A noninvasive screening algorithm for early diagnosis of CAD in asymptomatic HD patients with altered MBD parameters is necessary. Applying MBD-coronary risk score might be an important step in the prevention of major coronary episodes by extending the indication for further investigations, early diagnosis and treatment management.

Objective: The aim of the study was to assess the particularities of very elderly patients with high blood pressure and atrial fibrillation, which associate other comorbidities. Design and method: We performed a retrospective study on a group of 97 very elderly patients over 90 years with hypertension, admitted to an emergency hospital in the last 5 years. Results: The average age was 92 years. 67% of the patients were female and 33% male. 40.21% of these patients also had atrial fibrillation. In the subgroup of patients with hypertension and atrial fibrillation, the gender distribution was: 64.10% Female and 35.90% Male. The minimum age was 90 years, the maximum age 98 years. 5.13% Of them came from an old foster care and 41% were immobile. 17.95% Had bed sores. The mean systolic blood pressure that was detected at admission was 135 mmhg and the mean diastolic blood pressure was 75 mmhg. 84.62% of patients were diagnosed with chronic heart failure (33.34% Nyha class ii, 36.36% Nyha class iii and 30.3% Nyha class iv). An echocardiography was performed in 30.77% Of cases and 25% of patients had a preserved ejection fraction. Changes in the electrocardiogram encountered were: right branch block in 12.82% of patients, left branch block in 10.26%, Premature ventricular contractions in 5.13%, And atrial fibrillation with rapid ventricular response in 28.21%. Other co-morbidities: 51.28% Presented with respiratory failure, 15.38% Had copd, 20.51% Required noninvasive ventilation and at the same number of patients an oxygen concentrator was recommended at discharge. 17.95% Of patients had type 2 diabetes mellitus, 20.51% Had a history of stroke and 94.87% Had an altered estimated glomerular filtration rate (based on mdrd formula). Conclusions: The management of very elderly patients is a challenge for the clinician. It is necessary to pay greater attention to the interactions between drugs and the type of administration. They are very fragile patients, with many comorbidities that can lead to complications.

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GAVE syndrome (gastric antral vascular ectasia) is a rare cause of gastrointestinal bleeding. It affects mainly the elderly. The syndrome was named “watermelon stomach” because of its typical endoscopic appearance of “watermelon stripes” observed at the gastric antral level. We present the case of an 80-year-old female patient, under iron substitution therapy for an iron deficiency anemia previously diagnosed. The woman was admitted to our hospital for non-specific symptoms, severe asthenia and postural instability. The clinical examination noted pallor of skin and sclera, without hematemesis or melena. Paraclinical tests revealed severe hypochromic microcytic anemia and hyposideremia, with a positive fecal occult blood test. Because the patient was refractory to the iron therapy, presenting with severe anemia, which required blood transfusions, we suspected a diagnosis of acute hemorrhagic gastritis. In order to reveal the source of the hemorrhage, an upper gastrointestinal endoscopy was performed, which described the typical appearance of prominent, tortuous, erythematous streaks traversing the antrum and converging toward the pylorus, creating the “watermelon stripes” pattern, with lesions that bleed easily during the biopsy process. In a different endoscopic session, the argon plasma coagulation treatment was applied, resulting in clinical and biological improvement.Gastric antral vascular ectasia is a rare medical condition, insufficiently recognized and poorly understood, which can be treated efficiently by endoscopic means, if it is early diagnosed. Although this condition tends to be underdiagnosed at the present time, doctors may exceed their limits by acquiring a high grade of clinical suspicion.