Zinc status and dietary intake of pregnant women, Alexandria, Egypt

Deficiencies of protein, energy, and micronutrients are highly prevalent in developing countries and have major effects on pregnancy outcome. Low dietary intake is the most common reason for zinc deficiency. The present research is part of a larger double-blind randomized-controlled trial to evaluate the effect of zinc supplementation on the pregnancy outcome. The aim of the present study was to assess the zinc status and dietary intake of zinc and other macronutrients and micronutrients among pregnant women in Alexandria, Egypt. Participants were pregnant women attending two antenatal care centers that serve low-income and middle-income pregnant populations. A total of 1055 healthy pregnant women aged 20-45 years were assessed for eligibility. Of these, only 675 had serum zinc level below the median for the gestational age. They were assigned randomly to one of three parallel groups. Zinc supplements were provided from 16 weeks until delivery. A subsample of 100 women was assessed for their dietary intake. A questionnaire interview was used to collect basic socioeconomic and data on current pregnancy and labor. Dietary data were collected using the 24-h recall method and a food frequency questionnaire. The nutritive value of the daily diet was computed using the Egyptian food composition tables. The blood hemoglobin level, serum zinc level, and fasting blood sugar were determined. Zinc deficiency was detected among 53.5% of the sample. Dietary intake of zinc was low, representing 59.4, 59.4, and 62% of the recommended dietary allowance [RDA] for the zinc group, zinc plus multivitamins, and the placebo group, respectively. The iron intake was below 50% of the RDA. Protein intake was less than 70% of the RDA. The mean intakes of fat were 191.97, 211.8, and 196.3g/day for the three groups. The mean energy intake represented 51.1, 53.5, and 49.8% of the RDA. Except for carbohydrate intake, the dietary intake of all macronutrients and micronutrients was low. The lowest intake was of iron [below 50% of the RDA]. Zinc and protein intake represented less than 70% of the RDA. The overall energy intake was around 50% of the RDA. Nutritional health education should be used as a preventive approach to allow the large sector of the low-income population to maximize the use of the limited resources in the best way. In women at high risk of zinc deficiency, zinc supplementation should be added to the routine supplements

An evaluation of the effectiveness of skin-to-skin care for low-birth-weight in Egypt

Kangaroo Mother Care [KMC] or Skin-to-skin care [SSC] is a universal model of care for preterms. It involves continued skin-to-skin contact between mother and baby for 24 hours a day. Baby is placed in an upright position up on the mother's chest between her breasts and inclined in a position so as to facilitate breastfeeding. It is evidence based medical practice that has been shown to be safe and highly beneficial for the growth and development of babies, in addition to being cost-effective as apposed to incubators and nursing care. It place mothers at the center of care for her baby, enhances recovery and promotes breastfeeding thus reduces the cost of medications and long term complications. However this method is poorly accepted and not implemented in Egypt. Aim: The aim of this study was to assess the knowledge, attitudes and skills [KAS] of health staff with regards KMC; to identify ways to facilitate its introduction in Egypt and to assess the outcome of this intervention on the growth and health states of'infants exposed to this technique of care as compared to traditional care by incubators. Person to person interviews were conducted with 57 physicians and nurses in two neonatal intensive care units [NICUs] in a urban [Cairo University] and 2 regional situated university hospitals [Zagazig and Benha] before and after the intervention. The intervention in the urban university consisted of orientation seminars and on the job training by exposure to a trial of the procedure with 20 mothers-infant pairs. In the intervention unit staff showed a statistically significant improvement in relation to knowledge and attitudes at P<0.05 but not in practice of skills [P>0.05]. Babies exposed to KMC doubled their weights faster, shortened their stay in the NICU and had fewer morbidity problems. KMC is a safe and beneficial technique. Hands-on training of staff, mothers and families can make them more accepting to the technique and promote its implementation in NICUs and in the community

Acute normovolemic hemodilution in sickle cell patient

Sickle cell disease patients with relatively high hemoglobin [>/= 12 g.dl] and those who have elevated alloimmunizations antibodies with rare phenotype subgroups, are problems challenging anesthesiologists. Acute Normovolemic Hemodilution [ANH] is rarely used in the perioperative management of homozygous sickle cell disease [SCD] in patients undergoing surgery. We hereby present a case in which ANH was used successfully. A 22 year old male patient with known homozygous sickle cell disease undergoing orthopedic surgery, underwent Acute Normovolemic Hemodilution [ANH] because of the absence of blood and suitable blood donors and high hemoglobin level. Just before establishing spinal anesthesia, a 400 ml blood was extracted from patient and then replaced by 6% Hydroxyethylstarch HES solution. The surgery was performed uneventfully under spinal analgesia. Patient was discharged 48 hours later. A week later, his follow up visit showed no complications and his lab work returned to basic levels. We recommend the ANH technique as an on hand tool in the perioperative anesthetic management of sickle cell disease patients who have high Hb S with relatively high Hb levels, and in those special patients who have no blood available because of high alloimmunization antibodies or rare phenotype blood groups

Spirometric plus left ventricular and pulmonary blood flow echocardiographic findings in patients with scleroderma before and after sildenafil

Systemic sclerosis [scleroderma] is a chronic debilitating disease that is caused by the occurrence of fibrotic changes and vascular abnormalities at various levels such as: Skin, lungs, kidneys or heart. Lung involvement in scleroderma is one of the leading causes of mortality in this disease. Sildenafil inhibits phosphodiesterase type 5, an enzyme that metabolizes cyclic guanosine monophosphate, thereby enhancing the cyclic guanosine monophosphate-mediated relaxation and growth inhibition of vascular smooth-muscle cells, including those in the lung. We hypothesized that chronic oral administration of the phosphodiesterase-5 inhibitor sildenafil could improve the pulmonary haemodynamics in Systemic sclerosis [Ssc] patients. To investigate the use of sildenafil, detect the effect of sildenafil on the left ventricular function and the pulmonary blood flow echocardiographic parameters and pulmonary functions in a series of SSc patients. Twenty three systemic sclerosis cases were selected for the study. All patients were subjected to clinical evaluation, laboratory investigations, plain chest X-ray, ECG, basal pulmonary function tests and basal echocardiographic assessment. One week of therapy with oral sildenafil 75mg/day in three divided doses was given to the patients, after which they were subjected to a second assessment of respiratory function tests and echocardiography. Sildenafil therapy resulted in the following changes: Mitral E/A was significantly increased [p<0.05]. This was further supported by a significant drop of the pre-ejection period [p<0.001] after using sildenafil. There was a significant rise in acceleration time and the ratio between it and ejection time in both aortic and pulmonary Doppler. Also there was a significant decrease in pulmonary artery diameter [p<0.001], maximal pulmonary flow velocity [p<0.001], pulmonary integral area under the curve [p<0.001] and mean acceleration [p=0.007]. Some ventricular contractility indices as the posterior wall excursion [p=0.001], inter-ventricular septal excursion [p=0.043], velocity of posterior wall excursion [p<0.001], velocity of interventricular septal excursion [p<0.001] showed statistically significant increase. The left ventricular internal dimensions and volume in diastole showed a significant drop [p=0.001, p=0.002 respectively], there was a significant increase in the interventricular septum thickness in systole and diastole [p<0.05] with a borderline significant increase in posterior wall thickness in systole [p=0.05]. Spirometric studies showed a statistically significant increase in FEV[25-75] after the use of sildenafil, [p<0.05] which denotes improvement of airway obstruction. Sildenafil improved left ventricular systolic and diastolic functions and may improve pulmonary blood flow in patients with systemic sclerosis. PDE-5 inhibitors are efficacious in scleroderma-associated pulmonary hypertension