Evidence for an immune barrier after in utero hematopoietic-cell transplantation

The competence of the immune system of the developing fetus to act as a barrier to in utero hematopoietic-cell transplantation (IUHCT) has been a source of debate. Until now, comparisons of allogeneic and congenic engraftment have been inconclusive due to methodologic limitations resulting in minimal and inefficient engraftment. In this study, E14 fetal mice received transplants of either allogeneic or congenic bone marrow using a new intravascular technique that allows definitive administration of much higher doses of donor cells. Our results demonstrate that 100% of surviving recipients demonstrate engraftment at 1 week of age, but that 70% of allogeneic recipients lose engraftment by 1 month of age, and 80% ultimately fail to sustain long-term chimerism. In contrast, all congenic recipients maintain stable, long-term, multilineage chimerism. These results strongly support an immune barrier to allogeneic engraftment after IUHCT.     

Ad libitum feeds after laparoscopic pyloromyotomy: a retrospective comparison with a standardized feeding regimen in 227 infants

PURPOSE: The best feeding regimen after pyloromyotomy for hypertrophic pyloric stenosis continues to be a topic of some debate. Postoperative emesis and length of hospital stay are principal concerns. We compared the outcome of infants after laparoscopic pyloromyotomy who were fed using a standardized feeding regimen or ad libitum. MATERIALS AND METHODS: We reviewed the records of 227 infants who underwent laparoscopic pyloromyotomy within a 5-year period. We compared two sets of patients: those fed using a standardized feeding regimen and those fed ad libitum. The choice of feeding regimen was based solely on the attending surgeon's preference. Each group was examined for frequency of postoperative emesis, time to full feeds, and length of hospital stay. RESULTS: Of the 227 patients in the study, 170 (74.9%) were fed using the standardized feeding regimen and 57 (25.1%) were fed ad libitum. The two groups were comparable with respect to age and sex distribution. Although children fed ad libitum had a significantly shorter time to full feeds that those fed a standardized feeding regimen (19.0 vs. 23.1 hours; P < 0.01), there was no significant difference in the frequency of postoperative emesis (1.8 vs. 1.9 times per patient; P = 0.68) or total length of hospital stay (49.0 vs. 50.3 hours; P = 0.73) when the ad libitum and standardized feed groups were compared. There were no complications in either group. CONCLUSION: A standardized feeding regimen offers no advantage over ad libitum feeds for infants who have undergone laparoscopic pyloromyotomy. Infants fed ad libitum are able to tolerate full feeds sooner and the frequency of postoperative emesis is not increased. Ad libitum feeding has become the standard postoperative feeding regimen for infants who have undergone pyloromyotomy at our hospital.     

Are malaria treatment expenditures catastrophic to different socio‐economic and geographic groups and how do they cope with payment? A study in southeast Nigeria

Objectives To determine the inequities in the household income depletion resulting from malaria treatment expenditures, the sacrifice of basic household needs (catastrophe) and the differences in payment strategies among different socio‐economic and geographic groups in southeast Nigeria. Methods Data were gathered through pre‐tested, structured questionnaires from a random sample of 2 250 householders in rural and urban parts of southeast Nigeria. The level of catastrophic malaria treatment expenditure was computed as the percentage of average monthly malaria treatment expenditure divided by the average monthly non‐food household expenditure, using a threshold of 5%. Socio‐economic inequity was established using a socio‐economic status (SES) index, while a rural‐urban comparison examined geographic disparities. Results The average cost to treat a case of malaria was 796.5 Naira ($6.64) for adults and 789.0 Naira ($6.58) for children. The monthly malaria treatment expenditure as a proportion of monthly household non‐food expenditure was 7.8%, 8.5%, 5.5% and 3.9% for the most poor, very poor, poor and least poor SES groups respectively. Malaria treatment accounted for 7.1% and 5.0% of non‐food expenditures for rural and urban dwellers, respectively. More than 95% of the people financed their treatment through out‐of‐pocket payment (OOP), with no SES and rural–urban variance, as opposed to insurance payment mechanisms and fee exemptions. Conclusion There were socio‐economic and geographic inequities in the financial burden resulting from malaria treatment. The treatment expenditure depleted more of the aggregate income of the two worse‐off SES (Q1 and Q2) and of the rural dwellers. Government and donor agencies should institute the abolition of user fees for malaria, the transition from OOP to pre‐payment mechanisms and the improvement of physical access to appropriate malaria treatment services, as well as subsidies and deferrals in order to engender financial risk protection from malaria treatment.     

Socio-economic differences in preferences and willingness to pay for different providers of malaria treatment in southeast Nigeria

This article determined whether there are links between socio-economic status (SES) and preferences of consumers for different strategies for improving timely and appropriate management of malaria. Ranking of preferences and willingness to pay (WTP) for 5 different strategies for improving the management of malaria in Enugu State, southeast Nigeria were elicited from randomly selected respondents. The results showed that the people were also willing to pay for improved management of malaria, though the levels of WTP was dependent on the SES of the respondents, with the poorest SES group willing to pay the least amount of money. Also, the respondents generally mostly preferred timely and appropriate management of malaria through formal public healthcare system. Hence, to decrease the inequity in malaria management and ensure the ready availability of appropriate treatment to the poorest households, the government should increase the availability and accessibility of publicly owned healthcare services, complemented by community-based health services.     

Attitudes,beliefs and social norms regarding infant and young child feeding among Nigerian mothers,fathers and grandmothers across time

Infant and young child feeding (IYCF) interventions in low-resource countries mainly target pregnant women and mothers of young children; however, fathers and grandmothers also influence IYCF practices. We conducted focus group discussions with mothers, fathers and grandmothers of young children across three time points in areas where an IYCF social and behaviour change intervention was implemented in Nigeria to explore differences by participant type and shifts over time in attitudes, beliefs and social norms related to breastfeeding and dietary diversity (DD). Overall, across time points, we found more discrepancies in attitudes, beliefs and social norms for early initiation of breastfeeding (EIBF) and exclusive breastfeeding (EBF) among different participant types than for DD. Although most participants agreed EIBF and EBF are good practices, mothers believed this more strongly than fathers and grandmothers; however, at endline, a shift towards acceptance of EIBF and EBF appeared among fathers and grandmothers. Across time points, all participant types acknowledged the nutritional and health benefits of green leafy vegetables and animal-source foods but described various barriers to feeding them to children. Across time points, all participant types also highlighted the importance of health workers and antenatal visits as important sources of IYCF knowledge and facilitators to following recommended practices. Insights from this study highlight the importance of including key influencers of IYCF practices in qualitative research.     

Laparoscopic excision of an extra-biliary gallbladder duplication cyst in a 9-month-old infant

Duplication of the gallbladder is a rare congenital anomaly of the biliary system. We herein present a case of a 9-month-old full-term female with a prenatally identified gallbladder duplication cyst managed via laparoscopic excision.Key words: Gallbladder duplication, paediatric laparoscopy, prenatal diagnosis     

Humoral and Mucosal Antibody Response to RSV Structural Proteins in RSV-Infected Adult Hematopoietic Cell Transplant (HCT) Recipients

Respiratory syncytial virus (RSV) is an important cause of lower respiratory tract infection in infants, the elderly, and immunocompromised patients. RSV antibodies play a role in preventing reinfection and in clearance of RSV, but data regarding the levels of viral protein-specific antibodies elicited and their contribution to patient recovery from RSV-induced disease are limited. We prospectively enrolled a cohort of RSV-infected adult hematopoietic cell transplant (HCT) recipients (n = 40). Serum and nasal-wash samples were obtained at enrollment (acute samples) and convalescence (convalescent samples). We measured (1) humoral IgG and mucosal IgA binding antibody levels to multiple RSV proteins (F, G, N, P, and M2-1) by Western blot (WB); (2) neutralizing antibody (Nt Ab) titers by microneutralization assay; and (3) palivizumab-like antibody (PLA) concentrations by an ELISA-based competitive binding assay developed in the lab. Finally, we tested for correlations between protein-specific antibody levels and duration of viral shedding (normal: cleared in <14 days and delayed: cleared ≥14 days), as well as RSV/A and RSV/B subtypes. Convalescent sera from HCT recipients had significantly higher levels of anti-RSV antibodies to all 5 RSV structural proteins assayed (G, F, N, P, M2-1), higher Nt Abs to both RSV subtypes, and higher serum PLAs than at enrollment. Significantly higher levels of mucosal antibodies to 3 RSV structural proteins (G, N, and M2-1) were observed in the convalescent nasal wash versus acute nasal wash. Normal viral clearance group had significantly higher levels of serum IgG antibodies to F, N, and P viral proteins, higher Nt Ab to both RSV subtypes, and higher PLA, as well as higher levels of mucosal IgA antibodies to G and M2-1 viral proteins, and higher Nt Ab to both RSV subtypes compared to delayed viral clearance group. Normal RSV clearance was associated with higher IgG serum antibody levels to F and P viral proteins, and PLAs in convalescent serum (p < 0.05). Finally, overall antibody levels in RSV/A- and/B-infected HCT recipients were not significantly different. In summary, specific humoral and mucosal RSV antibodies are associated with viral clearance in HCT recipients naturally infected with RSV. In contrast to the humoral response, the F surface glycoprotein was not a major target of mucosal immunity. Our findings have implications for antigen selection in the development of RSV vaccines.     

Satisfaction of HIV patients with pharmaceutical services in South Eastern Nigerian hospitals

Background Pharmacists play an important role in the care of HIV patients especially by providing pharmaceutical care. Thus it is imperative to assess the experience and satisfaction of HIV patients with the pharmaceutical services they receive as this will ensure that quality care is provided. Objective The objective of this study was to assess HIV-infected patients’ satisfaction with pharmaceutical services provided in South-Eastern Nigeria’s HIV/AIDS clinics. A secondary aim was to repeat the validation process in order to confirm the initial validation of ‘Patient Satisfaction with Pharmaceutical Service’ (PSPS) questionnaire. Methods The survey was conducted in six HIV/AIDS clinics in South-Eastern Nigeria. Multi-stage sampling technique was used to select the clinics. The level of satisfaction of the participants was determined. Variance in satisfaction score among the different demographic variables was also assessed. Re-validation techniques employed include factor analysis, reliability test, and construct validity. Results The response rate was 81.85 % (1,637 patients). With the exception of item 12 which examined provision of written information by pharmacists, the average score obtained in the survey was high. Most of the average scores ranged from 4 to 5, signifying that responses ranged from agree to strongly agree. Re-validation of the PSPS questionnaire revealed the same result obtained in the original validation exercise. Conclusion HIV patients were highly satisfied with services rendered by the pharmacists in South-Eastern HIV clinics in Nigeria and PSPS proved to be a reliable and valid instrument for measuring satisfaction of HIV patients with pharmaceutical services.