Prevalence of multiple micronutrient deficiencies amongst pregnant women in a rural area of Haryana

Deficiencies of micronutrients (zinc, iron, folic acid and iodine) during pregnancy are known causes of Low Birth Weight (LBW). Studies have documented status of one or two micronutrients amongst pregnant women (PW). However, no attempt has been made to concurrently assess the prevalence of multiple micronutrient deficiencies and the factors associated with them amongst PW.Objective: The present study was undertaken to assess the prevalence of multiple micronutrient deficiencies amongst PW in a rural area.Methods: A community based cross sectional survey was conducted in six villages of a rural area of district Faridabad in Haryana state, India during November 2000 and October 2001. All PW aged 18 years or more, with pregnancy duration of more than 28 weeks were enrolled. Data were collected on socio-economic status and other demographic parameters. Serum zinc, copper and magnesium levels were estimated by utilizing the Atomic absorption spectrophotometry (AAS); serum ferritin and folate was estimated by Enzyme Linked Immuno Sorbent Assay (ELISA) method and the Radio-lmmuno Assay (RIA) method, respectively and serum thyroid stimulating hormone (TSH) level was estimated by the Abbot AxSYM System. Serum zinc, copper, magnesium, ferritin, and folate levels less than 70.0 μg/dl, 80.0 μg/dl, 1.80 mg/dl, 15 ng/ml, and 3 ng/ml, respectively were considered as indicative of deficiency for respective micronutrients. The TSH levels of 4.670 and more indicated iodine deficiency status. Dietary intake of micronutrients was assessed utilizing 1-day 24-hour dietary recall methodology. Food consumption pattern was assessed utilizing the food frequency questionnaire methodology.Results: Nearly 73.5, 2.7, 43.6, 73.4, 26.3, and 6.4 percent PW were deficient in zinc, copper, magnesium, iron, folic acid and iodine, respectively. The highest concurrent prevalence of two, three, four and five micronutrient deficiency was of zinc and iron (54.9%); zinc, magnesium and iron (25.6%); zinc, magnesium, iron and folic acid (9.3%) and zinc, magnesium, iron, folic acid and iodine (0.8%), respectively. No pregnant woman was found to have concomitant deficiencies of all the six micronutrients. Dietary intake data revealed an inadequate nutrient intake. Over 19% PW were consuming less than 50% of the recommended calories. Similarly, 99, 86.2, 75.4, 23.6, 3.9 percent of the PW were consuming less than 50% of the recommended folic acid, zinc, iron, copper, and magnesium. The consumption of food groups rich in micronutrients (pulses, vegetables, fruits, nuts and oil seeds, animal foods) was infrequent. Univariate and Multivariate logistic regression analysis revealed that low dietary intake of nutrients, low frequency of consumption of food groups rich in micronutrients and increased reproductive cycles with short interpregnancy intervals were important factors leading to micronutrient deficiencies.Conclusion: There was a high prevalence of micronutrient deficiencies amongst the PW of the area, possibly due to the poor dietary intake of food and low frequency of consumption of food groups rich in micronutrients. The concurrent prevalence of two, three, four and five micronutrient deficiencies were common.     

Elimination of iodine deficiency disorders in Delhi

Objective: The present study was conducted in year 2002 in NCT of Delhi with the objective to re-assess the prevalence of iodine deficiency disorders.Methods : A total of 7009 children in the age group of 6–11 years were clinically examined for presence of goiter. A total of 991 salt samples were also collected randomly. On the spot casual urine samples were collected from 1395 children.Results : The total goiter prevalence was found to be 6.2 %. The percentage of children with urinary iodine excretion (UIE) of <20.0, 20.0-<50.0, 50.0–99.9 and 100.0 Μg/l and above was 0.8, 1.8, 8.7 and 88.7%, respectively. The median UIE level was 200 Μg/L The assessment of iodine content of salt revealed that only 16% of the families were consuming salt with iodine content less than 5 ppm.Conclusion : The findings of the present study indicated that the population is in a transition phase from iodine deficient (as revealed by Total Goiter Prevalence) to iodine sufficient nutriture (as revealed by median UIE 200 Μg/l). A significant progress has been achieved towards elimination of IDD from NCT of Delhi.     

Cerebro-oculo-facio-skeletal (COFS) syndrome in siblings

The authors report two sibs with COFS syndrome and review the relevant literature in brief. They emphasize the importance of prenatal diagnosis in this syndrome that has many mimics.     

Tuberous sclerosis: a case report

A case of tuberous sclerosis (TS) with classic triad of seizures, mental deficiency and angiofibromas is presented. The child also presented with self-mutilating behavior, which resulted in the fracture of her anterior teeth. A comprehensive treatment was rendered to the patient under general anesthesia and a mouth guard was given to prevent further trauma to the teeth.     

Hemodynamic status after the Norwood procedure: a comparison of right ventricle-to-pulmonary artery connection versus modified Blalock-Taussig shunt

Background

The aim of this study is to compare hemodynamic status, in particular systemic oxygen delivery, in patients undergoing a Norwood procedure with a right ventricle-to-pulmonary artery (RV-PA) versus a modified Blalock-Taussig (mBT) shunt.

Methods

From June 2000 to November 2003, 44 consecutive neonates with hypoplastic left heart syndrome underwent a Norwood procedure. The first 25 patients received an mBT shunt; the subsequent 19 an RV-PA shunt. Hemodynamic data, including mixed venous oxygen saturation, was determined during the first 48 hours after surgery.

Results

The mBT and RV-PA shunt patients had no significant differences in systemic oxygen saturation, mixed venous oxygen saturation, arteriovenous oxygen saturation difference, or oxygen excess factor during the first 48 hours. Mixed venous saturation declined to a nadir in both groups at 6 to 12 hours. The RV-PA patients had significantly higher diastolic and mean blood pressures, and lower systolic blood pressure. Mean heart rate, common atrial pressure, and inotrope score did not differ between the two groups. The RV-PA patients received higher fraction of inspired oxygen and minute ventilation to achieve partial pressures of arterial oxygen and carbon dioxide, and pH, similar to mBT patients. Durations of mechanical ventilation, intensive care unit stay, and hospital stay did not differ between mBT and RV-PA patients. Operative survival in the mBT versus RV-PA group was 20 of 25 (80%) versus 17 of 19 (89%; p = 0.7).

Conclusions

Indicators of postoperative systemic oxygen delivery are equivalent in neonates who have undergone a Norwood procedure with an mBT or RV-PA shunt. Both mBT and RV-PA patients undergo similar declines in hemodynamic status 6 to 12 hours after surgery. Any advantages of one approach over the other lie in areas other than systemic oxygen delivery, such as resistance to physiologic insults, or preservation of ventricular function.     

Bidirectional glenn operation in infancy

The ideal age for bidirectional Glenn shunt (BDGS) as the first stage of staged Fontan is still not clear. Because of the concerns regarding relatively high pulmonary vascular resistance during infancy, many centres would bridge through a systemic to pulmonary artery shunt in this age group. Patients and Methods We did a retrospective analysis of 28 infants who had undergone bidirectional Glenn shunt at our institute from February 200. Results The mean age was 5 months (2.5–11) and the mean weight was 6.5 Kg (3.4–8.7). Boys dominated the group (25∶3). 7 infants had previous procedures. In 3 patients, BDGS was done as a salvage procedure. Formal Cardiopulmonary bypass (CPB) was used in all but 4 patients, in whom a right heart bypass was used. Superior Vena Cava (SVC) or innominate vein was cannulated in 12 patients and the rest were managed with temporary occlusion of SVC under deep hypothermic low flow bypass. 9 infants had bilateral BDGS. The main pulmonary artery was interrupted in 12 and atrial septectomy was done in 10 patients. Additional procedures with BDGS included Patent Ductus Arterious (PDA) interruption, Blalock Taussig (BT) shunt interruption, Left pulmonary arterioplasty, Stansel procedure and redo TAPVC repair. The mean SVC pressure post operatively was 14 (10–24) and only 2 patients needed pulmonary vasodilators in the post-oprative period. There is only one mortality in this series and the duration of chest tube drainage and Intensive Care Unit (ICU) stay is comparable with the older age group. Conclusion BDGS can be performed safely in infants more than 2 months of age electively or as a salvage procedure. It helps to avoid one step in the form of aortopulmonary shunt and hence the ventricular volume overload associated with it. Further studies are required to establish the growth potential of pulmonary arteries following an early BDGS. Presented at the 50th annual meeting of IACTS, New Delhi, Feb. 2004.     

Combination therapy with polymyxin B for the treatment of multidrug-resistant Gram-negative respiratory tract infections

BACKGROUND: The treatment of infections caused by multidrug-resistant (MDR) Gram-negative organisms poses a therapeutic challenge. The use of polymyxin B has been resurrected specifically for this purpose. PATIENTS AND METHODS: We retrospectively reviewed the clinical and microbiological efficacy, and safety profile of polymyxin B in the treatment of MDR Gram-negative bacterial infections of the respiratory tract. Twenty-five critically ill patients received a total of 29 courses of polymyxin B administered in combination with another antimicrobial agent. RESULTS: Patients were treated with intravenous, and/or aerosolized polymyxin B. Mean duration of polymyxin B therapy was 19 days (range 2-57 days). End of treatment mortality was 21%, and overall mortality at discharge was 48%. Nephrotoxicity was observed in three patients (10%) and did not result in discontinuation of therapy. CONCLUSIONS: Polymyxin B in combination with other antimicrobials can be considered a reasonable and safe treatment option for MDR Gram-negative respiratory tract infections in the setting of limited therapeutic options.     

Wound problems due to zinc deficiency

Zinc deficiency, though uncommon, can occasionally present in current medical practice. A 4.5-year-old boy with previous gastrointestinal surgery presented with diarrhoea, disinterest and dermatitis affecting the face and perineum. The clinical diagnosis was confirmed by the presence of a low serum zinc level. Administration of parenteral zinc led to rapid improvement in diarrhoea, demeanor and dermatitis. Further surgery was then undertaken, surgery had been postponed until normalisation of zinc levels due the association between zinc deficiency and poor postoperative wound healing.