Ghanaian Female Adolescents Perceived Changes in Nutritional Behaviors and Social Environment After Creating Participatory Videos: A Most Significant Change Evaluation.

Background: Understanding the influence of participatory video-making on the nutrition-related behavior of video creators may help shape nutrition education interventions. Objectives: This study assessed the perceived value and influence of a participatory video intervention among participants and stakeholders. Methods: A 2018-2019 cluster randomized controlled trial (registered at clinicaltrials.gov as NCT03704649) selected 20 schools (10 intervention, n = 181; 10 control, n = 170) in 1 Ghanaian rural district, enrolled adolescent girls aged 13-16 y, and provided a nutrition curriculum. Each intervention school also participated in 2 series of activities designed to help adolescents plan, film, and screen 2 nutrition-related videos. The Most Significant Change method involved intervention participants and local stakeholders to assess the value and influence of the intervention - a secondary outcome of the trial. Project staff collected 116 stories of change from the adolescents. Stories described shifts in 4 domains: participant, peer, and family behavior, and structural changes in the school. The project team used a selection rubric to identify 14 stories that reflected heightened nutrition literacy. Staff conducted interviews with the 14 adolescents whose stories were selected to elaborate on details and perceived resonance. Finally, local stakeholders assessed the stories to identify the 4 most significant changes of the intervention - 1 per domain. A separate thematic analysis identified emerging patterns of motivation and action across the 14 interviews. Results: The chosen Most Significant Change stories revealed how adolescents found creative solutions to acquire iron-rich foods, encouraged neighbors to eat iron-rich foods, taught their family new agricultural practices, and promoted change in their school canteen. Local stakeholders valued stories that addressed common community nutrition issues in a creative and sustainable way, whereas adolescents prioritized stories that showed a change in health outcomes. Conclusion: Stories of change revealed that the intervention promoted a transformative influence; participants modified their eating habits, lifestyle, and their environment.

Crustal rheology of the Himalaya and Southern Tibet inferred from magnetotelluric data.

The Cenozoic collision between the Indian and Asian continents formed the Tibetan plateau, beginning about 70 million years ago. Since this time, at least 1,400 km of convergence has been accommodated by a combination of underthrusting of Indian and Asian lithosphere, crustal shortening, horizontal extrusion and lithospheric delamination. Rocks exposed in the Himalaya show evidence of crustal melting and are thought to have been exhumed by rapid erosion and climatically forced crustal flow. Magnetotelluric data can be used to image subsurface electrical resistivity, a parameter sensitive to the presence of interconnected fluids in the host rock matrix, even at low volume fractions. Here we present magnetotelluric data from the Tibetan-Himalayan orogen from 77 degrees E to 92 degrees E, which show that low resistivity, interpreted as a partially molten layer, is present along at least 1,000 km of the southern margin of the Tibetan plateau. The inferred low viscosity of this layer is consistent with the development of climatically forced crustal flow in Southern Tibet.

Association of serum selenium with thyroxin in severely iodine-deficient young children from the Amhara region of Ethiopia.

BACKGROUND/OBJECTIVES: Selenium (Se) as part of glutathione peroxidase and iodothyronine deiodinase enzymes influences thyroid metabolism. This study investigated the association of serum Se levels with thyroid metabolism of severely iodine-deficient young children from the Amhara region of Ethiopia. SUBJECTS/METHODS: In a cross-sectional study, Se, thyroid-stimulating hormone, total thyroxin, total triiodothyronine and thyroglobulin in serum of children (N=628) 54-60 months of age from the Amhara region, Ethiopia, were analyzed. In addition, iodine in urine and household salt was analyzed, and the presence of goiter was assessed. RESULTS: The median serum Se concentration was 61.4 µg/l (10.7-290.9 µg/l). Selenium deficiency (serum Se <70 µg/l) was detected in 57.8% (N=349) of the children. The median urinary iodine concentration (UIC) was 9.8 µg/l. The majority (86.6%, N=449) of children had UIC below the recommended value (100 µg/l). In addition, 59.8% (N=310) of children were severely iodine deficient (UIC<20 µg/l). Only 12.7% of salt samples had iodine. Goiter was present in 44.6% (N=280) of the children. Selenium-deficient children had higher serum thyroxin (T4) than children with normal serum Se concentration (P<0.001). CONCLUSIONS: Serum Se was negatively associated with T4 level in young children from the Amhara region of Ethiopia and may endanger the effectiveness of the salt iodization program.

Histochemical and immunochemical study of the fate of Candida albicans inside human neutrophil phagolysosomes.

To further define the ultrastructural events associated with the killing of Candida albicans by human neutrophils, four methods were used: (1) the periodate-thiocarbohydrazide-silver proteinate (PA-TCH-SP) staining of vicinal-glycol-containing complex carbohydrates; (2) the localization of thermostable immunodeterminants of the yeast cell wall, mannans or mannoproteins, using monospecific antibodies and a protein A-gold complex (monAb-gold); (3) the localization of mannose residues with concanavalin A labeled with gold particles (Con A-gold); (4) the localization of chitin oligomers using wheat germ agglutinin and ovomucoid labeled with gold particles (WGA-gold). The mannan-rich cell wall layers were progressively lost as shown by altered PA-TCH-SP reactivity and a diffuse pattern of staining with Con A-gold and monAb-gold. The de novo appearance of conspicuous amounts of glycogen-like particles near the plasmalemma and in the cell wall was interpreted as evidence of a reparative process of the yeast cell wall. Chitin was seemingly unaltered and readily demonstrated by the WGA-gold in the wall remnants of ghost cells.

Effect of dietary viscosity on energy intake by breast-fed and non-breast-fed children during and after acute diarrhea.

To determine the effect of dietary viscosity on energy consumption by young children, 56 Peruvian children 9-20 mo of age with acute diarrhea were randomly assigned to either a liquid or semisolid diet, with or without added amylase to reduce viscosity. Intakes of the study diet, breast milk, and other foods were measured for 2 consecutive d during and again after illness. Total 24-h energy intake (chi +/- SD) during diarrhea, 349.4 +/- 121.8 kJ/kg (83.6 +/- 29.1 kcal/kg) was 18% less than intake after recovery, 428.9 +/- 141.0 kJ/kg (102.6 +/- 33.7), P < 0.001. In the ANOVA breast-fed children consumed significantly less total energy (P = 0.008) and energy from the study diet (P = 0.02) than non-breast-fed children. Breast milk intake did not change with illness. There was no significant relationship between viscosity of the study diet and either total energy intake or intake of energy from the study diet. Energy intake by these children was primarily determined by health status and breast-feeding practice, not by dietary viscosity.

Breast milk or animal-product foods improve linear growth of Peruvian toddlers consuming marginal diets.

Although breast-feeding is widely accepted as important for infant health, its benefits during the second year of life have been questioned. We analyzed data from 107 breast-fed and weaned Peruvian children living in a periurban community to determine whether breast milk contributed to improved linear growth between 12 and 15 mo of age. Breast-feeding frequency was self-reported; intakes of complementary foods and animal products were estimated from a food-frequency survey. Multivariate-linear-regression analysis was used to predict the length of the children at 15 mo of age. Determinants of length included length and weight-for-length at 12 mo of age (US National Center for Health Statistics standards), interval between 12- and 15-mo measurements, breast-feeding frequency, incidence of diarrhea, and intakes of complementary and animal-product foods. Complementary foods, animal-product foods, and breast milk all promoted toddlers' linear growth. In subjects with low intakes of animal-product foods, breast-feeding was positively associated (P < 0.05) with linear growth. There was a 0.5-cm/3 mo difference in linear growth between weaned toddlers and children who consumed the average number of feedings of breast milk. Linear growth was also positively associated with intake of animal-product foods in children with low intakes of complementary foods. The negative association between diarrhea and linear growth did not occur in subjects with high complementary-food intakes. When the family's diet is low in quality, breast milk is an especially important source of energy, protein, and accompanying micronutrients in young children. Thus, continued breast-feeding after 1 y of age, in conjunction with feeding of complementary foods, should be encouraged in toddlers living in poor circumstances.

PIP: The contribution of prolonged breast feeding to linear growth at 12-15 months of age was investigated in 107 breast-fed and weaned toddlers from a low-income neighborhood in Lima, Peru. The median duration of breast feeding in this sample was 17.1 months; by 15 months, 46 children had been weaned. The prevalence of stunting (length-for-age score -2 SD below the reference standard) was 17.8% at 12 months and 24.3% at 15 months; no child was wasted. Complementary foods, animal product foods, and breast milk all promoted toddlers' linear growth. In children with low intakes of animal product foods, breast feeding was positively associated with linear growth at 15 months (p 0.05). There was a 0.5 cm/3 months difference in linear growth between weaned toddlers and those who consumed the average number (6.3/day) of breast feeds. Linear growth was further positively associated with intake of animal product foods in children with low intakes of complementary foods. The negative association between diarrhea and linear growth did not occur in children with high intakes of complementary foods. When the household diet is of poor quality, breast feeding is an especially important source of energy, protein, and micronutrients in toddlers and should be continued beyond 12 months of age in conjunction with the provision of complementary foods. Breast milk not only added to the total diet of these young children, but also potentiated the beneficial effects of complementary foods consumed by increasing their growth promotion capacity.

Influence of muramyl dipeptide on renal candidiasis in genetically distinct mice.

Susceptible (DBA/2) and resistant (C57BL/6) mice were inoculated intravenously with Candida albicans to evaluate the effect of a four-day prophylaxis with muramyl dipeptide (MDP) on the renal burden of organisms during the first week after infection. In sham-treated DBA/2 mice injected with 8 x 10(4) candida cells, renal CFU (LOG10 +/- SEM) on days 1, 4 and 7 after infection were found to average 5.050 +/- 0.109, 4.882 +/- 0.133 and 5.482 +/- 0.245. In sham-treated C57BL/6 mice injected with 2 x 10(5) candida cells, renal CFU on days 1, 4 and 7 reached only 3.610 +/- 0.118, 3.404 +/- 0.107 and 4.176 +/- 0.580. MDP-treated DBA/2 mice achieved significant reduction in CFU of C. albicans on day 1 (1.3 log units) and day 4 (0.6 log unit), while MDP-treated C57BL/6 mice had significant reduction in CFU of C. albicans only on day 1 (0.6 log unit) after infection. Sham-treated mice of both strains had a 28.6 to 30% increase in kidney weights on day 4 only, a transient change not seen in MDP-treated mice. Histopathological examination on days 8, 15 and 21 after infection revealed a higher incidence of renal papillary necrosis in DBA/2 mice than C57BL/6 mice (approximately 70% vs 10%). The incidence of granulomas and of chronic interstitial inflammation was much higher in MDP-treated mice. We conclude that the genetic makeup of the host influences the potential effectiveness of MDP as a biological response modifier.

Association of breastfeeding and stunting in Peruvian toddlers: an example of reverse causality.

BACKGROUND: Child feeding recommendations include breastfeeding beyond 12 months, however, some researchers have reported increased rates of malnutrition in breastfed toddlers. A negative association between growth and breast-feeding may reflect reverse causality; that is, the outcome (growth) is a determinant of the predictor (breastfeeding), and not vice versa. We examined this question with data from 134 Peruvian toddlers. METHODS: A linear regression analysis predicted length at the age of 15 months by length at 12 months, study interval, and 12-14.9-month breastfeeding, complementary food intake, and diarrhoeal incidence. This analysis defined the association between breastfeeding and linear growth. To elucidate the direction of the effect between breastfeeding and linear growth, logistic regression was used to predict the probability of weaning by the end of 14 months. Determinants included weight-for-age (W/A) at 12 months, complementary food intake at 9-11.9 months, and change in diarrhoeal incidence between 9 and 14.9 months. RESULTS: There was a significant (P < 0.01) interaction of breastfeeding, diarrhoeal incidence, and complementary food intake on length at 15 months. Increased breastfeeding was associated with a 1.0 cm decrease in length gain when dietary intake was low and diarrhoeal morbidity was high, implying that breastfeeding is harmful. The logistic analysis, however, demonstrated that the risk of weaning decreased only when W/A and dietary intake were low and diarrhoeal morbidity was high. CONCLUSIONS: The negative association between breastfeeding and linear growth reflected reverse causality. Increased breastfeeding did not lead to poor growth; children's poor growth and health led to increased breastfeeding. Children's health must be considered when evaluating the association of breastfeeding with anthropometric outcomes.

PIP: There has been a perplexing finding, in many developing countries, of increased rates of stunting and growth faltering in breast-fed toddlers receiving complementary foods relative to their non-breast-fed counterparts. Longitudinal data on 134 children 12-15 months of age from Lima, Peru, were used to investigate the hypothesis that the negative association between growth and breast feeding reflects reverse causality. The toddlers were participants in a broader persistent diarrhea surveillance survey conducted during 1985-87. 72.9% of children were breast-fed beyond 12 months (median duration, 16.8 months). Anthropometric measurements revealed stunting in 19.4% of toddlers at 12 months and in 29.1% at 15 months. Linear growth between 12 and 15 months had a complex relationship with breast feeding, diarrhea, and dietary factors. Increased breast feeding was associated with a 1.0 cm decrease in length gain between 12 and 15 months when dietary intake was low and diarrheal morbidity was high. However, logistic analysis demonstrated that mothers whose children had low dietary intakes, low weight-for-age, and increased incidence of diarrhea were less likely to wean their infants at 12 and 14 months. This finding that mothers modified their children's feeding practices according to the child's health and growth status supports a reverse causality process in which poor growth is a determinant rather than a result of breast feeding.

Viability assessment by dye exclusion. A fluorescent method for fungal cells.

A new fluorescent staining technique for fungi utilizes the differential affinity of dead cells for rhodamine B. A mounting medium has been devised that includes the dye. This medium allows direct processing of cells from a broth and provides optimal conditions for fluorescence intensity. Comparison with the standard methylene blue exclusion test as applied to the Candida albicans yeast phase indicates similar specificity. Various pseudohyphae and several fungi also exhibited selective uptake of the dye when killed. This technique should prove useful in studying the effect of both drugs and cells on pathogenic yeasts.

Prevalence and symptoms of Enterobius vermicularis infections in a Peruvian shanty town.

The prevalence and symptoms of pinworm infection were determined in a shanty town in Lima, Peru. In 206 families, pinworm infection rates were highest in primary school age children (42%). Approximately one-fourth of pre-school children and secondary school-age children were infected with pinworms. Two examinations detected 74% of patients who were positive after 5 examinations. Symptoms often attributed to pinworm infection, such as perianal itching enuresis, and teeth grinding, occurred in a similar proportion of infected children (15%, 17%, 13%, respectively) and non-infected subjects (11%, 13%, 11%, respectively). Enuresis was more common in primary school-age children with high pinworm egg counts than in their non-infected contemporaries. 52% (28/54) of children under 5 years old became reinfected within 6 months of effective treatment. In a community where water is scarce and hand washing is infrequent, the high rate of perianal itching is probably an important source of faecal-oral contamination. The low morbidity and high reinfection rate make routine treatment of pinworm infection in third world countries a low priority, except when clinically indicated.

Recognizing the reversible nature of child-feeding decisions: breastfeeding, weaning, and relactation patterns in a shanty town community of Lima, Peru.

Researchers have normally considered weaning to be a non-reversible event. To determine the validity of this assumption, we interviewed 36 mothers of toddlers who were living in a poor shanty town of Lima, Peru. Data from 32 women were complete and used in this analysis. Mothers described their beliefs, practices, and decisions about breastfeeding, weaning, and relactation (the reintroduction of breastfeeding after weaning). We recorded attempted weaning events if the mother reported (1) purposefully not breastfeeding with the intention to wean, or (2) carrying out an action that was believed to cause the child to stop breastfeeding. Using a constant comparative approach, references to child-feeding decisions were coded, categorized, and analyzed. All mothers breastfed for at least 12 months; the median duration of breastfeeding was 25 months. There were several different patterns of child-feeding. Thirteen women never attempted to wean their children or had weaned on the first attempt. The majority (n = 19) of women, however, attempted to wean their children - some as early as 3 months of age but relactated between less than 1 day and 3 months later. Factors that influenced feeding decisions were primarily related to maternal and child health, and maternal time commitments. Children were weaned when there was a perceived problem of maternal health or time commitments and child health was not at risk of deterioration. Mothers postponed weaning because of poor child health. The primary reason for relactation was a child's negative reaction to weaning (e.g., incessant crying or refusal to eat). Personalities of the mother and child were important determinants of feeding decisions. These results demonstrate that maternal and child factors jointly influence child-feeding decisions and that these decisions are easily reversed. As relactation is culturally acceptable, health practitioners should consider recommending relactation when children have been prematurely weaned and human milk would improve their nutritional and health status.

Infective endocarditis update experience from a heart hospital.

In a retrospective study of 50 patients with infective endocarditis (IE), we found an overall mortality of 44%: among the 26 patients with natural valves (NV) the mortality was 19%; among the 24 with prosthetic valves (PV) it was 71%. Congenital heart disease was recognized in 17 of our cases, with a significant clustering in the NV group (50% vs 17%, p = 0.029); the most frequently encountered malformation was the bicuspid aortic valve. The incidence of rheumatic heart disease was 46% in the NV group and 83% in the PV group (p = 0.015). Manifestations of IE were protean and multisystemic. We calculated an average of 4.6 symptoms and 4.7 signs for each patient. Although sepsis was abated with appropriate antibiotics, death often ensued from multiple complications: congestive heart failure, arrhythmia, stroke, embolic myocardial infarction, valvular destruction or dehiscence, coagulopathy. New features of natural valve infective endocarditis are a rising incidence in the elderly and a survival rate seemingly at its peak. Features of prosthetic valve infective endocarditis include overwhelmingly frequent embolization to the central nervous system (p = 0.004), spleen (p = 0.009) and kidney (p = 0.010). Advances in therapy for this disease may come from early surgery in late prosthetic valve endocarditis and from future prospective studies to define how the host response influences the outcome.

Muramidase-mediated damage to Candida yeast cells. Histochemical and immunochemical characterization of accumulating wall-like material.

Hen egg-white lysozyme is known to be fungicidal to blastoconidia of Candida albicans under defined in vitro conditions. This lethal action leads to changes in the layering of cell wall and to plasmolysis, caused by unremitting accumulation of wall-like material between the yeast cell wall and cytoplasmic membrane. Here, several methods were applied on ultrathin sections to define the nature of wall-like material: histochemical staining with periodic acid-thiocarbohydrazide-silver proteinate, periodic acid-alkaline bismuth, and phosphotungstic acid at low pH; the localization of the carbohydrate residues with lectin-gold complex; immunocytochemical staining with monospecific antibodies, factor 1 and 6, which recognized major cell wall antigens. The wall-like material was almost uniformly highlighted with periodic acid-thiocarbohydrazide-silver proteinate, factor 1 antibody, concanavalin A-gold and wheat germ agglutinin-ovomucoid-gold, indicating the presence of mannoproteins and chitin. The serotype A-specific epitope recognized by factor 6 antibody was not detected in the wall-like material, although it was demonstrated in the outer cell wall layers after 2 h of exposure to lysozyme.

[Endocarditis caused by Candida parapsilosis (para-krusei)]. / Endocardite à Candida parapsilosis (para-krusei).

This paper describes a case of Candida Parapsilosis endocarditis in a patient with a mitral valve prosthesis implanted two years previously. This history started with a cerebrovascular accident associated with pyrexia. A complex medico-surgical therapeutic approach controlled the infection. This consisted of systemic and local (immersion of the prosthesis) antifungal therapy, bathing the left heart chambers in 5 p. 100 iodine solution and two valve replacements at 8 months intervals. The second surgery was not related to recurrence of the candida infection but to a perivalvular leak attributed to the insertion of the prosthesis into tissues inflamed by recent infection. Despite the improvement in the prognosis of fungal infection due to an early surgical approach, it is still essential to try and prevent the disease, the mortality rate still being over 80 p. 100. It is essential to be very careful when using intravenous catheters and aerosols; the indications of antibiotherapy must also be respected.

[Actinobacillus actinomycetemcomitans infectious endocarditis. Apropos of 2 cases and review of the literature]. / Endocardite infectieuse à Actinobacillus actinomycetemcomitans. A propos de 2 cas et revue de la littérature.

This work reports two cases of endocarditis caused by Actinobacillus actinomycetemcomitans. As noted in the medical literature, the mean clinical features are a subacute infection without know source of bacteremia, in a male patient aged 40 years or older and who is suffering from a heart disease. In our two presentations, the good response to single antibiotic treatment, although the optimal therapeutic approach is not yet defined, and the lack of embolism phenomena are of special interest. Spectrum of bacteria which can be responsible of infective endocarditis is widening rapidly; this study is an example of this trend.

[Anti-Candida albicans serology. A study carried out on 178 pregnant women in labour (author's transl)]. / Sérologie anti-Candida albicans. Etude réalisée chez 178 femmes enceintes en période de travail.

The serological study of 178 women investigated during labor shows that the number of patients with a significant titer of Candida albicans antibodies is 161 % higher in those suffering from vulvovaginitis due to this fungus as compared to patients without current infection. Among the 30 patients having vaginitis, 73 % harbor the yeast in the gastrointestinal tract. Precipitins were present in 6 patients : all of them also have a high titer of fluorescent antibodies. From the results of this work, it can be concluded that Candida albicans serology, although still difficult in its interpretation, is an interesting tool for the clinician and for the study of the physiopathology of candidosis.