844 Evaluation of Iron Chelation Therapy in Beta Thalassemia Major Patients in East Delta of Egypt

Badr, Mohamed; Hesham, Mervat; Hassan, Tamer; Badawy, Sherif M.

doi:10.1203/00006450-201011001-00844

Cited by 7 publications

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“…The onset of hypoglycemia may be directly promoted by fuel imbalance, like a gradual decrease in availability of glucose and free fatty acids. Similar to our previous study in a non malaria area of Madagascar, the occurrence of hypoglycemia and the risk of mortality are linked to both duration of fasting and malnutrition status [ 57 ].…”

Section: Discussionsupporting

confidence: 82%

High Mortality Risk in Hypoglycemic and Dysglycemic Children Admitted at a Referral Hospital in a Non Malaria Tropical Setting of a Low Income Country

Hubert

Sayavong

Pussard³

2016

PLoS ONE

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IntroductionHypoglycemia is a recognized feature of severe malaria but its diagnosis and management remain problematic in resource-limited settings. There is limited data on the burden and prognosis associated with glycemia dysregulation in non-neonate children in non-malaria areas. We prospectively assessed the abnormal blood glucose prevalence and the outcome and risk factors of deaths in critically ill children admitted to a national referral hospital in Laos.MethodsConsecutive children (1 month-15 years) admitted to the pediatric ward of Mahosot hospital, were categorized using the integrated management of childhood illness (IMCI). Blood glucose was assessed once on admission through a finger prick using a bedside glucometer. Glycemia levels: hypoglycemia: < 2.2 mmol/L (< 40 mg⁄ dl), low glycemia: 2.2–4.4 mmol/L (40–79 mg⁄ dl), euglycemia: 4.4–8.3 mmol/L (80–149 mg⁄ dl), and hyperglycemia: > 8.3 mmol/L (≥150 mg⁄ dl), were related to the IMCI algorithm and case fatality using univariate and multivariate analysis.ResultsOf 350 children, 62.2% (n = 218) were severely ill and 49.1% (n = 172) had at least one IMCI danger sign. A total of 15 (4.2%, 95%CI: 2.4–6.9) had hypoglycemia, 99 (28.2%, 95%CI: 23.6–33.3) low glycemia, 201 (57.4%, 95% CI: 52.0–62.6) euglycemia and 35 (10.0%, 95% CI: 7.0–13.6) hyperglycemia. Hypoglycemia was associated with longer fasting (p = 0.001) and limited treatment before admission (p = 0.09). Hypoglycemia and hyperglycemia were associated with hypoxemia (SaO2) (p = 0.001). A total of 21 (6.0%) of the children died: 66.6% with hypoglycemic, 6.0% with low glycemic, 5.7% with hyperglycemic and 1.4% with euglycemic groups. A total of 9 (2.5%) deaths occurred during the first 24 hours of admission and 5 (1.7%) within 3 days of hospital discharge. Compared to euglycemic children, hypoglycemic and low glycemic children had a higher rate of early death (20%, p<0.001 and 5%, p = 0.008; respectively). They also had a higher risk of death (OR: 132; 95%CI: 29.0–596.5; p = 0.001; and OR: 4.2; 95%CI: 1.1–15.6; p = 0.02; respectively). In multivariate analyses, hypoglycemia (OR: 197; 95%CI: 33–1173.9), hypoxemia (OR: 5.3; 95%CI: 1.4–20), presence of hepatomegaly (OR: 8.7; 95%CI: 2.0–37.6) and having an illiterate mother (OR: 25.9; 95%CI: 4.2–160.6) were associated with increased risk of death.ConclusionHypoglycemia is linked with a high risk of mortality for children in non malaria tropical settings. Blood sugar should be monitored and treatment provided for sick children, especially with danger signs and prolonged fasting. Further evaluations of intervention using thresholds including low glycemia is recommended in resource-limited settings. Research is also needed to determine the significance, prognosis and care of hyperglycemia.

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Section: Discussionsupporting

confidence: 82%

High Mortality Risk in Hypoglycemic and Dysglycemic Children Admitted at a Referral Hospital in a Non Malaria Tropical Setting of a Low Income Country

Hubert

Sayavong

Pussard³

2016

PLoS ONE

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“…SAM has been associated with liver steatosis and inflammation [ 28 ]. In addition, serum ALT has been found to be especially increased in kwashiorkor thus indicating hepatic injury [ 36 ]. Elevated ALT is also found in hepatic steatosis or NAFLD-like phenotype [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Impaired Bile Acid Homeostasis in Children with Severe Acute Malnutrition

et al. 2016

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ObjectiveSevere acute malnutrition (SAM) is a major cause of mortality in children under 5 years and is associated with hepatic steatosis. Bile acids are synthesized in the liver and participate in dietary fat digestion, regulation of energy expenditure, and immune responses. The aim of this work was to investigate whether SAM is associated with clinically relevant changes in bile acid homeostasis.DesignAn initial discovery cohort with 5 healthy controls and 22 SAM-patients was used to identify altered bile acid homeostasis. A follow up cohort of 40 SAM-patients were then studied on admission and 3 days after clinical stabilization to assess recovery in bile acid metabolism. Recruited children were 6–60 months old and admitted for SAM in Malawi. Clinical characteristics, feces and blood were collected on admission and prior to discharge. Bile acids, 7α-hydroxy-4-cholesten-3-one (C4) and FGF-19 were quantified.ResultsOn admission, total serum bile acids were higher in children with SAM than in healthy controls and glycine-conjugates accounted for most of this accumulation with median and interquartile range (IQR) of 24.6 μmol/L [8.6–47.7] compared to 1.9 μmol/L [1.7–3.3] (p = 0.01) in controls. Total serum bile acid concentrations did not decrease prior to discharge. On admission, fecal conjugated bile acids were lower and secondary bile acids higher at admission compared to pre- discharge, suggesting increased bacterial conversion. FGF19 (Fibroblast growth factor 19), a marker of intestinal bile acid signaling, was higher on admission and was associated with decreased C4 concentrations as a marker of bile acid synthesis. Upon recovery, fecal calprotectin, a marker of intestinal inflammation, was lower.ConclusionSAM is associated with increased serum bile acid levels despite reduced synthesis rates. In SAM, there tends to be increased deconjugation of bile acids and conversion from primary to secondary bile acids, which may contribute to the development of liver disease.

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“…Suitable feeding and rehydration regimens are still needed for the severe diarrhea commonly observed prior to and during rehabilitation of HIV-infected severely malnourished children, which is often associated with hypoglycemia [48, 49] and high case fatality rates [33, 50]. In the past, adequate treatment regimens were developed for HIV-uninfected children to reduce diarrheal morbidity and mortality, induce catch-up growth, and improve nutritional outcomes [51].…”

Section: Challenges In the Hospital Care Of Severely Malnourished mentioning

confidence: 99%

Challenges in the Management of HIV-Infected Malnourished Children in Sub-Saharan Africa

Trehan

O’Hare

Phiri

et al. 2012

AIDS Research and Treatment

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Infection with HIV, and oftentimes coinfection with TB, complicates the care of severely malnourished children in sub-Saharan Africa. These superimposed infections challenge clinicians faced with a population of malnourished children for whose care evidence-based guidelines have not kept up. Even as the care of HIV-uninfected malnourished children has improved dramatically with the advent of community-based care and even as there are hopeful signs that the HIV epidemic may be stabilizing or ameliorating, significant gaps remain in the care of malnourished children with HIV. Here we summarize what is currently known, what remains unknown, and what remains challenging about how to treat severely malnourished children with HIV and TB.

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844 Evaluation of Iron Chelation Therapy in Beta Thalassemia Major Patients in East Delta of Egypt

Abstract: Background: Hepatitis C infection is common in transfusion dependent thalassemia .The effect of alpha interferon and INF plus ribavirin on hepatitis C was examined in patients.

Cited by 7 publications

References 0 publications

High Mortality Risk in Hypoglycemic and Dysglycemic Children Admitted at a Referral Hospital in a Non Malaria Tropical Setting of a Low Income Country

High Mortality Risk in Hypoglycemic and Dysglycemic Children Admitted at a Referral Hospital in a Non Malaria Tropical Setting of a Low Income Country

Impaired Bile Acid Homeostasis in Children with Severe Acute Malnutrition

Challenges in the Management of HIV-Infected Malnourished Children in Sub-Saharan Africa

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