effectiveness of the WHO training course on complementary feeding counseling in a primary care setting, Ismailia, Egypt

The adequacy and timing of complementary feeding of the breastfed child are criticalfor optimal child growth and development.Considerable efforts have been made to improve complementary feeding in the first 2years of life. One of them was the WHO complementary feeding counseling course [CFC].To evaluate the effectiveness of the WHO CFC on knowledge and counseling abilitiesof primary healthcare physicians; on caretaker's knowledge and adherence tophysicians' recommendations and their feeding practices; and on children's growth.A single-blinded randomized-controlled study was carried out in 40 primary healthcarecenters divided into matched pairs according to their location, either in rural or urbanareas, and training of the selected physicians on integrated management of childhoodillness. One center from each pair was selected randomly for its physician to receive CFCtraining in nutrition counseling and the matched center was selected as a control. Fortyprimary healthcare center physicians and 480 mother-child [6-18 months] pairs wereincluded in the study. The mother-child pairs recruited were visited at home within 2weeks, 90, and 180 days after the initial consultation with trained health workers. Specialquestionnaires were used to collect information on healthcare providers' knowledgeof nutrition counseling and practice [counseling skills]; maternal knowledge of basicnutrition-counseling recommendations, maternal compliance with the recommendedfeeding practice; child dietary intake; and gains in weight and length.CFC-trained physicians were more likely to engage in nutrition counseling and to delivermore appropriate advice. This was reflected in improvements in maternal recall ofcomplementary feeding messages, which were higher in the intervention group comparedwith the control group. Six months after the consultation, children in the interventiongroup had significantly greater weight gains compared with the control group [0.96 vs.0.78 kg; P= 0.038]. Children in the intervention group, who were 12-18 months of ageat the time of recruitment, had significantly less faltering in length gain compared with thecontrol group [height/age Z-score; 0.23 vs. 0.04; P= 0.004].Nutrition counseling training improved counseling abilities of primary healthcarephysicians and led to improvements in mothers' knowledge and practicesof complementary feeding. In turn, this led to improved growth of children. Werecommend wide and regular utilization of the CFC course to improve the knowledge andskills of health workers who provide counseling to mothers for complementary feeding

Evaluation of procalcitonin, C-reactive protein and interleukin-6 level in neonatal sepsis

Bacterial sepsis is a major cause of morbidity and mortality in neonates. Diagnosis of neonatal sepsis may be difficult because clinical presentations are often nonspecific, bacterial cultures are time-consuming and other laboratory tests lack sensitivity and specificity. The aim of the present study was to evaluate the diagnostic use of procalcitonin, circulating cytokine [IL-6] and CRP in neonates with suspected sepsis. Blood was collected from 40 neonates admitted to neonatal intensive care units for suspicion of neonatal sepsis as well as 32 healthy controls. Sepsis group was subdivided into S1 [Proven sepsis n=16] and S2 [clinical sepsis n=24] according to the results of blood culture. Serum IL-6 was measured by Elisa, CRP was measured by nephlelometery and procalcitonin by Immunoluminometric assay. In sepsis group, level of CRP was significantly elevated compared to healthy controls P < 0.05. As regard to IL-6 level, it was significantly elevated in sepsis group compared to healthy control [P < 0.001], in addition it was increased in both patients subgroups S1, S2 with no statistically significant difference between both subgroups. Serum PCT concentration were significantly higher in sepsis group in comparison with the healthy control [P< 0.05]. PCT concentration were also significantly higher at initial suspicion and at 12-24 h and 36-48 h after the onset of symptoms in S1 than S2 subgroups. PCT seems to be a better marker of neonatal sepsis. Also, the combination of IL-6+CRP presented accuracy for differentiation between septic and non septic patients during the first 24 h of suspected sepsis

Efficacy of adding ipratropium bromide and budesonide to nebulized salbutamol in the managenent of acute bronchiolitis in infants

Brenchiolitis is the most common lower respiratory tract infection in infants with considerably increased rate of its associated hospitalizations in the last years. To date there is no a single, widely practiced, evidence- driven treatment approach for bronchiolitis. Different treatment modalities have been in practice for some years, some of these therapies are specific to the virus and others are symptomatic. The bronchodilators and corticosteroids are the most commonly used drugs. Some studies found some benefit in the use of these drugs and others didn't found any beneficial effect of its use. Bronchodilators like salbutamol showed a better effect in bronchiohtis with more agreement in its use than the other drugs but also to a limited extent of efficacy. The aim of the present study was to evaluate the efficacy of using two different drugs [budesonide and ipratrobium bromide] in addition to salbutamol in the management of acute bronchiolitis in infants in trial to search for an effective medical treatment of this condition. This study was a randomized, double- blind controlled trial. The studied infants were divided into three groups by systematic random sample: group A received ipratrobium bromide inhalation and salbutamol, group B received budesomde and salbutamol inhalation, and group C received salbutamol alone. The primary outcome was symptom improvement and secondary outcomes i,'ere length of stay in hospital, adverse events, and report of symptoms by parents in revisit to outpatient clinic one week after discharge. As regarding to O2 saturation, there were no statistically significant differences between the studied groups. There were a significant difference in the mean length of hospital stay between groups A and B and between groups B and C, but no significant difference between groups A and C. There was no statistically significant difference in severity of respiratory symptoms which was measured by Respiratory Distress Assessment Instrument [RDAI] in the studied groups. There were a significant difference between group [A] and group [B] and between group [B] and group [C] as regarding to the presence of respiratory symptoms one week after discharge. These results demonstrate that ipratrobium bromide has no significant effect if added to salbutamol in the treatment of acute bronchiolitis in infants. Adding budesonide decreasing significantly the duration of stay in the hospital and the prevalence of symptoms one week after discharge but has no effect on other outcomes, with the conclusion that the use of budesonide with salbutamol in acute bronchiolitis is recommended to decrease the post hospitalization symptoms and the duration of hospitalization