Growth and nutritional status of Bedouin infants in the Negev Desert, Israel: evidence for marked stunting in the presence of only mild malnutrition

Growth and feeding practices of 353 Bedouin infants from the Negev Desert, Israel, were compared to those of 302 Jewish infants from the same area and to American standards. These two populations differed in their cultures and educational backgrounds. The use of medical and health services was lower among the Bedouin population. The feeding practices of the Bedouin infants were markedly different from those of their controls. The Bedouin infants show a progressive decrease in weight, length, and head circumference (means of all three parameters were around the 5th percentile) while the Jews were comparable to Americans. The nutritional status was assessed by three different anthropometric measurements. The weight to length ratio showed that 88% of Bedouin and 96% of Jewish infants were above the 10th percentile. Tricep skinfold measurements showed that 96% of the Bedouins and 99% of the Jews were above the 5th percentile. The midarm circumference to head circumference ratio was in the range between 0.280 and 0.310 (mild malnutrition range) while that of the Jews was above 0.310 (well-nourished range). These data show marked stunting in the presence of only mild malnutrition. This observation argues against the general belief that marked stunting is the result of prolonged severe malnutrition. Differences in cultural and genetic backgrounds, as well as different feeding practices and increased morbidity, could contribute to this phenomenon.

Neutralizing antibodies to non-polio enteroviruses in human immune serum globulin

Neutralizing antibodies to selected non-polio enteroviruses were found in three lots of human immune serum globulin (ISG) prepared from the sera of persons from different geographic regions. Reciprocal titers to coxsackieviruses B3 and B4 ranged from 400 to greater than or equal to 2000, whereas titers to coxsackievirus A9 and ECHO viruses 5 and 9 ranged from 100 to 400 in all three lots of ISG. The presence of neutralizing antibodies to commonly occurring (coxsackieviruses B1 to B5 and A9 and ECHO viruses 3, 4 and 9) and infrequently encountered (ECHO viruses 5 and 13) serotypes, coupled with the increasing evidence that antibodies are an important factor in preventing illness, support recommending the administration of ISG to those at high risk for serious disease.

Cell mediated immunity and effects of "thymic humoral factor" in 15 patients with SSPE

Cell mediated immunity (CMI) in 15 patients with subacute sclerosing panencephalitis (SSPE) was assessed by E-rosette formation, leucocyte migration inhibition factor (LIF) production, and proliferative responses to mitogens. In eleven patients, one or more of these parameters were impaired. These defects varied among the different patients and no consistent or uniform pattern of immune deficiency could be demonstrated. Although no single patient had a generalized reduction of all the T-cell functions, a diminished percentage of E-rosetting cells was the most frequent abnormal parameter (7 out of 15 patients). There was no correlation between the clinical state of the patients and the immune defects. Thymic humoral factor (THF), a thymic hormone, reconstituted at least one CMI impaired function especially the reduced levels of E-rosette forming cells in 7 out of 9 patients. It seems unlikely that a generalized cell-mediated defect is the underlying cause of this disease, but immunomodulatory therapy should be considered in some selected cases.

Relationship of breast feeding versus bottle feeding with emergency room visits and hospitalization for infectious diseases

Breast-feeding habits of 480 Jewish infants visiting a pediatric emergency room (ER) with infectious diseases were compared to those of 502 healthy infants visiting maternal-child health centers (MCH). (These centers are attended by almost 100% of the Jewish infant population.) Among infants under 5 months of age with acute gastroenteritis and upper respiratory infections, breast feeding was significantly less prevalent than among age-matched infants in the MCH group (22.6%, 18.5% and 53.4% respectively, P less than 0.0001). Infants with acute otitis media and lower respiratory tract infections showed the same trend although the numbers were small. A very short breast-feeding period of 2 weeks or less was more prevalent among the ER group and was associated with increased hospitalization rate. These data emphasize the importance of breast milk in reduction of ER visiting and hospitalization rate.

Permanent tetraplegia as a consequence of tetanus neonatorum. Evidence for widespread lower motor neuron damage

It is generally believed that no permanent neurological damage is found among survivors of tetanus neonatorum. Newborns dying shortly after the onset of tetanus also lack significant neurological abnormalities. In adults a variety of neuromuscular lesions have been reported; however, a uniform pathological picture is absent. We report a case of a newborn with severe tetanus in whom striking evidence of anterior horn neuronal damage was documented, causing permanent nonprogressive tetraplegia. We suggest that the mechanism responsible for this lesion involves the retrograde axoplasmic flow of tetanus toxin reaching the spinal cord via nerve endings in the infected umbilical cord stump.

[Infantile rumination]

In a 3-month-old baby with recurrent vomiting, infantile rumination syndrome was diagnosed on the basis of the typical behavior, absence of any physical or radiological findings and failure of pharmacological treatment. The therapeutic approach, which consisted of daily visits to the clinic by the mother and effective psychological support by the pediatrician and the nurses, caused prompt improvement and indicated the importance of diagnosis and treatment in the ambulatory clinic.

Complications of splenectomy. Comparative study of elective, urgent and incidental splenectomy

In 160 patients who had undergone elective, urgent or incidental splenectomy, an assessment was made of the possible relationship between the reason for splenectomy and the postoperative course. In patients who had incidental splenectomy, the postoperative complication rate (56.6%), the hospitalization time (20.8 days), and the mortality rate (10%) were higher than among those who had elective or urgent surgery. Our results indicate that splenic injury sustained during abdominal surgery should be treated conservatively, by topical hemostasis or by suturing, in order to avoid complications related to splenectomy.

Subglottic mucocele in an infant

A subglottic mucocele caused partial obstruction of the upper airways. The radiologic findings were asymmetrical narrowing of the subglottic area with a mass arising from its posterior wall simulating a subglottic hemangioma. Surgical treatment was successfull.