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At least 127 records · Page 7Linked to original sources
PubMed1997

Clinical signs for the recognition of children with moderate or severe anaemia in western Kenya.

Optimal treatment of Plasmodium falciparum-related paediatric anaemia can result in improved haematological recovery and survival. Clinical predictors are needed to identify children with anaemia in settings where laboratory measurements are not available. The use of conjunctival (eyelid), palmar, nailbed, and tongue pallor to detect children with moderate anaemia (haemoglobin, 5.0-7.9 g/dl) or severe anaemia (haemoglobin, < 5.0 g/dl) was evaluated among children seen at an outpatient and inpatient setting in a hospital in western Kenya. Severe nailbed or severe palmar pallor had the highest sensitivity (62% and 60%, resp.), compared with severe conjunctival pallor (sensitivity = 31%), to detect children with severe anaemia in the outpatient setting. Children with moderate anaemia were best identified by the presence of nailbed or palmar pallor (sensitivity = 90% for both signs), compared with conjunctival pallor (sensitivity = 81%). Clinical signs of respiratory distress, in addition to the presence of severe pallor, did not increase the recognition of children requiring hospitalization for severe anaemia. Among inpatients, the sensitivity of severe nailbed pallor (59%) was highest for detecting children with severe anaemia, although the sensitivity of severe conjunctival pallor and severe palmar pallor was the same (53% for both signs). Presence of conjunctival pallor (sensitivity = 74%) was similar in sensitivity to both nailbed and palmar pallor (70% for both signs) among children with moderate anaemia. The sensitivity of tongue pallor was low among all children evaluated. Low haemoglobin levels were significantly associated with the likelihood of being smear-positive for P. falciparum. This study demonstrates that clinical criteria can be used to identify children with moderate and severe anaemia, thus enabling implementation of treatment algorithms. Children aged < 36 months who live in an area with P. falciparum malaria should receive treatment with an effective antimalarial drug if they have pallor.

Anemia↗
PubMed1997

Evaluation of clinical signs to diagnose anaemia in Uganda and Bangladesh, in areas with and without malaria.

The object of this study was to assess the ability of pallor and other clinical signs, including those in the Integrated Management of Childhood Illness (IMCI) guidelines developed by WHO and UNICEF, to identify severe anaemia and some anaemia in developing country settings with and without malaria. A total of 1226 and 668 children aged 2 months to 5 years were prospectively sampled from patients presenting at, respectively, a district hospital in rural Uganda and a children's hospital in Dhaka, Bangladesh. The study physicians obtained a standardized history and carried out a physical examination that included pallor, signs of respiratory distress, and the remaining IMCI referral signs. The haematocrit or haemoglobin level was determined in all children with conjunctival or palmar pallor, and in a sample of the rest. Children with a blood level measurement and assessment of pallor at both sites were included in the anaemia analysis. Using the haematocrit or haemoglobin level as the reference standard, the correctness of assessments using severe and some pallor and other clinical signs in classifying severe and some anaemia was determined. While the full IMCI process would have referred most of the children in Uganda and nearly all the children in Bangladesh with severe anaemia to hospital, few would have received a diagnosis of severe anaemia. Severe palmar and conjunctival pallor, individually and together, had 10-50% sensitivity and 99% specificity for severe anaemia; the addition of grunting increased the sensitivity to 37-80% while maintaining a reasonable positive predictive value. Palmar pallor did not work as well as conjunctival pallor in Bangladesh for the detection for severe or some anaemia. Combining "conjunctival or palmar pallor" detected 71-87% of moderate anaemia and half or more of mild anaemia. About half the children with no anaemia were incorrectly classified as having "moderate or mild" anaemia. Anaemia was more easily diagnosed in Uganda in children with malaria. Our results show that simple clinical signs can correctly classify the anaemia status of most children. Grunting may serve as a useful adjunct to pallor in the diagnosis of severe anaemia. Conjunctival pallor should be added to the IMCI anaemia box, or the guidelines need to be adapted in regions where palmar pallor may not readily be detected.

Anemia↗
PubMed2002

[Value of touch in the diagnosis of fever and of paleness in the diagnosis of anemia. Observational study in adults].

UNLABELLED: Estimation of fever by touch and of pallor as a sign of anemia are common practices during physical examination. The diagnostic value of these procedures has been extensively studied in children, but there are fewer studies in adults. OBJECTIVE: To evaluate the diagnostic value of physician's estimation of fever and anemia by touch and pallor, respectively. PATIENTS AND METHODS: The study included 600 patients (mean age 66 years, range 14-94 years, 58% males) admitted to a hospital (n = 300) or seen at its Emergency Department (n = 300). Two physicians independently estimated the presence of fever by touch, as well as the presence of anemia by pallor (in the skin, nail or conjunctiva). Axillary temperature and peripheral blood hemoglobin were employed as standards for comparison. RESULTS: Specificity of touch was higher than 90%, both for the diagnosis of axillary temperatures > or = 37.2 degrees C and > or = 38 degrees C, with a lower sensitivity. Interobserver concordance was fair (Kappa index, 0.47). Negative predictive value of touch was also high (99%) for the observed prevalence of fever (5%), with a very much lower positive predictive value. Similarly, specificity of pallor was high, particularly for hemoglobin values lower than 10 g/dL, with a substantially lower sensitivity. The best diagnostic values were obtained with conjunctival pallor. The Kappa index of concordance for the various types of pallor (skin, nail or conjunctiva) ranged between 0.39 and 0.44. Negative predictive value of pallor was high (98%) for the observed prevalence (9%) of significant anemia (hemoglobin < 10 g/dL), with a lower positive predictive value. CONCLUSIONS: In adult patients of a hospital, physi-cian's estimation of fever by touch and anemia by pallor have a relatively low diagnostic value. Nevertheless, the estimation that the patient is afebrile or not pale make very improbable the presence of fever and significant anemia, respectively.

Adolescent↗
PubMed1993

Choroidal rupture and optic atrophy.

The association between post-traumatic optic disc pallor and traumatic choroidal rupture is poorly understood. To further define this relationship, nine cases of indirect traumatic choroidal rupture and post-traumatic optic disc pallor were compared with cases of indirect choroidal rupture without disc pallor in terms of severity of ocular injury, fundus findings, and visual outcome. The type and severity of the injury did not appear to influence the risk of optic disc pallor. Optic disc pallor was associated with a slightly poorer long term visual acuity than eyes without pallor (p = 0.059). The presence of a relative afferent pupillary defect was strongly associated with optic disc pallor (p = 0.016). Peripapillary retinal pigment epithelial abnormalities were a common finding, suggesting peripapillary trauma as a cause for optic disc pallor.

Adolescent↗
PubMed1990

Usefulness of physical examination in detecting the presence or absence of anemia.

Previous studies addressing the usefulness of pallor in anemia are deficient because of observer or spectrum bias. Three internists made individual assessments of conjunctivae, face, nails, palms, and palmar creases in 98 male and 5 female hospitalized patients at a Veterans Administration Medical Center. The true-positive rates (sensitivities) were highest for pallor at any one of three sites (ie, the conjunctivae, face, or palms; 0.65) and for pallor of the palms (0.53). True-negative rates (specificities) were best for palmar creases (1.00), for pallor at conjunctivae, face, and palms (all three in combination; 0.95), and for the face (0.90). Receiver operator characteristic curve analysis revealed that the examination of the nailbeds is inferior to all other sites or combinations. Interobserver variability K scores were negative for palmar creases but ranged from .16 to .51 for other sites. We conclude that (1) the absence of pallor does not rule out anemia, and therefore this sign is not useful for screening an asymptomatic population; (2) pallor of the conjunctivae, face, and palms together is of benefit in confirming the presence of anemia; and (3) neither the nailbeds nor palmar creases are of value in assessing the presence or absence of anemia.

Anemia↗
PubMedDate not supplied

Evaluation of the Integrated Management of Childhood Illness guidelines for treatment of intestinal helminth infections among sick children aged 2-4 years in western Kenya.

Anthelmintic treatment of sick preschool-age children at health facilities is a potentially effective strategy for intestinal helminth control in this age-group. We conducted a study from July 1998 to February 1999 in western Kenya to determine whether the Integrated Management of Childhood Illness (IMCI) guidelines' clinical assessment can be used to identify helminth-infected children, and to evaluate the nutritional benefit of treating sick children without pallor with an anthelmintic (mebendazole is already part of IMCI treatment for sick children aged 2-4 years with palmar pallor in areas where hookworm and Trichuris trichiura infections are endemic). Sick children aged 2-4 years seen at 3 rural health facilities were clinically evaluated and tested for haemoglobin concentration, malaria parasites, and intestinal helminths. Children without pallor were randomly assigned to receive a single dose of 500 mg of mebendazole or a placebo and re-examined 6 months later. Among the 574 children enrolled, 11% had one or more intestinal helminths. Most infections were of light intensity. Selected clinical signs and symptoms available from the IMCI assessment, including palmar pallor and low weight-for-age, were not associated with helminth infection. Six months after enrollment, no differences in growth of children without pallor were observed between the mebendazole (n = 166) and placebo (n = 181) groups. However, there was a significantly greater mean increase in weight, height, and weight-for-age Z score among the helminth-infected children in the mebendazole group (n = 22) as compared with helminth-infected children in the placebo group (n = 20). We conclude that even lightly infected preschool-age children without palmar pallor benefit from anthelmintic treatment; however, in this study setting of low helminth prevalence and intensity, helminth-infected children could not be identified using the IMCI guidelines. Cost-effectiveness studies are needed to help define helminth prevalence thresholds for routine anthelmintic treatment of sick preschool-age children seen at first-level health facilities.

Animals↗
PubMed1994

A masked prospective evaluation of outcome parameters for cytomegalovirus-related retinal detachment surgery in patients with acquired immune deficiency syndrome.

PURPOSE: The management of cytomegalovirus (CMV)-related rhegmatogenous retinal detachments in patients with acquired immune deficiency syndrome (AIDS) has been the subject of recent attention and controversy because of the high degree of variability in visual outcome, as well as significant differences in the reported incidence of profound postoperative optic atrophy. This study was designed to evaluate the various parameters affecting postoperative visual outcome, and to quantitate the degree of postoperative optic disc pallor. METHODS: The results of 65 consecutive surgeries for CMV-related retinal detachments in 51 patients with AIDS were prospectively studied. Postoperative vision, survival, optic disc pallor, and retinitis extent were analyzed. Serial photographs of optic discs underwent masked evaluation. RESULTS: Mean postoperative survival was 30 weeks (range, 2-146 weeks). Mean best postoperative visual acuity was 20/66 (range, 20/20-2/200) and mean final postoperative visual acuity was 20/100 (range, 20/25-no light perception). Analysis of visual outcome for eyes with no macular or papillo-macular retinitis showed a best postoperative visual acuity of 20/60 (range, 20/25-2/200) and mean final postoperative visual acuity of 20/80 (range, 20/25-no light perception). Postoperative vision was not affected by the presence of a preoperative macular detachment, with both groups (macula on or off detachments), achieving a best postoperative visual acuity of 20/60 in the absence of macular retinitis. Mild postoperative optic disc pallor was observed in 30% of surgical eyes at the final postoperative visit, and moderate pallor was noted in 13%. The mean degree of optic disc pallor was not different from the degree of optic disc pallor seen in fellow, nonsurgical eyes with CMV retinitis (surgical versus fellow nonsurgical eyes, 29% +/- 23% versus 26% +/- 30%; P = 0.64). CONCLUSION: In this largest reported series of reattachment surgery for CMV-related retinal detachments, patients are experiencing increased postoperative survival, good vision, and relative optic nerve health.

AIDS-Related Opportunistic Infections↗
PubMed1989

Agreement between haemoglobin estimation and anaemia recognition card in assessment of anaemia in pregnant women.

Sensitivity and specificity of pallor signs were compared to haemoglobin determination for identifying nutritional anaemia in pregnant women. A total of 211 pregnant women were examined for signs of pallor using the anaemia recognition card, and their haemoglobin was determined by the cyanmethaemoglobin filter paper technique. The sensitivity of pallor signs in identifying severe nutritional anaemia in the population was fair, as 67 per cent of the pregnant women identified as anaemic by haemoglobin levels less than 8 g/dl were detected as anaemic by the presence of pallor signs. However, the specificity of the measure indicated that almost half of the pregnant women with haemoglobin level above 8 g/dl were misclassified as anaemic by presence of signs of pallor. Since the sensitivity and specificity of the pallor signs test are fairly low, the anaemia recognition card is an inefficient tool to be used to screen for severe cases of nutritional anaemia.

Anemia, Hypochromic↗
PubMed2006

Algorithm for the diagnosis of anaemia without laboratory facilities among small children in a malaria endemic area of rural Tanzania.

BACKGROUND: Anaemia among small children in tropical Africa is common and often caused by infection with Plasmodium falciparum. The diagnosis of anaemia is difficult without a laboratory estimation of haemoglobin. The aim of this study was to examine if clinical findings related to malaria and anaemia would help to detect moderate and/or severe anaemia in children in rural Tanzania. METHODS: Children between 6 and 36 months were examined by health workers in an Out Patient Department (OPD) to detect severe anaemia (packed cell volume, PCV< or =20%) and in a cross sectional survey at village level to identify moderate anaemia (PCV 21-25%). History of recent fever and treatments was recorded and a clinical examination was performed. FINDINGS: In the survey, comparison of 65 moderately anaemic children with 373 mild/non anaemic children revealed no differences in history of fever or in the clinical examination. In the OPD comparison of 100 severely anaemic children with 116 non-severely anaemic control children revealed that pallor, respiratory rate, number of fever days last week, deteriorated general condition, heart rate, age, splenomegaly, low body weight and elevated body temperature were all indicators of severe 'anaemia, only pallor, respiratory rate, fever days and palpable spleen however, remained associated with severe anaemia in multiple regression analysis. The combination of any pallor and either respiratory rate >55/min or fever >3 days, could predict severe anaemia with a sensitivity of 96% and a specificity of 71%. This was better than the currently recommended signs of severe pallor or an approximation of the Integrated Management of Childhood Illness (IMCI) criteria's for referral of children. INTERPRETATION: At primary health care level detection of severe anaemia can be improved by information about fever duration and determination of respiratory rate in children with pallor.

Algorithms↗
PubMed1991

Increased preferential optic disc asymmetry in ocular hypertensive patients compared with control subjects.

The authors determined asymmetrical differences in optic disc cupping and pallor between the right and left eyes of 57 control subjects and 75 patients with ocular hypertension. Photogrammetry was used to measure the optic disc cup, and computerized image analysis was used to measure the optic disc pallor for the total disc and its quadrants. Generally, for control and ocular hypertensive eyes, the median values of cupping and pallor were significantly larger in the left eye than in the right, except for depth in the inferior quadrant (right eye minus left eye = 9.3%, P = 0.000) and pallor in the nasal quadrant (right eye minus left eye = 21.3%, P = 0.01), which were preferentially larger in the right eye than in the left in ocular hypertensive eyes. Ocular hypertensive eyes also showed a greater difference between the right and left eyes compared with control eyes for inferior depth (P = 0.06) and nasal pallor (P = 0.02). Detection of optic disc differences as a sign of ocular hypertension between the right eye and the left should evaluate the inferior and nasal quadrants of the disc.

Aged↗
PubMed2004

Frequency doubling technology perimetry in non-arteritic ischaemic optic neuropathy with altitudinal defects.

AIM: To determine if frequency doubling technology perimetry (FDT) is more sensitive to optic nerve injury in non-arteritic ischaemic optic neuropathy (NAION) than standard automated perimetry (SAP). METHODS: Charts from 18 patients (20 eyes) with NAION with altitudinal defects who underwent a complete neuro-ophthalmic examination, SAP, and FDT were reviewed. The extent of damage as determined by SAP, FDT, and clinical estimation of the regional extent of optic disc pallor was compared. 10 subjects (20 eyes) with normal ocular examinations and full appearing optic nerve heads were included as a control group. RESULTS: FDT demonstrated more extensive visual field defects in the relatively intact hemifield on SAP (proportion of locations at 5% or worse in the total deviation plot was 8.7% (SD 6.2%) for SAP and 38.3% (39.5%) for FDT p<0.0027). 16 of 20 eyes with altitudinal NAION demonstrated diffuse optic disc pallor. 11 of these eyes with diffuse pallor demonstrated significant defects in both hemifields using FDT, while only two eyes demonstrated diffuse damage using SAP. Correspondence between the extent of optic disc pallor and the extent of visual scotoma was higher for FDT (85%) than with SAP (40%). CONCLUSION: FDT appears more sensitive to axonal injury reflected by the extent of optic disc pallor in altitudinal NAION than SAP and in some patients reveals visual dysfunction in the hemifield that appeared relatively uninvolved when evaluated using SAP.

Adult↗
PubMed2005

[Validity and reproducibility of the clinical signs for the diagnosis of anemia in children].

This study aimed to assess the validity and reproducibility of clinical signs (palmar and conjunctival pallor) in the diagnosis of anemia in children 6-23 months of age in Northeast Brazil. This was a cross-sectional study with a sample of 421 children in the child care and pediatric outpatient wards at the Mother and Child Care Institute of Pernambuco. Two examiners evaluated clinical signs using the Kappa coefficient, and validation (sensitivity and specificity) was performed using hemoglobin as the standard. Clinical signs demonstrated low reproducibility (kappa 0.24-0.25). The highest sensitivity for diagnosing anemia (Hb < 11 g/dl) and moderate/ severe anemia (Hb < 9 g/dl), respectively, was provided by combining palmar and conjunctival pallor (39.7% and 53.5%), followed by palmar pallor alone (29.9% and 40.0%). The highest specificity was provided by palmar pallor in the child as compared to the mother (95.5% and 90.1%, Hb < 11 g/dl and Hb < 9 g/dl, respectively). Sensitivity of clinical signs was better in diagnosing moderate/severe anemia, especially when combining palmar and conjunctival pallor, suggesting that their utilization does not provide a good instrument for diagnosing mild anemia.

Anemia↗