Journals Watch - Femoral nerve palsy and PPIs

Not had time to read the journals? Let Dr Suzanne Hunter bring you up to date with the latest research.

Pavlick harness: success depends on the rate of recovery from FNP (Photograph: Dr P Marazzi/Science Photo Library
Pavlick harness: success depends on the rate of recovery from FNP (Photograph: Dr P Marazzi/Science Photo Library

Femoral nerve palsy in Pavlik harness treatment
J Bone Joint Surg Am 2011; 93: 493-9

The Pavlik harness for congenital dislocation of the hip (CDH) has a high success rate but is also known to cause transient femoral nerve palsy (FNP).

This study looked at infants who developed FNP while undergoing Pavlik harness treatment to determine if this complication meant lower CDH treatment success.

The authors found FNP occurred in 2.5 per cent of cases and 87 per cent of cases presented within one week of application of the Pavlik harness.

The rate of recovery of FNP determined Pavlik harness treatment success rate; if the FNP recovered within three days the success rate of CDH was 70 per cent, if it failed to recover within 10 days the CDH failure rate was 70 per cent.

Overall the success rate of the Pavlik harness was 94 per cent in the non-FNP patients and 47 per cent in patients with FNP.

PPIs and BMI
Gut 2011; 60: 442-8

Upper GI symptoms are common and the treatment is not always straightforward. This study looked at patients who underwent endoscopy, had no macroscopic findings and were Helicobacter pylori negative. It aimed to identify whether there were any predictors of successful response to PPIs.

The authors found the only good non-invasive predictor of response was BMI and this compared well with the predictive values of abnormal manometry or oesophageal pH. Those with a BMI of more than 25kg/m2 were 3.9 times more likely to respond than those with a BMI below 25kg/m2.

Characteristics of symptoms were a poor predictor. BMI seems to be a good surrogate marker for reflux disease. This may be due to increased physical pressure on the stomach contents or is possibly a reflection of poorer dietary habits.

Probiotics and response to vaccinations
Arch Dis Child 2011; 96: 345-9

Immunisation against infectious diseases is one of the most cost-effective and beneficial disease prevention measures, but response to the vaccine is not always 100 per cent.

This small pilot study looked at whether a 30-day course of an oral probiotic would increase the response rate in 12-month-old infants receiving MMR and varicella vaccination compared with placebo.

They found a borderline significant benefit for probiotics. Of the 47 children in the study, in the probiotic group 8 per cent failed to seroconvert as opposed to 17 per cent in the placebo group (p=0.052).

Omalizumab for asthma
N Engl J Med 2011; 364: 1005-15

It has been found before that inner-city children, adolescents and young adults with asthma achieve better control with a reduction of exposure to allergens. Because of the heavy involvement of allergen exposure in inner city patients, this group were chosen for IgE-targeted treatment in this study.

This was a trial comparing omalizumab, an anti-IgE monoclonal antibody, with placebo. Omalizumab or placebo were added to conventional treatment in patients with established asthma of any severity. Both were given by a subcutaneous injection every two to four weeks.

The study found that compared with placebo, omalizumab reduced the number of days asthma symptoms were experienced, exacerbations, hospitalisations and need for inhaled steroids. There were no safety differences between the two groups.

Most interestingly it seemed to iron out the seasonal variation in exacerbations. The authors say this could be due to allergens and viruses interacting to produce exacerbations.

Tranexamic acid in trauma revisited
Lancet 2011; 377: 1096-101

Tranexamic acid is a menorrhagia medicine, but is also used in serious trauma cases to reduce death by bleeding. In the CRASH-2 trial, tranexamic acid was given by effusion to 20,000 serious trauma patients and was found to reduce all cause mortality and risk of death through bleeding over similarly administered placebo.

In this paper the researchers re-examined the data looking at whether the timing of giving tranexamic acid made a difference to outcomes.

They found that giving it under three hours post-trauma led to a decrease in the risk of death through bleeding whereas giving it after three hours could lead to an increase. It is thought that this is due to an inhibition of fibrinolysis leading to better haemostasis.

Vitamin D deficiency in nursing home residents
Age Ageing 2011; 40: 211-4

Most of our vitamin D is generated from sunlight exposure. This is fine for most of the population, but residents in nursing homes rarely get exposed to sunlight. This leads to deficiency with problems such as secondary hyperparathyroidism and fatigue.

This Dutch study looked at the effect of high intensity UVB for two minutes every week via a sunbed for eight weeks on elderly residents in a psychogeriatric home.

The authors found that all but one of the participants were vitamin D-deficient at the start of the trial.

Over the eight weeks the serum 25-hydroxyvitamin D levels doubled and parathyroid levels dropped by 20 per cent. The authors are planning to run the study for longer to see the effects after a year. They also intend to assess quality of life.

CPD IMPACT: EARN MORE CREDITS

These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Research the treatment options for congenital dislocation of the hip and produce a patient information leaflet.
  • Present to colleagues on the use of PPIs in patients with upper GI symptoms and devise a practice protocol for their treatment.
  • Meet with local nursing home managers to discuss increasing sunlight exposure for their residents.

Save this article and add notes with your free online CPD organiser at gponline.com/cpd Take clinical tests and claim certificates for CPD at myCME.com

  • Dr Hunter is a GP in Bishops Waltham, Hampshire and a member of our team who regularly review the journals

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