internal medicine wards, including infectious focus, most frequent
microbiological agents implied, treatment and outcomes.
We have performed a retrospective cohort study including
281 patients aged >65 years old with sepsis admitted to internal
medicine wards of our hospital during a 12-month period.
Their mean agewas 82.42 years, 52.3% were female and 94.3%
had significant comorbidities. On admission, 192 patients (68.3%) had
community acquired infection. 106 patients (37.7%) presented septic
shock. 91.5% of this infected population had microbiological docu-
mentation. More than half received inappropriate initial antibiotic
therapy, but still one quarter kept the initial treatment. 52.3% and
35.2% had urinary and respiratory infectious focus, respectively.
Multiresistant agents were found in 10.8% blood cultures, 28.4% in
urine cultures and 30.3% in spuctum cultures. 31.3% of the patients
died and roughly half of these patients had septic shock. Mean admis-
sion length was of 12 days. On multivariate analysis, the presence of
septic shock was an independent prognostic factor of mortality.
Sepsis in the elderly remains a challenge due to age-
related vicissitudes and to their comorbidities. Higher functional
disability as well as the use of inapropriate antibiotics are independent
prognostic factors wich adversely affect the outcome of patients with
sepsis admitted to Internal Medicine wards.
forgotten cause of severe anemia
F. Pontes, J. Leite, D. Aguiar, M. Valério, C. Athayde, A. Rodrigues.
Hospital Geral dos Covões, Coimbra, Portugal
Cameron lesions are an uncommon and frequently
overlooked cause of insidious gastrointestinal bleeding and iron
deficiency anemia. They are described as chronic linear erosions
or ulcers positioned on the crests of folds at the diaphragmatic
impression in patients with a large hiatal hernia. The cause of Cameron
lesions remains unclear and its diagnosis requires a high index of
suspicion. The response to medical treatment is variable. Treatment is
based on oral iron replacement therapy and antisecretory therapy with
proton pump inhibitors. A case with typical clinical and endoscopic
presentation and good response to medical therapy is reported.
To report a case of severe anemia due to Cameron Ulcer.
Design: Case report. Setting: Community teaching hospital. Patient:
84-year-old woman coming to the hospital with dyspnea and cough.
The X Ray reveled a Community Adquired Pneumonia. On presenta-
tion, her blood hemoglobin level was 4.6 g/dL, so she had to receive
blood transfusion. She underwent EGD which confirmed a large hiatal
hernia and showed milimetric ulcer, consistent with a Cameron lesion.
The ulcer was treated with a proton pump inhibitor. She started iron
and folic acid replacement therapy and recovered uneventfully.
Cameron ulcers are a mechanical phenomenon, related to
extrinsic compression of the diaphragm on the stomach in patients
with large hiatal hernias. These lesions should be suspected during
upper endoscopy in patients with large hiatal hernias as Cameron
ulcers may be overlooked due to their location along the diaphrag-
A difficult case of refractory heart failure
, F. Orso
, A. Baroncini
, A. Foschini
, E. Carrassi
, C. Ghiara
, A. Herbst
, N. Marchionni
, M. Di Bari
, S. Baldasseroni
Department of Experimental and Clinical Medicine, Careggi University
Hospital, University of Florence, Florence,
University of Florence, Florence
A 77 years old woman remained in good health until December 2013
when began to lose weight and to complain fatigue and dyspnea.
In March 2014 a cardiological evaluation was performed: echocardi-
ography showed moderate mitral regurgitation, elevated LV filling
pressures and increased PAPS. She was started on diuretic therapy and
nitrates. From May to June she was admitted three times for acute
heart failure; echocardiographic findings were stable. Cardiac MRI
demonstrated increased thickness of intraventricular septum and
widespread iperenhancement, especially in basal and middle seg-
ments of subepicardial layer. Protein electrophoresis detected two
monoclonal components (IgA lambda and small level of free lambda
chains). Periumbilical fat biopsy resulted negative. Abdominal CT
t show significant evidences. The patient returned home, but
from discharge dyspnea rapidly worsened together with increased
peripheral edema refractory to diuretic therapy. In July, again
hospitalized, the patient appeared somnolent, with low blood
pressure and in an anasarcatic state. At the Electrocardiography,
reduced voltage in the peripheral leads appeared; Nt-proBNP was
50,000 pg/mL. Serum immunofixation confirmed monoclonal com-
ponent IgA LAMBDA with abundant free light chains in serum
(428.00 mg/L; ratio kappa/lambda 0.0080). Sampling of periumbilical
fat was repeated with positive result. We concluded for diagnosis of
isolated cardiac AL amyloidosis. Chemotherapy was contraindicated
and the patient died after 12 days of hospitalization. Isolated cardiac
amyloidosis is a rare disease (3.9%): It should be suspected in all
patients with heart failure who have a wall thickening at echocardi-
ography, with normal size of the heart chambers and low ECG voltages.
Go slow? Twomonths experience in the first Portuguese
F.R. Rocha, R.T. Martins, E.D. Haghighi, J.A. Barata.
Geriatric Unit, Internal
Medicine Department, Hospital Vila Franca de Xira, Portugal
In Portugal Geriatric medicine it is in its early days and a
comprehensive health care approach of this age group is still sparse.
The pilot project of the Geriatric Unit of Hospital Vila Franca de Xira is
pioneer in Portugal and started on March 1st of 2016.
We retrospectively analysed the patients admitted to the
Geriatric Unit between March 1st and April 30th 2016. All patients
were submitted to a comprehensive geriatric assessment (CGA). We
divided the sample between patients with and without criteria for
admission, and in the former we evaluated the distribution by sex, age,
number of diagnosis and drugs taken, length of stay, CGA, admission
cause and final diagnosis.
From the 43 patients sample, 34 (79%) had admission criteria.
The main exclusion criteria were age, no reversibility potential, acute
disease only and terminal illness. Within the patients with criteria the
average age was 83.4 years, 67.6% were female and 32.4% male, 17.7% of
patients have had an admission in the previous month. The average of
drugs on admission was 7.8, the average of co-morbidities was 4. The
average length of stay was 8.9 days. The most common first discharge
diagnosis was acute tracheobronchitis, congestive heart failure
exacerbation and urinary tract infection.
As in many new projects, the Geriatric Unit Team
foresees several obstacles on the way to achieve the optimal elderly
care. The biggest barrier expected is the non-recognition by all
healthcare providers of a truly geriatric patient.
Emergency room utilization in tertiary Portuguese hospital by
, F. Leal-Seabra
, M. Brinquinho
, R. Veríssimo
Internal Medicine Department of Centro Hospitalar Vila
Nova de Gaia/Espinho
Emergency departments [ED] are challenged to provide
rapid access to high-quality care and are needed to create a pathway to
assist the elders. We describe the older profile.
Data were obtained from a sequence of 4 weeks. The
variables analyzed were: gender, age, ICD9, color of the Manchester
Triage System, discharge and length of stay. Statistical analysis was
used for comparing means to a pvalue <0.05 and relative risk (RR).
The admission to ED were 7827, and the data represent 87.7%.
Older adults comprised 33.7% of all ED visits during this time. Of note,
ED visits were more likely to be associated with women with middle
age, triage with yellow color [63.9%], moderate severity, ICD 9 injury
Poster presentations / European Geriatric Medicine 7S1 (2016) S29