Serum C-reactive protein is a useful marker for congenital infection

Serial quantitative measurements of C-reactive protein (CRP) were performed by reaction rate nephelometry on cord blood and scrum of 70 babies (60 preterm and 10 full term). There were 41 babies born to mothers with no risk factors for bacterial infection (Group 1) and 29 babies born to mothers with risk factors (Group 2), Maternal risk factors for congenital infection were: a history of prolonged rupture of membranes, maternal treatment with antibiotics, chorioamnionitis or positive cultures from high vaginal swabs. Twelve babies had raised CRP levels (>10 mg/1), 2 from Group 1 and 10 from Group 2, 9 of whom were subsequently found to have bacterial infections. One of the 2 babies without suspected infection had severe birth asphyxia. Specificity, sensitivity, positive and negative predictive values were calculated for CRP levels and total white cell counts (TWCC). Within Group 2, the specificity of raised CRP for diagnosis of congenital bacterial infection was 95% and the sensitivity was 100%, compared to the specificity of TWCC 95% and sensitivity 55%. CRP can be used as a marker for congenital bacterial infection and appears to be more sensitive than TWCC.     

Pattern of proteinuria in IgA nephropathy

Summary: Proteinuria is one of the bad prognostic indices in IgA nephritis (IgAN). This study compares the pattern of protein excretion in 10 patients with IgAN (IA) with that 5 years later (IB), when they developed renal impairment or hypertension. The pattern of proteinuria was analysed by SDS-PAGE and isoelectric focusing (IEF) and assayed for orosomucoid, α-1-microglobulin, retinol-binding protein, lysozyme, beta-2-microglobulin and N-acetyl-β-D-glucosaminidase activity. The data suggest that the changing pattern of proteinuria from IgA₁ to IgA₂ may reflect hyperfiltration as well as tubular injury.     

Changes in the perceived quality of primary care in Shanghai and Shenzhen,China: a difference-in-difference analysis

ObjectiveTo assess changes in the quality of primary care in two megacities following the introduction of health system reforms in China.MethodsWe conducted multistage stratified random face-to-face surveys of patients visiting community health centres in Shanghai in 2011 and 2013, and Shenzhen in 2012 and 2013. Quality of primary care was measured using an assessment tool. Difference-in-difference analyses based on multiple linear regressions were used to compare the changes over time, after controlling for potential confounders.FindingsMost (2721) of the 3214 participants used a community health centre as their regular source of care and were included in our analyses. The mean total scores for quality of primary care were similar for Shanghai and Shenzhen at baseline. In Shenzhen, the mean total scores for all participants and those on low incomes had worsened by 0.922 (95% CI: 0.629 to 1.215) and 1.203 (95% CI: 0.397 to 2.009), respectively. In Shanghai, however, there were improvements in the mean total scores which included increases in the scores for first-contact utilization, continuity, coordination of information and comprehensiveness.ConclusionThe quality of primary care improved in Shanghai but not in Shenzhen. This may be because, in Shanghai, beneficial long-term relationships between patients and general practitioners were supported by capitation payments and the provision of services tailored to the local health priorities.     

Minimally invasive plate osteosynthesis for humerus diaphyseal fractures

Background:

Minimally invasive plate osteosynthesis (MIPO) technique is reported as a satisfactory procedure for the treatment of humeral shaft fractures by the anterior approach by several authors. However, none of the published reports had a significant follow-up nor have they reported patient outcomes. We evaluated the clinical, radiographic, and functional outcome over a minimum follow-up of 2 years using the same MIPO technique to humeral shaft fracture.

Materials and Methods:

32 adult patients with diaphyseal fractures of the humerus treated with MIPO between June 2007 and October 2008 were included in the study. Patients with metabolic bone disease, polytrauma, and Gustilo and Anderson type 3 open fractures with injury severity score >16 were excluded from the study. All cases were treated with closed indirect reduction and locking plate fixation using the MIPO technique. The surgery time, radiation exposure, and time for union was noted. The shoulder and elbow function was assessed using the UCLA shoulder and Mayo elbow performance scores, respectively.

Results:

Of the 32 patients in the study, 19 were males and 13 were females. The mean age was 39 years (range: 22–70 years). Twenty-seven of the thirty-two patients (84.3%) had the dominant side fractured. We had eight cases of C2 type; five cases of C1 and A2 type; four cases of B2 type; three cases each of B3, B1, and A1 type; and one case of A3 type of fracture. The mean surgical time was 91.5 minutes (range: 70–120 minutes) and mean radiation exposure was 160.3 seconds (range: 100–220 seconds). The mean radiological fracture union time was 12.9 weeks (range: 10–20 weeks). Shoulder function was excellent in 27 cases (84.3%) and good in remaining 5 cases (15.6%) on the UCLA score. Elbow function was excellent in 26 cases (81.2%), good in 5 cases (15.6%), and fair in 1 case (3.1%) who had an associated olecranon fracture that was fixed by tension band wire in the same sitting.

Conclusion:

MIPO of the humerus gives good functional and cosmetic results and should be considered one of the management options in the treatment of humeral diaphyseal fractures.