Clinical patterns of X linked agammaglobulinemia in Malaysian children.

X linked agammaglobulinemia (XLA) is rarely reported from developing countries especially from South East Asia. It appears that X linked agammaglobulinemia is less common in certain ethnic groups. It is very uncommon in black people in USA and South Africa. In multiracial Malaysia we have documented five XLA in Malays and Indians but not in the Chinese that constitute about 31% of the population. First degree relatives afflicted with XLA or other primary immunodeficiencies occurred more often in our study. All showed lung involvement although the etiologic organisms involved were atypical, being Gram negative.

Antibody deficiency with hyper IgM--a case report.

A 20-month-old Indian boy presented with recurrent pyogenic infections and failure to thrive. His IgG and IgA levels were low, but his IgM was elevated. He also had undetectable isohaemagglutinin titre and neutropenia, both parameters being poor prognostic indicators in this very rare primary immunodeficiency state--antibody deficiency with hyper IgM. Our patient subsequently succumbed to Pseudomonas aeruginosa septicaemia and meningitis inspite of aggressive antibiotic and intravenous gammaglobulin therapy. To the best of our knowledge, this is the first such case to be documented in Malaysia.

Interaction of nutritional and socioeconomic status as determinants of cognitive development in disadvantaged urban Guatemalan children.

The relationship between nutritional status, measured by height for age, and cognition, measured by WISC full-scale IQ, was studied in a longitudinal sample of 459 urban Guatemalan children, aged 4-9 years, from a disadvantage community of the fringe of Guatemala City, examined annually over a 3 year period. Socioeconomic status (SES) was controlled by developing a composite index for each home. The mean IQ differed significantly from the lowest to the highest quartiles of stature, the difference between the two extreme quartiles being approximately 0.3 SD of IQ. There was a significant interaction between SES and stature in their effects on IQ. Whereas nutritional status and SES affected IQ in an additive fashion in the upper three SES quartiles, there was no difference in IQ attributible to stature among children from the most disadvantaged homes. This analysis indicates that the mild-to-moderate protein-energy malnutrition (defined by height for age) that is prevalent among children from disadvantaged environments in developing countries is significantly related to cognitive development. However, in the poorest homes, SES is seen as a more important determinant of cognitive development than stature.

Growth status of disadvantaged urban Guatemalan children of a resettled community.

This paper reports the physical growth and body composition from the first year of longitudinal study of 519 Guatemalan children, and their families, from a disadvantaged urban community consisting largely of refugees of the 1976 earthquake. Four cohorts are described, composed of children of 1,3,5, and 7 years at examination. The children are smaller, weigh less, and have reduced fat stores compared either to NCHS reference data or to upper SES Guatemalan children. Stature (or length) and head circumference deviate more from reference data than do triceps or upper arm muscle circumference. Greater deviations are found in the linear dimensions of males than of females. These children are the smallest yet described from Guatemala City, though they are slightly larger than available rural samples. This suggests a continuum of environmental effects acting upon the growth of children of differing socioeconomic levels.

Culturally interpreted symptoms or culture-bound syndromes: a cross-cultural review of nerves.

This paper explores a new approach to culture-specific mental disorders through cross-cultural examination of nerves. A number of case studies are presented from contrasting cultures. It is proposed that nerves be considered a culturally interpreted symptom rather than being culture-bound.

The cultural basis of health, illness and disease.

The cultural basis of health, illness and disease is reviewed in terms of its applicability to social work practice. Theories and perspectives from cultural and medical anthropology are applied to health care contexts and related to patient-practitioner interaction. The culture of medical bureaucracies as well as particular ethnic groups is explored through examples and brief case studies.

The effect of medical institutions on doctor-patient interaction in Costa Rica.

The nature and quality of interaction and communication between doctor and patient is an important determinant in adequacy of health care. But patient behavior and physician performance are themselves influenced by the institutional and political setting. Study of two Costan Rican medical care systems reveals how historical differences in ideology and expectation can shape institutions and their services.

Dr. Moreno Cañas: a symbolic bridge to the demedicalization of healing.

Costa Rica is a rapidly developing country with an expanding system of nationalized health care and a growing professional medical sector. This expansion affects the medicalization of health culture, including the symbolic and religious aspects of popular healing traditions. This study describes the myth and cult ot Dr Moreno Cañas, a physician murdered in 1938, who is prayed to, or ritually invoked for cures and good fortune. The cult of Dr Morena Cañas complements and modifies the healing role of the Costa Rican patron saint, the Virgen de Los Angeles, by idealizing modern science and technology. The cult of the doctor is a reaction of laypeople to the secularization of health problems, and to the medicalization of care. The myth and cult of Dr Morena Cañas creates a popular image of secular medicine that laypeople sacrilize by treating it in a religious manner, and in doing so demedicalize control of their own care.

The meaning of nervios: a sociocultural analysis of symptom presentation in San Jose, Costa Rica.

The foundation of the symbolic tradition in medical anthropology is the examination of a patient's experience of a category of illness. The interpretation of folk explanations of etiology and nosology provides insight into the cultural definition of what constitutes an illness, how and why an illness is labeled, and how the afflicted individual should be treated. Further, the analysis of sociocultural meaning emerges as a critical theoretical contribution to our understanding of health and culture. Allen Young in his article "Some Implications of Medical Beliefs and Practices for Social Anthropology" suggests " that if we want to learn the social meaning of sickness, we must understand that 'signs,' whatever their genesis, become 'symptoms' because they are expressed, elicited, and perceived in socially acquired ways" (1976: 14). He further states that some categories of sickness are particularly interesting in that they enable people to organize the illness event into an episode that has form and meaning (1976: 19-20). Nervios is an example of a symptom that has acquired a special sociocultural pattern of expression, elicitation and perception in San Jose, Costa Rica. The empirical study of symptom presentation in general medicine and psychiatric outpatient clinics describes the patients who present the symptom and their associated attributes and explanations of the symptom's occurrence. The meaning of nervios is then discussed within a social interactional and symbolic framework.