Challenges in a refeeding programme: case report of an Orang Asli boy at household level

@#Introduction: The refeeding programme in government hospitals is aimed at improving the nutritional status of malnourished children with weight-for-height z-score (WHZ) below -2.0, using special therapeutic food. However, there is a lack of data on the nutritional status of indigenous (Orang Asli) children when they return to the community after hospital discharge. Case Presentation: A 3-year-old Temiar boy residing in a tribal village in Hulu Perak was visited to determine his nutritional status following discharge from a refeeding programme in a government hospital. He was admitted to the hospital with a weight of 10.0 kg, height of 85.5 cm and WHZ of -2.09. The boy was later discharged weighing 11.0 kg, and with height unchanged at 85.5 cm and WHZ of -0.87. During our visit to the child’s home three months after discharge, his weight was 9.5 kg, height 86.0 cm, and WHZ –2.91. Discussion: The management of the case in the hospital was based on the Malnourished Orang Asli Protocols of the hospital. Household food insecurity, feeding and care practices, unhealthy household environment and the lack of communication between hospital and community health services were all identified as risk factors for malnutrition. Conclusion: The recurrence of malnutrition in this child, after successful improvement during hospital stay, highlights the importance of identifying factors that may affect nutritional status after hospital discharge. This knowledge will be beneficial in planning specific interventions, especially for Orang Asli children, living in remote villages

Ultrastructure and types of fimbriae in uropathogenic E-coli among bilharzial patients

The aim of this work was to study the association of different types of fimbriae of urinary E coli isolates with different disease entities. We collected a total of 57 urinary E. coli isolates from 3 groups of bilharrzial patients: group 1: with cystitis [21 isolates]; group 2: with pyelonephritis [18 isolates] and group 3: with urinary bladder carcinoma [18 isolates]. Each isolate was studied for: I. Fimbrial expression and type determination by haemagglutination [HA] of human and guinea pig erythrocytes. II. Electron microscopic [E/M] structure using negative staining, standard transmission and scanning electron microscopy. It was found that infection with mannose sensitive type 1 fimbriated E. coli dominated in group 1 and 3 [80.95% and 77.78% respectively]. In group2 [55.56%] were caused by mannose resistant P fimbriated E. coli. Although there was a perfect correlation between HA and the presence of fimbiriae by E/M [P< 0.01], yet E/M detected other types of fimibriae which could-have been missed by HA alone. Negative staining was the best technique in electron microscopy. We concluded that detection of P flimbriae in urinay E. coli strains may justify a vigorous antibiotic treatment to prevent development of pyelonephritis. Although type 1 fimbriae was associated with simple cystitis, yet follow up and complete investigations are recommended to detect an associated carcinoma

T-cell function in long term haemodialysis patients: impact of secondary hyperparathyroidism, oral one alpha calcidol and dialysis duration

The aim of this work was to study T-lymphocyte function in relation to secondary hyperparathyroidism, oral one alpha-calcidol treatment and dialysis duration. Eighty chronic renal failure patients who were maintained on regular haemodialysis treatment for 6-144 months [CRF] and 20 normal control subjects [N] were studied. Cases known to have autoimmune diseases, other diseases, which would affect the immune system or receiving medications known to affect immunity were excluded. CRF cases were 45 males and 35 females and their age was 43.06 +/- 11.1 years, while N cases were 12 males and 8 females and their age was 35.6 +/- 9.79 years. A11 CRF cases were receiving 1-alpha-calcidol orally as 1 mug/day for at least 3 months before the study onset. CRF and N cases were clinically examined and were tested for serum urea and creatinine, serum calcium and phosphorus, serum level of intact parathormone [RIA] beside the in vitro assessment of lymphoblastoid transformation of peripheral blood lymphocytes with and without phytohaemagglutinin [PHA] stimulation. The serum level of intact parathormone varied significantly among CRF cases; it was < 40 pg/ml in 13 [CRF1], 40-80 in 14 [CRF2] and > 80 in 53 [CRF3]. Among these 3 subgroups, pre-activation of T-lymphocytes was significantly higher in CRF3 [28 +/- 3.94 vs. 33.7 +/- 5.44 vs. 37.36 +/- 3.58% in CRF1, 2, 3 respectively],while PHA induced T-cell proliferation was significantly higher in CRF1 [77.54 +/- 3.97 vs. 73.7 +/- 4.83 vs. 59.9 +/- 7.37% in CRF1, 2, 3, respectively]. Duration of dialysis [DX] was significantly shorter in CRF1 [15.6 +/- 5.94 vs. 33.57 +/- 11.9 vs. 79.7 +/- 30.2 months in CRF1, 2, 3, respectively]. There was no significant difference between the 3 subgroups in dose or duration of 1-alpha-calcidol treatment. CRF1 had significantly higher s-phosphorus and s-PTH, significantly lower PHA induced T-cell proliferation and insignificant difference in serum calcium and T-lymphocytes pre-activation when compared to N [5.32 +/- 0.41 vs. 3.39 +/- 0.64 mg%, 30.08 +/- 4.89 vs. 19 +/- 4.57 pg/ml, 77.54 +/- 3.97 vs. 84.8 +/- 2.8%, 9.73 +/- 1.07 vs. 9.92 +/- 0.48 mg% and 28 +/- 3.94 vs. 29.2 +/- 4.73%,respectively]. DX had a significantly +ve correlation with either PTH level or T-lymphocytes pre-activation and a significantly -ve correlation with PHA induced T-cell proliferation. PTH had a significantly +ve correlation with T-lymphocytes pre-activation and a significantly -ve correlation with PHA induced T-cell proliferation. The study concluded that increased DX duration is responsible for: Significant increase in s-PTH; increased resistance of parathyroid to suppression by 1-alpha-calcidol and progressive deterioration of T-cell function as proved by increased T-lymphocytes pre-activation and decreased PHA induced T-cell proliferation

Antioxidant status in insulin and non-insulin dependent diabetes mellitus

This study was conducted on 125 cases of insulin-dependent and non- insulin-dependent diabetes mellitus [IDDM and NIDDM] as well as 20 healthy controls. The antioxidant enzymes; namely, superoxide dismutase, catalase and glutathione peroxidase were assayed. In addition, scavenger vitamins A, C, E and reduced glutathione level in blood were estimated, besides hemoglobin of different ligand derivatives. Superoxide dismutase, catalase, reduced glutathione as well as vitamins C and E were significantly lowered; while, the anti- peroxidative enzymes such as glutathione peroxidase [GPX] as well as Met-Hb and S-Hb were significantly elevated. These enzymes had a higher magnitude with the development of complication and in IDDM rather than NIDDM. Sulfohemoglobin was dependent on glibenclamide dose. The results suggested the deficiency of antioxidant that appeared early before the development of secondary complications