Human milk donation is an alternative to human milk bank.

BACKGROUND AND AIMS: Human milk bank is a source of human milk supply in many neonatal intensive care units. However, there are some hospitals without this facility because of financial or religious impediments, such as the Muslim community. METHODS: We introduced human milk donation as an alternative to human milk banking based on Islamic principles. The suitable donor is a healthy rooming-in mother whose expressed breastmilk is in excess of her baby's demand. The milk is used after 72 hours of freezing at -20°C. The donor must fulfill the criteria for selection of donors and be nonreactive to human immunodeficiency virus and syphilis. Once the recipient's family and the donor state their desire for the human milk donation, a meeting with both parties is made. Unpasteurized frozen-thawed donor's milk will be provided to the recipient after written consents are obtained from both parties. RESULTS: This study was carried out in the Duchess of Kent Hospital (Sandakan, Sabah, Malaysia) between January 2009 and December 2010. A total of 48 babies received donated breastmilk. Forty-two infants were from the special care nursery, and the remaining six were from the pediatric ward. Eighty-eight percent of the donors and 77% of the recipients were Muslims. Sixty percent of the infants who received donated human milk were premature. Two infants died because of the underlying nature of their disease. CONCLUSION: Human milk donation is an option for hospitals without a human milk bank or in the Muslim community.

Surveillance culture of endoscope to monitor the quality of high-level disinfection of gastrointestinal reprocessing.

BACKGROUND/AIMS: Inadequate reprocessing of endoscopes or endoscopic accessories may result in iatrogenic infection and present a risk to public health. The aim of this study is to utilize microbiological cultures of endoscopes to assess the adequacy of standard reprocessing procedures. METHODOLOGY: A prospective study to randomly cultures of endoscopes and colonoscopies immediately after the completion of the decontamination cycle monthly. The samples were obtained by flushing 50 ml sterile distilled water to the internal channel and collected into a sterile container. These samples were incubated at 37 degrees C and examined for bacterial growth. RESULTS: A total of 49 cultures were obtained from June to December in year 2005. Three out of 7 were culture positive in the first month initially, but after prolonged the soaking duration to 25 minutes, the subsequent cultures were reduced to 1 positive sample only. The positive culture rate was 18.4% (9/49), and 44.4% (4/9) in Monoflora culture and 55.6% (5/9) in Multi-flora. Upper endoscopes decontaminated by automated endoscopic washing machine labeled as number 5 was found persistently culture positive with varied organisms despite vigorous manual cleaning and prolonged disinfectant soaking duration. At repair, the relief valve in the automated endoscopes washing machine was damaged and disconnected. After repair, subsequent cultures were negative. CONCLUSIONS: Endoscopy culturing is a useful method to assess the effectiveness of standard reprocessing procedures. Servicing of automated endoscope washer regularly is mandatory to minimize cross infection and quality assurance.

Model for end-stage liver disease (MELD) score for predicting late esophageal varices rebleeding in cirrhotic patients.

BACKGROUND/AIMS: Esophageal varices bleeding is a fatal complication of portal hypertension. The model for end-stage liver disease (MELD) has been used as a tool to predict mortality risk in cirrhotic patients. It is currently unknown if MELD score can be applied to predicting late esophageal varices rebleeding. The predictive ability of the MELD score for short-term esophageal varices rebleeding was studied. METHODOLOGY: Ninety-five cirrhotic patients with esophageal varices bleeding were enrolled with a follow up period of at least 3 months. All patients had undergone a successful hemostasis at admission. Initial admission MELD score and 3-months MELD were obtained to observe their correlation with the late esophageal varices rebleeding. RESULTS: MELD score of 13 and 16 are the mean MELD score of the admission and 3-months respectively in the rebleeding group. The correlation between initial admission MELD score and late stage data showed a positive linear regression in the rebleeding patients (p=0.001, r=0.773) but not in the non-rebleeding group. CONCLUSIONS: The MELD score is a good predictor of short term esophageal varices rebleeding rate. At least 2 MELD score data is needed to evaluate the possibilities of rebleeding

Diarrhea in medical care workers with severe acute respiratory syndrome.

BACKGROUND AND GOAL: Several known coronavirus species cause a variety of diseases, including respiratory or enteric diseases. The purpose of this study was to investigate the interesting enteric symptoms of the medical care workers who were evidently infected with SARS by means of respiratory transmission. STUDY: Between May 1 and June 16, 2003, we enrolled 16 medical care workers who fulfilled the definition of probable SARS. Samples used for the detection of coronavirus RNA by RT-PCR were collected from throat and rectal swabs during acute phase. Serum anti-SARS IgG was checked by enzyme-linked immunosorbent assays at the convalescent phase. RESULTS: The incidence of watery diarrhea was 18.8% (3 of 16). The RT-PCR of coronavirus was positive in three (18.8%) of 16 throat swabs and in none (0%) of seven rectal swabs. Serum anti-coronavirus IgG was positive in 13 of the 15 patients (86.7%). The mortality rate was 6.25% (1 of 16). The diarrhea rate in our hospital was significantly lower in comparison with the 73% (55 of 75) of the Amoy Gardens outbreak in Hong Kong (P = 0.000073), and similar to the 19.6% (27 of 138) of the hospital-acquired outbreak in the Prince of Wales Hospital in Hong Kong (P = 0.798). In contrast to the high positive rate of feces RT-PCR (97%) in Amoy Gardens, our positive rate in rectal swab RT-PCT (0%) was significantly lower (P = 0.00000002). CONCLUSIONS: Hospital-acquired SARS cases infected mainly by respiratory route less commonly presented with diarrhea. Lower intestinal viral load, when the virus spread by respiratory route, may be contributive to lower diarrhea rate and lower positive rate in rectal swab RT-PCR.

Correlation of the morphology and size of colonic polyps with their histology.

BACKGROUND: Colonic adenomatous polyps are premalignant lesions; early recognition and use of a polypectomy for these polyps can reduce the occurrence of colorectal cancer. The purposes of this study were to evaluate the complications of polypectomy and the relationship between the morphology and size of colonic polyps and their histology. METHODS: Data on colonic polyps from 324 patients who received a polypectomy between April 1998 and December 2001 were collected. These included 207 men and 117 women, ranging in age between 17 and 86 years old, and who had had a colonoscopy or sigmoidoscopic examination. A polypectomy was performed on those colonic polyps discovered, and their morphology, size, and histology were analyzed. RESULTS: The histological findings of these polyps included adenoma, carcinoma, hyperplastic, and inflammatory polyps. One and a half percent (n = 6) were carcinomas, all of which belonged to the Yamada III or IV polyp group and were more than 1 cm in size, except for 1 polyp which was 0.7 cm. One case was complicated by colon perforation, and 2 cases experienced mild bleeding with no need for a blood transfusion or hospitalization. CONCLUSIONS: Morphology and size are closely related to the malignant change in colonic polyps. Colonic polyps with a size greater than 1 cm and classified as Yamada type III or IV have a higher potential for malignant change, and a polypectomy should be considered when they are discovered. A polypectomy is a safe procedure with only minor complications.