METHODS: A total of 1267 suspected cases of Toxoplasma infection were enrolled in this study from January 2016 to December 2016. The cases were screened for anti-Toxoplasma IgM and IgG by electrochemiluminiscence immunoassay (ECLIA) method. Based on the serological profiles, all cases with first seropositive serum samples were considered as suggestive cases of Toxoplasma infection. Thus, second serum samples were obtained after an interval of 2 weeks. The diagnosis was made based on laboratory results and clinical data.
RESULTS: A total of 482 T. gondii seroreactive cases were selected. The patient's records were traced and the data were analysed. Accordingly, 152 cases were diagnosed as clinically confirmed cases; 198 cases were clinically asymptomatic and 132 cases were newborn babies or infants who did not have toxoplasmosis and only acquired passive immunity from their mothers. The paired serum algorithm allowed classifying the seroreactive cases as follows: early (0.6%), acute (1.9%), reactivation (13.5%), recent (1.5%), passive immunity from mother (27.3%) and possible congenital infections (1.2%). In addition, cases of reactivated toxoplasmosis were detected among the pregnant mothers (13/82; 15.8%), children aged above 1 year (2/8; 25.0%) and immunocompetent mothers (5/135; 3.7%). Furthermore, the application of the paired serum analysis resulted in remarkably improved treatment initiation.
CONCLUSIONS: Toxoplasmosis diagnosis and treatment can be improved through the use of paired serum diagnostic algorithm.
OBJECTIVE: The aim is to document the post-operative refraction, VA and complications of non-traumatic pediatric cataract surgery performed in a tertiary referral center in Malaysia.
METHODOLOGY: This retrospective study reviewed case notes of all consecutive patients aged 12 years and below who underwent cataract surgery from January 2010 to December 2015. Patients were recruited if they had a minimum of six months post-operative follow-up. Exclusion criteria included traumatic cataract, central nervous system abnormalities, incomplete medical records or pre-existing ocular pathology. Subjects were divided into two groups based on refraction at one month. Subjects with refraction within 1- dioptre of the targeted spherical equivalent were in the success group and the rest were in the failure group.
RESULTS: A total of 111 subjects were recruited (65 subjects in success group and 46 subjects in the failure group). Mean age at surgery was 33.14 (SD: 33.47) months. The success group had significantly longer axial length (p:0.0045, CI: 0.566-0.994, OR: 0.750). At final review, 44.1%(49/111) subjects had visual acuity of 0.3LogMar or better. The success group had better final mean VA in comparison to the failure group (p:0.034, CI:1.079-7.224, OR: 2.791).
CONCLUSION: The outcome of non-traumatic paediatric cataract surgery was acceptable with 58.6% achieved targeted refractive correction at 1-month post-operative period. Longer axial length was associated with better refractive outcome. Capsule related complications was the most common intra-operative complication.
OBJECTIVES: To estimate prevalence and secular trends in children's hearing loss.
DATA SOURCES: We searched MEDLINE and Embase from January 1996 to August 2017.
STUDY ELIGIBILITY CRITERIA: We included epidemiologic studies in English reporting hearing loss prevalence.
STUDY APPRAISAL AND SYNTHESIS METHODS: The modified Leboeuf-Yde and Lauritsen tool was used to assess methodological quality. Meta-analyses combined study-specific estimates using random-effects models.
PARTICIPANTS: Children 0 to 18 years of age.
RESULTS: Among 88 eligible studies, 43.2% included audiometric measurement of speech frequencies. In meta-analyses, pooled prevalence estimates of slight or worse bilateral speech frequency losses >15 decibels hearing level (dB HL) were 13.1% (95% confidence interval [CI], 10.0-17.0). Using progressively more stringent cutpoints, pooled prevalence estimates were 8.1% (95% CI, 1.3-19.8) with >20 dB HL, 2.2% (95% CI, 1.4-3.0) with >25 dB HL, 1.8% (95% CI, 0.4-4.1) with >30 dB HL, and 0.9% (95% CI, 0.1-2.6) with >40 dB HL. Also, 8.9% (95% CI, 6.4-12.3) had likely sensorineural losses >15 dB HL in 1 or both ears, and 1.2% (95% CI, 0.5-2.1) had self-reported hearing loss. From 1990 to 2010, the prevalence of losses >15 dB HL in 1 or both ears rose substantially (all P for trend
DESIGN: Forty-four full-term healthy neonates (17 males and 27 females) participated in a longitudinal study. The neonates were assessed at 1-month intervals from 0 to 6 months of age using high-frequency tympanometry, acoustic stapedial reflex, distortion product otoacoustic emissions, and pressurized WBA. The values of WBA at tympanometric peak pressure (TPP) and 0 daPa across the frequencies from 0.25 to 8 kHz were analyzed as a function of age.
RESULTS: A linear mixed model analysis, applied to the data, revealed significantly different WBA patterns among the age groups. In general, WBA measured at TPP and 0 daPa decreased at low frequencies (<0.4 kHz) and increased at high frequencies (2 to 5and 8 kHz) with age. Specifically, WBA measured at TPP and 0 daPa in 3- to 6-month-olds was significantly different from that of 0- to 2-month-olds at low (0.25 to 0.31 kHz) and high (2 to 5 and 8 kHz) frequencies. However, there were no significant differences between WBA measured at TPP and 0 daPa for infants from 3 to 6 months of age.
CONCLUSIONS: The present study provided clear evidence of maturation of the outer and middle ear system in healthy infants from birth to 6 months. Therefore, age-specific normative data of pressurized WBA are warranted.
METHODS AND FINDINGS: We included all prospective controlled studies (randomised and non-randomised) comparing rooming-in to nursery care that reported full or partial breastfeeding up to six months. We used the 2016 search results of the Cochrane review and updated the search to August 2018 using OVID MEDLINE. Duplicate data extraction and assessment of risk of bias were performed. Meta-analyses were performed using REVMAN 5. The GRADE approach was used to assess quality of evidence. Seven studies were included, five had 24-hour-per-day, one daytime only and one 8-hours-per-day rooming-in. Four studies had at least one additional co-intervention: Differences in delivery room management, and educational packages. All studies contributing to meta-analyses had 24-hour rooming-in. There was no difference in the proportion of infants on full breastfeeding at 3 months (RR 1.14; 95% CI 0.84 to 1.54; very-low-quality evidence), 4 months (RR 0.99; 95% CI 0.73 to 1.33; very-low-quality evidence) and 6 months (RR 0.95; 95% CI 0.57 to 1.58; low-quality evidence). The proportion of infants on partial breastfeeding at 3-4 months was higher with rooming-in (RR 1.31; 95% CI 1.06 to 1.61; very-low-quality evidence).
CONCLUSION: The addition of non-randomised prospective controlled studies to existing evidence did not add further information on the effects of rooming-in on breastfeeding duration but resulted in lower quality of evidence. Uncertainty about the effects of rooming-in on breastfeeding duration remains.
Case presentation: In May 2015, a 20 year old first-time mother at 36 weeks gestation was seen in a district health clinic in Kuching, Sarawak in regards to her ability to breastfeed. She had a history of a flame burn at the age of 5 years old to her chest, abdomen, upper limb and part of her trunk. A skin graft was done on her whole chest and abdomen. Despite the injuries, she had pubertal and antenatal breast development. Her abdomen was able to stretch to accommodate her pregnancy. Physical examination showed a pregnancy which corresponded to date. The skin over her chest and abdomen appeared tight with areas of hyperpigmentation and hypopigmentation due to scarring from the skin graft. Breast tissues were palpable over her chest. The areola and nipple tissue were completely absent with complete scarring of the nipple-areolar complex. There was no duct opening to the areola for milk expression or leakage. Counselling regarding her breastfeeding issues was done. She delivered her baby at full term via spontaneous vaginal delivery with no complication. Oral cabergoline 1 mg was given on the first day postpartum. The baby was given infant formula via bottle feeding as the feeding method of choice.
Conclusion: Counselling plays an important part in the management of a mother with breastfeeding difficulty. Allaying the possible guilty feelings of not being able to breastfeed will fulfil the emotional gap which may arise in a mother with these challenges.
METHODS: A three-limbed double-blinded randomized control trial was conducted in a Level 3 neonatal intensive care unit. Forty five preterm neonates undergoing ROP screening were included. Eligible babies were randomly assigned to one of the three groups that orally received either expressed breast milk (n = 14), 10% dextrose solution (n = 14) or sterile water (n = 17), one minute before eye examination. The outcome measure was PIPP score.
RESULTS: All 3 groups were similar in baseline characteristics. The mean PIPP scores were comparable (p = 0.18) in the three groups (11.8 ± 2.8 vs. 9.8 ± 3.3 vs. 10.2 ± 2.9). The behavioral and physiological variables were also similar across all three groups.
CONCLUSIONS: Expressed breast milk, 10% dextrose or sterile water administered orally before ROP screening in preterm neonates have similar analgesic effects and do not significantly alleviate pain during the procedure.
OBJECTIVE: The review was performed to answer the following research question: "In VPNs, are high amounts of arginine in PN, compared with low amounts of arginine, associated with appropriate circulating concentrations of arginine?" Therefore, the aims were to 1) quantify the relationship between parenteral arginine intakes and plasma arginine concentrations in PN-dependent VPNs; 2) identify any features of study design that affect this relationship; and 3) estimate the target parenteral arginine dose to achieve desirable preterm plasma arginine concentrations.
DATA SOURCES: The PubMed, Scopus, Web of Science, and Cochrane databases were searched regardless of study design; review articles were not included.
DATA EXTRACTION: Only articles that discussed amino acid (AA) intake and measured plasma AA profile post PN in VPNs were included. Data were obtained using a data extraction checklist that was devised for the purpose of this review.
DATA ANALYSIS: Twelve articles met the inclusion criteria. The dose-concentration relationship of arginine content (%) and absolute arginine intake (mg/(kg × d)) with plasma arginine concentrations showed a significant positive correlation (P < 0.001).
CONCLUSION: Future studies using AA solutions with arginine content of 17%-20% and protein intakes of 3.5-4.0 g/kg per day may be needed to achieve higher plasma arginine concentrations.