Effect of long-term intermittent supplementation with multiple micronutrients compared with iron-and-folic acid supplementation on Hb and micronutrient status of non-anaemic adolescent schoolgirls in rural Bangladesh.

The present study examined whether long-term supplementation with once- and twice-weekly multiple micronutrients (MMN-1 and MMN-2) can improve Hb and micronutrient status more than twice-weekly Fe-folic acid (IFA-2) supplementation in non-anaemic adolescent girls in Bangladesh. An equal number of 324 rural schoolgirls aged 11-17 years were given MMN-1 or MMN-2 or IFA-2 supplements for 52 weeks in a randomised, double-blind trial. Blood samples were collected at baseline, and at 26 and 52 weeks of supplementation. The girls receiving IFA-2 supplements were more likely to be anaemic than the girls receiving MMN-2 supplements for 26 weeks (OR 5·1, 95% CI 1·3, 19·5; P = 0·018). All three supplements reduced Fe deficiency effectively. Both the MMN-1 and MMN-2 groups showed significantly greater improvements in vitamins A, B(2) and C status than the girls in the IFA-2 group, as might be expected. Receiving a MMN-1 supplement was found to be less effective than MMN-2 supplement in improving Fe, vitamins A, B(2) and folic acid status. Receiving micronutrient supplements beyond 26 weeks showed little additional benefit in improving micronutrient status. In conclusion, given twice-weekly for 26 weeks, MMN supplements can improve micronutrient status effectively with no significant increase in Hb concentration compared with IFA supplements in non-anaemic Bangladeshi adolescent girls. However, it significantly reduces the risk of anaemia. Before any recommendations can be made, further research, including into cost-effectiveness, is needed to see whether MMN supplementation has any additional longer-term health benefits over that of IFA supplementation in this population.

[Preoperative assessment of renal vascular anatomy for donor nephrectomy: Is CT superior to MRI?]. / Évaluation préopératoire du nombre de vaisseaux chez le donneur de rein vivant. La TDM est-elle supérieure à l'IRM ?

BACKGROUND: computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are both used in the preoperative assessment of vascular anatomy before donor nephrectomy. Our objective was to determine retrospectively and to compare the sensitivity of CTA and MRA imaging in preoperative renal vascularisation in living kidney donors. PATIENTS AND METHODS: between 1999 and 2007, 42 kidney donors were assessed in our center: 27 by MRA, 10 by CTA, and five by both techniques. Images were interpreted using multiplanar reconstructions. Results were compared retrospectively with peroperative findings; discordant cases were re-examined by an experienced radiologist. Numbers of vessels detected with imaging methods was compared with numbers actually found at the operating time. RESULTS: MRA showed 35/43 arteries (Se 81.4 %) and 33/34 veins (Se 97.1 %), and CTA showed 18/18 arteries (Se 100 %) and 15/16 veins (Se 93.8 %). The presence of multiple arteries was detected in only one third of cases (3/9) on MRI scans; this difference was statistically significant. The missed arteries were not detected on second examination of the MRI scans with the knowledge of peroperative findings. CONCLUSION: MRA is less sensitive than CTA for preoperative vascularisation imaging in living renal donors, especially in the detection of multiple renal arteries.

Long-term intermittent multiple micronutrient supplementation enhances hemoglobin and micronutrient status more than iron + folic acid supplementation in Bangladeshi rural adolescent girls with nutritional anemia.

Previous short-term supplementation studies showed no additional hematologic benefit of multiple micronutrients (MMN) compared with iron + folic acid (IFA) in adolescent girls. This study examines whether long-term once- or twice-weekly supplementation of MMN can improve hemoglobin (Hb) and micronutrient status more than twice-weekly IFA supplementation in anemic adolescent girls in Bangladesh. Anemic girls (n = 324) aged 11-17 y attending rural schools were given once- or twice-weekly MMN or twice-weekly IFA, containing 60 mg iron/dose in both supplements, for 52 wk in a randomized double-blind trial. Blood samples were collected at baseline and 26 and 52 wk. Intent to treat analysis showed no significant difference in the Hb concentration between treatments at either 26 or 52 wk. However, after excluding girls with hemoglobinopathy and adjustment for baseline Hb, a greater increase in Hb was observed with twice-weekly MMN at 26 wk (P = 0.045). Although all 3 treatments effectively reduced iron deficiency, once-weekly MMN produced significantly lower serum ferritin concentrations than the other treatments at both 26 and 52 wk. Both once- and twice-weekly MMN significantly improved riboflavin, vitamin A, and vitamin C status compared with IFA. Overall, once-weekly MMN was less efficacious than twice-weekly MMN in improving iron, riboflavin, RBC folic acid, and vitamin A levels. Micronutrient supplementation beyond 26 wk was likely important in sustaining improved micronutrient status. These findings highlight the potential usefulness of MMN intervention in this population and have implications for programming.

Pressure-controlled ventilation improves oxygenation during laparoscopic obesity surgery compared with volume-controlled ventilation.

BACKGROUND: We compared pressure and volume-controlled ventilation (PCV and VCV) in morbidly obese patients undergoing laparoscopic gastric banding surgery. METHODS: Thirty-six patients, BMI>35 kg m(-2), no major obstructive or restrictive respiratory disorder, and Pa(CO(2))<6.0 kPa, were randomized to receive either VCV or PCV during the surgery. Ventilation settings followed two distinct algorithms aiming to maintain end-tidal CO(2) (E'(CO(2))) between 4.40 and 4.66 kPa and plateau pressure (P(plateau)) as low as possible. Primary outcome variable was peroperative P(plateau). Secondary outcomes were Pa(O(2)) (Fi(O(2)) at 0.6 in each group) and Pa(CO(2)) during surgery and 2 h after extubation. Pressure, flow, and volume time curves were recorded. RESULTS: There were no significant differences in patient characteristics and co-morbidity in the two groups. Mean pH, Pa(O(2)), Sa(O(2)), and the Pa(O(2))/Fi(O(2)) ratio were higher in the PCV group, whereas Pa(CO(2)) and the E'(CO(2))-Pa(CO(2)) gradient were lower (all P<0.05). Ventilation variables, including plateau and mean airway pressures, anaesthesia-related variables, and postoperative cardiovascular variables, blood gases, and morphine requirements after the operation were similar. CONCLUSIONS: The changes in oxygenation can only be explained by an improvement in the lungs ventilation/perfusion ratio. The decelerating inspiratory flow used in PCV generates higher instantaneous flow peaks and may allow a better alveolar recruitment. PCV improves oxygenation without any side-effects.

[Severe bone marrow necrosis associated with septic shock in the intensive care unit]. / Nécrose médullaire osseuse sévère associée à un choc septique en réanimation.

Unexplained cytopenias can be related to bone marrow necrosis (BMN) in critically ill patients as it can be encountered in several diseases or life-threatening conditions. We present the case of a 39-year-old woman with pancytopenia revealing a BMN in the setting of an acute pyelonephritis with septic shock, multiple organ failure and sickle cell trait. After a short review on the subject, we suggest that various haematological abnormalities occurring in critically ill patients may be related to a mild to severe marrow necrosis.

Antioxidant capacity and total phenol content of commonly consumed selected vegetables of Bangladesh.

INTRODUCTION: The purpose of the study was to determine the antioxidant capacity (AC) and total phenolic content (TPC) of selected commonly consumed Bangladeshi vegetables and herbs. METHODS: Hydrophilic extracts from edible portions of ten vegetables and two herbs were analysed. The total phenolic amount ranged from 27.65 +/- 1.45 mg to 1.08 +/- 0.15 Gallic Acid Equivalent (GAE)/ g on a fresh weight (FW) basis. Contents of total phenol were determined spectrophotometrically according to the Folin-Ciocalteau method and the antioxidant capacity was determined by 2,2-diphenyl-1-1-picrylhydrazyl radical scavenging activity (DPPH-RSA). RESULTS: Antioxidant capacity varied from 8328.80 +/- 29.15 to 0.61 +/- 0.19 micromol Trolox Equivalent (TE)/g of FW. Ipomoea leaves showed the highest AC (8328.80 +/- 29.15 micromol TE/g), while the lowest AC (0.61 +/- 0.19 micromol TE/g) was seen in radish. A linear relationship was observed between Trolox Equivalent Antioxidant Capacity (TEAC) values and total phenol. Antioxidant capacity of the assayed samples correlated significantly and positively with total phenolic content (R2 = 0.814, p < 0.01). Vegetables with high polyphenol like Ipomoea leaves and mint showed high AC with the exception of raw banana which demonstrated moderate AC though it contained high TPC. Moderate TPC vegetables like amaranths and coriander leaves did not show substantial AC. CONCLUSION: The data indicates that indigenous vegetables containing high polyphenols may be a potential source of dietary antioxidants.

Protein concentration in pulmonary oedema fluid for negative pressure pulmonary oedema in children.

We report a case of acute pulmonary oedema following upper airway obstruction in a 1-year-old patient. We discuss the pathophysiology of this infrequent complication of upper airway obstruction and the interest of alveolar protein/blood protein ratio measurement to determine the mechanism of pulmonary oedema.

[Ureteral stenoses after renal transplantation]. / Les sténoses urétérales après transplantation rénale.

Out of 953 kidney transplantations performed in Lyon up to the end of 1984, we observed 28 (2.9%) post-operative ureteral stenoses. Most of them were diagnosed during the first year post-transplantation. Surgical reparation of the stenosis involved either ureterovesical reimplantation or pyeloureteral anastomosis with the patients' own ureter. Return to normal renal function was observed in 64.2% of our patients while in 10.7% renal function was stabilized. Actuarial postoperative graft survival was 66% at one year and 58% at two years of follow-up.

[Extracorporeal lithotripsy by shock waves. Initial results (322 cases)]. / Lithotritie extracorporelle par ondes de choc. Premiers résultats (322 patients).

Results of 322 patients treated with extracorporeal shock wave desintegration are reported (277 patients treated with the Dornier lithotripter, 45 patients treated with Solonithe using ultrasonic stone location). Lesions treated included 168 caliceal, 111 pyelic, 23 ureteral and 21 coralliform calculi. 45 patients presented multiple and 28 bilateral renal lithiasis. Stones were mainly between 10 and 20 mm in diameter (157 patients) but were less than 10 mm in size in 110 cases and more than 20 mm in 55. For poorly opaque stone, lithotripsy was performed after ultrasound localization with the Sonolithe apparatus. The Dornier machine was used to treat 277 patients during 308 sessions, equivalent to an 11% repeat rate. Fragmentation was excellent in 84% of cases after a single session, and 5% of stones could not be fragmented and required complementary therapy. Out of 200 patients reviewed after 3 months, only 8% had residual fragments (92% success rate), 5% having to undergo auxillary endoscopic manoeuvres: stenting ureteral catheter (4 cases); percutaneous nepholithotomy (3 cases); ureteroscopy (7 cases). Septic complications (6 patients) responded well to antibiotic treatment. Renal colic or pain was recorded in 25% of cases. One kidney was non-functional at 3 months due to distal ureteral obstruction without subsequent dilatation of the collecting system. Out of 45 patients treated with the Sonolithe, 3 (6.6%) were failures of fragmentation and 85% had satisfactory results. After a minimum follow up of 3 months, 20/22 patients were free of residual calculi, and there were no complications.(ABSTRACT TRUNCATED AT 250 WORDS)