Infant botulism following honey ingestion

Button Battery Ingestion in Children: An Educational Review for Perioperative Nursing

Button battery ingestion is potentially fatal, especially in children less than 6 years of age, most commonly due to esophageal perforation. The number of ingestions and complications has risen significantly in recent decades. Impacted button batteries should ideally be removed urgently within 2 hours of ingestion. However, many ingestions go unwitnessed, and children may present with variable, vague symptoms. The recommendation now is that children over the age 12 months consume honey when a button battery ingestion is witnessed or diagnosed, if less than 12 hours have elapsed. Importantly, though, honey should not be consumed if perforation is suspected. Induction of general anesthesia and battery removal should not be delayed to satisfy NPO guidelines, even if the child has eaten.

Do various types of prelacteal feeding (PLF) have different associations with breastfeeding duration in Indonesia? A cross-sectional study using Indonesia Demographic and Health Survey datasets

INTRODUCTION

Prelacteal feeding (PLF) is anything other than breastmilk given to newborns in the first few days of birth and/or before breastfeeding is established. PLF comes in many forms and is known as a challenge to optimal breastfeeding. Interestingly, both breastfeeding and PLF are common in Indonesia. This study investigated the association between PLF (any PLF, formula, honey, water and other milk) and breastfeeding duration.

METHODS

This study used Indonesia Demographic and Health Surveys data from 2002, 2007 and 2017. Sample sizes were 5558 (2007), 6268 (2007) and 6227 (2017) mothers whose last child was aged 0-23 months. We used Cox regression survival analysis to assess the association between PLF and breastfeeding duration, estimating hazard ratios (HR) for stopping earlier.

RESULTS

Overall PLF was prevalent (59%, 67% and 45% in 2002, 2007 and 2017, respectively), with formula being the most common (38%, 50% and 25%). No association between any PLF and breastfeeding duration in 2002 (HR 0.90 (95% CI 0.70 to 1.16)), but in 2007 and 2017, mothers who gave any PLF were more likely to stop breastfeeding earlier than those who did not (HR 1.33 (95% CI 1.11 to 1.61) and 1.47 (95% CI 1.28 to 1.69), respectively), especially in the first 6 months (HR 2.13 (95% CI 1.55 to 2.92) and 2.07 (95% CI 1.74 to 2.47), respectively). This association was more consistent for milk-based PLF. For example, HR in 2017 was 2.13 (95% CI 1.78 to 2.53) for prelacteal formula and 1.73 (95% CI 1.39 to 2.15) for other milk. The associations were inconsistent for the other PLF types. Prelacteal water showed no association while prelacteal honey showed some association with a longer breastfeeding duration in 2002 and 2007.

CONCLUSION

The impact of PLF on breastfeeding duration varied by type. While this study supports current recommendations to avoid PLF unless medically indicated, the potential consequences of different PLF types on breastfeeding outcomes should be clearly communicated to healthcare providers and mothers. Further research should explore the reasons for the high PLF prevalence in this setting.

Nemaline Myopathy in a Hypotonic Neonate: Diagnostic Approach for Early Detection and Management

Neonatal hypotonia presents with low muscle tone and an array of symptoms that vary depending on the etiology. The differential diagnosis for this condition is complex. It is crucial to exclude life-threatening causes before following a diagnostic algorithm and performing additional tests. Given the wide range of clinical symptoms and etiologies for neonatal hypotonia, rapid genetic testing has the potential to expedite diagnosis, reduce invasive testing such as muscle biopsy, reduce hospital stays, and guide condition management.  A four-week-old girl was admitted to the emergency department (ED) with a one-day history of lethargy, poor feeding, congestion, cough, and hypoxemia. Given positive rhino-enterovirus testing and high inflammatory markers, antibiotics were administered. Imaging, venous blood gas, and blood cultures were negative, and the patient was admitted to the pediatric intensive care unit (PICU) for hypoxemia. After speech-language pathology (SLP) and occupational therapy (OT) evaluation, weak orofacial muscles and feeding issues resulted in a nasogastric tube placement. A swallow study revealed decreased pharyngeal contraction and post-swallow liquid residue. Laryngoscopy showed mild laryngomalacia and dysphagia with aspiration. Genetic testing identified an ACTA1 mutation and confirmed nemaline myopathy (NM). The patient's oxygen levels dropped further during sleep, resulting in diagnoses of severe obstructive and moderate-severe central sleep apnea. Treatment included oxygen therapy, SLP, physical therapy, albuterol, and cough assists. After discharge, the patient was frequently re-admitted with chronic respiratory failure and bronchiolitis and later had gastrostomy and tracheostomy tubes inserted.  This specific case highlights the importance of implementing a diagnostic algorithm for neonatal hypotonia. It is also important for physicians, especially emergency medicine (EM) providers, to first exclude infection, sepsis, and cardiac and respiratory organ failure before looking into other tests. Then, physicians should evaluate for more rare etiologies. In this patient's case, the hypotonia was due to a rare genetic disease, nemaline myopathy, and a multidisciplinary approach was used for this patient's care.

A qualitative study to understand sociocultural beliefs around perinatal and neonatal health in rural areas of Mohali, Punjab, India

Introduction

Globally, 600,000 mothers (15-49 years) die every year due to pregnancy and childbirth-related complications. Wide variations are seen in cultural practices and beliefs surrounding this period of a woman's life. The present study explores the cultural beliefs and practices of women and families during pregnancy and the postnatal period in order to understand what behavioral management strategies are required to improve maternal and infant outcomes during pregnancy and the postpartum period.

Methods

The study was conducted in a rural area of Punjab, from December 2019 to March 2021. A total of 20 women (up to 3 months postpartum, age >18 years, were interviewed.

Results

In general, women described eating varied and fairly healthy diets during pregnancy, especially nutritious warm food, following traditional practices. Other cultural practices included restrictions on movement and mobile phone use and the use of unsafe home remedies to promote infant safety and wellbeing, such as using gripe water, applying black pencil to the baby's eyes, and feeding the baby honey. A few were not inclined to engage with these and other cultural expectations, preferring instead to follow contemporary practices influenced by social media. These practices included being accompanied by a family member during delivery, celebrating the baby's birth regardless of sex, and early bathing post-delivery.

Discussion

It can be concluded that while many traditional practices are still followed in India, there are new beliefs and behaviors arising from an intersection between culture and technology. Developing strategies that acknowledge older beliefs and modern approaches is essential to promoting better antenatal and postpartum care.

Knowledge, attitude and practice among mothers on the relationship between honey and botulism in Saudi Arabian infants: a cross-section study

BACKGROUND

Botulism is a rare disease, and infant botulism (IB) even rarer, especially when steering the condition to honey consumption. IB is considered a life-threatening disease as it leads to severe neurological symptoms. Exploring the knowledge, attitude, and practice (KAP) among mothers on the relationship between honey and IB will help public health professionals implement appropriate maternal health education materials targeting infant health and increase the awareness of the paediatric primary care providers, physicians, and nurse practitioners about the risk of IB among their patients.

OBJECTIVES

To determine the knowledge of mothers from Hail city in Saudi Arabia (SA) regarding IB and assess their attitude and practice towards feeding honey to their infants before 12 months of age.

METHODS

Using a comparative cross-sectional study, in February 2022, we broadcasted an online questionnaire through social networking and evaluated the KAP of 385 mothers.

RESULTS

Less than half (48%) of the mothers have heard about IB, 40% of them knew the relation between honey ingestion and IB and only 6.5% acknowledged that they knew the causative agent for IB. The prevalence of feeding honey to infants before 12 months was 52%. Mothers from Hail city were less likely to provide honey to their infants (p = 0.002).

CONCLUSION

The study revealed that mothers from Hail city have relatively low knowledge of IB and that they hold favourable perceptions of using honey as a food supplement and feeding honey to their infants before 12 months. Considering the high prevalence of honey feeding with the known low incidence of IB in SA, Medical professionals should consider IB in their differential diagnosis particularly in the presence of neurological symptoms.

Pyrrolizidine Alkaloids from Monofloral and Multifloral Italian Honey

Pyrrolizidine alkaloids (PAs) are secondary metabolites produced by plants as a self-defense against insects. After bioactivation in the liver, some PAs can cause acute or chronic toxicity in humans. The aim of this study was to determine the presence of PAs in 121 samples of monofloral and multifloral honey from three different Italian regions (Friuli-Venezia Giulia, Marche and Calabria) to meet the European Food Safety Authority (EFSA) suggestion. An in-house liquid chromatography with tandem mass spectrometry (LC-MS/MS) method was validated according to European Union Reference Laboratory (EURL) performance criteria. This method allowed the detection and quantification of 35 PAs. Of the 121 honey samples, 38 (31%), mostly from Calabria, contained PAs. The total content of the PAs ranged from 0.9 µg/kg to 33.1 µg/kg. In particular, echimidine was the most prevalent PA. A rapid human exposure assessment to PAs in honey and a risk characterization was performed using the EFSA RACE tool. The assessment highlighted a potential health concern only for toddlers who frequently consume elevated quantities of honey. This study showed a low presence of PAs in Italian honey; however, the importance of continuously monitoring these compounds is stressed, along with the suggestion that the relevant authorities establish maximum limits to guarantee support for producers and consumer safety.

Radioactivity evaluation and radiation dosimetry assessment in Greek honey

Greek honey was examined for ²³⁸U, ²³⁴U, ²¹⁰Pb, ²¹⁰Po, ⁴⁰K, and ¹³⁷Cs levels. ²³⁸U was calculated from 0.013 ± 0.007 Bq kg^-1 to 0.10 ± 0.02 Bq kg^-1 while ²³⁴U ranged from 0.017 ± 0.009 Bq kg^-1 to 0.11 ± 0.03 Bq kg^-1. ²¹⁰Pb measured from 0.04 ± 0.02 Bq kg^-1 to 1.70 ± 0.26 Bq kg^-1 whereas ²¹⁰Po activity determined between 0.02 ± 0.01 Bq kg^-1 and 2.31 ± 0.34 Bq kg^-1. ⁴⁰ K found at the range of 7.9 ± 1.6 Bq kg^-1 to 102.2 ± 19.7 Bq kg^-1 and ¹³⁷Cs 0.3 ± 0.1 Bq kg^-1 up to 0.8 ± 0.1 Bq kg^-1. Uranium isotopes and ²¹⁰Po were determined via alpha spectrometry. ²¹⁰Pb was also indirectly determined by alpha spectrometry. ⁴⁰ K and ¹³⁷Cs were measured through γ-ray spectrometry. An annual dose calculation was performed for different age groups.

Water is a preservative of microbes

Water is the cellular milieu, drives all biochemistry within Earth's biosphere and facilitates microbe-mediated decay processes. Instead of reviewing these topics, the current article focuses on the activities of water as a preservative-its capacity to maintain the long-term integrity and viability of microbial cells-and identifies the mechanisms by which this occurs. Water provides for, and maintains, cellular structures; buffers against thermodynamic extremes, at various scales; can mitigate events that are traumatic to the cell membrane, such as desiccation-rehydration, freeze-thawing and thermal shock; prevents microbial dehydration that can otherwise exacerbate oxidative damage; mitigates against biocidal factors (in some circumstances reducing ultraviolet radiation and diluting solute stressors or toxic substances); and is effective at electrostatic screening so prevents damage to the cell by the intense electrostatic fields of some ions. In addition, the water retained in desiccated cells (historically referred to as 'bound' water) plays key roles in biomacromolecular structures and their interactions even for fully hydrated cells. Assuming that the components of the cell membrane are chemically stable or at least repairable, and the environment is fairly constant, water molecules can apparently maintain membrane geometries over very long periods provided these configurations represent thermodynamically stable states. The spores and vegetative cells of many microbes survive longer in the presence of vapour-phase water (at moderate-to-high relative humidities) than under more-arid conditions. There are several mechanisms by which large bodies of water, when cooled during subzero weather conditions remain in a liquid state thus preventing potentially dangerous (freeze-thaw) transitions for their microbiome. Microbial life can be preserved in pure water, freshwater systems, seawater, brines, ice/permafrost, sugar-rich aqueous milieux and vapour-phase water according to laboratory-based studies carried out over periods of years to decades and some natural environments that have yielded cells that are apparently thousands, or even (for hypersaline fluid inclusions of mineralized NaCl) hundreds of millions, of years old. The term preservative has often been restricted to those substances used to extend the shelf life of foods (e.g. sodium benzoate, nitrites and sulphites) or those used to conserve dead organisms, such as ethanol or formaldehyde. For living microorganisms however, the ultimate preservative may actually be water. Implications of this role are discussed with reference to the ecology of halophiles, human pathogens and other microbes; food science; biotechnology; biosignatures for life and other aspects of astrobiology; and the large-scale release/reactivation of preserved microbes caused by global climate change.

Diversity of the Genomes and Neurotoxins of Strains of Clostridium botulinum Group I and Clostridium sporogenes Associated with Foodborne, Infant and Wound Botulism

Clostridium botulinum Group I and Clostridium sporogenes are closely related bacteria responsible for foodborne, infant and wound botulism. A comparative genomic study with 556 highly diverse strains of C. botulinum Group I and C. sporogenes (including 417 newly sequenced strains) has been carried out to characterise the genetic diversity and spread of these bacteria and their neurotoxin genes. Core genome single-nucleotide polymorphism (SNP) analysis revealed two major lineages; C. botulinum Group I (most strains possessed botulinum neurotoxin gene(s) of types A, B and/or F) and C. sporogenes (some strains possessed a type B botulinum neurotoxin gene). Both lineages contained strains responsible for foodborne, infant and wound botulism. A new C. sporogenes cluster was identified that included five strains with a gene encoding botulinum neurotoxin sub-type B1. There was significant evidence of horizontal transfer of botulinum neurotoxin genes between distantly related bacteria. Population structure/diversity have been characterised, and novel associations discovered between whole genome lineage, botulinum neurotoxin sub-type variant, epidemiological links to foodborne, infant and wound botulism, and geographic origin. The impact of genomic and physiological variability on the botulism risk has been assessed. The genome sequences are a valuable resource for future research (e.g., pathogen biology, evolution of C. botulinum and its neurotoxin genes, improved pathogen detection and discrimination), and support enhanced risk assessments and the prevention of botulism.

The study correlation between physicochemical properties, botanical origin and microbial contamination of honey from the south of Ukraine

The honey production is one of the most important agriculture branches of Ukraine. Since the beginning of 2000 year, honey becomes one of the first products of agriculture production that was allowed to export from Ukraine to the EU countries. The present study aims to evaluate microbial composition of honey of higher and first grades from south of Ukraine, which differ in water, sugar content and acidity. The correlation beetween physicochemical properties, botanical origin and microbial composition of honey were investigated. Total aerobic count (TAC), total count of fungi (TFC) and yeast (TYC), number of sporeforming anaerobes (SFA), Bacillus cereus and Clostridium botulinus were determined. Plate dilution method with specific cultural mediums and incubation conditions was used for indication and identification of microorganisms as well for quantitative CFU count determination in 1g of honey. The results indicated that the value of TAC was from 1.4 ±0.1 x 102 to 3.7 ±0.5 x 102 CFU.g-1 in higher grade honey and from 2.1 ±0.3 x 102 to 4.6 ±0.4 x 102 CFU.g-1 in first grade honey. Average amounts of fungi and yest in the first grade honey were more than in higher grade honey and amounted 15.±0.9 CFU.g-1, 6.48 ±0.7 CFU.g-1 and 17.98 ±1.2 CFU.g-1, 8.04 ±0.8 CFU.g-1 respectively. Also it was found that, 25.8% and 37.1% of higher and first grade honey samples had sporeforming anaerobes. The more of samples with Bacillus cereus and Clostridium botulinum were among samples of first-grade honey samples. In addition, we have determined that, samples of buckwheat honey and honey from fodder crops of both grades were more contaminated with all microorganisms than samples of sunflower honey and honey from fruit and non-fruit trees.Results of this work has revealed the relationship between the number of different groups and species of microorganisms in higher and first grade honey from south of Ukraine and its physicochemical properties and botanical origin. Our research could help to substantiate the sources of contamination of honey and confirm the existing findings of scientists about the direct proportional dependence of the content of microorganisms in honey, depending on its moisture content, acidity and sugars.

Clostridium botulinum and Clostridium perfringens Occurrence in Kazakh Honey Samples

The aim of this study was to assess occurrence of Clostridium botulinum and Clostridium perfringens in honey samples from Kazakhstan. Analyses were carried out using a set of PCR methods for identification of anaerobic bacteria, and detection of toxin genes of C. botulinum and C. perfringens. Among 197 samples, C. botulinum was noticed in only one (0.5%). The isolated strain of this pathogen showed the presence of the bont/A and ntnh genes. C. perfringens strains were isolated from 18 (9%) samples, and mPCR (multiplex PCR) analysis led to them all being classified as toxin type A with the ability to produce α toxin. Sequence analysis of 16S rDNA genes showed occurrence in 4 samples of other anaerobes related to C. botulinum, which were C. sporogenes and C. beijerinckii strains. C. botulinum prevalence in honey samples from Kazakhstan in comparison to the prevalence in samples collected from the other regions seems to be less. The highest prevalence of Clostridium sp. was noticed in the East Kazakhstan province. Our study is the first survey on BoNT-producing clostridia and C. perfringens prevalence in Kazakh honey.

Phenolic Compounds in Honey and Their Associated Health Benefits: A Review

Honey is a natural substance appreciated for its therapeutic abilities since ancient times. Its content in flavonoids and phenolic acids plays a key role on human health, thanks to the high antioxidant and anti-inflammatory properties that they exert. Honey possesses antimicrobial capacity and anticancer activity against different types of tumors, acting on different molecular pathways that are involved on cellular proliferation. In addition, an antidiabetic activity has also been highlighted, with the reduction of glucose, fructosamine, and glycosylated hemoglobin serum concentration. Honey exerts also a protective effect in the cardiovascular system, where it mainly prevents the oxidation of low-density lipoproteins, in the nervous system, in the respiratory system against asthma and bacterial infections, and in the gastrointestinal system. A beneficial effect of honey can also be demonstrated in athletes. The purpose of this review is to summarize and update the current information regarding the role of honey in health and diseases.

Honey and beehive products in otorhinolaryngology: a narrative review

BACKGROUND

Honey and beehive products were rediscovered as an alternative treatment in wounds. The medicinal properties also raised interest of their use in Otorhinolaryngology.

OBJECTIVE OF REVIEW

To give an overview of the effectiveness of beehive products in Otorhinolaryngology.

TYPE OF REVIEW

Narrative.

SEARCH STRATEGY AND EVALUATION

A literature search of the databases PubMed, EMBASE and Cochrane was performed from the last two decades till December 2014. The search terms 'honey', 'propolis' or 'royal jelly' were used. Articles, which evaluated the effectiveness of beehive products in Otorhinolaryngology, were included. The quality assessment of included studies was performed using the Cochrane Collaboration's risk of bias tool.

DISCUSSION AND CONCLUSION

A total of 36 studies were identified and evaluated. Eighteen studies investigated their effect in oral infections, seven in infection of the respiratory tract, six in rhino-sinusal diseases, four investigated the use in tonsillectomy and head and neck surgery and one study explored the preventive effect in otitis media. Honey can be considered as effective (additional) treatment in mucositis, childhood cough, persistent post-infectious cough and after tonsillectomy. Propolis may have a role in the treatment of (aphthous) stomatitis, mouth ulcer and prevention of acute otitis media. Royal jelly showed to reduce mucositis. In the presented studies, beehive products proved to be safe, with only minor adverse reactions. Studies showed to be diverse and had some methodological limitations.

Infant botulism in Andalusia (Southern Spain)

BACKGROUND

Infant botulism (IB) is caused by the intestinal colonization by Clostridium botulinum in the first year of life and its subsequent production of neurotoxins. Traditionally, IB has been associated to honey consumption. IB cases tend to cluster in geographic regions. In Europe, IB is a rare disorder. From 1976 through 2006, 65 cases were identified in 13 European countries. In Spain, in the last 15 years, most of the cases have been reported in one region, Andalusia (Southern Spain). A specific treatment for IB type A and type B (BabyBIG) is available outside of the United States since 2005.

METHODS

and aims: We performed a retrospective review of IB cases detected in Andalusia since 1997 and compare them with the cases of IB reported in Europe.

RESULTS

We identified 11 confirmed cases of IB in Andalusia since 1997, and 14 cases in Spain. Nine out of 11 cases were detected since 2007; none of these infants had been exposed to honey consumption. One case in 1997 and another in 2000 were associated to honey. Two cases were treated with BabyBIG in 2007. In the period 2006-2012 the cases of IB reported in Europe were 54.

CONCLUSIONS

We identified a considerable increase in the incidence of IB since 2006. A tendency to a reduction in the number of cases of IB linked to honey consumption has also been identified. An increase in the exposure to these bacteria from the environment could be presumed. Clinicians should maintain a high index of suspicion for this treatable disorder.