ABSTRACT
Purpose of Review: To highlight some achievements made through usage of telecommunication technologies in Mongolia as an example of a developing country with remote areas. Recent Findings: Telemedicine can be implemented not only for remote monitoring, diagnosing, and treating purposes but also can be effectively used for delivering knowledge and consultation services via modern technologies. Summary: Tele-health services can be successfully added to the traditional approach of physicians, especially in the countries with a vast territory with distant areas.
ABSTRACT
BACKGROUND: In winter in Mongolia, 80% of adults have 25-hydroxyvitamin D (25(OH)D) concentrations <25â¯nmol/l (<10â¯ng/ml) and 99% have <50â¯nmol/l (<20â¯ng/ml). The vitamin D dose to avert deficiency during pregnancy in this population is unknown. METHODS: We conducted a randomized, controlled, double-blind trial of daily 600, 2000, or 4000â¯IU vitamin D3 for pregnant women in Mongolia (Clinicaltrials.gov #NCT02395081). We examined 25(OH)D concentrations at baseline (12-16â¯weeks' gestation), 36-40â¯weeks' gestation and in umbilical cord blood, using enzyme linked fluorescent assay. Sample size was determined to detect 0.4 standard deviation differences in 25(OH)D concentrations with 80% power. FINDINGS: 119 pregnant women were assigned 600â¯IU, 121 assigned 2000â¯IU and 120 assigned 4000â¯IU from February 2015 through December 2016. Eighty-eight percent of participants took ≥80% of assigned supplements. At baseline, 25(OH)D concentrations were similar across arms; overall mean⯱â¯standard deviation concentration was 19⯱â¯22â¯nmol/l; 91% wereâ¯<â¯50â¯nmol/l. At 36-40â¯weeks, 25(OH)D concentrations increased to 46⯱â¯21, 70⯱â¯23, and 81⯱â¯29â¯nmol/l for women assigned 600, 2000, and 4000â¯IU, respectively (pâ¯<â¯0.0001 across arms; pâ¯=â¯0.002 for 2000 vs. 4000â¯IU). Mean umbilical cord 25(OH)D concentrations differed by study arm (pâ¯<â¯0.0001 across arms; pâ¯<â¯0.0001 for 2000 vs. 4000â¯IU) and were proportional to maternal concentrations. There were no adverse events, including hypercalcemia, attributable to vitamin D supplementation. INTERPRETATION: Daily supplementation of 4000â¯IU during pregnancy is safe and achieved higher maternal and neonatal 25(OH)D concentrations than 2000â¯IU. Daily 600â¯IU supplements are insufficient to prevent vitamin D deficiency in Mongolia. FUND: Anonymous foundation and Brigham and Women's Hospital.
Subject(s)
Fetal Blood/chemistry , Pregnancy Trimesters/blood , Vitamin D Deficiency/drug therapy , Vitamin D/analogs & derivatives , Adult , Dietary Supplements , Dose-Response Relationship, Drug , Double-Blind Method , Female , Humans , Pregnancy , Pregnancy Trimester, First/blood , Pregnancy Trimester, Third/blood , Treatment Outcome , Vitamin D/administration & dosage , Vitamin D/therapeutic use , Young AdultABSTRACT
Acute lung injury and acute respiratory distress syndrome among children are clinical entities of multifactorial origin requiring intensive care. Pediatric acute respiratory distress syndrome is a devastating lung condition with high mortality being the end result of a wide variety of inciting events. The purpose of this article is to review recent evidence for the epidemiology, clinical signs, diagnosis and treatment of the acute respiratory distress syndrome in chidlren.