Hospitalisation of adults with Down syndrome: lesson from a 10-year experience from a community hospital

BACKGROUND

Life expectancy of individuals with Down syndrome (DS) has improved significantly over the past decades. However, there are sparse data documenting the co-morbidities and hospitalisation of adult patients with DS in the literature. The aim of this study was to characterise the co-morbidities and pattern of hospitalisation in adult patients with DS during a 10-year period at the community hospital as well as to compare hospitalisation parameters with the general adult population during the same years.

METHOD

We reviewed the medical records of 81 hospitalisations from 37 patients with DS aged 21 to 68 years at Metrowest Medical Center during a 10-year period and compared with those of the general adult population during the same time. Co-morbidities were also described.

RESULTS

Adults with DS had a mean age at admission of 48.6 ± 8.8 years with the median length of stay of 3 days (interquartile range 4 days). Male patients were hospitalised longer than female patients (mean 5.0 vs. 2.8 days; P < 0.05), and patients who lived at home were admitted at earlier ages than those who came from residential healthcare facility (mean 41.5 vs. 52.2 years; P < 0.001). The most common cause of hospitalisation was pneumonia/aspiration syndrome (29.6%), and the most common co-morbidity was gastroesophageal reflux disease (GERD)/dysphagia (70.3%). Presence of GERD/dysphagia or seizure disorder was significantly associated with multiple admission and readmission within 1 month (P < 0.05). The mortality rate was 4.9%, and the rate of intensive care unit admission was 8.6%.

CONCLUSIONS

Our cohort did not show statistically significant different hospitalisation parameters such as inpatient mortality and average length of stay when compared with general adult population hospitalised at the same years. The care of adult patients with DS presents challenges in internal medicine due to its unique co-morbid profile and signifies the importance of multidisciplinary approach. In order to improve the care of this patient population, their co-morbidities, particularly GERD/dysphagia and seizure disorder, should be optimally managed and comprehensively addressed when patients are hospitalised.

Measurement of Intimacy Attitudes: The Intimacy Attitude Scale-Revisited

The study evaluated the reliability and validity of a revised version of the Intimacy Attitude Scale originally developed by Amidon. The Cronbach alpha measure of internal consistency showed alpha values between .78 and .86 in five different groups. The test-retest correlation was .57 which improved to .84 after exclusion of three extreme scores. Validity was examined by correlating with several variables. It was concluded that the revised Intimacy Attitude Scale is a reliable instrument with Some degree of Validity for use in research, diagnosis, and training.

A simulation model for assessing aberration detection methods used in public health surveillance for systems with limited baselines

Public health officials continue to develop and implement new types of ongoing surveillance systems in an attempt to detect aberrations in surveillance data as early as possible. In public health surveillance, aberrations are traditionally defined as an observed value being greater than an expected historical value for that same time period. To account for seasonality, traditional aberration detection methods use three or more years of baseline data across the same time period to calculate the expected historical value. Due to the recent implementation of short-term bioterrorism surveillance systems, many of the new surveillance systems have limited historical data from which to calculate an expected baseline value. Three limited baseline aberration detection methods, C1-MILD, C2-MEDIUM, and C3-ULTRA, were developed based on a one-sided positive CUSUM (cumulative sum) calculation, a commonly used quality control method used in the manufacturing industry. To evaluate the strengths and weakness of these methods, data were simulated to represent syndromic data collected through the recently developed hospital-based enhanced syndromic surveillance systems. The three methods were applied to the simulated data and estimates of sensitivity, specificity, and false-positive rates for the three methods were obtained. For the six syndromes, sensitivity for the C1-MILD, C2-MEDIUM, and C3-ULTRA models averaged 48.2, 51.3, and 53.7 per cent, respectively. Similarly, the specificities averaged 97.7, 97.8, and 96.1 per cent, respectively. The average false-positive rates for the three models were 31.8, 29.2, and 41.5 per cent, respectively. The results highlight the value and importance of developing and testing new aberration detection methods for public health surveillance data with limited baseline information.

Interferon in synovial fluid and serum of patients with rheumatic disease

Interferon (IFN) was sought in simultaneously obtained samples of synovial fluid (SF) and serum from patients with a variety of rheumatological diseases. IFN was identified in 11 of 84 samples of SF and 10 of 84 specimens of serum. IFN positive specimens were contributed by patients with rheumatoid arthritis (RA), systemic lupus erythematosus, seronegative spondyloarthropathies, pseudogout, coccidioidomycosis and unclassified arthritis. Significantly, IFN was frequently found either in SF or in serum but generally not in both of the simultaneously obtained fluids. The highest titers of IFN found in SF were from patients with RA.

Idiopathic thrombocytopenic purpura and Graves disease

A 31-year-old black woman was studied who, at the age of 12 years, underwent splenectomy for a bleeding disorder due to idiopathic thrombocytopenic purpura (ITP). More than 20 years after the first signs of her bleeding disorder, the patient developed signs of Graves disease. This condition was treated with 131I with resulting hypothyroidism. The rare combination of ITP and Graves disease was considered to be a manifestation of two separate autoimmune disease. For the second time in the literature, HLA typing was performed in a patient with such a disease combination, and it was found to be of the group A23, A28, and B17. This is different from B8, which is most frequently found in both isolated ITP and Graves disease. Possible racial factors may be involved. It is concluded that more cases of such combined disease need to be studied before possible genetic patterns can be established.

Giant liposarcoma of the spermatic cord

Liposarcoma of the spermatic cord is rare and easily masquerades as a more common benign neoplasm of the spermatic cord. If neglected, these malignancies may grow to tremendous size and become formidable management problems. The treatment of this malignancy is orchiectomy and en bloc removal of the tumor. More radical operative therapy has not generally proved beneficial. Adjunctive therapy may be helpful in selected cases.