Lactoferrin concentration in breast milk of mothers of low-birth-weight newborns.

OBJECTIVES: Lactoferrin (LF) is a breast milk glycoprotein with protective effects against neonatal infections, mainly in premature and low-birth-weight (LBW) neonates. The aims of this study were to determine LF concentration in breast milk of mothers of LBW infants during the first 2 months postpartum, and to identify the factors associated with LF concentration. STUDY DESIGN: Prospective study conducted as a part of an ongoing clinical trial in three Neonatal Units in Peru. We included 346 mothers of neonates with a birth weight <2000 g. We measured LF concentration in four stages of lactation using a commercial enzyme-linked immunosorbent assay kit. Multivariate analysis was performed to assess the association between maternal and neonatal factors, and LF concentration. RESULTS: We collected 695 milk samples. LF mean concentration±standard deviation was 14.92±7.96 mg ml-1 in colostrum (n=277), 10.73±5.67 in transitional milk (n=55), 10.34±6.27 at 1 month (n=259) and 8.52±6.47 at 2 months (n=104). There was a significant difference in LF concentration between different stages of lactation (P<0.001). Mothers with higher LF concentration in colostrum had higher values in the following 2 months. High maternal income and multiple gestation were significantly associated with higher LF levels; in contrast, maternal peripartum infections and male neonatal gender were associated with lower LF levels. CONCLUSIONS: LF concentration in breast milk of mothers of LBW infants was high and remained elevated even at 1 and 2 months postpartum. LF concentration in colostrum was higher in mothers with higher income and multiple pregnancies, and lower in mothers with peripartum infections.

Binational outbreak of Guillain-Barré syndrome associated with Campylobacter jejuni infection, Mexico and USA, 2011.

In June 2011, a cluster of suspected cases of Guillain-Barré syndrome (GBS), which can follow Campylobacter jejuni infection, was identified in San Luis Río Colorado (SLRC), Sonora, Mexico and Yuma County, Arizona, USA. An outbreak investigation identified 26 patients (18 from Sonora, eight from Arizona) with onset of GBS 4 May-21 July 2011, exceeding the expected number of cases (n = 1-2). Twenty-one (81%) patients reported antecedent diarrhoea, and 61% of 18 patients tested were seropositive for C. jejuni IgM antibodies. In a case-control study matched on age group, sex, ethnicity, and neighbourhood of residence, all Arizona GBS patients travelled to SLRC during the exposure period vs. 45% of matched controls (matched odds ratio 8·1, 95% confidence interval 1·5-∞). Exposure information and an environmental assessment suggested that GBS cases resulted from a large outbreak of C. jejuni infection from inadequately disinfected tap water in SLRC. Binational collaboration was essential in investigating this cross-border GBS outbreak, the first in mainland North America since 1976.

Gammacamara portátil en la localización intraoperatoria del ganglio centinela en cáncer de mama: experiencia en el Hospital Nacional Guillermo Almenara-EsSalud / Portable gamma camera in intraoperative localization of sentinel node in breast cancer: experience at the Hospital Nacional Guillermo Almenara-EsSalud

Objetivo: Mostrar la experiencia del uso de la gammacamara portátil en la localización intraoperatoria del ganglio centinela en cáncer de mama. Material y Métodos: Fueron incluidas en el estudio 103 pacientes mujeres con diagnostico de cáncer de mama con axila clínica y radiologicamente negativa. Se realizo inyección periareolar de un radiotrazador y de la sustancia colorante azul patente. Se adquirieron imágenes planares de la axila antes y durante la extracción del ganglio centinela. Se utilizo en el intraoperatorio una gammacámara portátil para la visualización del o los ganglios centinelas. Se comprobó ôcampo libreõ en todos los pacientes con la gammacámara portátil. Resultados: El promedio de la edad de los pacientes fue 52.5 años. La media de tamaño tumoral fue de 2.5 cm. La media de ganglios encontrados fue de 1.9 ganglios centinelas por paciente. Se localizaron los ganglios centinelas en el 91.2% de los pacientes, de los cuales 24 pacientes presentaron metástasis. El uso de la gamma cámara intraoperatoria mostro una sensibilidad de 97.8% y especificidad de 88.9% para la visualización de ganglios centinelas. Conclusiones: El empleo de la gammacamara portátil intraoperatoria en la localización del ganglio centinela en cáncer de mama es un método de alta sensibilidad y especificidad, útil para determinar, que todos los ganglios centinelas han sido extirpados, es decir ôcampo libreõ.

Objective: To show the experience of the use of portable gamma camera intraoperative node localization in breast cancer sentinel. Material and Methods: The study included 103 female patients diagnosed with breast cancer with clinical axillary and radiologically negative. Periareolar injection was performed a radiotracer and blue dye substance patent. It planar images acquired before and during axillary sentinel lymph node removal. Was used in the intraoperative a portable gamma camera for viewing or sentinel node was found "free field" for all patients the portable gamma camera. Results: The mean age of patients was 52.5 years. The mean tumor size was 2.5 cm. The average nodes found was 1.9 sentinel nodes per patient. Sentinel nodes were found in 91.2% of patients, of whom 24 patients had metastases. The use of intraoperative gamma camera showed a sensitivity 97.8% and specificity of 88.9% for the visualization of sentinel nodes. Conclusions: The use of intraoperative portable gamma camera in the location of the sentinel node in cancer breast is a method of high sensitivity and specificity, useful to determine that all sentinel nodes have been removed and free field.

A clinical prediction rule for pulmonary tuberculosis in emergency departments.

SETTING: University-affiliated hospital located in an area with a high incidence of pulmonary tuberculosis (PTB). OBJECTIVE: To develop a clinical prediction rule (CPR) based on information obtainable on admission, to permit rapid identification of patients with PTB. DESIGN: Information from patients with respiratory symptoms who attended the emergency department of Cayetano Heredia Hospital, Lima, Peru, was collected prospectively. Clinical symptoms, past medical history, demographic data and results of chest X-rays (CXRs), sputum smear and culture in Löwenstein-Jensen media were obtained. Based on logistic regression, we constructed a scoring system to predict PTB. RESULTS: A total of 345 patients were enrolled in the study, including 109 (31%) culture-proven PTB cases. In logistic regression analysis, we found age, previous history of PTB, weight loss, presence of cavities, upper lobe infiltrate and miliary pattern on CXR as independent predictors of PTB. We designed a scoring system with these variables, taking into account their statistical weight. The score attained 93% sensitivity and 42% specificity. CONCLUSION: The CPR that was developed performed well in our population. It merits further validation in other settings. It should not, however, replace, but should complement sputum microscopy when deciding on isolation, and it does not preclude microbiology in making a definitive diagnosis.

The relationship of NEO-PI performance to coping styles, patterns of use, and triggers for use among substance abusers.

We investigated the construct validity of the NEO Personality Inventory (NEO-PI) with a clinical population of 2,676 substance abusers. Scores on the NEO-PI were correlated with self-reported measures of psychopathology as well as patterns of substance abuse, reported coping styles, relapse triggers, and relapse confidence. Substance abusers were more Neurotic and less Agreeable and Conscientious than were the NEO-PI nonclinical normative sample. Within subgroups of substance users, cocaine-only users were more Extroverted and Open than were alcohol-only users. Polysubstance users were the least Agreeable and Conscientious group. Alcohol-only users and polysubstance users scored higher on Neuroticism than did other groups. Personality dimensions related to reported coping styles in meaningful ways. For example, Neuroticism was highly related to escape avoidant coping (r = .53), Agreeableness was negatively related to confrontive coping (r = -.28), and Conscientiousness was related to problem solving (r = -.27) and negatively related to escape avoidance (r = -.29). Neuroticism, Conscientiousness, Agreeableness, and Extroversion were associated with reported triggers of use including negative emotional states, social rejection, and tension. Higher levels of Conscientiousness, Agreeableness, and Extroversion were associated with greater confidence in ability to refrain from use, whereas Neuroticism was associated with a corresponding lack of confidence in self-restraint.

Fistulotomy without external sphincter division for high anal fistulae.

Thirty-two patients with high trans-sphincteric or suprasphincteric fistulae underwent fistulotomy without external sphincter division. Fifteen patients had posterior fistulae involving the deep postanal space and 17 patients had anterior fistulae. Primary healing, after removal of the seton, occurred in 25 of the 32 patients (78 per cent). Primary healing in patients with posterior fistulae occurred in 66 per cent and in 88 per cent of patients with anterior fistulae. Following surgery, eight patients (33 per cent) reported problems controlling flatus, six patients (25 per cent) reported mucous discharge and one patient (4 per cent) complained of occasional incontinence for liquid stool. No patient experienced problems controlling solid stool nor did any patient require the use of a protective pad. These results have encouraged us to use this method as the initial procedure of choice for these more difficult fistulae. A significant number of patients can be cured of their fistula while preserving the external sphincter, thereby minimizing the impact of surgical therapy on continence.