Vitamin K to Neonates: Peroral versus Intramuscular Administration

ABSTRACT. In a randomized study of 300 infants, the effect of 1 mg of peroral vitamin K given at birth was compared to the same dose given as an intramuscular injection. The combined activity of coagulation factor II + VII + X taken after 48 and before 72 hours after delivery served as the primary endpoint. Prothrombin (antigen) and PIVKA II (acarboxyprothrombin) were also measured. All infants were observed for events of bleeding until discharge from the hospital, normally on the fifth day. No significant differences between the groups in any of the biochemical markers were observed. The 95% confidence limits of the differences were very narrow for all factors. No cases of bleeding were observed. We conclude that administration of 1 mg peroral vitamin K is as efficient as intramuscular administration of the same dose in the prevention of classical hemorrhagic disease of the newborn.     

Enzyme Replacement Therapy for Murine Hypophosphatasia

Introduction: Hypophosphatasia (HPP) is the inborn error of metabolism that features rickets or osteomalacia caused by loss‐of‐function mutation(s) within the gene that encodes the tissue‐nonspecific isozyme of alkaline phosphatase (TNALP). Consequently, natural substrates for this ectoenzyme accumulate extracellulary including inorganic pyrophosphate (PP_i), an inhibitor of mineralization, and pyridoxal 5′‐phosphate (PLP), a co‐factor form of vitamin B₆. Babies with the infantile form of HPP often die with severe rickets and sometimes hypercalcemia and vitamin B₆‐dependent seizures. There is no established medical treatment. Materials and Methods: Human TNALP was bioengineered with the C terminus extended by the Fc region of human IgG for one‐step purification and a deca‐aspartate sequence (D₁₀) for targeting to mineralizing tissue (sALP‐FcD₁₀). TNALP‐null mice (Akp2^?/?), an excellent model for infantile HPP, were treated from birth using sALP‐FcD₁₀. Short‐term and long‐term efficacy studies consisted of once daily subcutaneous injections of 1, 2, or 8.2 mg/kg sALP‐FcD₁₀ for 15, 19, and 15 or 52 days, respectively. We assessed survival and growth rates, circulating levels of sALP‐FcD₁₀ activity, calcium, PP_i, and pyridoxal, as well as skeletal and dental manifestations using radiography, μCT, and histomorphometry. Results: Akp2^?/? mice receiving high‐dose sALP‐FcD₁₀ grew normally and appeared well without skeletal or dental disease or epilepsy. Plasma calcium, PP_i, and pyridoxal concentrations remained in their normal ranges. We found no evidence of significant skeletal or dental disease. Conclusions: Enzyme replacement using a bone‐targeted, recombinant form of human TNALP prevents infantile HPP in Akp2^?/? mice.     

Hais cuaj txub kaum txub—To Speak of All Things: A Hmong Cross-cultural Case Study

Cross-cultural medicine is a field that describes how disparate value and belief systems concerning health and disease affect the delivery of health care. This report describes the conflict between a Hmong immigrant family and the Western medical establishment over the care of their child with end stage renal disease [ESRD]. The health care providers, social service agencies and medical center failed to adequately respond to the needs of the family. The medical staff [nephrologist, nurse coordinator, dietician, social worker, and CPS worker] worked with a transcultural nurse, Hmong community health worker and the family, to design and negotiate a treatment plan that would be acceptable to the family and the health care team. Trust was reestablished between the family and the healthcare providers and the medical outcome for the child improved.     

The health care information directive

Background  

Developments in information technology promise to revolutionise the delivery of health care by providing access to data in a timely and efficient way. Information technology also raises several important concerns about the confidentiality and privacy of health data. New and existing legislation in Europe and North America may make access to patient level data difficult with consequent impact on research and health surveillance. Although research is being conducted on technical solutions to protect the privacy of personal health information, there is very little research on ways to improve individuals power over their health information. This paper proposes a health care information directive, analogous to an advance directive, to facilitate choices regarding health information disclosure.     

Daily mercury intake in fish-eating populations in the Brazilian Amazon

Although high levels of fish consumption and bioindicators of mercury exposure have been reported for traditional populations in the Amazon, little is known about their actual daily intake of Hg. Using an ecosystem approach, calculate daily mercury intake in adult fish-eaters, examine the relations between mercury intake and bioindicators of exposure and the factors that influence these relations. A cross-sectional dietary survey on fish and fruit consumption frequency was carried out with 256 persons from six villages of the Tapajós River. Fish portion per meal was determined. Mercury concentration was determined for 1123 local fish specimens. Daily mercury intake (microg/kg/day) was determined for men and women from each village using the average fish-mercury concentration for the fish caught in their fishing zone, the average quantity of fish per meal, fish-species frequency consumption and participants' body weight. Fish-mercury averaged 0.33 microg/g+/-0.33. Daily mercury intake varied between 0 and 11.8 microg/kg/day (mean 0.92 microg/kg/day+/-0.89) and varied by gender and village. Mean blood- and hair-mercury were 58.7+/-36.1 microg/l and 17.9+/-11.5 microg/g, respectively. There was a strong and positive relation between blood-mercury and daily mercury intake, with an inverse relation for fruit intake and schooling; significant variations were observed with immigrant status, and among villages. Hair-mercury was directly associated with daily mercury intake and inversely related to schooling and fruit consumption. Fruit consumption modified the relation between daily mercury intake and blood-mercury levels: for the same daily mercury intake, persons eating more fruit had lower blood-mercury concentrations (ANCOVA Interaction term: F=10.9, P<0.0001). The median difference of the ratio of blood-mercury to daily mercury intake between low and high fruit consumers was 26, representing a 26.3% reduction. These findings reveal high levels of daily mercury intake. Rigorous studies for developing risk-based reference doses in the Amazon should be undertaken to orient viable risk-management strategies to reduce exposure, while maintaining fish diet.