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Paid maternity leave extension and exclusive breastfeeding practice: evidence from Brunei

Abstract

Background

Exclusive breastfeeding (EBF) of infants in their first 6 months postpartum is beneficial. However, maternal employment and short maternity leave impede EBF practice. In 2011, Brunei implemented a new Maternity Leave Regulation to extend paid maternity leave.

Objectives

To compare the prevalence of EBF between employed and nonworking mothers in Brunei, before and after extending paid maternity leave, to determine its effect on EBF and to determine the effects of maternal and infant sociodemographic characteristics.

Methods

Cross-sectional review of feeding records for infants born in 2010 (n = 6412, 85.5% all live births) and 2013 (n = 6680, 85.7%).

Results

EBF prevalence at 6 months postpartum increased from 29% in 2010 to 41% in 2013. EBF prevalence was higher among multiparous mothers (P < 0.001), mothers of Malay ethnicity (P < 0.05), and mothers of girls (P < 0.01 only in 2013) in both years. EBF prevalence among government-employed mothers (81.0%, 67.7%, and 57.8%) was greater than it was among nonworking mothers (79.1%, 66.3%, and 56.9%) by 1.9, 1.4, and 0.9 percentage points, respectively, during the first 3 months of active paid maternity leave in 2013. Mothers employed in the government and private sectors showed greater increases in the practice of EBF (15.5 and 10.8 percentage points respectively) than nonworking mothers (8.8 percentage points) from 2010 to 2013.

Conclusions

EBF prevalence increased after extending paid maternity leave, with the greatest increases seen among employed mothers. Maternal ethnicity, parity, and the sex of the infant were also correlated with EBF.

Open access
Postoperative cure in Iranian patients with gastric cancer: estimating the crude conditional probability in a relative survival setting in the presence of competing risks

Abstract

Background

Following treatment, cancer patients may be clinically cured. However, they may die for reasons other than cancer, called competing risks.

Objective

To estimate postoperative cure while considering the competing risks in Iranian patients with gastric cancer.

Method

Data were obtained from the Cancer Institute of Imam Hospital in Tehran. The analysis was conducted within the framework of relative survival by fitting the data to a flexible parametric cure model, taking into account the competing risks using general population data by adjusting for age, sex, and year of diagnosis.

Results

Of the 326 patients (224 male and 102 female) whose data were included, 235 deaths (72.1%) occurred during the follow-up period. The probability of conditional cure in terms of crude ratios of dying from causes other than gastric cancer in the surviving patients increased with the passage of time, and the slope of excess mortality approached almost 0 after 7 years. The estimated cure ratios showed a variation from 69% for 50-year-old men with diagnosis at early stages (I and II) to 3% for 80-year-old women with diagnosis at stage IV.

Conclusion

The ratio of patients in Iran who were estimated to die from cancer reduced significantly with the passage of time following the diagnosis, and the statistical cure point was estimated to be 7 years after diagnosis. However, aging was shown to be inversely associated. Although the same trend was observed in both sexes, we showed that men were statistically more likely to reach the cure point.

Open access
Anti-inflammatory effect of the taffy mu yeot, made from the Korean radish Raphanus sativus L. in a lipopolysaccharide-induced murine model of pulmonary inflammation

Abstract

Background

Korean radish (Raphanus sativus L.) is used in kimchi, a staple of Korean cuisine. A taffy, mu yeot, that includes mainly radish together with other herbs (Bulbus Allii Sativi, Fructus Zizyphi, Semen Zizyphi, Rhizoma Zingberis, and Radix Glycyrrihizae) is used traditionally in Korea to improve pulmonary symptoms. However, to our knowledge, these effects of the taffy have not yet been studied systematically.

Objectives

To elucidate the anti-inflammatory effects of radish taffy on macrophages and a murine model of pulmonary inflammation, and to suggest the most likely candidate for the effects.

Methods

A macrophage cell line, RAW264.7, was used to examine effects of the radish taffy in vitro. Pulmonary inflammation was assessed 24 h after oral instillation of lipopolysaccharide in mice treated with radish taffy for 10 days. We determined the chemical components of radish taffy quantitatively using tandem HPLC mass spectroscopy.

Results

Radish taffy had no apparent effect on the RAW264.7 cells. Treatment of the mice with radish taffy significantly reduced the recruitment of neutrophils to the lung, and the level of myeloperoxidase in bronchoalveolar lavage fluid (BALF). ELISAs showed that the treatment significantly decreased the level of IL 6 in BALF induced by LPS, but not the levels of IFNγ, TNFα, IL 10, or IL 12. Nor did the taffy change the levels of those cytokines or NF-κB activation in lung homogenates. HPLC-MS suggested glycyrrhizin as the most likely candidate for the anti-inflammatory effects.

Conclusions

Radish taffy suppresses neutrophil recruitment to lungs of mice, possibly by reducing IL 6 levels, which may lead to reduced pulmonary inflammation.

Open access
Clinical and laboratory findings and outcomes of classic organic acidurias in children from north-eastern Thailand: a 5-year retrospective study

Abstract

Background

Classic organic acidurias, including isovaleric aciduria (IVA), propionic aciduria (PA) and methylmalonic aciduria (MMA), are rare inherited metabolic disorders caused by deficiencies of enzymes in catabolic pathways.

Objective

To report clinical and laboratory findings and outcomes of classic organic acidurias in children north-eastern Thailand and their outcomes over the past 5 years.

Methods

During 2010-2014, twelve patients were identified as having classic organic acidurias confirmed by urine organic acids analysis.

Results

Classic organic acidurias were identified as follows; 5 patients with IVA, 4 patients with PA, and 3 patients with MMA. Ten patients had neonatal-onset and 9 cases were diagnosed during the neonatal period with clinical signs and symptoms of altered consciousness, poor feeding, respiratory distress, abnormal odor, and shock. Common laboratory findings included metabolic acidosis with an elevated anion gap, hyperammonemia, hypocalcemia, and cytopenia. Ammonia levels could be extremely high, especially in PA. Three patients with neonatal-onset of acidurias died during their first catabolic crisis, and one patient died later. One patient with MMA had exfoliative erythema after excessive dietary restriction. Four of 8 surviving patients had IVA and had better neurodevelopmental outcomes than those with PA and MMA.

Conclusions

Neonatal-onset classic organic acidurias are more common than late-onset cases and usually mimic neonatal sepsis. Laboratory findings that include hematologic abnormalities should raise suspicion. Close monitoring of biochemical parameters, growth and neurodevelopmental outcomes is necessary in a long-term follow-up.

Open access
Clipless laparoscopic adrenalectomy for pheochromocytoma

Abstract

Background

Laparoscopic adrenalectomy remains a challenging operation for pheochromocytoma (PCC) because of excessive secretion of catecholamines causing hemodynamic instability.

Objectives

To evaluate the use of the LigaSure vessel sealing system (Covidien-Medtronic) to secure hemostasis during laparoscopic adrenalectomy for PCC.

Methods

In this observational study we retrospectively reviewed a case series of 19 patients with preoperatively diagnosed PCC, who underwent laparoscopic adrenalectomy who underwent laparoscopic adrenalectomy using the LigaSure vessel sealing instead of using vascular clips or suturing. We report intraoperative findings, conversion rates, blood loss, operative time, morbidity, and postoperative outcomes.

Results

Surgery was performed successfully for 18 patients. Surgery for the remaining 1 patient of the present case series was converted to open adrenalectomy because of surrounding tissue invasion. No mortality or major morbidity was observed. Estimated blood loss was a mean (range 20–300) 153 mL (excluding the loss in the patient whose surgery was converted to open adrenalectomy). The pathology showed 6 patients with potentially malignant PCC (Pheochromocytoma of the Adrenal Scaled Score (PASS) ≥ 4).

Conclusions

The LigaSure device appears to be safe and effective in laparoscopic adrenalectomy for PCC. This clipless approach can be used with acceptable outcomes.

Open access
Complications and secondary surgeries after free flap for limb reconstruction at King Chulalongkorn Memorial Hospital: a ten-year retrospective review of patient data

Abstract

Background

Free flap surgery is an essential tool in limb reconstruction, but complex and often followed by complications, with many cases requiring additional procedures.

Objectives

To analyze postoperative complications and need for secondary surgery after free flap surgery over a 10-year period at King Chulalongkorn Memorial Hospital.

Methods

We retrospectively reviewed data from a cohort of patients who underwent free flap surgery for limb reconstruction from 2004 to 2014.

Results

We included 35 free flap operations in 29 patients. Mean follow-up time was 6.4 y. Free flap surgical procedures included 7 gracilis transfers, 8 toe transfers, 5 latissimus dorsi flaps, 5 fibular transfers, 4 anterolateral thigh flaps, 2 lateral-arm flaps, 2 radial forearm flaps, and 2 venous free flaps. There were 4 categories of postoperative complications. (1) Patients were those who developed total flap loss after free flap surgery (7/35 flaps, 20%). (2) Patients had major complications requiring additional operations (11/35 flaps, 31%). Major complications included partial flap necrosis, wound swelling with delayed closure, arterial occlusion, postoperative bleeding, infection, and failed implant fixation. (3) Patients had minor complications that required no additional surgical procedures (8/33 flaps, 23%). (4) Patients with no postoperative complications (9/35 flaps, 26%). Secondary surgery after initial free flap was 51% overall (18/35 flaps). The 3 most common secondary procedures included second flap coverage, skin graft, and anastomosis revision. We found free flap surgery performed during the subacute period (14–90 d after injury) to have significantly (P = 0.028) more complications (categories 1 and 2) than surgery performed during the acute period (<14 d) or late reconstruction (>90 d).

Conclusions

Physicians should be prepared for a range of outcomes of free flap surgery and advise their patients of the risk of additional operations accordingly.

Open access
Congenital abdominal aortic aneurysm in a term neonate: a case report

Abstract

Background

Congenital abdominal aortic aneurysm (AAA) is a rare condition in neonates. To our knowledge, the natural course of the disease in a Thai neonate has not yet been reported.

Objectives

To report the characteristics and clinical course of congenital AAA in a Thai neonate.

Methods

A female Thai infant was born spontaneously at term (3,990 g) having a large, pulsatile, abdominal mass. Computed tomographic angiography (CTA) of the abdominal aorta showed a large infrarenal AAA, and a fusiform aneurysm at the left common iliac artery. Two small right renal arterial aneurysms were also noted. The large aneurysm was partially resected and a Gore-Tex vascular graft was placed at 15 days old. Histopathology of the aneurysmal wall revealed no specific etiology. Ultrasonography revealed thrombosis of the graft on the 13th day after surgery.

Results

Repeated CTA of the abdominal aorta at age 13 mo showed complete thrombosis of the graft with reconstitution of collateral circulation. The infrarenal AAA and left common iliac aneurysm and 2 small right renal artery aneurysms were completely thrombosed. The patient grew and developed normally to the most recent follow up at age 36 mo.

Conclusions

Congenital AAA with failure of graft replacement may regress spontaneously.

Open access
The distribution of cutaneous leishmaniasis in Iraq: demographic and climate aspects

Abstract

Background

Leishmaniasis is endemic in Iraq, where both cutaneous and visceral forms of the disease are reported.

Objectives

To determine the prevalence of cutaneous leishmaniasis (CL) and to identify associations of CL with age, sex, season, and provinces depending on some demographic and climatic aspects.

Methods

This study is retrospective and includes reported cases of infections using the available surveillance database taken from the Iraqi Ministry of Health for the years 2011, 2012, and 2013 for all provinces of Iraq.

Results

Men and boys were found to be at higher risk for CL compared with women and girls. The majority of cases were recorded among those in age groups 5–14 and 15–45 years old. Most cases were recorded from lowland provinces with moderate annual rainfalls and a high rural population.

Conclusions

This study provides initial necessary data for public health specialists working to assess management approaches for the control of cutaneous leishmaniasis in Iraq.

Open access