The development of a monoclonal antibody to a human gamma crystallin

A monoclonal antibody to human lens 24,000 molecular weight gamma crystallin has been produced in rat x mouse hybridoma cell lines. The antibody reacts specifically with the 24,000 molecular weight gamma crystallin and does not cross react with the 21,000 or the 19,000 gamma crystallins. The antibody reacts with protein from dog, mouse, monkey and bovine lenses but does not react with proteins from chick lens. The 24,000 molecular weight gamma protein increases from 2% of the soluble protein in the fetal lens to 14% in the 2 month old lens to 25% in the adult lens. No difference was observed in the amount of this crystallin between the nuclear and cortical regions of the adult lens. In one hypermature cataractous lens, the amount of this crystallin decreased to a value of about 5% of the total soluble protein.

Impact of massive doses of vitamin A on incidence of nutritional blindness

In a longitudinal study designed to assess the impact of a massive-dose vitamin A programme on the incidence of keratomalacia, 50 000 preschool children in 450 slum areas in Hyderabad city (India) were given 200 000 IU of vitamin A once every 6 months. During the study period, the incidence of keratomalacia in areas covered by the programme decreased by about 80%, while in control areas the reduction was of the order of 20%. To test whether large doses of vitamin A supplements prevented keratomalacia, a case-control analysis was done, with patients with severe protein-energy malnutrition being used as controls. The high odds ratio clearly indicated that keratomalacia was more likely to occur in children not receiving supplements.

Occurrence and prevention of rheumatic fever among ethnic groups of Hawaii

To assess the occurrence of acute rheumatic fever (RF) among the ethnic groups of Hawaii, the case records of hospitalized children with RF in Oahu were reviewed for the period from October 1976 to September 1980. One hundred four of the records met the modified Jones criteria. Incidence rates per 100,000 children were as follows: Japanese, 0; white, 9; Filipino, 9.1; Hawaiian and part-Hawaiian, 27.2; and Samoan, 96.5. Carditis was most common among Samoan children; it occurred in nine of 18 children. A streptococcal, throat culture program for children with respiratory infections was in progress in 60% of Oahu's public schools during this period of time. Children with positive cultures were excluded from school until the start of treatment. However, RF occurred with equal frequency in participating and nonparticipating schools. Rheumatic fever continues to be a substantial problem among Polynesian children in Hawaii, and it is apparent that the school-based primary prevention program used in Hawaii to control streptococcal disease has not altered the frequency of RF among them.

Effect of measles on the nutritional status of preschool children

A total of 1426 children admitted to the hospital for measles were studied. Of these, 84 were followed up for a period of 6 months after they were discharged from the hospital. It was observed that about 23% of the cases developed secondary infection during the acute stage of measles. Diarrhoea and respiratory infection were the common complications. Some children developed corneal lesions during the acute stage. Serum vitamin A levels were significantly low in these children and they showed a good clinical response to vitamin A therapy. During the follow-up period the children suffered from frequent episodes of infections for nearly 6 months after the attack of measles and the weight gain was significantly lower compared to normal children. These observations suggest that measles plays a significant role in precipitation of malnutrition and blindness due to vitamin A deficiency in preschool children.

Studies on vitamin D metabolism in malnourished children

1. Basal levels of serum 25-hydroxy vitamin D (25-OHD) were estimated in ten normal children and twenty-seven children with protein-energy malnutrition. 2. Five normal children and fourteen malnourished children were administered a single massive dose of 15 mg vitamin D orally and the remaining children received oral supplements of 50 micrograms vitamin D daily for 20 d. Blood samples were obtained after 10 and 20 d of dosing and serum 25-OHD levels were repeated. 3. The basal serum 25-OHD levels were significantly lower (P less than 0.05) in malnourished children than in normal children. 4. Administration of a single massive dose of vitamin D as well as daily supplementation of small doses resulted in significant increases in serum 25-OHD levels within 10 d. However, the increase with a massive dose was of a higher magnitude. There was no significant difference between the normal and malnourished children. 5. The binding capacity of serum to 25-OHD was similar in both the groups. 6. These results suggest that vitamin D metabolism is not altered in protein-energy malnutrition.

Nitrogen balance in Indian preschool children receiving the safe level of protein at varying levels of energy

1. A study was carried out to determine the effects of varying the level of energy intake on nitrogen balance in preschool children receiving the safe requirement level of protein, determined in an earlier study. 2. Seven preschool children received four energy levels, i.e. 293, 334, 376 and 418 kJ/kg body-weight at the safe level of protein intake of 1.75 g/kg body-weight and N balance determined. 3. The N balance decreased with a decrease in energy intake. However, the N balance was positive at all levels of energy intake studied. 4. Results indicated that at a protein intake of 1.75 g/kg body-weight the minimum level of energy intake for a retention of 40 mg N/kg body-weight in these children was found to be 326.2 +/- 45.5 (mean +/- SD) kJ/kg body-weight. Below this energy intake the safe level of protein intake became inadequate.

Effect of intramuscular vitamin A injection on plasma levels of vitamin A and retinol-binding protein in malnourished children

1. Serum levels of retinol-binding protein (RBP), total vitamin A and retinyl ester were measured in twenty-four malnourished children with corneal lesions and nine normal children. 2. Initially, the RBP and vitamin A levels were significantly lower in malnourished children than in normal children. 3. After intramuscular injection of 30000 microgram of aqueous vitamin A, serum levels of total vitamin A were increased significantly at 24 h and tended to fall within 5 d of treatment in both groups. 4. Before treatment, retinyl ester accounted for less than 10% of the vitamin in circulation. After vitamin A injection, it increased to 30%, a level much lower than that reported in patients with hypervitaminosis A. 5. There was no significant difference between the two groups of children and none of them showed clinical signs of toxicity. These observations indicate that administration of massive doses of vitamin A over a short period will not produce toxic effects even in malnourished children.

Bactericidal activity of human milk leukocytes

Breast milk samples obtained from 74 women, at different stages of lactation, were analysed for leukocyte concentration and their bactericidal activity. The total leukocyte count in colostrum was 5 000/mm3 a concentration which is similar to that in circulation. As lactation became established, there was a drop in leukocyte concentration and the average count in mature milk was around 2 000/mm3 after the first 3 months. Polymorphs and mononuclear leukocytes together constituted 90--95% of the cells and the rest were lymphocytes. Bactericidal activity of milk leukocytes was similar to that of circulating leukocytes, irrespective of the stage of lactation. These results indicate that breast milk is rich in living leukocytes and that these cells may have a protective role against infection in the infant. The total leukocyte concentration as well as their bactericidal capacity were similar in well nourished and undernourished women suggesting that the protective factors in milk are not influenced by nutritional status of the mother.

Influence of nutrition on postvaccinial tuberculin sensitivity

Response to BCG vaccination was studied in 261 apparently normal preschool children in a community. They were classified into different nutritional groups based on deficit in weight for age. In addition, nine children who had kwashiorkor and were admitted to the hospital were investigated. They were given 0.1 ml of BCG vaccine, and 6 months later, tuberculin sensitivity was assessed using 5 U of PPD. Blood samples were collected from 84 subjects and leukocyte migration inhibition was determined using the same antigen. After BCG vaccination, over 80% of children in the community showed positive tuberculin test, irrespective of the extent of growth retardation. There were no significant differences in the size of induration or the percentage of reactors between the various groups, indicating that the immune response to BCG vaccination is not affected by milder grades of malnutrition. However, the skin test was negative in most of the children who had had kwashiorkor. Leukocyte migration inhibition was similar in all the groups of children including those with kwashiorkor indicating that sensitisation of lymphocytes was not influenced by the nutritional status. In children with kwashiorkor, the leukocyte migration inhibition test was positive though the skin test was negative, suggesting that the former may be a better measure of assessing the response to BCG vaccination.

Ossified epidural hematoma: case report

We are reporting a case of ossified epidural hematoma that developed in a patient who had had a craniotomy at a different site for a brain tumor 14 years earlier. There was no history of trauma.

Papillary solute concentrations in acute ureteral obstruction. The effect of prostaglandin inhibition

Complete unilateral and bilateral ureteral obstruction (24 hr) was produced in rats to evaluate the pathogenesis of the renal concentrating defect. Papillary solute concentration was significantly altered by both. The tissue osmolality of the papilla of the obstructed kidney was depressed to 50% of that found in an unobstructed kidney as a result of a marked reduction in tissue sodium and urea concentrations. No effects on tissue potassium concentration were observed. The administration of indomethacin and meclofenamate did not prevent the derangement in tissue solute concentration produced by obstruction. We conclude that prostaglandins do not seem to contribute to the concentrating defect produced by ureteral obstructions.

Humoral immune response in children with iron-deficiency anaemia

The humoral immune response (as shown by plasma immunoglobulin concentrations and antibody response to diphtheria and tetanus toxoids) was evaluated in 14 children with iron-deficiency anaemia and in 24 normal controls. Mean concentrations of haemoglobin and serum iron and mean transferrin saturation were significantly lower in children with iron-deficiency anaemia than in controls. Serum immunoglobulin concentrations were within the normal range in both groups. Two weeks after immunisation with diphtheria and tetanus toxoids the concentrations of IgG increased significantly in both groups. Antibody titres in iron-deficient children were similar to those of controls before and after immunisation. The mean T-lymphocyte count was significantly lower in iron-deficient children than that in controls, but the mean B-lymphocyte counts were similar in the two groups. These observations suggest that humoral immunity in children is not affected by iron deficiency and that conventional immunisation programmes would be effective in children with iron-deficiency anaemia.

Serum 25-hydroxy-vitamin D levels in malnourished children with rickets

Serum levels of calcium, phosphorus, alkaline phosphatase, and 25 hydroxy-vitamin D (25-OH-D3) were measured in normal and malnourished children with and without rickets. Children with rickets had clinical, biochemical, and x-ray evidence of the disease; most of them were malnourished. 25-OH-D3 levels were lower than in normal children. After treatment with vitamin D their condition improved. 25-OH-D3 levels were also found to be reduced in malnourished children without rickets. These studies show that rickets is common in malnourished children. Inadequate exposure to sunlight appears to be the factor mainly responsible for the high incidence of the disease. In addition, malnutrition perhaps contributes to the development of rickets.

Effect of varying protein and energy intakes on nitrogen balance in Indian preschool children

1. The effect of varying protein intake at two energy levels of 334 and 418 kJ/kg body-weight was studied in four preschool children belonging to the low socio-economic group. 2. Results indicated a curvilinear relationship between N intake and N rentention. From this relationship, the protein requirement of the children at adequate energy intake was calculated. 3. At adequate energy intake (418 kJ/kg body-weight) the protein requirement of the children was 1.33 g/kg. On decreasing the energy intake by 20% to 334 kJ/kg body-weight the protein requirement was found to be increased by 20% to 1.64 g/kg. 4. Based on this study, a safe level of protein intake for Indian preschool children subsisting on a diet based predominantly on vegetable proteins has been suggested.

Congenital anastomosis between the vertebral artery and internal carotid artery in the neck. Case report

✓ A rare case of anastomosis between the vertebral artery and the internal carotid artery in the neck of a patient with an anterior communicating artery aneurysm is reported.

Effect of zinc supplementation on plasma levels of vitamin A and retinol-binding protein in malnourished children

The relationship between plasma levels of vitamin A and zinc was studied in 45 children suffering from vitamin A deficiency and 20 children with protein-energy malnutrition. Thirty apparently normal children of the same age group were also studied for comparison. The mean levels of plasma vitamin A, retinol-binding protein and zinc were significantly lower in vitamin A-deficient children and in children with PEM, as compared to controls. Supplementation with 40 mg zinc daily for 5--10 days resulted in a significant increase in plasma vitamin A and RBP levels in children with PEM but not in the vitamin A-deficient group. There was, however, no correlation between plasma levels of vitamin A and zinc. The data suggest that in children with PEM, apart from deficiencies of protein and vitamin A, zinc deficiency may also contribute to the lowering of plasma vitamin A levels. They also suggest that in vitamin A-deficient children, without protein-energy malnutrition, zinc deficiency does not seem to have a role.

Serum retinol-binding protein and vitamin A levels in malnourished children

Serum levels of vitamin A and retinol-binding protein (RBP) were measured in children with vitamin A deficiency, in children with protein-energy malnutrition (PEM) and in normal children, before and after administration of 100 000 IU of water-miscible vitamin A. Serum vitamin A and RBP levels were significantly low in children with vitamin A deficiency and in children with severe PEM, whereas the values in milder grades of PEM were similar to those of normal subjects. In severely malnourished children with corneal lesions, serum vitamin A concentration was reduced to a much greater extent than the level of serum RBP. Administration of vitamin A resulted in a significant increase in serum levels of both the components within 4 hours in all the 3 groups of children. The increase in RBP concentration observed in children with PEM was similar to that in vitamin A deficient children. These results indicate that in malnourished children, particularly in those who are at risk of developing keratomalacia, vitamin A is the main limiting factor. It is, therefore, recommended that children with PEM should be treated with vitamin A in addition to dietary protein and calories.

Interrelationship between vitamins E and A: a clinical study

Plasma vitamin A and vitamin E levels were determined in 45 children. Seven normal children and 7 children with vitamin A deficiency were given daily supplements of 100 mg vitamin E for two weeks. Seven others received a placebo and served as controls. The mean levels of plasma vitamin E and A were 694 microgram/dl and 21 microgram/dl respectively. There was no correlation between plasma levels of the two vitamins. Administration of vitamin E resulted in a significant increase in plasma vitamin A concentration both in normal children and in those with vitamin A deficiency, while there was no change in the control group.

Rose Bengal staining for detection of conjunctival xerosis in nutrition surveys

A hospital cum community based study indicated that rose Bengal staining of the eye could not only confirm clinically diagnosed cases of conjunctival xerosis but also detect those missed by clinical examination. However, some cases thus detected did not respond to a massive oral dose of vitamin A.

Alkaline ribonuclease activity in plasma and leucocytes of malnourished women

Alkaline RNase activity was measured in plasma and leucocytes of pregnant and non-pregnant women belonging to low and high socio-economic groups. It was observed that the enzyme activities were significantly higher in pregnant as well as non-pregnant women of the low socio-economic group as compared to women of the high socio-economic group. There was no correlation between the enzyme activities in maternal or cord blood on the one hand and birth weight of the infants on the other. These results suggest that RNase activities in maternal blood reflect the nutritional status of the mother but not that of the fetus.

Ribonuclease activity in plasma and leucocytes of malnourished children

RNAase activity was measured in plasma and leucocytes of manourished children. In subjects suffering from kwashiorkor, alk. RNAase levels in plasma and leucocytes were markedly raised and they returned to normal after therapy. However, the enzyme activity was not altered in undernourished children. These data indicate that circulating level of alkaline. RNAase is not a useful parameter for detecting milder grades of protein-calorie malnutrition (PCM).

Cell-mediated immunity and immunoglobulin levels in light-for-date infants

Cell-mediated immune response and circulating levels of immunoglobulins were studied in 75 full-term newborn babies. The results showed that though the immunoglobulin levels were not altered, cell-mediated immunity was significantly depressed in infants with birth weight less than 2 500 g and this may result in lowered resistance of infection.

Antimicrobial factors in human milk

Levels of immunoglobulins, lactoferrin and lysozyme were determined in milk samples obtained from well-nourished and under-nourished Indian women at different stages of lactation. The concentration of immunoglobulins and lactoferrin was higher in colostrum than in mature milk while the lysozyme levels showed a progressive increase with the period of lactation. There were no significant differences in the levels between the two groups of women. Administration of iron did not alter either the total or percentage saturation of lactoferrin in milk. These results indicate that antibacterial factors in milk are not influenced by the nutritional status of the mother and that iron supplementation does not interfere with the bacteriostatic function of lactoferrin.

Secretory IgA in protein-calorie malnutrition

The secretory IgA system was investigated in children with protein-calorie malnutrition (PCM). The results of the study indicated that in children suffering from kwashiorkor and marasmus the concentration of IgA in duodenal fluid, saliva, nasal secretions, and tears was significantly reduced on admission and returned to normal 4 weeks after treatment. However, the concentration of secretory IgA in children with mild to moderate PCM was similar to that of normal children. Secretory IgA deficiency may be an important factor in promoting bacterial growth and this may account for the increased incidence and severity of mucosal infections in children with severe PCM.