[Measurements of dispersion of erythrocyte distributions: significance and usefulness in primary care].
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Biomedical subjects
Publications and source records attributed to B García.
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We report on a male infant with congenital hypothyroidism owing to athyreosis occurring with the CHARGE association (bilateral papillary coloboma, congenital heart disease, dysmorphic ears, sensorineural deafness, psychomotor retardation, cryptorchidism, facial palsy, and vesicoureteral reflux). The coexistence of these two disorders has not been described previously.
A study was made of 20 rats infested by Giardia muris in which a histologic study was made of the liver, as well as of 25 patients with giardiasis and elevated alanine-aminotransferase levels. Patients with positive A or B hepatitis markers, cholelithiasis or history of drug or alcohol use were excluded. Tests of liver function and liver biopsy were performed and antiparasite therapy was given during three months of follow-up, after which the liver biopsy was repeated. Humoral alterations were compared to those of 30 patients with acute viral hepatitis (15 type A and 15 type B) over the same periods of time. In 20% of the rats, nonspecific liver lesions were found. In the patients liver enzymes and the thymol test normalized a month after treatment and serum bile acids became normal in the third month. The liver biopsy demonstrated hepatic damage in 94% of the patients (in 20 cases cell lesions and in 12 cases inflammatory lesions) which regressed in the third month, the follow-up biopsy being normal after eradication of the parasite was confirmed. The comparative study with viral hepatitis showed highly significant differences in all the variables studied during the follow-up stage. Emphasis is placed on the importance of this lesion and its differential diagnosis to prevent its progression to chronic liver disease.
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We reviewed 79 patients with a picture of pleural effusion (EP) and ascites, who represented 8% of a total of 982 pleural effusions studied. Liver cirrhosis (CH), 37 cases (47%), disseminated carcinomatosis, 31 cases (39.5%), and congestive heart failure, 6 cases (7%), were the main causes. We made two groups of liver cirrhosis: A) liver cirrhosis with hydropic decompensation, 12 patients (15%), and B) liver cirrhosis with an additional complication added to the above, 25 patients (31.5%), this being infectious in 88% of the cases. In the B group there were cases of left hydrothorax, more features of effusion and a lower survival at 3 months of follow-up than in tha A group. Effusions of neoplastic origin were most frequently seen in tumors of the ovary, digestive system, lymphomas and undetermined origin. In malignant effusions, the cytology was positive in pleura in 60% and in ascites in 55%. Twenty percent of peritoneal fluids and 47% of pleural effusions were serohemorrhagic and 100% and 88%, respectively, were of exudative nature. In liver cirrhosis the ascites was serofibrinous and transudated (100% in group A and 85.5% in B) and the pleural effusion was a serofibrinous transudate except in the cases in which there was an added infection. We confirm the ominous prognosis of the coexistence of pleural effusion and ascites.
To asses mothers' behavior in regard to their children's feeding when they were ill with diarrhea, 20 guatemalan periurban families with children under four years of age were observed throughout one day. The observations were repeated during children's recovery. Mothers did not deprive their children of either liquid or solid foods during the diarrheal process. The average amount of liquids children drank when ill did not differ from that drank during recovery. Most of the children's diets did not meet their requirements in neither of the two periods. In general, caloric and protein intakes were lower when children were ill than when they were healthy; similarly, their intake was lower when diarrhea lasted more than three days. These findings point out that the possible cause of the lower food consumption during illness was that children were anorexic. On the other hand, similarity of liquid intake during both periods probably was because children were not dehydrated. The problem of the children's low food consumption could be solved if mothers feed them more frequently during the day, or if they provide them meals with more caloric density.
The most recent and reliable information on the status of breast-feeding in Central América, Panama and the Dominican Republic indicates that during the last decades, in all of these countries there has been a decrease in the prevalence and duration of breast-feeding. In some of them, this situation would seem to be reverting. Considering the importance that breast-feeding has on children's health and nutrition, the Institute of Nutrition of Central America and Panama (INCAP), organized a Regional Seminar on the Promotion of Breast-feeding, which was held in Contadora Island, Panama, in April, 1983. Based on the discussions of the working groups, sectoral and integrated recommendations were formulated for the purpose of promoting breast-feeding. This document contains specific recommendations for each of the sectors represented in the Seminar.
This paper summarizes the data presented by the representatives of Central America, Panama and the Dominican Republic at the II Regional Seminar on the Promotion of Breast-Feeding, held in Isla Contadora, Panama, April 25-29, 1983. The representatives of Costa Rica, Honduras and Panama provided up-to-date, representative data in regard to the breast-feeding practice. The average weaning age in the urban and rural areas of Costa Rica is 6 and 4 months, respectively. In Honduras and Panama, 43 and 17% of the infants from urban areas, and 21 and 37% of the babies from rural areas, respectively, were weaned before they reached four months of age. The need for availability of permanent systems to collect information on the breast-feeding practice in the different countries is pointed out. With regard to promotion actions, the absence of a national policy in favor of breast-feeding is evident. Moreover, in the national education systems, little importance is given to the subject. On the other hand, the advances achieved by some hospitals in favoring breast-feeding are mentioned. These include rooming in, the feeding of colostrum to newborns, and the establishment of human milk banks to feed premature babies whose mothers are unable to breast-feed them. Another acknowledged fact is that in the rural areas the agricultural home educators do not reinforce the breast-feeding practice. Also, there is a lack of information on the fulfillment of laws instituted for the protection of pregnant and lactating mothers, as far as pre and postnatal rest is concerned.
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Prospective studies in Mayan Indian children living in their natural setting were carried out from 1964 through 1974; observations began at birth and extended at least throughout the first three years of life. Adequate growth and survival were characteristic of exclusively breast-fed infants in the first months of life. Despite the high rate of infection, children exhibited a considerable resistance to intestinal protozoa, enterobacteriaceae and enteric viruses. Resistance against colonic invaders is attributed to the bifidus flora, and that against agents acting in the small bowel, to specific antibodies present in colostrum and milk. Diarrhoeal disease was least in this period and increased with weaning to reach maximum peaks at the time of weaning. The protracted weaning consisted of progressive administration of foods of low biological value given under deficient sanitary conditions. The nutrient value of the diet as a function of the child's weight was adequate in protein but in most cases it was markedly deficient in calories. Infectious diseases, particularly diarrhoea, were found associated with pronounced reductions in the already deficient calorie intake. Infection and infectious disease were common particularly during the first 6 to 18 months of life. Weight loss was a frequent finding during and after episodes of disease. The consequence of the malnutrition-infection interaction is a marked stunting of growth, clearly evident from examination of the growth curves of village children. Nutrient intake did not correlate with growth velocity. By contrast, the duration of breast-feeding was strongly associated with growth in the linear segment of the curve, while in the period of faster growth the correlation was inverse. On the other hand, morbidity was inversely correlated with calorie and protein intake and this was more obvious in the second than in the first year of life. The data indicate that infection is one of the leading factors associated with reduced calorie (and protein) intakes during the critical period of onset of malnutrition and mortality in childhood. By preventing infection, particularly diarrhoea, the food intake, nutrition and growth of children could be significantly improved.
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