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Purpose@#We report outcomes and evaluate patient factors and the impact of surgical evolution on outcomes in consecutive ulcerative colitis patients who had restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) at an Australian institution over 26 years. @*Methods@#Data including clinical characteristics, preoperative medical therapy, and surgical outcomes were collected. We divided eligible patients into 3 period arms (period 1, 1990 to 1999; period 2, 2000 to 2009; period 3, 2010 to 2016). Outcomes of interest were IPAA leak and pouch failure. @*Results@#A total of 212 patients were included. Median follow-up was 50 (interquartile range, 17 to 120) months. Rates of early and late complications were 34.9% and 52.0%, respectively. Early complications included wound infection (9.4%), pelvic sepsis (8.0%), and small bowel obstruction (6.6%) while late complications included small bowel obstruction (18.9%), anal stenosis (16.8%), and pouch fistula (13.3%). Overall, IPAA leak rate was 6.1% and pouch failure rate was 4.8%. Eighty-three patients (42.3%) experienced pouchitis. Over time, we observed an increase in patient exposure to thiopurine (P=0.0025), cyclosporin (P=0.0002), and anti-tumor necrosis factor (P<0.00001) coupled with a shift to laparoscopic technique (P<0.00001), stapled IPAA (P<0.00001), J pouch configuration (P<0.00001), a modified 2-stage procedure (P=0.00012), and a decline in defunctioning ileostomy rate at time of IPAA (P=0.00002). Apart from pouchitis, there was no significant difference in surgical and chronic inflammatory pouch outcomes with time. @*Conclusion@#Despite greater patient exposure to immunomodulatory and biologic therapy before surgery coupled with a significant change in surgical techniques, surgical and chronic inflammatory pouch outcome rates have remained stable.
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Background. South Africa (SA), as a middle-income country, faces the nutrition transition and associated double burden of undernutrition and obesity. School feeding programmes are one way of ensuring that malnutrition in children is addressed, but questions remain about whether they can address both undernutrition and obesity.Objectives. To compare the obesity and stunting outcomes for children receiving different combinations of school feeding programmes in a rural district of SA.Methods. The evaluation involved a comparative design that compared the stunting obesity levels of three groups of children. Group 1 received one lunch meal a day for a prolonged period, group 2 both lunch and breakfast, and group 3 had started receiving a daily lunch shortly before the commencementofthresearch.Results. Group 1 had stunting levels in line with the national average. Group 2 had lower stunting levels than those receiving only the lunch meal. Children from group 3 had lower stunting levels than groups 1 and 2. Rates of obesity and overweight were markedly different between the groups. Group 3 had very high rates of overweight and obesity above the national average of 28%. In contrast, group 1 had far lower rates of overweight and obesity, and group 2exhibited the lowest levels. There was a significant decrease in the percentage of learners classified as overweight in group 3 over the 6-month period, from 26.1% to 19.2%.Conclusion. One lunch meal a day is associated with positive outcomes in relation to rates of stunting and obesity, and the lowest rates of obesity were measured when a breakfast meal was added. The addition of a breakfast meal to a lunch feeding programme shows promise,but this requires further investigation to understand whether causal linkages exist
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Child Nutrition Disorders , Double Effect Principle , Growth Disorders , Obesity , Parish Nursing , South AfricaABSTRACT
Aims: To understand the mechanisms of Early Growth Response Protein 1 (Egr-1) induction upon HSV-1 lytic infection and its roles in regulating viral gene expression and replication. Study Design: Rabbit corneal cell line SIRC and other cell lines were infected by HSV-1 to investigate the Egr-1 induction and its occupancy on the viral genome in different conditions. UV-inactivated HSV-1 and a recombinant virus over-expressing Egr-1 were generated to evaluate the regulatory effects on viral gene expression and replication during the infection. Methodology: Egr-1 induction triggered by viral infection was determined by Western Blot analyses and immune-fluorescent microscopy. Real-time RT-PCR and a novel Cignal™ Reporter Assay were used for quantitative measurement of Egr-1 expression. Chromatin Immuno-precipitation (ChIP) was performed to address the Egr-1 occupancy to the viral regulatory sequences and the influence on viral replication was assessed by plaque assays. Results: Our results indicated that Egr-1 expression requires viral gene expression since the UV-inactivated HSV-1 failed to produce Egr-1 protein. Blockade of viral replication did not block the Egr-1 protein synthesis, supporting the hypothesis that HSV-1 replication was not essential for Egr-1 production. Chromatin immune-precipitation (ChIP) and RT-PCR assays demonstrated that induced Egr-1 was able to interact with key regulatory elements near HSV-1 immediate-early (IE) genes and promote viral gene expression. Recombinant virus overexpressing Egr-1 revealed that Egr-1 enhanced the viral replication and the release of infectious virus. Conclusion: Together these results concluded that HSV-1 triggers the expression of an important host transcription factor Egr-1 via a unique mechanism and benefit the viral gene expression and replication.
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OBJECTIVE: To determine the prevalence of risk factors for chronic non-communicable diseases (CNCDs) among staff of The University of the West Indies (UWI), Cave Hill campus, in Barbados. METHODS: A self-administered questionnaire comprising validated questions from the WHO STEPS NCD Risk Factor Survey, the Jamaica Healthy Lifestyle (JHL) Survey and the Behaviour Risk Factor (BRF) Survey, was conducted during the Staff Health Day in May 2010, and at four locations on campus during July 2010. Standardized measurements of weight, height and blood pressure were taken. Data were analysed using EXCEL and STATA and results were compared to the Barbados 2007 STEPS NCD survey. RESULTS: The target population was all staff at the Cave Hill campus of UWI. The coverage rate was 25.2% (269/1068); 63.8% of males and 75% of females were either overweight or obese. Ninety-seven per cent ate less than the recommended 5 fruits and vegetables per day. Low levels of physical activity were reported in 51.9% of males and 62.2% of females. Thirty-two per cent of males and 13% of females were binge drinkers. All participants had at least one of the risk factors (current daily smoker, < 5 fruits and vegetables/day, physical inactivity, overweight/obese and raised blood pressure) whilst 48% of males and 57.2% of females demonstrated three or more risk factors. These results are similar to those found in the Barbados STEPS NCD risk factor survey of 2007. CONCLUSION: The results confirm a similar high prevalence of NCD risk factors among Cave Hill UWI staff as among the Barbadian population. The study reveals opportunities to inform policy on strategies to positively impact the risk factors.
OBJETIVO: Determinar la prevalencia de los factores de riesgo de ENCs entre el personal de la Universidad de West Indies (UWI), en el campus de Cave Hill, Barbados. MÉTODOS: El Día de la Salud del Personal en mayo de 2010, y en cuatro localidades del campus durante julio de 2010, se aplicó un cuestionario auto-administrado formado por varias preguntas validadas de las encuestas conocidas como WHO STEPS NCD Risk Factor Survey, JHL Survey y BRF Survey. Se hicieron mediciones estandarizadas del peso, la altura, y la presión arterial. Los datos fueron analizados usando EXCEL y STATA, y los resultados fueron comparados como los de la encuesta de Barbados 2007 STEPS NCD. RESULTADOS: La población objeto del estudio estuvo formada por todo el personal en el campus de Cave Hill de la Universidad de West Indies (UWI). La tasa de cobertura fue 25.2% (269/1068); el 63.8% de los varones y el 75% de hembras tenían sobrepeso o eran obesos. Noventa y siete por ciento consumía menos de las 5 frutas y vegetales recomendados por día. Se reportaron bajos niveles de actividad física en 51.9% de los varones y 62.2% de las hembras. Treinta y dos por ciento de los varones y 13% de las hembras eran bebedores consumados. Todos los participantes tenían al menos uno de los factores de riesgo (fumador consuetudinario, < 5 frutas y vegetales/día, inactividad física, sobrepeso/obeso, y alta presión arterial) en tanto que el 48% de los varones y el 57.2% de las hembras mostraron tres o más factores de riesgo. Estos resultados son similares a los hallados en la encuesta Barbados STEPS NCD Risk Factor Survey del 2007. CONCLUSIÓN: Los resultados confirman una alta prevalencia de factores de riesgo de ENC entre el personal de Cave Hill de UWI similar a la existente entre la población barbadense en general. El estudio revela oportunidades de informar las políticas sobre estrategias de modo que puedan lograr un impacto positivo sobre los factores de riesgo.