European Geriatric Medicine - Supplement 1 - Volume 7 - October 2016

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extruded two hard fragments that appear to be bone, which are used
for morphological study.
Results: The submitted sample is described as necrotic bone tissue
with abundant bacterial colonies of Actinomyces. Amoxicillin treat-
ment is initiated for a period of six weeks, being the patient
asymptomatic at the time of writing this report.
Key conclusions: The correct diagnosis of this entity is critical to set a
successful therapeutic treatment to prevent disabling symptoms such
as delirium.
P-044
Doctor, I have a terrible headache
T. Martínez Maroto, E. García Tercero, A. Blanco Orenes, F. Moreno
Alonso, B. Cámara Marín. Hospital Virgen del Valle
Introduction: Painful ophthalmoplegia is characterized by painful
ocular paralysis and resistant to analgesic treatment ipsilateral
headache. It is produced by an affectation of the cavernous sinus that
may be due to multiple causes.
Methods: The case below is a 84-year-old patient referring headache,
progressive, with twenty days of evolution. After having been valued
on several occasions in the Emergency Department, with normal
results on complementary tests, with analgesic treatment without
clinical improvement, the patient was hospitalized in our hospital.
She refers severe left hemicraneal headache with left cranial nerve VI
(CN VI) paralysis. Triptans were prescribed, persisting the symptons, so
we gave corticosteroids at high dose and request nuclear magnetic
resonance (NMR). Afer 24 hours with costicosteroids, she refers CN VI
paralysis without headache.
Results: The NMR shows diffuse meningeal thickening in both
cavernous sinus with left dominance, thickening of both ophthalmic
veins and perineural enhancement of both optic nerves, with left
dominance. Findings from imaging tests along with the clinical
improvement and discarded other pathologies, are compatible with
Tolosa-Hunt syndrome.
Key conclusion: Tolosa-Hunt syndrome is a rare disease, defined as a
idiopathic granulomatous inflammation of the cavernous sinus and
superior orbital fissure, characterized clinically by unilateral painful
ophthalmoplegia, associated with abnormalities in brain ’ s NMR. In
his diagnosis, exclusion of other causes of painful ophtalmoplegia
is important. The main pillar of the treatment are corticosteroids at
high doses and maintained over time, with fast response, showing
improvement in pain before 72 hours, although the ophthalmoplegia
may take weeks or months to resolve.
P-045
Walking in hospital is associated with a shorter length of stay in
older medical inpatients
R. McCullagh1, C. Dillon2, D. Dahly3, N.F. Horgan4, S. Timmons 1. 1Centre
for Gerontology and Rehabilitation, University College Cork, 2Department
of Epidemiology and Public Health, University College Cork, 3Clinical
Research Facility Cork, Mercy University Hospital, Cork, 4Royal College of
Surgeons in Ireland, Dublin, Ireland
Objective: We aimed to estimate the associations of step-count
(walking) in hospital with physical performance and length of stay in
older medical inpatients.
Methods: Medical in-patients aged ≥65 years, premorbidly mobile,
with an anticipated length of stay ≥3 days, were recruited.
Measurements included average daily step-count, continuously
recorded until discharge, or for a maximum of five weekdays
(Stepwatch Activity Monitor); co-morbidity (CIRS-G); frailty (SHARE
F-I); and baseline and end-of-study physical performance (Short
Physical Performance Battery). Linear regression models were used
to estimate associations between step-count and end-of-study
physical performance or length of stay. Length of stay was log
transformed in the first model, and step-count was log transformed
in both models. Similar models were used to adjust for potential
confounders.
Results: Data from 154 patients (mean 77 years, SD 7.4) were analysed.
The unadjusted linear regression models estimated for each unit
increase in the natural log of step-count, the natural log of length of
stay decreased by 0.18 (95% CI −0.27 to −0.09). After adjustment of
potential confounders, while the strength of the inverse association
was attenuated, it remained significant (βlog(steps) = −0.15, 95%CI
−0.26 to −0.04). This showed a 50% increase in step-count was
associated with a 6% shorter length of stay. There was no apparent
association between step-count and end-of-study physical perform-
ance once baseline physical performance was adjusted for.
Conclusions: The results indicate that step-count is independently
associated with hospital length of stay, and merits further
investigation.
P-046
Acute kidney injury: case report
C.M. Mendes1, J.M. Dias2, H. Silva2, E. Nogueira 2, S. Jorge2, J.M. Lopes1,
J.A. Lopes2. 1Centro Hospitalar de Lisboa Norte - Hospital de Santa Maria,
Medicina Interna 2, 2Centro Hospitalar de Lisboa Norte – Hospital de
Santa Maria, Nefrologia e Transplantação Renal, Lisboa, Portugal
Introduction: Acute interstitial nephritis (AIN) is an important cause
of acute kidney injury (AKI) and its prevalence in the elderly may be
increasing.
Case-report: We report a case of an 83-year-old man, with a prior
history of uncomplicated hypertension, who started ciprofloxacin for
acute infectious colitis. Three days later, he presented new onset of
nausea, vomiting and nonoliguric stage 3 (KDIGO) AKI with need of
renal replacement therapy. Urinary sediment revealed leukocytes,
erythrocytes and granular casts. The autoimmune study and renal
ultrasound were normal. Although kidney biopsy was inconclusive,
chronology of the events and evolution of the disease suggest AIN
due to ciprofloxacin. The patient started prednisolone 1 mg/Kg/day,
achieving normal renal function within 3 weeks.
Discussion: The majority of AIN among elderly are due to drugs,
while autoimmune or systemic causes are uncommon. The classical
presentation is featured by hypersensitivity manifestations (skin
rash, eosinophilia, fever) but has been largely replaced by oligosymp-
tomatic presentations that require a higher suspicion index. The
definitive diagnosis is dependent on kidney biopsy, however, a
relatively normal biopsy and urinalysis findings should not exclude
it. Therefore, drug-induced AIN (DI-AIN) should be suspected in a
patient who presents with AKI after administration of a known culprit
drug and a suggestive urinalysis. The presumptive diagnosis may be
established when drug discontinuation results in clinical improve-
ment. So, the mainstream of therapy is rapid discontinuation of the
culprit agent. Although corticosteroids are widely used in DI-AIN to
speed kidney function recovery and avoid chronic kidney disease, their
efficacy remain unproven.
P-047
Multidisciplinary frailty assessment in the emergency department:
driving the future today!
L. Mieiro1,2, O. Kayode2, F. Hayat2, F. McCarthy3, S. Green1. 1Department
of Medicine for Elderly People, Whipps Cross University Hospital, Barts
Health NHS Trust, 2Forest Assessment Unit, Whipps Cross University
Hospital, Barts Health NHS Trust, 3Admissions Avoidance Team, Whipps
Cross University Hospital, Barts Health NHS Trust, London, United
Kingdom
Background: Demographic change is an increasing challenge for
Emergency Departments (EDs). Frail elderly patients attending EDs are
exposed to more adverse outcomes, such as hospital admission and
multiple attendances. The authors analyse the impact of comprehen-
sive geriatric assessment (CGA) delivery in ED and explore possible
predictors of hospital admission in frail elderly patients.
Methods: Prospective observational cohort study in the ED of a British
University Hospital over an 8-week period. All cases assessed in the ED
Frailty Unit included. Statistical analysis performed on SPSSv23.
Poster presentations / European Geriatric Medicine 7S1 (2016) S29–S259 S40