Episode Of Fall Research Articles

Risk factors for osteoporotic hip fracture among community-dwelling older adults: a real-world evidence study

BackgroundHip fractures in the older adults lead to increased morbidity and mortality. Although a low bone mineral density is considered the leading risk factor, it is essential to recognize other factors that could affect the risk of hip fractures. This study aims to evaluate the contribution of clinical characteristics, patient-reported outcomes, and muscle and aerobic capacity for hip fractures in community-dwelling older adults.MethodsThis is a retrospective cohort study with real world-data from subjects ≥ 60 years old attending an outpatient clinic in Minas Gerais, Brazil, from May 1, 2019, to August 22, 2022. Data about clinical characteristics (multimorbidity, medications of long-term use, sedative and or tricyclic medications, number of falls), patient-reported outcomes (self-perception of health, self-report of difficulty walking, self-report of vision problems, and self-report of falls) and muscle and aerobic capacity (calf circumference, body mass index, and gait speed) were retrieved from an electronic health record. The association of each potential risk factor and hip fracture was investigated by a multivariable logistic regression analysis adjusted for age and sex.ResultsA total of 7,836 older adults were included with a median age of 80 years (IQR 72–86) and 5,702 (72.7%) were female. Hip fractures occurred in 121 (1.54%) patients. Multimorbidity was associated with an increased risk of hip fracture (OR = 1.12, 95%CI 1.06–1.18) and each episode of fall increased the chance of hip fracture by 1.7-fold (OR = 1.69, 95%CI 1.52–1.80). Patient-reported outcomes associated with increased fracture risk were regular or poor self-perception of health (OR = 1.59, 95%CI 1.06–2.37), self-report of walking difficulty (OR = 3.06, 95%CI 1.93–4.84), and self-report of falls (OR = 2.23, 95%CI 1.47–3.40). Body mass index and calf circumference were inversely associated with hip fractures (OR = 0.91, 95%CI 0.87–0.96 and OR = 0.93, 95%CI 0.88–0.97, respectively), while slow gait speed increased the chance of hip fractures by almost two-fold (OR = 1.80, 95%CI 1.22–2.66).ConclusionOur study reinforces the importance of identified risk factors for hip fracture in community-dwelling older adults beyond bone mineral density and available fracture risk assessment tools. Data obtained in primary care can help physicians, other health professionals, and public health policies to identify patients at increased risk of hip fractures.

Proportion, Pattern, and Predictors of Falls in Older Adults - A Community-based Observational Study in Rural West Bengal.

In spite of falls being a major public health problem, where most of the falls are preventable, there is a lack of epidemiological investigation among those aged 50 and above, especially in developing countries. Hence, we investigate the proportion, pattern, and predictors of falls in this age group. This cross-sectional community-based study was done in the Uluberia-II block of Howrah district, West Bengal, from February to July 2021. A multistage cluster sampling method was used to meet the sample size. Data were collected with the help of a structured interview schedule. Predictors were estimated by the SPSS version 16 and defined in adjusted odds ratio (AOR) with a 95% confidence interval. Among 170 study participants, 34.7% (59/170) experienced at least one episode of fall, while 20.6% (35/170) experienced recurrent falls in 12 months. Most (78%; 46/59) falls occurred in the home environment and due to slippage (67.8%; 40/59) on the floor. 84.7% (50/59) sustained any type of injuries, 47.5% (28/59) required either consultation of a physician or medication, and 6.8% (4/59) required hospitalization. Safety Checklist Score measured 75.3% (128/170) had a poor household environment, within that 30.6% (52/170) had a seriously poor household environment, which was an important predictor of falls ([AOR] = 3.59 [1.24-10.38]). Fear of fall (AOR = 6.18 [1.77-21.53]) measured by shortfall efficacy scale and nonformal education (AOR = 5.05 [1.33-19.07]) were also predictors of falls. Considerable proportion of falls occurred in the past year, which can be preventable by improving modifiable environmental factors and detection of fear of fall in persons at different levels of health-care facilities.

Traumatic rupture of an intracranial dermoid cyst: A case report

Intracranial dermoid cyst is a very rare primary intracranial tumor accounting for <0.5% of intracranial masses. They are usually congenital and benign. Rupture of intracranial dermoid may occur spontaneously or with trivial trauma. Most cases of rupture are spontaneous. There are very few reported cases of traumatic rupture of intracranial dermoid cysts in world medical literature. The presentation can range from headache to signs of meningeal irritation and focal neurological deficit. Computed tomography (CT) and magnetic resonance imaging (MRI) of the brain is of paramount importance for early diagnosis and prompt treatment planning which can reduce both morbidity and mortality. The following case report gives an account of a 49-year-old female who presented with complaints of headache after an episode of fall. She was examined and no neurological deficit was found. Examination of the neurological system was within normal limits. She underwent a CT and MRI of the brain and was subsequently diagnosed as traumatic rupture of dermoid cyst based on the findings. She was treated with high-dose steroids until resolution of her symptoms and then discharged with the advice of regular follow-up. This case report highlights the role of CT and MRI in early diagnosis and treatment planning of patients with ruptured dermoid cysts which leads to a decrease in mortality and morbidity and also the ability of the same to rule out other more sinister causes of headache in patients.

PORTAL VENOUS GAS CAUSING CEREBRAL VENOUS AND PULMONARY ARTERY AIR EMBOLISM

TOPIC: Critical Care TYPE: Fellow Case Reports INTRODUCTION: Venous air embolism can be caused by various mechanisms. Portal venous air as cause of venous air embolism has been reported very rarely in existing literature. CASE PRESENTATION: 67 y/o admitted to the hospital after episode of fall with hypoxia found to have right perinephric hematoma, multiple right rib fractures and bilateral transudative pleural effusion due to fluid overload. He also had MSSA bacteremia, getting treated with Cefazolin and HD catheter changed few weeks ago. Past medical history significant for ESRD on HD, DM II, CAD s/p CABG, A-fib on Coumadin, SSS s/p PPM, Bio prosthetic MVR, Infra-renal AAA, Chronic thrombocytopenia, HFpEF. Rapid response was called for acute change in neurological status and low BP of 84/58. He was noted to be alert but unresponsive even to pain, right gaze deviation, decorticate posturing. BP improved to 95/62 with 1L NS and was requiring 6LNC O2 supplementation to keep SpO2 > 90. Stroke Code was called, CTA Head and Neck showed air in multiple venous structures in neck, cavernous sinus, subarachnoid space and pulmonary artery. High flow oxygen was given and kept on Trendelenburg and left lateral position. CT Chest showed air in pulmonary artery and right atrium. CT Abdomen and Pelvis showed dilated small bowel with pneumatosis and extensive mesenteric venous and portal venous air. Surgery felt patient was poor surgical candidate. He went into sudden acute respiratory failure requiring intubation likely secondary to worsening air embolism. Due to poor prognosis and critical health family decided to transition to comfort care. DISCUSSION: Venous air embolism is usually caused by surgical procedure, trauma, central venous access and barotrauma. Pulmonary artery air embolism caused by portal venous air is rare with few case reported 1. Cerebral venous air embolism due to portal venous air has been reported only twice in literature 2,3. Based on literature review, there is no prior reported case of venous air embolism involving pulmonary artery and cerebral vein caused by portal venous air. CONCLUSIONS: Pulmonary artery air embolism and cerebral venous air embolism are rapidly fatal entity that could complicate patients with portal venous air, hence needs to be considered and recognized early. REFERENCE #1: Kamikado et al, Gas embolism caused by portal vein gas: case report and literature review. Case Rep Gastroenterology 2008;2:262-271 DOI: 10.1159/000146064 REFERENCE #2: Parikh et al, Gas embolic stroke secondary to bowel infarction. Journal of Stroke and Cerebrovascular Disease 2016;1;e1-e3 DOI: 10.1016 REFERENCE #3: Taydas et al, Retrograde cerebral air embolism in a patient with intestinal necrosis: a care report. Balkan Medical Journal 2017;34;371-373 DOI: 10.4274 DISCLOSURES: No relevant relationships by Woon Chong, source=Web Response No relevant relationships by Kiran Pokhrel, source=Web Response No relevant relationships by Gregory Wu, source=Web Response

Brodie’s Abscess of the Proximal Humerus Metaphysis: A Case Report

Introduction:Primary subacute pyogenic osteomyelitis, or Brodie’s abscess was initially documented by Sir Benjamin Brodie in 1832. We present a case report with a 6-months follow-up period, demonstrating the successful diagnosis and surgical treatment of a focal lesion of the proximal metaphysis of the right humerus in a 21-years-old female. The pathology of hematologic osteomyelitis and its role in the development of a subacute abscess along with a review of literature and an in detail description of the pathogenesis of Brodie’s abscess is discussed and submitted.Case Presentation:A 21- years -old healthy female with a history of fall sustaining injury to the right shoulder one 1 year back followed by which she presented to the outpatient clinic with a swelling over her right shoulder. The patient was managed conservatively with analgesics and was relieved of pain over a course of one 1 week of medications, the patient now presents with pain and swelling in the right shoulder joint on and off since the episode of fall one 1 year back, which had increased over a period of past one 1 week. A week before the most recent presentation she started experiencing some discomfort and pain in her right shoulder. No recent trauma was reported. A mild swelling appeared over the proximal part of the humerus. There were no constitutional symptoms of fever or any illness reported. On examination, there was noted a painful restriction of ROM at the right shoulder joint with no rotator cuff injury. Laboratory investigations were suggestive of raised inflammatory markers. Radiograph of the right shoulder taken in the true antero-posterior view with the shoulder in the neutral rotation was suggestive of an oval lucency with surrounding sclerosis in the proximal metaphyseal region of the humerus. Magnetic resonance imaging MRI of the right shoulder joint showed features consistent with Brodie’s abscess in the proximal metaphyseal region of the humerus. Surgical debridement of the abscess was planned. The right shoulder of the patient was immobilized by a universal shoulder immobilizer for 3 days post -operatively and then Pphysiotherapy for shoulder range of movements was started. Infectious parameters decreased and there were no complications in the postoperative period. Regular follow follow-up for two 2 weeks showed clinical improvement. At 6 months follow- up, the patient had made full recovery with radiographic improvement.Conclusion :Brodie’s abscess was first described by Sir Benjamin Brodie in 1832. Primary hematogenous subacute osteomyelitis is rarely seen in the proximal metaphysis of the humerus. With appropriate surgical debridement and aggressive antibiotic cover, a near 100% success rate is observed in the treatment of Brodie’s abscess with no residual deformities in the affected bones or restrictions in the range of movements in the neighboring joints.

Early Osteoporosis in RYR1-Related Central Core Disease

Background: Central core disease(CDC) is a congenital neuromuscular myopathy with a wide range of phenotypic presentations, ranging from delayed motor development, frequent falls, and difficulty maintaining posture. CDC is a rare presentation of RYR1 (Calcium release channel gene) mutation, which is also linked with the etiology of malignant hyperthermia. Clinical Case: We present a case of a 57-year-old woman who was diagnosed with osteoporosis at age of 52 with a T score of -2.3 after she had a fragility fracture of the knee. She suffered from multiple falls from poor balance. Her most recent DXA bone density scan from December of 2018 showed a T score of -2.6. On genetic testing, she was found to have a RYR1 heterozygous mutation, on exon 28.c.3800C to G(p.P1267 Arg). This sequence change led to the replacement of proline with arginine at codon 1267 of RyR1 protein. None of her immediate and extended family members showed any signs of CDC. We assume that the loss of sufficient muscle strain on bone and the catabolic effect of RYR1 myopathy are major causes of osteoporosis in our patient, although menopause, personal history of smoking, and alcohol intake could also be contributing factors. Teriparatide along with daily Calcium and Vitamin-D was prescribed. Later on, denosumab injection was also added to the regimen. The patient still has at least one episode of unprovoked fall in a month, but luckily she has not had any more fractures. Conclusion: To our knowledge, this is the first case where early osteoporosis in RYR1 myopathy has been reported.

A prospective study of functional outcome of treatment of supracondylar fracture of femur by locking compression plate

Aim: To evaluate the functional outcome of supracondylar femur fracture treated by locking compression plate. Materials and Methods: Our study consists of 20 cases of supracondylar femur fracture operated at Sanjay Gandhi institute of trauma and orthopaedics from November 2015 to march 2017.Functional outcome was assessed through Neers scoring system. All the cases in the study were posttraumatic. Mean duration of follow up was 11 months Results: There were 7 male patients and female were 13.Average age of the patients was 40.5 years with age ranging from 18 years to77 years.14 cases involved the right femur whereas 7 left sided femur fracture occured. The study included only one case of compound type 1 femur fracture and 19 cases were closed supracondylar femur fractures. The mode of injury was RTA for 12 cases and 8 cases had history of self-fall. Only 3 cases had associated injuries. In patients with associated injuries early rehabilitation were delayed but results were comparable with other cases of the study. In our study Muller type A3 was the most common fracture presentation which consists of 7 cases followed by 5 type A1 fractures. There were 4 cases of type C1 fractures, 2 cases of type C3 fracture and one case in each type A2 and C2 group. 5 cases were operated under MIPPO technique which were extraarticular fractures. Further all fractures which had articular involvement were operated on standard open approach. Average surgical procedure timing was 101.5 minutes in our study. Most of the patients had excellent postoperative knee flexion with average knee flexion of 119 degrees. Average duration of radiological union was 19.3 weeks and average duration of weight bearing was 20.3 weeks.1 patient in the study had delayed union, 2 cases had a extensor lag of 5 degree while 1 patient had an extensor lag of 10 degrees. 10 cases in the study had fracture union without any complications. Stiffness was present in 7 cases, Knee pain was reported in 3 cases. 1 cases had shortening of 1cm .Superficial infections were reported in two cases which responded to intravenous antibiotics based on pus culture report. There was no incidence of deep surgical site infection in our study. In our study there was one case of implant failure requiring revision surgery. The patient had a episode of fall 3 months after primary surgery. Radiograph showed implant failure with varus deformity at the fracture site and no signs of callus formation. Keywords: LCP, Supracondylar femur fracture, Distal femur fracture, Functional outcome

The Effect of Orthostatic Hypotension Detected Pre-Operatively on Post-Operative Outcome.

Exacerbation of or new onset orthostatic hypotension in perioperative patients can occur. There is complex underlying pathophysiology with further derailment likely caused by acute cardiovascular changes associated with surgery. The implications for post-operative recovery are unclear, particularly in frail and older patients. We retrospectively explored patient notes for evidence of post-operative orthostatic intolerance in relation to pre-operative orthostatic hypotension. Supine and 1-minute and 3-minute standing blood pressure measures obtained from adult patients before mainly general, orthopedic or uro/gynecology surgery were compared to post-operative outcome, specifically, evidence in patient notes about falls, feeling dizzy/unsteady and/or fearful to stand. Orthostatic hypotension was defined as a 20 mmHg or more and/or 10 mmHg or more fall in systolic and diastolic blood pressure, respectively, within ~3 minutes of standing after lying supine for an electrocardiogram. Whilst all patients included had a 1-minute standing blood pressure assessment (N = 170), 3-minute assessment was performed less commonly (N = 113). Nevertheless, one-quarter (23.5%; N = 40) of 170 patients had pre-operative orthostatic hypotension. This was not clearly explained by cardiac or neurological disease or by common medications, but did occur more frequently in older patients and in those aged 65 years or more with higher clinical frailty scale scores. The COVID-19 pandemic reduced the number of patients progressing to surgery within the planned study timescale (N = 143/170; 84.1%). Nevertheless, patients with orthostatic hypotension stayed longer in hospital post-operatively and were more likely to have an episode of fall, unsteadiness and/or dizziness documented (un-prompted) in their notes. These data provide further impetus for research into modifiable perioperative risk factors associated with orthostatic hypotension. These risks are not confined to those with a pre-existing dysautonomia diagnosis.

2374 Rare Microbiologic Etiologies of Spontaneous Bacterial Peritonitis

Introduction: Often regarded as a poor prognostic factor in ascites, spontaneous bacterial peritonitis (SBP) is usually caused by Gram negative rods (E. coli, K. pneumoniae) and Gram positive cocci (S. pneumoniae).This case report identifies 2 rare cases of SBP. CASE DESCRIPTION/METHODS: Case 1 A 59 yo M with h/o decompensated cirrhosis (ascites without SBP history, encephalopathy, and variceal bleed) due to HCV presented with an episode of fall requiring orthopedic procedures. Flapping tremor, mild icterus, anemia, thrombocytopenia, AKI, coagulopathy, hyperbilirubinemia, hypoalbuminemia, and MELD score of 18 were significant findings. Abdominal/pelvic CT revealed hydronephrosis, which was corrected with ureteral stent placement upon admission. While awaiting rehab placement, patient developed paralytic ileus, septic shock due to ceftriaxone susceptible E. coli bacteremia, upper GI bleed, hypernatremia, pancytopenia, worsening hepatic encephalopathy, and worsening ascites with PMN of 3062. Abdominal/pelvic CT revealed no bowel perforation or alternate peritonitis source. Initially covered with piperacillin/tazobactam (P/T) and vancomycin for 4 days, therapy was narrowed to ceftriaxone for the following 4 days. Unfortunately, ascitic culture revealed Eggerthella lenta on culture day 8 (susceptible to clindamycin, meropenem, amoxicillin/clavulanate); patient ultimately demised with multiorgan failure. Case 2 A 66 yo M with h/o HCV and alcoholic cirrhosis on ciprofloxacin SBP prophylaxis, HFrEF, PVD with non-healing ulcer, CKD, and COPD presented with abdominal distension for routine paracentesis. Patient requires 5 to 6 L of ascitic fluid drainage with albumin replacement every other week. Ascitic fluid revealed PMN of 384; ceftriaxone was administered for 5 days and patient was discharged on ciprofloxacin prophylaxis. Ascitic fluid drawn prior to discharge ultimately grew Paenibacillus barengoltzii. Patient was requested to return for repeat ascitic culture, which resulted negative. DISCUSSION: 1. E lenta and P. barengoltzii SBPs have not been previously described in literature; thus, both represent the first cases of each. A rare anaerobic intra-abdominal pathogen, E. lenta is associated with high mortality with P/T monotherapy. Paenibacillus species have not been studied in depth but are likely susceptible to third-generation cephalosporins. Gastroenterologists and internists managing similar cases may fail to identify these etiologies and appropriate treatment resulting in unfavorable outcomes.

Falls among community-dwelling older adults in Ethiopia; A preliminary cross-sectional study.

BackgroundFalls among older adults is a common precipitating factor for unintentional injuries and represent a major health problem associated with increased morbidity, mortality, and health care cost in low-and-middle-income countries. The burden of fall in this population is well established in high-income countries and scant attention is given to this precipitating factor in low-and-middle-income countries, including Ethiopia. Therefore, this study aimed to estimate the prevalence and factors associated with fall among community-dwelling older adults in Ethiopia.MethodsA community-based cross-sectional study was conducted among community-dwelling older adults of Gondar. Multi-stage random sampling technique was used across administrative areas. Six hundred and five households were selected proportionally using systematic random sampling technique. Physical measurement and face to face interview method were employed using a structured questionnaire for data collection. Data were analyzed descriptively and through uni- and multivariate logistic regression model.ResultsOne hundred and seventy (n = 170, 28.4%; 95% CI 24.7–32.1) community-dwelling older adults reported having experienced fall in the past 12 months. Sex (OR = 1.91, 95% CI: 1.24–2.95), low educational status (OR = 2.37, 95% CI: 1.19–4.74), uncomfortable home environment (OR = 2.02, 95% CI: 1.34, 3.04), having diagnosed medical condition (OR = 4.659, 95% CI: 1.20–18.02), and use of medication (OR = 5.57, 95% CI: 1.19–26.21) were significantly associated risk factors of self-reported fall in the past 12 months. Most outdoor falls are associated with females and participants aged below 66 years.ConclusionIn conclusion, more than 1/4th of the community-dwelling older adults experienced at least one episode of fall and about 60% of them reported recurrent falls. Identifying risk group and risk factors that could be modified so as to prevent falls in older adults deserves attention. Outdoor falls are usually attributable to modifiable environmental aspects and improvements in outdoor environment needed.

MON-091 THE RISK FACTORS OF FALLS IN PATIENTS WITH MAINTEINANCE HEMODIALYSIS

A one-year prospective observational study was conducted to evaluate the incidence rate and risk factors of falls among 306 hemodialysis patients in a single hemodialysis facility. Each participant was interviewed face-to-face by well-trained interviewers who completed the structure questionnaire. We enrolled 306 hemodialysis patients. Sixty-six patients (21.8%) with a median age 67.0 years fell at least once during one year. Of the 69 falls, 69.3% were indoors and 30.7% on outdoors. We used Hendrich Fall risk model and Morse Fall Scale to evaluate the risk of falls in our patients who had falls during follow up period. The results showed the highest risk in Hendrich Fall risk model was dizziness (53.5%). The average score of Morse Fall Scale was 56.29. The highest score of Morse Fall Scale was except as otherwise complications of kidney disease (75.5%). Beck Depression Inventory showed that 29% of participants had mild depression or worse. The risk factors of visual acuity and depression were associated with falls in our patients.Falls is the common accident in hemodialysis patients. We should find out the group with higher risk of falls and give more attention and education to avoid falls happened. Our study revealed the high risk group in our hemodialysis facility. We enrolled 306 patients with maintenance hemodialysis from a hemodialysis facility in Taiwan. The follow-up period was 12 months since enrollment. To find out the risk factors of falls, we used Hendrich Fall Risk Model, Morse Fall Scale and Beck Depression Inventory to evaluate the patients who had fallen history during follow up period. We also collected the rate of 3-year mortality from patients who had fallen history. In our cohort (306 patients with maintenance hemodialysis), sixty-nine patients had at least one episode of fall during one year follow-up period. The total episode of falls was ninety-nine. The mean age of patients who experienced falls was 66.6 years and the mean dialysis duration was 5.72 years. The prevalence of falls among men and women was 17.81% and 26.88%. To evaluate the risk of fall,.The most common three risk factors of Hendrich Fall Risk Model were sedatives and hypnotics (50.7%), dizziness (45.6%), and the inability to stand up from a sitting position (33.3%). The total average score for the Morse Fall Scale was 55.08 with 31 (54.9%) of the patients suffering from gait instability or assessed as bedridden. The results of the Beck Depression Inventory showed that 29% of participants had mild depression or worse . Fall risk factors were positively correlated with visual acuity and depression. Patients receiving hemodialysis have increased fall risk factors when they experience severe problems in visual acuity and score high on the depression inventory The first-year mortality of patients who suffered from recurrent falls was higher than that of those who had only experienced a single fall. In our cohort, we found out the most potential risk factors of falls in patients with maintenance dialysis in Taiwan. Furthermore, we revealed that higher mortality rate was found in patients with repeated falls history than in patients with single episode of fall. To reduce the risk of fall, we must find out the patients who had higher risk of falls and educate of fall prevention strategies.

A cross sectional study on the prevalence and risk factors of fall among the elderly in an urban slum in Chennai

Background: Falls are an important cause of morbidity and mortality in elderly people. Falls lead to multiple medical and psychological problems in the elderly. Aim was to study the prevalence of falls among the elderly and to find the associated risk factors for falls among the elderly living in an urban slum in Chennai.Methods: A cross sectional study was conducted among elderly population over 60 years and above, in an urban slum area. About 150 elderly were selected using simple random sampling method, using the voters list as the sampling frame. A pretested questionnaire was administered to collect information about falls. In statistical analysis univariate and multivariate logistic regression was employed using SPSS version 22.Results: Of the 150 elderly persons studied, prevalence of falls rate is 35.3% (95% CI 28.13 to 43.26). Of them 64.1% had one episode of fall and 35.8% had recurrent falls. The prevalence of fall among persons with comorbidities like hypertension or diabetes was 39.3% and 36.1% respectively .The rate of fall among those using a walking stick was 58.3%, having tremors was 15% and having abnormal gait was 40%. The risk factors found to be significantly associated in univariate analysis were gender and presence of tremors (p<0.05). In multivariate analysis none of the factors showed statistical significance.Conclusions: Falls are very common among elderly. It is utmost important to prevent the falls by making necessary environmental modifications and following healthy lifestyle.

Muscle Relaxant Use Among Hemodialysis Patients: Prevalence, Clinical Indications, and Adverse Outcomes

Muscle relaxants are often used to treat musculoskeletal pain or cramping, which are commonly experienced by hemodialysis patients. However, the extent to which muscle relaxants are prescribed in this population and the risks associated with their use have not been characterized. Observational cohort study. 140,899 Medicare-covered adults receiving hemodialysis in 2011, identified in the US Renal Data System. Time-varying muscle relaxant exposure. Primary outcomes were time to first emergency department visit or hospitalization for altered mental status, fall, or fracture. Secondary outcomes were death and composites of death with each of the primary outcomes. Multivariable Cox regression analysis. 10% of patients received muscle relaxants in 2011. 11%, 6%, 3%, and 13% had an episode of altered mental status, fall, fracture, and death, respectively. Muscle relaxant use was associated with higher risk for altered mental status (HR, 1.39; 95% CI, 1.29-1.51) and fall (HR, 1.18; 95% CI, 1.05-1.33) compared to no use. Muscle relaxant use was not statistically significantly associated with higher risk for fracture (HR, 1.17; 95% CI, 0.98-1.39). Muscle relaxant use was associated with lower hazard of death (HR, 0.85; 95% CI, 0.76-0.94). However, hazards were higher for altered mental status or death (HR, 1.17; 95% CI, 1.10-1.25), fall or death (HR, 1.14; 95% CI, 1.06-1.22), and fracture or death (HR, 1.10; 95% CI, 1.01-1.20). A causal association between muscle relaxant use and outcomes cannot be inferred, and residual confounding cannot be excluded. Exposure and outcomes were ascertained using administrative claims. Muscle relaxant use was common in hemodialysis patients and associated with altered mental status and falls. We could not rule out a clinically meaningful association between muscle relaxant use and fracture. The lower risk for death with muscle relaxants may have been the result of residual confounding. Future research to define the appropriate use of muscle relaxants in this population is warranted.

Ages and magnitudes of base level fall and valley downcutting in ten tributaries (the Ten Kongduis) of the upper Yellow River, China

Using a morphometric dating method and the S-A (channel slope vs. drainage area) power law relation, the history of tectonic uplift and valley downcutting was investigated in the catchments of the Ten Kongduis (ten ephemeral streams) in Inner Mongolia, China, for the past ca. 5 Ma. These streams drain an area of the northern Ordos Plateau and flow northward into the Hetao Basin where they eventually debouch into the Yellow River. To derive reasonable ages of tectonic perturbation in catchments with obviously different widths between their lower and upper sections, an index was constructed for removing the effect of geometric irregularity on the morphometric ages. The morphometric analysis discloses an episode of tectonic uplift in the study area as early as 2.2–5.8 Ma, an episode or episodes of tectonic uplift after 1.15–0.50 Ma, and an episode of base level fall starting from 0.025–0.036 Ma. In the period of 1.15–0.50 Ma, the eastern stream catchments were uplifted from 0.99–1.15 Ma, a middle stream catchment was uplifted after 0.74 Ma, and a western stream catchment was uplifted after 0.50 Ma. The episode of base level fall after 0.025–0.036 Ma was detected only in some western streams, presumably indicating a recent subsidence episode of the western part of the Hetao Basin. After the episode of tectonic uplift dated to 2.2–5.9 Ma, equilibrium longitudinal profiles were formed in the streams and preserved in the sources of some streams. By comparing the elevations of the projected equilibrium profiles based on their S-A power law relations with the current ones, and considering the valley downcutting of the equilibrium profiles in the past 0.5–1.15 Ma, the largest valley downcutting magnitude upstream of the southernmost fault between the Ordos Plateau and the Hetao Basin in two western and three eastern streams was found to be in the ranges of 142–194 m and 52–145 m, respectively, and the base level fall at the northernmost fault between the plateau and the basin was estimated to be 317 m and 138 m on average for the two western and three eastern streams, respectively.

ERDHEIM-CHESTER DISEASE: A RARE ENTITY

SESSION TITLE: Lung Cancer 2 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Erdheim-Chester disease (ECD) is a rare non-Langerhans form of histiocytosis of unknown origin. Its presentation can vary from asymptomatic bone lesions to multiorgan involvement. We describe a case of ECD with central nervous system (CNS), pulmonary, renal and retro-orbital involvement. CASE PRESENTATION: Sixty five year-old man with medical history significant for myelodysplastic syndrome (MDS) complicated by vascular events, chronic kidney disease, initially presented with severe headache and episode of fall, 20 lbs weight loss, multiple infections, recent bacteremia. During that admission, craniotomy done for possible subdural hematoma revealed extensive masses which were biopsied. He was discharged to an acute rehab but subsequently readmitted for progressive weakness.On admission, patient had thin extremities, distended abdomen, dependent pitting edema, rales in lung bases, splenomegaly, exophthalmos. CT Chest was significant for diffuse, marked interlobular septal thickening, ground glass opacities. New lucent lesions were identified on L1 vertebrae. MRI brain showed brain frontoparietal lesions upto 4 mm with mass effect for whichdecadrom was started. Eventually final pathology confirmed Non-Langerhans Histiocytosis along with positive BRAF V600E mutation. Vemurafenib was started, and patient’s initial symptoms of weakness improved. DISCUSSION: ECD is a rare form of non-Langerhans cell histiocytosis characterized by infiltration of lipid-laden histiocytes with foamy or eosinophillic cytoplasm to various organs along with specific immunohistochemistry pattern – CD68 positive and CD1a negative.(1) Mean age of presentation is at 53. Common clinical presentations include bone pain, fever and weight loss. About half of the patients will have extraosseous involvement of the disease, including the pericardium, exophthalmos, diabetes insipidus, CNS and pulmonary involvement. Both CNS and cardiac involvement carry poor prognosis.Pulmonary lesions in ECD are considered to be from histiocytic infiltration of pulmonary tissue.(2) Diagnosis is based in demonstration of histiocytes with characteristic immunohistochemistry pattern with supportive clinical and radiological findings. BRAF V600E mutation is demonstrated in about half of the patients. Interferon α and peginterferon α-2a are the most commonly used first line agent. Other agents like anakinra, toclizumab, infliximab and cladribine have been used with mixed response. In a recent case series targeted therapy with vemurafenib in patients with BRAF V600E mutation have shown promising results.(3) CONCLUSIONS: ECD is a rare disorder with wide spectrum of presentation. Diagnosis is based in demonstration of histiocytes with characteristic immunohistochemistry pattern with supportive clinical and radiological data. Vemurafenib has shown promising results in patient subset with BRAF V600E mutation. Reference #1: Cives M, Simone V, Rizzo FM, et al. Erdheim-Chester disease: a systematic review. Crit Rev Oncol Hematol. 2015;95(1):1-11. Reference #2: Mazor RD, Manevich-mazor M, Shoenfeld Y. Erdheim-Chester Disease: a comprehensive review of the literature. Orphanet J Rare Dis. 2013;8:137. Reference #3: Haroche J, Cohen-aubart F, Emile JF, et al. Reproducible and sustained efficacy of targeted therapy with vemurafenib in patients with BRAF(V600E)-mutated Erdheim-Chester disease. J Clin Oncol. 2015;33(5):411-8. DISCLOSURES: No relevant relationships by Mridul Gupta, source=Web Response No relevant relationships by Becky Lou, source=Web Response No relevant relationships by Luis Quintero, source=Web Response No relevant relationships by Effie Singas, source=Web Response

Late Quaternary uplift across northwest Luzon Island, Philippines constrained from emergent coral reef terraces

AbstractEmergent coral reef terraces in northwest Luzon Island, Philippines are studied to understand relative sea level (RSL) changes and uplift along the Manila Trench forearc region during the Late Quaternary. Coral reef sequences in Currimao, Badoc, and Badoc Island were mapped and were described based on geomorphological characteristics, elevation patterns, and ages. The lower emergent coral reef terraces, which are dated Holocene, are subdivided into three to possibly four terrace steps (TI–TIV in ascending order) with the highest terrace (TIII–TIV) rising up to ~7–9 m amsl. The well‐preserved staircase morphology and meter‐scale terrace risers possibly imply episodes of abrupt RSL changes that resulted from coseismic uplift during the mid‐Holocene. Around 6.8 kyr BP, ~3 m of rapid uplift (possibly coseismic) is inferred to account for the vertical separation of TI (6.2 kyr BP at 3.5 m amsl) and TII (6.8 kyr BP at 6.6 m amsl) in Currimao site. A subsequent episode of RSL fall occurred at 6 kyr BP, based on dated coral samples, and has emerged the lowest terraces in the study sites. New geomorphic and radiometric data suggest that the mid‐Holocene sea level highstand in northwest Luzon occurred at around 7–6 kyr BP. From the elevation and thorium‐230 age of dated terrace surfaces, we estimated Holocene uplift rates from 0.17 ± 0.12 to 0.82 ± 0.15 mm/yr across the three study sites. The estimated uplift rates of northwest Luzon are relatively lower than the uplift rates reported in similar tectonically active regions of the west Pacific such as Papua New Guinea, Taiwan, New Zealand, and Japan. The geomorphological characteristics and age of emergent coral reef terraces reported in this study offer insights on the preservation of long‐term deformation along the northwest Luzon coastal plain that is bordered by a subduction zone and upper‐plate faults. © 2018 John Wiley & Sons, Ltd.

Spatial variation in Late Ordovician glacioeustatic sea-level change

Mass extinction of Late Ordovician marine fauna closely coincided with southern hemisphere glaciation. The sequence stratigraphic architecture of shallow marine deposits informs estimates of glacioeustatic sea-level change at sites both proximal and distal to the reconstructed Ordovician ice sheet(s) and contemporaneous changes in ice volume. A recent correlation framework for the stratigraphic architectures of one near and one far field Late Ordovician margin concluded that the Late Ordovician glaciation encompassed multiple long-term cycles of ice volume growth and retreat with superimposed higher frequency cycles. Here we posit that—similar to Cenozoic glacial cycles—glacial isostatic adjustment can preclude synchronous and similar magnitude (or directional) changes in Late Ordovician sea level between ice proximal and ice distal locations and, hence, distort a globally correlative sequence stratigraphy. We explored whether long-duration (i.e., million year) Late Ordovician glacial cycles should produce a globally coherent, eustatic record of sea-level change between ice proximal and ice distal margins using a gravitationally self-consistent theory that accounts for the deformational, gravitational and rotational perturbations to sea level on a viscoelastic Earth model. We adopted a Late Ordovician paleogeography and a synthetic continental ice-sheet distribution and volume informed by the areal extent of glaciogenic deposits and geochemical records, respectively. We demonstrate that modeled million year Late Ordovician glacial cycles produce sea-level histories on near and far field margins that differ from eustasy, and from one another, due primarily to elastic flexure and associated gravitational effects. While predicted far-field sea-level histories faithfully preserve the temporal structure of modeled glacioeustasy, their amplitude may differ from eustasy by as much as 30–40%. The impact of glacial isostatic adjustment is largest at the margins of glaciated continents, and these effects can be of the same order of magnitude as the eustatic, and even induce a local sea-level rise during an episode of ice growth and eustatic sea-level fall, and vice versa. In this regard, stratal surfaces of maximum regression and flooding expressed at near-field margins need not reflect global (‘eustatic’) trends in ice sheet growth and decay, respectively, and thus may not provide chronostratigraphic horizons for correlation with far-field sequence stratigraphic architectures.

Opioid Analgesics and Adverse Outcomes among Hemodialysis Patients.

Patients on hemodialysis frequently experience pain and may be particularly vulnerable to opioid-related complications. However, data evaluating the risks of opioid use in patients on hemodialysis are limited. Using the US Renal Data System, we conducted a cohort study evaluating the association between opioid use (modeled as a time-varying exposure and expressed in standardized oral morphine equivalents) and time to first emergency room visit or hospitalization for altered mental status, fall, and fracture among 140,899 Medicare-covered adults receiving hemodialysis in 2011. We evaluated risk according to average daily total opioid dose (>60 mg, ≤60 mg, and per 60-mg dose increment) and specific agents (per 60-mg dose increment). The median age was 61 years old, 52% were men, and 50% were white. Sixty-four percent received opioids, and 17% had an episode of altered mental status (15,658 events), fall (7646 events), or fracture (4151 events) in 2011. Opioid use was associated with risk for all outcomes in a dose-dependent manner: altered mental status (lower dose: hazard ratio, 1.28; 95% confidence interval, 1.23 to 1.34; higher dose: hazard ratio, 1.67; 95% confidence interval, 1.56 to 1.78; hazard ratio, 1.29 per 60 mg; 95% confidence interval, 1.26 to 1.33), fall (lower dose: hazard ratio, 1.28; 95% confidence interval, 1.21 to 1.36; higher dose: hazard ratio, 1.45; 95% confidence interval, 1.31 to 1.61; hazard ratio, 1.04 per 60 mg; 95% confidence interval, 1.03 to 1.05), and fracture (lower dose: hazard ratio, 1.44; 95% confidence interval, 1.33 to 1.56; higher dose: hazard ratio, 1.65; 95% confidence interval, 1.44 to 1.89; hazard ratio, 1.04 per 60 mg; 95% confidence interval, 1.04 to 1.05). All agents were associated with a significantly higher hazard of altered mental status, and several agents were associated with a significantly higher hazard of fall and fracture. Opioids were associated with adverse outcomes in patients on hemodialysis, and this risk was present even at lower dosing and for agents that guidelines have recommended for use.

Prevalence of fall, and determinants of repeat incidents of fall in older persons living in old age homes in the National Capital Territory of Delhi, India.

Fall is a common morbidity in older persons. In India, the number of old age homes and persons living in them are increasing. We studied the prevalence of fall among older persons living in old age homes. We did a cross-sectional survey among persons aged 60 years or above, living in old age homes of Delhi, India. Information on location, type and bed-strength was collected for old age homes, and using their combination, 28 clusters of almost equal sizes (25-35) were created, of which, 13 were selected randomly to meet an estimated sample size of 340. All residents of the selected old age homes were recruited for the study. A self-developed, semi-structured interview schedule was used for recording the sociodemographic profile and history of fall in the past 6 months. Logistic regression was used to explore factors that might be associated with fall. Poisson regression was used to model the frequency of incidents of fall. A total of 335 older persons, with mean (SD) age of 75.2 (8.6) years were studied. At least 1 episode of fall was reported by 55 (16.4%), of whom, injury and disability were sustained by 54.5% and 23.3%, respectively. On multivariate logistic regression, for each additional morbidity, odds ratio of fall was 1.5 (95% confidence interval [CI] 1.09-1.95). Multivariate Poisson regression showed that age and tobacco use were significantly associated with the incidents of fall. For each unit increase in age, the incident rate ratio increased by 1.02 times (95% CI 1.01-1.03). Being a past user of tobacco had a statistically significant incident rate of 1.57 times (95% CI 1.01-2.45) compared to non-users of tobacco. One-sixth of individuals living in old age homes had experienced a fall in the past 6 months. Measures should be taken to prevent falls in old age home settings in India.

PROPENSITY FOR FALLS IN ELDERLY FEMALE AND MALE PRACTITIONERS AND NON- PRACTITIONERS OF PHYSICAL ACTIVITIES

Background: Aging being a natural physiological process can present both physical and psychic changes, due to the conditions of life of the person, and can be influencers for the installation of chronic non-communicable diseases, which may predispose this subject to an episode of fall. Objectives: To compare the propensity to fall in the elderly male and female, practitioners and non-practitioners of physical activities. Methods: The sample consisted of 120 elderly people of both genders practitioners and non-practitioners of physical activity and were used the “Timed Up and Go” and “Functional Reach” tests. Results: Among non-practitioners of physical activity, significant differences were observed between the values of functionality, being that the male group presented higher values than the female group, i.e., men move more, therefore has the lowest risk of fall. Conclusion: It was concluded that the female practitioners of physical activity have a greater risk of suffering an episode of fall compared to the non-practitioners, and in relation to the men practitioners and non-practitioners of physical activity there was no significant difference, showing that the elderly women have a higher risk to fall compared to the elderly men.