Accelerated Corneal Collagen Cross Linking

An informed written consent will be obtained from all patients that will be included in this study. Patients in this study will undergo specular microscopic examination of corneal endothelium before CXL procedure.
Patients will be assigned to undergo accelerated (epithelium-off ,transepithelial ) CXL .
Follow up specular microscopy will be done 3 months and 6 months after corneal collagen cross linking procedure .

specular microscopy

Assessment of Corneal Endothelium After Collagen Cross Linking

A Specular Microscopic Study of Corneal Endothelium After Accelerated Corneal Collagen Cross Linking

specular microscopy will be used to assess corneal endothelial cell count after accelerated corneal collagen cross linking

specular microscopy will be used to assess corneal endothelial cell morphology after accelerated corneal collagen cross linking

Naglaa Mostafa Abdelhafez Abdelmohsen

resident doctor

Assiut University

These treatment arm is the standard care for moderate malnutrition. This includes a fortified cereal supplement treatment until the child reaches MUAC of above 12.5. Currently, MAM and SAM are treated separately, overseen by different agencies. Breastfeeding is often overlooked.

Integrated protocol for treatment of children with MAM and SAM in humanitarian emergencies has the potential to result in a more streamlined, cost-effective program, higher recovery, and higher program coverage, allowing easier access to malnourished children, thus curing more children of malnutrition and preventing its lifelong effects.

Integrated protocol for treatment of children with MAM and SAM in humanitarian emergencies has the potential to result in a more streamlined, cost-effective program, higher recovery, and higher program coverage, allowing easier access to malnourished children, thus curing more children of malnutrition and preventing its lifelong effects.
Integrated Protocol: Implement an integrated protocol in Sierra Leone for the management of MAM and non-complicated SAM that uses a single anthropometric indicator as well as the same food but in different doses to treat the continuum of malnutrition. MAM children will be given 75 g/kg/day of RUTF whereas SAM will be given 175 gr/kg/day of RUTF until MUAC>12.5 cm is reached. Then child will be given LNS, a bed net, albendazole, zinc, referral for immunizations compliant with current WHO recommendations, oral rehydration salts to give if the child has more than three loose watery stools in 24 hours, and asked to return for follow-up in 1, 3 and 6 m

Integrated Protocol

These treatment arm is the standard care for moderate malnutrition. This includes a fortified cereal supplement treatment until the child reaches MUAC of above 12.5. Currently, MAM and SAM are treated separately, overseen by different agencies. Breastfeeding is often overlooked.
Current protocol: Current protocol for treating MAM in emergencies is supplemental food distribution, often providing a fortified blended food (FBF) that requires cooking. This treatment is the standard today for treating children with MAM.

Current Protocol

Total

Sex: Female, Male

Region of Enrollment

Midupper arm circumference

Recovery by the end of treatment standard protocol will be compared to the integrated protocol. Recovery will be defined as mid upper arm circumference (MUAC) reaching ≥12.5 cm.
Subjects will return to clinic every 2 weeks until MUAC of 12.5 cm is reached or until 12 weeks has elapsed.

Recovery Under the Integrated Program and the Standard Protocol

Subjects will return to clinic every 2 weeks until MUAC of 12.5 cm is reached or until 12 weeks has elapsed. Measurement is taken at each visit but final recovery measurement will be used.

Change in Growth Rates

Subjects will return to clinic every 2 weeks until MUAC of 12.5 cm is reached or until 12 weeks has elapsed. Time to achieve MUAC of 12.5 cm will be documented.

Duration of Treatment

Any changes in recovery will be measured 6 months at follow-up visit. Number of children still well nourished.

Change in Recovery Status After 12 Weeks

Overall Study

Mark Manary

Malnutrition

Implement an integrated protocol in Sierra Leone for the management of MAM and non-complicated SAM that uses a single anthropometric indicator as well as the same food but in different doses to treat the continuum of malnutrition. MAM children will be given 75 g/kg/day of RUTF whereas SAM will be given 175 gr/kg/day of RUTF until MUAC>12.5 cm is reached. Then child will be given LNS, a bed net, albendazole, zinc, referral for immunizations compliant with current WHO recommendations, oral rehydration salts to give if the child has more than three loose watery stools in 24 hours, and asked to return for follow-up in 1, 3 and 6 months. Caretakers will be instructed to seek medical care sooner if the child has fever, poor appetite or signs of an acute illness.

Current protocol for treating MAM in emergencies is supplemental food distribution, often providing a fortified blended food (FBF) that requires cooking. This treatment is the standard today for treating children with MAM.

Current protocol

Ethiopia Federal Ministry of Health. Protocol for the Management of Severe Acute Malnutrition. 2007

Measuring the effectiveness of Supplementary Feeding Programmes in emergencies. Humanitarian Practice Network. 2008

The Sphere Project. The Sphere Project - Humanitarian Charter and Minimum Standards in Humanitarian Response. 2011

Infant and young child feeding in emergencies (IFE) Core Group. Complementary Feeding of Infants and Young Children in Emergencies. 2009

. USAID and World Relief. Tube Poka Child Survival Project Final Evaluation Report

USAID and Medical Teams International. Grant Cape Mount Child Survival Program - Improved Child Health in a Transitional State through IMCI. Final Evaluation Report. 2011

GOAL and USAID. GOAL ETHIOPIA: Sidama Child Survival Program MID-TERM EVALUATION REPORT Awassa Zuria and Boricha Woredas of the Southern Nations, Nationalities, and Peoples (SNNP) Region of Ethiopia. 2009

Anon. The U.S. President's Emergency Plan for AIDS Relief

World Health Organization and UNICEF. Integrated Management of Childhood Illness (IMCI) Handbook. Geneva; 2005

World Health Organization, World Food Programme, United Nations Standing Committee on Nutrition and United Nations Children's Fund. Community-Based Management of Severe Acute Malnutrition. 2007

Project Peanut Butter Factory - 41D Wilkinson Road

Moderate Acute Malnutrition (MAM) and Severe Acute Malnutrition (SAM) in Sierra Leone

Conducting Research on Moderate Acute Malnutrition in Humanitarian Emergencies Integrated Management of MAM and SAM in Sierra Leone With Ready to Use Theraputic Foods (RUTF)

riboflavin/edema

Assessment of Corneal Endothelium After Collagen Cross Linking

Moderate Acute Malnutrition (MAM) and Severe Acute Malnutrition (SAM) in Sierra Leone

Oral Rehydration SolutionContaining Amylase Resistant Starch in Severely Malnourished Children.

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