The guidelines regarding the milk banks may not be applicable for the
developing countries, because these countries can not afford to have milk
banks due to its cost. But the very fact the viruses particularly human
immunodefiency virus can be inactivated by pasteurisation method is
notable. The dilemma of advising breast milk feeding to the infants born
to the HIV positive mothers in the developing cou...
The guidelines regarding the milk banks may not be applicable for the
developing countries, because these countries can not afford to have milk
banks due to its cost. But the very fact the viruses particularly human
immunodefiency virus can be inactivated by pasteurisation method is
notable. The dilemma of advising breast milk feeding to the infants born
to the HIV positive mothers in the developing countries may be lessened to
a large extent. But the pasteurisation method has to be simplified so that
an uneducated mother can understand and follow. High temparature short
time method (HTST) may suitable for small homes than the low temparature
longer time method described in the guidelines. The effect of high
temparature on the nutritional contents have not been delineated clearly.
If the studies can prove HTST method is as effective, then boiling the
breast milk for a shorter period of time will definitely help to bring
down the HIV transmission in children, in the developing countries.
I am a corporate member of UKAMB and consider issue
three of the Guidelines to be an excellent reference.
However, to minimise the risks after feed preparation
the thermal treatment (Pasteurisation)requirements
should not only mirror issue two published by RCPCH
but also include the following amplification of
treatment, based on work by the late Prof J David
Baum.
I am a corporate member of UKAMB and consider issue
three of the Guidelines to be an excellent reference.
However, to minimise the risks after feed preparation
the thermal treatment (Pasteurisation)requirements
should not only mirror issue two published by RCPCH
but also include the following amplification of
treatment, based on work by the late Prof J David
Baum.
The Pasteurisation method is raising the
temperature of the milk to 62.5°C, holding for 30
minutes, immediately cooled rapidly to less than
10 C. within the Pasteurisation Cycle.
Bottles must be submerged during the heating cycle
Bottles should not be submerged during the cooling
cycle (unless foil sealed bottles are used).
Independent verification of satisfactory treatment of
the milk (not the water bath) for the complete cycle
(heating & cooling) must be kept for future
reference.
A free fully evidence based 25 year practice proven
treatment guide can be obtained
from: info@sterifeed.com
In presenting various therapeutic approaches for the
management of Cystic Fibrosis (CF), Smyth RL primarily considers evidence
obtained from The Cochrane Library as either systematic reviews of
randomised controlled trials (RCTs) or RCTs .[1] The antibiotic treatment
of Pseudomonas aeruginosa (PA) when first isolated, is still an open
question. When discussing this aspect, Smyth RL considers only the...
In presenting various therapeutic approaches for the
management of Cystic Fibrosis (CF), Smyth RL primarily considers evidence
obtained from The Cochrane Library as either systematic reviews of
randomised controlled trials (RCTs) or RCTs .[1] The antibiotic treatment
of Pseudomonas aeruginosa (PA) when first isolated, is still an open
question. When discussing this aspect, Smyth RL considers only the RCT by
Valerius et al.[2]
In our critical review of published clinical studies evaluating the
early antibiotic treatment in asyntomatic PA-colonised CF patients [3], we
identified 3 relevant RCTs (2 vs placebo).[2,4,5] Our study also included
8 cohort studies, 2 of which with historical controls. Overall, 309
patients (range 7-91) were recruited. There was a high variability between
the individual studies for age, outcomes measures, duration of follow-up
and treatment (3 studies- 2 RCTs, 1 cohort used only aerosol tobramycin,
1 colistin, 4 aerosol colistin plus ciprofloxacin, 1 used intravenous
treatment and 2 miscellaneous therapy).
An overall critical evaluation
indicated that early antibiotic treatment can reduce the rate of positive
cultures and of anti-PA antibody titres. Long-term benefit is expected but
not yet proven. Moreover, we recently conducted an observational study
which found that nearly all CF centres in Italy treat asyntomatic PA-colonised patients in order to prevent or postpone chronic pulmonary
infection (unpublished data). However, the adopted prescribing practice
varies largely even within the same centre, highlighting the existing lack
of formal consensus on this subject.
Several therapeutic options (aerosol therapy alone or oral therapy
associated with aerosol inhalation) are available for the early treatment
of PA colonisation but no direct comparison has so far been made.
Prospective multi-centre randomised studies with relevant outcomes
measures [6] are needed to investigate which of the different proposed
antibiotic schemes has the best benefit/risk ratio and the best patient
compliance.
Department of Paediatrics Institute of Child Health Burlo Garofolo
University of Trieste
Via dell'Istria 65/1 34100 Trieste Italy
Competing interests: None declared
References
1. Smyth RL. Diagnosis and management of cystic fibrosis. Arch Dis
Child Ed Pract 2005;90:ep1-ep6.
2. Valerius N, Koch C, Hoiby N. Prevention of chronic Pseudomonas
aeruginosa colonisation in cystic fibrosis by early treatment. Lancet
1991;338:725–6.
3. Marchetti F, Giglio L, Candusso M, Faraguna D, Assael BM. Early
antibiotic treatment of pseudomonas aeruginosa colonisation in cystic
fibrosis: a critical review of the literature Eur J Clin Pharmacol
2004;60:67-74.
4. Wiesemann HG, Steinkamp G, Ratjen F et al Placebo-controlled,
double-blind, randomized study of aerosolized tobramycin for early
treatment of Pseudomonas aeruginosa colonization in cystic fibrosis.
Pediatr Pulmonol 1998;25(2):88-92.
5. Gibson RL, Emerson J, McNamara S, et al. Significant
microbiological effect of inhaled tobramycin in young children with cystic
fibrosis. Am J Respir Crit Care Med 2003;167 (6):841-9.
6. Ramsey BW, Boat TF. Outcome measures for clinical trials in cystic
fibrosis. J Pediatr 1994; 124:177-192.
Whilst we greatly enjoyed Mary C J Rudolph’s “Best Practice” article
on “The Obese Child” [1], we cannot agree with her conclusion that obesity
fulfils most of the criteria for a condition that justifies screening.
Our own local experience in Solihull, West Midlands, might illustrate this
point.
Using a grant from the Children’s Fund,
(www.cypu.gov.uk/corporate/childrenstrust/index,cfm)...
Whilst we greatly enjoyed Mary C J Rudolph’s “Best Practice” article
on “The Obese Child” [1], we cannot agree with her conclusion that obesity
fulfils most of the criteria for a condition that justifies screening.
Our own local experience in Solihull, West Midlands, might illustrate this
point.
Using a grant from the Children’s Fund,
(www.cypu.gov.uk/corporate/childrenstrust/index,cfm) we aimed to set up a
“Fit Club” serving children aged 7-11 in 7 wards in Solihull, with DETRI
deprivation indices ranging from 7.53 to 54.49. All 7 wards contain
enumeration districts with deprivation indices in the worse 15% of the
country.
We attempted to recruit 20 children, for an initial consultation
phase, in which they and their families would be able to discuss with our
multi disciplinary team the kinds of services they would like to tackle
the child’s weight. They would be able to try out various exercise
programmes if they wished, as well as receiving dietetic advice, and as an
incentive we also offered £10.00 worth of fresh fruit and vegetables. The
only criterion for recruitment was that the child should be perceived to
have a weight problem both by their family and professionals.
We attempted to recruit children via contact with school nurses,
recommendation from General Practitioners, and an advertisement in the
local paper. To our disappointment, we found that we were able to recruit
only 4 children. GPs had forwarded 7 names, of whom one actually made
contact with the service, whilst the school nurses informally fed back
that families felt that their child’s weight was not an issue upon which
they needed to take action. A final attempt at recruitment, based on one
large primary school with support of teaching staff, was similarly
completely unsuccessful. It would seem likely that a difference in
perception of the seriousness of overweight and the need for action
between parents and professionals explained our disappointing outcomes. [2]
Our experience thus leads us to believe that detecting obese or
overweight children by screening will not substantially alter the scale of
these problems on a population basis, although services for those that do
request them are clearly justified.
References
(1). Mary C J Rudolph. The Obese Child. Arch Dis Child Educ Pract Ed
2004;89:ep 57-ep 62
(2). A N Jeffery, L D Voss, B S Metcalf, S Alba, T J Wilkin. Parents’
Awareness of Overweight in Themselves and Their Child: Cross Sectional
Study Within a Cohort (EarlyBird21), BMJ 2005;330:23-24
Dear Editor
The guidelines regarding the milk banks may not be applicable for the developing countries, because these countries can not afford to have milk banks due to its cost. But the very fact the viruses particularly human immunodefiency virus can be inactivated by pasteurisation method is notable. The dilemma of advising breast milk feeding to the infants born to the HIV positive mothers in the developing cou...
Dear Editor,
I am a corporate member of UKAMB and consider issue three of the Guidelines to be an excellent reference.
However, to minimise the risks after feed preparation the thermal treatment (Pasteurisation)requirements should not only mirror issue two published by RCPCH but also include the following amplification of treatment, based on work by the late Prof J David Baum.
The Pasteurisati...
Dear Editor,
In presenting various therapeutic approaches for the management of Cystic Fibrosis (CF), Smyth RL primarily considers evidence obtained from The Cochrane Library as either systematic reviews of randomised controlled trials (RCTs) or RCTs .[1] The antibiotic treatment of Pseudomonas aeruginosa (PA) when first isolated, is still an open question. When discussing this aspect, Smyth RL considers only the...
Dear Editor,
Whilst we greatly enjoyed Mary C J Rudolph’s “Best Practice” article on “The Obese Child” [1], we cannot agree with her conclusion that obesity fulfils most of the criteria for a condition that justifies screening. Our own local experience in Solihull, West Midlands, might illustrate this point.
Using a grant from the Children’s Fund, (www.cypu.gov.uk/corporate/childrenstrust/index,cfm)...
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