Summary of childhood asthma guidelines, 2021 : a consensus document

Asthma is the most common chronic illness of childhood. The prevalence is rising and the mortality and morbidity from asthma are unacceptably high in South Africa. It is important to make a correct diagnosis based, most importantly, on the clinical history and supported by investigations. The appropriate drug and device must be chosen to achieve good asthma control. Patients must be followed up regularly and their asthma control must be assessed. The treatment can then be adjusted according to the level of control. The COVID-19 pandemic has placed new challenges on the care of our asthmatics. Asthma education and adherence are important components of management of the condition.http://www.samj.org.zadm2022Paediatrics and Child Healt

Looking beyond the magic bullet : novel asthma drugs or education, which works better?

Although ˂5% of children with asthma suffer from severe asthma, they account for the highest use of health resources. The field of asthma therapy is changing rapidly, with a number of new drugs and biologics being added to the treatment armamentarium, particularly for adults. This, though, is not the case for paediatric patients, in whom a number of these novel molecules and drugs have not been investigated. Even though adults have shown responses to medication in some studies, this does not necessarily imply that there will be similar results in children. In the management of severe asthma, use of specific interventions to ensure treatment adherence and goal-setting for selfmanagement is critical to ensure the best treatment outcomes. The objective of this article is to review and grade the current evidence base for use of novel asthma drugs and to make evidence-based recommendations for their administration in children with severe asthma in the South Africa context. We also review the evidence for medication-adherence strategies and self-management plans.SACAWG conducted a workshop, which received an unconditional educational grant from the Allergy Society of South Africa – funded by Novartis.http://www.samj.org.zaam2018Paediatrics and Child Healt

The effect of dietary protein on reproduction in the mare. III. Ovarian and uterine changes during the anovulatory, transitional and ovulatory periods in the non-pregnant mare

In the main experiment the total daily protein intake and quality (essential amino-acids) was varied in 4 groups of mares. The incidence of oestrus in mares during the transitional period was unaffected by protein nutrition. Ovarian activity, as evaluated by follicular development and size of the ovaries, was affected. Mares that received low-quality protein (Groups 1 and 2) had a higher number of smaller follicles (<10 mm) that developed during the transitional period compared to mares on a high-quality protein intake (Groups 3 and 4). The mares that received the high quality protein ovulated 2-3 weeks earlier in the breeding season in a synchronised period of 4-5 weeks compared to a period of 6-8 weeks in Groups 1 and 2. The duration of the subsequent oestrous cycles was not affected. There was no difference in the diameter of the largest follicle of mares between groups on the day before ovulation. In a separate experiment, 5 maiden Anglo-Arab mares, 4-5 years of age, were slaughtered at different stages during the anovulatory, transitional and ovulatory periods of the breeding cycle. The morphology of the ovaries and uteri of these mares was described and photographed for use as guidelines when comparing ovarian changes and follicular activity of mares

The effect of dietary protein on reproduction in the mare. VII. Embryonic development, early embryonic death, foetal losses and their relationship with serum progestagen

Sixty-four Thoroughbred and Anglo-Arab mares aged 6-12 years were randomly allocated to 4 dietary groups and fed diets that differed in the total protein content and quality (essential amino-acids). Forty mares were non-lactating and 24 lactating. Eight mares were withdrawn from the investigation owing to injuries or gynaecological pathology. An overall conception rate of 94.6 % and a foaling rate of 80 % was achieved. Five of 14 (35.7 %) mares (Group 1) fed a low-quality protein diet suffered from early embryonic loss before 90 days of pregnancy compared to 3 of 41 (7.3 %) mares in the remaining groups that received the higher-quality protein in their diets. Serum progestagen concentrations of mares in Group 1 that suffered foetal loss were indicative of luteal function insufficiency during the 1st 40 days post-ovulation. Non-lactating mares in all 4 groups gained on average approximately 30 kg in mass during the 90 days before the breeding period. Lactating mares in Group 1 (low-quality protein) lost on average 25 kg in mass during lactation, with no weight loss observed among the lactating mares in the other 3 groups. No difference in the diameter of the embryonic vesicle was found between dietary groups until Day 35 of pregnancy.Articl

The effect of dietary protein on reproduction in the mare. II. Growth of foals, body mass of mares and serum protein concentration of mares during the anovulatory, transitional and pregnant periods

The effect of 4 different diets, in terms of protein quantity and quality, on total serum protein (TSP), albumin and globulin was investigated. Non-pregnant mares that were not lactating (n = 36), pregnant mares that had foaled (n = 24) and their foals (n = 24) were used in this study. Daily total protein intake had no effect on blood protein concentrations in the mares. Total protein intake and quality (available essential amino-acids) did affect the body mass of mares during lactation. When mares were fed the minimum recommended (National Research Council 1989) total daily protein, foal mass decreased by approximately 25% at weaning compared to the foals whose dams were on a higher level of protein intake, The TSP concentrations of foals at birth were on average 10 g/l lower than those of the mares. Albumin concentrations of foals during the first 60 days of life were on average 2-3 g/l lower than those of the mares. Globulin concentrations of foals were approximately 5 g/l lower than those of mares at weaning.Articl

Effect of high levels of dietary molybdenum and sulphate on SA Mutton Merino sheep. II. Certain aspects of the oestrous cycle and pregnancy

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The effect of dietary protein on reproduction in the mare. VII. Embryonic development, early embryonic death, foetal losses and their relationship with serum progestagen

Sixty-four Thoroughbred and Anglo-Arab mares aged 6-12 years were randomly allocated to 4 dietary groups and fed diets that differed in the total protein content and quality (essential amino-acids). Forty mares were non-lactating and 24 lactating. Eight mares were withdrawn from the investigation owing to injuries or gynaecological pathology. An overall conception rate of 94.6 % and a foaling rate of 80 % was achieved. Five of 14 (35.7 %) mares (Group 1) fed a low-quality protein diet suffered from early embryonic loss before 90 days of pregnancy compared to 3 of 41 (7.3 %) mares in the remaining groups that received the higher-quality protein in their diets. Serum progestagen concentrations of mares in Group 1 that suffered foetal loss were indicative of luteal function insufficiency during the 1st 40 days post-ovulation. Non-lactating mares in all 4 groups gained on average approximately 30 kg in mass during the 90 days before the breeding period. Lactating mares in Group 1 (low-quality protein) lost on average 25 kg in mass during lactation, with no weight loss observed among the lactating mares in the other 3 groups. No difference in the diameter of the embryonic vesicle was found between dietary groups until Day 35 of pregnancy.Articl

The effect of dietary protein on reproduction in the mare. V. Endocrine changes and conception during the early post partum period

Pregnant Anglo-Arab and Thoroughbred mares (n = 24) were divided randomly according to age and breed into 4 groups of 6 mares each from approximately 6 weeks before their expected foaling date. Diets received by the 4 groups varied in essential amino-acid and total protein contents. Serum progestagen, FSH and LH concentrations were determined from the day of parturition until foal heat and during the 1st oestrous cycle following foal heat. Serum progestagen, FSH and LH concentrations did not differ between the treatment groups. Progestagen concentrations were high (x̄ = 7.0: 5.2-16.4 ng/ml) at parturition but decreased rapidly within 48 h. As progestagen concentrations decreased LH concentrations increased from Days 3-6 post partum to reach maximum values at, or the day after ovulation. FSH concentrations declined 3-4 d after parturition and increased 2-3 d before ovulation at foal heat. The duration of elevated progestagen concentrations during the luteal phase of the subsequent oestrous cycle affected the interovulatory period. A 12-14 d FSH cyclical releasing pattern occurred. Season/photoperiod affected the resumption of normal oestrous cyclicity during the post partum period. The duration of the 1st oestrous cycle after foal heat in mares fed a low-quality protein diet showed a greater range (13-30 d) compared to mares fed a high-quality protein diet (18-26 d).Articl