Fractionation of Crotalus durissus cumanensis venom by gel filtration

Serum lipid levels were determined in 30 children with kwashiorkor and in 30 healthy children of comparable age. The serum concentrations of unesterified and esterified cholesterol, albumin and the cholesterol esterifying activity (CEA) were also measured in children with kwashiorkor before treatment and after recovery. All serum lipid fractions were significantly lower in kwashiorkor than in the normal children. After treatment and recovery, serum lipid levels were comparable to those observed in normal children. There was also a significant increase in serum cholesterol esterifying activity (CEA) following recovery from kwashiorkor.     

Of sick turkeys, kwashiorkor, malaria, perinatal mortality, heroin addicts and food poisoning: research on the influence of aflatoxins on child health in the tropics

Similarities between the geographical and climatic prevalences of kwashiorkor and of exposure to dietary aflatoxins, and between the biochemical, metabolic and immunological derangements in kwashiorkor and those in animals exposed to aflatoxins, prompted investigation of the associations between kwashiorkor and aflatoxins. Studies in Africa in the 1980s indicated a role for these toxins in the pathogenesis of the disease. Paediatric cases of kwashiorkor are less prone to severe Plasmodium falciparum malaria than normal children. In mice infected with P. berghei, aflatoxin exposure inhibits parasite growth and ameliorates morbidity. Aflatoxins occur in < or = 40% of samples of breast milk from tropical Africa, usually as low concentrations of the relatively non-toxic derivatives of aflatoxin B1 (AFB1) but sometimes as high concentrations of the very toxic AFB1. This could explain kwashiorkor in breast-fed babies. Aflatoxin exposure occurs in > or = 30% of pregnancies in tropical Africa and the toxins are often in cord blood, sometimes at extremely high concentrations. Aflatoxins are now incriminated in neonatal jaundice and there is circumstantial evidence that they cause perinatal death and reduced birthweight. Aflatoxin-induced immunosuppresion may explain the aggressive behaviour of HIV infection in Africa. There are similarities between observations on HIV cases in Africa and those on heroin addicts in Europe, where 'street' heroin is frequently contaminated with aflatoxin. Aflatoxins were found in 20% of random urine samples from heroin addicts in the U.K. and the Netherlands. Aflatoxins have also been incriminated in episodes of food poisoning which have been associated with serious morbidity and mortality, particularly among young children.     

Fractionation of canine serum calcium, using a micropartition system

OBJECTIVE: To determine usefulness of a micropartition system for calcium fractionation of canine serum, and to establish reference values for protein-bound, complexed, and ionized calcium fractions in clinically normal dogs. DESIGN: Performance characteristics of a micropartition system were evaluated, using serum from clinically normal dogs. This micropartition system was then used to determine a reference range for calcium fractions. ANIMALS: 13 clinically normal dogs. PROCEDURE: Dog serum was placed in the micropartition system, and spun for 20 minutes at 1,300 x g. Total calcium concentration, ionized calcium concentration, and pH were measured in whole serum, and total calcium concentration was measured in the ultrafiltrate. The protein-bound fraction was calculated by subtracting total calcium of the ultrafiltrate from total calcium of whole serum. The ionized calcium measurement of whole serum was subtracted from the total calcium measurement of the ultrafiltrate, determining the complexed calcium fraction. RESULTS: During validation of the ability of the micropartition system to separate calcium fractions, no significant amount of serum calcium was adsorbed by the plastic micropartition system or membrane. The micropartition membrane separated the protein-bound calcium fraction (retentate) from the ultrafiltrate, which contained ionized and complexed fractions of calcium. Concentrations of protein-bound, ionized, and complexed calcium from clinically normal dogs were determined to be 3.40 +/- 0.63, 5.49 +/- 0.17, and 1.01 +/- 0.30 mg/dl, representing 34, 56, and 10% of the total calcium concentration, respectively. CONCLUSIONS: This method is a rapid, repeatable means to completely fractionate serum calcium, and most importantly provides accurate assessment of the protein-bound and complexed calcium fractions. CLINICAL RELEVANCE: Complete assessment of calcium fractions may increase sensitivity for detection of disease processes that affect calcium metabolism.     

Relationship of milk secretion to hypocalcemia in the dairy cow

After parturiton, alternate periods of milking for 4 days and nonmilking for 3 days produced marked changes in plasma concentrations of calcium, phosphorus, magnesium, chloride, and parathyroid hormone in Jersey cows. A 3- to 4-day period of hypocalcemia, increased parathyroid hormone concentrations, hypophosphatemia, and hypermagnesemia was associated with initiation of each milking period. These measurements did not return to normal until 6 to 7 days after initiation of milking. An "overshoot" of the calcium and phosphate concentrations after this adaptive period occurred in many of the cows. There was little difference in the time sequence of the hypocalcemic period that was associated closely with parturition and initiation of milk secretion in the cow and of hypocalcemic periods that could be induced by the alternate periods of milking. A "lag time" in the calcium homeostatic mechanisms of the cows was present, and for the calcium demand placed on the cows in these experiments the "lag time" was 5 to 7 days. This "lag time" appears to be important in development of parturient by hypocalcemia of dairy cows.     

Appendicular bone mass in children with a high prevalence of low dietary calcium intakes

We have previously documented evidence of dietary calcium deficiency in black children living in a rural community in the eastern part of South Africa. The present study determined the bone mass of the distal one-third of the radius in a random sample of children living in the same community and compared their bone mass measurements with those of black children living in a similar rural community but without evidence of dietary calcium deficiency. Further, factors (weight, height, serum corrected total calcium, phosphorus, and alkaline phosphatase [ALP]) that might influence appendicular bone mass were assessed and correlated with the bone mass measurements. A random sample of 306 boys and 345 girls between the ages of 1 and 20 years were included in the study. Hypocalcemia was found in 6.5% of the boys and 5% of the girls, while elevated ALP values were recorded in 20 and 26% of the boys and girls, respectively. After adjusting for differences in age, weight, and height, bone mineral density (BMD) and bone mineral apparent density (BMAD) were significantly lower and bone width (BW) greater in study than control children. In a stepwise regression analysis, weight and/or height accounted for the majority of the observed variance in BMC, BW, and BMD; however, a significant effect of serum calcium (positively) and ALP (negatively) on BMC and BMD was also found. In boys, but not girls, serum ALP also had a positive effect on BW.BMAD was negatively correlated to ALP and positively correlated to serum calcium in both boys and girls. Those children with hypocalcemia or elevated ALP levels had significantly lower BMC, BMD, and BMAD and a trend toward greater BW than children with normal biochemistry. The findings suggest that low dietary calcium intake may have a detrimental effect on appendicular bone density in rural black children. Whether or not these effects are disadvantageous in the long-term is not known.     

Lipids and lipoproteins of malnourished children during early renutrition: apolipoprotein A-IV as a potential index of recovery

Twenty-six children with marasmus and 27 with kwashiorkor were compared with 23 control children of matching ages. Kwashiorkor was characterized by increased phospholipids (NS), low (P < 0.01) apolipoprotein (apo) B-rich LDL, and near normal apo A-I and HDL-C. In children with marasmus apo B (P < 0.02) LDL-C (NS), apo A-I (P < 0.01), and HDL-C (P < 0.001) decreased. Fifteen children in each group were followed for 2 wk. Control values were progressively reached after 2 wk. In the younger children final apo B was higher than in control subjects (P < 0.03) but apo A-I was identical. Apo A-IV, assayed because it correlates with the functional state of intestine, was near normal in children with kwashiorkor and decreased with treatment. In children with marasmus apo A-IV decreased by 50%, increased with treatment in older children, but further diminished in younger children. After 2 wk apo A-IV was significantly lower in all patients than in control subjects. Apo A-IV, by remaining depressed after other variables normalized, seems a good index of nutritional status.     

Differences in the stress response of Wistar-Kyoto (WKY) rats from different vendors

This study tested the hypothesis that during treatment of kwashiorkor (including marasmic kwashiorkor) with infection there is a lower rate of amino acid oxidation when the dietary intake of amino acids resembles the amino acid composition of acute phase proteins (APPs). Twenty-two children in Blantyre, Malawi, with kwashiorkor and acute infection were fed an isoenergetic, isonitrogenous diet with either egg white or milk as a protein source. The whole-body amino acid oxidation rate was measured after 24 h by determining the plasma urea rate of appearance, and whole-body protein breakdown and synthesis rates were determined from the plasma leucine rate of appearance. Plasma concentrations of C-reactive protein, alpha1-antitrypsin, tumor necrosis factor alpha (TNF-alpha), and interleukin 6 (IL-6) were determined on admission and at 24 and 48 h. The 11 children who received milk had a lower rate of amino acid oxidation than the children who received egg white (x +/- SD: 137 +/- 65 compared with 195 +/- 66 micromol urea x kg body wt(-1) x h(-1), P < 0.05). No significant differences were found between the two groups in the rate of whole-body protein breakdown or protein synthesis. The TNF-alpha concentration correlated inversely with whole-body protein breakdown and synthesis rates, and the IL-6 concentration correlated directly with C-reactive protein. We conclude that by making the amino acid composition of the diet resemble that of APPs in the treatment of acute kwashiorkor, the rate of amino acid oxidation can be decreased.     

Intracranial chondromas

Biochemical and hormonal effects of oral calcium supplementation in premature and asphyxiated neonates during the first few days of life are described. Eight pairs of infants were matched for gestational age and one-minute Apgar score. One member of each pair served as a control and the other was given supplemental oral calcium (75 mg/kg/24 hr) beginning at 12 and ending at 72 hours of age. The supplemental infants had significantly higher serum calcium values both during the time of supplementation and for 36 hours after supplementation was stopped. The oral calcium supplements had no significant effect on serum concentrations of phosphate, magnesium, 25-hydroxy-vitamin D3, or parathyroid hormone, The incidence of hypocalcemia after 12 hours of age was 0 in eight supplemented infants and three in eight control infants. In patients at risk for hypocalcemia, prospective use of oral calcium supplements during the period when there is inadequate calcium intake from feedings may prevent hypocalcemia, appears to be without deleterious effect on measurable chemical and hormonal factors important in calcium homeostasis, and results in maintenance of higher serum calcium levels after supplementation has been discontinued.     

Brushing abrasion of eroded dentin after application of sodium fluoride solutions

OBJECTIVE: To examine the relationship between immunological variables and the different types and severity of malnutrition in Ghanaian children. DESIGN: Case-control study. SETTING: The study was done at Princess Marie Louise Hospital, Accra, Ghana. SUBJECTS: One hundred and seventy children, aged 8-36 months, were recruited at the clinical ward and public health service section of the hospital: 61 normal children, 49 moderately malnourished (underweight) children and 60 severely malnourished children (19 kwashiorkor, 30 marasmus, and 11 marasmic kwashiorkor children). METHOD: The children underwent clinical observations, anthropometric measurements and blood sampling for biochemical analysis to evaluate their nutritional and immunological status. Serum immunoglobulins (IgA subclasses, IgG subclasses and IgM), complements (C3 and C4) and lymphocyte subpopulations (T cells, B cells, CD4+, CD8+, NK cells and HLADR) were determined for the assessment of humoral and cell-mediated immunity. RESULTS: Serum levels of IgA1, IgA2 and C4 tended to be higher in severely malnourished children than in normal children, while serum level of C3 and the proportion of B cells were significantly lower in the severely malnourished children than in the normal children (P < 0.05). There were no notable differences in most immunological parameters among the three severely malnourished groups. No differences were observed in the immunological parameters except for the proportion of B cells between normal and moderately malnourished children. Factor analysis revealed that C3 levels were positively correlated with a factor which was strongly associated with weight-for-height z-score and biochemical indicators for evaluating protein nutrition. In addition, IgA2, IgG1 and IgM levels were positively correlated with a factor which was associated with C-reactive protein. CONCLUSION: Several immunological variables responded positively or negatively with the different levels of severity of malnutrition, but most variables did not on the different types of malnutrition. The changes of C3 level were more associated with the severity of malnutrition.     

A definition of catheter-related infection

A 5 year old boy with normal phenotype and normal renal function presented tetany. Hypocalcemia and hyperphosphatemia, with increased serum levels of parathyroid hormone (PTH) were detected in serial measurements. Pseudohypoparathyroidism was diagnosed. This disease presents the biochemical abnormalities of hypoparathyroidism (hypocalcemia, hyperphosphatemia) with peripheral resistance to PTH activity. The patient was treated effectively with calcium and vitamin D supplements. The causes of hypocalcemia related to parathyroid gland activity are reviewed and the physiopathology of pseudohypoparathyroidism is described.     

Effect of lysolecithin on gastric mucosal structure and potential difference

Calcium metabolism was studied prospectively in 12 patients with amyotrophic lateral sclerosis. Two patients showed mild hypocalcemia, malabsorption of calcium, and elevated plasma parathyroid hormone concentrations. Serum 25-hydroxyvitamin D was decreased in one and low-normal in the second. These two patients and a third showed aminoaciduria on thin layer chromatography. Calcium metabolism was apparently restored to normal by dihydrotachysterol, a vitamin D analog, but no improvement in neurologic function resulted. Bone radiographs taken in search of metabolic bone disease showed a significant increase in the incidence of congenital vertebral anomalies in the ALS patients (50% versus 8%). The relationship of the abnormalities in calcium metabolism and in vertebral structure to the etiology of motor neuron disease is not known.     

Desmin-rich smooth muscle bundles in chronic intestinal pseudo-obstruction

OBJECTIVE: To report a case of hypocalcemia and hypomagnesemia after ibuprofen overdose. CASE SUMMARY: A 21-month-old boy developed acute renal failure with severe metabolic acidosis after ingestion of ibuprofen 8 g. The infant developed tonic-clonic seizures 46 hours after ingestion, with significant hypocalcemia and hypomagnesemia that required electrolyte replacement to control the seizures. DISCUSSION: To our knowledge this is the first case report of hypocalcemia, hypomagnesemia, and seizures in a patient after ibuprofen overdose. The mechanism is unclear, the situation was probably aggravated by the use of sodium polystyrene sulfonate and furosemide. CONCLUSIONS: In patients with ibuprofen overdose, serum calcium and magnesium concentrations should be evaluated since seizures may be associated with a deficiency of these cations. The management of these patients should include calcium and/or magnesium supplementation when required and furosemide should be avoided.     

Assessment of parathyroid gland function: predictive value of a nomogram

Recent developments in measurement of intact parathormone (PTH) has enabled to generate a nomogram for parathyroid function. Blood levels of PTH can thus be interpreted in relation to calcemia. Intact PTH and calcium were assayed in blood from 99 healthy subjects studied under fasting conditions; 26 subjects were also studied during hyper- and hypocalcemia, induced by calcium and EDTA infusions, respectively. Serum levels of intact PTH which had been obtained in 99 patients were then analysed retrospectively by comparison with the nomogram. Patients whose intact PTH levels lie above the normal zone of the nomogram produce too much PTH relative to the blood calcium level (hyperparathyroidism); those falling under the normal zone produce too little (hypoparathyroidism).     

Ionized hypocalcemia during out-of-hospital cardiac arrest and cardiopulmonary resuscitation is not due to binding by lactate

OBJECTIVE: To determine the relationship between ionized calcium concentrations and blood lactate levels during cardiac arrest and cardiopulmonary resuscitation (CPR). DESIGN: A prospective cohort study. SETTING: Emergency department (ED) and general intensive care unit in a city hospital (tertiary care center). PATIENTS AND PARTICIPANTS: 32 patients with out-of-hospital cardiac arrest; 14 of the patients had a return of spontaneous circulation (ROSC) and 18 of the patients died. INTERVENTIONS: Basic and advanced life support. MEASUREMENTS AND RESULTS: Concentrations of ionized and total calcium, bicarbonate, lactate, and pyruvate and pH were simultaneously determined immediately upon arrival at the ED, and at 30 and 60 min. Upon arrival at the ED, all patients had ionized hypocalcemia (1.09 +/- 0.02 mmol/l). Ionized and total calcium concentrations progressively decreased during and after CPR, but pH and bicarbonate concentrations did not show any significant changes. In patients who had ROSC, a significant, but perhaps not clinically relevant, relationship was observed between the ionized calcium concentrations and pH (r2 = 0.152, p = 0.0117). In the patients who died, there were significant correlations between ionized calcium and pH (r2 = 0.382, p = 0.0001) and bicarbonate concentrations (r2 = 0.298, p = 0.0006). No definite correlations were demonstrated when comparing ionized calcium concentrations with lactate and pyruvate concentrations. CONCLUSIONS: Ionized hypocalcemia during out-of-hospital cardiac arrest and CPR is not due to binding by both lactate and pyruvate, but may be partly due to complexing by bicarbonate, with some modifications due to variations in pH.     

Secondary hyperparathyroidism is an expected consequence of parathyroidectomy for primary hyperparathyroidism: a prospective study

BACKGROUND: Parathyroidectomy for primary hyperparathyroidism (PHPT) can cause secondary hyperparathyroidism, with increased serum parathyroid hormone (PTH) and normal or low serum calcium concentrations. METHODS: A prospective study investigated 78 consecutive patients who underwent exploration for PHPT. Serum intact PTH and total calcium concentrations were measured the evening after operation and ionized Ca++ the following morning. These levels were reassayed 1 week later. RESULTS: Before operation, the mean PTH level was 138 +/- 15 pg/mL, total calcium concentration was 11.6 +/- 0.1 mg/dL, and ionized Ca++ concentration was 1.44 +/- 0.02 mmol/L. On the night of the operation, the PTH level was 11 +/- 2 pg/mL, and the total calcium concentration was 8.9 +/- 0.1 mg/dL. Fifty-five patients had hypoparathyroidism, with a PTH level less than 10 pg/mL. The day after the operation, the ionized Ca++ level was 1.14 +/- 0.01 mmol/L. One week later, PTH, ionized Ca++, and total serum calcium concentrations returned to normal levels. In 9 patients (12%), PTH levels were increased (98 +/- 16 pg/mL), although ionized Ca++ concentrations were normal (1.18 +/- 0.02 mmol/L), demonstrating secondary hyperparathyroidism. Risk factors for postoperative secondary hyperparathyroidism included older age, symptomatic hyperparathyroidism, higher preoperative PTH and alakaline phosphatase levels, and lower serum phosphorous levels. In 70% of these patients, PTH levels returned to normal in 3 to 12 months. CONCLUSIONS: Secondary hyperparathyroidism occurs in 12% of patients after surgical treatment of PHPT. It is transient, possibly compensating for relative hypocalcemia.     

Cerebral blood flow in asymptomatic individuals--relationship with cerebrovascular risk factors and magnetic resonance imaging signal abnormalities

The objective of this study was to evaluate the effects of a long-term, low-calcium diet on fetal calcium metabolism and fetal skeleton development in ewes. Eleven pregnant sheep were assigned to two groups, fed either a diet low in calcium (0.26% total dry matter) or normal in calcium (0.8% total dry matter) for 2 months, starting at 60 days gestational age. The ewes fed the low calcium diet showed lower plasma levels of calcium and higher plasma levels of hydroxyproline, parathyroid hormone, and 1,25(OH)2D compared with the ewes fed the normal calcium diet. There were no differences in these variables between the two groups of fetuses. These observations suggest that the plasma components of calcium homeostasis measured in the fetal lamb in the present study are independent of the ewe and are not significantly affected by the presence of lowered maternal calcium for many weeks during pregnancy. Despite the ability of the fetus of the ewe on the low calcium diet to maintain relatively normal circulating plasma components of calcium homeostasis, long-term maternal hypocalcemia delayed fetal skeletal ossification as shown by histological examination of the fetal humerus. The fetal humerus from low calcium-fed ewes showed a lower proportion of bone versus cartilage (45.6 +/- 5.9 versus 57.4 +/- 4.6%, mean +/- SD) lower ash content (15.4 +/- 1.5 versus 17.4 +/- 1.0%), and lower specific gravity (1.19 +/- 0.2 versus 1.22 +/- 0.02) (P < 0.05) than the humerus from fetuses of normal calcium-fed ewes. This study shows that the long-term calcium intake of the ewe does affect fetal skeletal development, despite a lack of observable effects on fetal plasma concentrations of calcium or known calcium regulating hormones such as 1,25(OH)2D or parathyroid hormone.     

The management of midtrimester abortion failures by vaginal evacuation

Ionized calcium was determined in vitro in human serum in relation to increased concentrations (0.32 to 10 mM) of free fatty acids. Serum iCa levels varied inversely and linearly with increasing FFA concentrations. It is suggested that the formation of Ca-FFA complexes at clinically attainable levels of FFA decreases iCa and that elevated serum FFA levels may be a factor in the development of hypocalcemia.     

Defective leucocyte inhibitory factor (LIF) production by lymphocytes in children with kwashiorkor

Production of the lymphokine leucocyte inhibitory factor (LIF) by phytohaemagglutinin (PHA)-stimulated lymphocytes was assessed in 25 children with kwashiorkor. Although the lymphocytes of 12 of these patients produced adequate amounts of LIF, the rest of the group failed to produce lymphokine after PHA activation. There was no correlation between the ability to produce LIF and the age, severity of malnutrition or any other clinical parameters assessed in these patients. This finding confirms the presence of defective cell-mediated immunity observed in a substantial proportion of kwashiorkor children.     

Severe hypophosphatemia in children with kwashiorkor is associated with increased mortality

Severe hypophosphatemia, serum phosphate concentration <0.32 mmol/L (<1.0 mg/dL), occurred in 8 of 68 (12%) of children with kwashiorkor within 48 hours of admission; 5 of 8 (63%) of these children died, compared with 13 of 60 (22%) children without severe hypophosphatemia (P <.02). Dermatosis and dehydration were significantly correlated with severe hypophosphatemia, but these clinical signs could not reliably predict fatal cases. Severe hypophosphatemia seems to be common and life-threatening in children with kwashiorkor in Malawi.     

Evaluation of domicilliary management of protein-calorie malnutrition

An approach to tackle protein-calorie malnutrition through domiciliary management is described. Children suffering from moderate and severe protein-calorie malnutrition were managed using a food supplement containing low cost locally available foodstuffs and nutrition education. An evaluation showed that the anthropometric improvement was closely associated with better concepts in nutrition and improved dietary practices following nutrition education. Parents of children suffering from kwashiorkor had better knowledge and practice compared with those of marasmus.