Dr Roshan Gunathilake

Background/Aim The aim of this study was to investigate factors that were associated with receiving anti-osteoporosis treatment (AOT) among patients with minimal trauma hip fracture admitted to an Australian tertiary trauma centre under the Acute Orthogeriatric Service (AOS) over a 6 month period. Design Observational study using prospectively collected data. Methods Demographic and clinical characteristics of 211 patients were extracted from the local hip fracture registry and electronic medical records. The outcome measure was receipt of AOT before separation from the AOS. Binary logistic regression was used to identify factors independently associated with treatment. Results 91 (45%) patients received AOT, including 51 (25.2%) treatment-naive patients. Factors significantly associated with receiving treatment included higher serum vitamin D level (OR 1.44, 95% CI 1.23¿1.70, p¿<¿0.001) and trochanteric vs. cervical fracture (OR 2.67, 95% CI 1.30¿5.49, p¿=¿0.007). Living in a residential aged care facility (RACF) prior to the index fracture (OR 0.2, 95% CI 0.08¿0.54, p¿=¿0.001) and higher American Society of Anaesthesiologists (ASA) physical status score (OR 0.5, 95% CI 0.25¿0.98, p¿=¿0.04) significantly lowered the likelihood of treatment. Age, gender, cognitive impairment, premorbid walking ability, previous fragility fracture and renal impairment did not correlate with treatment. Conclusion A significant proportion (55%) of hip fracture patients did not receive AOT in hospital. The probability of receiving treatment appears to be significantly associated with serum vitamin D level, fracture type, place of residence and comorbidity burden.

Most of the defensive functions of the human skin are localized to the stratum corneum (SC), the outermost layer of the epidermis consisting of several layers of cornified keratinocytes embedded in a lipid matrix. Included in the armamentarium of the epidermal barrier against microbial invasion are surface pH, SC lipids, specialized antimicrobial peptides such as defensins and cathelicidins, enzymes and enzyme inhibitors, chemokines, and epidermal Toll-like receptors. Multiple epidermal defensive mechanisms are co-localized, coregulated, and intertwined. The purpose of this review is to discuss patents and to describe the current knowledge that concerns the role of the epidermis as an antimicrobial barrier, outlining potential clinical and therapeutic implications.