Avaliação do desenvolvimento da preensão manual em crianças de 4 a 12 meses / Evaluation of manual prehension development in children between four and twelve months

Este trabalho teve como objetivo avaliar o desenvolvimento da preensão manual em crianças de 4 a 12 meses de idade institucionalizadas, em berçários privados e em berçários municipais, para verificar se existe um atraso no desenvolvimento da preensão e quais os possíveis fatores que podem interferir nesse desenvolvimento. Não foi encontrada na literatura uma avaliação do desenvolvimento da preensão manual em relação aos itens a serem avaliados neste trabalho; desse modo, optou-se por basear tal avaliação na revisão literária relacionando o desenvolvimento da preensão e a faixa etária da criança. Foram avaliadas 68 crianças de 4 a 12 meses de idade, de ambos os sexos, divididas em três grupos. Os resultados mostraram que as crianças institucionalizadas apresentaram um atraso no desenvolvimento da preensão manual na maioria dos itens avaliados. Observando o ambiente e de estímulos táteis dessas crianças, pôde-se perceber uma privação de espaço físico, de brinquedos e de estímulos táteis e senso-perceptivos, o que pode estar interferindo na aquisição de novos padrões de preensão e de manuseio dos objetos. Aponta-se para a importância do fisioterapeuta, entre outros profissionais da área da saúde, em relação ao desenvolvimento infantil e, em especial, à preensão manual

Amino acids and lipoproteins in plasma of duodenopancreatectomized patients: effects of glucagon in physiological amounts.

Duodenopancreatectomy induces a severe glucagon deficiency and elevated plasma concentrations of alanine, aspartate, glycine, proline, serine, arginine, citrulline, ornithine, phenylalanine and tyrosine. Restoring high physiological plasma glucagon in six such patients by infusing 0.3 mg/24 h of exogenous glucagon reduced significantly (P less than 0.01 or 0.001) the mentioned amino acids (except phenylalanine) and further asparagine, glutamine, methionine and threonine. In six normal subjects the same infusion reduced significantly (P less than 0.05 to 0.001) plasma alanine, asparagine, glutamate, glutamine, glycine, proline, serine, threonine, arginine, ornithine, lysine and tyrosine. However, the effect was significantly (P less than 0.01 or 0.001) less marked for alanine, glutamine, glycine, methionine, serine, threonine and arginine. This particular glucagon sensitivity of duodenopancreatectomized patients suggests that glucagon deficiency is the cause of their hyperaminacidaemia. By contrast, lipoprotein concentrations were virtually unaffected by either glucagon deficiency or its replacement. In the light of the marked hypoaminacidaemia in glucagonoma patients these results attribute to glucagon a major role as a regulator of protein metabolism.

Lipid, lipoprotein and APO-A and APO-B lipoprotein distribution in Italian and Swiss schoolchildren. The Geneva survey.

Cholesterol and triglyceride lipid, lipoprotein as well as apolipoprotein A and B levels, are presented for Italian and Swiss schoolchildren of similar socio-economic origin, living in Geneva, and ranging in age from 8-9 and 14-15 years. This cross-sectional study revealed some differences associated with the ethnic origin of the participants. Furthermore subtle changes were related to age, associated with puberty and were sex-specific. Apolipoprotein A and B levels were found to be significantly related to age and less significantly to sex, whereas apolipoprotein A levels decrease with puberty, apolipoprotein B levels increase slightly. Of the 387 Italian and the 416 Swiss participants, 173 Italian and 193 Swiss children had a complete lipoprotein examination including apolipoprotein determination, whereas serum cholesterol and serum triglycerides were studied in the total group.

[HDL and lipoproteins in the families of coronary patients]. / HDL et lipoprotéines dans les familles de malades coronariens.

Male first degree relatives of acute myocardial infarction patients differ from a control population by virtue of their low HDL cholesterol. The results are compared with those obtained previously in women and children who are first degree relatives of coronary patients. Low HDL cholesterol (Fig. 5) is a familial feature of first degree relatives of acute myocardial infarction patients. This observation is of considerable interest in view of the role of HDL cholesterol in the development of atherosclerosis.

[Distribution of plasma cholesterol in 4 Swiss cities]. / Distribution du cholestérol plasmatique dans quatre villes suisses.

As part of the Swiss National Research Programme on Primary Prevention of Cardiovascular Diseases, plasma cholesterol was determined in 7947 adults of all ages. The distribution of the values obtained in the four Swiss cities investigated is given by age, sex and nationality. Percentile graphs of the whole sample show the influence of age for each sex. On the basis of these results it is estimated that amongst people aged 16-69 years living Switzerland, 7.4% of the men and 8.4% of the women can be expected to have a plasma cholesterol level above 280 mg/dl (7.25 mmol/l). The different relationships between plasma cholesterol and other factors such as consumption of tobacco or alcohol and body mass index were investigated. The latter shows a significant correlation coefficient (r = 0.2, p less than 0.001) for each sex, for the age group 25-44 and for each of the cities. Alcohol consumption is also directly associated with total blood cholesterol. The role of this factor is discussed in relation to the differences in plasma cholesterol observed between the cities.

[High-density lipoproteins in children with coronary diseases]. / Lipoprotéines de haut densité chez les enfants de malades coronariens.

Low HDL-cholesterol and increased LDL-cholesterol have been shown to be cardiovascular risk factors. Recently, HDL/serum cholesterol and HDL/ LDL-cholesterol ratios have been advocated as more reliable indices of cardiovascular risk factors. In a comparative study, lipoprotein-cholesterol and lipoproteins-triglycerides as well as the HDL/serum cholesterol and HDL/LDL-cholesterol ratios were determined in children of patients with coronary heart disease (CHD) and in healthy control children. Sons of CHD patients had significantly lower HDL-cholesterol and HDL/LDL-cholesterol ratios than controls. In daughters, the HDL-cholesterol and HDL/LDL ratio were also decreased reaching significance in HDL only in the 12 to 16 year age group. Under comparative environmental situations, the results suggest that low HDL-cholesterol in children of CHD patients could be genetically determined.

[Effects of fenofibrate in four types of hyperlipoproteinaemia and on apoproteins A and B in type IIa HLP (author's transl)]. / Activité du fénofibrate dans quatre types d'hyperlipoprotéinémie et sur les apoprotéines A et B dans le type IIa.

Fenofibrate in doses of 300 mg/day was administered for 3 consecutive months to 31 patients with type IIa, IIb, III or IV hyperlipoproteinaemia (HLP). Mean plasma cholesterol levels decreased by 22% in type IIa (n = 15), by 19% in type IIb (n = 10), by 51% in type III (n = 2) and by 5% in type IV (n = 4) HLP. Mean plasma triglyceride levels were reduced by 32, 38, 60 and 52% respectively in these four types of HLP. Apo-A, measured in 11 patients with type IIa, HLP increased by up to 28% after three months' treatment, whereas alphalipoprotein cholesterol only slightly rose by a mean 11%. Apo-B decreased by 14%. Fenofibrate was well tolerated. Only one patient developed a pruriginous rash at the end of the treatment period.

Decreased HDL cholesterol in prepubertal and pubertal children of CHD patients.

Prepubertal boys and pubertal girls and boys selected because of the occurrence of acute myocardial infarction in their father or mother were characterized by a low HDL cholesterol when compared to healthy controls. This observation extends our previous observations of low HDL cholesterol in adult relatives of CHD patients to the children of the same patients. The occurrence of an HDL abnormality in young children demonstrates that the low HDL cholesterol precedes the occurrence of cardiovascular disease. Low HDL cholesterol was associated with increased VLDL cholesterol in prepubertal children and pubertal boys without significant increase in VLDL triglycerides. Smoking and drinking habits, and physical activity which are environmental factors known to affect HDL did not differ between these children and the controls and cannot account for the observed differences. The results show that the low HDL cholesterol is detectable early in life in close relatives of CHD patients, persists throughout the lifespan and is possibly genetically determined.

[Coronary atherosclerosis and serum lipoproteins]. / Athérosclérose coronarienne et lipoprotéines sériques.

VLDL triglycerides were increased both in obese patients and obese controls. In lean CHD patients the VLDL triglycerides were higher than in lean controls but lower than in obese CHD patients. CHD patients had lower HDL cholesterol than controls. The lowest HDL cholesterol was observed when VLDL triglycerides were high in both CHD patients and controls. However, the differences in HDL cholesterol between CHD patients and controls with low VLDL triglycerides were more marked. It appears that factors other than VLDL triglycerides may also contribute to the low HDL cholesterol observed in CHD patients. Serum cholesterol and triglycerides did not reflect the more subtle changes occurring in the lipoprotein lipids of CHD patients.

HDL lipids in close relatives of coronary heart disease patients. Environmental and genetic influences.

Female first-degree relatives of CHD patients differed, after the age of forty, from the normal control population by their low HDL cholesterol. Between the ages of 20 and 40 years a slight but significant increase in HDL triglycerides was observed. Except for hormonal contraception which induces significant lowering of HDL cholesterol in the first degree relatives, the observed differences in HDL lipids did not seem related to environmental factors but rather to be genetically determined. In contrast, the low HDL cholesterol observed in the wives of the CHD patients appeared to be related to differences in alcohol intake.

Treatment of hyperlipoproteinemia (HLP) type II A with a new phenoxy-isobuturic acid derivative, procetofen.

Eleven patients with hyperlipoproteinemia (HLP) type II A, were treated for 3 months with a new compound, a phenoxy-isobuturic acid derivative, procetofen, at a dosage of 100 mg t.i.d. Mean plasma cholesterol decreased after 3 months by 25% from a pretreatment value of 10.3 +/- 0.7 mmol/l (p less than 0.001). The reduction of plasma cholesterol was apparently due not only to a decrease in LDL, as expressed from a marked reduction (15%) of the major LDL apolipoprotein moiety, apolipoprotein B, but also presumably to a decrease in VLDL as reflected from a marked reduction (45%, p less than 0.05) in plasma triglycerides. Furthermore, a marked favourable increase (28%, p less than 0.001) in HDL major apolipoprotein moiety, apolipoprotein A, was observed. No disagreeable side-effects were recorded, except for a skin rash in one patient.

High density lipoprotein cholesterol in male relatives of patients with coronary heart disease.

To study factors that play a role in the familial occurrence of coronary heart disease, very low density lipoprotein (VLDL) triglycerides, low density lipoprotein (LDL) cholesterol and high density lipoprotein (HDL) cholesterol were measured after preparative ultracentrifugation in first degree male relatives of coronary patients and in control subjects. The HDL cholesterol concentration was significantly lower in relatives of 20--71 years old than in controls. No increase of serum and LDL cholesterol was found. A low level of HDL cholesterol was observed even in the younger relatives who are less likely to have cardiovascualr disease. In older relatives low HDL cholesterol was found in the presence or absence of clinical evidence of coronary artery disease. The HDL-cholesterol concentration was inversely related to the VLDL triglycerides both in relatives and controls, but the regression lines were different ((P less than 0.001) for the relative (y = --0.166x + 0.43) and for the controls (y = 0.191x + 0.49). A low HDL cholesterol level appears to be a marker of relatives of coronary patients.

[Low HDL cholesterol in close relatives and patients with myocardial infarct]. / HDL-cholestérol abaissé chez les proches parents et les malades victimes d'infarctus du myocarde.

Male patients aged 40 to 59 who had had acute myocardial infarction three months previously displayed a lower HDL cholesterol than the HDL cholesterol of an apparently healthy control group. The male first degree relatives of patients with acute myocardial infarction, like the patients with coronary disease, had a low HDL cholesterol which differed significantly from the HDL cholesterol of the control group. Low HDL cholesterol appears to be a better "marker" of patients with coronary disease and relatives of patients with acute myocardial infarction than serum cholesterol and triglycerides. The importance of low HDL' cholesterol could be related to the role of HDL in the cholesterol transport system from the peripheral tissues.

[Influence of hormonal contraception on serum lipoproteins]. / Influence de la contraception hormonale sur les lipoprotéines sériques.

Cholesterol and triglyceride measurements in lipoproteins (VLDL, LDL, HDL) separated by preparative ultracentrifugation showed that women aged 20 to 29 using oral hormonal contraceptives had increased LDL triglycerides without significant changes in serum lipids. Among older women (aged 30 to 39), changes induced by hormonal contraception were more pronounced. Triglycerides were increased in VLDL and LDL, with a significant rise in serum triglycerides. The LDL cholesterol was elevated without significant changes in serum cholesterol. None of the women had overt hyperlipoproteinemia. Routine serum cholesterol and triglyceride measurements may not reveal the changes in cholesterol and triglyceride lipoprotein content which may play a role in the increased incidence of cardiovascular disease among women using the "pill".

[Serum lipoproteins in family members of myocardial infarct victims]. / Etude des lipoprotéines sériques dans les familles de malades victimes d'infarctus du myocarde.

Men 40 to 59 years old, first degree relatives of patients with myocardial infarction had a lower HDL-cholesterol concentration than a control group. This is in analogy with the low concentration of HDL-cholesterol observed in the myocardial infarction patients themselves. LDL and VLDL in relatives were not elevated in comparison to the controls. The low HDL-cholesterol could be the expression of a familial defect in cholesterol transport.

[Hyperlipemia: practical attitudes]. / Hyperlipémies. Attitude pratique

Serum cholesterol and triglyceride levels may vary widely in a given patient, and therefore both of these lipid determinations should be repeated for initial evaluation. Later, the response of lipid values to diet and to drugs provides more information on the individual characteristics of a hyperlipoproteinemia than "typing" from one lipid evaluation. The type may actually change with lipid levels, whereas the basic tendencies to increased betalipoproteins (evaluated as cholesteremia) or prebetalipoproteins (evaluated as triglycerides) are more constant features in a patient. Alimentary conditions in most cases influence hyperlipemias, whether primary or secondary. Total caloric intake is a major factor in inducing augmented triglycerides in predisposed people. Hypertriglyceridemia is rare before 20 and not frequent in women. On the other hand, familial hypercholesteremia is present from the first weeks of life. Diet is of little help in these cases. When hypercholesteremia is related to food habits it usually appears after the third decade. The amount of fats rich in saturated fatty acids appears to be the chief causative factor in this regard. However, it is possible that genetic factors also affect the degree of alimentary influence on cholesterol level over many years. The use of hypolipemic drugs does not obviate the need for appropriate diet. If the prevention of early coronary disease is to be successful it should start in young people before the first clinical symptoms appear.