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Objective: To compare the characteristics of acute bacterial prostatitis between patients ≥75 years old with those <75 years old attended in the Emergency Department., Material and Methods: A descriptive and observational study was conducted with a prospective follow-up including all consecutive patients with acute bacterial prostatitis that were admitted during one year to the Emergency Department of a tertiary-care hospital. Data were collected for demographic variables, comorbidities, clinical and microbiological findings, treatment, outcome, and re-consultation at 30 days follow-up. Patients were compared depending on age., Results: A total of 241 episodes of acute bacterial prostatitis were included. The mean age was 62.9±16 years, and 64 patients (26.5%) were ≥75 years old. In the microbiology findings, 104 out of 215 (48.4%) of urine cultures and 25 out of 136 (18.4%) blood cultures were positive. Escherichia coli was the most frequent isolation, with resistance rates in elderly patients above 30% for ciprofloxacin, amoxicillin-clavulanic, and cotrimoxazole, and 15.4% of extended spectrum beta-lactamase producing strains. In the univariate analysis, previous manipulation of the urinary tract, history of cancer, previous antibiotic treatment, resistant E. coli strains, renal impairment, and admission to the hospital were more frequent among patients ≥75 years. Nonetheless, in the multivariate analysis only inadequate empirical antibiotic treatment was found to be significantly more frequent in elderly patients (P=.004)., Conclusions: Drug-resistance patterns to commonly used antibiotics should be considered when choosing empirical treatment for acute bacterial prostatitis in the Emergency Department setting, especially for patients ≥75 years., (Copyright © 2018 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background and Objective: Most studies on chronic obstructive pulmonary disease (COPD) exclude octogenarian patients. Therefore, the disease is not well characterized in this age group. The objective of this study is to analyze the clinical characteristics of octogenarian patients with COPD and the usefulness of the prognostic indexes used most frequently in this age group., Patients and Method: Retrospective study of consecutive patients seen at a clinic between 2009 and 2017. The following variables were analyzed: lung function parameters, distribution of clinical phenotypes, income history, mortality, comorbidities and usefulness of the Charlson, BODEX, COTE and CODEX indexes to predict mortality., Results: The sample comprised 698 patients, 82 aged (11.7%)≥80 years old. Mean follow-up time was 47.9±21.8 months. In octogenarian patients, the severity of the COPD, assessed by means of the FEV 1 % or BODEX index, was similar to that of younger patients, but dyspnea was worse in the elderly group. In these patients, the chronic bronchitis and frequent exacerbator phenotypes were the most frequent, whilst the emphysema phenotype was the least common. Octogenarians had a greater prevalence of cardiovascular comorbidities and renal diseases. Moreover, hospital admissions were more frequent and mortality was higher in these elderly patients. Most prognostic indexes were useful in predicting mortality in elderly patients. CODEX was the most useful index to predict mortality, both in octogenarian and younger patients., Conclusion: Octogenarian patients with COPD have differential characteristics which could imply the need for different therapeutic approaches. Prognostic indexes are useful for predicting mortality in this population., (Copyright © 2017 Elsevier España, S.L.U. All rights reserved.)

Introduction: Information is accumulating on exceptional cases of oily orange anal leakage, probably caused by certain foods and their form of consumption. The leakage is usually inadvertent and is worrisome for patients., Method: Clinical data was gathered on a case series presenting with massive and inadvertent orange oily anal leakage, without sphincter sensation, causing the patients to feel alarmed. This condition usually occurs after eating fish, especially Japanese cuisine., Results: Eleven patients were included (four women and seven men). The mean age was 47.3 years. Colonoscopy had previously been performed in four patients, with normal results. The symptoms, described as keriorrhea, were probably produced by accumulation of indigestible "wax esters", es Mero present in some oily fish, recently incorporated in raw fish dishes (sashimi) or as Japanese Mero sea bass. These oils, which cannot be absorbed or digested, accumulate in the rectum and may also filter spontaneously and induce toxin-related sphincter dysfunction. The same symptoms are sometimes produced after consumption of cooked versions of these species. The diagnosis is given by clinical data, prior ingestion of these types of fish and the self-limiting nature of the symptoms, without the need for further investigations., Conclusion: We describe a case series of a recently described entity associated with dietary changes. This entity is benign and self-limiting. Clinicians should be familiar with the symptoms to inform patients correctly and avoid unnecessary laboratory studies., (Copyright © 2011 Elsevier España, S.L. All rights reserved.)

Introduction: Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality in elderly patients. The short stay units can be an alternative for patients who need admission with acute illness., Material and Methods: Descriptive and retrospective study in an Short-Stay Unit (SSU) of a 900-bed tertiary-care teaching hospital in the metropolitan area of Barcelona, Spain., Period: a total of 22 months from January 2004 to December 2006., Patients: all patients ≥ 75 years admitted to EDSSU with a diagnosis of CAP. Data were collected for demographic variables, Pneumonia Severity Index score (PSI), microbiological findings, antibiotic treatment, length of stay, mortality rates and new admissions during the 30 days following discharge., Results: 175 consecutive patients ≥ 75 years with pneumonia were admitted to the EDSSU. Mean age was 84.31 years (range 75-100, SD ± 5.76), 92 (52,5%) were men, with 24 being nursing home residents. According to the PSI, 64 cases (36.6%) were scored as III, 97 (55.4%) as IV and 14 (8%) as V. A positive microbiological result was obtained in 46 cases (26.2%). Length of stay on average was 3.29 days (range 1-10, SD ± 1.56) and 19 patients died (10.8%). Six (3.8%) attended the ED in the 30 days following discharge., Conclusions: In view of our experience, the EDSSU can be an alternative to standard inpatient for elderly patients with pneumonia in PSI risk class III and IV., (Copyright © 2010 SEGG. Published by Elsevier Espana. All rights reserved.)

The Clinical Notes published in 2009 serve as a resource to reflect on clinical aspects relevant to different clinical entities. Through this review an attempt is likewise made to bring the reader closer to the clinical reality of our environment., (Copyright © 2010 SEPAR. Published by Elsevier Espana. All rights reserved.)