Effect of Cnidoscolus aconitifolius leaf extract on the blood glucose and insulin levels of inbred type 2 diabetic mice.

The effects of Cnidoscolus aconitifolius (CA) leaf extract and chlorpropamide on blood glucose and insulin levels in the inbred type 2 diabetic mice are reported. After treatment with CA, the glucose levels were measured at 0 and 2-hour intervals in experimental groups and controls. Group I received no treatment and served as control; Group II was the reference and it received chlorpropamide; Groups I-III were moderately diabetic, 100-300 mg/dL blood glucose levels while Group IV were severely diabetic (> 300 mg/dL). Groups III and IV received CA and served as test groups. There was no significant difference between the blood glucose levels at 0 and 2 hours for the control group, (P>0.23) but there were statistically significant differences for Group II (P<0.0002); Group III (P<0.002) and Group IV (P<0.0001). For moderately diabetic mice, CA and chlorpropamide decreased the glucose levels by 25.6% and 16.3% respectively while for the severely diabetic mice CA decreased the blood glucose by 43.7%. It is proposed that CA has an insulinogenic property that possibly stimulated dormant beta-cells to secrete insulin. The histopathology of several organs in the treated animals was found to differ from the expected. The islets of Langerhans for example were found to be preserved in the time frame examined. Also the liver and kidney were found to display milder pathology in the treated groups.

Childhood meningitis at King Fahad Hospital, Hofuf, Saudi Arabia.

The medical records of 132 children with meningitis treated at King Fahad Hospital, Hofuf, Saudi Arabia, between June 1994 and May 1996, were reviewed with a view to defining the incidence, types of meningitis, their management and clinical outcome. Subjects were classified into three groups: bacterial, partially treated, and viral meningitis. There were 37 patients (28%) in period I (1994/95) and 95 (72%) in period II (1995/96). The higher incidence in period II was accounted for by a sharply increased incidence of viral meningitis in the latter half of the period. Of the 132 patients, 36 (27.3%) had bacterial meningitis, 45 (34.1%) had partially treated meningitis and 51 (38.6%) had viral meningitis. The most common CSF isolate was Haemophilus influenzae type B (HIB) from 24 (66.7%) of the 36 bacterial meningitis cases. About half of the cases of HIB meningitis occurred in infants under the age of 12 months.

Analysis of the results of routine lumbar puncture after a first febrile convulsion in Hofuf, Al-Hassa, Saudi Arabia.

Cerebrospinal fluid (CSF) was analysed to determine a lumbar puncture (LP) yield for meningitis in 95 children who presented with their first febrile convulsions between July 1993 and June 1994. There were 52 males and 43 females aged six months to six years with a mean age of 21.9 +/- 13.0 months at presentation. 87(91.6%) had simple febrile convulsions (SFC) while the remaining 8(8.4%) had complex febrile convulsions (CFC). The majority of the subjects presented with a sudden onset of convulsions that were preceded by a day or two history of fever, coryza, cough and respiratory distress while others had their convulsions preceded by fever and passage of bloody stools. The LP yield for meningitis in this series was 6.3%. The CSF analysis revealed six cases of meningitis comprising an eight month old infant with Haemophilus influenzae type B (HIB) meningitis, two partially treated pyogenic meningitis and three aseptic meningitis. All of them had presented with febrile convulsions without signs of meningeal irritation. Excluding aseptic meningitis from this series, a 3.1% LP yield for pyogenic meningitis is significant enough to recommend continued performance of LP in children with first febrile convulsions, especially if under the age of eighteen months.

Seizure recurrence after a first febrile convulsion.

In this study, 140 children aged from 6 months to 6 years who presented with a first febrile convulsion at the King Fahad Hofuf Hospital, Al-Hassa, Saudi Arabia were retrospectively identified. Information about these children was obtained from their medical records covering a follow-up period of 3 years from July 1989 to June 1992. Recurrent febrile convulsions occurred in 60 of them (43%). Relevant risk factors that were observed to be significantly associated with seizure recurrence included an age of less than 18 months (odds ratio [OR] = 3.82; 95% confidence interval [CI] = 9.26, 1.58), an initial febrile convulsion that was complex (OR = 4.41; CI = 9.50, 2.05) and a positive family history of febrile convulsions (OR = 4.12; CI = 10.74; 1.58), while a decreased risk of recurrence occurred with a temperature of over 39 degrees C (OR = 4.60; CI = 9.44; 2.24). There was no association between seizure recurrence and the duration of the initial febrile convulsion (OR = 0.93; CI = 2.33; -2.04) or family history of epilepsy (OR = 0.88; CI = 4.22, -3.27). An important observation in the present study is the close association (ORM-H = 2.36; X2M-H = 9.65) between the development of an afebrile convulsion and seizure recurrence among the group of children with CFC. Anticonvulsant prophylaxis should therefore be considered for children whose initial febrile convulsions are complex in nature.

Acute bacterial meningitis in children.

A retrospective study of 48 children with pyogenic meningitis who were admitted between January 1986 and December, 1987 at the Ogun State University Teaching Hospital, Sagamu has shown that childhood meningitis is an important health problem in the community as it accounted for 2.8% of 1,724 admissions into the paediatric ward. The ages of the patients ranged from three weeks to twelve years with a mean of 2 1/2 years. The commonest causative organism was Streptococcus pneumoniae which accounted for 67.5% of all isolates. The mortality rate was 26.1% while significant morbidity occurred in 23.5% of survivors. Important prognostic factors included the presence of coma or persistent convulsions, low CSF glucose and low serum sodium levels as well as the interval between symptoms and treatment.

Immunity in malaria: depression of delayed hypersensitivity reaction in acute Plasmodium falciparum infection.

The effect of acute Plasmodium falciparum malaria infection on the cell-mediated immune response of 30 Nigerian children attending the General Out-patient (GOP) Clinic of the University College Hospital, Ibadan, Nigeria, was assessed in a controlled study. Delayed-type hypersensitivity skin reaction to five tuberculin units (5 TU) of purified protein derivative (PPD) was used as an indicator of cell-mediated immunity. The results showed marked depression of delayed hypersensitivity reaction to PPD in 27 (90%) of the malarious children, compared with four (16%) of the 25 control healthy subjects (P less than 0.0005). This depression was observed despite evidence of previous BCG vaccination in 38 (69.1%) of the 55 children in the study. The possible clinical significance of these observations in tropical paediatric practice, and the immunopathological implications, are discussed.

Low birthweight in an urban community in Nigeria.

Six thousand, one hundred and thirty-five consecutive live births in six major health centres in the city of Ibadan were studied between September 1982 and March 1983 in order to assess the incidence, distribution and causes of low birthweight (LBW) in an urban community in Nigeria. Of the 6135 live births, 504 (8.2%) were of LBW. Two hundred and thirty-six (62%) of the LBW were small-for-gestational-age (SGA), while 146 (38%) were appropriate-for-gestational-age (AGA). Two hundred and five (87%) of the SGA were term while 115 (79%) of the AGA infants were preterm. Multiple pregnancy was an important cause of LBW, occurring in 4.4% of pregnancies. One hundred and forty-six (2.6%) of the 5631 infants who weighed 2500 g or over and 122 (24.2%) of the LBW infants were products of multiple pregnancy (P less than 0.001). The young (less than 20 years), short statured (less than 155 cm) and primigravid mothers were more likely than the others to give birth to LBW infants (P less than 0.001). Of the obstetric and medical factors examined, pre-eclamptic toxaemia (PET) (P less than 0.01), ante-partum haemorrhage (APH) (P less than 0.01) and anaemia (P less than 0.02) significantly increased the risk of LBW. Pre-eclamptic toxaemia, eclampsia, hypertension and renal diseases tended to be associated with SGA while APH and anaemia were found more often with prematurity. Multiple pregnancy contributed equally to the delivery of preterm and growth-retarded infants. Although no obvious cause could be identified in about two-thirds of the cases, pre-conceptional maternal malnutrition and poor diet in pregnancy might play an important role.

Depressed natural killer cell activity in children with protein--calorie malnutrition. II. Correction of the impaired activity after nutritional recovery.

Natural killer (NK) cell activity and responsiveness to interferon (IFN) were measured in the peripheral blood of infants having kwashiorkor or marasmus and of nutritionally recovered malnourished children. Depression of NK activity in the peripheral blood lymphocytes (PBLs) of the malnourished children was noted, while normal levels of activity were observed in the nutritionally recovered infants. Addition of exogeneous interferon in vitro potentiated the NK levels of PBLs from well-nourished and nutritionally recovered infants, but had either a nonsignificant impact on cells from the marasmic infants or a suppressive effect on the cells from infants with kwashiorkor. The success of exogenous interferon to potentiate the NK levels of PBLs from nutritionally recovered infants suggests that nutritional repletion corrects the impaired cellular responsiveness in these patients.

Hormonal changes in severely malnourished children.

Hormonal changes during the acute phase of protein-energy malnutrition (PEM) and at recovery have been examined in thirty-four severely malnourished subjects (twenty-four kwashiorkor and ten marasmus) all of whom were aged 3 years and below. It was observed that except for cortisol, the hormonal values were different between the marasmic and kwashiorkor children. Serum insulin levels were depressed and growth hormone (GH) elevated among the kwashiorkor children most especially among the kwashiorkor sub-groups II and III cases who had the greatest deficit in body weight. Although the GH values were also elevated in the marasmic patients, the levels were much lower than those for the kwashiorkor children. There was no statistically significant difference in the mean serum concentration of both cortisol and thyroxine among the different sub-groups of kwashiorkor and the marasmic subjects. The identical serum levels of cortisol in both the marasmic and kwashiorkor children may have been due to similar extent of exposure of infections. With improved dietary intake and some degree of anthropometric recovery, GH concentration fell steadily while insulin rose especially among the kwashiorkor cases. The reasons for these hormonal changes, their functions during the acute phase of PEM and at recovery are discussed.

Clinical significance of serum transcobalamins in protein-energy malnutrition.

The serum concentrations of Unsaturated Vitamin B(12) binding (UBBC) capacity and the three individual transcobalamins were measured in 34 malnourished children aged 9 months-5 y. Levels of serum vitamin B12, aspartate aminotransferase, alanine aminotransferase, albumin and total proteins were also estimated. The serum UBBC, Transcobalamin I (TC I), Transcobalamin III (TC III), vitamin B12 and the enzyme activities were significantly higher in the kwashiorkor children when compared with both the marasmic and control children. There was also a marked reduction of serum Transcobalamin II (TC II), albumin and total proteins in the kwashiorkor children. In contrast with kwashiorkor, there was a slight increase of serum TC II in the marasmic children. Their serum UBBC, TC I, TC III and B12 were also raised but not as high as in kwashiorkor. These results are discussed in the light of the hepatic dysfunction in kwashiorkor affecting the production of TC II in the liver, while the elevated serum B12 in Protein-energy malnutrition (PEM) may be due to both hepatic damage and intensified release of TC I as a result of infection.

Erythrocyte transketolase activity in protein-energy malnutrition.

Erythrocyte transketolase activity (ETKA) and the percentage thiamine pyrophosphate (TPP) effects have been measured in a group of 10 healthy children and 50 malnourished subjects (23 oedematous and 27 non-oedematous cases). The observed ETKA values and percentage TPP effects for the two malnourished groups of subjects differed significantly (P less than 0.001) from the values for the control group. These values reverted almost to normal in 24 subjects who were re-tested after 6 weeks of thiamine therapy. Suggestions are made for this apparent biochemical thiamine deficiency without manifestations in these subjects.

Childhood acute leukaemia in a tropical population.

The clinical features of acute leukaemia (AL) were documented prospectively among Nigerian children resident in the South-Western rain-forest area of the country, and compared to the features in Caucasians. Twenty-nine of 51 newly diagnosed cases of AL occurred in childhood, including 19 cases of acute lymphoblastic leukaemia (ALL) and 11 of acute myelogenous leukaemia (AML). The incidence of ALL the AML in Ibadan children was the same, estimated as 0.8 X 10(-5). Thus childhood ALL was about one-third as common in Ibadan as in most developed Caucasian countries. ALL and AML occurred most frequently in the age groups 10-14 and 5-9 years respectively. Six cases of AML were associated with chloromas. Only 2 of the ALL patients survived more than one year after standard chemotherapy. The poor result appeared to be attributable to frequent occurrence among the ALL patients of adverse prognostic factors such as hyperleucocytosis, age less than 2 or greater than 7 years, L2 morphology and low PAS reactivity of the lymphoblasts. Unknown environmental factors are believed to be responsible for the unusual features of AL in children in Ibadan.

Plasma alpha-tocopherol (vitamin E) levels and tocopherol-lipid ratio among children with protein-energy malnutrition (PEM).

The fat-soluble vitamin E (alpha-tocopherol) status of 47 malnourished children was assessed and compared with that of a control group of ten age-matched normal children. Plasma levels of alpha-tocopherol, total lipid and the ratio of alpha-tocopherol to total lipid were determined. The plasma vitamin E level was low, with a value of less than 11.61 mumol/l (500 micrograms/dl) in 40 (85%) of the malnourished children while the remaining seven (15%) children had values that ranged between 11.61 and 17.20 mumol/l (500-741 micrograms/dl). On the other hand, the tocopherol/total lipid ratio was less than 0.8 mg/g of total lipid in only seven of the malnourished children. The remaining 40 (85%) subjects had values that ranged between 0.8 and 1.96 mg/g of total lipid, whereas in the control group, both the plasma tocopherol levels and the tocopherol/lipid ratio were greater than 11.61 mumol/l (500 micrograms/dl) and 0.8 mg/g of plasma total lipid respectively.