Adult polyglucosan body disease – Management and evolution in an intensive rehabilitation program / Enfermedad con cuerpos de poliglucosanos del adulto. Tratamiento y evolución en un programa intensivo de rehabilitación

Adult polyglucosan body disease is a rare neuromuscular genetic disorder. It is characterized by accumulation of an abnormal structural form of glycogen, particularly in central and peripheral nervous system and muscles. Functional impairments and the rehabilitation approach of this entity is rarely reported. We present a case of a 65-year-old female with several years of undiagnosed symptoms. One year after the diagnosis, the patient was evaluated for the first time in a physical and rehabilitation consultation. We describe the inpatient rehabilitation program – an approach planned to achieve high levels of treatment intensity and with intervention of a multiprofessional and multidisciplinary team (AU)

La enfermedad con cuerpos de poliglucosanos del adulto (ECPA) es un trastorno genético neuromuscular raro, que se caracteriza por la acumulación de una forma estructural del glucógeno anormal, particularmente en el sistema nervioso central y periférico, y en los músculos. Raramente se reportan el deterioro funcional y el enfoque de rehabilitación de esta entidad. Presentamos el caso de una mujer de 65 años con síntomas no diagnosticados durante muchos años. Transcurrido un año del diagnóstico, la paciente fue evaluada por primera vez en una consulta de fisioterapia y rehabilitación. Describimos el programa de rehabilitación hospitalaria, un enfoque planteado para lograr altos niveles de intensidad terapéutica, con intervención de un equipo multi-profesional y multidisciplinario (AU)

Adult polyglucosan body disease - Management and evolution in an intensive rehabilitation program.

Adult polyglucosan body disease is a rare neuromuscular genetic disorder. It is characterized by accumulation of an abnormal structural form of glycogen, particularly in central and peripheral nervous system and muscles. Functional impairments and the rehabilitation approach of this entity is rarely reported. We present a case of a 65-year-old female with several years of undiagnosed symptoms. One year after the diagnosis, the patient was evaluated for the first time in a physical and rehabilitation consultation. We describe the inpatient rehabilitation program - an approach planned to achieve high levels of treatment intensity and with intervention of a multiprofessional and multidisciplinary team.

A Brazilian regional basic diet-induced chronic malnutrition drives liver inflammation with higher ApoA-I activity in C57BL6J mice.

Malnutrition is still considered endemic in many developing countries. Malnutrition-enteric infections may cause lasting deleterious effects on lipid metabolism, especially in children living in poor settings. The regional basic diet (RBD), produced to mimic the Brazilian northeastern dietary characteristics (rich in carbohydrate and low in protein) has been used in experimental malnutrition models, but few studies have explored the effect of chronic RBD on liver function, a central organ involved in cholesterol metabolism. This study aimed to investigate whether RBD leads to liver inflammatory changes and altered reverse cholesterol metabolism in C57BL6/J mice compared to the control group, receiving a standard chow diet. To evaluate liver inflammation, ionized calcium-binding adapter protein-1 (IBA-1) positive cell counting, interleukin (IL)-1ß immunohistochemistry, and tumor necrosis factor (TNF)-α and IL-10 transcription levels were analyzed. In addition, we assessed reverse cholesterol transport by measuring liver apolipoprotein (Apo)E, ApoA-I, and lecithin-cholesterol acyltransferase (LCAT) by RT-PCR. Furthermore, serum alanine aminotransferase (ALT) was measured to assess liver function. RBD markedly impaired body weight gain compared with the control group (P<0.05). Higher hepatic TNF-α (P<0.0001) and IL-10 (P=0.001) mRNA levels were found in RBD-challenged mice, although without detectable non-alcoholic fatty liver disease. Marked IBA-1 immunolabeling and increased number of positive-IBA-1 cells were found in the undernourished group. No statistical difference in serum ALT was found. There was also a significant increase in ApoA mRNA expression in the undernourished group, but not ApoE and LCAT, compared with the control. Altogether our findings suggested that chronic RBD-induced malnutrition leads to liver inflammation with increased ApoA-I activity.

Protocol proposal to the initial assessment of the post-intensive care syndrome in COVID-19 patients, in an inpatient rehabilitation setting / Propuesta de protocolo para la evaluación inicial del síndrome post-cuidados intensivos en pacientes de covid-19, en un entorno de rehabilitación hospitalaria

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A Brazilian regional basic diet-induced chronic malnutrition drives liver inflammation with higher ApoA-I activity in C57BL6J mice

Malnutrition is still considered endemic in many developing countries. Malnutrition-enteric infections may cause lasting deleterious effects on lipid metabolism, especially in children living in poor settings. The regional basic diet (RBD), produced to mimic the Brazilian northeastern dietary characteristics (rich in carbohydrate and low in protein) has been used in experimental malnutrition models, but few studies have explored the effect of chronic RBD on liver function, a central organ involved in cholesterol metabolism. This study aimed to investigate whether RBD leads to liver inflammatory changes and altered reverse cholesterol metabolism in C57BL6/J mice compared to the control group, receiving a standard chow diet. To evaluate liver inflammation, ionized calcium-binding adapter protein-1 (IBA-1) positive cell counting, interleukin (IL)-1β immunohistochemistry, and tumor necrosis factor (TNF)-α and IL-10 transcription levels were analyzed. In addition, we assessed reverse cholesterol transport by measuring liver apolipoprotein (Apo)E, ApoA-I, and lecithin-cholesterol acyltransferase (LCAT) by RT-PCR. Furthermore, serum alanine aminotransferase (ALT) was measured to assess liver function. RBD markedly impaired body weight gain compared with the control group (P<0.05). Higher hepatic TNF-α (P<0.0001) and IL-10 (P=0.001) mRNA levels were found in RBD-challenged mice, although without detectable non-alcoholic fatty liver disease. Marked IBA-1 immunolabeling and increased number of positive-IBA-1 cells were found in the undernourished group. No statistical difference in serum ALT was found. There was also a significant increase in ApoA mRNA expression in the undernourished group, but not ApoE and LCAT, compared with the control. Altogether our findings suggested that chronic RBD-induced malnutrition leads to liver inflammation with increased ApoA-I activity.

Chediak-Higashi syndrome: Lessons from a single-centre case series

Background: Chediak-Higashi syndrome (CHS) is a rare and potentially fatal autosomal recessive disease characterized by frequent bacterial infections, bleeding tendency, oculocutaneous albinism, photosensitivity and progressive neurologic dysfunction. Owing to the rarity of this condition, the objective of this study was to describe patients with CHS. Methods: Retrospective evaluation of patients followed in a paediatric tertiary centre of Allergy and Immunology of São Paulo, Brazil, between 1986 and 2018 with a confirmed diagnosis of CHS. Data were obtained from medical records. Demographic aspects, family history, clinical findings, laboratory data, diagnosis, treatment and outcome were described. Results: A total of 14 patients (five male) were included. Clinical manifestations were first recognized at a median age of two months (at birth-20 months). Median age at diagnosis was 1.7 years (0-5 years). All patients had recurrent infections. Albinism was present in 13 patients and silvery or light hair was present in 14. Seven patients developed hemophagocytic lymphohistiocytosis (HLH); the median age at the diagnosis of HLH was 5.7 years (2.6-6.7 years) and the median interval between the diagnosis of CHS and HLH was 3.3 years (0-5 years). Four of the most recently diagnosed patients underwent bone marrow transplantation (BMT). Nine patients are deceased, and one was lost to follow-up. The median age of death was 6.7 years (3.8-22 years). Five patients died of HLH, one of lymphoma, and three of infection. All the patients who had HLH before the year of 2000 died of HLH. The two most recently diagnosed patients with HLH were able to cure the HLH, although they died of other causes. Four patients are alive, three of them after successful BMT. Conclusion: Thirty years of follow up showed an improvement in the prognosis in patients with CHS. The better understanding of the underlying biological mechanisms of HLH allowed the standardization of management protocols, resulting in survival improvement. BMT is the only treatment that can change CHS prognosis, which emphasizes the need for early identification of the disease

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Chediak-Higashi syndrome: Lessons from a single-centre case series.

BACKGROUND: Chediak-Higashi syndrome (CHS) is a rare and potentially fatal autosomal recessive disease characterized by frequent bacterial infections, bleeding tendency, oculocutaneous albinism, photosensitivity and progressive neurologic dysfunction. Owing to the rarity of this condition, the objective of this study was to describe patients with CHS. METHODS: Retrospective evaluation of patients followed in a paediatric tertiary centre of Allergy and Immunology of São Paulo, Brazil, between 1986 and 2018 with a confirmed diagnosis of CHS. Data were obtained from medical records. Demographic aspects, family history, clinical findings, laboratory data, diagnosis, treatment and outcome were described. RESULTS: A total of 14 patients (five male) were included. Clinical manifestations were first recognized at a median age of two months (at birth-20 months). Median age at diagnosis was 1.7 years (0-5 years). All patients had recurrent infections. Albinism was present in 13 patients and silvery or light hair was present in 14. Seven patients developed hemophagocytic lymphohistiocytosis (HLH); the median age at the diagnosis of HLH was 5.7 years (2.6-6.7 years) and the median interval between the diagnosis of CHS and HLH was 3.3 years (0-5 years). Four of the most recently diagnosed patients underwent bone marrow transplantation (BMT). Nine patients are deceased, and one was lost to follow-up. The median age of death was 6.7 years (3.8-22 years). Five patients died of HLH, one of lymphoma, and three of infection. All the patients who had HLH before the year of 2000 died of HLH. The two most recently diagnosed patients with HLH were able to cure the HLH, although they died of other causes. Four patients are alive, three of them after successful BMT. CONCLUSION: Thirty years of follow up showed an improvement in the prognosis in patients with CHS. The better understanding of the underlying biological mechanisms of HLH allowed the standardization of management protocols, resulting in survival improvement. BMT is the only treatment that can change CHS prognosis, which emphasizes the need for early identification of the disease.

Farmacopuntura utilizando os acupontos Hou Hai e Bai Hui em protocolos de sincronização de estro em cabras / Pharmacopuncture using acupoints Hou Hai and Bai Hui in estrous synchronization protocols in goats

Avaliou-se a eficiência da administração de subdoses de eCG nos acupontos Bai Hui e Hou Hai em protocolos de sincronização de estro em cabras. Na primeira etapa, 57 cabras foram distribuídas aleatoriamente em quatro tratamentos: T1- 300UI de eCG intramuscular (IM); T2- 60UI de eCG no acuponto Hou Hai; T3- 60UI de eCG no acuponto Bai Hui e T4- 60UI de eCG IM; e na segunda etapa, 28 cabras foram distribuídas aleatoriamente em três tratamentos: T1- 300UI de eCG IM; T2- 30UI de eCG no acuponto Bai Hui e T3- 30UI de eCG IM. Ao final do tratamento hormonal, as cabras foram monitoradas para detecção do estro, realização das coberturas e avaliação do comportamento reprodutivo. Os dados foram submetidos à análise de normalidade, seguida dos testes estatísticos adequados para cada variável. Na primeira etapa experimental, obteve-se maior duração de estro nas cabras do T1 (P=0,009). Na segunda etapa experimental, obteve-se maior número de animais em estros no T1 (P=0,03). As demais variáveis para ambas as etapas não sofreram influência dos tratamentos (P>0,05), demonstrando que a administração de subdoses de eCG nos acupontos Bai Hui e Hou Hai foi eficiente para sincronizar o estro.(AU)

The efficiency of administration of subdoses of eCG in the Bai Hui and Hou Hai acupoints in oestrus synchronization protocols in goats was evaluated. In the first stage, 57 goats were randomly assigned to four treatments: T1- 300UI of intramuscular eCG (IM); T2- 60UI of eCG in acupoint Hou Hai; T3- 60UI of eCG in the Bai Hui acupoint and T4- 60UI of eCG IM; and in the second stage, 28 goats were randomly assigned to three treatments: T1-300UI of eCG IM; T2-30UI of eCG in the Bai Hui acupoint and T3- 30UI of eCG IM. At the end of the hormonal treatment the goats were monitored for estrus detection, and evaluation of reproductive behavior. The data were submitted to normality analysis, followed by appropriate statistical tests for each variable. In the first experimental stage, a longer duration of estrus in the T1 goats (P= 0.009) was obtained. In the second experimental stage, a greater number of animals were obtained in estrus at T1 (P= 0.03). The other variables for both experiments were not influenced by the treatments (P> 0.05), demonstrating that administration of eCG subdoses in the Bai Hui and Hou Hai acupoints was efficient to synchronize the estrus.(AU)

Influence of mother nutrition during pregnancy and/or lactation on offspring food preference in experimental models / Influência da nutrição materna durante a gestação e/ou lactação na preferência alimentar da prole em modelos experimentais

Abstract Introduction Understanding associations between food preferences and maternal nutrition during pregnancy and lactation could inform efforts to understanding the obesity mechanisms and provide insight to prevent it. Objective: To identify studies that investigated the effects of nutritional interventions during the pregnancy and lactation on the food preferences of offspring. Method: The review was conducted with search for articles in the databases: Scopus, Pubmed, Medline, LILACS, Scielo and Science Direct. Exclusion criteria were used: reviews, human studies, studies with drugs or other substances not related to food. Results: At the end of the search in the databases, 176 references were found. After use the exclusion criteria, reading the titles, abstracts and full articles, were selected 11 articles to compose the review. Conclusion: The selected studies suggested that unbalanced nutrition in early life alters the food preference and neural components related to the consumption of fatty and sugary foods in offspring rodents.

Resumo Introdução O entendimento das associações entre as preferências alimentares e nutrição materna durante a gravidez e lactação poderia colaborar para a compreensão dos mecanismos da obesidade e fornecer informações para prevenir essa infermidade. Objetivo: Identificar estudos que investigaram os efeitos das intervenções nutricionais durante a gravidez e lactação em preferências alimentares dos descendentes. Método: A revisão foi conduzida com busca de artigos nas bases de dados: Scopus, Pubmed, Medline, Lilacs, Scielo e Science Direct. Os critérios de exclusão utilizados: revisões, estudos em humanos, estudos com drogas ou outras substâncias não-alimentares. Resultados: No final da pesquisa nas bases de dados, 176 referências foram encontradas. Depois de usar os critérios de exclusão, lendo os títulos, resumos e artigos completos, 11 artigos foram selecionados para compor a revisão. Conclusão: Os estudos selecionados sugeriram que a nutrição desequilibrada no início da vida altera a preferência alimentar e componentes neurais relacionadas com o consumo de alimentos gordurosos e açucarados em prole de roedores.

Influence of mother nutrition during pregnancy and/or lactation on offspring food preference in experimental models.

INTRODUCTION: Understanding associations between food preferences and maternal nutrition during pregnancy and lactation could inform efforts to understanding the obesity mechanisms and provide insight to prevent it. Objective: To identify studies that investigated the effects of nutritional interventions during the pregnancy and lactation on the food preferences of offspring. Method: The review was conducted with search for articles in the databases: Scopus, Pubmed, Medline, LILACS, Scielo and Science Direct. Exclusion criteria were used: reviews, human studies, studies with drugs or other substances not related to food. Results: At the end of the search in the databases, 176 references were found. After use the exclusion criteria, reading the titles, abstracts and full articles, were selected 11 articles to compose the review. Conclusion: The selected studies suggested that unbalanced nutrition in early life alters the food preference and neural components related to the consumption of fatty and sugary foods in offspring rodents.

Influence of mother nutrition during pregnancy and/or lactation on offspring food preference in experimental models

Abstract Introduction Understanding associations between food preferences and maternal nutrition during pregnancy and lactation could inform efforts to understanding the obesity mechanisms and provide insight to prevent it. Objective: To identify studies that investigated the effects of nutritional interventions during the pregnancy and lactation on the food preferences of offspring. Method: The review was conducted with search for articles in the databases: Scopus, Pubmed, Medline, LILACS, Scielo and Science Direct. Exclusion criteria were used: reviews, human studies, studies with drugs or other substances not related to food. Results: At the end of the search in the databases, 176 references were found. After use the exclusion criteria, reading the titles, abstracts and full articles, were selected 11 articles to compose the review. Conclusion: The selected studies suggested that unbalanced nutrition in early life alters the food preference and neural components related to the consumption of fatty and sugary foods in offspring rodents.

Resumo Introdução O entendimento das associações entre as preferências alimentares e nutrição materna durante a gravidez e lactação poderia colaborar para a compreensão dos mecanismos da obesidade e fornecer informações para prevenir essa infermidade. Objetivo: Identificar estudos que investigaram os efeitos das intervenções nutricionais durante a gravidez e lactação em preferências alimentares dos descendentes. Método: A revisão foi conduzida com busca de artigos nas bases de dados: Scopus, Pubmed, Medline, Lilacs, Scielo e Science Direct. Os critérios de exclusão utilizados: revisões, estudos em humanos, estudos com drogas ou outras substâncias não-alimentares. Resultados: No final da pesquisa nas bases de dados, 176 referências foram encontradas. Depois de usar os critérios de exclusão, lendo os títulos, resumos e artigos completos, 11 artigos foram selecionados para compor a revisão. Conclusão: Os estudos selecionados sugeriram que a nutrição desequilibrada no início da vida altera a preferência alimentar e componentes neurais relacionadas com o consumo de alimentos gordurosos e açucarados em prole de roedores.

A fast and simple method for the polymerase chain reaction-based sexing of livestock embryos.

Embryo sexing is a powerful tool for livestock producers because it allows them to manage their breeding stocks more effectively. However, the cost of supplies and reagents, and the need for trained professionals to biopsy embryos by micromanipulation restrict the worldwide use of the technology to a limited number of specialized groups. The aim of this study was to couple a fast and inexpensive DNA extraction protocol with a practical biopsy approach to create a simple, quick, effective, and dependable embryo sexing procedure. From a total of 1847 sheep and cattle whole embryos or embryo biopsies, the sexing efficiency was 100% for embryo biopsies, 98% for sheep embryos, and 90.2% for cattle embryos. We used a primer pair that was common to both species and only 10% of the total extracted DNA. The whole protocol takes only 2 h to perform, which suggests that the proposed procedure can be readily applied to field conditions. Moreover, in addition to embryo sexing, the procedure can be used for further analyses, such as genotyping and molecular diagnosis in preimplantation embryos.

Nosocomial bloodstream infections in a nationwide study: comparison between solid organ transplant patients and the general population.

BACKGROUND: The incidence of bloodstream infection (BSI) varies according to the transplanted organ. Mortality can be as high as 24%, with a significant impact on graft survival. Transplantation is a risk factor for multidrug-resistant (MDR) organisms, but comparison with a non-transplanted population in a single large cohort has not been described. METHODS: This is a prospective nationwide study (16 centers) reporting data on 2364 monomicrobial nosocomial BSIs, comparing 83 episodes in solid organ transplant patients with 2447 BSIs occurring in the general hospital population. RESULTS: The prevalence of groups of infecting organisms (gram-positive, gram-negative, and fungi) was similar between transplant patients and the general population and a similar crude mortality rate was observed (34.9% in transplant vs. 43.3% in non-transplant patients). Staphylococcus aureus was the single most frequently isolated organism in both groups, and Acinetobacter species was more frequently isolated in the general population. Regarding MDR organisms, Klebsiella species, and Enterobacter species resistant to cefepime, as well as Acinetobacter species resistant to meropenem, were significantly more frequent in transplant patients. CONCLUSION: Antimicrobial resistance is higher, particularly among gram-negative bacteria in the transplant population, although the overall mortality rate between transplant and non-transplant patients with nosocomial BSI is similar.

Isolation of Salmonella enterica subsp. enterica (O: 4, 5: i) and Salmonella enterica subsp. Typhimurium from free-living domestic pigeons (Columba livia) / Detecção de Salmonella enterica subsp enterica (O: 4, 5: i) e Salmonella enterica subsp. Typhimurium em pombo doméstico de vida livre (Columba livia)

The present study reports the isolation of Salmonella enterica in organs of free-living domestic pigeons. In the clinic examination, the presence of feces in the peri-cloacal and abdominal regions were observed, as well as symptoms such as cachexy, incoordination and opisthotonos. Before any therapeutic protocol was applied the bird died and a necropsy was then performed for the removal of spleen, liver, kidney and intestine for bacteriological examination and antibiotic sensitivity test. Salmonella enterica subsp.enterica (O:4,5:i-) and Salmonella enterica subsp. enterica serovar Typhimurium were isolated from the liver and intestine and the sensitivity test demonstrated that these strains are sensitive to several antibiotics...

O presente trabalho relata o isolamento de Salmonella enterica em órgãos de um pombo doméstico de vida livre. No exame clínico foi observada a presença de fezes pericloacal na região ventral, caquexia, incoordenação motora e opistótono. Antes de iniciar um protocolo terapêutico, a ave foi a óbito, e, em seguida, foi realizada uma necropsia para remoção do baço, fígado, rim e intestino para exame bacteriológico e teste de sensibilidade a antibióticos. Foi isolado Salmonella enterica subsp. enterica (O:4,5:i-) e Salmonella enterica subsp. enterica sorovar Typhimurium do fígado e intestino, e o teste de sensibilidade demonstrou que essas cepas são sensíveis a vários antimicrobianos...

Systemic immunosuppression by methylprednisolone and pregnancy rates in goats undergoing the transfer of cloned embryos.

The presence of the zona pellucida has been perceived as a requirement for the oviductal transfer of cloned embryos at early stages of development while protecting the embryo from an immune system response. We hypothesized that steroid hormone therapy could reduce a potential cellular immune response after the transfer of zona-free cloned embryos into the oviduct of recipient female goats. In Experiment 1, seven does were used to study the systemic immunosuppressant effect of the methylprednisolone administration (for 3 days) on blood cell counts. Whole blood was collected prior to treatment with methyprednisolone and then on Days 1, 2, 3, 4, 7, 14, 21 and 28 after the first dose of methylprednisolone for the analysis of haematological parameters. Methylprednisolone treatment significantly reduced circulating white blood cells and neutrophils in comparison with pre-treatment levels, demonstrating a systemic immunosuppressant effect. In Experiment 2, a group of 58 does were used as recipient females to study the effect of administration of methylprednisolone for 3 days on the establishment of pregnancies after the transfer of zona-free cloned embryos into the oviducts. No effects on pregnancy rates on Day 30 were observed regarding the distinct treatment groups (control vs. methylprednisolone), the source of oocytes (in vivo- vs in vitro-matured) or the presence or absence of the zona pellucida in embryos. In summary, methylprednisolone was effective at inducing a systemic immunosuppressed state in goats, but the treatment prior to embryo transfer did not affect pregnancy rates. Moreover, pregnancy rates were similar between zona-free and zona-intact goat cloned embryos.

Comparison of objectively measured and self-reported time spent sitting.

Until recently, methods for objective quantification of sitting time have been lacking. The aim of this study was to validate self-reported measures against objectively measured total sitting time and longest continuous time with uninterrupted sitting during working hours, leisure time on workdays and leisuredays. Objective diurnal measurement of sitting time was obtained among 26 office workers with 2 accelerometers (ActiGraph GT3X+) for a 7-day period. Customized software (Acti4) was used to identify sitting time separated from other sedentary behaviours. Self-reported sitting time was obtained from a retrospective 7-day questionnaire. A generalized linear model showed the difference between the methods. No significant correlations were found between objective and self-reported sitting time (r<0.315). Total sitting time was significantly underestimated (2.4 h) on a leisureday (p<0.001) and uninterrupted sitting time was in all 3 time settings significantly overestimated (0.4-0.5 h) (p<0.045). Poor agreement (mean difference between 0.5 to -2.4 h) between objectively measured and self-reported sitting time was shown in Bland-Altman plots with wide (3.3-10.8 h) limits of agreement. This study showed a great individual variation and a general lack of agreement between self-reported vs. objectively measured total and uninterrupted sitting time. Objective measures are recommended for determining sitting time.

Spreading of chronic pain between body regions: prospective cohort study among health care workers.

OBJECTIVE: To estimate the prognostic value of pain in one body region on the risk for developing chronic pain in other body regions. METHODS: Prospective cohort study among 5052 Danish female health care workers responding to a baseline and follow-up questionnaire in 2005 and 2006, respectively. Using adjusted logistic regression analysis, the risk for developing chronic pain (>30 days last year) at follow-up in the low back (among those without low back pain during the last year at baseline) when experiencing sub-chronic (1-30 days last year) or chronic pain in other body regions (i.e., the neck/shoulders and/or the knees at baseline) was modelled. Similar risks were modelled for developing chronic pain in the neck/shoulders and knees. RESULTS: Chronic pain in the neck/shoulders (OR 3.14; 95% CI 1.74-5.70) or knees (OR 2.57; 95% CI 1.28-5.16) at baseline increased the risk for developing chronic pain in the low back at follow-up. Likewise, chronic pain in the neck/shoulders (OR 2.39; 95% CI 1.36-4.17) or low back (OR 1.82 95%; CI 1.07-3.09) at baseline increased the risk for developing chronic pain in the knees at follow-up. The risk for developing chronic neck/shoulder pain was not significantly increased when having pain in the low back or knees at baseline. CONCLUSION: Among health care workers, chronic musculoskeletal pain in one body region increases the risk for developing chronic pain in other pain-free body regions. Prevention of musculoskeletal disorders among health care workers should focus holistically on the musculoskeletal system.

Intermittent preventive treatment of malaria in infants: how does it work and where will it work?

We discuss the potential public health impact of IPTi by estimating the cases of malaria, anaemia and hospital admissions likely to be averted in different transmission settings; and we review the mechanism of action, choice of drugs regimens, and the effect on immunity of IPTi. IPTi using an efficacious drug is likely to substantially reduce cases of clinical malaria in moderate to high transmission settings. However, geographical heterogeneity in malaria transmission could hamper rolling out IPTi as a national policy.