Biomedical subjects
Publications and source records attributed to W A Daniel.
Chest pain is a common symptom of older children and adolescents. The majority of the conditions causing it are benign and self-limiting. Almost all diagnoses can be made with a thorough history and physical examination. Most important, the patient and parents need to be assured that there is no heart defect and that there is no imminent danger of dying.
Hyperventilation is a common, though often unrecognized, disorder of adolescents. While relatively benign, the lack of recognition may lead to extensive, expensive, and unnecessary medical work-ups. The single most important factor in making the diagnosis of HVS lies in the awareness of the disorder's existence. HVS may be diagnosed through a positive response to the provocation test. Patients are asked to hyperventilate and questioned as to whether they experience the symptoms of which they have complained. Successful treatment involves reassurance, education, and giving the patient a strategy for controlling the hyperventilation. If treatment is not successful in a short period, patients should be referred to a qualified mental health professional. While the relationship between hyperventilation and anxiety disorders is unclear, some correlation between them does appear to exist.
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To determine whether or not adolescent female athletes were more in need of routine dietary iron supplements than their nonathlete peers, the iron status of 32 athletes and 31 nonathletes was assessed. The athletes were track-team members in the middle of their season. Hemoglobin, transferrin saturation, and serum ferritin were evaluated, as well as the amount of dietary iron intake. Athletes had significantly lower serum ferritin levels and transferrin saturation (less than 16%) than did nonathletes. Black girls were significantly lower than whites on all three values. There were also a greater number of black girls deficient in serum ferritin. We conclude that athletes may be at greater risk for iron deficiency and, therefore, for iron deficiency anemia; and black adolescents may have an increased prevalence of iron deficiency, with black female athletes being at potentially greater risk for iron deficiency and its possible consequences. We recommend a more sensitive assessment of iron status in female athletes.
Several highly significant changes occur within a relatively short period of time during adolescence. Great alteration in physique, developmental progress in thinking, and psychologic gains toward attaining ego identity take place but not always synchronously. Attention is paid to physical changes because they are visible and are of intense concern to adolescents, but physicians and other professionals should remember cognitive and psychosocial growth are affected by physical growth, and vice versa. Often there is a temporary disequilibrium in the relationship of these three areas of growth, and this can affect one or another part of the developmental pattern. It is therefore necessary to remind ourselves of the diversity of adolescent growth, and of adolescents, when caring for a young patient and be cognizant of growth in areas other than physical. More and more children with congenital or acquired handicaps are living to become adolescents and perhaps adults. Handicaps can be limited to one of the three major areas of growth or involve them all in varying degrees. For example, sickle cell disease, Crohn's disease, or ulcerative colitis may postpone physical growth for a significant period; this lack of pubertal change can affect psychosocial development but usually does not impair cognitive growth. Mental retardation may have no apparent effect on physical growth but can handicap the adolescent's psychosocial development. Growth still occurs in a sequential pattern but often it seems that handicapped youngsters reach a developmental milestone by a series of "detours." Physicians must recognize these lags or differences and try to facilitate progress, promote self-esteem, and provide understanding. Much can be done with anticipatory guidance. Adolescence often provides the opportunity to overcome past damage or, in some instances, to start anew on a more optimal program for physical and psychosocial growth. Young adolescent boys and girls usually look to the physician for factual information and guidance; they long for understanding by an adult outside of the family. If we can successfully fill their expectations, adolescents will be the better for it.
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A third amoebal virus type was isolated from four different strains of Entamoeba histolytica. The virus was most frequently seen as a linear structure about 235 nm long and consisting of 14 beadlike structures about 19 nm in diameter. A "dimer" of twice the length and consisting of 28 beads was occationally encountered. The virus replicated in the nucleus, forming ordered arrays. Acridine orange staining of viral aggregates in infected nuclei suggested the presence of double-stranded nucleic acid.
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The relationship of serum alkaline phosphatase concentrations to sex maturity ratings, age sex, and race was studied in healthy prepubertal and adolescent patients. Previous data concerning SAP concentrations in adolescents have been age related and do not give primary consideration to biologic growth during adolescence. The highest mean concentrations for girls occurred at SMR 2 and for boys at SMR 3, coinciding in each instance with peak height velocity and thus correlating with presumed maximum osteoblastic activity during growth. With increasing SMR or age, the SAP levels in both sexes decreased markedly. Black boys had higher SAP concnetrations than white boys at SMRs 2, 3 and 4, whereas black girls had higher values than white girls only at SMR 4. This study demonstrates the value of correlating the enzyme activity with sex maturity ratings rather than with chronologic age.
The relationship of maturity, age, race, sex and income level to dietary intake and body stores of iron, as indicated by percent of transferrin saturation, was studied in healthy adolescents. Maturity rating, sex, and race were significant. Level of family income was not a significant factor. Both boys and girls increase the intake of iron as they mature, boys more than girls, and white adolescents slightly more than their black counterparts. Range of intakes was large, and there was no significant correlation between quantity of dietary iron and the percent of transferrin saturation. Norms for dietary intake of iron and percent of transferrin saturation, based on sex, race, and maturity, are presented for use by physicians and nutritionists.
We desire to approach adolescent patients by liking them, being ourselves, trying to establish trust, and maintaining confidentiality. We want to help them grow well physically and develop normally emotionally. If we are concerned about them, take the time to listen to them, and let them know they are important to us, we will find that they are rewarding patients, and that they will educate us and increase our medical effectiveness.
Dietary intakes of folate and concentrations of plasma folate were obtained from healthy adolescents of families having low or high income. Results were tested statistically in relation to ages and to sex maturity ratings of the subjects. Maturity was a significant factor and age was not. Boys had higher dietary intakes of folate than girls, and family income was not significant. Low folate intakes are in general attributed to incomplete tables of folate content of foods and suggest a need for revision of existing standards. Plasma folate concentrations were higher in girls than in boys at all maturity ratings but both sexes showed decreasing concentrations as they became more mature. The paradox of increased dietary intake associated with decreased plasma folate concentration reflects increased need of folate for cellular manufacture associated with adolescent growth, particularly in boys. Plasma folate concentrations were subnormal in 9.4 percent of boys and 4.7 percent of girls from low-income families. Girls of higher income families had higher plasma folate due to their taking nonprescribed vitamin preparations containing folic acid. Family income did not affect dietary intakes but, either income or cultural pattern indirectly affected plasma folate concentrations. The study demonstrates the value of relating nutritional investigations to maturity ratings.
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We believe that the use of sex-maturity ratings as a routine part of physical examinations for adolescents is of value to all physicians caring for adolescents. The information is useful not only in following the growth of an individual patient but in detecting early abnormal patterns of adolescent development and also as a means of comparison with other adolescents. Because anaemia or a low haemoglobin-haematocrit value is a major concern during growth, we believe norms related to the sex, race, and maturity rating of an adolescent patient are of significant value. Caloric intake as well as dietary iron intake and percentage of transferrin saturation tend to increase with increasing maturity ratings and provide an indication for further evaluation if they are below the mean and standard deviation for the rating of maturity.
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