Cranial CT is a mandatory tool to exclude asymptomatic cerebral hemorrhage in elderly patients on anticoagulation

BackgroundTraumatic brain injury (TBI) after falls causes death and disability with immense socioeconomic impact through medical and rehabilitation costs in geriatric patients. Diagnosing TBI can be challenging due to the absence of initial clinical symptoms. Misdiagnosis is particularly dangerous in patients on permanent anticoagulation because minimal trauma might result in severe intracranial hemorrhage. The aim of this study is to evaluate the diagnostic necessity of cranial computed tomography (cCT) to rule out intracranial hemorrhage, particularly in the absence of neurologic symptoms in elderly patients on permanent anticoagulation in their premedication.Patients and methodsRetrospective cohort analysis of elderly trauma patients (≥ 65 years) admitted to the emergency department (ED) of the level-1-trauma center of the University Hospital Frankfurt from 01/2017 to 12/2019. The study included patients who suffered a ground-level fall with suspected TBI and subsequently underwent CT because of preexisting anticoagulation.ResultsA total of 227 patients met the inclusion criteria. In 17 of these patients, cCT showed intracranial hemorrhage, of which 14 were subdural hematomas (SDH). In 8 of the patients with bleeding showed no clinical symptoms, representing 5% (n = 160) of all symptom-free patients. Men and women were equally to suffer a post-traumatic hemorrhage. Patients with intracranial bleeding were hospitalized for 14.5 (±10.4) days. Acetylsalicylic acid (ASA) was the most prescribed anticoagulant in both patient cohorts—with or without intracerebral bleeding (70.6 vs. 77.1%, p = 0.539). Similarly, patients taking new oral anticoagulant (NOAC) (p = 0.748), coumarins, or other platelet inhibitors (p > 0.1) did not show an increased bleeding incidence.ConclusionAcetylsalicylic acid and NOAC use are not associated with increased bleeding risk in geriatric trauma patients (≥ 65 years) after fall-related TBI. Even in asymptomatic elderly patients on anticoagulation, intracranial hemorrhage occurs in a relevant proportion after minor trauma to the head. Therefore, cCT is an obligatory tool to rule out cerebral hemorrhage in elderly patients under anticoagulation

VITAMIN D METABOLISM DURING PREGNANCY: A STUDY OF KINETICS AND CANDIDATE BIOMARKERS

Vitamin D is critical to calcium and phosphorus homeostasis and skeletal health through the life span and may also influence extraskeletal health. Low maternal serum 25-hydroxyvitamin D (25(OH)D) concentration during pregnancy has been associated with many adverse outcomes including preeclampsia and poor neonatal bone health. However, questions remain about the functions of vitamin D during human pregnancy and gestation. Pregnancy is associated with adaptations in maternal vitamin D and calcium metabolism, and these adaptations alter indicators of vitamin D function. As a result, evaluation of serum 25(OH)D concentration and other vitamin D biomarkers is complex and may differ during pregnancy. The goal of this dissertation was to improve evaluation of vitamin D status and understanding of vitamin D metabolism during pregnancy. Two approaches were used: 1) a study of candidate biomarkers in pregnant adolescents and 2) a study of vitamin D3 kinetics in nonpregnant and pregnant women. Promising candidate biomarkers of vitamin D status include the serum 24,25(OH)2D concentration, which is an indicator of vitamin D catabolism, and the measured free 25(OH)D concentration. In study 1, we longitudinally assessed a comprehensive suite of vitamin D biomarkers including serum 24,25(OH)2D, free 25(OH)D, and vitamin D binding protein (DBP) in pregnant adolescents. We found that gestational age and maternal serum 25(OH)D concentration interacted to affect the 24,25(OH)2D concentration. Our results suggest that assessment of 24,25(OH)2D may provide information about the adequacy of the 25(OH)D supply during pregnancy. Furthermore, longitudinal increase in DBP was associated with modest decrease in measured free 25(OH)D. However, free 25(OH)D provided no advantage over total 25(OH)D as a predictor of circulating markers of vitamin D and calcium metabolism. In study 2, we developed a protocol and analytical methods to assess the serum appearance and disappearance of stable isotope-labeled vitamin D3 and labeled 25(OH)D3 after a single oral dose of trideuterated vitamin D3. Overall, the serum tracer concentration-time curves suggest our technique is a valid new tool for investigating vitamin D metabolism across physiologic conditions. Serum DBP concentration was higher in pregnant compared with nonpregnant women and was the main predictor of the area under the curve of trideuterated 25(OH)D3

Paternal Smoking and Increased Risk of Infant and Under-5 Child Mortality in Indonesia

We examined the relationship between paternal smoking and child mortality. Among 361 021 rural and urban families in Indonesia, paternal smoking was associated with increased infant mortality (rural, odds ratio [OR] = 1.30; 95% confidence interval [CI] = 1.24, 1.35; urban, OR = 1.10; 95% CI = 1.01, 1.20), and under-5 child mortality (rural, OR = 1.32; 95% CI = 1.26, 1.37; urban, OR = 1.14; 95% CI = 1.05, 1.23). Paternal smoking diverts money from basic necessities to cigarettes and adversely affects child health; tobacco control should therefore be considered among strategies to improve child survival