Clinical and Evolutive Aspects of Severe Acute Malnutrition in Children Aged 0 - 59 Months at Maroua Regional Hospital in Cameroon’s Far North Region

Introduction: Severe acute malnutrition remains one of the most important causes of under-five mortality. In Cameroon, the northern regions have the highest prevalence, with 1.4% in the Far North in 2021. These children are managed at the Internal therapeutic and Nutrional Centre, one of which is located at Maroua Regional Hospital, the third level referral Hospital. We therefore proposed to carry out a study on the clinical and evolutive aspects of these children. Materials and Methods: it was a descriptive, cross-sectional study from January 2020 to December 2022, at the ITNC (CNTI) of Maroua Regional Hospital. The sample size was obtained from the Lorentz formula. Patient records were used for data collection. We excluded all incomplete records and patients with less than 24 hours of admission. Results: Out of the 873 patients we recruited, the prevalence of severe malnutrition was estimated at 18 %. The average age was 14 months, with a male predominance. The main reasons for consultation were fever (42%) and diarrhoea (35%). Marasmus was the predominant clinical form. The major medical complications were sepsis (32.9%) and malaria (16.8%). HIV prevalence was 2.5% and tuberculosis was 4.9%. Most patients had haemoglobin levels between 7 and 10g/dl. 79.3% were cured and 6.5% died. The main causes of death were sepsis and malaria. Conclusion: Severe acute malnutrition remains a major problem in the Far North region. Several joint actions are needed to break this cycle.

Outcome after Discharge from Hospital of Children with Complicated Severe Acute Malnutrition and Predictors Factors of Non-Response during Outpatient Treatment, in Senegal

Introduction: Malnutrition is a public health problem. It is responsible for high morbidity and mortality in children aged 6 - 59 months. The aim of this study was to determine the outcome of children with complicated severe acute malnutrition after hospital discharge. Methods: This is a descriptive and analytical cross-sectional study conducted from March 1 to November 31, 2021 at the Albert Royer Children’s Hospital. Children discharged from hospital for complicated severe acute malnutrition were included. Results: A total of 103 children were included. The mean age of children at hospitalization was 16.41 ± 10.11 months and mean duration of follow-up after hospital discharge was 29.63 ± 8.59 months. Three children (2.91%) died after hospital discharge. The mean z-score of the weight-for-current height was -1.34 ± 1.08. Almost a quarter (24.27%) of the children remain acute malnourished with 3.88% of severe acute malnutrition (SAM). The predictors’ factors associated with non-response were weaning before 2 years of age (ORaj: 12.21;95% CI [6.82 - 18.44];p = 0.04) and tuberculosis (ORaj: 21.06;95% CI [12.54 - 41.09];p = 0.03). Conclusion: The rate of recovery of nutritional status in children with complicated severe acute malnutrition is satisfactory. Ablactation before the age of two and the existence of tuberculosis are significantly associated with non-recovery of nutritional status.

Clinical and Epidemiological Aspects of Severe Acute Malnourished Children from 6 to 59 Months Hospitalized in a Secondary Hospital in Mali

Introduction: Malnutrition acts on the immune system and thus increases susceptibility to infections. Infections can weaken the body and cause malnutrition, so we speak of a vicious circle between malnutrition and infection. Objective: To study the clinical and epidemiological aspects of severe acute malnutrition in children aged 6 to 59 months. Methodology: This was a prospective and descriptive study extending from July 1, 2018 to June 30, 2019. All severely acute malnourished children aged 6 to 59 months were hospitalized at URENI whose parents or careers accepted their participation in the study. Results: Severe acute malnutrition was diagnosed in 398 of the 671 hospitalized children, i.e. 59.3%. The median age was 15.33 months (2 months - 59 months). The sex ratio was 1.03 (M = 50.8 F = 49.2). Eighty-seven percent of mothers were housewives. Parents were uneducated in 49.3% for mothers and 51.8% for fathers. Marasmus represented 93.5% of cases, children diagnosed with HIV+ represented 6.3% with exclusively HIV1 (100%). Pneumopathy was most frequently associated pathology with 33.4%. The duration of hospitalization was less than 7 days in 67.6% of cases and 93.3% of children had been successfully treated. The mortality rate was 4%. Conclusion: Malnutrition still remains a public health problem affecting mainly children aged 13 to 24 months, mainly from low-income families.

Management of Severe Acute Malnutrition in a Senegalese Paediatric Hospital

Malnutrition is a global health problem. It is very common in developing countries where it contributes to an increase in morbidity and mortality, especially among children under five years of age. The main objective of this study was to describe the management of severe acute malnutrition (SAM) in children six months to five years of age hospitalized at Diamniadio Children’s Hospital (DCH). This was an epidemiological, retrospective, descriptive and cross-sectional study of children aged six to 59 months hospitalized at DCH for SAM. The study took place over a 12-month period (from January 1, 2018 to December 31, 2018). During the study period, 67 children were admitted for SAM, representing a hospital prevalence of 8.4%. The majority (88%) children were less than 24 months old. Reasons for consultations were dominated by diarrhea (57.5%) vomiting (38.8%). Complications related to SAM were mainly: anaemia (74.6%), infections (85%) and severe acute dehydration (40.3%). Factors associated with SAM were young age (infants under 24 months of age), poverty, the first four children of a sibling, poor behaviour of food diversification. The average length of hospitalization was 12 days. The nutritional recovery rate was 73.1% and lethality was 3%. Conclusion: The prevention of malnutrition must involve the fight against poverty, an optimal and well-diversified diet, monitoring the nutritional status of children up to five years of age.

Management of Severely Malnourished Children Aged 6 - 59 Months Hospitalized in the Pediatric Ward of Kayanza Hospital/Burundi

The implementation of WHO guidelines has significantly reduced hospital mortality due to severe malnutrition. Nevertheless, severe acute malnutrition in children under five remains a major public health problem in all low-income countries and is little studied. The study aimed to assess the nutritional status and quality of management of severe acute malnutrition in children aged 06 to 59 months hospitalized in the pediatric ward of Kayanza Hospital. This is a prospective study with descriptive and analytical aims over 6 months from February 10 to July 9, 2023. All children aged 6 to 59 months admitted for severe acute malnutrition are included in this study. The results show that the most affected age group is 12 to 23 months (42.55%). Marasmus is the most common clinical form, at 70.2%. Housewives and mothers from rural areas are the most affected, with rates ranging from 69.14% to 91.49%. The study shows that the reasons for consultation are respectively: edema (29.78%), diarrhea (26.59%), vomiting (19.14%), and fever (14.89%). Dehydration and hypothermia were the main complications observed in 45.74% and 22.34% respectively. Medical treatment was provided by antibiotics (44.68%), artesunate (31.91%), and resomal (21.27%). Nutritional treatment consisted of F75 100% milk and F100 100% milk. Pathologies observed were: anemia 38.29%, malaria 37.23%, urinary tract infection 12.7%, measles 11.7%. The national protocol for integrated management of acute malnutrition (PCIMA) was followed. This study shows that 72.3% of children were successfully treated, with 9.5% dropping out and dying, and 8.5% not responding. We found that malnutrition remains a public health problem, affecting mostly children aged 12 to 24 months. The main complications or pathologies associated with malnutrition are diarrhea, malaria, and fever, and the majority of children suffer from marasmus.

Economic Cost of Community-Based Management of Severe Acute Malnutrition in a Rural District in Ghana

Background: The community based management of severe acute malnutrition (CMAM) was introduced in Ghana in 2008 to manage cases of severe acute malnutrition (SAM) recorded at the community level. This study estimated the economic cost of the CMAM programme for children under-five in the Agona west municipality of Ghana. Methods: A retrospective cross sectional study that used a cost analysis design was employed to estimate the economic cost of the programme from the societal perspective. Household cost data from caregivers were obtained using a semi-structured questionnaire. That of programme cost data was obtained from document reviews as well as the use of semi-structured questionnaires and subsequent discussions with key personnel of the Ghana Health Service, Food and Nutrition Technical Assistance and UNICEF. One and multi-way sensitivity analyses were conducted to test how sensitive the cost estimates are to certain variations in the cost profiles. Results: The economic household cost of CMAM was estimated as $1905.32 ($47.63 per household) of which 79% was attributed to direct cost while the remaining 21% made up indirect cost. Programme economic cost of CMAM was estimated as $27633.5 (96% recurrent and 4% capital), with refresher training constituting majority of the cost (34%). The constituents of the total economic cost of the programme, estimated as $32214.56 are programme cost (86%), household costs (6%) and community volunteer cost (8%). Therefore, the economic cost of treating one SAM case using the CMAM protocol was estimated as $805.36. Conclusion: Although CMAM has proven to be an effective tool for the management of SAM, its associated costs are quite enormous when coverage levels (geographic) are high yet small number of cases are detected and treated. Therefore, it is prudent to implement several cost saving strategies such as a reduction in the number of days spent on trainings in order to reduce these costs.

Nutritional Outcome and Growth Monitoring in Under-Five Children of Severe Acute Malnutrition with and without Edema in Bangladesh: A Five-Year Retrospective Review of Facility-Based Inpatient Care

Introduction: Severe acute malnutrition (SAM) is an important cause of death in children. Bangladesh has a huge burden of SAM in under-five children, but documentation of their protocolized management and outcome is not so frequent. Objective: Our aim was to identify the pattern of the nutritional outcome and growth monitoring of 0-59 months old children with severe acute malnutrition treated with identified medical complications where the presence or absence of edema is an important clinical factor. Methods: This was a facility-based retrospective observational study that was conducted in the Severe Acute Malnutrition block of Chittagong Medical College Hospital, Chittagong. Here, a total of 485 patients were admitted during the period from 2013 to 2017. Based on WHO & National guidelines, admission and discharge criteria were considered and determined. A structured and prescribed data format was prepared and data were collected from the hospital records. Daily clinical follow-ups and weight monitoring of the patients were also documented. Both descriptive and analytic analyses were executed. After Data collection, it was cleaned, edited, and stored in excel, epi-INFO, and analyzed by SPSS. P-value < 0.05 was considered to be statistically significant. Results: 54.84% of the admitted patients were cured and discharged during the study period. The mean age of the observed patients was 22.35 ± 15.8607 months. The majority of the patients came from rural areas and about 50% of them belonged to lower-middle-class families. The median weight gain of the children at SAM block during the clinical review was found to be moderate (7.35g/kg/day). About 2/3rd of the admitted patients stayed in the hospital for two weeks. The mean duration of hospital stay (in days) of the patients with edema (15.64 ± SD 7.133 days) was higher than that of the patients without edema (9.47 ± SD 5.881 days). 4.3% of patients did not gain weight during their hospital stay, and overall 8.04% of patients died during this period. Conclusion: More than half of the admitted patients showed moderate to good weight gain during their hospital stay. Non-edematous patients started to gain weight early and their mean weight gain was also higher. A greater portion of patients who had edema was cured (117, 81.8%) but defaulter & death rates, where contributed to a significant overall outcome (188, 38.76%), were more in non-edematous patients.

Evaluation of the Quality of Hospital-Based Management of Severe Acute Malnutrition in Children under 5 in Benin

Introduction: The aim of the study was to assess the quality of the management of severe acute malnutrition in the Mono Departmental Hospital Center (CHD) in Benin. Methods: This was a cross-sectional and evaluative study which took place from 03 February to 20 July 2016. The study was carried out in the mono departmental hospital of Lokossa. The non-probabilistic sampling method was used to select all our study materials and all our targets were systematically selected. Our study materials involved observation checklist, guidelines documents and questionnaires to collect data. The assessment of the quality of the hospital management of severe acute malnutrition was based on national and international standards like Benin’s national protocol of acute malnutrition management. Results: In our study, 27 cases of severe acute malnutrition (SAM) in children were considered. The median age of those children was 12 months. The rates of the components inputs, process and results were 25% (poor), 58.33% (acceptable) and 40% (poor), respectively. The sub components with respect to the norms were all related to the management of severe acute malnutrition like, availability of therapeutic foods ready for use, availability of management protocol, availability of trained and supervised staff in the management of the severe acute malnutrition and the proportion of dead and cured children. The study showed that the quality of the management of severe acute malnutrition at the mono departmental hospital of Lokossa was poor with a rate of 41.38%. Conclusion: The quality of the management of severe acute malnutrition at the mono departmental hospital of Lokossa was poor. The sub components that need to improve were the availability of therapeutic foods ready for use, availability of management protocol, along with the training and supervision of staff in charge of the management of severe acute malnutrition.

Community Based Management of Severe Acute Malnutrition: The MSF Experience from an Urban Slum Setting in Bangladesh

Background: Until recently, the experience on implementing community based management of acute malnutrition (CMAM) among children has been largely based in African settings. While the government in Bangladesh is yet to scale up CMAM approach, there is still paucity of knowledge on the experience of CMAM within the complex milieu of an urban slum context. In Kamrangirchar slum, Dhaka, Bangladesh, this paper describes a CMAM programme performance and outcomes run by Médecins Sans Frontières (MSF)/Doctors without Borders, in light to performance indicators set by MSF and the Sphere minimum standards. Methods: This was a descriptive retrospective study using routinely collected programme data of children admitted with severe acute malnutrition between May 2010 and November 2011. Kamrangirchar is an urban slum of a large migrant population in Dhaka, Bangladesh. Results: There was a total of 640 new admissions, of whom 333 (52%) were males. The median age was 18 months (Inter-quartile range (IQR) 12 - 41). 599 children had a reported nutritional outcome at discharge from ambulatory therapeutic feeding centre (ATFC), this included: cure rate of 69% with an average length of stay of 68.8 (SD ± 46.0) days and average weight gain of 3.8 g/kg/day (SD ± 2.7). The lost-to-follow-up rate was 18% and 5% reported to the programme that they will leave the slum and go back to their villages. These performance indicators did not meet the threshold level indicators set by MSF and Sphere standards. Conclusions: Our experience highlights the need for developing more adapted and contextualised indicators for assessing the performance of CMAM programmes in settings such as urban slums. Community engagement in the process of developing relevant standards is crucial. Nutrition humanitarian actors have a vital role to collaborate with local authorities to contextualize and refine these standards.

Severe Acute Malnutrition among Hospitalized Children, Aden, Yemen

Objective: Severe acute malnutrition (SAM) is one of the most common causes of morbidity and mortality among children under 5 years of age worldwide. The aim of this study was to find out the prevalence of SAM among hospitalized children at Al-Wahda teaching hospital in Aden, Yemen. Methods: This descriptive cross-sectional hospital based study was conducted on 622 hospitalized children (336 males and 286 females) below 6 years of age during 2012-2013. SAM was defined as a very low weight for height (below-3 Z scores of the median WHO growth standards). Results: SAM was diagnosed in 622 children with prevalence rate of 5.2% from total 11,941 admissions during 24 months period. A higher proportion of patients were marasmus 586 (94.2%) and only 36 (5.8%) were kwashiorkor. Marasmus was common in <1 year of age in 347 (59.2%) while kwashiorkor between 1 - 5 years in 22 (61.1%) patients. Males (54%) predominated females (46%) with a male to female ratio of 1.18:1 in SAM but with no significant difference in sex. The highest comorbidities with SAM were gastroenteritis 442 (71.1%) and 103 pneumonia (16.6%) with a total cure of 492 (79.1%) patients. Conclusion: This high prevalence of SAM among males who were <5 years of age with high risk of gastroenteritis and pneumonia added weight to the urgent need to improve the nutritional status of children.

Outcomes of Severely Malnourished Children Aged 6 - 59 Months on Outpatient Management Program in Kitui County Hospital, Kenya

Severe acute malnutrition is a widely prevalent problem in developing countries and a major cause of morbidity and mortality. Traditionally, children with severe acute malnutrition were rehabilitated within inpatient services. Advent of ready to use therapeutic food made it possible to treat majority of these children in their homes. However, there is limited data about the outcomes of the program. Objectives: To determine the outcomes (recovery, default, mean weight gain and non-response rates) of severely malnourished children aged 6 - 59 months enrolled in outpatient therapeutic program at Kitui County Hospital. Methodology: A prospective longitudinal study design was carried out for one month. Hundred and four (104) children with SAM were recruited in the study. Anthropometric measurements, physical examination and appetite test of the children were conducted on a weekly basis for 28 days. Descriptive analysis was conducted using means, frequency and proportions. Paired t test was computed for mean weight gain and mid-upper arm circumference between admission and subsequent visits. Results: The findings of the study revealed that the recovery rate was 73.3%, weight gain rate of 5.1 g/kg/day, defaulter rate was 2.9% and non-response rate was 13.9% (WHZ = -3SD). Mean weight increased from 6.8 kg on the 1st visit to 7.5 kg in the 4th visit (P = 0.000) and the meanmid-upper arm circumferenceincreased from 11.1 cm at admission to 11.9 cm at 4th visit (P = 0.000). Conclusion: The recovery and weight gain rates were below the global acceptable SPHERE of minimum standards (recovery rate > 75% and weight gain rate > 8 g/kg/day). The defaulter rate was within the acceptable international standards (

Performance of three rapid diagnostic tests for the detection of Cryptosporidium spp.and Giardia duodenalis in children with severe acute malnutrition and diarrhoea

Background:There is significant need for accurate diagnostic tools for Cryptosporidium spp.and Qiordia duodenalis infections in resource limited countries where diarrhoeal disease caused by these parasites is often prevalent.The present study assessed the diagnostic performance of three commercially available rapid diagnostic tests(RDTs)based on faecal-antigen detection for Cryptosporidium spp.and/or G.duodenalis infections in stool samples of children admitted with severe acute malnutrition(SAM)and diarrhoea.An established multiplex PCR was used as reference test.Methods:Stool samples from children with SAM and diarrhoea enrolled in a randomized controlled trial(registered at clinicaltrials.gov/ct2/show/NCT02246296)in Malawi(n=175)and Kenya(n=120)between December 2014 and December 2015 were analysed by a multiplex PCR for the presence of Cryptosporidium sppv G.duodenalis or Entomoebo histolytica parasite DNA.Cryptosporidium-positive samples were species typed using restriction fragment length polymorphism analysis.A sub-sample of the stool specimens(n=236)was used for testing with three different RDTs.Diagnostic accuracy of the tests under evaluation was assessed using the results of PCR as reference standard using MedCalc software.Pearson Chi-square test and Fisher's exact test were used to determine(significant)difference between the number of cryptosporidiosis or giardiasis cases found by PCR in Malawi and Kenya.The overall diagnostic accuracy of each RDT was calculated by plotting a receiver operating characteristic(ROC)curve for each test and to determine the area under the curve(AUC)using SPSS8 software.Results:Prevalence of Cryptosporidium spp.by PCR was 20.0 and 21.7%in Malawi and Kenya respectively,mostly C.hominis.G.duodenalis prevalence was 23.4 and 5.8%in Malawi and Kenya respectively.E histolytica was not detected by PCR.RDT testing followed the same pattern of prevalence.RDT sensitivities ranged for cryptosporidiosis from 42.9 to 76.9%and for G.duodenalis from 48.2 to 85.7%.RDT specificities ranged from 88.4 to 100%for Cryptosporidium spp.and from 91.2 to 99.2%for G.duodenalis infections.Based on the estimated area under the curve(AUC)values,all tests under evaluation had an acceptable overall diagnostic accuracy(>0.7),with the exception of one RDT for Cryptosporidium spp.in Malawi.Conclusions:All three RDTs for Cryptosporidium spp.and Giardia duodenalis evaluated in this study have a moderate sensitivity,but sufficient specificity.The main value of the RDTs is within their rapidness and their usefulness as screening assays in surveys for diarrhoea.

重症SARS患者的临床营养支持及血糖水平和胰岛素用量与结局的关系

目的观察重症SARS患者接受临床营养支持前后部分与营养有关指标的变化,并分析血糖水平/胰岛素用量与结局的关系。方法以我所英东重症医学监护中心收治的21例临床诊断重症SARS患者为研究对象,转入ICU后均给予呼吸支持及临床营养支持。经肠内营养接受的热量约4184kJ/d(1000kcal/d),蛋白质约38g/d;经肠外营养接受的热量约3347.2kJ/d(800kcal/d)。监测给予患者肠内、肠外营养支持前后的血糖、血清白蛋白、血淋巴细胞总数及谷丙转氨酶等指标的变化。所有患者均接受甲基强的松龙约200mg/d。为将血糖保持在4.44～7.78mmol/L(80～140mg/dl)的较低水平,应用静脉泵入胰岛素,记录血糖及胰岛素用量,再分析其与结局的关系。结果在发病(11.0±2.8)d后转入ICU的21例患者中,16例(76.2%)伴有营养不良。经过平均12d肠内与肠外营养支持后,患者血清白蛋白显著升高犤(28.5±2.2)g/Lvs(37.0±4.1)g/L犦(P=0.0001);血淋巴细胞总数升高犤(0.74±0.47)×109/Lvs(1.22±0.73)×109/L犦(P=0.02);血谷丙转氨酶升高的病例有所下降,但差异不显著(81.0%vs57.1%,P=0.18);生存组血糖降至较低水平犤(9.5±2.3)mmol/Lvs(6.3±1.8)mmol/L犦(P=0.0002);死亡组血糖也有下降犤(13.0±3.3)mmol/Lvs(9.5±1.3)mmol/L犦(P=0.04);

重症SARS患者的临床营养支持及血糖水平和胰岛素用量与结局的关系

目的观察重症SARS患者接受临床营养支持前后部分与营养有关指标的变化,并分析血糖水平/胰岛素用量与结局的关系。方法以我所英东重症医学监护中心收治的21例临床诊断重症SARS患者为研究对象,转入ICU后均给予呼吸支持及临床营养支持。经肠内营养接受的热量约4184kJ/d(1000kcal/d),蛋白质约38g/d;经肠外营养接受的热量约3347.2kJ/d(800kcal/d)。监测给予患者肠内、肠外营养支持前后的血糖、血清白蛋白、血淋巴细胞总数及谷丙转氨酶等指标的变化。所有患者均接受甲基强的松龙约200mg/d。为将血糖保持在4.44～7.78mmol/L(80～140mg/dl)的较低水平,应用静脉泵入胰岛素,记录血糖及胰岛素用量,再分析其与结局的关系。结果在发病(11.0±2.8)d后转入ICU的21例患者中,16例(76.2%)伴有营养不良。经过平均12d肠内与肠外营养支持后,患者血清白蛋白显著升高犤(28.5±2.2)g/Lvs(37.0±4.1)g/L犦(P=0.0001);血淋巴细胞总数升高犤(0.74±0.47)×109/Lvs(1.22±0.73)×109/L犦(P=0.02);血谷丙转氨酶升高的病例有所下降,但差异不显著(81.0%vs57.1%,P=0.18);生存组血糖降至较低水平犤(9.5±2.3)mmol/Lvs(6.3±1.8)mmol/L犦(P=0.0002);死亡组血糖也有下降犤(13.0±3.3)mmol/Lvs(9.5±1.3)mmol/L犦(P=0.04);

高危急性淋巴细胞白血病患儿维持治疗阶段营养状况与重症感染的关系研究

目的探讨高危急性淋巴细胞白血病(ALL)患儿在维持治疗阶段的不同营养状况及其对重症感染发生率的影响。方法收集高危ALL患儿,调查其在维持治疗阶段的营养状况,并比较不同营养状况下重症感染的发生率。结果共168例高危ALL患儿纳入研究,其中营养良好、轻度营养不良及中度、重度营养不良的患儿分别占23.2%、40.5%、24.4%、11.9%,其并发重症感染的发生率分别为15.4%、14.7%、41.5%、60.0%,组间比较差异有统计学意义(P<0.001),重度营养不良组患儿的重症感染发生率高于营养良好组及轻度营养不良组患儿(P均<0.001),中度营养不良组的重症感染发生率高于轻度营养不良组(P<0.008)。结论高危ALL患儿在维持治疗阶段营养状况不容乐观,重症感染发生率与不同营养状况有关,营养状况越差,发生重症感染的风险越高。

王旭高治幼儿病医案探析

[目的]总结王旭高治疗幼儿病的经验。[方法]通过对王旭高诊治幼儿病医案如胎惊、童痨、疳劳、马脾风等的分析,探究王旭高论治幼儿病的临床特色。[结果]王旭高治疗幼儿病,非常重视脏腑虚实的辨析,深合钱乙所论幼儿生理"脏腑柔弱、气血未实"、病理"易虚易实、易寒易热"之旨。[结论]王氏对幼儿病的论治,灵活变化,颇有见效。

重度营养不良儿童重症肺炎合并横纹肌溶解综合征1例报告及文献回顾

目的:探讨重度营养不良儿童重症肺炎合并横纹肌溶解综合征(rhabdomyolysis,RM)的诊疗方法。方法:回顾性分析2021年1月12日我院普通儿科收治的1例重度营养不良儿童重症肺炎合并RM的诊疗经过,结合文献复习。结果:患儿女性,10岁,以“咳嗽10天,发热、气促伴发绀1天”入院;查体:体质指数11.3,下肢肌肉触痛;实验室检查示降钙素原(PCT)、血肌酸激酶(CK)、血尿素氮(BUN)及血肌红蛋白(Mb)均大幅度上升,甲型流感病毒IgM抗体阳性;胸部CT提示双肺炎症。诊断为重症肺炎合并RM、重度营养不良。予抗感染、补液、补碱及加强利尿等治疗,病情加重合并急性心力衰竭,予强心、镇静等综合救治,病情恢复后痊愈出院。结论:重度营养不良儿童重症肺炎可引发RM,应积极治疗原发病、水化、补碱等处理,而重度营养不良儿童补液时易出现容量超负荷,可监测左心室射血分数(EF)联合血清脑钠肽(BNP)。

Omega-6支撑身体,Omega-3支撑大脑:均衡摄入对儿童大脑发育的影响

人体大脑和身体的发育,需要从食物中摄取均衡的营养物质。人类大脑是区分人类和其他动物的特征。食物中的必需脂肪酸是机体组织结构和功能的必要组成部分。Omega-6(O6)亚油酸(LA6)是皮肤组织的组成成分,且是炎症、血栓形成、免疫和其他信号分子的前体;Omega-3(O3)α-亚麻酸(ALA3),特别是其长链代谢产物——二十二碳六烯酸(DHA3),是大脑、视网膜和部分神经组织中的关键组分。从富含LA6脂肪酸(缺乏O3脂肪酸)的植物籽中提取出的廉价而优质油脂,是20世纪的西方国家食品工业生产的主要脂肪来源。在代谢通路中,高浓度的LA6脂肪酸可拮抗O3脂肪酸代谢,造成O3脂肪酸不足,因此,在给怀孕动物的饲料中,只提供富含LA6但缺乏O3脂肪酸的油脂作为唯一的脂肪来源,会导致幼崽大脑发育不良。过去20~30年的研究表明,低含量LA6且含DHA3的油脂可改善大脑的功能。近年来的研究较多集中在营养因素对大脑发育的影响,最新研究数据表明,脂肪酸平衡对营养不良儿童的大脑发育尤为重要。世界卫生组织(WHO)越来越重视大脑的营养健康,通过其下属的食品法典委员会,建议用于治疗严重急性营养不良儿童的即食治疗食品中,使用含有均衡脂肪酸组成/构成的脂肪。同样,脂肪酸均衡对老年人可能也很重要。目前,业界已经有了调整油脂成分的方法,以确保脂肪酸均衡,从而维持人体整个生命周期的大脑健康。

Omega-6 for Body,Omega-3 for Brain:Balance for Brain Development in Children

Food must supply a balance of nutrients to support both brain and body.The human brain makes us uniquely human.Essential fatty acids are part of the metabolic pathways that define tissue structure and function.Omega-6(O6)linoleic acid(LA6)has long been known to be required for skin structure,and as a precursor for inflammatory,thrombotic,immune,and other signaling molecules.Omega-3(O3)alpha-linolenic acid(ALA3)and particularly its long chain product docosahexaenoic acid(DHA3)has a key structural role in the brain,retina,and related neural tissue.In the 20 th century western world,inexpensive,high quality oils primarily from LA6-rich/O3-poor vegetable seed oils became dominant fats produced by the food industry.Provision of LA6-rich/O3-poor oils as the sole source of fat in the diets of pregnant animals causes O3 deficiency and poor brain development,primarily because high LA6 antagonizes metabolism of all O3,creating an artificial metabolic demand for O3.Data developed over the last 2~3 decades show that provision of low LA6 combined with preformed DHA3 optimizes brain function.Recent studies emphasize the importance of nutrition to support brain development,with newer findings showing particular importance of fatty acid balance in malnourished children.The World Health Organization(WHO)through the Codex Alimentarius(“Code for Food”)is increasingly recognizing the primacy of brain health and in part on that basis recently acted to recommend balanced fat for Ready-to-Use-Therapeutic Foods used to treat children with severe acute malnutrition.Similar principles are likely to be important in older persons.Industry now has the tools to adjust the composition of oils to support brain health throughout the life cycle.

新型冠状病毒感染高峰期血液透析患者呼吸道感染的临床特点

目的总结新型冠状病毒感染高峰期门诊维持性血液透析患者呼吸道感染的流行病学及临床特征。方法回顾性分析2022年12月中下旬新型冠状病毒感染高峰期于首都医科大学附属北京地坛医院血液净化中心行血液透析的患者呼吸道感染的患病率、死亡率、死亡的危险因素及化验检查等临床资料。结果共纳入117例血液透析患者。呼吸道感染的患病率88.0%(103/117),死亡率6.8%(7/103)。多因素回归分析显示合并神经系统疾病和B型钠尿肽水平高是全因死亡的独立危险因素,P值分别为0.034和0.022。12.5%的呼吸道感染者新型冠状病毒特异性抗体阴性。呼吸道感染后1个月内,70例(59.8%)患者新型冠状病毒抗体IgG阳性,其中10例(14.3%)患者再经过1个月后IgG转为阴性。血液透析患者呼吸道感染后血红蛋白、血清白蛋白均较前下降,血清B型钠尿肽较前升高,P值均<0.001。血红蛋白、血清白蛋白的下降幅度与年龄呈正相关,R值分别为0.244和0.238,P值分别为0.017和0.019。结论血液透析患者在新型冠状病毒感染高峰期死亡率高,特异性抗体产生率低、抗体持续时间短。需重视血液透析患者呼吸道感染后营养不良的发生,及时予营养支持治疗,改善预后。