A prophylactic transfusion program for children with sickle cell anemia complicated by CNS infarction

CNS infarction is a devastating complication in sickle cell anemia. Episodes are frequently repetitive and often result in permanent neurologic abnormalities. In an attempt to prevent such recurences a periodic transfusion program was begun at the Children's Hospital of Michigan in 1969. Twenty-one children currently on the program receive buffy-coat poor transfusions on an out-patient basis every 3 weeks. Of 15 who have been on the program for periods of from 9 months to 5 ¾ years, none have had progression of neurologic abnormalities, and several have had definite improvement in neurologic function. One child who was not brought in regularly had recurrent CNS infarction. The only recognized complication has been one instance of serum hepatitis. While such a transfusion of neurologic abnormalities resulting from recurrent CNS infarction in sickle cell anemia.     

Elastase in gingival crevicular fluid from smokers and non-smokers with chronic inflammatory periodontal disease

OBJECTIVE: To compare elastase concentrations in gingival crevicular fluid (GCF) from individual sites of smokers and non-smokers.
MATERIALS AND METHODS: Twelve pairs of smokers and non-smokers with untreated, moderate to advanced chronic inflammatory periodontal disease were matched for gender, age, ethnicity and the clinical and radio-graphic extent of disease. Durapore filter strip samples were collected over 30 s from two mesiopalatal sites on upper left posterior teeth. Samples were analysed for: I) polymorphonuclear neutrophil leucocyte (PMNL) cell counts; 2) PMNL elastase-αI-antitrypsin complex in the GCF supernatant by ELISA; and 3) functional elastase, free or bound to α2-macroglobulin, estimated from activity against N-tert-butoxycarbonyI-alanyl-prolyl-nor-valylg-chlorothiobenzyl ester in supernatant and lysates of GCF PMNLs.
RESULTS: There were no differences in disease parameters between groups except that bleeding on probing was less extensive in smokers (P< 0.001). Cell counts and elastase content of crevicular PMNLs showed no differences between groups. Lower concentrations of elastase were found in GCF supernatants from smokers than non-smokers. This difference was observed for functional elastase (mean [s.d.] = 30.21 [17.60] against 73.77 [75.26] ng μI^-1, P <0.05) and elastase complexed with αl-antitrypsin (8.97 [6.54] ng μl^-1 against 25.71 [22.07] ng μI^-1, P < 0.001).
CONCLUSIONS: Smokers have lower elastase concentrations in GCF than non-smokers. Further investigation is required to elucidate the underlying cause and its relationship with periodontal disease.     

The therapeutic and prophylactic role of oral zinc sulfate in management of recurrent aphthous stomatitis (ras) in comparison with dapsone

OBJECTIVE: To evaluate the therapeutic and prophylactic effectiveness of oral zinc sulfate in recurrent aphthous stomatitis (RAS) in comparison with dapsone. METHODS: A double-blind placebo controlled study, conducted in the Department of Dermatology, Baghdad Teaching Hospitals, Baghdad, Iraq between May 2005 and October 2006, in which 45 patients with RAS were recruited and divided into 3 equal groups: group A (on zinc sulfate 150 mg twice daily), group B (on dapsone 50 mg twice daily), and group C (on glucose 250 mg as placebo). The drugs were prepared in identical capsules, and the patients were instructed to take the capsules twice daily after meals (in a double-blind manner). Assessment of each patient was carried out by the Oral Clinical Manifestation Index (OCMI) and the diameter of the ulcers at day 0, day 4, and at the second, fourth, sixth, eighth, tenth, and twelfth weeks of therapy. RESULTS: Forty-five patients were included in the study (25 males and 20 females), and their ages ranged between 16-45 years (mean+/-SD 31.24+/-8.14). In group A, the mean of OCMI and diameter of ulcers improved, with a p=0.0001 for OCMI, and 0.0001 for the diameter for ulcers at the end of the twelfth week of therapy, which was statistically significant. Group B, also showed significant improvement, however, the action was lower and slower (p=0.0001 for OCMI, and 0.001 for the diameter for ulcers). Group C revealed slight non-significant improvement (p=0.028 for OCMI, and 0.034 for the diameter of ulcers). In the sixth week of therapy, zinc sulfate was more effective than dapsone in reducing the OCMI of the ulcers (p=0.007). CONCLUSION: The present study showed that both zinc sulfate and dapsone had significant therapeutic and prophylactic effects in controlling RAS, however, zinc sulfate had much more rapid and sustained action.     

Evaluation of zearalenone and alpha-zearalenol toxicity on boar sperm DNA integrity

This study aimed at investigating the in vitro effects of zearalenone (zen) and alpha-zearalenol (alpha-zen) on motility and nuclear chromatin integrity (NCI) of boar spermatozoa. Mycotoxins were tested, at levels ranging from 10 to 30 microg ml(-1) of diluted semen. Four boars were used for semen collection (eight replicates per boar, four per mycotoxin). After the addition of zen or alpha-zen, semen samples were incubated for 4 h at 38.5 degrees C, 5% CO(2) and 96% humidified air. Motility and NCI were assessed at 0 and 4 h of incubation. No significant differences were noticed in motility among the experimental groups (P > 0.05) for all tested boars. Chromatin instability was significantly higher (P < 0.05) in spermatozoa of only one boar treated with zen and alpha-zen independently of the dose. In conclusion, under our experimental conditions, zen and alpha-zen did not affect the motility of boar sperm, whereas the effects of these toxins on sperm NCI were individual-dependent.     

Impact of an educational program based on evidence related to Fever management

Quality care is dependent on best evidence. Children's nurses are no exception to this and their philosophy of "the child first and always" will ensure that their evidence base for practice is commensurate with stance. For this reason, this study was conducted to assess the impact of an educational program based on evidence related to fever management on nurses' evidence-based knowledge and reported practices. An Educational program based on evidence was designed according to nurses' needs and new evidence findings in fever management. Results of the study showed that at the pre program phase, nurses had lower level of evidence-based knowledge than at the first follow-up. Their means of knowledge scores related to fever, measuring temperature, nursing management, administration of antipyretics and documentation were 3.69 vs 8.00, 5.06 vs 7.49, 3.99 vs 6.94, 4.07 vs 7.33 and 6.81 vs 9.76 respectively. Also, there was no statistical significant difference between level of evidence-based knowledge for nurses at the first and second follow-ups. It was concluded that an educational program based on evidence promotes the quality of nursing care in fever management.     

Impact of supplemental feeding on pain in neonatal intensive care unit

Neonates can't report pain for a variety of reasons. Therefore, behavioral changes and physiological changes such as heart and respiratory rates, facial expression, reduction in crying, position in bed, activity and consolability were used to assess pain for 60 newborns (30 experimental and 30 control). Neonates in the experimental group were provided supplemental feeding during painful procedures. Meanwhile, neonates in the control group were not provided any feeding while painful procedures were carried up by nurses. Results showed greater reductions in means heart rate (143.0 vs 158.2 b/m), respiratory rate (43.4 vs 61.2 c/m)and scores of observational checklist (2.3 vs 5.0) between newborns in the experimental group than in the control group. Therefore, it was concluded that supplemental feeding should be provided during painful procedures because it provides some form of pain reduction during painful procedures.