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The guidance here, including the protocols, can be used as part of providing regular health services in a clinic or community setting or to inform the use of anthropometric measurement in population-based surveys. The guide is also useful for anyone engaged in improving or understanding food security, nutrition, or health in developing countries who wishes to better understand the information provided through anthropometry. There are six modules and a section of annexes: 0 1 2 3 Children & 4 Pregnant & 5 Adults 7 Introduction Anthropometry Children Protocols & Adolescents Postpartum 18 years Annexes to the Guide Basics 0 to 5 years Equipment 5 to 19 years Women & Girls & older Module 1 explains anthropometry and its use, defnes key nutrition concepts (such Within a module, you as undernutrition and overweight), and includes a summary of all anthropometric can navigate quickly measurements, indices, indicators, and cutofs provided in the guide. Clinicians should use their judgment on which indices, indicators, and cutofs to use when measuring individuals who are between 18 and 19 years of age. Nutrition indicators and/or programs commonly use slightly diferent age ranges or focus on a subset of the age groups described above. Good nutrition is essential for the health, growth, development, and economic well-being of individuals and populations. In addition, malnourished individuals are less likely to achieve their full potential in terms of education and economic productivity, and they earn less income than well-nourished peers, making it difcult to break the cycle of poverty (Victora et al. Addressing malnutrition is essential to promote development, and measuring nutritional status is crucial to identifying individuals who need nutritional care and support and to monitoring the nutrition situation of a population. Malnutrition can appear as either undernutrition (including micronutrient defciency) or overweight/obesity. Undernutrition is a consequence of inadequate nutrient intake and/or absorption, and/or illness or disease. In addition, undernutrition, particularly early in life, hinders optimal physical growth and cognitive, motor, and socio-emotional development, which may in turn lead to short and long-term impacts on learning and productivity (Grantham-McGregor 2007).
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His heart rate is 120 beats/min, respiratory rate is 18 breaths/min, and blood pressure is 100/65 mm Hg. On physical examination, you note that he has conjunctival petechiae, but no conjunctivitis or rhinorrhea. He has small, nontender lymph nodes in the anterior cervical chain; he has no jugular venous distension. His oropharynx is clear, his chest is clear, his cardiac examination shows a regular rate and rhythm, and a normal S1 and S2 with a 2/6 systolic murmur at the left mid-axillary line and the fourth intercostal space. The chest radiograph may be useful to look for evidence of infected pulmonary emboli and the resultant multiple infarcts, but would not establish the etiology of the infection. The child in this vignette does not have signs of congestive heart failure or a murmur to suggest severe valvular regurgitation. His laboratory work is significant for leukocytosis and elevated erythrocyte sedimentation rate. Multiple blood cultures are very important in being able to make a firm diagnosis. The number of blood cultures needed and the volume of blood needed in each age group varies. In a large meta-analysis in the adult population (23, 313 patients), 2 sets of 3 blood culture bottles (each 10 mL samples) done within 30 min was as effective as 3 sets of blood cultures. In this setting, 2 aerobic and 1 anaerobic cultures were found to increase the yield, and allowed for declaration of a positive blood culture when 2 were required to rule out a contaminant. The most frequent pathogens were Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Enterococcus, and coagulase-negative Staphylococcus. Priority is placed on aerobic cultures in the smaller infants: For premature infants less than 1 kg, 1 blood culture with 2 mL of blood For infants between 1. Infectious disease consultation is very helpful to plan the acute and long term antibiotic management of patients who are managed medically. Patients at high risk deserve close scrutiny for physical signs of endocarditis, especially changes in their cardiac examination such as a new regurgitant murmur in the setting of febrile illness. Multiple blood cultures with adequate volume of blood are more sensitive in making the diagnosis than an echocardiogram. The echocardiogram will be crucial in the decision to obtain surgical consultation.
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The association of hyperplastic pineal tumors with decreased gonadal function, and destructive tumors with precocious puberty, suggested that the pineal is the source of gonadal inhibiting substances. Normal reproductive function returns to the 132 pinealectomized rat several weeks after pinealectomy; blind women have normal fertility, and pinealectomy in a primate did not affect pubertal development. Short days and long nights result in gonadal atrophy, and this is the major mechanism governing seasonal breeding. In humans, melatonin secretion increases after darkness and peaks in the middle of the night, and then decreases. Possible roles in humans may be to give circadian rhythmicity to other functions such as temperature and sleep. In all vertebrates tested so far, there is a daily and seasonal rhythm in melatonin secretion: high values during the dark and low during light, greater secretion in the winter compared to the summer. Desynchronization with travel across time zones may contribute to the symptom complex known as jet lag. Melatonin ingestion improves both the duration and quality of slee, but the 131 optimal timing of administration is unknown. The pineal, therefore, serves as an interface between the environment and hypothalamic-pituitary function. In order to correctly interpret day length, animals require a daily rhythm in melatonin secretion. This coordination of temporal, environmental information is especially important in seasonal breeders. This pineal rhythm appears to require the suprachiasmatic nucleus, perhaps the site at which pineal function and light changes are coordinated. Melatonin is synthesized and secreted by the pineal gland and circulates in the blood like a classical hormone. It affects distant target organs, especially the neuroendocrine centers of the central nervous system. This hypothesis is challenged by the association of blindness in human females with an age of 135 132 menarche that is earlier than normal. Pineal activity can be viewed as the net balance between hormone and neuron mediated influences. The pineal contains receptors for the active sex hormones, estradiol, testosterone, dihydrotestosterone, progesterone, and prolactin. Furthermore, the pineal converts testosterone and progesterone to the active 5a-reduced metabolites, and androgens are aromatized to estrogens. The pineal also appears to be unique in that a catecholamine neurotransmitter (norepinephrine), interacting with cell membrane receptors, stimulates cellular synthesis of estrogen and androgen receptors. In general, however, the sympathetic activity producing the circadian rhythm takes precedence over hormonal effects. Despite a variety of suggestive leads, there is no definitive evidence for a role of the pineal in humans. Nevertheless the important relationship between light exposure 136 and circadian rhythms continues to focus attention on the pineal gland as a coordinator.
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Many children with chronic medical conditions have increased metabolic needs, including increased requirements of protein. These conditions include cancer, cystic fibrosis, failure to thrive, and other scenarios in which children require additional calories. There are also conditions that require lower protein intake, including chronic renal and liver disease. The mother reports that he rolled over at 5 months of age, sat at 9 months of age, and began crawling at 16 months of age. His birth history is significant for mild intrauterine growth retardation and an unusual high-pitched cry that has persisted. The remainder of his past medical history is notable for gastroesophageal reflux and hypospadias. His height and weight are at the first percentile; his head circumference is at the second percentile. Dysmorphologic examination shows microcephaly, mild hypertelorism, broad nasal bridge, short palpebral fissures, bilateral epicanthal folds, and micrognathia (Item Q88). This is a genetic disorder caused by a chromosomal deletion of varying size of the short arm of chromosome 5. Classic features include a high pitched or cat-like cry (> 95%), small head, epicanthal folds, micrognathia, broad nasal bridge, hypertelorism, downward-slanting palpebral fissures, and moderate to severe intellectual disability. Other systemic congenital malformations are not common, but can include congenital heart disease, renal anomalies, hypospadias, cryptorchidism, and ear tags. The characteristic cat like cry is secondary to laryngeal and epiglottic anomalies. The American College of Medical Genetics and the American Academy of Pediatrics recommend all children presenting with developmental delay have a chromosomal microarray, which would not only pick up a gross chromosomal deletion as in the child in the vignette, but also microdeletions that could be easily missed on a high resolution karyotype. An array would also be helpful at clarifying specific breakpoints and genes involved in the deletion. There exists genotype and phenotype correlation dependent on the size of the actual deletion. Early intervention and therapies can improve the prognosis and social communication of patients with cri-du-chat. Some patients have sensorineural deafness, so a formal audiologic examination is recommended. Survival is high with low morbidity because of the low incidence of major congenital malformations. Most cases are caused by a de novo random event; however, parental analysis should be performed to exclude a balanced translocation in the unaffected parent, which could incur an increased risk for recurrence. Angelman syndrome manifests with severe developmental delay, significant speech impairment, gait ataxia, microcephaly, seizures, and a happy demeanor with inappropriate laughing and excitability. They lack the classic facial dysmorphology and cat-like cry seen in cri-du-chat syndrome.