The role of breast milk fortifier in the post-discharge nutrition of preterm infants.

Infants born prematurely are often discharged from hospital before 37 weeks post-menstrual age. While breastfeeding will meet all the nutritional requirements of full-term infants, these preterm infants may need enhanced levels of protein, minerals and possibly energy to ensure optimum growth, bone mineralisation and neurological development. To meet these additional nutrient needs in the neonatal unit, it is currently recommended that multinutrient breast milk fortifier is added to maternal breast milk. There may also be benefits in continuing to provide fortified milk after discharge, potentially including improved growth and preserving breastfeeding, and this is increasingly becoming a recognised practice in some neonatal units. This article presents the discussion and consensus of a multidisciplinary panel of neonatologists, neonatal dietitians, a GP and a neonatal outreach sister. The aim is to develop guidance on providing safe and effective nutritional supplementation for preterm infants after discharge in order to maintain optimal growth. This guidance is aimed at community healthcare staff and is based on the limited evidence available, using shared best practice and expertise.

The "ups" and "downs" of a bike race in people with type 1 diabetes: dramatic differences in strategies and blood glucose responses in the Paris-to-Ancaster Spring Classic.

OBJECTIVE: Recommendations for insulin adjustments and carbohydrate intake exist for individuals with type 1 diabetes who are undertaking moderate exercise. Very few guidelines exist for athletes with type 1 diabetes who are competing in events of higher intensity or longer duration. This observational study reports the strategies adopted by 6 habitually active men with type 1 diabetes (glycated hemoglobin = 8.3%±2.0%) undertaking a relatively intense endurance cycling event. METHODS: Participants wore continuous glucose monitoring (CGM) sensors for 24 hours before competition, while racing and overnight postrace. They were asked to eat their regular meals and snacks and make their usual insulin adjustments before, during and after competition. All food intake and insulin adjustments were recorded in detail. RESULTS: Participants used a variety of adjustments for exercise. Of 6 participants, 4 decreased their insulin dosages and all participants consumed carbohydrates during the race (mean = 87±57 g). In spite of these strategies, 3 of the 6 participants experienced mild to moderate hypoglycemia (not requiring assistance) during the event. Hyperglycemia was seen in all participants 3 hours postexercise. There were no incidents of nocturnal hypoglycemia. CONCLUSIONS: Individuals with type 1 diabetes can compete in intensive long-distance athletic events using a variety of nutrition- and insulin-adjustment strategies. In addition to finely tuned insulin adjustments and increased carbohydrate intake, vigilance will always be required to maintain some semblance of glycemic control during events of extended duration.

Evaluation of the innovance d-dimer assay for the diagnosis of disseminated intravascular coagulopathy in different clinical settings.

Disseminated intravascular coagulopathy (DIC) is a serious disease with fatal consequences. We prospectively analyzed Innovance d-dimer immunoturbidimetric assay in 68 patients diagnosed with DIC on the background of malignancy (22), severe infection (20), or multitrauma (26) at a single institution between January 2010 and January 2011. Median age was 61 years (range 20-89). All patients were assessed according to the International Society of Thrombosis and Haemostasis (ISTH) DIC score. Applying a threshold of Innovance d-dimer of 10 mg/L fibrinogen equivalent unit (normal <0.5) was correlated with the highest sensitivity in malignancy (86%) and trauma/surgery (80%) compared to 54% in infection. The specificity remained high at 97% in infection, 81% in trauma and 77% in malignancy with a negative predictive value of 97% in trauma and malignancy, and 88% in infection. Our data suggest that Innovance d-dimer is a useful and simple tool that enhances the ISTH DIC diagnostic criteria. Further studies to confirm these findings are warranted.

In vitro delivery of novel, highly potent anti-varicella zoster virus nucleoside analogues to their target site in the skin.

PURPOSE: To determine the in-vitro dermal delivery of a new class of lipophilic, highly potent and uniquely selective anti-VZV nucleoside analogues in comparison with aciclovir. METHODS: Three test compounds (Cf1698, Cf1743, Cf1712) and aciclovir were formulated into propylene glycol/aqueous cream BP formulations and finite doses applied to full-thickness pig ear skin for 48 hours in vertical Franz-type diffusion cells. Receptor phase samples were taken at specific intervals to determine permeation, and depth profiles were constructed following tape stripping and membrane separation. RESULTS: All three test compounds reached the target basal epidermis in concentrations suggesting they would be highly efficacious in reducing viral load. Furthermore, the data showed that each of the test compounds would perform in a far superior manner to aciclovir, the current treatment of choice. CONCLUSIONS: The dermatomal site of viral replication during secondary infection--the basal epidermis--was successfully targeted. Topical delivery of these compounds is highly promising as a new first line treatment of VZV infections. By attacking the virus at the first sign of reactivation, it is proposed that the extent of damage caused by the virus would be significantly lowered, thereby limiting the extent and severity of post-herpetic neuralgia.

Targeted dermal delivery of highly potent anti-varicella zoster virus nucleoside analogues from saturated solutions and ethanolic oil-in-water creams.

Varicella zoster virus (VZV) is responsible for causing chickenpox and shingles infections, the latter of which can lead to long-term post-herpetic neuralgia (PHN), the most common complication of VZV infections. A class of anti-VZV nucleoside analogues has been synthesised that shows up to 30,000 times the potency of aciclovir in vitro. The relatively high lipophilicities exhibited by the compounds led them to be selected for dermal delivery. The aim was to assess the relative penetration and permeation of the compounds into and through the skin, ideally targeting the region of skin in which the reactivated virus replicates. By targeting the skin it should be possible to reduce the viral load that causes damage to the nerves, thereby limiting zoster-associated pain, in particular PHN. Three compounds, as saturated solutions or as ethanol-based creams, were applied to full-thickness pig ear skin in Franz-type diffusion cells. An ethanolic and water receptor phases were compared. Samples of the receptor phase were taken at specific intervals, followed by tape stripping and separation of the remaining membrane at the end of the experiment. Analysis of the samples showed that all three compounds penetrated into the ethanolic receptor phase to a considerable degree, while only the least lipophilic compound entered the water receptor phase. The effects of the organic solvent in the receptor phase were visible in both the penetration and permeation of the compounds. All three compounds were distributed throughout the membrane in a manner that indicates that the site of viral replication in the skin is reached.