Apr–Jun 2014 • Vol LIII • No 4
9
Latest in Medicine
Breast-feeding Protects Against
Infantile Diarrhea Caused by
Intestinal Protozoan Infections
Abdel-Hafeez EH, et al
Korean J Parasitol.
2013;51(5):519–524.
Breastfeeding provides significant protection against many
diseases including diarrhea in infancy. This is attributable to a
complex of acquired and innate factors unique to human milk.
However, there are little conflicting opinions concerning breast
milk and its anti-infective functions.
This study investigated the effect of breastfeeding in protection
against protozoan infection in infants with persistent diarrhea.
Infants were classified into 2 groups—161 breastfed infants
and the same number of nonbreastfed infants. Microscopic
examinations of stool were done for detecting parasites and
measuring the intensity of infection. Furthermore, serum levels of
IgE and TNF-
α
were measured by ELISA.
Cryptosporidium
spp,
Entamoeba histolytica, Entamoeba dispar
,
Giardia lamblia
, and
Blastocystis
spp were observed in infants with persistent diarrhea.
The percentage of protozoan infections was significantly lower in
breastfed infants than that in the nonbreastfed infants. The levels
of IgE and TNF-
α
were significantly lower in the breastfed group
than in the nonbreastfed group. There were significant positive
associations between the serum levels of IgE and TNF-
α
and the
intensity of parasite infection in the breastfed group.
It is suggested that breastfeeding has an attenuating effect on the
rate and intensity of parasite infection.
Predictors of Early
Postoperative Pain After Stapled
Haemorrhoidopexy
Zhao Y, et al
Colorectal Dis.
December 18, 2013 (doi: 10.1111/codi.12531).
This study was designed to identify the predictors of postoperative
pain after stapled hemorrhoidopexy (SH).
Seventy-six patients with grade 2 to 4 hemorrhoids who
underwent SH were selected. Pain was evaluated during the first
24 h after the operation. Its intensity was classified into 3 grades
according to the visual analogue scale (VAS) score as—mild,
VAS ≤ 3; moderate, VAS > 3 to < 5; and severe, VAS ≥ 5. Both
univariate and multivariate analyses were used to determine the
predictors of postoperative pain.
Moderate and severe pain was noted in 43 (58.9%) patients.
No patient was readmitted due to persistent anal pain during 1
month following discharge. Postoperative pain was significantly
associated with gender (
P
= .017), age (
P
= .014), initial sensory
volume (
P
= .023), and constipation (
P
= .005) in univariate
analysis. Multivariate analysis identified male gender as an
independent predictor of postoperative moderate to severe pain
(
P
= .037; OR = 3.1; 95%CI = 1.07–9.09). The initial sensory
volume and preoperative coexisting constipation were negative
predictors of postoperative moderate to severe pain after SH
(
P
= .037 and
P
= .036, respectively).
Male gender and the initial sensory volume are predictors of
postoperative pain after SH. Anal manometry is recommended
before the SH procedure.
Matrix Metalloproteinases in
Pathogenesis of Hemorrhoidal
Disease
Kisli E, et al
Am Surg.
2013;79(11):1181–1184.
The aim of this study was to investigate the accuracy of serum
matrix metalloproteinase (MMP) levels in an effort to find a
reliable factor that may play an important role in the pathogenesis
of hemorrhoidal disease.
Twenty controls, 21 grade 1, 19 grade 2, 20 grade 3, and 21
grade 4 patients with internal hemorrhoids were included in
this prospective study. Ten milliliters of blood was taken from
all patients. Enzyme-linked immunosorbent assay (ELISA) for
MMP-1, MMP-2, MMP-7, and MMP-9 levels was performed.
There was a significant difference in the serum levels of MMP-9
(
P
< .01) between grade 1 and grade 2 groups. Patients with grade
3 hemorrhoidal disease had significantly higher serum levels of
all MMPs than patients with grade 1 and grade 2 hemorrhoidal
disease (
P
< .001). Also, patients with grade 4 hemorrhoidal
disease had higher serum levels of MMP-7 and MMP-9
compared to grade 1, 2, and 3 groups (
P
< .01 and
P
< .001,
respectively). High serum levels of MMP are present in patients
with hemorrhoids, suggesting the possible mechanism in the
pathogenesis of hemorrhoids.
