Lactose is the main carbohydrate in human and mammalian milk. Lactose requires enzymatic hydrolysis by lactase into D-glucose and D-galactose before it can be absorbed. Term infants express sufficient lactase to digest about one liter of breast milk daily. Physiological lactose malabsorption in infancy confers beneficial prebiotic effects, including the establishment of Bifidobacterium-rich fecal microbiota. In many populations, lactase levels decline after weaning (lactase non-persistence; LNP). LNP affects about 70% of the world’s population and is the physiological basis for primary lactose intolerance (LI). Persistence of lactase beyond infancy is linked to several single nucleotide polymorphisms in the lactase gene promoter region on chromosome 2. Primary LI generally does not manifest clinically before 5 years of age. LI in young children is typically caused by underlying gut conditions, such as viral gastroenteritis, giardiasis, cow’s milk enteropathy, celiac disease or Crohn’s disease. Therefore, LI in childhood is mostly transient and improves with resolution of the underlying pathology. There is ongoing confusion between LI and cow’s milk allergy (CMA) which still leads to misdiagnosis and inappropriate dietary management. In addition, perceived LI may cause unnecessary milk restriction and adverse nutritional outcomes. The treatment of LI involves the reduction, but not complete elimination, of lactose-containing foods. By contrast, breastfed infants with suspected CMA should undergo a trial of a strict cow’s milk protein-free maternal elimination diet. If the infant is not breastfed, an extensively hydrolyzed or amino acid-based formula and strict cow’s milk avoidance are the standard treatment for CMA. The majority of infants with CMA can tolerate lactose, except when an enteropathy with secondary lactase deficiency is present.
To explore the possible determinants of duration of breastfeeding in Kuwait, 234 mothers completed a questionnaire concerning the feeding of their youngest infant. The questionnaire addressed the factors that contributed to their willingness to continue breastfeeding and enquired about the factors leading to their decision to end it. Only 26.5% of the mothers had continued breastfeeding for 6 months or more. Separate family housing, higher maternal age, late initiation of breastfeeding, being employed without the feasibility to breastfeed at work, breastfeeding information given after rather than before birth, and maternal and infant sickness were all significant contributors influencing early cessation. Father's support was a significant factor that encouraged the practice. In conclusion, preventive strategies are recommended for boosting breastfeeding, with special emphasis on the factors linked to early cessation, aiming at full implementation of the WHO global public health recommendations for successful breastfeeding in Kuwait.
This paper covers algorithms for the management of regurgitation, constipation and infantile colic in infants. Anti-regurgitation formula may be considered in infants with troublesome regurgitation, while diagnostic investigations or drug therapy are not indicated in the absence of warning signs. Although probiotics have shown some positive evidence for the management of functional gastrointestinal disorders (FGIDs), the evidence is not strong enough to make a recommendation. A partially hydrolyzed infant formula with prebiotics and β-palmitate may be considered as a dietary intervention for functional constipation in formula fed infants. Lactulose has been shown to be effective and safe in infants younger than 6 months that are constipated. Macrogol (polyethylene glycol, PEG) is not approved for use in infants less than 6 months of age. However, PEG is preferred over lactulose in infants >6 months of age. Limited data suggests that infant formula with a partial hydrolysate, galacto-oligosaccharides/fructo-oligosaccharides, added β-palmitate may be of benefit in reducing infantile colic in formula fed infants in cases where cow's milk protein allergy (CMPA) is not suspected. Evidence suggests that the use of extensively hydrolyzed infant formula for a formula-fed baby and a cow's milk free diet for a breastfeeding mother may be beneficial to decrease infantile colic if CMPA is suspected. None of the FGIDs is a reason to stop breastfeeding.
BackgroundEarly diagnosis of food allergies (FA) is important for a favorable prognosis. This study aimed to determine the level of awareness of FA among pediatricians in Kuwait.MethodA 43-item self-administered questionnaire was designed and distributed to pediatricians working at 4 government hospitals in Kuwait.ResultsA total of 140 pediatricians completed the questionnaire, with a participation rate of 51.1% (81 males and 59 females). The mean age of participants was 40.81 years, and the mean number of years working in pediatrics was 13.94 years. The mean overall knowledge score was 22.2. The pediatricians’ overall knowledge scores were found to be significantly associated with their age (older pediatricians had higher overall scores) and years of experience as a pediatrician but were independent from hospital site, gender, or rank. A multiple linear regression revealed pediatrician age and gender were the only variables that were significantly associated with the overall knowledge score. Only 16.4% of the participants answered at least 2/3 of the survey questions correctly. The questions that were correctly answered by ≤ 2/3 of the participants constituted 80% of clinical presentation questions, 66.6% of diagnostics questions, 77.7% of treatment questions, and 42.8% of prevention questions. Interestingly, among 68 pediatricians (48.5%) who determined that they felt comfortable evaluating and treating patients with FA, only 12 (17.6%) passed the questionnaire.ConclusionsThis survey demonstrates that there is a noteworthy deficiency of pediatricians’ awareness about FA. The implementation of strategies to improve pediatricians’ awareness is critical to diagnose food allergy patients early and improve their health and outcomes.
The purpose of this work is to do a research on the level of awareness about sexually transmitted diseases (STD) of adolescence and the factors effecting it. Method A number of adolescent at the ages of 14-17 (n=527) were asked to complete a survey questioning their level of knowledge of STDs and their sociological and demographical issues.Data were entered into the SPSS 15.0 program and evaluated. A value of p<0.05 was assumed for statistical significance. Findings 78.9% of the adolescent responded positively to the question of whether or not they are aware of the fact that diseases could be transmitted via sexual intercourse. 48.6% of the adolescent responded negatively to whether or not they knew "how the diseases are transmitted", 59.4% responded negatively to whether or not they know "how to protect themselves from those diseases", and 67.2% responded negatively to whether or not they know "the symptoms of STDs". The count of the right answers were in increase in correlation with the education and economic level of the parents (p<0.05). The results showed that 49.3% of them learned information about STDs at school and from medical institutions. 9.3% of them stated that they had intercourse in the last one-year period and 8.0% of them utilized a method of protection. Result Awareness level of adults about STDs is inadequate. For that, schools and medical institutions, where they are inclined most to get education, should organize mass education events for them about these matters. RELATIONSHIP BETWEEN OBESITY AND 8-HYDROXY 2-DEOXY GUANOSINE AS AN OXIDATIVE MARKER IN Anthropology, National Research Centre, Cairo, EgyptBackground and Aim This study was conducted to assess the relationship between obesity markers (Body mass index "BMI", fat percentage) and DNA oxidative marker 8-hydroxyl guanosine (OHG), as a predictor for future clinical problems in obese adolescents of Giza. Methods The study was conducted on 103 adolescents aged 13-18 years (22 boys, 81 girls). BMI was calculated as body weight (kg) divided by height (m 2 ) squared and obesity was defined as BMI of 95 percentile. Fat percentage was determined by using Biological impedance technique. Oxidative stress markers as 8-hydroxyl guanosine, superoxide and gluthione were measured. The adolescents were divided according to BMI into two groups. Group I with BMI > 95 percentile and less than 97 percentile (obese) and Group ∩ with BMI > 97 percentile (severely obese). Results Significant differences were detected between the two groups of the study as regard obesity markers (BMI, fat %) and oxidative stress markers (lipid oxidation, superoxide dismutase enzyme activity, glutathione peroxidase enzyme activity, 8-hydroxyl guanosine) (p<0.0005). Significant positive correlations were detected between obesity markers and oxidative stress markers among severely obese adolescent (group II). Obesity is highly associated with states of oxidative stress in adolescents, with a positive relation with 8-hydroxy-guanosine and obesity markers and other oxidative marke...
BackgroundThere is controversy surrounding the management of young children who have a fever without a source (FWS). Several strategies have been designed with the purpose of managing children with FWS.AimsTo assess the applicability of a standardized guideline for children up to 36 months of age with FWS.SettingPediatric emergency unit, Al-Adan Hospital, Kuwait City, Kuwait, from May 2011 to October 2011.DesignProspective, cross-sectional study.Methods and materialsThe study involved children with FWS up to 36 months of age. The guideline classifies the risk of serious bacterial infection (SBI) according to the age of the child, the presence or absence of toxemia, clinical presentation, and laboratory screening tests.ResultsA total of 481 children were included in the present study, but only 385 cases completed the study; 3.9% of patients had toxemia at the initial evaluation. We found 26 children with SBI (6.8%); 12 patients with SBI did not present with toxemia. In all, 40.4% of studied newborns were diagnosed as having a urinary tract infection, and 42.7% of patients as self-limited probable viral etiology. Of the 109 young infants without toxemia, 53.2% were classified as being at high risk of SBI. Of the 163 toddlers without toxemia, 72.4% were treated with antibiotics; 48.4% of patients received therapeutic treatment and 25.8% received empirical treatment.ConclusionThe guideline followed in our pediatric emergency unit seemed to be appropriate in following up with these children using simple laboratory tests. The most frequent SBI in this sample was urinary tract infection.
Background: Cow’s milk allergy (CMA) and cow’s milk intolerance (CMI) are the major cow’s milk disorders observed in infants and young children. This study investigates, for the first time, physician knowledge regarding CMA and CMI prevalence, diagnosis, and management in the Middle East and North Africa (MENA) region. In addition, we explore the role of goat milk-based formula as an alternative in infants suffering from CMI. Method: This cross-sectional survey was conducted from December 2020 to February 2021. A convenience sample of 2500 MENA-based physicians received the questionnaire, developed by a working group of pediatric experts. Results: 1868 physicians completed the questionnaire, including pediatric specialists (80.8%), training physicians (0.2%), dermatologists (0.1%), family/general physicians (12.9%), neonatologists (3.6%), neurosurgeons (0.2%), allergy nurse specialists (0.3%), pharmacists (2.1%), and public health workers (0.1%). Differentiation between CMA and CMI was recognized by the majority of respondents (80.7%), for which the majority of respondents (35.4%) identified that the elimination and challenge test was the best test to differentiate CMA from CMI, whereas 30.7% and 5.4% preferred the immunoglobulin E (IgE) test and skin prick test, respectively. In addition, 28.5% of respondents reported that there is no confirmatory test to differentiate CMA from CMI. The majority of respondents (47.3%) reported that amino acid-based formula (AAF)/ extensively hydrolyzed formula (EHF) is the cornerstone for the management of CMA. However, most respondents (33.7%) reported that lactose avoidance was best for the management of CMI. Overall, 65% of the respondents were aware of nutritionally adapted goat’s milk formula as an alternative to cow’s milk products and 37% would recommend its routine use in infants (≤2 years of age). Conclusion: The results of this survey demonstrate that the majority of physicians are aware of the underlying pathophysiology and management of CMA and CMI. However, a significant proportion of physicians do not follow the clinical guidelines concerning CMA/CMI diagnosis and management. Notably, this survey identified that goat’s milk formulas may offer a suitable alternative to AAF/EHF in infants with CMI as they contain β-casein protein which is easily digestible. In addition, goat’s milk formulas contain higher levels of oligosaccharides and medium-chained fatty acids compared with standard cow’s milk formulas, yet further clinical trials are warranted to support the inclusion of goat’s milk formulas in clinical guidelines.
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