Increased Serum Total and Free 25-Hydroxyvitamin D with Daily Intake of Cholecalciferol-Fortified Skim Milk: A Randomized Controlled Trial in Colombian Adolescents.

BACKGROUND: The efficacy of cholecalciferol (vitamin D3) food fortification in low- and middle-income countries near the Equator is unknown. OBJECTIVES: We examined the effects of providing cholecalciferol-fortified skim milk to adolescents and their mothers on serum total 25(OH)D, free 25(OH)D, and vitamin D-binding protein (DBP) concentrations in a randomized controlled trial. METHODS: We randomly assigned 80 Colombian families each with a child aged 12-14.5 y and their mother 1 L of skim milk daily, either fortified with 2400 IU (60 µg) cholecalciferol or unfortified, for 6 wk. We prescribed 500 mL of milk daily to adolescents; mothers consumed the remainder ad libitum. We estimated intent-to-treat effects as the between-arm difference in the change in serum total and free 25(OH)D and DBP concentrations from baseline to the end of follow-up. Secondary analyses included stratification by baseline characteristics and per-protocol comparisons. RESULTS: Among adolescents, fortification effects (95% CI) on serum total 25(OH)D, free 25(OH)D, and DBP concentrations were 5.4 nmol/L (2.1, 8.8 nmol/L), 0.6 pmol/L (-0.2, 1.4 pmol/L), and -416 nmol/L (-944, 112 nmol/L), respectively. Effects on total 25(OH)D were stronger in adolescents with lower DBP concentrations, darker skin, less sunlight exposure, and higher compliance than in their respective counterparts. Fortification increased free 25(OH)D concentrations in high compliers. Among mothers, the effects (95% CI) on total 25(OH)D and DBP concentrations were 4.0 nmol/L (0.6, 7.5 nmol/L) and -128 nmol/L (-637, 381 nmol/L), respectively. There were no adverse events. CONCLUSIONS: Provision of cholecalciferol-fortified skim milk increases serum total 25(OH)D concentrations in Colombian adolescents and adult women.

Effect of the Helping Babies Breathe Program on Newborn Outcomes: Systematic Review and Meta-Analysis.

Background and objectives: In low- and middle-income countries, the leading cause of neonatal mortality is perinatal asphyxia. Training in neonatal resuscitation has been shown to decrease this cause of mortality. The program "Helping Babies Breathe" (HBB) is a program to teach basic neonatal resuscitation focused on countries and areas with limited economic resources. The aim of the study was to determine the effect of the implementation of the HBB program on newborn outcomes: mortality and morbidity. Material and Methods: A systematic review was carried out on observational studies and clinical trials that reported the effect of the implementation in low- and middle-income countries of the HBB program on neonatal mortality and morbidity. We carried out a meta-analysis of the extracted data. Random-effect models were used to evaluate heterogeneity, using the Cochrane Q and I2 tests, and stratified analyses were performed by age and type of outcome to determine the sources of heterogeneity. Results: Eleven studies were identified. The implementation of the program includes educational strategies focused on the training of doctors, nurses, midwives, and students of health professions. The poled results showed a decrease in overall mortality (OR 0.67; 95% CI 0.57, 0.80), intrapartum stillbirth mortality (OR 0.62; 95% CI 0.51, 0.75), and first-day mortality (OR 0.70; 95% IC 0.64, 0.77). High heterogeneity was found, which was partly explained by differences in the gestational age of the participants. Conclusions: The implementation of the program HBB in low- and medium-income countries has a significant impact on reducing early neonatal mortality.

Comparacion de las estrategias tradicionales y la teoria de Stewart en la interpretacion de las alteraciones acido-basicas en pacientes pediatricos con disfuncion multiorganica en el postoperatorio de cirugia cardiaca / Comparison of the traditional strategy of acid-basic analysis with the novel Steward's theory in pediatric patients with multiorganic dysfunction undergoing cardiac surgery

Objetivo: Comparar las estrategias tradicionales del análisis ácido-básico con la teoría de Stewart en pacientes pediátricos con disfunción multiorgánica en postoperatorio de cirugía cardiaca. Materiales y métodos: Estudio observacional analítico de cohorte concurrente, realizado en 66 pacientes pediátricos sometidos a circulación extracorporea (CEC) con una técnica estándar. En el postoperatorio inmediato se tomo muestra arterial para realizar el análisis ácido-básico tradicional y según Stewart; se aplicó diariamente la escala SOFA de disfunción orgánica durante tres días y se obtuvieron los valores mas altos. Los pacientes se dividieron en dos grupos de acuerdo a quienes presentaron falla orgánica (SOFA > 7; 20 pacientes) y sin falla orgánica (SOFA < 7; 46 pacientes). Resultados y conclusiones: El análisis tradicional en los pacientes que no desarrollaron falla mostró acidosis metabólica (pH 7.36 +/- 0.08, HCO3 16.6 +/- 2.6, BE -6.03 +/- 3.5). Los pacientes que desarrollaron falla mostraron resultados normales (pH 7.39 +/-0.08, HCO3 17.9+/-2.1, BE-4.8+/-2.6). El análisis de Stewart evidenció una mayor aparición de aniones anormales en los pacientes que desarrollaron falla (-4.2 vs -2.6), además sugiere que la acidosis evidenciada en los pacientes sin falla se explica por los cambios en la concentración de cloro y sodio producidos por la CEC