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Delirium is associated with increased mortality in the geriatric population

Abstract Objective: The aim of this study was to investigate the prevalence of delirium and its association with mortality rates in elderly inpatients. Methods: The medical records of 1435 patients over 65 years old who were treated at a regional university hospital and were referred to the university’s Consultation and Liaison Psychiatry Clinic for psychological evaluation were retrospectively analyzed. Patients with and without a diagnosis of delirium were compared. The National Survival Database was used to determine mortality rates. Results: The prevalence of delirium was 25.5%. The delirium group was older (p < .0001) and had a larger proportion of males (p < .0001). Mortality rate was higher in the delirium group at 1, 2, 3, 4, and 5 years (p < .0001 for all). Age, gender, lower urinary system diseases, chronic liver disease, solid hematologic malignancy, infections, and Alzheimer’s disease emerged as significant parameters associated with mortality. Multivariate analysis of these parameters indicated that comorbid diseases (lower urinary system diseases, chronic liver disease, solid hematologic malignancy, infections, and Alzheimer’s disease) are risk factors for mortality independent of demographic data such as age and gender. Conclusions: Independent of all other factors, delirium is associated with higher mortality risk.

High C-Reactive Protein and Low Albumin Levels Predict High 30-Day Mortality in Patients Undergoing Percutaneous Endoscopic Gastrotomy

Background Percutaneous endoscopic gastrotomy (PEG) enables long-term enteral feeding. The aim of this study was to identify biomarkers that may guide the decision of whether to perform the elective procedure of PEG. Methods The medical records of all patients who underwent PEG in our hospital from 2010 to 2016 were screened retrospectively. Patients with mortality within a 30-day follow-up period and those without were compared using the Chi-square test, and continuous variables were compared with the Kruskal-Wallis and Mann-Whitney U tests. Receiver operating characteristic (ROC) curve analysis was used to demonstrate the ability of biomarkers to predict mortality; a cut-off point was determined and its sensitivity, specificity, and positive and negative predictive values were calculated. The Youden index was used to determine the cut-off point. Kaplan-Meier analysis was used to identify PEG-related mortality risk factors and a Cox regression model was applied for risk characterization. Results A total of 120 patients who underwent PEG were evaluated in the study. The mean age was 67.00 ± 18.00 years. The most common indication for PEG was cerebrovascular disease, in 69 (57.5%) of the patients. Infection of the PEG site was most common within 14 days after PEG tube placement, occurring in 13 patients (10.3%). The mortality rate among patients with post-PEG infection was 68.2%, significantly higher than in patients without infection (P = 0.012). Thirty-four patients (28.3%) died within 30 days of undergoing PEG. CRP values ≥ 78.31 mg/L increased mortality by 8.756-fold, and albumin levels < 2.71 g/dL increased mortality by 2.255-fold. Conclusion Our results indicate that the presence of both high CRP level and low albumin level were associated with significantly higher rate of mortality (73.1%) in patients who underwent PEG.

Üst gastrointestinal sistem kanaması ile başvuran gastrik gastrointestinal stromal tümör olgusu

Gastrointestinal stromal tumorler gastrointestinal sistemin nadir (%1) mezenkimal neoplazmidir. Yerlesim yeri siklik sirasina gore mide (%60-70), ince barsaklar, kolorektum ve ozofagustur. Capi 4 cm’den buyuk, sinirlari duzensiz, heterojen ekolu, ekojenik odaklar ve kistik olusumlar iceren Gastrointestinal stromal tumorler genellikle maligndir. Seckin tedavisi komplet cerrahi rezeksiyondur. Ust gastrointestinal sistem kanamasi ile prezente olan, gastrointestinal stromal tumor saptanan, 65 yasinda, erkek hasta sunulmustur.

Evaluation of attempted older adults suicides admitted to a University Hospital Emergency Department: Izmir study

INTRODUCTION Advanced age is one of the risk factors for attempting suicide. Suicide attempts are one of the reasons for elderly patients to admit emergency services. The aim of this study was to investigate the relationship between suicidal behavior and sociodemographic factors and concurrent somatic diseases. METHODS The medical records of patients aged 60 years and over who presented to the emergency department of our university hospital for attempted suicide between the dates of January 1, 2007 and December 31, 2015 were screened retrospectively. Individuals recorded as cases of suicide on the forensic case report form were identified, the data recorded at our hospital were obtained, and telephone interviews were conducted to acquire any missing data. RESULTS A total of 63 patients with a mean age of 65.88 years were included in the study. A large proportion of the suicide attempts occurred in the years 2014 and 2015. Overall, 23.8% of the patients had a previous history of suicide attempt. Overdose was the method in 74.6% of the suicide attempts, and 70.2% were impulsive; 63.5% of the patients had a history of psychiatric disease. The most common psychopathology was major depressive disorder. CONCLUSION We found that suicide attempts were more common among older adults with a history of depression, that approximately one in four had previously attempted suicide, and that the majority of individuals attempting suicide chose to use their own medication.

Akut karın ağrısında nadir bir sebep: ince bağırsak adenokarsinomu

Introduction: Malignant tumors of the small intestine comprise 2-3% of all gastrointestinal cancers. Adenocarcinomas account for 95% of primary small intestine malignancies. The prevalence of adenocarcinoma increases with advanced age. They are commonly located in the distal duodenum and the proximal jejunum. They are usually diagnosed coincidentally and are most effectively treated by surgery. Case Presentation : Here we present a 67-year-old female patient who underwent emergency surgery for acute strangulated hernia during which a tumoral mass was discovered in the ileum, leading to a diagnosis of adenocarcinoma of the ileum. Conclusion: The most effectively treated method is surgery in small intestine adenocarcinomas.

Perforation of Ileum Due to Thrombosis in the Course of Paroxysmal Nocturnal Hemoglobinuria: A Case Report

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare disease which is characterized by hemolysis, thromboses in unexpected sites and multi-organ involvement. Arterial thromboses could result in necrosis and dysfunction of involved organs. In some cases, organ dysfunctions could be fatal as in involvement of heart, small intestine and lung. Eculizumab is a monoclonal antibody which decreases risk of thrombosis and hemolysis in patients with PNH by inhibiting complement system. Hereby, we present a case with acute abdomen which was operated and small intestinal necrosis was detected due to thromboses which was resulted in PNH undiagnosed until the time of operation. Unexpected thromboses should be carefully investigated in terms of potential coexistence of PNH associated with multi-organ involvement and treated appropriately.