Eyassu Habte-Gabr

Sleep patterns in rural elders: Demographic, health, and psychobehavioral correlates

Altered sleep patterns, including changes in bedtime, sleep latency, total sleep time, and arising time, have been reported to occur with increasing age. We examine self-reported sleep patterns in a geographically-defined population (n = 3097) of persons aged 65 years and older. Sleep patterns were characterized according to demographic variables, clinical conditions, and physical, psychological, and social functioning. Sleep latency and total hours of sleep increased with age, and older respondents went to bed earlier. The percentage of respondents who reported feeling rested in the morning decreased with age. Women went to bed later, had longer sleep latency, and fewer hours of sleep than men, and were less likely to report feeling rested than men. Sleep patterns were also related to educational attainment, self-perceived health status, physical functional status, psychotropic drug use, alcohol use, depressive symptoms, life satisfaction, and social and recreational activity level. This population study suggests that sleep problems among the elderly are sometimes associated with treatable health conditions and modifiable behavioral and environmental characteristics.

Fulminant Disseminated Toxoplasmosis in an HIV Patient

Disseminated toxoplasmosis in AIDS is a rare condition. We present an unusual case of a fulminant form of disseminated toxoplasmosis in a young male homosexual. He was a 30-year-old HIV-positive (diagnosed 4 months earlier), admitted with a 5-day history of diarrhea, vomiting, fever, and cough. He had been generally healthy except for an 8-week history of weight loss and malaise. On admission, except for a temperature of 37.6 degrees C, the physical examination was normal. He was treated symptomatically. Four days after admission he suddenly became short of breath. Despite intensive management, he continued to deteriorate and expired 6 h later. Postmortem examination revealed disseminated toxoplasmosis involving the heart, lungs, brain, stomach, small intestine, and colon. This is an unusual presentation of disseminated toxoplasmosis because of its rapid course with no prior indication of infection. To our knowledge, such an atypical and rapid downhill course of toxoplasmosis (with minimal clinical and laboratory features) has not been reported previously. Increased awareness of this infection in all HIV patients and its possibly rapid course is needed.

Infected Arteriovenous Hemodialysis Graft Presenting as Left and Right Infective Endocarditis

Prosthetic grafts have become an acceptable alternative to the autogenous arteriovenous dialysis fistula. The major drawback in their use for the dialysis patient is infection. We present a case of infected polytetrafluoroethylene arteriovenous fistula (endarteritis) with signs of unilateral splinter hemorrhage, Janeway lesions in the affected limb and septic venous embolization to the lungs. The graft eventually ruptured requiring emergency surgery. Staphylococcus aureus is by far the most common implicated organism. An otherwise non-threatening infection at a fistula site can lead to more serious complications such as infective endocarditis.

Varicella Zoster Vasculopathy

Varicella-zoster virus can cause neurological disease in primary and reactivated latent forms, with a wide spectrum of disorders throughout a person’s lifetime. 35-year-old male with AIDS; histoplasmosis; mild, intermittent asthma; and hypertension presented to hospital with left-sided weakness and slurred speech. Exam showed left hemiparesis with left upper motor neurons facial palsy and dysarthria. Acute right basal ganglia infarct was detected in head CT without contrast. A subsequent MRI showed acute non-hemorrhagic infarct, right basal ganglia; fusiform dilatation, and proximal right middle cerebral artery. A CT angiogram of the bilateral carotid arteries revealed occlusion of the right anterior cerebral artery with conical dilatation at the origin; significant stenosis, and dilatation of the right middle cerebral artery. These findings were consistent with vasculitis. Patient was successfully treated with IV acyclovir. Rapid diagnosis of VZV vasculopathy is important because it is a treatable cause of stroke. Mortality rate is 25% without treatment.

Multifocal tubercular osteomyelitis: a case with atypical manifestations.

Skeletal tuberculosis (TB) accounts for about 1–2% of all TB cases and 10% of extrapulmonary TB cases. We present a 19-year-old male with multifocal tubercular osteomyelitis, who presented with progressively worsening back pain, weight loss, fatigue, anorexia, decreased mobility, low-grade fever, and night sweats—but without pulmonary involvement.

Systemic Antifungal Agents

Anti-fungal agents are classified under two major headings, systematic and topical agents. Only systematic anti-fungal agents will be discussed in this chapter. Since the discovery in 1955, amphotericin B has been the cornerstone of anti-fungal treatment. It is active against most species of fungl. However,Candida lusitaniae, Pseudallescheria boydii, and fusarium spp have primary resistance to amphotericin B. Recently, new liposomal preparations of amphotericin B have been developed. They are less nephrotoxic. The azole family of anti-fungal includes two broad classes: the imidazoles (clotrimazote, ketoconazote, miconazole) and the triazoles (flucouazole and itracouazole). Imidazoles are still widely used for the treatment of superficial mycoses and vaginal candidiasis. The systematic triazoles are more slowly metabolized and have less effect on human synthesis than imidazoles, hence they are preferred for systemic therapy. Flucytosine is a fluorinated pyrimidine. Clinically, the principal use of flucytosine is as adjunctive therapy with amphotericin B in the treatment of candidial or cryptococcal diseases. Griseofuluin is derived from penicillium. It is fungistaticin vitro for species of dermatophytes. It is useful for the treatment of tinea capitis and tinea unginum.

Infective endocarditis in haemodialysis patients: lower complications and same mortality rate as in non-haemodialysis patients.

Infective endocarditis in haemodialysis patients: lower complications and same mortality rate as in non-haemodialysis patients Emad Abu Sitta, Eyassu Habte-Gabr, Zaid Qaraghan, Nour Aljariri Alhesan & Carlos Rios-Bedoya To cite this article: Emad Abu Sitta, Eyassu Habte-Gabr, Zaid Qaraghan, Nour Aljariri Alhesan & Carlos Rios-Bedoya (2016): Infective endocarditis in haemodialysis patients: lower complications and same mortality rate as in non-haemodialysis patients, Infectious Diseases, DOI: 10.1080/23744235.2016.1236288 To link to this article: http://dx.doi.org/10.1080/23744235.2016.1236288

SEPTICEMIA IN OLDER PEOPLE: TRENDS IN PATIENT AND DISEASE CHARACTERISTICS

lavage were used more frequently than ipecac syrup as routine treatment course. We also found that almost 60% of the patients were hospitalized for further treatment. These results confirm that older people are less likely to improve rapidly. Figure 1 further classifiespoison exposures according to the type of agent used. Drugs were responsible for almost 50% of all poisoning cases. In the drug group, benzodiazepines were the most frequently used agents (29%, Figure 1), with diazepam accounting for 41 of 64 of these cases. Because benzodiazepines are the most frequently prescribed sedative/ hypnotic, the high incidence of poisonings observed with these agents was justified. Our previous work on fatal outcome results from poisoning also indicated that many of the deaths attributable to cardiovascular drugs were accidental in nature and occurred mainly in older people. Cardiac glycosides were responsible for 67% of the cardiovascular drug poisonings. Psychotherapeutic drugs, including antipsychotics and antidepressants, closely followed cardiovascular agents as the cause of poisoning (18%, Figure 1). Tricyclic antidepressants were responsible for almost 60% of the poisonings with these agents. As shown in Figure 1, opiate products (opium, heroin, opiate) were next to drugs in frequency of usage (88 out of 384). The number of poisoning cases attributed to pesticides was also noticeable (8%). More than 60% of the poisonings with pesticides occurred with insecticides, mainly organophosphorus compounds. The results from our previous studies on poisoning cases leading to fatality, placed pesticides second to drugs on the frequency of usage. Chemicals followed pesticides as th next leading cause and were involved in 7% of poisoning cases. Older people are more likely to use old-fashioned household products such as cleaners and disinfectants in attempts at self poisoning; this is in agreement with the types of products shown in our survey. Depilatory (main ingredients are arsenic and calcium hydroxide) and kerosene oil were also used commonly as poisoning agents by older people. With the improvements in health care standards, the older population is expected to grow. Therefore, future studies are required to further characterize poisonings in older people and to reduce the incidence of poisoning. Educating medical professionals about the trends and special circumstances of poisoning in this population is of utmost importance.