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Biomedical subjects

E L Marcus

Publications and source records attributed to E L Marcus.

At least 19 recordsLinked to original sources
PubMed2005

Strict vegan, low-calorie diet administered by caregiving daughter to elderly mother--is this elder abuse?

We present a case in which a 40 year old woman, who was the primary care-giver of her 78 year-old mother, provided a strict vegan diet which caused the mother severe malnutrition. The mother was hospitalized with severe functional deterioration and, while eating a proper diet during hospitalization, gained weight and her condition improved. The case was reported to the Welfare Officer and the mother was released under the supervision of the Welfare Officer. Cases of severe malnutrition and even death of infants who were fed a strict vegan diet have been reported. This case raises some ethical and legal issues. Should a guardian or a caregiver be allowed to make decisions regarding the way of life and medical treatment of the person in his/her charge which are likely to endanger that person's health and when is it appropriate for society to intervene in individual freedom? The paper includes a review of some reported cases of child and elder abuse or neglect which illustrate these issues.

Adult Children↗
PubMed2001

Ethical issues relating to the use of antimicrobial therapy in older adults.

This article aims to review the literature relating to the ethics of antibiotic prescription decisions in older adults and to offer some suggestions as to how one might approach these difficult problems. According to many studies, most patients and their family members wish to receive antibiotics even when they are terminally ill or suffering from advanced dementia. Health care professionals are also frequently reluctant to deny the use of antibiotics in such situations. We suggest that the difficult decisions regarding whether one should withhold treatment can be based on consideration of the ethical principles of autonomy, beneficence, nonmaleficence, and justice. From the public health point of view, one should also take into account the need to avoid the emergence of antimicrobial resistance, keeping in mind the balance between the benefit to the specific patient and the cost to future patients. Infectious diseases consultants should actively participate in these ethical dilemmas.

Aged↗
PubMed1999

Marked elevation of serum creatine kinase associated with olanzapine therapy.

OBJECTIVE: To report a case of marked elevation of serum creatine kinase (CK) associated with olanzapine therapy. CASE SUMMARY: A 39-year-old white Jewish schizophrenic man treated with olanzapine developed an elevated serum CK concentration with a peak concentration of 4000 IU/L (normal < 230). No other diagnostic criteria for neuroleptic malignant syndrome (NMS) were present. On discontinuation of the drug, serum CK concentrations returned to normal within eight days. DISCUSSION: Olanzapine, like other atypical antipsychotic drugs, may cause muscle injury with concomitant elevations of serum CK of muscle origin. We suggest that in patients treated with olanzapine, CK concentrations should be checked on initiation of therapy, within the first 48 hours, and weekly thereafter for at least one month. In addition, patients with clinical signs suggestive of NMS should be monitored more carefully. For those patients with a history of NMS, or even of isolated serum CK elevation during antipsychotic therapy, follow-up should be stricter. CONCLUSIONS: Marked elevation of serum CK may be a possible complication of olanzapine therapy.

Adult↗
PubMed1998

Refusal to eat in the elderly.

Refusal to eat by the elderly, and subsequent malnutrition, occurs in both institutional and community settings. Causes include physiologic changes associated with aging, mental disorders such as dementia and depression, and medical, social, and environmental factors. Treatment approaches call for management of these causes while considering the roles that medicine, ethics, and culture play in the process.

Aged↗
PubMed1997

Viral hepatitis in older adults.

The objective of this paper is to review the epidemiology, manifestations, therapy, and prevention of viral hepatitis in older people and to discuss issues of prevention and management. In developed countries a significant portion of the adult population is not immune to Hepatitis A virus (HAV). Morbidity and mortality from HAV infection increases with age. A safe and effective hepatitis A vaccine is available and health authorities should consider immunization early in life and for healthy adults as well as for potential high risk groups such as nursing home residents. Acute hepatitis due to Hepatitis B virus (HBV) is rare in older people and is usually a mild disease. Most older patients with chronic HBV infection who suffer from advanced liver disease have no evidence of ongoing viral replication. Therefore, they are not candidates for interferon therapy. Those with evidence of ongoing viral replication and compensated liver disease should be offered interferon or be included in clinical trials with new antiviral drugs such as lamivudine. Since the response rate to hepatitis B vaccination decreases with age, developing vaccines with greater immunogenicity is crucial. Hepatitis C virus (HCV) is the most frequent cause of acute viral hepatitis in older people. Acute hepatitis C is usually a mild disease in this age group. Because many older patients with chronic HCV infection have compensated liver disease, they could benefit from antiviral therapy. In light of the low response rate to interferon in older patients with chronic hepatitis C and the side effects of the drug, interferon therapy should be reserved for those with the best chance of response. "Combination" antiviral therapy should be on trial for older patients with chronic HCV infection who do not respond to interferon. The recently discovered RNA virus, Hepatitis G (HGV), has been associated with liver disease in older people. It's role in the pathogenesis of liver injury remains to be elucidated.

Adult↗
PubMed1996

Suspected neuroleptic malignant syndrome in a patient receiving clozapine.

OBJECTIVE: To report a case of suspected neuroleptic malignant syndrome (NMS) associated with clozapine therapy. CASE SUMMARY: A 42-year-old schizophrenic man treated with clozapine developed a temperature of 39.5 degrees C, diaphoresis, tachycardia, rigidity, and leukocytosis. His serum creatine kinase concentration was 25 000 U/L. A diagnosis of NMS was made. He was treated with bromocriptine and supportive therapy, and recovered within a week. DISCUSSION: Despite earlier expectations that clozapine, with a pharmacologic profile differing from that of other antipsychotic medications, might not cause NMS, NMS remains the most likely diagnosis in this case. CONCLUSIONS: NMS may be a possible complication of clozapine therapy.

Adult↗
PubMed1995

Urinary bladder rupture in an elderly patient: case report.

Urinary bladder rupture should be suspected in elderly patients with an acute abdomen. Because symptoms are often atypical among elderly patients, this condition is often undetected. Early diagnosis and treatment could help reduce the mortality rate associated with this condition.

Aged↗
PubMed1993

Miliary Crohn's disease: early or different?

We describe what we take to be the eighth case of miliary Crohn's disease since 1967 with a view to the possibility that miliary Crohn's disease is a disease different from Crohn's disease, and not just an early stage. Miliary Crohn's disease might be a different disease because (a) miliary tubercles are seen so rarely on the serosal surface of the bowel, (b) the 100% chance of finding crowded, typical granulomas in the bowel wall, and (c) the anatomic distribution of the lesion.

Adolescent↗
PubMed1992

Occult elevation of CK as a manifestation of rhabdomyolysis in the elderly.

OBJECTIVE: To evaluate the incidence, etiology and clinical course of rhabdomyolysis in hospitalized elderly patients. DESIGN: Retrospective case series. SETTING: Acute geriatric department of a university-affiliated teaching hospital. PATIENTS: Twenty-three patients who fulfilled our criteria of rhabdomyolysis. Criteria for inclusion were the finding of elevated serum creatine kinase of five-fold or greater above the upper reference limit and greater than 97% MM isoenzyme. RESULTS: In a 3-year period 23 patients out of 2,870 admissions fulfilled the criteria for rhabdomyolysis, an incidence rate of 0.8%. Diseases or insults associated with rhabdomyolysis were, in order of frequency, acute immobilization, infectious disease, cerebrovascular accident, hyperosmolar state, hyponatremia, hypernatremia, hypothermia, and a fall. Twenty-two patients recovered from the acute illness; one patient died from respiratory failure. Seventeen patients had renal failure (serum creatinine greater than 180 mumol/L), none necessitating dialysis. Serum creatinine always declined following recovery. CONCLUSION: Elevation of CK with few other clinical features of rhabdomyolysis is common in admissions to a geriatric service. It is due to complete immobilization resulting from acute illness. Renal failure is mild and reversible, and the prognosis for recovery is excellent.

Acute Disease↗