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Idiopathic dilated cardiomyopathy as cor bovinum in infancy: “A foggy road in winter” 婴儿期特发性扩张型心肌病:“冬季雾蒙蒙的路”
Pub Date : 2021-12-16 DOI: 10.32677/ijch.v8i11.3115
Debasish Das, A. Banerjee, Tutan Das, S. Singh, J. Gupta, Subhash R. Pramanik
Dilated cardiomyopathy, when diagnosed in infancy, poses an array of difficulties from reaching an etiological diagnosis to prognosticating the long-term outcome. Here, we report a case of idiopathic dilated cardiomyopathy in a 6-month-old child who responded well to beta-blocker (Carvedilol) in optimum dosage and revealed favorable cardiac remodeling over 6 months with substantial improvement in ejection fraction (EF) (EF of 22–44%) with significant amelioration of child’s symptoms. Our case has a unique message that while treating idiopathic dilated cardiomyopathy (DCM) in infancy, optimized use of the beta-blockers is most often the only way to clear the foggy road of idiopathic DCM and obtain a favorable outcome.
扩张型心肌病,当诊断在婴儿期,提出了一系列的困难,从达到病因诊断到预后的长期结果。在这里,我们报告了一个6个月大的特发性扩张型心肌病患儿,他对最佳剂量的卡维地洛-受体阻滞剂反应良好,6个月后心脏重塑良好,射血分数(EF)显著改善(EF为22-44%),儿童症状显著改善。我们的病例提供了一个独特的信息,即在治疗婴儿期特发性扩张型心肌病(DCM)时,优化β受体阻滞剂的使用通常是清除特发性DCM模糊道路并获得良好结果的唯一途径。
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引用次数: 0
Clinical and laboratory profile of multisystem inflammatory syndrome in children: A cross-sectional study in a tertiary care hospital, Mysuru 儿童多系统炎症综合征的临床和实验室概况:迈苏尔一家三级医院的横断面研究
Pub Date : 2021-12-16 DOI: 10.32677/ijch.v8i11.3110
Raksha Kottakki, S. Rudrappa, Pratibha Manjunath Patagar
Background: Multisystem inflammatory syndrome in children (MIS-C) is considered to be a rare, yet serious complication of coronavirus disease 2019, where there is immune dysregulation related to past infection with the virus. It is an inflammatory syndrome affecting multiple systems with varied manifestations including gastrointestinal, cardiovascular, respiratory, neurological, renal, hepatobiliary, and dermatological symptoms. Aim: Current study aimed to investigate the clinical and laboratory profile of MIS-C. Materials and Methods: A cross-sectional study of 40 hospitalized children who were diagnosed as MIS-C and studied over a 12-month period from June 2020 to May 2021 at Cheluvamba Hospital in a tertiary care center attached to Mysore Medical College and Research Institute Mysuru, Karnataka. Results: Out of the 40 children studied, all fulfilled the diagnostic criteria of MIS-C. The most common symptom was fever (100%), followed by gastrointestinal symptoms (90%). The next most common system involved in our study was cardiovascular system (52.5%). The most common laboratory findings included elevated inflammatory markers (100%). Furthermore, there was high incidence of hematological alterations, in the form of anemia (62.5%), thrombocytopenia (57.5%), and neutrophilia (27.5%). About 33.3% cases had echocardiography abnormalities. All patients received intravenous methylprednisolone and intravenous immunoglobulin. There were six deaths (15%) in our study and the remaining cases had good immediate outcome. Conclusion: Early recognition and prompt medical attention are necessary for a favorable outcome in MIS-C. However, there is scarcity of data regarding its long-term outcome.
背景:儿童多系统炎症综合征(MIS-C)被认为是2019冠状病毒病罕见但严重的并发症,其中存在与过去感染病毒相关的免疫失调。它是一种影响多系统的炎症综合征,表现多样,包括胃肠道、心血管、呼吸系统、神经系统、肾脏、肝胆和皮肤症状。目的:本研究旨在探讨MIS-C的临床和实验室特征。材料和方法:对40名被诊断为misc的住院儿童进行横断面研究,研究时间为2020年6月至2021年5月,为期12个月,在卡纳塔克邦迈索尔医学院和研究所附属三级保健中心Cheluvamba医院进行。结果:40例患儿均符合MIS-C诊断标准。最常见的症状是发热(100%),其次是胃肠道症状(90%)。在我们的研究中,第二常见的系统是心血管系统(52.5%)。最常见的实验室结果包括炎症标志物升高(100%)。此外,血液学改变的发生率也很高,表现为贫血(62.5%)、血小板减少(57.5%)和嗜中性粒细胞增多(27.5%)。超声心动图异常约33.3%。所有患者均静脉注射甲基强的松龙和静脉注射免疫球蛋白。在我们的研究中有6例死亡(15%),其余病例有良好的即时预后。结论:早期识别和及时就医是MIS-C预后良好的必要条件。然而,缺乏关于其长期结果的数据。
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引用次数: 0
Multisystem inflammatory syndrome in neonates due to severe acute respiratory syndrome coronavirus 2: An emerging entity 严重急性呼吸综合征冠状病毒引起的新生儿多系统炎症综合征2:一个新兴实体
Pub Date : 2021-12-16 DOI: 10.32677/ijch.v8i11.3153
Ashwini Nagda, V. Sawant, K. Rajput, S. Malik, Vinaya A. Singh, S. Kondekar
Severe acute respiratory syndrome coronavirus 2 was declared as a pandemic in March 2020. The virus has affected more adults than children, with disease severity being lesser in children. We present a case of a neonate who tested positive for coronavirus disease 2019 infection on day of life 3, 6, and 15. The baby had fever, respiratory distress, and shock. Laboratory investigations showed raised inflammatory markers, raised D dimer suggesting coagulopathy, coronary dilatation on 2D echocardiogram, and raised N terminal pro-brain natriuretic peptide. The neonate was successfully treated with good supportive care, lung-protective ventilatory strategies, early intravenous immunoglobulin administration, corticosteroids, and remdesivir.
2020年3月,严重急性呼吸综合征冠状病毒被宣布为大流行。受该病毒影响的成年人多于儿童,儿童的疾病严重程度较轻。我们报告了一例在生命第3、6和15天检测出2019冠状病毒感染阳性的新生儿。婴儿有发烧、呼吸窘迫和休克。实验室检查显示炎症标志物升高,D二聚体升高提示凝血功能障碍,二维超声心动图显示冠状动脉扩张,N端脑利钠肽前体升高。新生儿通过良好的支持护理、肺保护性通气策略、早期静脉注射免疫球蛋白、皮质类固醇和瑞德西韦成功治疗。
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引用次数: 1
A study on the comparison of minimally invasive surfactant therapy with insure technique of surfactant therapy in preterm babies with respiratory distress in a tertiary care hospital – A prospective cohort study 微创表面活性剂治疗与表面活性剂治疗在三级医院早产儿呼吸窘迫的比较研究——一项前瞻性队列研究
Pub Date : 2021-11-11 DOI: 10.32677/ijch.v8i10.3097
Andra Akhila, B. Ghoshal, N. Mahapatra
Background: Respiratory distress syndrome (RDS) is a common problem in preterm babies due to surfactant deficiency. Initially, babies were given surfactant therapy by intubation, surfactant administration, and extubation (INSURE) method. Minimally invasive surfactant therapy (MIST) is a novel method of surfactant administration without intubation to spontaneously breathing preterm babies with RDS without the removal of continuous positive airway pressure (CPAP). Aim: This study aims to compare the surfactant therapy in preterm babies with RDS through MIST and INSURE technique. Methods: This prospective, observational cohort study was conducted in the neonatology unit of Calcutta National Medical College and Hospital. A total of 212 preterm babies of <37 weeks of gestation with features of RDS, who require surfactant are taken and divided into two groups. Very sick babies with congenital anomalies are excluded from the study. In MIST group (n=102), 8 Fr feeding tube is used to deliver surfactant while the baby is on CPAP. In INSURE group (n=102), surfactant is given by intubation through endotracheal tube without CPAP and extubated. Results: Mean birth weight was 1.26 kg in MIST and 1.22 kg in INSURE. Mean gestational age was 31.33 weeks in MIST and 31.11 weeks in INSURE. It was observed that there is a significant difference in terms of duration of oxygen requirement, neonatal intensive care unit stay, and surfactant spillage during administration in MIST group compared to INSURE group. However, duration of mechanical ventilation, CPAP, number of doses of surfactant, sepsis, intraventricular hemorrhage, retinopathy of prematurity, pneumothorax, bronchopulmonary dysplasia, and mortality did not show significant difference in both the groups. Conclusion: MIST is safe, feasible, and more beneficial than INSURE technique.
背景:呼吸窘迫综合征(RDS)是由于表面活性剂缺乏引起的早产儿常见问题。最初,婴儿通过插管、表面活性剂给药和拔管(INSURE)方法给予表面活性剂治疗。微创表面活性剂治疗(MIST)是一种无需插管给药的新方法,用于自主呼吸的RDS早产儿,无需移除持续气道正压通气(CPAP)。目的:通过MIST和INSURE技术比较表面活性剂治疗早产儿RDS的效果。方法:这项前瞻性、观察性队列研究在加尔各答国立医学院和医院新生儿科进行。选取212例妊娠期<37周且有RDS特征且需要表面活性剂的早产儿分为两组。患有先天性畸形的重病婴儿被排除在研究之外。MIST组(n=102)在CPAP治疗期间使用8fr饲管输送表面活性剂。INSURE组(n=102)经气管插管给予表面活性剂,不加CPAP,拔管。结果:MIST组平均出生体重1.26 kg, INSURE组平均出生体重1.22 kg。平均胎龄为31.33周,平均胎龄为31.11周。观察到,与INSURE组相比,MIST组在给药期间的需氧量、新生儿重症监护病房住院时间和表面活性剂溢出方面存在显著差异。然而,机械通气时间、CPAP、表面活性物质剂量、败血症、脑室内出血、早产儿视网膜病变、气胸、支气管肺发育不良和死亡率在两组间无显著差异。结论:MIST技术安全、可行,且比INSURE技术更有益。
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引用次数: 0
An in-depth multidimensional review of hypertension in adolescents in relation to obesity: Risk approach management is the solution 对青少年高血压与肥胖的关系进行深入的多维回顾:风险方法管理是解决方案
Pub Date : 2021-11-11 DOI: 10.32677/ijch.v8i10.3055
A. A. Fadl, A. Al-Jawaldeh
Background: The emergence of isolated high blood pressure (HBP) among adolescents and its relation to obesity needs to be investigated. Aim: This study aims to assess prevalence, underlying risk factors, and consequences of HBP among adolescents in Egypt. Methods: We consolidated findings from three studies. The first one examined 150 adolescents (age: 16–18 years) for HBP and obesity using body mass index (BMI); the second one studied 150 adolescents for the lifestyle risk factors in relation to depression, anxiety, general health score, and suicidal score (SS) using relevant tools; the third one was a nested case–control study of 60 obese versus 60 non-obese adolescents examined for HBP, BMI, lifestyles and dietary habits, biochemical markers as lipid profile, fasting blood sugar (FBS), insulin, and homeostatic model assessment for insulin resistance (HOMA-IR). Results: In Stage I, the prevalence of HBP was 8% of whom, 58.3% were obese. Stage II: Dietary risk behavior as junk foods (high in salt) and soft drinks was 75.3% and 80%, respectively, and was linked with a high SS. Smoking was associated with a high anxiety score (p<0.05) and not playing sports with a higher depression score (p<0.05). The nested case–control study for obese versus non-obese showed that HBP (both systolic and diastolic) was significantly higher in the obese. Consumption of junk foods, sugary drinks, and inactivity was significantly higher in the obese (p<0.05). Lipid profile, FBS, fasting insulin, and HOMA-IR were significantly higher in the obese group versus non-obese control group (p<0.05). Conclusion: Lifestyle and unhealthy diet are the underlying cause of HBP, obesity, and mental health problems including SS, atherosclerosis, and high FBS. Increasing awareness about risk factors and using them in clinical practice for early detection of HBP is recommended.
背景:青少年孤立性高血压(HBP)的出现及其与肥胖的关系有待研究。目的:本研究旨在评估埃及青少年高血压的患病率、潜在危险因素和后果。方法:我们综合了三项研究的结果。第一项研究使用体重指数(BMI)检查了150名青少年(16-18岁)的血压和肥胖情况;第二项研究采用相关工具对150名青少年的生活方式风险因素与抑郁、焦虑、一般健康评分和自杀评分(SS)的关系进行研究;第三个是一项巢式病例对照研究,对60名肥胖青少年和60名非肥胖青少年进行了HBP、BMI、生活方式和饮食习惯、血脂等生化指标、空腹血糖(FBS)、胰岛素和胰岛素抵抗的稳态模型评估(HOMA-IR)。结果:ⅰ期HBP患病率为8%,其中58.3%为肥胖。第二阶段:垃圾食品(高盐)和软饮料等饮食风险行为分别为75.3%和80%,并与高SS相关。吸烟与高焦虑评分相关(p<0.05),不参加运动与高抑郁评分相关(p<0.05)。肥胖与非肥胖的嵌套病例对照研究显示,肥胖者的HBP(收缩压和舒张压)明显更高。在肥胖人群中,垃圾食品、含糖饮料的摄入量和缺乏运动的比例显著高于其他人群(p<0.05)。肥胖组血脂、FBS、空腹胰岛素和HOMA-IR显著高于非肥胖对照组(p<0.05)。结论:生活方式和不健康的饮食是高血压、肥胖和精神健康问题(包括SS、动脉粥样硬化和高FBS)的潜在原因。建议提高对危险因素的认识,并在临床实践中早期发现高血压。
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引用次数: 0
How we handled COVID crisis? Experience of an Indian tertiary level NICU 我们如何应对COVID危机?在印度三级新生儿重症监护室工作的经验
Pub Date : 2021-11-11 DOI: 10.32677/ijch.v8i10.3064
H. Kaur, Anita Singh, Kirti M. Naranje
Background: Coronavirus disease (COVID-19) has imposed several challenges in clinical care. With rapid increase in the disease, there has been lot of incidences of COVID-19 positive exposure among the healthcare workers resulting in major crisis. Aim: The aim of the study was to emphasize various methods that can be used to manage COVID-19 crisis due to accidental exposure. Methods: An unprecedented exposure occurred to a COVID-19 positive healthcare worker in the Neonatal Intensive Care Unit (NICU), which led to quarantine of almost 90% of the primary staff. The methods undertaken included communication and continuation of clinical care through teleconsultation (video calling, zoom meetings for clinical decision, telecharting of daily prescription, and facilitating manpower from allied departments [only one pediatric resident each day], and restoration of services with come back). Results: There were total 11 babies at the time of exposure. Two babies were on respiratory support. The parents were counseled through teleconsultation. Nine babies could be discharged during quarantine period and there was no significant deterioration in the clinical condition of the two babies on respiratory support. All the babies were tested for COVID-19 as per post-exposure protocol and remained negative. Conclusion: With the help of teleconsultation and support from allied specialties and other health facilities, the crisis of COVID-19 exposure can be handled well.
背景:冠状病毒病(COVID-19)给临床护理带来了一些挑战。随着疫情的迅速增加,医护人员中出现了大量的COVID-19阳性暴露事件,造成了重大危机。目的:研究的目的是强调可用于管理因意外暴露而导致的COVID-19危机的各种方法。方法:新生儿重症监护病房(NICU)的一名COVID-19阳性医护人员出现了前所未有的接触,导致近90%的初级工作人员被隔离。所采取的方法包括通过远程会诊(视频通话、临床决策的变焦会议、日常处方的远程记录、促进联合科室的人力(每天只有一名儿科住院医师)、通过复诊恢复服务)进行临床护理的沟通和延续。结果:暴露时共11例婴儿。两名婴儿需要呼吸支持。家长们通过远程咨询得到了建议。9名婴儿在隔离期间可以出院,2名婴儿在呼吸支持下临床状况无明显恶化。根据接触后方案,所有婴儿都接受了COVID-19检测,结果均为阴性。结论:通过远程会诊和相关专科及其他卫生机构的支持,可以很好地处理COVID-19暴露危机。
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引用次数: 0
Vomiting in a toddler – An unsuspected cause 蹒跚学步的孩子呕吐——原因不明
Pub Date : 2021-11-11 DOI: 10.32677/ijch.v8i10.3073
N. Rashmi, D. Yerrapragada, M. G. Kumar
Vomiting in young children can be due to a varied etiology ranging from gastritis, urinary tract infection, and metabolic problems to serious life-threatening conditions such as myocarditis, intracranial space occupying lesions, and acute surgical conditions such as intussusception, malrotation, and torsion testis. However, intractable vomiting in a toddler as presented here was due to an unexpected cause as the history was not initially forthcoming for the same. Here, we presented the case of a 21-month-old girl who was admitted with vomiting and low-grade fever, initially suspected to have viral fever/urinary tract infection. All relevant investigations were within normal limits, ruling out metabolic causes. However, on day 3, she showed features of intestinal obstruction for which imaging was done which revealed a mass in the distal ileum, and she was taken up for immediate laparotomy and the ileal mass was excised, which turned out to be a foreign body, that is, three rubber balls. The child recovered completely post-surgery and was discharged three days later. Hence, the lessons learnt from this case would be that, there is no short cut to detailed history taking and meticulous clinical examination; using imaging at the appropriate time helps in timely intervention and life-saving management.
幼儿呕吐的病因多种多样,从胃炎、尿路感染、代谢问题到严重危及生命的疾病,如心肌炎、颅内占位性病变,以及急性手术条件,如肠套叠、旋转不良和睾丸扭转。然而,顽固性呕吐在这里提出的幼儿是由于一个意想不到的原因,因为历史上最初没有提供相同的。在这里,我们报告了一个21个月大的女孩,她因呕吐和低烧入院,最初怀疑有病毒性发烧/尿路感染。所有相关调查都在正常范围内,排除了代谢原因。然而,在第3天,她表现出肠梗阻的特征,影像学显示回肠远端有肿块,她立即接受剖腹手术,切除了回肠肿块,结果是一个异物,即三个橡皮球。患儿术后完全康复,三天后出院。因此,从这个病例中得到的教训是,详细的病史和细致的临床检查没有捷径;在适当的时间使用成像有助于及时干预和挽救生命的管理。
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引用次数: 0
Child sex ratio - declining trend: Reasons and consequences 儿童性别比-下降趋势:原因和后果
Pub Date : 2021-11-11 DOI: 10.32677/ijch.v8i10.3091
N. George, R. Britto, R. Abhinaya, M. Archana, A. Aruna, M. Narayan
Child sex ratio (CSR) and over all sex ratio have found to be the important indicator to examine the social commitment against female child. According to census 2011, CSR has been decreased from 927 to 919 in 2011. Many researchers have reported that the sex ratio at birth is in favor of males and the low sex ratio is found to be due to the sex selection strategies of the parents. Despite the higher mortality preponderance for male child, the females were having a decreased ratio during childhood years. Gender discrimination and female infanticide have found to be the important factor responsible for the low CSR. This article tries to shed light into the issue among the states of India, giving a special attention to the state of Tamil Nadu and proposes few remedial measures.
儿童性别比(CSR)和总体性别比已被发现是检验对女童社会承诺的重要指标。根据2011年的人口普查,CSR已经从927减少到2011年的919。许多研究人员报告说,出生时的性别比有利于男性,而低性别比被发现是由于父母的性别选择策略。尽管男孩的死亡率较高,但在儿童时期,女孩的死亡率有所下降。性别歧视和杀婴行为是造成社会责任低的重要因素。本文试图揭示印度各邦的这一问题,特别关注泰米尔纳德邦,并提出一些补救措施。
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引用次数: 1
Blue rubber bleb nevus syndrome: A rare cause of chronic gastro intestinal bleed in children 蓝橡胶水泡痣综合征:儿童慢性胃肠道出血的罕见原因
Pub Date : 2021-11-11 DOI: 10.32677/ijch.v8i10.3088
S. Saxena, Himanshu Batra, V. Taneja
Blue rubber bleb nevus syndrome (BRBNS) is a rare congenital disorder presenting with multifocal venous malformations of the skin, soft tissues, and gastrointestinal (GI) tract. Here, we report a case of a 10-year-old girl who presented with recurrent lower GI bleeding and abdominal pain requiring repeated blood transfusion for 2 years. A contrast computed tomography showed multiple cavernous haemangiomas in the liver, oesophagogastroduodenoscopy and colonoscopy showed multiple hemangiomas from esophagus to large bowel. Her molecular pathology confirmed BRBNS. She underwent endoscopic argon plasma coagulation with uneventful recovery. In spite of a wide range of therapeutic options for the management of BRBNS described in the literature, the efficacy of those available therapies, including surgical excision, is not well established.
蓝橡胶水泡痣综合征(BRBNS)是一种罕见的先天性疾病,表现为皮肤,软组织和胃肠道的多灶静脉畸形。在这里,我们报告一个10岁的女孩,她表现为复发性下消化道出血和腹痛,需要反复输血2年。对比计算机断层扫描显示肝脏多发海绵状血管瘤,食管、胃十二指肠镜和结肠镜显示从食管到大肠多发血管瘤。分子病理学证实为BRBNS。她接受了内窥镜氩等离子凝固治疗,恢复正常。尽管文献中描述了多种治疗BRBNS的方法,但包括手术切除在内的现有治疗方法的疗效尚未得到很好的证实。
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引用次数: 0
A clinical study of anemia in children aged 6 months–5 years in a tertiary care center, Bengaluru, Karnataka, India 印度卡纳塔克邦班加罗尔一家三级保健中心6个月至5岁儿童贫血的临床研究
Pub Date : 2021-11-11 DOI: 10.32677/ijch.v8i10.3067
S. Saranappa, Jennifer Wu
Background: Anemia is the most commonly observed hematological diseases in children. The World Health Organization (WHO) has estimated that globally, 1.62 billion people are anemic, with the highest prevalence of anemia (47.4%) among preschool-aged children. Of these 293 million children, 89 million live in India. Aim: This study aims to evaluate the factors causing anemia in children aged between 6 months and 5 years and its prevalence within this age group. Methods: This study is a prospective observational study conducted in KIMS Hospital, Bengaluru, Karnataka. A total of 200 children in the age group of 6 months–5 years with features of anemia or having hemoglobin <11 g/dl were included in the study for a duration of 18 months between January 2019 and June 2020. Detailed history was recorded and examination findings were noted. The data collected were tabulated and statistically analyzed accordingly. Results: About 57.5% of the children with anemia fell between the age group of 6 months and 2 years and 42.5% of children were in the age groups of 2–5 years. A male predominance was seen (61%) with male-to-female ratio of approximately 1.56:1. Most of the children were found to have mild (46%) and moderate anemia (46%) with only a minority (8%) presenting with severe anemia. About 56.5% of the children had a normal nutritional status while 41% were malnourished and 2.5% had both wasting and stunting. Exclusive breastfeeding (for 6 months) history was present in 59% of the children. These children belonged mostly to the upper lower (45%) and lower middle (41%) socioeconomic status. This study also showed anemia in children most commonly presented majorly with concurrent involvement of the respiratory system (31%) followed by infectious diseases (30%) and gastrointestinal disorders (23%). Conclusion: The current study concludes that iron deficiency anemia is a multifactorial hematological disease. Learning about the predisposing risk factors can help to adopt the necessary precautions to prevent anemia in these children. Improving the nutritional status of the children by involving parents and counseling them regarding important feeding practices can help to prevent anemia.
背景:贫血是儿童最常见的血液病。世界卫生组织(世卫组织)估计,全球有16.2亿人患有贫血,其中学龄前儿童的贫血患病率最高(47.4%)。在这2.93亿儿童中,有8900万生活在印度。目的:本研究旨在评估6个月至5岁儿童贫血的影响因素及其在该年龄组中的患病率。方法:本研究是在卡纳塔克邦邦班加罗尔的KIMS医院进行的前瞻性观察研究。在2019年1月至2020年6月的18个月期间,共有200名年龄在6个月至5岁之间、具有贫血特征或血红蛋白<11 g/dl的儿童被纳入研究。详细记录病史并记录检查结果。将收集到的数据制成表格并进行相应的统计分析。结果:6个月~ 2岁患儿占57.5%,2 ~ 5岁患儿占42.5%。男性占优势(61%),男女比例约为1.56:1。大多数儿童被发现有轻度(46%)和中度贫血(46%),只有少数(8%)表现为严重贫血。约56.5%的儿童营养状况正常,41%的儿童营养不良,2.5%的儿童消瘦和发育迟缓。59%的儿童有纯母乳喂养(6个月)史。这些儿童大多属于社会经济地位的中上层(45%)和中下层(41%)。该研究还显示,儿童贫血最常见的表现是并发呼吸系统疾病(31%),其次是感染性疾病(30%)和胃肠道疾病(23%)。结论:缺铁性贫血是一种多因素血液病。了解易患的危险因素有助于采取必要的预防措施来预防这些儿童的贫血。通过让父母参与进来,并就重要的喂养方法向他们提供咨询,从而改善儿童的营养状况,有助于预防贫血。
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引用次数: 0
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The Indian journal of child health
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