Burden of influenza among hospitalized febrile children in Ghana

Background

Influenza surveillance data from Africa indicate a substantial disease burden with high mortality. However, local influenza data from district hospitals with limited laboratory facilities are still scarce.

Objectives

To identify the frequency and seasonal distribution of influenza among hospitalized febrile children in a rural hospital in Ghana and to describe differential diagnoses to other severe febrile infections.

Methods

Between January 2014 and April 2015, all children with a temperature of ≥38°C admitted to a district hospital in Ghana were screened for influenza A and B by RT‐PCR and differentiated to subtypes A(H1N1)pdm09 and A(H3N2). Malaria microscopy and blood cultures were performed for each patient.

Results

A total of 1063 children with a median age of 2 years (IQR: 1‐4 years) were recruited. Of those, 271 (21%) were classified as severe acute respiratory infection (SARI) and 47 (4%) were positive for influenza, namely 26 (55%) influenza B, 15 (32%) A(H1N1)pdm09, and 6 (13%) A(H3N2) cases. Influenza predominantly occurred in children aged 3‐5 years and was more frequently detected in the major rainy season (OR = 2.9; 95% CI: 1.47‐6.19) during the first half of the year. Two (4%) and seven (15%) influenza‐positive children were co‐diagnosed with an invasive bloodstream infection or malaria, respectively.

Conclusion

Influenza contributes substantially to the burden of hospitalized febrile children in Ghana being strongly dependent on age and corresponds with the major rainy season during the first half‐year.     

Metabolic effects of melatonin on oxidative stress and diabetes mellitus

Previous studies have reported allelic loss in chromosomal region 13q14 in pituitary tumors. However, the role of RB1 in this region has not been clarified. We performed a tumor deletion map of chromosomal region 13q14 with pituitary adenomas and matched blood samples of 43 patients with acromegaly. Twenty-one patients had non-invasive tumors, 19 had invasive tumors, and in 3 this information was not available. Results showed loss of heterozygosity in at least one microsatelite marker of region 13q14 in 12% (5 of 43) of the somatotropinomas. Retention of marker D13S1325, telomeric to RB1, suggests that the putative tumor suppressor gene is located centromeric to this region, which includes RB1 locus. The participation of RB1 was excluded in four of the five cases because retinoblastoma protein was shown to be positive in these tumors in our previous study. Allelic loss occurred in similar frequency in invasive and noninvasive adenomas. In summary, we confirmed the participation of chromosomal region 13q14 in a subset of GH-secreting adenomas with no regard to tumor grade. RB1 was not implicated, suggesting the participation of another tumor suppressor gene in this region during the first steps of somatotropinoma development.     

儿童上呼吸道感染伴热性惊厥与铁代谢的相关性研究

目的研究儿童上呼吸道感染伴热性惊厥（FC）与铁代谢指标的关系。 方法选取2018年6月-2019年12月佛山市妇幼保健院收治的146例上呼吸道感染伴热性惊厥患儿,其中57例儿童为复杂型热性惊厥（CFC）,89例患儿临床诊断符合单纯型热性惊厥（SFC）,同期85例无惊厥发作的上呼吸道感染（URI）为对照组。测定其血红蛋白（Hb）、平均红细胞体积（MCV）、平均红细胞血红蛋白含量（MCH）、平均红细胞血红蛋白浓度（MCHC）、C反应蛋白（CRP）、降钙素原（PCT）、血清铁蛋白（ SF）、血清铁（SI）。 结果三组的Hb、MCV、MCH、MCHC、CRP和PCT水平对比差异均无统计学意义（P>0.05）,三组儿童确诊为贫血的比例对比差异无统计学意义（P>0.05）,三组的SF、SI水平对比差异具有统计学意义（P<0.001）,其中CFC组和SFC的SF水平显著低于URI组（P<0.05）,CFC、SFC组的SI水平显著低于URI组,且CFC组的SI水平显著低于SFC组,差异具有统计学意义（P<0.05）。 结论儿童上呼吸道感染伴热性惊厥的发生与血清铁蛋白及血清铁的代谢密切相关,复杂型热性惊厥与血清铁降低相关。     

Trace elements as a component of oxidative stress in COPD

OBJECTIVE: The purpose of this study was to assess the serum concentrations of those trace elements that act as a component of oxidative stress in COPD patients. Clinically stable COPD outpatients (n = 26) and healthy controls (n = 24) were studied. METHODOLOGY: Serum concentrations of copper (Cu) and zinc (Zn) were determined using a Varian Spectra AA220 flame atomic absorption spectrophotometer. Serum concentration of iron (Fe) was measured by the ferene assay, using a commercially available kit (IL Test Iron) with the ILAb 900 autoanalyser. The lipid peroxidation product malondialdehyde (MDA) in serum samples was measured spectrophotometrically in terms of TBARS (thiobarbituric acid reactive substances). RESULTS: The serum MDA concentration in COPD patients was found to be similar to the control group (0.68 +/- 0.15 nmol/mL vs 0.62 +/- 0.13 nmol/mL, respectively; P= 0.163). The serum concentrations of the trace elements in both study groups were in the normal reference range. There was no difference in Fe concentration between COPD patients and the control group (0.81 +/- 0.38 micro g/mL vs 0.92 +/- 0.41 micro g/mL; P= 0.360). Copper concentrations were higher (1.06 +/- 0.26 microg/mL vs 0.92 +/- 0.19 microg/mL; P <0.040); while zinc was lower in the COPD group compared to the controls (0.83 +/- 0.25 microg/mL vs 1.03 +/- 0.23 microg/mL; P= 0.006). Serum Zn concentrations were lower in the severe COPD patients compared to mild-moderate COPD patients (P = 0.038). CONCLUSION: The results of this study indicate that there are alterations in serum concentrations of trace elements in COPD patients, suggesting that they may play a role in the pathophysiology of this disease by virtue of their role in oxidative stress. We recommend further studies on the role of trace elements in the pathophysiology of COPD, their association with markers of oxidant/antioxidant status and on the clinical significance of their deficiency.     

Hemodynamic and oxidative stress profile after exercise in type 2 diabetes

This study investigated the effect of an acute bout of exercise (>85% VO2Max) on biochemical, hemodynamic and oxidative stress variables in sedentary and physically active subjects with type 2 diabetes (T2D). Blood measurements were taken before and after a treadmill test on 12 sedentary non-diabetes subjects (ND), 12 sedentary type 2 diabetes (T2S) and 9 physically active T2D subjects (T2DA). T2DS subjects before and after the treadmill test showed a higher plasma glucose (123.2 +/- 19.0 mg/dL versus 108.9 +/- 16.8 mg/dL, p < 0.001), HbA1C (8.7 +/- 2.4% versus 7.3 +/- 1.2%, p < 0.001) and body fat% (21.3 +/- 5.7% versus 34.6 +/- 4.5%, p < 0.001) than T2DA subjects. T2DA had higher VO2Max (37.7 +/- 3.5 versus 29.5 +/- 3.2, p < 0.05), time on treadmill (22.3 +/- 2.1 min versus 16.1 +/- 2.1 min, p < 0.05), hemoglobin (17.9 +/- 0.9 g/dL, p < 0.05) and lower blood pressure levels in comparison to ND and T2DS subjects. Thiobarbituric acid substances (TBARS) in T2DS were higher than in T2DA subjects (0.27 +/- 0.1 nmol/mL versus 0.21 +/- 0.1 nmol/mL, p < 0.05). Glutathione (GSH) levels were similar among the groups. Physically active type 2 diabetes subjects had a more favorable biochemical, hemodynamic and oxidative stress profile than sedentary subjects. The coexistence of a poor cardiopulmonary performance and high oxidative stress environment can determine a profile of high risk for serious cardiovascular events in patients with diabetes.     

Correlation between oxidative stress and hematological profile abnormalities in diabetic nephropathy

AimsDiabetes patients with renal impairment commonly have a degree of hematological abnormalities than those non-diabetics with chronic kidney disease. The present study aimed to clarify the association between oxidative stress and hematological abnormalities with the progression of diabetic nephropathy.MethodsA total of 20 healthy subjects and 100 patients were enrolled in the study. Eligible renal dysfunction patients were classified according to biochemical markers into five groups (20 patients); diabetic patients, pre-renal failure patients, diabetic pre-renal failure patients, renal failure patients, and diabetic renal failure patients.ResultsErythrocytes and platelets count, hemoglobin and hematocrit levels revealed a significant decrease in all renal dysfunction groups, while leukocytes count, red cell distribution width, platelet distribution width, and mean platelet volume showed significant increases in diabetic and renal dysfunction groups as compared to the healthy control. Nitric oxide level increased significantly, while reduced glutathione showed a marked decrease in diabetic and all renal dysfunction groups compared to the healthy control.ConclusionNitric oxide and reduced glutathione were associated with the inflammatory status in diabetic renal dysfunction patients which reflected by elevation in leukocytes and neutrophils count, red cell distribution width as well as the reduction in values of erythrocytes, platelets count, hemoglobin and hematocrit. Therefore, hematological indices can play a role in predict the progression of diabetic nephropathy.     

小儿大骨节病与微量元素的关系及其临床意义

目的 观察微量元素及相关生物活性物质在小儿大骨节病中的作用及硒对小儿大骨节病的治疗效果。方法 检测40例大骨节病患儿和30例健康儿童体内7种血清微量元素、血浆谷胱甘肽过氧化物酶(GSH-Px)活力，丙二醛(MDA)水平及相关临床指标。大骨节病组患儿服用亚硒酸钠1．0mg／d，连服1周，以后每周1．0mg，疗程6个月。观察治疗前后血清硒(Se)、GSH-Px活力、MDA、骨碱性磷酸酶(BALP)活性、甲状腺激素及免疫球蛋白(IgG、IgA、IgM)等指标，随访1年，以观察远期疗效。结果 治疗后大骨节病组患儿血清Se水平及GSH-Px活力明显增加，MDA显著降低，BALP、IgG和IgM恢复正常。完全缓解者24例(60％)，明显好转10例(25％)，总有效率达85％。远期疗效较好。结论 用亚硒酸钠治疗该地区大骨节病患儿有明显的疗效，Se水平低表明该地区小儿大骨节病可能与缺硒有关，提示临床可适量使用亚硒酸钠。     

Routine lumbar puncture in children with febrile seizures in Ghana: should it continue?

OBJECTIVES: Performing routine lumbar punctures in children with febrile seizures has been controversial. This study aimed to determine the positive yield of lumbar punctures in a setting where routine lumbar puncture is routinely carried out and to determine if any other parameter could help differentiate bacterial meningitis from the various other diagnoses of children who presented with a febrile seizure. DESIGN: A prospective study was carried out among children aged three months to 15 years of age, hospitalized at the Komfo Anokye Teaching Hospital in Kumasi, Ghana, between July and August 2000. RESULTS: There was a 10.2% (n = 19) positive yield for bacterial meningitis with a case fatality rate of 36.8% (n = 7). Cerebral malaria, which is not easily distinguishable from bacterial meningitis, accounted for 16.1% (n = 30) of the children. Twenty percent of bacterial meningitis patients had a positive blood smear for malaria. The indication for doing a lumbar puncture was similar in both cerebral malaria and bacterial meningitis patients. Signs of meningism were not the primary reason for carrying out a lumbar puncture, even in the group of children who had bacterial meningitis. CONCLUSION: Performing routine lumbar punctures may still have a role to play in the management of children with febrile seizures.     

Management of febrile seizures in a developing country

In the analysis of 128 patients with febrile convulsions, we identified hazards not encountered in the western world, which could alter the ultimate management of the child. These include administration of home remedies during the seizures, detrimental cultural beliefs and poor socio-economic conditions. All complex seizures in our series were initial seizures. Recurrent benign febrile seizures did not predispose to a complex seizure. Behaviour disorders were the most prominent side effect following long term phenobarbitone administration.     

肺炎患儿血清中微量元素含量的临床探讨

目的研究肺炎患儿血清中铜、锌、铁、镁、钙等微量元素的含量的变化情况。方法选择50例肺炎的患儿作为观察组,随机选择同期在我院门诊健康体检的50例健康儿童作为对照组,分别测定两组患儿血清中微量元素铜、锌、铁、镁、钙的含量。结果观察组中患有肺炎的患儿血清中的铜、锌、钙的含量明显低于对照组,具有统计学意义(P<0.01);观察组中患有重症肺炎的患儿血清中钙。镁、铁、锌、铜的含量都比轻症肺炎患儿显著降低,具有显著差异性(P<0.01)。结论肺炎患儿血清中钙、铁、锌、铜、镁等微量元素的代谢紊乱,故应对肺炎患儿进行血微量元素的检测,并对缺乏者给予合理的补充治疗,以助疾病的迅速恢复。     

Hair toxic and essential trace elements in children with autism spectrum disorder

The objective of the study was to investigate hair trace elements content in children suffering from autism spectrum disorder (ASD). A total of 74 ASD children and 74 sex- and age-matched controls divided into two age groups (2–4 and 5–9 years) were investigated. Hair trace elements content was assessed using inductively coupled plasma mass spectrometry. A general cohort of ASD children was characterized by 29 %, 41 %, and 24 % lower hair levels of chromium (Cr), iodine (I), and vanadium (V), respectively, whereas the level of selenium (Se) exceeded the respective control values by 31 %. In ASD children aged 2–4 years hair Cr, I and V content was 68 %, 36 % and 41 % lower than in the controls. Older ASD children were characterized by 45 % increase in hair Se levels. In a general cohort of ASD children hair beryllium (Be) and tin (Sn) levels were 50 % and 34 % lower than the control values. In the first age group (2–4 years) of ASD children 34 %, 42 %, and 73 % lower levels of arsenic (As), boron (B), and Be were detected. In the second age group of ASD children only a nearly significant 25 % decrease in hair lead (Pb) was detected. Surprisingly, no significant group difference in hair mercury (Hg), zinc (Zn), and copper (Cu) content was detected. Generally, the results of the present study demonstrate that children with ASD are characterized by lower values in hair of not only essential but also toxic trace elements.

     

Potential oxidative stress in children with chronic constipation

AIM: To investigate the potential oxidative stress in children with chronic constipation and to explore its mechanisms. METHODS: Seventy children with chronic constipation and 70 age- and sex-matched healthy children were enrolled in a randomized controlled study. Plasma levels of vitamins C and E, activities of superoxide dismutase and catalase and lipoperoxide level in erythrocytes were determined by spectrophotometry. RESULTS: Compared with healthy children whose vitamin C, vitamin E, superoxide dismutase, catalase and lipoperoxide were 58.35±14.42 μmol/L, 27.15±6.55 μmol/L, 2 206±171 U/(g·Hb), 327.3±82.2 K/(g·Hb) and 19.18±4.27 nmol/(g·Hb) respectively, the levels of vitamin C, vitamin E, the activity of superoxide dismutase, and catalase in the children with chronic constipation significantly decreased [46.59±11.51 μmol/L, 20.65±4.80 μmol/L, 1943±147 U/(g·Hb) and 269.3±67.8 K/(g·Hb), respectively (P<0.01], while the lipoperoxide significantly increased [25.22±5.01 nmol/(g·Hb), P<0.01]. With a prolonged course of disease, the levels of vitamin C, vitamin E, the activity of superoxide dismutase and catalase in the children with chronic constipation gradually decreased, while the level of lipoperoxide gradually increased. CONCLUSION: Chronic constipation can cause potential oxidative stress in children.     

Epidemiology and trace elements

Basically, epidemiology is the making of measurements of known reproducibility, in a bias-free manner, on representative samples of subjects drawn from defined communities. Epidemiology has become a relatively precise science and its value in medicine is widely appreciated. So too are its limitations: the difficulties in achieving a high response rate, in identifying and controlling confounding factors in the examination of an association, and the ultimate difficulties in distinguishing causation from association. While the value of community-based studies seems to be recognized by those interested in man and his environment, the need for the strict application of epidemiological procedures, and the limitations imposed on conclusions drawn from studies in which these procedures have been compromised, does not seem to be adequately understood. There are certain known links between trace elements in the environment and disease: for example the level of iodine in soil and water and the prevalence of goitre; the level of fluoride in water and the prevalence of dental caries. The investigation of other possible associations is difficult for a number of reasons, including interrelationships between trace elements, confounding of trace element levels (and disease) with social and dietary factors, and the probability that relationships are generally weak. Two conditions in which associations are likely are cardiovascular disease and cancer. Despite research along a number of lines, the relevance of trace elements to cardiovascular disease is not clear, and certainly the apparent association with hardness of domestic water supply seems unlikely to be causal. The same general conclusion seems reasonable for cancer, and although there are a very few well established associations which are likely to be causal, such as exposure to arsenic and skin cancer, the role of trace elements is obscure, and likely to be very small.