Terminal deletion of chromosome 4p (4p16.3) shows a breakpoint between loci linked to Huntington disease

A 15-year-old boy with a terminal deletion of the short arm of chromosome 4 is described. The patient has a mild clinical phenotype that is incompatible with Wolf-Hirschhorn syndrome. Careful neurological examination including CT scan did not show any signs of Huntington disease. The chromosomal breakpoint was analyzed by means of polymorphic DNA probes localized close to the tentative Huntington (HD) locus. The breakage has occurred between D4S43 and D4S90 loci and thus deletes part of the chromosomal candidate regions for the HD locus. © 1992 Wiley-Liss, Inc.     

Hydrotherapy after total knee arthroplasty. A follow-up study

The study evaluated the subjective functional outcome following total knee arthroplasty (TKA) in participants who underwent hydrotherapy (HT) six months after discharge from a rehabilitation unit. A total of 70 subjects, 12 of which were lost at follow-up, were randomly assigned to either a conventional gym treatment (N = 30) or HT (N = 28). A prospective design was performed. Participants were interviewed with Western-Ontario McMasters Universities Osteoarthritis Index (WOMAC™) at admission, at discharge and six months later. Kruskal-Wallis and Wilcoxon tests were applied for statistical analysis. Both groups improved. The WOMAC™ subscales, namely pain, stiffness and function, were all positively affected. Statistical analysis indicates that scores on all subscales were significantly lower for the HT group. The benefits gained by the time of discharge were still found after six months. HT is recommended after TKA in a geriatric population.     

Duration of surgery and patient age affect wound healing in children

The migration of inflammatory cells into a wound and their subsequent changes during wound healing are essential for the complex processes of tissue repair to occur. The aim of this work was to investigate the number of wound leukocytes during early wound healing at different time periods in children. Wound cells of 184 children aged 0-15 years, operated on for a benign disease in the lower abdominal region, were harvested with the Cellstick(R) device. The device was removed from the wound at 3, 6, or 24 hours after surgery and differential cell counts were performed. The cellular patterns were significantly influenced by the age of the patient and by the duration of the surgery. The proportions of neutrophils, lymphocytes, and monocytes changed significantly from 3-24 hours. Our results suggest that there is a distinct time-related change in the pattern of inflammatory cells in the early phase of wound healing in children. This pattern is affected by the age of the child and by the duration of the surgery.     

A rapid ELISA for the diagnosis of MB leprosy based on complementary detection of antibodies against a novel protein-glycolipid conjugate

Despite the widespread use of multidrug therapy for treatment, delays in clinical recognition and under-reporting of leprosy indicate that Mycobacterium leprae transmission is continuing. Thus, leprosy is likely to persist as a significant burden on health systems in many regions. In this study, we combined 2 previously characterized leprosy antigens, leprosy IDRI diagnostic-1 (LID-1) and ND-O, into the single fusion complex (ND-O–LID) and determined the serum antibody responses of leprosy patients from Colombia and the Philippines. Following confirmation that antibodies recognized each component within the conjugate, we assessed the performance of a rapid enzyme-linked immunosorbent assay (ELISA) system (Leprosy Detect^TM fast ELISA; InBios International, Inc., Seattle, WA, USA) based on ND-O–LID capable of generating results within 1.5 hours of sample addition. We found ELISA results correlated with the bacteriological index and Ridley–Jopling categorization, with lepromatous leprosy patients having the highest responses, while those of borderline tuberculoid patients were lower. Multibacillary (MB) leprosy patients were distinguished with a high degree of sensitivity (95.7%) and specificity (93.2%), suggesting that this ELISA could potentially replace invasive and insensitive skin slit smear procedures that require expert microscopic examinations. Due to the speed and robustness of this assay, we believe this is an excellent tool for detecting MB leprosy patients in a simple and highly-quantitative manner.     

Distribution of Working Time and Contents of Physiotherapy Activities in a Clinical Setting.

The purpose of the present study was to collect personnel utilization data in the physiotherapy department of a general hospital as a basis for improving the practice of physiotherapy. Over a four-week period in a process of continuous observation 12 physiotherapists recorded their activities under predefined task categories. The percentages of total time used in the observed activities were as follows: direct patient treatment 31%, other work (planning, recording, arranging walking aids and student guidance) 10%, and cooperation (consultation, meetings, arranging patients' affairs, counselling relatives and parents) 9%. The proportion of uncategorized work amounted to half of the total working time. Physical exercise and counselling in direct patient care, preparation and records in other work and teamwork and cooperation with parents were the commonest activities recorded. The physiotherapists' time schedule in the different wards differed in terms of mean treatment time per patient and amount of patients per day. The major problems were felt to be the lack of assessment methods of follow-up and feed-back systems for patients after hospital care and uncertainty as to what the content of practise should contain. The observation method appeared to be a useful tool for collecting personnel utilization data in a physiotherapy department.     

CURB-65 as an initial prognostic score in Internal Medicine patients

BackgroundThere are few validated tools to assess severity in patients admitted to an Internal Medicine service. The aim of this study was to evaluate if CURB-65 score, previously validated as mortality index in community acquired pneumonia, could also be used in those patients.MethodsWe analyzed prospectively all patients admitted to Hospital Sierrallana (Spain) from 1 March to 31 October 2010. Variables of the CURB-65 score (confusion, serum urea > 7 mmol/L (42 mg/dl), respiratory rate ≥ 30/min, systolic blood pressure < 90 mm Hg and/or diastolic blood pressure ≤ 60 mm Hg, and age ≥ 65) and other clinical and epidemiological data and laboratory findings were recorded. Charlson comorbidity index was also estimated. Prognostic variables were identified using multiple logistic regression with 30 days mortality as the outcome measure.Results539 patients were studied (51% males; mean age: 78 ± 14 years; mortality 12%). A high CURB-65 score was a significant predictor of 30 day mortality (p < 0.001). Eighty-six percent of the patients who died had high CURB-65 score at admission, and none of them had low score. Sensitivity and specificity for high CURB-65 score were 86% and 70%, respectively, and negative predictive value was 97%. Receiver–operator characteristic curve showed an area under curve of 0.79 for CURB 65-score. Charlson index also correlated with mortality, but its performance was worse than that of CURB-65.ConclusionOur findings suggest that CURB-65 score may be a simple and useful tool to help clinicians in establishing the prognosis of patients admitted to general Internal Medicine wards.