a small number of instruments have been validated for screening for dementia in general hospital. Understanding strengths and weaknesses of currently available instruments allows informed decisions about screening in this setting.

Background: Delirium is a common complication after surgery in the elderly that leads to increased length of stay and other adverse outcomes. The aim of this study was to better understand the exact causes of post-operative delirium in patients undergoing surgery for neck of femur (NOF) fractures.Methods: We performed a prospective cohort study of 381 consecutive patients undergoing surgery for NOF fractures at a single institution. Baseline cognitive status and risk factors were recorded on admission. Post-operative cognitive status was assessed at regular intervals until discharge. Binary logistic regression was performed to identify independent predictors of delirium.Results: Patients who developed post-operative delirium (n = 70) were significantly older (average age 83 vs. 78, p = 0.019) and more likely to be female (79% vs. 67%, p = 0.062) than non-affected patients. The presence of delirium was associated with increased length of stay (13 vs. 10 days, p = 0.001) and 1-year mortality (25.7% vs. 15% p = 0.03). Independent predictors of delirium included age ≥65 years (Odds Ratio = 5.8), presence of anaemia (OR = 2.9), hypoxia (OR = 2.86), cardiac disease (OR = 2.8), Chronic Obstructive Pulmonary Disease (OR = 2.5), new onset electrolyte imbalance (OR = 2.2) and renal failure (OR = 1.9).Conclusion: Overall analysis demonstrated an increased incidence of delirium in older females with greater comorbid conditions. It was also found to be associated with increased morbidity and mortality. We recommend clinicians put greater effort into recognising risk factors of delirium and diagnosing it in a timely manner to mitigate its effects.

SUMMARYWe describe the case of a 79-year-old man who presented 'off legs' with acute right leg pain. He was initially treated for suspected cellulitis but subsequently found to have spontaneous soft tissue bleeding into the right thigh. He was eventually diagnosed with idiopathic acquired haemophilia A and treated with activated prothrombin complex concentrates to control acute bleeding followed by immunosuppressant therapy. Acquired haemophilia A is a potentially life-threatening and under-recognised bleeding disorder that results from the immune-mediated development of autoantibodies directed against coagulation factor VIII. The disease is more common in elderly individuals where early recognition and treatment is compounded by the presence of other comorbid conditions, including other potential causes of bleeding. These confounding factors and lack of awareness among non-specialists accounts for the delay in diagnosis that is common in this disease and contributes to the persistently high mortality in this age group. BACKGROUND

Introduction: Worldwide incessantly menace "Dengue Fever" is a health phenomenon nowadays. We targeted three big provinces of Pakistan including Sindh, Punjab, and Khyber Pukhtoon Khwan. It makes a figure of 21,580 dengue cases and out of them, 317 patients fall in death group. Materials and methods: A cross-sectional case-control study has been conducted at the general tertiary care hospital in Karachi, Pakistan. Physicians, Residents and Interns from all the specialty of targeted the hospital, were included. Four major sections were plotted i.e. general and specified knowledge of Dengue, Dengue symptoms knowledge, Knowledge of practices and management practices of Dengue fever. Results: A randomized sample of 378 respondents was collected during the time period. In General, from 80 to 97% physician mark the correct answer of Dengue Fever Knowledge. It was strongly commented by the results that physicians have advance knowledge of Dengue symptoms. It was also observed that almost every physician has the knowledge Aspirin and Non-Steroidal Anti-Inflammatory Drugs must be avoided during the dengue fever or shock syndrome. Conclusion: In spite of a major number of dengue patients in hit list cities, physicians have lack of knowledge about certain topics. Advance knowledge about dengue, symptomatic illness like pain behind the back of eyes is a symptom of dengue, vaccines of dengue, practices, and medication which should not be given to dengue fever or shock patients were found to be Do Not Know by the selected hospital physicians.

Hip fractures in the young, healthy population are rare and often the result of high-energy trauma. A previously healthy 17-year-old patient presented to our institution with a 5-week history of left hip and knee pain in the absence of any trauma. Pelvic radiograph revealed a subacute left femoral neck fracture. He subsequently underwent surgical fixation and made an uneventful recovery. Further endocrine evaluation revealed isolated vitamin D deficiency to be the likely underlying cause for this fracture. Multiple previous opportunities were missed to identify the cause for this patient's symptoms. An intracapsular fracture in a young adult requires early recognition and prompt anatomical reduction. This case emphasises the need to maintain a high index of suspicion for atraumatic fractures in healthy adolescents with unexplained joint pain. Further endocrine and metabolic investigations are warranted, and isolated vitamin D deficiency must be considered as a potential causative factor.