Self-Help Devices: Crutch Prescriptions: Modifications

In estimating physical impairment, accurate measurement of range of motion is essential, but other factors also must be considered. In the method of calculation described, the percentage of impairment due to limited motion is determined first, and if they are important, estimations of impairment due to pain, weakness, instability, sensory loss, or shortened extremities are added.     

NDM-1 has arrived: first report of a carbapenem resistance mechanism in South Africa

The New Delhi Metallo-β-lactamase (NDM) resistance mechanism in Enterobacteriaceae threatens to render serious Gram-negative infections untreatable. The NDM-1 enzyme hydrolyses all available penicillin, cephalosporin and carbapenem antibiotics, and is commonly accompanied by additional resistance mechanisms to multiple antibiotic classes. Initially identified as a significant healthcare risk on the Indian sub-continent, it has rapidly become a global problem, posing significant diagnostic and management challenges. Here we report the first laboratory-confirmed case of NDM-1 in South Africa.     

Nonspherocytic Haemolytic Anaemia with Increased Red Cell Adenine Nucleotides, Glutathione and Basophilic Stippling and Ribosephosphate Pyrophosphokinase (RPK) Deficiency: Studies on Two New Kindreds

The second and third kindreds with hereditary haemolytic anaemia characterized by marked basophilic stippling of the erythrocytes, increased red-cell GSH and adenine nucleotides, and ribosephosphate pyrophosphokinase (RPK, PRPP synthetase) deficiency are reported. In each affected subject increased auto-haemolysis was not corrected by glucose additives in the autohaemolysis test. Despite the clearly hereditary nature of the syndrome, a heterozygous 'carrier' state could not be demonstrated in any family members. While autosomal recessive transmission is likely, the genetics remain obscure. The roles of substantial RPK deficiency as either a causative factor or an epiphenomenon is likewise not firmly established.     

Mast cells,neuropeptides and inflammation

Conclusions We have demonstrated that, unlike mast cells of the lung, adenoids, tonsils and intestine, whose primary role is thought to be IgE-mediated host defence, human skin mast cells respond to neuropeptide stimulation with a rapid release of histamine and minimal generation of PGD₂ and LTC₄. This ability of skin mast cells to release mediators in response to neuropeptide stimulation is evidence in favour of a neuro-immune interaction within human skin which may have evolved to promote angiogenesis [70] or control cutaneous blood flow [71]. In this context, it is interesting to note that mast cells are found in particularly high numbers in the blush areas of the neck and face [72].A knowledge of the functional heterogeneity of human mast cells, and of their responsiveness to neuropeptides in particular, will prove to be of great importance to our understanding of the role of mast cells in health and disease. Enhanced responsiveness of skin mast cells to neuropeptides may contribute to the aetiology of some forms of urticaria as suggested by the presence of enhanced weal responses of patients with chronic idiopathic urticaria to various non-immunological stimuli [73–76]. Furthermore, the high ratios of histamine to PGD₂ (>10001) [31, 32] in the venous effluent of thermally-challenged limbs of patients with heat- or cold-induced urticaria suggests mast cell activation by a neuropeptide rather than an immunological stimulus. However, the caveat applies that these two mediators may have been metabolised to different extents before reaching the sampling site.