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- The effect of topical calcipotriol or zinc on tuberculin skin tests in hospitalised South African children. [Journal Article]
- Int J Tuberc Lung Dis 2014 Apr; 18(4):388-93.
The tuberculin skin test (TST) is used to help diagnose tuberculosis (TB) in acutely ill hospitalised children. OBJECTIVE To investigate the potential augmentative effect of topical calcipotriol (a vitamin D analogue) or zinc on TST induration.Three TSTs were performed among 64 hospitalised children; each site was covered with topical aqueous cream (control), calcipotriol or zinc and assessed 24 and 48 h later by investigators blinded to all topical applications.TSTs were reactive in 15 (23.4%) children, of whom 13 (20.3%) were TST-positive. Topical calcipotriol and zinc induced TST positivity in two children with reactive but negative control TSTs. These treatments, however, did not significantly increase TST positivity rates. In children with reactive TSTs, the median 48 h induration diameter was not significantly different between the control, calcipotriol- or zinc-treated groups, which were respectively 12.0 (25%-75% IQR 5.0 - 18.0), 14.0 (25%-75% IQR 10.0 - 15.0) and 12.0 (25%-75% IQR 8.0 - 15.0) mm. Topical treatments did not induce TST reactivity or TST positivity in children with culture-confirmed TB disease (n = 4), human immunodeficiency virus infection (n= 18) or kwashiorkor (n = 9).Topical calcipotriol or zinc does not induce TST reactivity or significantly increase TST positivity rates in acutely ill hospitalised children. However, further studies are required to assess the effects of topical treatments on TST positivity in severely malnourished children.
- Dermatosis in children with oedematous malnutrition (Kwashiorkor): a review of the literature. [JOURNAL ARTICLE]
- J Eur Acad Dermatol Venereol 2014 Mar 24.
Children with oedematous malnutrition, known as kwashiorkor, may develop a characteristic skin lesion, named 'Dermatosis of Kwashiorkor' (DoK). Only a few studies have been concerned with this condition, and the reason for the development of DoK remains unexplained. This study review the existing studies concerning DoK, including its clinical manifestations, histopathology, suggested pathophysiology, current treatment and prognosis for children of the age of 6 months to 5 years. Standardized clinical studies are needed to further understand the implications of DoK. Such studies would suffer from the lack of consistency concerning the terminology and scoring of the lesions in DoK. We therefore stress the need for a standardized scoring of the degree of DoK. This would facilitate valid and comparable studies and the development of better treatment for this vulnerable group of patients.
- Glucose metabolism in adult survivors of severe acute malnutrition. [JOURNAL ARTICLE]
- J Clin Endocrinol Metab 2014 Feb 11.:jc20133511.
Context and Objectives : The clinical syndromes of severe acute malnutrition may have early life origins, as children with marasmus have lower birth weight than those with kwashiorkor. We hypothesized that resultant metabolic effects may persist into adulthood. We investigated whether marasmus survivors (MS) are more insulin resistant and glucose intolerant than kwashiorkor survivors (KS). Research design and setting : This was a case-control study in Jamaican adults. Subjects : We performed oral glucose tolerance tests on 191 adults (age 17-50 years; 52% male; BMI 24.2 ± 5.5 kg/m(2)). There were 43 MS; 38 KS; 70 age, sex and BMI-matched community controls (CC); and 40 age and birth weight matched controls (BC). Measurements : We measured insulin sensitivity with the whole body insulin sensitivity index (WBISI), and beta-cell function with the insulinogenic index (IGI) and oral disposition index (oDI). Results : Fasting glucose was comparable across groups, but glucose intolerance was significantly more common in MS (19%) than in KS (3%), CC (11%) and BC (10%). WBISI was lower in MS than KS (P = 0.06), but similar between MS and controls. IGI and oDI were lower in MS compared to all three groups (P-values < 0.02). Conclusions : Marasmus survivors tend to be less insulin sensitive, but have significantly lower insulin secretion and are more glucose intolerant compared to kwashiorkor survivors and controls. This suggests that poor nutrition in early life causes beta cell dysfunction which may predispose to the development of diabetes.
- The role of underutilized fruits in nutritional and economic security of tribals: a review. [Journal Article]
- Crit Rev Food Sci Nutr 2014; 54(7):880-90.
The tribal people of Rajasthan are severely malnourished along with multiple nutrient-deficiency disorders due to ignorance about importance of fruits and vegetables in their diets. The tribal areas are full of biodiversity having natural vegetation which is not harnessed fully. Due to which a wide gap is formed between health and optimal use of natural sources of nutrients, i.e., underutilized crops. The crops, which are neither grown commercially on large scale nor traded widely, may be termed as underutilized horticultural crops. These crops are cultivated, traded, and consumed locally. These crops have many advantages like easier to grow and hardy in nature, producing a crop even under adverse soil and climatic conditions. So, exploitation of underutilized horticultural crops can become a solution to the social problem of health and nutrition insecurity, poverty, and unemployment. The consumption of underutilized fruit crops can provide nutrition to the poor and needy tribals by meeting the nutrient requirements of vulnerable groups. As underutilized fruits, nuts, and vegetables are a rich of source of carbohydrates, fats, proteins, energy, vitamins-A, B1, B2, B3, B6, B9, B12, C, folic acid, and minerals-Ca, P, Fe, and dietary fiber. Thus, they have the nutritional capacity to prevent and cure various diseases like kwashiorkor, marasmus, night blindness, anemia, diabetes, cancer, hypertension, and hidden hunger. It is also established fact that seasonal, locally available, and cheap fruits and vegetables can also keep the population healthy and nutritionally secure rather than costly off-season ones. Also, the underutilized crops have the potential to give economic security to tribals by giving employment and by fetching good returns from their sale in raw form as well as value-added products.
- Incidence and course of child malnutrition according to clinical or anthropometrical assessment: a longitudinal study from rural DR Congo. [Journal Article, Research Support, Non-U.S. Gov't]
- BMC Pediatr 2014.:22.
Longitudinal studies describing incidence and natural course of malnutrition are scarce. Studies defining malnutrition clinically [moderate clinical malnutrition (McM) marasmus, kwashiorkor] rather than anthropometrically are rare. Our aim was to address incidence and course of malnutrition among pre-schoolers and to compare patterns and course of clinically and anthropometrically defined malnutrition.Using a historical, longitudinal study from Bwamanda, DR Congo, we studied incidence of clinical versus anthropometrical malnutrition in 5,657 preschool children followed 3-monthly during 15 months.Incidence rates were highest in the rainy season for all indices except McM. Incidence rates of McM and marasmus tended to be higher for boys than for girls in the dry season. Malnutrition rates increased from the 0-5 to the 6 - 11 months age category. McM and marasmus had in general a higher incidence at all ages than their anthropometrical counterparts, moderate and severe wasting. Shifts back to normal nutritional status within 3 months were more frequent for clinical than for anthropometrical malnutrition (62.2-80.3% compared to 3.4-66.4.5%). Only a minority of moderately stunted (30.9%) and severely stunted children (3.4%) shifted back to normal status. Alteration from severe to mild malnutrition was more characteristic for anthropometrically than for clinically defined malnutrition.Our data on age distribution of incidence and course of malnutrition underline the importance of early life intervention to ward off malnutrition. In principle, looking at incidence may yield different findings from those obtained by looking at prevalence, since incidence and prevalence differ approximately differ by a factor "duration". Our findings show the occurrence dynamics of general malnutrition, demonstrating that patterns can differ according to nutritional assessment method. They suggest the importance of applying a mix of clinical and anthropometric methods for assessing malnutrition instead of just one method. Functional validity of characterization of aspects of individual nutritional status by single anthropometric scores or by simple clinical classification remain issues for further investigation.
- Flaky paint dermatosis. Kwashiorkor. [Case Reports, Journal Article]
- JAMA Dermatol 2014 Jan; 150(1):85-6.
- Effects of pneumonia and malnutrition on the frequency of micronuclei in peripheral blood of pediatric patients. [Journal Article]
- Int J Clin Exp Med 2013; 6(10):942-50.
The aim of this study was to evaluate the effects of bacterial pneumonia and malnutrition on the frequency of micronuclei (MN) in peripheral blood of pediatric patients through flow cytometric analysis. The study was an analytical case-control study carried out on 35 malnourished children with bacterial pneumonia and 20 well-nourished children with bacterial pneumonia, in addition to 20 healthy children as controls. Complete physical examination including; anthropometric measurement, Chest roentgenograms were done for all cases. Assessment of MN was done by FACSCalibur flow cytometry. The frequency of micronucleated reticulocytes (MN-RETs) was higher both in the malnourished children with pneumonia and well-nourished children with pneumonia than the controls. Within the malnourished children with pneumonia, patients with kwashiorkor had more micronucleated mature erythrocytes (MN-RBCs) and MN-RETs than patients with marasmus. In conclusion: Pneumonia is associated with an increased frequency of MN and this increment is more pronounced in children with severe malnutrition especially kwashiorkor group.
- Decreased metabolism of 13C-caffeine via hepatic CYP1A2 in marasmus and kwashiorkor based on breath test. [JOURNAL ARTICLE]
- J Basic Clin Physiol Pharmacol 2013 Oct 11.:1-9.
Abstract Background: Hepatic metabolism of drugs has been rarely studied in children with malnutrition. Caffeine breath test (CBT) has been used to determine the activity of cytochrome P450 1A2 (CYP1A2) enzymes in children. We used the CBT to assess how marasmus and kwashiorkor differentially affect 13C-caffeine metabolism. Methods: A total of 45 children composed of 15 children per group of malnutrition (marasmus, marasmic-kwashiorkor, and kwashiorkor) were studied during malnutrition and after nutritional recovery. After an overnight fast, patients ingested 3 mg/kg 13C-caffeine at 0900 h. Duplicate breath samples were collected into an Exetainer bottle at -20, -10, and -1 min and at 15-min intervals for 2 h. The mean cumulative percent dose recovered (CPDR) of 13C-caffeine in the expired 13CO2 was determined over the study period. Results: The CPDR in the expired 13CO2 in 2 h significantly increased after nutritional recovery in children with marasmus (from 6.80%±3.00% to 7.67%±2.81%; Student's t-test, p=0.001), marasmic-kwashiorkor (from 6.61%±2.26% to 7.56%±2.46%, p=0.041), and kwashiorkor (from 6.29%±1.06% to 7.20%±1.80%, p=0.002). When the three groups of malnutrition were compared, there was no significant difference in their mean CPDR in 2 h during malnutrition [p=0.820, analysis of variance (ANOVA)] and after nutritional recovery (p=0.810, ANOVA). Conclusions: Hepatic metabolism of caffeine significantly decreased in children with marasmus, marasmic-kwashiorkor, and kwashiorkor compared to after they had recovered nutritionally. This suggests a decreased CYP1A2 activity in all categories of malnutrition.
- Lactobacillus reuteri and Escherichia coli in the human gut microbiota may predict weight gain associated with vancomycin treatment. [Journal Article]
- Nutr Diabetes 2013.:e87.
Background:Antibiotics, used for 60 years to promote weight gain in animals, have been linked to obesity in adults and in children when administered during early infancy. Lactobacillus reuteri has been linked to obesity and weight gain in children affected with Kwashiorkor using ready-to-use therapeutic food. In contrast, Escherichia coli has been linked with the absence of obesity. Both of these bacteria are resistant to vancomycin.Objectives and methods:We assessed vancomycin-associated weight and gut microbiota changes, and tested whether bacterial species previously linked with body mass index (BMI) predict weight gain at 1 year. All endocarditis patients treated with vancomycin or amoxicillin in our center were included from January 2008 to December 2010. Bacteroidetes, Firmicutes, Lactobacillus and Methanobrevibacter smithii were quantified using real-time PCR on samples obtained during the 4-6 weeks antibiotic regimen. L. reuteri, L. plantarum, L. rhamnosus, Bifidobacterium animalis and E. coli were quantified on stool samples obtained during the first week of antibiotics.
Results:Of the193 patients included in the study, 102 were treated with vancomycin and 91 with amoxicillin. Vancomycin was associated with a 10% BMI increase (odds ratio (OR) 14.1; 95% confidence interval (CI; 1.03-194); P=0.047) and acquired obesity (4/41 versus 0/56, P=0.01). In patients treated with vancomycin, Firmicutes, Bacteroidetes and Lactobacillus increased, whereas M. smithii decreased (P<0.05). The absence of E. coli was an independent predictor of weight gain (OR=10.7; 95% CI (1.4-82.0); P=0.02). Strikingly, a patient with an 18% BMI increase showed a dramatic increase of L. reuteri but no increase of E. coli.
Conclusion:The acquired obesity observed in patients treated with vancomycin may be related to a modulation of the gut microbiota rather than a direct antibiotic effect. L. reuteri, which is resistant to vancomycin and produces broad bacteriocins, may have an instrumental role in this effect.
- Hematologic and Bone Marrow Changes in Children with Protein-Energy Malnutrition. [JOURNAL ARTICLE]
- Pediatr Hematol Oncol 2013 Aug 29.
Background: All systems in an organism are affected by protein-energy malnutrition (PEM), but one of the worst affected is the hematopoietic system. Today PEM remains a very serious problem in developing countries. We examined the relationships between clinical features, hematological, and bone marrow changes with severe PEM from Turkey. Method: We evaluated 34 (11 females and 23 males) consecutive cases of severe PEM, with no underlying diseases aged 3-20 months. The clinical nutritional conditions of the patients were determined using the Wellcome-Trust PEM classification. Ten of the patients were in the Marasmic-Kwashiorkor (M-K) group, 10 were in the Kwashiorkor (KW) group, and 14 were in the Marasmic (M) group. Full blood count, protein, albumin, serum iron (SI), iron-binding capacity (TIBC), ferritin, vitamin B12, folic acid, complement-3 (C3), complement-4 (C4), and bone marrow were investigated in all groups. Results: Anemia was detected in 97% of patients. We determined serum iron levels were low in 67.6% of the patients, TS levels were low in 76.4% of the patients and ferritin levels were low in 20.5%. The level of vitamin B12 was normal in all patients. Bone marrow analysis showed erythroid series hypoplasia in 28.5% of patients in the M group, 50% in the KW group, and 30% in the M-K group. Marrow iron was absent in 58.8% of patients. Conclusion: The most common hematologic change in the children with PEM was anemia and major cause of anemia was iron deficiency in this study. Patients with severe PEM have normal Vit B12 and serum folate levels. Most of the patients with severe PEM had normal cellularity with megaloblastic and dysplastic changes in bone marrow due to the inadequate and imbalanced intake of protein and energy.