A prospective study of the risk of diarrheal diseases according to the nutritional status of children

Prospective field data were employed to examined the effect of child malnutrition on the subsequent risk of diarrhea among preschool children in rural Bangladesh. A total of 2019 children aged 12-23 months were classified according to weight-for-age, weight-for-height, and height-for-age of the Harvard median standard. Over a 24-month prospective period, diarrheal hospitalization rates among the children were matched to the initial anthropometric assessment. No differences in diarrheal hospitalization rates were noted for the children according to initial nutritional status. Another group of 207 children under five years of age were classified according to weight-for-age and their diarrheal attack rate in the field was followed prospectively for one year after nutritional assessment. Again, no differences in field diarrheal attack rates were noted between children of varying nutritional status categories. The nutritional status of the 207 children was then defined as monthly growth velocity (kilogram change in body weight, per cent change of initial body weight, and per cent change in weight-for-age) and the diarrheal attack rate for the subsequent one month period was observed. No differences in attack rates were noted between nutritional groups. The study failed to demonstrate that nutritional status defined by anthropometry was associated with the subsequent risk of diarrheal diseases.

Breast-feeding and food intake among children with acute diarrheal disease

To quantitate reduced food intake during diarrhea and to assess possible means of promoting such intake, the 24-hr food and breast milk intakes of 41 children 6 to 35 months divided into three groups were measured. The energy and protein intake of 15 children hospitalized with acute watery diarrhea averaged 75 kcal/kg and 0.96 g/kg, respectively. The energy and protein consumption of another group of 15 children with diarrhea whose mothers received intensive education to promote food intake during hospitalization averaged 60.9 kcal/kg and 0.70 g/kg, respectively. These intake levels were significantly lower than 129.9 kcal/kg and 1.89 g/kg observed among healthy control children. These results suggest that child anorexia may be an important cause of reduced food intake during diarrhea. Anorexia was not overcome with intensive educational efforts. Breast milk was found to be important nutrient source with breast-fed children better protected against reduced intake during diarrhea.

Anthropometric assessment of energy-protein malnutrition and subsequent risk of mortality among preschool aged children

This paper examines the usefulness of various anthropometric classification systems of nutritional status in prognosticating the subsequent risk of mortality among 2019 children aged 13 to 23 months residing in a rural area of Bangladesh. The indices investigated included: weight-for-age; weight-for-height; height-for-age; arm circumference-for-age; arm circumference-for-height; weight quotient; and height quotient. Cross-sectional anthropometry was conducted during October 1975 to January 1976 and the mortality experience of the study children was followed prospectively over 24 months. Results indicated that severely malnourished children, according to all indices, experienced substantially higher mortality risk. Normal, mild, and moderately malnourished children all experienced the same risk. All indices were found to discriminate mortality risk; weight/age and arm circumference/age were strongest and weight/height weakest. For each index, a threshold level was noted below which mortality risk climbed sharply. The discriminating power of anthropometry was enhanced when maternal weight, maternal height, or housing size were included.

Epidemiology and causes of death among children in a rural area of Bangladesh

From a longitudinal surveillance programme among a rural Bangladesh population of 260,000, the epidemiology and causes of child death (under age 5) over 3 years (1975-1977) were analyzed. The most significant causes of death were diarrhoea (watery and dysentery), tetanus, measles, fever, respiratory disease, drowning, skin disease, and other causes. Of an infant mortality rate of 142.6/1000 live births, neonatal tetanus (37.4/1000), diarrhoea (19.6/1000), and respiratory disease (10.4/1000) were the most significant identifiable causes. Many infant deaths (62.2/1000) were unidentified, taking place during the neonatal (1-28 days) period. The 1-4 year mortality averaged 34.3/1 000. Diarrhoea (15.1/1 000), measles (4.5/1 000), fever (2.9/1 000) and respiratory disease (1.6/1 000) accounted for most 1-4 year deaths. Mortality trends over the past 10 years showed sharp temporary fluctuations in response to 2 disasters but no definitive long-term trend. Most causes of death displayed seasonal fluctuation, and sex differentials were marked with female deaths exceeding male deaths for all ages after the neonatal period. Malnourished children from low socioeconomic status families had higher mortality rates than their better nourished and wealthier counterparts. Overall, the data suggest that the delivery of a few basic health measures (oral hydration and immunization) could result in substantial reduction of under 5 mortality.

Village-based distribution of oral rehydration therapy packets in Bangladesh

The distribution of sucrose-electrolyte oral therapy packets (1 liter) by community-based workers in a rural Bangladesh population of 157,000 was evaluated. A similar population of 134,000 served as a comparison group. The locally-produced packets showed satisfactory chemical composition with a shelf-life of up to 3 months and a cost of U.S. $0.05. After 4 months the workers were distributing an average of 70 packets/1,000 population per month. Most patients used one packet for each episode of diarrhea; 13% of children used two packets, and 15% and 8% of adults used, respectively, two and three packets. The electrolyte composition of the oral fluids prepared by field workers and mothers showed substantial variation, but no hyperconcentrated solutions were noted. A comparison of the hospitalization rate from the two study areas suggested a 29% reduction in hospitalization for diarrhea during the 4 months of distribution.

The relative transfer rates for sodium and xenon from gut lumen to plasma in man

1. A whole-gut perfusion technique has been used to compare the rates of intestinal absorption of sodium and xenon. 2. The calculated transit-time spectra for sodium and xenon across the gut mucosa do not differ significantly either in mean transit time or, for the first 15 min, in shape. 3. These results support the hypothesis that the rate of transfer of sodium from the small intestinal lumen to plasma is limited by blood flow. 4. It is suggested that some features of cholera can be explained by the hypothesis.

A single column packing for the gas-liquid chromatographic separation of various biologically important compounds

The use of a single, commercially available column packing, TabsorbR, is described for the g.l.c. separation of a large number of different compounds. The resolution of the homologous members of the following series of compounds was achieved: (1) saturated fatty acids (C1-C18), (2) normal aliphatic saturated dicarboxylic acids (C2-C14), (3) normal aliphatic saturated alcohols (C1-C24), (4) normal aliphatic saturated amines (C1-C12), (5) the common amino acids except arginine, histidine and cysteine, (6) aliphatic hydrocarbons (C10-C20) and (7) monosaccharides. It should be noted that twenty-two monosaccharides including three hexosamines and two anhydrohexoses, could be resolved as alditol acetates in a single run. In addition, galacturonic, glucuronic and iduronic acids could be separated from one another as their 1,4-lactones. The resolution achieved in these series of compounds was found to be consistent and highly reproducible. It is of further interest that certain isomers of the higher fatty acids and hydrocarbons with one double bond could also be separated from the normal and saturated compounds, respectively. The applicability of "Tabsorb" for the g.l.c. separation, although noted above to be considerably broad, is by far not yet exhausted. These procedures which form the basis for the quantitative determinations of the various compounds studied as demonstrated by analysis of glycopeptides for neutral hexoses and proteins for the amino acids, can readily be adapted to preparative methods. From the biochemical point of view "Tabsorb" is an extremely versatile column packing in that it can be used for the identification of many of the common building blocks of natural products.

A study of intercellular spaces in the rabbit jejunum during acute volume expansion and after treatment with cholera toxin

The effects of acute volume expansion and of intraluminal administration of cholera toxin have been examined in rabbit jejunum. Acute volume expansion was shown to reverse the normal reabsorptive flux of water and cause significant fluid secretion. Phase and electronmicroscopic examination of the jejunal epithelium showed that marked distension of the intercellular spaces had occurred. Examination of the jejunal epithelium after treatment with cholera toxin showed that, in association with high rates of fluid secretion, the intercellular spaces were extremely small and lateral membranes of adjacent cells were in close apposition to one another. Thus the mechanisms of fluid secretion in these two situations would appear to be quite different. The secretion associated with volume expansion, and accompanied by a rise in venous pressure and bullous deformations of terminal junctions, could well be due to hydrostatic pressure applied through intercellular channels. The secretion of cholera appears to be unrelated to hydrostatic pressure and is more likely due to body-to-lumen active ion transport.

Plasma concentration and protein binding of oestriol and its conjugates in pregnancy

Oestriol (OE3), oestriol-3-sulphate-16-glucosiduronate (OE3-3S,16Gl), oestriol-3-glucosiduronate (OE3-3Gl), oestriol-16-glucosiduronate (OE316Gl) and oestriol-3-sulphate (OE3-3S) concentrations were measured in a pool of plasma collected from 38 healthy pregnant women at 32 to 36 weeks of gestation. Using tritiated internal standards, OE3 and its 4 conjugates were isolated by countercurrent distributions and, following enzyme hydrolysis and chromatography, quantitated by fluorometry: OE3=1.48 μg/100 ml (13.8%), OE3-3S,16Gl = 3.78 μg/100 ml (35.2%), OE3-3Gl3-3Gl = 1.09 μg/100 ml (10.2%), OE3-16Gl= 1.59 μg/100 ml (14.8%) and OE3-3S = 2.79 μg/100 ml (26%).

OE3 and its conjugates were found to bind to serum proteins in Sephadex G-25 gel filtration and equilibrium dialysis studies. Considerably more OE3-3S and OE3-3S,16Gl than unconjugated OE3, and particularly OE3-16Gl and OE3-3Gl was bound at corresponding serum protein concentrations. When serum was fractionated by starch block electrophoresis and gel filtration on Sephadex G-200, OE3 conjugates were found to be bound by protein(s) present in the albumin fraction.

The difference in plasma protein binding between OE3-3S/OE3-3S,16Gl and OE3-16Gl/OE3-3Gl explains, in part, the preponderance of OE3 sulphoconjugates in plasma and their paucity in urine, as well as the rapid renal excretion of OE3-16Gl and OE3-3Gl. Protein binding thus appears to play an important role in OE3 conjugate transport, metabolism and excretion.

Properties of adenyl cyclase from human jejunal mucosa during naturally acquired cholera and convalescence

The enterotoxin of Vibrio cholerae causes copious fluid production throughout the lenght of the small intestine. As this is thought to be mediated by stimulation of adenyl cyclase, a study has been made of the activity and properties of this enzyme in jejunal biopsy tissue taken from patients during the diarrheal phase of cholera and after recovery. Adenyl cyclase activity during cholera was increased more than twofold relative to the enzyme in convalescence. Under both conditions stimulation by prostaglandin E(1) (PGE(1)) and by fluoride was observed. The responsiveness to PGE(1) was not altered in cholera; the total activity of the fluoride-stimulated enzyme was similar, a finding that suggests cholera toxin stimulates pre-existing enzyme in the intestinal cell. The enzymes during cholera and convalescence were similar in all other properties examined. Optimal Mg(++) concentration was 10 mM; Mn(++) at 5 mM stimulated the enzyme but could not replace Mg(++) except in the presence of 10 mM fluoride. Calcium was markedly inhibitory at concentrations greater than 10(-4) M. The pH optimum was 7.5 and the Michaelis constant (K(m)) for ATP concentration approximated 10(-4) M. Thus the interaction of cholera toxin with human intestinal adenyl cyclase does not alter the basic properties of the enzyme. When biopsy specimens were maintained intact in oxygenated Ringer's solution at 0 degrees C, no loss of activity was observed at 1(1/2) and 3 hr. In contrast, when the cells were homogenized, rapid loss of activity, with a half-life of 90 min was seen even at 0 degrees C. Consequently for comparative assays of human jejunal adenyl cyclase, strict control of the experimental conditions is required. It was under such conditions that a twofold increase in basal adenyl cyclase activity during cholera was observed.

Effect of spironolactone on stool electrolyte losses during human cholera

This study demonstrated that endogenous aldosterone, as determined by its transient competitive block by spironolactone, caused significant sodium and chloride retention during naturally acquired cholera. This beneficial effect of the hormone is accompanied, however, by a deleterious depletion of potassium. In addition, it was found that stool rate significantly altered the sodium and potassium concentrations in cholera stool despite minimal or absent aldosterone activity.

Permeability and selectivity of canine and human jejunum during cholera

Increased permeability of the intestinal mucosa to small molecules and ions has previously been proposed as a mechanism causing the profuse diarrhoea characteristic of Asiatic cholera. A technique for measuring absorption rates of (14)C-urea and (3)H-arabinose has been employed to study jejunal permeability during experimental canine and naturally acquired human cholera. The ratio of the absorption rates of these two solutes of different size is an expression of intestinal membrane selectivity and permits calculation of an equivalent pore radius. No change of membrane selectivity was observed in canine loops after challenge with cholera toxin. During naturally acquired human cholera, jejunal pore size was not significantly different from that measured during convalescence. This method was demonstrated to be sensitive to changes induced by amphotericin B, an antibiotic known to alter membrane permeability and selectivity. These data are inconsistent with the hypothesis of increased intestinal permeability during cholera.

BONNEMAISONIA HAMIFERA HARIOT IN NATURE AND IN CULTURE(2) (3)

In culture tetraspores of the sporophyte (Trailliella intricata) of Sonnemaisonia hamifera gave rise to male gametophytes only. In the Gulf of St. Lawrence tetrasporangia occur annually during the autumn, but mature gametophytes have not been recorded. However, gametophytes with antheridia were found during the winter on the Atlantic coast of Nova Scotia. Both phases are capable of vegetative propagation, and this is probably the usual method of reproduction in nature.