With the global aging trend, the incidence of falls and hip fractures is projected to rise, leading to an increased associated burden. Over 90% of hip fractures result from falls, yet not all falls cause fractures, suggesting specific fall characteristics may contribute to hip fractures. This review provides insights into fragility hip fracture-related falls among the older adults, aiding in understanding and developing effective fall prevention strategies for this population. Searches encompassed PubMed, OVID, EMBASE, Cochrane Library, and Web of Science, supplemented by citation checks. We included non-randomized studies detailing characteristics of fragility hip fracture-related falls in the older individuals, with or without a non-hip fracture control. Evaluated fall characteristics included height, location, direction, time, mechanism, activity during the fall, hip impact, protective responses, walking aid use, and impact surface. Results were analyzed using a narrative synthesis approach. The quality of these studies was assessed using the revised Risk of Bias Assessment tool for Non-randomized Studies 2 (RoBANS2). A total of 30 articles were reviewed, comprising 23 non-case control and 7 case-control studies, with a mean age of 75.6 years. Studies presented varied details on fall characteristics. Hip-fracture related falls typically occur indoors at or around standing height during daytime, often involving sideways or backward motions with inadequate protective responses. Slipping is predominant, yet lost balance and weakness/collapse are notable. Walking precedes many falls, but stationary activities (lack of forward motion, changing positions, sitting or standing still, transfer) also contribute. Low usage of walking aids and impact on hard surfaces are common features of these falls. This review underscores fall characteristics associated with fragility hip fractures in older adults, highlighting features more aligned with age-related physical frailty than general falls. Such insights can guide healthcare providers in implementing tailored interventions to reduce hip fractures and related challenges.

Background: The objective of this study was to evaluate the efficacy and safety of repeated low-dose rituximab treatment guided by monitoring circulating CD19+ B cells in patients with refractory myasthenia gravis (MG). Methods: Patients with refractory MG who had received rituximab treatment at two teaching hospitals between September 2013 and January 2017 were reviewed retrospectively. The treatment protocol consisted of an induction treatment with low-dose rituximab (375 mg/m² twice with a 2-week interval), followed by retreatment (375 mg/m² once). Retreatment was based on either circulating CD19+ B-cell repopulation or clinical relapse. Outcome measures included the MG Foundation of America (MGFA) clinical classification and postintervention status, prednisolone dose, CD19+ B-cell counts, clinical relapse, and adverse effects. Results: Of 17 patients, 11 (65%) achieved the primary endpoint, defined as the minimal manifestation or better status with prednisolone ⩽5 mg/day, after median 7.6 months (range, 2–17 months) following rituximab treatment. Over a median follow up of 24 months (range, 7–49 months), a total of 30 retreatments were undertaken due to clinical relapse without B-cell repopulation ( n = 6), on the basis of B-cell repopulation alone ( n = 16) and both ( n = 8). B-cell recovery appeared to be in parallel with clinical relapse on the group level, although the individual-level association appeared to be modest, with B-cell repopulation observed only at 57% (8/14) of clinical relapses. Conclusions: The repeated low-dose rituximab treatment based on the assessment of circulating B-cell depletion could be a cost-effective therapeutic option for refractory MG. Further studies are needed to verify the potentially better cost-effectiveness of low-dose rituximab, and to identify biomarkers that help optimize treatment in MG patients.

Jung S, et al. J Clin Neurol. 2023 Jul;19:e56. https://doi.org/10.3988/jcn.2023.0007

Ahn S, et al. J Korean Med Sci. 2022 Feb;37(7):e56. https://doi.org/10.3346/jkms.2022.37.e56

Background: Aseptic meningitis comprises meningeal inflammation and cerebrospinal fluid (CSF) pleocytosis without positive Gram stain and culture. Regional differences exist in the prevalence of viral etiologies of aseptic meningitis. We aimed to assess the etiologies of aseptic meningitis in immunocompetent adults, focusing on herpes simplex virus type 2 (HSV-2). Methods: This study retrospectively analyzed immunocompetent adults diagnosed with meningitis at a Korean tertiary care hospital from 2016 to 2018. Aseptic meningitis was defined through clinical and CSF analysis. We compared clinical and laboratory characteristics across viral etiologies and investigated predictors of HSV-2 meningitis. Results: A total of 98 patients (46.9% female) with aseptic meningitis were finally enrolled. The etiologies of aseptic meningitis were identified in 62 patients (63.3%), including enterovirus (28.5%), HSV-2 (16.3%), and varicella zoster virus (VZV, 15.3%). HSV-2 showed female predominance, with shorter admission times with longer hospital stays and a recurrent meningitis history. Compared to other viral etiologies, HSV-2 showed higher CSF white blood cell (WBC) counts and protein levels but lower C-reactive protein (CRP) levels. A random forest model identified previous meningitis history and serum CRP level as key predictors of HSV-2 meningitis. Conclusions: This study provides insights into the etiologies of aseptic meningitis in a specific Korean region, identifying HSV-2 as a notable cause. The prediction model suggested that the clinical history of previous meningitis and serum CRP level may guide clinical assessment of meningitis.