A novel technique for NOD2/CARD15 genotyping using PCR-SSP

The Nucleotide-binding Oligomerisation Domain (NOD) 2 protein is encoded by the Caspase Recruitment Domain (CARD) 15 gene and has a critical role in innate immunity. Recent studies have implicated Single Nucleotide Polymorphisms (SNPs) of the NOD2/CARD15 gene with the onset of several Inflammatory Bowel Disorders (Crohn's Disease, Blau syndrome) and the progression of several malignant diseases. The identification of SNPs in the genotypes of donor and recipient pairs prior to haematopoietic stem cell transplantation have also been shown to predict for a worse outcome, specifically causing increases in the incidence and severity of acute Graft-versus-Host disease, disease relapse and mortality. In light of these widespread areas of interest, we have developed a Polymerase Chain Reaction assay using Sequence Specific Primers (PCR-SSP) to identify the three SNPs that have been implicated, (SNPs 8, 12 and 13). The assay has proven to be a rapid and accurate method of performing NOD2/CARD15 genotyping when compared to other techniques described to date.     

Mainstream Time-Capnography: An Aid to Select an Appropriate Uncuffed Endotracheal Tube in Small Children

Uncuffed endotracheal tubes are commonly used in children in an attempt to decrease the potential for pressure induced tracheal injury. However, uncuffed endotracheal tube may increase the risk of aspiration and lead to erratic delivery of preset tidal volume during mechanical ventilation. Therefore, it is desirable to intubate trachea with an appropriate but not an oversized endotracheal tube. In children, for selecting an endotracheal tube, a variety of formulas and techniques are used to find the endotracheal tube size that minimizes both pressure induced tracheal injury and aspiration potential or variable ventilation. Air-leak following tracheal intubation can be recognized by the presence of audible leak, by auscultation over the trachea, by palpation over the trachea and by observing effects of positive end-expiratory pressure on inspiratory expiratory tidal volume difference during mechanical ventilation. We describe mainstream time-capnograph as an aid to recognize leak around the endotracheal tube and its utility to determine appropriate endotracheal tube size in small children. Neema PK, Jayant A, Manikandan S, Rathod RC. Mainstream time-capnography: An aid to select an appropriate uncuffed endotracheal tube in small children.     

Understanding the barriers to clubfoot treatment adherence in Uganda: a rapid ethnographic study

PURPOSE: The Ponseti method has been demonstrated to be an effective, low-technology method of correcting congenital clubfoot. The purpose of this paper is to identify barriers to adherence to the Ponseti method of clubfoot treatment in Uganda. Understanding of barriers underlies successful and culturally appropriate approaches to program implementation. METHOD: A qualitative study (rapid ethnographic study), using semi-structured interviews, focus groups and observation, was conducted. Interviews were conducted with parents of children with clubfoot (42), adults with clubfoot (2), community leaders (40), traditional healers (39) and practitioners treating clubfoot (38). Some 48 focus groups (24 male, 24 female) were conducted with general community members to ascertain their opinions on the potential barriers. The data was collected by a team of researchers in 8 districts of Uganda over the period of one month. It was then coded manually by the researchers and sorted into themes. RESULTS: The barriers to adherence were classified into 6 themes: (i) problems with programmatic resource availability and regional differences, (ii) distance to treatment site, (iii) poverty, (iv) lack of paternal support, (v) caregiver's other responsibilities, and (vi) challenges of the treatment process. A number of factors that were helpful for encouraging adherence were also identified: (i) outreach and follow-up services, (ii) counselling/caregiver-practitioner partnership, (iii) family harmony and solidarity, and (iv) receiving quality care. CONCLUSIONS: Our study highlights the barriers to adherence in the treatment of clubfoot, as well as factors that could be helpful for overcoming these barriers. This information provides health planners with knowledge to assist them in meeting the needs of the population and implementing effective and appropriate awareness and treatment programs for clubfoot in Uganda.