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Around 1/4 of the strokes is cryptogenic. 25% of the

strokes is related to atrial fibrillation (AF), which is often asymptomatic

and difficult to detect. Implantable Loop Recorder (ILR) proved to

be superior than conventional follow-up in detecting AF after a

cryptogenic stroke (1).


Between 2010 and 2016, 26 patients with cryptogenic stroke

underwent ILR implantation, aimed at detecting AF; 2 other patients

with a complex clinical scenario, have been implanted to better guide

the therapy.


Mean age was 69 years. 67% of the patients was on

acetylsalicyclic acid, 10.7% on thienopyridines and 7.1% of the patients

was on double anti-platelet therapy. 2 patients with a complex clinical

scenario were on oral anticoagulant therapy.

After a mean follow-up of 10 ± 12 months, AF was detected in 7

patients, two of whom also experienced asystole. One patient with

AF, stroke and syncope showed an asystole lasting 20 seconds. One

patient with paroxysmal AF after an acute myocardial infarction,

showed recurrence of AF, that led to maintain oral anticoagulation. A

pacemaker was implanted in 3 patients, 4 patients started warfarin

and 2 patients new oral anticoagulant therapy.


The ILR is a useful device both in the diagnosis of

arrhythmias and in guiding the therapy in complex clinical scenarios.


1. Sanna T, Diener HC, Passman RS

et al.

Cryptogenic stroke and

underlying atrial fibrillation.

N Engl J Med

. 2014;370:2478



Should we use Cystatine C based equations to estimate GFR in

elderly patients 80 plus?

P. Weiler, B. Hölzl.

Landesklinik St. Veit, Paracelsus Medical University,

Salzburg, Austria


The incidence of chronic kidney disease (CKD), heart

failure (HF) and atrial fibrillation (AF) is increasing with age. Aim of

the study was to analyze the correlation between creatinine and/or

cystatine based estimated GFR equations and NT-proBNP or AF,



100 consecutive patients, mean age 86 (80

95), 81% females

were included. eGFR was calculated employing MDRD, CKD-Epi 2009

(creatinin based), CKD-Epi 2012 (creatinine/cystatine based) and

Grubb equation (cystatine/age) respectively. NT-proBNP was mea-

sured. Additionally the prevalence of AF was determined in the

study population. Anova, Spearman

s and Pearson-Correlation-Test,

Mann-Whitney U Test, Chi squared Test, logistic regression test were



NT-proBNP (median 3,617 pg/mL with 779 pg/mL without

AF) correlated highly significant (p 0,0001) with AF NT-proBNP higher

than 500 pg/mL showed lower eGFR (p 0,019) (Grubb Formula). Cut

off point was 900 pg/mL (p 0,054) for MDRD Equation. Patients

with AF showed lower eGFR (Grubb Formula: p 0,032); (CKD-Epi 2012:

p 0,042); (CDK-Epi 2009: p 0,05); (MDRD: p 0,07 ns).


Cystatine C based equations to estimate GFR in elderly

patients showed a higher association with cardiovascular risk factors

as HF and AF, than creatinine based formulas. Reliable risk stratification

may help to avoid over- or undertreatment, especially in the elderly.

Area: Infectious diseases and vaccines


Golden hours of sepsis for long term patients in Enaya Specialized

Care Center

I. Badarudeen, H. Alhamad, S. Osman, M. Malkawi, R. Attalla,

N. Alsalami, W. Alam.

Hamad Medical Corporation, Doha, Qatar


The Enaya Specialized Care Center is a support facility

that works with Hamad General Hospital and Rumailah Hospital and

provides 24-hour care to long-term patients. The center features 156

patient beds, is the only specialized facility of its kind in Qatar, and one

of the first in the Arab World. Sepsis is one of the most prevalent

diseases and one of the main causes of death among hospitalized

patients. The Severe Sepsis 3-Hour Bundle represents a distillation of

the recommendations found in the practice guidelines published by

the Surviving Sepsis Campaign.

In Enaya, there was low rate of compliance (52%) with 3 hours sepsis

bundle (blood cultures, intravenous fluids, lactate level, antibiotics) in

patients with sepsis which leads to increased morbidity and mortality.

A quality improvement project was carried out from September 2015

to December 2015.


To increase the compliance rate of 3 hour sepsis bundle from 50%

to 80% in patient with sepsis in ENAYA.


Data collection and analysis

Educational sessions and surveys

Designed pocket cards on systemic inflammatory response

syndrome and sepsis for nurses and doctors

Designed, piloted and implemented a compliance monitoring tool

for the monitoring compliance to sepsis bundle


By the end of December 2015, the compliance to sepsis

bundle improved from52% to 100%. In themonths thereafter, the effect

of our project was sustained through January-March 2016, with

compliance rate average of 94%.


Clostridium difficile infection mortality prediction model in

geriatric patients

K. Bielakova, H.M. Kube



Department of Internal Medicine, Geriatrics

and General Practice, Faculty of Medicine, Masaryk University, Faculty

Hospital Brno, Czech Republic


Clostridium difficile infection (CDI) is becoming a

serious problem predominantly in geriatric patients, who are a

significant risk group. The goal of this study was to evaluate the risk

factors for mortality in CDI patients and to construct a binary logistic

regression model which describes the probability of mortality in

geriatric patients suffering from CDI.


In this retrospective study the group of 235 patients over 65

years of age with confirmed diagnoses of CDI, hospitalised at the

Department of Internal Medicine, Geriatrics and General Practice,

Brno, from January 2008 to December 2013, were evaluated. The

examined group consisted of 148 women (63%) and 87 men (37%). For

the diagnosis of CDI, confirmation of A and B toxins in the patients

stool or autopsy confirmation was crucial.


The impact of antibiotic therapy in patients

histories on the

increased incidence of CDI was clearly confirmed in our study group.

Other risk factors included cerebrovascular disease, dementia, the

presence of pressure ulcers and immobility. Our new model con-

sisted of a combination of the following parameters: the number of

antibiotics used from patients

history, nutritional status (Mini

Nutritional Assessment short-form test), presence of pressure ulcers,

and occurrence of fever.


Our logistic regression model may predict mortality in

geriatric patients suffering from CDI. This could help improving the

therapeutic process.


Seroprevalence of hepatitis B and hepatitis C virus infections in

elderly residents in nursing homes in a metropolitan area of Sicily

D. Brischetto


, G. Caccamo


, S. Maimone


, P. Parisi


, G. Pettinato



A. Catalano


, A. Lasco


, G. Basile


, G. Raimondo




Unit of Geriatrics,

University Hospital of Messina,


Unit of Clinical and Molecular

Hepatology, University Hospital of Messina,


Nursing Home




Nursing Home

Giardino sui Laghi

, Messina, Italy


The hepatitis B virus (HBV) and hepatitis C virus (HCV)

prevalence in Italy is reported to be significantly higher in elderly

Poster presentations / European Geriatric Medicine 7S1 (2016) S29