Encopresis: a study of treatment alternatives and historical and behavioral characteristics.

The historical, demographic and pre/post treatment behavioral profiles of a Health Maintenance Organization's (HMO) encopresis patients were studied. The efficacy of two maintenance treatments were also compared. Management included an initial bowel evacuation, high fiber diet, behavior modification program, and random assignment to maintenance on oral laxatives or conditional rectal cathartics. Of the 136 patients evaluated, 61 completed treatment (oral 24; rectal 37). Significant behavioral problems were identified. However, the majority (65%) of patients were managed without psychosocial intervention and successful completion of treatment significantly improved most behaviors. There were no significant differences in efficacy between the oral laxative or conditional rectal cathartic maintenance groups completing treatment. In 87% success continued 6 to 12 months post-treatment.

Trials of intradermal hepatitis B vaccines in Gambian children.

Three trials of intradermal hepatitis B virus (HBV) vaccines were made in Gambian children. In the first trial HBV vaccine (1 microgram) was given to neonates in the same syringe with BCG followed by two further does of 1.0 microgram of intradermal HBV vaccine. The trial was a failure, for 19 of 32 subjects had an HBV surface antibody response of less than 10 m.i.u./ml. In the second trial in young children two different regimes were used: two doses of 2 micrograms HBV vaccine were given intradermally after a 20 micrograms intramuscular dose or three doses of 2 micrograms were given intradermally. In both cases geometric mean antibody responses were significantly lower than in the control group who were given 20 micrograms HBV intramuscularly followed by two 10 micrograms doses intramuscularly. Vaccine failures, defined as the presence of HBV surface antigen or core antibody or absence of surface antibody, were also significantly higher in the intradermal groups. In the third trial 4 micrograms of vaccine were given intradermally to 20 young children with a multiple orifice head fired by a jet gun: all had a good HBV surface antibody response of greater than 100 m.i.u./ml of serum.

Effect of supplementary vitamins and iron on malaria indices in rural Gambian children.

The effect of a combined supplement of iron, thiamine, riboflavin and vitamin C on malarial incidence in 5 to 14-year-old children was tested in a malnourished rural community in a region of The Gambia noted for high prevalence of malaria during the rainy season. 190 children, divided into 2 matched groups, received either the supplement or a matching placebo for 3 months. No significant difference in malarial incidence was observed between the 2 groups, despite a major improvement in biochemical indices of nutrient status in the supplemented group, especially for riboflavin and vitamin C. Severity of episodes was also similar between groups, but in subjects who developed parasitaemias there was a trend towards higher parasite counts in those receiving the active supplement. Nutritional interventions in malarious areas may have adverse effects on malaria, and the increase in parasitaemia was compatible with the hypothesis that a small but significant reduction in defences had occurred. However, the absence of increases in the incidence of proven malaria cases and their severity must also be taken into account, in order to make a balanced assessment of the possible increase in risk. Further investigations are needed to measure the risk in benefit rates, and to consider the effects of individual nutrients in isolation.

Effects of a multivitamin and iron supplement on running performance in Gambian children.

Forty boys and girls between 11 and 14.5 years with evidence of subclinical vitamin deficiencies were allocated to two groups to receive, twice weekly, either a placebo or a multivitamin and iron supplement. Prior to supplementation and on two subsequent occasions about 5 weeks apart, the children performed an exercise regimen on a treadmill during which expired air was collected and heart rate monitored. The supplement resulted in marked improvements in riboflavin and vitamin C status and checked the decline in iron stores seen in the unsupplemented children. During the study the running performance of unsupplemented children deteriorated, and markedly so in a subgroup with initially poor nutrient status. The vitamin and iron supplement prevented this deterioration so as to produce a significant reduction in the energy cost of treadmill running in the more malnourished subgroup, relative to the changes seen in children receiving no supplement.

Haematological response to supplements of iron and riboflavin to pregnant and lactating women in rural Gambia.

Eighty-one pregnant or lactating women living in a village in The Gambia were allocated to treatment groups to receive a daily placebo, riboflavin, ferrous sulphate or ferrous sulphate plus riboflavin. At the beginning of the study and at 3 and 6 weeks thereafter women were examined clinically and blood samples collected for haematological and biochemical measurements. Pregnant women showed a wide range of response to supplement but among the lactating women an interesting pattern emerged: whereas the haematological status of the placebo group declined over 6 weeks, in the group receiving iron supplements this deterioration was reduced although not significantly. Riboflavin given in addition to iron resulted in a significant increase in circulating plasma iron and in iron stores, relative to the placebo.

The relative effectiveness of iron and iron with riboflavin in correcting a microcytic anaemia in men and children in rural Gambia.

Adult males and children between 4 and 12 years in a subsistence farming community in The Gambia were screened for haematological status. 80 men and 80 children with initially poor status were identified and allocated to three treatment groups comprising: a placebo, ferrous sulphate, and ferrous sulphate with riboflavin. Over a period of 6 weeks of supplementation there was a general improvement in haematological status in the two supplemented groups. The inclusion of riboflavin in the supplement enhanced recovery, particularly in those individuals with strikingly low levels of haemoglobin at the outset.

Efficacy of a riboflavin supplement given at fortnightly intervals to pregnant and lactating women in rural Gambia.

Thirty-seven women living in two rural Gambian villages, who were either pregnant or lactating at the outset of the study, received a tablet containing 15 mg riboflavin, or a placebo, at fortnightly intervals for 10 weeks at a time of year when riboflavin status was deteriorating. Clinical assessments were carried out once a week, with particular attention to signs and symptoms of riboflavin deficiency, and blood samples were taken at the beginning of the study and after 4 and 10 weeks supplementation for the assessment of riboflavin status by the activation coefficient of erythrocyte glutathione reductase. The overall incidence of lingual papillary atrophy increased significantly during the course of the study, but the increase was significantly smaller in the supplemented than in the placebo group. More complaints of sore mouths were encountered in the placebo group. Biochemical evidence of deficiency was very marked at the outset, and showed some improvement after supplementation, but values within the normal range were not achieved. It is concluded that a riboflavin supplement given at spaced intervals can be clinically beneficial, despite failure to achieve normal biochemical indices. This may have practical implications for intervention programmes.

The effect of vitamin C supplementation on lactating women in Keneba, a West African rural community.

A study of vitamin C requirements was undertaken in the village of Keneba, The Gambia, during the rainy season, when the intake of vitamin C-rich foods is very low. The effect of four supplementary levels of vitamin C (0, 24, 47 and 60 mg/day), together with a milk and biscuit food supplement which provided 34 mg vitamin C/day, was studied for a five-week period. Plasma ascorbate increased from 0.25 to 0.72 mg/dl; buffy coat ascorbate increased from 14.7 to 24.3 micrograms/10(8) cells and breast milk ascorbate increased from 3.4 to 5.5 mg/dl as intake increased from 34 to 103 mg/dl. Breast milk ascorbate approached a plateau at the high intakes. A fasting plasma ascorbate of at least 0.3 mg/dl in 97.5% of the population of lactating women in Keneba would require a daily vitamin C intake of about 117 mg. No differences between vitamin C supplementation levels were observed with respect to changes in plasma iron, total iron-binding capacity or its percentage saturation. Whole blood histamine levels showed a slight downward trend as the vitamin C intake increased.

A trial of ascorbic acid and of multivitamin supplementation on the oral health of West African children.

204 children between the ages of 1.5 and 6.5 years living in a West African village where the incidence of gingivitis and bleeding gums is about 40% of the population at the end of the rainy season, were given vitamin C or a placebo for 69 days, followed by a multivitamin supplement or placebo for 47 days. The condition of their gums was continuously monitored by trained field workers and by a paediatrician during the supplementation period, and was also assessed in greater detail by the paediatrician at the beginning and end of each treatment period. No benefit of either type of supplement could be detected, either on incidence of bleeding, or on over-all severity of gingivitis, although there was a clear-cut seasonal trend towards lower incidence of bleeding in both groups as the study progressed.

Calcification of basal ganglia and cerebellar roof nuclei in mentally defective patient with hidrotic ectodermal dysplasia. Analysis of intracranial concretions by electon microprobe.

This report describes, for the first time, an analysis by electron microprobe of concretions in the brain of an individual with striopallidodentate calcification. We also report the unique association of this intracranial syndrome with hidrotic ectodermal dysplasia. An institutionalized male with impaired intellectual function and hidrotic ectodermal dysplasia was known since the age of 3 years to have bilateral radiopaque densities in the region of the basal ganglia on skull roentgenogram. He died at age 29 in congestive heart failure from rheumatic pancarditis. At autopsy, concretions were identified in globus pallidus, caudate nuclei, thalamus, and dentate nuclei. Mineral deposits within the brain, analyzed by energy dispersive x-ray microanalysis, consisted predominately of calcium and phosphorus. Trace amounts of magnesium, iron, and silicon also were detected.