Diagnostico precoz de la inmunodeficiencia severa combinada: es un candidato a incluir en los programas de cribado neonatal?

Inmunodeficiencia Combinada Severa (SCID): Se caracteriza por una ausencia o muy baja concentración de células T funcionales, en muchos casos combinada con una deficiencia cuantitativa de células B y/o NK.

G181(P) Evaluation of a new e-health intervention in neonatal care : perspectives of parents and health professionals.

Aim This paper will report findings from the first phase of an evaluation of a new e-health intervention designed to allow mothers to ‘see’ their baby in neonatal care (NNU) when they are not able to be with them. The intervention, MyLittleOne, involves a web-camera being placed over the incubator in NNU, which transmits a real-time video wirelessly to a coupled tablet device at the mother’s bedside. Guided by the MRC Framework for the Development and Evaluation of Healthcare Interventions (MRC, 2008), the aim was to explore parent and professional views of the technology and make recommendations for its future development, use and evaluation. Methods A qualitative approach was adopted, guided by a critical realist perspective (McEvoy and Richards, 2003). The study took place in a Level 3 NNU in Scotland. Participants were recruited purposively and included parents (n = 33) and a range of health professionals working in neonatal and postnatal care (n = 21). The data were collected during semi-structured individual, paired and small group interviews and were analysed thematically using NVivo v10. Results The majority of parents and professionals spoke positively about MyLittleOne. Perceptions were that: use of the technology assisted bonding and responsiveness; it promoted the recovery process following birth; and, for mothers who wished to breast-feed, being able to see their baby on the tablet device encouraged the ‘let-down’ reflex. An additional benefit was that siblings and others who may not be able to visit the NNU were able to see the baby. In contrast, for a small number of mothers, viewing their baby remotely appeared to increase their levels of anxiety. Switching off the camera during a medical procedure and back on after the procedure was completed was found to be problematic, at times and in different ways, for both parents and professionals. Conclusions Findings from this preliminary evaluation will guide future developments of the technology, including its use in family homes following the mother’s discharge. The findings will also inform the design of a feasibility study and subsequent RCT to assess the impact of MyLittleOne on a range of psychological indicators of postnatal adjustment.

Anthropometric indicators of nutritional status and growth in very low birth-weight premature infants hospitalized in a neonatal intensive care unit

Background: Anthropometric indicators are difficult to interpret in very low birth weight (VLBW) premature infants, including both appropriate for gestational age (AGA) and small for gestational age (SGA) infants. Therefore, the purpose was to describe the anthropometric indicators of growth and nutritional status in VLBW premature infants AGA and SGA, hospitalized in a neonatal intensive care unit (NICU). Study design: The descriptive and prospective study design included 114 preterm infants, adequate for gestational age/small for gestational age hospitalized in the intensive care unit. Head, thigh, mid upper arm circumference, skin-fold measurements and weight/age, length/ age, and weight/length indices were obtained. Correlations were made among the anthropometric indices, and a multivariate regression analysis with weight/age as dependent variable was performed. Results: Weight/age in AGA premature infants had high number of significant anthropometric correlations. The SGA premature infants had few and weak correlations. The regression analysis showed that anthropometric indices better explain changes in the weight/age index in adequate for gestational age premature infants. Conclusion: Weight/age in the VLBW/AGA premature infants could reflect growth, nutritional status and energy stored as fat, but in the VLBW/SGA premature infants, thigh circumference and mid arm circumference would be better indicators just of nutritional status.

KANGAROO CARE: MATERNAL PERCEPTION OF THE EXPERIENCE IN THE NEONATAL INTENSIVE CARE UNIT

Objective: To investigate the maternal perception of the experience in the first phase of the Kangaroo Mother Care Method in the Neonatal Intensive Care Unit (NICU). Methods: Descriptive, exploratory and qualitative study, conducted in the period from August to October 2014, with 10 mothers of newborn preterm (NP) infants, who were admitted to the Maternity School Assis Chateaubriand (MEAC) in Fortaleza, Brazil, and had received skin-to-skin contact through the Kangaroo Care Method during hospitalization in the NICU. Data was collected by semi-structured interview, directed by guiding questions. Content analysis was used for processing the data, being established four categories: “The bond and the attachment”, “Maternal competence”, “The fear of losing the baby” and “The importance of the multidisciplinary team”. Results: The Kangaroo Care Method is a safe and pleasurable practice for mothers and relatives, in addition to providing social and psychoaffective benefits, found in the imagery of the method institutionalization and in the mothers’ experience when properly supported. The meanings of the maternal feelings of apprehension as a result of the first physical contact with the hospitalized child can be evidenced. Regarding the evaluation of its clinical practice, this method has provided better development of the newborn infant and a reduction in hospital stay. Conclusion: The study shows relevance, since the evidence of the maternal perception of this method supports its establishment as a mandatory practice in maternity hospitals, in view of the benefits to the mother and the neonate.

Mortalidad neonatal en los hospitales Vicente Corral Moscoso y José Carrasco Arteaga, en el año 2008

Se realizo un estudio retrospectivo, cuyo universo fueron todas las historias clínicas que registraron a neonatos durante el año 2008, en el servicio de Neonatología de estas instituciones, y como muestra las historias clínicas que registraron a neonatos fallecidos durante ese periodo. Las investigadoras procedimos a recolectar los datos, en un formulario previamente validado, cuya información se ingresó en el programa estadístico Microsoft Office Excel, versión 2007; y el programa SPSS 15.0, versión evaluación, para realizar la tabulación, el análisis y graficación correspondiente. Las medidas estadísticas utilizadas fueron: número de casos (n), porcentaje (%) y chi cuadrado (x2). Resultados: en el Hospital Vicente Corral Moscoso según características maternas: 60.3% tuvo entre 19 a 30 años de edad. El 35.8% ha estudiado hasta la primaria completa. El 69.8% perteneció a la zona urbana. El 46.3% fueron multíparas. El 45% de las gestantes no tuvo enfermedad. El 53.4% de los neonatos fueron femeninos. Según características neonatales: El 72.4% de los fallecidos tenían menos de 7 días de edad. El 86.2% tenía peso menor que 2500gr y talla menor a 47cm. El 67.2% tuvo un perímetro cefálico menor que 33cm. El 46.6% tuvo un APGAR al 1 de moderado y a los 5 el 44.8% fue normal. El 55.2% tuvieron como diagnostico de fallecimiento insuficiencia respiratoria. La asociación entre peso del neonato y diagnostico de fallecimiento si es significativo (P menor que 0.005) En el Hospital José Carrasco Arteaga, según características maternas: el 80% tuvo entre 19 a 30 años de edad, el 66.7% ha estudiado hasta la secundaria completa, el 86.7% perteneció a la zona urbana, el 66.7% fueron multíparas, el 53.4% de las gestantes no tuvo enfermedad. Según características neonatales: el 66% fueron masculinos, el 60% fallecidos tenían menos de 7 días de edad, el 80% tenía peso menor que 2500gr, el 86.7% con talla menor a 47cm, el 60% tuvo un perímetro cefálico inferior a 33cm, el 46.7% tuvo un APGAR 1 de moderado y a los 5 el 40% fue moderado. El 46.7% tuvieron como diagnostico de fallecimiento, insuficiencia respiratoria. Conclusiones: pese a la gratuidad de la atención prenatal, parto postparto y al aumento de la cobertura, aún existe un alto índice de mortalidad neonatal, que pertenecen principalmente a zonas urbanas y que eran multigestas

In vivo and in vitro disappearance of energy and nutrients in novel carbohydrates and cereal grains by pigs

In vivo and in vitro experiments were conducted to determine digestibility of GE and nutrients, as well as DE and ME of carbohydrates fed to growing pigs. The objective of Exp. 1 was to determine the DE and ME of 4 novel carbohydrates fed to pigs. The 4 novel carbohydrates were 2 sources of resistant starch (RS 60 and RS 70), soluble corn fiber (SCF), and pullulan. These carbohydrates were produced to increase total dietary fiber (TDF) intake by humans. Maltodextrin (MD) was used as a highly digestible control carbohydrate. The DE and ME for RS 60 (1,779 and 1,903 kcal/kg, respectively), RS 75(1,784 and 1,677 kcal/kg, respectively), and SCF (1,936 and 1,712 kcal/kg, respectively) were less (P < 0.05) than for MD (3,465 and 3,344 kcal/kg, respectively) and pullulan (2,755 and 2,766 kcal/kg, respectively), and pullulan contained less (P < 0.05) DE and ME than MD. However, there was no difference in the DE and ME for RS 60, RS 75, and SCF. The varying degrees of small intestinal digestibility and differences in fermentability among these novel carbohydrates may explain the differences in the DE and ME among carbohydrates. Therefore, the objectives of Exp. 2 were to determine the effect of these 4 novel carbohydrates and cellulose on apparent ileal (AID) and apparent total tract (ATTD) disappearance, and hindgut disappearance (HGD) of GE, TDF, and nutrients when added to diets fed to ileal-cannulated pigs. The second objective was to measure the endogenous flow of TDF to be able to calculate the standardized ileal disappearance (SID) and standardized total tract (STTD) disappearance of TDF in the 4 novel fibers fed to pigs. Results of the experiment indicated that the AID of GE and DM in diets containing cellulose or the novel fibers was less (P < 0.05) than of the maltodextrin diet, but the ATTD of GE and DM was not different among diets. The addition of RS 60, RS 75, and SCF did not affect the AID of acid hydrolysed ether extract (AEE), CP, or ash, but the addition of cellulose and pullulan reduced (P < 0.01) the AID of CP. The average ileal and total tract endogenous losses of TDF were calculated to be 25.25 and 42.87 g/kg DMI, respectively. The SID of TDF in diets containing RS 60, SCF, and pullulan were greater (P < 0.01) than the SID of TDF in the cellulose diet, but the STTD of the SCF diet was greater (P < 0.05) than for the cellulose and pullulan diets. Results of this experiment indicate that the presence of TDF reduces small intestinal disappearance of total carbohydrates and energy which may reduce the DE and ME of diets and ingredients. Therefore, the objective of Exp. 3 was to determine the DE and ME in yellow dent corn, Nutridense corn, dehulled barley, dehulled oats, polished rice, rye, sorghum, and wheat fed to growing pigs and to determine the AID and ATTD of GE, OM, CP, AEE, starch, total carbohydrates, and TDF in these cereal grains fed to pigs. Results indicated that the AID of GE, OM, and total carbohydrates was greater (P < 0.001) in rice than in all other cereal grains. The AID of starch was also greater (P < 0.001) in rice than in yellow dent corn, dehulled barley, rye, and wheat. The ATTD of GE was greater (P < 0.001) in rice than in yellow dent corn, rye, sorghum, and wheat. With a few exceptions, the AID and ATTD of GE and nutrients in Nutridense corn was not different from the values for dehulled oats. Likewise, with a few exceptions, the AID, ATTD, and HGD of GE, OM, total carbohydrates, and TDF in yellow corn, sorghum, and wheat were not different from each other. The AID of GE and AEE in dehulled barley was greater (P < 0.001) than in rye. The ATTD of GE and most nutrients was greater (P < 0.001) in dehulled barley than in rye. Dehulled oats had the greatest (P < 0.001) ME (kcal/kg DM) whereas rye had the least ME (kcal/kg DM) among the cereal grains. Results of the experiment indicate that the presence of TDF and RS may reduce small intestinal digestibility of starch in cereal grains resulting in reduced DE and ME in these grains. Digestibility experiments involving animals are time consuming and expensive. Therefore, the objective of Exp. 4 was to correlate DM and OM digestibility obtained from 3 in vitro procedures with ATTD of GE and with the concentration of DE in 50 corn samples that were fed to growing pigs. The second objective was to develop a regression model that can predict the ATTD of GE or the concentration of DE in corn. The third objective was to evaluate the suitability of using the DaisyII incubator as an alternative to the traditional water bath when determining in vitro DM and OM digestibility. Results indicated that corn samples incubated with Viscozyme for 48 h in the DaisyII incubator improved (P < 0.001) the ability of the procedure to detect small differences in the ATTD of GE or to detect small differences in the concentration of DE in corn. Likewise, compared with using cellulase or fecal inoculum, the variability in the ATTD of GE and the variability in the DE in corn was better (R2 = 0.56; P < 0.05 and R2 = 0.53; P < 0.06, respectively) explained if Viscozyme was used than if cellulase or fecal inoculum was used. A validated regression model that predicted the DE in corn was developed using Viscozyme and with the corn samples incubated in the DaisyII incubator for a 48 h. In conclusion, this present work used the pig as a model for human gastrointestinal function and evaluates carbohydrates from 2 different nutritional perspectives – humans and animals. The addition of novel carbohydrates reduced the digestibility of energy in the diets without necessarily reducing the digestibility of other nutrients. Thus, supplementation of novel carbohydrates in the diets may be beneficial for the management of diabetes. Aside from diabetic management, cereal grains such as rye and sorghum, may also help in BW management because of there low caloric value, but for undernourished individuals, dehulled oats, dehulled barley, and rice are the ideal grains. From an animal nutrition standpoint, high concentration of dietary fiber is undesirable because it reduces feed efficiency. Therefore, the inclusion of feed ingredients that have a high concentration of dietary fiber is often limited in animal diets. Although in vivo determination is ideal, in vitro procedures are useful tools to determine caloric value of food and feed ingredients.

Prevalencia de infecciones del sitio quirúrgico y profilaxis antibiótica preoperatoria en procedimientos neuroquirúrgicos espinales en pacientes entre la edad neonatal y los 5 años, Enero – Diciembre de 2014, Hospital Nacional de Niños Benjamín Bloom

En la cirugía neuroquirúrgica los datos sobre profilaxis antibiótica no son claros ya que no cuentan a su favor con estudios que avalen o rechacen su uso. Es por esto mismo que surge la necesidad de indagar en la prevalencia de infecciones del sitio quirúrgico y la profilaxis antibiótica preoperatoria en procedimientos neuroquirúrgicos espinales en pacientes entre la edad neonatal y los 5 años de edad. Materiales y métodos: se realizó un estudio descriptivo retrospectivo de corte transversal, haciendo revisión sistemática de los expedientes clínicos de los pacientes que ingresaron en el año 2014 que cumplieron con los criterios de inclusión. Resultados: Se estudió una población muestral correspondiente a 76 pacientes, en los que se evidencia que la mayoría de cirugías practicadas durante el periodo estudiado fue de manera electiva; sin embargo una cantidad significativa de cirugías (38%) fue sometida de emergencia, lo que predispone a infecciones y alargamiento del esquema antibiótico. El 89% de los esquemas de antibióticos fueron utilizados como tratamiento terapéutico relacionado principalmente con mielo-meningoceles y únicamente el 11% de todos los pacientes estudiados recibió profilaxis antibiótica preoperatoria pura. El 83% de los casos no se relacionó con infección de sitio quirúrgico y un 17% si lo presentó. El 86% de los casos estuvo relacionado con el uso de dos antimicrobianos de forma terapéutica y un 14% se relacionó con el uso de un solo antimicrobiano como profilaxis. Evidenciándose así, que no hay un esquema terapéutico especifico definido; y paradójicamente se evidencia una mayor prevalencia de infecciones de sitio quirúrgico con biterapia; puesto a que el 85% de los casos que desarrollaron infección de sitio quirúrgico tenían esquema de biterapia antimicrobiana y un 15% tenía esquema de monoterapia antimicrobiana. Conclusiones: La mayoría de los pacientes estudiados fueron intervenidos de manera electiva (62%); sin embargo, el 38% fue sometido a cirugía de emergencias; lo que conlleva al uso de un esquema terapéutico de tratamiento antibiótico en lugar de uno profiláctico.

Is facility based neonatal care in low resource setting keeping pace? A glance at Uganda’s National Referral Hospital.

Objectives: To identify reasons for neonatal admission and death with the aim of determining areas needing improvement. Method: A retrospective chart review was conducted on records for neonates admitted to Mulago National Referral Hospital Special Care Baby Unit (SCBU) from 1st November 2013 to 31st January 2014. Final diagnosis was generated after analyzing sequence of clinical course by 2 paediatricians. Results: A total of 1192 neonates were admitted. Majority 83.3% were in-born. Main reasons for admissions were prematurity (37.7%) and low APGAR (27.9%).Overall mortality was 22.1% (Out-born 33.6%; in born 19.8%). Half (52%) of these deaths occurred in the first 24 hours of admission. Major contributors to mortality were prematurity with hypothermia and respiratory distress (33.7%) followed by birth asphyxia with HIE grade III (24.6%) and presumed sepsis (8.7%). Majority of stable at risk neonates 318/330 (i.e. low APGAR or prematurity without comorbidity) survived. Factors independently associated with death included gestational age <30 weeks (p 0.002), birth weight <1500g (p 0.007) and a 5 minute APGAR score of < 7 (p 0.001). Neither place of birth nor delayed and after hour admissions were independently associated with mortality. Conclusion and recommendations: Mortality rate in SCBU is high. Prematurity and its complications were major contributors to mortality. The management of hypothermia and respiratory distress needs scaling up. A step down unit for monitoring stable at risk neonates is needed in order to decongest SCBU.

Does prenatal diagnosis modify neonatal treatment and early outcome of children with esophageal atresia?

International audience

Prevalencia de artritis séptica neonatal en un hospital universitario

Introducción: La artritis séptica neonatal es un padecimiento poco común que se ha relacionado con recién nacidos internados en la unidad de cuidados intensivos neonatal, cuyo principal factor de riesgo es el uso previo de catéter central. Objetivo: establecer la prevalencia de la artritis séptica neonatal en nuestro Hospital. Material y método: estudio observacional descriptivo de prevalencia. Se incluyeron todos los recién nacidos con diagnostico de artritis séptica neonatal internados un la unidad de cuidados intermedios e intensivos neonatal del Hospital Universitario Dr. José Eleuterio González del año 2003 al 2007. Se revisaron los expedientes y se registraron variables generales, factores de riesgo, bacteriología y mortalidad. Resultados: Se diagnosticaron 26 casos de artritis séptica neonatal durante el periodo de tiempo estudiado, solo 20 casos lograron criterios de inclusión: la prevalencia fue de 1.2 casos por cada 1,000 nacidos. La edad gestacional fue 39.2 ± 1.3 semanas, con peso 3193 ± 709 g. El factor de riesgo que se presento con mas frecuencia fue el antecedente de uso previo de catéter en 75% de los casos. Se aisló microorganismo en 80% de los casos, los bacterias grampositivas se aislaron en 80% de los casos; el Staphylococcus aureus fue el microorganismo aislado predominantemente en 75% de los casos. La presentación poliarticular fue en 40% de los casos. La mortalidad fue de 0%. Conclusiones: La prevalencia fue menor a lo reportado en la literatura. Los microorganismos grampositivos continúan siendo los microorganismos predominantes en la artritis séptica neonatal. La mortalidad es baja.

Molecular characterization of extended-spectrum cephalosporin-resistance in Escherichia coli in pigs on-farm and from clinical cases throughout Quebec, Canada during 16 years

Le développement de la multirésistance chez Escherichia coli est un problème important en médecine animale et humaine. En outre, l’émergence et la diffusion des déterminants de résistance aux céphalosporines à larges spectres de troisième génération (ESCs) parmi les isolats, incluant des céphalosporines essentielles en médecine humaine (ex. ceftriaxone et ceftiofur), est un problème majeur de santé publique. Cette thèse visait trois objectifs. D’abord étudier la dynamique de la résistance aux antimicrobiens (AMR) ainsi que la virulence et les profils génétiques de la AMR des E. coli isolées de porcs recevant une nourriture post-sevrage supplémentée avec de la chlortétracycline et de la pénicilline G, et, accessoirement, évaluer les effets d'additifs alimentaires sur cette dynamique en prenant pour exemple d'étude un minéral argileux, la clinoptilolite, étant donné son possible lien avec le gène blaCMY-2 qui confère la résistance au ceftiofur. L'objectif suivant était d'investiguer les mécanismes menant à une augmentation de la prévalence du gène blaCMY-2 chez les porcs qui reçoivent de la nourriture médicamentée et qui n'ont pas été exposés au ceftiofur Ici encore,nous avons examiné les effets d’un supplément alimentaire avec un minéral argileux sur ce phénomène. Enfin, notre dernier objectif était d’étudier, dans le temps, les génotypes des isolats cliniques d'E. coli résistant au ceftiofur, isolés de porcs malades au Québec à partir du moment où la résistance au ceftiofur a été rapportée, soit de 1997 jusqu'à 2012. Dans l'étude initiale, la prévalence de la résistance à 10 agents antimicrobiens, incluant le ceftiofur, s’accroît avec le temps chez les E.coli isolées de porcelets sevrés. Une augmentation tardive de la fréquence du gène blaCMY-2, encodant pour la résistance au ceftiofur, et la présence des gènes de virulence iucD et tsh a été observée chez les isolats. La nourriture supplémentée avec de la clinoptilolite a été associée à une augmentation rapide mais, par la suite, à une diminution de la fréquence des gènes blaCMY-2 dans les isolats. En parallèle, une augmentation tardive dans la fréquence des gènes blaCMY-2 et des gènes de virulence iucD et tsh a été observée dans les isolats des porcs contrôles, étant significativement plus élevé que dans les porcs ayant reçu l'additif au jour 28. La diversité, au sein des E. coli positives pour blaCMY-2 , a été observée au regard des profils AMR. Certaines lignées clonales d'E.coli sont devenues prédominantes avec le temps. La lignée clonale du phylotype A prédominait dans le groupe supplémenté, alors que les lignées clonales du phylotype B1, qui possèdent souvent le gène de virulence iucD associé aux ExPEC, prédominaient dans le groupe contrôle. Les plasmides d'incompatibilité (Inc) des groupes, I1, A/C, et ColE, porteurs de blaCMY-2, ont été observés dans les transformants. Parmi les souches cliniques d'E.coli ESC-résistantes, isolées de porcs malades au Québec de 1997 à 2012, blaCMY-2 était le gène codant pour une β-lactamase le plus fréquemment détecté; suivi par blaTEM et blaCTX-M,. De plus, les analyses clonales montrent une grande diversité génétique. Par contre, des isolats d'E. coli avec des profils PFGE identiques ont été retrouvés dans de multiples fermes la même année mais aussi dans des années différentes. La résistance à la gentamicine, kanamycine, chloramphenicol, et la fréquence de blaTEM et de IncA/C diminuent significativement au cour de la période étudiée, alors que la fréquence de IncI1 et de la multirésistance à sept catégories d'agents antimicrobiens augmente significativement avec le temps. L'émergence d'isolats d'E. coli positifs pour blaCTX-M, une β-lactamase à large spectre et produisant des ESBL, a été observée en 2011 et 2012 à partir de lignées clonales distinctes et chez de nombreuses fermes. Ces résultats, mis ensemble, apportent des précisions sur la dissémination de la résistance au ceftiofur dans les E. coli isolées de porcs. Au sein des échantillons prélevés chez les porcs sevrés recevant l'alimentation médicamentée sur une ferme, et pour laquelle une augmentation de la résistance au ceftiofur a été observée, les données révèlent que les souches d'E. coli positives pour blaCMY-2 et résistantes aux ESCs appartenaient à plusieurs lignées clonales différentes arborant divers profils AMR. Le gène blaCMY-2 se répand à la fois horizontalement et clonalement chez ces E. coli. L'ajout de clinoptilotite à la nourriture et le temps après le sevrage influencent la clonalité et la prévalence du gène blaCMY-2 dans les E. coli. Durant les 16 années d'étude, plusieurs lignées clonales différentes ont été observées parmi les souches d'E. coli résistantes au ceftiofur isolées de porc malades de fermes québécoises, bien qu’aucune lignée n'était persistante ou prédominante pendant l'étude. Les résultats suggèrent aussi que le gène blaCMY-2 s'est répandu à la fois horizontalement et clonalement au sein des fermes. De plus, blaCMY-2 est le gène majeur des β-lactamases chez ces isolats. À partir de 2011, nous rapportons l'émergence du gène blaCTX-M dans des lignées génétiques distinctes.

Relación de la seroconversión positiva a neospora caninum con problemas reproductivos y mortalidad neonatal en vacas holstein

La neosporosis bovina es una enfermedad parasitaria causada por el protozoo Neospora caninum (NC). Se considera una de las principales causas de aborto en la especie bovina, especialmente en el ganado lechero y está relacionada con pérdidas productivas y trastornos de la fertilidad. Su prevalencia es variable alrededor del mundo así como su comportamiento epidemiológico. El objetivo de este trabajo fue determinar la relación entre la seropositividad producto de la transmisión horizontal y distintos problemas reproductivos identificados en vacas Holstein de la sierra sur del Ecuador.

The effects of acute administration of Chinese aphrodisiacs sold in Blantyre City on sperm characteristics and fertility profile in guinea pigs

Background Chinese aphrodisiacs have become popular remedy for sexual dysfunction and improvement of libido in men in Malawi. However, selling of these drugs seems not to be well regulated. Probably the aphrodisiacs that are currently on the market have unknown efficacy, potency and safety profiles. The aim of this study was to assess the efficacy of imported Chinese aphrodisiacs using guinea pigs as a model. Materials and Methods Two types of drugs were purchased from vendors in Blantyre City. Tonic tea, which was purported to improve erectile function and libido, and sperm multiplier tablets which were claimed to increase the sperm count. The tonic tea was prepared by soaking one tea bag in 100ml boiling water. The tea was cooled and administered to eight male experimental animals in varying doses. Each animal was introduced into a separate cage with a female guinea pig. Sexual behaviour such as mounting, sniffing behind the female were observed and recorded. Each sperm multiplier tablet was dissolved in distilled water and administered to the experimental animals in the morning and evening for seven days. At the end of the treatment, the experimental and control animals were sacrificed, their semen collected and analysed sperm motility, concentration and morphology. Results For the tonic tea, there were no statistical differences between the experimental and the control animals in terms of the number of mountings and sniffing behind the female. The sperm multiplier drug showed statistically significant differences between the experimental and the control animals in terms of the sperm motility (78.24 ± 1.35 vs. 86.54 ± 1.88, p< 0.05), and concentration (54.28 ± 1.24 vs. 67.59 ± 2.12, p<0.05). Conclusion The tonic tea did not show any efficacy in improving erection and libido. The sperm multiplier tablets, purported to increase sperm production, significantly increased the sperm motility, sperm concentration in the treated animals.

Risk Factors for Neonatal Sepsis and Method for Reduction of Blood Culture Contamination

Background False-positive blood cultures findings may lead to a falsely increased morbidity and increased hospital costs. Method The survey was conducted as retrospective - prospective study and included 239 preterm infants (born before 37 weeks of gestation) who were treated in Neonatal Intensive Care Unit (NICU) in Institute for Child and Youth Health Care of Vojvodina during one year (January 1st, 2012 to December 31st, 2012). The retrospective part of the study focused on examination of incidence of neonatal sepsis and determination of risk factors. In the prospective part of the study infants were sub-divided into two groups: Group 1- infants hospitalized in NICU during the first 6 months of the study; blood cultures were taken by the ‘’clean technique’’ and checklists for this procedure were not taken. Group 2- neonates hospitalized in NICU during last 6 months of the study; blood cultures were taken by ‘’sterile technique’’ and checklists for this procedure were taken. Results The main risk factors for sepsis were prelabor rupture of membranes, low gestational age, low birth weight, mechanical ventilation, umbilical venous catheter placement, and abdominal drainage. Staphylococcus aureus and coagulase negative Staphylococcus were the most frequently isolated microorganisms in false-positive blood samples. Conclusions Education of employees, use of checklists and sterile sets for blood sampling, permanent control of false positive blood cultures, as well as regular and routine monthly reports are crucial for successful reduction of contamination rates.

Supra-treatment threshold neonatal jaundice: Incidence in HIV-exposed compared to non-exposed neonates at Queen Elizabeth Central Hospital in Blantyre, Malawi

Introduction Jaundice is the yellowish pigmentation of the skin, sclera, and mucous membranes resulting from bilirubin deposition. Children born to mothers with HIV are more likely to be born premature, with low birth weight, and to become septic—all risk factors for neonatal jaundice. Further, there has been a change in the prevention of mother-to-child transmission (PMTCT) of HIV guidelines from single-dose nevirapine to a six-week course, all of which theoretically put HIV-exposed newborns at greater risk of developing neonatal jaundice. Aim We carried out a study to determine the incidence of severe and clinical neonatal jaundice in HIV-exposed neonates admitted to the Chatinkha Nursery (CN) neonatal unit at Queen Elizabeth Central Hospital (QECH) in Blantyre. Methods Over a period of four weeks, the incidence among non-exposed neonates was also determined for comparison between the two groups of infants. Clinical jaundice was defined as transcutaneous bilirubin levels greater than 5 mg/dL and severe jaundice as bilirubin levels above the age-specific treatment threshold according the QECH guidelines. Case notes of babies admitted were retrieved and information on birth date, gestational age, birth weight, HIV status of mother, type of feeding, mode of delivery, VDRL status of mother, serum bilirubin, duration of stay in CN, and outcome were extracted. Results Of the 149 neonates who were recruited, 17 (11.4%) were HIV-exposed. One (5.88%) of the 17 HIV-exposed and 19 (14.4%) of 132 HIVnon- exposed infants developed severe jaundice requiring therapeutic intervention (p = 0.378). Eight (47%) of the HIV-exposed and 107 (81%) of the non-exposed neonates had clinical jaundice of bilirubin levels greater than 5 mg/dL (p < 0.001). Conclusions The study showed a significant difference in the incidence of clinical jaundice between the HIV-exposed and HIV-non-exposed neonates. Contrary to our hypothesis, however, the incidence was greater in HIVnon- exposed than in HIV-exposed infants.