High Prevalence of Dysplastic Development of Sacral Vertebral Arches in Pediatric Enuresis / 대한배뇨장애요실금학회지

Purpose@#This is the first report to compare 3-dimensional computed tomography (3D-CT) images between pediatric patients with enuresis and children without lower urinary tract symptoms who underwent pelvic CT for other reasons. @*Methods@#Forty-seven children (33 boys and 14 girls) with primary enuresis underwent 3D-CT of sacrococcygeal bones. The control group consisted of 138 children (78 boys and 60 girls) who underwent pelvic CT for other reasons. First, we determined the presence or absence of unfused sacral arches at the L4-S3 levels in both cohorts. Subsequently, we compared the fusion of sacral arches in age- and sex-matched children from these 2 groups. @*Results@#Dysplastic sacral arches, characterized by lack of fusion at 1 or more levels of the S1–3 arches, were observed in nearly all patients in the enuresis group. In the control group (n=138), 54 of 79 children over 10 years old (68%) exhibited fused sacral arches at 3 S1–3 levels. All 11 control children under 4 years old displayed at least 2 unfused sacral arches at the S1–3 levels. In a comparative study of age- and sex-matched patients with enuresis and control children aged 5 to 13 years (n=32 for each group, with 21 boys and 11 girls; mean age, 8.0±2.2 years [range, 5–13 years]), only 1 patient (3%) in the enuresis group exhibited fusion of all S1–3 arches. In contrast, 20 of 32 control group participants (63%) had 3 fused sacral arches (P<0.0001). @*Conclusions@#Sacral vertebral arches typically fuse by the age of 10 years. However, in this study, children with enuresis exhibited a significantly elevated prevalence of unfused sacral arches, suggesting that dysplastic development of sacral vertebral arches may play a pathological role in enuresis.

Assessing the iodine status of children, availability and awareness of iodised salt, use of salty condiments and flavoring in households in Zia community, Huon District, Morobe Province Papua New Guinea

@#The strategy of fortifying food grade salt with iodine has been globally successful in increasing iodine intake and significantly reducing the prevalence of iodine deficiency. In addition, the consumption of salt through processed foods is increasing in many countries. The major objectives of the current study were to assess the iodine nutritional status among school children, the availability and awareness of iodized salt, the use of salty condiments and flavorings in households in a remote Zia community. This was a school and community based prospective cross-sectional study carried out in February 2020. The study population included 6 to 12 years old school children in five schools in Zia. Simple random sampling was used to select the children. Salt samples were collected from randomly selected households in the community. Discretionary salt intake was also assessed in a sub-set of households. The size of the thyroid gland of the children was assessed by a single specialist endocrinologist using the standardized procedure for palpation and grading, after which a single urine sample was collected from the children after obtaining informed consent from their parents. A pre-tested questionnaire was used to assess the awareness and use of iodized salt in the households. The iodine content in salt samples was measured using the single wavelength semi-automated WYD Iodine Checker Photometer. The urinary iodine concentration (UIC) was measured by isotopic dilution, using 129I as a spike. The 127I/129I ratio was measured by Inductively Coupled Plasma Mass Spectrometry (ICPMS) (quadrupole ICP-MS iCap). The volume of urine required per run was 0.3ml. The mean iodine content of the salt samples from the Households was 31.7 ± 5.9mg/kg. The daily per capita discretionary intake of salt was 5.7 ± 2.2g. The calculated per capita discretionary intake of iodine was 126.5 ± 48.8μg per day. The Median UIC among the children was 147.5μg/L, which indicates normal iodine status at the time of this study. A total of 44.5% of all the children had palpable goiter (grade 1). This may indicate long-standing prevalence of mild status of iodine deficiency. Majority of the households (93.9%) used Maggi Kakaruk stock cubes to make their food salty compared to 90.9% that used salt. Instant noodles/2-minute noodles are the best wheat based alternative processed foods that should be fortified with iodine. Salt and Maggi Kakaruk stock cubes are the two optimal food vehicles for fortification with iodine in this remote community.

National and state-level colorectal cancer mortality trends in Mexico, 1998-2018 / Tendencias nacionales y estatales de mortalidad por cáncer colorrectal en México, 1998-2018

Abstract: Objective: To describe the burden of colorectal cancer (CRC) in Mexico and understand mortality patterns based on sex, geography, and insurance status. Materials and methods: Mortality data (1998-2018) from the Instituto Nacional de Estadística y Geografía was obtained. We included colon (C18.0, C18.2-18.9) and rectal cancer ICD-10 codes (C19, C20), and estimated age-standardized national, state-level and health insurance mortality rates. We estimated the average annual percent change using joinpoint regression. Results: Between 1998 and 2018, the observed women and men mortality rate increased annually by 1.3 and 2.7%, respectively. Higher CRC mortality was observed in northern and more urbanized states and in groups with greater access to health insurance, which currently facilitates but does not routinely cover screening. Conclusion: CRC mortality in Mexico is increasing rapidly, with marked differences based on sex, geography, and insurance status. Our findings underscore potential benefits of increased investment in comprehensive screening, diagnosis, and treatment strategies for the general population.

Resumen: Objetivo: Describir la carga del cáncer colorrectal (CCR) en México y patrones de mortalidad según sexo, geografía y servicios de salud. Material y métodos: Se obtuvieron datos de mortalidad (1998-2018) del Instituto Nacional de Estadística y Geografía. Se incluyeron códigos CIE-10 de cáncer de colon (C18.0,C18.2-18.9) y recto (C19,C20). Se estimaron tasas de mortalidad nacionales, estatales y por servicio de salud, estandarizadas por edad. Se estimó el cambio porcentual anual promedio usando regresión joinpoint. Resultados: Entre 1998-2018, la tasa de mortalidad aumentó anualmente 1.3% en mujeres y 2.7% en hombres. Se observó mayor mortalidad por CCR en estados del norte, más urbanizados y con afiliación a servicios de salud que actualmente facilitan pero no cubren rutinariamente la detección. Conclusión: La mortalidad por CCR en México está aumentando rápidamente, con diferencias por sexo, geografía y afiliación. Los presentes hallazgos destacan los beneficios potenciales de mayor inversión en estrategias integrales de detección, diagnóstico y tratamiento para la población.

Developing a collaborative international partnership for cancer control in Mexico / Desarrollo de una alianza internacional colaborativa para el control del cáncer en México

Abstract: In 2014, a partnership was established between the University of California and Mexico, which subsequently catalyzed formation of collaborations between cancer researchers at University of California, San Francisco and in Mexico. Over the past two decades cancer burden has dramatically increased in Mexicans on both sides of the California - Mexico border. Together, we face a growing burden of cancer in the context of globalized economies, diverse migration patterns, and dynamic immigration policies. Our partnership aims to: 1) understand the life course impact of cancer risk factors and interactions with changing environments; 2) address cancer disparities within Mexico, in Mexican migrants to the United States, and in naturalized Mexican-Americans; and 3) identify effective cancer screening strategies and cancer control policies that are tailored to existing healthcare systems and social and cultural factors. Herein, we describe the principles of partnership and early successes and challenges of this collaboration.

Resumen: En 2014, se estableció un convenio de colaboración colaboración entre la Universidad de California y México, que posteriormente catalizó colaboraciones específicas entre investigadores en cáncer en la Universidad de California, San Francisco y en México. En las últimas dos décadas, la carga del cáncer ha aumentado drásticamente en mexicanos de ambos lados de la frontera entre California y México. Juntos, enfrentamos una carga creciente de cáncer en un contexto de economías globalizadas y diversos patrones y políticas de migración dinámicas. Nuestra colaboración tiene como objetivo: 1) entender el impacto a lo largo de la vida de factores de riesgo de cáncer y sus interacciones en un entorno cambiante; 2) abordar disparidades del cáncer dentro de México, en os migrantes mexicanos a los Estados Unidos y en los mexicoamericanos naturalizados; y 3) identificar estrategias efectivas de detección del cáncer y políticas de control del cáncer que se adapten a sistemas de salud existentes y a factores sociales y culturales. Aquí describimos los principios de esta colaboración y los primeros éxitos y retos de la misma.

Eliminación y prevención de la deficiencia de yodo en mujeres gestantes de Perú / Elimination and prevention of iodine deficiency in pregnant women from Peru

RESUMEN La deficiencia de yodo (DI) causa daño a través de todos los ciclos de la vida, la vulnerabilidad es mayor durante la gestación y la infancia. La yodación universal de la sal (IUS) para consumo humano es la estrategia más costo-efectiva y sostenible para su control. Perú ha logrado la eliminación sostenida de los desórdenes por deficiencia de yodo (DDI) desde 1994. Objetivo: Determinar la efectividad del programa nacional de control de los DDI y la estrategia IUS para satisfacer el mayor requerimiento de yodo y asegurar la nutrición óptima de yodo de las mujeres embarazadas de la sierra, una región con severa deficiencia natural de yodo. Material y Métodos: El estudio ha incluido a 489 mujeres embarazadas de la sierra, seleccionadas entre las asistentes a control pre natal en los centros asistenciales. En cada sujeto se verificó el consumo de sal yodada y se colectó una muestra casual de orina para el análisis de la concentración de yodo y creatinina. Resultados: Según la encuesta de admisión el 99.6 % de los hogares consumen sal yodada. La mediana global de la concentración urinaria de yodo (CUI) 209 µg/L está dentro del rango adecuado para gestantes y demuestra un estado nutricional de yodo normal. La concentración de creatinina en la orina es normal. Conclusión: Estos resultados confirman la eficiencia y el éxito del programa nacional para la eliminación sostenida de los DDI, garantizando la nutrición normal de yodo durante la gestación y, por lo tanto, previniendo el riesgo de daño cerebral de los recién nacidos cada año en la sierra.

ABSTRACT Iodine is an essential element for synthesizing thyroid hormones, it is also essential for cell metabolism and tissue development, especially in the brain. Iodine requirements are higher during pregnancy and lactation. Iodine deficiency (ID) is a widespread condition all over the world; it is frequent in Peruvian highlands and rainforest. ID causes damage in all life periods, and vulnerability for this is greater during pregnancy and infancy. Universal salt iodination (USI) for human use is the most cost-effective and sustainable strategy for controlling ID. Peru has achieved the sustained elimination of iodine deficiency disorders (IDD) since 1994. Objective. To determine the effectiveness of the national program for controlling IDDs and the USI strategy for complying with the increased iodine requirement and to assure optimal iodine nutrition in pregnant women from the Peruvian highlands, a region with severe natural iodine deficiency. Material and Methods. The study included 489 pregnant women from the highlands, who were selected from those attending prenatal assessment in healthcare centers. Iodinated salty consumption was verified in each subject and a casual urine sample was collected for measuring iodine and creatinine concentration. Results. According to the admission survey, 99.6% of household use iodinated salt. The overall mean of iodine urine concentration (IUC) was 209 µg/L, which is well within the adequate range for pregnant women, and it shows a normal iodine nutrition status. The creatinine urinary concentration was normal. Conclusion. These results confirm the efficiency and success of the national program for the sustained elimination of IDDs, assuring normal iodine nutritional supply during pregnancy; and, therefore, preventing the risk for brain damage in newborns every year in the highlands.

Confocal Laser Endomicroscopy in the Diagnosis of Biliary and Pancreatic Disorders: A Systematic Analysis

Background/Aims@#Endoscopic visualization of the microscopic anatomy can facilitate the real-time diagnosis of pancreatobiliary disorders and provide guidance for its treatment. This study aimed to review the technique, image classification, and diagnostic performance of confocal laser endomicroscopy (CLE). @*Methods@#We conducted a systematic review of CLE in pancreatic and biliary ducts of humans, and have provided a narrative of the technique, image classification, diagnostic performance, ongoing research, and limitations. @*Results@#Probe-based CLE differentiates malignant from benign biliary strictures (sensitivity, ≥89%; specificity, ≥61%). Needlebased CLE differentiates mucinous from non-mucinous pancreatic cysts (sensitivity, 59%; specificity, ≥94%) and identifies dysplasia. Pancreatitis may develop in 2-7% of pancreatic cyst cases. Needle-based CLE has potential applications in adenocarcinoma, neuroendocrine tumors, and pancreatitis (chronic or autoimmune). Costs, catheter lifespan, endoscopist training, and interobserver variability are challenges for routine utilization. @*Conclusions@#CLE reveals microscopic pancreatobiliary system anatomy with adequate specificity and sensitivity. Reducing costs and simplifying image interpretation will promote utilization by advanced endoscopists.

Southern Philippines Medical Center - One Hospital Command Center

@#The Department of Health (DOH), through Department Order (DO) 2020-0653, established a One Hospital Command System (OHCS) to facilitate coordination among health care facilities and enhance the referral system for patients with COVID-19.1 2 On August 6, 2020, the DOH and the Inter-agency Task Force on Emerging Infectious Diseases (IATF-EID) launched the One Hospital Command Center (OHCC) at the Metro Manila Development Authority Arena, Makati City.

Underactive Bladder; Review of Progress and Impact From the International CURE-UAB Initiative / 대한배뇨장애요실금학회지

There is a significant need for research and understanding of underactive bladder (UAB). The International Congress of Urologic Research and Education on Aging UnderActive Bladder (CURE-UAB) was organized by Doctors Michael Chancellor and Ananias Diokno in order to address these concerns. CURE-UAB was supported, in part, by the US National Institute of Aging and National Institute of Diabetes Digestive and Kidney. Since 2014, there have been 5 successful CURE-UAB congresses. They have brought together diverse stakeholders in the UAB field to identify areas of major scientific challenge and initiated a call to action among the medical community. In this review, we will highlight current and novel treatments under development for UAB and the progress and impact from the CURE-UAB initiative.

Descriptive epidemiology of anaemia among pregnant women initiating antenatal care in rural Northern Ghana

Background: Anaemia in pregnancy is associated with adverse obstetric outcomes. When detected early in pregnancy, it can be treated; however, information on its prevalence and associated factors is limited in rural Ghana.Aim: The aim of this study was to determine the prevalence and maternal factors associated with anaemia in pregnancy at first antenatal care (ANC) visits.Setting: The study was conducted in the Navrongo War Memorial Hospital, a secondary referral facility in the Kassena-Nankana district in rural northern Ghana.Methods: A retrospective analysis of antenatal clinic records of pregnant women collected from January to December 2014. All pregnant women initiating antenatal clinic, who had initial haemoglobin (Hb) levels measured, were included in the study. Logistic regression analyses were carried out to determine factors associated with anaemia at the initiation of ANC.Results: We analysed data from 506 women with median Hb of 11.1 g/dL (IQR 7.31­13.8). The median gestational age at booking was 14 weeks (5­36 weeks). The prevalence of anaemia was 42.7%, with 95% confidence interval (CI) [38.4­47.1], and was high among teenage mothers (52% [34.9­67.8]), mothers who booked in the third trimester (55% [33.6­74.7]) and grand multiparous women (58% [30.7­81.6]). Factors associated with anaemia included grand multiparity (odds ratio [OR] = 1.94 with 95% CI [1.58­2.46]), booking during the third trimester (OR = 2.06 [1.78­2.21]) and mother who were underweight compared to those with normal weight (OR = 3.17 [1.19­8.32]).Conclusion: Burden of anaemia in pregnancy is still high in rural northern Ghana. We advocate further strengthening of the primary health care system to improve early access to ANC deliver

Descriptive epidemiology of anaemia among pregnant women initiating antenatal care in rural Northern Ghana

Background: Anaemia in pregnancy is associated with adverse obstetric outcomes. When detected early in pregnancy, it can be treated; however, information on its prevalence and associated factors is limited in rural Ghana. Aim: The aim of this study was to determine the prevalence and maternal factors associated with anaemia in pregnancy at first antenatal care (ANC) visits. Setting: The study was conducted in the Navrongo War Memorial Hospital, a secondary referral facility in the Kassena-Nankana district in rural northern Ghana. Methods: A retrospective analysis of antenatal clinic records of pregnant women collected from January to December 2014. All pregnant women initiating antenatal clinic, who had initial haemoglobin (Hb) levels measured, were included in the study. Logistic regression analyses were carried out to determine factors associated with anaemia at the initiation of ANC. Results: We analysed data from 506 women with median Hb of 11.1 g/dL (IQR 7.31­13.8). The median gestational age at booking was 14 weeks (5­36 weeks). The prevalence of anaemia was 42.7%, with 95% confidence interval (CI) [38.4­47.1], and was high among teenage mothers (52% [34.9­67.8]), mothers who booked in the third trimester (55% [33.6­74.7]) and grand multiparous women (58% [30.7­81.6]). Factors associated with anaemia included grand multiparity (odds ratio [OR] = 1.94 with 95% CI [1.58­2.46]), booking during the third trimester (OR = 2.06 [1.78­2.21]) and mother who were underweight compared to those with normal weight (OR = 3.17 [1.19­8.32]). Conclusion: Burden of anaemia in pregnancy is still high in rural northern Ghana. We advocate further strengthening of the primary health care system to improve early access to ANC delivery

TGF-β Signalling is Suppressed under Pro-Hypertrophic Conditions in MSC Chondrogenesis Due to TGF-β Receptor Downregulation

BACKGROUND AND OBJECTIVES: Mesenchymal stem cells (MSCs) become hypertrophic in long term despite chondrogenic differentiation following the pathway of growth plate chondrocytes. This terminal differentiation leads to phenotypically unstable cartilage and was mirrored in vitro by addition of hypertrophy inducing medium. We investigated how intrinsic TGF-β signaling is altered in pro-hypertrophic conditions. METHODS AND RESULTS: Human bone marrow derived MSC were chondrogenically differentiated in 3D culture. At day 14 medium conditions were changed to 1. pro-hypertrophic by addition of T3 and withdrawal of TGF-β and dexamethasone 2. pro-hypertrophic by addition of BMP 4 and withdrawal of TGF-β and dexamethasone and 3. kept in prochondrogenic medium conditions. All groups were treated with and without TGFβ-type-1-receptor inhibitor SB431542 from day 14 on. Aggregates were harvested for histo- and immunohistological analysis at d14 and d28, for gene expression analysis (rt-PCR) on d1, d3, d7, d14, d17, d21 and d28 and for Western blot analysis on d21 and d28. Induction of hypertrophy was achieved in the pro-hypertrophic groups while expression of TGFβ-type-1- and 2-receptor and Sox 9 were significantly downregulated compared to pro-chondrogenic conditions. Western blotting showed reduced phosphorylation of Smad 2 and 3 in hypertrophic samples, reduced TGF-β-1 receptor proteins and reduced SOX 9. Addition of SB431542 did not initiate hypertrophy under pro-chondrogenic conditions, but was capable of enhancing hypertrophy when applied simultaneously with BMP-4. CONCLUSIONS: Our results suggest that the enhancement of hypertrophy in this model is a result of both activation of pro-hypertrophic BMP signaling and reduction of anti-hypertrophic TGFβ signaling.

Should We Resect and Discard Low Risk Diminutive Colon Polyps

Diminutive colorectal polyps <5 mm are very common and almost universally benign. The current strategy of resection with histological confirmation of all colorectal polyps is costly and may increase the risk of colonoscopy. Accurate, optical diagnosis without histology can be achieved with currently available endoscopic technologies. The American Society of Gastrointestinal Endoscopy Preservation and Incorporation of Valuable endoscopic Innovations supports strategies for optical diagnosis of small non neoplastic polyps as long as two criteria are met. For hyperplastic appearing polyps <5 mm in recto-sigmoid colon, the negative predictive value should be at least 90%. For diminutive low grade adenomatous appearing polyps, a resect and discard strategy should be sufficiently accurate such that post-polypectomy surveillance recommendations based on the optical diagnosis, agree with a histologically diagnosis at least 90% of the time. Although the resect and discard as well as diagnose and leave behind approach has major benefits with regard to both safety and cost, it has yet to be used widely in practice. To fully implement such as strategy, there is a need for better-quality training, quality assurance, and patient acceptance. In the article, we will review the current state of the science on optical diagnose of colorectal polyps and its implications for colonoscopy practice.

Recent Advance in Colon Capsule Endoscopy: What's New?

Colon capsule endoscopy (CCE) is a relatively new diagnostic procedure for patients with suspected colonic diseases. This convenient, noninvasive method enables the physician to explore the entire colon without significant discomfort to the patient. However, while CCE can be performed painlessly without bowel air insufflation, the need for vigorous bowel preparation and other technical limitations exist. Due to such limitations, CCE has not replaced conventional colonoscopy. In this review, we discuss historical and recent advances in CCE including technical issues, ideal bowel preparation, indications and contraindications and highlight further technical advancements and clinical studies which are needed to develop CCE as a potential diagnostic tool.

Patient satisfaction and penile morphology changes with postoperative penile rehabilitation 2 years after Coloplast Titan prosthesis / 亚洲男科学杂志(英文版)

A common complaint after inflatable penile prosthesis surgery is reduced penile length. We previously reported how using the Coloplast Titan inflatable penile prosthesis with aggressive new length measurement technique (NLMT) coupled with postoperative IPP rehabilitation of the implant for 1-year helped to improve patient satisfaction and erectile penile measurements. This is a 2 years follow-up of a prospective, three-center, study of 40 patients who underwent Titan prosthesis placement, with new length measurement technique for erectile dysfunction. Patient instructions were to inflate daily for 6 months and then inflate maximally for 1-2 h daily for 6-24 months. Fifteen penile measurements were taken before and immediately after surgery and at follow-up visits. Measurement changes were improved at 24 months as compared to immediately postoperative and at 12 months. 67.8% of subjects were satisfied with their length at 2 years, and 77% had perceived penile length that was longer (30.8%) or the same (46.2%) as prior to the surgery. 64.3% and 17.9% of subjects had increased and unchanged satisfaction, respectively, with penile length as compared to prior to penile implant surgery. All but one subject (96.5%) was satisfied with the overall function of his implant. This study suggests using the Coloplast Titan with aggressive cylinder sizing, and a postoperative penile rehabilitation inflation protocol can optimize patient satisfaction and erectile penile measurements at 2 years postimplant.

Assessment of zinc Fortification of a Household- Based Water Filtration Device: Zn Absorption Using Stable Isotopes and Efficacy in a Controlled Trial in Beninese School Children.

Objectives: Zinc bioavailability from foods is limited due to the presence of absorption inhibitors. Water as a vehicle for zinc could be effective in improving zinc status. LifeStraw®Family (LSF) is a water filtration device that fortifies water with zinc. We assessed the absorption of zinc and the response of plasma zinc (PZn) to long-term consumption of the zinc fortified water. Methods: The LSF filters were placed in rural households in Benin (n=139) to assess compliance and acceptability. Bioavailability was measured in young adults with the urinary monitoring of two stable zinc isotopes. A double blind, randomised, controlled trial (RCT) was carried out in school children aged 5-10y (n=278) from a rural village in Benin. Over 20 weeks, including sparse midpoint sampling, children received either zinc fortified LSF-filtered water (Zn), non-fortified LSFfiltered water (Fltr) or non-fortified non-filtered water (Ctrl). The Zn group received a daily zinc dose of 4.6±2.2 mg. Results: Geometric mean (-SD,+SD) zinc absorption from fortified water was 65.9% (42.2,102.4). At baseline, mean PZn was 69.2±12.6 μg/dl and 35.9% of children were zinc deficient. During the RCT, there was a significant treatment effect on PZn (ANCOVA, p=0.029): final PZn in the Zn group was 4.2 and 1.9 μg/dl higher than the Fltr and the Ctrl group, respectively. Further analysis integrating the sparse midpoint PZn response will allow evaluation of plasma zinc kinetics. Conclusions: The LSF filter delivers water fortified with low doses of highly bioavailable zinc. Long-term consumption of zinc fortified water from the LSF filter improved zinc status in Beninese school children.

Effect of Provitamin A-biofortified Cassava on Vitamin A Status of Kenyan Children: A Randomised Controlled Trial.

Objectives: To measure the effect of daily consumption of provitamin A-biofortified cassava on vitamin A status in children aged 5-13 years. Methods: Mild-to-moderate vitamin A deficient children (n=342) were randomly allocated to groups receiving: 1) 375 g of white cassava and placebo supplement; 2) 375 g of white cassava and a supplement of β-carotene (1,054 μg); 3) 375 g of biofortified cassava and placebo supplement. Children received the intervention 6 days/week for 18.5 weeks. Field staff and participants were blinded to supplementation. Cooked cassava was mashed with salt and 4 g of oil per portion. Biofortified cassava supplied 208 μg RAE, which is ~50% of the age-specific estimated average requirement for vitamin A for children. The primary endpoint was serum retinol concentration and secondary endpoint was serum β-carotene concentration, both at end of intervention; in the analysis, we adjusted for sex and serum concentrations at baseline of retinol, C-reactive protein and α1-acid-glycoprotein. Results: Complete data were collected for 337 children. Compliance to cassava feeding was similar between treatment groups. Preliminary results showed that consumption of biofortified cassava and β-carotene supplementation resulted in a similar increase in retinol concentrations (for both interventions, mean: 0.81 μmol/L versus 0.77 μmol/L; difference, 95% CI: 0.04 μmol/L, 0.00─0.07 μmol/L) but in a different increase in serum β-carotene concentration (for β-carotene supplement group, mean: 0.25 μmol/L (95% CI: 0.17─0.33), for biofortified cassava group, mean: 0.81 μmol/L (95% CI: 0.73-0.88)) Conclusions: Provitamin A-biofortified cassava improves the vitamin A status of primary school children in Kenya.

Awareness of healthcare workers to total parenteral feeding in neonatal units

The partnership between hospital policy and staff procedures needs to be coordinated. In the case of neonatal care, failures of this partnership can result into complications. To evaluate staff awareness, hospital policy and current procedures relating to total parenteral nutrition [TPN] in Neonatal Intensive Care Units in Bahrain. A Self-Administered Questionnaire. NICU, King Hamad University Hospital [KHUH] and Salmaniya Medical Center [SMC], Bahrain. The study population consisted of nurses and neonatal doctors in NICUs in King Hamad University Hospital and Salmaniya Medical Center. Participation in the study implied consent; and the survey was anonymous. The self-administered questionnaire was distributed in August 2013 and consisted of 10 multiple-choice and open-ended questions. Sixty-two [80%] were aware of the risks of administering TPN. Different policies and guidelines were followed depending on the institution. Fifty-four [69%] respondents thought that TPN preparation should be carried out under sterile conditions; 63 [80%] preferably by a pharmacist rather than in the ward by doctors or nurses. Low staff satisfaction was found in 19 [67%] because the pharmacy did not prepare the TPN. Although staff may have high knowledge and awareness to reduce TPN risks, there is a clear need for hospital policy to consider the needs of the end user to reduce the neonatal infections