Promoting safe infant feeding practices – the importance of structural,social and contextual factors in Southern Africa

There has been significant progress towards the goal of eliminating vertical transmission of HIV by 2015. However, a question that remains is how we can most effectively prevent late postnatal transmission of HIV through infant feeding. Guidelines published by the World Health Organization in 2010 have been widely adopted. These guidelines place strong emphasis on exclusive breastfeeding, in some countries over‐turning a prior emphasis on formula feeding. Where available, provision of antiretroviral treatment for HIV‐positive mothers or prophylaxis for infants offers additional protection against vertical transmission through infant feeding. However, merely changing guidelines is not sufficient to change practice, particularly with regard to culturally sanctioned forms of feeding, such as mixed feeding. This commentary highlights structural, social and contextual barriers to effective implementation of the guidelines and suggests ways to address some of these barriers.     

High-dose cytosine arabinoside and daunorubicin as consolidation therapy for acute nonlymphocytic leukemia in first remission: a pilot study

High-dose (HD) cytosine arabinoside (ARA-C) is more effective treatment than conventional-dose ARA-C regimens for patients with relapsed acute nonlymphocytic leukemia (ANLL). We report here that HD ARA-C given during the first remission of ANLL has resulted in long remission durations and a high proportion of patients who survive more than three years free of disease. From August 1979 to September 1983, 36 adult patients with ANLL in first remission received one to three courses of HD ARA-C (3 g/m2 by one-hour infusion every 12 hours for 12 doses on days 1 through 6) alone or with daunorubicin (30 mg/m2 for two or three doses on days 7 through 9). Three patients died of sepsis or hemorrhage during consolidation, and 14 patients have relapsed from five to 48 months after diagnosis. The remaining 19 patients are in continued complete remission (CCR) from 11 to 62 months. Denoting all deaths in remission as relapse, the actuarial probability of CCR is 42% at 62 months, with an apparent plateau in the survival curve. Of the first 22 patients treated, ten remain in CCR from 37 to 62 months with no therapy for at least three years. Due to its heightened anti-leukemic activity, HD ARA-C allows brief but effective consolidation of ANLL in first remission, with long-term disease-free survival comparable to other approaches.     

Studies on the central and peripheral dopaminergic control of PRL secretion in man: failure to demonstrate the existence of a dopamine-mediated prolactin-inhibiting factor

The existence of a putative central prolactin-inhibiting factor (PIF) distinct from dopamine (DA) but dependent on DA mechanisms for release has been suggested from recent animal studies. We investigated the possibility of the existence of such a PIF in man by combining the use of monoiodotyrosine (MIT), an inhibitor of central DA synthesis, domperidone, a DA receptor antagonist that does not enter the blood-brain barrier and DA itself. 6 normal volunteers underwent three sets of studies: (1) PRL stimulation test to 400 micrograms TRH i.v., 1 g MIT orally or 5 mg domperidone i.v., (2) peripheral DA receptor blockade study in which either domperidone, MIT or TRH was administered at 120 min during a 240-min domperidone infusion (50 micrograms/min) which was preceded by a 5-mg bolus dose of domperidone i.v. and, (3) DA infusion study in which MIT was administered at 120 min during a 240-min infusion of DA in a dose (0.5 microgram/kg X min) known to elevate peripheral DA concentration to levels reported for pituitary portal plasma. In the PRL stimulation tests, the mean +/- SE peak response was significantly greater (p less than 0.002) with domperidone (3,900 +/- 840 mIU/l) than with MIT (1,880 +/- 400 mIU/l) or TRH (2,094 +/- 450 mIU/l). In the peripheral DA receptor blockade study the initial domperidone-induced PRL response was not sustained during the domperidone infusion. Neither a second dose of domperidone nor MIT administration at 120 min resulted in a significant release of PRL.(ABSTRACT TRUNCATED AT 250 WORDS)     

Arthroscopic bone tunnel augmentation for rotator cuff repair

Transosseous repair of the rotator cuff has been shown to recreate the anatomic rotator cuff footprint in a secure and cost-efficient manner. However, the potential for sutures cutting through bone remains a concern with this strategy. Devices have been used successfully during open transosseous rotator cuff repair to augment the bone tunnels, potentially avoiding suture cut-out through the weak bone of the greater tuberosity. Recently, arthroscopic transosseous fixation of rotator cuff tears has become an alternative to arthroscopic suture anchor and open transosseous techniques. This method is expected to have the same potential pitfalls at the bone-suture interface as the open technique. The authors describe a technique for rotator cuff repair using a secure method of arthroscopic bone tunnel augmentation.     

Preoperative imaging of cervical pedicles: comparison of accuracy of oblique radiographs versus axial CT scans

In spite of concerns about safety during their insertion, cervical spine pedicle screws have demonstrated biomechanical superiority over lateral mass screws in several biomechanical studies. One of the concerns for placement of cervical pedicle screws is their small size. Preoperative planning with computed tomography to assess pedicle width has been shown to be extremely accurate and is recommended by several authors. To date there has been no study assessing the accuracy of oblique radiographs for pedicle measurement. We sought to compare accuracy of the oblique radiographic measurements of cervical pedicle width with axial CT scan measurements. Five fresh-frozen human cadaveric cervical spines C3–C7 were studied. Thin cut 1.25 mm computed tomography axial cuts were made through the pedicle isthmus. Oblique radiographs at 35°, 45°, and 55° angles were taken of the right and left pedicles of each specimen using a standardized technique. Each radiograph contained a pin of known length to correct for magnification. All pedicles were again measured and corrected for magnification using the standard pin. Corrected oblique radiograph measurements were compared to CT for each specimen. The outer pedicle width was measured and agreed upon by consensus. The radiograph measurements were on average significantly larger than CT measurements for the pedicles indicating that the pin standard did not completely correct magnification. Plain radiographic data failed to reveal that one oblique angle was favorable to another in terms of magnification or precision. Plain radiographs at oblique angles do not provide accurate measurements of subaxial cervical pedicles at 35°, 45°, or 55° angles. We recommend that thin cut axial CT scans be obtained on all patients prior to transpedicular fixation in the cervical spine. This research was supported by Evanston Northwestern Healthcare Medical Group Orthopaedic Faculty Practice Institutional funds.     

AN EPIDEMIC OF PLEURISY AMONGST MILITARY RECRUITS

An epidemic amongst recruits who presented with acute viral exudative pleural effusion with lymphocytic pleocytosis is analysed. Histologic and bacteriologic proof of tuberculosis was lacking in majority. Most of them recovered without pleural thickening. Overcrowding, inadequate clothing protection, stress and strain of vigorous recruit training could be important precipitating factors. None reported with parenchymal tuberculosis in two year follow up.KEY WORDS: Pleural effussion, Viral     

Acute myocardial ischemia: MR imaging with Mn-TP

Cardiac-gated magnetic resonance (MR) imaging was performed in rats to determine the effects of manganese ethylenediaminetetraphosphonate (TP). Ten normal rats received Mn-TP in a dose of 50 mumol/kg through a tail-vein injection. Spin-echo MR images were obtained before and every 10 minutes after Mn-TP injection for 1 hour. Cardiac signal intensity (SI) increased more than 70% after Mn-TP injection and remained nearly unchanged 1 hour after injection. Myocardial T1 was 517 +/- 49 msec in eight control rats and 282 +/- 61 msec (P less than .001) in six rats 81 +/- 0 minutes after injection. Nine rats underwent occlusion of the left anterior descending coronary artery prior to MR imaging. Images were obtained before and 15, 30, and 60 minutes after Mn-TP injection. In normal myocardium, SI increased up to 82% and remained elevated for 1 hour. In ischemic myocardium, SI rose 11%, leading to a marked contrast between the two tissue zones. T1 was also different in the two regions: In normal tissue, it was 206 msec +/- 54; in ischemic tissue, 338 +/- 82 (P less than .001). With T1-weighted MR imaging, Mn-TP showed a potential for delineating the jeopardized area after acute myocardial ischemia.     

5-Methoxy Psoralen, Etretinate, and UVA for Psoriasis

This first Australasian randomized trial of 5-methoxy psoralen (5-MOP) PUVA for psoriasis shows, conclusively, less acute side effects than 8-MOP PUVA. Daily addition of oral etretinate to the PUVA regimen (Re-PUVA) produces a valuable reduction in total joules and more so with 5-MOP than with 8-MOP. The clearing phase with 5-MOP Re-PUVA is quicker than with 8-MOP Re-PUVA in skin types 1, 2, and 3 (most Anglo-Saxon-Celtic Australians). Doses, when adapted to total body surface rather than mg/kg, allow superior control of therapy. Emollient creams, tar gels, nonsteroidal scalp applications, etc. allow more patient comfort.     

Allogeneic hematopoietic cell transplantation for metastatic breast cancer

We reviewed 66 women with poor-risk metastatic breast cancer from 15 centers to describe the efficacy of allogeneic hematopoietic cell transplantation (HCT). Median follow-up for survivors was 40 months (range, 3-64). A total of 39 patients (59%) received myeloablative and 27 (41%) reduced-intensity conditioning (RIC) regimens. More patients in the RIC group had poor pretransplant performance status (63 vs 26%, P=0.002). RIC group developed less chronic GVHD (8 vs 36% at 1 year, P=0.003). Treatment-related mortality rates were lower with RIC (7 vs 29% at 100 days, P=0.03). A total of 9 of 33 patients (27%) who underwent immune manipulation for persistent or progressive disease had disease control, suggesting a graft-vs-tumor (GVT) effect. Progression-free survival (PFS) at 1 year was 23% with myeloablative conditioning and 8% with RIC (P=0.09). Women who developed acute GVHD after an RIC regimen had lower risks of relapse or progression than those who did not (relative risk, 3.05: P=0.03), consistent with a GVT effect, but this did not affect PFS. These findings support the need for preclinical and clinical studies that facilitate targeted adoptive immunotherapy for breast cancer to explore the benefit of a GVT effect in breast cancer.