[Rights: the rights of the patient]. / Regte: die reg van die pasiënt.

Medical development has made rights a crucial problem. Basic to the question of patient rights is the fundamental principles that a patient maintains his rights in any health service situation. The patient retains the right to be free from any physical harm, privacy and freedom of movement. Because the nurse is continuously involved with the patient and is responsible for monitoring the patient's progress and carrying out the doctors orders, she is the obvious person to give attention to the rights of the patient. The ICN also points out that nurses must not only ensure patient rights during political uprisings, wars and imprisonment but nurses should also react in the everyday work situation where exploitation or mistreatment of patients may take place. Every nurse is obliged to know, understand, support and protect the moral and legal rights of clients.

Iron, folate and vitamin B12 nutrition and anaemia in black preschool children in the northern Transvaal.

The prevalence of anaemia and deficiencies of iron, folate and vitamin B12 were investigated in 140 rural black preschool children aged 3-5 years living in five different villages in the Letaba area, near Tzaneen. Anaemia was highly prevalent, 39.2% of the children having haemoglobin levels below 11.1 g/dl. Approximately 10% were considered to be iron-deficient. On the basis of subnormal red cell folate values, 1 in 4 children was folate-deficient, suggesting the need for intervention at the community level such as enrichment of the staple foodstuff, maize meal, with folic acid.

Dissociation of methionine synthetase (EC 2.1.1.13) activity and impairment of DNA synthesis in fruit bats (Rousettus aegyptiacus) with nitrous oxide-induced vitamin B12 deficiency.

1. The effect of methylcobalamin inactivation by the anaesthetic gas nitrous oxide on the activity of the cobalamin-dependent methionine synthetase (5-methyltetrahydrofolate homocysteine methyltransferase; EC 2.1.1.13) reaction, and on DNA synthesis, in the fruit bat Rousettus aegyptiacus, was examined. 2. Methionine synthetase activity in the liver of bats exposed to N2O-oxygen (50:50, v/v) for 90 min/d averaged 32% of that of controls after 4 d of exposure and only 5% after 12-14 weeks of exposure. 3. DNA synthesis in the bone marrow, as reflected by the deoxyuridine suppression test, was unaffected by 4 d of exposure to N2O and only minimally affected after 5-10 weeks of exposure. 4. These results suggest that DNA synthesis in the fruit bat is unusually resistant to inhibition of methionine synthetase and imply the existence of a non-methylated circulating folate pool in this species.

Ferritin in breast milk of black urban and rural mothers.

Ferritin levels in serum and milk were investigated in series of 15 urban and 18 rural black mothers. No mother was anaemic. Mean serum ferritin levels in the urban and rural groups were 57 +/- 55 ug/l and 25 +/- 28 ug/l (mean +/- SD). Corresponding milk ferritin concentrations were 21 +/- 22 ug/l and 29 +/- 30 ug/l respectively. The significance of ferritin in human milk is discussed.

Serum vitamin B12 binders in South African blacks with hepatocellular carcinoma.

Sera from 242 South African blacks with hepatocellular carcinoma were assayed for unsaturated vitamin B12 binding capacity (UBBC) and vitamin B12 activity. Six patients were younger than 20 years of age, and 24% were younger than 30 years of age. Eighty-four percent of the patients had a slightly raised UBBC and 86% had a slightly elevated vitamin B12 value, but in no patient was an exceptionally high UBBC present. Serum UBBC and vitamin B12 were not higher in younger patients, and raised UBBC values were not related to serum alpha-fetoprotein values. Serum UBBC and vitamin B12 concentrations were not significantly different in patients with and without coexisting cirrhosis. In none of the patients with a UBBC above 3000 pg/ml was the fibrolamellar variant of hepatocellular carcinoma present. The authors conclude that South African blacks with hepatocellular carcinoma do not secrete an abnormal vitamin B12 binding protein.

Plasma amino acids and tissue methionine levels in fruit bats (Rousettus aegyptiacus) with nitrous oxide-induced vitamin B12 deficiency.

The effect of methylcobalamin inactivation by the gas nitrous oxide on plasma amino acid and tissue methionine levels in fruit bats (Rousettus aegyptiacus) was examined. Animals exposed to N2O-oxygen (1:1, v/v) for 90 min daily received a fruit diet with or without methionine or betaine supplements. Exposure and diets were continued for up to 17 weeks or until neurological impairment and muscular weakness was established. All the groups exposed to N2O had significantly lower liver, brain and plasma methionine concentrations except the methionine-supplemented animals which showed significantly raised levels. Plasma homocysteine, which was absent in controls, was present in all the N2O-exposed groups. Betaine supplementation resulted in reduced accumulation of homocysteine in plasma. However, plasma and liver methionine levels were only slightly increased compared with animals on the basal diet, and brain methionine levels were the lowest of all the groups studied. These results support the hypothesis that reduced methionine synthesis is an important contributor to the development of neurological impairment in this species and suggest that dietary supplementation with the methionine precursor betaine cannot replace the loss of vitamin B12-dependent methionine synthesis.

A sex difference in serum cobalamin and transcobalamin levels.

In healthy young adults, serum levels of cobalamin, unsaturated and total cobalamin binding capacity, and transcobalamin (TC) II are significantly higher in females, while TC III is higher in males. These findings have relevance to the reference values in normals for these tests.

Transition from a hunter-gatherer to a settled lifestyle in the !Kung San: effect on iron, folate, and vitamin B12 nutrition.

In 1969 a group of hunter-gatherer San were studied (Am J Clin Nutr 1971;24:229-42). Their state of hematological nutrition was excellent with a negligible incidence of iron, folate, or vitamin B12 deficiency. A genetically and linguistically similar San community who have been settled for the past 15 yr were the subjects of the present study. Anemia, due in the main to iron and/or folate deficiency, has become more common. Alcoholism has become rife in both sexes and all age groups. Our findings show that a settled lifestyle has resulted in a significant deterioration in the San's hematological nutrition.

The haemoglobin H disease mental retardation syndrome: molecular studies on the South African case.

The child with haemoglobin H (HbH) disease and multiple congenital abnormalities reported by Borochowitz et al (1970) has been more fully investigated in view of the recent report by Weatherall et al (1981) of a 'new' syndrome of HbH disease and mental retardation. Restriction enzyme analysis indicates that the child's HbH disease results from the inheritance of an alpha-thalassaemia 2 chromosome (-alpha/) from his mother and, from his father, a chromosome which has undergone a deletion including the zeta- and alpha-globin genes as well as an undefined length of DNA. Striking similarities between our patient and Weatherall et al's patients at the clinical level and between our patient and their patient number 1 at the molecular level, confirm that a new syndrome has been defined.

Absorption of biliary cobalamin in baboons following total gastrectomy.

Absorption of radiolabeled cobalamin in baboons was assessed by whole body counting. Retention of biliary cobalamin and an aqueous solution of cyanocobalamin was measured in normal baboons and in baboons after total gastrectomy by using 57Co-labeled biliary cobalamin and 58C0-cyanocobalamin, with and without baboon gastric juice containing intrinsic factor. Radiolabeled biliary cobalamin was obtained by intravenous injection of 57Co-cyanocobalamin in baboons and collection of bile through a cannula placed in the common bile duct. Cobalamin absorption was not completely abolished by gastrectomy and biliary cobalamin was better retained than cyanocobalamin; intrinsic factor enhanced absorption of both forms. After gastrectomy there was steady depletion of liver and serum cobalamin levels, which ceased after a new equilibrium was reached between a progressively diminishing cobalamin loss and the impaired but significant residual level of absorption. These studies in the nonhuman primate provide further information concerning the enterohepatic circulation of cobalamin and suggest that the form of cobalamin in bile may be more readily absorbed than is cyanocobalamin or that bile itself may have an enhancing effect on cobalamin absorption. The data also suggest that physiologically significant amounts of cobalamin may be absorbed in the absence of a gastric source of intrinsic factor.

Enterohepatic circulation of cobalamin in the nonhuman primate.

Biliary excretion of cobalamin was studied in baboons after intravenous injection of 57Co-radiolabeled cyanocobalamin. Radioactivity appeared in bile after 20 min, and up to 4.4% of the dose was recovered in 6 h. It was estimated that 4 microgram cobalamin traverses the baboon biliary tract each day. These studies in the nonhuman primate confirm that there is considerable biliary excretion of cobalamin and that enterohepatic circulation of the vitamin is important for maintenance of normal cobalamin balance.

Pancreatic polypeptide (PP) responses to oral and intravenous glucose in man.

Serum human pancreatic polypeptide (hPP) responses to 50 gm. of oral glucose and a 25 gm. intravenous bolus of glucose were measured in 10 healthy human volunteers. Oral glucose caused a 50% rise, whereas I.V. glucose caused a 35% fall in hPP concentration. There was no relationship between the absolute glucose concentration or the change in glucose level and the PP concentration. It is suggested that oral and I.V. glucose affect PP by indirect mechanisms and that PP may be involved in carbohydrate metabolism in man.