Mandibulotomy access to tumour sites: fewer complications for postoperative compared with preoperative radiotherapy.

The purpose of this study was to compare complication rates at the mandibulotomy site between patients receiving preoperative radiotherapy (RT) and those receiving postoperative RT during treatment for oral and oropharyngeal cancer where the surgical procedure required a mandibular osteotomy to gain access to the tumour. Sixty-four consecutive patients treated during the period 2000-2015 were available for analysis. Their medical records were reviewed retrospectively. All patients were followed for at least 1year postoperatively. A subgroup of patients received RT on several occasions or long before the mandibulotomy, therefore the statistical comparisons focused on the two groups of patients receiving RT on one occasion and within 6 months prior to or following surgery. Seventeen patients presented a total of 29 complications, yielding an overall complication rate of 27%. Orocutaneous fistula was the most common complication. Patients who received RT preoperatively presented a higher complication rate (9/15; 60%) when compared to those who received RT postoperatively (2/31; 6.5%) (odds ratio 21.8, P<0.001). This study demonstrated fewer complications in the mandibulotomy area exposed to postoperative RT compared with preoperative RT. It is therefore suggested that, when possible, RT should be given postoperatively if combination treatment with RT and surgery, including a mandibulotomy, is planned.

Activation of the prolactin receptor but not the growth hormone receptor is important for induction of mammary tumors in transgenic mice.

Transgenic mice overexpressing the human growth hormone gene develop mammary carcinomas. Since human growth hormone gene can activate both the growth hormone receptor (GHR) and the prolactin (PRL) receptor (PRLR), it is not clear which receptor system is responsible for the malignant transformation. To clarify the receptor specificity, we created transgenic mice with two different genes: (a) transgenic mice overexpressing the bovine growth hormone (bGH) gene having high levels of bGH only activating the GHR and also high serum levels of IGF-I; and (b) transgenic mice overexpressing the rat PRL (rPRL) gene that have elevated levels of PRL (one line 150 ng/ml and one line 13 ng/ml) only binding to the PRLR and with normal IGF-I levels. When analyzed histologically, all of the PRL transgenic female mice developed mammary carcinomas at 11-15 mo of age. Only normal mammary tissue was observed among the bGH transgenic animals and the controls. Cell lines established from a tumor produced rPRL and expressed PRLR. In organ culture experiments, an auto/paracrine effect of rPRL was demonstrated. In conclusion, activation of the PRLR is sufficient for induction of mammary carcinomas in mice, while activation of the GHR is not sufficient for mammary tumor formation.

Prolactin (PRL) receptor gene expression in mouse adipose tissue: increases during lactation and in PRL-transgenic mice.

There are indications that PRL may exert important metabolic actions on adipose tissue in different species. However, with the exception of birds, the receptor has not been identified in white adipose tissue. The present study was designed to examine the possible expression and regulation of the PRL receptor (PRLR) in mouse adipose tissue. The long PRLR messenger RNA (mRNA) splice form (L-PRLR) and two short splice forms (S2- and S3-PRLR) were detected in mouse adipose tissue by RT-PCR. Furthermore, L-PRLR mRNA was detected by ribonuclease protection assay. Immunoreactive PRLR with a relative molecular mass of 95,000 was revealed by immunoblotting. Furthermore, L-PRLR mRNA expression was demonstrated in primary isolated adipocytes. In mouse adipose tissue, the level of L-PRLR mRNA expression increased 2.3-fold during lactation compared with those in virgin and pregnant mice. In contrast, in the liver the expression of L-PRLR increased 3.4-fold during pregnancy compared with those in virgin and lactating mice. When comparing the levels of L-PRLR expression in virgin female and male mice, no difference was detected in adipose tissue. However, in virgin female liver the expression was 4.5-fold higher than that in male liver. As PRL up-regulates its own receptor in some tissues, we analyzed L-PRLR expression in PRL-transgenic female and male mice. In PRL-transgenic mice L-PRLR expression was significantly increased in both adipose tissue (1.4-fold in females and 2.4-fold in males) and liver (1.9-fold in females and 2.7-fold in males) compared with that in control mice. Furthermore, in female PRL-transgenic mice retroperitoneal adipose tissue was decreased in weight compared with that in control mice. However, no difference was detected when comparing the masses of parametrial adipose tissue. Our results suggest a direct role for PRL, mediated by PRLR, in modulating physiological events in adipose tissue.

The effects of different doses of oral iodized oil on goiter size, urinary iodine, and thyroid-related hormones.

The prevention of iodine deficiency is still a worldwide concern. This study, conducted in Soja in western Sudan, was carried out to evaluate the effects of a dose of iodized oil sufficient enough to give maximum protection against goiter and provide an acceptable iodine supply without side-effects over a sufficiently long period of time. Adult goitrous subjects (n = 117) were randomly assigned to three groups, A, B, and C, and received a single oral dose of 200, 400, or 800 mg iodine, respectively. Urine and blood samples were collected at the start of the study and monitored for 1 yr. In the 3 groups, mean serum T4 and median urinary iodine and serum TSH values were restored to reference limits, and these were maintained for about 1 yr. In each treatment group, about two thirds of the subjects displayed a reduction in goiter size, and the 400- and 800-mg doses were not more efficient than the 200-mg dose to accomplish normalization of thyroid hormone values. A temporary rise in TSH was noted 1 week after iodine administration in 1, 3, and 10 subjects, respectively, and 1, 0, and 3 subjects showed biochemical signs of thyrotoxicosis during the year after treatment with the 3 different doses. The data indicate that oral administration of 200 mg iodine is effective and acceptable for treating iodine deficiency in adults for 1 yr. Because of the risks of side-effects and the shortage of medical resources, higher doses are not recommended.

Dietary intake in the third trimester of pregnancy and birth weight of offspring among nonprivileged and priviledged women.

The dietary intake during the third trimester of pregnancy among 20 nonprivileged and 10 privileged primigravidae in Addis Ababa was studied in a 2 day weighting inventory survey. With the exception of iron and thiamin, the nonprivileged group consumed a diet that was deficient in all nutrients, with an average daily protein and energy intake below 60% of the FAO/WHO Recommendations. The privileged group was found to meet the recommendations for all nutrients except for calcium and riboflavin. Infants born to the nonprivileged women had significantly lower mean birth weight when compared with the infants born to the privileged women.

Westernization of diet and serum lipids in Ethiopians.

The dietary pattern, physical work output, and blood lipids were studied in three groups of healthy, young, urban Ethiopian men differing in the degree of "Westernization." The results showed striking increases in serum lipids that were associated with the degree of Westernization of the diet. These changes could not be accounted for by differences in other group characteristics such as age, weight, smoking, or length of residence in Addis Ababa. The effects of the level of physical work output on serum lipids were equivocal because the methods used for the assessment of energy output yielded crude approximations only.

Breast milk composition in Ethiopian and Swedish mothers. IV. Milk lipases.

The (potential) activities of the two lipases in human milk were determined in breast milk samples collected from Ethiopian and Swedish mothers. The major lipase in human milk is dependent on bile salts for activity and probably participates in intestinal digestion of milk lipids in the newborn. The level of this lipase in the milk did not change with time after parturition, but differed between the groups so that it was higher in the privileged Ethopian mothers than in the nonprivileged Ethiopian mothers, who in turn had a higher level than the Swedish mothers. The other lipase is a serum-stimulated lipase (lipoprotein lipase). The level of this lipase varied between samples from different mothers as well as between different samples from the same mother. It tended to be lower in samples obtained at 4 to 5 days after parturition (Swedish mothers) than in later samples. There were in this case no significant differences between nonprivileged and privileged Ethiopian mothers or between them and Swedish mothers.

Breast milk composition in Ethiopian and Swedish mothers. II. Lactose, nitrogen, and protein contents.

Breast milk from underprivileged and privileged Ethiopian mothers was collected at different stages of lactation and analyzed for total nitrogen, nonprotein nitrogen, lactose, and individual milk proteins (lactoferrin, alpha-lactalbumin, serum albumin, IgG and IgM). These values and the milk volume of one meal were compared to corresponding results from well-nourished Swedish mothers. No significant differences between the levels of these constituents or the milk volumes were found between the two groups of Ethiopian mothers. When comparison was made between breast milk from these two Ethiopian groups and the Swedish group, the former two showed significantly higher values for the iron-binding protein lactoferrin.

PIP: Protein composition of milk from mothers belonging to 2 different socioeconomic groups in Ethiopia was studied and is compared with results obtained earlier based on well-nourished Swedish women's milk (these were considered normal data). Breast milk from different stages of lactation were analyzed for total nitrogen, nonprotein nitrogen, lactose, and milk proteins (lactoferrin, alpha-lactalbumin, serum albumin, immunoglobulin G and IgM). Between the 2 Ethiopian groups, characterized as privileged or not, as a nutrition index, there were no significant differences in levels of any milk constituents or milk volume. However, when the Ethiopian data were combined and compared with Swedish data, the Ethiopian group had significantly higher values for the iron-binding protein lactoferrin (P about .001). All Swedish data were characterized as from privileged women.

Breast milk composition in Ethiopian and Swedish mothers. I. Vitamin A and beta-carotene.

The vitamin A and beta-carotene contents of breast milk were determined at different stages of lactation in three population groups: nonprivileged Ethiopian, privileged Ethiopian, and Swedish mothers. In addition, a fractionation of vitamin A giving the proportion of retinol was performed. The concentrations of retinol-binding protein (RBP) and (in part of the material) beta-carotene and prealbumin in plasma were also measured. The mean concentrations of vitamin A and beta-carotene in the milk from the Swedish mothers (period 0.5 to 6.5 months) were in the range of 40.0 to 53.1 and 16.3 to 20.8 mug/100 ml, respectively. For the privileged Ethiopian mothers (period 0.5 to 3.5 months) the corresponding ranges were 36.2 to 36.4 and 26.2 to 28.1 mug/100 ml and for the nonprivileged Ethiopian mothers (period 0.5 to 6.5 months) 28.1 to 33.1 and 23.9 to 25.6 mug/100 ml. Only the nonprivileged Ethiopian mothers were examined during a later stage of lactation (6.5 to 11.5 and 11.5 to 23.5 months). The concentrations of vitamin A and beta-carotene in their milk showed a downward trend. The proportion of retinyl ester (percentage of total vitamin A content) was significantly higher in the milk of Swedish mothers than in privileged and nonprivileged Ethiopian mothers. In the Swedish mothers retinol constituted 3.5% of the total vitamin A content of the milk; in Ethiopian mothers it was 15 to 30%. Determination of RBP in plasma showed normal values for Swedish mothers and lowered values for Ethiopian mothers--particularly the nonprivileged, in whom 14 of 81 values were below 20 mug/ml. RBP was demonstrated in colostrum, but only in a low concentration (in the order of 5 mug/ml).

Breast milk composition in Ethiopian and Swedish mothers. III. Amino acids and other nitrogenous substances.

The content of amino acids and other nitrogenous substances was determined in milk samples from Ethiopian and Swedish mothers. The Ethiopian mothers were divided into two groups, one with children having low weight for age and one with children having standard weight for age. All children were in the age range 2 to 5 months, and there were eight in each group. The main findings were as follows: 1) The mean daily milk volumes and total daily nitrogen content in the milk were found to be similar in all three groups. The Swedish group had a significantly lower nitrogen content per milliliter than did the Ethiopian group with low weight for age. 2) The total amino acid composition of the milk was almost identical in the three groups studied except for the tyrosine value, which was significantly lower in the Ethiopian standard group than in the low weight for age group. The composition corresponded well with previous findings. 3) The protein fraction constituted 90 to 92% of the total amino acids, the peptide fraction 4 to 5%, and the free amino acids 5%. 4) The concentrations of free amino acids in milk were lower (2 to 6 times) than in plasma, except for glutamic and aspartic acid. The taurine concentration was much higher in milk than in plasma. Only the urea levels in milk and plasma were significantly correlated. The implications of these findings in child health are discussed.

Ascariasis and malnutrition. A study in urban Ethiopian children.

Treatment of 13 urban Ethiopian children with mild ascariasis did not produce any evidence of improved intestinal morphology and absorption or nutritional status. Ascariasis treatment had no impact on anthropometric measures in an additional study group of 84 children. A review of the literature reveals that the nutritional consequences of ascariasis are uncertain.

PIP: Ascariasis, highly prevalent among children in developing countries, is thought to cause widespread and important morbidity. The role of ascariasis as a contributory factor in the etiology of childhood malnutrition has been illustrated by clinical observation of patients with massive infection; however, systematic evidence and objective information are scanty. The prevalence of ascariasis among Ethiopian children is about 10% in infants, 28% in children 1-2 years old, and 62% in children over 3 years. 2 clinical trials were conducted to determine the effect of the infection on childhood nutrition and to assess the desirability of allocating scarce resources to treatment and control. In a double blind trial, 13 boys with the infection were given piperazine citrate or a placebo syrup. Stool analyses for worm load, fat and nitrogen excretion, and anthropometric measurements, tests for xylose absorption, and jejunal biopsies were conducted. 24 hour dietary recalls were obtained from the mothers. In the 2nd trial, complete information including anthropometric measurements and incidence of morbidity was obtained on 44 infected and 40 uninfected children between the ages of 1-4 as part of a community study. A double blind system of allocating treatment and placebo to underweight infected and noninfected children and normal weight infected and uninfected children was implemented. The results showed that the individual wormload in the children was low. Initial treatment did not result in complete deworming. The nutritional status of the children was unaffected by treatment, although in the community study, a somewhat lower rate of acute morbidity was noted in treated children. The results of other metabolic and functional studies are inconsistent; in some studies, a treatment effect was noted. However, the results of these studies are questionable because intervening factors, such as the presence of infection in the study groups, were not adequately controlled. The results of other community studies are also inconsistent. So far little clear cut epidemiological evidence exists regarding the relative importance of ascariasis in the causation of malnutrition in communities suffering from concommitant infection and other ills of poverty. Clinical evidence suggests that massive infection may result in malnutrition, and treatment of symptomatic ascariasis is justified. At the community level, deworming programs do not have a clear beneficial nutrition effect.

How exclusive is exclusive breastfeeding? A comparison of data since birth with current status data.

BACKGROUND: There is no accepted and widely used indicator for exclusive breastfeeding since birth. Indeed, the difference between 'current status' data on exclusive breastfeeding and data on 'exclusive breastfeeding since birth' is rarely recognized. We used data from a longitudinal study to examine this issue. METHODS: A descriptive longitudinal, prospective study design was used in which 506 mother-infant pairs were included. The mothers completed daily recordings on infant feeding during the first nine months after birth. A research assistant conducted fortnightly home visits with structured interviews. The resulting data on breastfeeding patterns are presented in two different ways: analysis of 'current status' data based on a single 24-hour recording of infant feeding at 2, 4 and 6 months of age, and analysis of data 'since birth', i.e. data on infant feeding for every day, starting from birth until the ages of 2, 4 and 6 months. RESULTS: A wide discrepancy between the results obtained from the two analyses was found. The difference in the exclusive breastfeeding rate was over 40 percentage points at both 2 and 4 months of age (92% versus 51% at 2 months and 73% versus 30% at 4 months) and 9 percentage points at 6 months (11% versus 1.8%). CONCLUSIONS: Current status indicators based on a 24-hour period may be inadequate and even misleading for many purposes. We propose that in many studies an indicator called 'exclusive breastfeeding since birth' could be added.

Changes in iodine metabolism during late pregnancy and lactation: a longitudinal study among Sudanese women.

OBJECTIVE: To elucidate the persistence, or otherwise, of the pregnancy-related changes in the iodine metabolism and thyroid function in a population residing in an area of mild iodine deficiency in the Sudan. DESIGN: A longitudinal prospective cohort study involving pregnant women who were recruited during their third trimester of pregnancy and were followed up for up to nine months after delivery. SETTING: The study was conducted among Sudanese women residing in the Omdurman area in Khartoum, an area with a total goitre rate of 17.5%. SUBJECTS: Forty-seven pregnant women were recruited during their third trimester of pregnancy. Their mean age and weight were 29+/-4.6 y and 62.4+/-8.7 kg, respectively. Age matched healthy non-pregnant women living in the same area (n=40) served as a control group. METHODS: Serum levels of thyrotropin (TSH), thyroxine (T4), triiodothyronine (T3), thyroglobulin (Tg) and the urinary iodine concentration (UIC) were determined during the third trimester (first occasion), and subsequently at three months (second occasion), six months (third occasion) and nine months after delivery (fourth occasion). Control subjects provided corresponding samples on one occasion. MAIN OUTCOMES MEASURES: UIC, TSH, Tg, FT4 and T3. RESULTS: During the third trimester of pregnancy the median UIC and the free T4 (FT4) were lower than in the control group (P<0. 0001, P<0.0001, respectively), while the median Tg was higher than in the controls (P<0.03). Three months post-partum maximum thyroidal stimulation was evident, with elevated serum levels of TSH and Tg (P<0.0001, P<0.03) and reduced UIC and serum T3 and FT4 (P<0.0004, P<0.0005, P<0.0001), compared with the control group. Nine months post-partum the thyroid function was restored to the pre-pregnancy state, and the median values of TSH, Tg, T3, FT4 and UIC did not differ significantly from those in the control group. CONCLUSIONS: Our study suggests that the reversibility of the pregnancy-induced changes in the iodine status and thyroid function to the pre-pregnancy levels may depend on the iodine status of the mother during and after pregnancy. The thyroidal stress during the first three months of the post-partum period, which is partially due to the iodine loss in the breast milk, justifies further detailed studies to assess the iodine content of the breast milk and the role of breast milk as a vehicle for iodine supply of infants in situations of iodine deficiency. SPONSORSHIP: This study was supported by a grant from the Swedish Agency for Research Co-operation with Developing Countries.

Increase in serum beta-carotene following dark green leafy vegetable supplementation in Mebendazole-treated school children in Bangladesh.

OBJECTIVE: To study the effect of consumption of dark green leafy vegetables (DGLV) and sweet pumpkin on serum beta-carotene and retinol concentrations in children treated for Ascaris lumbricoides. DESIGN: Experimental study with a randomised design. SUBJECTS: A total of 110 primary school children aged 8-12 y in northwestern Bangladesh. INTERVENTIONS: All children were de-wormed and 2 weeks later randomly assigned to one of three groups to receive for 6 days per week, for 6 weeks, one complete meal containing either: (1) 4.4 mg beta-carotene from DGLV (n=37, after 18 dropouts); (2) 1.5 mg beta-carotene from sweet pumpkin (n=36, 18 dropouts); or (3) vegetables containing virtually no beta-carotene (control) (n = 37, 18 dropouts). RESULTS: Significant increases (P < 0.001) in mean serum beta-carotene concentrations were seen in all three study groups, with a statistically higher increase (micromol/l) in the DGLV group (0.44; 95% confidence interval (CI) 0.32, 0.55) compared to the control group (0.20; 95% CI 0.14, 0.26; P = 0.002). The increase in serum retinol (micromol/l) was statistically significant (P=0.04) only in the DGLV group (mean 0.066; 95% CI 0.002, 0.13), but this increase was not different from the increase in the control group. CONCLUSION: In children successfully treated for Ascaris lumbricoides, a substantial increase in serum beta-carotene was seen after feeding with a moderately high cumulative dose of DGLV for 6 weeks.

Evidence of grave vitamin A deficiency among lactating women in the semi-arid rural area of Makhaza in Zimbabwe. A population-based study.

OBJECTIVE: To assess the vitamin A and iron status of lactating women. DESIGN: A population-based cross-sectional descriptive study. SETTING: A semi-arid rural area of Makhaza in Zimbabwe. SUBJECTS: Two hundred and seven lactating women with babies aged 2-12 months. METHODS: Serum retinol (SR) was measured by HPLC, serum ferritin (SF) by ELIZA, haemoglobin (Hb) by HemoCue and C-reactive protein (CRP) by a turbo metric method. A seven-day recall of consumption of vitamin A containing foods was recorded. MAIN OUTCOME MEASURES: Relative dose response (RDR), SR, SF, Hb and CRP. RESULTS: Dark green leafy vegetables were the main sources of vitamin A; retinol-containing foods and yellow to red fruits and vegetables were rarely consumed. Five women had elevated CRP and these women had lower SR (P < 0.001) than the rest. Forty percent of the women had vitamin A deficiency (SR < 20 microg/dl), 76% had low liver stores of vitamin A (RDR > 20%) while 15 women had both abnormal SR and abnormal RDR. Forty percent had anaemia (Hb < 12 g/l) while 12% had iron deficiency (SF < 12 microg/dl) and 4% (n = 7) had iron deficiency anaemia. CONCLUSION: Vitamin A and iron deficiencies are problems of public health significance among the lactating women in the Makhaza area.

Iodine status, thyroid function and pregnancy: study of Swedish and Sudanese women.

OBJECTIVE: To examine and compare the effects of pregnancy on the thyroid hormone homeostasis in two different populations with variable iodine supply. DESIGN: A longitudinal prospective cohort study throughout pregnancy involving Swedish and Sudanese pregnant women. SETTING: The subjects were enrolled consecutively during their antenatal follow-up at health centres at Nyby in Uppsala, Sweden and Omdurman in Sudan. SUBJECTS: Fifty-one apparently healthy women from Uppsala, Sweden and twenty-eight pregnant women from Omdurman, Sudan were recruited during pregnancy. The mean age and weight of the Swedish women at the beginning of pregnancy were 29.9+/-5.4 y and 66.3+/-12.9 kg respectively. The corresponding figures for the Sudanese women were 28.0+/-4.9 y and 64.8+/-9.4 kg respectively. METHODS: Blood samples were drawn on four occasions from the Swedish group at 11-13, 24, 32, and 38 weeks of pregnancy, and on three occasions from the Sudanese group at 10-12, 20-24, and 36-39 weeks. Twenty-four hour urine samples were collected from the same subjects and on the same occasions as blood sampling. The urine samples were kept in a refrigerator until the volumes were measured, after which 20 mL aliquots were taken and kept frozen until analysed. MAIN OUTCOME MEASURES: Twenty-four hour urinary iodine output, TSH, FT4 and T3. RESULTS: The 24 h urinary iodine output at the different times during gestation were higher among the Swedish women, with mean values (95% confidence interval) of 1.40 (1.19-1.61), 1.33 (1.14-1.51), 1.45 (1.06-1.84) and 1.14 (0.88-1.39) micromol/d, than among the Sudanese cohort, with corresponding values of 0.49 (0.27-0.72), 0.29 (0.19-0.39), 0.56 (0.25-0.88) micromol/d. No significant changes in daily urinary iodine loss were observed in the two groups with progression of pregnancy. However, in the Swedish women the mean free T4 concentration fell from 11.81 pmol/l at the beginning of pregnancy to 8.82 pmol/l and the mean TSH rose from 1.11-1.95 mU/I between the beginning and end of pregnancy. Such changes were not detected among the Sudanese women, who had significantly lower mean TSH values than the Swedish women in weeks 36-39 of pregnancy (P < 0.02), and significantly higher FT4 values than the Swedish women both in weeks 20-24 and in weeks 36-39 (P < 0.005 and P < 0.001) respectively. CONCLUSIONS: The study suggests that determination of urinary iodine alone gives inadequate information about the capacity of an individual to utilize an available iodine supply and it also shows the existence of different patterns of thyroid response during pregnancy. The history of iodine availability prior to and during pregnancy seems to be an important determinant of the mechanism of thyroid gland response to ensure the extra iodine needed by the growing fetus.

A study of antenatal care at village level in rural Tanzania.

Antenatal care is an acknowledged measure for the reduction of maternal and perinatal mortality. In the rural village of Ilula, Tanzania, the possible impact of antenatal care on mortality was studied longitudinally on the basis of the 707 women delivered in the study period. Ninety-five percent of the antenatal records were available. Anemia, malaria and anticipated obstetric problems were the most frequent reasons for interventions. Among the women from the area who were delivered in hospital, 90% had been referred there. No relationship was found between the number of antenatal visits and the pregnancy outcome, but perinatal mortality was correlated to a low birth weight. Even with a mean attendance rate of six visits and full coverage by antenatal care maternal and perinatal mortality remains high.

PIP: An area-based, prospective study was undertaken in the rural village of Ilula, Tanzania on the possible impact of antenatal care on maternal and perinatal mortality. Between June 1, 1983 and November 30, 1985 683 women were studied. The number of visits averaged 6.4, with a range from 1 to 14. At these antenatal visits, 292 complaints were noted. Fever, rupture of membranes, anemia, twins, and breech presentations were among the most common complications. Interventions were most commonly medication for malaria and anemia. Referrals were made for blood transfusion, consultation of doctor, hospital admission, and hospital delivery. Of the 16 women with twin pregnancies diagnosed before birth, 6 delivered at home; 5 were sent to the referral hospital. Breech presentation was correctly diagnosed in 8 of 17 cases. No relationship was found between number of visits and pregnancy outcome, but perinatal mortality was correlated to a low birth weight. There were 4 maternal deaths; all of which occurred in term deliveries around the time of delivery. In no case could the outcome be linked to insufficient antenatal care. This study suggests that more emphasis should be placed on preventive medical and social measures. Strengthening of the referral mechanism is also necessary.

Serum selenium is related to low-density lipoproteins in healthy children but not in children with diabetes.

The serum concentrations of selenium in 13 healthy children and 27 children with type 1 diabetes mellitus were evaluated in relation to serum lipoprotein and apolipoprotein concentrations. In healthy children a correlation was found between serum selenium and both serum cholesterol (r = 0.56; p less than 0.05) and serum triglycerides (r = 0.56; less than 0.05) and their low-density lipoprotein (LDL) + very low-density lipoprotein (VLDL) fractions (r = 0.60 and 0.56 respectively; p less than 0.05), but not their high-density lipoprotein fractions. Associations were also found between selenium and apolipoproteins, especially A II and C II (r = 0.57; p less than 0.05). In diabetic children serum selenium was significantly correlated with apolipoproteins A II and Apo C II, but not with any lipoprotein or lipid or any of their fractions. This study supports the hypothesis that serum selenium is an integral part of the defence system against degradation products associated with LDL and VLDL in young healthy humans. These associations were not found in diabetes, which might suggest that the defence system against lipid peroxidation is less effective in this disease.

A prospective area-based study of the outcome of pregnancy in rural Tanzania.

A prospective area-based study on the outcome of pregnancy was carried out in the rural village of Ilula in Tanzania. A coverage of 99% (n = 719) regarding the ultimate outcome for mother and child was achieved, including deliveries that took place in hospital (9%), at the dispensary (67%) and at home (23%). There were four maternal deaths (6/1,000). The mean birth weight for singletons was 3,070 g and the low birth weight (less than 2,500 g) rate 13%. From a gestational age of 37 weeks onwards there was a definite slowing of fetal growth. Perinatal mortality rate was 82 per 1,000 born, half of the deaths occurring in low birth weight babies. Twinning occurred in 3.5% and the mean length of gestation at delivery for these pregnancies was 35.5 weeks. Twins constituted 6.8% of newborns but accounted for 23.0% of perinatal losses, making twin pregnancy a major contributor to perinatal mortality. Post-term pregnancies carried no significant increase in mortality. It is concluded that reliable area-based data on the outcome of pregnancy in Tanzania can be obtained at village level, with good coverage of the study population, by properly instructed and motivated local staff with moderate supervisory support.