Ultrastructural defects of the ciliary epithelium in a child with Kartagener's syndrome.

Kartagener's syndrome is a well known classical triad of presentations consisting of bronchiectasis, sinusitis and situs inversus. It is now recognized that the syndrome is an extreme presentation of primary ciliary dyskinesia, a large group of conditions with ultrastructural ciliary defects, leading to poor ciliary motility in various organ systems. A case of Kartagener's syndrome is presented in an eight year old Thai boy in whom the ultrastructural ciliary defects have been examined and described in detail for the first time in Thailand. Incomplete lack of dynein arms was recognized. In addition, disorientation of ciliary axis was noticed. Due to severe bronchiectatic changes of the right lower lobe and right lingular lobe which did not improve despite adequate antibiotics, these lobes were surgically removed. The child has done well since, but still suffers occasional and recurrent bouts of sinusitis.

Height and weight of Thai children: high socioeconomic group of the some selected urban population.

A total of 4,371 high socioeconomic children, 2,220 boys and 2,151 girls, from Bangkok Metropolis, from 1985 to 1986 was studied. The height and weight were computed according to sex and age, height and weight for age, and weight for height were calculated in different percentiles (P5, P25, P50, P75 and P95). It was found that height and weight for age of a selected population of children are generally higher, they are taller and heavier than the children of previous studies. At 18 years of age, the average boy is 171 cm and 58 kg, while the average girls is 157.5 cm and 47 kg. The growth rate of Thai adults should be better with socioeconomic improvement in the standards of living in the future. Weight for height is not different from the previous studies, this is a more reliable and better parameter to evaluate the growth of children.

The weight of Thai infants exclusively breast-fed and formula-fed from birth to four months.

PIP: The 18-month Industry-Based Family Planning Project, which involved 30 industrial establishments located in Metro Manila (Philippines), combined a heavy interpersonal component, through a network of trained in-plant volunteers (IPVs), with an intensive in-plant information campaign. The latter made use of seminars, audiovisual presentations, posters, brochures, leaflets, photo exhibits, and contests. Training of the project staff -- 5 project officers and a project coordinator -- included providing them with the knowledge, attitudes, and skills necessary to carry out their tasks. Tasks were: to transfer to the IPVs knowledge of the concept of responsible parenthood and the various family planning methods, skills in motivating other workers, and responding to rumors and misconceptions about family planning methods; to act as resource persons on responsible parenthood and family planning methods in the industry setting; and to provide the technical support to the IPVs on responsible parenthood. The campaign plan centered on strategies which would help achieve the project objective, i.e., to increase the demand for and the availability of family planning information and services using nongovernment and government organizations. Basically, the plan addressed 2 segments of the industrial sector: the workers as the primary audience and the company managers as the secondary target. According to the program's pro-choice policy, a wide range of approved family planning services were made available to interested employees either by accredited company clinics or outside family planning service centers. Services by outside family planning service clinics were delivered via referrals or, in some instances, at the company's "doorstep." The end-of-project evaluation and the analysis of data gathered from reports and records maintained by the companies and by the Population Center Foundation (PCF) indicate that, after 18 months of operation, the project was able to substantially achieve its objective. It increased the demand for family planning information and services among workers in 30 industrial establishments located in Metro Manila. The more frequently mentioned sources of information on responsible parenthood and family planning were project-related personnel. Additionally, the different family planning methods became more widely known in the companies.^ieng

Protective value of BCG vaccination in children in Bangkok, Thailand.

The protective effect of bacille Calmette-Guérin (BCG) vaccination against tuberculosis is controversial. In a study, 330 patients less than 12 years of age with tuberculosis, 52.1% of whom had had BCG vaccination, were compared with a control group of 1106 patients free of tuberculosis, 81% of whom had BCG vaccination. The occurrence of disseminated forms of tuberculosis, tuberculous meningitis, tuberculous peritonitis, and tuberculosis of bone and joints in BCG-vaccinated patients was quite low. With BCG vaccination, the incidence of the disseminated form of tuberculosis was significantly lower than that of pulmonary tuberculosis with pulmonary parenchymal lesions, primary pulmonary complexes, and pleural effusion. Tuberculous peritonitis was significantly less frequent than pulmonary tuberculosis with pulmonary parenchymal lesions, enlarged hilar glands, pulmonary primary complex, and pleural effusions. The study demonstrated that BCG gave an overall protective effect of 74% and that a major effect of this immunity was to produce a localized form of tuberculosis.

Intestinal parasites in pediatric patients with diarrhoeal diseases in Bangkok.

Stool examinations of 147 pediatric patients with diarrhoeal disease were carried out at Siriraj Hospital, Bangkok by using the direct-smear technique. Stool of 27 patients (18.4%) were positive for intestinal parasites. Children under one year of age were free of intestinal helminths and protozoa. Parasites were equally prevalent in males and females and without any age group predilection. The prevalence of intestinal parasites were Entamoeba histolytica 6.8%, Giardia lamblia 6.1%, others were Ascaris lumbricoides, hookworm, Trichuris trichiura and Balantidium coli. Although the incidence of parasitism was not high as to be the main causatic agent of pediatric diarrhoea, the intestinal parasites may increase susceptibility to infection with other intestinal pathogens. The diagnosis of intestinal parasitoses can be determined by a simple direct faecal-smear technique and so that specific therapy can be instituted without delay in management of parasite-related diarrhoeas.

Disappearance of measles antibody in Thai infants after birth.

A seroepidemiology of measles hemagglutination inhibition antibody was studied in infants at birth to 8 months of age. It was found that at birth the antibody was greater than 1:8 in 56 of 64 newborns. At 2 and 4 months of age, 9 of 21 and 12 of 21 respectively had measles antibody titer less than 1:8, while at 8 months of age, only 1 of 6 had the antibody titer greater than 1:8. It shows that the maternal measles antibody can protect the infant at young age and the decrease in antibodies occur as the child grows. The measles vaccine should be given when the maternal passive immunity of measles disappears. This study indicates that the optimal age to recommend measles vaccination should be at the age of 9 months.

Cerebrospinal fluid lactate level in childhood purulent meningitis.

Cerebrospinal fluid lactate was determined in 54 pediatric patients by means of enzymatic method of Marbach and Weil. The mean value of cerebrospinal fluid lactate in 13 purulent meningitis patients was 80.4 mg/dl, in 9 clinical purulent meningitis patients was 72.7 mg/dl, in 18 non-purulent meningitis patients and 14 controls were 17.0 and 11.8 mg/dl respectively. The present study demonstrated that a cerebrospinal fluid lactate level of 35 mg/dl may be used as a cut off point to differentiate bacterial from non-bacterial infection of the central nervous system. It should served as a supplementary aid to clinical examinations and conventional methods to diagnose bacterial meningitis.

Electrolytes, sugar, calories, osmolarity and pH of beverages and coconut water.

Oral rehydration has been recommended in patients with diarrhoea to replace fluid loss from the gastrointestinal tract and reduce the need for intravenous therapy. Beverages (i.e. Cola, Sprite etc.) and coconut water may be used as sources of oral fluid when glucose-electrolyte solution is not available. To evaluate the usefulness and effectiveness of these soft drinks, the basic data such as electrolytes, sugar, calories, osmolarity and pH were determined. The electrolytes of the beverages were significantly lower (p less than 0.001) than the coconut water, especially potassium. The osmolarity of the beverages, which were 693 mOsm/l, was significantly higher (p less than 0.001) than the coconut water (288 mOsm/l); pH of the beverages (3.1) was more acidic (p less than 0.001) than the coconut water (5.4). While the sugar content of the beverages, which were 8.7 gm/dl, was significantly higher (p less than 0.001) than the coconut water (1.1 gm/dl). On comparison, all brands of beverages would give more calories than the coconut water however the coconut water would be absorbed more easily than any brand of soft drink beverage.

Tuberculous peritonitis in children.

Twelve patients with tuberculous peritonitis were studied. The provisional diagnosis was based on clinical, laboratory and radiological investigations. Later on peritoneoscopy with biopsy established the diagnosis. The presenting symptoms varied and not one symptom or sign was of definite diagnostic significance. Ten of the twelve patients gave a history of exposure to tuberculosis. Ascites was present in three patients, while liver enlargement was observed in seven patients. At the original clinical examination none was diagnosed as tuberculous peritonitis. The results of 5 TU tuberculin test were 10 mm or more in six patients. The chest roentgenogram was abnormal in seven patients, while multiple calcified mesenteric lymph nodes were demonstrated in three patients on the abdominal roentgenogram. Proven sites of tuberculosis besides the tuberculous peritonitis were discovered in seven patients, including pulmonary tuberculosis and tuberculous cervical adenitis. The ascitic fluid studies did not allow a conclusive diagnosis; only one of three ascitic fluid yielded acid-fast bacilli. Peritoneoscopy performed at the same time with peritoneal biopsy seems to be the best approach to establish a definite diagnosis. This disease may easily be overlooked and misdiagnosed, and without specific treatment may give rise to serious complications.

Protein and amino acids of breast milk from Thai mothers.

The protein, amino acids, and nonprotein nitrogen of milk samples obtained from Thai mothers over a period of 0 to more than 270 days postpartum were determined. Protein levels decreased from 1.56% during the 1st wk to a low of about 0.6% from 180 to 270 days and then rose to about 0.7%. The amino acid pattern of the milks suggested a number of differences in their composition and those of samples analyzed in other countries. Nonprotein nitrogen varied from 20 to 40% of the total nitrogen of the milk. It has been concluded that the need for supplementation of breast-fed Thai babies may occur earlier than many nutritionists advocate.

PIP: This study evaluates the effects of prolonged lactation on the quantity of protein and pattern of amino acids in breast milk of 135 Thai women at various times of lactation (from 0 to 270 days postpartum). Breast milk samples were collected approximately 3 hours after nursing at various times during 1978. Total nitrogen, tryptophan and amino acids were respectively analyzed by the methods of Williams, Lorenzo-Andreu and Frandsen and Matheson, and Hitachi Perkin-Elmer Model KLA3B amino acid analyzer. Protein level in breast milk was highest during the 1st week (1.56%) and decreased steadily with time until a level of 0.60% during the period of 180 to 270 days, after which protein content appeared to increase. Ratio of essential to nonessential amino acids was constant throughout the study. Protein or amino acid levels during lactation were not significantly affected by maternal age and parity, although maternal age, parity and socioeconomic factors had been known to affect total milk secretion. Amino acid levels in this study were generally similar to reported values from American and Scottish women, although methionine, valine and tyrosine were lower and tryptophan and lysine were higher. Although breast milk has a nutritional value of the highest quality, it can be argued that the need for supplemental feeding may still occur earlier in life than is often realized. A discussion of the FAO/WHO standards for protein allowances suggests that infants up to 3 months of age require approximately 2 or more g of milk protein per kg daily, while children 60 to 12 months of age require about 1.5 g/kg/daily. Considering that protein content of Thai breast milk is about 0.9% after 3 months of lactation, it is estimated that 1250 ml of milk are needed to supply the protein needs of a 3-month old child, and 950 ml would be insufficient (average daily production of milk varies from 850 ml to 1200 ml). Many Thai and other women who are exclusively breastfeeding may find it difficult to provide the protein needs of their infants, unless supplemental feeding is carried out.

Papulonecrotic tuberculid in childhood.

A case of papulonecrotic tuberculids of anterior abdominal wall with active tuberculous cervical lymph gland in a 12-year-old girl was demonstrated. This case illustrated the fact that although the papulonecrotic tuberculid is a rare entity, physicians should be aware of its existance to be considered in the differential diagnosis of dermatological lesions. Lesions, which appear in crops resembling chickenpox, with a longer duration and a strongly positive tuberculin test should lead to the diagnosis of papulonecrotic tuberculid. The investigations should include biopsy and demonstration of an active tuberculous foci. The lesions will regress if the patient receive antituberculosis therapy. Misdiagnosis and postponement of treatment with specific drugs may give rise to unsatisfactory consequences.