Prevalence of Drug Related Admissions to a Hospital Geriatric Service

217 consecutive admissions to an acute geriatric care facility in a teaching hospital were prospectively evaluated to assess the prevalence of drug related problems (DRPs) contributing to admission. DRPs were considered to include adverse drug reactions (ADRs), toxic overdose and poor compliance leading to therapeutic failure. The prevalence of DRPs on admission was 22.1% of total patients or 24.0% of those on prescribed medication at the time of admission. DRPs comprised 41 cases (85.4%) of ADRs, 1 case (2.1%) of exacerbated disease due to withdrawal of medication by the prescriber, and 6 cases (12.5%) of patient non-compliance. DRPs were significantly associated with both the total number of immediate pre-admission medications and the presence of a previous history of ADR. No other significant associations were found. The results suggest that prescriber behaviour, as opposed to patient behaviour, is a major contributor to DRPs and accordingly indicate the need for education of doctors about the risks of polypharmacy.     

Neonatal Cyanosis Due to a Novel Fetal Hemoglobin: Hb F-Circleville [Gγ63(E7)His→Leu,CAT>CTT]

Neonatal cyanosis can result from a multitude of acquired and inherited causes. Cyanosis resulting from fetal M hemoglobin (Hb) variants is very rare. Only two ^Gγ variants causing methemoglobinemia and cyanosis in the newborn have been reported to date. Here we describe a novel fetal Hb variant, Hb F-Circleville [^Gγ63(E7)His→Leu], associated with methemoglobinemia and cyanosis in the newborn. The patient's sister also had neonatal cyanosis at birth.     

Effect of Date Fruit Consumption on the Glycemic Control of Patients with Type 2 Diabetes: A Randomized Clinical Trial

Objective. Date fruit has been reported to have benefits in type 2 diabetes (T2D), though there is a concern, given the high sugar content, about its effects on glycemic control. Design and Setting. Prospective, interventional, randomized, parallel study. Participants. In total, 79 patients with T2D (39 male and 40 female). Intervention. Participants were randomly allocated to either 60 g date fruit or 60 g raisins daily of the equivalent glycemic index (amount split, given as midmorning and midafternoon snack) for 12 weeks. Main Outcome Measures. The primary outcome was to investigate the effect of date fruit on HbA1c and fasting blood glucose, and their variability, in patients with T2D in comparison to the same glycemic load of raisins. The secondary outcomes were to determine whether date fruit affected cardiovascular risk by measuring fasting lipids, C-reactive protein (CRP), blood pressure, and insulin resistance (IR) as measured by Homeostatic Model Assessment (HOMA-IR). Results. In total, 61 (27 female and 34 male) of 79 patients completed the study. There was no difference between or within groups for HbA1c or HbA1c variability, fasting glucose or glucose variability, insulin resistance (HOMA-IR), insulin sensitivity (HOMA-S), beta cell function (HOMA-B), the disposition index, lipids, systolic (SBP) or diastolic blood pressure (DBP), or C-reactive protein (CRP) (p > 0.05). Conclusion. No improvement in glycemic indices was seen following supplementation of 60 g daily date fruit or raisins, though neither had a deleterious effect on glycemic control over a 12-week period, indicating their safety when consumed in T2D. Additionally, no beneficial therapeutic effects of date fruit on other cardiovascular indices in T2D were seen.     

Inflammatory Markers in Non-Obese Women with Polycystic Ovary Syndrome Are Not Elevated and Show No Correlation with Vitamin D Metabolites

Introduction. Chronic low-grade inflammation is a characteristic of women with polycystic ovary syndrome (PCOS), although this may be obesity-driven rather than an intrinsic facet of PCOS; furthermore, vitamin D deficiency, another common feature of PCOS, is reported to have an association with increased inflammation. Therefore, circulating inflammatory protein levels and circulating levels of vitamin D may be linked in PCOS, though it is unclear which vitamin D metabolites may be important. Methods. We measured plasma levels of 24 inflammatory proteins and 12 matrix metalloproteinases (proteins modulated by the inflammatory process) by slow off-rate modified aptamer (SOMA)-scan plasma protein measurement in weight and aged-matched non-obese non-insulin resistant PCOS (n = 24) and control (n = 24) women. Inflammatory proteins and matrix metalloproteinases were correlated to 25-hydroxy vitamin D₃ (25(OH)D₃), its epimer 25-hydroxy-3epi-vitamin D (3epi25(OH)D) and the active 1,25-dihydroxyvitamin D₃ (1,25(OH)₂D₃) as measured by gold standard isotope-dilution liquid chromatography tandem mass spectrometry. Results. PCOS women had both an elevated free androgen index and circulating anti-mullerian hormone, though insulin resistance was comparable to controls. C-reactive protein, as a standard circulatory marker of inflammation, was comparable between cohorts. Levels of circulating inflammatory proteins and matrix metalloproteinases were not different between the PCOS and control women, with no correlation of 25(OH)D_3, 1,25(OH)₂D₃ or 3epi25(OH)D with any of the inflammatory proteins. Conclusion. In a non-obese PCOS population matched for age and insulin resistance, circulating inflammatory proteins and matrix metalloproteinases were not elevated and did not correlate with 25(OH)D_3, its epimer 3epi25(OH)D or 1,25(OH)₂D₃ in either control or PCOS women, indicating that the inflammatory response is absent and the vitamin D-metabolite independent in non-obese women with PCOS.     

Current comment. (xix). Why don't general practitioners refer their disabled Asian patients to district nurses?

Research into the needs of disabled people in Central Birmingham and their use of community health and social services has shown that Asian people are 'underusers' of these services, particularly district nursing. We have found that in this district, general practitioners (GPs) refer the majority of district nurses' disabled patients, but they are not referring Asians. Possible explanations--that elderly Asians have low contact rates with GPs, lack knowledge about the district nursing services, or refuse to use the service--are not supported by the research data. More likely explanations are offered--that GPs hold stereotyped views about Asians and their needs, have a misunderstanding of the role and function of the district nurse and inflexible assumptions about the 'typical' patient seen by the district nurse. Attention is drawn to the urgent need for GPs to address these issues and for further research as the numbers of older Asians are set to rise sharply.