Breastfeeding perceptions in communities in Mangochi district in Malawi

Aim: To investigate mothers’ perceptions of breastfeeding and influences from their social network. Methods: A cross‐sectional survey was carried out in Mangochi district, Malawi where questionnaire data from 157 rural and 192 semi‐urban mother–infant pairs were obtained. Results: The proportion of mothers who thought that exclusive breastfeeding should last for 6 months and those who reported to have actually exclusively breastfed were 40.1% and 7.5% respectively. Of those who reported practising exclusive breastfeeding for 6 months, 77.5% stated that exclusive breastfeeding should last for 6 months. This opinion was independently associated with giving birth in a Baby‐Friendly facility, OR = 5.22; 95% CI (1.92–14.16). Among the mothers who thought that exclusive breastfeeding should last for less than 6 months, 43.9% reported having been influenced in their opinion by health workers. Infant crying was the most common (62.4%) reason for stopping exclusive breastfeeding. Conclusion: The findings illustrate the positive impact health workers can have, as well as the need to raise awareness of the benefits of exclusive breastfeeding among both health workers and mothers. Furthermore, continued counselling of mothers on how to deal with stressful infant behaviour such as crying may assist to prolong exclusive breastfeeding.     

Burkitt's Lymphoma in a Child with Aids

Few systemic lymphomas have been reported in children with AIDS. We report a case of disseminated Burkitt's lymphoma with lung involvement occurring in a 33-month-old child with acquired immunodeficiency syndrome. Lymphoid interstitial pneumonia was diagnosed by lung biopsy at 23 months of age, but lymphoma was not diagnosed before autopsy.     

Relationship between intraepithelial neoplasia of the cervix and the size and number of nucleolar organizer regions

A silver colloid technique was applied to 18 colposcopic biopsies of the cervix. These comprised 7 cases of cervical intraepithelial neoplasia I (CIN I), 5 cases of CIN II, and 6 cases of CIN III. The nucleolar organizer regions subsequently visualized (AgNORs) were enumerated using an oil immersion lens. The maximum diameters of the AgNORs and aggregates thereof were measured, by hand, from carefully calibrated monochrome photographs. The mean numbers of AgNORs subsequently identified steadily increased, whereas the mean sizes of AgNORs decreased from CIN I to CIN III. In CIN I the mean AgNOR number was 2.3 (range 1.8-3.4) and the AgNOR mean maximum diameter (Dmax) was 1.28 microns (range 0.75-1.75). In CIN II the mean number was 3.5 (range 3.1-4.6) and the AgNOR Dmax was 0.98 micron (range 0.9-1.18). In CIN III the mean number was 4.7 (range 4.0-6.1) and the Dmax was 0.62 micron (range 0.51-0.9). CIN III could be distinguished from CIN I and CIN II on the basis of AgNOR sizes, and an inverse relationship between AgNOR numbers and sizes was established.     

Assessment of an abbreviated odorant identification task for children: a rapid screening device for schools and clinics

To validate the level of olfactory performance of children, we tested 825 volunteers, aged 4–17 years, with an abbreviated form of our pediatric odorant identification task. The test consisted of sniffing and identifying five odorants (baby powder, bubble gum, candy cane, licorice and peach). Mean olfactory scores increased as a function of age, reaching a plateau of about 94–95% correct at 8 years of age. In general, girls out–performed boys. Physicians require a test instrument such as the one we have devised to allow them to diagnose olfactory dysfunction in children. The present task is particularly applicable in screening large numbers of children in clinics or schools because it can be administered easily and rapidly. Adult subjects with olfactory dysfunction also performed poorly on this odorant identification task designed for children. Therefore, we expect that our odorant identification task will also detect children with severe olfactory dysfunction.     

S-100 protein localization in minor salivary gland tumours: an aid to diagnosis

The clinician is almost entirely dependent on the histopathologist to accurately diagnose minor salivary gland tumours, but in some cases the histological interpretation of the specimen is very difficult. Recently it has been demonstrated using immunohistochemical techniques that S-100 protein is present in some salivary gland tissues and its localization has been used as an aid in the differentiation of major salivary gland tumours. To assess its value in the diagnosis of minor salivary gland tumours it was localized in sections from 15 such tumours using both a standard peroxidase-antiperoxidase (PAP) and a newly developed immunogold-silver staining sequence (IGSS) technique. Strong staining for S-100 protein was seen in the nuclei and cytoplasm of the cellular areas and also in the cells in the chondroid and myxoid areas of pleomorphic adenomas. Generally the staining was more intense and widespread with the IGSS method. No staining was observed in any of the other tumour types. We conclude that S-100 protein localization is a valuable aid in the differentiation of minor salivary gland tumours. Furthermore, the IGSS method enables more sensitive 'reading' of the staining reaction.     

Extramedullary hematopoiesis within the hypotympanicum presenting as a glomus tympanicum

We discuss the case of a 22-year-old black woman who presented with a mass in the left hypotympanicum. Both the pre- and postoperative diagnosis of the lesion was a glomus tympanicum. Histopathologic examination revealed the "tumor" to be a nodule of extramedullary hematopoiesis. Many sickled erythrocytes were also noted within the lesion. A multilingual literature search (English, French, German, Spanish, Portuguese, Italian, and Russian) failed to reveal a documented case of extramedullary hematopoiesis in the hypotympanicum. We assume that the patient's hemoglobinopathy was the cause of her unusual focus of extramedullary hematopoiesis.     

Asymptomatic neonatal colonisation by Clostridium difficile

In a prospective survey of infants born in a single maternity unit, asymptomatic faecal colonisation by Clostridium difficile occurred in 31 (47%) of 66 babies who provided a faecal sample during week one of life and at age 14 and 28 days, and in 46 (30.7%) of the total of 150 babies for whom at least one faecal sample was obtained during the month of study. There was no evidence for acquisition of the organism from the mother during delivery and colonisation was unrelated to the means of delivery, infant sex, means of feeding, duration of hospital stay, or antibiotic treatment. New colonisation occurred throughout the month of the study and further evidence for environmental acquisition was obtained by the finding of a similar strain of C difficile in 7 babies from one ward together with positive environmental cultures. Colonisation was frequently transient and occasionally intermittent; most infants kept the same strain during their period of carriage. Twenty two (47.8%) babies colonised by C difficile had low titres of cytopathic faecal toxin but none had symptomatic diarrhoea or features of necrotizing enterocolitis. The in vitro toxigenic potential of 57 toxigenic isolates from 36 babies was low and 12 babies carried non-toxigenic strains. Transient colonisation by C difficile in early life is almost certainly more common than is generally recognized and the neonate provides an important reservoir of potential infection.