An evidence-based review on the validity of the Kaltenborn rule as applied to the glenohumeral joint

Kaltenborn's convex-concave rule is a familiar concept in joint treatment techniques and arthrokinematics. Recent investigations on the glenohumeral joint appear to question this rule and thus accepted practice guidelines. An evidence-based systematic review was conducted to summarize and interpret the evidence on the direction of the accessory gliding movement of the head of the humerus (HOH) on the glenoid during physiological shoulder movement. Five hundred and eighty-one citations were screened. Data from 30 studies were summarized in five evidence tables with good inter-extracter agreement. The quality of the clinical trials rated a mean score of 51.27% according to the Physiotherapy Evidence Database scale (inter-rater agreement: kappa=-0.6111). Heterogeneity among studies precluded a quantitative meta-analysis. Weighting of the evidence according to Elwood;s classification and the Agency for Health Care Policy and Research classification guidelines indicated that evidence was weak and limited. Poor methodological quality, weak evidence, heterogeneity and inconsistent findings among the reviewed studies regarding the direction of translation of the HOH on the glenoid, precluded the drawing of any firm conclusions from this review. Evidence, however, indicated that not only the passive, but also the active and control subsystems of the shoulder may need to be considered when determining the direction of the translational gliding of the HOH. The indirect method, using Kaltenborn's convex-concave rule as applied to the glenohumeral joint, may therefore need to be reconsidered.     

Lyssaviruses

Lyssaviruses are the etiological agents of rabies, one of the oldest viral diseases known to man and a disease that has persisted over many centuries. Together with sound diagnostic methods and efficacious vaccines--both of which had been available for many decades, an understanding of the epidemiology of the disease have enabled its control and even elimination in some specific reservoir species in North America and Western Europe. However, worldwide rabies still radiates into new host species and geographical domains and has become vastly underestimated throughout the developing world through lack of awareness, apathy and poor surveillance. As a result, this disease is now more of a global public and veterinary health threat than it has ever been.     

Mokola virus in domestic mammals, South Africa

We recently identified 2 Mokola viruses from domestic mammals (a dog and a cat) in South Africa. These cases occurred 8 years after the last reported case of infection with this virus. Our findings emphasize the endemicity of rabies-related lyssaviruses in South Africa and the need to better understand the epidemiology of Mokola viruses.     

A pooled analysis to study trends in exposure to antineoplastic drugs among nurses

OBJECTIVES: Several studies have shown that exposure to antineoplastic drugs can cause toxic effects on reproductive health as well as carcinogenic effects. Numerous studies have corroborated that hospital workers are exposed to these drugs. This study focused on trends in exposure to antineoplastic drugs since the introduction of guidelines in The Netherlands. METHODS: Data from three cross-sectional exposure surveys conducted in The Netherlands were pooled to examine trends in occupational exposure to cyclophosphamide. Nurses' 24 h urine samples were analyzed in separate fractions, surface contamination was determined and gloves used during preparation or while handling patient urine were collected. The difference in detectable urine samples between 1997 and 2000 was determined by a generalized estimating equations (GEE) binomial regression model. Mixed models were used to study the time trend in surface and glove contamination levels. RESULTS: The percentage of nurses' urine samples with detectable cyclophosphamide had decreased 4-fold between 1997 and 2000. Median cyclophosphamide levels in the positive urine samples were 3-fold lower in 2000 than in 1997. Surface and glove contamination had statistically significantly decreased between 1997 and more recent years. CONCLUSIONS: Nurses working at outpatient clinics or oncology wards are still being exposed to cyclophosphamide, but their exposure decreased considerably between 1997 and 2000, presumably due to the introduction of detailed guidelines and regulations in The Netherlands, the subsequent increased use of LuerLock connections and infusion systems prefilled with saline, and growing hazard awareness of nurses working with antineoplastic drugs.     

Generation and evaluation of a recombinant modified vaccinia virus Ankara vaccine for rabies

Modified vaccinia virus Ankara (MVA) has become a vaccine vector of choice for recombinant vaccine development. A MVA-based rabies vaccine would be advantageous for use as a vaccine for dogs (and wildlife), particularly if it proves innocuous and efficacious by the oral route. Here, the generation and immunological testing of a recombinant MVA expressing a rabies virus glycoprotein gene is described. In a murine model, higher dosages of recombinant MVA were needed to induce equivocal immune responses as with Vaccinia Copenhagen or Vaccinia Western Reserve recombinants, when administered by a parenteral route. The MVA recombinant was not immunogenic or efficacious when administered per os in na?ve mice. The ability of the recombinant MVA to induce anamnestic responses in dogs and raccoons was also investigated. Recombinant MVA boosted humoral immune responses in these animals when administered peripherally, but not when administered orally.     

Ethnicity and patient satisfaction with tuberculosis care: A cross‐sectional study

Patients presenting in major tuberculosis (TB) centres in two Australian metropolitan hospitals and three central hospitals in Malawi were interviewed for health and other information, including their satisfaction with nursing care. The main objective of the study was to investigate differences in satisfaction rates among ethnically similar and different patients coming from two dissimilar health systems. A multivariable Generalized Estimating Equations model was constructed to identify sociodemographic and health‐related factors associated with dissatisfaction, while focusing on ethnic differences between and within each country. The Australian and Malawian patients were similar in age, gender, marital status, and employment. However, the Malawians were mostly inpatients, with recurrent TB episodes, and were more seriously ill with impaired physical and mental wellbeing. Nonetheless, being Australian was more associated with dissatisfaction observed in all components of care. However, Australian ethnic minorities were less dissatisfied than their Anglo‐Saxon or European counterparts, being more similar to Malawian patients irrespective of the health care provided. Our study suggests that patients coming from similar ethnic backgrounds may express similar satisfaction irrespective of the health system they belong to.     

Sepsis in obstetrics and the role of the anaesthetist

Sepsis in pregnancy and the puerperium remains a significant cause of maternal mortality and morbidity worldwide. Major morbidity arising as a result of obstetric sepsis includes fetal demise, organ failure, chronic pelvic inflammatory disease, chronic pelvic pain, bilateral tubal occlusion and infertility. Early recognition and timely response are key to ensuring good outcome. This review examines the clinical problem of sepsis in obstetrics and the role of the anaesthetist in the management of this condition.     

Changes in causes of low vision between 1988 and 2009 in a Dutch population of children

Purpose: Causes of low vision in the Netherlands may have changed over time. The purpose of this study is to assess trends over the last two decades. Methods: Socio‐demographic and medical data, including ophthalmic diagnosis and inheritance patterns for 2843 children with low vision (0–21 years; 50% representation) referred to a Dutch institute for low vision (Bartiméus) over a 21‐year period between 1988 and 2009, were included in the analysis. For the 19 most common diagnoses, inheritance and presence of mental impairment, trend analyses were performed with logistic regression models; odds ratios (OR) for a 10‐year time span were reported. Results: Cerebral visual impairment (CVI) was found in 27.2% (97% mental impairment), albinism in 8.0%. Over time, nystagmus (6.6%; OR = 1.42), retinitis pigmentosa (2.9%; OR = 1.61), cone‐rod dystrophy (2.6%; OR = 1.98) and hyperopia (2.0%; OR = 3.66) increased significantly. Cataract (4.9%; OR = 0.64), aniridia (1.6%; OR = 0.42) and retinopathy of prematurity (ROP; 2.0%; OR = 0.45) decreased significantly. There was a significant increase in genetic disorders (41.0%; OR = 1.49) and in co‐occurrence of mental impairment (52.2% OR = 1.16). Conclusion: In the last two decades, treatable or preventable disorders (such as cataract and ROP) have become a less common cause of low vision in children. However, the prevalence of complex (genetic) and untreatable disorders (CVI) has taken its place, as a result of increased survival of preterm and low birth weight children and improved diagnostic possibilities. Knowledge of the prevalence of low vision, its causes and trends over time may help policy makers to define effective intervention strategies and to monitor its impact.     

Monoclonal antibody BA-1 does not bind to hematopoietic precursor cells

Monoclonal antibody BA-1 binds to B lymphocytes, to cells from most cases of non-T acute lymphoblastic leukemia (ALL), and weakly to neutrophils. To determine whether BA-1 also reacts with hematopoietic progenitor cells (HPC), we studied the effect of removal of BA-1+ cells from human bone marrow on the proliferation in vitro of the trilineage precursor cell CFU-GEMM, and on the committed progenitor cells of granulopoiesis (CFU-C) and erythropoiesis (BFU-E/CFU-E). Complement- mediated cytotoxicity using BA-1 at concentrations far beyond those required to lyse BA-1+ bone marrow cells and ALL cells did not result in inhibition of colony formation in any of the assays. A rosette separation method, using ox red blood cells coated with BA-1, resulted in enrichment of HPC in the BA-1-depleted interface, whereas very few HPC were found in the BA-1-enriched pellet. Both methods indicate that BA-1 does not bind to HPC, although binding of the antibody to the lymphohematopoietic stem cell cannot be excluded yet. The high cytotoxic capacity of the IgM antibody BA-1, and the lack of reactivity with HPC, make the antibody particularly suitable for use in autologous bone marrow transplantation for patients with ALL.