Anaemia and blood transfusion in African children presenting to hospital with severe febrile illness

BACKGROUND: Severe anaemia in children is a leading cause of hospital admission and a major cause of mortality in sub-Saharan Africa, yet there are limited published data on blood transfusion in this vulnerable group. METHODS: We present data from a large controlled trial of fluid resuscitation (Fluid Expansion As Supportive Therapy (FEAST) trial) on the prevalence, clinical features, and transfusion management of anaemia in children presenting to hospitals in three East African countries with serious febrile illness (predominantly malaria and/or sepsis) and impaired peripheral perfusion. RESULTS: Of 3,170 children in the FEAST trial, 3,082 (97%) had baseline haemoglobin (Hb) measurement, 2,346/3,082 (76%) were anaemic (Hb <10 g/dL), and 33% severely anaemic (Hb <5 g/dL). Prevalence of severe anaemia varied from 12% in Kenya to 41% in eastern Uganda. 1,387/3,082 (45%) children were transfused (81% within 8 hours). Adherence to WHO transfusion guidelines was poor. Among severely anaemic children who were not transfused, 52% (54/103) died within 8 hours, and 90% of these deaths occurred within 2.5 hours of randomisation. By 24 hours, 128/1,002 (13%) severely anaemic children had died, compared to 36/501 (7%) and 71/843 (8%) of those with moderate and mild anaemia, respectively. Among children without severe hypotension who were randomised to receive fluid boluses of 0.9% saline or albumin, mortality was increased (10.6% and 10.5%, respectively) compared to controls (7.2%), regardless of admission Hb level. Repeat transfusion varied from ≤2% in Kenya/Tanzania to 6 to 13% at the four Ugandan centres. Adverse reactions to blood were rare (0.4%). CONCLUSIONS: Severe anaemia complicates one third of childhood admissions with serious febrile illness to hospitals in East Africa, and is associated with increased mortality. A high proportion of deaths occurred within 2.5 hours of admission, emphasizing the need for rapid recognition and prompt blood transfusion. Adherence to current WHO transfusion guidelines was poor. The high rates of re-transfusion suggest that 20 mL/kg whole blood or 10 mL/kg packed cells may undertreat a significant proportion of anaemic children. Future evaluation of the impact of a larger volume of transfused blood and optimum transfusion management of children with Hb of <6 g/dL is warranted. Please see related article: http://dx.doi.org/10.1186/s12916-014-0248-5. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12916-014-0246-7) contains supplementary material, which is available to authorized users

Antihypertensive drug class and dyslipidemia: risk association among Chinese patients with uncomplicated hypertension

Factors associated with dyslipidemia in Chinese patients with uncomplicated hypertension were investigated in 1,139 patients newly prescribed a single antihypertensive drug in the public primary healthcare setting in Hong Kong, where their fasting lipid profiles were measured 4 to 16 weeks after the first prescription. Multivariate logistic regression showed that thiazide users were more likely (OR 3.67, 95% C.I. 1.13, 11.88, p=0.030) to have adverse (&gt; 6.2mmol/l) total cholesterol (TC) compared with drugs acting on the renin angiotensin system (RAS), but the absolute difference in mean TC between thiazide users and all patients was small ( 0.14 mmol/l), while advanced age and male gender were also associated with some aspects of dyslipidemia. Clinicians should be aware of the increased risk of dyslipidemia in these groups, but the mild dyslipidemic profile associated with thiazides should not in itself deter its use as a possible first-line antihypertensive agent among Chinese patients

Anomalous Rotational Relaxation: A Fractional Fokker-Planck Equation Approach

In this study we obtained analytically relaxation function in terms of rotational correlation functions based on Brownian motion for complex disordered systems in a stochastic framework. We found out that rotational relaxation function has a fractional form for complex disordered systems, which indicates relaxation has non-exponential character obeys to Kohlrausch-William-Watts law, following the Mittag-Leffler decay.Comment: Revtex4, 9 pages. Paper was revised. References adde

WHO guidelines on fluid resuscitation in children: missing the FEAST data.

The World Health Organization recommendations on management of common childhood illnesses affect the lives of millions of children admitted to hospital worldwide. Its latest guidelines,1 released in May 2013, continue to recommend rapid fluid resuscitation for septic shock, even though the only large controlled trial of this treatment (Fluid Expansion as a Supportive Treatment (FEAST) found that it increased the risk of death in African children.2 A subsequent systematic review of bolus resuscitation in children with shock resulting from severe infection also did not support its use.3 Failure to take this evidence into account is not consistent with WHO’s commitment to systematically and transparently assess evidence using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) process when producing guidelines and could endanger the lives of children

Mathematical modeling of cell population dynamics in the colonic crypt and in colorectal cancer

Colorectal cancer is initiated in colonic crypts. A succession of genetic mutations or epigenetic changes can lead to homeostasis in the crypt being overcome, and subsequent unbounded growth. We consider the dynamics of a single colorectal crypt by using a compartmental approach [Tomlinson IPM, Bodmer WF (1995) Proc Natl Acad Sci USA 92: 11130-11134], which accounts for populations of stem cells, differential cells, and transit cells. That original model made the simplifying assumptions that each cell popuation divides synchronously, but we relax these assumptions by adopting an age-structured approach that models asynchronous cell division, and by using a continuum model. We discuss two mechanims that could regulate the growth of cell numbers and maintain the equilibrium that is normally observed in the crypt. The first will always maintain an equilibrium for all parameter values, whereas the second can allow unbounded proliferation if the net per capita growth rates are large enough. Results show that an increase in cell renewal, which is equivalent to a failure of programmed cell death or of differentiation, can lead to the growth of cancers. The second model can be used to explain the long lag phases in tumor growth, during which news, higher equilibria are reached, before unlimited growth in cell number ensues

History Dependent Phenomena in the Transverse Ising Ferroglass: the Free Energy Landscape

In this paper we investigate the relationship between glassy and ferromagnetic phases in disordered Ising ferromagnets in the presence of transverse magnetic fields, $\Gamma$. Iterative mean field simulations probe the free energy landscape and suggest the existence of a glass transition as a function of $\Gamma$ which is distinct from the Curie temperature. New experimental field-cooled and zero-field-cooled data on LiHo$_x$Y$_{1-x}$F$_4$ provide support for our theoretical picture.Comment: 4 pages RevTex; 5 figure

Spectral Classification; Old and Contemporary

Beginning with a historical account of the spectral classification, its refinement through additional criteria is presented. The line strengths and ratios used in two dimensional classifications of each spectral class are described. A parallel classification scheme for metal-poor stars and the standards used for classification are presented. The extension of spectral classification beyond M to L and T and spectroscopic classification criteria relevant to these classes are described. Contemporary methods of classifications based upon different automated approaches are introduced.Comment: To be published in "Principles and Perspectives in Cosmochemistry" Lecture Notes on Kodai School on Synthesis of Elements in Stars: Ed Aruna Goswami & Eswar Reddy, Springer Verlag, 2009, 17 pages, 10 figure

Production of ethanol from livestock, agricultural, and forest residuals: An economic feasibility study

In this study, the economic feasibility of producing ethanol from gasification followed by syngas fermentation via commercially available technologies was theoretically evaluated using a set of selected livestock and agricultural and forest residuals ranging from low valued feedstocks (i.e., wood, wheat straw, wheat straws blended with dewatered swine manure, and corn stover) to high valued oilseed rape meal. A preliminary cost analysis of an integrated commercial system was made for two cases, a regional scale 50 million gallon (189,271 m3) per year facility (MGY) and a co-op scale 1–2 MGY facility. The estimates for the minimum ethanol selling prices (MESP) depend heavily on the facility size and feedstock costs. For the 1–2 MGY (3785–7571 m3/y) facility, the MESP ranged from $5.61–$7.39 per gallon ($1.48–$1.95 per liter) for the four low-value feedstocks. These high costs suggest that the co-op scale even for the low-value feedstocks may not be economically sustainable. However, the MESP for the 50 MGY facility were significantly lower and comparable to gasoline prices ($2.24–$2.96 per gallon or $0.59–$0.78 per liter) for these low-value feedstocks, clearly showing the benefits of scale-up on construction costs and MESP. © 2019 by the authors. Licensee MDPI, Basel, Switzerland