Cutaneous inflammatory response in kwashiorkor.
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Biomedical subjects
Publications and source records attributed to V Reddy.
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1. A study was carried out to determine the effects of varying the level of energy intake on nitrogen balance in preschool children receiving the safe requirement level of protein, determined in an earlier study. 2. Seven preschool children received four energy levels, i.e. 293, 334, 376 and 418 kJ/kg body-weight at the safe level of protein intake of 1.75 g/kg body-weight and N balance determined. 3. The N balance decreased with a decrease in energy intake. However, the N balance was positive at all levels of energy intake studied. 4. Results indicated that at a protein intake of 1.75 g/kg body-weight the minimum level of energy intake for a retention of 40 mg N/kg body-weight in these children was found to be 326.2 +/- 45.5 (mean +/- SD) kJ/kg body-weight. Below this energy intake the safe level of protein intake became inadequate.
1. Serum levels of retinol-binding protein (RBP), total vitamin A and retinyl ester were measured in twenty-four malnourished children with corneal lesions and nine normal children. 2. Initially, the RBP and vitamin A levels were significantly lower in malnourished children than in normal children. 3. After intramuscular injection of 30000 microgram of aqueous vitamin A, serum levels of total vitamin A were increased significantly at 24 h and tended to fall within 5 d of treatment in both groups. 4. Before treatment, retinyl ester accounted for less than 10% of the vitamin in circulation. After vitamin A injection, it increased to 30%, a level much lower than that reported in patients with hypervitaminosis A. 5. There was no significant difference between the two groups of children and none of them showed clinical signs of toxicity. These observations indicate that administration of massive doses of vitamin A over a short period will not produce toxic effects even in malnourished children.
Breast milk samples obtained from 74 women, at different stages of lactation, were analysed for leukocyte concentration and their bactericidal activity. The total leukocyte count in colostrum was 5 000/mm3 a concentration which is similar to that in circulation. As lactation became established, there was a drop in leukocyte concentration and the average count in mature milk was around 2 000/mm3 after the first 3 months. Polymorphs and mononuclear leukocytes together constituted 90--95% of the cells and the rest were lymphocytes. Bactericidal activity of milk leukocytes was similar to that of circulating leukocytes, irrespective of the stage of lactation. These results indicate that breast milk is rich in living leukocytes and that these cells may have a protective role against infection in the infant. The total leukocyte concentration as well as their bactericidal capacity were similar in well nourished and undernourished women suggesting that the protective factors in milk are not influenced by nutritional status of the mother.
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The humoral immune response (as shown by plasma immunoglobulin concentrations and antibody response to diphtheria and tetanus toxoids) was evaluated in 14 children with iron-deficiency anaemia and in 24 normal controls. Mean concentrations of haemoglobin and serum iron and mean transferrin saturation were significantly lower in children with iron-deficiency anaemia than in controls. Serum immunoglobulin concentrations were within the normal range in both groups. Two weeks after immunisation with diphtheria and tetanus toxoids the concentrations of IgG increased significantly in both groups. Antibody titres in iron-deficient children were similar to those of controls before and after immunisation. The mean T-lymphocyte count was significantly lower in iron-deficient children than that in controls, but the mean B-lymphocyte counts were similar in the two groups. These observations suggest that humoral immunity in children is not affected by iron deficiency and that conventional immunisation programmes would be effective in children with iron-deficiency anaemia.
Response to BCG vaccination was studied in 261 apparently normal preschool children in a community. They were classified into different nutritional groups based on deficit in weight for age. In addition, nine children who had kwashiorkor and were admitted to the hospital were investigated. They were given 0.1 ml of BCG vaccine, and 6 months later, tuberculin sensitivity was assessed using 5 U of PPD. Blood samples were collected from 84 subjects and leukocyte migration inhibition was determined using the same antigen. After BCG vaccination, over 80% of children in the community showed positive tuberculin test, irrespective of the extent of growth retardation. There were no significant differences in the size of induration or the percentage of reactors between the various groups, indicating that the immune response to BCG vaccination is not affected by milder grades of malnutrition. However, the skin test was negative in most of the children who had had kwashiorkor. Leukocyte migration inhibition was similar in all the groups of children including those with kwashiorkor indicating that sensitisation of lymphocytes was not influenced by the nutritional status. In children with kwashiorkor, the leukocyte migration inhibition test was positive though the skin test was negative, suggesting that the former may be a better measure of assessing the response to BCG vaccination.
Serum levels of calcium, phosphorus, alkaline phosphatase, and 25 hydroxy-vitamin D (25-OH-D3) were measured in normal and malnourished children with and without rickets. Children with rickets had clinical, biochemical, and x-ray evidence of the disease; most of them were malnourished. 25-OH-D3 levels were lower than in normal children. After treatment with vitamin D their condition improved. 25-OH-D3 levels were also found to be reduced in malnourished children without rickets. These studies show that rickets is common in malnourished children. Inadequate exposure to sunlight appears to be the factor mainly responsible for the high incidence of the disease. In addition, malnutrition perhaps contributes to the development of rickets.
We are reporting a case of ossified epidural hematoma that developed in a patient who had had a craniotomy at a different site for a brain tumor 14 years earlier. There was no history of trauma.
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Complete unilateral and bilateral ureteral obstruction (24 hr) was produced in rats to evaluate the pathogenesis of the renal concentrating defect. Papillary solute concentration was significantly altered by both. The tissue osmolality of the papilla of the obstructed kidney was depressed to 50% of that found in an unobstructed kidney as a result of a marked reduction in tissue sodium and urea concentrations. No effects on tissue potassium concentration were observed. The administration of indomethacin and meclofenamate did not prevent the derangement in tissue solute concentration produced by obstruction. We conclude that prostaglandins do not seem to contribute to the concentrating defect produced by ureteral obstructions.
The relationship between plasma levels of vitamin A and zinc was studied in 45 children suffering from vitamin A deficiency and 20 children with protein-energy malnutrition. Thirty apparently normal children of the same age group were also studied for comparison. The mean levels of plasma vitamin A, retinol-binding protein and zinc were significantly lower in vitamin A-deficient children and in children with PEM, as compared to controls. Supplementation with 40 mg zinc daily for 5--10 days resulted in a significant increase in plasma vitamin A and RBP levels in children with PEM but not in the vitamin A-deficient group. There was, however, no correlation between plasma levels of vitamin A and zinc. The data suggest that in children with PEM, apart from deficiencies of protein and vitamin A, zinc deficiency may also contribute to the lowering of plasma vitamin A levels. They also suggest that in vitamin A-deficient children, without protein-energy malnutrition, zinc deficiency does not seem to have a role.
1. The effect of varying protein intake at two energy levels of 334 and 418 kJ/kg body-weight was studied in four preschool children belonging to the low socio-economic group. 2. Results indicated a curvilinear relationship between N intake and N rentention. From this relationship, the protein requirement of the children at adequate energy intake was calculated. 3. At adequate energy intake (418 kJ/kg body-weight) the protein requirement of the children was 1.33 g/kg. On decreasing the energy intake by 20% to 334 kJ/kg body-weight the protein requirement was found to be increased by 20% to 1.64 g/kg. 4. Based on this study, a safe level of protein intake for Indian preschool children subsisting on a diet based predominantly on vegetable proteins has been suggested.
Serum levels of vitamin A and retinol-binding protein (RBP) were measured in children with vitamin A deficiency, in children with protein-energy malnutrition (PEM) and in normal children, before and after administration of 100 000 IU of water-miscible vitamin A. Serum vitamin A and RBP levels were significantly low in children with vitamin A deficiency and in children with severe PEM, whereas the values in milder grades of PEM were similar to those of normal subjects. In severely malnourished children with corneal lesions, serum vitamin A concentration was reduced to a much greater extent than the level of serum RBP. Administration of vitamin A resulted in a significant increase in serum levels of both the components within 4 hours in all the 3 groups of children. The increase in RBP concentration observed in children with PEM was similar to that in vitamin A deficient children. These results indicate that in malnourished children, particularly in those who are at risk of developing keratomalacia, vitamin A is the main limiting factor. It is, therefore, recommended that children with PEM should be treated with vitamin A in addition to dietary protein and calories.