Breastfeedilzg Support Services in the Neonutd Intensive-Care Unit

Objective: To describe a model for providing breastfeeding support in the neonatal intensive-care unit (NICU).
Design: Naturalistic, participant observation.
Setting: Suburban Level III NICU.
Patients: One hundred thirty-two mother-infant pairs over 1 year. Infants were hospitalized In the NICU, and mothers had initiated lactation efforts.
Interventions: Investigators provided breastfeeding interventions for the mother-infant pairs, based on identified problems, the research literature, or both.
Main Outcome Measures: Percentage of mothers who were breastfeeding at the time of discharge from the NICU.
Results: Interventions were classified into jive categories: expression and collection of mothers' milk, gavage feeding of expressed mothers' milk, in-hospital breastfeeding sessions, postdischarge breastfeeding management, and additional consultation.
Conclusions: This model was effective In preventing breastfeeding failure for this population. The model can provide the basis for NICU breastfeeding standards of care, protocols, and chart records, or for reimbursement purposes. The model also provides a framework for studying a specific category or breastfeeding intervention.     

The Influence of Pyridostigmine Administration on Human Neuromuscular Functions--Studies in Healthy Human Subjects

Pyridostigmine has a protective effect against organophosphatepoisoning when given in a dosage of 30 mg three times dailycausing 20–40% cholinesterase inhibition. To test itssafety in the human neuromuscular system, a double-blind studyon 35 subjects divided into two matched groups was performed.One group was treated with pyridostigmine in a dose of 30 mgthree times daily and the other group was treated similarlywith placebo, both for a 10-day period. The resultant averagecholinesterase inhibition in the treatment group was 23%. Musclestrength and endurance were tested before, during (on the 8thday), and after treatment. Electrodiagnostic studies, includingnerve conduction, electromyography, and response to repetitivestimulation, were carried out on four subjects of the treatmentgroup and on two subjects of the placebo group, both beforeand during treatment (eighth day). Isometric handgrip strength,isokinetic elbow flexor, and extensor strength did not differbetween groups as a result of the treatment. Knee flexor andextensor isokinetic strength showed a small (but statisticallysignificant) trend to improve more during placebo treatment,whereas knee extensor endurance decreased slightly in the placebogroup. Both these effects are probably due to large fluctuationsin performance of the placebo group, whereas the treatment groupperformance was quite constant. They probably do not representany adverse effect of pyridostigmine. No electrophysiologicalchanges were found in any of the subjects during treatment.We conclude that pyridostigmine does not cause any significantneuromuscular effect in healthy subjects when taken in a dosageof 90 mg daily for 8 days, causing 20–30% inhibition ofCholinesterase.     

Retention of dental sealants placed on sound teeth and incipient caries lesions as part of a service‐learning programme in rural areas in Mexico

International Journal of Paediatric Dentistry 2012; 22: 451–458 Background. Dental sealants are an effective treatment for the prevention and management of caries. Objective. To determine the retention of sealants placed in a rural setting in Mexico as part of an international service‐learning (ISL) programme and to determine associations between dental sealant’s retention and caries diagnosis at the time of sealant placement. Methods. Children aged 6–15 were examined for dental caries, received sealants by dental students as part of an ISL programme, and were re‐examined 4, 2, or 1 years after placement to assess sealant survival. Sealants were placed on permanent sound surfaces and enamel caries lesions [International Caries Assessment and Detection System (ICDAS) criteria]. Sealant survival was explored using Cochran–Mantel–Haenszel tests and multivariate prediction models. Results. 219 (46%) of 478 (mean age = 10.53 SD = 5.11) children who had received sealants returned for a recall examination (mean age = 10.89 SD = 3.11). After 1–4 years, 96.4% to 60.6% of the sealants placed on sound teeth had survived, and for sealants placed on surfaces with enamel caries lesions (ICDAS 1–3), 94.2% to 55.6% had survived. Differences were not statistically significant. Conclusions. Sealants had survival rates comparable to those previously reported in the literature. Sealants placed on sound and enamel caries lesions had similar survival rates.     

Biliary Infections and the Choice of Antibiotics

In a prospective study of 200 patients undergoing cholecystectomy, gallbladder bile was cultured. In the whole group, 32% of specimens yielded a positive growth: in those with acute cholecystitis 65% had a positive culture. The proportion of positive growths increased with age. Among patients with cholecystitis and gallstones only 27% had a positive bacterial growth, while in those with cholecystitis not associated with gallstones, 43% had a positive bacterial growth, E. coli was the most frequent organism isolated, with other bowel organisms identified less frequently. In a study of in vitro sensitivities, it was found that kanamycin, gentamicin and colistin were effective against all organisms isolated.     

Unsweetened ice popsicles impart a positive feeling and reduce self‐mutilation after paediatric dental treatment with local anaesthesia

International Journal of Paediatric Dentistry 2010; 20: 382–388 Aim. The purpose of the current study was to assess whether an unsweetened ice‐popsicle imparts a positive feeling to children after dental treatment in which local anaesthesia is administered, and whether it reduces the tendency of children to self‐mutilate (bite the lip, cheek or tongue) after the administration of local anaesthesia. Design. Crossover study of 31 children aged 4–11 years old who needed similar dental treatments on both sides of the mandible or maxilla under local anaesthesia. At the end of each appointment the child received a toy or an ice‐popsicle especially made for this study. Patients and parents answered a questionnaire regarding the children’s behaviour and feeling immediately after the treatment, and 10 and 30 min after receiving the ice‐popsicle or toy. Results. Children who received ice‐popsicles after dental treatment under local anaesthesia felt less discomfort and suffered less soft tissue trauma than they did when they received a toy. Reduction in soft tissue trauma was evident 10 min after receiving the ice‐popsicles. Conclusion. Licking of an ice‐popsicle after dental treatment with local anaesthesia reduces the feeling of discomfort and the biting of soft tissue and self‐ mutilation.     

Inappropriate Implantable Cardioverter-Defibrillator Therapy Due to the Detection of Premature Ventricular Complexes

Inappropriate shocks delivered by implantable cardioverter-defibrillators may occur in 15%-40% of patients treated with these devices. This article describes a rare cause for inappropriate shocks. Two patients received inappropriate shocks due to the presence of premature ventricular complexes during attempted reconfirmation of ventricular fibrillation. Knowledge of device algorithms for detection and reconfirmation of ventricular fibrillation, designed to have a high degree of sensitivity and therefore lower specificity, allows for reprogramming to avoid further inappropriate shocks.     

Angiotensin converting enzyme insertion allele in relation to high altitude adaptation

Angiotensin converting enzyme ( ACE ) gene I/D polymorphism has been associated with high altitude (HA) disorders as well as physical performance. We, however, envisage that the polymorphism may be associated with adaptation to the hypobaric hypoxia of altitude, thus facilitating physical performance. For this purpose, three unrelated adult male groups, namely (1) the Ladakhis (HLs), who reside at and above a height of 3600 m, (2) lowlanders, who migrated to Ladakh (MLLs), and (3) resident lowlanders (LLs), have been investigated. The HLs had significantly ( p < 0.001) greater numbers of the II homozygotes and the ID heterozygotes than the DD homozygotes, the genotype distribution being 0.46, 0.43 and 0.11 for II, ID and DD genotypes respectively. The MLLs comprised 60% II homozygotes, which was higher ( p < 0.001) than the HLs (46%). In the LLs, the heterozygotes were greater ( p < 0.001) in number than the II and DD homozygotes. The I allele frequency was 0.72 in the MLLs, 0.67 in the HLs and 0.55 in the LLs. Polymorphism study suggested that the II genotype could be associated with altitude adaptation, which might influence physical efficiency.