QJM: An International Journal of Medicine最新文献

Background: Falls are frequently reported within the HSE. The Irish Longitudinal Study on Ageing(TILDA) found that 40% of over 50 s experience a fall in a two year period, with 20% requiring hospital attendance (1). It has been estimated that the cost of injuries related to falls in older people will increase exponentially over the coming years (2). There is no national database in Ireland with statistics for nursing home(NH) residents presenting with falls to our Emergency Departments(ED).

Aim: To review the prevalence and risk factors for nursing home patients presenting to the Emergency Department with falls.

Design: Retrospective chart review.

Method: Retrospective review of all NH presentations to the ED of a university hospital over one year.

Results: There were 519 ED presentations by NH residents over one year. 48.17% (n = 250), presented with a fall. One third of ED visits presented during conventional working hours. Falls patients were more likely to be admitted when not reviewed by a G.P. prior to presentation. The average length of stay for falls admissions was 10.77 days(n = 132), vs 9.56(n = 153) for admissions with no documented fall. There was no statistical difference in the falls risk medications between groups. Patients presenting with falls were more likely to have bone protection reviewed during their stay(P=.011). Patients with falls were also more likely to use mobility aids(P < 0.001).

Conclusion: Rapid referral to falls prevention programmes and the use of standardised care pathways for high falls risk patients are essential for future prevention and management.

Background: Although there have been reports that green tea intake has thromboprophylactic effect, it was still unknown whether it had adjuvant effect on the basis of conventional anticoagulation for patients diagnosed with venous thromboembolism (VTE).

Methods: VTE patients were retrospectively classified into green tea group and no green tea group in a 1:1 ratio using propensity score matching, based on whether they drank green tea during the 3 months' period after VTE diagnosis. Primary outcomes were VTE recurrence at 3 months after VTE diagnosis and VTE-related death during 3 months after VTE diagnosis. Secondary outcomes were all-cause death and major bleeding during 3 months after VTE diagnosis. The primary and secondary outcomes were compared between the green tea and no green tea groups, in all patients, PE patients, and patients with cancer-associated VTE, respectively.

Results: The VTE recurrence at 3-month after VTE diagnosis occurred less in the green tea group (N = 1102) than in the no green tea group (N = 1102) (19 [1.7%] vs 55 [5.0%], P < 0.001). The VTE-related mortality during 3 months after VTE diagnosis occurred similarly between the two groups (13 [1.2%] vs 21 [1.9%], P = 0.187). The all-cause mortality (82 [7.4%] vs 78 [7.1%], P = 0.682) and major bleeding (55 [5.0%] vs 40 [3.6%], P = 0.142) during 3 months after VTE diagnosis both occurred similarly between the two groups. The results of VTE recurrence analysis in PE and cancer-associated VTE subgroups were both consistent with the main findings.

Conclusions: Green tea intake on the basis of conventional anticoagulation can lead to a lower short-term VTE recurrence rate without safety concern, compared with isolated conventional anticoagulation.

Background: ALG8-congenital disorder of glycosylation (ALG8-CDG) is a rare inherited metabolic disorder leading to severe multisystem manifestations, with no reported prenatal patients to date.

Methods: We describe two fetuses from a single family with ALG8-CDG presenting with prenatal hydrops, undergoing comprehensive prenatal ultrasound, umbilical cord blood biochemistry, autopsy, placental pathology, and genetic testing.

Results: Prenatal ultrasound revealed fetal hydrops, skeletal anomalies, cardiac developmental abnormalities, cataracts, echogenic kidneys and bowel, oligohydramnios, choroid plexus cysts, and intrauterine growth restriction. Umbilical cord blood biochemistry demonstrated fetal anemia, coagulation disorders, and abnormal liver and kidney function. Autopsy confirmed fetal hydrops and associated anomalies. A novel compound heterozygous mutation comprising the missense variant c.754T>C (p.Ser252Pro) and a partial exonic deletion (deletion of exons 1-2) in the ALG8 gene was identified in fetus P2.

Conclusions: This study represents the first prenatal diagnosis of ALG8-CDG, comprehensively delineating the prenatal phenotypic spectrum. Prenatal ultrasound, umbilical cord blood biochemistry, and placental pathology findings aid in the assessment of prenatal manifestations, invaluable for prenatal diagnosis, genetic counseling, and potential interventions in future patients.

Background: The optimal approach to the diagnosis of atrial fibrillation in primary care is unclear.

Aim: To determine if external loop recorder (ELR) screening improves atrial fibrillation detection in community dwelling adults with a CHA2DS2-VASc score of greater than two.

Design: Randomised cross-over clinical trial.

Methods: Community dwelling adults ≥55 years with a CHA2DS2-VASc score of greater than two, who were deemed suitable for atrial fibrillation screening and oral anticoagulation by their general practitioner were randomly assigned to immediate or delayed ELR monitoring. The intervention period was ELR cardiac monitoring for 1 week and the usual care period was healthcare professional pulse screening and completion of electrocardiogram (ECG) or cardiac rhythm strip if pulse was identified as irregular.

Results: Of 488 participants randomized, 244 were assigned to the immediate monitoring period (intervention) and 244 were assigned to the delayed monitoring period. Mean (SD) age was 75.0 (7.0) years and 333 participants were women (68%). Atrial fibrillation was detected in 32 of 488 participants (6.6%) in the intervention period versus 5 of 488 (1%) in the usual care period (absolute difference, 5.53% (3.2%-7.9%), P < 0.001; number needed to screen 15 (11-23). Twelve cases (37.5%) of ELR-detected atrial fibrillation were greater than 24 hours in duration. Oral anticoagulation was initiated in all participants (n = 32).

Conclusions: Among older community dwelling adults with a CHA2DS2-VASc score of greater than 2, screening with ELR for one week was associated with a 5.5% incremental detection of new atrial fibrillation over usual care.

Trial registration: ClinicalTrials.gov Register: NCT03911986.