Scientific Research

Introduction

As we face a 7th wave of Covid in our geriatric wards, we as caregivers are exhausted and find it increasingly difficult to repeat these isolation measures again and again. We are aware of the importance of avoiding clusters but it is mostly the elderly who are positive for Sars-Cov-2 and hospitalised. Fortunately the virus no longer kills, but nevertheless has enormous deleterious consequences on the mental health of our elderly.

Methods

To expose the practical consequences of clinical cases experienced during these successive waves of Sars-Cov-2 and make a review of the literature concerning this theme.

Results

The patients with moderate to severe cognitive disorders almost all presented a confused state and lost autonomy during their period of isolation. After more than 2 years, it can be stated that these patients really suffered from this quarantine for sometimes 14 days or more. Behavioural disorders increased, patients who were paranoid increased their disorders The families also suffered as well as the geriatric carers who had all the difficulties to take care of these patients in a global way with all the paramedics and stimulations that we usually bring them.

Conclusions

The consequences of this forced isolation, whether in hospital in an acute unit, at home or in a nursing home, has had and will have serious consequences on the mental well-being of our seniors. If we "have to live with these successive mutations", should we not think about not isolating our elderly patients in such a deleterious way? Ethical considerations must be analysed as much as public Health. We must also be careful not to increase "ageism" in this period of pandemic.

^{References R.Manca et al,Front.Psychiatry,2020,D.Piette et al, Louvain Medical ,2021,B.Meisner et al,Canadian Journal on Aging,2020}

Pancreatic cancer represents one of the most prothrombotic neoplasms secondary to high tumoral expression of tissue factor, cytokine release, activation of leukocytes and hypofibrinolysis. Studies have shown that the incidence of thrombotic complications can reach up to 36%.

We present a case of an 84-year-old male patient who was admitted onto the Geriatrics ward with a 3-day history of sudden-onset dyspnoea, productive cough, pallor, and general malaise. Admission blood revealed microcytic anaemia (Hb 91 g/L), neutrophilic leukocytosis (WCC 29.9 x 10^9/L, Neut 26.9 x10^9/L) and elevated C-reactive protein (211 mg/L). Despite high clinical suspicion of pneumonia, chest X-ray did not demonstrate any pathology.

On day 2 of admission, D-dimer was requested, and the critical result of 3500 ng/mL was noted. Patient was immediately commenced on anticoagulation therapy and urgent CT-PA demonstrated the presence of a pulmonary embolus in a posterior sub-segmental artery of the right lower lobe.

On day 3, patient manifested left-sided lower limb weakness along with reduced sensation to light touch up to the left knee. Patient did not demonstrate cortical symptoms. Urgent CT-Head revealed hypodensity in the right parietal region suggestive of acute ischaemic infarction.

On day 5, patient reported pain and swelling of the left calf. Physical examination rendered high suspicion of left deep vein thrombosis with calf circumferential difference of 4cm (Left 34cm, Right 30cm) and significant tenderness on palpation. In light of three consecutive thromboembolic events within 5-day course of admission, suspicion of cancer-associated thrombosis was established. Urgent CT-AP was conducted, 5cm carcinoma at the tail of the pancreas with extensive hepatic, splenic and adrenal metastatic disease. The following case warrants attention from the clinicians as unprovoked pulmonary embolism should prompt investigation for potential underlying malignancy.

Furthermore, it highlights the malignancy-induced hypercoagulability and risk of cancer-associated thrombosis, particularly in the context of pancreatic carcinoma.