Probiotics and nutrients for the first 1000 days of life in the developing world.

Clinically proven probiotics are, for the most part, not available in the developing world and certainly not affordable for the majority of people. This is unconscionable considering these products can alleviate diarrhoea and various infections, which are by far the major cause of death in children and in adults who are HIV positive. Indeed, some of these products have been proven in developing world settings. Distribution networks exist along with pharmacies and clinics that dispense drugs and products that require refrigeration. So, are lack of profit or company resources the problem? Our university has shown that alternative community based kitchen models that produce probiotics can be established. These empower local people, are socially responsible, produce affordable products and deliver benefits to over 3,000 children and adults daily. Surely, other institutions and corporations can multiply this effect and develop social business models across the developing world that are supported by clinical and basic science studies? In this review, we will discuss the application of probiotics and selected nutrients in the first 1000 days of life, a critical timepoint which is particularly challenging in resource disadvantaged countries.

Point-of-care testing: the views of the working group of the Dutch Association of Clinical Chemistry.

There is clearly a demand for near-patient laboratory testing. Modern technological developments support its implementation, but these are not the only preconditions that need to be satisfied in order to successfully introduce decentralized testing. In part 2 of this paper we give a definition of decentralized testing. Part 3 presents the advantages and disadvantages. This list is a summary taken from the suggested literature. Part 4 examines the formal position of the clinical chemist. Of major importance to the situation in the Netherlands are the Care Institutions Quality Act and the Individual Health Care Professions Act. Part 5 discusses professional standards. Part 6 outlines practical considerations which might support the implementation of decentralized testing. The clinical chemist should play an active role in drawing up a discussion paper for his own hospital.

Evaluation of the creatinine assay on the Reflotron analyser under centralized and non-centralized conditions.

The creatinine assay, performed on Reflotron "dry chemistry" analysers in six offices of general practitioners, was evaluated as part of a project on the quality of laboratory determinations in decentralized situations. The method itself was evaluated before this investigation was started. Differences were noticed between Reflotron machines, batches of strips, and various types of sample, viz. heparin-treated blood or plasma gave higher results than serum of EDTA-treated samples. All Reflotron results were lower in comparison with wet chemistry methods. The "dry chemistry" technique was not influenced by the presence of glucose or bilirubin (below 170 mumol/l); haemoglobin interfered. By simultaneous sampling, all creatinine determinations performed on whole EDTA blood in the general practitioners offices were repeated on serum in centralized laboratories using "wet chemistry" techniques. In this comparison 3% of all creatinine determinations in general practitioners offices were outside the 95% confidence interval. We conclude that the creatinine determination on the Reflotron may be used in general practitioners office testing as long as the general practitioner is aware of its limitations and can rely on a "reference" laboratory for training, quality control and repetition of unexpected results.

Relocation. An educational challenge.

Moving! The word evokes thoughts of chaos, disorder, and stress. In this article, the authors describe their experience in designing and providing educational programs to facilitate the relocation of an entire hospital to a new facility in a large metropolitan area.

[Extended spinal decompression using an anterior approach in the treatment of myelopathies caused by cervical arthrosis]. / Décompression médullaire étendue par voie antérieure dans le traitement des myélopathies par cervicarthrose.

Forty-five patients suffering from severe myelopathy due to cervical spondylosis with stenosis of the spinal canal were treated by anterior decompression extending over three levels or more. In eight instances, the decompression was the only surgical procedure: in 37 instances, there was associated bone graft. No severe complications were noted. The clinical results were assessed, using the Nurick scale. The average follow-up was four years. No patient was made worse. Twelve were completely relieved, 21 were improved and 12 were unchanged. The authors conclude that this technique is worthwhile. Grafting should be done only in cases where there is post-operative instability. After a review of the literature, the authors conclude that anterior resection of the vertebral bodies is more reliable than extensive laminectomy.

Clinical implications of differences between two recommended procedures for determination of aspartate aminotransferase.

We compared two officially recommended methods for determination of aspartate aminotransferase (EC 2.6.1.1): that of the International Federation of Clinical Chemistry (IFCC) and that of the Deutsche Gesellschaft für Klinische Chemie (DGKC). We used automated enzyme analyzers, initiating the reactions with 2-oxoglutarate. Normal values, 10-30 U/L (IFCC) and 7-18 U/L (DGKC), were apparently insensitive to intra-individual variations. Samples obtained from patients with heart disease showed a markedly different amount of activation with pyridoxal phosphate as compared with samples from other patient categories. Ratios for aspartate aminotransferase/alanine aminotransferase, as used in the differentiation of liver disease, can still be used with either method for determination of aspartate aminotransferase.

Gentamicin assay: comparison of an adapted EMIT method and an RIA method.

The EMIT technique for gentamicin assay adapted to the Centrifichem-300 system was compared with an established RIA procedure. EMIT results correlated very well with the results obtained by the RIA method (r = 0.976, N = 48). For the adapted EMIT assay, the interassay coefficient of variation was 4-8% and for the RIA method 6-14%. Several possible interfering agents were investigated, of which only carbenicillin showed interference in both assays. Our data indicate that the EMIT technique exhibits adequate precision and accuracy for routine gentamicin determinations.