Fortification of Carica papaya fruit seeds to school meal snacks may aid Africa mass deworming programs: a preliminary survey.

BACKGROUND: Soil transmitted helminths (STHs) are among the world's neglected tropical diseases. Morbidity due to STHs is greatest in school-age children who typically have the highest burden of infection. In 2001, WHO passed a resolution for the use of large-scale mass drug administration (MDA) to deworm vulnerable children through school based programs. Though effective, there is concern that MDA might not be sustainable over extended periods. Additionally the current MDA strategy does not consider child malnutrition, a very common malady in resource limited countries. We report a pilot evaluation of an innovation that bundles school feeding and deworming. METHODS: We designed a maize (corn) flour fortified with grounded dried papaya (Carica papaya) seeds and used it to prepare porridge as per the usual school meal recipe Children from three primary schools from Nandi County in Kenya were randomized into three arms: One school received 300 ml papaya fortified porridge daily (papaya group), the second school received similar serving of plain porridge without the pawpaw ingredient (control group) and the third school received plain porridge and the conventional MDA approach of one time 400 mg dosage of albendazole (albendazole arm). Prior to the randomization, an initial baseline stool microscopy analysis was done to determine presence and intensity of intestinal worms. Core indicators of nutrition-height, weight and hemoglobin counts were also assessed. The children were monitored daily for two months and final stool sample analysis and clinical monitoring done at the end of the study. Baseline and follow-up data were analyzed and compared through SAS version 9.1 statistical package. RESULTS: A total of 326 children participated in the trial. The overall prevalence of Ascaris lumbricoides was 29.4% (96), Trichuris Trichura 5.2% (17) and hookworm 1 (0.3%). Papaya seed fortified porridge reduced the Ascaris lumbricoides egg count by 63.9% after the two month period (mean 209.7epg to 75.7 p < 0.002) as compared to the albendazole arm 78.8% (129.5 epg to 27.5, p value 0.006). The control group showed an increase in egg count (42.epg to 56.3) though it was not statistically significant. Hemoglobin counts in the papaya group increased from a mean of 2 g/dL (11.5 g/dL to 13.5 g/dL, p < 0.001), as compared to the albendazole arm that increased by 1 g/dL (12.8-13.9, p < 0.001). No significant change was observed in the placebo arm (13.2 to 13.1). Interestingly the papaya group showed a significant reduction of children with Tinea capitis (ringworms) (54.4 to 34%, p < 0.002) as compared to the albendazole arm that showed an increase in ringworm infestation though not statistically significant (39.7 to 64.7% p = 0.608). CONCLUSION: Papaya seed fortified porridge had a significant effect on reduction of Ascaris lumbricoides burden. It had a better nutritional outcome and effect on child fungal infections than albendazole. Its application as a routine school meal may aid current national school based nutrition and deworming programs in Africa. TRIAL REGISTRATION: This study was retrospectively registered at Clinicaltrials.gov Ref. NCT02725255 on 31st March 2016.

Severe neonatal nemaline myopathy with delayed maturation of muscle.

A Japanese infant with a severe neonatal form of nemaline myopathy showed features of muscle immaturity as well as rods in the biopsied quadriceps femoris muscle, and involvement of diaphragm was first confirmed at autopsy. The biopsied muscle showed numerous rods in 80% of muscle fibers, and an increased number of type 2C fibers (23.2%). Electron microscopic findings were characterized by the presence of many small, immature round fibers with central nuclei and sparse myofibrils, and an increased number of satellite cells in close association with the small muscle fibers, as well as numerous rod structures. These microscopic and electron microscopic findings are interpreted as immature muscle fibers. Maturational delay or arrest implies deprivation of a development promoting factor such as a neuronal signal. Severe involvement with numerous rods was demonstrated in both diaphragm and intercostal muscles at the time of the postmortem examination, compatible with the patient's respiratory failure.

Ionic size and behavior of diclofenac salts in water and ethanol/water mixtures by conductivity at 25 degrees C.

The objectives of this study were to evaluate the size of the diclofenac ion and the electrical behavior of diclofenac salts (DM; M = Li, Na, or K) in ethanol/water mixtures. The molar conductance of DM in aqueous solution was measured in a dilute concentration range of < 10 mol.m-3 at 25 degrees C. The Fuoss-Onsager conductance equation for unassociated electrolytes was used to determine the limiting molar conductance (lambda degrees) of DM. The molar conductivity of DM at a finite concentration was, however, larger than the value calculated by the Fuoss-Onsager limiting law. To correct the difference in the experimental data, two equations were employed to fit the experimental molar conductance of DM. The size of the diclofenac ion was calculated from the limiting molar conductance and compared with the values obtained by the Fedors method and the apparent ionization constant (pKa) of sodium diclofenac in ethanol/water mixture. The Walden products of DM increased up to 20% (w/w) ethanol, but above this concentration of ethanol they decreased. Specific interactions between the ions and solvent are discussed.

[A case of perinatal cytomegalovirus infection with severe progressive brain atrophy].

A 2-month-old girl had focal tonic convulsions. Brain CT showed no abnormalities on admission. Three weeks later she got a severe epileptic status. T 1-weighted MRI demonstrated low intensity areas in the right occipital and left frontal regions, and enhanced CT demonstrated low density areas in the same region. An increase of CMV antibody titer in serum suspected CMV infection associated with brain infarction. Then gamma-globulin was given in addition to PB, CBZ, and VPA, resulting in suppression of seizures. At 9 months of age, she had right tonic hemiconvulsions. An increase of CMV IgM antibody titer showed reactivation of CMV infection. Acyclovir and gamma-globulin were given, and her seizures were controlled. However, she showed progressive motor disability with spastic muscle tonus. CT and MRI showed a severe progressive atrophy of the cerebrum and brain stem.

Superoxide dismutase in polymorphonuclear leukocytes of term newborn infants and very low birth weight infants.

We investigated the activity and the content of copper and zinc-containing superoxide dismutase (SOD) and superoxide anion (O2-) production in polymorphonuclear leukocytes (PMN) from healthy term newborn infants, very low birth wt infants, and healthy adults. SOD activity in PMN was measured with nitroblue tetrazolium reduction assay on PAGE, and the SOD content in PMN was determined with an ELISA using a monoclonal antibody against human copper and zinc-containing SOD. The activity and the content of SOD in the term neonatal PMN and VLBW-infants' PMN were significantly lower than those in the adults' PMN (term newborn infants, 6.6 +/- 0.6 U/mg protein and 170.4 +/- 16.3 ng/mg protein, n = 10; VLBW infants, 6.8 +/- 0.9 and 173.0 +/- 16.2, n = 6; adults, 10.3 +/- 0.6 and 241.9 +/- 13.3, n = 10; values were expressed as mean +/- SEM). Both the phorbol myristate acetate- and the N-formyl-methionyl-leucyl-phenylalanine-induced O2- production rates of VLBW-infants' PMN were significantly higher than those of the term neonatal PMN. The phorbol myristate acetate-induced O2- production rate of the term neonatal PMN was significantly lower than that of the adults' PMN. The phorbol myristate acetate-induced H2O2 production rate of the term neonatal PMN was significantly lower than that of the adults' PMN. The conversion rate from O2- to H2O2 of the neonatal PMN was similar to that of the adults' PMN.(ABSTRACT TRUNCATED AT 250 WORDS)