796 Post Operative Drop in Haemoglobin Is Associated with Increased Morbidity and Mortality in Fracture Neck of Femurs

Aim

Post-operative anaemia in hip fracture patients is associated with increased risk of blood transfusion, poorer outcomes, increased morbidity, and mortality. Our aim is measure the drop in haemoglobin(Hb) post-operatively in hip fracture surgery and its impact on length of stay, morbidity and 30-day mortality.

Method

A retrospective study of neck-of-femur patients looking at pre-op and discharge haemoglobin levels, taking into consideration conditions that could affect Hb, and adverse effects peri-operatively.Data collected from Medway, Clinic letters, ICE and NHFD database.

Results

257 patients were included in the study. Mean age was 82(range 43–100). Pre-operatively 60(23%) had normal Hb, 34(13%) had borderline, and 163(64%) had severe anaemia. 131(51%) had hemi-arthroplasty, 61(24%) had DHS, 45(18%) had IM nail and 20(7%) had THR.Normal Hb found in 62 patients (24%), 33(13%) had borderline and 162(63%) had severe anaemia at discharge.30 patients (11.7%) had post-op transfusions and 7 were prescribed oral iron. Readmission rate was 4.3%(11 patents) of which 8(73%) had severe anaemia.Average length of stay in patients with severe anaemia was 21 days.Overall 30-day mortality was 17%(43 patients); in patients with severe anaemia, mortality was 50%(21 patients).

Conclusions

Most patients (63%) had severe anaemia at discharge. There was a significant drop of Hb post-operatively especially THR and hemi-arthroplasty. Our study demonstrates pre-surgical anaemia in hip fracture patients is associated with increased hospital morbidity and mortality.Identification of anaemia at admission and discharge provides an opportunity for treatment to avoid transfusions and improve patient outcomes.

Impact of early diagnosis and control of chronic respiratory diseases on active and healthy ageing. A debate at the European Union Parliament

A debate at the European Union Parliament was held on 13 November 2012 on the Impact of early diagnosis and control of chronic respiratory diseases on Active and Healthy Ageing (AHA). The debate was held under the auspices of the Cyprus Presidency of the European Union (2012) and represents a follow-up of the priorities of the Polish Presidency of the European Union (2011). It highlighted the importance of early life events on the occurrence of chronic respiratory diseases later in life and their impact on active and healthy ageing. Epidemiologic evidence was followed by actions that should be taken to prevent and manage chronic respiratory diseases in children. The debate ended by practical, feasible and achievable projects, demonstrating the strength of the political action in the field. Three projects will be initiated from this debate: The first will be a meeting sponsored by the Région Languedoc-Roussillon on the developmental origins of chronic diseases and ageing: from research to policies and value creation. The second project is being led by the WHO Collaborating Centre for Asthma and Rhinitis: Prevention of Asthma, Prevention of Allergy (PAPA). The third project is the GA(2)LEN sentinel network.

Restricted spirometry in the Burden of Lung Disease Study

BACKGROUND

The presence of restrictive lung disease has classically required the measure of total lung capacity to document 'true' restriction, which has limited its detection in large population-based studies.

METHODS

We used spirometric data to classify people with restricted spirometry (forced expiratory volume in 1 second [FEV(1)]/forced vital capacity ≥ 0.70 and FEV(1) < 80% predicted) in the Burden of Lung Disease (BOLD) Study and determined the relation between this finding and demographic factors and the presence of chronic diseases, including diabetes mellitus, hypertension and cardiovascular disease.

RESULTS

Overall, we found that 11.7% of men (546/4664) and 16.4% of women (836/5098) had restricted spirometry. Prevalence varied widely by site, from a low of 4.2% among males in Sydney, Australia, to a high of 48.7% among females in Manila, The Philippines. Compared to people with normal lung function, those with restricted spirometry had a higher prevalence of diabetes (12.2% vs. 4.6%), heart disease (15.0% vs. 7.7%) and hypertension (38.8% vs. 22.8%).

CONCLUSIONS

Restricted spirometry is a common finding in population studies. Additional research is needed to better define and describe the mechanisms that lead to restricted spirometry and potential interventions.

How to design and evaluate randomized controlled trials in immunotherapy for allergic rhinitis: an ARIA-GA(2) LEN statement

Specific immunotherapy (SIT) is one of the treatments for allergic rhinitis. However, for allergists, nonspecialists, regulators, payers, and patients, there remain gaps in understanding the evaluation of randomized controlled trials (RCTs). Although treating the same diseases, RCTs in SIT and pharmacotherapy should be considered separately for several reasons, as developed in this study. These include the severity and persistence of allergic rhinitis in the patients enrolled in the study, the problem of the placebo, allergen exposure (in particular pollen and mite), the analysis and reporting of the study, the level of symptoms of placebo-treated patients, the clinical relevance of the efficacy of SIT, the need for a validated combined symptom-medication score, the differences between children and adults and pharmacoeconomic analyses. This statement reviews issues raised by the interpretation of RCTs in sublingual immunotherapy. It is not possible to directly extrapolate the rules or parameters used in medication RCTs to SIT. It also provides some suggestions for the research that will be needed. Interestingly, some of the research questions can be approached with the available data obtained from large RCTs.

MeDALL (Mechanisms of the Development of ALLergy): an integrated approach from phenotypes to systems medicine

The origin of the epidemic of IgE-associated (allergic) diseases is unclear. MeDALL (Mechanisms of the Development of ALLergy), an FP7 European Union project (No. 264357), aims to generate novel knowledge on the mechanisms of initiation of allergy and to propose early diagnosis, prevention, and targets for therapy. A novel phenotype definition and an integrative translational approach are needed to understand how a network of molecular and environmental factors can lead to complex allergic diseases. A novel, stepwise, large-scale, and integrative approach will be led by a network of complementary experts in allergy, epidemiology, allergen biochemistry, immunology, molecular biology, epigenetics, functional genomics, bioinformatics, computational and systems biology. The following steps are proposed: (i) Identification of 'classical' and 'novel' phenotypes in existing birth cohorts; (ii) Building discovery of the relevant mechanisms in IgE-associated allergic diseases in existing longitudinal birth cohorts and Karelian children; (iii) Validation and redefinition of classical and novel phenotypes of IgE-associated allergic diseases; and (iv) Translational integration of systems biology outcomes into health care, including societal aspects. MeDALL will lead to: (i) A better understanding of allergic phenotypes, thus expanding current knowledge of the genomic and environmental determinants of allergic diseases in an integrative way; (ii) Novel diagnostic tools for the early diagnosis of allergy, targets for the development of novel treatment modalities, and prevention of allergic diseases; (iii) Improving the health of European citizens as well as increasing the competitiveness and boosting the innovative capacity of Europe, while addressing global health issues and ethical issues.

Prey selection and functional morphology through ontogeny of Amphiprion clarkii with a congeneric comparison

The relationship between the complexity of the feeding apparatus and prey selection through ontogeny was examined in Amphiprion clarkii larvae. Larvae were reared from 1 to 10 days post-hatch (dph) on a diet of rotifers, wild-caught plankton and newly hatched Artemia sp. nauplii. Results were compared with available data on the relationship between functional morphology and prey selection of Amphiprion frenatus to establish patterns of functional morphology and prey selection between the larvae of two species of coral-reef fishes. Larvae of both species exhibited an increase in selection of larger prey through ontogeny coincident with an increase in the complexity of the feeding apparatus. The first elements to ossify in larvae of both species were the pharyngeal teeth (A. clarkii: 5 dph, near +/-s.d. Standard length, L(S),4. 3 +/- 0. 2 mm; A. frenatus: 5 dph, L(S)5. 0 +/- 0. 4 mm) which, in combination with the development of a more functional feeding apparatus, may have permitted larvae to better process new types and sizes of prey. Prey items, however, were selected differentially between the two fish species, which could not be fully explained by the functional state of the feeding apparatus. While prey selection is influenced by the functional state of the feeding apparatus, all aspects of larval fish biology (morphology, behaviour and physiology) should be considered.

GA2LEN (Global Allergy and Asthma European Network) addresses the allergy and asthma 'epidemic'

Allergic diseases represent a major health problem in Europe. They are increasing in prevalence, severity and costs. The Global Allergy and Asthma European Network (GA(2)LEN), a Sixth EU Framework Program for Research and Technological Development (FP6) Network of Excellence, was created in 2005 as a vehicle to ensure excellence in research bringing together research and clinical institutions to combat fragmentation in the European research area and to tackle allergy in its globality. The Global Allergy and Asthma European Network has benefited greatly from the voluntary efforts of researchers who are strongly committed to this model of pan-European collaboration. The network was organized in order to increase networking for scientific projects in allergy and asthma around Europe and to make GA(2)LEN the world leader in the field. Besides these activities, research has also been carried out and the first papers are being published. Achievements of the Global Allergy and Asthma European Network can be grouped as follows: (i) those for a durable infrastructure built up during the project phase, (ii) those which are project-related and based on these novel infrastructures, and (iii) the development and implementation of guidelines. The major achievements of GA(2)LEN are reported in this paper.

Geographical distribution of atopic rhinitis in the European Community Respiratory Health Survey I

BACKGROUND

No large studies in adults has examined geographical variation in the prevalence of nasal allergy/allergic rhinitis in adults or considered the proportion of reported nasal symptoms on exposure to allergen attributable to atopy. The aim of this report was to describe the geographic distribution of subjects with nasal symptoms who are sensitized as determined by skin prick tests, using data from the European Community Respiratory Health Survey I.

METHODS

Information on the presence of nasal allergy, nasal symptoms on exposure to allergen and atopy using skin prick tests was collected from 15,394 adults aged 20-44 years living in 35 centres in 15 countries. Age sex standardized prevalence of symptoms and the attributable fraction of IgE sensitization for nasal symptoms on exposure to allergen were determined.

RESULTS

The age-sex standardized prevalence of nasal allergy ranged from 11.8% in Oviedo (Spain) to 46.0% in Melbourne (Australia). The prevalence of atopic nasal allergy ranged from 4.6% in Oviedo to 31.8% in Melbourne (analysis limited on 12,566 subjects). The median attributable fraction for atopy on nasal symptoms on exposure ranged between 12.8% and 65.9% (median 27.2%).

CONCLUSION

In the general population there is a wide variation in the prevalence of nasal allergy in young adults. Many subjects complaining from nasal symptoms on exposure to allergen are not atopic.

The European Community Respiratory Health Survey: what are the main results so far? European Community Respiratory Health Survey II

The European Community Respiratory Health Survey (ECRHS) was the first study to assess the geographical variation in asthma and allergy in adults using the same instruments and definitions. The database of the ECRHS includes information from approximately 140,000 individuals from 22 countries. The aim of this review is to summarize the results of the ECRHS to date. The ECRHS has shown that there are large geographical differences in the prevalence of asthma, atopy and bronchial responsiveness, with high prevalence rates in English speaking countries and low prevalence rates in the Mediterranean region and Eastern Europe. Analyses of risk factors have highlighted the importance of occupational exposure for asthma in adulthood. The association between sensitization to individual allergens and bronchial responsiveness was strongest for indoor allergens (mite and cat). Analysis of treatment practices has confirmed that the treatment of asthma varies widely between countries and that asthma is often undertreated. In conclusion, the European Community Respiratory Health Survey has shown that the prevalence of asthma varies widely. The fact that the geographical pattern is consistent with the distribution of atopy and bronchial responsiveness supports the conclusion that the geographical variations in the prevalence of asthma are true and most likely due to environmental factors.

Occurrence of non-Hodgkin's lymphoma in Williams syndrome--case report

The authors present a case of a twenty-nine-year-old woman with Williams syndrome and non-Hodgkin's lymphoma. The patient had been told that she had had an atrial septal defect from the time of her birth.

Endomyocardial disease and eosinophilia

The authors discuss the hypereosinophilic syndrome:incidence, terminology, cytotoxicity, clinical presentation and diagnosis, prognosis, and treatment, and they provide a literature review.