Does hyponatremia pose a risk factor for hip fractures in the elderly? Can a primary physician prevent it?

Objective: Fracture around the hip is amongst the most common and serious fractures in the elderly, which leads to significant morbidity and mortality. In literature, many authors noted that even mild hyponatremia adversely affects bone, leading to an increased incidence of fractures. We aim to determine whether chronic hyponatremia (>90-day duration) increases the risk of hip fracture in the elderly and whether primary care physicians can help to prevent it. Materials and Methods: During the period from January 2020 to March 2022, we identified 145 patients aged between 65 and 90 years who were admitted to the hospital with hip fractures following a fall and compared them with 140 healthy controls. We recorded sodium (Na) serum levels in all included patients at the time of arrival and consequently for 3 days and compared them with those of controls. Logistic regression was used to calculate odds ratios (ORs). We measured serum Na levels for 3 days and took the average to ascertain hyponatremia. Result: In the study, the odds of hyponatremia were 70.3% with a confidence interval of 95% versus 3.6% in controls (P = 0.05). Age and hyponatremia were strongly associated with hip fractures following a fall. With a 5-year increase in age, the univariate OR for hip fracture increased by 5.67 (P < 0.0001). After adjusting for age, cases were nearly six times more likely to be hyponatremic than controls (OR = 4.90, P = 0.04). Conclusion: In our study, we noted that even mild chronic hyponatremia in old age increased the chance of falls. Addressing hyponatremia in the elderly may reduce the risk of falls and minimize hip fractures.

Rare Presentation of Subacromial Bursitis Mimics Neoplasm in a Case of Rheumatoid Arthritis.

INTRODUCTION: We report a rare case of massive subacromial bursitis in Rheumatoid Arthritis (RA) patient. A solid tumor was initially suspected because it was very large with no apparent local sign of inflammation or infection in a 69-year-old patient. Isolated subacromial bursa is an uncommon and it is usually small in size. This bursa usually does not enlarge enough to mimic a neoplastic lesion. The presence of huge swelling around shoulder usually raises the suspicion of neoplastic lesion. However, even in the presence of huge swelling, a benign lesion such as infection, cyst, or bursitis should be considered. This case report presents that even if swelling is huge, the benign lesion must be considered as a differential diagnosis of swelling around shoulder joint. CASE REPORT: We describe the clinical presentation, radiological investigations, and strategies for the management of a 69-year-old patient who was a known case of RA, and he was non-diabetic. Patient presented with massive swelling around shoulder for the past 6 years. We performed radiograms, a plain computed tomography, magnetic resonance imaging, a 99m Tc-MDP bone scintigram, and a 67Ga-citrate scintigram, which all indicated no evidence of tumor. It was treated by excision and no recurrence observed after 5 years. CONCLUSION: Massive subacromial bursitis is rarely reported in medical literature. Even if swelling is massive, the benign lesion must be considered as a differential diagnosis of swelling around shoulder joint.

Can self-perceived easy fatigability be a predictor of vitamin D deficiency in young Indian women?

BACKGROUND: Easy fatigability is a common presenting complaint in Indian women who visited primary care hospitals. Many medical conditions like cancer, chronic bronchial asthma, prolonged use of glucocorticosteroid, renal disorder, and hypothyroidism have been associated with low levels of vitamin D. Correction of vitamin D level improves the symptom of fatigue. Whether low vitamin D causes fatigue in otherwise healthy women is the subject of research. AIM: This prospective nonrandomized and therapeutic study observed the prevalence of hypovitaminosis D in women with fatigue and the effect of correction of vitamin D level in fatigue-like symptoms. MATERIAL AND METHODS: One thousand two hundred adult women, who presented in our primary care hospital with complaints of easy fatigue, otherwise no associated medical illness were included. They completed the fatigue assessment questionnaire (FAQ). Patients with hypovitaminosis D received cholecalciferol (60000 IU) therapy for 5 weeks. Scores of pre- and post-treatment FAQs were noted and compared. RESULTS: The prevalence of low vitamin D was noted in 84.8% women who presented with main complaints of fatigue. After the correction of vitamin D level, fatigue symptom scores improved significantly (P < 0.001) in 82.6% of the women in all five-subscale categories of the FAQ. CONCLUSION: We observed a high prevalence of low serum vitamin D level in women who presents with fatigue with no medical illness. A significant improvement was noted in the severity of their fatigue symptoms after the correction of vitamin D levels with cholecalciferol therapy.

Epidemiology and outcome of trauma victims admitted in trauma centers of tertiary care hospitals - A multicentric study in India.

BACKGROUND: Roadside trauma in India is an increasingly significant problem, particularly because of bad roads, irregular road signs, overcrowding, overspeeding, and bad traffic etiquettes. Adequate information on the characteristics of victims, causes of accidents, frequency, vehicles involved, alcohol intake, and outcome of management is essential for understanding and planning for better management. AIM: This study aimed to determine the characteristics of trauma (roadside accidents) victims admitted to various trauma centers in India. The purpose of this study is to examine the epidemiology of trauma within a local community in India through data gained from the different emergency centers and to analyze trauma patients to find the predictors that led to the deaths of trauma patients. MATERIALS AND METHODS: The present observational study involved trauma victims over 1-year period in three centers. Demographical details recorded were age, sex, alcohol intake, systolic blood pressure on arrival, respiratory rate, Glasgow Coma Scale (GCS) score, the interval between injury and admission, Injury Severity Score (ISS) risk factors, hospital stay, and outcome. RESULTS: A total of 2650 injuries were recorded in 2466 patients. The mean age was 42.45 ± 15.7 years, the mean ISS was 13.82 ± 6.2, and the mean GCS was 12.20 ± 4.1. The mean time to admission at different trauma centres was 48.41 ± 172.8 h. The head injury was the most common (29.52%). CONCLUSION: Road side accidents due to overspeeding was the most common cause whereas driving under the effect of alcohol was the second most common cause. Accidents are common because of bad traffic etiquette on Indian roads.

Is it necessary to screen patient with adhesive capsulitis of shoulder for diabetes mellitus?

BACKGROUND: Idiopathic adhesive capsulitis of shoulder is common cause of pain and restriction of shoulder motion between the ages of 30 and 65. The prevalence of adhesive capsulitis is as high as 10% to 22% in diabetes mellitus as compared normal population which is 02% and 04%. Therefore, the doubt arises whether patients developed adhesive capsulitis are at greater risk to develop diabetes mellitus and should be screen for diabetes so that it can be detected early. PURPOSE: To compare the prevalence of prediabeties and diabetes mellitus among patients with features of idiopathic adhesive capsulitis of shoulder who are otherwise healthy. METHODS: Patients between 30-65 years of age who attended Orthopaedics OPD with features of idiopathic adhesive capsulitis of shoulder were included. Participated underwent a 2 hour long oral glucose tolerance test and based on fasting and 2-hour plasma glucose levels, patients were diagnosed as normal glucose tolerance, prediabetic, or diabetic and the results were matched with previous published data. RESULTS: 135 patients as participated and completed the test. 21 (15.5%) patients with idiopathic adhesive capsulitis of shoulder were found to be prediabetic, and 37 (27.4%) patients were found to be diabetic. However, 31 patients had family history of diabetes. CONCLUSION: Based on our study, we can recommend that patients with features of idiopathic adhesive capsulitis of shoulder should be screened at least for fasting and post prandial blood sugar so that diabetes can be detected early.

Prevalence of Osteoporosis in Peri- and Post-menopausal Women in Slum Area of Mumbai, India.

OBJECTIVE: We conducted our study involving 1400 peri- and post-menopausal women who live in a slum area of Mumbai to determine the prevalence of osteoporosis, awareness about osteoporosis, education (knowledge regarding osteoporosis), treatment and prevention of osteoporosis. MATERIAL AND METHODS: A detailed medical, surgical, obstetrical & gynecological, menstrual, and drug history was recorded in a predesigned questionnaire designated for the study. Height and weight and body mass index were measured, physical activity level especially load bearing exercise was recorded, and amount of sunlight exposure per day was also recorded. Food intake was estimated using the 24 h dietary recall method and calcium and Vitamin D consumption pattern was assessed. We used calcaneum quantitative ultrasound to assess bone mineral density (BMD) for such large population. RESULTS: The prevalence of low BMD was found in more than half of this population (81%). The mean age in Group I was found to be 36.50 ± 2.74 years as compared to 37.5 ± 3.44 years in Group II with low BMD, which was statistically significant (P = 0.02). The average age at menopause was 51.62 ± 5.72 years in Group I and 49.43 ± 4.52 years in Group II. The number of children and type of menopause has been found to be associated with low BMD in our study. Lack of physical exercise and low-calcium diet were significantly associated with low BMD. CONCLUSION: Our study showed that there is a high prevalence of Vitamin D deficiency and Osteoporosis even in adult women who live in a slum area. The findings from the study also suggest the need for large community-based studies so that high-risk population can be picked up early and early interventions and other lifestyle changes can be instituted so that no delay in implementing state and national or international health policy to tackle this increasing global health problem. The public awareness is important, and strategies to identify and manage low BMD in the primary care setting needs to be established and implemented.