Use of femur length/abdominal circumference ratio in detecting the macrosomic fetus

The femur length/abdominal circumference ratio, expressed as FL/AC X 100, was determined in 156 fetuses and evaluated as a predictor of fetal macrosomia within one week prior to delivery. The normal range (mean +/- 2 SD) in the 105 normal-weight fetuses was 22.0 +/- 2, while the normal range in the 51 macrosomic fetuses was 20.5 +/- 2; these differences were highly significant (P = less than .0001). The predictive power of a positive ratio was 68%, with a sensitivity of 63%. This ratio was particularly useful in the subset (n = 9) of macrosomic fetuses whose mothers were diabetic, correctly identifying 89% of this group. Because it is age independent, this ratio should prove most helpful in identifying fetuses at risk for macrosomia in patients whose dates are not known, since it may become abnormal before the fetal weight falls above the 90th percentile at term (3,900 g). In patients whose dates are known, early fetal macrosomia is best predicted by evaluating the abdominal circumference against normal standards for age.     

Efficacy of Amodiaquine/Artesunate Combination Therapy for Uncomplicated Malaria in Children Under Five Years in Ghana

Background

In 2005, following several years of declining efficacy of chloroquine, the Ministry of Health recommended the use of Amodiaquine/Artesunate combination therapy for the treatment of uncomplicated malaria. A system of continuous monitoring of therapeutic responses has been established in 10 district hospitals across the country. The data gathered will enable National Malaria Control Programme (NMCP) to respond to changes in the efficacy of the new treatment in a timely manner.

Objectives

To determine the 28 day therapeutic efficacy of Amodiaquine/Artesunate (AQ/AS) combination treatment in children with uncomplicated malaria in Ghana.

Methods

Children aged 6 – 59 months attending clinic with signs/symptoms of uncomplicated malaria at 9 district hospitals (3 in each of the 3 eco-epidemiological zones of the country) were eligible for enrolment. Enrolled children were followed up after treatment for a total of 28 days to record the clinical and parasitological resolution of their malaria episode as well as any adverse drug reactions.

Results

Treatment resulted in rapid and complete cure in almost all the children; 99.3% 14 days after treatment and 93.0%, 28 days after treatment. The majority of treatment failures on D28 were seen in the 3 sites located in the forest zones (Sunyani, Bekwai and Begoro). There was no case of Early Treatment Failure at both D14 and D28 assessments. Adverse events (AE''s) were minimal, less than 4%, with the most common complaint being vomiting.

Conclusion

AQ/AS combination for uncomplicated malaria is efficacious and safe in children less than 5 years.     

Experience-dependent alteration of zinc-containing circuits in somatosensory cortex of the mouse.

Histochemical staining was used to localize zinc-sequestering terminals in somatosensory barrel cortex of normal mice and mice subjected to tactile deprivation by simple whisker trimming from birth. In normal mice, density of synaptic zinc was highest in laminae I, II and V, intermediate in laminae III and VI, and lowest in lamina IV barrel hollows. Whisker trimming from birth led to increased density of synaptic zinc specifically within deprived barrel hollows.     

Swedish physicians' perspectives on the introduction of the Stockholm model

Reports findings on the perspectives of Swedish physicians since the introduction of the Stockholm model. Subjects were asked to describe their work, how long they had been working and whether they were familiar with the Stockholm model. Questions also focused on professional autonomy, use of diagnostic related groups (DRGs), quality of care and competition among health-care providers. Most of the physicians interviewed reported that the Stockholm model had the advantage of increasing efficiency and productivity, that economic incentives influenced their medical decisions, and medical treatment appears more patient-focused than before. Finally, primary care physicians report an enhanced status within the medical profession.     

Unilateral microscopic approach for lumbar spinal stenosis decompression: a scoping review

Background

Microscopic unilateral laminotomy for bilateral decompression (ULBD) is a minimally invasive technique used in the treatment of lumbar spinal stenosis and could limit spinal instability and be associated with better clinical outcomes. However, there is ongoing debate regarding its utility compared to conventional laminectomy (CL). The primary objective was to collate and describe the current evidence base for ULBD, including perioperative parameters, functional outcomes, and complications. The secondary objective was to identify operative techniques.

Methods

A scoping review was conducted between January 1990 and August 2022 according to the PRISMA extension for scoping reviews (PRISMA-ScR) guidelines. Major databases were searched for full text English articles reporting on outcomes following microscopic unilateral laminotomy in patients with lumbar spinal stenosis.

Results

Seventeen articles met the inclusion criteria. Two studies were randomised controlled trials. Two studies were prospective data collection and the rest were retrospective analysis. Three studies compared ULBD with CL. ULBD preserves the osteoligamentous complex and may be associated with shorter operative time, less blood loss, and similar clinical outcomes when compared to CL.

Conclusion

This review highlights that ULBD aims to minimise disruption to the normal posterior spinal anatomy and may have acceptable clinical outcomes. It also highlights that it is difficult to draw valid conclusions given there are limited data available as most studies identified were retrospective or did not have a comparator group.

     

Biofilm formation by Streptococcus pneumoniae isolates from paediatric patients

Tapiainen T, Kujala T, Kaijalainen T, Ikäheimo I, Saukkoriipi A, Renko M, Salo J, Leinonen M, Uhari M. Biofilm formation by Streptococcus pneumoniae isolates from paediatric patients. APMIS 2010; 118: 255–60. The clinical significance of pneumococcal biofilm formation is largely unknown. To clarify this, we tested whether the ability of pneumococcal clinical isolates to form biofilm in vitro accounts for the diverse clinical outcomes. Clinical pneumococcal isolates were cultured from the nasopharynx (n = 106), middle ear effusion (n = 43) and blood (n = 55) of 204 children altogether. Biofilm formation, assessed by measuring optical density (OD) values in microtitre plates after crystal violet staining, did not differ between the bacteria from different sources (p = 0.18), the mean OD values of the isolates being 0.119 [95% confidence interval (CI) 0.100–0.138] in the nasopharynx samples, 0.094 (95% CI 0.069–0.119) in the acute otitis media cases, 0.109 (95% CI 0.077–0.141) in the secretory otitis media cases, 0.122 (95% CI 0.084–0.160) in those with sepsis and 0.175 (95% CI 0.071–0.280) in those with other invasive infections. Serotypes 33 and 14 were the most efficient in forming biofilms, whereas serotypes 3 and 38 were poor biofilm producers. We conclude that the clinical presentation of pneumococcal disease did not differ in relation to biofilm formation in vitro, even though there was marked variation between the clinical isolates and serotypes.     

Health care financing in Uganda: the role of social health insurance

PURPOSE: The purpose of this article is to explore the feasibility of introducing a social health insurance (SHI) scheme in Uganda from the perspectives of a targeted population of respondents in Kampala, Uganda. DESIGN/METHODOLOGY/APPROACH: Out of 100 questionnaires distributed to a random sample of Ugandans, 74 were returned, yielding a 74 percent response rate. FINDINGS: Results show that all Ugandans surveyed support the introduction of SHI. Some are willing to contribute financially and most believe that the Ugandan government should make this benefit available to all Ugandans. While there is a great deal of support for introducing SHI, several respondents noted that cost sharing, in whatever form taken, is burdensome on people with lower incomes and has disastrous consequences for the delivery and utilization of health services among the poor. ORIGINALITY/VALUE: A larger study exploring Ugandans' perspectives may provide valuable information on how Africans can begin to design a workable health financing structure to promote better access to health care for the most vulnerable groups in society.