Months Of Life Research Articles

Associations between turn out practices and rates of musculoskeletal disease and injury in Thoroughbred foals and yearlings on stud farms in the United Kingdom.

Early-life locomotor activity during turn out may alter susceptibility to musculoskeletal disease and injury via modulation of behaviours and tissue development during growth. Investigate associations between turn out practices and rates of musculoskeletal disease and injury in young Thoroughbreds on stud farms in the United Kingdom. Prospective cohort. Daily records were kept on location and duration of turn out for 134 Thoroughbred foals on six stud farms, from birth until leaving the farm or study exit. Data on veterinary-attended episodes of musculoskeletal disease or injury were collated concurrently. Average daily turn out times (hours), areas (acres) and group size (n foals) were calculated for rolling 7- and 30-day periods of age. Multivariable Cox regression, including farm as a random effect, was used to investigate associations between turn out practices and musculoskeletal disease and injury. The overall incidence of musculoskeletal disease or injury was 5.3 cases/100 foal-months at risk (95% confidence interval [CI]: 4.2-6.6). Compared with 24/7 turn out, average daily turn out times of between 9 and 23 hours over a 7-day period were associated with a 4.6-fold increase in musculoskeletal injury rate (95% CI: 1.7-12.3; P < 0.001), adjusting for farm and paddock area. Each 1-acre increase in the average daily turn out area during the 4th month of life, reduced the rate of musculoskeletal disease and injury between 6 and 18 months of age by 24% (hazard ratio 0.76, 95% CI: 0.58-0.99; P < 0.001), adjusting for farm and turn out time. Non-random sample of participants may affect generalisability. Use of veterinary-attended events likely underestimates disease/injury rates. Results suggest that disruptions or alterations to turn out time routines increase injury risk and should be avoided where possible. Turn out in larger paddocks, particularly before weaning, may confer protection against subsequent musculoskeletal disease and injury.

EFFECT OF PROBIOTIC VETOM 1.1. ON PHYSICAL AND BIOCHEMICAL INDICATORS OF CHICKENS

Industrial poultry farming is the leading branch of agriculture. Therefore, it is necessary to consider the body’s physiological state, the resistance of organs and tissues, and their resistance to various influences during the intensive use of poultry. These factors are the basis for maintaining the health and productivity of the bird. Different biologically active substances are used to increase young poultry’s viability. Probiotics deserve special attention. They are essential in the first days of the life of young animals when the intestines are colonised by microflora. Probiotics deserve special attention. They are necessary for the first days of the life of young animals when the intestines are colonised by microflora. The study aimed to study the effect of the probiotic preparation Vetom 1.1 on chickens’ growth and blood biochemistry parameters. The research was carried out based on LLC APF “Yeniseiskaya”—Maloeniseikoye of the Biysk district of the Altai Territory. Two groups of analogue chickens were formed: experimental and control. Each group had 15 Brown Nick goals. In the biochemical study of blood, the following were considered: total protein, glucose, cholesterol, aspartate aminotransferase, and alanine aminotransferase. The assessment was done every two weeks from the first day of life. Thus, the effectiveness of using probiotics as a prophylactic agent and growth stimulator of chickens was established. On the first day of life in chickens, the metabolic parameters (total protein, glucose, cholesterol, aspartate aminotransferase, alanine aminotransferase) were in the lower range of physiological values. In control chickens, there was a tendency to metabolic disorders and an increased likelihood of liver damage by the 4th month of life. The probiotic preparation Vetom 1.1 in the diet normalises metabolic processes and increases average daily gains in chickens.

Child Health and Poverty in Pakistan

This study examines the health status of Pakistani children using two important indicators, morbidity and malnutrition measured by weight-for-age and height-for-age. The demand for medical services has also been determined. The main data source used in this study is the 2000-01 Pakistan Social-Economic Survey (PSES), which provides sufficient information on child health and poverty. Findings of the study show that both exclusive breastfeeding during the first 4-5 months of life and immunisation can help control the occurrence of illness significantly among the young children (0-5 months). These also reinforce the role of mother’s education in the production of child health (nutritional status). This role of mother’s education is found to be more pronounced in the poor families than in the non-poor families. The rise in poverty since the mid-1990s has adversely influenced the nutritional status of children. The basic issue is about how to reduce the household food insecurity. The benefits of recent high GDP growth may be transferred to the poor through employment generation, which has been slow in the past decade. Real incomes of the poor and the vulnerable segments of the population may also be protected against the rise in prices of essential food items. At present, the health and nutrition sector is getting only 0.7 percent of the GDP. Health care facilities in the country are curative in nature, and are heavily skewed in favour of the diagnostic and treatment side, not preventive healthcare aspects. More resources should be made available for preventive healthcare aspects. Coverage of child immunisation should be enhanced, and the provision of safe drinkingwater may be given high priority in the social sector policies.

Military HealthySteps Pilot Program Outcome Study.

Military families face many unique challenges, including frequent separations, demanding work hours, and relocations. The HealthySteps (HS) program may offset these challenges utilizing the expertise of a nonclinical child development specialist called a HS specialist who offers enhanced well-child visits (WCVs), support between visits, and connections to community resources. Our study sought to identify the impact of the military HS pilot program on the timeliness of WCVs, immunizations, routine behavioral and developmental screenings, and referrals to community resources within the first 15 months of life (MOL). We retrospectively reviewed charts of 26 HS-enrolled and 26 randomly selected age-matched non-HS-enrolled children from age 2 to 15 MOL. Demographic variables obtained include child's gender, child's birth order, mother's age, active duty parent's rank classification, and active duty parent's gender. We examined five outcomes measures aligning with the American Academy of Pediatrics health supervision, immunization, and screening recommendations and National Committee for Quality Assurance Healthcare Effectiveness Data and Information Set measures: (1) completed six or more WCVs in the first 15 MOL, (2) completed developmental screening at the 9-month WCV, (3) up to date on vaccinations at 15 MOL, (4) completed three or more postpartum depression (PPD) screens in the first 6 MOL, and (5) the total number of documented referrals to community resources within the first 15 MOL. Chi-square analysis and independent t-tests were used to compare the groups. There was no statistical significance (P > .05) between the HS-enrolled and control groups for all five demographic variables. A significantly higher percentage of children in the HS-enrolled group received PPD screening compared to the control group (96% vs. 73.1%, P = .021). The HS-enrolled group had a higher mean number of community resource referrals at 15 MOL of 2.46 (SD = 1.14) vs. the control group with a mean of 0.19 (SD = 0.49). None of the other outcomes showed a statistically significant difference between groups. The results of this study indicate the positive impacts of the military HS program on referrals to community resources and PPD screening, reflecting the HS specialist focus on the family unit. Limitations of this study include the small population size and limited demographic information resulting from the retrospective nature of the study and pilot status of the HS program. Larger prospective studies are needed to clarify the true impact of the HS program in the military health system.

Exposure to antenatal corticosteroids and infant cortisol regulation

Administration of antenatal corticosteroids (AC) is the standard of care during pregnancy for women who are at risk of early delivery. Evidence indicates that AC improve survival and reduce morbidity for preterm infants. However, research suggests that infants whose mothers receive AC have an altered hypothalamic-pituitary-axis (HPA) response to stressors in early life. Results are mixed regarding the nature of these effects, with studies showing both suppressed and augmented HPA activity. In addition, research is very limited beyond the 4th month of life. The purpose of this study was to determine if AC exposure was associated with infant cortisol levels in a resting state or in response to a stressor at 1, 6 and 12 months postnatal. We also evaluated the moderating role of preterm birth in this association. 181 women and their infants participated in the study. Women were recruited during the 3rd trimester of pregnancy; at this time, they completed the Perceived Stress Scale and provided 8 salivary samples over a 2-day period for cortisol assay. They provided these data again at 6 and 12 months postnatal. At 1, 6, and 12 months postnatal, salivary samples were collected from infants to examine their cortisol levels before and after participation in a ‘stressor protocol’. Data were extracted from the medical record on AC exposure, gestational age, maternal obstetric risk, and neonatal morbidity. Mixed effects multilevel regression modeling was used to examine the aims. Infants whose mothers received AC had significantly lower resting state (B = −2.47, CI: −3.691, −0.0484) and post-stressor (B = −2.51, CI: −4.283, −0.4276) cortisol levels across the first year of life than infants whose mothers did not receive AC. There was no moderating effect of preterm birth on the relationship between AC exposure and cortisol. Results indicate a state of dampened HPA activation and cortisol hypo-arousal that persists across the first year of life among infants who were exposed to corticosteroids in utero. Further research is needed to examine mechanisms responsible for any alterations that occur during development of the fetal HPA axis, including epigenetic and biochemical factors that control hormonal secretion, negative feedback, and glucocorticoid receptor function throughout the HPA axis. Findings warrant careful consideration by obstetric clinicians of the benefits and risks of prescribing AC.

Hymenal Tag in a Newborn.

Case presentationWe report on a 7-day-old female newborn at term, with no associated pathology, in whom a smooth pinkish formation was observed in the dorsal part of the hymen, protruding between the labia minora Fig. 1. Physical examination suggested a hymenal tag, a polypoid hymenal lesion secondary to maternal estrogen exposure that tends to resolve spontaneously in the first months of life, and thus excluded the initial need for complementary tests. As expected, the excrescence progressively disappeared during the first months of life Fig. 2.

Tuticaj telesne težine na razvoj sekundarnih centara osifikacije i termina zatvaranja velike fontanele kod odojčadi

Introduction: during the infant development, the organ growth is influenced by genetic factors, diet, hormones and many neuropeptides. The secondary ossification center in the hip joint begins to form around the 4th month of life. Primary dentition begins at the age of 5-6 months with the emergence of the central incisor in the maxilla. At birth, 6 fontanelles are present between the plate bones of the cranium. The largest is the anterior or large fontanelle. Objective of our research is to analyze the development of the secondary ossification center in the femoral head in relation to dentition and closure of the anterior fontanelle closure as well as influence of childrens' birth weight and current weight on these processes. Methodology: The study included 284 infants, male and female, aged 3 to 8 months. Clinical examination of the musculoskeletal system, anthropomentric measurements and ultrasonographic findings of the hip joint were performed at the Pediatric Clinic of the Clinical Hospital Center Pristina in Gracanica. Results: The development of secondary ossification centre correlated with child's age, dentition, anterior fontanelle closure, birth weight and delivery method, as well as actual body weight. Anterior fontanelle size was inversely related to age, body weight and secondary ossification. Conclusions: According to regression analysis, body weight is the only factor that has a direct and independent impact on the onset and progression of ossification process. Every additional kilogram of a child's body weight accelerates secondary ossification by 1.3-3.77 times.

1240-P: Changes in Protein Expression during Islet Regeneration in a Cystic Fibrosis-Related Diabetes (CFRD) Ferret Model

Diabetes is a common complication among persons with cystic fibrosis (CF), affecting nearly 20% of adolescents and 50% of all adults with CF. The Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) knockout (KO) ferret is a well-characterized animal model of CF that exhibits distinct periods of dysglycemia and pancreatic remodeling that are similar to patterns observed in humans. After the first month of life (normoglycemia/Phase I), hyperglycemia develops during the second month of life (Phase II) with reduced islet mass, followed by a period of near normoglycemia (Phase III) during which the islet mass regenerates, followed by persistent hyperglycemia/CFRD at the 4th month of life (Phase IV). While dynamic changes in islet hormone mRNA levels have been described across these phases, changes in protein expression patterns have not been characterized. To this end, immunofluorescence was performed to characterize islet hormone expression patterns in age-matched CFTR KO and wild type (WT) ferrets, focusing on the regenerative Phase III. The relative intensity of immunofluorescent staining per islet area was calculated. Compared to WT ferrets, the relative staining intensity of insulin and glucagon increased (4.687 vs. 3.228, p&amp;lt;0.05 and 0.827 vs. 0.238, p&amp;lt;0.0001, respectively ), while the intensity of proinsulin decreased (1.061 vs. 1.455, p&amp;lt;0.05) in CF ferret sections. Our findings suggest increased efficiency of proinsulin processing and a potential compensatory upregulation of insulin expression during this phase with the surprising finding of increased glucagon expression. Additional studies are underway to further characterize changes in islet hormone expression across each of the four described phases as well as potential cellular dedifferentiation patterns. Disclosure H. M. Ismail: None. R. G. Mirmira: Advisory Panel; Self; Hibercell Inc., Sigilon Therapeutics, Inc., Veralox Therapeutics, Employee; Spouse/Partner; Beta Bionics, Inc. C. Evans-molina: Advisory Panel; Self; Provention Bio, Inc., Consultant; Self; Dompe, Other Relationship; Self; Bristol-Myers Squibb Company, Nimbus Pharmaceuticals, Pfizer Inc. R. N. Bone: None.

Prenatal diagnosis of complete transposition of the great arteries and dextrocardia in the fetus with left juxtaposition of the atrial appendages and subpulmonary ventricular septal defect

The case of prenatal ultrasound diagnosis of complete transposition of the great arteries and dextrocardia in the fetus with left juxtaposition of the atrial appendages and subpulmonary ventricular septal defect in the third trimester is presented. The postnatal echocardiography confirmed the prenatal diagnosis. At 2 months of life, first surgical intervention under extracorporeal circulation was performed: the arterial switch operation and narrowing of the dilated pulmonary artery root, closure of patent foramen ovale, ligation of patent ductus arteriosus. At the age of 8 months, the child underwent a second operation: closure of ventricular septal defect with the transventricular approach and plastic surgery of the pulmonary artery. After an operation third-degree atrioventricular block (bradyarrhythmias) has occurred and 2 weeks later patient's health improvement was achieved, and he underwent implantation of a single-chamber pacemaker. Currently, the child is 2 years old, physical and mental development corresponds to age and he remains under the supervision of specialists.

Impact of Age at Starting Cysteamine Therapy on Serum Chitotriosidase in Cystinotic Iraqi Children

Cystinosis is a rare autosomal recessive lysosomal storage disease with high morbidity and mortality. Itis caused by mutations in the CTNS gene that encodes the cystine transporter, cystinosin, which leadsto lysosomal cystine accumulation. It is the major cause of inherited Fanconi syndrome and should besuspected in young children with failure to thrive and signs of renal proximal tubular damage. The diagnosiscan be missed in infants, because not all signs of renal Fanconi syndrome are present during the first monthsof life. Elevated white blood cell cystine content is the corner stone for the diagnosis. Since chitotriosidase(CHIT1 or chitinase-1) is mainly produced by activated macrophages both in normal and inflammatoryconditions. Which suggests that cystinosis should be included in the differential diagnosis of disorders withincreased plasma chitotriosidase activity. This study is aimed to investigate the impact of cystinosis on therenal function in relation to age at detection and initiation of treatment course,besides estimating serumchitotriosidase level,as a screening marker and therapeutic monitor for cystinosis disease in Iraqi childrenwith cystinosis.The present study is a case-control study included a samples of 30 children with nephropathic cystinosis,compared to 25 healthy control children from those attending at The Genetic Rare Diseases Center/ALEmamain AL-Kadhimain teaching hospital, Baghdad-Iraq.Our results report patients who started taking the medication (cysteamine) before two years of age werepresented with significantly lower levels of cystine and chitotriosidase in addition to better renal function(higher GFR) (P-value = 0.0001) .In other words, earlier treatment led to better disease control and lessdeterioration of renal function.In conclusion serum chitotriosidase activity estimation might aid in monitoring therapeutic benefit ofcysteamine therapy and the prognosis of the disease when WBC cystine assessment is not available.

Atresia de vías biliares extrahepaticas en pediatria y citomegalovirus como causante

La atresia de vías biliares es una alteración con gran importancia clínica, más frecuente en la primera infancia, secaracteriza por la obliteración proliferativa de los conductos biliares que progresa a fibrosis hepática, cirrosis einsuficiencia hepática en etapa terminal.El objetivo es presentar un caso clínico inusual y conocer la forma de actuar ante un caso similar. Se trata depaciente femenino de 4 meses de edad, con piel y mucosas ictéricas – verdosas, con hígado palpable debajodel reborde costal derecho, bazo palpable debajo del reborde costal izquierdo. Serología para Citomegaloviruspositivo. La ecografía abdominal reporto: Atresia de vías biliares.Se indicó una portoenterostomia de Kasai, sin embargo por la edad de la paciente, el procedimiento quirúrgicono se realizó.La atresia de vías biliares es una patología poco frecuente, su etiología es desconocida, pero es importante saberreconocerla durante los primeros 2 meses de vida, para evitar complicaciones.

P1452 A rare case of embolic blindness in an adult patient with univentricular heart after fontan operation

Abstract Background Thromboembolic complications following Fontan procedure are one of the major causes of mortality and morbidity among patients with univentricular heart. We may classify thromboembolic complications into two groups: systemic- and nonsystemic. We present a case of a patient with a manifestation of both. Case report 24-year old female, foreign student was admitted to Ophthalmology Department due to sudden blindness of the left eye. Performed studies revealed embolus in the left central retinal artery. Because the patient had the history of congenital heart defect she was referred to our department. Analysis of medical documentation showed that the patient has combined congenital heart defect including right ventricle hypoplasia, tricuspid atresia, pulmonic stenosis, ventricular septal defect, atrial septal defect and persistent ductus arteriosus. She had a history of two surgeries: modified left-side Blalock-Tausing connection (in 4th month of life) and total cavo-pulmonary connection with the closure of Blalock-Tausing and excision of interatrial septum (in 2,5 year of life). On admission she presented with left-eye blindness. She had no dyspnoea or palpitations. However she reported very severe migraines from a few days preceding the admission to hospital. Echocardiography revealed tricuspid atresia, hypoplastic right ventricle, preserved systolic and diastolic function of left ventricle, atrial septal defect with no restriction. We observed enlarged diameter of vena cava inferior with no respirophasic variations and massive thrombus in inside with very low flow. The connection between inferior vena cava and right pulmonary artery was working properly with no visible fenestration. We also observed a winding vessel between ascending aorta and truncus pulmonalis/pulmonary artery with continuous flow of blood from left to right side. Computer tomography confirmed the diagnosis of massive thrombosis of vena cava inferior. Patient had anticoagulation started. Two days later we the flow in inferior vena cava returned – we did not observe any thrombus. Patient was referred to catheterization and had chronic anticoagulation initiated. Three months follow-up revealed no changes in clinical condition of a patient. Discussion The palliative Fontan operation predispose to the increased risk of thromboembolic complication. Despite the risk factors of such complications have been identified, there are no guidelines about prophylactic anticoagulation in that group of patients. As a result, chronic anticoagulation is initiated in patients who have other indications e.g. atrial fibrillation. It seems that it would be beneficial to define the group of patients after Fontan procedure with indications to chronic anticoagulation therapy despite arrhythmias.

Optimal timing of hepatitis C treatment among HIV/HCV coinfected ESRD patients: Pre- vs posttransplant.

Patients with end-stage renal disease (ESRD) who are coinfected with hepatitis C virus (HCV) and human immunodeficiency virus (HIV) have access to effective treatment options for HCV infection. However, they also have access to HCV-infected kidneys, which historically afford shorter times to transplantation. Given the high waitlist mortality and rapid progression of liver fibrosis among coinfected kidney-only transplant candidates, identification of the optimal treatment strategy is paramount. Two strategies, treatment pre- and posttransplant, were compared using Monte Carlo microsimulation of 1000000 candidates. The microsimulation was stratified by liver fibrosis stage at waitlist addition and wait-time over a lifetime time horizon. Treatment posttransplant was consistently cost-saving as compared to treatment pretransplant due to the high cost of dialysis. Among patients with low fibrosis disease (F0-F1), treatment posttransplant also yielded higher life months (LM) and quality-adjusted life months (QALM), except among F1 candidates with wait times ≥ 18months. For candidates with advanced liver disease (F2-F4), treatment pretransplant afforded more LM and QALM unless wait time was <18months. Moreover, treatment pretransplant was cost-effective for F2 candidates with wait times >71months and F3 candidates with wait times >18months. Thus, optimal timing of HCV treatment differs based on liver disease severity and wait time, favoring pretransplant treatment when cirrhosis development prior to transplant seems likely.

PIN99 - DOES A CHANGE IN VACCINATION SCHEME AFFECT PNEUMOCOCCAL CONJUGATE VACCINATION ADHERENCE? COMPARISON OF QUOTAS AND ADHERENCE IN MATURE BORN INFANTS IN GERMANY

In August 2015, the German standing vaccination committee changed the pneumococcal conjugate vaccination (PCV) regimen from a 3+1 scheme (3, 4, 5 and 12-15 months of life (MoL) to a 2+1 scheme (3, 5 and 12-15 MoL) for mature born infants up to 24 MoL. Albeit the potentially reduced effectiveness, application of one dose less might reduce cost and potentially improve vaccination scheme adherence. Study aim was to assess vaccination quotas and timeliness for PCV in children pre and post scheme-adaptation to analyse adherence improvement to vaccination recommendations based on real world data. A retrospective claims data analysis was conducted using the InGef research database containing a representative sample of the German SHI. The study population consisted of all mature infants from the first two birth quarters of 2013 (reference cohort) and 2016 (observational cohort). Both cohorts were followed-up for an individual timeframe of 9 MoL. Hexavalent combination vaccination (HEXA) with a consistent 3+1 scheme was analysed as reference vaccination. “Vaccinated” was defined as at least one dose application, “completed primary series” as administration of all recommended doses (3 in reference cohort, 2 in observational cohort), “timeliness” as time of administration according to the recommended age for the respective dose. 24,005 (reference cohort 2013: 17,466) mature born children were analysed with 88.45% (88.94%) being vaccinated against pneumococcal diseases compared to 89.20% (86.97%) against HEXA at 9 MoL. Primary PCV series were completed in 76.80% (74.43%) of infants, primary HEXA series in 77.43% (75.00%). The last dose of primary PCV series was administered in 33.38% (29.24%) on time. The 2+1 scheme seemed implemented in mature born infants, while the rate of unvaccinated remained unchanged. Currently there is no evidence that dose reduction lead to remarkably improved vaccination rates or adherence. Further analyses will include a 24 month follow-up with data availability.

Cistinosis nefropática: caso clínico que ilustra diagnóstico molecular

Nephropatic cystinosis (NC) is a rare disease associated with pathogenic variants in the CTNS gene, with a common variant that consists of a 57kb-deletion involving CTNS. Patients with NC that are treated with cysteamine improve their life quality and expectancy. We report a 12-month-old girl with a poor growth rate since the 4th month of life. She was admitted to the Hospital with acute kidney injury, severe dehydration and metabolic acidosis. She was treated with volume restorative and bicarbonate. Proximal tubulopathy and Fanconi's syndrome was diagnosed. Medical treatment improved renal function that was stabilized in stage 4 chronic kidney disease (CKD). Since infantile NC was suspected, CTNS genetic analysis was considered. Genomic DNA was isolated from peripheral blood to perform PCR for exons 3-12 in CTNS gene and for the specific 57kb-deletion PCR. Afterwards, variant segregation analysis was performed in the familiar trio. The genetic analysis showed that the patient was homozygous for the common 57kb-deletion encompassing CTNS that had been inherited from her asymptomatic heterozygous parents. The molecular confirmation allowed genetic counselling for parents and facilitated the access to cysteamine. Oral treatment with cysteamine resulted in improvement of renal function to CKD stage 3. After 16 months of treatment the patient shows metabolic stability and mild recovery of height. Ophthalmologic follow-up detected ocular cystine crystals 12 months after diagnosis, starting cysteamine drops.

The Prognosis for Fetuses with Vein of Galen Malformation and Symptoms of Heart Failure

Abstract Vein of Galen Malformation (VGM) it is the most common cerebral arteriovenus malformation in fetuses and children. Usually VGM causes volume overload of the heart and can induce mass effect in the brain, causing progressive neurological impairment. Modern treatment allow on earlier therapy (before the 5th monthof life). This gives the newborn with isolated VGM and heart failure a chance of survival. This work presents case of isolated vein of Galen malformation with diagnosed cardiomegaly, monophasic flow through the tricuspid valve, large right heart, pericardiac effusion, dilatation of SVC and abnormal doppler exam. Postnatal management included aggressive medical treatment of cardiac failure and early transarterial embolization of the selected vessels feeding the aneurysm at 6 days of age. The newborn is 6 month old, growing normally without neurological deficits or developmental retardation and waiting of next stage therapy. New techniques of treatment give fetuses with VGM and prenatal signs of cardiac insufficiency a chance of survival and healthy life, in a group of selected cases. The analysis of the cardiovascular system in fetuses with VGM according to uniform criteria is essential in order to assess the influence of these malformations on the survivability of newborns.

Necrotizing Retinitis Secondary to Congenital Cytomegalovirus Infection Associated with Severe Combined Immunodeficiency.

A 20-day-old male infant who was born at 39 weeks of gestation was admitted to neonatal intensive care unit due to severe respiratory insufficiency. In retinal examination, peripheric retinal white-black color areas that correspond to necrotizing retinitis, moderate vitritis, macular and optic nerve head involvement, vascular leakage, and sheathing indicating perivasculitis were revealed. Despite the fact that CMV specific IgM was undetectable, CMV DNA with high viral load was found in his blood sample by means of real-time polymerase chain reaction assay. Serologic examination (IgM) for rubella, toxoplasma, herpes simplex type 2, and human immunodeficiency virus (anti-HIV) was negative. During the further evaluation for systemic immune dysfunction, decreased immunoglobulin and lymphocyte levels that confirm the diagnosis of severe combined immunodeficiency have been reached. Although given systemic intravenous ganciclovir and antibiotics treatment, the patient died at the 4th month of life due to respiratory insufficiency.

Balancing Benefits and Risks of Iron Fortification in Resource-Rich Countries

In the recommendations, the contrast in the iron exposure of formula-fed infants vs breastfed infants has primarily focused on the better bioavailability of the iron in breast milk. Although an absorption efficiency of approximately 50% is often quoted, some studies have actually reported absorption in the range of 12%-16%, 7,8 making that bioavailability distinction much less potent. This also suggeststhat absorptionof substantialamountsof dietary ironsimply isnot critical during the early monthsof life in healthy infants of normal birth weight. Among all the compositional differences between human milk and formula, the differences in iron content are the most extreme. Virtually all mammalian milks are low in iron, with the exception of rodents, inwhichpostnatalgrowth isextremely rapid.Itseemsimplausiblethatthisconservedbiologicalpatterniswithoutpurpose.Itis also clear that iron deficiency occurs in breastfed infants only after the very early months of life. The practical challenge is to identify when the birth iron endowment is exhausted, at which point the infant needs a source of iron from the diet. This article will discuss the potential advantages of a low iron intake for the infant and the potential adverse effects of drastically altering this, especially in the first 6 months of life. From the outset, two realities must be acknowledged. First, iron deficiency (especially without anemia) in infants remains common, particularly in high-risk groups, including older normal breastfed infants and premature and/or in low birth weight infants. Whether this mild iron deficiency has adverse effects on development is not known. Second, research on potential adverse effects of early and excessive iron exposure is limited, and the evidence base for caution is suggestive but not yet demonstrated by rigorously designed trials. Thus, this represents an emerging area of consideration, and, given the advances in understanding of iron metabolism, the interaction between iron and inflammation, and the importance of early influences on the immature gut and immune system, it is an area that warrants much stronger scientific investigation.

A decision-analytic model of idelalisib in relapsed or refractory patients with follicular lymphoma in the United States.

30 Background: There are currently few treatment options for relapsed/refractory (RR) indolent non-Hodgkin’s lymphoma (iNHL) patients. Idelalisib (IDELA) is a first-in class PI3Kδ inhibitor with substantial clinical efficacy in iNHL patients refractory to rituximab and an alkylating agent. A single-arm clinical trial (Study 101-09) showed RR iNHL patients treated with IDELA have a median of 11 and 20.3 months of progression-free and overall survival (PFS and OS), respectively. Efficacy was also demonstrated in patients with iNHL subtypes such as follicular lymphoma (FL). The objective of this study was to project the health outcomes of IDELA versus the current standard of care for US FL patients. Methods: A partitioned survival model simulated a cohort of RR FL patients over 10 year time horizon. Patients first received IDELA or an aggregate comparator of current RR iNHL chemotherapy regimens in a progression-free state before transitioning to a progressive-disease state where they received palliative care until death. Survival data was fit and extrapolated from Study 101-09 (IDELA) for FL patients. A real-world database claims analysis provided survival, disease- and treatment-related adverse event (AEs) profiles, and medical resource utilization data for RR iNHL patients for the comparator. All outcomes were discounted at 3%. Results: Claims data predicted a median of 6.16 and 13.04 months of PFS and OS, respectively, for the comparator. Our model suggests that IDELA treatment improved health outcomes over 10 years versus the comparator, increasing life-months (LMs) and progression-free life-months (PFLMs) by 9.94 and 4.63 mos, respectively. Over 1 year, IDELA reduced both AEs and hospitalisations in FL patients by 40.3% and 49.8%, respectively. Deterministic and probabilistic sensitivity analyses demonstrated the model results are robust across different methods of survival extrapolation. Conclusions: IDELA was projected to improve health outcomes in RR FL patients compared to current treatments, largely driven by improved PFS and OS; short-term reductions in AEs and hospitalisation were specifically related to a delayed disease progression.

Morphological studies on the harderian gland in the ostrich (Struthio camelus domesticus) on the embryonic and post-natal period.

The present investigation was performed on 50 ostriches from 28th day of incubation until the 7th month of life. The morphological (morphometric, histological, histometric and histochemical) studies were conducted. Tissue sections were stained with haematoxylin-eosin, methyl green-pyronin Y, periodic acid-Schiff, alcian blue pH 2.5, aldehyde fuchsin and Hale's dialyzed iron studies. The Harderian gland becomes macroscopically visible on the 28th day of incubation. It is situated in the ventronasal angle of the orbit near inter-orbital septum, between medial rectus muscle, pyramidal and ventral oblique muscles. The Harderian gland of ostrich is a tubulo-acinar gland. The acini were composed of tall conical cells which formed a small lumen and were surrounded by myoepithelial cells. These cells had a granular basophilic, vacuolated cytoplasm. Each of the lobes has a system of complex branching ducts - tertiary, secondary and primary. In the III of research group (3rd week of life), the presence of few plasma cells was demonstrated, which were located within acini and tertiary and secondary ducts, whereas the biggest concentration of plasma cells was observed in group IV of research tissue (4th month of life). The dark cells were observed first time in main ducts 72h after hatching of nestlings (group II). The morphometric and histometric studies showed that the most intensive growth of Harderian gland occurred between the third week and the seventh month of birds' life. The histochemical study indicated the presence of neutral and acidic mucins, glycoproteins and carboxylated acid mucopolysaccharides.