Growth of Infants Born To HIV-Positive Mothers Fed a Whey-Adapted Acidified Starter Formula with Prebiotics and Nucleotides

Objectives: The objectives of this study were to evaluate whether infants born to known HIV-positive mothers; but who were not themselves infected with HIV and who were fed a chemically acidified starter formula with prebiotics with or without nucleotides during their first six months; displayed growth rates equal to uninfected infants fed a chemically acidified starter formula without prebiotics or nucleotides. Design: The design was a multi-centre; double-blinded randomised controlled trial. Setting: The study was carried out in four academic hospitals; three in Johannesburg and one in Cape Town; South Africa. Subjects and intervention: The subjects were newborn infants born to consenting HIV-positive women who had previously decided not to breast feed. The infants were randomised to receive one of three milk formulas. The intervention comprised chemically acidified formula without prebiotics or nucleotides; with prebiotics only; or with prebiotics and nucleotides. Outcome measures: The outcome measures were the growth parameters through the first six months of life. Results: Of the 150 randomised infants; 50 did not complete the study and 16 (12.8of those tested) were infected with HIV; leaving 84 infants available for analysis. All three formulas were tolerated well; with no differences in growth parameters seen with the addition of prebiotics and nucleotides. The growth rates of the study infants up to the age of six months were very good; showing an increase in Z-scores from negative values at the time of enrolment in the first week after birth to around zero for length and 0.5 for weight.Conclusions: The three chemically acidified formulas were tolerated well and resulted in good growth over the first six months of life. No benefits were seen with the addition of prebiotics or nucleotides. The growth rates were similar to those found in previous studies of ours on biologically acidified formulas. The chemical acidification of infant formulas appears to be a realistic alternative to biological acidification should an acidified formula be required

Growth of Infants Born To HIV-Positive Mothers Fed a Whey-Adapted Acidified Starter Formula with Prebiotics and Nucleotides

Objectives: The objectives of this study were to evaluate whether infants born to known HIV-positive mothers; but who were not themselves infected with HIV and who were fed a chemically acidified starter formula with prebiotics with or without nucleotides during their first six months; displayed growth rates equal to uninfected infants fed a chemically acidified starter formula without prebiotics or nucleotides. Design: The design was a multi-centre; double-blinded randomised controlled trial. Setting: The study was carried out in four academic hospitals; three in Johannesburg and one in Cape Town; South Africa. Subjects and intervention: The subjects were newborn infants born to consenting HIV-positive women who had previously decided not to breast feed. The infants were randomised to receive one of three milk formulas. The intervention comprised chemically acidified formula without prebiotics or nucleotides; with prebiotics only; or with prebiotics and nucleotides. Outcome measures: The outcome measures were the growth parameters through the first six months of life. Results: Of the 150 randomised infants; 50 did not complete the study and 16 (12.8of those tested) were infected with HIV; leaving 84 infants available for analysis. All three formulas were tolerated well; with no differences in growth parameters seen with the addition of prebiotics and nucleotides. The growth rates of the study infants up to the age of six months were very good; showing an increase in Z-scores from negative values at the time of enrolment in the first week after birth to around zero for length and 0.5 for weight.Conclusions: The three chemically acidified formulas were tolerated well and resulted in good growth over the first six months of life. No benefits were seen with the addition of prebiotics or nucleotides. The growth rates were similar to those found in previous studies of ours on biologically acidified formulas. The chemical acidification of infant formulas appears to be a realistic alternative to biological acidification should an acidified formula be required

Mitral valve replacement at Tygerberg Hospital: a 5 year follow-up: mitral valve replacement

"This study provides 5-year follow-up data of isolated mitral valve replacements with mechanical prosthesis at a large South African tertiary hospital. It also assessed the significance of pre-operative parameters to predict mortality. This is a retrospective study of 187 patients that underwent isolated mitral valve replacement at Tygerberg Hospital from Jan 1998-Dec 2002. Twenty seven patient's data was incomplete and they were excluded from the study. All patients had rheumatic mitral valve disease and the valve lesions included mitral incompetence; mitral stenosis and mixed mitral valve disease. All patients had a mechanical prosthesis implanted (St Jude medical or Orbis bileaflet valves). The mean follow-up time was 5.41-years. The 30 day mortality was 5.62and the 5-year survival was 80. Pre-operative risk factors that significantly increased mortality were pulmonary hypertension and mitral stenosis. Valve-related complications were more common in this series compared to other First World populations but our results compare well with other Third World population groups. Valve thrombosis 4.32(0.8/yr); thromboembolism 8.71(1.61/yr); anticoagulant related haemorrhage 6.87(1.27/yr); prosthetic valve endocarditis 3.08(0.57/yr) and re-operation 8.12(1.5/yr). Conclusion: Mechanical valve replacement for mitral valve disease that requires valve replacement is still a good treatment option even in third world population groups. In our series; severe pulmonary hypertension; mitral stenosis and reoperation was statistically significantly more common in the ""non-survivors"" group."

Paediatric ophthalmology - What every GP should know

At birth one does not know for sure that a baby's eyes are normal and fully functional. The general practitioner's role is to identify the risk of inherited disease and to perform the relatively simple screening examinations for conditions that require referral for specialist attention. These depend on the child's age and serve to identify different conditions at different ages. Acquired conditions are most commonly allergic or infective in origin. The present review will highlight some of these conditions

Bilan de quelques etudes sur l'observance aux ARV en Afrique

L'article rapporte les resultats d'une etude realisee dans cinq capitales d'Afrique subsaharienne (Bangui; Casablanca. Cotonou; Libreville et Yaounde) pour etudier les facteurs limitant ou favorisant l'observance au traitement par ARV et/ou cotrimoxazole en prophylaxie primaire. Les patients adultes etaient interroges a la sortie de la consultation de suivi sur les problemes et les solutions qu'ils proposaient pour y remedier. L' observance etait mesuree par une question sur un saut de prise dans les 4 jours precedents; le comptage des comprimes restant et la regularite aux rendez-vous. Le taux d'observance varie de 65 a 90selon les lieux et la methode de mesure. Tous les patients ont souligne l'impact du traitement sur leur vie quotidienne et les difficultes pour suivre correctement les prescriptions. Les problemes qui minorent l'observance sont l'alimentation; le manque d'info rm ations; les couts annexes (incluant examens biologiques; transports; pertes de revenus); les effets secondaires; les longs temps d'attente; la stigmatisation et les discriminations. Au total; les efforts pour augmenter le nombre de patients traites ne pourront pas etre efficaces sans accroitre parallelement les moyens d'aide a l'observance