Class of 2013 Abstract / Specific Aims: To assess whether vitamin D supplementation is associated with a reduced risk of type I diabetes in infants. Methods: This study was a systematic review using Pubmed, Google Scholar and reference lists of retrieved articles. Only randomized controlled trials and prospective observational studies were considered for this study. Data were extracted and organized into tables. The data were organized into three categories; study characteristics, patient characterisitics and study outcomes. The main outcomes were association of type I diabetes with vitamin D deficiency and identify the proper dose of vitamin D in pediatric population. Main Results: A total of 3 randomized controlled trials and 2 prospective observational studies were found that met the inclusion criteria; retrospective studies and case control studies were excluded. Combining all studies, no association was seen between vitamin D supplement and control group. Most of the randomized control studies have not shown a statistically significant association between Hb A1C, C-Peptide and vitamin D level with type I diabetes. The Gabbay et al. study showed that vitamin D serum concentrations (25(OH)D3) in the cholecalciferol and placebo groups were not significant at 6 ( P= 0.93),12( P= 0.81), and 18 (P= 0.53) months of follow up. The vitamin D concentration was increased during the 6 months period compared to baseline value (Basal: 26.34ng/ml vs 6 months: 60.88 ng/mL; P <001). Also, Bizzarri et al. study showed that at 6, 12, and 24 months the A1C and insulin usage in both calcitrol and placebo groups were not different. On the other hand, the observational study by Vojtková et al. showed that two thirds of children with type I diabetes had insufficient vitamin D concentration and lower Z score of lumbar spine. Also, the Fronczak observational study showed that maternal Intake of vitamin D via food was significant in decrease of IA-2 autoantibodies in offspring ( HR=0.37;95%Cl 0.17-0.78). Variety of different dosage of vitamin D supplement has been used in primary literatures. The data from Wicklow and Hypponen et al. used 2000IU/d that decreased risk of type I diabetes in diabetes type I. Conclusion: Reported studies did not have consistent conclusion for association of type I diabetes and vitamin D. The data from the randomized clinical trials have shown that vitamin D supplementation can increase serum vitamin D >30 ng/ml but none support the use of vitamin D in prevention of type I diabetes. Given the lack of data to support the use of vitamin D to reduce the risk of type I diabetes, vitamin D supplementation should be used to supplement vitamin D levels in children not exposed to adequate sunlight. There is no clear recommendation dose for treatment and prevention of vitamin D supplementation for pediatric patients. Therefore, monitoring and routine measurements of vitamin D by physician can play an important role. More randomized control trials with large sample would be needed to answer all of the unknown questions regarding the dosage of vitamin D supplement.

Best Mom es un centro especializado para el entrenamiento físico de las gestantes teniendo en cuenta la fisiología del embarazo y la capacidad funcional del cuerpo en dicho estado, liderado por profesionales de la salud (Obstetra), este servicio fortalecerá y beneficia el proceso de gestación de las gestantes, ya que su atención en prevenir los dolores lumbares, mejora la tensión arterial, reduce las molestias digestivas, ayuda a controlar el peso y ayuda a recuperar la silueta de las gestantes. Nuestro servicio, atiene a las madres gestantes entre 25 y 35 años, con un estilo de vida moderno y sofisticado, desarrollando ejercicios físicos, clases de natacias y yoga, beneficianto el proceso de gestación, este atenderá un nicho de mercado que aún no ha sido atendido. Nuestra porpuesta de valor es el servicio personalizado a las mujeres gestantes, con controles diarios de la mejora que se va generando con los ejercicios que se realizan, lo cual permitirá un mejor embarazo y preparándola para el parto. El equipo es multidisciplinario, conformado por profesionales que se encuentran cursando la carrera de administración de empresa, la carrera de negocios internacionales y la de marketing, por otro lado, estos mismos profesionales aportaren con su experiencia profesional desarrollados en varios sectores, para la ejecución del proyecto. El análisis financiero del proyecto muestra que los resultados son convervadores con una tasa interna de rendimiento de 65.21% para los inversionistas, además los flujos de caja de los próximos años son positivos. / Best Mom is a specialized center for the physical training of pregnant women taking into account the physiology of pregnancy and the functional capacity of the body in said state, led by health professionals (Obstetrician), this service will strengthen and benefit the gestation process of pregnant women, since their attention to preventing low back pain, improves blood pressure, reduces digestive discomfort, helps to control weight and helps to recover the shape of pregnant women. Our service, caters to pregnant mothers between 25 and 35 years old, with a modern and sophisticated lifestyle, developing physical exercises, swimming classes and yoga, benefiting the gestation process, this will serve a market niche that has not yet been attended. Our value proposition is the personalized service to pregnant women, with daily controls of the improvement that is generated with the exercises that are carried out, which will allow a better pregnancy and prepare it for delivery. The team is multidisciplinary, made up of professionals who are studying business administration, international business and marketing, on the other hand, these same professionals will contribute with their professional experience developed in various sectors, for the execution of the draft. The financial analysis of the project shows that the results are converging with an internal rate of return of 65.21% for investors, and also the cash flows in the coming years are positive. / Trabajo de investigación

Thesis (MMed)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: The aim of this pilot project was to determine whether mothers with laboratory confirmed or clinically suspected tuberculosis (TB) had evidence of TB in the placenta. A secondary objective was to correlate evidence of placental TB with neonatal outcome. A total of 56 placentas were examined to determine if there were any specific histopathological features predictive of tuberculosis together with Ziehl-Neelsen (ZN) staining. A total of 30 cases were positive for maternal TB and one case was a false positive maternal diagnosis of TB, whilst 25 cases were negative for maternal TB. Biopsies from these 56 placentas were collected for conventional PCR from the paraffin embedded tissue blocks. The performance of these two diagnostic modalities (histopathology and PCR) was assessed coll ectively and individually, and compared to the neonatal outcome (presence or absence of active clinical mycobacterial tuberculosis infection) and evidence of maternal pulmonary and extra pulmonary tuberculosis. The recognition of specific sites of lesions in the placenta (e.g. membranes vs. intervillous space) may lead to an understanding of the pathogenic mechanisms involved in matern alfetal transmission of tuberculosis, and thereby pave the way for further studies in understanding the pathogenesis of congenital TB. Invaluable knowledge was obtained in the diagnoses of M.tuberculosis in the placenta as it was found that micro abscesses and intervillositis were strong indicators of TB infection in the placenta, however, ZN staining still remains the gold standard for diagnosing M.tuberculosis infection in the placenta. PCR is found to have limitations, because only M.tuberculosis DNA is amplified and does not distinguish live from dead bacteria. The conclusion reached is that PCR is of limited value in the diagnosis of active M.tuberculosis infection in the placenta using FFPE tissue, while certain histological changes may be indicative of such infection; however confirmation of the organism by ZN staining is still essential. / AFRIKAANSE OPSOMMING: Die hoofdoelwit van hierdie projek was om vas te stel of moeders met bevestigde of vermoedelike TB enige indikasie van TB in die plasenta toon. ‘n Tweede doelwit was om die neonatale uitkoms teenoor die plasentale TB te korreleer. ‘n Totale getal van 56 plasentas is ondersoek om vas te stel of daar enige spesifieke histopatologiese indikasies is van tuberkulose met die hulp van die ZN spesiale kleuring. Die totale getal positiewe vir TB was 30 asook ‘n vals positiewe geval vir TB en daar was 25 TB negatiewe gevalle. Ses en vyftig biopsies is versamel van paraffien in gebedteerde weefsel vir die gebruik in PKR. Die uitvoering van hierdie twee diagnostiese modaliteite is elk individueel ondersoek asook gesamentlik om dit te vergelyk met die neonatale uitkoms (m.a.w die teenwoordigheid of aanwesigheid van mikobakteriale tuberkulose infeksie) asook die teenwoordigheid van moederlike pulmunere en ekstra-pulmunere tuberkulose. Die spesifieke ligging van die letsels in die plasenta (bv. membrane vs. intervillus spasie) kan lei tot verbeterde begrip van die patogeniese meganismes betrokke in die moeder fetale oordrag van tuberkulose en dit kan lei tot toekomstige navorsing. Waardevolle kennis is opgedoen in die diagnose van M.tuberkulose in die plasenta, want die letsels van mikro abbesses en intervillisitus gee ‘n goeie aanduiding van TB infeksie in die plasenta. Die ZN kleuring bly nog steeds die standaard metode om M.tuberculose in die plasenta te diagnoseer. PKR het baie limiete want dit kan slegs die M.tuberkulose DNA vermeningvuldig, maar dit kan nie onderskeid tref tussen lewendige en dooie bakterie nie. The slotsom in hierdie projek is dat PKR ‘n be pperkte waarde het in die diagnose van aktiewe M .tuberkulose in die plasenta, deur die gebruik van formalien gefikseerde paraffien ingebedteerde weefsel nie terwyl sekere histologiese veranderinge ‘n aa nduiding van sodanige infeksie kan wees maar dat dit deur die spesiale kleruring (ZN) bevestig moet word. / National Health Laboratory Service (NHLS)

MPM / Oliver Tambo Institute of Governance and Policy Studies

In 2011, African Americans in Tarrant County, Texas experienced an infant mortality rate of 14.3 per 1,000 live births. The leading cause of infant mortality in Tarrant County is prematurity and maternal nutritional status. Both maternal under-nutrition and over-nutrition are known risk factors for premature birth. Improving maternal nutrition, by reducing rates of gestational diabetes and preeclampsia, and by increasing consumption of essential prenatal vitamins and nutrients, is a road to decreasing preterm birth in African Americans. This qualitative study, based on both anthropology and public health theory, of the nutrition behavior of a group of African American expectant mothers and the experience of their health care providers and co-facilitators had a goal to provide a foundation for future development of nutrition behavior research and education for this specific population. The main finding of this study was the substantial gap of lived experience and education between the patients and their providers and co-facilitators, which hinders delivery of care and the patients’ acquiescence to nutrition recommendations. The discrepancies between the authoritative knowledge of the providers and the bodily knowledge of expectant mothers were responsible for the ineffectiveness of nutrition recommendations.