Specialized formulas and feedings for infants with malabsorption or formula intolerance

The composition of specialized formulas for infants who experience malabsorption or formula intolerance is described in detail. The limited studies of efficacy, as well as a rationale for selecting an appropriate formula for infants with malabsorption or formula intolerance, are discussed. Infants with symptoms of diarrhea or emesis may have intolerance to milk lactose or milk protein. Soy formulas contain no lactose or cow's milk and should be the first choice of an alternative feeding because of cost and convenience. Some infants may be intolerant of soy as well as cow's milk protein. They benefit from formula containing neither cow's milk nor soy protein or from a specially processed milk-based formula containing hydrolyzed casein. A carbohydrate-free formula to which the desired type of carbohydrate is added may be helpful in the diagnosis and treatment of disaccharidase deficiencies and monosaccharide intolerances. Infants with extensive intestinal resections or intractable diarrhea may require specialized infant formulas with qualitative/quantitative modifications of fat, carbohydrate, and protein. Formulas with medium-chain triglycerides may be useful for infants with steatorrhea. "Preterm" formulas or milk from the infant's mother are preferred for preterm infants, since such feedings promote improved fat and carbohydrate absorption and better meet the infant's nutrient requirements.     

Damage criteria for cerebral cortex cells subjected to hyperthermia

Temperatures above the normal physiological threshold may cause damage to cells and tissue. In this study, the response of a culture of dissociated cerebral cortex cells exposed to laser-induced temperature gradients was examined. The cellular response was evaluated using a fluorescent dye indicating metabolic activity. Furthermore, by using a finite element model of the heating during the pulsed laser application, threshold temperatures could be extracted for the cellular response at different laser pulse lengths. These threshold temperatures were used in an Arrhenius model to extract the kinetic parameters, i.e. the activation energy (E_a), and the frequency factor (A_c), for the system. A damage signal ratio was defined and calculated to 5% for the cells to increase their metabolism as a response to the heat. Furthermore, efficient stimulation with 20-ms long laser pulses did not evoke changes in metabolism. Thus, 20?ms could be a potential pulse length for functional stimulation of neural cells.     

Anti-oncospheral antibodies in the serum of lambs experimentally infected with eitherTaenia ovis orTaenia hydatigena

Using a peroxidase micro-enzyme-linked-immunosorbent assay (ELISA) method anti-oncospheral antibodies were demonstrated in sera from four lambs after primary and challenge infections withTaenia ovis orT. hydatigena. Antibodies assayed using homologous oncospheral antigen (OA) reached a peak by 3–4 weeks after primary infection and at 1–3 weeks post-challenge infection, but waned to pre-infective, background levels by 8–12 weeks after each infection. Antibodies assayed against antigens in strobilar or cystic larval extracts persisted for long periods after the initial infections and exhibited different kinetics of response from those demonstrated against OA. These antibodies showed increased levels after challenge infection. Oncospheral antigens did not seem to be species specific although they appeared to elicit a stage-specific response. It is suggested that the anti-oncospheral antibody response could be associated with protective or functional antibody.     

Immunisation of mice againstTaenia taeniaeformis using antigens prepared fromT. pisiformis andT. hydatigena eggs or oncospheres

Experiments were carried out to investigate the degree of immunity stimulated againstTaenia taeniaeformis infection in mice by prior administration of eggs or ultrasonically disrupted oncospheres ofT. pisiformis ort. hydatigena. Sonicated oncospheral antigens were given either orally or by subcutaneous injection in Freund's complete adjuvant, and eggs were given orally. Three inbred strains of mice with varying degrees of innate resistance to initial infection withT. taeniaeformis were used in the experiments. These were the moderately resistant BALB/c, moderately susceptible CBA/H, and highly susceptible C3H/He strains. It was found that BALB/c mice developed high levels of immunity when immunised with eitherT. pisiformis orT. hydatigena eggs, or with sonicated oncospheres administered orally or parenterally. CBA/H mice developed moderate immunity, and C3H/He mice generally did not develop a satisfactory level of resistance. The implications of these findings with respect to immunisation of outbred animals against natural infection with larval cestodes using antigens prepared from the oncospheres of heterologous parasite species is discussed.     

Effect of fluticasone propionate and salmeterol in a single device, fluticasone propionate, and montelukast on overall asthma control, exacerbations, and costs.

BACKGROUND: Inhaled corticosteroids are the most effective class of anti-inflammatory agents and are recommended for patients with persistent asthma. OBJECTIVE: To compare the effectiveness of (1) fluticasone propionate, 100 microg, and salmeterol, 50 microg; (2) fluticasone propionate, 100 microg; and (3) montelukast, 10 mg, as first-line maintenance treatment for persistent asthma. METHODS: Combined analysis of 4 clinical trials, 2 that compared fluticasone propionate-salmeterol with montelukast and 2 that compared fluticasone propionate with montelukast as initial asthma therapy. RESULTS: The 4 studies had a total of 1,910 patients 15 years or older with symptomatic asthma previously treated with inhaled short-acting beta2-agonists alone. At the end point, there were significantly greater increases in forced expiratory volume in 1 second with fluticasone propionate-salmeterol (0.57 L; P < or = .004) vs fluticasone propionate (0.48 L) and montelukast (0.31 L) and significantly greater increases in morning peak expiratory flow rate (84.9 L/min; P < .001) vs fluticasone propionate (56.0 L/min) and montelukast (36.1 L/min). Fluticasone propionate-salmeterol significantly increased the percentage of symptom- and rescue-free days and significantly reduced albuterol use vs fluticasone propionate and montelukast (P < or = .04 for both). Patients treated with fluticasone propionate and montelukast had 2.6 and 3.6 greater risk, respectively, of having an asthma-related exacerbation vs fluticasone propionate-salmeterol users. In addition, mean daily exacerbation costs per treated patient were dollars 0.41 for fluticasone propionate-salmeterol, dollars 4.60 for fluticasone propionate, and dollars 7.57 for montelukast, whereas mean daily costs per patient exacerbation for fluticasone propionate-salmeterol, fluticasone propionate, and montelukast were dollars 29, dollars 128, and dollars 154, respectively. CONCLUSIONS: Patients with symptomatic asthma previously treated with short-acting beta2-agonists only who require maintenance therapy are likely to have greater clinical benefits, lower risk of an asthma exacerbation, and reduced exacerbation-related costs when initiating therapy with fluticasone propionate-salmeterol vs fluticasone propionate or montelukast.     

Genetic analysis of the connexin-26 M34T variant: identification of genotype M34T/M34T segregating with mild-moderate non-syndromic sensorineural hearing loss

Mutations in the human gap junction β-2 gene (GJB2) that encodes connexin-26 have been shown to cause non-syndromic sensorineural hearing loss (NSSNHL) at the DFNB1 locus on 13q11. Functional and genetic data regarding the disease causing potential of one particular GJB2 sequence variant, 101 T→C (M34T), have proven contradictory. In this study, we found the prevalence of the M34T allele in a cohort of white sib pairs and sporadic cases with NSSNHL from the United Kingdom and Ireland to be 3.179% of chromosomes screened. Significantly, we identified the first M34T/M34T genotype cosegregating in a single family with mid to high frequency NSSNHL. Screening a control population of 630 subjects we identified 25 M34T heterozygotes; however, no M34T homozygotes were detected. Surprisingly, the majority of M34T alleles (88%) were in cis with a 10 bp deletion in the 5' non-coding sequence. This non-coding deletion was also homozygous in the homozygous M34T subjects. Microsatellite analysis of flanking loci in M34T heterozygotes and controls does not define an extensive ancestral haplotype but preliminary data suggest two common alleles in subjects with the M34T allele. In summary, we provide data that support M34T acting as a recessive GJB2 allele associated with mild-moderate prelingual hearing impairment.


Keywords: GJB2; connexin-26; M34T; hearing loss     

Can we achieve consensus on central venous catheter-related infections?

Central venous catheter-related bacteraemia is a substantial and preventable source of iatrogenic morbidity and mortality. A single episode of catheter-related bacteraemia has an estimated cost of A$50,000, with an attributable mortality between 10 and 35%. Catheter colonization is diagnosed with standard culture techniques. Diagnostic criteria for catheter-related bacteraemia include the results of cultures from the catheter tip, the peripheral blood and other possible sites of infection. The presence of clinical symptoms and subsequent defervescence may assist in making the diagnosis. This review explores the existing definitions of catheter-related infections and proposes a new and more rigorous classification with criteria for definite, probable and possible catheter-related bacteraemia. The authors hope that this classification will enhance the interpretation of the literature and the planning of new investigations. Infection rates can be reduced by appropriate site selection, adequate skin preparation, sterile technique and appropriate dressings. Decreased manipulation of administration sets, with more careful technique and less frequent set replacement, may reduce hub contamination. Infection rates increase with the duration in situ of the catheter, however are not reduced by regular scheduled catheter replacement or guide-wire exchanges. A range of antimicrobial catheter materials and coatings are under investigation, some of which are effective in reducing the rate of catheter-related bacteraemia. Chorhexidine-silver sulphadiazine and rifampicin-minocycline are the best studied combinations to date. Further developments are expected, although none are likely to be as effective as not inserting or removing the central venous catheter when it is not required.     

Diagnosis of Kaposi's sarcoma by fine-needle aspiration biopsy

Fifteen cases of Kaposi's sarcoma diagnosed by fine-needle aspiration biopsy were reviewed. The diagnosis was confirmed by tissue biopsy in eight of the cases. All of the patients were homosexual males, and 13 had a previous diagnosis of AIDS. The aspirates were obtained from enlarged lymph nodes (five cases), soft-tissue masses (two cases), oral cavity lesions (seven cases), and an abdominal mass. The most characteristic cytologic features were intact tissue fragments composed of overlapping spindle cells with nuclear distortion and ill-defined cytoplasmic borders. Smaller groups of loosely cohesive spindle-shaped cells and individual spindle cells with cytoplasm were also helpful features. In the appropriate clinical setting, these cytologic features on FNAB are felt to be diagnostic of Kaposi's sarcoma.