Sheila M. Pereira

Calcium balance studies on children accustomed to low calcium intakes.

1. Calcium balance studies were carried out on twenty-eight apparently normal preschool children who had been for several months on a low Ca intake of 200 mg/child per day. 2. Three-day balances showed that all subjects were in positive balance. The absorption was 50% of the intake. 3. When the dietary intake was increased to 280 mg/day there was a greater absorption and retention of Ca. Serum Ca, inorganic phosphorus and alkaline phosphatase were within the normal range for this age group. 4. Fourteen of the subjects were on wheat supplemented with lysine. The addition of a single amino acid to the diet was shown not to improve the absorption and retention of Ca over that of the controls.

Serum Amino Acids of Children on High and Low Protein Intakes

altered by the feeding of protein supplements as is evident from the data obtained in this laboratory. Variations in the levels of some of the free amino acids in the serum of children with kwashiorkor have been reported by several investigators.5 Using chromatographic methods Whitehea& observed that, in general, the indispensable amino acids are reduced in concentration while the dispensable ones are almost unaffected. The levels of the branchedchain amino acids (leucine, isoleucine and valine) and methionine were particularly low, whereas those of glycine, serine, glutamine and taurine remained in the normal range. The method described by Whitehead is sufficiently simple to be applicable to the screening of large numbers of specimens. This paper presents a modification of Whitehead’s method applied to serum samples from children on diets limited in protein content. The results suggest that the method may be of value in detecting subclinical levels of protein deficiency in large groups of children in field surveys.

Outcome of the haemolytic-uraemic syndrome complicating bacillary dysentery.

Seventy-eight children were treated for the haemolytic-uraemic syndrome complicating bacillary dysentery over a ten-year period. Early dialysis favoured survival significantly. The renal status of 22 of the 28 survivors was re-evaluated 18-84 months after initial hospitalization. Complete recovery was found in all except two patients; one of them had neurological sequelae and the other a glomerulonephritic disease.

The growth of exclusively breastfed infants.

To determine the pattern of growth of exclusively breastfed babies and to establish their incremental weight gains, 329 babies attending a well baby clinic were studied. The weight gains were most rapid over the first 6 weeks and were of the order of 41.4 and 39.2 g/day in the boys and girls respectively. Underweight mothers did not produce lighter babies than mothers of desirable weight, nor did their nutritional status influence the weight gains of their infants over the first 6 weeks. Low birthweight infants doubled their weights by 9-10 weeks, while heavier babies took 15 to 18 weeks. The pattern of growth of exclusively breastfed infants appears to be different from that of artificially fed infants.

Studies in iron supplementation of preschool children.

1. The effect of daily supplements of 20-30 mg inorganic iron as ferrous sulphate on the growth, activity and haematological status of preschool children was studied for 3.5, 7 and 12 months and compared to that of children who served as controls. All children were given their daily requirements of energy and protein. In addition, they received 5 microgram cyanocobalamin and 200 microgram folic acid. 2. Fe supplementation increased the haemoglobin, serum Fe and percentage saturation of transferrin and reduced the unsaturated Fe-binding capacity significantly compared to corresponding values for the controls. 3. Height and activity were unaffected by Fe supplements. 4. Of the children 45% had haemoglobin values below 110 g/l at the end of 7-12 months of Fe supplementation.

Electroencephalograms and nerve conduction in survivors of kwashiorkor.

1. Electroencephalographic and nerve-conduction studies were undertaken in children who had been treated in hospital for kwashiorkor 6–8 years previously; the results were compared with those for age-matched controls of similar cultural and socio-economic backgrounds. 2. The electroencephalograms were normal in all. 3. In three survivors of kwashiorkor, the amplitude of the sural nerve potential was less than that of the lower limit of the normal range. 4. The findings are discussed in the context of the present knowledge of protein-energy (protein-calorie) malnutrition.

Feeding trials with lysine- and threonine-fortified rice

I . The effect of fortification of rice with lysine and threonine (at levels of z g and I g/kg respectively) on the growth of preschool children was assessed in feeding trials at a residential orphanage and a village day-care centre. 2. In the first trial, the children at the orphanage were offered a diet based on rice, to provide the recommended allowances of protein and energy. For the children in the experimental group, the rice was fortified with lysine and threonine for the 6 months of the trial. 3. Statistically significant differences in final height and weight were not observed between the children in the control and in the experimental groups. 4. The children in the control group grew at optimal rates. 5 . In the second trial, the diet provided approximately 80 of the daily energy and protein intakes from rice and was offered ad lib. at four meals a day in the orphanage and at three meals a day in the day-care centre. 6. In the orphanage, most children ate enough of this high-bulk diet to ensure an adequate energy intake. The childrcn given the fortified rice and those who served as controls grcw at very satisfactory rates. 7. 4 t the village centre most of the children were unable to eat enough food to achieve an adequate intake of energy. The children given thc fortified rice did not grow taller than those given unfortified rice. 8. Fortification of rice with lysine and threonine did not improve rates of growth of preschool children.

Latex agglutination: an appropriate technology for the diagnosis of bacterial meningitis in developing countries

We evaluated prospectively the utility of a latex agglutination technique for the diagnosis of Haemophilus influenzae type b meningitis in a paediatric ward in India. Eight of 44 children had H. influenzae grown from cerebrospinal fluid. These proven cases plus four additional cases of H. influenzae meningitis were detected by the latex agglutination test. There were no cross reactions with other organisms. The high degree of sensitivity and specificity, combined with the speed and simplicity of this technique make it an appropriate method for developing countries.

Pyomyositis in south Indian children

Thirty-two children with pyomyositis were studied. In 28 children, 23 boys and 5 girls, Staphylococcus aureus was the aetiological agent. The strains isolated were resistant to penicillin. The muscles of the thigh, back and upper arm were most frequently involved. Eight children had infections in other parts of the body, namely pneumonia, empyema, pericarditis, meningitis, osteomyelitis and arthritis. Two children died. At follow-up one child had chronic osteomyelitis. In four neonates, beta haemolytic streptococcus was the causative organism. All were septicaemic. One infant died.

Physical growth and neurointegrative performance of survivors of protein--energy malnutrition.

1. The anthropometric measurements and neurointegrative performance of seventy-nine children aged 6--12 years who had survived kwashiorkor in early childhood were compared to those of 142 children who served as controls. 2. For the boys the differences in height and weight between those who had survived protein--energy malnutrition (PEM) and the controls were significant (P less than 0.01). 3. For the girls the differences in height and weight between those who had survived PEM and the controls were not significant. 4. In the tests chosen, the performances of the survivors of PEM was significantly poorer than that of the controls. 5. There was no improvement in the performance when thirteen survivors were reassessed at 10 years of age. 6. There was a significant difference in scholastic performance between the survivors of PEM and the normal controls. The scholastic performance of the siblings of PEM survivors was also significantly better than that of the PEM survivors. 7. The dietary intakes at the time of reassessment were unsatisfactory in 25% of the survivors, but did not relate to their scholastic abilities.