Sepsis is the most common cause of death in the newborn and is a particular problem for premature and very low birth weight infants. Necrotizing enterocolitis is an inflammatory condition predominantly affecting premature infants, and infection may be a contributory factor. Antibiotics used to treat sepsis and necrotizing enterocolitis are not always effective, and their widespread use can lead to antibiotic resistance. Lactoferrin, which occurs naturally in human colostrum, milk, tears and saliva, has been shown to have antimicrobial activity and is a constituent of natural immunity. This Cochrane review investigates whether lactoferrin might prevent sepsis and necrotizing enterocolitis in premature infants.

A new approach

HoLEP is typically performed with the patient under general anesthesia. The surgeon uses the laser to enucleate the entire adenoma, leaving just the capsule in place. The surgeon pushes the excised adenoma into the bladder and then uses a morcellation device to grind up and remove the tissue.

Prostatic urethra with incision

Widely acknowledged as a benchmark BPH procedure, HoLEP requires specialized skills and training. Mayo Clinic is among the few medical centers in the United States that performs HoLEP procedures, at its campuses in Arizona and Minnesota.

At the patients’ final clinic visit, 75% of those treated with febuxostat 80 mg/day achieved urate-lowering to a goal of less than 6 mg/dl, but only 38% of patients taking allopurinol 300 mg/day achieved that goal (P<0.001), according to Michael Becker, MD, of the University of Chicago.

When the researchers looked a further urate lowering, they found that 65% of those on the higher febuxostat dose achieved a serum urate level below 5 mg/day, as did 47% on the lower febuxostat dose and just 13% on allopurinol. The differences between both febuxostat treatment groups and the allopurinol group were again significant at P<0.001.

Despite lower serum urate levels, no differences were observed between treatments for gout flares or reduction of tophi.

Another significant advantage for belimumab was in the percentage of patients able to reduce steroid doses to 7.5 mg/day (prednisone equivalent) or less: 25.8% and 27.7% for the low and high doses, compared with 17.5% of the placebo group (P<0.05).

Nearly all patients in the study experienced some type of adverse event. Severe events were recorded in about 20% of patients, spread equally among the treatment arms.

With 4.3 years of treatment in a randomized, placebo-controlled trial, the hazard ratio for developing vitamin B₁₂ deficiency while on metformin was 5.5 relative to placebo (95% CI 1.6 to 19.1), reported Coen Stehouwer, MD, of Maastricht University in the Netherlands, and colleagues online in BMJ.

“Our study shows that this decrease is not a transitory phenomenon, but persists and grows over time,” the researchers wrote.

From a mean of about 355 pmol/L at the end of the run-in phase, B₁₂ levels dropped to about 305 pmol/L after four months, and from there to 280 pmol/L over the next four years.

PPIs are frequently used to reduce the risk of gastrointestinal bleeding in patients treated with clopidogrel. However, a growing volume of evidence has suggested that PPIs might reduce clopidogrel’s efficacy, the authors wrote.

In one recent study, patients treated with omeprazole (Prilosec) in addition to aspirin and clopidogrel had a significantly higher platelet reactivity index score after seven days of treatment than patients who didn’t get the PPI (J Am Coll Cardiol 2008; 51: 256-60).

However, a subgroup analysis of a large clinical trial showed no increased risk of adverse events in patients who received clopidogrel with or without a PPI (Circulation 2008; 118(suppl 2): Abstract 3999).

Moreover, the relative risk for women who were overweight and did not engage in leisure time physical activity was 2.09 (95% CI 1.36 to 3.21), the researchers reported in the May issue of Arthritis Care & Research.

Studies have shown lower levels of physical fitness among patients with fibromyalgia compared with healthy controls.

The analysis also found a nonsignificant tendency toward a dose-response effect for physical activity, with women who reported exercising at least four times per week having a 29% lower risk of fibromyalgia compared with those who were inactive (adjusted RR 0.71, 95% CI 0.46 to 1.09, P for trend =0.13).

Women who exercised for two hours or more per week had a relative risk of 0.77 (95% CI 0.52 to 1.15, P for trend =0.16).

2. Donor’s facial skin, muscles, nose, cheekbones, teeth and jawbone used to rebuild patient’s face. Metal plates used to support new facial structure, which included reconstructing the roof of the mouth.

3. Donor’s nerves, blood vessels and skin connected to patient. Patient will have to take anti-rejection drugs for the rest of his life.

Source: Vall D’Hebron Hospital, Barcelona

The New England Journal of Medicine reported that many patients had improved quality of life.

UK stroke experts said the advance was “exciting” but added that robots were still at early stages of development.

Strokes can leave people with long-lasting disability, which can include limited movement and weakness in upper limbs.

Intensive therapy, starting as soon as possible after the stroke, is the recommended way to maximise the amount of movement recovered.

However, providing the physiotherapist needed for at least a hour per patient per day places large demands on the NHS.

The Brown University trial tested a device called the MIT-Manus, specifically designed to help exercise the upper limbs.

Riley Joyce had no pulse and was not breathing when he was first delivered by emergency Caesarean section at the Royal United Hospital, Bath.

He had a 50:50 chance of permanent brain injury and was transferred to St Michael’s Hospital, Bristol.

‘Cooling babies’

She said: “Over the past eight years, we have shown in the laboratory that xenon doubles the protective effect of cooling on the brain.

Professor Thoreson said: “After seven days, Riley was alert, able to look at his mother’s face, hold up his head and begin to take milk.”

Every year in the UK more than 1,000 otherwise healthy babies born at full term die or suffer brain injury caused by a lack of oxygen or blood supply at birth.

“Xenon is a precious and finite resource and difficult to extract so it can cost up to £30 a litre.