[Instrument for the evaluation of the development of preschool children of the Preschool Education and Nutrition Centers].
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Biomedical subjects
Publications and source records attributed to J Fernandes.
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The effect on elastic stockings on ambulatory venous pressure was investigated in 22 limbs with deep venous insufficiency. The failure of some elastic stockings to reduce the ambulatory venous pressure in some limbs is due to the lack of graduated compression, which is caused by ankle-calf disproportion--narrow ankles and wide calves. This can be recognised by using the pressure-girth profile and corrected by specially made stockings with increased tension at the ankle. A pressure-girth profile established for each stocking enabled the exact compression exerted by the stocking along the length of each limb to be determined. Elastic stockings exerting a graduated compression between ankle and calf induced a reduction in the ambulatory venous pressure in all but one limb. The greater the degree of graduated compression between ankle and calf exerted by the stocking, the greater the fall in ambulatory venous pressure. This may explain the beneficial effect of compression in limbs with venous ulceration.
The effect of oral calcium carbonate on serum lipoprotein concentrations was tested in 50 children with familial hypercholesterolemia (type II-A) consuming a low cholesterol high polyunsaturated fat diet, using a cross-over design versus a placebo. Cholesterol was measured in serum and in the individual lipoprotein density classes. Serum apolipoprotein B (the protein moiety of low density lipoprotein) and apolipoprotein A-I (the main protein of high density lipoprotein) were measured by specific immunoassays. Calcium carbonate treatment induced only a slight increase in serum apolipoprotein A-I (+ 4%) and a slight decrease in low density lipoprotein cholesterol (-4%), both changes being significant at the P = 0.05 level.
An oral sucrose tolerance test was performed in a group of 103 children, aged between 3 months and 15 years because of episodic diarrhea and/or abdominal pains. Sucrose malabsorption defined as an abnormal increase in expired hydrogen, was found in only 3 children who suffered from congenital sucrase-isomaltase deficiency. This 1% incidence of sucrose malabsorption was lower than the incidence of lactose malabsorption found in this group (33%). Mean rise in blood glucose during the sucrose test was higher (3.4 +/- 1.4 vs. 2.4 +/- 1.2 mmol/l, p less than 0.0001) and the occurrence of false flat blood glucose curves was lower (3% vs. 12.8%, p less than 0.05) than during the lactose test. These findings are consistent with the higher sucrase activity in the small bowel mucosa compared to lactase. In contrast to the lactose tolerance test, sucrose tolerance test should not be used as a screening procedure for secondary disaccharidase deficiency in children.
Carbohydrate malabsorption in 110 healthy, term neonates was studied by estimating expired hydrogen (H2) before and after a feed on day 6 or 7. Carbohydrate malabsorption was assumed to be present if the infant excreted > 20 parts per million (ppm) H2. The frequency of carbohydrate malabsorption in 49 breast-fed infants was 25% (n = 12), in 35 infants fed a 7.5% lactose formula it was 31% (n = 11), in 26 infants fed a formula containing 1% lactose and 7.3% maltodextrin it was 15% (n = 4). These differences in frequency were not significant. Peak H2 concentration of the malabsorbers in each group, indicating the degree of carbohydrate malabsorption, was 64, 52, and 32 ppm respectively. The degree of carbohydrate malabsorption did not differ significantly between the breast-fed and the high lactose formula groups, but both groups differed from the low lactose group. H2 excretion was studied for 5 months in an exclusively breast-fed infant. In the first 2 months high concentrations were found and the infant produced 3-5 stools a day. In the next 3 months however, most H2 estimations were normal and only 1-2 stools a week were passed. With the introduction of solids, daily bowel movements promptly reoccurred. Frequency of carbohydrate malabsorption in newborn infants is fairly high and is primarily related to the lactose intake. The frequency and degree of carbohydrate malabsorption were comparable in breast-fed infants and in infants fed on a high lactose formula; this differs from results previously reported.
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Hypersarcosinaemia is a rare inborn error of metabolism, caused by a deficiency of the sarcosine dehydrogenase complex with tetrahydrofolate as a formaldehyde acceptor needed for the sarcosine-glycine conversion. Prolonged therapy with folic acid on a hypersarcosinaemic patient resulted in a significant effect on the urinary excretion of sarcosine, leading to the conclusion that the patient has a folic acid dependent hypersarcosinaemia.
UNLABELLED: Six patients with glucose-6-phosphatase deficiency were treated for 12 hr at night with gastric drip feeding (GDF), containing soy milk plus glucose, dextrimaltose, and starch. An alarm system (thermistor), connected to the gastric tube, was devised in case of displacement of the tube by the child. The effects of GDF were as follows. Base deficit and lacticaciduria decreased, but did not normalize. Serum cholesterol levels tended to normalize, but serum triglycerides remained elevated. The hepatic and extrahepatic components of plasma lipoprotein lipase were measured separately 5 and 40 min after iv heparin injection. Hepatic triglyceride lipase activities which were subnormal to normal increased to the lower normal range. Extrahepatic lipoprotein lipase activities, though increasing after GDF, remained abnormally low. Catch-up growth occurred in all four growth-retarded children. The pronounced liver enlargement of the five patients, not previously treated with GDF, decreased markedly. SPECULATION: Nocturnal GDF in glucose-6-phosphatase deficient children, suppresses the tendency for hypoglycemia and acidosis which are causes for stress, catabolism, and anorexia. By suppressing these factors, GDF promotes anabolism and caloric intake, thus accounting for the catch-up growth seen in the patients with growth retardation.
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The zinc, copper, and selenium content of commonly used intravenous solutions, aminoacid solutions, and fresh-frozen plasma was determined by atomic absorption spectrometry and fluorimetry. Very small amounts of copper and variable, but substantial, amounts zinc were present in all solutions tested. Zinc contamination could have come from the rubber stoppers for the glass bottles. Selenium could not be detected in any of the solutions. Fresh-frozen plasma contained high levels of zinc and physiological amounts of copper and selenium.
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Respiratory hydrogen excretion was measured during tolerance tests with lactose, glucose plus galactose, and skim milk in 52 children, 4 to 15 years of age. Ten children appeared to be lactose-malabsorbers, as reflected by increased respiratory hydrogen excretion after administration of 2 g lactose per kilogram, maximum 50 g. Skim milk, equivalent to 0.5 g lactose per kilogram was administered to all lactose-malabsorbers. Eight children were tolerant and two children were "intolerant" for this physiological amount of lactose when administered as skim milk. Disaccharidase activities of jejunal biopsies were determined in all 10 children with lactose malabsorption. Lactase activity was deficient in nine children and normal in one child. The increase of blood glucose during the lactose tolerance test did reflect lactose malabsorption less accurately than the respiratory hydrogen excretion.
Expired hydrogen and blood glucose were measured during an oral lactose tolerance test in 163 children aged between 9 months and 14 years. Lactose malabsorption, defined as an abnormal increase in expired H2 during a lactose tolerance test, was found in 54 children. Of these, 30 were found to be lactose intolerant as the increased expired H2 was accompanied by clinical symptoms. The other 109 children, in whom there was no rise in expired H2, were assumed to have normal lactose absorption. In children with lactose intolerance the increase in expired H2 tended to occur earlier after lactose ingestion than in children with malabsorption. The mean value of the rise in blood glucose was 2.4 mmol/100 ml) in the lactose-tolerant children and 1.0 mmol/1 (18 mg/100 ml) in the lactose-intolerant ones. Although this difference is significant (p less than 0.001), the rise in blood glucose, in predicting the correct diagnosis, was wrong in 13% of cases in the lactose-tolerant group, and wrong in 37% in the lactose-intolerant group (95% confidence limits 9-19% and 22-53% respectively). It is concluded that a rise in blood glucose, whether or not of more that 1.2 mmol/1 (22mg/100 ml) is of little help in differentiating lactose tolerance from intolerance.
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The 125I-labelled fibrinogen test has been used to assess the incidence of deep venous thrombosis in 88 patients who had undergone elective aorto-iliac reconstruction. Deep venous thrombosis was detected in 18 (20.5 per cent). The results suggest that these patients merit prophylaxis.