Rapid weight gain in early life is associated with severity of respiratory syncytial virus (RSV) bronchiolitis in children

Objectives: This study aimed to investigate whether rapid weight gain in early life was associated with the severity of respiratory syncytial virus (RSV) bronchiolitis in children.Methods: We retrospectively reviewed 190 patients (1–24 months) hospitalized for RSV bronchiolitis. Parameters of bronchiolitis severity were compared between rapid (change in weight z-score from birth >0.67, n = 65) and normal weight gain groups (n = 125). We assessed for correlations between bronchiolitis severity and weight gain. Linear regression was performed to predict for bronchiolitis severity based on weight gain, controlling for covariates. SPSS was used for statistical analyses.Results: The rapid weight gain group had longer mean durations of tachypnea (2.3±2.0 vs. 1.7±1.8 days, P = 0.027), wheezing (3.2±2.5 vs. 1.6±1.8 days, P < 0.001), and chest retractions (1.5±2.2 vs. 0.6±1.3 days, P = 0.007). Correlations of weight gain with tachypnea (r = 0.146), wheezing (r = 0.279), and chest retractions (r = 0.179) were statistically significant. Weight gain predicted for tachypnea (B = 0.485, P = 0.013) and wheezing (B = 0.846, P = 0.001) durations after adjusting for covariates of severity (age, sex, current weight, RSV type, coin-fection, recurrent bronchiolitis, hospital stay, fever, oxygen supplementation, maximal respi-ratory and heart rates, and laboratory indices).Conclusions: Our findings suggest an association between weight gain and severity of RSV bronchiolitis in young children. Weight gain was significantly associated with the durations of tachypnea and wheezing. The trajectory of weight gain in early life may play a significant role in the clinical course of RSV bronchiolitis.

Effects of Schisandra chinensis Extract on the Learning and Memory Ability of Mice With Learning and Memory Disorders

The effect of Schisandra chinensis extract (SCE) on the learning and memory ability of mice with learning and memory disorders was investigated. After mice were given SCE prophylactically, different methods were used to establish mouse learning and memory disorders, and the radial maze test was used for the observation of SCE on the learning and memory ability of mice with learning and memory disorders. A mouse aging model was established by subcutaneously injecting d-galactose. The antiaging, antifatigue, and antioxidant effects of SCE were evaluated by weight change, the loaded swimming test, and changes in total antioxidant capacity and superoxide dismutase (SOD) levels in the serum and brain of mice. The result showed that SCE could significantly improve the learning and memory behavior of mice with learning and memory disorders induced by scopolamine, chloramphenicol, and 40% ethanol, respectively, maintain normal weight gain, prolong the loaded swimming time, improve the antioxidant capacity, and increase the activity of SOD in the serum and brain of aging mice. SCE can significantly improve the learning and memory ability of mice with learning and memory disorders, which may be related to its antioxidant effect.

Effect of Gestational Weight Gain on Perinatal Outcomes in Low Risk Pregnancies with Normal Prepregnancy Body Mass Index

Objective. This study aimed to clarify the effect of gestational weight gain (GWG) on perinatal outcomes in low risk pregnancies with normal prepregnancy body mass index (BMI). Study Design. A total of 572 low-risk pregnant women with a normal prepregnancy BMI were included. GWG and inadequate or excessive weight gain were defined according to the United States Institute of Medicine updated guidelines. Adverse perinatal outcomes were compared among inadequate, normal, and excessive weight gain groups. Results. Of the 572 pregnant women enrolled, 62 belonged to inadequate GWG group, 80 to excessive GWG group, and 430 to normal GWG group. Maternal age, prepregnancy BMI, gravity, parity, and previous cesarean delivery rates were similar among groups. Adverse perinatal outcomes were not statistically significant among groups. Fetal weight was significantly lower in inadequate weight gain group compared to normal weight gain group (p<0.001) and fetal weight was significantly lower in normal weight gain group compared to excessive weight gain group (p<0.001). Additionally, low birth weight <2.5kgs, birth weight > 4.0kgs, and SGA and LGA rates were similar among groups (P = 0.765, P = 0. 711, P = 0. 702, and P = 0.414, respectively). Although gestational age at delivery was term in normal percentile it was significantly lower in the inadequate weight gain group compared to others (P=0.010). Conclusions. This study showed that an inadequate or excessive weight gain in low-risk pregnancies with a normal prepregnancy BMI did not increase the risk of adverse perinatal outcomes.

Pre-pregnancy nutritional status versus maternal weight gain and neonatal size

Background. Maternal weight during pregnancy may affect both, the course of pregnancy and the anthropometric parameters of the newborn. The steadily growing problem of excessive weight in reproductive-age women is associated with the risk for gestational obesity and its negative consequences for the infant. Objectives. The aims of the study were to analyze the following: (i) maternal weight gain as compared to the pre-pregnancy BMI, and (ii) the link between maternal weight and other environmental factors versus neonatal size. Material and methods. The study was conducted among 94 women in singleton term pregnancy, who delivered at the Department of Obstetrics, Gynecology and Oncology, Medical University of Warsaw. The American Institute of Medicine criteria for the recommended weight gain were followed. Multivariate logistic regression model and multiple regression analysis were used for statistical analysis. Results. Normal weight gain was observed in only one-third of the subjects, while excess weight gain was detected in as many as 42.5% of the women. Active smokers were at a 4-fold higher risk for excess weight gain as compared to nonsmokers (OR 4.13, 95% CI 1.19 - 14.34, p = 0.026). Infants born to mothers with insufficient weight gain (24.5% of the mothers) were lighter by 302 g (p=0.0405) and shorter by 2.4 cm (p=0.0025) as compared to those born to mothers with normal weight gain. Conclusions. Maternal weight gain in most of our subjects was not compliant with the current recommendations, regardless of the pre-pregnancy BMI. Inadequate pregnancy weight gain negatively affects the anthropometric parameters of the newborn.

Tuberculosis in Pregnancy: A Review

Tuberculosis (TB) was declared a public health emergency by WHO in 2005. The disease is a significant contributor to maternal mortality and is among the three leading causes of death among women aged 15–45 years in high burden areas. The exact incidence of tuberculosis in pregnancy, though not readily available, is expected to be as high as in the general population. Diagnosis of tuberculosis in pregnancy may be challenging, as the symptoms may initially be ascribed to the pregnancy, and the normal weight gain in pregnancy may temporarily mask the associated weight loss. Obstetric complications of TB include spontaneous abortion, small for date uterus, preterm labour, low birth weight, and increased neonatal mortality. Congenital TB though rare, is associated with high perinatal mortality. Rifampicin, INH and Ethambutol are the first line drugs while Pyrazinamide use in pregnancy is gaining popularity. Isoniazid preventive therapy is a WHO innovation aimed at reducing the infection in HIV positive pregnant women. Babies born to this mother should be commenced on INH prophylaxis for six months, after which they are vaccinated with BCG if they test negative. Successful control of TB demands improved living conditions, public enlightenment, primary prevention of HIV/AIDS and BCG vaccination.

Treatment of Congenital Hyperinsulinism with Lanreotide Acetate (Somatuline Autogel)

Context: Congenital hyperinsulinism (CH) may be treated conservatively in many children with octreotide given by multiple sc injections or via an insulin pump. Objective: We describe two children treated with a once-monthly injection of a long-acting somatostatin analog. Patients and Methods: Both patients presented with hypoglycemia 30 min after birth and were subsequently diagnosed with CH. Patients were initially treated with diazoxide, hydrochlorothiazide, frequent feedings, and octreotide via an insulin pump. With this therapy, they were normoglycemic with a good growth rate, normal weight gain, and excellent neurodevelopment. Treatment with the long-acting somatostatin analog lanreotide acetate (Somatuline Autogel), administered by deep sc injection of 30 mg once a month, was started at the ages of 4½ and 4 yr, respectively. Octreotide infusion was gradually weaned over 1 month. Continuous glucose monitoring after discontinuation of pump therapy showed normoglycemia. The first patient has now been treated with the lanreotide acetate for over 5 yr, and the second for 3 yr. Treatment is well-tolerated, and both the patients and their parents are satisfied with the transition from pump therapy to once-a-month injection and prefer it to pump therapy. Conclusion: Lanreotide acetate may be a safe and effective alternative to octreotide pump therapy in patients with CH, offering an improved quality of life. Longer follow-up of a larger patient group is needed.

Clinical Management of Infants and Children with Gastroesophageal Reflux Disease

Gastroesophageal reflux refers to the passage of gastric contents including food, acid, and digestive enzymes up into the esophagus. Reflux is most commonly recognized in infants when it is associated with regurgitation, known as “spitting up,” and it is usually a self-limited, benign process that has little or no effect on normal weight gain or development. Adults and adolescents may also have reflux, which is usually either asymptomatic or recognized as dyspepsia or “heartburn.” Gastroesophageal reflux disease (GERD) is defined as symptoms or complications that result from reflux. Most evidence suggests the mechanism of reflux is due to transient relaxations of the lower esophageal sphincter at inappropriate times. The diagnosis of suspected GERD in infants and children depends on the age and the presenting symptoms. A thorough history, physical examination, and growth charts are sufficient for the evaluation and diagnosis of GERD in most infants with recurrent vomiting or children with regurgitation and heartburn. Additional evaluation may include an upper gastrointestinal series, esophageal pH monitoring, or endoscopy. The goals of GERD management are eliminating symptoms, healing esophagitis, preventing complications, promoting normal weight gain and growth, and maintaining remission. Therapeutic options include lifestyle changes, pharmacologic therapy, and anti-reflux surgery. Currently available pharmacologic agents for the treatment of GERD include antacids, mucosal protectants, prokinetic agents, and acid suppressants.

A re-evaluation of the anabolic effect of testosterone in rats: interactions with gonadectomy, adrenalectomy and hypophysectomy

Growth and body composition were determined in rats implanted with silastic tubes containing testosterone. The implant (i) had no effect on growth in intact males, (ii) restored the sub-normal weight gain of gonadectomized males to normal (+ 30%; p<0.01), (iii) substantially increased weight gain in intact females (+ 172%; p<0.001), and (iv) caused a further increase (+32%; p<0.01) in the accelerated weight gain resulting from ovariectomy. In intact animals of both sexes, testosterone caused significant atrophy of the reproductive tissues; this was accompanied in females by reduced plasma estradiol concentrations. Thus the large effect of testosterone on growth in intact females is probably due to diminished secretion of ovarian estradiol, and is distinct from the smaller effect observed in castrated animals of both sexes. To investigate the mechanism underlying the latter response, testosterone was implanted in rats which had been both adrenalectomized and gonadectomized, and also in hypophysectomized animals. In each case a significant anabolic effect was observed, showing that the response requires neither adrenal nor pituitary glands. In all experiments, increased body weights resulting from testosterone treatment consisted at least partly of fat-free mass.