Psychotropic medications,including short acting benzodiazepines,strongly increase the frequency of falls in elderly

ObjectivesFalls in the elderly are common and often serious. The aim of this study was to examine the association between the use of different classes of psychotropic medications, especially short acting benzodiazepines, and the frequency of falling in elderly.Study design This retrospective cohort study was performed with patients who visited the day clinic of the department of geriatric medicine of the University Medical Center Utrecht in the Netherlands between 1 January 2011 and 1 April 2012.Measurements Frequencies of falling in the past year and medication use were recorded. Logistic regression analysis was performed to assess the relationship between the frequency of falling in the past year and the use of psychotropic medications.ResultsDuring this period 404 patients were included and 238 (58.9%) of them had experienced one or more falls in the past year. After multivariate adjustment, frequent falls remained significantly associated with exposure to psychotropic medications (odds ratio [OR] 1.96; 95% confidence interval [CI] 1.17–3.28), antipsychotics (OR 3.62; 95% CI 1.27–10.33), hypnotics and anxiolytics (OR 1.81; 95% CI 1.05–3.11), short-acting benzodiazepines or Z-drugs (OR 1.94; 95% CI 1.10–3.42) and antidepressants (OR 2.35; 95% CI 1.33–4.16).ConclusionsThis study confirms that taking psychotropic medication, including short-acting benzodiazepines, strongly increases the frequency of falls in elderly. This relation should be explicitly recognized by doctors prescribing for older people, and by older people themselves. If possible such medication should be avoided for elderly patients especially with other risk factors for falling.     

Anti-leukotriene therapy in asthma

There is ample evidence that leukotrienes are important inflammatory mediators of asthma. Anti-leukotriene therapy is a novel, specific anti-asthma strategy providing both reliever and controller effects. Currently, two types of anti-leukotriene drugs are being registered in several countries: leukotriene receptor antagonists and leukotriene biosynthesis inhibitors. Both types of drugs have shown comparable bronchodilator effects, and provided protection against bronchoprovocation tests with cold dry air, exercise, allergen and aspirin. Moreover, beneficial effects have been shown in the treatment of day-to-day asthma resulting in improvement of clinical symptoms, lung function parameters, and a reduction in β₂-agonist- and corticosteroid-use. Furthermore, some studies showed a decrease in the airway eosinophil counts after longterm administration of anti-leukotriene drugs, suggestive of anti-inflammatory effects. Because of these properties in combination with generally mild adverse effects, anti-leukotrienes seem promising in the treatment of patients with various types and severities of asthma, including children. However, their definitive place in the management of asthma will eventually depend on their effectiveness to modulate the chronic airway inflammation, which induces the structural changes within the airways, determining the severity of clinical symptoms of asthma.     

Diagnosis of malignant versus tuberculous ascites using tumor markers and globulin ratios in serum and ascites: A Fisher discriminant model

Background and study aimsThis study was conducted to investigate the significance of tumor and biochemical markers in serum and ascitic fluid in the differential diagnosis of tuberculous and malignant ascites.Patients and methodsBased on findings from natural orifice transluminal endoscopic surgery and postoperative pathology or cytology of 63 patients, they were divided into the malignant group (31 patients) and the tuberculous group (32 patients). Levels of tumor markers, albumin, globulin, and lactate dehydrogenase were measured simultaneously. Data were statistically analyzed, and a Fisher discriminant model was established. The receiver operating characteristic curve was constructed to confirm the discriminant value.ResultsThe levels of carcinoembryonic antigen (CEA), cancer antigen 125 (CA125), cancer antigen 19-9 (CA 19-9), and globulin in serum and ascitic fluid were different between the tuberculous and malignant ascites groups (P < .05). The ratios of ascites-to-serum levels of CEA, CA125, and CA 19-9, as well as the ratio of serum-to-ascites of globulin levels, were different between the two groups (P < .05). The Fisher discriminant model was established based on the ascites-to-serum ratios of CEA, CA125, and CA 19-9 levels and the serum-to-ascites ratio of globulin levels. The area under the curve was 0.908, the sensitivity was 0.838 (26/31), and the specificity was 0.875 (28/32).ConclusionA Fisher discriminant model can be established using serum and ascites tumor markers and globulin ratios, which is valuable in the differential diagnosis of tuberculous versus malignant ascites.     

Intracerebral hemorrhage after liver transplantation

We report 5 patients with intracerebral hemorrhage afterorthotopic liver transplantation (OLT) and identify the possible risk factors. Between November 1991 and April 1999, 75 adult patients received 77 orthotopic liver transplants at Queen Mary Hospital, Hong Kong. Five patients (6.5%) developed intracerebral hemorrhage postoperatively. Clinical and laboratory data were reviewed, and potential risk factors were analyzed. The 5 patients developed intracerebral hemorrhage within 40 days (range, 1 to 37 days; median, 4 days) after OLT The mortality rate was 80% (4 of 5 patients). The intraoperative blood transfusion volume (median, 17,200 mL; range, 15,750 to 30,360 mL) administered to patients who developed intracerebral hemorrhage postoperatively was significantly greater than that (median, 6,990 nil, range, 1,840 to 22,680 mL) for patients without the complication (P = .0008). Massive intraoperative transfusion (> 15,000 mL) was required in all 5 patients (100%) with intracerebral hemorrhage but only 9 of 72 patients (12.5%) in the other group (P = .0001). Four of 5 patients (80%) with intracerebral hemorrhage had intraoperative hypotension compared with 7 of 72 patients (9.7%) in the other group (P = .001). No significant difference was found in age, prothrombin time (PT), activated partial thromboplastin time (APTT), incidence of hypertension, bleeding at extracerebral sites, cyclosporine A neurotoxicity, thrombocytopenia, hemodialysis, and sepsis between the patients with and without intracerebral bleeding. However, the median cumulative score of coagulation parameters (PT, APTT, platelet count) was significantly greater in the group with than without intracerebral bleeding (median score, 3 ν 1; P = .023). Intracerebral hemorrhage is 1 of the most disastrous complications after OLT Intraoperative hypotension, massive intraoperative transfusion, and coagulopathy may be correlated with this complication.