Apparent life threatening events and infant holding practices

Two 4 week old infants are reported who suffered apparent life threatening events (ALTE) while being cradled in adult arms. The events, which could be reproduced under controlled circumstances, were not associated with any struggling by the infants. Alteration of infant holding practices in both cases resulted in cessation of the events. A case of cardiorespiratory arrest during breast feeding in an 8 week old infant that was unnoticed by her mother is also described. These cases suggest that certain infants may not respond normally to airway occlusion while being held or nursed, and show that careful study of the events surrounding ALTE may reveal contributing environmental factors. If ALTE occur around feeding time, observation of how caretakers place the infant during and after feeding may be informative.     

Sex differences in high-density lipoprotein cholesterol and subfractions among young black adults

The high-density lipoprotein cholesterol and high-density lipoprotein subfraction (HDL2 and HDL3) concentrations were examined in 170 young black adults. The women examined had significantly higher total high-density lipoprotein cholesterol concentrations than the men, i.e., 57.0 mg/dl vs 51.2 mg/dl, P less than 0.002. The increased high-density lipoprotein cholesterol among women represented a significant increase in both HDL2 and HDL3 cholesterol concentrations. The sex differential could not be explained by body mass index, alcohol consumption, or physical activity. The determinants of high-density lipoprotein cholesterol for men appeared to be different than those for women.     

Effects of epitopes combination and adjuvants on immune responses to anti-Alzheimer disease DNA vaccines in mice

Alzheimer disease （AD） is a neurodegenerative disorder characterized by neuropathological hallmarks including deposits of the beta-amyloid peptide （AssP）. Studies have shown that immunization with Abeta42 peptide reduces both the spatial memory impairments and Alzheimer disease-like neuropathologic changes in Alzheimer disease transgenic mice, but can cause side effect of a cell-mediated autoimmune meningoencephalitis. Recently, some studies showed that DNA vaccination could be used to generate an antibody response to Abeta without the adverse cell-mediated immune effect. In the current study, we generate four DNA vaccine plasmlds （pV-GE1, pV-GE2, pV-GE3, and pV-GE4） against Alzheimer disease by separately fusing Abeta epitope sequences （coding for EFGH, DAEFGH, EFGH ＋ EFGH, and EFGH ＋ DAEFGH） with IgG heavy chain coding region of mouse. Meanwhile, the full-length gene Abeta encoding plasmid （pV-Abeta）, empty vector （pVAX） and synthetic AssP were also included as control. The sera of BALB/c mice immunized via intramuscular with plasmids and peptide were tested by indirect ELISA for auto-AssP immunoreactivity. The results showed that all the DNA vaccine plasmids induced AssP-specific antibodies; moreover pV-GE2 and pV-Abeta constructs elicited higher antibody titers than other constructs （P〈0.05）. To further enhance the immune response, GM-CSF encoding plasmid （pGM-CSF） and purified BCG-DNA were used as molecular adjuvants. BCG-DNA could enhance humoral and cellular immune responses simultaneously and did not alter the phenotype of the immune responses,     

Fournier gangrene associated with Crohn disease

A 17-year-old boy presented with Fournier gangrene associated with previously undiagnosed Crohn ileocolitis. Fournier gangrene was managed by débridement, broad-spectrum antibiotics, and hyperbaric oxygen. A diverting ileostomy was performed before skin grafting and scrotal reconstruction. Microscopy of a full-layer surgical sample from the terminal ileum revealed granulomas with multinucleated histiocytes, consistent with Crohn disease. Crohn disease was treated with mesalamine, metronidazole, 6-mercaptopurine, and infliximab. The patient was discharged on hospital day 32. At 6-month follow-up, reconstruction of his scrotum had completely healed. Ostomy output was normal.     

BDNF levels and genotype are associated with antipsychotic-induced weight gain in patients with chronic schizophrenia.

Recent evidence suggests that centrally released brain-derived neurotrophic factor (BDNF) modulates eating behavior and metabolism that is responsible for body weight fluctuation. BDNF also may play an important role in the therapeutic action of antipsychotic medications. We investigated whether the Val66Met polymorphism of the BDNF gene affected weight gain after long-term antipsychotic treatment in schizophrenia. The polymorphism was genotyped in 196 Chinese patients with schizophrenia on long-term antipsychotic medication. Serum BDNF was measured in all patients and 50 normal controls. Mean body mass index (BMI) change was evaluated retrospectively by means of clinical records. The results showed that there was a significant relationship between the three BDNF Val/Met genotypes and mean BMI gain, with genotype having a strong effect on BMI gain in male but not female patients. BDNF levels were significantly lower in patients than normal controls, and negatively correlated with BMI gain in female but not male patients. Our results suggest that variation in the BDNF gene may be a risk factor for weight gain in male patients with schizophrenia on long-term antipsychotic treatment, and decreased BDNF levels may be associated with weight gain in females.     

Effects of D-cycloserine on cue-induced craving and cigarette smoking among concurrent cocaine- and nicotine-dependent volunteers

Rates of cigarette smoking are 3- to 4-fold greater among those with cocaine-dependence, and compared to non-users, cocaine users are at greater risk of incurring smoking-related negative health effects and death. The current study examined D-cycloserine's (0 or 50 mg once weekly) effects on 1) extinction of cue-induced craving for cigarettes, 2) cigarette smoking in conjunction with cognitive–behavioral therapy, and 3) safety and tolerability in cocaine-dependent smokers. This was a double-blind, placebo-controlled, between groups, outpatient study. Participants (N = 29) were concurrent cocaine- and nicotine-dependent volunteers seeking treatment for their cigarette smoking. Study visits were 3 times per week for 4 consecutive weeks. At each visit, participants received cognitive–behavioral therapy for smoking, were exposed to smoking cues. A subset of participants (N = 22) returned for 6-month follow-up visits. While craving decreased, no significant effects of D-cycloserine treatment were observed. Likewise, significant decreases in smoking were observed at study days 6 (p < 0.002) and 12 (p < 0.0001) relative to baseline, although no participants achieved complete abstinence. However, there was no effect of D-cycloserine on cigarette smoking during treatment or at 6-mos follow-up. The treatment was safe and tolerable, with nearly 90% of treatment sessions attended based on an intent-to-treat analysis. While no effects of D-cycloserine on craving or smoking were observed in the current study, the results do suggest that smoking treatment is well accepted and may be effective for cocaine-dependent individuals.     

Utilization of Clean and Safe Delivery Service Package of Health Services Extension Program and Associated Factors in Rural Kebeles of Kafa Zone,Southwest Ethiopia

Background

In Ethiopia, 94% of births take place at home unattended by trained persons. The government introduced an innovative strategy, Health Services Extension Program in 2003. Clean and safe delivery service is a component of maternal and child healthcare package of the program. However, little is known about the status of uptake of the service. This study thus aimed to assess utilization of clean and safe delivery service and associated factors in rural kebeles of Kafa Zone, Ethiopia.

Methods

A community based cross sectional survey was conducted in rural kebeles of Kefa Zone from January 21^st to February 25^th, 2009 using a sample of 229 mothers. Kafa Zone is located 465 kilometres away from Addis Ababa to southwest of Ethiopia. Data were collected using a structured questionnaire and analyzed using SPSS for windows version 16. OR and 95% CI were calculated. P< 0.05 was considered statistically significant.

Results

Utilization of clean and safe delivery service was 43(19%). Women with formal schooling and those who knew at least two danger signs of pregnancy and labor were more likely to use the service than their counterparts; (AOR=5.8, 95% CI=2.1, 16) and (AOR=3.0, 95% CI=2.2, 10.6), respectively. Of 108(47.8%) mothers who had at least one antenatal care visit, 36(33.3%), were not advised about danger signs. Women who had at least one ANC visit and those who were advised about the danger signs of pregnancy and labor appeared to be more likely to use the service than their counterparts; (AOR=6.1, 95% CI=1.9, 21.3), and (AOR=5.4, 95%CI= 1.4, 21.7), respectively.

Conclusion

Utilization of the service is low and was determined by women''s educational status, history of abortion, knowledge of danger signs and antenatal care attendance. Educating women and improving their knowledge about danger signs of pregnancy and labor is recommended. Health extension workers should consider antenatal care visits as opportunities for this purpose.     

Variation of breast cancer risk among BRCA1/2 carriers

Context  The risk of breast cancer in BRCA1 and BRCA2 mutation carriers has been examined in many studies, but relatively little attention has been paid to the degree to which the risk may vary among carriers. Objectives  To determine the extent to which risks for BRCA1 and BRCA2 carriers vary with respect to observable and unobservable characteristics. Design, Setting, and Participants  Probands were identified from a population-based, case-control study (Women’s Environmental Cancer and Radiation Epidemiology [WECARE]) of asynchronous contralateral breast cancer conducted during the period of January 2000 to July 2004. Participants previously diagnosed with contralateral breast cancer or unilateral breast cancer were genotyped for mutations in BRCA1 and BRCA2. All participants had their initial breast cancer diagnosed during the period of January 1985 to December 2000, before the age of 55 years. Main Outcome Measure  Incidence of breast cancer in first-degree female relatives of the probands was examined and compared on the basis of proband characteristics and on the basis of variation between families. Results  Among the 1394 participants with unilateral breast cancer, 73 (5.2%) were identified as carriers of deleterious mutations (42 with BRCA1 and 31 with BRCA2). Among the 704 participants with contralateral breast cancer, 108 (15.3%) were identified as carriers of deleterious mutations (67 with BRCA1 and 41 with BRCA2). Among relatives of carriers, risk was significantly associated with younger age at diagnosis in the proband (P = .04), and there was a trend toward higher risk for relatives of contralateral breast cancer vs unilateral breast cancer participants (odds ratio, 1.4 [95% confidence interval, 0.8-2.4]; P = .28). In addition, there were significant differences in risk between carrier families after adjusting for these observed characteristics. Conclusion  There exists broad variation in breast cancer risk among carriers of BRCA1 and BRCA2 mutations.