Introduction: Severe acute malnutrition (SAM) is one of the main public health problems in the world. It is responsible in addition to the general symptoms, vitamin A deficiency which can cause serious eye damage incl...Introduction: Severe acute malnutrition (SAM) is one of the main public health problems in the world. It is responsible in addition to the general symptoms, vitamin A deficiency which can cause serious eye damage including keratomalacia. This work aims to study possible ophthalmological lesions in severely acutely malnourished children from 0 to 60 months. Patients and Method: This study was carried out in a secondary ophthalmology center. It concerned all severely acute malnourished patients admitted for consultation in the pediatric department. Results: A total of 174 eyes of 87 children aged 0 to 60 months were examined. Two-thirds of the patients were aged between 6 and 18 months. Palpebral lesions are rare, however, we observed 12.64% blepharitis and palpebral dermatitis. Ocular involvement due to vitamin A deficiency was 6.9%, including one case of BITOT SPOT, 4 cases of conjunctival xerosis and one case of keratomalacia. Conclusion: Xerophthalmia is an ocular lesion due to a dietary intake deficient in vitamin A that occurs during severe acute malnutrition. Its occurrence is increasingly rare even in developing countries. However, some cases are observed in practice and may be responsible for profound visual impairments.展开更多
Introduction: Severe acute malnutrition (SAM) is one of the main public health problems in the world. It is responsible in addition to the general symptoms, vitamin A deficiency which can cause serious eye damage incl...Introduction: Severe acute malnutrition (SAM) is one of the main public health problems in the world. It is responsible in addition to the general symptoms, vitamin A deficiency which can cause serious eye damage including keratomalacia. This work aims to study possible ophthalmological lesions in severely acutely malnourished children from 0 to 60 months. Patients and Method: This study was carried out in a secondary ophthalmology center. It concerned all severely acute malnourished patients admitted for consultation in the pediatric department. Results: A total of 174 eyes of 87 children aged 0 to 60 months were examined. Two-thirds of the patients were aged between 6 and 18 months. Palpebral lesions are rare, however, we observed 12.64% blepharitis and palpebral dermatitis. Ocular involvement due to vitamin A deficiency was 6.9%, including one case of BITOT SPOT, 4 cases of conjunctival xerosis and one case of keratomalacia. Conclusion: Xerophthalmia is an ocular lesion due to a dietary intake deficient in vitamin A that occurs during severe acute malnutrition. Its occurrence is increasingly rare even in developing countries. However, some cases are observed in practice and may be responsible for profound visual impairments.展开更多
There is inadequate information on the etiology of diarrhea in severely malnourished (SM) young children. Thus, the study aimed to determine the etiology of diarrhea among severely malnourished (z score ?3.00 SD) chil...There is inadequate information on the etiology of diarrhea in severely malnourished (SM) young children. Thus, the study aimed to determine the etiology of diarrhea among severely malnourished (z score ?3.00 SD) children in rural and urban Bangladesh. From the database (2000-2011) of Diarrheal Disease Surveillance Systems (DDSS) at rural Matlab and urban Dhaka hospitals of icddr,b, 2234 and 3109 under-5 children were found severely malnourished (underweight, stunted or wasted) respectively. Two comparison groups [moderately malnourished (MM) and well-nourished (WN)] were randomly selected in a ratio of 1:1:1. Children with all categories of SM were more likely to be infected with Vibrio cholerae (rural—11%;urban—15%), Shigella (16%;9%), Salmonella (1%;2%) and Campylobacter (3%;4%);and less likely to have rotavirus (25%;20%) compared to only one SM category. Isolation rate of Vibrio cholerae was significantly higher among SM both in rural and urban children (7%;13%) than those of MM (5%;10%) and WN (2%;8%) and lower for rotavirus (30%;31%), (34%;43%), (35%;47%) respectively (p 0.01). However, for Shigella it was only higher among rural SM children (11%) [MM (9%), and WN (8%) (p 0.01)]. The isolation rate of Salmonella in SM (2%) was similar to that in MM (2%;p = 0.72) but significantly higher than that in WN (1%;p 0.01) among urban children. Isolation rates of bacterial enteric pathogens were higher but rotavirus was lower in SM children in both rural and urban area with geographical heterogeneity.展开更多
<strong>Background:</strong> The question of where to hospitalize extremely malnourished patients with anorexia nervosa (AN) is a real dilemma. On one hand, psychiatrists have to deal with severe medical c...<strong>Background:</strong> The question of where to hospitalize extremely malnourished patients with anorexia nervosa (AN) is a real dilemma. On one hand, psychiatrists have to deal with severe medical complications that are not within their competences and that justify hospitalization in an internal medicine ward. On the other hand, medical doctors have to face psychic decompensations that would justify admission to a psychiatric ward. In this context, we share our experience of management of severely malnourished AN adult patients in a transdisciplinary specialized eating disorders (ED) unit, referral center for AN associated with somatic severity. <strong>Method:</strong> First, we described the modalities of care proposed to patients with AN hospitalized in the medical unit. Intensive medical care, both somatic and psychiatric, are provided thanks to a transdisciplinary therapeutic program, where objectives are to: medically stabilize the patient, initiate progressive refeeding and start supportive psychotherapy before being transferred to a psychiatric ED unit. Secondly, we conducted a retrospective descriptive study that included all adult patients with AN admitted for the first time to the unit, between November 1997 and January 2014, for severe malnutrition and/or complications of the ED. Objective was to specify patients’ characteristics: demographic, nutritional status, history of ED, care pathway. <strong>Results: </strong>Among a cohort of 386 adult patients with AN (21 males and 365 females) admitted for the first time in the unit, mean age was 29.4 (±11.5) years, mean BMI was 12.7 (±2.2) kg/m<sup>2</sup>. Before being supported in the unit, 78.2% of patients had already been hospitalized in other hospitals. Mean length of stay was 35.2 days. Patients were clinically serious and unstable because of life-threatening somatic complications due to a low BMI. During hospital stay, a temporary transfer to medical intensive care unit was necessary for 25.6% of patients. Average patient weight gain was展开更多
SETTING: Special Care Ward (SCW) of the Dhaka Hospital of icddr,b, Bangladesh. OBJECTIVE: To evaluate the clinical and laboratory predictors of death in under-five children with clinically defined sepsis presenting wi...SETTING: Special Care Ward (SCW) of the Dhaka Hospital of icddr,b, Bangladesh. OBJECTIVE: To evaluate the clinical and laboratory predictors of death in under-five children with clinically defined sepsis presenting with diarrhea. METHODS: We prospectively enrolled all the diarrheal children (n = 151) aged 0 to 59 months with clinical sepsis admitted in the SCW during September’2007 through December’2007. Comparison was made between deaths (n = 23) and survivors (n = 128). Sepsis is defined as presence of inflammation [abnormal WBC count (>11 × 109/L or, 9/L or, band and neutrophil ratio ≤0.10] plus presence or presumed presence of infection with thermo-instability [hypo (≤35.0℃) or hyperthermia (≥38.5℃)], tachycardia, tachypnea, and/or the indications of altered organ function (altered mental status and bounding pulse) in the absence of clinical dehydration or after correction of dehydration. RESULTS: The median (inter-quartile range) age (months) of the children who survived and died was comparable [4.0 (2.0, 12.0) vs. 1.5 (0.8, 10.0);p = 0.703]. In the logistic regression analysis, after adjusting for potential confounders, such as abnormal WBC count, use of intravenous fluid, patient with fatal outcome more often presented with hypernatremia (odds ratio = 16.48, 95% confidence interval = 2.21 -?123.12;p = 0.006), lobar consolidation (odds ratio = 19.9, 95% confidence interval = 2.99 - 132.80;p = 0.002), hypoxemia (odds ratio = 14.78, 95% confidence interval = 1.38 157.90;p = 0.026) and severe under-nutrition (odds ratio = 7.57, 95% confidence interval = 1.24 - 46.11;p = 0.028). CONCLUSIONS: Our data suggest that children under-five with clinical sepsis who present with lobar pneumonia, hypoxaemia, severe acute malnutrition and hyperntaemia are at higher risk of death and identification of these simple factors may help clinicians to take prompt initiative for the aggressive management of such children especially in a resource-limited setting like Bangladesh.展开更多
文摘Introduction: Severe acute malnutrition (SAM) is one of the main public health problems in the world. It is responsible in addition to the general symptoms, vitamin A deficiency which can cause serious eye damage including keratomalacia. This work aims to study possible ophthalmological lesions in severely acutely malnourished children from 0 to 60 months. Patients and Method: This study was carried out in a secondary ophthalmology center. It concerned all severely acute malnourished patients admitted for consultation in the pediatric department. Results: A total of 174 eyes of 87 children aged 0 to 60 months were examined. Two-thirds of the patients were aged between 6 and 18 months. Palpebral lesions are rare, however, we observed 12.64% blepharitis and palpebral dermatitis. Ocular involvement due to vitamin A deficiency was 6.9%, including one case of BITOT SPOT, 4 cases of conjunctival xerosis and one case of keratomalacia. Conclusion: Xerophthalmia is an ocular lesion due to a dietary intake deficient in vitamin A that occurs during severe acute malnutrition. Its occurrence is increasingly rare even in developing countries. However, some cases are observed in practice and may be responsible for profound visual impairments.
文摘Introduction: Severe acute malnutrition (SAM) is one of the main public health problems in the world. It is responsible in addition to the general symptoms, vitamin A deficiency which can cause serious eye damage including keratomalacia. This work aims to study possible ophthalmological lesions in severely acutely malnourished children from 0 to 60 months. Patients and Method: This study was carried out in a secondary ophthalmology center. It concerned all severely acute malnourished patients admitted for consultation in the pediatric department. Results: A total of 174 eyes of 87 children aged 0 to 60 months were examined. Two-thirds of the patients were aged between 6 and 18 months. Palpebral lesions are rare, however, we observed 12.64% blepharitis and palpebral dermatitis. Ocular involvement due to vitamin A deficiency was 6.9%, including one case of BITOT SPOT, 4 cases of conjunctival xerosis and one case of keratomalacia. Conclusion: Xerophthalmia is an ocular lesion due to a dietary intake deficient in vitamin A that occurs during severe acute malnutrition. Its occurrence is increasingly rare even in developing countries. However, some cases are observed in practice and may be responsible for profound visual impairments.
文摘There is inadequate information on the etiology of diarrhea in severely malnourished (SM) young children. Thus, the study aimed to determine the etiology of diarrhea among severely malnourished (z score ?3.00 SD) children in rural and urban Bangladesh. From the database (2000-2011) of Diarrheal Disease Surveillance Systems (DDSS) at rural Matlab and urban Dhaka hospitals of icddr,b, 2234 and 3109 under-5 children were found severely malnourished (underweight, stunted or wasted) respectively. Two comparison groups [moderately malnourished (MM) and well-nourished (WN)] were randomly selected in a ratio of 1:1:1. Children with all categories of SM were more likely to be infected with Vibrio cholerae (rural—11%;urban—15%), Shigella (16%;9%), Salmonella (1%;2%) and Campylobacter (3%;4%);and less likely to have rotavirus (25%;20%) compared to only one SM category. Isolation rate of Vibrio cholerae was significantly higher among SM both in rural and urban children (7%;13%) than those of MM (5%;10%) and WN (2%;8%) and lower for rotavirus (30%;31%), (34%;43%), (35%;47%) respectively (p 0.01). However, for Shigella it was only higher among rural SM children (11%) [MM (9%), and WN (8%) (p 0.01)]. The isolation rate of Salmonella in SM (2%) was similar to that in MM (2%;p = 0.72) but significantly higher than that in WN (1%;p 0.01) among urban children. Isolation rates of bacterial enteric pathogens were higher but rotavirus was lower in SM children in both rural and urban area with geographical heterogeneity.
文摘<strong>Background:</strong> The question of where to hospitalize extremely malnourished patients with anorexia nervosa (AN) is a real dilemma. On one hand, psychiatrists have to deal with severe medical complications that are not within their competences and that justify hospitalization in an internal medicine ward. On the other hand, medical doctors have to face psychic decompensations that would justify admission to a psychiatric ward. In this context, we share our experience of management of severely malnourished AN adult patients in a transdisciplinary specialized eating disorders (ED) unit, referral center for AN associated with somatic severity. <strong>Method:</strong> First, we described the modalities of care proposed to patients with AN hospitalized in the medical unit. Intensive medical care, both somatic and psychiatric, are provided thanks to a transdisciplinary therapeutic program, where objectives are to: medically stabilize the patient, initiate progressive refeeding and start supportive psychotherapy before being transferred to a psychiatric ED unit. Secondly, we conducted a retrospective descriptive study that included all adult patients with AN admitted for the first time to the unit, between November 1997 and January 2014, for severe malnutrition and/or complications of the ED. Objective was to specify patients’ characteristics: demographic, nutritional status, history of ED, care pathway. <strong>Results: </strong>Among a cohort of 386 adult patients with AN (21 males and 365 females) admitted for the first time in the unit, mean age was 29.4 (±11.5) years, mean BMI was 12.7 (±2.2) kg/m<sup>2</sup>. Before being supported in the unit, 78.2% of patients had already been hospitalized in other hospitals. Mean length of stay was 35.2 days. Patients were clinically serious and unstable because of life-threatening somatic complications due to a low BMI. During hospital stay, a temporary transfer to medical intensive care unit was necessary for 25.6% of patients. Average patient weight gain was
文摘SETTING: Special Care Ward (SCW) of the Dhaka Hospital of icddr,b, Bangladesh. OBJECTIVE: To evaluate the clinical and laboratory predictors of death in under-five children with clinically defined sepsis presenting with diarrhea. METHODS: We prospectively enrolled all the diarrheal children (n = 151) aged 0 to 59 months with clinical sepsis admitted in the SCW during September’2007 through December’2007. Comparison was made between deaths (n = 23) and survivors (n = 128). Sepsis is defined as presence of inflammation [abnormal WBC count (>11 × 109/L or, 9/L or, band and neutrophil ratio ≤0.10] plus presence or presumed presence of infection with thermo-instability [hypo (≤35.0℃) or hyperthermia (≥38.5℃)], tachycardia, tachypnea, and/or the indications of altered organ function (altered mental status and bounding pulse) in the absence of clinical dehydration or after correction of dehydration. RESULTS: The median (inter-quartile range) age (months) of the children who survived and died was comparable [4.0 (2.0, 12.0) vs. 1.5 (0.8, 10.0);p = 0.703]. In the logistic regression analysis, after adjusting for potential confounders, such as abnormal WBC count, use of intravenous fluid, patient with fatal outcome more often presented with hypernatremia (odds ratio = 16.48, 95% confidence interval = 2.21 -?123.12;p = 0.006), lobar consolidation (odds ratio = 19.9, 95% confidence interval = 2.99 - 132.80;p = 0.002), hypoxemia (odds ratio = 14.78, 95% confidence interval = 1.38 157.90;p = 0.026) and severe under-nutrition (odds ratio = 7.57, 95% confidence interval = 1.24 - 46.11;p = 0.028). CONCLUSIONS: Our data suggest that children under-five with clinical sepsis who present with lobar pneumonia, hypoxaemia, severe acute malnutrition and hyperntaemia are at higher risk of death and identification of these simple factors may help clinicians to take prompt initiative for the aggressive management of such children especially in a resource-limited setting like Bangladesh.
