Addressing child undernutrition in Tanzania with the ASTUTE program.

BACKGROUND: Optimal infant and young child feeding practices (IYCFP) reduce childhood stunting and are associated with additional health benefits. In Tanzania, IYCFP are far from optimal where 32% of children under the age of 5 years are stunted. The purpose of this study was to examine whether behavior change communication focused on reducing child undernutrition was associated with improved IYCFP in Tanzania. METHODS: A cross-sectional survey was administered to approximately 10,000 households with children under the age of 2 at baseline and endline. Bivariate analyses and logistic regression was used to examine the relationship between exposure to behavior change communication and timely initiation of breastfeeding, exclusive breastfeeding, continued breastfeeding at one year, timely complementary feeding (CF), minimum meal frequency (MMF), minimum dietary diversity (MDD), and minimum acceptable diet (MAD). RESULTS: Mothers who heard a radio spot about IYCFP were more likely than mothers who had not heard a radio spot about IYCFP to begin complementary foods at six months. Their children were also more likely to achieve MMF, MDD, and MAD with odds ratios of 2.227 (p = 0.0061), 1.222 (p = 0.0454), 1.618 (p = < .0001), and 1.511 (p = 0.0002), respectively. Mothers who saw a TV spot about IYCFP were more likely to have greater odds of knowing when to begin complementary feeding, feeding their child a minimally diverse diet (4 food groups or more), and serving a minimum acceptable diet with odds ratios of 1.335 (p = 0.0081), 1.360 (p = 0.0003), and 1.268 (p = 0.0156), respectively. CONCLUSION: Exposure to behavior change communication in Tanzania was generally associated with some increased knowledge of optimal IYCFP as well as practicing IYCF behaviors. Behavior change communication planners and implementers may want to consider conducting similar campaigns as an important component of behavior change to reduce undernutrition and poor health outcomes in developing settings.

Eukaryotic initiation factor 4E-binding protein 1 (4E-BP1): a master regulator of mRNA translation involved in tumorigenesis.

Protein synthesis activity is abnormally enhanced in cancer cells to support their uncontrolled growth. However, this process needs to be tightly restricted under metabolic stress-a condition often found within the tumor microenvironment-to preserve cell viability. mTORC1 is critical to link protein synthesis activity to nutrient and oxygen levels, in part by controlling the 4E-BP1-eIF4E axis. Whereas mTORC1 and eIF4E are known pro-tumorigenic factors, whose expression or activity is increased in numerous cancers, the role of 4E-BP1 in cancer is not yet definitive. On the one hand, 4E-BP1 has tumor suppressor activity by inhibiting eIF4E and, thus, blocking mRNA translation and proliferation. This is corroborated by elevated levels of phosphorylated and hence inactive 4E-BP1, which are detected in various cancers. On the other hand, 4E-BP1 has pro-tumorigenic functions as it promotes tumor adaptation to metabolic and genotoxic stress by selectively enhancing or preventing the translation of specific transcripts. Here we describe the molecular and cellular functions of 4E-BP1 and highlight the distinct roles of 4E-BP1 in cancer depending on the microenvironmental context of the tumor.

Evaluating the validity of responsiveness to inhaled nitric oxide in pediatric patients with ARDS: an analytic tool.

OBJECTIVES: To determine whether improved oxygenation indicates a valid response to inhaled nitric oxide (iNO) therapy in patients with pediatric ARDS, and to establish an analytic tool to differentiate the iNO effects from those of other interactive factors in pediatric patients with ARDS. DESIGN: Consecutive case series evaluated by post hoc analysis tool. PATIENTS AND METHODS: Nineteen patients treated with iNO for ARDS or pulmonary hypertension were enrolled in our study. We evaluated the PaO(2)/fraction of inspired oxygen ratio (PF ratio), oxygenation index (OI), patient position (prone vs supine), PaCO(2), pH, and vasoactive drug support, and classified patients' responsiveness to iNO into three categories: (1) possible response, an increase in PF ratio, with no alteration of the aforementioned variables in a direction known to improve oxygenation; (2) nonspecific response, an increase in PF ratio with no increase in OI, and alteration of one or more of the other four criteria in a direction known to improve oxygenation; and (3) undetermined response, an increase in both the PF ratio and OI, indicating a deliberate augmentation in ventilator support. RESULTS: A total of 119 data points were evaluated. Fifty data points (42%) exhibited no response to iNO. Thirty-two data points (27%) were classified as having possible responses, 35 data points (29%) as nonspecific, and 2 data points (2%) as undetermined responses to the iNO treatment. CONCLUSIONS: In ARDS, improved oxygenation amid iNO treatment is multifactorial. In only 27% of our evaluated data points could the increase in PF ratio be attributed to iNO. We suggest that when clinically utilizing iNO, the interactive factors described by us should be taken into account for data analysis.

Comparison of flow cytometry for DNA content and brush cytology for detection of malignancy in pancreaticobiliary strictures.

Brush cytology for the routine microscopic examination of malignant pancreaticobiliary strictures has been shown to have a high degree of specificity but a sensitivity of less than 75%. We wanted to determine whether flow cytometric analysis for DNA content could increase the sensitivity of routine cytology in brushings from these strictures, especially in those patients with atypical cells noted by brush cytology but no definite tumor cells. Fifty-one sets of brushings were obtained from 48 patients in whom ERCP revealed pancreaticobiliary strictures. Specimens were obtained for both routine cytology and flow cytometry. Both studies were shown to have a sensitivity of 42% in diagnosing malignant strictures. The specificity was 92% for routine cytology and 77% for flow cytometry, with false-positive results obtained in one patient by the former technique and in three by the latter. When the studies were combined, so that the presence of either tumor cells or abnormal DNA content was diagnostic of malignancy, the sensitivity rose to 63%. However, the specificity fell to 69%. Routine cytology identified atypical cells in 13 patients with malignant strictures (39%). Flow cytometry identified abnormal DNA content in only six of these patients with atypical cytological specimens (46%). Although flow cytometry succeeded in identifying eight additional strictures as malignant, it was associated with a greater false-positive rate than was routine cytology. For patients with pancreatic carcinoma, increased survival was noted in those with a diploid cell population (mean, 8.9 months) as revealed by flow cytometry compared to those with aneuploid brushings (mean, 3.0 months). We conclude that the addition of flow cytometry for DNA content to routine cytology increases the diagnostic yield of brushings from pancreaticobiliary strictures. However, these results need to be interpreted together with the patient's history, ERCP, and other clinical findings in order to minimize false-positive results.

High-dose carmustine and autologous bone marrow reinfusion in the treatment of refractory or relapsed small cell lung carcinoma.

Fourteen patients with small cell carcinoma of the lung in relapse or with disease refractory to chemotherapy were treated with carmustine (BCNU) at doses of 600 to 1000 mg/m2 intravenously followed by autologous bone marrow transplantation. All patients previously were treated with cyclophosphamide, doxorubicin, vincristine, and etoposide. Seven of the 14 patients responded to the high-dose BCNU (50% response with 95% confidence limits ranging from 23% to 77%). Three patients had a complete response, and four had a partial response. Regrowth of tumor occurred within 60 days of treatment in the responding patients. Death occurred in six patients before the recovery of the platelet count to 50,000 cells/microliters. Although the response rate was high, the toxicity was excessive. In the dosage range of 600 to 1000 mg/m2 in heavily pretreated patients, BCNU is not recommended, but additional investigation may be warranted in patients with central nervous system metastases who previously were treated with radiation therapy.

HIV among pregnant women: north central Wisconsin.

The incidence of infection by the human immunodeficiency virus (HIV) among pregnant women in north central Wisconsin is unknown. We devised and used an anonymous screening protocol to determine both the incidence of HIV infection and the rate of infection spread in this population. Our data demonstrate an extremely low incidence of HIV infection. Further, over the time periods studied, no clear evidence of an increase in the incidence of this severe infection could be demonstrated.

Skin testing in farmers' lung disease.

Intradermal skin tests with a culture filtrate antigen of Micropolyspora faeni grown on a synthetic medium were performed on patients with farmers' lung disease (FLD) and well farmers with and without antibodies to a panel of FLD antigens. Seventy-five percent of the FLD patients, 79% of the well farmers with M. faeni antibody, and 5% of well farmers without M. faeni antibody had a 2+ or greater intradermal immediate skin-test reaction. Prausnitz-Küstner (P-K) reactions were positive using serum of M. faeni immediate skin test-positive FLD patients. IgG-rich fractions from a staphylococcal protein A-Sepharose column of such serum contained the sensitizing factor whereas IgG-depleted fractions did not. M. faeni-specific IgE could not be detected in serum by a polystyrene radioimmunoassay. Positive late-onset (6-hr) skin tests occurred only in FLD patients and farmers with precipitating antibody. Biopsy specimens of the 6-hr reactions revealed a generalized dermal and perivascular polymorphonuclear infiltrate with deposits of immunoglobulin and complement about blood vessels. The skin-sensitizing factor noted in FLD patients and well farmers with antibody is not disease specific. This factor appears to be associated with the IgG-rich fraction of serum, and its role in the pathogenesis of FLD is unclear.

Multilocular cyst of the kidney. Report of three cases with review of the literature.

Multilocular cyst of the kidney is an uncommon lesion. Approximately 70 cases are reported in the literature, with more than half occurring in children. The etiology and pathogenesis are not known, although the microscopic appearance in certain cases resembles that of Wilms' tumor. Three additional cases are presented and the literature is reviewed.