, by directives to shelter in place in response to the COVID-19 pandemic and the ensuing restrictions and lockdowns worldwide. While the UN acknowledges domestic violence against women as a "shadow pandemic," elder abuse may be just as dangerous. This article highlights elder abuse by doing a critical review of some of the recent studies conducted preceding to and during the outbreak of COVID-19. Its purpose is to critically examine existing claims that elder abuse has increased in prevalence since the coronavirus outbreak, to highlight critical public health implications, and to suggest additional initiatives for the early detection and management of elder abuse.
Wound contamination and subsequent colonization by microbes can significantly impair tissue repair and lead to the development of chronic non-healing ulcers. Atypical Burkholderia and Actinomycetes bacterial species are common in cases of soil contamination of open wounds leading to a complex infection that is both difficult to diagnose and treat. Despite much research on the involvement of atypical organisms, including Burkholderia and Actinomycetes, in antibiotic resistance, there is no consensus on the timeline from contamination to infection and on an algorithm for early diagnosis and management. Thus, the ways in which these organisms interact in settings of co-infection and contribute to cross-resistance remains unclear. The generally low index of clinical suspicion for atypical microbial infections and the absence of clear diagnostic protocols have multiple consequences, ranging from excessive reliance on pathology, delayed treatment, expensive and ineffective investigations and treatment, and progressive wound sepsis and morbidity.We are reporting a case of Burkholderia cepacia infection, co-infection with Actinomyces spp., and resistance to ceftazidime/avibactam and co-trimoxazole in a 28-year-old previously healthy farmer following soil contamination of an open wound. This is one of only a few reported cases of Burkholderia resistance to ceftazidime/avibactam and the first reported case of B. cepacia bacteremia due to peripheral contamination.
BackgroundLong-term longitudinal studies on giant cell arteritis (GCA) hospitalizations are limited. Here we aim to fill gaps in knowledge by analyzing longitudinal trends of GCA hospitalizations over the last two decades in the United States (U.S.). Materials and methodsWe performed a 21-year longitudinal trend analysis of GCA hospitalizations using data obtained from the National Inpatient Sample (NIS) database between 1998 and 2018. Using the NIS database, we searched for hospitalizations for patients aged ≥ 50 years with a principal diagnosis of GCA using ICD billing codes. The principal diagnosis was the main reason for hospitalization. We used all hospitalizations in patients without GCA aged ≥50 years as the control population. Multivariable logistic and linear regression analysis was utilized to calculate the adjusted p-trend for outcomes of interest. ResultsThe incidence of GCA hospitalization remained stable at about one per 100,000 U.S. persons throughout the study period. There was no statistically significant change in the inpatient mortality for the GCA group during the study period (adjusted p-trend=0.111). In comparison, inpatient mortality reduced from 4.4% to 3.1% from 1998 to 2018 (adjusted p-trend <0.0001) in the control group. The proportion of whites reduced, while the proportion of racial minorities increased over time in both the GCA and control groups. ConclusionThe non-GCA control population saw significant reductions in mortality over time, but unfortunately, the GCA group did not see such improvements. More research into additional treatment modalities for inpatient GCA management may help improve mortality.
BackgroundThere is scarcity of national level data on the reasons for Emergency Department (ED) presentation among patients with Giant cell arteritis (GCA) in the United States. This study aims to outline the most common reasons for ED presentation among these patients, and the baseline characteristics and outcomes of ED visits principally for GCA. Materials and methodsWe obtained data from the Nationwide Emergency Department Sample (NEDS) 2018 database. Each ED visit in the NEDS has a principal diagnosis (the main reason for the visit) and can have up to 34 other secondary diagnoses. We searched for ED visits for patients aged ≥50 with any diagnosis of GCA using ICD-10 codes. The most common principal discharge diagnoses were divided into organ systems, and specific principal discharge diagnoses were recorded for ED visits among patients with GCA in descending order of frequency. We then outlined baseline characteristics and outcomes of ED visits with a principal diagnosis of GCA. ResultsThere were 20,886 ED visits for patients with GCA in 2018. Infections, as well as rheumatologic and cardiovascular disease were the most common reasons for ED presentation, and GCA was the most common specific principal discharge diagnosis for ED visits. There were 3888 ED visits with a principal diagnosis of GCA. These patients were predominantly elderly females, admitted, Medicare insured, with minimal comorbidity burden, and presented to metropolitan teaching hospitals in the south. ConclusionGCA patients are most likely to present to the ED due to their underlying GCA. Infections and CV are also common reasons for presentation to the ED.
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