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A 2½ years old girl presented with generalized itching since 8 months of age. There was no history of jaundice. Her milestones were appropriate for age. On examination, weight was 9.4 kg, height was 8...
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Pratibha Singhi*
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Seizures are a common problem about 10% of people have one seizure in their lifetime, however 50-70% do not have a recurrence. Epilepsy is defined as two or more unprovoked epileptic seizures. Epilepsy occurs in 0.5% of the population and about 60% of epilepsy has its onset in childhood. In this paper only recurrent epileptic seizures are discussed. Seizures that do not require a diagnosis of epilepsy such as febrile seizures are not discussed.
A basic understanding of the International Classification of seizures (Table 1) and epilepsy and (Table 2) is essential. Most epileptic seizures in children can be classified into various Childhood Epileptic Syndrome (CES), which consist of common clusters of characteristics such as age seizure type, EEG, and prognosis, which define a unique epilepsy condition. They may have different etiologies. In our country however, CNS infections constitute an important cause of recurrent seizures. These particularly include post meningitic seizures and seizures secondary to granulomas such as Neurocysticercosis (NCC), and tuberculomas. It is important to ensure that one is not dealing with nonepileptic events (NEE), (which may resemble seizures), before approaching a child with recurrent seizures. Some of the common NEEs in childhood are listed in Table 3.
Table 1. SUMMARY OF INTERNATIONAL CLASSIFICATION OF SEIZURES
Partial (local focal)
- Simple partial
- Complex partial
* With impairment of consciousness at onset
* Simple partial onset followed by impairment of consciousness
* Partial evolving to generalized tonic clonic
* Complex including those with simple partial onset
Generalized [convulsive or non-convulsive]
Typical absence and atypical absence
Myoclonic, tonic, clonic, tonic-clonic Unclassified
Table 2. INTERNATIONAL CLASSIFICATION OF EPILEPSY AND EPILEPTIC SYNDROME (ICE) (ILAE-REVISED 1989)
Localization-related (Focal/local/partial) idiopathic, symptomatic, cryptogenic
Idiopathic, cryptogenic West, LGS
Symptomatic - non-specific/specific etiology
Undetermined (whether focal or Gen./Both) equivocal
Special syndromes
Situation related-febrile, isolated status/seizure, metabolic encephalopathy, drug induced, etc.
Table 3. Some Common Non-epileptic Events
Syncopal attacks
Benign paroxysmal vertigo
Complicated migraine
Shuddering attack
Breath holding spells
Night terrors
GER with laryngospasm and apnea
Transient ischemic attacks
In our country however, CNS infections constitute an important cause of recurrent seizures.
A) Child Epileptic Syndrome (CES)
Most CES are age specific and are often different in neuro-developmentally normal children and in children with neurological abnormalities and developmental delays. Consideration of the (i) age and (ii) neuro-developmental status of the child and (iii) the type of seizures, helps in making a presumptive diagnosis of a CES, which can then be confirmed by EEG. Further investigations such as neuro-imaging, metabolic and genetic tests can then be planned depending upon the CES under consideration. Etiologically CES can be classified into idiopathic, cryptogenic or symptomatic depending upon whether there is any identifiable or suspected or known etiology. In certain situations the child may be neuro-developmentally normal, and may show regression after the onset of the CES; the infantile epileptic encephalopathies are severe epilepsies wherein the severe epilepsy is itself associated with an encephalopathic condition. The ILAE Task Force (1997) has suggested that the diagnosis of epilepsy be made in various axes (Table 4).
Table 4. ILAE Task Force on Classification 1997 Axes
Ictal phenomenology
Seizure type
Some of important CES include
Onset in neonatal period (birth 3 months):
Neonates may have seizures due to various causes, particularly metabolic problems, and hypoxic ischemic encephalopathy. These will not be discussed here.
In otherwise healthy, and neurologically and developmentally normal neonates, the occurrence of multi-focal clonic seizures, indicates either Benign Neonatal Convulsions (BNC) or Benign Neonatal Familial Convulsions (BNFC). If there is a positive family history, consider BNFC; In the absence of family history, consider BNC. One must exclude underlying etiology and follow the neurodevelopment of the baby. BNC are short lived; BNFC may last for 1-6 months. These babies have a normal neuro-developmental outcome and good prognosis. They do not need long term AEDs.
In otherwise healthy, and neurologically and developmentally normal neonates, the occurrence of multi-focal clonic seizures, indicates either Benign Neonatal Convulsions (BNC) or Benign Neonatal Familial Convulsions (BNFC).
Pyridoxine dependency or deficiency must always be excluded in neonates as well as infants.
Ohtahara syndrome and early myoclonic encephalopathy occur in neurologically impaired, or high-risk neonates, with the occurrence of repeated tonic or myoclonic seizures and fragmentary myoclonus. The EEG shows a burst suppression pattern. Progressive neurologic deterioration occurs, and about half the cases die within a few months; survivors have severe disabilities. Most AEDs and steroids are ineffective.
Onset in Infancy (3 months - 2 yrs)
Benign Myoclonic Epilepsy of Infancy (BMEI):
This is characterized by myoclonic seizures in otherwise normal infants and toddlers 4 months to 3 years of age. Seizures are brief, and involve mainly the arms and head. Family history of epilepsy is reported in 25-30% cases. The interictal EEG is usually normal. Valproate is the drug of choice and the prognosis is good with a normal neuro-developmental outcome.
Infantile Spasms (IS) West's Syndrome (WS):
This is characterized by infantile spasms, neuro-developmental impairment and hypsarrhythmia on EEG. The peak age of onset is between 4-6 months but may occur any time in the first two years of life; 90% of IS begin before 12 months of age. The spasms may be flexor, extensor or mixed, and occur in clusters, generally on awakening. Crying or irritability during or soon after a cluster is often seen.
Most children are neurologically abnormal. A small number of cases may be idiopathic, some apparently normal children may show regression after the onset of spasms.
ACTH injections or corticosteroids are generally used. Vigabatrin is used in children with tuberous sclerosis (TS) but also in other symptomatic cases. However its cost and side effects need to be considered. Valporate and nitrazepam have been used particularly for relapses. LTG and TPM are the newer AEDS that are effective in WS.
ACTH injections or corticosteroids are generally used. Vigabatrin is used in children with tuberous sclerosis (TS) but also in other symptomatic cases.
Severe Myoclonic Epilepsy of Infancy (SMEI) (Dravet Syndrome):
This usually starts as prolonged or recurrent febrile seizures in the first year of life in apparently normal children. In the second year, myoclonus starts and later absence; partial and other types of seizures may occur. Child then shows developmental delay and mental deficiency. It is resistant to most AEDs.
Onset in Early Childhood:
Certain benign partial epilepsies and absence epilepsy are important in the age group. The important CES include:
Childhood Absence Epilepsy:
This is seen most often in school age (4-10 yrs) with a peak at 6-7 years. It occurs in normal children and consists of typically short (absences) seizures lasting 5-30 sec with abrupt onset and cessation, generally frequent, 10-100/day. In 50% cases associated clonic tonic seizures be seen. The EEG shows a normal background with typical bilateral, synchronous, symmetrical spike waves, usually 3 Hz that are precipitated on hyperventilation. Children with typical absences do not need any further investigations. The AEDs of choice are valproate, ethosuximide and LTG, AEDs that may worsen absences such as OXC, CBZ, VGB and TG are contraindicated. The outcome in typical CAE is generally good, and most cases remit by puberty. Patients with atypical absences do not have a good prognosis.
Lennox Gastaut Syndrome:
This has an onset from 1-8 yrs, with a peak between 3-5 yrs. It consists of multiple seizure types: tonic, atonic, atypical absence, myoclonic, GTCS, partial. Repeated seizures, and status epilepticus are common. Tonic seizures are most frequent, and cause repeated falls. There is associated mental retardation. The EEG shows abnormal background with slow spike/poly spike-waves 2.5-2.5 Hz; multi-focal abnormalities may be seen.
Most cases of LGS, are symptomatic with previous CNS insult/epilepsy (60%), West's syndrome (30-40%).
Treatment: Valproate and Lamotrigine are the drugs of choice. Topiramate has also been reported to be effective. Benzodiazepines such as clonazepam may also be needed. The seizures are resistant to most AEDs, and a complete control is rarely achieved, even with poly-therapy. Ketogenic diet improves seizure control in about a third to half the cases. In spite of polytherapy seizure control is often poor.
Onset in Late Childhood/Puberty
Benign Childhood Epilepsy with centrotemporal spikes BCECT (Rolandic epilepsy):
This has an onset from 3-13 years with a peak at 7-9 yrs. It occurs in neurologically normal children with and is characterized by brief, simple partial hemifacial motor seizures with associated somatosensory symptoms. These evolve into GTCs in 25% cases especially during sleep. The EEG shows characteristic blunt high-voltage centrotemporal spikes followed by slow waves. Some physicians do not use antiepileptics, majority treat with OXC or CBZ. Outcome is good; seizures are easily controlled especially in cases with secondary generalization; remission occurs at 18 yrs in most cases.
Juvenile Absence Epilepsy (JAE):
The onset is generally during or after puberty. The frequency of absences is less than in CAE. Treatment is similar to CAE. The incidence of GTCS and the likelihood of absence persisting into adulthood are higher than in CAE.
Juvenile Myoclonic Epilepsy (JME):
This puberty 12-18 yrs; boys are equals to girls. It is characterized by the occurrence of myoclonic jerks, shortly after awakening with no loss of consciousness. The seizures are precipitated by sleep deprivation and hand activities. About 90% cases also have GTCs on awakening. About 30% cases have absences. The interictal EEG shows bilateral symmetric diffuse spike waves and poly-spike waves 4-6 Hz with photosensitivity.
Treatment: Valproate is the drug of choice. Lamotrigine has been found effective and may be preferred in some adolescent girls. Precipitating factors such as sleep deprivation, early awakening, flickering lights and fatigue should be avoided. The epilepsy gets well controlled, but long term AEDs are required to avoid recurrence.
Progressive myoclonic epilepsy (PME):
This is characterized by development of progressive myoclonus, ataxia and other neurological signs. Myoclonic seizures are generalized, and often associated with other seizure types. There is progressive mental deterioration. The underlying etiology is variable and conditions such as Unverricht-Lundborg disease, Lafora body disease and Neuronal ceroid lipofuscinosis need to be considered. Valproate and BDZs especially CZP are generally tried. Treatment is difficult, polytherapy is often required.
Onset at any Age:
Certain Localization related epilepsies may occur at any age. These include Mesial temporal lobe epilepsy syndromes, Lateral temporal lobe syndromes, Frontal lobe epilepsy syndromes, Parietal lobe epilepsy syndromes, Occipital lobe epilepsy syndromes. They are characterized by predominantly partial seizures which may be simple or complex, and at times tonic clonic seizures. The associated symptomatology is determined by the localization. The EEG shows a localized seizure focus. OXC & CBZ are the drugs of choice for most partial seizures.
Certain Localization related epilepsies may occur at any age. These include Mesial temporal lobe epilepsy syndromes, Lateral temporal lobe syndromes, Frontal lobe epilepsy syndromes, Parietal lobe epilepsy syndromes, Occipital lobe epilepsy syndromes.
B. Recurrent seizures secondary to CNS Infections
Seizures are often a presenting feature of most CNS infections. They are generally acute symptomatic and short lived. However, in some cases, infections may leave permanent defects, such as infarcts, gliosis etc that maybe responsible for long term, recurrent seizures. Both pyogenic and tubercular meningitis, and severe meningoencephalitis may cause symptomatic epilepsy. The nature of the seizures is determined by the type of CNS involvement. The AEDs are chosen according to the type of seizures Table 5.
Table 5. Drug choices by seizure type
Seizure type
with/without secondary generalization
CNS granulomas, particularly NCC is the commonest cause of partial seizures in India. The NCC lesions are usually solitary and the seizures are often brief, seen in clusters in an otherwise normal child. Neuroimaging is thus indicated in all cases of partial seizures (that are not clearly due to an idiopathic epilepsy syndrome such as BCECT) in our country. The drugs of choice are OXC & CBZ. The seizures are usually well controlled.
Management of recurrent seizures requires understanding of the type of seizures, and whenever possible the CES. A good EEG is needed in all cases. Further investigations can be accordingly planned and the etiology arrived at, in most cases. Appropriate AEDs and other therapies can then be decided. Seizures that are refractory to AEDs may require alternative therapies and surgery. Management of associated problems and co-morbidities is also important. Patient rapport, patient and parent education are important to ensure compliance and regular follow up.
Abbreviations Used
Antiepileptic Drugs (AED), Carbamazepine (CBZ), Phenytoin (PHT), Valproate (VAL), Phenobarbitone (PB), Oxcarbamazepine )OXC), Lamotrigine (LTG), Topiramate (TPM), Gabapentin (GBP), Ethosuximide (ESM), Zonisamide (ZM), Adrenocorticotropic hormone (ACTH).
References :
Commission on Classification and Terminology of the International League Against Epilepsy. Proposal for revised clinical and electroencephalographic classification of epileptic seizures. Epilepsia. 1981;22:489-501.h
Commission on Classification and Terminology of the International League Against Epilepsy. Proposal for revised classification of epilepsies and epileptic syndromes. Epilepsia 1989;30:389-99.
Glauser T, Ben- Menachem E, Bourgeois B, et al. ILAE treatment guidelines: Evidence-based analysis of Antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes. Epilepsia, 2006;47:1094-120.
Wheless JW, Clarke DF, Carpenter D. Treatment of pediatric epilepsy: expert opinion, 2005. J Child Neurol, 2005; Suppl. 1:S1-60.
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A 2½ years old girl presented with generalized itching since 8 months of age. There was no history of jaundice. Her milestones were appropriate for age. On examination, weight was 9.4 kg, height was 81 cms, and she had dry excoriated skin with 9 cms hepatomegaly. Other syste...
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A child comes in emergency and needs admission urgently, but cannot afford the hospital cost. What should be done_?
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text: Assembly Areas In the event of any emergency where total evacuation is necessary, the following locations have been designated as assembly areas where students, faculty, staff, and visitors are to report once they have evacuated a building. Remain at the designated location until you are accounted for and released by emergency management personnel. Please contact Fire and Life Safety at 215-895-5908 for additional information regarding these locations. RESIDENCE HALL ASSEMBLY AREA Caneris Hall 32nd and Cuthbert Street (Armory) Calhoun Hall Race Street Hall Kelly Hall Race Street Hall Myers Hall Race Street Hall Towers Hall Race Street Hall North Hall Race Street Hall Race Street Hall North Hall University Crossings 32nd and Cuthbert Streets (Armory) Van Rennsalear Hall 32nd and Powelton Avenue BUILDING ASSEMBLY AREA Academic Building Buckley Recreational Field Alumni Engineering Laboratories 31st and Ludlow Streets (Parking Lot F) Bossone Research Enterprise Center 32nd Street Plaza (100 feet from building) Center For Automation Technology 31st and Ludlow Streets (Parking Lot F) Creese Student Center 32nd and Chestnut Streets Curtis Hall 100 feet from building Daskalakis Athletic Center (DAC) In front of Rush Building Design Arts Annex 32nd And Cherry Streets (Parking Lot) Disque Hall Quad Vidas Athletic Complex Field House Parking Lot General Services Building/Parking Garage 100 feet from building Hagerty Library Newman Center Parking Lot Hess Engineering Research Laborites Parking Lot Korman Center Quad Language & Communication Center Parking Lot Law Building and Library 100 feet from building Lebow Engineering Center 31st and Ludlow Streets (Parking Lot F) Main Building 32nd Street Plaza (100 feet from building) Mandell Theater 33rd and Chestnut Streets Matheson Hall Quad 3210 Cherry Street (Math Forum) 32nd and Cherry Streets (Parking Lot) MacAlister Hall 33rd and Chestnut Streets Nesbitt Hall 32nd and Cuthbert Streets (Armory) Peck Alumni Center 32nd Street Plaza (100 feet from building) PSA Building Parking Lot Randell Hall 100 feet from building Ross Commons 34th and Powelton Avenue Rush Building Daskalakis Athletic Center (DAC) 400 N. 31st Street (Environmental Safety & Health Office) 31st and Baring Streets Security Building 34th and Race Streets Stratton Hall Quad Area 3201 Arch Street Buckley Recreational Field Pearlstein Business Learning Center Quad Area Law Building and Library Hagerty Library


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Book your room at Days Inn Calgary Northwest
Get an overview of this hotelFamily-friendly hotel with free breakfast and 24-hour fitness center
This family-friendly Calgary hotel is located on the Strip, within 1 mi (2 km) of Shouldice Athletic Park and Edworthy Park. University of Calgary and McMahon Stadium are also within 3 mi (5 km).
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This smoke-free hotel features a 24-hour fitness center, a 24-hour business center, and laundry facilities. Free continental breakfast, free WiFi in public areas, and free self parking are also provided. Additionally, a 24-hour front desk, a computer station, and free newspapers are onsite.
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All 68 individually decorated rooms feature free WiFi and pillowtop beds. For a bit of entertainment, LCD TVs come with cable channels, and guests can also appreciate conveniences like sitting areas and refrigerators.Information missing or incorrect? Tell us!
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Hotel Amenities
A computer station is located on site and high-speed wireless Internet access is complimentary. A 24-hour business center is on site. A complimentary breakfast is offered. This family-friendly hotel also offers a 24-hour fitness center, complimentary newspapers in the lobby, and laundry facilities. Complimentary self parking is available on site.
Days Inn Calgary Northwest is a smoke-free property.
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Calvin students study education in Zambia
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A geography professor writes about walking the mudflats of the Wadden Sea during last spring's Semester in the Netherlands.
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January 10, 2012 | Myrna Anderson
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July 19, 2012 | Myrna Anderson
Calvin orchestra gets new conductor
Conductor, performer and teacher John Varineau will conduct Calvin's orchestras.
January 29, 2013 | Myrna Anderson
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Calvin's senior engineering majors prepare for Senior Projects Night—the annual showcase of the students' engineering ingenuity.
May 06, 2010 | Myrna Anderson , Matt Kucinski
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November 17, 2011 | Myrna Anderson
Schmidt is children's choice
Okay for Now, a novel by English professor Gary Schmidt has won a Children's Choice Book Award.
May 17, 2012 | Myrna Anderson
A "Full Partner" in anti-racism
Calvin College earned "Full Partner" status from Partners for a Racism-Free Community.
March 09, 2012 | Myrna Anderson
Calvin in 24 - 2012
On Oct. 12, students, faculty and staff took photos of their day—and we have the winners!
October 08, 2012 | Myrna Anderson
Two $200,000 grants for improving teacher quality
Calvin faculty are working with teachers from area schools to improve their teaching of writing, math.
April 11, 2013 | Myrna Anderson
Chatting with Randy Wolthuis
After 10 years as director of the Broene Counseling Center, Randy Wolthuis is leaving Calvin to re-enter private practice as a specialist in marital issues.
May 10, 2010 | Myrna Anderson
Kuyers introduces whatiflearning.com
A new website from the Kuyers Institute puts the giving in math, the community in history and the wonder in flowers.
August 22, 2012 | Myrna Anderson
New enrollment VP recruits ambassadors
Everyone is an ambassador for Calvin, says new enrollment VP Russ Bloem.
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text:
First Bites: Complementary Feeding - A Global Network Cluster Randomized Controlled Trial
- Full Text View
- Tabular View
- No Study Results Posted
- Disclaimer
- How to Read a Study Record
The specific aims of this project is to determine the impact of a daily intake of one half ounce of lyophilized meat between 6-18 months of age (0.5 oz for 6-12 mo; 0.75 oz for 12-18 mo) on linear growth velocity, zinc and iron intakes and status, brain growth and neurocognitive development, and infectious disease morbidity in populations traditionally dependent on non-micronutrient fortified plant foods for complementary feeding.
Complementary Feeding
Infant Growth
Other: Lyophilized meat
Other: Cereal
Phase 3
|Study Type:
|Study Design:
|Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
|Official Title:
|Complementary Feeding - A Global Network Cluster Randomized Controlled Trial
- Linear growth velocity [ Time Frame: 6 to 18 months of age ] [ Designated as safety issue: No ]
- Infant Zinc and Ferritin levels [ Time Frame: 18 months ] [ Designated as safety issue: No ]
- Bayleys II [ Time Frame: 18 months ] [ Designated as safety issue: No ]
- Incidence of diarrhea, lower respiratory infection, and malaria [ Time Frame: 6 to 18 months ] [ Designated as safety issue: No ]
|Study Start Date:
|July 2008
|Study Completion Date:
|July 2010
|Primary Completion Date:
|April 2010 (Final data collection date for primary outcome measure)
|Assigned Interventions
Active Comparator: 1
Daily intake of one half ounce of lyophilized meat between 6-18 months of age (0.5 oz for 6-12 mo; 0.75 oz for 12-18 mo)
Other: Lyophilized meat
Daily intake of one half ounce of lyophilized meat between 6-18 months of age (0.5 oz for 6-12 mo; 0.75 oz for 12-18 mo)
Active Comparator: 2
Daily intake of an equi-caloric fortified cereal as complementary feed from 6 to 18 months.
Other: Cereal
Daily intake of an equi-caloric fortified cereal as complementary feed from 6 to 18 months.
Detailed Description:
Inadequate and inappropriate complementary feeding are major factors contributing to excess morbidity and mortality in young children. Prominent among nutrient inadequacies are those of iron and zinc. While huge campaigns are being mounted to fortify complementary foods and to distribute supplements, the effectiveness of these programs is generally uncertain and they do not reach millions of rural poor. By comparison, little support is being given to local food-based solutions. These not only require diversity of plant foods but appear to require the inclusion of meat to achieve zinc and iron requirements. Local supplies of meat are achievable but only with a concerted international and local effort. To justify this effort requires a multi-site efficacy study, the results of which, if positive, will leave no doubt that the effort required to provide sustainable local sources of meat for complementary feeds is worthwhile. The principal hypothesis to be tested is that daily intake of beef (1 oz/d for 6-12 mo and 1.5 oz/d for 12-18 mo) added to usual primarily plant-derived complementary feeds plus selected repetitive nutrition education messages results in greater linear growth velocity than does a micronutrient (including Zn and Fe) fortified equi-caloric cereal/legume supplement plus the same educational messages. Participants from four sites in the Global Network which have stunting rates > 20%, i.e. Guatemala, Pakistan and Zambia will be randomized by clusters to receive either ½ oz lyophilized beef (equivalent to 1 oz cooked beef)/d or the equi-caloric micronutrient-fortified plant-based supplement (both increasing by 50% at age 1 year). Both groups will receive three repetitive messages delivered by study coordinators and through the local health system as part of integrated health care. These are: provide a thick puree/gruel; feed complementary foods at least three times per day; and maximize dietary diversity. These interventions will be preceded by messages to promote exclusive breast feeding until 6 months and to start complementary feeding promptly at that time as far as possible. The meat or fortified cereal supplement will be provided daily in a group setting for each cluster; as necessary the food intervention and messages will be delivered at home by the assigned community coordinator or alternate. Outcome measures, obtained by a separate group of local, trained assessment workers, include: longitudinal linear growth between 6-18 months (primary outcome); weight and head circumference; assessment of dietary variety and diversity at 6,9,12, and 18 months; indices of iron, zinc and Vitamin B12 status at 18 months; neurocognitive development at 18 months; and incidence of diarrhea and lower respiratory infections. A positive multi-country, multi-culture outcome of this trial will demonstrate the efficacy of a regular intake of meat commencing at age 6 months to achieve nutritionally complete complementary feeding and will provide a strong rationale for global efforts to enhance local supplies of meat and achieve acceptance of meats as complementary food.
|Ages Eligible for Study:
|3 Months to 4 Months
|Genders Eligible for Study:
|Accepts Healthy Volunteers:
Inclusion Criteria:
- Inclusion criteria for clusters: Each cluster will be a rural community characterized by inhabitants with low income and served by one community health center. A primary criterion is that national or other available statistics indicate a prevalence of stunting (mean length for age Z-scores in second year < -2) of at least 20% in young children.
Inclusion criteria for individual families:
- Infant aged 3-4 months;
- Primarily or exclusively breast feeding with intent to continue breast feeding through at least 1 year.
Exclusion Criteria:
- Exclusion criteria for individual families: Exclusion criteria include any population/family that is receiving or likely to receive free or subsidized complementary foods (or infant formula) through the health system or NGOs; any individual families who are feeding or intend to feed fortified infant formula or micronutrient-fortified commercial complementary foods.
Exclusion criteria for infants: Infants meeting the following criteria will be excluded from participation:
- known congenital anomaly;
- infant of multiple births;
- known neurological deficit apparent at the time of enrollment (including seizures).
Please refer to this study by its ClinicalTrials.gov identifier: NCT01084109
|Kinshasa School of Public Health
|Karawa, Congo
|Institute for Nutrition of Central America and Panama (INCAP)
|Chiimaltenango, Guatemala
|Agha Khan University
|Karachi, Pakistan
|University of Zambia
|Lusaka, Zambia
No publications provided by NICHD Global Network for Women's and Children's Health
Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
|Responsible Party:
|NICHD Global Network for Women's and Children's Health
|ClinicalTrials.gov Identifier:
|NCT01084109 History of Changes
|Other Study ID Numbers:
|Study First Received:
|March 9, 2010
|Last Updated:
|November 22, 2013
|Health Authority:
|United States: Federal Government
Keywords provided by NICHD Global Network for Women's and Children's Health:
Complementary feeding
Infant growth
Developing countries
ClinicalTrials.gov processed this record on October 09, 2015


text:
Poem: 'Glove'
Anne Carson
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Vol. 33 No. 18 · 22 September 2011 » Anne Carson » Poem: 'Glove'
page 14 | 632 words


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IRIS International Inc. Stock Downgraded (IRIS)
TheStreet) -- IRIS International (Nasdaq: IRIS) has been downgraded by TheStreet Ratings from buy to hold. The company's strengths can be seen in multiple areas, such as its revenue growth, largely solid financial position with reasonable debt levels by most measures and increase in net income. However, as a counter to these strengths, we find that the company's return on equity has been disappointing.Editor's Note: TheStreet ratings do not represent the views of TheStreet's staff or its contributors. Ratings are established by computer based on metrics for performance (which includes growth, stock performance, efficiency and valuation) and risk (volatility and solvency). Companies with poor cash flow or high debt levels tend to earn lower ratings in our model NEW YORK (
-- Written by a member of TheStreet Ratings Staff
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- The revenue growth came in higher than the industry average of 8.3%. Since the same quarter one year prior, revenues slightly increased by 2.5%. This growth in revenue appears to have trickled down to the company's bottom line, improving the earnings per share.
- IRIS has no debt to speak of therefore resulting in a debt-to-equity ratio of zero, which we consider to be a relatively favorable sign. Along with this, the company maintains a quick ratio of 2.66, which clearly demonstrates the ability to cover short-term cash needs.
- Powered by its strong earnings growth of 450.00% and other important driving factors, this stock has surged by 43.58% over the past year, outperforming the rise in the S&P 500 Index during the same period. Setting our sights on the months ahead, however, we feel that the stock's sharp appreciation over the last year has driven it to a price level which is now relatively expensive compared to the rest of its industry. The implication is that its reduced upside potential is not good enough to warrant further investment at this time.
- IRIS INTERNATIONAL INC reported significant earnings per share improvement in the most recent quarter compared to the same quarter a year ago. This company has reported somewhat volatile earnings recently. But, we feel it is poised for EPS growth in the coming year. During the past fiscal year, IRIS INTERNATIONAL INC swung to a loss, reporting -$0.07 versus $0.17 in the prior year. This year, the market expects an improvement in earnings ($0.33 versus -$0.07).
- The company's current return on equity has slightly decreased from the same quarter one year prior. This implies a minor weakness in the organization. Compared to other companies in the Health Care Equipment & Supplies industry and the overall market, IRIS INTERNATIONAL INC's return on equity significantly trails that of both the industry average and the S&P 500.
-- Written by a member of TheStreet Ratings Staff
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If you're creating a strategy, writing copy, designing sharable images, or producing content for digital engagement, ask yourself these four questions.
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A good experience over Twitter is good for everybody. Twitter certification is about a smart company reaching out to their ecosystem to help deliver better, more satisfying customer experiences and we're glad to be a part of it.
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To be strong is to shut your mouth at Thanksgiving. To be strong on social media is to do the same. Just because you can't see the looks of horror on your audience's face doesn't mean they aren't horrified.
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