Physical growth in thalassemic children of 2-12 years with multiple transfusions

The hemoglobinopathies are the most common single-gene defect in man. The thalassemia syndromes are a heterogeneous group of hereditary disorder due to decreased synthesis of either α or β globin chain of Hb A. There are 3 phases of growth disturbances and have three different etiologies. First phase: growth disturbances is mainly due to hypoxia, anaemia, ineffective erythropoiesis and nutritional factors; the Second phase: During late childhood, growth retardation is mainly due to iron overload affecting the GH-IGF-1 axis and other endocrinal complications. Third phase: after the age of 10-11 years, delayed or arrested puberty is an important contributory factor to growth failure in adolescents thalassemic who does not show any growth spurt. Cross-sectional, observational, single-centre, tertiary hospital-based study. Children of thalassemia major of 2-12 years with multiple transfusions was taken over 1 year. Study population was divided into 2 groups: Group1-irregularly transfused; Group 2-regularly transfused. Clinical settings, anthropometry, laboratory tests like serum ferritin, pre-transfusion haemoglobin, total leucocyte count etc. were taken into consideration. Thalassemia children with other comorbidities like tuberculosis, chronic kidney disease, chronic heart diseases etc. were excluded from the study.Among the 200 children, 143 (71.5%) were taking regular (2-4 weekly) transfusion therapy and 57 (28.5%) were taking irregular transfusion (>4weekly). Mean age of diagnosis was 18.66 ± 7.443months in Group 1 (Irregularly transfused) and 18.93 ± 7.218 months in Group 2 (Regularly transfused). Among the regularly transfused thalassemic 17.7% children had W/A < 3 percentile and among the irregularly transfused children it was 15%. Among the irregularly transfused children, 27. 1% and among the regularly transfused children 21.6% had H/A <3rd percentile. In the present study children 61% had normal BMI and only 5.4 % had BMI less than 3rd percentile overall. Among irregularly transfused thalassemic children >10years of age, 86.7% have not attained puberty yet. Among the regularly transfused thalassemic children 96.7% have not attained puberty yet. US and LS individually affected resulting in stunting but it was proportionate innature so US: LS ratio was according to age. A positive correlation between pre-transfusion haemoglobin and W/A and H/A suggested that with decreasing pre-transfusion haemoglobin concentration more child had growth retardation. Mean value of serum Ferritin was 941 ± 608.490 ng/ml in Group 1(Irregularly transfused) and Mean value of serum Ferritin was 1403 ± 685.584ng/ml in Group 2(Regularly transfused). MUAC in the present study was 12.44cm suggesting mild-moderate malnutrition. Extremely variable clinical and haematological findings were observed in these patients. Growth retardation has found in both regularly and irregularly transfused patients. These findings are almost comparable to other Indian studies. Appropriate knowledge regarding prenatal counselling, early diagnosis, regular transfusions and overall treatment can help better management of this group of patients.

Antiphospholipid antibodies, genetic thrombophilia and fetal growth retardation

Aim: to study the role of antiphospholipid antibodies (AРA) and genetic thrombophilia as a potential cause of the development or a component in the pathogenesis of early and late fetal growth retardation (FGR).Materials and Methods. There was conducted a prospective randomized controlled trial with 118 women enrolled. The main group consisted of 83 patients, whose pregnancy was complicated by FGR degrees II and III, stratified into two groups: group 1 – 36 pregnant women with early FGR, group 2 – 47 pregnant women with late FGR. Women were subdivided into subgroups according to the FGR severity. The control group consisted of 35 pregnant women with a physiological course of pregnancy. АРА were determined according to the Sydney antiphospholipid syndrome criteria by enzyme immunoassay (ELISA): against cardiolipin, β2 -glycoprotein 1, annexin V, prothrombin, etc. (IgG/IgM isotypes); lupus anticoagulant – by the three-stage method with Russell's viper venom; antithrombin III and protein C levels – by chromogenic method; prothrombin gene polymorphisms G20210A and factor V Leiden – by polymerase chain reaction; homocysteine level – by ELISA.Results. AРA circulation (medium and high titers), genetic thrombophilic defects and/or hyperhomocysteinemia were detected in 40 (48.2 %) patients with FGR, which was significantly higher than that in the control group (p < 0.05): in group 1 (41.7 % of women) AРA (30.6 %) and AРA with genetic thrombophilia or hyperhomocysteinemia (11.1 %) were revealed; in group 2 (51.1 % of women) AРA (21.3 %), AРA with hyperhomocysteinemia (4.3 %), genetic thrombophilia (25.5 %), and due to hyperhomocysteinemia (2.1 %) were found. No differences in prevalence of thrombophilia rate in patients were observed related to FGR severity, but a correlation between the FGR severity and AРA titers was found.Conclusion. Testing for the presence of AРA, genetic thrombophilia and hyperhomocysteinemia should be recommended for patients with FGR (including those with FGR in medical history), especially in the case of its early onset. It is recommended to determine the full AРA spectrum.

Neonatal hypoglycemia in children with risk factors

Objective: The analysis of clinical-laboratory peculiarities and the dynamics of glycemia clarifying the terms of blood glucose stabilization during the early neonatal period in children having risk factors of the development of such state.Methods: Open, retrospective , continuous, single-center study was conducted. It was aimed at getting preliminary data that is important for planning further tactics of examining newborns having risk factors on hypoglycemia development (kids having large body weight at birth, children whose mothers have diabetes, newborns having intrauterine growth retardation).The target group of the survey included 522 newborns of both genders in the early neonatal period (from 0 to 7 days of life).Results: There is data on the frequency of first indicated hypoglycemia in newborns having risk factors of the development of such state, clinicallaboratory peculiarities, the dynamics of glycemia during early neonatal period, and also the period of blood glucose stabilization (the age of reaching normoglycemia). Neonatal hypoglycemia was detected in 40.2% of examined children. Laboratory manifestation during the first day of life was noticed 62.9% of cases with the further normalization of glucose level in blood in 24 hours in 73.3% of newborns. Significant reduction of blood glucose was observed in 54.8% of cases requiring hypoglycemia therapy with parenteral prescription of 10% glucose solution. Hypoglycemia jugulated against oral correction of 5% glucoses solution in 40.5 % of cases. 4.8% of children got the level of glucose stabilized after introduction of supplementary feeding.Conclusion: The results of the newborns having risk factors on hypoglycemia development (kids having large body weight at birth, children whose mothers have diabetes, newborns having intrauterine growth retardation) examinations are presented. The peculiarities of neonatal hypoglycemia are: the absence of a typical clinical symptoms among 89% of children. Asymptomatic course of hypoglycemia confirms the importance and necessity of glycemia monitoring in the early neonatal period in order to conduct timely and adequate therapy.

A Comparative Study to Assess the Knowledge and Attitude Regarding Intra Uterine Growth Retardation and its Prevention Among Antenatal Mothers in Rural and Urban Areas

Intra Uterine Growth Retardation is an important cause of fetal and neonatal morbidity and mortality. The present study was undertaken to compare the knowledge and attitude regarding intra uterine growth retardation and its prevention among antenatal mothers in rural and urban areas Khammam, Telangana. The objectives of the study were to describe the levels of knowledge and attitude, to compare the levels of Knowledge and attitude in rural and urban areas, to find out the association between knowledge and attitude scores with their selected socio-demographic variables. A quantitative survey approach and comparative descriptive design was used for this study. The sample for current study is antenatal mothers who were residing at Raghunadhapalem rural area and Ballepalli urban area, Khammam. The sample size was 100((50 rural+50 urban) and the sample was selected by non-probability convenience sampling technique. Data was collected by using structure interview schedule. The Findings revealed that the knowledge means of antenatal mothers in rural and urban areas were 14.10 and 16.68 respectively. Standard deviations were 3.29 and 3.3 respectively. The ‘t’ calculated value was 3.89 which is significant at 0.05. The attitude means of antenatal mothers in rural and urban areas were 36.08 and 36.02 respectively. Standard deviations were 2.15 and 2.48 respectively. The ‘t’ calculated value was 0.12 which is significant at 0.05. The study concluded that the level of knowledge is low in rural area by comparing with urban area. There is an increased need for awareness program regarding intra uterine growth retardation and its prevention in selected setting in order to promote the health of the fetus and the mother.

Fetal growth retardation in multiple pregnancy: anthropometrical and haemodynamic criteria of early antenatal diagnosis

Ultrasound investigation o f feta l biometry and haemodynamic indices in fetoplacental system during pregnancy since 14 weeks was carried out in 53 women havingtwins as a result o f spontaneous pregnancy or using o f assisted reproductive technology methods. The frequency and possible reasons oflU G R development in multiple pregnancy were analyzed. To predict the possibility o f IUG R in II and III trimester o f multiple pregnancy the mathematic model was worked out based on the standard fetometric indices measuring at 14-16 weeks o f pregnancy.

Improvement of Growth Retardation and Related Immunodeficiency by Dietary Intervention with Crackers Containing Animal Source Ingredients in Malnourished Rats

Hidden hunger is a risk factor for many health problems, including stunting, which is one of the globally prevalent signs of malnutrition. Stunting can be reduced through feeding on animal source foods. In our study, some animal source foods (egg, butter, yoghurt, and white cheese) in addition to other nutritious ingredients (wheat flour, minced fresh carrot, wheat germ, yeast, and iodine salt) were used to prepare four samples of crackers, with different taste (cumin, paprika, tomato, and cheese). The dough from all ingredients was prepared, flattened, cut then baked to prepare the crackers. These crackers were organoleptically and physically evaluated. Antioxidant activity, total phenolic content (TPC) and total flavonoid contents of the crackers’ samples were determined. The cumin-flavored crackers (the highest in TPC, flavonoids, and antioxidant activity) was evaluated for its macro-and micronutrients and studied in malnourished rats. Two groups of rats (each of 12) were fed on a balanced diet and a protein-deficient diet, respectively for 3 weeks. Six rats from each group were sacrificed and the remaining rats were fed on a balanced diet and diet supplemented with the cumin-flavored crackers, respectively for 5 weeks. The cumin-flavored crackers (100 g) contained 15.64 g protein, 231.00 mg calcium, 4.00 mg zinc, 83.75 µg iodine, arginine (16.53 mg/g protein), and lysine (19.30 mg/g protein). Malnutrition, immunodeficiency (as evidenced by a drop in cluster of differentiation 4 (CD4), cluster of differentiation 8 (CD8) and CD4/CD8 ratio), and stunting (as evidenced by a decrease in rat length, femur length, and insulin growth factor-1) were all observed in rats fed a protein-deficient diet for 3 weeks. Also, femur calcium and magnesium decreased in the malnourished rats. The dietary intervention with the cumin-flavored crackers reversed the reduction in aforementioned parameters in the malnourished rats. The cumin-flavored crackers may improve growth retardation and related immunodeficiency in previously malnourished rats.