Maternal country of birth and previous pregnancies are associated with breast milk characteristics

Populations in high infectious exposure countries are at low risk of some immune-mediated diseases such as Crohn's disease and allergy. This low risk is maintained upon immigration to an industrialized country, but the offspring of such immigrants have a higher immune-mediated disease risk than the indigenous population. We hypothesize that early life exposures in a developing country shape the maternal immune system, which could have implications for the offspring born in a developed country with a low infectious load. The aim of this study was to investigate if exposures in childhood (indicated by country of origin) and subsequent exposures influence immunologic characteristics relevant to stimulation of offspring. Breast milk components among 64 mothers resident in Sweden, 32 of whom immigrated from a developing country, were examined using the ELISA and Cytometric Bead Array methods. Immigrants from a developing country had statistically significantly higher levels of breast milk interleukin-6 (IL-6), IL-8 and transforming growth factor-β1. A larger number of previous pregnancies were associated with down-regulation of several substances, statistically significant for soluble CD14 and IL-8. The results suggest that maternal country of birth may influence adult immune characteristics, potentially relevant to disease risk in offspring. Such a mechanism may explain the higher immune-mediated disease risk among children of migrants from a developing to developed country. Older siblings may influence disease risk through the action of previous pregnancies on maternal immune characteristics.     

Intestinal flora in very low-birth weight infants

Aim:  To study the early faecal microbiota in very low-birth weight infants (VLBW, <1500 g), possible associations between faecal microbiota and faecal calprotectin (f-calprotectin) and to describe the faecal microbiota in cases with necrotizing enterocolitis (NEC) before diagnosis.
Methods:  Stool samples from the first weeks of life were analysed in 48 VLBW infants. Bacterial cultures were performed and f-calprotectin concentrations were measured. In three NEC cases, cultures were performed on stool samples obtained before diagnosis.
Results:  Bifidobacteria and lactobacilli were often identified in the first stool sample, 55% and 71% of cases, respectively within the first week of life. A positive correlation between lactic acid bacteria (LAB) and volume of enteral feed was found. Other bacteria often identified were Escherichia coli , Enterococcus and Staphyloccus sp. F-calprotectin was not associated with any bacterial species. All NEC cases had an early colonization of LAB. Prior to onset of disease, all cases had a high colonization of non- E. coli Gram-negative species.
Conclusion:  In contrast to the previous studies in VLBW infants, we found an early colonization with LAB. We speculate that this may be due to early feeding of non-pasteurized breast milk.     

Anger Mediates the Relation Between Violence Exposure and Violence Perpetration in Incarcerated Boys

Youth who are exposed to violence are more likely to perpetrate violence. Incarcerated youth are a special population that is at a significantly greater risk for violent offending because of their relatively greater rates of violence exposure. Two important outcomes of violence exposure that may help explain its link with violence perpetration are posttraumatic stress disorder and problematic anger. The primary aim of the current study is to examine whether these important risk factors mediate the relation between two types of violence exposure (i.e., witnessing and victimization) and various types of violence perpetration in a sample of 373 incarcerated male adolescent offenders. A second aim is to test whether another well-established correlate of violence in youth, callous-unemotional (CU) traits (lack of empathy, guilt), adds unique variance beyond violence exposure, anger, and PTSD symptomatology. Findings suggest that anger is a robust predictor of violence and appears to at least partially act as the mechanism through which violence exposure is linked with violence perpetration. CU traits also contribute unique variance, beyond the significant effect of anger, to the statistical prediction of community, but not institutional, violence.     

Clinically detectable copy number variations in a Canadian catchment population of schizophrenia

Copy number variation (CNV) is a highly topical area of research in schizophrenia, but the clinical relevance is uncertain and the translation to clinical practice is under-studied. There is a paucity of research involving truly community-based samples of schizophrenia and widely available laboratory techniques. Our objective was to determine the prevalence of clinically detectable CNVs in a community sample of schizophrenia, while mimicking typical clinical practice conditions. We used a brief clinical screening protocol for developmental features in adults with schizophrenia for identifying individuals with 22q11.2 deletions and karyotypically detectable chromosomal anomalies in 204 consecutive patients with schizophrenia from a single Canadian catchment area. Twenty-seven (13.2%) subjects met clinical criteria for a possible syndrome, and 26 of these individuals received clinical genetic testing. Five of these, representing 2.5% of the total sample (95% CI: 0.3%-4.6%), including two of ten patients with mental retardation, had clinically detectable anomalies: two 22q11.2 deletions (1.0%), one 47, XYY, and two other novel CNVs - an 8p23.3-p23.1 deletion and a de novo 19p13.3-p13.2 duplication. The results support the utility of screening and genetic testing to identify genetic syndromes in adults with schizophrenia in clinical practice. Identifying large, rare CNVs (particularly 22q11.2 deletions) can lead to significant changes in management, follow-up, and genetic counselling that are helpful to the patient, family, and clinicians.     

Defining Laterality of the Descending Thoracic Aorta in a 4‐Chamber View of the Heart

Objective. Right descending aortas have been correlated with an increased risk of congenital heart disease. Nevertheless, the aortic position remains a largely overlooked diagnostic tool in second‐trimester sonography because no formal system for assessing the position exists. By developing a method of assigning the position of the aorta relative to the thoracic midline, diagnostic use of the descending aorta's position might be implemented more easily. Methods. The method of assessing the position relative to the midline was tested by comparing the analysis of 2 independent observers, who showed a 94.4% concordance rate. Results. Comparison of the percentages of aortic positions between the gestational ages (GAs) of 18 and 21 weeks showed no significant correlation between the aortic position and GA. Conclusions. We suggest simply paying attention to the aortic position in an already standard view. The extra effort is minimal, and it has the potential to improve the diagnostic accuracy of the 4‐chamber view.     

Mortality in Autism: A Prospective Longitudinal Community-Based Study

The purposes of the present study were to establish the mortality rate in a representative group of individuals (n = 120) born in the years 1962–1984, diagnosed with autism/atypical autism in childhood and followed up at young adult age (≥18 years of age), and examine the risk factors and causes of death. The study group, which constituted a total population sample of children with these diagnoses, were followed up in Swedish registers. Nine (7.5%) of the 120 individuals with autism had died at the time of follow-up, a rate 5.6 times higher than expected. The mortality rate was significantly higher among the females. Associated medical disorders (including epilepsy with cognitive impairment) and accidents accounted for most of the deaths, and it was not possible to determine whether autism “per se” actually carries an increased mortality risk.     

Fatigue after myocardial infarction: Relationships with indices of emotional distress,and sociodemographic and clinical variables

Alsén P, Brink E, Brändström Y, Karlson BW, Persson L‐O. International Journal of Nursing Practice 2010; 16 : 326–334
Fatigue after myocardial infarction: Relationships with indices of emotional distress, and sociodemographic and clinical variables Fatigue and depressive symptoms are relatively common among patients recovering from myocardial infarction (MI). The symptoms of depression and fatigue overlap. The present study aimed at identifying patient fatigue and at examining the incidence of fatigue, particularly without coexisting depression, after MI. The sample comprised 204 consecutive patients who had completed the questionnaires Hospital Anxiety and Depression Scale and the Multidimensional Fatigue Inventory–20 after MI (1 week and 4 months). The results showed that fatigue had decreased after 4 months compared with the time of MI onset. Compared with the general population, patients reported significantly higher levels of fatigue. Furthermore, fatigue was associated with depression, but 33% of the sample reported fatigue without coexisting depression after 4 months. In order to prevent or treat patients' symptoms of fatigue after MI, the concepts of fatigue and depression should be assessed separately so as to exclude overlapping effects.     

Fracture of the tympanic plate with soft tissue extension into the auditory canal resulting from an unfavorable chewing experience

Abstract –  We present a case where a patient sustained a tympanic plate fracture of the right side while chewing a sandwich. Intense pain with temporomandibular joint (TMJ) symptoms such as restrained painful mouth opening and functional pain in full occlusion followed the incident and the fracture was diagnosed after ocular and CT-examination of the right external auditory canal. Non-ruptured soft tissue could be seen protruding into the external auditory canal and the size of the mass changed during movement of the TMJ. Treatment was not needed to resolve the situation and at 3-year follow-up the patient has no clinical symptoms.