Feeding strategies for premature infants: randomized trial of gastrointestinal priming and tube-feeding method

BACKGROUND: Data on enteral feeding management of premature infants are limited and often not the subject of randomized clinical trials. Several small studies suggest benefits from the early initiation of feeding, but do not assess the combined effects of time of initiation of feeding, tube-feeding method, and type of milk used. Either singly or in combination, these treatments may affect growth, bone mineralization, biochemical measures of nutritional status, and feeding tolerance, and, ultimately, the duration of hospitalization. METHODS: A total of 171 premature infants, stratified by gestational age (26 to 30 weeks) and diet (human milk or preterm formula) were assigned randomly among four treatment combinations in a balanced two-way design comparing the presence or absence of gastrointestinal (GI) priming for 10 days and continuous infusion versus intermittent bolus tube-feeding. RESULTS: The major outcome, time required for infants to attain full oral feeding, was similar among treatments. GI priming was not associated with any measured adverse effect and was associated with better calcium and phosphorus retention, higher serum calcium and alkaline phosphatase activity, and shorter intestinal transit times. The bolus tube-feeding method was associated with significantly less feeding intolerance and greater rate of weight gain than the continuous method. In addition, the greater the quantity of human milk fed, the lower the morbidity. CONCLUSIONS: Early GI priming with human milk, using the bolus tube-feeding method, may provide the best advantage for the premature infant.     

Lithium stimulation of granulopoiesis in diffusion chambers--a model of a humoral, indirect stimulation of stem cell proliferation

Lithium has been recognized as a stimulator of granulopoiesis both in vivo and in vitro. The mechanism by which lithium provokes this stimulation is unclear, with previous data focusing on such divergent causes as direct effects on progenitor cells v elevations in granulocyte macrophage colony-stimulating activity (GM-CSA) production. In the present study, we used a model system of granulopoiesis in diffusion chambers to study this stimulation of granulopoiesis. Lithium pretreatment of mice followed by a rest period to allow for excretion of the lithium (confirmed by serum assays) revealed a stimulation of progenitor cell growth within the diffusion chambers. No changes in the serum and chamber fluid GM-CSA levels were discernible between the control host mice and the lithium-pretreated mice. These data indicate that lithium stimulates granulopoiesis by an indirect mechanism that does not appear to involve GM-CSA.     

Tooth sensitivity experience among residential university students

To cite this article:
Int J Dent Hygiene
DOI: 10.1111/j.1601‐5037.2009.00385.x
Bamise CT, Kolawole KA, Oloyede EO, Esan TA. Tooth sensitivity experience among residential university students Abstract: Objectives: The aim of this study was to assess the experience of residential University students about ‘sensitive teeth’. Subject and methods: Self‐administered questionnaires were given randomly to students in all the residential hostels located in the University campus. Data on presence of sensitive teeth, initiating stimulus and duration of each episode of discomfort were elicited. History of common aetiological factors of tooth sensitivity was also taken. Results: One thousand and nineteen responses (650 males; 369 females) were analysed in this study. Approximately 697 (68.4%) volunteers claimed to have sensitive teeth. Majority described their discomfort as sharp pain, cold as the initiating stimulus and drinking was mostly interfered with. Tooth sensitivity was found to be common among hard toothbrush users. Multiple regression analysis showed that hard toothbrush had a significant association with tooth sensitivity. Other common aetiological factors, such as history of gastric acid reflux, vomiting, soft drinks and the use of vitamin C were found to have a weak association with tooth sensitivity. Conclusion:  Prevalence of tooth sensitivity was 68.4%. Presence of tooth sensitivity among these students was associated more with history of hard toothbrush use contrary to widely held belief that erosive agents were mostly responsible. Future studies are needed to provide more epidemiological data on tooth brushing and tooth sensitivity.     

Infant feeding intentions and practices of HIV-positive mothers in southwestern Nigeria

It has been shown that infant feeding pattern affects mother-to-child transmission of HIV. This study reports the infant feeding practices of HIV-positive mothers in southwestern Nigeria.     

Combination of narrow band UVB and topical calcipotriol for the treatment of vitiligo

BACKGROUND: Narrow band ultraviolet B (NB-UVB) phototherapy has been used successfully for the treatment of vitiligo. Recently, topical calcipotriol has also been claimed to be effective, either as monotherapy or as a part of combination therapies. OBJECTIVE: The aim of the present study was to compare the clinical efficacy of NB-UVB and NB-UVB plus topical calcipotriol in the treatment of vitiligo. METHODS: NB-UVB treatment was given to 24 patients with generalized vitiligo three times weekly. Topical calcipotriol cream was only applied to the lesions located on the right side of the body. Treatment was continued for 6 months. Treatment efficacy was evaluated by determining the average response rates of the lesions at 3-month intervals. RESULTS: The average response rates of patients receiving combination of NB-UVB plus calcipotriol and NB-UVB alone were 51 +/- 19.6% and 39 +/- 18.9%, respectively. The median cumulative UVB dose and number of UVB exposures for initial repigmentation were 6345 mj/cm(2) (range; 2930-30980) and 18 (range; 12-67) for the combination therapy, and 8867.5 mj/cm(2) (range; 2500-30980) and 24 (range; 15-67) for the narrow band UVB therapy, respectively. CONCLUSIONS: These findings indicate that concurrent topical calcipotriol potentates the efficacy of NB-UVB in the treatment of vitiligo. This combination not only provides earlier pigmentation with lower total UVB dosage and less adverse UVB effects, but also reduces the duration and cost of treatment as well.     

Medical mortality in an emergency department in Nigeria: the transition is obvious!

IntroductionThe emergency department (ED), a major entry point into the hospital, provides an insight to the type of cases seen, the quality of care and mortality spectrum in a health institution. We aim to identify the spectrum of medical causes of mortality in our ED, the demographic pattern and duration of stay before death.MethodThis is a retrospective study that looked at medical mortality in the ED from January 2004 to December 2009. We obtained data on the demographics and causes of death from the medical records and case notes of the deceased.ResultsA total of 16587 patients were admitted during the period under review, of these 1262 (7.61%) died in the ED. The male to female ratio was 1.58:1.0 [772 males (61.2%), and 489 females (38.8%)]. Mortality was highest among the 20–45 years age range, followed by 46–65 years, >65 years and < 20 years in decreasing frequency [589(46.7%), 421(33.4%), 186 (14.8%) and 66(5.2%) respectively]. The three most common causes of death were stroke 315(25%), HIV related illnesses 126(10.0%), and heart failure 123(9.7%). Most deaths occurred less than 24hours of admission, 550(43.6%), followed by one day (36.0%) and two days (10.8%) post admissions respectively.ConclusionThe commonest cause of death in the ED was stroke. The burden of death was highest in the younger age group, with most occurring less than 24 hours of admission.     

Human Rotavirus Group a Serotypes Causing Gastroenteritis in Children Less Than 5 Years and HIV-Infected Adults in Viwandani Slum,Nairobi

Background

Rotavirus remains a leading cause of acute gastroenteritis in children worldwide with an estimated 2000 deaths each day in developing countries. Due to HIV/AIDS scourge in Kenya, it is possible that rotavirus-related gastroenteritis has been aggravated in adults. The Global Alliance for Immunizations has ranked rotavirus infection a priority for vaccine, and, to ensure its success, there is a need to document the local strain(s) circulating in different regions.

Methods

A cross-sectional study was conducted to document human rotavirus group A serotypes in children below 5 years and HIV-infected adults in Viwandani slum in Nairobi, Kenya. A total of 260 (128 from children and 132 from HIV infected adults) fecal specimen samples were analyzed from August 2012 to July 2013. Screening for rotavirus was done by antigen based enzyme immune-sorbent assay (ELISA), Polyacrylamide gel electrophoresis (PAGE) was used to detect rotavirus electropherotypes and finally genotyping was done by RT-PCR using genotype-specific primer sets targeting VP4 and VP7 genes.

Results

Rotavirus was detected in 23% and 8% of children and adult, respectively. Prevalence was high in children of < 2 years and adults of > 48 years. Long electropherotypes accounted for 80% and 60% while short electropherotypes accounted for 20% and 40% in children and adult, respectively. The common globally distributed strains, G1 and G3, accounted for 60% detections while the unusual G9 strain accounted for 80% infection in adults. G1P[8] was the common genotypic combination in children, accounting for 40% infection, whereas G9 [P8] accounted for 60% of the infections in adults.

Conclusion

This study shows the existence of strain diversity between rotavirus circulating in children and adults within this study group. It further shows that as currently constituted, the 2 vaccines recommended for rotavirus would cover the circulating strain in Viwandani slum. Finally, there is a need for continuous rotavirus strain surveillance in children and a further focus on HIV infected adults.     

The rate and cost of hospitalisation in children with sickle cell anaemia and its implications in a developing economy

Background

There is paucity of data on the cost and rate of hospitalization in children with sickle cell anaemia (SCA) in most developing nations.

Objective

To estimate the rate and cost of hospitalization in children with SCA in Nigeria and evaluate the economic burdens on their families.

Methods

The number and duration of hospitalizations; estimated aggregate family''s monthly income, cost of care and percentage of the mean annual income spent on hospitalization for each respondent were obtained using a structured questionnaire.

Results

The mean age of the 73 children was 61.1(44.3) months; M:F was 1:1.6. They had 183 admissions (average of 2.5(1.9) admissions per child per year). The mean family monthly income was $250.37, while the average cost of care per hospitalization per subject was $132.67. The total cost of care during the year was $24,278.37. About one-third of the caregivers spent at least 10% of their estimated annual income as total cost of hospitalization.

Conclusion

The rate and the cost of hospitalization for children with SCA and the percentage of income spent on hospitalization were too high in our environment. Government should strengthen the National Health Insurance Scheme and subsidise the cost of care to these children.