Effect of targeted food supplementation and services in the Bangladesh Integrated Nutrition Project on women and their pregnancy outcomes

Monitoring data from the Bangladesh Integrated Nutrition Project and new data collected for this purpose were analyzed to assess the effects of targeted project services, including supplementation of food, on malnourished pregnant women (women with a body mass index [BMI] of < or = 18.5 in early pregnancy). Monitoring data on 456 women--195 receiving food supplement and 261 not receiving supplement--were collected from 17 upazilas (sub-districts) in four districts of Bangladesh. The assessment found that, despite lower economic status, the women with low BMI receiving supplementation of food and intensified services were more likely to have adequate pregnancy-related weight gain than the more economically-advantaged women with higher BMI. Primigravidae receiving supplementation were also more likely to have adequate pregnancy-related weight gain than the better-off non-supplemented primigravidae (85.7% vs 51.9%, p = 0.044). The mean birth-weights of infants of the supplemented women with low BMI were comparable to those of the better-off, non-supplemented women.     

Non-specific effect of measles vaccination on overall child mortality in an area of rural India with high vaccination coverage: a population-based case-control study

OBJECTIVE: To determine whether vaccination against measles in a population with sustained high vaccination coverage and relatively low child mortality reduces overall child mortality. METHODS: In April and May 2000, a population-based, case-control study was conducted at Ballabgarh (an area in rural northern India). Eligible cases were 330 children born between 1 January 1991 and 31 December 1998 who died aged 12-59 months. A programme was used to match 320 controls for age, sex, family size, and area of residence from a birth cohort of 15 578 born during the same time period. FINDINGS: The analysis used 318 matched pairs and suggested that children aged 12-59 months who did not receive measles vaccination in infancy were three times more likely to die than those vaccinated against measles. Children from lower caste households who were not vaccinated in infancy had the highest risk of mortality (odds ratio, 8.9). A 27% increase in child mortality was attributable to failure to vaccinate against measles in the study population. CONCLUSION: Measles vaccine seems to have a non-specific reducing effect on overall child mortality in this population. If true, children in lower castes may reap the greatest gains in survival. The findings should be interpreted with caution because the nutritional status of the children was not recorded and may be a residual confounder. "All-cause mortality" is a potentially useful epidemiological endpoint for future vaccine trials.     

Osteofibrous dysplasia: a review of the literature and presentation of an additional 3 cases

Osteofibrous dysplasia is a rare fibro-osseous lesion of uncertain etiology that occurs exclusively in the pediatric population. Diagnosis and treatment are complicated by the fact that osteofibrous dysplasia can resemble monostotic fibrous dysplasia and adamantinoma of long bones grossly and microscopically and that it tends to recur if surgical intervention is performed before skeletal maturity is reached. We present 3 cases of this lesion seen at our institution and provide a review of all previous cases reported in the literature.     

Hepatobiliary dysfunction as the initial manifestation of disseminated cryptococcosis

A case of hepatobiliary dysfunction as the initial manifestation of disseminated cryptococcosis is described. The patient was admitted with symptoms of hepatitis with cholestatic jaundice. Antibody tests for hepatitis B and C and human immunodeficiency virus were negative. The patient continued to deteriorate clinically. Eventually, the patient succumbed to hepatic failure. Autopsy disclosed systemic cryptococcosis that caused extensive necrosis of the liver. In review of the literature, only nine cases of cryptococcal infection presenting as hepatitis, cholangitis, and cholecystitis as initial manifestation were reported. Four of these patients had been subjected to exploratory laparotomy for clinical suspicion of acute abdomen. One patient developed cirrhosis as a result of cryptococcal hepatitis. Two patients succumbed to hepatic failure. Cryptococcosis is known to occur commonly in immunocompromised patients, yet only two reported cases presenting as hepatitis were associated with immunocompromised status.     

Role of action potential shortening in the prevention of arrhythmias in canine cardiac tissue

1. The effects of the K+ channel opener diazoxide and the oxime-containing Ca2+ and K+ channel blocker salicylaldoxime were tested in canine cardiac Purkinje tissue. 2. Both drugs shortened action potential duration (APD). For salicylaldoxime (0.1-1.0 mmol/L), the reductions in APD were statistically significant at the 25% level of repolarization (APD25) for 0.1 mmol/L (P < 0.05, n = 14) and 0.5 and 1.0 mmol/L (P < 0.01, n = 6), at the 50% level of repolarization (APD50) for 0.1 mmol/L (P < 0.05, n = 14) and 0.5 and 1.0 mmol/L (P < 0.01, n = 6) and at the 90% level of repolarization (APD90) for 0.5 and 1.0 mmol/L (P < 0.01, n = 6). In contrast, diazoxide (0.05-0.1 mmol/L) significantly shortened APD at all levels of repolarizations, with the APD50 and APD90 reduced most significantly (P < 0.01, n = 6) for higher concentrations of the drug (0.07-0.1 mmol/L). Both drugs significantly reduced the force of contraction. 3. Diazoxide (10 experiments) was more potent in suppressing strophanthidin-induced arrhythmias than salicylaldoxime (three of seven experiments). Salicylaldoxime reduced APD even further in the presence of diazoxide. 4. Although salicylaldoxime and diazoxide modulate different ion channels, it appears APD shortening may be a necessary, but insufficient, factor for the suppression of strophanthidin-induced arrhythmias.     

Trend of Changes in Serum Albumin and Its Relation with Sex,Age, and BMI Following Laparoscopic Mini-gastric Bypass Surgery in Morbid Obese Cases

Background

The aim of this study is to investigate the pattern of changes in serum albumin level after mini-gastric bypass (MGB) and its association with gender, age, and body mass index (BMI) of the patients.

Methods

This cohort study was conducted on 196 morbidly obese patients undergoing MGB followed for 1 year. The data on BMI, serum albumin level, demographic, anthropometric, biochemical variables and comorbidities were gathered before and after (3, 6, and 12 months) surgery. The trend of changes in BMI and serum albumin of the patients was investigated by repeated measures tests using general linear model (GLM) and generalized estimating equations (GEE) approaches.

Results

The mean age, baseline median BMI, and albumin of the patients were 41.34 ± 11.03 years, 44.54 kg/m², and 4.00 g/dl, respectively. There was a chronologically significant trend of decline in BMI (P < 0.001). GEE demonstrated no chronologically significant trend in serum albumin (P = 0.278). The trend of changes in albumin was significantly associated only with age grouping and baseline serum albumin level (P = 0.017 and 0.001, respectively). This trend had fluctuations in patients older than 40 years with baseline serum albumin level of 3.50–3.90 g/dl. For patients with any age and baseline serum albumin level of 4.00–4.90 g/dl, this trend was stable in all periods of follow-up.

Conclusion

MGB is an effective technique to lose weight. The trend of changes in serum albumin level was affected by its baseline levels and age.

     

Influence of sociocultural and structural factors on functional ability: the case of elderly people in Bangladesh

OBJECTIVE. To describe and contextualize functional status of elderly people (greater or lesser than 60 years) in Bangladesh by relating it to gender, region, and socioeconomic status. METHODS. In this community-based study (N = 696), functional status was described through assessment of activities of daily living (ADL) and instrumental activities of daily living (IADL). Information was obtained on type of help used for ADLs and IADLs and reason for nonperformance of IADLs. RESULTS. Findings indicate differential performance in ADLs and IADLs by gender and region. Socioeconomic status is found to influence IADLs only. Empirical evidence regarding type of help used and reason for not performing a task enables understanding of sociocultural and structural influence on functional ability. DISCUSSION. The underlying assumption of ADL and IADL instruments that an individual will perform an activity given physical or cognitive ability is questioned. It is suggested that sociocultural and structural factors are strong determinants of task performance.     

Distribution and spread of colonic lesions in shigellosis: a colonoscopic study

In a study of the distribution and severity of colonic lesions in patients with shigellosis, colonoscopy was performed for 33 men with this disease. All 33 patients had inflammatory lesions in the rectosigmoid area; in 18 (55%) the lesions extended to the splenic flexure, in 14 (42%) the disease extended to the distal transverse colon, in nine (27%) the area of involvement included the proximal transverse colon, and in five (15%) pancolitis was evident. In most patients lesions were continuous and diffuse, with the intensity of inflammation decreasing in a proximal direction. Biopsied samples from proximal lesions usually showed less severe inflammation than did those from more distal lesions. Aphthoid erosions, which have not previously been described in shigellosis, were observed in five patients. Proximal colitis was associated with diarrhea of four or more days' duration (P less than .01, Fisher's exact test). These findings indicate that the rectosigmoid is the most frequently and most severely affected area of the colon in shigellosis and suggest that during the course of shigella infection, colonic lesions extend in a proximal direction.