Effect of Zinc Intake on Growth in Infants: A Meta-analysis.

A systematic review and meta-analysis of available randomized controlled trials (RCTs) was conducted to evaluate the effect of zinc (Zn) intake on growth in infants. Out of 5500 studies identified through electronic searches and reference lists, 19 RCTs were selected after applying the exclusion/inclusion criteria. The influence of Zn intake on growth was considered in the overall meta-analysis. Other variables were also taken into account as possible effect modifiers: doses of Zn intake, intervention duration, nutritional status, and risk of bias. From each select growth study, final measures of weight, length, mid upper arm circumference (MUAC), head circumference, weight for age z-score (WAZ), length for age z-score (LAZ), and weight for length z-score (WLZ) were assessed. Pooled ß and 95% confidence interval (CI) were calculated. Additionally, we carried out a sensitivity analysis. Zn intake was not associated with weight, length, MUAC, head circumference, and LAZ in the pooled analyses. However, Zn intake had a positive and statistically effect on WAZ (ß = 0.06; 95%CI 0.02 to 0.10) and WLZ (ß = 0.05; 95%CI 0.01 to 0.08). The dose-response relationship between Zn intake and these parameters indicated that a doubling of Zn intake increased WAZ and WLZ by approximately 4%. Substantial heterogeneity was present only in length analyses (I(2) = 45%; p = 0.03). Zn intake was positively associated with length values at short time (four to 20 weeks) (ß = 0.01; CI 95% 0 to 0.02) and at medium doses of Zn (4.1 to 8 mg/day) (ß = 0.003; CI 95% 0 to 0.01). Nevertheless, the effect magnitude was small. Our results indicate that Zn intake increases growth parameters of infants. Nonetheless, interpretation of these results should be carefully considered.

Perceptions of European medical staff on the facilitators and barriers to physical closeness between parents and infants in neonatal units.

AIM: Studies have provided insights into factors that may facilitate or inhibit parent-infant closeness in neonatal units, but none have specifically focused on the perspectives of senior neonatal staff. The aim of this study was to explore perceptions and experiences of consultant neonatologists and senior nurses in five European countries with regard to these issues. METHODS: Six small group discussions and three-one-to-one interviews were conducted with 16 consultant neonatologists and senior nurses representing nine neonatal units from Estonia, Finland, Norway, Spain and Sweden. The interviews explored facilitators and barriers to parent-infant closeness and implications for policy and practice, and thematic analysis was undertaken. RESULTS: Participants highlighted how a humanising care agenda that enabled parent-infant closeness was an aspiration, but pointed out that neonatal units were at different stages in achieving this. The facilitators and barriers to physical closeness included socio-economic factors, cultural norms, the designs of neonatal units, resource issues, leadership, staff attitudes and practices and relationships between staff and parents. CONCLUSION: Various factors affected parent-infant closeness in neonatal units in European countries. There needs to be the political motivation, appropriate policy planning, legislation and resource allocation to increase measures that support closeness agendas in neonatal units.

Some perspectives on the risks and benefits of biological control of invasive alien plants in the management of natural ecosystems.

Globally, invasions by alien plants are rapidly increasing in extent and severity, leading to large-scale ecosystem degradation. Weed biological control offers opportunities to arrest or even reverse these trends and, although it is not always effective or appropriate as a management strategy, this practice has an excellent record of safety and many notable successes over two centuries. In recent years, growing concerns about the potential for unintended, non-target damage by biological control agents, and fears about other unpredictable effects on ecosystems, have created an increasingly demanding risk-averse regulatory environment. This development may be counter-productive because it tends to overemphasize potential problems and ignores or underestimates the benefits of weed biological control; it offers no viable alternatives; and it overlooks the inherent risks of a decision not to use biological control. The restoration of badly degraded ecosystems to a former pristine condition is not a realistic objective, but the protection of un-invaded or partial restoration of invaded ecosystems can be achieved safely, at low cost and sustainably through the informed and responsible application of biological control. This practice should therefore be given due consideration when management of invasive alien plants is being planned. This discussion paper provides a perspective on the risks and benefits of classical weed biological control, and it is aimed at assisting environmental managers in their deliberations on whether or not to use this strategy in preference, or as a supplement to other alien invasive plant control practices.

Chronic infrarenal aortic occlusion: predictors of surgical outcome in patients undergoing aortobifemoral bypass reconstruction.

AIM: Chronic infrarenal aortic occlusion is relatively infrequent. Aortobifemoral bypass has been the traditional treatment. The aim of this study is to evaluate the prognostic factors related to long-term survival and patency rates of chronic infrarenal aortic occlusion after aortobifemoral bypass. METHODS: From January 1984 to December 2004, we performed consecutively 278 aortobifemoral for aortoiliac occlusive disease. Of these, 67 (24%) patients, 62 men (92.5%), presented with ischemia due to aortic occlusion. The log-Rank test was used to determine predictors of long-term survival and graft patency in a univariate analysis. With a model of proportional-hazards Cox regression the independent prognostic factors of long-term survival were determined. RESULTS: The postoperative mortality was 8.9%. The estimated cumulative long-term survival for aortic occlusion patients was 56% and 38% at 10 and 20 years, respectively. The estimated cumulative primary patency was 79% at 10 years and 40% at 20 years. The 20-year limb survival rate was 86%. There was no statistical difference in long-term survival and graft patency between TASCIC-D and IRAO. Previous coronary disease (P=0.008) and postoperative complications (P=0.017) significantly decreased the survival of patients. Both variables retained significance on multivariable analysis. The presence of chronic renal failure significantly decreased the patency of the aortobifemoral bypass (P=0.013). CONCLUSION: Aortobifemoral bypass for chronic infrarenal aortic occlusion has an excellent primary patency rate with reasonable morbi-mortality. The presence of concomitant coronary disease and postoperative complications are prognostic factors of long-term survival.

[Long-term results of mitral valve repair for ischemic mitral insufficiency]. / Resultados alejados de la cirugía reparadora de la insuficiencia mitral isquémica.

BACKGROUND: The preferred treatment for ischemic mitral insufficiency is mitral valve repair with a prosthetic ring, because it does not deteriorate left ventricular function, allowing better immediate and long-term results. AIM: To assess long-term results of mitral annuloplasty with a prosthetic ring for ischemic mitral insufficiency. PATIENTS AND METHODS: One hundred patients (68 men), with a mean age of 65.7 ± 8.6 years were included. They underwent a mitral annuloplasty with a prosthetic ring to treat ischemic mitral insufficiency, between February 1992 and May 2009. Forty four had a history of prior myocardial infarction and 46 had an evolving acute coronary syndrome. The inferior left ventricular wall was involved, exclusively or associated with an adjacent wall, in 72 cases. Coronary artery bypass grafts were performed in 92 patients and 32 required intra-aortic balloon pumping at some time during the peri-operative period. RESULTS: Operative mortality was 10% (10 patients). During follow-up 30 patients died, at an average of 39 months after surgery (range: 3-142 months). Actuarial long-term survival rates at 1, 3 and 5 years were 79%, 72% and 64.5%, respectively. Trans esophageal echocardiogram performed in the operating room showed none or minimal residual mitral insufficiency in 96% of the cases. Echocardiographic follow-up was completed in 80% of the survivors; 79% of them had no or minimal mitral insufficiency. Only one patient was re-operated on due to severe mitral insufficiency and 4 required a permanent pacemaker. CONCLUSIONS: Considering the critical illness of these patients, good long-term results were observed after treatment of ischemic mitral regurgitation performing a mitral annuloplasty with a prosthetic ring.

Cervical Injury Outcomes among Older Adults Admitted to an Inpatient Trauma Service.

OBJECTIVE: Older adults are an increasing proportion of patients admitted to trauma services. Trauma in older adults' results from many mechanisms of injury with the distribution of mechanisms of injury among older adults different than those of younger adults. The acute management of these injuries may determine the patients' ability to return to independent living. It is known that prolonged immobilization of older patients results in deterioration of their functional status and increases the likelihood of hospital acquired complications, notably pneumonia, delirium, and loss of ambulation. DESIGN/SETTING: We reviewed 213 patients aged 65 and older admitted to our trauma services who sustained cervical spine injuries that were either placed in c spine immobilization or were not to understand the outcomes associated with their mechanism of injury. RESULTS: The youngest patients (65-74 years) were proportionately more likely to have sustained high energy injuries associated with motor vehicle crashes (36%) with a mortality rate of 11.5%. The oldest age group (> 85 years) had a higher mortality rate from falls from standing injuries (31%). Patients discharged with a collar were more likely to return to independent living. In addition, 96% of the patients that died in the acute care setting were not in cervical collar immobilization. CONCLUSION: Patients under 85 years with a cervical spine injury should be placed in c-spine immobilization and aggressively managed with a multidisciplinary team approach. The older adult trauma population requires specialty care including rapid cervical spine evaluation and prescreening of functional status on admission. The NEXUS guideline should be enhanced for the older adult trauma population.

Radiation dose produced by patients during radiopharmaceutical incorporation in nuclear medicine diagnostic procedures.

OBJECTIVES: The aim of this study was to assess the dose received by members of the public due to close contact with patients undergoing nuclear medicine procedures during radiopharmaceutical incorporation, and comparing it with the emitted radiation dose when the test was complete, in order to establish recommendations. MATERIAL AND METHODS: A prospective study was conducted on 194 patients. H*(10) dose rates were measured at 0.1, 0.5, and 1.0m after the radiopharmaceutical administration, before the image acquisition, and at the end of the nuclear medicine procedure. Effective dose for different close contact scenarios were calculated, according to 95th percentile value (bone scans) and the maximum value (remaining tests). RESULTS: During the radiopharmaceutical incorporation, a person who stays with another injected patient in the same waiting room may receive up to 0.59 mSv. If the patient had a medical appointment, or went to a restaurant or a coffee shop, members of the public could receive 23, 43, and 22 µSv, respectively. After finishing the procedure, these doses are reduced by a factor 3. In most of the studies, the use of private instead of public transport may reduce the dose by more than a factor 6. CONCLUSION: It is recommended to increase the distance between the patients during the radiopharmaceutical incorporation and to distribute them according to the diagnostic procedure. Patients should be encouraged to use private instead of public transport. Depending on the number of nuclear medicine outpatients per year attended by a physician, it could be necessary to apply restrictions.

Zinc intake, status and indices of cognitive function in adults and children: a systematic review and meta-analysis.

In developing countries, deficiencies of micronutrients are thought to have a major impact on child development; however, a consensus on the specific relationship between dietary zinc intake and cognitive function remains elusive. The aim of this systematic review was to examine the relationship between zinc intake, status and indices of cognitive function in children and adults. A systematic literature search was conducted using EMBASE, MEDLINE and Cochrane Library databases from inception to March 2014. Included studies were those that supplied zinc as supplements or measured dietary zinc intake. A meta-analysis of the extracted data was performed where sufficient data were available. Of all of the potentially relevant papers, 18 studies met the inclusion criteria, 12 of which were randomised controlled trials (RCTs; 11 in children and 1 in adults) and 6 were observational studies (2 in children and 4 in adults). Nine of the 18 studies reported a positive association between zinc intake or status with one or more measure of cognitive function. Meta-analysis of data from the adult's studies was not possible because of limited number of studies. A meta-analysis of data from the six RCTs conducted in children revealed that there was no significant overall effect of zinc intake on any indices of cognitive function: intelligence, standard mean difference of <0.001 (95% confidence interval (CI) -0.12, 0.13) P=0.95; executive function, standard mean difference of 0.08 (95% CI, -0.06, 022) P=0.26; and motor skills standard mean difference of 0.11 (95% CI -0.17, 0.39) P=0.43. Heterogeneity in the study designs was a major limitation, hence only a small number (n=6) of studies could be included in the meta-analyses. Meta-analysis failed to show a significant effect of zinc supplementation on cognitive functioning in children though, taken as a whole, there were some small indicators of improvement on aspects of executive function and motor development following supplementation but high-quality RCTs are necessary to investigate this further.

The relationship between zinc intake and growth in children aged 1-8 years: a systematic review and meta-analysis.

BACKGROUND/OBJECTIVES: It is estimated that zinc deficiency affects 17% of the world's population, and because of periods of rapid growth children are at an increased risk of deficiency, which may lead to stunting. This paper presents a systematic review and meta-analysis of the randomised controlled trials (RCTs) that assess zinc intake and growth in children aged 1-8 years. This review is part of a larger systematic review by the European Micronutrient Recommendations Aligned Network of Excellence that aims to harmonise the approach to setting micronutrient requirements for optimal health in European populations (www.eurreca.org). SUBJECT/METHODS: Searches were performed of literature published up to and including December 2013 using MEDLINE, Embase and the Cochrane Library databases. Included studies were RCTs in apparently healthy child populations aged from 1 to 8 years that supplied zinc supplements either as capsules or as part of a fortified meal. Pooled meta-analyses were performed when appropriate. RESULTS: Nine studies met the inclusion criteria. We found no significant effect of zinc supplementation of between 2 weeks and 12 months duration on weight gain, height for age, weight for age, length for age, weight for height (WHZ) or WHZ scores in children aged 1-8 years. CONCLUSIONS: Many of the children in the included studies were already stunted and may have been suffering from multiple micronutrient deficiencies, and therefore zinc supplementation alone may have only a limited effect on growth.

Urinary hormone levels during the natural menstrual cycle: the effect of age.

A number of studies have identified hormonal changes in women during their reproductive lifespan, many focusing upon changes in women over the age of 40 years. The present study has determined the effect of increasing age on hormone levels over three decades. Daily early morning urine samples were assayed for estrone-3-glucuronide (E3 G), pregnanediol-3-glucuronide (P3 G), testosterone-17-glucuronide (T17 G), FSH and LH. An examination of the validity of using creatinine as a volume adjuster in urine samples formed an integral part of the analysis. Volunteers were healthy women who had regular (25-35 days) cycles, were not taking oral contraceptives, hormone therapies or any other medication. Three age groups were compared: 20-29 years (n=13), 30-39 years (n=9) and 40-49 years (n=13). Statistical analyses were carried out using two-way ANOVA and post hoc t-tests. Creatinine excretion, despite revealing no cycle-related variation in any age group, showed a decline with increasing age. Creatinine output was significantly lower in the 40-49 years age group in all phases of the cycle than in the 20-29 and 30-39 groups (P<0.0001). Uncorrected levels of E3 G were significantly higher in the 30-39 years group when compared with the 40-49 age group (P<0.0001). Uncorrected P3 G output was significantly higher in women aged 20-29 years than in women aged 40-49 years (P<0.001) and levels of uncorrected T17 G were higher in the 20-29 year age group when compared with the 30-39 or 40-49 years age group (P<0.0001). The present study is consistent with previous reports that have revealed a decline in creatinine clearance with increasing age, and therefore casts into some doubt the validity of using creatinine clearance as a procedure to correct for volume fluctuations in differing age groups of women. The study also demonstrates unequivocally that age-related variations in hormone levels are not restricted to women over 40 years of age. The novel finding of highly significant differences in mean levels of T17 G between the age groups is of considerable interest. It is presently unclear whether this resulted from specifically increased ovarian and/or adrenal secretion. The possible impacts of changes in testosterone levels during the female reproductive lifespan merits further study.

Biocontrol of a perennial legume, Sesbania punicea, using a florivorous weevil, Trichapion lativentre: weed population dynamics with a scarcity of seeds.

The establishment in South Africa of a florivorous, apionid weevil, Trichapion lativentre, on Sesbania punicea, a leguminous weed of South American origin, has reduced seed production of the plants by >98%. Surveys of the age structure and density of plants in infestations of S. punicea throughout South Africa have shown that the rate of recruitment of seedlings has drastically declined within a few years in many areas, due to the weevils. However, there has unexpectedly not been a corresponding decline in the density of mature plants in extant infestations of S. punicea. In spite of this, T. lativentre has curtailed the rate of spread of the weed into uninvaded habitats and has impeded reinvasion into areas cleared of infestations by mechanical means or by another complimentary biocontrol agent.

The population dynamics of an introduced tree, Sesbania punicea, in South Africa, in response to long-term damage caused by different combinations of three species of biological control agents.

This paper contributes to the relatively sparse literature on the effects of insect herbivory on the population dynamics of plants and is probably unique in that it reports the long-term effects of combinations of three insect herbivore species on the population densities of a moderately long-lived tree species. The tree is Sesbania punicea, a leguminous perennial from South America that has been the target of a biological control programme in South Africa for almost 20 years. Sixteen infestations of the weed have been monitored for periods of up to 10 years to determine changes in the density of the mature, reproductive plants under the influence of different combinations of three biological control agents (i.e. with one, two or three of the agent species present in the weed infestation). The three biological control agents, all weevil species, include Trichapion lativentre, which primarily destroys the flower-buds, Rhyssomatus marginatus, which destroys the developing seeds, and Neodiplogrammus quadrivittatus, whose larvae bore into the trunk and stems of the plants. While T. lativentre occurs throughout the range of the weed in South Africa, the other two species are less mobile, more recent introductions and are largely confined to the vicinity of selected release sites. There has been a significant decline in the density of mature S. punicea in areas where two or more of the agents are established. The decline of the weed has been most evident where N. quadrivittatus is active and particularly so where both of the other two weevil species are also present.

Acute fatty liver of pregnancy: CT evaluation. Case report.

CT scans of two patients with acute fatty liver of pregnancy were reviewed in conjunction with the clinical evolution of this uncommon and potentially fatal disorder. In each of the CT scans, liver density measurements were less than those of the spleen. While the findings are non-specific, in the proper clinical context they are highly suggestive and may be the sole method of diagnosis, as these patients often have coagulation problems which rule out liver biopsy. It is an important diagnosis, as the high maternal and fetal mortality rates appear to be considerably reduced by early foetal delivery.

A critical analysis of the content of the tools that measure breast-feeding interaction.

OBJECTIVE: To undertake a critical analysis of the content of six tools, which have been designed to evaluate the breast-feeding interaction. DESIGN: The tools are viewed as discourses and are examined in terms of the insight they give into the assumptions about and attitudes towards breast-feeding inherent in the authors who have produced them. FINDINGS: The findings indicate that there is little agreement between the existing breast-feeding assessment tools as to how to measure a successful breast feed and that the tools appear to place insufficient reliance upon the research evidence related to lactation. KEY CONCLUSIONS: The lack of commonality between evaluation tools appears to reflect a prevailing inconsistency in the advice given by health workers to breast-feeding mothers. Reports of their unreliability may be indicative of the problems inherent when attempting to impose a biomedical model upon an intrinsically natural interaction. IMPLICATIONS FOR PRACTICE: It is suggested that, if evaluations of the breast-feeding interaction are to be useful, a tool which places greater emphasis on the research evidence is called for. Otherwise, given the limitations of such tools, their use may actively hinder the establishment of successful breast feeding.

An evaluation of skills acquisition on the WHO/UNICEF Breastfeeding Management Course using the pre-validated Breastfeeding Support Skills Tool (BeSST).

OBJECTIVE: To test the hypothesis that midwives who had completed the 20-hour WHO/UNICEF Breastfeeding Management Course would score significantly higher on a validated, quantitative measure of breast-feeding support skills, the Breastfeeding Support Skills Tool (BeSST), than a control group of midwives who had not undertaken the course. DESIGN: Breast feeding support skills were assessed using a between-subjects design conducted in midwives who had not attended the course and at two weeks following the 20 hour course. PARTICIPANTS AND SETTING: Two groups, consisting of 13 pre- and 15 post-course midwives, were compared. The research was carried out at four hospital sites in the UK, three of which had undertaken the 20 hour course and one which had not adopted the course. FINDINGS: Scores on the BeSST were significantly higher in the post-course group (mean = 29.9) than in the pre-course group (mean = 19.8), t (23.39) = 2.94, P < 0.01. KEY CONCLUSIONS: It is clear that breast-feeding support skills, as demonstrated by the BeSST, are significantly improved two weeks following the 20-hour WHO/UNICEF Breastfeeding Management Course. IMPLICATIONS FOR PRACTICE: By demonstrating the effectiveness of the 20-hour course in teaching breast-feeding support skills, additional hospitals may be encouraged to adopt the course and thereby contribute further to the advancement of optimum breast-feeding practices. Furthermore, this approach to assessment may be transferred to other areas of midwifery practice enabling the effective evaluation of courses and assessment of student learning.

[Tomographic study of the intra-abdominal digestive tract. Contributions of percutaneous echography and scanner in daily practice]. / Exploration par coupes du tube digestif intra-abdominal. Apports de l'échographie percutanée et du scanner en pratique quotidienne.

Endoscopy and radiological imaging are complementary. However the gastro-intestinal tract is routinely being imaged in CT and ultrasound, often performed for other indications. When an abnormality is discovered, several questions have to be addressed. Is the lesion due to a bowel abnormality? When bowel wall thickening is present, is it due to poor opacification or is it due to inflammation or tumor? Circumferential symmetrical thickening is more in favor of an inflammatory lesion, while focal asymmetrical thickening is more in favor of a neoplastic lesion. Inflammatory and lymphomatous lesion can have similar appearances. Guidelines to aid in diagnostic interpretation of gastrointestinal lesions are discussed, including features of appendicitis and obstruction.

[Acute fatty liver of pregnancy. Apropos of 4 cases: contribution of x-ray computed tomography]. / Stéatose hépatique aiguë gravidique. A propos de 4 cas: apport de la tomodensitométrie.

Acute fatty liver of pregnancy is a disease of the third trimester, generally considered to be rare and to have a grave prognosis. Histologically the characteristic fine droplet steatosis usually produces distinct vacuolization. Successful treatment depends on accurate diagnosis and early delivery. Computed tomography is of value in the diagnosis of fatty liver through liver and spleen attenuation value measurements. We reviewed 4 cases of acute fatty liver of pregnancy. Computed tomography was performed in two cases and was very helpful in the diagnosis of this condition.

[Effectiveness of partial splenectomy in the treatment of hereditary spherocytosis]. / Efectividad de la esplenectomía parcial en el tratamiento de la esferocitosis hereditaria.

OBJECTIVES: To evaluate the hematological and clinical response to partial splenectomy in a group of children with hereditary spherocytosis. MATERIAL AND METHODS: We analyzed the main hematological and clinical features in 13 patients with hereditary spherocytosis submitted to partial splenectomy. The diagnosis of the disease and the hematological studies was made according to standard methods. To establish the inheritance pattern we also studied both parents. During the surgical procedure the upper two thirds of the spleen were removed and the lower pole was preserved. We use prophylactic penicillin (250 mg twice a day) during 3 years. RESULTS: The diagnosis of the disease was made during the first year of life in 11 patients, 76.9% had neonatal hyperbilirrubinemia, 53.8% showed hepatomegaly and in 69.2% we observed splenomegaly. 84.6% received blood transfusion. The hemoglobin level was significantly increased (p = 0.04) and the reticulocytes significantly diminished (p = 0.01) after splenectomy. No hemolytic crises, blood cell transfusion requirement neither infection was observed after surgery. CONCLUSIONS: Although the number of patients and the post-surgical follow-up is reduced, the hematological recovery observed in our cases suggest that partial splenectomy is a beneficial surgical procedure for the treatment of the typical and severe form of hereditary spherocytosis.