Closure of a large perimembranous ventricular septal defect in a 4.8 kg baby with Down syndrome using a duct occluder

A 9.5-month-old boy with Down syndrome, weighing 4.8 kg, presented with history of failure to thrive. Clinically, he had symptoms and signs of congestive heart failure. His echocardiogram showed a large perimembranous ventricular septal defect [pmVSD] with some inlet extension covered by a large aneurysmal tissue with multiple right ventricular [RV] exits. Additionally, he had hypothyroidism and Hirschsprung disease. Instead of closing the VSD surgically, the VSD was successfully closed utilizing an 8 × 6 mm duct occluder. The baby remained in the intensive care unit for one night. The day after the procedure, the infant was stable and showed clinical improvement. Electrocardiogram [ECG] showed normal sinus rhythm with no evidence of heart block. Twenty-four hours later, echocardiography showed the device was in an excellent position, with a small residual leak. There was normal tricuspid valve inflow and normal aortic valve outflow with no significant valvar insufficiency. The baby was discharged after 3 days in stable condition. We believe infants with such co-morbidities which might complicate their post-operative course and prolong the intensive care unit admission, might benefit from such alternative management

Angiotensin converting enzyme inhibitor as an additive treatment after successful balloon dilation of a critical pulmonary valve stenosis

A 2 days old, 2.7 kg heavy baby boy with critical pulmonary stenosis, underwent successful balloon dilation. After the uneventful procedure, he remained oxygen dependent. The baby was given oral angiotensin converting enzyme inhibitor [ACE inhibitor] instead of an infusion of alpha blocker. Within few hours, in the afternoon of the same day after administration of ACE Inhibitor, the baby could be weaned off oxygen, maintaining on room air, oxygen saturation between 87% and 92%. At follow-up, two months later, his saturation was 99% on room air. We believe that some neonates with critical pulmonary valve stenosis who remain oxygen dependent despite successful balloon dilation, could benefit from such management

Nutrition capacity development in the middle East and North Africa

The Middle East and North African Nutrition Capacity Development Initiative started in July 2004 as a component of a global initiative spearheaded by UNU and IUNS for development of human and institutional capacity in nutrition. The Middle East and North Africa Nutrition Association [MENANA] was established as an affiliated body to IUNS and took responsibility for identifying core areas for nutrition capacity building in the region. The members adopted a "new conceptual framework for planning nutrition capacity development activities within a comprehensive ten-year plan of action, using a new Conceptual Framework and Guideline for Nutrition Capacity Development Planning developed by Dr. Gohar for use by the MENANA members. A future vision for food security was agreed upon, supported by a prioritized plan of action. The member found that Regional research capacity needs strengthening to address the role of nutrition in prevention of diet related diseases and combating .malnutrition, including micronutrient deficiencies. Mapping research centers in the region was the first task decided to be undertaken by MENANA. Nutrition training to strengthen regional skills of nutritionists has been planned. Nutrition academic education and accreditation of dieticians was discussed, and a regional accreditation examination for dietitians established by MENANA. In the area of nutrition advocacy/education communication, a steering committee was established to organize workshops to enhance regional advocacy. Nutrition networking was planned to strengthen regional inter-country collaboration and cooperation for nutrition capacity building. The selected priorities were supported by the establishment of a regional Nutrition Capacity Building website to include a database of nutritionists in the region, their affiliations and field of interest. A matrix of selected, simple and sensitive nutrition status indicators was planned to be published in the website for the purpose of monitoring regional nutrition status. The website will also provide information services to nutrition professionals in the region and will be linked to important updated nutrition information

Food consumption pattern as a method for prediction of nutrient deficiencies

This presentation will focus on possible prediction of nutrient deficiencies in the Egyptian diet. The study of food consumption patterns and knowledge of the diversity of the diet will allow the prediction of nutritional deficiencies as vitamin A, B[12] and C. Choices of basic staples and methods of preparation will predict iron, zinc and niacin deficiencies while knowledge of local soil and water will predict iodine and selenium. During the years 1993 and 1994 approximately 7000 households were sampled from five Egyptian governorates. The food consumption pattern was recorded by using a quantitative 24 hour recalls of food intake for the adult female respondent and for a child between two and six years of age. The results show that underweight among women was relatively rare but obesity was common. Among children, almost one third were short for their age, reflecting the cumulative effects of mild to moderate undernutrition. Energy and protein intakes were generally adequate. A substantial proportion of women and children had diets which were low, relative to recommended intakes in vitamin A, calcium, riboflavin, vitamin C and vitamin B[12]. The results will be discussed in relation to household food security concepts and the possible role of changing food consumption patterns to combat nutrient deficiencies