Probiotics and prebiotics in non-bovine milk.

Probiotics are live microorganisms that, when administered in adequate numbers, confer health benefit/s on the host, while prebiotics are nondigestible food ingredients that are selectively stimulate the growth of beneficial microorganisms in the distal parts of the host digestive tract conferring health benefits. Dairy products manufactured mainly using bovine milk is the major vehicle in delivering probiotics to humans. At present, there is an increasing demand for non-bovine probiotic milk products. Both bovine and non-bovine dairy products contain several ingredients with prebiotic properties such as oligosaccharides that could positively interact with probiotics to alter their functional properties. Furthermore, these bovine and non-bovine products could be fortified with prebiotics from various sources such as inulin and oligofructose in order to provide additional health benefits. In addition, non-bovine milk products are good sources for isolating novel potential probiotics. Non-bovine milk such as goat, sheep, camel and donkey have been used in producing several probiotic products including set-yoghurt, drinking-yoghurt, stirred-yoghurt, ice cream and cheese. Prebiotic inclusions in non-bovine milk at present is mainly associated with goat and sheep milk products. In this context, this chapter focuses on the different types of non-bovine milk products containing probiotics and prebiotics, and product quality and microbiological characteristics with special reference to probiotic viability.

Probiotics in Goat Milk Products: Delivery Capacity and Ability to Improve Sensory Attributes.

Dairy foods, particularly those of bovine origin, are the predominant vehicles for delivery of probiotic bacteria. Caprine (goat) milk also possesses potential for successful delivery of probiotics, and despite its less appealing flavor in some products, the use of goat milk as a probiotic carrier has rapidly increased over the last decade. This review reports on the diversity, applicability, and potential of using probiotics to enhance the sensory properties of goat milk and goat milk-based products. A brief conceptual introduction to probiotic microorganisms is followed by an account of the unique physicochemical, nutritive, and beneficial aspects of goat milk, emphasizing its advantages as a probiotic carrier. The sensory properties of probiotic-enriched goat milk products are also discussed. The maintenance of probiotic viability and desirable physicochemical characteristics in goat milk products over shelf life is possible. However, the unpleasant sensory features of some goat milk products remain a major disadvantage that hinder its wider utilization. Nevertheless, certain measures such as fortification with selected probiotic strains, inclusion of fruit pulps and popular flavor compounds, and production of commonly consumed tailor-made goat milk-based products have potential to overcome this limitation. In particular, certain probiotic bacteria release volatile compounds as a result of their metabolism, which are known to play a major role in the aroma profile and sensory aspects of the final products.

The efficacy and side effects of topiramate on refractory epilepsy in infants and young children: a multi-center clinical trial.

OBJECTIVES: This study has been conducted to assess the efficacy and safety of topiramate in refractory epilepsies in infants and young children. METHODS: A prospective clinical trial was performed in three tertiary care hospitals, on 47 children aged 6-60 months with refractory epilepsy. Topiramate was added to at least two baseline anti-epileptic drugs. The efficacy was rated according to seizure type, frequency and duration. RESULTS: Children with refractory epilepsy were classified according to their clinical, neuro-imaging, and neurophysiological profile into infantile spasms (IS) (9 cases, 19%), Lennox-Gastaut syndrome (LGS) (25 cases, 53%) and other epilepsies (13 cases, 28%). Children were also classified into cryptogenic and symptomatic epilepsy. Topiramate was introduced as add-on therapy in a daily dose of 1 mg/kg/day for 2 weeks, followed by increments of 1-3 mg/kg/day at 2-week intervals, up to a maximum of 10 mg/kg/day. After a minimum treatment period of 6 months, 28 (60%) of the children had a satisfactory response (completely seizure free, or more than a 50% seizure reduction). The remaining 19 children (40%) had an unsatisfactory response (50% or less reduction in seizure frequency, no change or increased seizure frequency). Topiramate appeared to be equally effective in infantile spasms, Lennox-Gastaut syndrome and children with other types of epilepsy, with no significant difference between those with a satisfactory and an unsatisfactory response (p=0.089). There was also no significant difference in response between patients with cryptogenic and symptomatic epilepsy (p=0.360). Mild to moderate adverse effects, mainly somnolence, anorexia and nervousness, were present in 25 (53%) of children. One of the children developed hypothyroidism. CONCLUSION: Although the long term safety and possible adverse effects of topiramate have not been fully established in infants and young children, this study has shown that it is a useful option for children with frequent seizures unresponsive to standard anti-epileptic drugs.

Febrile convulsions in children.

The term febrile convulsion is not a diagnostic entity. It simply describes any seizure that occurs in response to a febrile stimulus. It usually occurs between the age of 3 months and 5 years and occurs in 2-4% of young children. The typical febrile convulsion is a generalized tonic clonic seizure lasting between a few seconds and 15 minutes, followed by a period of drowsiness. Febrile seizures tend to occur in families, although the exact mode of inheritance is not known. Viruses are the most common cause of illness in children admitted to the hospital with a first febrile seizure. Routine laboratory studies are not indicated for patients who have febrile seizures and should be performed only as part of the evaluation for a source of fever. Prognosis is generally good. Only a small minority of children develop epilepsy or recurrent non-febrile seizures. Children with febrile seizures are at no greater risk of intellectual impairments than their peers. Treatment to prevent recurrence has not been shown to prevent later development of epilepsy.

Febrile convulsions in children.

The term febrile convulsion is not a diagnostic entity. It simply describes any seizure that occurs in response to a febrile stimulus. It usually occurs between the age of 3 months and 5 years and occurs in 2-4% of young children. The typical febrile convulsion is a generalized tonic clonic seizure lasting between a few seconds and 15 minutes, followed by a period of drowsiness. Febrile seizures tend to occur in families, although the exact mode of inheritance is not known. Viruses are the most common cause of illness in children admitted to the hospital with a first febrile seizure. Routine laboratory studies are not indicated for patients who have febrile seizures and should be performed only as part of the evaluation for a source of fever. Prognosis is generally good. Only a small minority of children develop epilepsy or recurrent non-febrile seizures. Children with febrile seizures are at no greater risk of intellectual impairments than their peers. Treatment to prevent recurrence has not been shown to prevent later development of epilepsy.

Guillain-Barre syndrome clinical profile and the efficacy of immunoglobulin therapy.

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Endoscopic suspension of bladder neck for treatment of female stress urinary incontinence.

Between the years 1984 and 1993, a total of 72 female patients underwent endoscopic suspension of bladder neck for treatment of stress urinary incontinence at the King Hussein Medical Center and Hamad General Hospital, Amman, Jordan. The age of the study patients ranged between 32 and 75 years (mean: 46.5 years). Fifteen (20.8%) had history of previous operations for incontinence. The overall success rate achieved was 93.1%. Post-operative complications were encountered in seven (9.8%) patients within follow-up period of 4 to 43 months. Treatment failure occurred in five patients (6.9%). Our experience further confirms that endoscopic suspension of the bladder neck is a simple and reliable procedure in the treatment of female stress urinary incontinence.

Henoch-Schonlein purpura: clinical experience and contemplations on a streptococcal association.

Henoch-Schonlein Purpura (HSP) is a common cause of vasculitis in children. The role of an antecedent streptococcal infection is still controversial. The aim of this study is to verify such a relationship, as well as to provide a profile of the clinical features and the magnitude of this disorder in Jordan. We identified 69 cases of HSP below the age of 13 years between January 1991 and April 1994 admitted to the two main hospitals in northern Jordan. Thirty-five of these cases were prospectively enrolled during the last year of the study. Forty-three controls, frequency-matched to the cases on age and sex, were selected from the out-patient clinics of the same two hospitals. The minimum estimate of the annual incidence was 8.5/100,000. All patients recovered completely and were well after a mean period of follow-up of 16 months. The clinical features were essentially similar to those reported by others. Unusually, two of our cases followed mumps and one occurred after otitis media caused by Streptococcus pneumoniae. Forty-nine per cent of all patients in this series had evidence of a recent streptococcal infection (elevated antistreptolysin O titre) compared to 16 per cent of the controls. The difference was statistically significant (P = 0.004). This finding supports a role for antecedent streptococcal infection in the pathogenesis of HSP.

The clinical spectrum of Henoch-Schönlein purpura in infants and young children.

UNLABELLED: Henoch-Schönlein purpura is a common cause of childhood vasculitis. The rarity of the disease under 2 years of age has been the subject of few reports. We present the clinical spectrum of Henoch-Schönlein purpura in 12 children younger than 2 years of age at presentation. The median age at presentation was 11 months. The purpuric skin rash was present in all patients and involved the face in 10 of them. While oedema was a prominent feature in all of our patients only one third had involvement of the kidneys, gastro-intestinal tract or joints. All patients recovered completely after a mean duration of follow up of 10.6 months (range 2-39 months). CONCLUSION: Henoch-Schönlein purpura under the age of 2 years is characterized clinically by oedema and a purpuric skin rash which frequently affects the face. Involvement of the joints, kidneys and gastro-intestinal tract is uncommon and the prognosis is excellent. The clinical spectrum in this age group is a continuation with that of Henoch-Schönlein purpura in older children suggesting a nosological entity.