Autologous red blood cell transfusion does not result in a more profound increase in pulmonary capillary wedge pressure compared to saline in critically ill patients: A randomized crossover trial.

BACKGROUND AND OBJECTIVES: Transfusion-associated circulatory overload (TACO) is a major cause of severe transfusion-related morbidity. Transfusion of red blood cells (RBCs) has been shown to induce hydrostatic pressure overload. It is unclear which product-specific factors contribute. We set out to determine the effect of autologous RBC transfusion versus saline on pulmonary capillary wedge pressure (PCWP) change. MATERIALS AND METHODS: In a randomized crossover trial, patients who had undergone coronary bypass surgery were allocated to treatment post-operatively in the intensive care unit with either an initial 300 ml autologous RBC transfusion (salvaged during surgery) or 300 ml saline infusion first, followed by the other. Primary outcome was the difference in PCWP change. Secondary outcome measures were the difference in extra-vascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI). RESULTS: Change in PCWP was not higher after autologous RBC transfusion compared to saline (ΔPCWP 0.3 ± 0.4 vs. 0.1 ± 0.4 mmHg). ΔEVLWI and ΔPVPI were significantly decreased after autologous RBC transfusion compared to saline (ΔEVLWI -1.6 ± 0.6 vs. 0.2 ± 0.4, p = 0.02; ΔPVPI -0.3 ± 0.1 vs. 0.0 ± 0.1, p = 0.01). Haemodynamic variables and colloid osmotic pressure were not different for autologous RBC transfusion versus saline. CONCLUSION: Transfusion of autologous RBCs did not result in a more profound increase in PCWP compared to saline. RBC transfusion resulted in a decrease of EVLWI and PVPI compared to saline. Our data suggest that transfusing autologous RBCs may lead to less pulmonary oedema compared to saline. Future studies with allogeneic RBCs are needed to investigate other factors that may mediate the increase of PCWP, resulting in TACO.

Multi-domain probiotic consortium as an alternative to chemical remediation of oil spills at coral reefs and adjacent sites.

BACKGROUND: Beginning in the last century, coral reefs have suffered the consequences of anthropogenic activities, including oil contamination. Chemical remediation methods, such as dispersants, can cause substantial harm to corals and reduce their resilience to stressors. To evaluate the impacts of oil contamination and find potential alternative solutions to chemical dispersants, we conducted a mesocosm experiment with the fire coral Millepora alcicornis, which is sensitive to environmental changes. We exposed M. alcicornis to a realistic oil-spill scenario in which we applied an innovative multi-domain bioremediator consortium (bacteria, filamentous fungi, and yeast) and a chemical dispersant (Corexit® 9500, one of the most widely used dispersants), to assess the effects on host health and host-associated microbial communities. RESULTS: The selected multi-domain microbial consortium helped to mitigate the impacts of the oil, substantially degrading the polycyclic aromatic and n-alkane fractions and maintaining the physiological integrity of the corals. Exposure to Corexit 9500 negatively impacted the host physiology and altered the coral-associated microbial community. After exposure, the abundances of certain bacterial genera such as Rugeria and Roseovarius increased, as previously reported in stressed or diseased corals. We also identified several bioindicators of Corexit 9500 in the microbiome. The impact of Corexit 9500 on the coral health and microbial community was far greater than oil alone, killing corals after only 4 days of exposure in the flow-through system. In the treatments with Corexit 9500, the action of the bioremediator consortium could not be observed directly because of the extreme toxicity of the dispersant to M. alcicornis and its associated microbiome. CONCLUSIONS: Our results emphasize the importance of investigating the host-associated microbiome in order to detect and mitigate the effects of oil contamination on corals and the potential role of microbial mitigation and bioindicators as conservation tools. Chemical dispersants were far more damaging to corals and their associated microbiome than oil, and should not be used close to coral reefs. This study can aid in decision-making to minimize the negative effects of oil and dispersants on coral reefs. Video abstract.

Supramolecular strategy for reducing the cardiotoxicity of bedaquiline without compromising its antimycobacterial efficacy.

Bedaquiline (BDQ) is a newly approved anti-tuberculosis drug in treating multidrug-resistant tuberculosis. However, it has very poor aqueous solubility and several case reports have proposed that BDQ has potential risk of cardiotoxicity to patients. In this present study, we have explored into employing host-guest interactions between a synthetic receptor, cucurbit[7]uril (CB[7]), and BDQ aiming to improve the solubility and reduce the inherent cardiotoxicity of BDQ. HPLC-UV test on the solubility of BDQ in the absence and in the presence of increasing concentrations of CB[7] suggested a host-dependent guest-solubility enhancements. Cardiovascular studies using an in vivo zebrafish model demonstrated that the cardiotoxicity of BDQ was indeed alleviated upon its complexations by the synthetic receptor. Furthermore, our in vitro antibacterial studies suggested that CB[7] formulated BDQ preserved its antimycobacterial efficacy against Mycobacterium smegmatis. Therefore, CB[7] may become a suitable pharmaceutical excipient in formulating BDQ for improving its physiochemical properties (such as solubility), and for alleviating its side effects (such as cardiotoxicity), while the antimycobacterial efficacy of BDQ may be well maintained.

Promotion of Weight Gain in Early Childhood Does Not Increase Metabolic Risk in Adolescents: A 15-Year Follow-Up of a Cluster-Randomized Controlled Trial.

BACKGROUND: A rapid gain in weight for length may put children at a higher risk of noncommunicable diseases later in life. OBJECTIVE: The objective of this study was to assess the long-term effects of nutrition counseling delivered in the first 2 y of life in Pelotas, a city in Southern Brazil. METHODS: The original cluster-randomized controlled trial was conducted in 1998. Nutrition counseling (breastfeeding promotion and increased intake of micronutrient-rich and energy-dense foods) was delivered to mothers of children aged 0-17.9 mo attending primary care. Six months later, weight gain was higher in the intervention group than in the control group for children ≥12 mo of age at enrollment. In 2013 (mean age 15 y), assessments included anthropometric measurements, body composition (air-displacement plethysmography), body shape (3-dimensional photonic scan), and plasma total, LDL, and HDL cholesterol, triglycerides, C-reactive protein, and glucose. RESULTS: A total of 363 of the 424 original participants were assessed. An a priori decision was made to prioritize analyses of subjects aged 12-17.9 mo at enrollment (51 from the intervention group and 45 from the control group). In this subgroup, boys in the intervention group were [mean (95% CI)] 3.4 (0.8, 6.0) cm taller than those in the control group. Systolic blood pressure tended to be 5.2 (-0.8, 11.1) mm Hg higher in male subjects from the intervention group than in those in the control group. Lipid profiles tended to be healthier in the intervention group. The plasma total cholesterol concentration was -17.8 (-29.8, -5.7) mg/dL lower in boys in the intervention group than in those in the control group. The total-to-HDL cholesterol ratio and triglyceride concentration in the girls in the intervention group were -0.4 (-0.6, -0.1) and -26.3 (-46.3, -6.3) mg/dL, respectively, lower than in the control group. There was no difference between the groups in terms of body composition. CONCLUSIONS: Promotion of weight gain in children between 12.0-17.9 mo of age was not associated with higher metabolic risk 15 y later. On the contrary, there was some evidence of reduced metabolic risk in the intervention group.

CdTe quantum dots conjugated to concanavalin A as potential fluorescent molecular probes for saccharides detection in Candida albicans.

Semiconductor colloidal quantum dots (QDs) have been applied in biological analysis due to their unique optical properties and their versatility to be conjugated to biomolecules, such as lectins and antibodies, acquiring specificity to label a variety of targets. Concanavalin A (Con A) lectin binds specifically to α-d-mannose and α-d-glucose regions of saccharides that are usually expressed on membranes of mammalian cells and on cell walls of microbials. Candida albicans is the most common fungal opportunistic pathogen present in humans. Therefore, in this work, this fungus was chosen as a model for understanding cells and biofilm-forming organisms. Here, we report an efficient bioconjugation process to bind CdTe (Cadmium Telluride) QDs to Con A, and applied the bioconjugates to label saccharide structures on the cellular surface of C. albicans suspensions and biofilms. By accomplishing hemagglutination experiments and circular dichroism, we observed that the Con A structure and biochemical properties were preserved after the bioconjugation. Fluorescence microscopy images of yeasts and hyphae cells, as well as biofilms, incubated with QDs-(Con A) showed a bright orange fluorescence profile, indicating that the cell walls were specifically labeled. Furthermore, flow cytometry measurements confirmed that over 93% of the yeast cells were successfully labeled by QD-(Con A) complex. In contrast, non-conjugated QDs or QDs-(inhibited Con A) do not label any kind of biological system tested, indicating that the bioconjugation was specific and efficient. The staining pattern of the cells and biofilms demonstrate that QDs were effectively bioconjugated to Con A with specific labeling of saccharide-rich structures on C. albicans. Consequently, this work opens new possibilities to monitor glucose and mannose molecules through fluorescence techniques, which can help to optimize phototherapy protocols for this kind of fungus.

Does galvanic vestibular stimulation reduce spatial neglect? A negative study.

INTRODUCTION: In spatial neglect, the functional benefit of rehabilitation methods is subject to debate. A few studies have reported that galvanic vestibular stimulation (GVS) is efficacious in spatial neglect. The objective of the present study was to establish whether the effects of GVS persist after the end of stimulation. MATERIALS: Four patients with pathological rightward deviation in a bisection task at least three months after right hemisphere stroke. A single-blind, randomized crossover design was used to assess the effects of GVS on performance in line bisection and star cancellation tasks under three different conditions (cathode-right, cathode-left and sham stimulation). RESULTS: There were no significant differences in the performance of either task following GVS (relative to sham stimulation). CONCLUSION: Galvanic vestibular stimulation did not reduce spatial neglect symptoms in any of the stimulation conditions. Further studies are necessary to understand the disparity between our results and those reported in the literature. Repeated sessions, a higher current intensity and/or alternating-current stimulation may improve this method before it can be used clinically.

Antiplasmodial and anti-inflammatory activities of Canthium henriquesianum (K. Schum), a plant used in traditional medicine in Burkina Faso.

ETHNOPHARMACOLOGICAL RELEVANCE: Canthium henriquesianum (K. Schum) is traditionally used in Burkina Faso for the treatment of malaria, but has not been properly investigated, yet. The aim of this study was to characterize in vitro the antiplasmodial and the anti-inflammatory activity of extracts from Canthium henriquesianum (K. Schum). In parallel, extracts of Gardenia sokotensis (Hutch) and Vernonia colorata (Willd), also traditionally used together in Burkina Faso and already reported with antimalarial activity, were compared. MATERIALS AND METHODS: Plant extracts were tested in vitro for antimalarial activity against chloroquine susceptible (D10) and resistant (W2) strains of Plasmodium falciparum using the lactate dehydrogenase assay. Cell cytotoxicity was assessed on human dermal fibroblast (HDF) by the MTT assay. The selectivity index (SI) was used as the ratio of the activity against the parasites compared to the toxicity of the plant extract against HDF. In vitro cytokine production was assessed by ELISA technique. RESULTS: Canthium henriquesianum aqueous extract had a moderate antimalarial activity (IC50<50 µg/ml) with a good selectivity index (SI=HDF/D10>7). Canthium henriquesianum diisopropyl ether extract was the most potent inhibitor of parasite growth with an IC50 9.5 µg/ml on W2 and 8.8 µg/ml on D10 and limited toxicity (SI>2). Gardenia sokotensis and Vernonia colorata aqueous extracts were shown to be significantly less active (IC50≥50 µg/ml) with substantial toxicity. In addition, when the production of IL-1ß and TNFα by lipopolysaccharide (LPS) or hemozoin (malaria pigment) stimulated human THP-1 monocytes was assayed, it was found that the extract of Canthium henriquesianum induced a dose-dependent inhibition of IL-1ß, but not of TNFα production, thus confirming its traditional use as antipyretic. By NMR analysis, the chromone was identified as the mostly represented compound in the diisopropyl ether extract of Canthium henriquesianum. Chromone however, was less active as antimalarial than the crude extract and it did not inhibit cytokine production at not toxic doses, indicating that other molecules in the total extracts contribute to the antiplasmodial and anti-inflammatory activity. CONCLUSION: Canthium henriquesianum seems to possess antimalarial activity in vitro and the ability to inhibit the production of the pyrogenic cytokine IL-1ß.

Exome sequencing identifies INPPL1 mutations as a cause of opsismodysplasia.

Opsismodysplasia (OPS) is a severe autosomal-recessive chondrodysplasia characterized by pre- and postnatal micromelia with extremely short hands and feet. The main radiological features are severe platyspondyly, squared metacarpals, delayed skeletal ossification, and metaphyseal cupping. In order to identify mutations causing OPS, a total of 16 cases (7 terminated pregnancies and 9 postnatal cases) from 10 unrelated families were included in this study. We performed exome sequencing in three cases from three unrelated families and only one gene was found to harbor mutations in all three cases: inositol polyphosphate phosphatase-like 1 (INPPL1). Screening INPPL1 in the remaining cases identified a total of 12 distinct INPPL1 mutations in the 10 families, present at the homozygote state in 7 consanguinous families and at the compound heterozygote state in the 3 remaining families. Most mutations (6/12) resulted in premature stop codons, 2/12 were splice site, and 4/12 were missense mutations located in the catalytic domain, 5-phosphatase. INPPL1 belongs to the inositol-1,4,5-trisphosphate 5-phosphatase family, a family of signal-modulating enzymes that govern a plethora of cellular functions by regulating the levels of specific phosphoinositides. Our finding of INPPL1 mutations in OPS, a severe spondylodysplastic dysplasia with major growth plate disorganization, supports a key and specific role of this enzyme in endochondral ossification.

Intraoral electrostimulator for xerostomia relief: a long-term, multicenter, open-label, uncontrolled, clinical trial.

OBJECTIVE: A previous sham-controlled multinational study demonstrated the short-term efficacy and safety for xerostomia treatment of an intraoral device that delivers electrostimulation to the lingual nerve. The objective of this study was to test the hypothesis that those beneficial effects would be sustained over an 11-month period. STUDY DESIGN: The device was tested on a mixed sample of 94 patients with xerostomia in an open-label, uncontrolled, prospective multicenter trial. Statutory outcome assessments were done at 5th, 8th, and 11th months and analyzed by multiple comparisons. RESULTS: Improvements achieved at month 5 from baseline were sustained throughout the follow-up period for the primary outcome, xerostomia severity, and the secondary outcomes resting whole salivary flow rate, xerostomia frequency, oral discomfort, and difficulties in speech, swallowing, and sleeping. No significant side effects were detected. CONCLUSIONS: The beneficial effects of a removable intraoral electrostimulating device were sustained for an 11-month period.

Flour fortification with iron has no impact on anaemia in urban Brazilian children.

OBJECTIVE: To verify the impact of flour fortification on anaemia in Brazilian children. The survey also investigated the role of Fe deficiency as a cause of anaemia and estimated the bioavailability of the Fe in the children's diet. This local study was complemented by a nationwide survey of the types of Fe compounds added to flour. DESIGN: Series of population-based surveys conducted in 2004 (baseline study), 2005, 2006 and 2008. SETTING: Pelotas, Rio Grande do Sul, Brazil. SUBJECTS: Children under 6 years of age residing in the urban area of the city of Pelotas, Southern Brazil (n 507 in 2004; n 960 in 2005; n 893 in 2006; n 799 in 2008). In 2008, a sub-sample of children (n 114) provided venous blood samples to measure body Fe reserve parameters (ferritin and transferrin saturation). RESULTS: We found no impact of fortification, with an increase in anaemia prevalence among children under 24 months of age. Hb levels decreased by 0.9 g/dl in this age group between 2004 and 2008 (10.9 g/dl to 10.0 g/dl; P < 0.001). Roughly 50 % of cases of anaemia were estimated to be due to Fe deficiency. Half of the mills surveyed used reduced Fe to fortify wheat flour. Total Fe intake from all foodstuffs was adequate for 88.6 % of the children, but its bioavailability was only 5 %. CONCLUSIONS: The low bioavailability of the Fe compounds added to flours, combined with the poor quality of children's diets, account for the lack of impact of mandatory fortification.

Sub-Saharan Rubiaceae: a review of their traditional uses, phytochemistry and biological activities.

Rubiaceae family is a large family of 630 genera and about 13000 species found worldwide, especially in tropical and warm regions. These plants are not only ornamental but they are also used in African folk medicine to treat several diseases. Based on online published data and library bibliographic research, we herein reported accumulated information related to their traditional usages in sub-Saharan traditional medicine, their chemical composition and the screened pharmacological activities. Indeed, more than 60 species are used for more than 70 medicinal indications including malaria, hepatitis, eczema, oedema, cough, hypertension, diabetes and sexual weakness. Through biological screening following leads supplied with traditional healers, many of these plants exhibited antimalarial, antimicrobial, antihypertension, antidiabetic, antioxidant and anti-inflammatory activities. Bioactive compounds including indole alkaloids, terpenoids and anthraquinones have been isolated from these bioguided fractionation studies. It is evidence that great attention has been paid to species such as Nauclea latifolia, Morinda lucida, Mitragyna inermis and Crossopteryx febrifuga; however, several compounds should be waiting to be discovered since none of these plants has been systematically investigated for its biochemical composition. According the current global health context with the recrudescence of HIV, much effort should be oriented towards this virus when screening Rubiaceae.

In vitro antiplasmodial activity of crude extracts from Togolese medicinal plants.

OBJECTIVE: To investigate the antimalarial effect of a few plants in Togo folk medicine. METHODS: After ethnobotanical survey, Opilia celtidifolia, Pavetta corymbosa (P. corymbosa) and Tamarindus indica (T. indica) were selected for screening. In vitro antimalarial tests were performed on crude extracts against fresh clinical isolates of Plasmodium falciparum using the semi microtest. RESULTS: Different IC(50) values of the extracts ranged from 2.042 to 100.000 µg/mL. According to the results, the methanol extract of aerial part of P. corymbosa followed by aqueous extract of fruit of T. indica were the most active (IC(50) of 2.042 and 4.786 µg/mL, respectively). Qualitative test revealed the presence of alkaloids in the leaves of P. corymbosa that may be responsible for the activity of the plant. CONCLUSIONS: Our study provides scientific evidence for usage of plant in the folk medicine, and further studies are needed for identification and purification of the active principles.

The possible role of selenium status in adverse pregnancy outcomes.

The present study reviews the possible role of Se status during pregnancy regarding adverse pregnancy outcomes, with emphasis on those related to diminished antioxidant activity and increased oxidative stress. Studies have reported that Se could play an important role in adverse outcomes such as miscarriages, neural tube defects, diaphragmatic hernia, premature birth, low birth weight, pre-eclampsia, glucose intolerance and gestational diabetes. Also, low Se status has been associated with adverse outcomes among HIV-infected pregnant women and their offspring. Nevertheless, the function of Se in the aetiology of pregnancy complications is yet to be elucidated. Available evidence presents the following limitations: most study designs do not allow conclusions about causal relationships; study populations, selection of subjects, research setting, procedures for defining sample size and analytical methods are often poorly described; many studies fail to adjust for important confounding variables. In addition, population studies assessing the relationship between Se intake during pregnancy and health outcomes are scarce. Further research is still needed to clarify the role of Se status in adverse pregnancy outcomes, especially those related to augmented oxidative stress.

Low-grade hypothalamic inflammation leads to defective thermogenesis, insulin resistance, and impaired insulin secretion.

Hypothalamic inflammation is present in animal models of obesity, and the intracerebroventricular injection of TNFα can reproduce a number of features of the hypothalamus of obese animals. Because obesity is a risk factor for type 2 diabetes (DM2) we hypothesized that, by inducing hypothalamic inflammation, we could reproduce some clinical features of DM2. Lean Wistar rats and TNF receptor 1-knockout mice were employed to determine the effects of hypothalamic actions of TNFα on thermogenesis and metabolic parameters. Signal transduction and protein expression were evaluated by immunoblot and real-time PCR. Thermogenesis was evaluated in living rats, and respirometry was determined in isolated muscle fiber. In Wistar rats, hypothalamic TNFα blunts the anorexigenic effect of leptin, which is accompanied by reduced leptin signaling and increased expression of suppressor of cytokine signaling 3. In addition, hypothalamic TNFα reduces O(2) consumption and the expression of thermogenic proteins in brown adipose tissue and skeletal muscle. Furthermore, hypothalamic inflammation increases base-line plasma insulin and insulin secretion by isolated pancreatic islets, which is accompanied by an impaired insulin signal transduction in liver and skeletal muscle. Hypothalamic inflammation induced by stearic acid also reduces O(2) consumption and blunts peripheral insulin signal transduction. The use of intracerebroventricular infliximab restores O(2) consumption in obese rats, whereas TNF receptor 1-knockout mice are protected from diet-induced reduced thermogenesis and defective insulin signal transduction. Thus, low-grade inflammation of the hypothalamus is sufficient to induce changes in a number of parameters commonly impaired in obesity and DM2, and TNFα is an important mediator of this process.

Efficacy and safety of an intraoral electrostimulation device for xerostomia relief: a multicenter, randomized trial.

OBJECTIVE: To evaluate the efficacy and safety of an intraoral electrostimulation device, consisting of stimulating electrodes, an electronic circuit, and a power source, in treating xerostomia. The device delivers electrostimulation through the oral mucosa to the lingual nerve in order to enhance the salivary reflex. METHODS: The device was tested on a sample of patients with xerostomia due to Sjögren's syndrome and other sicca conditions in a 2-stage prospective, randomized, multicenter trial. Stage I was a double-blind, crossover stage designed to compare the effects of the electrically active device with the sham device, each used for 1 month, and stage II was a 3-month open-label stage designed to assess the long-term effects of the active device. Improvement in xerostomia severity from baseline was the primary outcome measure. RESULTS: A total of 114 patients were randomized. In stage I, the active device performed better than the sham device for patient-reported xerostomia severity (P<0.002), xerostomia frequency (P<0.05), quality of life impairment (P<0.01), and swallowing difficulty (P<0.02). At the end of stage II, statistically significant improvements were verified for patient-reported xerostomia severity (P<0.0001), xerostomia frequency (P<0.0001), oral discomfort (P<0.001), speech difficulty (P<0.02), sleeping difficulty (P<0.001), and resting salivary flow rate (P<0.01). CONCLUSION: Our findings indicate that daily use of the device alleviated oral dryness, discomfort, and some complications of xerostomia, such as speech and sleeping difficulties, and increased salivary output. The results show a cumulative positive effect of the device over the period of the study, from baseline to the end of the trial.

In vitro antiplasmodial activity of crude extracts from Togolese medicinal plants

OBJECTIVE@#To investigate the antimalarial effect of a few plants in Togo folk medicine.@*METHODS@#After ethnobotanical survey, Opilia celtidifolia, Pavetta corymbosa (P. corymbosa) and Tamarindus indica (T. indica) were selected for screening. In vitro antimalarial tests were performed on crude extracts against fresh clinical isolates of Plasmodium falciparum using the semi microtest.@*RESULTS@#Different IC(50) values of the extracts ranged from 2.042 to 100.000 μg/mL. According to the results, the methanol extract of aerial part of P. corymbosa followed by aqueous extract of fruit of T. indica were the most active (IC(50) of 2.042 and 4.786 μg/mL, respectively). Qualitative test revealed the presence of alkaloids in the leaves of P. corymbosa that may be responsible for the activity of the plant.@*CONCLUSIONS@#Our study provides scientific evidence for usage of plant in the folk medicine, and further studies are needed for identification and purification of the active principles.

Vitamin A supplementation for postpartum women.

BACKGROUND: In vitamin A deficient populations, the amount of vitamin A may be insufficient for maintenance of maternal health and levels in breast milk may be insufficient for breastfeeding infants' needs. OBJECTIVES: To assess the effects of postpartum maternal vitamin A supplementation on maternal and infant health. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2010), LILACS (1982 to July 2010), Web of Science (1945 to July 2010) and Biological Abstracts (1998 to July 2010). SELECTION CRITERIA: Randomised controlled trials evaluating the effects of postpartum maternal vitamin A supplementation. DATA COLLECTION AND ANALYSIS: Two review authors assessed the studies independently. MAIN RESULTS: We included 12 trials at moderate risk of bias, enrolling 25,465 mother-baby pairs and comparing several postpartum doses (200,000-400,000 IU) of vitamin A or 7.8 mg daily beta-carotene, with placebo, iron or no supplement; or higher (400,000 IU) versus lower dose (200,000 IU). The majority of infants in all studies were at least partially breastfed for six months.Maternal: we observed no impact of vitamin A on maternal mortality (two trials of 9,126 women), morbidity (one trial of 50 women) or adverse effects (subset of 786 women in one trial). Vitamin A enhanced serum and breast milk retinol at three months in five trials, but these improvements were generally not sustained.Infant: we observed no significant differences for infant mortality RR 1.14 95% CI 0.84 to 1.57 (five trials (6,170 infants) or morbidity (three trials) except for fewer episodes of fever with vitamin A in one small trial. No significant differences in infant vitamin A status were seen with maternal vitamin A supplementation (five trials).No beneficial effects for maternal or infant health were associated with higher compared to lower doses of vitamin A in two trials. AUTHORS' CONCLUSIONS: The lack of effect on maternal and infant mortality and morbidity, with exception of some improved infant morbidity in one small study, and the improvement in maternal vitamin A status, suggest that maternal postpartum vitamin A supplementation offers limited benefits.

Ensaio randomizado sobre o impacto da multimistura no estado nutricional de crianças atendidas em escolas de educação infantil / Randomized clinical trial of the impact of a nutritional supplement \"multimixture\" on the nutritional status of children enrolled at preschools

OBJETIVO: Avaliar o efeito da multimistura adicionada à merenda escolar sobre o estado nutricional de crianças atendidas em escolas municipais de educação infantil. MÉTODOS: Estudo de intervenção, longitudinal e controlado, incluindo 24 escolas de educação infantil que foram comparadas antes e depois da intervenção. Os grupos controle e intervenção foram definidos por sorteio das escolas que haviam sido emparelhadas por situação nutricional. A intervenção consistiu em adicionar 10 g de multimistura à alimentação fornecida às crianças que freqüentavam as 12 escolas do grupo intervenção. As medidas de desfecho incluíram as diferenças de escore z dos três índices nutricionais e dos valores de hemoglobina no período de 6 meses em que a suplementação foi fornecida. Modelo multinível foi utilizado nas análises. RESULTADOS: As médias de escore z de peso por idade ao final do acompanhamento foram de 0,40 (±1,34) e 0,31 (±1,32), respectivamente, nos grupos intervenção e controle. A análise em multiníveis mostra diferenças não significativas a favor da intervenção nas médias de escore z de peso para idade (β 0,05; IC95 por cento -0,03 a 0,12) e de estatura para idade (β 0,02; IC95 por cento -0,06 a 0,09). A diferenηa média de hemoglobina foi contrária à intervenção, mas também não foi significativa (β -0,01; IC95 por cento -0,36 a 0,34). CONCLUSÃO: A suplementação com 10 g de multimistura não mostrou efeito significativo sobre nenhuma das medidas ou índices nutricionais estudados em crianças atendidas em escolas municipais de educação infantil.

OBJECTIVE: To evaluate the effect of adding a nutritional supplement "multimixture" to school meals on the nutritional status of children enrolled at municipal preschools. METHODS: Longitudinal, controlled intervention study of 24 preschools which were compared before and after an intervention. The control and intervention groups were defined by drawing lots to choose schools that had previously been paired for nutritional status. The intervention consisted of the addition of 10 g of multimixture to the meals provided to children attending the 12 schools in the intervention group. Outcome measures include changes in z scores for the three nutritional indices and hemoglobin values over the 6-month period during which the supplement was added. A multilevel model was used for analyses. RESULTS: Mean z scores for weight for age at the end of follow-up were 0.40 (±1.34) and 0.31 (±1.32) for the intervention and control groups, respectively. The multilevel analysis demonstrated non-significant differences in favor of the intervention in mean z scores for weight for age (β 0.05; 95 percentCI -0.03 to 0.12) and height for age (β 0.02; 95 percentCI -0.06 to 0.09). Mean change in hemoglobin was against the intervention, but this was also without significance (β -0.01; 95 percentCI -0.36 to 0.34). CONCLUSIONS: Supplementation with 10 g of multimixture did not have a significant effect on any of the nutritional indices or measurements of the municipal preschool pupils studied here.

The lethality of Euphorbia conspicua to adults of Biomphalaria glabrata, cercaria of Schistosoma mansoni and larvae of Artemia salina.

Leaf extracts of Euphorbia conspicua (Euphorbiaceae), together with the latex and fractions derived therefrom, were evaluated for their molluscicidal and cercaricidal activities and their toxicities to brine shrimps. Whilst the leaf extracts were inactive against Biomphalaria glabrata, the latex, its triterpenic fraction and irritant fractions I and II exhibited high activities against adult snails with LC90 values of 4.87, 10.55, 0.64 and 0.10 microg/mL, respectively. The latex and its derived fractions were considered lethal to the cercaria of Schistosoma mansoni at concentrations of 100 microg/mL. The toxicities of the latex and the irritant fractions, but not of the triterpenic fraction, against Artemia salina were high with LC50 values < 10 microg/mL. The possible application of the latex of E. conspicua as an alternative natural molluscicide is considered.