Growth of children receiving a dehydrated potato-soy protein concentrate or corn-soy blend as part of a food aid program in Northern Senegal

Rations distributed by food aid programs are intended to improve the growth of undernourished children. In practice, food programs target individual children and provide a supplement to the family that is intended to increase the energy and nutrient intake of undernourished children. Multiple food rations are available yet few studies have compared their differential effect on the growth of children. The objective of the study was to compare growth in undernourished Senegalese children who received a newly developed dehydrated potato-soy protein concentrate blend (PSB) to those supplemented with the currently available corn-soy blend (CSB). The first child at each site was randomly assigned to receive PSB or CSB and subsequent children alternately received PSB or CSB. Eligibility for obtaining the food ration was basedon criteria determined by the USAID (P.L. 480) Title II Food Aid Program. Children received iso-caloric amounts of the two supplements each month (23,000kcals). Weight, height and mid-upper arm circumference (MUAC) were taken over a fourmonth period. Z-scores were calculated for weight-for-age (WAZ), weight-for-height (WHZ) and for length/height-for-age measures (HAZ).The study was conducted at 7 clinics which served as food distribution sites in northern Senegal. The study enrolled348 children 18-56 months old with a weight-for-age z-score below the �yellow� zone of the locally available growth chart (equivalent to WAZ < -1.0). WAZ and HAZ significantly increased over time but there was no difference between the two ration groups. In a subset of 280 children (145 PSB, 135 CSB) who attended all four appointments and received the full complement of ration, there was significant and equivalent increase for both groups in WAZ and WHZ. These findings indicate thatchildren participating in the food aid program significantly improved their growth over a four-month period. Using the new PSB as a ration had the same impact on growth as the standard CSB and required less fuel to prepare

Clinical utilization of anti-vascular endothelial growth-factor agents and patient monitoring in retinal vein occlusion and diabetic macular edema

Szilárd Kiss,1 Ying Liu,2 Joseph Brown,3 Nancy M Holekamp,4,5 Arghavan Almony,6 Joanna Campbell,2 Jonathan W Kowalski2 1Weill Cornell Medical College, New York, NY; 2Allergan, Inc., Irvine, CA; 3IMS Health, Woodland Hills, CA; 4Pepose Vision Institute, Chesterfield, MO; 5Washington University School of Medicine, St Louis, MO; 6Carolina Eye Associates, Southern Pines, NC, USA Purpose: To examine the utilization of bevacizumab and ranibizumab and disease monitoring in patients with branch or central retinal vein occlusion (BRVO/CRVO) or diabetic macular edema (DME) in clinical practice.Patients and methods: This retrospective claims analysis included newly diagnosed patients with one or more bevacizumab or ranibizumab injections. Bevacizumab or ranibizumab utilization was assessed by year of first injection: 2008–2010 cohorts (12-month follow-up), January to June 2011 cohort (6-month follow-up). The main outcome measures were mean annual numbers of injections, ophthalmologist visits and optical coherence tomography examinations, and proportion of patients with additional laser or intravitreal triamcinolone (IVTA) use.Results: A total of 885 BRVO, 611 CRVO, and 2,733 DME patients treated with bevacizumab were included, with too few ranibizumab-treated patients for meaningful analysis. Across the 2008, 2009, and 2010 cohorts, mean annual numbers of bevacizumab injections increased, but remained low (BRVO 2.5, 3.1, 3.3; CRVO 3.1, 3.1, 3.5; and DME 2.2, 2.5, 3.6, respectively); mean ophthalmologist visits ranged between 4.4 and 6.5, and mean optical coherence tomography examinations ranged between 3.1 and 3.9 across all conditions. A total of 42.0% of BRVO, 16.5% of CRVO, and 57.7% of DME patients received additional laser or IVTA therapy. The number of bevacizumab injections was positively associated with laser use in BRVO (3.3 versus 2.9, P<0.03), and with laser or IVTA use in DME (laser, 3.3 versus 2.7, P<0.03; IVTA, 3.3 versus 3.0, P<0.05).Conclusion: During the study period (2008–2011), bevacizumab was the main anti-VEGF therapy used in clinical practice for BRVO, CRVO, and DME. Patients treated with bevacizumab were monitored less frequently and received fewer injections than patients in major clinical trials of ranibizumab. Keywords: anti-vascular endothelial growth factor, bevacizumab, ranibizumab, diabetic macular edema, retinal vein occlusion, intravitrea

Threshold Amsler grid as a screening tool for asymptomatic patients on hydroxychloroquine therapy

Background/aims: Patients taking hydroxychloroquine (HCQ) are at risk of developing classic bull’s eye maculopathy. Currently, the standard Amsler grid (AG) is one of the most useful methods to identify such lesions. However, AG is a suprathreshold target and may not detect relative central scotomas. The aim of this study was to determine if the threshold Amsler grid (TAG) test, which varies light transmission through two cross polarising filters, allows increased detection of scotomas caused by HCQ toxicity. Methods: 56 rheumatological patients taking HCQ and 12 similar patients not taking HCQ were tested by AG, red Amsler grid (RAG), and TAG. Results: No scotomas were observed in patients never treated with HCQ. Among patients who had been treated with HCQ, AG revealed scotomas in two of 56 (3.64%) patients; in contrast, six (10.7%) and 37 (66.1%) scotomas were identified by RAG and TAG testing respectively. Additionally, the average area of each scotoma detected by all three methods expanded from 34.5 square degrees of central field loss on AG testing to 71 square degrees on RAG and 117 on TAG. Conclusion: By decreasing the perceived luminance of the suprathreshold AG, TAG testing provides a novel alternative to detect shallow scotomas and areas of depressed retinal activity secondary to HCQ toxicity

Growth Of Children Receiving A Dehydrated Potato-Soy Protein Concentrate Or Corn-Soy Blend As Part Of A Food Aid Program In Northern Senegal

Rations distributed by food aid programs are intended to improve the growth of undernourished children. In practice, food programs target individual children and provide a supplement to the family that is intended to increase the energy and nutrient intake of undernourished children. Multiple food rations are available yet few studies have compared their differential effect on the growth of children. The objective of the study was to compare growth in undernourished Senegalese children who received a newly developed dehydrated potato-soy protein concentrate blend (PSB) to those supplemented with the currently available corn-soy blend (CSB). The first child at each site was randomly assigned to receive PSB or CSB and subsequent children alternately received PSB or CSB. Eligibility for obtaining the food ration was based on criteria determined by the USAID (P.L. 480) Title II Food Aid Program. Children received iso-caloric amounts of the two supplements each month (23,000kcals). Weight, height and mid-upper arm circumference (MUAC) were taken over a four-month period. Z-scores were calculated for weight-for-age (WAZ), weight-for-height (WHZ) and for length/height-for-age measures (HAZ).The study was conducted at 7 clinics which served as food distribution sites in northern Senegal. The study enrolled 348 children 18-56 months old with a weight-for-age z-score below the "yellow" zone of the locally available growth chart (equivalent to WAZ ≤ -1.0). WAZ and HAZ significantly increased over time but there was no difference between the two ration groups. In a subset of 280 children (145 PSB, 135 CSB) who attended all four appointments and received the full complement of ration, there was significant and equivalent increase for both groups in WAZ and WHZ. These findings indicate that children participating in the food aid program significantly improved their growth over a four-month period. Using the new PSB as a ration had the same impact on growth as the standard CSB and required less fuel to prepare

Validity of Self-Report in Type 1 Diabetic Subjects for Laser Treatment of Retinopathy.

PURPOSE: This study sought to determine the validity of self report of prior pan-retinal photocoagulation (PRP) and focal photocoagulation (FP) compared to fundus photography. DESIGN: Prospective cohort study. PARTICIPANTS: 1363 type 1 diabetic subjects from the Epidemiology of Diabetes Interventions and Complications (EDIC) Study, a subset of the 1441 subjects originally enrolled in the multi-center Diabetes Control and Complications Trial. METHODS: At each annual visit, subjects were asked by EDIC staff whether they had PRP and/or FP since the last completed annual clinic visit. Fundus photographs were collected in one quarter of the cohort each year and in the whole cohort at EDIC years 4 and 10. Photographs were graded for the presence and extent of PRP and FP. Seventeen years of subject reporting and photograph grading of PRP and FP were compared in EDIC subjects. MAIN OUTCOME MEASURES: Kappa, sensitivity, specificity, and positive and negative predictive values were calculated for subject-reported PRP and FP. Factors influencing subject misreporting were investigated. RESULTS: For subject reporting, 1244 (96%) of 1296 subjects with gradable photographs accurately reported whether they had a history of PRP in one or both eyes, and 1259 (97.5%) of 1291 with valid photographs correctly reported their history of FP. Sensitivities for PRP and FP were 90.4 and 74.0%; specificities, 96.0 and 98.8%; positive predictive values, 75.9 and 80.3%; negative predictive values, 98.9 and 98.4%; and kappa 0.80 and 0.76. Risk factors associated with misreporting include prior laser for diabetic retinopathy and prior ocular surgery (each p <0.04). CONCLUSIONS: For subjects with type 1 diabetes, in the absence of a clinical exam or fundus photographs, subject self report could be a reliable tool in a well-monitored study for assessing laser treatment type in diabetic retinopathy

Uveal Melanoma Treated With Iodine-125 Episcleral Plaque: An Analysis of Dose on Disease Control and Visual Outcomes

PURPOSE: In the treatment of uveal melanomas, the optimal prescribed dose to maximize disease control, but minimize radiation-related complications is unknown. Historically our institution has treated uveal melanomas to doses less than 85 Gy to the tumor apex even if the apex was less than 5mm in height. Here, we investigate how tumor control and visual outcomes are affected by the radiation dose at the tumor apex. METHODS AND MATERIALS: A retrospective review was performed to evaluate patients treated for uveal melanoma with Iodine-125 plaques between 1988 and 2010. Radiation dose is reported as dose to tumor apex and dose to 5 mm. Primary end points included time to local failure, distant failure, and death. Secondary end points included eye preservation, visual acuity, and radiation-related complications. Univariate and multivariate analyses were performed to determine association between radiation dose and the end point variables. RESULTS: One hundred ninety patients with sufficient data to evaluate the end points were included. The 5 year local control (LC) rate was 91%. The 5 year distant metastases (DM) rate was 10%. The 5 year overall survival (OS) rate was 84%. There were no differences in outcome (LC, DM, OS) when dose was stratified by apex dose quartile (<69 Gy, 69–81 Gy, 81–89 Gy, >89 Gy). However, increasing apex dose and dose to 5 mm depth were correlated with greater visual acuity loss (p=0.02, p=0.0006), worse final visual acuity (p=0.02, p<0.0001) and radiation complications (p<0.0001, p=0.0009). In addition, enucleation rates were worse with increasing quartiles of dose to 5 mm (p=0.0001). CONCLUSIONS: Doses at least as low as 69 Gy prescribed to the tumor apex achieve rates of local control, distant metastasis free survival, and overall survival that are similar to radiation doses of 85 Gy to the tumor apex, but with improved visual outcomes