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Failure to Thrive in the Elderly

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81. Management of obesity

+ Liver disease Compared to healthy-weight patients, overweight and obese patients with abdominal fat distribution experience higher rates of hospitalisation and death due to cirrhosis. 43 37% of asymptomatic morbidly obese patients have histological non-alcoholic steatohepatitis (compared with 3% in the general population) and 91% have steatosis (compared with 20% in the general population). 44,45 In one study of subjects with acute liver failure, obese patients had an RR of 1.63 for transplantation (...) or death. 46 2 + Mortality Obesity is associated with excess mortality. 47,48,49 BMI (above 22.5-25 kg/m 2 ) is a strong predictor of overall mortality with most of the excess mortality likely to be causal and due to vascular disease. In the elderly (age =65), a BMI in the moderately obese range is associated with a modest increase in mortality risk regardless of sex, disease state and smoking status. 50 Physical inactivity and adiposity have both independent and dependent effects on all-cause

2010 SIGN

84. Ulcerative colitis

present with weight loss, failure to thrive in children, and chronic diarrhoea. For more information, see the CKS topic on . Anal fissure — may present with severe anal pain on defecation (with or without blood). For more information, see the CKS topic on . Pseudomembranous colitis — can present with abdominal pain and chronic diarrhoea, with or without blood in the stool. Infection is more likely if the person has recently taken antibiotics or been admitted to hospital. For more information, see (...) : Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy (including a review of TA140 and TA262) National Institute for Health and Care Excellence. [ ] NICE (2015) TA342: Vedolizumab for treating moderately to severely active ulcerative colitis. National Institute for Health and Care Excellence [ ] Economic appraisals No new economic appraisals relevant to England since 1 July 2014. Systematic reviews and meta-analyses

2014 NICE Clinical Knowledge Summaries

85. Gastroenteritis

, or beverages contaminated by the faeces of infected humans or animals. Many cases are associated with recent foreign travel. The symptoms of giardiasis include acute and chronic diarrhoea (which can last for 2–6 weeks and occasionally longer), malabsorption, weight loss, and (in children) failure to thrive. Other symptoms include abdominal pain, anorexia, flatulence, bloating, and nausea. Vomiting and fever are uncommon. [ ; ; ; ; ] Prevalence How common is it? About 20% of the UK population develop (...) is variable, depending on the duration of symptoms and the causative pathogen [ ]. Dehydration is more likely to occur in young children than in teenagers. Haemolytic uraemic syndrome (HUS) HUS is a rare but serious complication of acute infectious gastroenteritis that occurs mostly in young children and the elderly [ ]. It is a potentially life-threatening complication [ ], characterized by acute renal failure, haemolytic anaemia, and thrombocytopenia may occur [ ]. Initial presenting features include

2014 NICE Clinical Knowledge Summaries

86. Kanuma - sebelipase alfa

and the scientific discussion within the Committee, issued a positive opinion for granting a Marketing Authorisation to Kanuma. 2. Scientific discussion 2.1. Introduction The target disease of the ERT product sebelipase alfa is known as LAL deficiency, and is a progressive multisystem disease which frequently manifests early in life leading to serious complications. In infants, these complications include failure to thrive with progressive liver injury, rapid development of liver fibrosis, and early death (...) plays a key role in the metabolism and degradation of cholesteryl esters and triglycerides, and its marked reduction or absence leads to accumulation of these lipid substrates in the lysosomes of various tissues and cell types throughout the body, particularly affecting the liver, leading to fibrosis, organ dysfunction and failure, as well as the intestine, leading to malabsorption and adverse effects on growth, and other issues that may result from these. LAL deficiency has two distinct forms

2015 European Medicines Agency - EPARs

87. Depression - antenatal and postnatal

[ ; ]. Depression in pregnancy, particularly if not treated, may affect the cognitive, emotional, social, educational, behavioural, and physical development of the infant, although a minority of children are affected [ ; ]. Peripartum depression is associated with failure to thrive, attachment disorder, and developmental delay at a year old [ ]. There is an association with depression in pregnancy and depression in adolescents and young adults [ ]. Depression in the postnatal period may be associated

2013 NICE Clinical Knowledge Summaries

88. Eczema - atopic

eczema that has not been controlled by optimum management, particularly if associated with gut dysmotility (colic, vomiting, altered bowel habit) or failure to thrive. Most people do not need allergy testing. Advise avoidance of over-the-counter tests as these are of no proven value. If a food allergy is suspected, manage in primary care if the expertise and support are available, otherwise refer to secondary care. If other types of allergies are suspected, refer to secondary care as appropriate

2013 NICE Clinical Knowledge Summaries

90. Telavancin (Vibativ)

levels between 30 mL/min to 50 mL/min. Several committee members noted that the renal effects would likely be a manageable toxicity, and all committee members advised more analysis regarding nephrotoxicity and explicit warnings related to the degree of renal impairment. One member expressed concern with the Applicant’s data showing congestive heart failure and multiple organ failure that was not discussed at the meeting, and noted that these should be looked at more closely to see (...) be minimized and rapid de-escalation criteria should be included in the study protocol. In Studies 0015 and 0019, the diagnosis of renal failure was left to the discretion of the investigator, and in some cases it is unclear whether some of the patients may have had acute as well as chronic renal failure. For patients with potential risk factors, renal status should be more specifically defined by standardized measures at entry and followed more closely for at least 28 days in future clinical trials

2013 FDA - Drug Approval Package

92. Assistive Devices to Improve Independence (Follow-up)

> Geriatric Rehabilitation Updated: Mar 19, 2019 Author: Julie A Muché, MD; Chief Editor: Stephen Kishner, MD, MHA Share Email Print Feedback Close Sections Sections Geriatric Rehabilitation Overview Overview As we age, we face many physical and emotional changes that can affect our level of function and well-being. Our baby-boomer population is aging, and people are living longer. We must maintain functional independence in the elderly and address the needs of our older generation. Rehabilitation (...) of geriatric patients is imperative for the patients' well-being and for society, so that we can thrive socially and economically. [ ] Essential to geriatric rehabilitation is communication, specifically improving any sensory impairment, including those related to vision and hearing. The prevention of falls and osteoporosis can protect the patient's health and improve longevity. Addressing malnutrition can promote healing and vitalize the patient to participate in a formal rehabilitation program

2014 eMedicine.com

93. Upper Respiratory Tract Infection (Diagnosis)

to the necessary equipment are required if respiratory failure is a possibility Administer humidified oxygen to all hypoxemic patients. In patients who do not require oxygen therapy, a cool-mist humidifier may be used IV or oral glucocorticoids are commonly used to reduce symptoms and shorten hospitalization in patients with moderate to severe croup Inhaled racemic epinephrine may temporarily dilate the airways Rhinosinusitis Most cases of acute rhinosinusitis, including mild and moderate bacterial sinusitis (...) affect the prevalence of colds, because most viral URI agents thrive in the low humidity that is characteristic of winter months. Low indoor air moisture may increase friability of the nasal mucosa, increasing a person's susceptibility to infection. Laryngotracheobronchitis, or croup, occurs in fall and winter. Seasonality does not affect rates of epiglottitis. The figure below illustrates the peak incidences of various agents by season. Rhinoviruses, which account for a substantial percentage

2014 eMedicine.com

94. Ureterocalicostomy (Diagnosis)

can result in impairment of renal function, pain, infection, and/or stones. Previous Next: Presentation Clinical symptoms of obstruction include urosepsis, failure to thrive, flank pain or mass, and hematuria. As first described by Dietl, the episodes of flank pain, nausea, and vomiting may present during periods of rapid diuresis with large volumes of liquid intake (so-called Dietl crisis). This may manifest only after consumption of liquids that promote brisk diuresis, such as beer or coffee (...) ; renal capsule, peritoneal, or pericardial flap; [ ] Davis intubated ureterotomy, [ ] buccal mucosa graft, [ , ] and nephrectomy. The decision to perform a nephrectomy must be based on the level of function in the obstructed kidney and the function of the contralateral kidney. If the renal function of the affected kidney is less than 25%, surgical correction has a high risk for failure, and nephrectomy may ultimately be required. If the patient's renal function is less than 10%, recovery is unlikely

2014 eMedicine.com

95. Ureteropelvic Junction Obstruction (Diagnosis)

assistance, is the treatment of choice in older children and in most adults. [ ] Next: History of the Procedure UPJ obstruction is the most common cause of neonatal and , occurring in one per 1500 live births. Prior to the use of prenatal ultrasonography, most patients with UPJ obstruction presented with pain, hematuria, urosepsis, failure to thrive, or a palpable mass. With the enhanced ability and availability of prenatal ultrasonography, urologic abnormalities are being diagnosed earlier and more (...) may lead to progressive renal damage and deterioration. UPJ obstruction presents most frequently in childhood, but adult and elderly individuals can also present with a primary obstructive lesion. In adults, other etiologies for ureteral obstruction must be considered, including , ureteral compression due to extrinsic processes, , and other inflammatory processes. Previous Next: Epidemiology Frequency Epidemiologic features of UPJ obstruction are as follows: Ultrasonography reveals fetal upper

2014 eMedicine.com

96. Breathing-Related Sleep Disorder (Overview)

of a Z appliance, which is an original design of F. Danziger, DDS, FAGD. Previous Next: Surgery To Increase Upper Airway Size Pediatric patients The first line and most common procedure done in children with obstructive sleep apnea (OSA) and adenotonsillar hypertrophy who are surgically acceptable candidates is an adenotonsillectomy. High-risk children, including those with obesity or failure to thrive, young age, severe apnea, craniofacial anomalies, or neuromuscular or cardiac disease should (...) . [ ] In women, menopause, pregnancy, and polycystic ovaries are associated with increased risk. [ ] In children, prevalence ranges between 1 and 4 % with habitual snoring prevalence at about 7.45 %. [ ] Consequences of untreated sleep apnea can be life altering and include both cardiovascular and neurobehavioral morbidities. In children, growth failure can also occur. The aim of this article is to increase the reader's awareness of the importance of sleep-disordered breathing in daily practice. Treatment

2014 eMedicine.com

97. Assistive Devices to Improve Independence (Overview)

> Geriatric Rehabilitation Updated: Mar 19, 2019 Author: Julie A Muché, MD; Chief Editor: Stephen Kishner, MD, MHA Share Email Print Feedback Close Sections Sections Geriatric Rehabilitation Overview Overview As we age, we face many physical and emotional changes that can affect our level of function and well-being. Our baby-boomer population is aging, and people are living longer. We must maintain functional independence in the elderly and address the needs of our older generation. Rehabilitation (...) of geriatric patients is imperative for the patients' well-being and for society, so that we can thrive socially and economically. [ ] Essential to geriatric rehabilitation is communication, specifically improving any sensory impairment, including those related to vision and hearing. The prevention of falls and osteoporosis can protect the patient's health and improve longevity. Addressing malnutrition can promote healing and vitalize the patient to participate in a formal rehabilitation program

2014 eMedicine.com

98. Rhinocerebral Mucormycosis (Diagnosis)

formation occur, and this allows the organism to invade the patient's blood vessels. Mucormycosis is described almost exclusively in patients with compromised immune systems or metabolic abnormalities. Rhizopus species have an active ketone reductase system that enables them to thrive in an acidic pH and glucose-rich medium. Hyperglycemia enhances fungal growth and impairs neutrophil chemotaxis; therefore, individuals with are commonly affected. Rhizopus species also favor an iron-rich environment (...) .) This diabetic patient with mucormycosis presented with complete ophthalmoplegia and proptosis. Note the complete ptosis and periorbital edema on the right side. Iron overload Iron overload states, as observed with and deferoxamine treatment in patients receiving dialysis, may be risk factors. Iron enhances fungal growth and increases susceptibility. Researchers have reported infection in patients with liver and renal failure. [ ] Burns In individuals with burns, mucormycosis generally involves only the skin

2014 eMedicine.com

99. Coronary Artery Atherosclerosis (Diagnosis)

. United States statistics In the United States, approximately 14 million persons experience CAD and its various complications. Congestive heart failure (CHF) that develops because of ischemic cardiomyopathy in hypertensive MI survivors has become the most common discharge diagnosis for patients in American hospitals. Approximately 80 million people, or 36.3% of the population, have cardiovascular disease. Annually, approximately 1.5 million Americans have an AMI, a third of whom die. In 2009, 785,000 (...) comorbidities than test subjects. The guideline is now “effectiveness-based” rather than “evidence-based.” Effectiveness-based considerations have reduced the strength of previous recommendations for use of aspirin, statins (in women with elevated C-reactive protein but normal cholesterol), and aggressive glycemic control in diabetes. The elderly and coronary artery disease Age is the strongest risk factor for the development of CAD. Most cases of CAD become clinically apparent in patients aged 40 years

2014 eMedicine.com

100. Dermatologic Manifestations of Gastrointestinal Disease (Diagnosis)

, and respiratory tracts, leading to fragility and resulting in extracutaneous complication. [ ] A retrospective analysis of 223 patients with EB found 58% of patients had GI complications. [ ] In EB simplex, constipation and gastroesophageal reflux (GOR) were frequently observed. In junctional EB, failure to thrive and protein-losing enteropathy (PLE) were the prominent findings. Constipation was common in patients with dystrophic EB. GOR and dysphagia affected most of the patients with recessive dystrophic EB (...) . [ ] Therefore, it is particularly difficult to identify the sign of Leser-Trélat in the setting of an elderly patient. As such, this finding may be more useful in younger patients, when there is a rapid increase in the size and number of lesions or when other suspicious findings such as acanthosis nigricans, florid cutaneous papillomatosis, weight loss, dysphagia, or changes in bowel movements are present. Similar to acanthosis nigricans, patients presenting with the sign of Leser–Trélat have a poor

2014 eMedicine.com

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