Search

Introduction: Social determinants of health (SDH) may influence children's weight status. Our objective was to examine relationships between SDH and preschoolers' weight status., Methods: This retrospective cohort study included 169 465 children (aged 4-6 years) with anthropometric measurements taken at immunization visits from 2009 to 2017 in Edmonton and Calgary, Canada. Children were categorized by weight status based on WHO criteria. Maternal data were linked to child data. The Pampalon Material and Social Deprivation Indexes were used to assess deprivation. We used multinomial logistic regression to generate relative risk ratios (RRRs) to examine associations between ethnicity, maternal immigrant status, neighbourhood-level household income, urban/ rural residence and material and social deprivation with child weight status., Results: Children of Chinese ethnicity were less likely than those in the General Population to have overweight (RRR = 0.64, 95% CI: 0.61-0.69) and obesity (RRR = 0.51, 0.42-0.62). Children of South Asian ethnicity were more likely than those in the General Population to have underweight (RRR = 4.14, 3.54-4.84) and more likely to have obesity (RRR = 1.39, 1.22-1.60). Children with maternal immigrant status were less likely than those without maternal immigrant status to have underweight (RRR = 0.72, 0.63-0.82) and obesity (RRR = 0.71, 0.66-0.77). Children were less likely to have overweight (RRR = 0.95, 0.94-0.95) and obesity (RRR = 0.88, 0.86-0.90) for every CAD 10 000 increase in income. Relative to the least deprived quintile, children in the most materially deprived quintile were more likely to have underweight (RRR = 1.36, 1.13-1.62), overweight (RRR = 1.52, 1.46-1.58) and obesity (RRR = 2.83, 2.54-3.15). Relative to the least deprived quintile, children in the most socially deprived quintile were more likely to have overweight (RRR = 1.21, 1.17-1.26) and obesity (RRR = 1.40, 1.26-1.56). All results are significant to p < 0.001., Conclusion: Our findings suggest the need for interventions and policies to address SDH in preschoolers to optimize their weight and health., Competing Interests: GDCB served as a member of the Novo Nordisk Canada Pediatric Expert Obesity National Advisory Board. The other authors have no conflicts of interest to declare.

Angiotensin-converting enzyme inhibitors (CEI) have been found effective in numerous cases of arterial hypertension, even non renovascular, and they are now widely used. However, the reference compound, captopril, has exhibited various side-effects, including acute renal failure. Different mechanisms may be responsible for this complication. In some case haemodynamic changes occur which are rapidly reversible after treatment is discontinued. In other, less frequent cases, captopril induces an immunoallergic interstitial nephritis, sometimes accompanied by skin rashes and/or eosinophilia. Since renal biopsies have been performed in only a few cases of CEI-induced nephropathy, we thought that it might be of interest to report a case of acute renal failure due to acute interstitial nephritis with epithelioid granulomas in the interstitium. The favourable outcome was confirmed by two successive follow-up renal biopsies.

A 33-year-old woman presented with chronic diarrhea, vomiting and anasarca due to systemic lupus erythematosus with protein-losing enteropathy, interstitial cystitis and glomerulonephritis. Methylprednisolone could not prevent aggravation of diarrhea, obstructive uropathy, and nephrotic syndrome, and prolonged intestinal ileus developed. Because of this steroid-resistance, bolus injections of cyclophosphamide (1 g i.v. monthly) were decided. Protein-losing enteropathy and ileus both disappeared rapidly following the first injection. Protein-losing enteropathy, intestinal ileus and interstitial cystitis are exceptional manifestations of systemic lupus erythematosus; steroid-resistance of the digestive manifestations has only been reported in one case and our observation is the first reporting the efficacy of cyclophosphamide.

To the best of our knowledge this is the reported first case of the successive occurrence in the same patient of chronic active hepatitis and acquired pure red cell aplasia, both probably of autoimmune origin. The diagnosis of autoimmune hepatitis was based on the presence of characteristic lesions at the examination of the liver biopsy specimen, high titer of anti-smooth muscle antibodies in the serum, and remission obtained by steroid therapy. Erythroid aplasia, which appeared during the course of this treatment, was revealed by a regenerative anemia (4.4 g Hb/100 ml) and proved by bone marrow aspiration and biopsy. In vitro bone marrow culture was normal, suggesting the in vivo presence of an inhibitor of erythroblastic differentiation. Red cell aplasia was cured by cyclophosphamide (100 mg/day during 56 days). No recurrence was noted until the death of the patient, which occurred one year later, due to hepatic cholangiocarcinoma. Action of cyclophosphamide on the pure red cell aplasia suggested the immune origin of this disease. The liver and the bone marrow erythroid lineage have probably been the successive targets of immunologic dyscrasia.

A retrospective study of 150 patients with acute renal failure (ARF) was conducted to assess the influence of both protein and caloric intake and non-renal complications on the prognosis, as well as the predictive value of plasma protein levels. The majority of ARF had occurred in medical or surgical settings (46% and 32.7%, respectively). Nutritional data were available from 94 patients, fed either by parenteral or enteral routes, or both. The mean caloric intake was higher (29 kcal/kg/day) in patients who recovered than in those who did not (24 kcal/kg/day, p less than 0.01). A caloric intake above 35 kcal/kg/day resulted in an improved survival, independently of either patients' age or non-renal complications. Serum prealbumin and transferrin levels were higher in surviving patients than in those who died, 0.25 vs 0.16 g/l (p less than 0.001) and 1.7 vs 1.4 g/l (p less than 0.01), respectively. Nutritional support in ARF could be adapted according to the variations of these serum markers. Its influence on survival should be assessed with regard to the associated prognosis factors.