Risk factors associated with iron deficiency anemia in children under 5 years of age attending a health center in chachapoyas, Peru

Desenho do estudo: Estudo retrospectivo de casos-controle. Objetivo: Identificar fatores de risco entre as características sociodemográficas, nutricionais e de saúde associados à anemia por deficiência de ferro em crianças menores de cinco anos de idade, atendendo à clínica de crescimento e desenvolvimento do Centro de Saúde Nueve de Enero de Chachapoyas durante 2019. Método: Foram formados dois grupos, cada um formado por 50 crianças. O grupo 1 (G1, casos) eram crianças diagnosticadas com anemia por deficiência de ferro e um grupo controle (GC) de crianças saudáveis, com idade compatível, residentes na mesma jurisdição. Os dados foram coletados dos registros médicos do centro de saúde, em uma ficha de registro estruturada com base nas variáveis do estudo: idade, peso ao nascer, doenças parasitárias ou sintomas associados, como diarréia, freqüência e tipo de alimentação antes e depois dos seis meses de idade. Os dados foram agrupados em tabelas de contingência para o cálculo do Odds Ratio (OR), e a significância estatística foi estimada pela análise de variância (ANOVA) com 95% de confiança. Resultados: Todos os fatores considerados apresentaram associação significativa p<0,05, com exceção do sexo, no que diz respeito à presença de anemia em crianças. Com valores OR de: menos de 32 meses de idade (OR=2,26, 95% CI 0,59-2,79), menos de 2900 g de peso ao nascer (OR=2,98, 95% CI 0,43-2,99), amamentação exclusiva prolongada (OR=3,14, 95% CI 1. 55-3. 88), ablactação precoce (OR=4,96, 95% CI 1,27-5,07), baixo consumo de alimentos de origem animal (3,5, 95% CI 1,18-3,61), baixo consumo de frutas e vegetais (2,33, 95% CI 0,86-2,63), entre outros. Conclusão: Na população de Chachapoyas, os fatores considerados no estudo aumentam em mais de 93% o risco de desenvolver anemia em crianças com menos de cinco anos de idade. Sua probabilidade de ocorrência justifica uma reavaliação das estratégias aplicadas nos diferentes programas ou intervenções realizadas na área para o controle e prevenção da anemia.Study Design: Retrospective case-control study. Objective: To identify risk factors among sociodemographic, nutritional and health characteristics associated with iron deficiency anemia in children under five years of age, attending the growth and development clinic of the Nueve de Enero de Chachapoyas Health Center during 2019.  Methods: Two groups were formed, each consisting of 50 children. Group 1 (G1, cases) were children diagnosed with iron deficiency anemia and a control group (CG) of age-matched healthy children residing in the same jurisdiction. Data were collected from the medical records of the health center, in a structured record card based on the study variables: age, birth weight, parasitic diseases or associated symptomatologies such as diarrhea, frequency and type of feeding before and after six months of age. The data were grouped in contingency tables for the calculation of Odds Ratio (OR), and statistical significance was estimated by analysis of variance (ANOVA) with 95% confidence. Results: All the factors considered presented significant association p<0.05, with the exception of sex, with respect to the presence of anemia in children. With OR values of: under 32 months of age (OR=2.26, 95% CI 0.59-2.79), under 2900 g birth weight (OR=2.98, 95% CI 0.43-2.99), prolonged exclusive breastfeeding (OR=3.14, 95% CI 1. 55-3.88), early ablactation (OR=4.96, 95% CI 1.27-5.07), low consumption of foods of animal origin (3.5, 95% CI 1.18-3.61), low consumption of fruits and vegetables (2.33, 95% CI 0.86-2.63), among others. Conclusions: In the population of Chachapoyas, the factors considered in the study increase the risk of developing anemia in children under five years of age by more than 93%. Its probability of occurrence warrants a reevaluation of the strategies applied in the different programs or interventions carried out in the area for the control and prevention of anemia.Study Design: Retrospective case-control study. Objective: To identify risk factors among sociodemographic, nutritional and health characteristics associated with iron deficiency anemia in children under five years of age, attending the growth and development clinic of the Nueve de Enero de Chachapoyas Health Center during 2019.  Methods: Two groups were formed, each consisting of 50 children. Group 1 (G1, cases) were children diagnosed with iron deficiency anemia and a control group (CG) of age-matched healthy children residing in the same jurisdiction. Data were collected from the medical records of the health center, in a structured record card based on the study variables: age, birth weight, parasitic diseases or associated symptomatologies such as diarrhea, frequency and type of feeding before and after six months of age. The data were grouped in contingency tables for the calculation of Odds Ratio (OR), and statistical significance was estimated by analysis of variance (ANOVA) with 95% confidence. Results: All the factors considered presented significant association p<0.05, with the exception of sex, with respect to the presence of anemia in children. With OR values of: under 32 months of age (OR=2.26, 95% CI 0.59-2.79), under 2900 g birth weight (OR=2.98, 95% CI 0.43-2.99), prolonged exclusive breastfeeding (OR=3.14, 95% CI 1. 55-3.88), early ablactation (OR=4.96, 95% CI 1.27-5.07), low consumption of foods of animal origin (3.5, 95% CI 1.18-3.61), low consumption of fruits and vegetables (2.33, 95% CI 0.86-2.63), among others. Conclusions: In the population of Chachapoyas, the factors considered in the study increase the risk of developing anemia in children under five years of age by more than 93%. Its probability of occurrence warrants a reevaluation of the strategies applied in the different programs or interventions carried out in the area for the control and prevention of anemia

Undergraduate medical textbooks do not provide adequate information on intravenous fluid therapy: a systematic survey and suggestions for improvement

<b>Background</b><p></p> Inappropriate prescribing of intravenous (IV) fluid, particularly 0.9% sodium chloride, causes post-operative complications. Fluid prescription is often left to junior medical staff and is frequently poorly managed. One reason for poor intravenous fluid prescribing practices could be inadequate coverage of this topic in the textbooks that are used.<p></p> <b>Methods</b><p></p> We formulated a comprehensive set of topics, related to important common clinical situations involving IV fluid therapy, (routine fluid replacement, fluid loss, fluids overload) to assess the adequacy of textbooks in common use. We assessed 29 medical textbooks widely available to students in the UK, scoring the presence of information provided by each book on each of the topics. The scores indicated how fully the topics were considered: not at all, partly, and adequately. No attempt was made to judge the quality of the information, because there is no consensus on these topics.<p></p> <b>Results</b><p></p> The maximum score that a book could achieve was 52. Three of the topics we chose were not considered by any of the books. Discounting these topics as “too esoteric”, the maximum possible score became 46. One textbook gained a score of 45, but the general score was poor (median 11, quartiles 4, 21). In particular, coverage of routine postoperative management was inadequate.<p></p> <b>Conclusions</b><p></p> Textbooks for undergraduates cover the topic of intravenous therapy badly, which may partly explain the poor knowledge and performance of junior doctors in this important field. Systematic revision of current textbooks might improve knowledge and practice by junior doctors. Careful definition of the remit and content of textbooks should be applied more widely to ensure quality and “fitness for purpose”, and avoid omission of vital knowledge

A Goal-Oriented Autonomous Controller for Space Exploration

The Goal-Oriented Autonomous Controller (GOAC) is the envisaged result of a multi-institutional effort within the on-going Autonomous Controller R&D activity funded by ESA ESTEC. The objective of this effort is to design, build and test a viable on-board controller to demonstrate key concepts in fully autonomous operations for ESA missions. This three-layer architecture is an integrative effort to bring together four mature technologies; for a functional layer, a verification and validation system, a planning engine and a controller framework for planning and execution which uses the sense-plan-act paradigm for goal oriented autonomy. GOAC as a result will generate plans in situ, deterministically dispatch activities for execution, and recover from off-nominal conditions

Risk factors associated with iron deficiency anemia in children under 5 years of age attending a health center in Chachapoyas, Peru.

Study Design: Retrospective case-control study. Objective: To identify risk factors among sociodemographic, nutritional and health characteristics associated with iron deficiency anemia in children under five years of age, attending the growth and development clinic of the Nueve de Enero de Chachapoyas Health Center during 2019.  Methods: Two groups were formed, each consisting of 50 children. Group 1 (G1, cases) were children diagnosed with iron deficiency anemia and a control group (CG) of age-matched healthy children residing in the same jurisdiction. Data were collected from the medical records of the health center, in a structured record card based on the study variables: age, birth weight, parasitic diseases or associated symptomatologies such as diarrhea, frequency and type of feeding before and after six months of age. The data were grouped in contingency tables for the calculation of Odds Ratio (OR), and statistical significance was estimated by analysis of variance (ANOVA) with 95% confidence. Results: All the factors considered presented significant association p<0.05, with the exception of sex, with respect to the presence of anemia in children. With OR values of: under 32 months of age (OR=2.26, 95% CI 0.59-2.79), under 2900 g birth weight (OR=2.98, 95% CI 0.43-2.99), prolonged exclusive breastfeeding (OR=3.14, 95% CI 1. 55-3.88), early ablactation (OR=4.96, 95% CI 1.27-5.07), low consumption of foods of animal origin (3.5, 95% CI 1.18-3.61), low consumption of fruits and vegetables (2.33, 95% CI 0.86-2.63), among others. Conclusions: In the population of Chachapoyas, the factors considered in the study increase the risk of developing anemia in children under five years of age by more than 93%. Its probability of occurrence warrants a reevaluation of the strategies applied in the different programs or interventions carried out in the area for the control and prevention of anemia

Marrow-Infiltrating Regulatory T Cells Correlate with the Presence of Dysfunctional CD4⁺PD-1⁺ Cells and Inferior Survival in Patients with Newly Diagnosed Multiple Myeloma

PURPOSE: Immune dysregulation is described in multiple myeloma(MM). While preclinical models suggest a role for altered T cell immunity in disease progression, the contribution of immune dysfunction to clinical outcomes remains unclear. We aimed to characterise marrow infiltrating T cells in newly diagnosed patients and explore associations with outcomes of first line therapy. EXPERIMENTAL DESIGN: We undertook detailed characterisation of T cells from bone marrow(BM) samples, focusing on immune checkpoints and features of immune dysfunction, correlating with clinical features and progression free survival. RESULTS: We found that patients with MM had greater abundance of BM regulatory T cells (Tregs) which, in turn, expressed higher levels of the activation marker CD25 compared to healthy donors. Patients with a higher frequencies of Tregs (Treghi) had shorter PFS, and a distinct Treg immune checkpoint profile (increased PD-1, LAG-3) compared to Treglopatients. Analysis of CD4 and CD8 effectors revealed that low CD4effector:Treg ratio, and increased frequency of PD-1 expressing CD4effcells were independent predictors of early relapse over and above conventional risk factors such as genetic risk and depth of response. Ex-vivo functional analysis and RNA sequencing revealed that CD4 and CD8 cells from patients with greater abundance of CD4effPD-1+ cells displayed transcriptional and secretory features of dysfunction. CONCLUSIONS: BM infiltrating T cell subsets, specifically Treg and PD-1 expressing CD4 effectors, negatively influence clinical outcomes in newly diagnosed patients. Pending confirmation in larger cohorts and further mechanistic work, these immune parameters may inform new risk models, and present potential targets for immunotherapeutic strategies