Cow’s milk protein elimination in autistic children: language, cognitive and behavioral outcome

Background: Behavioral modification and structured education are necessary in autism but rather insufficient. Various dietary restrictions have been suggested as important prerequisites to benefit from other interventions in this disorder. Objective: This study was designed to highlight the degree of benefit in various aspects of development of autistic children upon elimination of cow's milk protein (CMP) from their diet and assess the level of specific IgE for CMP in their sera. Methods: The current study was conducted on 22 autistic children who were compared to 30 age and sex matched healthy children. Enrolled autistic children were randomly assigned to one of two groups. The parents of first group were instructed to eliminate cow milk (CM) from the diet of their children throughout the study period while patients of the second group were allowed to eat without restrictions. Each enrolled child was subjected to complete dietetic history taking, clinical examination and measurement of IgE for CM antigen in their sera by enzyme immunoassay. Autistic patients underwent a Childhood Autism Rating Scale (CARS) test. The patients were also subjected to language and intelligent quotient (IQ) testing, social and mental age assessment and child psychiatric evaluation. The autistic children received an interventional program for six months and were then re-evaluated using the previous clinical parameters. Results: The first group achieved significantly lower CARS test results (p < 0.01), significantly higher language age (p < 0.05) and significantly higher rate of change of CARS, language, social age, mental age and IQ (p < 0.001, <0.05, <0.05, <0.01 and <0.05 respectively) compared to the second group after 6 months of follow up. There was also a significantly higher mean specific IgE level to CMP in the autistic patients as compared to the controls. Additionally, 45.5% of patients who were on CM elimination diet went one CARS category down compared to only 36.4% of the second group. Conclusion: We report improvement in language, cognition and behavioral capabilities upon CM elimination in a group of autistic children. The higher CM specific IgE in these children may suggest that such adverse reaction to CM may have an allergic basis. Wider scale studies are needed to justify this adjuvant therapeutic option in autistic children hoping for better achievement from the current interventional programs. Keywords: Allergy – Autism – CARS – Cow milk – IgE – IQEgypt J Pediatr Allergy Immunol 2006; 4(1): 15-2

Vaccine strategies: Optimising outcomes

AbstractSuccessful immunisation programmes generally result from high vaccine effectiveness and adequate uptake of vaccines. In the development of new vaccination strategies, the structure and strength of the local healthcare system is a key consideration. In high income countries, existing infrastructures are usually used, while in less developed countries, the capacity for introducing new vaccines may need to be strengthened, particularly for vaccines administered beyond early childhood, such as the measles or human papillomavirus (HPV) vaccine. Reliable immunisation service funding is another important factor and low income countries often need external supplementary sources of finance. Many regions also obtain support in generating an evidence base for vaccination via initiatives created by organisations including World Health Organization (WHO), the Pan American Health Organization (PAHO), the Agence de Médecine Préventive and the Sabin Vaccine Institute. Strong monitoring and surveillance mechanisms are also required. An example is the efficient and low-cost approaches for measuring the impact of the hepatitis B control initiative and evaluating achievement of goals that have been established in the WHO Western Pacific region. A review of implementation strategies reveals differing degrees of success. For example, in the Americas, PAHO advanced a measles-mumps-rubella vaccine strategy, targeting different population groups in mass, catch-up and follow-up vaccination campaigns. This has had much success but coverage data from some parts of the region suggest that children are still not receiving all appropriate vaccines, highlighting problems with local service infrastructures. Stark differences in coverage levels are also observed among high income countries, as is the case with HPV vaccine implementation in the USA versus the UK and Australia, reflecting differences in delivery settings. Experience and research have shown which vaccine strategies work well and the factors that encourage success, which often include strong support from government and healthcare organisations, as well as tailored, culturally-appropriate local approaches to optimise outcomes

Screening for Celiac Disease in Children with Dental Enamel Defects

Background. Dental enamel defects (DEDs) are seen in celiac disease (CD). Aim was to detect frequency of CD among such patients. Methods. This study included 140 children with DED. They were tested for CD. Gluten-free diet (GFD) was instituted for CD patients. A cohort of 720, age and sex-matched, normal children represented a control group. Both groups were evaluated clinically. Serum calcium, phosphorus, alkaline phosphatase, serum IgA, and tissue transglutaminase (tTG) IgG and IgA types were measured. Results. CD was more diagnosed in patients with DEDs (17.86%) compared to controls (0.97%) (P < 0.0001). Majority of nonceliac patients showed grade 1 DED compared to grades 1, 2, and 3 DED in CD. Five children had DED of deciduous teeth and remaining in permanent ones. After 1 year on GFD, DED improved better in CD compared to nonceliac patients. Gastrointestinal symptoms did not vary between celiac and nonceliac DED patients. Lower serum calcium significantly predicted CD in this cohort. Conclusion. CD is more prevalent among children with DED than in the general population. These DEDs might be the only manifestation of CD; therefore, screening for CD is highly recommended among those patients especially in presence of underweight and hypocalcemia

Vaccine safety evaluation: Practical aspects in assessing benefits and risks

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Vitamin D deficiency and insufficiency in Africa and the Middle East, despite year-round sunny days

Exposure to sunlight, specifically ultraviolet B (UVB), is essential for cutaneous vitamin D synthesis. Despite significant daily sunlight availability in Africa and the Middle East, persons living in these regions are frequently vitamin D insufficient or deficient. Vitamin D insufficiency (25-hydroxyvitamin D (25(OH)D) between 15 and 20 ng/mL (37.5 - 50 nmol/L)) has been described in various population groups, ranging from 5% to 80%. Risk factors include traditional dress and avoidance of sunlight exposure, and multiple dietary factors as a result of specific cultural beliefs. Vitamin D resistance due to calcium deficiency mechanisms has been described in similar population groups, which may lead to hypovitaminosis D. Should the new diseases related to hypovitaminosis D prove to be truly associated, Africa and the Middle East will become an epicentre for many of these conditions. Urgent attention will need to be paid to cultural dress and dietary behaviours if hypovitaminosis D is to be taken seriously. Should such factors not be correctable, new strategies for supplementation or food fortification will have to be devised.http://www.samj.org.zaam201

Vitamin D deficiency and insufficiency in Africa and the Middle East, despite year-round sunny days

Exposure to sunlight, specifically ultraviolet B (UVB), is essential for cutaneous vitamin D synthesis. Despite significant daily sunlight availabilityin Africa and the Middle East, persons living in these regions are frequently vitamin D insufficient or deficient. Vitamin D insufficiency(25-hydroxyvitamin D (25(OH)D) between 15 and 20 ng/mL (37.5 - 50 nmol/L)) has been described in various population groups, ranging from 5%to 80%. Risk factors include traditional dress and avoidance of sunlight exposure, and multiple dietary factors as a result of specific cultural beliefs.Vitamin D resistance due to calcium deficiency mechanisms has been described in similar population groups, which may lead to hypovitaminosis D.Should the new diseases related to hypovitaminosis D prove to be truly associated, Africa and the Middle East will become an epicentrefor many of these conditions. Urgent attention will need to be paid to cultural dress and dietary behaviours if hypovitaminosis D is to betaken seriously. Should such factors not be correctable, new strategies for supplementation or food fortification will have to be devised

Symptoms and management of cow's milk allergy: perception and evidence

IntroductionThe diagnosis and management of cow's milk allergy (CMA) is a topic of debate and controversy. Our aim was to compare the opinions of expert groups from the Middle East (n = 14) and the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) (n = 13).MethodsThese Expert groups voted on statements that were developed by the ESPGHAN group and published in a recent position paper. The voting outcome was compared.ResultsOverall, there was consensus amongst both groups of experts. Experts agreed that symptoms of crying, irritability and colic, as single manifestation, are not suggestive of CMA. They agreed that amino-acid based formula (AAF) should be reserved for severe cases (e.g., malnutrition and anaphylaxis) and that there is insufficient evidence to recommend a step-down approach. There was no unanimous consensus on the statement that a cow's milk based extensively hydrolysed formula (eHF) should be the first choice as a diagnostic elimination diet in mild/moderate cases. Although the statements regarding the role for hydrolysed rice formula as a diagnostic and therapeutic elimination diet were accepted, 3/27 disagreed. The votes regarding soy formula highlight the differences in opinion in the role of soy protein in CMA dietary treatment. Generally, soy-based formula is seldom available in the Middle-East region. All ESPGHAN experts agreed that there is insufficient evidence that the addition of probiotics, prebiotics and synbiotics increase the efficacy of elimination diets regarding CMA symptoms (despite other benefits such as decrease of infections and antibiotic intake), whereas 3/14 of the Middle East group thought there was sufficient evidence.DiscussionDifferences in voting are related to geographical, cultural and other conditions, such as cost and availability. This emphasizes the need to develop region-specific guidelines considering social and cultural conditions, and to perform further research in this area

Retrieval of behavior trees using map-and-reduce technique

There has been an increased interest in the creation of AI social agents who possess complex behaviors that allow them to perform social interactions. Behavior trees provide a plan model execution that has been widely used to build complex behaviors for AI social agents. Behavior trees can be represented in the form of a memory structure known as cognitive scripts, which would allow them to evolve through further development over multiple exposure to repeated enactment of a particular behavior or similar ones. Behavior trees that share the same context will then be able to learn from each other resulting in new behavior trees with richer experience. The main challenge appears in the expensive cost of retrieving contextually similar behavior trees (scripts) from a repertoire of scripts to allow for that learning process to occur. This paper introduces a novel application of map-and-reduce technique to retrieve cognitive with low computational time and memory allocation. The paper focuses on the design of a corpus of cognitive scripts, as a knowledge engineering key challenge, and the application of map-and-reduce with semantic information to retrieve contextually similar cognitive scripts. The results are compared to other techniques used to retrieve cognitive scripts in the literature, such as Pharaoh which uses the least common parent (LCP) technique in its core. The results show that the map-and-reduce technique can be successfully used to retrieve cognitive scripts with high retrieval accuracy of 92.6%, in addition to being cost effective