Rheumatology)

Introduction

Metformin has pleiotropic biological effects which might improve muscle function in older people. The MET-PREVENT trial tested the efficacy and safety of metformin as a therapy for sarcopenia and frailty in older people.

Methods

Double blind, randomised, parallel-group, placebo-controlled trial. Participants aged ≥65 with walk speed <.8m />s and low muscle strength (handgrip <16kg for women, <27kg for men, or 5x sit to stand >15s) were recruited from primary care and hospital clinics. Participants were randomised 1:1 using a web-based interactive system to receive 4 months of 500mg metformin or matching placebo 3x/day. The primary outcome, analysed by intention to treat, was the between-group difference in 4m walk speed at 4 months, adjusted for baseline values. Secondary outcomes included grip strength, short physical performance battery, six-minute walk distance, muscle mass by bioimpedance, quality of life and activities of daily living. All adverse events were recorded.

Results

Seventy-two participants were randomised, mean age 80 (SD 6) years. 42 (58%) were women, 42 (58%) were frail (Fried score ≥3); mean baseline 4m walk speed was 0.59 m/s (SD 0.22). 70 (97%) completed the trial (metformin 34/36, placebo 36/36). 14 (40%) discontinued metformin and 5 (14%) discontinued placebo. There was no difference in the primary outcome between the metformin (0.57 m/s [SD 0.19] m/s) and placebo group (0.58 m/s [SD 0.24]); adjusted treatment effect was 0.001 m/s (95%CI -0.06, 0.06); p=0.96. There was no significant effect on measures of muscle mass, physical performance, quality of life or activities of daily living. The metformin group had more adverse events (110 vs 77) and more hospital admissions (12 vs 3)

Conclusions

MET-PREVENT achieved successful recruitment with high retention rates, however metformin did not improve physical performance and was poorly tolerated with high rates of adverse events in older people with sarcopenia.

Introduction

• Preoperative systemic inflammation has been shown to worsen postoperative outcome in emergency surgical patients.
• C-reactive protein (mg/L)/Albumin (g/L) ratio is a well validated inflammation marker.
• Studies have shown an inverse relationship between 25-hydroxyvitamin D level and markers of inflammation. Vitamin D deficiency has been previously shown to be associated with inflammation.

Aims and Objectives

• To determine the relationship between 25-hydroxyvitamin D level and CRP/Albumin ratio in older acute hip fracture patients.
• To explore the impact of gender on this relationship.

Methods

• A retrospective review of electronic notes from the hip fracture database was carried out on hip fracture patients attending a single trauma centre from January to December 2022.
• Anonymised data were extracted from the database. Patients aged 60 years and older who sustained an acute hip fracture were included. Patients with incomplete data were excluded. The IBM SPSS 29 software was used for statistical analysis.
• Descriptive statistics was used for baseline characteristics. Linear regression was used to determine correlation.

Results

• A total of 293 patients were analysed: 82 males and 211 females with a mean age of 81.6(SD 8.28) and 83.2(SD 7.85) years respectively.
• Mean 25-hydroxyvitamin D levels were 39.1 (SD 25.0) and 49.7 (SD 29.01) nmols/L respectively.
• Mean CRP/Albumin ratio was 0.94 (SD 1.51) and 0.71 (SD 1.34).
• There was a negative, statistically significant correlation between 25-hydroxyvitaminD and CRP/Albumin ratio in male patients but not in the females (r = -.274; p = .013 & r = - .035; p = .61) respectively.

Conclusion

• In this study, 25-hydroxyvitamin D levels are inversely correlated with markers of inflammation (CRP/Albumin ratio) in older male hip fracture patients but not older female hip fracture patients. More studies are needed to clarify whether vit D lowers inflammation or inflammation lowers 25-hydroxyvitamin D concentrations and to investigate the gender difference.

A 75-year-old male presented with chronic fatigue and gradually worsening generalised muscle weakness over three years. He was treated by his GP for two months for a suspected case of polymyalgia rheumatica with a two-month course of steroids, which resulted in no significant improvement. His medical history included post-COVID syndrome and mixed anxiety and depressive disorder. He lives at home with his wife and requires assistance to navigate stairs, using a walking stick for mobility. On examination, he exhibited grade 4/5 muscle weakness in both proximal and distal muscles. Blood tests revealed low haemoglobin, elevated C-reactive protein (CRP), and white blood cell (WBC) counts. A blood film showed positive cold agglutination, leading to a haematology consultation for haemolytic screening and direct antiglobulin testing, which later yielded negative results. Persistently elevated CRP and WBC levels prompted intravenous antibiotics and a comprehensive CT scan of the chest, abdomen, and pelvis, which showed no signs of infection or malignancy. A rheumatology consultation and extensive investigations revealed a positive Mi2a antibody. An MRI of the lower limbs demonstrated bilateral symmetrical oedema and increased signal within the anterior compartment muscles, particularly affecting the right tibialis anterior along with minor atrophy of the proximal muscles. Rheumatology was not convinced due to normal creatine kinase (CK) levels. After consulting a musculoskeletal radiologist, it was decided that a biopsy from the anterior tibialis was necessary to establish the diagnosis. Surprisingly, the biopsy was suggestive of inflammatory myositis. The patient was subsequently started on mycophenolate mofetil. This case highlights the unusual presentation of myositis, involving proximal muscles and negative CK levels. It underscores the importance of thorough diagnostic evaluation in elderly patients, emphasising that such patients should not be prematurely classified under chronic fatigue syndrome or fibromyalgia, as appropriate treatment can significantly improve their quality of life.

Introduction The aim of this study was to examine the prevalence of vitamin D deficiency in elderly patients with fragility fractures of the hip by estimating 25-hydroxyvitamin D levels, whether low levels of Vitamin D at the time of admission affects the functional outcomes and mortality at 28 day and one year. Methods A retrospective study of all the patients admitted with a fracture neck of femur from Jan 2018 to March 2021 was carried out. The data was obtained from NHFD (National Hip Fracture Database) and Medway software. A total of 1221 patients were admitted during this period. Patient demographics including age, sex, fracture pattern, Vitamin D levels at the time of admission, function at 120 days, mortality at one month and one year were calculated. Results Of the 1221 patients, 106 patients did not have the Vit D levels checked at the time of admission. The average age was 81.91 (range-60 to 108). There were 845(70%) females and 376(30%) males. The serum Vit D levels were low in 611(55.3%) patients. The mobility in patients with Vit D deficiency 261(40.9%) has dropped significantly in the 3 months after surgery for fractures of proximal femurs. The 28 day and one year mortality was 6.74% and 30.3% compared to 4.7% and 27.3% for those with low and normal levels of vitamin D respectively. Patients with low Vit D levels at the time of admission with proximal femur fractures has got higher 28 day and one year mortality rates compared to those with normal levels. Conclusion Our study showed that low levels of Vitamin D at the time of admission with proximal femur fractures are associated with poor functional mobility, higher perioperative and one year mortality

Background: Motoric cognitive risk syndrome (MCR), characterized by slow gait speed (GS) and subjective cognitive complaints, is a simple way to screen older adults at high risk of dementia. In primary care service, however, assessing GS may still be a challenge due to the short consultation time and space constraints common in general practice. Therefore, there is a need to explore alternative MCR subtypes with motor domains that can be measured conveniently. This study aimed to explore a new subtype of MCR, using low handgrip strength (HGS) as the motoric phenotype, and examined its association with the incidence of cognitive impairments among the Chinese community-dwelling older adults.

Methods: We used four-wave data (2011-2018) of participants (≥60 years) in the China Health and Retirement Longitudinal Study. We investigated two MCR subtypes. First, MCRg was defined in the literature as the coexistence of slow GS and cognitive complaints without dementia or morbidity disability. Then, we defined a new subtype, MCRh, by replacing slow GS with low HGS. Cox proportional hazards models were used to examine the association between baseline MCR subtypes (MCRg and MCRh) and incident cognitive impairment, controlling for sociodemographic characteristics, lifestyle behaviors and health conditions.

Results: Of 3325 participants (Mean age: 66.7±5.7, males: 54.9%), 5.2% had MCRg and 5.4% MCRh. Based on Cox models, both MCR subtypes were associated with the increased risk of cognitive impairment, with adjusted hazard ratios (95% CI) of 1.821 (1.402 to 2.368) for MCRg and 2.008 (1.567 to 2.574) for MCRh.

Conclusion: Low HGS, which can be quickly measured and requires no additional space, may be considered as a promising motoric phenotype of MCR subtypes. This study preliminarily supports the potential utilization of the HGS-based MCR subtype for early risk identification of cognitive impairment in primary care settings.

Introduction: Poor muscle health is associated with a series of chronic and metabolic conditions that are prevalent in individuals who chronically experience poor-quality sleep. But there is no study deciphering the role of sleep deprivation on muscle ageing. Therefore, in the present study we have measured the ultrastructure, histopathology, and oxidative stressors in soleus muscle of wistar rat after sleep deprivation and recovery sleep.

Material and Methods: The experiments were conducted in18 rats of three groups. Group I rats had normal sleep wake cycle, Group II rats were subjected to 24 h sleep deprivation (SD) by gentle handling method1 and Group III rats had recovery sleep after 24 h SD. At the end of the sleep, sleep deprivation and recovery period, soleus muscle tissue was collected for ultrastructural, histological and oxidative stress markers. Oxidative damage was assessed by lipid peroxidation, catalase activity, reduced glutathione and nuclear labelling of 8-OHdG. The study was conducted as per the guidelines of the Institutional Animal Ethics Committee (960/IAEC/16).

Results: The data demonstrated that SD leads to ultrastructural changes in soleus muscle which includes sarcolemmal and mitochondrial alterations. In case of histopathological and histomorphological changes there was signs of tissue degeneration, inflammatory infiltrate in type I fibers and muscle atrophy was observed in soleus muscles. There was significant increase in level of 8-OHdG (p=0.02) and malondialdehyde in 24h SD (p=0.02) than control and recovery sleep groups. Moreover, the catalase activity and reduced glutathione level was significantly decreased in 24h SD group (p≤0.02) than control and recovery sleep.

Conclusion: 24hr sleep deprivation leads to an ageing like state in the skeletal muscle, which was recovered after sleep rebound.