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The dumping syndrome in childhood is an uncommon complication of gastro-oesophageal surgery, principally Nissen fundoplication. A Jamaican child developed the syndrome after fundoplication and pyloroplasty to relieve gastro-oesophageal reflux complicating the repair of a congenital tracheo-oesophageal fistula. He developed marasmus and failed to gain weight on the standard remedial milk-based high energy diet. An oral glucose tolerance test confirmed the diagnosis of dumping syndrome. A low sugar low milk diet based on adult type meals with continous nibbling of fried dumplings relieved his diarrhoea and hypoglycaemia and he gained weight. This is a cheaper and more practical dietary therapy than the regimens described previously(AU)

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A follow-up study is reported of 18 children 4 y after treatment for the Trichuris dysentery syndrome (TDS) and matched control children. The TDS children were initially severely stunted and had extremely low developmental levels. They showed catch-up in height of 1.9 z-scores even though they remained in very poor environments. Their intelligence quotients, school achievement and cognitive function remained significantly lower than those of the controls. Controlling for their earlier developmental levels, the TDS children showed a small improvement in mental development relative to the controls (Au)

Assuntos

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The present study examines antigenic variability for the human whipworm Trichuris trichiura. Recognition by IgG of somatic antigens of individual worms collected from 3 intensely infected children from Jamaica, West Indies has been investigated by immunoblotting. When probed with 1 plasma sample, significant differences in recognition of 2 selected antigens among worm populations and between male and female worms was observed. In addition, there was evidence for antigenic variability within worm populations at the individual worm level. Such variations may have considerable implications for the development of immunity to parasitic nematodes.(AU)

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The biochemical markers of growth, insulin-like growth factor-1 (IGF-1) and the carboxyterminal propeptide of the type 1 procollagen (PICP) have been related to anthropometric indicators of growth. We have demonstrated a relationship among plasma levels of IGF-1 and height (ht) for age and weight (wt) for age Z-scores in children 2-10 years. PICP has been associated with height (kit) velocity. We therefore looked at plasma levels of these indicators in adolscents expected to attain maximum growth velocity during the year: boys ( n=20) 13-14 years old (mean age, 13.7 years) and girls ( n=18) 11-12 years old (mean age, 11.6 years). Ht, wt, mid-upper arm circumference (MUAC), triceps and subscapular skinfold thickness were measured at baseline, then every 3 months for a year. At each visit, a venous blood sample was taken for plasma determinations of IGF - 1 and PICP by radioimmunoassay (RIA). The girls were slightly above and the boys were slightly below the NCHS references for their age with the exception of the triceps skinfold. The observed mean ht and wt velocities among the boys were 5.5 cm/year and 5.3 kg/year and the girls, 5.3 cm/year and 4.9 kg/year. The mean plasma level of IGF -1 in the adolescents were double those in the 2 - 10 year old age group with the girls (41.02 nmol/ml 95 percent CI22.0, 60.0) higher than the boys (35.39 nmol/ml 95 percent CI15.4,55.39). The difference was statistically significant. The mean plasma levels of PICP were similar for boys, (399.63 ng/ml 95 percent CI59.83, 739.43) and for the girls (398.76 ng/ml 95 percent CI 114.36, 683.16). These values were slightly higher than those in the 2-10 year-old age group. These values of IGF-1 and PIUCP are comparable to those of other populations. Mean percent body fat (PBF) increased linearly during the year in the girls, was related to the their body mass index (BMI) and was significantly higher than that in the boys. There was no association between PBF and BMI in the boys. Unlike the 2-10 year-old age group, there were no consistent relationships demonstrated among the anthropometric and the biochemical markers of growth in adolscents. This may reflect the mixed levels of maturity and the influence of the pubertal hormones in this group of adolescents. (AU)

Assuntos

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About 85% of strokes in the U.S. occur in people over 65 years of age. As such, stroke is the third leading cause of death, and stroke management and prevention are important topics in geriatric cardiology. Approximately 50%-80% of strokes are preventable. Therefore, treatable stroke risk factors such as hypertension, atrial fibrillation and other manifestations of heart disease, cigarette smoking, diabetes mellitus, excessive alcohol intake, TIAs, and hypercholesterolemia must be identified and vigorously controlled. Once TIAs or other signs of stroke appear, the patient should be immediately transported to the nearest hospital emergency room arriving within one or two hours following the onset of symptoms. Currently accepted approaches to the management of acute stroke symptoms ("Brain Attack") are reviewed. New therapeutic and preventive stroke measures may help reverse the recent national rise in stroke occurrence and mortality as seen most prominently in African-Americans.

RESUMO

Children with the Trichuris Dysentery Syndrome (TDS) are both stunted and wasted. Following treatment, these children show rapid gain in height and weight. Levels of insulin-like growth factor-1 (IGF-1), the main mediator of growth hormone (GH) in plasma, have been related to growth velocity. We therefore looked at the relationship between IGF-1 and the anthropometric and biochemical indices of growth in a group of 14 children (2-10 years old) affected by TDS (cases). We also looked at the same indices in 28 unaffected (control) children matched by age, gender, neighbourhood and socio-economic status. The cases were admitted to the Tropical Metabolism Research Unit (TMRU) and treated with albendazole and iron. The following series of anthropometric measurements: height (Ht), weight (Wt), head circumference (HC), mid-upper arm circumference (MCA), triceps and subscapular skinfold thicknesses were made at predetermined intervals for one year. On each measuring day, blood samples were drawn for plasma IGF-1 determination by radioimmunoassay (RIA). On admission, the mean levels of plasma IGF-1 were significantly lower in the cases than in the controls. More than half of the individual cases (57 percent) fell below the IGF-1 assay reference levels for their age and gender, the others were at the low end of the range. All of the control levels were within the reference range. Three weeks after hospital discharge (approximately 4 weeks after worm expulsion) the cases had a significant rise in levels of plasma IGF-1: mean = 13.09, SD = 2.97, SEM = 0.86, but were still significantly lower than the controls, 95 percent CI (-11.34, -2.19), p = 0.008. Three months after treatment, there was no significant difference in mean plasma IGF-1 levels between the cases and the controls. This study indicates that low circulating IGF-1 is associated with reduced collagen synthesis. Levels of plasma IGF-1 are correlated with the anthropometric indices of growth and nutrition and reflect the severity of disease in these children (AU)

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The case fatality ratio (CFR) in acute protein-energy malnutrition (PEM) achieved in the Tropical Metabolism Research Unit (TMRU) was compared with that of other tertiary care facilities in Kingston. Trends in admission and fatality rates, case severity and complications were also examined. From ward admission registers for Bustamante Hospital for Children (BHC), the University Hospital of the West Indies (UHWI), children's wards and the TMRU all cases of PEM admitted from 1982 through 1991 were enumerated and there was a docket search for random subsamples. Ten-year mean CFR percent for BHC was 8.8 (n=1974); for UHWI wards 5.5 (n=658); for TMRU 7.1 (n=662). BHC has the least restrictions on admission and showed most clearly that the peak time in Kingston for admission of PEM was around 1985, falling to a minimum in 1988 - 1990 and rising again in 1991; however, the other sites also showed similar trends. BHC had a range of CFR precent p.a. of 20.0 to 3.0, with a striking fall in the second half of the decade. There was no temporal CFR trend for the UHWI or TMRU. The latter institution had the highest proportion of admissions with marasmic-kwashiorkor and the lowest proportion with recorded infection. The annual variation in numbers of PEM deaths at BHC was best accounted for by (a) percentage change in consumer price index and (b) percentage change in the US$ value of the Jamaican $, in the preceding year, and (c) annual number of admissions, together. Generally, our findings suggest a minor role for expert in-patient management in reducing deaths from PEM

Assuntos

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The case fatality ratio (CFR) in acute protein-energy malnutrition (PEM) achieved in the Tropical Metabolism Research Unit (TMRU) was compared with that of other tertiary care facilities in Kingston. Trends in admission and fatality rates, case severity and complications were also examined. From ward admission registers for Bustamante Hospital for Children (BHC), the University Hospital of the West Indies (UHWI), children's wards and the TMRU all cases of PEM admitted from 1982 through 1991 were enumerated and there was a docket search for random subsamples. Ten-year mean CFR percent for BHC was 8.8 (n=1974); for UHWI wards 5.5 (n=658); for TMRU 7.1 (n=662). BHC has the least restrictions on admission and showed most clearly that the peak time in Kingston for admission of PEM was around 1985, falling to a minimum in 1988 - 1990 and rising again in 1991; however, the other sites also showed similar trends. BHC had a range of CFR precent p.a. of 20.0 to 3.0, with a striking fall in the second half of the decade. There was no temporal CFR trend for the UHWI or TMRU. The latter institution had the highest proportion of admissions with marasmic-kwashiorkor and the lowest proportion with recorded infection. The annual variation in numbers of PEM deaths at BHC was best accounted for by (a) percentage change in consumer price index and (b) percentage change in the US$ value of the Jamaican $, in the preceding year, and (c) annual number of admissions, together. Generally, our findings suggest a minor role for expert in-patient management in reducing deaths from PEM (AU)

Assuntos

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Children with trichuris dysentery syndrome (TDS) tend to have growth and nutritional deficits, as shown by their consistently short stature and variable amount of wasting (low weight for their attained height). Two previous reports have described the accelerated growth of two small series of these children in their homes after treatment of the dysentery and anaemia. We now report on the 6-month post-treatment growth velocities of a complete series of 63 children with TDS. The children had a mean age of 6.4 years (SD 1.9) at the mid-point of their 6 month interval, whereas their height-age at the mid-point was 3.2 y (SD 1.5). This shows the extent of their stunting. Over the 6-month interval after initiation of treatment the average height velocity was 10.9 cm per year (SD 3.3) and the weight velocity was 4.0 kg per year (SD 2.3). There was no effect of age on the ability to initiate catch-up from stunting (although we cannot as yet say anything about the children's final attained heights). The mean growth velocities of this complete series of Jamaican children and the distributions about these means provide the best evidence to date of the tendency to catch-up growth, without change in environment, after treatment of intense infection of Trichuris trichiura (AU)

Assuntos

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Trichuris dysentry syndrome is a severe form of trichuriasis which develops as a result of infection by Trichuris trichuria and can adversely affect the growth and iron status of children. We examined the growth and iron status of ten Jamaican children with trichuris dysentery syndrome, aged 2 to 7 years. Data were collected before treatment and serially, for six months, after treatment. Heights and weights are expressed as standard deviation (Z) scores, which were calculated using the National Center for Health Statistics growth charts. Mean Hb, PVC, MCHC, height Z-score and median serum ferritin before and after treatment are presented in the table. There was a significant increase in the mean height Z-score, mean weight Z-score and mean haemoglobin after treatment; however, median serum ferritin concentration and mean PCV did not increase significantly. The change in average MCHC approached significance. Anthelmintic treatment and iron therapy resulted in an improvement in the Hb, PCV and MCHC levels but did not affect iron stores. Treatment resulted in an increase in the weight Z-score and height Z-score of the patients - table included (AU)

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