The relationship between maternal 25-hydroxyvitamin D status in pregnancy and childhood adiposity and allergy: an observational study.

BACKGROUND: Vitamin D insufficiency (defined as <75 nmol l-1) is widespread among pregnant women around the world and has been proposed to influence offspring outcomes in childhood and into adult life, including adiposity and allergy. Disorders, including asthma and eczema, are on the rise among children. Our aim was to investigate the relationship between maternal 25-hydroxyvitamin D status in pregnancy and offspring adiposity, asthma and eczema in childhood. SUBJECTS AND METHODS: Maternal 25-hydroxyvitamin D concentrations were analysed in serum samples collected at 15 weeks' gestation from 1710 participants of the prospective Screening for Pregnancy Endpoints cohort study. The offspring of 1208 mothers were followed up at age 5-6 years. Data collected included height, weight, percentage body fat (PBF, measured by bioimpedance) and history of asthma and eczema. Multivariable analysis controlled for maternal body mass index (BMI), age and sex of the child and season of serum sampling. RESULTS: Complete data were available for 922 mother-child pairs. Each 10 nmol l-1 increase in maternal 25-hydroxyvitamin D concentration at 15 weeks' gestation was associated with a decrease in offspring PBF of 0.2% (95% confidence interval 0.04-0.36%, P=0.01) after adjustment for confounders but was not related to child BMI z-score. Maternal mean (±s.d.) 25-hydroxyvitamin D concentration was similar in children who did and did not have asthma (71.7±26.1 vs 73.3±27.1 nmol l-1, P=0.5), severe asthma (68.6±28.6 vs 73.3±26.8 nmol l-1, P=0.2) and eczema (71.9±27.0 vs 73.2±27.0 nmol l-1, P=0.5). CONCLUSIONS: The finding of a relationship between maternal vitamin D status and adiposity in childhood is important, particularly because vitamin D insufficiency in pregnancy is highly prevalent. The association between maternal vitamin D supplementation in pregnancy and adiposity in the offspring merits examination in randomised controlled trials.

Antibiotic resistant Staphylococcus aureus in hospital wastewaters and sewage treatment plants with special reference to methicillin-resistant Staphylococcus aureus (MRSA).

AIMS: To investigate the presence of methicillin-resistant Staphylococcus aureus (MRSA) in untreated hospital wastewaters (UHWW), their transmission into the receiving sewage treatment plant (STP) and survival through the STP treatment. METHODS AND RESULTS: Over eight consecutive weeks of sampling, we isolated 224 Staph. aureus strains from UHWW-1, UHWW-2 and its receiving STP inlet (SI) and post-treatment outlet (SO). These strains were typed using the PhP typing method and RAPD-PCR and tested for their antibiotic resistance patterns. Resistance to cefoxitin and the presence of mecA gene identified MRSA isolates. In all, 11 common (C) and 156 single (S) PhP-RAPD types were found among isolates, with two multidrug resistant (MDR) C-types found in H2, SI and SO. These C-type strains also showed resistance to cefoxitin and vancomycin. The mean number of antibiotics to which the strains from UHWW were resistant (5.14 ± 2) was significantly higher than the STP isolates (2.9 ± 1.9) (P < 0.0001). Among the 131 (68%) MRSA strains, 24 were also vancomycin resistant. MDR strains (including MRSA) were more prevalent in hospital wastewaters than in the STP. CONCLUSION: This study provides evidence of the survival of MRSA strains in UHWWs and their transit to the STP and then through to the final treated effluent and chlorination stage. SIGNIFICANCE AND IMPACT OF THE STUDY: This preliminary study identifies the need to further investigate the load of MRSA in hospitals' wastewaters and possible their survival in STPs. From a public health point of view, this potential route of hospital MRSA dissemination is of great importance.

Milk versus medicine for the treatment of iron deficiency anaemia in hospitalised infants.

AIMS: To compare iron fortified follow-on milk (iron follow-on), iron fortified partially modified cows' milk (iron milk), and iron medicine for the treatment of iron deficiency anaemia (IDA) in hospitalised infants. METHODS: In a randomised controlled trial, infants aged 9-23 months with IDA and who were hospitalised with an acute illness received iron follow-on (12 mg/l ferrous iron), iron milk (12.9 mg/l ferrous iron), or iron medicine (ferrous gluconate at 3 mg/kg of elemental iron once daily). All interventions were given for three months. Changes in measures of iron status three months after hospital discharge were determined. RESULTS: A total of 234 infants were randomised. Iron status was measured at follow up in 59 (70%) iron medicine, 49 (66%) iron follow-on, and 54 (70%) iron milk treated infants. There was a significant (mean, 95% CI) increase in haemoglobin (15 g/l, 13 to 16) and iron saturation (9%, 8 to 10) and decrease in ferritin (-53 microg/l, -74 to -31) in all three groups. Mean cell volume increased in iron follow-on (2 fl, 1 to 3) and iron milk (1 fl, 0.1 to 3) treated infants, but not in the iron medicine group (1 fl, -1 to 2). The proportion with IDA decreased in all three groups: iron medicine 93% to 7%, iron follow-on 83% to 8%, and iron milk 96% to 30%. Adverse effects, primarily gastrointestinal, occurred in 23% of the iron medicine, 14% of the iron follow-on, and 13% of the iron milk group. CONCLUSIONS: Iron fortified follow-on milk, iron fortified partially modified cows' milk, and iron medicine all effectively treat IDA in infancy.

Maternal nutritional risk factors for small for gestational age babies in a developed country: a case-control study.

AIMS: To assess the effect of maternal diet during pregnancy on the risk of delivering a baby who is small for gestational age (SGA). METHODS: Case-control study of 844 cases (SGA) and 870 controls (appropriate size for gestational age (AGA)). Only term (37+ completed weeks of gestation) infants were included. Retrospective food frequency questionnaires were completed at birth on the diet at the time of conception and in the last month of pregnancy. RESULTS: At the time of conception, mothers of AGA infants ate significantly more servings of carbohydrate rich food and fruit, and were more likely to have taken folate and vitamin supplements than mothers of SGA infants. There was some evidence that mothers of AGA infants also ate more servings of dairy products, meat, and fish (0.05 < p < 0.1). However, after adjustment for maternal ethnicity, smoking, height, weight, hypertension, and occupation, fish intake (p = 0.04), carbohydrate-rich foods (p = 0.04), and folate supplementation (p = 0.02) were associated with a reduced risk of SGA. In the last month of pregnancy, only iron supplementation was associated with a reduced risk of SGA (p = 0.05) after adjustment for potential confounders. CONCLUSIONS: This study suggests that small variations in maternal diets within the normal range during pregnancy in developed countries are associated with differences in birth weight.

Phytoestrogens decrease brain calcium-binding proteins but do not alter hypothalamic androgen metabolizing enzymes in adult male rats.

Phytoestrogen [plant estrogenic-like molecule(s)] research has grown rapidly in recent years due to their potential health benefits. However, little is known about phytoestrogen's effects on the CNS. Androgen metabolizing enzymes are known to regulate neuroendocrine functions and reproductive behaviors, while calcium-binding proteins are associated with protecting against neurodegenerative diseases. Therefore, we examined aromatase and 5alpha-reductase enzyme activities in the medial basal hypothalamic and preoptic area (mbh-poa) and characterized mbh-poa and amygdala (amy) calbindin and calretinin levels (via Western analysis) from animals fed a phytoestrogen-free (P-free) vs. a phytoestrogen-containing diet [(P-600); that had 600 microg/g of phytoestrogens]. After approximately 5 weeks on the diets, the male rats were killed at 105 days. P-600 plasma phytoestrogen levels were 78-fold higher than the P-free values and the mbh-poa phytoestrogen content was 8-fold higher than the P-free group, demonstrating the passage of phytoestrogens into brain. In general, brain aromatase or 5alpha-reductase activity levels were not significantly altered by the experimental diets. However, independent of brain site (i.e., mbh-poa or amy) the abundance of calbindin from male P-600 rats was significantly lower than P-free animals. Conversely, for calretinin there were no significant alterations in the mbh-poa tissue site, while in the amy a similar pattern of expression was seen to that of the calbindin results. These data suggest that consumption of phytoestrogens via a soy diet for a relatively short interval can significantly: (1) elevate plasma and brain phytoestrogens levels and (2) decrease brain calcium-binding proteins without altering brain androgen metabolizing enzymes.

Pediatric assessment in the home.

Caring for children holistically in the home can be challenging and is dependent on working closely with families. This article identifies the four roles a nurse performs when conducting a home pediatric assessment. The Home Risk Assessment Tools presented assist nurses in evaluating a child's physical and psychosocial needs.

Characterization of 5-lipoxygenase inhibitors in biochemical and functional in vivo assays.

Several potent and selective inhibitors of 5-lipoxygenase (5-LO) have been recently developed with excellent activity in certain in vivo assays of leukotriene production. The efficacy of three such inhibitors that have been in clinical trials (zileuton, A-78773 and ZD2138) were evaluated in: 1) ex vivo whole blood assay, 2) dermal Arthus reaction, and 3) functional airway response. In addition, a model of eicosanoid production in rat lung was developed that provides a simple assay for evaluation of the biochemical efficacy of 5-LO inhibitors in the lung. Bronchoalveolar lavage of rat lung with calcium ionophore A23187 resulted in rapid and robust production of PGE2, 6-keto-PGF1 alpha, thromboxane (TxB2), and leukotriene B4 (LTB4). Supplementation of lavage fluid with archidonic acid markedly augmented production of all eicosanoids except LTB4. All three inhibitors were potent and selective blockers of LTB4 production in the ex vivo whole blood assay and in the dermal Arthus reaction. In contrast, higher doses of inhibitor were needed to block LTB4 production in the rat lung lavage model than were needed to block ex vivo whole blood LTB4 production when both end points were measured in the same animal. Similarly, zileuton and A-78733 were less effective in suppressing the functional airway response to antigen in sensitized guinea pigs, whereas both inhibitors were effective in suppressing LTB4 production in the ex vivo whole blood assay. These results demonstrate that different 5-LO inhibitors have markedly distinct efficacy for inhibition of leukotriene production, depending on the animal model.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of ewe body condition at lambing on colostral immunoglobulin G concentration and lamb performance.

Body condition was scored at lambing (BCSL) on 101 mature (4 to 7 yr old) Polypay ewes and related to colostral immunoglobulin G (IgG) concentration and lamb performance. Colostrum samples were collected from each ewe within 12 h of lambing and litters of more than two lambs were reduced to two within 2 h of lambing. Colostral IgG concentrations decreased rapidly with time (b = -3.28; R2 = .2132) and linear regression analysis projected that colostral IgG concentrations would diminish to zero milligrams/milliliter by 23 h postpartum. Body condition score at lambing varied from 2.5 to 3.5 and had no effect on colostral IgG concentration, which averaged 79 +/- 5.6 mg/mL, adjusted to the time of parturition. Total birth weights of lambs were higher for the oldest ewes (7 yr old), but this group had the lowest prolificacy. This age group weaned the lowest total lamb weight and number of lambs. Total weight of lambs born was not affected by BCSL. Lamb mortality from birth to weaning was 19.0% and was not affected by BCSL, sex, litter size, or breed of sire, but the older (7 yr old) ewes had greater lamb mortality. Total weight of lamb weaned was not affected by BCSL, although ewes with a BCSL of 3.0 tended ( P = .11) to wean more kilograms of lamb than ewes with a BCSL of 3.5. Ewes bred to Polypay rams weaned more total weight of lamb than those bred to Columbia rams, which was due to increased survival rate to weaning for the Polypay rams. We conclude that, within a range of 2.5 to 3.5, BCSL is not an important factor affecting the colostral IgG concentration, total weight of lamb born, lamb mortality, or total weight of lamb weaned.

Tension myalgia as a diagnosis at the Mayo Clinic and its relationship to fibrositis, fibromyalgia, and myofascial pain syndrome.

Tension myalgia is a diagnosis that has been in use at the Mayo Clinic for more than 40 years. The term describes a common muscle pain disorder that is conceptually similar to other muscle pain disorders such as fibrositis, fibromyalgia, and myofascial pain syndrome. This article outlines the history of these disorders and proposes "tension myalgia" as a term that unifies these separate diagnoses under one conceptual framework. Because the diagnostic criteria for tension myalgia have been vague, the Department of Physical Medicine and Rehabilitation at the Mayo Clinic has developed specific criteria for generalized, regional, and localized forms of this disorder. The recommended treatment approach includes reassurance, elimination of contributing factors, physical therapy to restore normal neuromuscular function, conditioning, and medications.

Microwave hyperthermia in the treatment of spontaneous canine tumours: an analysis of treatment parameters and tumour response.

Fifty-one spontaneous canine tumours were treated with combined radiation and hyperthermia in a pilot study designed to investigate the feasibility and efficacy of the combined modality treatment in the dog. The tumours varied in site and histological type: 35 were in the oral cavity and included squamous cell carcinoma, melanoma and various 'sarcomas'. All animals received radiation (36-40 Gy in four weekly fractions) and post-irradiation hyperthermia (prescription -44 degrees C for 30 min) on one or two occasions. The microwave hyperthermia system was technically satisfactory in elevating tumour temperature to 44 degrees C or above in 95 per cent of treatments. However, thermal gradients of the order of 3-5 degrees C were frequently measured across the tumour, and rarely did all peripheral points achieve the target of 44 degrees C for 30 min. The overall tumour response rate (CR + PR) was 87.7 per cent with 60.7 per cent of tumours achieving complete regression. Smaller lesions showed a significantly greater response rate (P = 0.004) and those lesions which received two thermal treatments show an increased response (P = 0.0095). Fifty-one per cent of tumours showed significant necrosis following hyperthermia. Normal tissue necrosis was seen in three patients; in two cases this was attributed to hyperthermia. Local tumour control rate and necrosis was not correlated with measured minimum, mean or maximum thermal doses.

Clinical evaluation of moxalactam.

Moxalactam was administered intravenously or intramuscularly or both in doses of 1 to 12 g/day to 45 patients with clinically significant infections (17 soft tissue or bone, 9 pleuropulmonary, 9 septicemic, 6 urinary tract, and 4 intraabdominal infections). Mean 0.5-h postinfusion levels were 105 micrograms/ml for a 4.0-g dose, 44.7 micrograms/ml for a 2.0-g dose, and 18 micrograms/ml for a 1.0-g dose. We identified 28 isolates of Enterobacteriaceae, 10 Pseudomonas aeruginosa isolates, 9 Staphylococcus aureus isolates, and 15 anaerobic bacterial isolates. A total of 15 patients were clinically cured, 8 patients improved, 13 patients improved initially but suffered subsequent relapses or superinfections, and 10 patients failed therapy. Toxicity was generally minimal (reversible eosinophilia, and mild liver function abnormalities, and elevated prothrombin time). The selection or emergence of resistant organisms in 17 patients during treatment (particularly Pseudomonas, enterococci, and Candida) was a disturbing feature of therapy. Our results were generally favorable, considering the complicated underlying medical problems of this group of patients.

Pancuronium binding by serum proteins.

Pancuronium has not been suspected of binding to serum proteins. Experimental evidence is presented of strong binding to gamma globulin, and of moderate binding to albumin. No evidence could be found of binding to alpha of beta globulin fractions. Less than 13% of a dose in the clinical range would be unbound and active.

Maternal factors in neonatal hypocalcaemia: a study in three ethnic groups.

To assess the significance of various maternal and neonatal factors in the aetiology of neonatal tetany we have investigated the serum calcium, phosphorus, magnesium, and heat-labile alkaline phosphatase of 250 mothers from three ethnic groups at several stages of pregnancy and the serum calcium, phosphorus, and magnesium of many of their infants. Subclinical hypocalcaemia was found to be much commoner in full-term infants on the sixth day of life than is generally appreciated, especially during the winter months and in babies of Asian parents. It is considered that this is a result of high phosphorus loads in artificial milks and is also influenced by maternal vitamin D and possibly calcium intake during pregnancy. The importance of ensuring that Asian women take adequate vitamin D supplements during pregnancy is stressed.