.
The incidence of chronic subdural haematoma (CSDH) is rising in the elderly, yet there is limited research focusing on patients aged > 80. In the United Kingdom, the decision to transfer for neurosurgical intervention is dependent upon the acceptance of a CSDH management referral by a tertiary centre. This study thus aims to identify key predictors of referral acceptance in octogenarian and nonagenarian age groups, in comparison to the adult population. A multi-centre retrospective case series analysis from January 2015 to May 2020 was conducted. Patients were grouped as < 80 (‘adult’) or > 80 (‘ultra-geriatric’), with the latter further subgrouped into 80–89 (‘octogenarian’), and ≥ 90 (‘nonagenarian’). Multivariable logistic regression assessed age, headache, dementia, motor weakness, midline shift, CSDH size, and premorbid quality of life (QoL) to determine predictors of referral acceptance. With a total of 3002 patient referrals, referral acceptance was significantly higher in adults compared to the ultra-geriatric group (38.1
INTRODUCTION:Recurrent acute otitis media (RAOM) is a common condition most frequently affecting children under two years of age. The main causative agent is Streptococcus pneumoniae. Pneumococcal vaccination has been shown to be an effective method of RAOM prophylaxis. Currently, pneumococcal antibody testing can be performed to assess immunity levels, followed by booster vaccination if protection is suboptimal. We aimed to explore the role of antibody testing and vaccination in the context of managing paediatric RAOM. METHOD:A retrospective study was performed between January and December 2023. A total of 1,004 paediatric referrals (age: ≤ 16 years) to our trust were reviewed. Patients with RAOM who underwent pneumococcal antibody testing were identified. Suboptimal antibody levels were defined as ≥ 6 low serotypes out of 13. This study took place at Royal Preston Hospital, United Kingdom. RESULTS:Our cohort includes 169 children with RAOM, of which 42 underwent pneumococcal antibody testing with available results. Of these patients, 19 (45.2%) had suboptimal pneumococcal antibody levels; 13 (68.4%) patients received a booster vaccine. A reduction in RAOM episodes was reported in 92.3% (12/13) of vaccinated children at follow-up (≥ 3 months), with improvement in symptoms, including otalgia, fever, and hearing loss. Adequate Haemophilus influenzae antibody levels were found in every tested child with RAOM (n=43). CONCLUSION:These findings indicate that approximately half of children with RAOM have suboptimal pneumococcal antibody levels, which can be successfully addressed with booster vaccination. Re-testing pneumococcal antibody levels after booster vaccination and performing H. influenzae antibody levels are not required. Further work is required to identify if booster vaccinations reduce the frequency or severity of RAOM presentations.
Nodular lymphoid hyperplasia (NLH) is a rare, benign condition of lymphoid proliferation within the gastrointestinal tract. NLH is a recognized feature of specific immunodeficiency syndromes, including common variable immunodeficiency and selective IgA deficiency. NLH may develop throughout the gastrointestinal tract; however, it usually develops in the small intestine. We report an extremely unusual case of previously undiagnosed selective IgA deficiency presenting with subacute rectosigmoid obstruction.
AIMS:High plantar pressure is associated with diabetic foot ulcer (DFU) development; however, previous studies are limited to a 'snapshot' plantar pressure measurement taken at study onset or post-DFU healing. The aim of this prospective study was to provide a unique insight into sustained plantar pressures developed during the three months preceding ulceration. METHODS:Forty-six patients with diabetic peripheral neuropathy and DFU history wore an intelligent insole system, which continuously assessed plantar pressure for 18-months or until ulceration. Sustained pressure parameters in the three months preceding DFU were compared between feet that developed DFU and those remaining ulcer-free, using multilevel binary logistic regression analysis. RESULTS:Twelve feet ulcerated, all under the forefoot. DFU feet experienced more minutes of sustained plantar pressure [19(95%CI,0.86-37, P = 0.04)] and more 'bouts' of sustained pressure [0.64(0.024-1.3, P = 0.042)] at the forefoot region during the three months preceding DFU, compared to ulcer-free feet. CONCLUSIONS:Plantar pressures during daily activities were continuously measured in the three months preceding DFU using an intelligent insole system, with a greater number of minutes and bouts of sustained plantar pressure preceding DFU development. Daily monitoring of sustained pressure areas, using insole systems, may prove useful for preventing DFU development.
