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Objective: To evaluate the effects of dietary calcium (Ca) intervention on adolescent pregnant mothers and their newborns.Methods: Seventy-two pregnant adolescent mothers were randomized into one of 3 groups: control, orange juice fortified with calcium, and dairy. The orange juice and dairy groups were required to take more than 1,200 mg Ca. Calcium tablets were added for those not able to meet required Ca. Maternal and infant weight, length, and blood pressure (BP) were recorded. Maternal dietary records were evaluated. Mother's blood was drawn for serum Ca, phosphate (P), magnesium (Mg), and vitamin 25-hydroxyvitamin D (D). Cord blood was collected for serum Ca and D. Newborn total body Ca was determined.Results: All mothers were similar in weight, height, and BP. Mothers in the orange juice plus calcium and dairy groups had higher intakes of Ca (1,472 mg and 1,771 mg) than controls (862 mg). One half of the mothers in the orange juice plus calcium group required Ca tablets. Mothers in the dairy group had higher intakes of P, D, and Mg, higher serum folate and D, and higher cord D levels. Mothers in the orange juice plus calcium group had higher serum P but lower serum folate and D. Infants (3,517+/-273 g) in the dairy group were heavier than infants in the control (3,277+/-177 g) and orange juice plus calcium (3,292+/-165 g) groups. Infants in the dairy group had higher total body calcium than control infants.Conclusion: Calcium diet supplemented with dairy products during adolescent pregnancy resulted in higher maternal vitamin D and folate serum levels and higher newborn weight and bone mineralization compared with controls. [ABSTRACT FROM AUTHOR]

Likelihood ratios compare two values (i.e., case rates) in order to illustrate the magnitude of the difference between the two. This ratio increases the confidence one can have in a diagnostic test from a different vantage point than that of sensitivity and specificity. The calculations of likelihood ratios are presented along with a simplified approach. Likelihood ratios are another tool the toxicologist should employ in their understanding of statistics and probability., (© 2024. American College of Medical Toxicology.)

Notwithstanding the oldest-old cohort being the fastest-growing population in most ageing societies, characterizing successful ageing in adults of advanced age, such as nonagenarians and centenarians, remains challenging. This study investigated the successful ageing subphenotypes using the data from Hong Kong Centenarian Study 2. Between April 2021 and September 2022, 146 family caregivers of community-dwelling older adults aged 95 or above were interviewed by phone. Latent class analysis identified three classes- Overall Frail (46.6%) with poor mobility, cognitive and functional health, Nonambulant (37.0%) but good functional health, and Robust (16.4%) with overall good health-from 11 indicators based on caregivers' reports. Although we found a low prevalence of fulfillment of all indicators of successful ageing, our findings will help care professionals appreciate the heterogeneity underlying partial successful ageing in this vulnerable cohort for segmented and targeted healthy longevity interventions., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Pregnant women are reported to be at increased risk of severe coronavirus disease 2019 (COVID-19) due to underlying immunosuppression during pregnancy. However, the clinical course of COVID-19 in pregnancy and risk of vertical and horizontal transmission remain relatively unknown. We aim to describe and evaluate outcomes in pregnant women with COVID-19 in Singapore., Methods: Prospective observational study of 16 pregnant patients admitted for COVID-19 to 4 tertiary hospitals in Singapore. Outcomes included severe disease, pregnancy loss, and vertical and horizontal transmission., Results: Of the 16 patients, 37.5%, 43.8% and 18.7% were infected in the first, second and third trimesters, respectively. Two gravidas aged ≥35 years (12.5%) developed severe pneumonia; one patient (body mass index 32.9kg/m2) required transfer to intensive care. The median duration of acute infection was 19 days; one patient remained reverse transcription polymerase chain reaction (RT-PCR) positive >11 weeks from diagnosis. There were no maternal mortalities. Five pregnancies produced term live-births while 2 spontaneous miscarriages occurred at 11 and 23 weeks. RT-PCR of breast milk and maternal and neonatal samples taken at birth were negative; placenta and cord histology showed non-specific inflammation; and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific immunoglobulins were elevated in paired maternal and umbilical cord blood (n=5)., Conclusion: The majority of COVID-19 infected pregnant women had mild disease and only 2 women with risk factors (obesity, older age) had severe infection; this represents a slightly higher incidence than observed in age-matched non-pregnant women. Among the women who delivered, there was no definitive evidence of mother-to-child transmission via breast milk or placenta.

The COVID19 crisis has provided a portal to revisit and understand qualities of screening tests and the importance of Bayes' theorem in understanding how to interpret results and implications of next actions., Competing Interests: Declaration of competing interest None., (Copyright © 2020 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Simultaneous bilateral quadriceps femoris tendon rupture is a relatively rare occurrence. As such, patients frequently experience a delay in receiving an accurate diagnosis. It is often associated with significant morbidity and loss of function. We report a case of simultaneous bilateral quadriceps tendon ruptures in a patient with chronic renal insufficiency., Case Report: A 46-year-old white man presented to the Emergency Department (ED) via ambulance, reporting sudden onset of bilateral lower limb weakness. He had a medical history of renal insufficiency due to immunoglobulin-A-induced glomerulopathy, with secondary hyperparathyroidism and gout. Examination of his lower limbs revealed significant swelling in his distal thighs anteriorly and suprapatellar defects at the insertion of the quadriceps tendon. No other palpable deficits were identified. The patella was in a normal position and there was minimal tenderness on palpation. He had complete loss of active knee extension. Bilateral patella reflexes were absent. Lower-limb sensation was intact bilaterally and no other neurovascular deficits were elicited. Thompson test was negative and the rest of the clinical examination was unremarkable. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The inability to walk is a common ED presentation. The differential diagnosis is vast and includes but is not limited to: spinal cord injury, Guillain-Barré syndrome, myopathies, and even malingering. This case report details an uncommon cause for a common ED presentation. Furthermore, this case illustrates the importance of a detailed clinical history and physical examination, which narrowed the differential diagnosis and ultimately led to the clinical diagnosis. Knowledge of the patient's past medical history combined with simple imaging modalities permitted a prompt clinical diagnosis of an uncommon condition, which facilitated early operative management., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: This study examined the effectiveness of a translated version of Resources for Enhancing Alzheimer's Caregiver Health (REACH) II in Hong Kong's service delivery context., Method: The localized intervention was adapted from REACH II with 12 individual-based sessions, which addressed multiple domains including disease education, safety, caregiver (CG) well-being, and care recipients' problem behavior. Two-hundred and one dementia family dyads completed the intervention., Results: The efficacy of the intervention was demonstrated by the significant improvement in the perception of positive aspects of caregiving, reduction in depressive symptoms, subjective burden, bother and caregiving risks among CGs, and abatement in behavioral problems among care recipients. Treatment implementation was reflected from the high rate of adoption of each intervention component by interventionists and satisfactory reception from CGs. Promises in reach and adoption were demonstrated by the participation of 85 interventionists from 11 NGOs across 18 districts and CGs of a variety of demographic characteristics., Discussion: This study is the first attempt to translate a highly successful evidence-based dementia CG intervention developed in the USA into the Hong Kong service delivery context. The current results echoed the success of REACH II. The values and challenges of translational research are discussed., (Copyright © 2014 John Wiley & Sons, Ltd.)

We describe Resonance Raman based skin carotenoid measurements in newborns and infants. Skin- and serum carotenoid levels correlate with high statistical significance in healthy newborns and infants, and with reduced accuracy also in prematurely born infants, who in general feature very low carotenoid levels and thin transparent skin giving rise to large background absorption effects. Skin carotenoid levels can be easily compared among subjects and/or tracked in longitudinal studies with the highly molecule-specific Raman method. It therefore holds promise as a rapid, non-invasive, carotenoid antioxidant assessment method for newborns and infants in the field of pediatrics., (Copyright © 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Objective: Fortification of human milk for preterm infants is necessary and a common newborn intensive care practice. Currently, acidified human milk as part of a human milk fortifier is being fed to preterm infants. However, there are little data on the acidification effects on mother's milk. The aim of this study is to determine the effects of acidification on human milk's cellular and nutritional composition., Study Design: One hundred milk samples were collected from eight mothers who had infants in the neonatal intensive care unit. All milk samples were frozen at 4 °C. The frozen samples were thawed and divided into two equal aliquots, control and acidified. The control milk sample had its pH determined while the other sample was acidified to pH 4.5. Each milk sample was examined for pH, white cells, total protein, creamatocrit, lipase activity and free fatty acids., Result: Mean pH of the human milk control was 6.8 ± 0.1 (M ± s.d.) with the acidified milk at 4.5 ± 0.1. Acidification caused a 76% decrease in white cells, a 56% decrease in lipase activity and a 14% decrease in the total protein but a 36% increase in the creamatocrit., Conclusion: Acidification of human milk causes significant changes of the milk's cellular and nutritional components that may not be beneficial to preterm infants.

Objective: The aim of the study was to validate the noninvasive resonance Raman spectroscopy (RRS) method in infants in comparison with the high-performance liquid chromatography (HPLC) method, and to evaluate the carotenoid status in preterm infants fed with mother's milk or formula., Methods: In the first phase of the study, resonance Raman measurements were made on male term infants' skin and correlated with tissue harvested at the time of circumcision. Each baby's foreskin was weighed, enzymatically digested, and the total carotenoids were extracted and quantitated by the HPLC. Next, to evaluate the carotenoid status of preterm infants (BW <1500 g), the skin and serum carotenoids in infants fed with either human milk or preterm formula were studied from the start of feedings and every 2 weeks until hospital discharge. Skin carotenoids were measured by RRS and the serum total carotenoids by HPLC., Results: Foreskin carotenoid levels measured by RRS correlated with HPLC measurements of total serum carotenoids (R = 0.52, P < 0.01, n = 16). Forty preterm infants were studied for their carotenoid status. Thirty-two infants were fed mother's milk, whereas 8 were fed a preterm infant formula that was not enriched with carotenoids. The gestation and birth weight of the 2 feeding groups were similar. The infants fed human milk had a higher serum total carotenoid concentration and skin Raman counts than formula-fed infants. The skin Raman counts and total serum carotenoid correlated (R = 0.44, P = 0.01). The human milk-fed infants' serum total carotenoid concentrations and Raman values did not change during the study period; however, the formula-fed group's total serum and skin carotenoid decreased significantly during the study., Conclusions: RRS of infant's skin reliably assesses total carotenoid status noninvasively. Human milk-fed preterm infants have higher serum and skin carotenoids than formula-fed infants suggesting that formula-fed infants may benefit from carotenoid supplementation.

Clinical experience supports a critical role for nutrition in patients with spinal muscular atrophy (SMA). Three-day dietary intake records were analyzed for 156 visits in 47 SMA type I patients, 25 males and 22 females, ages 1month to 13years (median 9.8months) and compared to dietary reference intakes for gender and age along with anthropometric measures and dual-energy X-ray absorptiometry (DEXA) data. Using standardized growth curves, twelve patients met criteria for failure to thrive (FTT) with weight for age <3rd percentile; eight met criteria based on weight for height. Percentage of body fat mass was not correlated with weight for height and weight for age across percentile categories. DEXA analysis further demonstrated that SMA type I children have higher fat mass and lower fat free mass than healthy peers (p<0.001). DEXA and dietary analysis indicates a strong correlation with magnesium intake and bone mineral density (r=0.65, p<0.001). Average caloric intake for 1-3years old was 68.8±15.8kcal/kg - 67% of peers' recommended intake. Children with SMA type I may have lower caloric requirements than healthy age-matched peers, increasing risk for over and undernourished states and deficiencies of critical nutrients. Standardized growth charts may overestimate FTT status in SMA type I., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Objective: Dietary carotenoids (lutein, lycopene and β-carotene) may be important in preventing or ameliorating prematurity complications. Little is known about carotenoid status or effects of supplementation., Study Design: This randomized controlled multicenter trial compared plasma carotenoid levels among preterm infants (n=203, <33 weeks gestational age) fed diets with and without added lutein, lycopene and β-carotene with human milk (HM)-fed term infants. We assessed safety and health., Result: Plasma carotenoid levels were higher in the supplemented group at all time points (P<0.0001) and were similar to those of term HM-fed infants. Supplemented infants had lower plasma C-reactive protein (P<0.001). Plasma lutein levels correlated with the full field electroretinogram-saturated response amplitude in rod photoreceptors (r=0.361, P=0.05). The supplemented group also showed greater rod photoreceptor sensitivity (least squares means 6.1 vs 4.1; P<0.05)., Conclusion: Carotenoid supplementation for preterm infants raises plasma concentrations to those observed in HM-fed term infants. Carotenoid supplementation may decrease inflammation. Our results point to protective effects of lutein on preterm retina health and maturation.

Background: Multiple lines of evidence have suggested that valproic acid (VPA) might benefit patients with spinal muscular atrophy (SMA). The SMA CARNIVAL TRIAL was a two part prospective trial to evaluate oral VPA and L-carnitine in SMA children. Part 1 targeted non-ambulatory children ages 2-8 in a 12 month cross over design. We report here Part 2, a twelve month prospective, open-label trial of VPA and L-carnitine in ambulatory SMA children., Methods: This study involved 33 genetically proven type 3 SMA subjects ages 3-17 years. Subjects underwent two baseline assessments over 4-6 weeks and then were placed on VPA and L-carnitine for 12 months. Assessments were performed at baseline, 3, 6 and 12 months. Primary outcomes included safety, adverse events and the change at 6 and 12 months in motor function assessed using the Modified Hammersmith Functional Motor Scale Extend (MHFMS-Extend), timed motor tests and fine motor modules. Secondary outcomes included changes in ulnar compound muscle action potential amplitudes (CMAP), handheld dynamometry, pulmonary function, and Pediatric Quality of Life Inventory scores., Results: Twenty-eight subjects completed the study. VPA and carnitine were generally well tolerated. Although adverse events occurred in 85% of subjects, they were usually mild and transient. Weight gain of 20% above body weight occurred in 17% of subjects. There was no significant change in any primary outcome at six or 12 months. Some pulmonary function measures showed improvement at one year as expected with normal growth. CMAP significantly improved suggesting a modest biologic effect not clinically meaningful., Conclusions: This study, coupled with the CARNIVAL Part 1 study, indicate that VPA is not effective in improving strength or function in SMA children. The outcomes used in this study are feasible and reliable, and can be employed in future trials in SMA. TRIAL REGSITRATION: Clinicaltrials.gov NCT00227266.

Background: Valproic acid (VPA) has demonstrated potential as a therapeutic candidate for spinal muscular atrophy (SMA) in vitro and in vivo., Methods: Two cohorts of subjects were enrolled in the SMA CARNIVAL TRIAL, a non-ambulatory group of "sitters" (cohort 1) and an ambulatory group of "walkers" (cohort 2). Here, we present results for cohort 1: a multicenter phase II randomized double-blind intention-to-treat protocol in non-ambulatory SMA subjects 2-8 years of age. Sixty-one subjects were randomized 1:1 to placebo or treatment for the first six months; all received active treatment the subsequent six months. The primary outcome was change in the modified Hammersmith Functional Motor Scale (MHFMS) score following six months of treatment. Secondary outcomes included safety and adverse event data, and change in MHFMS score for twelve versus six months of active treatment, body composition, quantitative SMN mRNA levels, maximum ulnar CMAP amplitudes, myometry and PFT measures., Results: At 6 months, there was no difference in change from the baseline MHFMS score between treatment and placebo groups (difference = 0.643, 95% CI = -1.22-2.51). Adverse events occurred in >80% of subjects and were more common in the treatment group. Excessive weight gain was the most frequent drug-related adverse event, and increased fat mass was negatively related to change in MHFMS values (p = 0.0409). Post-hoc analysis found that children ages two to three years that received 12 months treatment, when adjusted for baseline weight, had significantly improved MHFMS scores (p = 0.03) compared to those who received placebo the first six months. A linear regression analysis limited to the influence of age demonstrates young age as a significant factor in improved MHFMS scores (p = 0.007)., Conclusions: This study demonstrated no benefit from six months treatment with VPA and L-carnitine in a young non-ambulatory cohort of subjects with SMA. Weight gain, age and treatment duration were significant confounding variables that should be considered in the design of future trials., Trial Registry: Clinicaltrials.gov NCT00227266.

A 2-year-old girl was found with an empty bottle of levothyroxine and blue coloring around her mouth. Forty tablets of 150-microg levothyroxine tablets were missing. Her 6-hour postingestion total thyroxine (T4) level was 68.1 microg/dL (normal range: 5-12 microg/dL), and her total triiodothyronine (T3) level was 472 ng/dL (normal range: 40-130 ng/dL). Serum levels of thyrotropin, T3, and T4 were then checked on days 3, 5, 7, and 10. On postingestion day 5, the child presented for follow-up with hyperthermia, vomiting, irritability, and increased lethargy. She was referred to the emergency department, where a heart rate of 220 beats per minute, a blood pressure of 130/80 mm Hg, and a temperature of 101 degrees F were recorded. She also had multiple episodes of diarrhea. The patient was treated with oral propranolol (0.8 mg/kg) every 6 hours, intravenous normal saline, and ibuprofen; all her vital signs improved. Serial T3, T4, and thyrotropin serum levels were measured. Her total T3 levels were >800, 798, 445, 446, and 98 ng/dL on days 3, 5, 6, 9, and 13, respectively. Total T4 measurement was repeated on day 13, and the concentration was found to be 11.9 microg/dL. Her thyrotropin levels remained undetectable throughout the course of treatment. The patient was discharged from the hospital after a 4-day PICU stay, in good condition, on oral propranolol 0.8 mg/kg every 8 hours. Propranolol administration was discontinued 8 days after initiation with no further tachycardia, hypertension, or hyperthermia. The child tolerated the recommended regimen.

Objective: To evaluate the health benefits of an exclusively human milk-based diet compared with a diet of both human milk and bovine milk-based products in extremely premature infants., Study Design: Infants fed their own mothers' milk were randomized to 1 of 3 study groups. Groups HM100 and HM40 received pasteurized donor human milk-based human milk fortifier when the enteral intake was 100 and 40 mL/kg/d, respectively, and both groups received pasteurized donor human milk if no mother's milk was available. Group BOV received bovine milk-based human milk fortifier when the enteral intake was 100 mL/kg/d and preterm formula if no mother's milk was available. Outcomes included duration of parenteral nutrition, morbidity, and growth., Results: The 3 groups (total n = 207 infants) had similar baseline demographic variables, duration of parenteral nutrition, rates of late-onset sepsis, and growth. The groups receiving an exclusively human milk diet had significantly lower rates of necrotizing enterocolitis (NEC; P = .02) and NEC requiring surgical intervention (P = .007)., Conclusions: For extremely premature infants, an exclusively human milk-based diet is associated with significantly lower rates of NEC and surgical NEC when compared with a mother's milk-based diet that also includes bovine milk-based products., (Copyright 2010 AUR. Published by Mosby, Inc. All rights reserved.)

Objective: Activity has been demonstrated in promoting bone mass in infants and adults. One of the major signs of fetal activity may be the length of the umbilical cord. We hypothesized that the fetus with a shortened umbilical cord may have low bone mineralization because of decreased movement or activity., Study Design: We investigated eight healthy term infants with shortened umbilical cords and 15 control term infants. Mothers with pre-eclampsia or hypertension, chorioamnionitis or prolonged ruptured of membranes were excluded from the study. Mother's age, parity, infants' gender, and birth and placenta weights were recorded. The umbilical cord length and diameter were measured as well as the newborn's tibial speed of sound (SOS). SOS measurements (Sunlight Omnisense 7000P instrument) were obtained at the tibial midshaft., Results: Measurement reproducibility was 0.8+/-0.6% (mean+/-s.d.) for repeat SOS measures. There were no differences between the two groups in mother's age (24.6+/-5.8 vs 25.8+/-3.3 years), parity (2+/-1 vs 2+/-1), infant's gender (25% females vs 47% females), birth weights (3320+/-451 vs 3409+/-452 g), or placental weights (521+/-69 vs 588+/-105 g). Umbilical cord diameters were also similar, 1.1+/-0.3 vs 1.1+/-0.2 cm. However, there was a difference in the cord length between the two groups, 46+/-2 vs 57+/-4 cm (Mann-Whitney, P<0.001). The newborn infants with the shorter umbilical cord also had lower tibial SOS compared with controls, 3047+/-107 vs 3194+/-311 m/sec (Mann-Whitney, P<0.05). Tibial SOS was related to the infant's umbilical cord length (r=0.57, P<0.01) but not to infant's birth weight, gender, umbilical cord diameter, maternal age, or placenta weight., Conclusion: Infants with a short umbilical cord length have lower bone strength.

The athletic performance supplement industry is a multibillion-dollar business and one popular category claims to increase nitric oxide (NO) production. We report three patients presenting to the emergency department with adverse effects. A 33-year-old man presented with palpitations, dizziness, vomiting, and syncope, after the use of NO(2) platinum. His examination and electrocardiogram (ECG) were normal. The dizziness persisted, requiring admission overnight. A 21-year-old man with palpitations and near syncope had used a "nitric oxide" supplement. He was tachycardic to 115 bpm with otherwise normal examination. Laboratory values including methemoglobin, and ECG were unremarkable. He was treated with 1 L of saline with no change in heart rate. He was admitted for observation. A 24-year-old man presented after taking NO-Xplode with palpitations and a headache. His examination, laboratory values, and ECG were normal. He was discharged. The purported active ingredient in these products is arginine alpha-ketoglutarate (AAKG), which is claimed to increase NO production by supplying the precursor L-arginine. The symptoms could be due to vasodilation from increased levels of NO, though other etiologies cannot be excluded. AAKG containing supplements may be associated with adverse effects requiring hospital admission.

Unlabelled: The use of race as a risk assessment tool and pharmacologic target has garnered recent attention and debate. It is currently unclear if a relationship between race and the development of severe alcohol withdrawal exists. We explored this potential relationship using several study groups., Methods: A simultaneous prospective enrollment of patients and retrospective chart review of severe alcohol withdrawal in two separate settings was performed comparing both the incidence of withdrawal and alcoholism based on race. These two study groups were then compared to an "at risk" group of alcoholics and the general ED population to determine differences in the distribution of race., Results: Individuals of white race in both study groups were at increased odds [OR 1.93 (CI 1.11-3.39) and 2.19 (CI 1.41-3.40)] of having severe alcohol withdrawal when compared to non-White "at risk" alcoholics. Blacks in both study groups however, appear to have lower odds [OR 0.23 (CI 0.11-0.47) and 0.11 (CI 0.05-0.23)] of having severe alcohol withdrawal when compared to non-Black "at risk" alcoholics., Conclusions: Despite the controversial use of race in medical research and targeting therapies, there appears to be a difference in the odds of severe alcohol withdrawal based on race. The reasons for this finding are currently unclear.

Burns are a serious injury that requires optimal nutritional support. This review discusses the nutritional care for adults and children with major burns. A burned patient's metabolism is greatly accelerated with increased requirements for energy, carbohydrates, proteins, fats, vitamins, minerals, and antioxidants. Early nutrition by parenteral and enteral feedings is vital. Careful assessment of the nutritional state of the burn patient is also important to reduce infection, recovery time, and long-term sequelae.

Unlabelled: Preliminary in vitro and in vivo studies with valproic acid (VPA) in cell lines and patients with spinal muscular atrophy (SMA) demonstrate increased expression of SMN, supporting the possibility of therapeutic benefit. We performed an open label trial of VPA in 42 subjects with SMA to assess safety and explore potential outcome measures to help guide design of future controlled clinical trials. Subjects included 2 SMA type I ages 2-3 years, 29 SMA type II ages 2-14 years and 11 type III ages 2-31 years, recruited from a natural history study. VPA was well-tolerated and without evident hepatotoxicity. Carnitine depletion was frequent and temporally associated with increased weakness in two subjects. Exploratory outcome measures included assessment of gross motor function via the modified Hammersmith Functional Motor Scale (MHFMS), electrophysiologic measures of innervation including maximum ulnar compound muscle action potential (CMAP) amplitudes and motor unit number estimation (MUNE), body composition and bone density via dual-energy X-ray absorptiometry (DEXA), and quantitative blood SMN mRNA levels. Clear decline in motor function occurred in several subjects in association with weight gain; mean fat mass increased without a corresponding increase in lean mass. We observed an increased mean score on the MHFMS scale in 27 subjects with SMA type II (p

Objective: To study the growth and bone mineralization of children born prematurely., Study Design: A cohort of healthy children who were born prematurely with birth weight less than 1.5 kg were compared by weight and height to a national reference. Bone mineral status of preterm infants was compared with children who were born at term gestation. The average follow-up was 7 years. A sample of children who were born prematurely was recalled from an infant nutrition study. Children born at term gestation who had similar body weight for age were recruited from the community. Bone mineral evaluation was conducted in a group of 20 children born prematurely with birth weight less than 1.5 kg and in 15 children born at term gestation. Body weight for age was similar between the groups. All children were born of appropriate size for gestational age at birth. All children had their body weight and height measured. Comparisons for growth assessment status were made with the NHANES III database and published standards. Dietary intakes and food frequency were analyzed. The bone mineral status was measured at two sites, lumbar spine and distal third radius bone., Results: The average age was 7 years, with a range of 5 to 9 years. Compared with the reference population, children who were born prematurely on the average had lower weights, heights and body mass index. Preterm children had a lower lumbar bone mineral content than term children, 12.8+/-3.0 and 14.7+/-2.2 g cm(-1) (P<0.05). The lumbar bone mineral density was lower in the preterm group than in the term group, 0.525+/-0.062 and 0.574+/-0.073 g cm(-2), respectively (P<0.04). Three of the preterm children had a history of fracture whereas none of the term children reported any fractures., Conclusion: Children who were born prematurely with birth weights less than 1.5 kg tend to be significantly smaller for age and have lower lumbar spinal bone mineral content and density compared with children born at term gestation.

Objective: To determine if physical activity delivered by an infant's mother would be as effective in promoting bone mineral acquisition in preterm very low birth weight (VLBW) infants as the same intervention administered by a trained therapist., Patients and Methods: Preterm VLBW infants were randomized to receive daily physical activity administered by the infant's mother (MOM, n=11) or a trained therapist (OT, n=11), or control (n=11). Physical activity consisted of range of motion movements against passive resistance to all extremities for 5 to 10 min daily. All infants were fed mother's milk with fortification to 24 kcal oz(-1). Dual energy x-ray of the forearm bone area (BA, cm(2)), mineral content (BMC, g), and density (BMD, g/cm(2)) and measurement of bone formation (bone-specific alkaline phosphatase, BAP) and resorption (urine pyridinium crosslinks of collagen, Pyd) were obtained at study entry and at 2.0 kg of body weight., Result: Forearm BA and BMC gains were greater in MOM and OT infants compared to the control infants despite similar postnatal growth rate and nutrient intake. Serum BAP levels decreased in controls but remained unchanged in MOM and OT infants. Urine Pyd levels were similar at baseline to 2.0 kg for all groups. These findings suggest greater bone growth and mineral acquisition in MOM and OT infants than control infants., Conclusion: This study demonstrates that a physical activity program administered by the infant's own mother is as equally effective as therapist-administered physical activity in promoting greater bone growth and mineral acquisition in preterm VLBW infants.

Objectives: To compare the effects of a human breastmilk-derived fortifier on the antibacterial activity of milk obtained from lactating mothers delivering prematurely with the effects of a powdered fortifier on the same milk., Study Design: Human milk samples were obtained after the first week of postnatal life from 10 lactating mothers, who had delivered prematurely. A bovine milk-based powdered fortifier and a human breastmilk-based frozen fortifier were evaluated. All mothers were healthy and they were not on any medications, although they were taking prenatal vitamins during lactation. The effects of each fortifier on the antimicrobial activity of milk toward Enterobacter sakazaki (ES), Escherichia coli, Clostridium difficile (CD), and Shigella soneii (SS) were evaluated by both the filter paper method and the growth inhibition method., Results: Human milk inhibited the growth of all of the test organisms. This antibacterial activity was almost totally inhibited by the addition of the bovine protein-based human milk fortifier, while it remained unaffected by the addition of the human breastmilk-based fortifier., Conclusions: Breastmilk from women who have delivered preterm has antibacterial activity that can be affected by the addition of bovine-based fortifier, but not by the addition of a human breastmilk-based fortifier.

Objective: The purpose of this study is to describe the processing of human milk to remove its fat content and its use in seven infants with chylothorax., Study Design: The mother's milk was centrifuged at 3000 r.p.m. for 15 min at 2 degrees C. After centrifugation, the milk separated into a solidified-fat top layer and a lower liquid portion. The fat-free liquid portion was then poured into collection cups and frozen for the patient's use at a later date. A sample of the mother's milk before and after processing was stored and analyzed for fat, sodium, potassium, calcium and zinc., Results: The mean fat removed was 5+/-1 g/dl (mean+/-s.d.), which was the same as the pre-fat content of the mother's milk. Seven infants with chylous pleural effusions used the fat-free human milk. All infants started on the fat-free milk after a month of age for an average of 16 days duration (7 to 34 days range). There was no reaccumulation of the chylous pleural effusions with the use of the fat-free mother's milk. Mother's milk electrolytes were similar before and after processing., Conclusion: Fat-free human milk may be an important additional dietary therapy for infants with chylothorax and may add the immunologic properties of human milk that other feedings cannot provide.

Calcium is a vital mineral for the developing newborn infant. This review discusses perinatal and neonatal calcium metabolism, with an emphasis on enteral calcium absorption and the nutritional factors affecting calcium bioavailability including the three major endocrine hormones involved in calcium metabolism: parathyroid hormone, vitamin D, and calcitonin. The placenta transports calcium to the fetus throughout pregnancy, with the largest amount of fetal calcium accumulation occurring in the third trimester. At birth, the newborn transitions to intestinal absorption to meet the body's calcium needs. Most calcium is absorbed by paracellular passive diffusion in the small intestine. Calcium intestinal absorption is affected by the type and amount of calcium ingested. It is also affected by the amount of intestinal calcium that is bound to dietary fats and proteins. One major consequence of decreased calcium absorption is metabolic bone disease in which there is a failure of complete mineralization of the bone osteoid.

Introduction: The emergency department (ED) evaluation of cocaine-associated acute coronary syndrome (CAACS) is often a diagnostic and therapeutic challenge., Case Report: We are reporting on the treatment of a patient with cocaine-associated acute coronary syndrome (CAACS) who did not benefit from standard therapy, but who eventually responded positively to phentolamine, an alpha-adrenergic receptor antagonist., Discussion: This report should encourage physicians to add phentolamine to their pharmacotherapeutic armamentarium in the treatment of CAACS.

Intrauterine growth retardation (IUGR) increases the risk of neuroendocrine reprogramming. In the rat, IUGR leads to persistent changes in cerebral mRNA levels. This suggests lasting alterations in IUGR cerebral transcriptional regulation, which may result from changes in chromatin structure. Candidate nutritional triggers for these changes include altered cerebral zinc and one-carbon metabolite levels. We hypothesized that IUGR affects cerebral chromatin structure in neonatal and postnatal rat brains. Rats were rendered IUGR by bilateral uterine artery ligation; controls (Con) underwent sham surgery. At day of life 0 (d0), we measured cerebral DNA methylation, histone acetylation, expression of chromatin-affecting enzymes, and cerebral levels of one-carbon metabolites and zinc. At day of life 21 (d21), we measured cerebral DNA methylation and histone acetylation, as well as the caloric content of Con and IUGR rat breast milk. At d0, IUGR significantly decreased genome-wide and CpG island methylation, as well as increased histone 3 lysine 9 (H3/K9) and histone 3 lysine 14 (H3/K14) acetylation in the hippocampus and periventricular white matter, respectively. IUGR also decreased expression of the chromatin-affecting enzymes DNA methyltransferase 1 (DNMT1), methyl-CpG binding protein 2 (MeCP2), and histone deacetylase (HDAC)1 in association with increased cerebral levels of zinc. In d21 female IUGR rats, cerebral CpG DNA methylation remained lower, whereas H3/K9 and H3/K14 hyperacetylation persisted in hippocampus and white matter, respectively. In d21 male rats, IUGR decreased acetylation of H3/K9 and H3/K14 in these respective regions compared with controls. Despite these differences, caloric, fat, and protein content were similar in breast milk from Con and IUGR dams. We conclude that IUGR results in postnatal changes in cerebral chromatin structure and that these changes are sex specific.

The Vietnamese centipede (Scolopendra subspinipes) is one of the largest and most aggressive tropical centipedes. It has become a popular pet among arthropod enthusiasts and the general public. Despite their reputation, few well-documented cases of envenomation are reported in the medical literature. A 53-yo man developed severe pain, swelling and erythema of his left hand and forearm after being bitten on the hand by his pet Vietnamese centipede. The neurological and vascular examination of the arm was normal. He was admitted to the hospital, treated with arm elevation, analgesics and parenteral antibiotics. His symptoms gradually resolved and he was discharged after 4 d with no neurological or cosmetic sequelae.