Reduction in in-hospital mortality of children with malnutrition

OBJECTIVE: To investigate the nature and accuracy of information carried by patients about their drug allergies. SUBJECTS: 2500 new adult patients. SETTING: Accident and emergency department of a tertiary referral centre. METHODS: Patients were questioned about drug allergies. Where they claimed allergies, general practitioners were contacted for corroboration. RESULTS: 242 patients (9.7%) claimed 276 allergies; 32 different drugs were implicated. Penicillin was implicated most often (151 patients); 38 patients could not remember what they were allergic to; 21 described severe reactions, but four could not remember the drugs involved. Only seven patients carried evidence of their allergies. General practitioners were contacted about 240 of the drug allergies; only 114 were confirmed as described. CONCLUSIONS: Many patients who believe themselves to have drug allergies are poorly informed about them. Emergency prescribing for these patients may risk anaphylaxis. The future acceptance of "Smart cards"would reduce this risk. In the meantime, patients with drug allergies should be strongly encouraged to carry evidence of their allergies.     

Secretory and serum IgA in children with protein-calorie malnutrition

The local immune system of children suffering protein-calorie malnutrition (PCM) was investigated by analyzing the amount of immunoglobulins in the nasal washing on admission, repeatedly during 84 days of hospital therapy, and on follow-up, one to two years later. Although measured concentrations of total protein, IgG, and albumin in nasal washings were reduced in children with PCM, only secretory IgA concentrations were significantly lower (P less than .01) in PCM compared to normal children. Mean secretory IgA concentrations were significantly reduced on admission through hospital day 70 and returned to near normal thereafter. At one to two years after hospital discharge, mean concentrations of secretory IgA in nasal secretions were within normal limits. The concentrations of secretory IgA in nasal washings were lowest at a time when serum IgA was markedly elevated; serum IgA concentrations fell to normal values during dietary treatment. The possible role of secretory IgA deficiency in PCM and infection is discussed.     

Efficacy and pharmacokinetics of a new intrarectal quinine formulation in children with Plasmodium falciparum malaria

The O-2A progenitor cell, which serves as a stem cell for the myelinating oligodendrocyte, has been implicated as a major target for radiation-induced spinal cord injury. In an attempt to increase the number of O-2A cells in the spinal cord, we applied an ex vivo gene therapy procedure for delivering platelet derived growth factor (PDGF). Recombinant fibroblasts expressing PDGF A chain were injected into the cisterna magna of adult rats, which resulted in cell seeding of the subarachnoid space of the cervical spinal cord. The number of O-2A progenitors in the cervical spinal cord was then assessed with an in vitro clonogenic assay. O-2A cells were found to be increased 8 days after recombinant cell injection, and they remained elevated up to at least 14 days. Analysis of O-2A colonies indicated that the implantation of PDGF-expressing cells increased the number of O-2A progenitors without affecting their in vitro proliferation potential or differentiation capacity. These data suggest that implantation of PDGF-expressing cells in the subarachnoid space of the cervical spinal cord may influence a stem cell population critical to the repair of demyelinated lesions.     

Factors influencing malnutrition in children waiting for liver transplants

Nutrition deficiencies are common in children with chronic liver disease. To determine whether age, hepatic dysfunction, or energy intake influences this malnutrition, we evaluated the nutritional status of 49 children aged 2.5 mo to 13 y (mean: 35 mo; median: 12 mo). The children were divided into two groups according to age: group 1-29 patients aged < or = 1 y (mean: 7 mo; median: 7 mo); and group 2-20 patients > 1 y (mean: 75 mo; median: 59 mo). Hepatic dysfunction was defined according to the Malatack criteria. Seventy-two-hour dietary intakes were recorded by a nutritionist. Nutritional status was assessed by anthropometric measures when the patients were enrolled on the waiting list for liver transplants. We evaluated the following indexes: weight, height, fat body mass, and lean body mass on the basis of height-age (age at which height reached 50th Italian height percentile). Mean height Z scores were low in both groups, but the difference was not significant. Mean weight Z scores and mean percentages of fat body mass were significantly lower (P < 0.001) in group 1 than in group 2 patients. In group 2, lean body mass and fat body mass were significantly lower (P < 0.05) in patients with moderate-to-severe hepatic failure than in patients with mild hepatic dysfunction. The mean energy intake was in the range of the recommended daily allowances for age but was insufficient for both groups of patients. The evidence of significant acute and chronic malnutrition confirmed the need for nutritional support, especially for younger and older children with moderate-to-severe hepatic dysfunction. We emphasize the necessity of accurate assessment of nutritional status by simple anthropometric measurements to be sure of the effects and adequacy of the nutritional intervention.     

The pharmacokinetics of quinine in patients with hepatitis

The pharmacokinetics of quinine were studied in six patients with hepatitis B infection (during acute and convalescent periods) and six healthy subjects. A single 10 mg kg-1 dose of quinine was given intravenously over 2 h. Pharmacokinetic parameters of quinine during the acute phase of the infection were not different from those during the recovery phase. However, when compared with those obtained from healthy subjects, significant changes were found. The terminal elimination half-life was prolonged (17 and 15 vs 10 h) and clearance was lower (2.9 and 2.3 vs 3.5 ml min-1 kg-1). Unbound quinine concentration in plasma at 2 h was approximately 10% of the total concentration in all subjects in the three study groups. A prolonged QTc interval (< 25%) was observed in all groups. The present data suggest that current dosage regimens of quinine used in the treatment of falciparum malaria may not be suitable for malaria patients with acute hepatitis or those who have had hepatitis within the past 3 months.     

Cognitive functions of school children with normal IQ and histories of severe and early malnutrition

Reference values of some hematologic and plasma chemical parameters were established in two species of clinically normal Cercopithecidae. The following variables were studied in seven mandrills (Mandrillus sphinx) and nine white-crowned mangabeys (Cercocebus torquatus lunulatus): hematocrit, hemoglobin concentration, erythrocyte and leucocyte counts, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, glucose, urea, uric acid, cholesterol, creatinine, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, creatinine phosphokinase, lactic dehydrogenase, gamma glutamyl transpeptidase, total serum proteins, albumin, globulins, albumin-globulin ratio, sodium, potassium, calcium, magnesium, total phosphorus, chloride, and serum osmolality. Few differences were observed when compared with human hematological data and with other species of Cercopithecidae Primates.     

Risk factors for the prevalence of malnutrition among urban children in Ghana

Alternative splicing has been shown to occur at the metabotropic glutamate receptor 1 (mGluR1) gene. Three main isoforms that differ in their carboxy-termini have been described so far and named mGluR1alpha, mGluR1beta and mGluR1c. These variants when expressed in recombinant systems all activate phospholipase C, although the [Ca2+] signals generated have different kinetics. Tissue distribution studies of specific mGluR1 splice variants are limited to the mGluR1alpha isoform. In the present work, we examined the localization of mGluR1beta in the adult rat and mouse forebrain by using a specific antipeptide antibody. Furthermore, the mGluR1beta immunostaining was compared with that obtained with antibodies specific for mGluR1alpha or with a pan-mGluR1 antibody which recognizes all isoforms. mGluR1beta-like immunoreactivity (LI) was found confined to the neuropil and neuronal perikarya and appeared discretely distributed in the rodent forebrain. Differential cellular distribution between mGluR1alpha and mGluR1beta was observed. In the hippocampus, mGluR1alpha-LI was restricted to non-principal neurons in all fields, whereas mGluR1beta-LI was strongest in principal cells of the CA3 field and dentate granule cells but absent in CA1. We have also shown that the vast majority of neurons in the striatum express mGluR1. The predominant form appeared to be mGluR1beta, with a distribution pattern reflecting the patch-matrix organization of the striatum. The specificity of the immunoreactivity described for mGluR1 splice variants was confirmed in mGluR1-deficient mice. The observation of a different cellular and regional distribution of mGluR1 splice variants, in particular in the hippocampus, suggests that they may mediate different roles in synaptic transmission.     

Effects of chronic oral dosing with quinine sulphate in the rat

Male Leeds strain rats were given 0.1% guinine sulphate in their drinking water for up to 15 months. A high mortality rate was obtained, but no tumours arose during the 20 month duration of the experiment. However, liver parenchymal changes were observed which appeared to be associated with chronic toxicity due to quinine and did not include hyperplasia.     

Protein energy malnutrition, vitamin A deficiency and night blindness in Bangladeshi children

The occurrence of night blindness and serum vitamin A concentrations among children in rural Bangladesh were studied in relation to protein energy malnutrition, dietary habits and intake of vitamin A capsules. In 1992, 124 night-blind children were registered in a cross-sectional survey in the northern part of Bangladesh, and age-, sex- and neighbourhood-matched controls were selected. Of these, the first reported night-blind child from a household (n = 105) and their controls were included in the analyses. Our results showed that night blindness was associated with protein energy malnutrition when using the mid-upper arm circumference (MUAC) as a measure of nutritional status. The odds ratio for a confirmed diagnosis of night blindness among children with a MUAC < 80% of the reference versus normal children was 5.4 (CI 1.9-15.5). Low MUAC was associated with low intake of beta-carotene-rich and vitamin A-containing foods as well as with low serum vitamin A in the total series of cases and controls. This may indicate that night blindness is only one aspect of the general protein energy malnutrition problems in this population. We therefore suggest that measures to prevent vitamin A-related morbidity and mortality should include improvement of the general diet with increased consumption of dietary vitamin A.     

Hyperactivity to quinine associated with osmotic thirst in the rat.

Studied cellular and extracellular fluid depletion in 5 experiments with Sherman female albino rats (N = 103). Drinking in response to cellular dehydration, but not in response to water deprivation, was severely disrupted by mild quinine adulteration of the drinking fluid. Cellular dehydration in conjunction with deprivation, although enhancing the intake of water, actually suppressed quinine intake. In contrast, intravascular fluid depletion added to water privation enhanced intake both of water and of quinine solutions. It is concluded that the heightened reactivity to quinine which accompanies cellular dehydration reflects a specific property of the osmotic-thirst mechanism. (24 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk factors for protein-energy malnutrition in pre-school shantytown children in S?o Paulo, Brazil

OBJECTIVES: To investigate the health and nutritional conditions of people living in a shantytown in the city of S?o Paulo in order to identify risk factors for infant malnutrition. DESIGN: A retrospective cohort study. PARTICIPANTS: Children living in a shantytown was conducted among children less than 72 months of age. METHODS: Home visits were made and information was collected regarding the risk factors for malnutrition. RESULTS: The prevalence of chronic malnutrition was 41.6% according to Gomez, 36.6% according to Waterlow, and 17.6% according to WHO. Risk factors for malnutrition, according to the weight-for-age index, included birthweight, presence of upper respiratory tract infections, number of pregnancies, number of births, maternal body mass index, birthplace of father, and home building material; according to the weight-for-height index, they included birthweight and maternal age at the time of birth; and according to the height-for-age index, they included the number of prenatal medical visits, birthweight, maternal height, maternal body mass index, father's employment being unregistered, and maternal birthplace. An instrument for identifying children at risk of malnutrition was devised from these major risk factors for future malnutrition, which may then be applied to newly-born children.     

The management of malnutrition in hospital

Treatable malnutrition may occur in up to 25% of hospital patients, depending on the specialty concerned. Nutritional status may also deteriorate during a prolonged hospital stay. The management and prevention of malnutrition requires a climate in which hospital managers have a positive policy towards nutritional care, a screening system to identify the patients at risk, and appropriate protocols for action. Catering services need to be reorganized to address the problems of the sick, so that appropriate food is not only prepared but delivered in a way which makes it likely to be consumed. For the optimal management of artificial nutrition by the enteral or parenteral route, a skilled nutrition team is both necessary and cost-effective.     

Management of malnutrition in peritoneal dialysis

Peritoneal dialysis is associated with nutritional abnormalities due to peritoneal glucose absorption and protein or amino acid losses into the dialysate. Nutritional assessment, every four months, is essential, based on body composition, anthropometric measurements, clinical characteristics, biochemical parameters and dietary survey. Thus 1.2 g to 1.3 protein/kg/day and 30 to 35 kcal/kg/day energy intake may be required. Oral, parenteral or intraperitoneal amino acids supplementation can improve the nutritional status in peritoneal dialysis patients.     

Growth, morbidity, and mortality of children in Dhaka after treatment for severe malnutrition: a prospective study

Over 1300 severely malnourished children (< 60% of US National Center for Health Statistics weight-for-height, with edema, or both) are admitted each year to the Children's Nutrition Unit in Dhaka. Fatality during treatment is low and recovery is rapid. Our aim was to determine whether this initial success is sustained when children return home. A previous attempt to address this question was frustrated by the difficulty in tracing children after discharge because most are from slum settlements and families move frequently. This prospective study with fortnightly monitoring was therefore undertaken. The main outcomes of interest were anthropometric status, relapse, morbidity, and mortality. Children (n = 437) who had been treated for severe malnutrition when aged 12-59 mo and had reached the discharge criterion of 80% of weight-for-height, were followed for the next 12 mo. During follow-up, 7.5% were lost without trace, 0.6% relapsed, and 2.3% died. Morbidity was high, with a mean of seven episodes of diarrhea during the year. Outpatient visits for diarrhea occurred for 67% of children, and 58% had pneumonia (10% had pneumonia three times). After 12 mo, mean weight-for-height was 91% (-0.92 z score) but mean height-for-age remained at 84% (-4.14 z score). Weight gain, but not height gain, tended to be lower in children who experienced more diarrhea. Fever and cough were not associated with either weight or height gain. The high prevalence of illness highlights the need for continued accessible health care and for interventions to reduce disease acquisition.     

Incidence and recognition of malnutrition in hospital

OBJECTIVES: To determine incidence of malnutrition among patients on admission to hospital, to monitor their changes in nutritional status during stay, and to determine awareness of nutrition in different clinical units. DESIGN: Prospective study of consecutive admissions. SETTING: Acute teaching hospital. SUBJECTS: 500 patients admitted to hospital: 100 each from general surgery, general medicine, respiratory medicine, orthopaedic surgery, and medicine for the elderly. MAIN OUTCOME MEASURES: Nutritional status of patients on admission and reassessment on discharge, review of case notes for information about nutritional status. RESULTS: On admission, 200 of the 500 patients were undernourished (body mass index less than 20) and 34% were overweight (body mass index > 25). The 112 patients reassessed on discharge had mean weight loss of 5.4%, with greatest weight loss in those initially most undernourished. But the 10 patients referred for nutritional support showed mean weight gain of 7.9%. Review of case notes revealed that, of the 200 undernourished patients, only 96 had any nutritional information documented. CONCLUSION: Malnutrition remains a largely unrecognised problem in hospital and highlights the need for education on clinical nutrition.