Nutritional issues in pediatric inflammatory bowel disease.

Malnutrition, characterized by weight loss, growth failure and micronutrient depletion, are prominent features of inflammatory bowel disease (IBD) in the pediatric age group. Accurate evaluation of the patient's nutritional status and appropriate nutritional support, whether enteral or parenteral, constitute integral parts of the management of the growing child with IBD. Over the past two decades, a number of studies have supported the potential use of nutritional therapy to induce remission and to control disease activity in symptomatic Crohn's disease. More recently, preliminary studies on the use of dietary supplements of marine-oil-derived omega-3 fatty acids have also indicated a beneficial effect in IBD patients. In parallel with these clinical trials, scientific research has recently focused on the concept that specific dietary alterations can modulate the immune response. Components of the diet that may have particular relevance to mucosal immunity and the pathogenesis of IBD include polyunsaturated fatty acids, nucleotides, and amino acids such as glutamine and arginine. Future research in the interactions between specific nutrients and the immune system will likely increase our understanding of the causes of IBD, as well as enhance the development of novel nutritional therapies for IBD patients.     

Parental occupation and birth outcome in an agricultural community

The general birth outcome and prevalence of specific birth defects was investigated within an agricultural community through the review of birth records in a major hospital in Imperial County, California. Of all singleton births (N = 2 463) occurring within a four-year period, 990 or 40.2% involved offspring with one or both parent(s) who were agricultural workers. The progeny of agricultural and nonagricultural workers were similar with regard to sex ratios, prevalence of low birth-weight infants, stillbirth rate, minor and major malformation rates, and prevalence of neonatal deaths. Limb reduction defects, however, occurred more frequently among offspring of agricultural workers (5.05 per 1 000 total births versus 2.19 per 1 000 total births, rate ratio = 2.3). Furthermore, the prevalence of limb reduction defects among agricultural workers was 3- to 14-fold higher than available United States rates (0.36-1.65 per 1 000 total births). Findings from our study suggest that agricultural communities and, in particular, agricultural workers may be at excess risk of producing a child with a limb reduction defect.     

Protracted hemorrhagic gastritis in an infant recovering from acute pancreatitis--successful management with prostaglandin E2 analogue

This case report describes the course and management of a 10-week-old boy with idiopathic hemorrhagic pancreatitis who presented initially with ascites. His hospital course was complicated by severe recurrent intraperitoneal bleeding, requiring, in less than 5 days three exploratory laparotomies to control the hemorrhage. In the following 11 weeks he had five major bleeding episodes attributed to ulcers, gastritis, and esophagitis. Continuous infusion of H2 blockers, antacid drip, and sucralfate combined with Nissen fundoplication, elective vagotomy, and pyloroplasty were used unsuccessfully to control the bleeding until a prostaglandin E2 analogue at 18 micrograms/kg/day in four divided doses was given enterally. During the following 19 months, there has been no recurrence of bleeding.     

Isolation and characterization of the mouse homolog of the preprodynorphin (Pdyn) gene

We have isolated and sequenced the mouse preprodynorphin gene (Pdyn). The Pdyn gene can encode for six biologically active dynorphin peptides. The predicted mouse preprodynorphin has 90%, 67%, and 66% identity with the predicted rat, porcine, and human preprodynorphins, respectively. Using an RT-PCR technique, we show that the Pdyn gene starts being expressed at embryonic day 12.5, with a steep increase of expression by embryonic day 14.5; in the adult mouse it is expressed in the brain, but not in liver, heart, spleen, or kidney.     

To participate or not participate in unprofessional behavior – Is that the question?

Introduction: Medical education provides students with abundant learning opportunities, each of which is embodied with messages concerning what is expected from students. This paper analyses students? exposure to instances of unprofessional behavior, investigating whether they judge such behavior to be unprofessional and whether they also participate in unprofessional behavior.

Methods: The survey developed in the Pritzker School of Medicine at the University of Chicago was the basis of this questionnaire that was answered by 276 students from two medical schools in Brazil and Portugal.

Results: Unprofessional behavior was observed frequently by students in both universities, and the mean participation rates were similar (26% and 27%). Forty-five percent of students? participation in unprofessional behavior was explained by academic year, prior observation, and judgment.

Discussion: The results indicate that once students have observed, participated in or misjudged unprofessional behavior, they tend to participate in and misjudge such behavior. The frequency with which students judged behaviors they had observed or participated in as ?borderline? or unprofessional could mean that they are experiencing moral distress.

Conclusion: Proper discussion of unprofessional behavior should foster a broad debate to encourage empowered students, faculties, and physicians to co-create a more professional environment for patient care.