Protecting and improving breastfeeding practices during a major emergency: lessons learnt from the baby tents in Haiti

Problem

The 2010 earthquake in Haiti displaced about 1.5 million people, many of them into camps for internally displaced persons. It was expected that disruption of breastfeeding practices would lead to increased infant morbidity, malnutrition and mortality.

Approach

Haiti’s health ministry and the United Nations Children’s Fund, in collaboration with local and international nongovernmental organizations, established baby tents in the areas affected by the earthquake. The tents provided a safe place for mothers to breastfeed and for non-breastfed infants to receive ready-to-use infant formula. Such a large and coordinated baby tent response in an emergency context had never been mounted before anywhere in the world.

Local setting

Baby tents were set up in five cities but mainly in Port-au-Prince, where the majority of Haiti’s 1555 camps for displaced persons had been established.

Relevant changes

Between February 2010 and June 2012, 193 baby tents were set up; 180 499 mother–infant pairs and 52 503 pregnant women were registered in the baby tent programme. Of infants younger than 6 months, 70% were reported to be exclusively breastfed and 10% of the “mixed feeders” moved to exclusive breastfeeding while enrolled. In 2010, 13.5% of registered infants could not be breastfed. These infants received ready-to-use infant formula.

Lessons learnt

Thanks to rapid programme scale-up, breastfeeding practices remained undisrupted. However, better evaluation methods and comprehensive guidance on the implementation and monitoring of baby tents are needed for future emergencies, along with a clear strategy for transitioning baby tent activities into facility and community programmes.     

Frequency of disease subsets and patterns of organ involvement among Egyptian patients with systemic sclerosis – A retrospective study

Aim of the workTo determine the prevalence and disease characteristics of Systemic Sclerosis among Egyptian patients presented to Rheumatology departments in Cairo University & Bani Swief University.Patients & methodsThis is a retrospective study that included 75 patients with systemic sclerosis diagnosed according to the American college of rheumatology criteria. Their ages ranged between 17 and 70 years, all patients data were collected by medical records review.ResultsOut of the studied 75 patients, 14 (18.7%) were males and 61 (81.3%) were females with a ratio of 1:4.3. Fourteen patients (18.7%) had diffuse cutaneous systemic sclerosis and 61/75 (81.3%) had limited cutaneous systemic sclerosis. The commonest initial presenting manifestation in all patients was Raynaud’s phenomenon in 58/75 patients (77.3%), followed by arthritis in 9/75 patients (12%) & skin tightness in 7/75 patients (9.3%). Interstitial lung disease was significantly more frequent within the diffuse compared to the limited subtype (78.6%, 47.5%, respectively P = 0.042). Secondary pulmonary hypertension was significantly more common among the patients with dcSSc compared to the limited subtype (35.7%, 6.6%, respectively P = 0.009). No significant difference was observed between males and females in the disease pattern.ConclusionLimited cutaneous systemic sclerosis is more common than diffuse ‘subtype’. Raynaud’s phenomenon is the commonest initial presentation. Diffuse subtype is more commonly associated with interstitial lung disease, secondary pulmonary hypertension and proteinuria than the limited subtype. Gender does not affect the frequency of organ involvement significantly.     

Potent antimalarial activity of 2-aminopyridinium salts, amidines, and guanidines

We describe the design, synthesis, and antimalarial activity of 60 bis-tertiary amine, bis-2(1 H)-imino-heterocycle, bis-amidine, and bis-guanidine series. Bis-tertiary amines with a linker from 12 to 16 methylene groups were active against the in vitro growth of Plasmodium falciparum within the 10 (-6)-10 (-7) M concentration range. IC 50 decreased by 2 orders of magnitude for bis-2-aminopyridinium salts, bis-amidines, and bis-guanidines (27 compounds with IC 50 < 10 nM). Increasing the alkyl chain length from 6 to 12 methylene groups led to increased activity, while beyond this antimalarial activity decreased. Antimalarial activities appear to be strictly related to the basicity of the cationic head with an optimal p K a over 12.5. Maximal activity occurs for bis-2-aminopyridinium, two C-duplicated bis-amidines, and three bis-guanidines, with IC 50 values lower than 1 nM. In comparison to similar quaternary ammonium salts, amidinium compounds have distinct structural requirements for antimalarial activity and likely additional binding opportunities on account of their hydrogen-bond-forming properties.     

Changes in acetylator phenotype over the lifespan in the Wistar rat

Acetylation capacity during drug metabolism differs between species, gender and age groups. OBJECTIVE: The purpose of this work was to determine variations in the acetylating phenotype (AP), in a longitudinal study, as a function of growth and development. METHODS: Twenty male Wistar rats were studied. AP was determined on days 21, 48, 114, 180, 457 and 780 with oral doses of 30mg/kg of sulphadiazine (SDZ) by urine collection. The Schr?eder and Vree methods were used to obtain SDZ concentrations, both acetylated and not acetylated. Rats were classified as slow or fast acetylators in accordance with previously validated metabolic indicators. RESULTS: Of the 20 rats phenotyped at 21 and 48 days of age, 18 were slow and 2 were fast acetylators. As age and consequent growth progressed, changes in the expression of AP were registered. At 114 days, 16 rats were slow and 4 were fast acetylators; at 180 days, 12 were slow and 8 were fast; at 457 days, 6 were slow and 14 were fast; at 780 days, the 20 rats were fast acetylators. Slow acetylation predominates at younger ages. CONCLUSIONS: The effect of growth and developmental progress on AP is evident and relates to previous reports of changes in AP, determined by age in animal and human models. The relevance of changes determined by growth and development should be considered in rational drug management.     

Salmonella porins induce a sustained, lifelong specific bactericidal antibody memory response

We examined the ability of porins from Salmonella enterica serovar typhi to induce a long-term antibody response in BALB/c mice. These porins triggered a strong lifelong production of immunoglobulin G (IgG) antibody in the absence of exogenous adjuvant. Analysis of the IgG subclasses produced during this antibody response revealed the presence of the subclasses IgG2b, IgG1, IgG2a and weak IgG3. Despite the high homology of porins, the long-lasting anti-S. typhi porin sera did not cross-react with S. typhimurium. Notably, the antiporin sera showed a sustained lifelong bactericidal-binding activity to the wild-type S. typhi strain, whereas porin-specific antibody titres measured by enzyme-linked immunosorbent assay (ELISA) decreased with time. Because our porin preparations contained the outer membrane proteins C and F (OmpC and OmpF), we evaluated the individual contribution of each porin to the long-lasting antibody response. OmpC and OmpF induced long-lasting antibody titres, measured by ELISA, which were sustained for 300 days. In contrast, although OmpC induced sustained high bactericidal antibody titres for 300 days, postimmunization, the bactericidal antibody titre induced by OmpF was not detected at day 180. These results indicate that OmpC is the main protein responsible for the antibody-mediated memory bactericidal response induced by porins. Taken together, our results show that porins are strong immunogens that confer lifelong specific bactericidal antibody responses in the absence of added adjuvant.