The response of megaloblastic macrocytic anaemia to crystalline penicillin G; preliminary report

Endemic tropical sprue in Rhodesia

The existence of tropical sprue in Africa is controversial. In this paper we present 31 cases seen in Rhodesia over a 15 month period. They have the clinical features, small intestinal morphology, malabsorption pattern, and treatment response of tropical sprue. Other causes of malabsorption, and primary malnutrition, have been excluded. The severity of the clinical state and intestinal malabsorption distinguish these patients from those we have described with tropical enteropathy. The previous work on tropical sprue in Africa is reviewed and it is apparent that, when it has been adequately looked for, it has been found. It is clear that the question of tropical sprue in Africa must be re-examined and that it existence may have hitherto been concealed by the assumption that primary malnutrition is responsible for the high prevalence of deficiency states.

Vitamin B12 absorption in megaloblastic anaemia

1. The response to cyanocobalamin and folic acid therapy was studied in forty-seven subjects with severe nutritional megaloblastic anaemia; twenty-five were vitamin B12deficient and, of these, ten were also folic acid deficient.

2. In twenty-four of the subjects, absorption of orally administered cyanocobalamin was normal, and there was a haematological response to small doses of orally administered cyanocobalamin, indicating adequate absorption. In one subject there was impaired cyanocobalamin absorption although free gastric hydrochloric acid was present.

3. The findings indicate that the absorptive function of the small intestine was unimpaired, with one exception, although there was a possible defect in nucleoprotein synthesis associated with a lack of vitamin B12and folic acid. Addisonian pernicious anaemia was not found in any of the subjects.

Significance of milk pH in newborn infants

Bottle-fed infants do not gain weight as rapidly as breast-fed babies during the first week of life. This weight lag can be corrected by the addition of a small amount of alkali (sodium bicarbonate or trometamol) to the feeds. The alkali corrects the acidity of cow's milk which now assumes some of the properties of human breast milk. It has a bacteriostatic effect on specific Escherichia coli in vitro, and in infants it produces a stool with a preponderance of lactobacilli over E. coli organisms. When alkali is removed from the milk there is a decrease in the weight of an infant and the stools contain excessive numbers of E. coli bacteria.A pH-corrected milk appears to be more physiological than unaltered cow's milk and may provide some protection against gastroenteritis in early life. Its bacteriostatic effect on specific E. coli may be of practical significance in feed preparations where terminal sterilization and refrigeration are not available. The study was conducted during the week after birth, and no conclusions are derived for older infants. The long-term effects of trometamol are unknown. No recommendation can be given for the addition of sodium bicarbonate to milks containing a higher content of sodium.

Extensive myeloid response during folic acid therapy in megaloblastic anaemia of pregnancy

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