Research on kwashiorkor in Africa--historical aspects of causation, pathophysiology and treatment.
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Biomedical subjects
Publications and source records attributed to J D Hansen.
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Sequences homologous to a potato cathepsin D inhibitor cDNA, p749, were identified in the genomic DNA of tomato (Lycopersicon esculentum) and of two non-tuber-bearing potato species (Solanum etuberosum and S. brevidens) by means of Southern blot analysis. The expression of these p749 genes in leaves was induced at the RNA level in response to wounding. High levels of p749 transcripts were detected in polyadenylated RNA extracted from locally wounded leaves 12 h after wounding. Systemic induction of the cathepsin D inhibitor gene also occurred in nonwounded leaves of wounded plants. Both potato and tomato leaves treated with the oligosaccharide chitosan showed an induced accumulation of p749 transcripts. Even though the cathepsin D inhibitor genes from tomato and from non-tuber-bearing potato species are wound inducible, they could not be induced in leaf explants cultured on medium containing very high concentrations of sucrose. Only leaf explants from the tuber-bearing potato (S. tuberosum) accumulated p749 transcripts when cultured on high sucrose medium. A sequence related to the 22-kD potato proteinase inhibitor cDNA, p34021, was identified in tomato by means of genomic Southern blot analysis. Northern blot hybridization showed that p34021 transcripts accumulated in potato (S. tuberosum) leaf explants, but not in tomato explants, when cultured on high sucrose medium. This study demonstrates that the expression of a potato cathepsin D inhibitor gene in tomato and in non-tuber-bearing potato species is wound inducible, but not sucrose inducible.
The sodium contents of six differently prepared oral rehydration solutions (ORS) were measured. A total of 452 solutions were prepared in our gastro-enteritis unit. The finger-pinch-and-cup method produced sodium values that were too high and too variable. The most acceptable sodium level was achieved using half a 5 ml medicine teaspoon or 1 level common household teaspoon of salt in 1 litre of water. Half a commonly available household teaspoon of salt caused sodium levels to be low but still acceptable and safe. We recommend that half a teaspoon of salt in 1 litre of water be used when preparing an ORS.
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One hundred sixteen patients who had had kwashiorkor between the ages of 5 months and 4 4/12 years and 89 controls were the subjects of a 15-year follow-up study of their growth and development. We report the findings of a longitudinal analysis of 53 (30 females) of the ex-patients and 30 (15 females) of the controls, selected because at the end of 15 years of study they conformed to the criteria of adult secondary sexual characteristics, height velocity less than 2 cm/yr, and completeness of data. Nonlinear curve-fitting techniques were applied to the height and weight data for these subjects using the Preece-Baines model 1 growth function to determine the timing and magnitude of adolescent growth spurts and the associated biologic changes. Both ex-patients and controls grew below the 25th percentile of British longitudinal standards, but the male ex-patients were heavier, and perhaps taller, than the controls for most of their childhood and adolescence. Velocity curves indicated that the ex-patients had higher pre-adolescent peak increments than the controls and a generally longer growth spurt of reduced magnitude. Two possible explanations are discussed: Garrow and Pike's theory that children with kwashiorkor have a genetic potential for greater physical growth, and a socioeconomic crisis occurring within a family affects the youngest child, who subsequently requires a longer time to recover than do siblings within an improving socioeconomic situation.
A series of 221 infants admitted to hospital with kwashiorkor between 1958 and 1960 has been followed up for 15 years. Seventy-two (32%) died of malnutrition either at the time of first admission or shortly thereafter. The subsequent physical growth and development of the survivors remaining in Cape Town has been compared with that of 89 of their siblings who had never had kwashiorkor, but grew up in the same environment. No differences were noted between the two groups, but considered together they demonstrated a pattern of retarded growth and delayed development. This suggests an adaptive mechanism suited to survival in poor socio-economic circumstances. The years of poor growth in childhood and early adult life are not associated with an undue mortality, and malnutrition exacts its toll of morbidity and mortality in the early years of life. It is to this age group that intervention with short-term solutions (food subsidization and supplementation) should be applied with the expectation of demonstrable benefit. The long-term solution depends on advancing socio-economic conditions, bringing better nutrition and enlightened health practices; this will eventually lead to improved standards of growth and development.
Of 221 infants serially admitted to hospital with kwashiorkor and continuously observed thereafter, 116 were available for study after 15 years. Eighty-nine siblings formed the comparison group. This report is a final assessment of their social circumstances, attainment in education and adjustment to society. Economic circumstances had improved considerably, housing adequacy had deteriorated and family instability had become relatively less marked. Achievement in education resembled that of the population from which the sample was drawn, and there was no difference between that of ex-patients and siblings. The majority of school-leavers were in gainful occupation but the nature of the work was unskilled or semiskilled. Delinquency was equally common in ex-patients and siblings. More than a quarter of the boys showed serious or potentially serious antisocial behaviour.
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One newborn child was selected from 14 families in which kwashiorkor had occurred. Undernutrition in this test group was prevented for the first two years of life by the provision of supplementary feeding. Controls who were the siblings directly preceding each of the 14 test children received no supplementary feeding, but received medical attention and management. In each family an older child who previously had kwashiorkor (kwashiorkor group), and the nearest sibling who had received neither extra feeding nor medical management (kwasiorkor control group) were also available for comparison. A battery of psychologic tests was administered when the mean age of the test group was 8.9 years. The mean full-scale IQ of the supplementary feeding group at an average age of 8.9 years was significantly higher than that of any of the other three groups. There was no significant difference between test and control groups on nonverbal IQ. Measures of "brain damage" did not discriminate between any of the four groups. The results suggest that nutritional factors contribute especially to the elevation of verbal intelligence. Environmental stimulation (daily contact with a more alert child) apparently contributed to the elevation of the nonverbal scores of the controls.
44 randomly selected infants under age one year with suspected lower respiratory infections were investigated for the presence of subclinical rickets. Seven infants had metaphyseal changes at the wrist compatible with a diagnosis of rickets and all of these infants had 25-hydroxy-vitamin D (25-OHD) concentrations less than 12 ng/ml. Serum calcium and phosphorus concentrations were normal in all 44 children. Alkaline phosphatase concentrations did not correlate with the presence of metaphyseal changes. The clinical presence of craniotabes or splaying and loss of definition of the anterior ends of the ribs on x-rays did not correlate with metaphyseal changes at the wrist or with 25-OHD concentrations. An x-ray of the wrist is essential to confirm the presence of subclinical rickets and the at-risk infant can be detected by measuring serum 25-OHD concentrations.
The present study was designed to test the comparative efficacy of cow's milk, a protein, vitamin and mineral mixture (PVM) and soybean textured vegetable protein (SOMOS) as supplements to maize meal porridge in the dietary treatment of children with protein energy malnutrition (PEM). Each diet was designed to provide approximately 480 kJ/kg with 2 protein/kg from the test protein, and 1,8 g protein/kg from maize. Response to treatment was measured by loss of oedema, subsequent weight gain, rate of generation of serum albumin, and serum amino acid patterns. In 36 children studied to date the three dietary regimens all produced satisfactory rates of cure of PEM. The clinical and economic implications of these results are discussed.
During the last quarter of a century there has been a gradual change in the doctor's role from that of being the personal provider of medical care to that of the leader of a health care team which is placing increasing emphasis on promotive and preventive health. For the doctor this has necessitated learning additional skills, particularly in the delegation of specific tasks to nurses and other paramedical personnel, the co-ordination of the activities of the health care team, and in teaching and management. The new Health Act of 1977 will enable doctors to develop along these new lines by making closer liaison between hospital and community-based services possible. These new trends in medical care will in turn require urgent re-orientation in planning for new buildings and facilities in the health service; especially with a view to keeping expenditure within available resources so that health skills and knowledge can be made available to everyone.
Patterns of paediatric illness in hospital were surveyed with a view to planning for improved community health services. High morbidity and early mortality from neonatal, nutritional, gastro-intestinal and respiratory disease reflected late referral to hospital of seriously ill children. Combined preventive, promotive and primary care clinics, health education and improved transport facilities for the sick are a high priority for the area.
Successful therapy with zinc sulphate is reported in 3 children suffering from acroedematitis enteropathica.
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Residue levels of azinphosmethyl and captan were determined from blotter paper patches attached to the clothing of personnel participating in an orchard spray program. Average exposure of 1.74 mg/man/hr for azinphosmethyl and 1.94 mg/man/hr for captan were extrapolated from mean residue values obtained from analyzing the patches. Azinphosmethyl residue found on apple and peach foliage had been reached by 69% by the tenth day post-application, while captan residue had been reduced 50% for the same period. There was no evidence of a buildup of either azinphosmethyl or captan on treated foliage as the season progressed.