Determination of an Acceptable Portion Size of Daal for a Bangladeshi Community-Based Iron Intervention in Adolescent Girls: A Feasibility Study

Widely consumed daal (lentils) in Bangladesh are an ideal vehicle for iron (Fe) fortification; however, an acceptable portion size in meals needs to be determined to carry out a community feeding study in at-risk adolescent girls. A non-randomized crossover trial was conducted with n = 100 Bangladeshi girls (12.9 ± 2.0 years of age). Two recipes (thin and thick) and three portion sizes (25 g, 37.5 g, 50 g of raw lentil) of daal were served with 250 g of cooked white rice in a counter-balanced manner over 12 weeks. Each meal was fed to participants 5 days/week for two weeks. Ratings of hunger, satiety, and palatability were measured before and after each meal using Visual Analog Scales (VAS). The thick preparation in the 37.5 g portion (~200 g cooked) elicited higher VAS ratings of hunger, satiety, and palatability compared to all other meals. The 50 g portion of the thin preparation had VAS ratings similar to those of the 37.5 g thick preparation. Consuming the 37.5 g portion of fortified daal would provide 6.9 mg Fe/day to girls in a community-based effectiveness study. This would meet ~86% and ~46% of the Recommended Dietary Allowance (RDA) for Fe for girls aged 9–13 and 14–18 years, respectively.     

Ingestion of an indigestible saccharide, difructose anhydride III, partially prevents the tannic acid-induced suppression of iron absorption in rats

Dietary tannic acid (TA) inhibits iron absorption and some indigestible oligosaccharides have been shown to promote mineral absorption. In this study, we examined whether difructose anhydride III (DFA III) or fructooligosaccharide (FOS) stimulate iron absorption in TA-fed rats. Two experiments were conducted using male Sprague-Dawley rats (weighing 90-110 g) in a randomized block design. Rats were fed control, DFA III or FOS (30 g/kg) diets in expt. 1, and control, TAcontrol, TAFOS or TADFA III (TA, 15 g/kg) diets in expt. 2 for 3 wk during which blood sampling was performed weekly and fecal collection twice. In expt. 1, apparent iron absorption was higher (P < 0.001) in the DFA III-fed (65.7 and 55.9%, d 8-10 and 19-21) and FOS-fed (59.9%, d 19-21) groups than in the control group (48.4 and 45.4%, d 8-10 and 19-21) without differences in blood hemoglobin concentrations or hematocrits. TA feeding reduced hemoglobin concentrations and hematocrits (119.1 g/L, 0.360; P < 0.001), and the feeding of TADFA III partially improved this anemic condition (129.6 g/L, 0.403), whereas TAFOS feeding did not influence these variables (120.6 g/L, 0.342; expt. 2). Iron absorption was lower in the TA-fed groups (19.8%; P < 0.001) than in the control group (49.4%), whereas the absorption in both TA-fed indigestible sugar groups was higher (DFA III, 43.2 and 38.2%, d 8-10 and 19-21; FOS, 39.4%, d 8-10; P < 0.001) than in the TA-control group except for the TAFOS-fed group (25.1%, d 19-21). Serum iron concentrations, unsaturated iron-binding capacities, total iron-binding capacities and transferrin saturations (%) were not improved by the feeding of TADFA III or TAFOS. Furthermore, liver iron concentrations were decreased by TA feeding (P < 0.001) and were not increased by the feeding of indigestible sugars. The feeding of DFA III or FOS decreased the pH of the cecal contents (P < 0.001) while increasing major organic acid pools. In all groups fed TA, approximately 18% of the ingested TA was recovered in the feces. Our results demonstrate that TA reduces iron absorption and induces anemia, conditions that are partially prevented by the feeding of DFA III, but not FOS.     

Factors affecting newborn care practices in Bangladesh

Newborn care is of immense importance for the proper development and healthy life of a baby. Although child and infant mortality in South Asia has reduced substantially, the rate of neonatal mortality is still high, although these deaths can be prevented by adopting simple interventions at the community level. The aim of the study was to identify the associated factors which affect newborn care practices. Data for the study were drawn from the Bangladesh Demographic and Health Survey 2007, in which 6150 mothers were considered. The mean age of the mothers was 18 (±3.2) years. A little over 62% of the pregnant women received at least one antenatal check-up during the entire period of their pregnancy. About 70% of deliveries were conducted at home either by unskilled family members or by relatives. A clean instrument was used for cutting the cord of 87% of the newborn babies, while about 34% of them were reported to have had their first bath immediately after delivery. Initiation of breast feeding immediately after birth was practised in only about 19% of the cases. Compared with mothers with no education, those with secondary or higher levels were associated with clean cord care [odds ratio (OR) = 1.3, 95% confidence interval (CI) 1.0, 1.9] and early breast feeding [OR = 1.6, 95% CI 1.2, 2.2]. The study revealed an urgent need to educate mothers, and train traditional birth attendants and health workers on clean delivery practices and early neonatal care. Increasing the number of skilled birth attendants can be an effective strategy to increase safe delivery practices, and to reduce delivery complications.     

First Steps in Initiating an Effective Maternal,Neonatal, and Child Health Program in Urban Slums: the BRAC Manoshi Project’s Experience with Community Engagement,Social Mapping,and Census Taking in Bangladesh

The processes for implementing effective programs at scale in low-income countries have not been well-documented in the peer-reviewed literature. This article describes the initial steps taken by one such program—the BRAC Manoshi Project, which now reaches a population of 6.9 million. The project has achieved notable increases in facility births and reductions in maternal and neonatal mortality. The focus of the paper is on the initial steps—community engagement, social mapping, and census taking. Community engagement began with (1) engaging local leaders, (2) creating Maternal, Neonatal, and Child Health Committees for populations of approximately 10,000 people, (3) responding to advice from the community, (4) social mapping of the community, and (5) census taking. Social mapping involved community members working with BRAC staff to map all important physical features that affect how the community carries out its daily functions—such as alleys, lanes and roads, schools, mosques, markets, pharmacies, health facilities, latrine sites, and ponds. As the social mapping progressed, it became possible to conduct household censuses with maps identifying every household and listing family members by household. Again, this was a process of collaboration between BRAC staff and community members. Thus, social mapping and census taking were also instrumental for advancing community engagement. These three processes—community engagement, social mapping, and census taking—can be valuable strategies for strengthening health programs in urban slum settings of low-income countries.     

Zinc Supplementation with or without Additional Micronutrients Does Not Affect Peripheral Blood Gene Expression or Serum Cytokine Level in Bangladeshi Children

Preventive zinc supplementation provided as a stand-alone dispersible tablet, or via home fortification as multiple micronutrient powders (MNPs), has been considered a potential strategy to prevent zinc deficiency and improve health (including immune) outcomes among children in low- and middle-income countries. However, the impact of zinc supplementation on immune profiles has not been well characterized. We sought to define the effect of zinc supplementation on peripheral blood gene expression and cytokine levels among young children in Dhaka, Bangladesh. In a sub-study of a large randomized, controlled, community-based efficacy trial where children 9–11 months of age received one of the following interventions on a daily basis for 24 weeks: (1) MNPs containing 10 mg of zinc; (2) dispersible tablet containing 10 mg zinc; or (3) placebo powder, we used RNA sequencing to profile the peripheral blood gene expression, as well as highly sensitive multiplex assays to detect cytokine profiles. We profiled samples from 100 children enrolled in the parent trial (zinc MNPs 28, zinc tablets 39, placebo 33). We did not detect an effect from either zinc intervention on differential peripheral blood gene expression at the end of the intervention, or an effect from the intervention on changes in gene expression from baseline. We also did not detect an effect from either intervention on cytokine concentrations. Exploratory analysis did not identify an association between undernutrition (defined as stunting, underweight or wasting) and peripheral blood gene expression. Zinc interventions in children did not produce a gene expression or cytokine signature in the peripheral blood. However, this study demonstrates a proof of principle that sensitive multi-omic techniques can be applied to samples collected in field studies.     

Accuracy of routinely collected comorbidity data in patients undergoing colectomy: a retrospective study

Objectives

This paper aimed to determine the baseline accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of routinely collected comorbidity data in patients undergoing any types of colectomy.

Methods

All patients aged >18 who underwent right hemicolectomy, left hemicolectomy, sigmoid colectomy, subtotal colectomy, or total colectomy between 1 January 2015 and 1 November 2016 were identified. The following comorbidities were considered: hypertension, ischemic heart disease (IHD), diabetes, asthma, chronic obstructive pulmonary disease (COPD), cerebrovascular disease (CVD), chronic kidney disease (CKD), and hypercholesterolemia. The comorbidity data from clinical notes were compared with corresponding data in hospital episode statistics (HES) database in order to calculate accuracy, sensitivity, specificity, PPV, and NPV of HES codes for comorbidities. In order to assess the agreement between clinical notes and HES data, we also calculated Cohen’s kappa index value as a more robust measure of agreement.

Results

Overall, 267 patients comprising 2136 comorbidity codes were included. Overall, HES codes for comorbidities in patients undergoing colectomy had substandard accuracy 94% (kappa 0.542), sensitivity (39%), and NPV (89%). The HES codes were 100% specific with PPV of 100%. The results were consistent when individual comorbidities were analyzed separately.

Conclusions

Our results demonstrated that HES comorbidity codes in patients undergoing colectomy are specific with good positive predictive value; however, they have substandard accuracy, sensitivity, and negative predictive value. Better documentation of comorbidities in admission clerking proforma may help to improve the quality of source documents for coders, which in turn may improve the accuracy of coding.

     

Effect of Glucocorticoids on Serum Lipid Profile and Endothelial Function and Arterial Wall Mechanics

Objective

To determine the effect of glucocorticoids on lipid profile, endothelial function and arterial wall mechanics in children.

Methods

Thirty patients who had received glucocorticoids for 4 to 8 wk were compared with 30 age and sex matched healthy controls. Baseline evaluation included weight, height, body mass index (BMI), blood pressure (BP), lipid profile and Ultrasonographic evaluation of brachial artery for endothelial dependant as well as endothelial independent vasodilatation and evaluation of common carotid artery for intima media thickness (IMT) and arterial wall mechanics. All of these parameters were evaluated two more times- after 4 wk of steroid therapy and 2 wk after stopping the drug.

Results

Patients were found to have significant increase in BMI; systolic and diastolic BP; total and LDL cholesterol and carotid IMT and also a decrease in cross sectional compliance (CSC) after 4 wk of steroid therapy (oral prednisolone). However, all these parameters returned towards baseline, 2 wk after stopping the drug. No endothelial dysfunction was observed in these patients.

Conclusions

Four to eight wk of glucocorticoids use in children leads to reversible changes in BMI, systolic and diastolic BP, total and LDL cholesterol, carotid IMT and CSC.     

Leflunomide in systemic onset juvenile idiopathic arthritis

Methotrexate, the mainstay of treatment in Juvenile idiopathic arthritis, might not be effective in a few patients of polyarticular and systemic onset juvenile idiopathic arthritis. Use of biologicals like TNF-α blockers, the next line of preferred drugs is constrained by the high cost. We successfully used leflunomide in four patients.