Nutritional interventions or exposures in infants and children aged up to 3 years and their effects on subsequent risk of overweight,obesity and body fat: a systematic review of systematic reviews

This study, performed as part of the international EarlyNutrition research project ( http://www.project‐earlynutrition.eu ), provides a systematic review of systematic reviews on the effects of nutritional interventions or exposures in children (up to 3 years of age) on the subsequent risk of obesity, overweight and adiposity. Electronic databases (including MEDLINE, Embase and Cochrane Library) were searched up until September 2015. Forty systematic reviews were included. A consistent association of breastfeeding with a modest reduction in the risk of later overweight and obesity in childhood and adulthood was found (the odds decreased by 13% based on high‐quality studies), but residual confounding cannot be excluded. Lowering the protein content of infant formula is a promising intervention to reduce the risk of later overweight and obesity in children. There is no consistent evidence of an association of the age of introducing complementary foods, sugar‐sweetened beverage or energy intake in early childhood with later overweight/obesity, but there are some indications of an association of protein intake during the complementary feeding period with later overweight/obesity. There was inadequate evidence to determine the effects of other nutritional interventions or exposures, including modifications of infant formula composition, fat intake or consumption of different food groups.     

Cytomegalovirus strain diversity in seropositive women

Infection and reinfection with multiple cytomegalovirus (CMV) strains have been shown to occur in immunocompromised individuals, sexually transmitted disease clinic attendees, and children attending day care centers. To characterize the CMV diversity in healthy seropositive individuals, 16 CMV PCR-positive specimens from 113 seropositive women were analyzed for glycoprotein gN and gB genotypes by cloning, followed by nucleotide sequencing of the plasmid DNA and/or restriction fragment length polymorphism (RFLP). The results showed that most (93.7%) of the PCR-positive specimens contained multiple gN and/or gB genomic variants, suggesting that the majority of women were infected with more than one virus strain. The results also showed that the RFLP technique might not be sufficiently sensitive to detect all of the genomic variants present in a sample.     

Pathway to care of epilepsy patients: Exploratory study from an urban slum in Northern India

Introduction:

Epilepsy is a chronic neurological disorder with major psychosocial correlates. Most epilepsy patients in developing countries are untreated or inadequately treated. It is essential to understand the pathway, to care taken by epilepsy patients in a community, to be able to target appropriate services to them.

Materials and Methods:

A community based study was conducted on all epilepsy patients in an urban slum in Northern India to study their pathways to care. A list of persons suffering from epilepsy was generated by house to house visits, snowballing, and key informant contacts. In-depth interview and Medical Record Review were used to document their pathway to care.

Results:

Thirteen of the twenty two patients had contacted a health-care provider for their first episode. The most common first link of care for the patients was secondary level Government hospitals. The next common was private practitioners, followed by Tertiary Care Hospitals, and registered medical practitioners. Eleven out of twenty two patients had to contact a Tertiary Level Center for seeking care. The number of health-care facilities consulted before arriving at their latest point of care ranged from 0 to 5. Traditional or faith healers were consulted at some point of time for cure.

Conclusion:

There is a need to focus on strengthening and capacity building of the primary care settings for managing epilepsy to enable their better utilization. This shall prevent unnecessary referrals and hence the load on the already burdened higher facilities.     

Tumor-induced osteomalacia—a diagnostic dilemma for an orthopedic surgeon

Tumor-induced osteomalacia is a rare condition caused by excess production of phosphatonins most notably fibroblast growth factor?23 (FGF-23), by the tumor cells, leading to phosphate wasting and consecutive severe hypophosphatemia. This results in patient developing gradually progressive muscle weakness and bone loss resulting in severe osteomalacia, making the patient bedbound. These tumors are mostly benign mesenchymal tumors, which remain hidden in soft tissues or bone and thus are difficult to diagnose. And in the presence of normal serum calcium and parathyroid levels with only mild alteration of vitamin D levels, the diagnosis gets further delayed causing a lot of apathy to the patient. We hereby present a thorough review of this condition along with our experience in diagnosing and treating this patient. This underlines the fact that a high index of suspicion is required for diagnosing this condition in a patient with persistent complains of fatigue and bone pains. Appropriate investigations done at an early stage can help one in identifying and excising these tumors, bringing about a rapid relief of symptoms and saving the patient from a lot of distress.     

Bone allografting: an Indian experience

Freeze-drying is considered to be the best technique for allograft preparation and storage. This method is, however, unsuitable for use in developing countries due to high costs. Ethylene oxide sterilization is still controversial because of its effect on osteoinductive capacity. This study involved setting up a bone bank for the first time. Cancellous bone collected from 40 patients was cleaned thoroughly, chemically processed, and sterilized with ethylene oxide gas and stored doubly packed. The grafts were implanted in 11 patients with 14 nonunions. Patients were followed up clinically and radiologically. Thirteen sites were united at the end of 12 months, taking an average of 44.8 weeks to unite. Allograft was also used in 8 benign bone lesions, which showed incorporation of the graft by 29 weeks. This study shows cancellous allograft is suitable for packing cavities in the treatment of benign bone lesions and in treatment of nonunion. There was one deep infection. The low infection rate confirms the efficacy of ethylene oxide as a reliable option for sterilization of bone allograft, and it is also cost effective.

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Résumé La congélation sèche est considéré comme la meilleure technique pour la préparation et le stockage des allogreffes. Cependant cette méthode est inapte pour les pays en voie de développement en raison des coûts élevés. La stérilisation à loxyde déthylène est encore controversée à cause de son effet sur losteoinductivité. De los spongieux de 40 patients a été collecté, nettoyé entièrement, traité chimiquement et stérilisé avec de loxyde déthylène gazeux puis entreposé sous double emballage. Les implantations ont été faites à 11 malades avec 14 non-consolidations. Les malades ont été suivis dune manière clinique et radiologique. Treize sites étaient consolidés à 12 mois avec une moyenne de délai de 44,8 semaines. Ces allogreffes a aussi été utilisées dans 8 lésions osseuses bénignes qui ont montré une incorporation de la greffe à 29 semaines. Cette étude montre que les allogreffes spongieuses sont convenable pour combler des cavités dans le traitement de lésions bénignes aussi bien que dans le traitement des non-consolidations. Il y avait une infection profonde. Le faible taux de linfection confirme lefficacité de loxyde déthylène pour la stérilisation des allogreffes osseuses ce qui a, de plus, a un coût assez bas.

     

Surgery for large hydrocele

Nine hundred fifty cases of moderate to large hydrocele were surgically treated by excising the skin, dartos, spermatic fascia, sac, and the median septum, leaving sufficient scrotal skin to construct a new scrotum—just enough to accommodate both the testes. The cure was complete, and the postoperative complications were minimal. The redundant skin and subcutaneous tissues were removed because they would otherwise hang and flop against the inner aspect of the patient's thighs, resulting in great difficulty and dissatisfaction in walking. This method of skin excision can also be applied to a huge inguinoscrotal hernia after its repair.