Comparison of quality and interpretation of newborn ultrasound screening examinations for developmental dysplasia of the hip by basically trained nurses and junior physicians with no previous ultrasound experience.

BACKGROUND: We are obliged to give babies the chance to profit from a nationwide screening of developmental dysplasia of the hip in very rural areas of Mongolia, where trained physicians are scarce. This study aimed to compare the quality and interpretation of hip ultrasound screening examinations performed by nurses and junior physicians. METHODS: A group of 6 nurses and 6 junior physician volunteers with no previous ultrasound experience underwent Graf's standard training in hands-on practice. Newborns were examined before discharge from the hospital, according to the national guideline. Two standard documentation images of each hip were saved digitally. The groups were compared on the proportion of good quality of sonograms and correct interpretation. Two Swiss supervisors' agreed diagnosis according to Graf was considered the final reference for the study purposes. RESULTS: A total of 201 newborns (402 hips or 804 sonograms) were examined in the study, with a mean age of 1.3±0.8 days at examination. Junior physicians examined 100 newborns (200 hips or 400 sonograms), while nurses examined 101 newborns (202 hips or 404 sonograms). The study subjects of the two groups were well balanced for the distribution of baseline characteristics. The study observed no statistically significant difference in the quality of Graf's standard plane images between the providers. Eventually, 92.0% (92) of the physician group and 89.1% (90) of the nurse group were correctly diagnosed as "Group A" (Graf's Type 1 hip) or "Non-Group A" hips (p = 0.484). The most common errors among the groups were a missing lower limb, wrong measurement lines, and technical problems. CONCLUSION: Our study provides evidence that while there might be a trend of slightly more technical mistakes in the nurse group, the overall diagnosis accuracy is similar to junior physicians after receiving standard training in Graf's hip ultrasound method. However, after basic training, regular quality control is a must and all participants should receive refresher trainings. More specifically, nurses need training in the identification of anatomical structures.

Traditional Mongolian swaddling and developmental dysplasia of the hip: a randomized controlled trial.

BACKGROUND: Mongolian traditional swaddling of infants, where arms and legs are extended with a tight wrapping and hips are in adduction position, may lead to abnormal maturation and formation of the hip joint; and is a contributing factor for developmental dysplasia of the hip (DDH). This hypothesis was tested in this randomized controlled trial. METHODS: Eighty newborns with one or two hips at risk of worsening to DDH (Graf Type 2a; physiologically immature hips) at birth were randomized into 2 groups at a tertiary hospital in Ulaanbaatar. The "swaddling" group (n = 40) was swaddled in the common traditional Mongolian method for a month while the "non-swaddling" group (n = 40) was instructed not to swaddle at all. All enrollees were followed up on monthly basis by hip ultrasound and treated with an abduction-flexion splint if necessary. The groups were compared on the rate of Graf's "non-Type 1" hips at follow-up controls as the primary outcome. Secondary outcomes were rate of DDH and time to discharge (Graf Type 1; healthy hips). In addition, correlation between the primary outcome and swaddling length in days and frequency of swaddling in hours per day were calculated. RESULTS: Recruitment continued from September 2019 to March 2020 and follow-up data were completed in June 2020. We collected final outcome data in all 80 enrollees. Percentages of cases with non-Type 1 hip at any follow-up examination were 7.5% (3/40) in the non-swaddling group and 40% (16/40) in the swaddling group (p = 0.001). There was no DDH case in the non-swaddling group while there were 8 cases of DDH in the swaddling group. The mean time to discharge was 5.1 ± 0.3 weeks in the non-swaddling group and 8.4 ± 0.89 weeks in the swaddling group (p = 0.001). There is a correlation between the primary outcome and the swaddling frequency in hours per day (r = 0.81) and swaddling length in days (r = 0.43). CONCLUSIONS: Mongolian traditional swaddling where legs are extended and hips are in extension and adduction position increases the risk for DDH. TRIAL REGISTRATION: Retrospectively registered, ISRCTN11228572 .

Implementation of a nationwide universal ultrasound screening programme for developmental dysplasia of the neonatal hip in Mongolia.

PURPOSE: Mongolia is the first Asian country to launch universal ultrasound screening for newborns with developmental dysplasia of the hip (DDH). The aims of this study were to determine the coverage and treatment rate of this programme. METHODS: Data from birth statistics and ultrasound hip screening from 29 hospitals were retrospectively reviewed (2010 to 2016, pre-nationwide phase; and 2017 to 2019, nationwide programme). DDH was diagnosed using the Graf-technique and treated according to 'ABCD', a modified Graf classification (Group A: Graf Type 1, mature; B: 2a, physiologically immature; C: 2c to 3, early DDH; D: 4, dislocated). Group B children were followed with monthly ultrasound. Group C and D children were treated with a flexion and abduction orthosis (Tübingen). Screeners used a web-based platform to upload images for quality surveillance. RESULTS: Between 2017 and 2019, 230 079 live births were registered and 176 388 newborns screened. The nationwide screening coverage rate in newborns increased from 73.6% in 2017 to 82.1% in 2019. Group A (148 510 children, 84.2%) was discharged, while Group B (25 820, 14.6%) was followed. Among children in Group B, 284 cases worsened to Group C and were, therefore, treated with a Tübingen orthosis. The remaining 2058 (1.2%) of newborns with DDH were treated with a Tübingen orthosis, including 1999 newborns in Group C and 59 in Group D. Since 2017, a total of 142 860 (81.0%) hip sonograms were uploaded to the platform. CONCLUSION: A simplified diagnostic and therapeutic framework for ultrasound DDH screening for newborns was successfully deployed in Mongolia, a developing country, providing high surveillance coverage and appropriate treatment.Level of evidence: IV.

Association of C(-106)T polymorphism in aldose reductase gene with diabetic retinopathy in Chinese patients with type 2 diabetes mellitus.

OBJECTIVE: To identify the possible association between C(-106)T polymorphism of the aldose reductase (ALR) gene and diabetic retinopathy (DR) in a cohort of Chinese patients with type 2 diabetes mellitus (T2DM). METHODS: From November 2009 to September 2010, patients with T2DM were recruited and assigned to DR group or diabetic without retinopathy (DWR) group according to the duration of diabetes and the grading of 7-field fundus color photographs of both eyes. Genotypes of the C(-106)T polymorphism (rs759853) in ALR gene were analyzed using the MassARRAY genotyping system and an association study was performed. RESULTS: A total of 268 T2DM patients (129 in the DR group and 139 in the DWR group) were included in this study. No statistically significant differences were observed between the 2 groups in the age of diabetes onset (P=0.10) and gender (P=0.78). The success rate of genotyping for the study subjects was 99.6% (267/268), with one case of failure in the DR group. The frequencies of the T allele in the C(-106)T polymorphism were 16.0% (41/256) in the DR group and 19.4% (54/278) in the DWR group (P=0.36). There was no significant difference in the C(-106)T genotypes between the 2 groups (P=0.40). Compared with the wild-type genotype, odds ratio (OR) for the risk of DR was 0.7 (95% CI, 0.38-1.3) for the heterozygous CT genotype and 0.76 (95% CI, 0.18-3.25) for the homozygous TT genotype. The risk of DR was positively associated with microalbuminuria (OR=4.61; 95% CI, 2.34-9.05) and insulin therapy (OR=3.43; 95% CI, 1.94-6.09). CONCLUSIONS: Microalbuminuria and insulin therapy are associated with the risk of DR in Chinese patients with T2DM. C(-106)T polymorphism of the ALR gene may not be significantly associated with DR in Chinese patients with T2DM.