Mortality and morbidity of stairlift injuries: Analysis of the UK TARN database

AIMS

To investigate the incidence and pattern of injury in patients with a diagnosis of a fall from a stairlift.

METHODS

Data was analysed from the Trauma Audit and Research Network (TARN) database from 2000 to 2018 for those recorded suffering stairlift related injuries between the ages of 40-100 years. Patient demographics, injury mechanism and pattern, mortality rate and height of fall were analysed.

RESULTS

1069 patients were identified in the initial search with 651 having an eligible mechanism of injury. The mean age was 82 (range 41.4-100.1) years. The most common site of injury was the limbs (49.2%) with the most severe injuries to the head (mean AIS 3.1). The mean ISS was 12.5 (Range 1-75). There was no relationship between height of fall and ISS (r_s 0.054 p = 0.4). Individuals were 78% more likely to have an ISS score of 15 or more if they had a head injury, (OR: 0.12; 95% CI: 0.06-0.24) and 79% more likely to have sustained an injury to the thorax (OR: 0.21; 95% CI: 0.11-0.41). Injury to the head was 95% more likely in individuals with an ISS score greater than 25 points or more (OR: 0.05; 95% CI: 0.01-0.16) and 69% more likely for those who sustain injury to the thorax. Individuals with an ISS score of 25 points or more were 18 times more likely to have sustained injury getting off their stair lift compared to any other method of falling from their stair lift. Mortality was associated with injuries to the thorax in those aged 70 years or below, injuries to the face, spine and limb for those aged 71-85 years and with head injury in those over 85 years. The overall mortality rate was 15.7%.

CONCLUSION

Falls from stairlifts commonly result in limb injuries and most severe injuries are sustained to the head. When patients fall getting off from astairlift, have injuries to their head or thorax they have a higher ISS. The overall mortality is 15.7%. Given the increasing use of stairlifts in our ageing population, strategies should be considered to make these safer.

A Comparative Study of Craniosonogram and CT scan of Brain in CNS Complication of Perinatal Asphyxia

Pereinatal asphyxia is one of the most important complications related with the process of birth and this complications affect not only the brain but also many other organs. The purpose of this cross sectional study is to compare the role of craniosonogram and CT scan of the brain to delineate the cerebral pathology in respondent of preterm and term infant and to assess the Kappa test for agreement. This study was carried out in the department of Radiology & Imaging of Mymensingh Medical College Hospital, during the period of July 2015 to June 2017. A total number of 40 neonates clinically diagnosed as perinatal asphyxia referred for Craniosonogram and Computed tomography (CT) were included in this study. The test of agreement of USG in detection of neonatal cerebral pathology was calculated. Male to female ratio was 1:1.4. More than half (55.0%) patients were preterm age. The mean birth weight was found 2.3±0.6 kg and mean age was 22.7±12.7 days. Fifty five percent respondent mothers had antenatal check up and 27% had anemia, 11% had premature rupture of membrane, 9% had multiple pregnancy and 7% patient had hypertension. Cerebral pathology was found 28 and 31 cases by Craniosonogram and CT scan respectively. Germinal matrix hemorrhage/IVH (Intra ventricular hemorrhage) found 7(17.5%) in USG and 4(10.0%) in CT scan. Hypoxic ischaemic changes with mild ventriculomegaly observed 5(12.5%) in USG and 7(17.5%) in CT scan. Hypoxic ischaemic change found 4(10.0%) in USG and 5(12.5%) in CT scan. In USG evaluation of 28 patients having cerebral pathology & 16(72.7%) had in preterm group and 12(66.7%) in term group. In CT scan of brain 31 patients with cerebral pathology & 15(37.5%) in preterm group and 16(40.0%) in term group. CT scan found cerebral pathology 77.5% (31/40) cases and USG found 70.0% (28/40), with Kappa value was 0.551, which indicates that fair agreement between USG and CT scan for detection of cerebral pathology in respondent. Craniosonogram is a useful method in all neonates specially preterm to see the CNS complication of perinatal asphyxia.

Antithyroid Antibody Status in Non-Pregnant Adult Bangladeshi Patients with Subclinical Hypothyroidism

Sub clinical hypothyroidism (SCH) is common in clinical practice. Autoimmunity is thought to be the most important cause of SCH. In this cross-sectional study, we investigated 120 SCH patients and 100 healthy controls attending the Endocrinology Outpatient Department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from June 2014 to April 2015 for anti-thyroid antibodies (anti-TPO and anti-Tg). Measurement of serum TSH, FT4, anti-TPO, and anti-Tg antibodies were done by using the chemiluminescent sequential immunometric assay. SCH patients had a higher mean age; the frequencies of female subjects, those having family history of thyroid disease or other autoimmune diseases, and goiter were higher in SCH group than in the control group. Forty-five percent (45%) of SCH patients were positive for anti-thyroid antibodies (23.3% for both anti-TPO and anti-Tg, 16.7% for only anti-TPO, and 5% positive for only anti-Tg) in comparison to only 10% anti-thyroid antibody positive controls (none for both antibodies, 8% for only anti-TPO, and 2% positive for only anti-Tg). The SCH subjects in the lower age group, females and with a TSH >10μIU/mL had the higher frequency of thyroid autoimmunity. Female gender, high socioeconomic condition, the presence of other autoimmune diseases, the presence of goiter and TSH >10μIU/mL were associated with higher odds of anti-thyroid antibody positivity in the SCH group, though none were statistically significant. The frequency of anti-thyroid antibody was higher in SCH and was more prevalent among the females, younger patients and those having a goiter, other autoimmune diseases, and TSH >10μIU/mL.

Lifestyle and Depression in Urban Elderly of Selected District of Bangladesh

Global population is ageing and Bangladesh has one of the fastest growing ageing populations in this region. Growth in the elderly population relative to other age groups challenges existing health services, family relationships and social security. Combined with this, depression has become a major mental health problem for elderly people especially for urban elderly for nuclear family norm in urban areas. The study was descriptive type of cross-sectional in nature and was conducted in Rangpur Medical College Hospital, Rangpur & Prime Medical College Hospital, Rangpur, Bangladesh. The objective of this study was to assess the lifestyle and level of depression in urban elderly. Depression was measured by questionnaire of geriatric depression scale among 254 respondents. 87.8% of the respondents were age between 60-70 years. Majorities (63%) of the respondents were male, 54% of the respondents lived in nuclear type family and the rest (46%) in joint type of family. Among respondents near half (47.2%) of the respondents found Mild depressive, around one third (32.7%) were severe depressive, and the rest (20.1%) were normal. There was significant association between occupational status of the respondents and depression (x² = 45.600, df=14, p=0.000). Farmers unemployed found severely depressive (52.1%) followed by day-labourer (50%) and businessmen (37.5%). There was significant association between financial self dependency and depression of the respondents (x²= 34.072, df=4, p=0.000). Severe depression (43.8%) was found among those who were not financially self dependent. There was also significant association between monthly income and depression of the respondents (x²= 67.327, df=8, p=0.000). The study also found that lower income group (<Tk 10000) suffer more from severe depression (42.1% vs. 16.67%) than that of higher income group (Tk 50000-99999). Another significant association found between respondents living with family and depression (x²=16.025, df=2, P=0.000). Respondents those not living with family were suffering more from severe depression (55.55%). Association between social activity and depression (x²=31.724, df=4, p=0.000) revealed that those not involved in social activities were in severe depression (40.55%). The study concluded that lifestyle factors and socio-demographic conditions directly influence the state of depression. Those who lead a healthy social life with friends and family, with a stable income source are less prone to severe depression and vice versa. The study recommended the formulation of strategies for the well being of urban elderly that should include social awareness about positive lifestyle changes, social mobilization, health assurance, and response from the government so that depression and its associated serious diseases can be prevented.

Programming effects of maternal and gestational obesity on offspring metabolism and metabolic inflammation

With the increasing prevalence of obesity in women of reproductive age there is a need to understand the ramifications of this on offspring. The purpose of this study is to investigate the programming effects of maternal obesity during preconception and the preconception/gestational period on adiposity and adipose tissue inflammation in offspring using an animal model. Adult female C57Bl/6J mice were assigned either normal diet, high fat diet (HFD) prior to pregnancy, or HFD prior to and through pregnancy. Some offspring were maintained on normal diet while others started HFD later in life. Offspring were assessed for body composition and metabolic responses. Lipid storing tissues were evaluated for expansion and inflammation. Male offspring from the preconception group had the greatest weight gain, most subcutaneous adipose tissue, and largest liver mass when introduced to postnatal HFD. Male offspring of the preconception/gestation group had worsened glucose tolerance and an increase in resident (CD11c⁻) adipose tissue macrophages (ATMs) when exposed to postnatal HFD. Female offspring had no significant difference in any parameter between the diet treatment groups. In conclusion, this study demonstrates that prenatal and pregnancy windows have independent programming effects on offspring. Preconception exposure affects body composition and adiposity while gestation exposure affects metabolism and tissue immune cell phenotypes.

Commotio Cordis Caused During Hurling Game

A teenage boy had a cardiac arrest following a blow to the chest from a hurling ball (sliotar). Prompt resuscitation and automated external defibrillation enabled a full recovery. This is the first reported case of commotio cordis caused by a sliotar although it is described in other sports. Primary prevention of commotio cordis (CC) and secondary prevention of cardiac death are discussed.

African swine fever virus evasion of host defences

African swine fever virus causes a haemorrhagic fever in domestic pigs and wild boar. The continuing spread in Africa, Europe and Asia threatens the global pig industry. The lack of a vaccine limits disease control. To underpin rational strategies for vaccine development improved knowledge is needed of how the virus interacts with and modulates the host's responses to infection. The virus long double-stranded DNA genome codes for more than 160 proteins of which many are non-essential for replication in cells but can have important roles in evading the host's defences. Here we review knowledge of the pathways targeted by ASFV and the mechanisms by which these are inhibited. The impact of deleting single or multiple ASFV genes on virus replication in cells and infection in pigs is summarised providing information on strategies for rational development of modified live vaccines.

P72 Riluzole causing pancytopenia: a clinically important rarity

Design

Case Report: An 83-year-old lady, was admitted with progressive speech and swallowing difficulty and wasting of small muscles of hand for 3 months. EMG revealed widespread anterior horn cell disease. With a diagnosis of MND, She was started on Riluzole 50 mg, LFT and FBC were normal before and 2 days after 1 st dose and the dose increased to a recommended dose of 50 mg twice a day. While waiting for PEG tube insertion, within 7 days, FBC showed a significant drop in Hb of 23 g/L ( from 125 to 102 g/L), Platelet dropped to 150×x10^9/L from 208 × 10^9/L, leucopenica ( 2.4 × 10^9/L) without any significant neutropenia. Her follow up haemogram showed persistent pancytopenia with more evident leucopenia and thrombocytopenia over next 7 days. She had no symptoms and signs of infection with normal infection screen. Her medication history was unremarkable apart from riluzole and thyroxine. No past history of liver disease or haematological conditions. Serum electrophoresis, Vitamin B12 and Folate were completely normal. A diagnosis of riluzole induced pancytopenia was made. A study by FDA suggests out of 861 patients, 3 patients (0.35%) developed Pancytopenia and 100% of them had it in the 1 st month. The aim of this case report to highlight the importance of considering Pancytopenia as an adverse reaction of riluzole. Patient may develop overt sepsis as a part of the spectrum. In that case, risk and benefit of riluzole prescription needs to addressed as an individual case basis.

WP1-25 Improving neurological examination in acute admission: the INSPECT method

Objectives

Clerking proforma in the trust includes a detailed neurology examination which is mandatory to fill up according to the trust guideline. Incomplete neurological examination at the time of admission significantly increases length of hospital stay and hamper the overall prognosis.

Design

A retrospective study was conducted for 2 weeks on 60 patients clerked in AMU. A general survey was conducted among 26 doctors to detect the possible reasons and suggestions.To ensure every patient gets a quick and accurate neurological examination during clerking, we suggested a new mnemonic method called ‘INSPECT’: I – Inspection ( GCS, GAIT), N- Neck Rigidity, S –Speech, sensory P- Pupil E- Eye movement, C –Cerebellar and Cranial Nerves, T- (Tone, Power, Reflexes).

Results

The primary audit revealed that the neurology proforma completed in 18.3% notes, Partially completed – 43.2% Not completed – 38.5% and frequently missed examinations were Cranial Nerve examination: 68.3%, Sensory: 56.2% Cerebellar: 42.1%, Motor power: 21% Doctor’s survey revealed reasons behind examinations not being carried out: Time consuming: 46.1%, Not relevant: 23.07%. Not enough training 15.38%.

Conclusions

Results showed that only 18.3% patients had complete neurological examination, mostly missed cranial nerves examination ( 68.3% ) Survey suggested time constraint is a major issue ( 46.1% ) and quicker assessment and concise proforma will help. The suggested method will be re-audited in 3 months time.

Kinetic and Electrochemical Reaction Mechanism Investigations of Rodlike CoMoO4 Anode Material for Sodium-Ion Batteries

Sodium-ion batteries are considered the most promising power source for electrical energy storage systems because of the abundance of sodium and their significant cost advantages. However, high-performance electrode materials are required for their successful application. Herein, we report a monoclinic-type CoMoO₄ material which is synthesized by a simple solution method. An optimized calcination temperature with a high crystallinity and a rodlike morphology of the material are selected after analyzing the as-synthesized powder by temperature-dependent time-resolved X-ray diffraction. The CoMoO₄ rods exhibit initial discharge and charge capacities of 537 and 410 mA h g^-1, respectively, when used as an anode for sodium-ion batteries. The sodium diffusion coefficient in the bimetallic CoMoO₄ anode is measured using the galvanostatic intermittent titration technique and calculated in the range of 1.565 × 10^-15 to 4.447 × 10^-18 cm² s^-1 during the initial cycle. Further, the reaction mechanism is investigated using ex situ X-ray diffraction and X-ray absorption spectroscopy, and the obtained results suggest an amorphous-like structure and reduction/oxidation of Co and Mo during the sodium insertion/extraction process. Ex situ transmission electron microscopy and energy-dispersive spectroscopy images of the CoMoO₄ anode in fully discharged and recharged state reveal the rodlike morphology with homogenous element distribution.

Unveiling the mechanism of sodium ion storage for needle-shaped ZnxCo3-xO4 nanosticks as anode materials

The interest in the development of micro-nanostructured metal oxides has been increasing recently because of their advantages as electrode materials in energy storage applications. In this study, dandelion-like ZnxCo3-xO4 microspheres assembled with porous needle-shaped nanosticks were synthesized by co-precipitation followed by a post-annealing treatment. The open space between neighboring nanosticks enables easy infiltration of the electrolyte; therefore, each nanostick is surrounded by the electrolyte solution, which ensures proper utilization of the active material during the electrochemical reaction. The dandelion-like ZnxCo3-xO4 hierarchical microspheres exhibit a greatly improved electrochemical performance with a high capacity and good cyclability as anodes for sodium-ion batteries (SIBs). A high initial reversible capacity of 612 mA h g-1 (at 35 mA g-1, ∼0.04C) is obtained and a capacity of 349 mA h g-1 is retained after 200 cycles. Meanwhile, the electrode shows a high rate performance with a capacity of 246 mA h g-1 at 2.0C-rate. The conversion of ZnxCo3-xO4 with Na is followed by ex situ X-ray absorption spectroscopy (XAS) and transmission electron microscopy (TEM) in different sodiation/de-sodiation states during electrochemical cycling. These analyses reveal that Na insertion/extraction is followed by complete reduction/oxidation of both metallic cobalt and zinc. The development of metallic Co and Zn after complete discharge and the formation of Co3O4 and ZnO when the electrode was fully recharged were identified by ex situ TEM analysis. In addition, the ZnxCo3-xO4 anode demonstrates feasible operation in a full cell by pairing with a NaNi2/3Bi1/3O2 cathode, affording a sodium-ion battery with an average working voltage of 2.6 V.

Short Term Outcome of Cardiac Resynchronization Therapy on Functional Recovery of Patients with Congestive Heart Failure in Bangladeshi Population

Cardiac resynchronization therapy (CRT) reduces symptoms and improves left ventricular function in patients with heart failure due to left ventricular systolic dysfunction and cardiac dyssynchrony. We analyzed the clinical and echocardiographic outcome of CRT in heart failure patients. Thirty five (35) heart failure patients were included in this prospective observational study, conducted from February 2015 to February 2016 in the Department of cardiology, National Institute of Cardiology & Vascular Disease (NICVD) hospital, Dhaka, Bangladesh. Patients underwent CRT-P (BiV pacemaker) or CRT-D (defibrillator) implantation and were followed up. Clinical, electrocardiographic and echocardiographic study were performed before and 3 months after CRT implantation. After 3 months of BiV pacing, New York Heart Association functional class has improved from 3.3±0.44 to 1.7±0.60; (p<0.001). Left ventricular end diastolic diameter was reduced from 67.9±5.20 to 61.9±5.90mm; (p<0.001) and left ventricular end systolic diameter was reduced from 56.4±6.50 to 50.5±7.20mm; (p<0.001). Ejection fraction was significantly increased from 27.5±4.3% to 38.8±6.7%; (p<0.001). The average grade of mitral regurgitation was decreased from 1.49±0.65 to 0.43±0.61; (p<0.001). The number of hospitalization was also significantly reduced from 2.51±1.44 to 0.11±0.32; (p<0.001). Among the study patients, 71.4% patient was responders, 17.1% super responders and 11.4% non-responders. Although the study was performed on a small number of patients, it can be considered that CRT had favorable hemodynamic and clinical results and reduced the need for hospitalization in our heart failure patients.

Prevalence and Predictors of Depression among Patients with Type 2 Diabetes: A Multicenter Cross-sectional Study from Bangladesh

Depression is a common comorbidity of type 2 diabetes mellitus (T2DM) which adversely affects diabetes management and outcome. Identifying and treating comorbid depression may improve diabetes care. This cross-sectional study was conducted in several tertiary hospitals throughout Bangladesh from July 2017 to April 2018. Nine hundred (900) adult patients with T2DM aging ≥25 years having diabetes for at least 6 months and equal numbers of non-diabetic otherwise healthy controls were recruited from the outpatient departments of these centers. Depression was assessed in all consenting patients and controls by administering the Bangla (local language) version of the PRIME-MD Patient Health Questionnaire (PHQ-9); participants obtaining a score of 5 or more were labeled to have depression. Depression was present in 60.3% of T2DM patients and in 29.4% of controls. Statistically significant difference was found in age, marital status, occupation, body mass index (BMI), waist circumference, systolic blood pressure (BP), diastolic BP and PHQ-9 score between diabetic and non-diabetic subjects (<0.001). T2DM subjects had 4.71-fold higher odds of depression in comparison to the controls (95% CI: 3.76-5.90; p<0.001). Age ≥50 years, unmarried status, years of schooling ≤10 years, underweight, abdominal obesity, and hypertension appeared to be the significant predictors of depression in the study subjects. In T2DM subjects, diabetes in the family members, the presence of other comorbidities, diabetic complications, diabetes duration >5 years, insulin use, using insulin syringe for injection, albuminuria and CKD were the important predictors of depression. Our study found higher prevalence and risk of depression in T2DM patients than their non-diabetic counterparts. T2DM patients should be screened for depression in order to achieve and maintain the treatment goals.