Feeding practices in public hospitals’ neonatal intensive care units: An exploration into the ways in which COVID-19 affected the best practice in Gauteng

BackgroundSouth Africa’s healthcare system has a multitude of pre-existing challenges prior to the onset of the coronavirus disease 2019 (COVID-19) pandemic, ranging from reduced number of staff, lack of resources and units being at overcapacity both in the adult and paediatric populations. The neonatal intensive care units (NICUs) require a team approach to ensure best practice with vulnerable infants, but little is known about how the onset of the COVID-19 pandemic and the resultant lockdown restrictions impacted the feeding practices within the NICU.ObjectivesThis study aimed to explore the impact that COVID-19 had on the feeding practices within the NICU settings in public hospitals in Gauteng.MethodsA qualitative design was employed with data collected in two NICUs in Gauteng. Data were collected in the form of observations and semi-structured interviews with healthcare workers (HCWs) in the NICU. Data were analysed using inductive thematic analysis.ResultsAlthough the sample size of participants was limited, social distancing proved to be a challenge resulting in mothers and healthcare workers being given restricted access. This had effects on the ability to provide adequate feeding practices and resulted in anxiety for the mothers and mental health challenges for the HCWs when feeding these at-risk infants. A limitation of this study was the use of only two sites.ConclusionCOVID-19 amplified the existing challenges in the NICU. A multidisciplinary and family-centred approach to address feeding challenges is required to offset the challenges resulting from the pandemic and subsequent lockdown.     

Noreupenifeldin, a tropolone from an unidentified ascomycete

Noreupenifeldin ( 2), a new monotropolone derivative of the bistropolone eupenifeldin ( 1), was isolated from an unidentified ascomycete by bioassay-guided fractionation as part of our search for new anthelmintics. The structure of 1 was confirmed by comparison with literature data. The structure of 2 was elucidated from MS and 1D and 2D NMR data. Compounds 1 and 2 are diastereomers of pycnidione ( 3) and epolone A ( 4), respectively. Compounds 1- 3 were evaluated for their anthelmintic activity against the parasitic worm Hemonchus contortus. Compounds 1 and 3 exhibited modest in vitro activity, showing EC 90 50 and 83 microg/mL, respectively, in reducing motility of L3 larvae of H. contortus. Compound 2 was inactive, indicating that the second tropolone moiety is required for activity.     

The extensive sexual violation and sexual abuse histories of incarcerated women

A growing body of research reports on the lifetime prevalence of sexual victimization experiences among incarcerated women. However, none of this research provides a detailed account of the many types and levels of sexual violations and sexual abuses, the age of occurrence, and the victim-offender relationship. This study used the Sexual Abuse Checklist (designed by the first author) and a modified version of the Sexual Experiences Survey (SES) to obtain a detailed account of 391 incarcerated women's self-reported sexual violation and abuse histories. Seventy percent of the women reported at least one violation consistent with what qualifies as "rape" in most states in the United States today, and half of the women reported child sexual abuse victimization. The most prevalent victim-offender relationships were male strangers, male lovers or boyfriends, male dates, husbands, uncles, brothers, male cousins, and stepfathers.     

Implementing an oral health program in a group prenatal practice

The Rochester Adolescent Maternity Program (RAMP) has incorporated evidence-based oral health guidelines into its prenatal care. These guidelines focus on tracking oral health services, screening and triaging prenatal patients, and providing patient and staff with the education needed to decrease oral health risks to mother, fetus, and baby. The RAMP process serves as a model for promoting quality oral health practices in pregnant teenagers and their babies.     

Donating eggs for research--should the HFEA reconsider its policy on payments to egg donors?

The Human Fertilisation and Embryology Authority (HFEA) policy on payments to egg donors states that an 'expense neutral' approach is to be adopted, regardless of whether the donation is for treatment or research purposes. In this article the HFEA case against compensatory payments for egg donors will be examined as will the expectation that women should donate eggs for medical research without the offer of financial recompense. This will be shown to sit uneasily alongside existing policy that both permits indirect payments by way of egg-sharing schemes and allows healthy participants in research trials to receive financial remuneration for their contribution to medical science. It will be concluded that the HFEA should reconsider its policy on paying women to donate eggs for medical research.     

Effect of the COVID-19 pandemic on ST-elevation myocardial infarction presentation and survival

Presentation and outcomes of patients with ST-elevation myocardial infarction (STEMI) may change during viral pandemics. We compared symptom-tocall (STC), call-to-balloon (CTB), doorto-balloon (DTB) times; high-sensitivity troponin (hs-cTnI) levels; and survival of patients (n=39) during the first wave of the COVID-19 pandemic (defined as a ‘COVID period’ starting four weeks before lockdown) to historical controls from a ‘pre-COVID period’ (n=45).STEMI admissions fell one week before lockdown by 29%. Median STC times began to rise one month before lockdown (54 vs. 25 min, p=0.06), with peak increases between 9 March and 5 April (166 vs. 59 min, p=0.04). Median CTB and DTB times were unchanged. Mean peak hs-cTnI increased during COVID-19 (15,225 vs. 8,852 ng/ml, p=0.004). Six-month survival following all STEMI reduced (82.1% vs. 95.6%, p<0.05).STC times are the earliest indicator that STEMI-patient behaviour changed four weeks before lockdown, correlating with higher troponin levels and reduced survival. These early signals could guide public health interventions during future pandemics.Key words: COVID-19, outcomes, percutaneous coronary intervention (PCI), ST-elevation myocardial infarction (STEMI)     

Differential Effects of Dietary versus Exercise Intervention on Intrahepatic MAIT Cells and Histological Features of NAFLD

Background: Mucosal-associated invariant T (MAIT) cells promote inflammation in obesity and are implicated in the progression of non-alcoholic fatty liver disease (NAFLD). However, as the intrahepatic MAIT cell response to lifestyle intervention in NAFLD has not been investigated, this work aimed to examine circulating and intrahepatic MAIT cell populations in patients with NAFLD, after either 12 weeks of dietary intervention (DI) or aerobic exercise intervention (EI). Methods: Multicolour flow cytometry was used to immunophenotype circulating and intrahepatic MAIT cells and measure MAIT cell expression (median fluorescence intensity, MFI) of the activation marker CD69 and apoptotic marker CD95. Liver histology, clinical parameters, and MAIT cell populations were assessed at baseline (T0) and following completion (T1) of DI or EI. Results: Forty-five patients completed the study. DI participants showed decreased median (interquartile range) expression of the activation marker CD69 on circulating MAIT cells (T0: 104 (134) versus T1 27 (114) MFI; p = 0.0353) and improvements in histological steatosis grade post-intervention. EI participants showed increased expression of the apoptotic marker CD95, both in circulating (T0: 1549 (888) versus T1: 2563 (1371) MFI; p = 0.0043) and intrahepatic MAIT cells (T0: 2724 (862) versus T1: 3117 (1622) MFI; p = 0.0269). Moreover, the percentage of intrahepatic MAIT cells significantly decreased after EI (T0: 11.1 (14.4) versus T1: 5.3 (9.3)%; p = 0.0029), in conjunction with significant improvements in fibrosis stage and hepatocyte ballooning. Conclusions: These data demonstrate independent benefits from dietary and exercise intervention and suggest a role for intrahepatic MAIT cells in the observed histological improvements in NAFLD.     

Effects of an Amino Acid-Based Formula Supplemented with Two Human Milk Oligosaccharides on Growth,Tolerability, Safety,and Gut Microbiome in Infants with Cow’s Milk Protein Allergy

This open-label, non-randomized, multicenter trial (Registration: {"type":"clinical-trial","attrs":{"text":"NCT 03661736","term_id":"NCT03661736"}}NCT 03661736) aimed to assess if an amino acid-based formula (AAF) supplemented with two human milk oligosaccharides (HMO) supports normal growth and is well tolerated in infants with a cow’s milk protein allergy (CMPA). Term infants aged 1–8 months with moderate-to-severe CMPA were enrolled. The study formula was an AAF supplemented with 2′-fucosyllactose (2′-FL) and lacto-N-neotetraose (LNnT). Infants were fed the study formula for 4 months and were offered to remain on the formula until 12 months of age. Tolerance and safety were assessed throughout the trial. Out of 32 infants (mean age 18.6 weeks; 20 (62.5%) male), 29 completed the trial. During the 4-month principal study period, the mean weight-for-age Z score (WAZ) increased from –0.31 at the baseline to +0.28 at the 4-months’ follow-up. Linear and head growth also progressed along the WHO child growth reference, with a similar small upward trend. The formula was well tolerated and had an excellent safety profile. When comparing the microbiome at the baseline to the subsequent visits, there was a significant on-treatment enrichment in HMO-utilizing bifidobacteria, which was associated with a significant increase in fecal short-chain fatty acids. In addition, we observed a significant reduction in the abundance of fecal Proteobacteria, suggesting that the HMO-supplemented study formula partially corrected the gut microbial dysbiosis in infants with CMPA.