RESUMEN
Anemia-specific mortality was markedly elevated among refugee children < 5 years of age in Tanzania. In a randomized, double-blind study, 215 anemic children were initially treated for malaria and helminth infection and then received 12 weeks of thrice-weekly oral iron and folic acid. Group I received placebo and chloroquine treatment for symptomatic malaria infection (i.e., no presumptive anti-malarial treatment given). Group II received placebo and monthly presumptive treatment with sulfamethoxazole-pyrimethamine (SP). Group III also received monthly SP and thrice-weekly vitamins A and C (VAC). Mean hemoglobin concentration increased from 6.6 to 10.2 g/dL, with no significant differences among groups. Group II had lower mean serum transferrin receptor levels (TfR) than group I [P = 0.023]. A greater proportion of participants in group III had normal iron stores (TfR < 8.5 microg/ mL) than in group II [P = 0.012]. Initial helminth and malaria treatment, followed by thrice-weekly iron and folic acid supplements resulted in increased hemoglobin levels. Monthly SP and thrice-weekly VAC contributed to improve iron stores. Monthly SP may have a role in situations where asymptomatic disease is prevalent or where access to care is limited. Because administration of VAC also hastened recovery of iron stores over administration of monthly SP alone, health care personnel could add VAC to the treatment for moderate anemia if maximum recovery of iron stores is desired.
Asunto(s)
Anemia Ferropénica/tratamiento farmacológico , Antimaláricos/uso terapéutico , Cloroquina/uso terapéutico , Malaria/tratamiento farmacológico , Pirimetamina/uso terapéutico , Sulfametoxazol/uso terapéutico , Ácido Ascórbico/administración & dosificación , Preescolar , Método Doble Ciego , Esquema de Medicación , Femenino , Ácido Fólico/administración & dosificación , Humanos , Lactante , Hierro de la Dieta/administración & dosificación , Masculino , Refugiados , Índice de Severidad de la Enfermedad , Tanzanía , Vitamina A/administración & dosificaciónRESUMEN
Opinions expressed in commentaries are those of the authors and not necessarily those of the American Academy of Pediatrics or its Committees. Commentaries are not peer-reviewed.
Asunto(s)
Raquitismo/epidemiología , Lactancia Materna/estadística & datos numéricos , Niño , Niño Hospitalizado/estadística & datos numéricos , Preescolar , Femenino , Georgia/epidemiología , Humanos , Lactante , Trastornos de la Nutrición del Lactante/epidemiología , Trastornos de la Nutrición del Lactante/etiología , Recién Nacido , Leche Humana/fisiología , Raquitismo/etiología , Factores de Riesgo , Deficiencia de Vitamina D/epidemiología , Deficiencia de Vitamina D/etiología , DesteteRESUMEN
BACKGROUND: Hemolysis associated with hemodialysis is rare. The most frequent causes of hemodialysis-associated hemolysis are chemical contamination, heat, or mechanical injury of erythrocytes from occluded or kinked hemodialysis blood lines. When patients in three states developed hemolysis while undergoing hemodialysis between May 13 and 23, 1998, an investigation was initiated. METHODS: A case-patient was defined as any patient at healthcare facilities A (Nebraska), B (Maryland), or C (Massachusetts) during May 13 through 23, 1998 (epidemic period), who had hemolysis diagnosed > or =48 hours after undergoing hemodialysis. To identify case-patients and to determine background rates, the medical records of patients from facilities A, B, and C who were undergoing hemodialysis during the epidemic and pre-epidemic (that is, May 5 through 19, 1998) periods were reviewed. Experiments simulating hemodialysis with the same lot numbers of hemodialysis blood tubing cartridge sets used on case- and control-patients were conducted. RESULTS: The rates of hemolysis among patients at facilities A, B, and C were significantly higher during the epidemic than the pre-epidemic period (13 out of 118 vs. 0 out of 118, P < 0.001; 12 out of 298 vs. 0 out of 298, P = 0.001; and 5 out of 62 vs. 0/65, P = 0.03, respectively). All case-patients had hemolysis. Twenty (66%) had hypertension. Eighteen (60%) had abdominal pain, and 10 (36%) were admitted to an intensive care unit. There were two deaths. The only commonality among the three outbreaks was the use of the same lot of disposable hemodialysis blood tubing from one manufacturer. Examination of the implicated hemodialysis blood tubing cartridge sets revealed narrowing of an aperture through which blood was pumped before entering the dialyzers. In vitro experiments with the hemodialysis blood tubing revealed that hemolysis was caused by increased pressure on erythrocytes as they passed through the partially occluded hemodialysis blood tubing. CONCLUSIONS: Our investigation traced the multiple hemolysis outbreaks to partially occluded hemodialysis blood tubing produced by a single manufacturer. On May 25, 1998, the manufacturer issued a voluntary nationwide recall of the implicated lots of hemodialysis blood tubing cartridge sets.