Prognostic Implications of Predischarge Assessment of Gait Speed After Hip Fracture Surgery.

BACKGROUND AND PURPOSES: Hip fracture represents one of the most severe injuries in the older adults. In long-term survivors, disability is common and walking ability may be considered an important predictor of functional recovery. We investigated whether 4-m gait speed, assessed in older persons early after surgical repair of hip fracture, could predict functional recovery and subsequent development of major clinical outcomes. METHODS: This was a prospective cohort study. We included adults older than 65 years, admitted to a community acute care hospital with hip fracture, undergoing surgical repair. As soon as the participant was able to stand and walk, using walking aids as needed but with no person's help, the 4-m walking speed was tested as the main predictive variable. The outcome variables included the change in the Barthel Index (BI) from prehospital through 1 year postoperative as a continuous variable and 2 dichotomous outcomes, that is, (1) a decrease in BI greater than 5 points in 1 year and (2) a composite endpoint, combining 5+ points BI decline, death, falls, institutionalization, and need for 24-hour home assistance in 1 year. RESULTS: Sixty-two participants (mean age = 85 years) were enrolled and evaluated, on average 6 days (standard error of the mean [SEM] = 0.2) after hip fracture surgery. Compared with prefracture (mean = 96.3; SEM = 0.9), BI decreased 1 month after surgery (mean = 76.5; SEM = 2.1) and recovered only partially at 2 (mean = 84.1; SEM = 2.2) and 12 months (mean = 87.2; SEM = 2.8). A predischarge value of the walking speed below the median (20.5 cm/s) predicted a substantial BI reduction throughout the 12 months. Furthermore, the adjusted risk of a decline in functional status was reduced by 5% (odds ratio = 0.95; 95% confidence interval, 0.91-0.997; P = .038) and that of the combined outcome by 7% (odds ratio = 0.93; 95% confidence interval, 0.88-0.99; P = .013) for each centimeter per second of predischarge walking speed. DISCUSSION AND CONCLUSION: The 4-m walking speed, measured early after surgical repair of hip fracture, has profound long-term prognostic implications. This assessment approach might prove helpful in clinical decision-making on the postoperative management of older hip fracture persons.

Tumour necrosis factor, interleukin-6 and C-reactive protein in patients with louse-borne relapsing fever in Ethiopia.

The serum concentrations of tumour necrosis factor (TNF), interleukin-6 (IL-6) and C-reactive protein (CRP) were studied in 25 patients with louse-borne relapsing fever, to evaluate their association with the level of bacteraemia, anti-borrelia chemotherapy and the presence of a Jarish-Herxheimer reaction (JHR). Although there was an association between the level of bacteraemia and the development of JHR and complications during treatment, TNF, IL-6 and CRP concentrations were not associated with the JHR. TNF concentrations increased after the administration of antibiotics and remained high for 24 h. IL-6 was elevated on admission but soon decreased. CRP was high on admission and remained so throughout the illness. The observed elevations in TNF, IL-6 and CRP may be associated more with the administration of antibiotics than with the presence of a JHR.

Louse-borne relapsing fever. A clinical and an epidemiological study of 389 patients in Asella Hospital, Ethiopia.

An outbreak of louse-borne relapsing fever, due to the return of soldiers to their original recruitment areas, after the end of thirty years of fighting in northern Ethiopia, was reported in Arsi region, southern Ethiopia. The epidemic spread to different members of the community and eventually the schools. We studied 389 patients affected by the epidemic and who were admitted to Asella Hospital between June 1991 and May 1992. Twenty-seven per cent of the patients were ex-soldiers; 28% were students, who were admitted to the hospital since the schools were opened after the summer vacations. The common clinical features of the disease were fever (99%), headache (92%), hepatosplenomegaly (66%), myalgia (55%), arthralgia (51%), petechial rash (43%), epistaxis (24%) and jaundice (23%). Observed complications were pneumonia (10%), pulmonary edema (6%), myocarditis (3%) and 6 abortions in 15 pregnancies. Patients were treated with low dose penicillin and i.v. fluids. The in-hospital case fatality rate was 3.6%. Jarisch-Herxheimer reaction occurred in 43% of the patients. 1.8% of the patients had relapses after treatment.

[Seroprevalence of HIV-1 virus in Zaire. Analysis of 1404 subjects]. / Séroprévalence du VIH1 au Zaïre. Analyse chez 1,404 sujets.

Between January and December 1989, 1,404 subjects (mean age 26 years) admitted or seen at the out-patient clinic of the hospital of Goma, Northern Kivu, were investigated for anti-HIV 1 antibodies by the ELISA and Western blot techniques. Seventy-eight out of 808 men (10 percent) and 127 out of 596 women (21 percent) were seropositive. Anti-HIV1 antibodies were found in 14/631 blood donors (2 percent), 25/241 in-patients awaiting blood transfusion (10 percent), 3/42 women hospitalized for complications of pregnancy (7 percent), 130/388 subjects with signs and/or symptoms of HIV1 infection (33 percent) and 33/102 patients with tuberculosis (32 percent). The difference in seropositivity between men and women was statistically significant. A significantly high seroprevalence was found in men who were having regular sexual intercourse with prostitutes (42/167 = 25 percent, P less than 0.01) and in subjects with a history of sexually transmitted disease during the last 5 years (64/180 = 36 percent, P less than 0.01), compared with subjects who had none of these risk factors. The installation of a blood bank where blood products are controlled has contributed to the reduction of HIV1 transmission throughout the town. The foundation of an association of unpaid voluntary blood donors recruited among secondary school students has been another educative measure in the anti-AIDS national plan.

Experience with itraconazole in cryptococcosis and aspergillosis.

Cryptococcosis and aspergillosis in immunocompromised patients are extremely difficult clinical conditions to manage and treatment with available antifungal drugs often fails. Itraconazole, R-51211, Janssen Pharmaceutica, a new orally absorbed triazole, is a possible alternative drug which is potentially effective and nontoxic. Preliminary experience with 28 patients, eight with cryptococcosis and 20 with aspergillosis, is reported. Of these patients, 16 were immunocompromised (seven with the acquired immune-deficiency syndrome (AIDS), five heart transplant recipients and four with leukaemia or lymphoma). Overall, results of treatment were good (18 in remission, four markedly improved, four moderately improved and two failed). Prevention of relapses of cryptococcosis was obtained in all patients with AIDS on long-term itraconazole monotherapy (3 mg/kg). Treatment of invasive aspergillosis required a higher dosage (about 5 mg/kg) and prolonged administration. Besides its efficacy this antifungal agent allowed outpatient management.

Clinical and immunological assessment in HIV+ subjects receiving inosine-pranobex. A randomised, multicentric study.

Inosine-pranobex (methisoprinol, isoprinosine; INPX) is the p-acetamidobenzoic salt of N,N-dimethylamino-2-propanol and inosine in a 3:1 molar ratio. In early studies, INPX was found to partially inhibit human immunodeficiency virus (HIV) and to increase the immunocompetence of HIV-infected subjects in vitro. We report the results of a randomised, multicentric clinical trial carried out on 553 HIV+ patients. 261 individuals were treated with INPX (two 500 mg tablets every 6 h for 3 months) and the remaining 292 constituted the untreated control group. INPX treatment was associated with a slightly improved clinical condition or with a trend in that direction, as compared to the untreated group. A preservation of the CD4/CD8 cell ratio values, a decrease in the CD8+ cells and an increase in the Leu 2-7+ cell number better than in the untreated individuals was also observed in the patients taking INPX. No serious or adverse effects of INPX have been observed.

IgE and IgG antibodies in Toxocara canis infection. A clinical evaluation.

The relationship between IgE and IgG antibodies against the metabolic exoantigen of Toxocara canis (TEX antigen) in sera of selected patients with the ocular and visceral form of the disease have been investigated. The specificity and sensitivity of the TEX antigen employed in immunoenzymatic and radioimmunologic assays have been verified. Six hundred and forty-one sera from healthy donors were tested as controls. Our data emphasize the importance of IgE antibodies to ocular larva migrans syndrome and suggest that they play a significant role as a marker of infection. In the visceral form, IgG antibodies seem to mask the presence of IgE by a competitive mechanism toward the same epitopes of the parasite. In fact, IgE antibody titers increase after depletion of IgG from serum.

Immune response in a symptomatic case of Tetrapetalonema perstans infection.

The immune response in a 49-year-old Italian nun affected by Tetrapetalomena (Dipetalonema) perstans following an eight-year stay in Cameroon is reported. On admission the patient presented with polyarthralgia, conjunctival pruritus and irritation, oedema of the limbs, generalized itching, hypereosinophilia and low total IgE titre. During diethylcarbamazine treatment and, subsequently, during mebendazole administration, an exacerbation of her symptoms was observed. At the same time, activation of the alternative complement pathway and the appearance of circulating immune complexes were noted, suggesting a type III hypersensitivity reaction. Circulating immune complexes and diethylcarbamazine-induced release of parasitic antigens may also be considered responsible for the decrease of OKT3 and OKT4 positive lymphocytes.

Humoral immune responses in human loaiasis.

Some immunological parameters in three white patients who contracted loaiasis in endemic areas are reported. Microfilariae count in peripheral blood was elevated in one patient, discrete in another while in the third no microfilariae were detected. Serum IgE levels were elevated in two patients and normal in one of them. High eosinophils percentage (greater than 30%) and high titres of specific anti-filarial antibodies were detected in all patients. C3 and C4 levels fell between the normal values and C3PA was low in one patient. No circulating immune complexes were demonstrated. Two patients showed high anticomplementary activity. Our results are in accord with the possibility of a suppression mechanism in immune response in patients with high microfilaremia. Clinical features of loaiasis could be related to a type 1 (reaginic) reaction.

[Activity of coagulation factors in liver coma caused by viral hepatitis]. / Comportamento dei fattori della coagulazione nel coma epatico da epatite virale.

Coagulation studies were performed on 8 patients with acute liver failure from viral hepatitis. Four died and four recovered. At the time of development of coma, levels of clotting factors resulted markedly reduced in all cases and were not of value as a prognostic index. Subsequent serial determinations (every 8 hours) during the evolution of coma showed that prothrombin activity and levels of factor I, II, V and X were not correlated with clinical conditions, most probably owing to the influence of the administration of blood and blood components. Of all coagulation tests, the assay of factor VII, which has the shortest half-life, appeared the most reliable index of hepatic synthetic function at a particular point in time.