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Failure to Thrive in the Elderly

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181. Overview of Immunodeficiency Disorders

-linked) Oral candidiasis, Pneumocystis jirovecii pneumonia, diarrhea before 6 mo, failure to thrive, graft vs host disease, absent thymic shadow, lymphopenia, bone abnormalities (in ADA deficiency), exfoliative dermatitis as part of Omenn syndrome* X-linked recessive WASP Typically, pyogenic and opportunistic infections, eczema, thrombocytopenia Possibly GI bleeding (eg, bloody diarrhea), recurrent respiratory infections, cancer (in 10% of patients > 10 yr), varicella-zoster virus infection (...) , herpesvirus infection *Omenn syndrome is an autosomal recessive form of severe SCID causing erythroderma, desquamation, alopecia, chronic diarrhea, failure to thrive, lymphadenopathy, eosinophilia, hepatosplenomegaly, and elevated serum IgE levels. ADA = adenosine deaminase; ATM = ataxia telangiectasia–mutated; DOCK = dedicator of cytokinesis; IL-2RG = IL-2 receptor gamma; JAK = Janus kinase; MHC = major histocompatibility complex; NEMO = nuclear factor–kappa-B essential modulator; PTPRC = protein

2013 Merck Manual (19th Edition)

182. Adverse Drug Reactions

information provided by the manufacturer. Symptoms and signs may manifest soon after the first dose or only after chronic use. They may obviously result from drug use or be too subtle to identify as drug-related. In the elderly, subtle ADRs can cause functional deterioration, changes in mental status, failure to thrive, loss of appetite, confusion, and depression. Table Classification of Adverse Drug Reactions (ADRs) Severity Description Example Mild No antidote or treatment is required; hospitalization (...) , coexisting disorders, genetic or geographic factors) and by drug factors (eg, type of drug, administration route, treatment duration, dosage, bioavailability). Incidence is higher with advanced age and polypharmacy. ADRs are more severe among the elderly (see ), although age per se may not be the primary cause. The contribution of prescribing and to the incidence of ADRs is unclear. Pearls & Pitfalls Adverse drug reactions occur in 10 to 20% of hospitalizations. About 10 to 20% of these reactions

2013 Merck Manual (19th Edition)

183. Vitamin Deficiency, Dependency, and Toxicity - Vitamin A

, severe headache, pseudotumor cerebri, and generalized weakness develop. Cortical hyperostosis of bone and arthralgia may occur, especially in children. Fractures may occur easily, especially in the elderly. In children, toxicity can cause pruritus, anorexia, and failure to thrive. Hepatomegaly and splenomegaly may occur. In carotenosis, the skin (but not the sclera) becomes deep yellow, especially on the palms and soles. Diagnosis Clinical evaluation Diagnosis of vitamin A toxicity is clinical. Blood (...) or treatment for skin disorders). Acute toxicity causes rash, abdominal pain, increased intracranial pressure, and vomiting. Chronic toxicity causes rash, increased intracranial pressure, sparse and coarse hair, dry and rough skin, and arthralgia; risk of fractures is increased, especially in the elderly. Diagnose based on clinical findings. When vitamin A is stopped, symptoms (except birth defects) usually resolve within 1 to 4 wk. Last full review/revision March 2018 by Larry E. Johnson, MD, PhD NOTE

2013 Merck Manual (19th Edition)

184. AIDS

without treatment. for HIV and AIDS per 100,000 inhabitants as of 2004. no data ≤ 10 10–25 25–50 50–100 100–500 500–1000 1,000–2,500 2,500–5,000 5,000–7500 7,500–10,000 10,000–50,000 ≥ 50,000 The primary causes of death from HIV/AIDS are and , both of which are frequently the result of the progressive failure of the immune system. Risk of cancer appears to increase once the CD4 count is below 500/μL. The rate of clinical disease progression varies widely between individuals and has been shown (...) , it became legal for people with AIDS to marry in China. In 2013 the developed a traveling exhibition titled, "Surviving and Thriving: AIDS, Politics, and Culture", covering medical research, U.S. government's response, and personal stories from people with AIDS, caregivers, and activists. Economic impact Main articles: and Changes in life expectancy in some African countries, 1960–2012 HIV/AIDS affects the economics of both individuals and countries. The of the most affected countries has decreased due

2012 Wikipedia

185. Hemoglobin

altitudes, such as those in the mountains. hemoglobin featured mutations that allowed for oxygen delivery at lower temperatures, thus enabling mammoths to migrate to higher latitudes during the . This was also found in hummingbirds that inhabit the Andes. Hummingbirds already expend a lot of energy and thus have high oxygen demands and yet Andean hummingbirds have been found to thrive in high altitudes. Non-synonymous mutations in the hemoglobin gene of multiple species living at high elevations (...) hemoglobin include loss of blood, nutritional deficiency, bone marrow problems, chemotherapy, kidney failure, or abnormal hemoglobin (such as that of sickle-cell disease). The ability of each hemoglobin molecule to carry oxygen is normally modified by altered blood pH or , causing an altered . However, it can also be pathologically altered in, e.g., . Decrease of hemoglobin, with or without an absolute decrease of red blood cells, leads to symptoms of anemia. Anemia has many different causes, although

Full Text available with Trip Pro

2012 Wikipedia

186. Hypertension

with hypertension in newborns and young infants. In older infants and children, hypertension can cause headache, unexplained irritability, , failure to thrive, , , and . Causes [ ] Primary hypertension [ ] Main article: Hypertension results from a complex interaction of genes and environmental factors. Numerous common genetic variants with small effects on blood pressure have been identified as well as some rare genetic variants with large effects on blood pressure. Also, have identified 35 genetic loci related (...) peripheral which may increase , increase cardiac and, ultimately, cause . (the difference between systolic and diastolic blood pressure) is frequently increased in older people with hypertension. This can mean that systolic pressure is abnormally high, but diastolic pressure may be normal or low, a condition termed . The high pulse pressure in elderly people with hypertension or isolated systolic hypertension is explained by increased , which typically accompanies aging and may be exacerbated by high

2012 Wikipedia

187. Soybean

quantities to reach a threshold to provoke actual symptoms. Soy can also trigger symptoms via , a situation where no allergic mechanism can be proven. One scenario is seen in very young infants who have vomiting and when fed soy-based formula, which resolves when the formula is withdrawn. Older infants can suffer a more severe disorder with vomiting, diarrhoea that may be bloody, , weight loss and failure to thrive. The most common cause of this unusual disorder is a sensitivity to cow's milk, but soy

2012 Wikipedia

188. Organ transplantation

medicine. Some of the key areas for medical management are the problems of , during which the body has an to the transplanted organ, possibly leading to transplant failure and the need to immediately remove the organ from the recipient. When possible, transplant rejection can be reduced through to determine the most appropriate donor-recipient match and through the use of . Contents Types of transplant [ ] Autograft [ ] Main article: Autografts are the transplant of tissue to the same person. Sometimes (...) in the 4th century, many decades after their deaths; some accounts have them only instructing living surgeons who performed the procedure. The more likely accounts of early transplants deal with skin transplantation. The first reasonable account is of the Indian surgeon in the 2nd century BC, who used autografted skin transplantation in nose reconstruction, a . Success or failure of these procedures is not well documented. Centuries later, the surgeon performed successful skin autografts; he also failed

2012 Wikipedia

189. Chronic wound

be prevented, the factors may be sequestered and unable to perform their metabolic roles, or degraded in excess by cellular or bacterial proteases. Chronic wounds such as diabetic and venous ulcers are also caused by a failure of to produce adequate ECM proteins and by to epithelialize the wound. Fibroblast gene expression is different in chronic wounds than in acute wounds. Though all wounds require a certain level of elastase and proteases for proper healing, too high a concentration is damaging (...) are less effective. Classification [ ] The vast majority of chronic wounds can be classified into three categories: , , and . A small number of wounds that do not fall into these categories may be due to causes such as or . Venous and arterial ulcers [ ] , which usually occur in the legs, account for about 70% to 90% of chronic wounds and mostly affect the elderly. They are thought to be due to caused by improper function of that exist in the to prevent blood from flowing backward. results from

2012 Wikipedia

190. Pyelonephritis

, or of complications of significant renal damage: Fever Malaise Loin pain Nausea Vomiting Dysuria Hypertension Failure to thrive Features of CKD Investigations Urine microscopy, culture and sensitivity : this may be helpful in identifying the organism involved in recurrent infection but negative urine culture does not exclude diagnosis. Imaging : Renal ultrasound may show small kidneys with a thin cortex. Intravenous pyelogram (IVP) may show small kidneys, ureteric and caliceal dilatation/blunting with cortical (...) recommend admission for pregnant women, due to the risk of complications. [ ] Other indications for admission include: [ ] Severe vomiting. Comorbidity such as diabetes. Signs of sepsis (eg, tachypnoea, tachycardia, hypotension). Dehydration or inability to take fluids/medication. Severe pain or debility. Failure of response to treatment in primary care within 24 hours. [ ] Urinary tract obstruction. Oliguria or anuria. Suspected complications (see 'Complications', below). Uncertain diagnosis. Social

2008 Mentor

191. Photosensitive Eruptions (Photodermatoses)

. It presents with failure to thrive, stunted growth, small and narrow facies, sun-sensitive facial telangiectasias, immunodeficiency and increased risk of malignancies. [ ] Defective DNA repair This includes: - a collection of several genetic variants which present in childhood with severe redness and swelling up to 72 hours after sun exposure, resulting in scarring. Very rare. Other These include: Subacute cutaneous lupus erythematosus - this can occur in people with , and , or it may be drug-induced (...) a nutritional supplement containing lycopene, beta-carotene and Lactobacillus johnsonii. [ ] See also separate article . Chronic actinic dermatitis (actinic reticuloid) This is a rare condition affecting mainly middle-aged and elderly men. It often follows years of . Presentation Lichenified plaques on light-exposed skin. It is initially worse in the summer but can become perennial. There is usually little doubt about the diagnosis; however, consider the possibility of a drug-induced photodermatosis

2008 Mentor

192. Non-pulmonary Tuberculosis

before TB developed. [ ] The onset of TB is insidious. Primary infection is usually asymptomatic. The presentation of secondary infection is variable and often nonspecific. A high index of suspicion in patients from particular risk groups is essential to make a diagnosis. TB can affect all organs and body systems. Extrapulmonary TB is more common in children or in the immunosuppressed. General symptoms : fatigue, malaise, fever, weight loss, anorexia, failure to thrive and pyrexia of unknown origin (...) remaining stable at 4.1/100,000 per year. Within this population, those most at risk remain individuals from ethnic minority groups, those with social risk factors and the elderly. The proportion of TB cases with resistance to any first-line drug (7.4%) was slightly lower in 2012 than in 2011, while the proportion of multidrug-resistant (MDR) TB cases (1.6%) remained stable. About one third of the world's population has latent TB infection (LTBI). Over 95% of TB deaths occur in low- and middle-income

2008 Mentor

193. Nephrogenic Diabetes Insipidus

for each patient but polyuria is generally defined as urine output exceeding 3 litres per day in adults. [ ] Polydipsia and chronic thirst are usually a feature and there may be a predilection for very cold drinks, and usually water. Nocturia occurring several times per night is common, particularly in older adults. Children may develop nocturnal enuresis, where they have previously been continent. Infants may present with irritability, failure to thrive, protracted crying, fever, anorexia (...) . Its deficiency or failure to act causes an inability to concentrate urine in the distal renal tubules, leading to the passage of copious volumes of dilute urine. Usually the person with this condition passes >3 litres/24 hours of low osmolality (<300 mOsmol/kg) urine. There are two major forms of DI: Cranial DI: decreased secretion of ADH. Decreased secretion of ADH reduces the ability to concentrate urine and so causes polyuria and polydipsia. Nephrogenic DI: decreased ability to concentrate

2008 Mentor

194. Malnutrition

[ , ] . Nutritional support should be considered for those: With a BMI <18.5. With unintentional weight loss of >10% over the previous 3-6 months. With a BMI <20 and unintentional weight loss of >5% over the previous 3-6 months. Who have eaten little or nothing for >5 days and who are unlikely not to for the following 5 days or longer. Who have poor absorption, high nutrient losses or increased nutritional needs. Differential diagnosis Elderly failure-to-thrive (weight loss >5% of baseline, decreased appetite (...) . ; Management of acute moderate and severe childhood malnutrition. BMJ. 2008 Nov 13337:a2180. doi: 10.1136/bmj.a2180. ; British Association of Parenteral and Enteral Nutrition (BAPEN) ; Validation of the Mini Nutritional Assessment short-form (MNA-SF): a practical tool for identification of nutritional status. J Nutr Health Aging. 2009 Nov13(9):782-8. ; Geriatric failure to thrive. Am Fam Physician. 2004 Jul 1570(2):343-50. ; Dietary advice with or without oral nutritional supplements for disease-related

Full Text available with Trip Pro

2008 Mentor

195. Tuberculosis

before TB developed. [ ] The onset of TB is insidious. Primary infection is usually asymptomatic. The presentation of secondary infection is variable and often nonspecific. A high index of suspicion in patients from particular risk groups is essential to make a diagnosis. TB can affect all organs and body systems. Extrapulmonary TB is more common in children or in the immunosuppressed. General symptoms : fatigue, malaise, fever, weight loss, anorexia, failure to thrive and pyrexia of unknown origin (...) remaining stable at 4.1/100,000 per year. Within this population, those most at risk remain individuals from ethnic minority groups, those with social risk factors and the elderly. The proportion of TB cases with resistance to any first-line drug (7.4%) was slightly lower in 2012 than in 2011, while the proportion of multidrug-resistant (MDR) TB cases (1.6%) remained stable. About one third of the world's population has latent TB infection (LTBI). Over 95% of TB deaths occur in low- and middle-income

2008 Mentor

196. Hypervitaminosis

present with craniotabes, irritability, failure to thrive, decreased appetite and pruritus. Craniotabes is abnormally soft bones of the skull and is unrelated to tabes dorsalis. Complications include: . Hypercalciuria and . Benign intracranial hypertension. Vitamin A may be associated with increased bone fragility and an increased risk of fractures but current evidence is inconclusive. [ ] Investigation FBC. U&E, especially if there is vomiting. LFTs. Ca ++ . Dual-energy X-ray absorptiometry (DEXA (...) be harmful with unwanted consequences to our health, especially in well-nourished populations. The optimal source of antioxidants seems to come from our diet, and not from antioxidant supplements in pills or tablets. Vitamin A and vitamin E supplements may even increase mortality. [ , ] However, vitamin D3 seems to decrease mortality in elderly people living independently or in institutional care. [ ] Vitamin C supplementation has not been shown to reduce the incidence of colds in the general population

2008 Mentor

197. Homocystinuria

to tall stature (occasionally failure to thrive in infancy), fine, brittle hair, hypopigmentation, high arched palate, crowded teeth, arachnodactyly, limited joint mobility, pectus excavatum/carinatum, kyphoscoliosis. Eyes: dislocation of the lens usually downward and medially (ectopia lentis), myopia, glaucoma. CNS: general learning disability (average IQ = 80; 30% have normal IQ), seizures, cerebrovascular events, psychiatric disorders [ ] . Differential diagnosis is the main differential diagnosis (...) to consider [ ] . Marfan's syndrome Homocystinuria Autosomal dominant Aortic incompetence Upwards lens dislocation Normal mentality Scoliosis Flat feet Herniae Autosomal recessive Heart rarely affected Downwards lens dislocation General learning disability Recurrent thromboses Osteoporosis The following conditions also elevate urinary cysteine levels: Elderly Postmenopausal Renal failure Hypothyroidism Leukaemia Psoriasis Drugs - eg, methotrexate, isoniazid Investigations The cyanide-nitroprusside test

2008 Mentor

198. Cranial Diabetes Insipidus

is generally defined as urine output exceeding 3 litres per day in adults. [ ] Polydipsia and chronic thirst are usually a feature and there may be a predilection for very cold drinks, and usually water. Nocturia occurring several times per night is common, particularly in older adults. Children may develop nocturnal enuresis, where they have previously been continent. Infants may present with irritability, failure to thrive, protracted crying, fever, anorexia and fatiguability or feeding problems (...) deficiency or failure to act causes an inability to concentrate urine in the distal renal tubules, leading to the passage of copious volumes of dilute urine. Usually the person with this condition passes >3 litres/24 hours of low osmolality (<300 mOsmol/kg) urine. There are two major forms of DI: Cranial DI: decreased secretion of ADH. Decreased secretion of ADH reduces the ability to concentrate urine and so causes polyuria and polydipsia. Nephrogenic DI: decreased ability to concentrate urine because

2008 Mentor

199. Childhood Tuberculosis

before TB developed. [ ] The onset of TB is insidious. Primary infection is usually asymptomatic. The presentation of secondary infection is variable and often nonspecific. A high index of suspicion in patients from particular risk groups is essential to make a diagnosis. TB can affect all organs and body systems. Extrapulmonary TB is more common in children or in the immunosuppressed. General symptoms : fatigue, malaise, fever, weight loss, anorexia, failure to thrive and pyrexia of unknown origin (...) remaining stable at 4.1/100,000 per year. Within this population, those most at risk remain individuals from ethnic minority groups, those with social risk factors and the elderly. The proportion of TB cases with resistance to any first-line drug (7.4%) was slightly lower in 2012 than in 2011, while the proportion of multidrug-resistant (MDR) TB cases (1.6%) remained stable. About one third of the world's population has latent TB infection (LTBI). Over 95% of TB deaths occur in low- and middle-income

2008 Mentor

200. The effectiveness of domiciliary health visiting: a systematic review of international studies and a selective review of the British literature

intellectual development among children especially among children with a low birth weight or failure to thrive; a reduction in the frequency of unintentional injury as well as a reduction in the prevalence of home hazards; improvements in the detection and management of postnatal depression; enhancement of the quality of social support to mothers; and improved rates of breast-feeding. A meta-analysis of 4 RCTs indicated that intervention group mothers were significantly less likely to report problems (...) programmes were treated as a single study. The studies were divided into two sections: those assessing the outcome of home visiting to parents and young children, and those assessing the outcome to elderly people and their carers. Parents and young children (34 studies). There was evidence to suggest that home visiting was associated with improvements in parenting skills and in the quality of the home environment; amelioration of several child behavioural problems including sleeping behaviour; improved

2000 DARE.

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