Interventions for promoting the initiation of breastfeeding

BACKGROUND: Despite the widely documented health advantages of breastfeeding over formula feeding, initiation rates remain relatively low in many high-income countries, particularly among women in lower income groups. OBJECTIVE : To evaluate the effectiveness of interventions which aim to encourage women to breastfeed in terms of changes in the number of women who start to breastfeed. METHODS : Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (July 2007), handsearched the Journal of Human Lactation, Health Promotion International and Health Education Quarterly from inception to 15 August 2007, and scanned reference lists of all articles obtained. Selection criteria: Randomized controlled trials, with or without blinding, of any breastfeeding promotion intervention in any population group except women and infants with a specific health problem. Data collection and analysis: One review author independently extracted data and assessed trial quality, checked by a second author. We contacted investigators to obtain missing information. MAIN RESULTS: Main results: Eleven trials were included. Statistical analyses were conducted on data from eight trials (1553 women). Five studies (582 women) on low incomes in the USA with typically low breastfeeding rates showed breastfeeding education had a significant effect on increasing initiation rates compared to standard care (risk ratio (RR) 1.57, 95% confidence interval (CI) 1.15 to 2.15, P = 0.005). Subgroup analyses showed that one-to-one, needs-based, informal repeat education sessions and generic, formal antenatal education sessions are effective in terms of an increase in breastfeeding rates among women on low incomes regardless of ethnicity and feeding intention. Needs-based, informal peer support in the antenatal and postnatal periods was also shown to be effective in one study conducted among Latina women who were considering breastfeeding ...

Microbiological profile of orbital abscess.

Background: Knowledge of the culture and sensitivity pattern is necessary, for the institution of appropriate empirical antibiotic therapy in orbital abscess. Objective: The objective of this study is to describe culture and sensitivity patterns of specimens from the orbit and surrounding structures. Materials and Methods: Retrospectively the medical records of 56 cases of orbital abscess were reviewed. Results: Cultures were positive in 38/56 (68.8%) orbital specimens and the organisms included Staphylococcus aureus 18, Streptococci 7, Pseudomonas aeruginosa 3, 2 each of Enterobactersp, Escherichia coli, Proteus mirabilis, Acinetobacter sp. and 1 each of Actinomyces israelii, Diptheroids, Coagulase negative Staphylococcus, Citrobacter freundii, Methicillin-resistant S. aureus and Enterococcus faecalis. Four had polymicrobial infection. Culture of purulent nasal discharge, swabs taken from foci of infection on the face, and blood cultures were done in 26/56, and positive cultures were obtained in 16/26 (61.5%) specimens. In 12 patients, there was a concurrence in the organism cultured from the orbit and from cultures from other sites. Gram-negative organisms were associated with increased ocular morbidity. Conclusion: Gram-positive cocci, especially S. aureus are the most common organisms isolated from orbital abscesses. Infections by Gram-negative organisms were associated with more complications. Empirical intravenous antibiotic therapy should have a broad spectrum of activity effective against a wide range of Staphylococcal organisms and Gram-negative bacilli.

Healthcare-seeking Behaviour for Common Infectious Disease-related Illnesses in Rural Kenya: A Community-based House-to-house Survey.

Community surveys of healthcare-use determine the proportion of illness episodes not captured by health facility-based surveillance, the methodology used most commonly to estimate the burden of disease in Africa. A cross-sectional survey of households with children aged less than five years was conducted in 35 of 686 census enumeration areas in rural Bondo district, western Kenya. Healthcare sought for acute episodes of diarrhoea or fever in the past two weeks or pneumonia in the past year was evaluated. Factors associated with healthcare-seeking were analyzed by logistic regression accounting for sample design. In total, 6,223 residents of 981 households were interviewed. Of 1,679 children aged less than five years, 233 (14%) had diarrhoea, and 736 (44%) had fever during the past two weeks; care at health facilities was sought for one-third of these episodes. Pneumonia in the past year was reported for 64 (4%) children aged less than five years; 88% sought healthcare at any health facility and 48% at hospitals. Seeking healthcare at health facilities was more likely for children from households with higher socioeconomic status and with more symptoms of severe illness. Health facility and hospital-based surveillance would underestimate the burden of disease substantially in rural western Kenya. Seeking healthcare at health facilities and hospitals varied by syndrome, severity of illness, and characteristics of the patient.

Pharmacological applications of a novel neoepitope antibody to a modified amyloid precursor protein-derived beta-secretase product

We have previously described a novel artificial NFEV β-secretase (BACE1) cleavage site, which when introduced into the amyloid-β precursor protein (APP), significantly enhances APP cleavage by BACE1 in in vitro and cellular assays. In this study, we describe the identification and characterization of a single chain fragment of variable region (scFv), specific to the EV neo-epitope derived from BACE1 cleavage of the NFEV-containing peptide, and its conversion to IgG1. Both the scFv displayed on phage and EV-IgG1 show exquisite specificity for binding to the EV neoepitope without cross-reactivity to other NFEV containing peptides or WT-APP KMDA cleavage products. EV-IgG1 can detect as little as 0.3 nmol/L of the EV peptide. EV-IgG1 antibody was purified, conjugated with alkaline phosphatase and utilized in various biological assays. In the BACE1 enzymatic assay using NFEV substrate, a BACE1 inhibitor MRK-3 inhibited cleavage with an IC(50) of 2.4 nmol/L with excellent reproducibility. In an APP_NFEV stable SH-SY5Y cellular assay, the EC(50) for inhibition of EV-Aβ peptide secretion with MRK-3 was 236 nmol/L, consistent with values derived using an EV polyclonal antibody. In an APP_NFEV knock-in mouse model, both Aβ_EV40 and Aβ_EV42 peptides in brain homogenate showed excellent gene dosage dependence. In conclusion, the EV neoepitope specific monoclonal antibody is a novel reagent for BACE1 inhibitor discovery for both in vitro, cellular screening assays and in vivo biochemical studies. The methods described herein are generally applicable to novel synthetic substrates and enzyme targets to enable robust screening platforms for enzyme inhibitors.

Quality of cause-of-death statements and its impact on infant mortality statistics in Hermosillo, Mexico / Calidad de la consignación de la causa de muerte y su impacto en las estadísticas de mortalidad infantil en Hermosillo, México

Objectives. This study evaluates the quality (completeness and accuracy) of cause-of-death (COD) statements in infant death certificates as entered into a vital records system and assessesits impact on infant mortality statistics in Hermosillo, Sonora, Mexico. Methods. COD statements in a systematic random sample of 200 infant death certificateswere compared to their corresponding medical charts. The underlying CODs (UCODs) originally recorded in each death certificate were contrasted with those assigned by an expert reviewer.Coding for the original and “new” UCODs was based on the three-digit category of the International Classification of Diseases, 10th Revision. Measurements of agreement between the two sets of UCODs were calculated and logistic regression was performed to determine factors associated with agreement. Results. Overall agreement between the original and new UCODs was 52%. Agreementwas excellent for the group of deaths due to congenital malformations, deformations, and chromosomal abnormalities (kappa = 0.77); substantial for conditions originating in the perinatal period (kappa = 0.74); and poor for certain infectious and parasitic diseases, and respiratory diseases (kappa = 0.35). Overestimation (false-positive reporting) was highest (13%) for perinatal conditions, while underestimation (false-negative reporting) was highest (71%) for certain infectious and parasitic diseases, and respiratory diseases. Agreement was associated with type of UCOD (endogenous versus exogenous) and time of death. Conclusion. More than half (53%) of COD statements in infant death certificates in Hermosillo were inaccurately completed, which may lead to inaccurate interpretation of causes ofinfant mortality. Systematic assessments of the quality of COD statements may improve the quality of mortality statistics.

Objetivos. Evaluar la calidad (grado de compleción y exactitud) de la consignación de la causa de muerte (CM) en los certificados de defunción de niños menores de 1 año, según los sistemas de registros demográficos, y determinar su impacto en las estadísticas de mortalidad de menores de 1 año en Hermosillo, Sonora, México.Métodos. Se comparó la consignación de la CM en una muestra sistemática aleatoria de 200 certificados de defunción de niños menores de 1 año con sus correspondientes historias clínicas. Se contrastaron las CM subyacentes originales registradasen cada certificado de defunción con las CM subyacentes asignadas por un revisor experto. La codificación de las CM subyacentes, tanto las originales como las asignadas, se basó en las categorías de tres dígitos de la Clasificación Internacional de Enfermedades, 10.a revisión. Se calcularon las medidas de concordancia entre los dos conjuntos de CM subyacentes y se determinaron los factores asociados con esa concordanciamediante regresión logística. Resultados. La concordancia general entre las CM subyacentes originales y las asignadas fue de 52%. La concordancia fue excelente en el grupo de muertes por malformaciones, deformaciones y alteraciones cromosómicas congénitas (kappa = 0,77); fue notable en los trastornos originados en el período perinatal (kappa = 0,74); y baja en algunasenfermedades infecciosas, parasitarias y respiratorias (kappa = 0,35). La sobreestimación (informes falsos positivos) fue mayor (13%) en las afecciones perinatales, mientras que la subestimación (informes falsos negativos) fue mayor (71%) en algunasenfermedades infecciosas, parasitarias y respiratorias. La concordancia se asoció con el tipo de CM subyacente (endógena vs. exógena) y el momento de la muerte. Conclusiones. Más de la mitad (53%) de las consignaciones de CM en los certificados...

Primary care of Hiv-infected adults

HIV infection is increasingly becoming a chronic illness as effective treatment allows patients to live longer and stay healthier. HIV-infected patients often benefit from having both a generalist familiar with primary care medicine and a HIV expert involved in their care. This article is geared at the generalist who is involved with the care of HIV-infected patients and presents a series of cases to address topics important in the primary care of patients wit HIV infection

Eikenella corrodens from a brain abscess

A 2-year-old boy with underlying congenital cyanotic heart disease presented with seizures and fever and was found to have bilateral parietal cerebral abscesses. Drainage of the pus from the abscesses was done in stages; on the day of admission, four days after admission and 3 weeks after admission. Although the pus from the first drainage did not grow any organisms, the pus from the second drainage on the fourth day of admission yielded a mixed growth of Eikenella corrodens and Streptococcus milleri. Following the second drainage of pus, the child was noted to have mild weakness (grade 3/5) and increased tone in the left upper limb. Three weeks after admission, due to recurring fever, further neurological signs and findings of an enlarging right cerebral abscess on a repeat CT scan, a third drainage was carried out. However no growth was obtained from this specimen. This patient was managed both surgically and with appropriate antibiotics. Over the next four months, serial CT scans revealed gradual resolution of the abscesses with disappearance of the surrounding oedema. The child showed gradual recovery of his left sided weakness with resolution of tone and reflexes to normal.

The effects of cyclophosphamide treatment on the pathogenesis of subgroup J avian leukosis virus (ALV-J) infection in broiler chickens with Marek's disease virus exposure

Studies were performed to determine the effects of Bcell suppression on the pathogenesis of Subgroup J avian leukosis virus (ALV-J) in broiler chickens. Neonatal chickens were treated with cyclophosphamide (CY) or PBS, and then infected with ALV-J (ADOL-7501) at 2 weeks of age. CY treatment induced B cell specific immunosuppression throughout the experiment confirmed by decreased bursal weight, intact lymphocyte mitogenetic activity stimulated by Con A and increased relative subpopulation of CD3-positive cells as measured by flow cytometry. Chickens in this experiment had Mareks disease virus exposure prior to three weeks of age as determined by the presence of lymphocytic infiltration and antibody. Virus neutralizing antibody against ALV-J was first observed at 6 weeks post-infection in some of the infected chickens in the PBS group. As expected, none of the chickens from the CY group and uninfected chickens developed virus-neutralizing antibody. The viremic status was measured by real time RT-PCR using SYBR green I dye. The percentage of viremic chickens was significantly higher, and more chickens had high titered viremia, in the CY treated group. No neoplastic foci consistent with ALVJ infection were observed in any of the experimental chickens. The frequency and intensity of viral antigen expression determined by immunohistochemistry was significantly higher in tissues from CY treated birds than those of PBS treated chickens at 3 weeks post-infection. This study showed that B cell specific immunosuppression with CY treatment in chickens resulted in increase in viremia and viral antigen load in tissues.

The Effect of Ketorolac and Fentanyl on the Emergence Characteristics after Sevoflurane Anesthesia in Children Undergoing Tonsillectomy and Adenoidectomy / 대한마취과학회지

BACKGROUND: The rapid emergence and recovery from general anesthesia provided by sevoflurane is associated with a frequent incidence of emergence agitation in children. In this study, we compared the emergence and recovery profiles of patients who received sevoflurane with or without intravenous ketorolac or/and fentanyl. METHODS: By using a prospective, double blinded design, 60 children of 3 to 10 year of age, scheduled for elective tonsillectomy and adenoidectomy, were anesthetized with sevoflurane (1-3 vol%) in a 50% N2O/O2 gas mixture. Patients were randomized to one of four groups (group 1: sevoflurane only, group 2: sevoflurane + ketorolac 0.5 mg/kg, group 3: sevoflurane + fentanyl 1microgram/kg, group 4: sevoflurane + ketorolac 0.5 mg/kg + fentanyl 1microgram/kg). A blinded observer evaluated each patient using an agitation scale, Faces scale and an Objective pain/discomfort scale. RESULTS: No significant differences were observed among the four groups regarding age, sex, weight or duration of anesthesia. Recovery and discharge times were not statistically different. The incidence of severe agitation and the scores of Faces scale in the post anesthesia care unit, were significantly lower in groups 2, 3 and 4 than in group 1 (P < 0.05). The incidence of severe pain in the post anesthesia care unit, was significantly lower in groups 3 and 4 than in group 1 (P < 0.05). CONCLUSIONS: We conclude that a dose of 0.5 mg/kg of ketorolac, 1microgram/kg of fentanyl or both were sufficient to prevent severe emergence agitation and pain in children undergoing tonsillectomy and adenoidectomy with sevoflurane anesthesia.

Effects of cyclosporin A treatment on the pathogenesis of avian leukosis virus subgroup J infection in broiler chickens with Marek's disease virus exposure

In this study, we investigated the effects of T-cell suppression on the pathogenesis of subgroup J avian leukosis virus (ALV-J). Chickens were treated with cyclosporin A (CSP) 50 mg/Kg body weight or a corresponding volume of olive oil per every three days after hatching until the end of experiment. Some of the chickens from each treatment group were infected with an isolate of ALV-J, ADOL-7501, at 2 weeks of age. The effects of viral infection were compared to uninfected birds in same treatment group. Intramuscular injection of CSP induced significant T-cell specific immunosuppression determined by decreased cutaneous basophilic hypersensitivity response and decreased lymphocyte mitogenic activity using concanavalin A. Most of the chickens examined had Marek's disease virus infection prior to 3 weeks of age. The percentage of antibody-positive birds and antibody titers were similar in infected chickens between both treatment groups. The ratio of viremic chickens was significantly higher in CSP treated group than that of the Oil treated group. Microscopically, one CSP treated chicken had a nephroblastoma at 10 weeks post infection. At 7 and 10 weeks post-infection, more chickens had myeloid cell infiltrations in multiple organs including heart, liver and occasionally lung. Expression of ALV-J viral antigen determined by immunohistochemical staining was significantly higher in CSP treated chickens than Oil treated chickens at 10 weeks post-infection. This study indicated that chemically-induced T-cell suppression may enhance pathogenicity of the AVL-J virus in broilers.

Adult diapause morph of the brown stink bug, Euschistus servus (Say) (Heteroptera: Pentatomidae) / Diapausa em adultos do percevejo marrom neártico, Euschistus servus (Say) (Heteroptera: Pentatomidae)

The brown stink bug, Euschistus servus (Say), is abundant throughout most of eastern North America and is commonly found feeding on soybean, mullein, beans, tomatoes, peas, cotton, wheat, corn, tobacco and peach. Color change in E. servus from green to reddish-brown was shown to be an indicator of reproductive diapause. Reddish-brown insects lived longer than green individuals, females laid no eggs, and males did not produce pheromone. The high mortality registered for the green colony of E. servus adults was associated with the physiological cost associated with reproduction. The main pheromone component of this species is methyl 2E,4Z-decadienoate, in agreement with previous work. The first generation of this species develops on noncrop hosts and the second generation often migrates to crops where they may then exceed economic damage thresholds. Traps or trap crops baited with pheromone to catch or concentrate females for destruction, or even a pheromone-based disruption of orientation behavior to decrease the mating success, are possible semiochemical techniques to suppress populations of second generation of E. servus.

O percevejo marrom neártico, Euschistus servus (Say), é abundante em toda a Região Leste da América Norte e é encontrado geralmente alimentando-se em culturas de soja, mullein, feijão, tomate, ervilha, algodão, trigo, milho, tabaco e pêssego. A mudança da coloração de verde para marrom demonstrou ser um indicativo de diapausa reprodutiva em E. servus. Os insetos de coloração marrom viveram por mais tempo que os indivíduos de coloração verde, as fêmeas não colocaram nenhum ovo, e os machos não produziram feromônio sexual. A alta taxa de mortalidade registrada para a colônia de indivíduos verdes de adultos de E. servus foi interpretada como custo fisiológico associado à reprodução. O componente principal do feromônio dessa espécie foi confirmado como 2E, 4Z-decadienoato de metila, de acordo com trabalho realizado anteriormente. A primeira geração dessa espécie se desenvolve em plantas silvestres e a segunda geração migra frequentemente para culturas onde podem exceder os níveis de dano econômico. Porém, técnicas semioquímicas podem ser empregadas para suprimir populações da segunda geração de E. servus. Armadilhas ou culturas armadilhas iscadas com feromônio podem capturar ou concentrar as fêmeas da espécie para serem destruídas, ou mesmo a técnica do confundimento, pode ser utilizada para diminuir a possibilidade de acasalamentos.

Desnutrición en embarazadas y su repercusión sobre le producto

Se trata de una investigación prospectiva longitudinal lógico-estadística en 100 mujeres con edades entre 18-30 años, embarazadas, desnutridas, de las que acudieron en trabajo de parto al hospital Materno-Infantil San Lorenzo de lOs Mina, durante el año 1988. 89 de las pacientes fueron desnutridas I y 11 desnutridas II. Las medidas antropométricas, así como el apgar, estuvieron dentro de lo normal, excepto el perímetro cefálico que se encontró en la mayoría de los casos por debajo de lo normal