Background: In Côte d’Ivoire so far, the circulating haplotypes have been inferred on the phenotypic profiling of SCD patients. The impact of the circulating haplotypes on the use of Hydroxyurea has not been ass...Background: In Côte d’Ivoire so far, the circulating haplotypes have been inferred on the phenotypic profiling of SCD patients. The impact of the circulating haplotypes on the use of Hydroxyurea has not been assessed yet. Therefore the objective of this study is to identify in Abidjan the HbS haplotypes that modulate HU treatment responses. Methods: In a cross-sectional descriptive and analytical study, children aged 5 to 15 years with SCD, and carrying the hemoglobin phenotypes SSFA2 and SFA2, were recruited into a HU treatment cohort. Various parameters on the haplotypes and the outcomes of the treatment were analyzed. Results: Thirty nine children with SCD were included. The phenotypic profile of the cohort was 86.6% of SSFA2 and 15.4% of SFA2. Three haplotypes were found, the Benin haplotype, the Senegal haplotype, and an atypical one. The participants belonged to three genotypes, Benin/atypical (64.1%), Benin/Senegal (33.3%) and Senegal/Senegal (2.6%). Overall, HU treatment was successful in all haplotypes with 12 out of 39 patients failing treatment after 12 months in the Benin haplotype group. The association between HU treatment success and the Benin haplotype was found in terms of the decrease in the number of white blood cells and the students missing class. Conclusion: The study revealed that inferring haplotype based on the phenotypic profile could be inaccurate. The proportion of atypical haplotype that were not previously described in Côte d’Ivoire was high. All the haplotypes seemed to be associated with HU treatment success but some patients with Benin haplotype did not respond well.展开更多
Introduction: Arterial hypertension (AH) in children is under-diagnosed and often has a poor prognosis. The aim of this study was to describe the epidemiological, diagnostic, therapeutic and evolutionary aspects of hy...Introduction: Arterial hypertension (AH) in children is under-diagnosed and often has a poor prognosis. The aim of this study was to describe the epidemiological, diagnostic, therapeutic and evolutionary aspects of hypertension in children at the University Hospital of Bouaké, with a view to improving the prognosis. Methods: This was a cross-sectional, analytical study carried out in the paediatrics department of Bouaké University Hospital. It concerned the medical records of children aged 4 to 15 hospitalised from 1 January 2017 to 31 December 2020 for hypertension. Diagnosis was based on the simplified blood pressure guidelines of the Expert Consensus of the French Society of Hypertension. The variables studied were epidemiological, diagnostic, therapeutic and evolutionary. Quantitative variables were compared at the significance level p ≤ 0.05. Results: The hospital incidence of hypertension was 0.32% (69/21,642). The sex ratio was 0.72. 97.1% of the children were over five years of age. Oedema (49.3%) and breathing difficulties (20.2%) were the main reasons for consultation. Hypertension was classified as threatening (56.5%), confirmed (31.9%) and borderline (11.6%). The cause was renal in 66.7%, dominated by impure nephrotic syndrome (24.6%). Treatment for hypertension consisted mainly of a diuretic (79.7%) and a calcium channel blocker (47.8%). Outcome was favourable in 50.7% of cases. Mortality was 20.3%. No factor was significantly associated with death. Conclusion: Hypertension in children at Bouaké University Hospital is serious. The aetiology is mainly renal. Early diagnosis and management are key to improving prognosis.展开更多
AIM: To study the frequency of vitamin D deficiency in patients with hepatitis C virus(HCV) infection and to evaluate the role of vitamin D supplementation in improving antiviral therapy.METHODS: Sixty-six children ag...AIM: To study the frequency of vitamin D deficiency in patients with hepatitis C virus(HCV) infection and to evaluate the role of vitamin D supplementation in improving antiviral therapy.METHODS: Sixty-six children aged from 7-14 years(mean ± SD, 11.17 ± 2.293) diagnosed with HCV infection were matched to 28 healthy controls. Serum levels of 25(OH) D3, calcium, phosphorus, alkaline phosphatase and plasma level of parathormone were measured. Quantitative PCR for HCV was performed Bone density was determined by dual energy X-ray absorptiometry. All cases received conventional therapy, and only 33 patients received vitamin D supplementation.RESULTS: Children with HCV showed significantly increased levels of HCV RNA(P < 0.001), parathormone(P < 0.01) and decreased vitamin D levels(P < 0.05)(33.3% deficient and 43.3% insufficient) compared with controls. Abnormal bone status(Z score-1.98 ± 0.75) was found in ribs, L-spine, pelvis and total body. Cases treated with vitamin D showed significant higher early(P < 0.04) and sustained(P < 0.05) virological response. There was a high frequency of vitamin D deficiency among the Egyptian HCV children, with significant decrease in bone density. The vitamin D level should be assessed before the start of antiviral treatment with the correction of any detected deficiency. CONCLUSION: Adding vitamin D to conventional Peg/RBV therapy significantly improved the virological response and helped to prevent the risk of emerging bone fragility.展开更多
BACKGROUND Vitamin D is an essential fat-soluble secosteroid hydroxylated by the liver to form the intermediate metabolite calcidiol{25-hydroxy vitamin D[25(OH)D]},which is a reliable indicator to investigate individu...BACKGROUND Vitamin D is an essential fat-soluble secosteroid hydroxylated by the liver to form the intermediate metabolite calcidiol{25-hydroxy vitamin D[25(OH)D]},which is a reliable indicator to investigate individual vitamin D status.Vitamin-D-binding protein(VDBP)is a multifunctional glycoprotein mainly synthesized in the liver and the major transport protein for vitamin D and its metabolites.Serum vitamin D and VDBP are both associated with hepatitis B.However,few studies have reported the relationship and clinical significance of vitamin D and VDBP with hepatitis B virus(HBV)replication and hepatic fibrosis in children with chronic hepatitis B(CHB).AIM To explore vitamin D and VDBP serum levels in children with CHB and the association of vitamin D and VDBP with HBV replication and hepatic fibrosis.METHODS We enrolled 204 children with CHB admitted to Hunan Children’Hospital in summer and autumn between 2018 and 2019 and 170 healthy controls.CHB patients included:164 hepatitis B e antigen(HBeAg)positive and 40 HBeAg negative;193 hepatitis B surface antigen(HBsAg)positive and 11 HBsAg negative;164 with detectable HBV deoxyribonucleic acid(DNA)and 40 with undetectable HBV DNA;131 with HBV genotype B and 23 with HBV genotype C;and 27 without hepatic fibrosis and 97 with hepatic fibrosis.Serum levels of 25(OH)D,VDBP,liver function markers,and other clinical parameters were collected to analyze their association with vitamin D and VDBP.Mann-Whitney U test,Kruskal-Wallis H test,or t test was used to analyze serum 25(OH)D and VDBP levels in different groups.Spearman rank correlation test was utilized to analyze the correlation of 25(OH)D and VDBP with other markers.Statistically significant factors determined by univariate analysis were further analyzed by binary multivariate logistic regression analysis.P<0.05 was considered statistically significant.RESULTS Children with CHB had lower serum 25(OH)D(56.64±17.89 nmoL/L)and VDBP[122.40(70.74-262.84μg/L)]levels than healthy controls had(P<0.001).Serum 25(OH)D and VDBP levels were significantly different among the different grades of hepatic fibrosis(P<0.05).VDBP levels in children with HBV genotype C,HBsAg,HBeAg,and detectable HBV DNA were significantly lower than those in children with HBV genotype B,no HBsAg,no HBeAg,and undetectable HBV DNA(P<0.05).Serum 25(OH)D level was negatively correlated with age and serum total bilirubin level(r=-0.396 and-0.280,respectively,P<0.001).Serum VDBP level was negatively correlated with HBV DNA(log10 IU/mL)(r=-0.272,P<0.001).Serum 25(OH)D level was not correlated with VDBP level(P>0.05).Univariate(P<0.05)and multivariate logistic regression analysis showed that low level of 25(OH)D(odds ratio=0.951,95%confidence interval:0.918-0.985)and high level of HBV DNA(odds ratio=1.445,95%confidence interval:1.163-1.794)were independently correlated with hepatic fibrosis(P<0.01).CONCLUSION Serum levels of 25(OH)D and VDBP are decreased in children with CHB.Serum VDBP level is negatively correlated with HBV replication.Low level of 25(OH)D is independently associated with hepatic fibrosis in children with CHB.There is no significant association between serum levels of 25(OH)D and VDBP.展开更多
Background: Recent studies suggested that vitamin D deficiency among children is widespread worldwide. Most of the Asian countries are suffering from high prevalence of vitamin D deficiency, especially in children. Ho...Background: Recent studies suggested that vitamin D deficiency among children is widespread worldwide. Most of the Asian countries are suffering from high prevalence of vitamin D deficiency, especially in children. However, the vitamin D deficiency of Bangladeshi children has not been investigated yet. The objective of the study was to assess the prevalence of vitamin D deficiency among children in Dhaka city, Bangladesh. Methods: A cross-sectional study was designed. Children aged 0 month to 16 years attended Pediatrics’ clinics with minor illness were conveniently recruited. After obtaining informed written consent, venous blood was taken and serum 25(OH)D levels were determined by direct enzyme-linked immunosorbent assay. Descriptive statistics were performed for age, sex, biochemical parameters. Socio-economic status (SES) was estimated using a wealth index, producing a weighted score. Scores were categorized into quintiles, with category 1 representing the poorest and category 5 the richest. Serum 25(OH)D was categorized: deficient as Results: 31.88% children of 0 - 1 year had deficient serum 25(OH)D level and 52.17% children had insufficient level. Among 2 - 5 years’ group, 38.16% were deficient and 50% were insufficient. Among the 6 - 11 years group, 41.02% were deficient and 52.56% were insufficient. Among 12 - 16 years group, 46.75% were deficient and 51.95% were insufficient. That means, serum 25-hydroxyvitamin D deficiency and insufficiency rate is found very high among Bangladeshi children. Conclusions: The prevalence of vitamin D deficiency and insufficiency among children in Bangladesh is high. The study recommended that vitamin D supplementation in Bangladeshi children should be formally launched from first day of birth up to adolescence.展开更多
Introduction: Vitamin D’s action outside of bone, especially on immunity, is widely reported in the international scientific literature over the last years. Objective: Calculate the frequency of hypovitaminosis D in ...Introduction: Vitamin D’s action outside of bone, especially on immunity, is widely reported in the international scientific literature over the last years. Objective: Calculate the frequency of hypovitaminosis D in children aged 6 to 59 months suffering from severe malaria in the CHUD-P pediatric unit in 2016. Setting and Methods: This research work is a cross-sectional study with descriptive and analytical purposes. Data gathering was prospective. The study involved children aged 6 to 59 months hospitalized for severe malaria in the CHUD-P pediatric unit. The said children were HIV-uninfected, eutrophic and had not received vitamin D supplementation during the last 6 months. Vitamin D dose was measured using the High Performance Liquid Chromatography (HPLC) technique. Results: A total of 80 subjects were involved in the survey. Mean age was 26.08 months, sex ratio was 0.8 and average weight was 10.80 kg. Hypovitaminosis D frequency was 83.8% (67 cases out of 80 children investigated during the survey) with an average plasma concentration of vitamin D estimated at 21.57 ng/ml ± 7.34 with two extremes (11.24 - 42.32) ng/ml. The minimum parasitaemia was 202 P/μl and the maximum was 580,000 P/μl. Conclusion: Hypovitaminosis D is common in children suffering from severe malaria;this result suggests conducting a large-scale community-based study to decide on vitamin D inclusion in national supplementation policies and severe malaria management.展开更多
Purpose: A better understanding of urinary tract infection (UTI) and the role of host, bacterial and environmental factors have improved the ability to identify the patients at risk and prevent or minimize sequelae. K...Purpose: A better understanding of urinary tract infection (UTI) and the role of host, bacterial and environmental factors have improved the ability to identify the patients at risk and prevent or minimize sequelae. Kidney stones may be a complicated subject and its etiology is related to diet, increase urinary solutes and colloids in hot weather. Hypercalcaemia produced by taking large doses of vitamin D, creates high blood pressure and calcium deposits that can produce renal and bludder stones in all age groups including children. The objective of the present study was to estimate the serum level of vitamin D among patients particularly children taking treatable vitamin D. Correlation between vitamin D renal stones and UTI was also assessed. Methods: The number of patients studied was 150 collected during 2010 and 2011 in University teaching hospital. Forty two of them were children. The patients under study should have renal stone confirmed by ultrasound examination. Urine, blood and stone samples were taken for relevant laboratory investigations including identification of bacteriuria and its causative agents. Serum ions and vitamin D were also estimated. Type of renal stone collected was chemically identified. Results: One hundred and fifty patients with urolithiasis were included in the present study whose ages ranged from 8 months to 69 years and the ratio of males to females was 1.7:1. The frequency of patients revealed UTI was 52% and 78% of the infected patients were suffered from Gram-negative bacteria particularly Escherichia coli. Renal stones of mixed chemical composition were almost 72% and 78.2% of the stones were infection type. The mean of serum calcium was 2.157 mmol/L. The serum means of vitamin D among children and adults were 50.9 and 31.4 nmol/L respectively and the peak of this vitamin was recorded during summer. Conclusion: The frequency of UTI among urolithiasis patients was greater than that of non-urolithiasis. Enterobacteriaceae was the dominant family causing UTI particularly among females. Urolithiasis was more prevalent in males (62%). Recurrence of urolithiasis was high (39%) which indicated insufficient treatment of the underlying causes. Serum ions concentrations among children and adults were variables. Vitamin D values in children were higher than those estimated among adults and the peak of its overall concentration mean was found during summer (39.7 nmol/L). There was a strong relation between vitamin D level and the incidence of urolithiasis particularly among children with dietary problems.展开更多
Background: Vitamin D plays a pivotal role in supporting the immune system, helping to reduce the risk of infections and certain autoimmune diseases. Adequate vitamin D levels may be associated with a reduced risk of ...Background: Vitamin D plays a pivotal role in supporting the immune system, helping to reduce the risk of infections and certain autoimmune diseases. Adequate vitamin D levels may be associated with a reduced risk of certain health conditions like pre-eclampsia, gestational diabetes, and postpartum depression. Brittle bones, osteoporosis in the elderly, and osteomalacia in young children are all symptoms of vitamin D insufficiency. Additionally, it contributes to problems linked to gum disease, including an increase in dental cavities, alveolar bone loss around the teeth, and other problems. It could lead to depression, tiredness, and a loss of appetite. In this study, urban children and adolescents in Dhaka city, Bangladesh are examined for vitamin D deficiency, insufficiency, and sufficiency. Methods: The Study was a cross-sectional study conducted under Dhaka National Medical College and Hospital, Dhaka and additionally included two other health centers Medinova Medical Services and Monoara General Hospital Service Golap bag, Dhaka from October 2020 to November 2021. The study location was at the 3 (Three) different hospitals which was located in Dhaka City. In this cross-sectional study, Participants will be selected purposively and conveniently based on the age categories from 0 - 19 years of age at the outdoor department of the hospital. The study included the secondary dataset of ambulatory individuals who came to the 3 (three) hospitals, randomly to evaluate serum vitamin D levels on referral from a general out-patient-department (OPD). They were examined for laboratory findings of serum 25 hydroxyvitamin D levels to determine vitamin D deficiency, insufficiency, and sufficiency among children and adolescent groups of both male and female Sex. Results: A total of 6394 individuals with a diverse age group were statistically examined for laboratory findings of serum vitamin D levels. Vitamin D deficiency was observed in 40.58% of individuals with a mean log of 1.01 ± 0.18 ng/ml serum vitamin D levels, vitamin D insufficiency in 30.93% of individuals with a mean log of 1.38 ± 0.05 ng/ml serum vitamin D levels and vitamin D sufficiency in 19.49% individuals with a mean log of 1.63 ± 0.12 ng/ml serum vitamin D levels. The highest percentage of individuals deficient in vitamin D were children and adolescents of age ranging between 15 to 19 years. Conclusion: The findings of vitamin D deficiency in children and adolescents direct higher authorities in the public health sector to take immediate steps to screen, intervene and educate high-risk populations incorporating vitamin D supplements to establish preventive and therapeutic measures.展开更多
Introduction: Nutritional rickets is the visible tip of the iceberg formed by the diseases caused by hypovitaminosis. Vitamin D plasma is essentially influenced by the level of sunlight which is significant in Sub-Sah...Introduction: Nutritional rickets is the visible tip of the iceberg formed by the diseases caused by hypovitaminosis. Vitamin D plasma is essentially influenced by the level of sunlight which is significant in Sub-Saharan Africa and in Benin. However, there are factors likely to impede endogenous production of that vitamin in children in our environment. This research work was conducted with the view to investigate hypovitaminosis D prevalence and associated factors in children aged 6 to 59 months in the District of Parakou in 2017. Methods: This research work was a cross-sectional study with prospective collection of data carried out in community in the District of Parakou in 2017. The study involved euthrophic and non-HIV infected children aged 6 to 59 months who did not benefit from vitamin D supplementation during the past three months. Vitamin D plasma concentration was obtained using “Radioimmunoassay” after cluster random sampling in accordance with WHO guidelines. According to Schwartz formula, nominal minimum sample size was 321. In this study, hypovitaminosis D was defined as a plasma level lower than 30 ng/l. Data processing was carried out using softwares such as EPI INFO version 7.2 and SPSS 21. Results: In total, 400 children were involved in the survey. Hypovitaminosis prevalence was 9.5% (38 out of 400 cases). In our research work, the factors associated with hypovitaminosis were child’s age (p = 0.0470), mother’s age (p = 0.0000), weaning age lower than 6 months (p = 0.0466) and mother’s occupation out of direct sunlight (p = 0.0012). Conclusion: Nearly one out of ten children suffers from hypovitaminosis D in the District of Parakou in 2017. The associated factors were age of child and mother, early weaning and mother’s professional occupation held out of direct sunlight. This research work should be continued and improved by a nationwide multicentre study. This could lead to the adoption of measures for hypovitaminosis D prevention among children in Benin.展开更多
Background: Hypovitaminosis D (serum concentration of 25(OH)D Methods: This was a cross sectional observational study having conducted at a paediatric clinic in Chittagong Metropolitan City from July, 2012 to December...Background: Hypovitaminosis D (serum concentration of 25(OH)D Methods: This was a cross sectional observational study having conducted at a paediatric clinic in Chittagong Metropolitan City from July, 2012 to December, 2017 including 524 children of 0 - 18 years by convenient sampling. The relevant data were assessed using standard case record form and lab parameter of 25(OH)D assay. Serum level of 25(OH)D of Results: The prevalence of Hypovitaminosis D was 50.57%. Compared with the infancy age group the odds of Hypovitaminosis D is 1.36 times more likely in >5 yrs children. The odds of association (odds ratio or OR = 0.19) of rural population with Hypovitaminosis D is lower than urban population. The formula fed children had less chance of association (OR = 0.32) of developing hypovitaminosis D in comparison to exclusively breastfed babies. Occasional Sun exposed group was 1.40 times more likely to develop hypovitaminosis D in comparison to daily sun exposure group. The odds of Hypovitaminosis D were 1.9 times more in winter season than summer season. School going children had double the chance of Hypovitaminosis D than children with no education. Subjects with high weight for age were 3.65 times increased risk of suffering from hypovitaminosis D compared with normal weight for age. Girls had a little bit more chance of hypovitaminosis D than boys. Children coming from family with monthly Income > 10,000 BDT are associated with more Hypovitaminosis D. Among clinical variables only wheeze has significant association (OR = 1.83). Conclusion: Hypovitaminosis D (<20 ng/ml) prevails significantly among Infants and children of South-East region of Bangladesh. Age, area of residence, feeding pattern, sun exposure practice, seasons, schooling pattern, weight for age have strong association with Hypovitaminosis D.展开更多
The prevalence of obesity related hypertension has dramatically increased in children with the parallel increase in pediatric obesity.This pediatric health problem may adversely affect cardiovascular health in adult l...The prevalence of obesity related hypertension has dramatically increased in children with the parallel increase in pediatric obesity.This pediatric health problem may adversely affect cardiovascular health in adult life.The pathogenesis of hypertension in obese children is not widely understood.We therefore undertake this review to raise public awareness.Early childhood parameters like birth weight and postnatal weight gain may play important roles in risk for obesity and obesity related hypertension later in childhood and adult life.Further information is required to confirm this origin of hypertension so that appropriate measures are taken in the peri-natal period.The role of sympathetic nervous system has now been well established as one of the principle mechanisms involved in obesity related hypertension.The Renin-Angiotensin system,insulin resistance due to obesity and as a part of metabolic syndrome along with imbalance in adipokines such as leptin and adiponectin,cause activation of the sympathetic system,vasoconstriction,endothelial dysfunction and sodium reabsorption among other perturbations.Multi-step interventions targeting these various mech-anisms are required to break the cycle of obesity and metabolic syndrome.Vitamin D deficiency,sleep apnea due to airway obstruction and hyperuricemia may also play a significant role and should not be ignored in its early stages.Obesity is a risk factor for other comorbid conditions like chronic kidney disease and fatty liver which further accentuate the risk of hypertension.Increased awareness is required to prevent,diagnose and treat obesity related hypertension among the pediatric population.展开更多
Background:Cryoablation of accessory pathways(APs)is effective and very safe in children,as previously reported by our group.The aim of this retrospective study was to evaluate the current efficacy of 3D non-fluorosco...Background:Cryoablation of accessory pathways(APs)is effective and very safe in children,as previously reported by our group.The aim of this retrospective study was to evaluate the current efficacy of 3D non-fluoroscopic cryoablation of right sided APs in children,comparing results obtained with the Ensite VelocityTM and the more recent Ensite PrecisionTM 3D mapping systems.Methods and Results:From January 2016 to December 2019,102 pediatric patients[mean age 12.5±2.8,62 males(61%of total cohort)]with right APs underwent 3D non-fluoroscopic transcatheter cryoablation at our Institution.Fifteen(14.7%)patients had previously undergone catheter ablation.Acute procedural success rate was 95.1%(n=97).No significant differences were detected in acute success rates achieved with Ensite Velocity^(TM)or Ensite PrecisionTM systems nor between manifest(94%)and concealed APs(100%).No permanent complications occurred.During follow-up(428±286 days,median 396 days[interquartile range 179-713]),19 patients(19.6%)had recurrences.Recurrences were more frequent for parahissian/anterior APs compared to midseptal/posterior and lateral APs(p=0.043).Recurrences were not related to the Ensite system used.A redo ablation procedure was attempted in 13 cases,11 cryoablation and 2 radiofrequency ablations:the former was successful in 10 cases out of 11(90.9%).Conclusion:3D cryoablation of right-sided APs is associated with a very high acute success rate with limited use of fluoroscopy,resulting in great benefit to the children.Recurrence rates are not high and patients can be retreated with cryo-energy with higher success rates.展开更多
文摘Background: In Côte d’Ivoire so far, the circulating haplotypes have been inferred on the phenotypic profiling of SCD patients. The impact of the circulating haplotypes on the use of Hydroxyurea has not been assessed yet. Therefore the objective of this study is to identify in Abidjan the HbS haplotypes that modulate HU treatment responses. Methods: In a cross-sectional descriptive and analytical study, children aged 5 to 15 years with SCD, and carrying the hemoglobin phenotypes SSFA2 and SFA2, were recruited into a HU treatment cohort. Various parameters on the haplotypes and the outcomes of the treatment were analyzed. Results: Thirty nine children with SCD were included. The phenotypic profile of the cohort was 86.6% of SSFA2 and 15.4% of SFA2. Three haplotypes were found, the Benin haplotype, the Senegal haplotype, and an atypical one. The participants belonged to three genotypes, Benin/atypical (64.1%), Benin/Senegal (33.3%) and Senegal/Senegal (2.6%). Overall, HU treatment was successful in all haplotypes with 12 out of 39 patients failing treatment after 12 months in the Benin haplotype group. The association between HU treatment success and the Benin haplotype was found in terms of the decrease in the number of white blood cells and the students missing class. Conclusion: The study revealed that inferring haplotype based on the phenotypic profile could be inaccurate. The proportion of atypical haplotype that were not previously described in Côte d’Ivoire was high. All the haplotypes seemed to be associated with HU treatment success but some patients with Benin haplotype did not respond well.
文摘Introduction: Arterial hypertension (AH) in children is under-diagnosed and often has a poor prognosis. The aim of this study was to describe the epidemiological, diagnostic, therapeutic and evolutionary aspects of hypertension in children at the University Hospital of Bouaké, with a view to improving the prognosis. Methods: This was a cross-sectional, analytical study carried out in the paediatrics department of Bouaké University Hospital. It concerned the medical records of children aged 4 to 15 hospitalised from 1 January 2017 to 31 December 2020 for hypertension. Diagnosis was based on the simplified blood pressure guidelines of the Expert Consensus of the French Society of Hypertension. The variables studied were epidemiological, diagnostic, therapeutic and evolutionary. Quantitative variables were compared at the significance level p ≤ 0.05. Results: The hospital incidence of hypertension was 0.32% (69/21,642). The sex ratio was 0.72. 97.1% of the children were over five years of age. Oedema (49.3%) and breathing difficulties (20.2%) were the main reasons for consultation. Hypertension was classified as threatening (56.5%), confirmed (31.9%) and borderline (11.6%). The cause was renal in 66.7%, dominated by impure nephrotic syndrome (24.6%). Treatment for hypertension consisted mainly of a diuretic (79.7%) and a calcium channel blocker (47.8%). Outcome was favourable in 50.7% of cases. Mortality was 20.3%. No factor was significantly associated with death. Conclusion: Hypertension in children at Bouaké University Hospital is serious. The aetiology is mainly renal. Early diagnosis and management are key to improving prognosis.
文摘AIM: To study the frequency of vitamin D deficiency in patients with hepatitis C virus(HCV) infection and to evaluate the role of vitamin D supplementation in improving antiviral therapy.METHODS: Sixty-six children aged from 7-14 years(mean ± SD, 11.17 ± 2.293) diagnosed with HCV infection were matched to 28 healthy controls. Serum levels of 25(OH) D3, calcium, phosphorus, alkaline phosphatase and plasma level of parathormone were measured. Quantitative PCR for HCV was performed Bone density was determined by dual energy X-ray absorptiometry. All cases received conventional therapy, and only 33 patients received vitamin D supplementation.RESULTS: Children with HCV showed significantly increased levels of HCV RNA(P < 0.001), parathormone(P < 0.01) and decreased vitamin D levels(P < 0.05)(33.3% deficient and 43.3% insufficient) compared with controls. Abnormal bone status(Z score-1.98 ± 0.75) was found in ribs, L-spine, pelvis and total body. Cases treated with vitamin D showed significant higher early(P < 0.04) and sustained(P < 0.05) virological response. There was a high frequency of vitamin D deficiency among the Egyptian HCV children, with significant decrease in bone density. The vitamin D level should be assessed before the start of antiviral treatment with the correction of any detected deficiency. CONCLUSION: Adding vitamin D to conventional Peg/RBV therapy significantly improved the virological response and helped to prevent the risk of emerging bone fragility.
基金Supported by Hunan Provincial Health Commission Science Foundation of China,No.20200017.
文摘BACKGROUND Vitamin D is an essential fat-soluble secosteroid hydroxylated by the liver to form the intermediate metabolite calcidiol{25-hydroxy vitamin D[25(OH)D]},which is a reliable indicator to investigate individual vitamin D status.Vitamin-D-binding protein(VDBP)is a multifunctional glycoprotein mainly synthesized in the liver and the major transport protein for vitamin D and its metabolites.Serum vitamin D and VDBP are both associated with hepatitis B.However,few studies have reported the relationship and clinical significance of vitamin D and VDBP with hepatitis B virus(HBV)replication and hepatic fibrosis in children with chronic hepatitis B(CHB).AIM To explore vitamin D and VDBP serum levels in children with CHB and the association of vitamin D and VDBP with HBV replication and hepatic fibrosis.METHODS We enrolled 204 children with CHB admitted to Hunan Children’Hospital in summer and autumn between 2018 and 2019 and 170 healthy controls.CHB patients included:164 hepatitis B e antigen(HBeAg)positive and 40 HBeAg negative;193 hepatitis B surface antigen(HBsAg)positive and 11 HBsAg negative;164 with detectable HBV deoxyribonucleic acid(DNA)and 40 with undetectable HBV DNA;131 with HBV genotype B and 23 with HBV genotype C;and 27 without hepatic fibrosis and 97 with hepatic fibrosis.Serum levels of 25(OH)D,VDBP,liver function markers,and other clinical parameters were collected to analyze their association with vitamin D and VDBP.Mann-Whitney U test,Kruskal-Wallis H test,or t test was used to analyze serum 25(OH)D and VDBP levels in different groups.Spearman rank correlation test was utilized to analyze the correlation of 25(OH)D and VDBP with other markers.Statistically significant factors determined by univariate analysis were further analyzed by binary multivariate logistic regression analysis.P<0.05 was considered statistically significant.RESULTS Children with CHB had lower serum 25(OH)D(56.64±17.89 nmoL/L)and VDBP[122.40(70.74-262.84μg/L)]levels than healthy controls had(P<0.001).Serum 25(OH)D and VDBP levels were significantly different among the different grades of hepatic fibrosis(P<0.05).VDBP levels in children with HBV genotype C,HBsAg,HBeAg,and detectable HBV DNA were significantly lower than those in children with HBV genotype B,no HBsAg,no HBeAg,and undetectable HBV DNA(P<0.05).Serum 25(OH)D level was negatively correlated with age and serum total bilirubin level(r=-0.396 and-0.280,respectively,P<0.001).Serum VDBP level was negatively correlated with HBV DNA(log10 IU/mL)(r=-0.272,P<0.001).Serum 25(OH)D level was not correlated with VDBP level(P>0.05).Univariate(P<0.05)and multivariate logistic regression analysis showed that low level of 25(OH)D(odds ratio=0.951,95%confidence interval:0.918-0.985)and high level of HBV DNA(odds ratio=1.445,95%confidence interval:1.163-1.794)were independently correlated with hepatic fibrosis(P<0.01).CONCLUSION Serum levels of 25(OH)D and VDBP are decreased in children with CHB.Serum VDBP level is negatively correlated with HBV replication.Low level of 25(OH)D is independently associated with hepatic fibrosis in children with CHB.There is no significant association between serum levels of 25(OH)D and VDBP.
文摘Background: Recent studies suggested that vitamin D deficiency among children is widespread worldwide. Most of the Asian countries are suffering from high prevalence of vitamin D deficiency, especially in children. However, the vitamin D deficiency of Bangladeshi children has not been investigated yet. The objective of the study was to assess the prevalence of vitamin D deficiency among children in Dhaka city, Bangladesh. Methods: A cross-sectional study was designed. Children aged 0 month to 16 years attended Pediatrics’ clinics with minor illness were conveniently recruited. After obtaining informed written consent, venous blood was taken and serum 25(OH)D levels were determined by direct enzyme-linked immunosorbent assay. Descriptive statistics were performed for age, sex, biochemical parameters. Socio-economic status (SES) was estimated using a wealth index, producing a weighted score. Scores were categorized into quintiles, with category 1 representing the poorest and category 5 the richest. Serum 25(OH)D was categorized: deficient as Results: 31.88% children of 0 - 1 year had deficient serum 25(OH)D level and 52.17% children had insufficient level. Among 2 - 5 years’ group, 38.16% were deficient and 50% were insufficient. Among the 6 - 11 years group, 41.02% were deficient and 52.56% were insufficient. Among 12 - 16 years group, 46.75% were deficient and 51.95% were insufficient. That means, serum 25-hydroxyvitamin D deficiency and insufficiency rate is found very high among Bangladeshi children. Conclusions: The prevalence of vitamin D deficiency and insufficiency among children in Bangladesh is high. The study recommended that vitamin D supplementation in Bangladeshi children should be formally launched from first day of birth up to adolescence.
文摘Introduction: Vitamin D’s action outside of bone, especially on immunity, is widely reported in the international scientific literature over the last years. Objective: Calculate the frequency of hypovitaminosis D in children aged 6 to 59 months suffering from severe malaria in the CHUD-P pediatric unit in 2016. Setting and Methods: This research work is a cross-sectional study with descriptive and analytical purposes. Data gathering was prospective. The study involved children aged 6 to 59 months hospitalized for severe malaria in the CHUD-P pediatric unit. The said children were HIV-uninfected, eutrophic and had not received vitamin D supplementation during the last 6 months. Vitamin D dose was measured using the High Performance Liquid Chromatography (HPLC) technique. Results: A total of 80 subjects were involved in the survey. Mean age was 26.08 months, sex ratio was 0.8 and average weight was 10.80 kg. Hypovitaminosis D frequency was 83.8% (67 cases out of 80 children investigated during the survey) with an average plasma concentration of vitamin D estimated at 21.57 ng/ml ± 7.34 with two extremes (11.24 - 42.32) ng/ml. The minimum parasitaemia was 202 P/μl and the maximum was 580,000 P/μl. Conclusion: Hypovitaminosis D is common in children suffering from severe malaria;this result suggests conducting a large-scale community-based study to decide on vitamin D inclusion in national supplementation policies and severe malaria management.
文摘Purpose: A better understanding of urinary tract infection (UTI) and the role of host, bacterial and environmental factors have improved the ability to identify the patients at risk and prevent or minimize sequelae. Kidney stones may be a complicated subject and its etiology is related to diet, increase urinary solutes and colloids in hot weather. Hypercalcaemia produced by taking large doses of vitamin D, creates high blood pressure and calcium deposits that can produce renal and bludder stones in all age groups including children. The objective of the present study was to estimate the serum level of vitamin D among patients particularly children taking treatable vitamin D. Correlation between vitamin D renal stones and UTI was also assessed. Methods: The number of patients studied was 150 collected during 2010 and 2011 in University teaching hospital. Forty two of them were children. The patients under study should have renal stone confirmed by ultrasound examination. Urine, blood and stone samples were taken for relevant laboratory investigations including identification of bacteriuria and its causative agents. Serum ions and vitamin D were also estimated. Type of renal stone collected was chemically identified. Results: One hundred and fifty patients with urolithiasis were included in the present study whose ages ranged from 8 months to 69 years and the ratio of males to females was 1.7:1. The frequency of patients revealed UTI was 52% and 78% of the infected patients were suffered from Gram-negative bacteria particularly Escherichia coli. Renal stones of mixed chemical composition were almost 72% and 78.2% of the stones were infection type. The mean of serum calcium was 2.157 mmol/L. The serum means of vitamin D among children and adults were 50.9 and 31.4 nmol/L respectively and the peak of this vitamin was recorded during summer. Conclusion: The frequency of UTI among urolithiasis patients was greater than that of non-urolithiasis. Enterobacteriaceae was the dominant family causing UTI particularly among females. Urolithiasis was more prevalent in males (62%). Recurrence of urolithiasis was high (39%) which indicated insufficient treatment of the underlying causes. Serum ions concentrations among children and adults were variables. Vitamin D values in children were higher than those estimated among adults and the peak of its overall concentration mean was found during summer (39.7 nmol/L). There was a strong relation between vitamin D level and the incidence of urolithiasis particularly among children with dietary problems.
文摘Background: Vitamin D plays a pivotal role in supporting the immune system, helping to reduce the risk of infections and certain autoimmune diseases. Adequate vitamin D levels may be associated with a reduced risk of certain health conditions like pre-eclampsia, gestational diabetes, and postpartum depression. Brittle bones, osteoporosis in the elderly, and osteomalacia in young children are all symptoms of vitamin D insufficiency. Additionally, it contributes to problems linked to gum disease, including an increase in dental cavities, alveolar bone loss around the teeth, and other problems. It could lead to depression, tiredness, and a loss of appetite. In this study, urban children and adolescents in Dhaka city, Bangladesh are examined for vitamin D deficiency, insufficiency, and sufficiency. Methods: The Study was a cross-sectional study conducted under Dhaka National Medical College and Hospital, Dhaka and additionally included two other health centers Medinova Medical Services and Monoara General Hospital Service Golap bag, Dhaka from October 2020 to November 2021. The study location was at the 3 (Three) different hospitals which was located in Dhaka City. In this cross-sectional study, Participants will be selected purposively and conveniently based on the age categories from 0 - 19 years of age at the outdoor department of the hospital. The study included the secondary dataset of ambulatory individuals who came to the 3 (three) hospitals, randomly to evaluate serum vitamin D levels on referral from a general out-patient-department (OPD). They were examined for laboratory findings of serum 25 hydroxyvitamin D levels to determine vitamin D deficiency, insufficiency, and sufficiency among children and adolescent groups of both male and female Sex. Results: A total of 6394 individuals with a diverse age group were statistically examined for laboratory findings of serum vitamin D levels. Vitamin D deficiency was observed in 40.58% of individuals with a mean log of 1.01 ± 0.18 ng/ml serum vitamin D levels, vitamin D insufficiency in 30.93% of individuals with a mean log of 1.38 ± 0.05 ng/ml serum vitamin D levels and vitamin D sufficiency in 19.49% individuals with a mean log of 1.63 ± 0.12 ng/ml serum vitamin D levels. The highest percentage of individuals deficient in vitamin D were children and adolescents of age ranging between 15 to 19 years. Conclusion: The findings of vitamin D deficiency in children and adolescents direct higher authorities in the public health sector to take immediate steps to screen, intervene and educate high-risk populations incorporating vitamin D supplements to establish preventive and therapeutic measures.
文摘Introduction: Nutritional rickets is the visible tip of the iceberg formed by the diseases caused by hypovitaminosis. Vitamin D plasma is essentially influenced by the level of sunlight which is significant in Sub-Saharan Africa and in Benin. However, there are factors likely to impede endogenous production of that vitamin in children in our environment. This research work was conducted with the view to investigate hypovitaminosis D prevalence and associated factors in children aged 6 to 59 months in the District of Parakou in 2017. Methods: This research work was a cross-sectional study with prospective collection of data carried out in community in the District of Parakou in 2017. The study involved euthrophic and non-HIV infected children aged 6 to 59 months who did not benefit from vitamin D supplementation during the past three months. Vitamin D plasma concentration was obtained using “Radioimmunoassay” after cluster random sampling in accordance with WHO guidelines. According to Schwartz formula, nominal minimum sample size was 321. In this study, hypovitaminosis D was defined as a plasma level lower than 30 ng/l. Data processing was carried out using softwares such as EPI INFO version 7.2 and SPSS 21. Results: In total, 400 children were involved in the survey. Hypovitaminosis prevalence was 9.5% (38 out of 400 cases). In our research work, the factors associated with hypovitaminosis were child’s age (p = 0.0470), mother’s age (p = 0.0000), weaning age lower than 6 months (p = 0.0466) and mother’s occupation out of direct sunlight (p = 0.0012). Conclusion: Nearly one out of ten children suffers from hypovitaminosis D in the District of Parakou in 2017. The associated factors were age of child and mother, early weaning and mother’s professional occupation held out of direct sunlight. This research work should be continued and improved by a nationwide multicentre study. This could lead to the adoption of measures for hypovitaminosis D prevention among children in Benin.
文摘Background: Hypovitaminosis D (serum concentration of 25(OH)D Methods: This was a cross sectional observational study having conducted at a paediatric clinic in Chittagong Metropolitan City from July, 2012 to December, 2017 including 524 children of 0 - 18 years by convenient sampling. The relevant data were assessed using standard case record form and lab parameter of 25(OH)D assay. Serum level of 25(OH)D of Results: The prevalence of Hypovitaminosis D was 50.57%. Compared with the infancy age group the odds of Hypovitaminosis D is 1.36 times more likely in >5 yrs children. The odds of association (odds ratio or OR = 0.19) of rural population with Hypovitaminosis D is lower than urban population. The formula fed children had less chance of association (OR = 0.32) of developing hypovitaminosis D in comparison to exclusively breastfed babies. Occasional Sun exposed group was 1.40 times more likely to develop hypovitaminosis D in comparison to daily sun exposure group. The odds of Hypovitaminosis D were 1.9 times more in winter season than summer season. School going children had double the chance of Hypovitaminosis D than children with no education. Subjects with high weight for age were 3.65 times increased risk of suffering from hypovitaminosis D compared with normal weight for age. Girls had a little bit more chance of hypovitaminosis D than boys. Children coming from family with monthly Income > 10,000 BDT are associated with more Hypovitaminosis D. Among clinical variables only wheeze has significant association (OR = 1.83). Conclusion: Hypovitaminosis D (<20 ng/ml) prevails significantly among Infants and children of South-East region of Bangladesh. Age, area of residence, feeding pattern, sun exposure practice, seasons, schooling pattern, weight for age have strong association with Hypovitaminosis D.
基金Supported by The National Institute of Health U01 DK-3-012 grantinvestigator-initiated grants from the Cystinosis Research Foundation and Abbott Laboratories
文摘The prevalence of obesity related hypertension has dramatically increased in children with the parallel increase in pediatric obesity.This pediatric health problem may adversely affect cardiovascular health in adult life.The pathogenesis of hypertension in obese children is not widely understood.We therefore undertake this review to raise public awareness.Early childhood parameters like birth weight and postnatal weight gain may play important roles in risk for obesity and obesity related hypertension later in childhood and adult life.Further information is required to confirm this origin of hypertension so that appropriate measures are taken in the peri-natal period.The role of sympathetic nervous system has now been well established as one of the principle mechanisms involved in obesity related hypertension.The Renin-Angiotensin system,insulin resistance due to obesity and as a part of metabolic syndrome along with imbalance in adipokines such as leptin and adiponectin,cause activation of the sympathetic system,vasoconstriction,endothelial dysfunction and sodium reabsorption among other perturbations.Multi-step interventions targeting these various mech-anisms are required to break the cycle of obesity and metabolic syndrome.Vitamin D deficiency,sleep apnea due to airway obstruction and hyperuricemia may also play a significant role and should not be ignored in its early stages.Obesity is a risk factor for other comorbid conditions like chronic kidney disease and fatty liver which further accentuate the risk of hypertension.Increased awareness is required to prevent,diagnose and treat obesity related hypertension among the pediatric population.
文摘Background:Cryoablation of accessory pathways(APs)is effective and very safe in children,as previously reported by our group.The aim of this retrospective study was to evaluate the current efficacy of 3D non-fluoroscopic cryoablation of right sided APs in children,comparing results obtained with the Ensite VelocityTM and the more recent Ensite PrecisionTM 3D mapping systems.Methods and Results:From January 2016 to December 2019,102 pediatric patients[mean age 12.5±2.8,62 males(61%of total cohort)]with right APs underwent 3D non-fluoroscopic transcatheter cryoablation at our Institution.Fifteen(14.7%)patients had previously undergone catheter ablation.Acute procedural success rate was 95.1%(n=97).No significant differences were detected in acute success rates achieved with Ensite Velocity^(TM)or Ensite PrecisionTM systems nor between manifest(94%)and concealed APs(100%).No permanent complications occurred.During follow-up(428±286 days,median 396 days[interquartile range 179-713]),19 patients(19.6%)had recurrences.Recurrences were more frequent for parahissian/anterior APs compared to midseptal/posterior and lateral APs(p=0.043).Recurrences were not related to the Ensite system used.A redo ablation procedure was attempted in 13 cases,11 cryoablation and 2 radiofrequency ablations:the former was successful in 10 cases out of 11(90.9%).Conclusion:3D cryoablation of right-sided APs is associated with a very high acute success rate with limited use of fluoroscopy,resulting in great benefit to the children.Recurrence rates are not high and patients can be retreated with cryo-energy with higher success rates.
