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Optimal nutritional support in childhood cancer relies on the adequate provision of energy. This study investigated the impact of chemotherapy on resting energy expenditure (REE) during the first six months of treatment and the accuracy of predictive equations in calculating said requirements of newly diagnosed children with cancer. REE was measured at diagnosis utilising a validated bioelectrical impedance analysis (BIA) mobile unit and compared with three predictive equations (Schofield 1985, World Health Organization [WHO] 1985 and the Recommended Dietary Allowance [RDA] 1989). Agreement and accuracy of these equations were tested by determining bias and agreement rates and displayed using the Bland–Altman plot. Baseline values were plotted against monthly follow-up measurements over time. Statistical significance was 5% and a priori limits of agreement set between 90% and 110% of measured REE. Forty-three newly diagnosed children with median age 4 years (IQR 2.0–7.6) were measured prior to chemotherapy initiation. Compared with measured REE (mean ± SD) 719.53 ± 206.29 kcal/day, all predictive equations significantly overestimated REE: WHO 1985 (889.75 ± 323.31 kcal/day; 23% overestimation), Schofield 1985 (899.62 ± 336.10 kcal/day; 25% overestimation) and RDA (1647.67 ± 481.06 kcal/day; 129% overestimation) (p < 0.001). Despite significant proportionate bias in all three equations (p < 0.001), the intra-class consistency coefficient showed good reliability for the Schofield 1985 (0.864) and WHO 1985 (0.849) equations. Though statistically significant (chi-square = 23.11, p < 0.003), the overall 1 kcal/kg (1.3%) increase for all cancer types at six months may not be clinically significant. Existing predictive equations are unable to calculate REE accurately at childhood cancer diagnosis, highlighting the need for future investigations into the development of cancer-specific equations. [ABSTRACT FROM AUTHOR]

Children with cancer require adequate nutritional support to prevent malnutrition. This study investigated the impact of chemotherapy on anthropometrical status and body composition during the first six months of treatment. Anthropometrical status and body composition were measured at diagnosis, utilizing standardized protocols and validated S10 InBody bio-electrical impedance (BIA) measurements and compared to subsequent consecutive monthly follow-up measurements to plot changes over time during the first six months. Statistical significance was defined as p < 0.05. Forty-three newly diagnosed children (median age 4 years, IQR: 2.0-7.6; male-female ratio 1:0.9; 53% haematological malignancies and 47% solid tumors) were included. Prevalence of malnutrition varied, with under-nutrition 14% (mid-upper arm circumference (MUAC)/body mass index (BMI)), over-nutrition 9.3% (BMI) and stunting 7% at diagnosis. MUAC (14%) identified fewer participants with underlying muscle store depletion than BIA (41.8%). Chemotherapy exposure acutely exacerbated existing nutritional depletion during the first two months after diagnosis for all variables except fat mass (FM), with contrary effects on cancer type. Haematological malignancies had rapid increases in weight, BMI and FM. All patients had an acute loss of skeletal muscle mass. Nutritional improvement experienced by all cancer types during month two to three of treatment resulted in catch-up growth, with a significant increase in weight (chi2=40.43, p < 0.001), height (chi2=53.79, p < 0.001), BMI (chi2=16.32, p < 0.005), fat free mass (chi2=23.69, p < 0.003) and skeletal muscle mass (chi2=24.19, p < 0.001) after six months. Monthly nutritional assessments, including advanced body composition measurements, are essential to provide timely nutritional interventions to overcome the acute decline in nutritional reserves observed during the first two months of chemotherapy exposure. [ABSTRACT FROM AUTHOR]

Canine parvovirus (CPV) enteritis has, since its emergence in 1978, remained a common and important cause of morbidity and mortality in young dogs. The continued incidence of parvoviral enteritis is partly due to the virus' capability to evolve into more virulent and resistant variants with significant local gastrointestinal and systemic inflammatory sequelae. This paper reviews current knowledge on historical-, signalment-, and clinical factors as well as several haematological-, biochemical- and endocrine parameters that can be used as diagnostic and prognostic biomarkers in CPV enteritis. These factors include season of presentation, purebred nature, bodyweight, vomiting, leukopaenia, lymphopaenia, thrombocytopaenia, hypercoagulability, hypercortisolaemia, hypothyroxinaemia, hypoalbuminaemia, elevated C-reactive protein and tumour necrosis factor, hypocholesterolaemia and hypocitrullinaemia. Factors contributing to the manifestations of CPV infection are multiple with elements of host, pathogen, secondary infections, underlying stressors and environment affecting severity and outcome. The availability of several prognosticators has made identification of patients at high risk of death and their subsequent targeted management more rewarding. [ABSTRACT FROM AUTHOR]

In a previous study from this institution, patients at high risk for preterm labour were screened for the presence of bacterial vaginosis (BV). When BV was present, they were randomised to receive either treatment (metronidazole) or placebo (vitamin C). There were significantly more patients with preterm labour in the metronidazole group. The aim of this double-blind randomised placebo-controlled trial study was to determine whether vitamin C could indeed reduce the recurence risk of preterm labour. Patients with a history of preterm labour in a preceding pregnancy were randomised to receive 250mg vitamin C or a matching placebo twice daily until 34 weeks gestation. They attended a dedicated premature labour clinic. Significantly more women delivered before term in the group that received vitamin C, but there was no difference in the outcome of the babies between the two groups. Supplementation with vitamin C did not prevent premature labour. [ABSTRACT FROM AUTHOR]

Three recent studies found that corticosteroids improve clinical outcome and mortality in tuberculous meningitis (TBM), although the exact mechanism of action of the drug remains speculative. A number of reports on the effect of corticosteroids on cerebrospinal fluid (CSF) findings in TBM have been published, often with conflicting results regarding serial cell counts and protein levels. As part of a controlled, randomized trial on the effect of oral prednisone on outcome in childhood TBM at our institution, CSF was collected and analysed weekly during the 1st month of treatment. We found no significant difference in serial CSF cell counts between the steroid and non-steroid groups in the study. However, the steroid group had significantly lower CSF protein and globulin levels after the 1st month of treatment, and a more steady rise in CSF glucose levels than the non-steroid group. Knowledge of the different CSF responses during the course of anti-tuberculosis therapy is important in clinical decisionmaking. [ABSTRACT FROM AUTHOR]

Hydrocephalus is a common complication of tuberculous meningitis (TBM) in children. In this study, 217 patients with stage II and III TBM and hydrocephalus (TBMH) were reviewed. Ventriculoperitoneal shunting (VPS) was performed in the acute stage if the hydrocephalus was non-communicating or following failed medical therapy if the hydrocephalus was communicating. Following this protocol only 65 of 217 (29.9%) patients eventually required VPS. Non-communicating hydrocephalus was present in 38 of 65 (58.5%) and communicating hydrocephalus in 27 of 65 (41.5%) of the shunted cases. These 65 cases were followed for 6 months and their outcome assessed. Good outcome or moderate disability was seen in 55.4% and 12.3% died. Different factors relating to outcome are discussed. The shunted patients in this study had a high complication rate of 32.3%, with shunt infection and shunt obstruction each occurring in 9 of 65 (13.5%) of cases. TBM complicated by hydrocephalus remains a devastating condition and VPS in these patients has a high complication rate. Identifying those patients who may be managed without shunting will save costs and reduce complications, however early VPS in patients with non-communicating hydrocephalus is still indicated. [ABSTRACT FROM AUTHOR]

This study was conducted as part of a double-blind randomised placebo-controlled trial, the aim of which was to determine whether vitamin C could reduce the recurrence risk of pre-term labour. In this study, women with a history of pre-term labour in a preceding pregnancy were randomised to receive either 250 mg vitamin C or a matching placebo twice daily until 34 weeks' gestation. They attended a dedicated pre-term labour clinic every 2 weeks. All women were screened for bacterial vaginosis (BV) at each visit. It was first determined that vitamin C did not have any effect on the presence of BV. Women who were diagnosed with BV before 20 weeks' gestation were at higher risk of delivering pre-term than those who developed BV after 20 weeks. [ABSTRACT FROM AUTHOR]