全民食盐加碘前后不同地区儿童碘营养状况分析

目的　了解不同地区儿童碘营养状况在全民食盐加碘前后有何变化。方法　对安徽省大别山、巢湖缺碘地区及合肥市学龄儿童在全民食盐加碘前及全民食盐加碘一年后进行碘营养状况调查。结果　全民食盐加碘前已进行了长期碘盐防治碘缺乏病工作的大别山区儿童尿碘中位数由２６９．１μｇ／ Ｌ 升至全民食盐加碘后的３９２０μｇ／ Ｌ，甲肿率由２４％ 下降至１４４％ 。巢湖组儿童尿碘中位数由全民食盐加碘前１９２μｇ／ Ｌ 升至全民食盐加碘后的３８４０μｇ／ Ｌ，甲肿率由５４１％ 降至２０６％ 。合肥市儿童尿碘中位数由全民食盐加碘前７９２μｇ／ Ｌ 升至全民食盐加碘后的２６８８μｇ／ Ｌ，甲肿率由４０％ 升至７５％ 。全民食盐加碘一年后３个地区儿童尿碘超过１００μｇ／ Ｌ 者均占９５％ 以上。结论　全民食盐加碘后不同碘营养地区儿童均在一个碘充足的状态，补碘效果明显。     

全民食盐碘化十年后广东三个城市青少年的碘营养状况

采用分层随机整群抽样方法对三个城市总共3589名青少年的尿碘水平进行横断面调查.调查城市中南雄青少年尿碘水平最高,中位数286.6μg/L;广州和茂名分别为204.1μg/L和166.μ/L,总人群尿碘中位数为231.7μg/L.受调查人群碘营养水平已略超出世界卫生组织建议的适宜量.     

Mortality in children with juvenile dermatomyositis: two decades of experience from a single tertiary care centre in North India

Survival and outcomes have improved considerably among patients with juvenile dermatomyositis (JDM) in the west. However, mortality continues to be high in the developing world. There is paucity of literature on this aspect of JDM from developing countries. We reviewed case files of all patients with JDM registered in the Pediatric Rheumatology Clinic, Advanced Pediatrics Centre at the Post Graduate Institute of Medical Education and Research, Chandigarh, during the period 1993–2013. Seventy-six children were diagnosed to have inflammatory myopathy during this period. Of these, 63 had JDM, 3 had polymyositis while 10 had an overlap syndrome. We had reported 2 deaths out of 33 (8.3 %) patients with JDM in 2004, and over the last 9 years, we have encountered five more deaths in this group, thereby accounting for a mortality rate of 11.1 % (7/63) over two decades of follow-up. In these five children now being described, the mean duration between onset of symptoms and institution of appropriate therapy was 9.2 months. Four children (80 %) had severe muscle weakness needing nasogastric tubes at the onset, three (60 %) had cutaneous ulcers and three (60 %) had superadded infections. Two children (40 %) had gastrointestinal vasculitis and one of these developed an intestinal perforation. Three patients (60 %) had progressive pulmonary disease and air leak was identified in two of them. Although the prognosis for survival in JDM has steadily improved, in our experience the disease remains a serious illness and still carries significant mortality in the context of a developing country.     

贵州省黔南州供碘20年后8～10岁儿童碘营养状况和智力调查

目的 了解贵州省黔南州供碘20年后8～10岁儿童碘营养状况和智力水平.方法 对黔南州8～10岁儿童421名采用触诊法进行甲状腺检查,用酸消化砷铈接触法检测尿碘,用<中国联合型瑞文测验>进行智商(IQ)测定.结果 8～10岁儿童甲状腺肿大率为5.0%(21/421),尿碘中位数为331.2μg/L,8～10岁儿童IQ均值为93.32±18.68,不同碘营养水平的儿童IQ值比较,差异有统计学意义(P＜0.05).结论 食盐加碘后黔南州儿童的碘营养缺乏状况已得到纠正,8～10岁儿童尿碘水平、甲状腺肿大率已达到国家消除碘缺乏病标准,智力水平发育基本正常.     

Determination of iodine concentration in urine by isotope dilution analysis and thyroid volume of school children in the west coast of Turkey after mandatory salt iodization

OBJECTIVE: This study was designed to evaluate iodine deficiency status in children 6-12 years in the west coast (Aegean Region) of Turkey after 5 years of mandatory iodine prophylaxis. A total of 2300 children from 72 populations (rural and urban area) were evaluated with urinary iodine excretion and thyroid volume. DESIGN: Cross-sectional, observational study designed and performed according to surveillance methods for iodine deficiency disease (IDD) prevalence recommended by WHO/UNICEF/ICCIDD. SUBJECTS: The study population consisted of 2300 school children age ranging from 6 to 12 years. The children were selected by multiple stage randomization from 91 primary schools of 76 zones (91 clusters). Information about the use of iodized salt was obtained from the families. MEASUREMENTS: Data on the following were collected: birth date, sex, weight, height, thyroid size by palpation and ultrasonography; and urinary iodine by isotope dilution analysis method. Thyroid volumes above 97th percentile according to the WHO/ICCIDD by age and body surface area (BSA) were accepted as goitre. RESULTS: Iodized salt consumption was 51.7%. The prevalence of goitre determined by palpation was 12.1% and by ultrasound based on BSA and age were 9.8% and 5.5%, respectively. Median urinary iodine was 53 (2-142) microg/l. CONCLUSION: Mild to severe degree of iodine deficiency was detected in the west coast of Turkey.     

碘化食盐是否能满足妊娠期间的碘需求

全球至少22亿人口(占世界总人口的38%)受到碘缺乏的影响.即使由轻微碘缺乏引起的母体T4水平下降,也可能对其后代的认知能力造成负面影响.同时,碘缺乏仍然是世界范围内导致可预防性智力发育迟缓的主要原因.     

湖北省实施全民食盐加碘后8～10岁儿童碘营养现状调查

目的了解湖北省实施全民食盐加碘（USI）措施后人群碘营养现状。方法采用人口比率概率抽样法（PPS），检测盐碘、儿童尿碘及儿童甲状腺肿大（甲肿）率。结果湖北省碘盐覆盖率和合格碘盐食用率分别从1995年的92．1％和47．8％上升至2005年的99．8％和96．2％；触诊法儿童甲肿率从1995年的11．2％下降到2005年的6．5％；尿碘中位数在200～390μg／L。结论人群碘营养状况良好，湖北省已经实现消除碘缺乏病目标。     

全民食盐加碘前及1年后安徽省大别山碘缺乏病病区儿童碘营养甲状腺功能状态的研究

了解安徽大别山区全民食盐加碘防治碘缺乏病（简称ＩＤＤ）效果和儿童营养,甲状腺功能的变化,方法对大别山区霍山县太平畈乡５的小学的８４９名７－１４岁儿童,进行了加碘前及加碘１年后的尿碘,甲状腺肿大率,血清ＦＴ３、ＦＴ４、ＴＧ、ｓＴＳＨ及ＴＲＨ－ＳＴ的对比研究。结果甲肿率明显下降（Ｐ〈０．００１）,以７－８岁儿童最为显。甲肿率随年龄增长而增加,且同年龄组中女性高于男性（Ｐ〈０．００１）。加碘前,后尿碘     

重庆市普供碘盐8年儿童智商调查分析

目的评价食盐加碘8年对儿童智商的影响。方法2005年．在重庆市采用人口比例概率抽样方法（PPS），按儿童年龄和性别分组，用中国联合型瑞文测验第二次修订版（CRT-C2）测验儿童智商，同时检查儿童甲状腺肿大（简称甲肿）率和测定尿碘水平。结果共检测8-10岁儿童1260名，平均智商值为106.32．男、女儿童分别为106．1、106．5，不同年龄儿童智商以普供碘盐后出生的8岁组儿童为优（107．83）。儿童甲肿率触诊法和B超法分别为10，5％（132／1260）、9．9％（125／1260），低于2002年的13，8％（166／1200）、14，7％（176／1200）。触诊法10岁组儿童甲肿率（13，1％）高于8岁组（7.2％）。儿童尿碘中位数266，65μg／L。结论重庆市普供碘盐8年，有效地保护了儿童智力发育。     

江苏省全民食盐加碘后学龄儿童尿碘水平的动态变化

目的了解全民食盐加碘政策的实施及现行食盐加碘浓度调整对学龄儿童尿碘水平的影响。方法对1997～2002年问尿碘监测结果的动态变化进行分析。结果1997～2002年间学龄儿童尿碘中位数均在100μg/L以上；碘盐浓度调整后尿碘水平下降，但人群的碘营养仍是充足的。结论现阶段食盐加碘浓度是适宜的，但需进一步提高碘盐的质量。     

食盐加碘对轻度碘缺乏地区住院甲状腺疾病谱的影响

目的　研究全民食盐加碘 (USI)对住院甲状腺疾病谱的影响。方法　采用回顾性调查方法查阅甲状腺疾病住院病史。结果　USI实施 1～ 4年甲状腺疾病占总住院比例呈逐渐升高趋势 ,由 7.6‰升高到 11.0‰ ;男 /女比例由 1:3 .6升到 1:4.1;<2 0岁组比例由 2 .5 %上升到 3 .4% ;甲状腺良性肿瘤由 48.5 %下降到 3 8.5 % ,甲状腺功能亢进症由 2 7.1%上升到 3 7.2 %。实施USI后居民食盐碘含量和尿碘中位数分别由 <5mg/kg和 72 μg/L上升到 48mg/kg和 3 75 μg/L。 结论　住院甲状腺疾病的增加可能与USI的实施使碘营养状态急速改善有关。可适当降低食盐加碘量 ,使之达到推荐碘摄入水平。     

福州市区全民食盐加碘前后甲状腺功能亢进发病率动态分析

目的 评价全民食盐加碘对甲状腺疾病的影响。方法 观察福州市某大医院1990-1999年在采取全民食盐加碘干预措施前后甲状腺功能亢进（甲亢）等甲状腺疾病的发病率变化。结果 食盐加碘当年甲亢和桥本氏病发病率分别为531.0和238.3/10万人，比加碘前每年157.7和6.0/10万人有明显上升，1997年甲亢发病率达到高峰，1998年两者发病率逐年下降，1999年下降至加碘前水平；加碘后人群甲亢和桥本氏病发病的相对危险度也呈类似的变化规律；1995年8月食盐加碘前甲亢发病率306.37/10万人就已明显高于1994年的157.7/10万人。结论 近几年甲亢和桥本氏病发病率上升的原因比较复杂，甲亢发病率本身就存在上升趋势，个别病例可能与补碘有关，且目前甲亢和桥本氏病发病率都恢复至加碘前水平，因此视有碘摄入量对人群是安全的。     

全民食盐加碘前安徽大别山巢湖缺碘病区和合肥市儿童碘营养及甲状腺功能的研究

对安徽大别山、巢湖缺碘病区和合肥市共３７５９例儿童在全民食盐加碘前的碘营养、垂体—甲状腺轴功能状态进行研究。结果表明：巢湖组为重病区（肿大率为５５．８％），儿童人群严重缺碘（尿碘中位数为１９．２μｇ／Ｌ），垂体—甲状腺轴功能呈高代偿状态，有亚临床甲状腺功能减退存在。大别山组，尿碘（中位数２６９．１μｇ／Ｌ）虽高，但甲肿率为２２．４％，为中等病区水平，且垂体—甲状腺轴功能呈代偿状态，也提示有亚甲减存在，而合肥市甲肿率低，各项功能正常，为非病区，但尿碘水平偏低，提示碘营养不足。显示了全民食盐加碘防治的必要性。     

Time trends in epidemiology of peptic ulcer disease in India over two decades

Background

Epidemiology of peptic ulcer disease (PUD) in India differs from that in the West. It may have undergone a change with recent improvement in hygiene and availability of potent antisecretory and ulcerogenic drugs. We therefore tried to assess time-trends in the frequency of PUD over the past two decades.

Methods

Records of patients with uninvestigated dyspepsia and no alarm symptoms who had undergone upper gastrointestinal endoscopy at our institution during the years 1988 (n?=?2,358), 1992 (n?=?2,240), 1996 (n?=?5,261), 2000 (n?=?7,051), 2004 (n?=?5,767) and 2008 (n?=?7,539) were retrospectively reviewed. The frequencies of duodenal and gastric ulcer disease in these groups were compared.

Results

Of the 30,216 patients (age:41.7±12.7 years, 34?% females) during the six study periods, 2,360 (7.8?%) had PUD. The frequencies of both duodenal ulcer and gastric ulcer showed a decline from 1988 to 2008, i.e. from 12?% to 2.9?% and 4.5?% to 2.7?%, respectively (p-value <0.001 for trend for each). The decline was more marked for duodenal ulcer, and the ratio of duodenal to gastric ulcer declined from 2.7 in 1988 to 1.1 in 2008.

Conclusions

The epidemiology of PUD in India may have changed in the past two decades with the incidence of duodenal ulcer declining more rapidly than that of gastric ulcer.     

轻病区全民食盐加碘后5～15年住院甲状腺疾病

目的 研究全民食盐加碘(USI)对住院甲状腺疾病影响。方法 住院甲状腺疾病采用回顾性调查方法。结果 实施USI后5～15年住院甲状腺疾病占总住院比例下降到1.9‰～2.8‰,平均2.2‰,女/男比率为4.2,<20岁组和≥60岁组比例分别为3.2％和12.2％。甲状腺良性肿瘤下降到37.9％,甲亢仍保持32.3％,甲状腺炎降到4.9％。居民食盐碘含量和目标人群尿碘分别增加到52.5ppm和572.0μg/L。结论 甲状腺毒症和甲状腺功能减退症的增加与盐中的碘过多有关。食盐加碘量应当调整使之达到推荐摄入量,调整依据是其它来源的碘量、每天食盐食用量和碘在盐中的丢失。     

The health and nutritional status of school children in two rural communities in Sri Lanka

There is growing evidence of considerable burden of morbidity and mortality due to infectious diseases and undernutrition in school children. This study describes the nutritional status and parasitic infections of school children in two areas of rural Sri Lanka. All children in four primary schools in the Moneragala district of Sri Lanka were included in the study. The height and weight of children were measured and anthropometric indices calculated. Stool and blood samples were examined for evidence of intestinal helminthiasis, malaria and anaemia. A greater proportion of boys than girls were underweight, wasted and stunted. Over 80% of the children were anaemic but did not apparently have iron deficiency anaemia according to their blood picture. The prevalence of parasitic infections such as hookworm and Plasmodium spp that may contribute to anaemia was low.     

Thyroid volumes and urinary iodine in German school children.

Several recently published investigations showed a significant improvement in the iodine supply of the German population, but so far Germany is still considered an iodine deficient country. However most of the studies presented do not meet the epidemiological criteria established by WHO, UNICEF and ICCIDD and may therefore suffer from a selection bias with respect to goiter prevalence estimates. School children, owing to their easy recruitment, representativeness of different socio-economic classes and high vulnerability of Iodine deficiency disorders (IDD), are one of the best target groups for surveillance of IDD. In this field study a total of 591 children were investigated. The total sample included 268 females and 323 males aged 7-17 years. The following data were collected: thyroid size by ultrasound, urinary iodine concentration in a first-morning spot urine, weight, height, sex and age. The median urinary iodine concentration of the children was 183 microg/L. The proportion of samples with concentrations below 100 microg/L or below 50 microg/L was 15.4% and 4.3% respectively. Urine samples with high iodine concentrations were also found amounting to 17.3%. Almost all families (97%) declared to use iodized kitchen salt and 19.6% of all children are taking regularly iodine tablets. Application of the WHO/ICCIDD thyroid volume references to the German children resulted in a goiter prevalence of 0.2%, using either age/sex-specific or body surface area (BSA)/sex-specific cut-off values. Comparison with the P97 values of the original normative data of Gutekunst and Martin-Teichert however gives a goiter prevalence of 3% as expected. The thyroid volumes of the children in our study appear comparable with those reported recently for iodine sufficient children from Switzerland and for iodine replete Berlin children and for children with sufficient iodine supply in the region of Leipzig, so that Germany probably has no longer to be considered an iodine deficient country. Our own study and the most recently published studies on iodine replete children give rise to the supposition that the WHO/ICCIDD recommended thyroid volume references are too high.     

全民食盐加碘后贵州省儿童甲状腺肿大率消长反常原因的调查分析

目的　查明全民食盐加碘后贵州省儿童甲状腺肿大 (甲肿 )率消长反常现象的原因。方法　采用点面结合的“典型调查”方法 ,即先用触诊法初筛贵州省 19所小学校的适龄儿童 ,然后从中遴选出 度甲肿率较高的并有层次代表性的 3所学校纳入全面调研的视野。结果　儿童甲肿率消长反常现象在贵州省较为普遍 ,甲肿病情严重程度的排序是村屯级 >乡镇级 >县城级 >省城级。结论　高甲肿率与当地多种因素密切相关 ,水硬度大、辣椒氟严重超标以及贫困等因素在致病过程中发挥着修饰性放大作用。这一结论有待进一步通过病例对照研究和前瞻性队列研究证实。     

Hepatitis B reactivation after chemotherapy: two decades of clinical research

Hepatitis due to hepatitis B virus reactivation after cytotoxic or immunosuppressive therapy is a serious cause of liver-related morbidity and mortality. With the characterization of the underlying pathogenesis, much progress in the management of this important clinical problem has been made in the past 2 decades. By year 2008, it is mandatory to screen for hepatitis B surface antigen status before initiating intensive chemotherapy or immunosuppressive therapy. All those who are hepatitis B surface antigen positive should be started on preemptive nucleos(t)ide analogues. However, there remains important issues, such as the type and duration of nucleos(t)ide analogue therapy, which need to be understood. As not all hepatitis B surface antigen-positive patients will suffer from HBV reactivation, it is therefore useful to identify risk factors related to HBV reactivation so that patients will not be treated unnecessarily with nucleos(t)ide analogues. To date, a high baseline level of viral replication, as reflected by high serum HBV DNA level, positive serum hepatitis B e antigen, and a high intrahepatic covalently closed circular DNA level, is the most important predictor for HBV reactivation. Recently, there has been an increased awareness of reactivation of occult hepatitis B virus, especially in hepatitis B virus endemic area, such as the Asia-Pacific region. Careful epidemiological study will be needed to clarify the impact of occult hepatitis B infection in patients treated with cytotoxic or immunosuppressive therapy.