Association between Vitamin D Deficiency and Prognosis after Hip Fracture Surgery in Older Patients in a Dedicated Orthogeriatric Care Pathway.

OBJECTIVES: Vitamin D deficiency is common in patients undergoing hip fracture surgery (HFS) and has been found to be associated with poor post-operative outcome in other settings. This study aimed to analyze the association between vitamin D status and prognosis after HFS. DESIGN: Observational, prospective, single-center study. SETTING AND PARTICIPANTS: All patients admitted in a peri-operative geriatric unit between 2009 and 2020 for HFS were included. MEASUREMENTS: A moderate vitamin D deficiency was defined by a vitamin D level between 25 and 75 nmol/l and a severe deficiency by a vitamin D level <25 nmol/l. Primary endpoint was mortality 6 months after surgery. Secondary endpoints were bacterial infections and delirium during hospitalization. Odds ratio (OR) and 95% confidence interval (95%CI) were computed using logistic regression models with adjustment for confounders. RESULTS: 1197 patients were included (median age 87 years, IQR [82-91]). Median vitamin D level was 55 nmol/l (IQR [30-75 nmol/l]). Moderate and severe vitamin D deficiencies were reported in 53% and 21% of patients, respectively. There was no significant association between moderate or severe vitamin D deficiencies and 6-month mortality (OR 0.91, 95%CI [0.59-1.39], and OR 1.31, 95%CI [0.77-2.22], respectively), bacterial infection (OR 0.89, 95%CI [0.60-1.31] and OR 1.55, 95%CI [0.99-2.41], respectively), nor delirium (OR 1.03, 95%CI [0.75-1.40], and OR 1.05, 95%CI [0.70-1.57], respectively). CONCLUSION: Vitamin D deficiency was not associated with mortality, bacterial infection or delirium after HFS. Our results suggest that comorbidities, functional status and post-operative complications are the main determinants of post-operative outcome after HFS.

[Improvement of pneumococcal immunization coverage in older patients]. / Amélioration de la couverture vaccinale anti-pneumococcique chez le sujet âgé.

PURPOSE: To study pneumococcal immunization coverage in older patients in hospital, and the impact of two actions aiming at improving this coverage. METHODS: We reported a prospective and descriptive study conducted from November 2009 to August 2010, including all new patients ≥75 years old received in a geriatric short-stay department and residing in Val-de-Marne, France. This study was performed in three successive three-month periods, to assess the vaccination coverage in the months following hospital release. Period I was the reference; Period II included an awareness campaign of general practitioners relying on the hospitalization discharge report, containing an indication for the vaccination; Period III consisted in a systematic proposal of vaccination by the geriatric hospital department. RESULTS: Indication for pneumococcal vaccination has been given to 139 patients (61.2%) in 227 processed questionnaires. The main indication was heart failure for 105 patients (75.5%). Twenty-four patients were already vaccinated (17.2%). No vaccination was reported in the three months following period I in 33 included patients. The awareness campaign targeting regular doctors resulted in only one vaccination out of 37 patients. Immunization coverage in the department had reached 84.5% of inoculation (38 of 45 patients). CONCLUSION: Pneumococcal vaccination is often prescribed in elderly patients but generally not executed. The awareness campaign did not result in a big enough immunization coverage improvement, compared to a codified proposal of vaccination during hospital stay.

Delirium in older people after proximal femoral fracture repair: role of a preoperative screening cognitive test.

OBJECTIVE: Preoperative cognitive impairment has been identified as a major risk factor for postoperative delirium in older people. The aim of this study was to evaluate whether a validated and rapid screening cognitive test - COgnitive Disorder EXamination (CODEX) - performed preoperatively before proximal femoral fracture repair, was associated with a risk of postoperative delirium. STUDY DESIGN: We performed an observational prospective cohort study in orthopedic surgery department of a French hospital. PATIENTS: We included patients aged 70years or older undergoing proximal femoral fracture repair and who were free of known dementia and delirium at the preoperative phase. METHODS: Before surgery, the anesthesiologist realized the CODEX based on three-word recall test, simplified clock drawing and if one of these tasks was abnormal, spatial orientation was assessed. Delirium was routinely sought on postoperative day 3 (D3) using the Confusion Assessment Method by the geriatrician. RESULTS: Among the 52 included patients, seven (13.5%) had delirium on D3. All seven patients were among the 25 patients with abnormal CODEX results. None of the 27 patients with normal CODEX results had postoperative delirium. Abnormal CODEX was significantly associated with the risk of postoperative delirium in univariate analysis and after adjustment for age (odds ratio [OR]: 13.33; 95% confidence interval, [95%CI]: 1.85±∞; P<0.003). CONCLUSION: Abnormal preoperative rapid screening test CODEX is independently associated with postoperative delirium in older people undergoing hip fracture surgery and free of known dementia.

Neuropsychiatric symptoms in elderly inpatients: a multicenter cross-sectional study.

BACKGROUND/AIMS: We determined the prevalence of neuropsychiatric symptoms in geriatric rehabilitation patients to compare neuropsychiatric symptoms between patients with and without dementia, and to evaluate associations linking severity of cognitive impairment and neuropsychiatric symptoms. METHODS: In February 2009, we studied patients aged 75 years or older who had been admitted to four geriatric rehabilitation units in the Paris area. The twelve Neuropsychiatric Inventory items and four neuropsychiatric subsyndromes defined by the European Alzheimer's Disease Consortium were evaluated. RESULTS: Of the 194 patients, 149 (76.8%) had dementia, and 154 (79.4%) had exhibited at least one neuropsychiatric symptom during the past week. Agitation was the most common neuropsychiatric symptom in the group with dementia (36.9%) and depression in the group without dementia (35.6%). The dementia group had significantly higher prevalences of hyperactivity (p < 0.001) and delusions (p = 0.01) than the non-dementia group. In the dementia group, severity of cognitive impairment was associated with hyperactivity (p = 0.01) and psychosis (p = 0.02). CONCLUSION: The prevalence of neuropsychiatric symptoms among geriatric rehabilitation patients was high but not higher than in elderly outpatients.

Detection of respiratory syncytial virus antigen after seventy-two hours of culture.

Between September, 1987, and April, 1989, three techniques for the detection of respiratory syncytial virus (RSV) were compared: indirect immunofluorescence (IF) on the sample, indirect immunofluorescence after 72 h of MRC-5 cell culture (IF 72h), and detection of the cytopathic effect (CPE) by MRC-5 and HEp-2 cell culture. A study of 383 nasal aspirates from young children admitted to the Centre Hospitalier de Nantes (CHR) showing miscellaneous respiratory symptoms produced the following results: 143 samples (37%) were RSV positive by IF, 119 (31%) were positive by IF 72h, and 117 (31%) showed RSV-induced CPE. In comparison with tissue culture isolation (TC), the sensitivities of IF and IF 72h were 89% and 80% and their specificities 85% and 91%, respectively. During the winter of 1988-1989, of the 110 RSV-positive nasal aspirates (104 by IF, 89 by IF 72h, 83 by CPE detection), 109 were identified by IF and/or IF 72h. IF 72h affords rapid detection of RSV.

[Immunologic response in herpes encephalitis: development of the antibody serum/cerebrospinal fluid ratio in 13 cases]. / Réponse immunologique dans les encéphalites herpétiques: évolution du rapport anticorps sériques/rachidiens dans treize observations.

Serological monitoring was performed in 13 cases of herpetic encephalitis (one infant and 12 adults). Samples taken simultaneously from blood and cerebrospinal fluid (CSF) were tested before and after initiation of antiviral treatment. Antiherpesvirus (anti-HSV) antibodies were assayed by an ELISA method. The state of the blood-brain barrier was controlled by assaying other antiviral antibodies. Immune response was studied during the 3-to-4 weeks of the course of the infection. Anti-HSV IgG levels in CSF increased markedly after 12 days. At the same time, antibody serum/CSF ratios dropped below a value of 20, indicating intrathecal secretion of the antibody. Based on results in monitoring these 13 cases, it may be suggested that 3 samples of serum and CSF are required to confirm the herpetic etiology, including 2 samples taken during the second week of the course of encephalitis.

[Comparison of 2 immunoenzyme methods for the determination of anti-cytomegalovirus IgM]. / Comparaison de deux méthodes immunoenzymatiques pour la détermination des IgM anti-cytomegalovirus.

An antibody capture assay technique using a labeled antigen (Wellcome Laboratories) and an ELISA technique performed after elimination of serum IgG (Behring Laboratories) were assessed for determination of anti-cytomegalovirus IgM. Their specificity and sensitivity were compared in tests on 208 sera, some (60) of which had IgM rheumatoid factor, antinuclear antibodies or anti-Epstein-Barr virus antibodies. The other sera were analyzed relative to diagnosis of a cytomegalovirus infection. The antibody capture assay technique was slightly more sensitive than the ELISA technique but did not resolve all the specificity problems.