C-reactive protein as a predictor of fetal and maternal infective morbidity and fetal mortality

The value of maternal C-reactive protein (CRP) levels as predictors of fetal and maternal infective morbidity and fetal mortality was assessed prospectively over a 6-month period in all cases of premature rupture of the fetal membranes or suspected premature labour. Statistical analysis of results showed that CRP at a level of 1.32 mg/dl is a sensitive marker of infective morbidity in mother and neonate. Furthermore, there was a significant association between raised CRP levels and low-birth-weight babies, suggesting that intra-uterine infection is a major cause of prematurity in the study population.     

Provision of immunisation--the Gazankulu experience

Following the outbreak of poliomyelitis in Gazankulu in 1982, the immunisation services in Gazankulu were thoroughly examined. As a result of this, a comprehensive immunisation policy for Gazankulu was accepted in November 1986. The broad aim of the policy is to provide effective immunisation to all Gazankulu residents against tuberculosis, diphtheria, pertussis, tetanus, poliomyelitis and measles. A specific objective is that by the end of 1987, 85% of under-5s should have been vaccinated against these six diseases and by the end of 1990 this percentage should be 97%. The detailed strategies to reach these objectives are highlighted. Within the framework of the objectives, the policy allows different areas to formulate individual strategies. Programme monitoring and community involvement are two crucial aspects of the policy and these are discussed in detail. The early successes and difficulities in implementing this policy are discussed.     

Rapid action of 1,25-dihydroxyvitamin D3 on calcium transport in perfused chick duodenum: effect of inhibitors

Transport of 45Ca from the lumen to the venous effluent was studied in duodena of normal, vitamin D3-replete (+D) chicks perfused through the celiac artery with 130 pM 1,25(OH)2D3 or vehicle. Administration of actinomycin D 3 h prior to perfusion did not alter the unstimulated transport rate or diminish the response to exogenous 1,25(OH)2D3: After 40 min exposure to the seco-steroid, 45Ca in the vascular effluent was 140% of control levels. The anti-microfilament agent cytochalasin b and the ionophore monensin, an inhibitor of Golgi function, similarly failed to suppress 1,25(OH)2D3-stimulated calcium transport. In pilot studies, Golgi and basal-lateral membrane fractions were prepared from duodenal epithelium of vitamin D-deficient (-D) chicks treated with vehicle or 650 pmol of 1,25(OH)2D3 in vivo 2 h, 10 h, or 15 h before sacrifice, as well as from +D birds. Analyses of Golgi fractions for cathepsin B (CB) activity revealed a biphasic response with time, increasing to 200% of -D levels 2 h after 1,25(OH)2D3 administration and in equivalent preparations from +D birds. Less pronounced increases in acid phosphatase activity were observed in the same membrane fractions. In basal-lateral membranes, enhanced CB activity was detectable 10 h after 1,25(OH)2D3 in vivo, rose to 155% of -D levels at 15 h, and to 245% of controls in fractions from +D birds, whereas acid phosphatase was 75%, 81%, and 125% of controls, respectively, at these times.(ABSTRACT TRUNCATED AT 250 WORDS)     

A study of the use of intravenous cannulas for medical emergencies in Newham--implications for financial savings

A study of intravenous (i.v.) cannula usage for medical emergencies admitted to hospitals in the Newham Health District was undertaken during two defined periods (24 and 35 days). Almost half the cannulas inserted (47%) were not flushed following an initial bolus injection of heparinized saline. The duration that cannulas remained in a vein ranged from 24 hours to 8 days (median 2 days) and inflammation around the cannula site was related to the length of time since insertion but unrelated to whether the cannula was flushed regularly or to the type of fluid used. Our findings indicate a substantial wastage of i.v. cannulas due to difficulties with insertion and suggest that isotonic saline, without heparin, is effective in maintaining cannula patency for 48 hours. It is concluded that these findings are not unique to the Newham Health District and worthwhile financial savings should be achieved throughout the NHS if clinicians reconsider the indications and use of i.v. cannulas for their patients.     

Recovery profile of single motoneurons after electrical stimuli in man

The H-reflex of 120 soleus motoneurons was recorded using fibre EMG. The recovery profile of these motoneurons was studied during monitoring surface H-reflex records in 28 adult subjects. The spectrum of motoneurons tested was homogeneous with two extremes of neurons having different characteristics. A motoneuron population (forming about 69% of our sample) had a high threshold level for electrical stimuli, short recovery time, and short recovery fringe time (called type A). A second population of motoneurons (forming about 20-30% of our sample) had a low threshold level for electrical stimuli, long recovery fringe time (called type B). During an isometric muscle contraction every motoneuron showed an early shift in recovery time (i.e. each had a shorter recovery time) with shortened recovery fringe time. These changes were larger for motoneurons type B than motoneurons type A. With paired identical electrical stimuli of varying interstimulus intervals a motoneuron may fire in response to the conditioning and test stimuli giving an H2, but not in response to both stimuli. This occurred for interstimulus intervals of 4-11 ms. A strong inhibition period was recorded with interstimulus intervals of 12-80 ms in which all motoneurons did not show any recovery. Most motoneurons recovered in orderly fashion between 80 and 300 ms of interstimulus interval, and this recovery coincided with the fast recovery recorded in surface H-reflex. All motoneurons were recovered by 3000 ms of interstimulus intervals. These findings emphasize the importance of eliciting the H-reflex every 3-5 s in H-reflex methodology in order to be assured that all excited motoneurons have been recovered.     

Haemoglobin A1 and congenital malformation

Two hundred and thirty pregnancies were studied in 196 diabetic women. Seven women with babies found to have major malformations had a higher median first trimester haemoglobin A1 (12.9%) than the median HbA1 (10.8%) in those with normal babies (p = 0.06). No relationship was found between the occurrence of minor malformations and first trimester maternal haemoglobin A1. Two of the seven congenital malformations were diagnosed antenatally at a time when therapeutic abortion could be offered. Expert antenatal ultrasound scanning should be offered to all pregnant diabetic women as poor glycaemic control at the time of conception and organogenesis, as evidenced by raised first trimester HbA1, predisposes to congenital malformation.     

Toward the ideal state mental hospital: the human equation

This paper gives the historical sketch necessary for an understanding of the current state of American psychiatry. It reviews some of the reasons why the rendering of good hospital care must be reconsidered, and describes some of the main features of the future public institution.     

A double blind comparison of diclofenac and indomethacin in the treatment of ankylosing spondylitis

During almost 12 years of development and clinical trials, diclofenac sodium has been shown to be both effective and safe as a new nonsteroidal antiinflammatory drug (NSAID) for the treatment of rheumatic diseases including ankylosing spondylitis (AS). We compared the safety and efficacy of 75, 100, or 125 mg/day of diclofenac with the same doses of indomethacin in a multicenter, randomized, parallel group trial in patients with AS. A single blind placebo washout period of 2 days to 2 weeks preceded the 13-week double blind treatment period. Both diclofenac and indomethacin produced significant (p less than 0.001) improvement from baseline for all 14 efficacy variables analyzed. There were no significant between treatment differences. Differences favored diclofenac in the frequency and the severity of adverse experiences reported and in the frequency of complaints affecting the central nervous system.