Hip Fracture Post-operative Mortality and Polypharmacy: A New Risk Predictor?

Introduction Hip fractures include intra- and extracapsular fractures with hip hemiarthroplasty, intramedullary (IM nailing), dynamic hip screw (DHS) fixation and cannulated cancellous screws being the main treatment options. The Nottingham Hip Fracture Score (NHFS) is used to predict the risk of 30-day mortality with some studies investigating its use for one-year mortality. This study aims to investigate the impact of polypharmacy on post-operative hip fracture mortality and the correlation with NHFS predicted mortality. Methods A retrospective single-centre analysis was carried out on hip fracture patients aged 65 years and over who underwent operative management. Primary outcome measures were 30-day and one-year mortality along with the presence of polypharmacy. Secondary outcome measures were mortality based on procedure type, NHFSs for polypharmacy and non-polypharmacy groups, number of medications, American Society of Anesthesiologists (ASA) grade, age and gender. Polypharmacy was defined as five or more long-term medications from a selected list of drug classes. Results Thirty-day mortality was 19.3% for the polypharmacy group and 2.4% for the non-polypharmacy group (P≤0.00001), while one year mortality was 50.9% for the polypharmacy group and 2.4% for the non-polypharmacy group (P≤0.00001), the NHFS was 5.16 (±1.38) on average for the polypharmacy group and 5.07 (±1.47) for the non-polypharmacy group. Thirty-day mortality was 10/116 (8.6%) for the hemiarthroplasty patients, 3/66 (4.5%) for the DHS fixation patients and 1/32 (4.5%) for the IM nailing patients. One-year mortality was 33/116 (28.4%) for the hemiarthroplasty patients, 11/66 (16.7%) for the DHS fixation patients and 4/32 (12.6%) for the IM nailing patients. Conclusion Polypharmacy correlated with a significantly higher one-year and 30-day postoperative mortality after hip fractures with the NHFS predicting no difference in mortality. This finding could assist in decision making and help facilitate discussions with patients and family members regarding post-operative mortality risks. The NHFS may also benefit from integrating polypharmacy possibly leading to more accurate risk predictions. The IM nailing and DHS fixation patients were found to have a lower 30-day and one-year mortality than the hemiarthroplasty patients.

High dissolved organic radiocarbon in precipitation during winter and its implication on the carbon cycle.

Radiocarbon (14C) analysis is a powerful tool for tracing carbon in the global carbon cycle. Precipitation is a component of the global carbon cycle through which dissolved organic carbon (DOC) enters terrestrial and aquatic ecosystems from the atmosphere. In previous studies, the Δ14C of DOC in rain or snow was negative indicating an input of relatively old organic carbon including fossil fuels, with only a few positive values up to +108‰ showing the signal of recent photosynthesis. However, here we report surprisingly high Δ14C-DOC in bulk precipitation, more than 1000‰ in Seoul, South Korea, especially when the Northwesterly wind blows during winter. In contrast, Δ14C of particulate organic carbon (POC) in bulk precipitation was negative, indicating that the sources of POC and DOC were different. Although the sources of the high Δ14C-DOC are not clear and future studies on them are required, the relatively high Δ14C-DOC in a nearby headwater stream suggests that precipitation DOC has the potential to affect the local carbon cycle, and that stream DOC derived from terrestrial ecosystems could be older than previously thought. The analysis of Δ14C-DOC of precipitation in many other locations is necessary to understand how long carbon stays in terrestrial ecosystems.

Panton-Valentine leukocidin-positive Staphylococcus aureus osteomyelitis of the tibia in a 10-year-old child.

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is increasing in prevalence among asymptomatic carriers and in cases of paediatric soft-tissue infections alike. CA-MRSA may express virulence factors such as Panton-Valentine leukocidin, which makes soft-tissue and hard-tissue infections due to such organisms challenging to treat. We report a case of osteomyelitis of the proximal tibia in a 10-year-old boy and discuss its management in what is to the authors' knowledge the first case report of Panton-Valentine leukocidin-positive CA-MRSA osteomyelitis in a child in the UK.