血清铁缺乏与血管迷走性晕厥发病机制的关系

血管迷走性晕厥是儿童晕厥中最常见的病因,其发病机制涉及血流动力学、血管舒张功能、脑血流异常、神经体液因子改变等,而机体铁缺乏时亦可造成上述变化,该文综述血清铁缺乏与这些变化的内在联系.     

Emerging viral infections after hematopoietic cell transplantation

Abstract:  This overview summarizes recent data on emerging viruses after hematopoietic cell transplantation (HCT), including adenovirus, BK virus, human metapneumovirus (hMPV), and human herpesvirus (HHV) 6. The increased recognition of these infections is due to improved molecular detection methods, increased surveillance and more profound immunosuppression in the host. Adenovirus can cause serious disease especially in T-cell depleted transplant recipients. Adenovirus viremia is an important risk factor for disease in this setting. BK virus has been associated with hemorrhagic cystitis in HCT recipients. BK viremia is significantly associated with hemorrhagic cystitis. hMPV shows a seasonal distribution and can cause fatal pneumonia in HCT recipients. hMPV may be the etiology of some cases previously categorized as idiopathic pneumonia syndrome. HHV-6 commonly leads to viremia in HCT recipients. HHV-6 has been strongly associated with encephalitis and delayed platelet engraftment. Prospective studies are needed to further examine epidemiology, disease associations, and management strategies for these viruses.     

Fetal iron status in maternal anemia

Hemoglobin, serum iron, transferrin saturation and ferritin were measured on paired maternal and cord blood samples in 54 anemic (hemoglobin < 110 g/L) and 22 non-anemic (hemoglobin ≥ 110 g/L) pregnant women at term gestation. The levels of hemoglobin, serum iron, transferrin saturation and ferritin were significantly low in the cord blood of anemic women, suggesting that iron supply to the fetus was reduced in maternal anemia. The linear relationships of these parameters with both maternal hemoglobin and maternal serum ferritin indicated that the fetus extracted iron in amounts proportional to the levels available in the mother. Infants of mothers with moderate and severe anemia had significantly lower cord serum ferritin levels and hence poor iron stores at birth. It is concluded that iron deficiency anemia during pregnancy adversely affects the iron endowment of the infant at birth.     

新生儿缺氧缺血性脑病血清铁和血清铁蛋白的动态变化及意义

目的探讨铁代谢紊乱在新生儿缺氧缺血性脑病（HIE）再灌注损伤中的作用。方法 分别测定60例HIE足月新生儿（其中轻度30例,中度20例,重度10例）入院时（日龄48h内）、日龄3～5天时血清铁（SI）及血清铁蛋白（SF）含量,并与20名健康新生儿（对照组）进行比较。结果 轻、中、重度HIE组入院时SI分别为（9.8±3.6）μmol/L、（9.7±4.3）μmol/L和（7.8±2.7）μmol/L,均低于对照组（14.5±5.0）μmol/L（P均〈0.05）;入院时轻、中、重度HIE组SF分别为（145.2±59.9）μg/L、（141.7±30.8）μg/L和（110.6±29.0）μg/L,均低于对照组（216.0±90.0）μg/L（P均〈0.05）;轻、中、重度HIE组日龄3～5天时SI分别为（18.7±4.2）μmol/L、（19.2±5.5）μmol/L和（26.1±5.6）μmol/L,均高于对照组（14.8±4.8）μmol/L（P均〈0.05）;SF分别为（314.3±93.0）μg/L、（397.1±95.3）μg/L和（546.6±98.9）μg/L,均高于对照组（218.6±75.4）μg/L（P均〈0.05）。结论 HIE患儿出生48h内循环铁降低,日龄3～5天时升高,提示铁代谢紊乱可能在HIE再灌注损伤中起一定作用。     

Epidemiology and potential preventative measures for viral infections in children with malignancy and those undergoing hematopoietic cell transplantation

In pediatric patients with malignancy and those receiving hematopoietic stem cell transplants, bacterial and fungal infections have been the focus of fever and neutropenia episodes for decades. However, improved diagnostic capabilities have revealed viral pathogens as a significant cause of morbidity and mortality. Because of limited effective antiviral therapies, prevention of viral infections is paramount. Pre-exposure and post-exposure prophylaxis and antiviral suppressive therapeutic approaches are reviewed. Additionally, infection control practices specific to this patient population are discussed. A comprehensive approach utilizing each of these can be effective at reducing the negative impact of viral infections.     

重症病毒性脑炎患儿非惊厥性癫痫持续状态9例临床分析

目的 通过分析重症病毒性脑炎患儿非惊厥性癫痫持续状态（NCSE）的临床特征、诊断和治疗,提高对NCSE的认识。方法 回顾性分析2012年6月至2014年9月广州市妇女儿童医疗中心神经内科诊断为重症病毒性脑炎NCSE的病例。结果 ①9例重症病毒性脑炎NCSE连续病例进入本文分析,男5例。脑炎起病年龄（7.2±3.9）岁;Glasgow评分（8.6±1.9）分;脑炎起始与NCSE起始间隔4~70（19.4±20.9）d;昏迷中癫痫持续状态（SEC）4例,复杂部分发作持续状态4例,不典型失神发作持续状态1例。②病因包括病毒性脑炎8例,病毒性脑炎抗癫痫药物调整1例;9例前驱均有惊厥,其中3例伴惊厥性癫痫持续状态。③9例临床发现主要有口面部或肢体微小抽动、认知障碍、孤独症样行为等。④VEEG发作期主要以背景活动变慢,伴δ、θ、β、棘节律,或棘慢波持续发放为特征。⑤4例SEC患儿予麻醉药联合多种抗癫痫药物治疗,发作平均持续42.8 d;5例非SEC患儿予多种抗癫痫药物治疗,其中3例发作平均持续9 d,1例抗癫痫药物调整所致NSEC发作持续4个月。⑥1例自动出院失访,1例死亡,余7例随访3个月至2.5年;6例VEEG均有不同程度的发作期或发作间期脑电异常,1例正常;1例神经学功能正常,5例有不同程度认知下降伴继发性癫痫,1例持续植物状态伴继发性癫痫。结论 口面部或肢体运动现象、认知及行为改变为重症病毒性脑炎患儿NCSE临床特征;发作期脑电波形变异大,棘节律可能是重症病毒性脑炎患儿NCSE的独特形式;抗癫痫治疗及起效时间与NCSE类型相关。     

Emerging viral infections in Australia

Emerging viruses include known viruses that have increased in incidence or geographic range (such as enteroviruses and Japanese encephalitis virus), new viruses associated with known diseases (Australian bat lyssavirus) and new viruses associated with previously unrecognized diseases (Hendra and Nipah viruses). Some may have a predilection for children (Japanese encephalitis, influenza viruses and enterovirus 71) and vigilance is essential to ensure early recognition of these agents.     

Herpes simplex virus infections in the neonate

Objectives: To review the experience of the Camperdown Children's Hospital with neonatal herpes simplex viral (HSV) infections between 1960 and 1992.
Design: A retrospective record review of all cases of HSV infection.
Results: Fifteen proven HSV infections were found. Only three cases had a definite history of HSV infection during pregnancy. Six were delivered at 36 weeks gestation or earlier. Seven weighed 2500 g or less. Forty-three per cent developed physical signs within 7 days of birth. Three cases were confined to skin, eyes and mouth, five were generalized, six had encephalitis with or without skin lesions, and one had pneumonitis. The mortality rate comprising the five with generalized infection was 47%, one with encephalitis and the one with pneumonitis. Four of the eight survivors have persisting neurological impairment. Those with disseminated infection and encephalitis did poorly regardless of antiviral treatment.
Conclusion A high index of suspicion of HSV infection is important so that antiviral treatment can be commenced early, particularly for those infections localized to skin, eye and mouth where there may be a good prognosis.     

Wheezing bronchitis in children. Incidence, viral infections, and other risk factors in a defined population

Risk factors for severe wheezing bronchitis were studied in children aged 4 months to 4 years in need of hospitalization. The children included in the study consisted of all cases generated from a geographically defined population, the catchment area of St Göran's hospital in Stockholm, The incidence was 3/1000 children and year, during the two years of observation, with the highest rate in boys under the age of 18 months (4. 7/1000). Symptoms of a preceding upper respiratory tract infection were reported in 90% of the cases, but a viral etiology could only be demonstrated with virus isolation in 26%. Respiratory syncytial virus was the most common finding in younger children. Rhinovirus was primarily seen in older children with a history of previous wheezing. Regardless of whether the cases had a positive or negative virus isolation they showed the same seasonal distribution. Furthermore, there was no difference in risk factors between children with a positive and negative virus isolation. Children older than 18 months with negative virus isolation had higher IgE levels than those with positive isolation, suggesting that atopy is of greater importance in this group.     

Emerging viral infections in transplantation

Viral infections are an important complication of transplantation. The introduction of more potent immunosuppressive agents over the past decade correlates with an increase in the rate of hospitalizations of transplant patients with infections. Specifically, viral infections have emerged as a major source of morbidity and mortality in transplantation. There are several potential intervention strategies in the face of emerging infections and it is likely that the approach will differ depending on the virus in question. These include viral surveillance and pre-emptive therapy, intervention of the transplant community, and policy change at the level of government, blood bank and organ procurement organizations. This review focuses on the emergence of the herpesviruses; HHV-6 and HHV-7. In addition, the issue of virus transmission through organ transplant is addressed with a discussion of West Nile virus and the rabies virus.     

Dietary iron intake and iron status in adolescents

The aim of this study was to evaluate the dietary iron intake of 15-year-old adolescents from two different regions of Sweden, in relation to their iron status. The study comprised 185 boys and 209 girls, randomly selected from the official population register. The iron intake was calculated from a 7-day record, and varied between 7 and 35 and 6 and 27 mg per day for boys and girls, respectively. The daily median intakes in boys and girls were 18.7 and 14.2 mg, respectively. S-ferritin, s-iron, and s-transferrin saturation, measured in all the subjects, did not differ significantly between the two regions. However, the mean serum ferritin concentration was significantly higher in the boys (36.4μgl^-1) than in the girls (29.4μgl^-1)( p < 0.001). Low s-ferritin levels, defined as s-ferritin < 12 μgl^-1 were found in seven boys (3.7%) and in 29 girls (13.9%). None of the adolescents had iron deficiency anaemia, defined as Hb< 110gl^-1 in combination with s-ferritin < 12μgl^-1. Regression and correlation analyses did not show any significant correlation between dietary iron intake and s-ferritin, or between s-ferritin and haemoglobin (Hb), MCH and MCHC. A significant correlation was found, however, between s-ferritin and transferrin saturation ( p < 0.005) in both sexes. When the adolescents who still had s-ferritin < 12μgl^-1 at a second blood examination were given a 6 weeks trial with oral iron therapy, all of them showed an increase both in s-ferritin and in blood Hb. The 95% confidence intervals of s-ferritin for 15-year-old Swedish boys and girls were defined as 11-90 and 7 85 μ.gl^-1, respectively.     

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??Respiratory infections??especially respiratory viral infections??are common diseases in children. Although most respiratory viral infection diseases are self-limiting??some children may be hospitalized or even life-threatened due to severe viral lower respiratory tract infection. With the progress of virology research??new and effective antiviral drugs have been developed. Thus??the study focuses on the therapeutic progress of respiratory viral infections so as to improve the treatment for common respiratory viral infections in children.     

Predicting iron status in low birthweight infants

OBJECTIVE: To determine the iron status of a selected group of low birthweight infants at approximately 9 months of age, and examine the feasibility of predicting iron status by examining the history of supplementary iron intake. METHODS: All live low birthweight infants recorded in the Dunedin Hospital Queen Mary Maternity Unit birth register who reached 9 months of age between November 1995 and September 1996 were eligible to participate. Infants were categorized into 'high' or 'low' iron intake groups depending on their consumption of infant formula or medicinal iron for one month prior to the study, and their iron status compared. RESULTS: Eighty-one infants of 73 mothers, with an average age of 10 months (range 8-13 months), participated. Thirty-three per cent (n = 27) were iron deficient: 19% (n = 15) had latent iron deficiency and 15% (n = 12) had iron deficiency anaemia. Those with a 'low' iron intake were 13-fold more likely to be iron deficient than infants with a 'high' iron intake (95% confidence interval: 4.4-41.5). Screening for iron deficiency using categories based on supplementary iron intake had a positive predictive value of 66% and a negative predictive value of 88%. CONCLUSIONS: The risk of iron deficiency was considerably greater for infants who had not received supplementary iron daily over the course of the previous month. Current preventative methods for avoiding poor iron status in this group of high risk infants are not effective. Screening for iron deficiency in low birthweight infants on the basis of iron intake from infant formula or medicinal iron provides a useful method for identifying infants whose iron status should be investigated.     

Serodiagnosis of acute respiratory infections in children in Georgia

Objective To investigate the etiology of acute respiratory infections in hospitalized children. Methods A total of 808 children were studied. Investigation ofRSV, Adenovirus, Parainfluenza, Influenza A and B, C.trachomatis, C.pneumoniae, M. pneumonia andLegionella were performed with an ELISA for IgM, IgG and IgA antibodies detection. Results There were 496 males and 312 females giving a male: female ratio of 1.6∶1. Ages range from 1 month to 15 years. The overall detection rate was 57.9%. The most frequently detected were:parainfluenza 12.6%,adenovirus 11.2%,influenza A 7.3%,RSV 6%,M. pneumoniae 5.4%,C.trachomatis 3.5% and mixed-infections 9.2%. Pneumonia was associated most frequently withadenovirus and mixed-infections; wheezing bronchitis—withadenovirus, RSV andM. pneumoniae; bronchitis —withparainfluenza andadenovirus, diseases of upper respiratory tract—withparainfluenza andadenovirus. Peak of the virus activity was during winter (influenza, parainfluenza, adenovirus, RSV) and autumn (parainfluenza, RSV). Conclusion Viruses are the main causes of ARI in Georgian children. A better understanding of the etiology of ARI in all of the regions of the world may be helpful for timely decision of specific therapy, which can help pediatricians to estimate and manage children with ARI.     

Severity of meningococcal infections is related to anthropometrical parameters

Background

Invasive meningococcal infections remain an important cause of death in children. In addition, malnutrition has been classically associated with increased severity of infectious diseases. However, in our experience lethal meningococcaemia in clinically malnourished children is extremely rare. Our purpose was to determine whether there is an association between nutritional status and outcome in children with invasive meningococcal infection.

Methods

We carried out an observational study and prospectively determined anthropometrical parameters in 127 children aged 1 month to 4 years with invasive meningococcal infection seen in our inpatient facilities from August 1999 to May 2004. Severity and survival were the clinical end points analysed.

Results

Children with severe disease had higher weight for age (1.02 vs −0.19) and height for age (1.12 vs −0.58) z scores than those with non‐severe disease. Non‐survivors had higher weight for age (0.90 vs −0.16) and height for age (0.73 vs −0.57) z scores than survivors. Clinical and biological variables usually accepted as predictors of high mortality or severity in patients with meningococcal infection were not significantly associated with weight for age and height for age z scores.

Conclusion

In the present prospective series of children with invasive meningococcal disease, severity and death were linked to anthropometrical parameters and seemed to be associated with a very good nutritional status, which confirmed our previous uncontrolled observations.     

Familial hemophagocytic lymphohistiocytosis and viral infections

A retrospective study was performed in 32 children with hemophagocytic lymphohistiocytosis, 16 of whom had affected siblings. Altogether 22 of these children, of whom the majority (13/22) were familial cases, had clinical or laboratory signs of infection. Laboratory analysis demonstrated Epstein-Barr virus in five children, cytomegalovirus in three and human parvovirus in two. Two siblings with onset of familial hemophagocytic lymphohistiocytosis within one month of each other, both of whom demonstrated serological indications of a recent human parvoviral infection at onset, are described. It is concluded that a viral infection cannot serve as the sole criterion for distinguishing a virus-associated hemophagocytic syndrome as an entity separate from familial hemophagocytic lymphohistiocytosis. Instead, it is suggested that viral infections may elicit a bout of the familial hemophagocytic lymphohistiocytosis disorder in genetically predisposed individuals.     

Enteric viral infections in pre-school children in Karachi,Pakistan

A prospective study was conducted in Karachi, Pakistan on the virology of enteropathogens excreted by children with acute gastroenteritis and the results were compared with a control group of healthy children. Rotavirus and Adenovirus detection was done using ELISA techniques, while enterovirus isolation was done by virus culture. In 1990, 12.3% children with acute watery diarrhoea excreted rotavirus, as compared to 24.4% children in 1991. None of the healthy children excreted adenovirus 40 and 41. Preliminary results of 1992 revealed that rotavirus was seen in 13% of children with acute watery diarrhoea and adenovirus in 10% of children. Enteroviruses were isolated in the same frequency in all three groups i.e. children with acute watery diarrhoea, children with poliomyelitis and healthy children. Non-polio enteroviruses were excreted in 50–52% in all the 3 groups. The rate of enterovirus excretion is much higher than seen in other developed countries and is the same in children with diarrhoea and healthy children.     

Undernutrition in Nepalese children: a biochemical and haematological study

Aim: This study was undertaken to assess the nutritional status of 6–10 years old Nepalese children by measuring some haematological and biochemical parameters. Methods: Nutritional status was assessed by height‐for‐age z‐score. Total count of red blood corpuscles (TC of RBC), packed cell volume, haemoglobin concentration, mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH) and mean corpuscular haemoglobin concentration were measured. Biochemical parameters such as serum iron, total iron‐binding capacity (TIBC), serum ferritin, serum transferrin, transferrin saturation (TS) and serum albumin were also measured. Serum folate and vitamin B₁₂ were measured in well‐nourished and undernourished children. Results: TC of RBC, serum iron, serum ferritin, TS and serum albumin of stunted children were significantly lower (p < 0.05) than that of well‐nourished children. MCV, MCH, TIBC and serum transferrin of stunted children were significantly higher (p < 0.05) than that of well‐nourished children. Serum folate and vitamin B₁₂ values of stunted children were significantly lower (p < 0.001) than that of well‐nourished children. Conclusion: A mild iron deficiency was found in stunted Nepalese children. The serum ferritin has been identified as a sensitive marker for measurement of iron status in surveyed children. A deficiency of serum protein, serum folate and vitamin B₁₂ was also found in the undernourished Nepalese children.     

上海地区急性呼吸道感染患儿病毒病原学研究

目的探讨上海地区近5年来急性呼吸道感染患儿病毒病原和支原体病原感染状况。方法采用系列呼吸道病毒单克隆抗体桥联酶标法或聚合酶链反应技术,对上海地区5年中的急性呼吸道感染患儿5496例标本进行病毒学或肺炎支原体-DNA检测。结果检出病毒阳性2257例,阳性率41.07％以上,肺炎支原体-DNA检出率16.2％(572／3538)。结论连续5年中上海地区有2次急性呼吸道病毒感染发病高峰(1994年和1998年),病毒性感染流行季节主要在每年1～2月和11～12月。