RESUMO
OBJECTIVE: Developing countries have adopted universal, high-potency vitamin A (VA) supplementation and food fortification as major strategies to control deficiency, prevent nutritional blindness and reduce child mortality. Yet questions persist regarding how best to measure impact and when to phase out supplementation. The present paper provides guidance on the use and interpretation of serum retinol (SROL) distributions as indicators of both programme impact and adequate VA intake in a population. DESIGN: We reviewed extant data on SROL's response to high-potency VA supplementation and VA-fortified foods in children. RESULTS: Supplementation virtually eliminates xerophthalmia and reduces child mortality; however, it shifts the SROL distribution only transiently (<2 months). Regular consumption of VA-fortified foods prevents xerophthalmia, lowers mortality and sustainably improves SROL distributions, from which both compliance and public health impact can be inferred. CONCLUSIONS: Given SROL's limited responsiveness to high-potency VA supplementation, target population coverage remains the preferred performance indicator. However, periodic SROL surveys do reflect underlying dietary risk and can guide programming: low or marginal SROL distributions in areas with high supplementation coverage do not signify programme failure, but rather suggest the need to continue supplementation while working to effectively raise dietary VA intakes. We propose that a sustained rise in the SROL distribution, defined as ≤5 % prevalence of SROL < 0·70 µmol/l among vulnerable population groups in at least two consecutive surveys (≥1 year apart), be used as an indicator of stable and adequate dietary VA intake and status in a population, at which point programmes may re-evaluate the need for continued universal supplementation.
Assuntos
Suplementos Nutricionais , Alimentos Fortificados , Deficiência de Vitamina A/epidemiologia , Deficiência de Vitamina A/prevenção & controle , Vitamina A/administração & dosagem , Vitamina A/sangue , Pré-Escolar , Bases de Dados Factuais , Guias como Assunto , Humanos , Lactente , Saúde Pública , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Deficiência de Vitamina A/complicações , Xeroftalmia/etiologia , Xeroftalmia/prevenção & controleRESUMO
Blepharoplasty is one of the most popular and common procedures in facial plastic surgery. Initially performed in 1818 for eyelid reconstruction, blepharoplasty has evolved to become a cosmetic or functional operation. Although the surgical approaches are relatively straightforward, achieving natural and predictable results require precision and judgment. After performing more than 3500 blepharoplasties, the senior author has learned that the "art of blepharoplasty" has less to do with how much skin or fat is removed and is more about understanding the anatomic changes associated with aging, developing an individualized surgical plan, and anticipating postoperative outcomes or complications.
Assuntos
Blefaroplastia/métodos , Envelhecimento/patologia , Blefaroplastia/classificação , Técnicas Cosméticas , Sobrancelhas/anatomia & histologia , Pálpebras/patologia , Músculos Faciais/patologia , Humanos , Nariz/anatomia & histologia , Planejamento de Assistência ao Paciente , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios , Procedimentos de Cirurgia Plástica , Rejuvenescimento , Ritidoplastia , Resultado do Tratamento , Xeroftalmia/prevenção & controleRESUMO
OBJECTIVE: To assess the preventive effects of extract of Buddleja officinalis on dry eye in castrated rabbits and to discuss the mechanism of these effects. METHODS: It was a experimental study. Thirty male rabbits were divided equally into normal group (A), disease group (B) and treatment group (C, D, and E). The dry eye model was established with orchiectomy (ORX) in Group B, C, D and E. Group C, D and E were gastrically perfused with single-dose or double-does of Buddleja officinalis extract or genistein for 30 days. All rabbits were examined with Schirmer I test (SIT). TGF-beta1, IL-1beta, TNF-alpha, Fas, FasL, Bax and bcl-2 were detected by immunohistochemistry. Morphological and ultrastructure changes were observed by electron microscopy. RESULTS: The SIT value of group C, D, E was significantly greater than that of group B (P < 0.01). The expression of IL-1beta, TNF-alpha, Fas, FasL and Bax in acinar cells and glandular tube cells of group C, D, E were significantly lower than those of group B (P < 0.01) and the expression of TGF-beta1 and bcl-2 in acinar cells and glandular tube cells of group C, D, E were significantly higher than those of group B (P < 0.01). Furthermore, ultrastructure of lacrimal gland in group C, D, E was much healthier than that of group B. The results obtained from all of these studies showed that the lacrimal glands status in group C, D was significantly better than that of group E (P < 0.05). CONCLUSION: Extract of Buddleja officinalis has a significant effect on the prevention of experimental dry eye in castrated male rabbits. The main components of extract of Buddleja officinalis are the flavonoids. The flavonoids display androgen-like activity. Therefore, it can adjust gonadal hormone level in vivo. As a result, it can inhibit local inflammation in lacrimal gland and reduce apoptosis of lacrimal gland cells.
Assuntos
Buddleja/química , Flavonas/uso terapêutico , Fitoterapia , Extratos Vegetais/uso terapêutico , Xeroftalmia/tratamento farmacológico , Animais , Aparelho Lacrimal/efeitos dos fármacos , Masculino , Coelhos , Xeroftalmia/prevenção & controleRESUMO
The aim of this study was to assess the anti-inflammatory and anti-apoptotic effects of KIOM-2015EW, the hot-water extract of maple leaves in hyperosmolar stress (HOS)-induced human corneal epithelial cells (HCECs). HCECs were exposed to hyperosmolar medium and exposed to KIOM-2015EW with or without the hyperosmolar media. Tumor necrosis factor (TNF)-α, interleukin (IL)-1ß, and IL-6 production and apoptosis were observed, and the activation of mitogen-activated protein kinases (MAPKs) including extracellular signal regulated kinase (ERK), p38 and c-JUN N-terminal kinase (JNK) signaling and nuclear factor (NF)-κB was confirmed. Compared to isomolar medium, the induction of cell cytotoxicity significantly increased in HCECs exposed to hyperosmolar medium in a time-dependent manner. KIOM-2015EW-treatment significantly reduced the mRNA and protein expression of pro-inflammatory mediators and apoptosis. KIOM-2015EW-treatment inhibited HOS-induced MAPK signaling activation. Additionally, the HOS-induced increase in NF-κB phosphorylation was attenuated by KIOM-2015EW. The results demonstrated that KIOM-2015EW protects the ocular surface by suppressing inflammation in dry eye disease, and suggest that KIOM-2015EW may be used to treat several ocular surface diseases where inflammation plays a key role.
Assuntos
Acer , Anti-Inflamatórios/farmacologia , Apoptose/efeitos dos fármacos , Epitélio Corneano/efeitos dos fármacos , Pressão Osmótica , Extratos Vegetais/farmacologia , Xeroftalmia/prevenção & controle , Acer/química , Anti-Inflamatórios/isolamento & purificação , Células Cultivadas , Relação Dose-Resposta a Droga , Epitélio Corneano/metabolismo , Epitélio Corneano/patologia , Humanos , Mediadores da Inflamação/metabolismo , Interleucina-1beta/metabolismo , Interleucina-6/metabolismo , Proteínas Quinases Ativadas por Mitógeno/metabolismo , Fosforilação , Fitoterapia , Extratos Vegetais/isolamento & purificação , Folhas de Planta , Plantas Medicinais , Transdução de Sinais/efeitos dos fármacos , Fatores de Tempo , Fator de Transcrição RelA/metabolismo , Fator de Necrose Tumoral alfa/metabolismo , Xeroftalmia/etiologia , Xeroftalmia/metabolismo , Xeroftalmia/patologiaRESUMO
The Sjogren's syndrome (SS) is an chronic inflammatory autoimmune disease of the exocrine glands as well as of internal apparatus. The therapy of exocrinopathy is represented by parasympathomimetic drugs such as pilocarpine and cevimeline. The therapy of systemic manifestations, actually is represented by the inhibitors of TNF alfa, as well as leflunomide, methotrexate and cyclosporine-A, but the results are quite insufficient and disappointed. In order to the involvement of B-cell function in the pathogenesis of SS, one of the most important option in the future should be specific inhibitors of that cells.
Assuntos
Linfócitos B , Imunossupressores/uso terapêutico , Parassimpatomiméticos/uso terapêutico , Síndrome de Sjogren/tratamento farmacológico , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados , Anticorpos Monoclonais Murinos , Linfócitos B/efeitos dos fármacos , Ciclosporina/uso terapêutico , Etanercepte , Humanos , Imunoglobulina G/uso terapêutico , Infliximab , Isoxazóis/uso terapêutico , Leflunomida , Metotrexato/uso terapêutico , Agonistas Muscarínicos/uso terapêutico , Pilocarpina/uso terapêutico , Quinuclidinas/uso terapêutico , Receptores do Fator de Necrose Tumoral/uso terapêutico , Rituximab , Síndrome de Sjogren/complicações , Síndrome de Sjogren/fisiopatologia , Tiofenos/uso terapêutico , Resultado do Tratamento , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Xeroftalmia/prevenção & controle , Xerostomia/prevenção & controleRESUMO
OBJECTIVE: To investigate tear film changes after recovery from acute conjunctivitis. METHODS: This study involved 73 eyes of 56 consecutive patients who had recovered from acute conjunctivitis after routine treatment in Zhongshan Ophthalmic Center between July 2002 and August 2003. Excluded other factors which could affect the stability of the tear film, tear film break up time (BUT), Schirmer I test (ST), fluorescein staining (FL) and the height of tear meniscus were measured on both recovered and healthy eyes of the patients at 3, 7, 14, 21 and 30 days after recovery. RESULTS: BUT was 14.72 s in healthy eyes, 5.23, 5.11, 7.84, 10.26 and 12.74 s in recovered eyes at 3, 7, 14, 21 and 30 days (P = 0.012, 0.018, 0.032, 0.028 and 0.122), respectively. FL scored at 2.26 in healthy eyes, 3.02, 6.23, 7.92, 6.37 and 3.53 at 3, 7, 14, 21 and 30 days in recovered eyes (P = 0.063, 0.017, 0.008, 0.024 and 0.074), respectively. ST scored at 16.30 mm in healthy eyes, 9.39, 11.48, 13.85, 21.24 and 17.40 mm, at 3, 7, 14, 21 and 30 days in recovered eyes (P = 0.025, 0.040, 0.082, 0.012 and 0.104), respectively. The height of tear meniscus was 0.62 mm in healthy eyes; it scored at 0.39, 0.32, 0.44, 0.53 and 0.58 mm at 3, 7, 14, 21 and 30 days in recovered eyes (P = 0.008, 0.015, 0.037, 0.120 and 0.182), respectively. CONCLUSIONS: Instability of tear film and transient dry eye can occur after recovery from acute conjunctivitis. However, dry eye can be avoided during the treatment of acute conjunctivitis by consideration of drug side effects to the tear film and minimizing the unnecessary use of drugs.
Assuntos
Conjuntivite/fisiopatologia , Lágrimas/fisiologia , Doença Aguda , Adolescente , Adulto , Túnica Conjuntiva/patologia , Conjuntivite/tratamento farmacológico , Conjuntivite/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Xeroftalmia/prevenção & controleRESUMO
We examined the effect of 60-mg (200,000-IU) supplements of vitamin A administered every 6 mo on the incidence of xerophthalmia among preschool children who were free of eye symptoms and signs of vitamin A deficiency. We also prospectively studied the relationship of dietary vitamin A intake with the same endpoint. After 18 mo of follow-up, 400 children developed xerophthalmia during 80,104 child-periods of follow-up. Vitamin A supplementation only modestly reduced the risk of xerophthalmia (relative risk 0.88, 95% confidence interval 0.72-1.07, P = 0.19). On the other hand, total dietary vitamin A intake was strongly associated with reduced risk of xerophthalmia; the multivariate relative risk when children in extreme quintiles were compared was 0.38 (95% confidence interval 0.19-0.74; P for trend over quintiles = 0.002). These results emphasize the need for further data on factors that modify the bioavailability of large-dose vitamin A supplements. Increased consumption of inexpensive vegetables and fruits is highly likely to reduce significantly the risks of vitamin A deficiency, including nutritional blindness in developing countries.
Assuntos
Dieta , Vitamina A/uso terapêutico , Xeroftalmia/prevenção & controle , Criança , Fenômenos Fisiológicos da Nutrição Infantil , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Masculino , Estado Nutricional , Fatores de Risco , SudãoRESUMO
The fruit of buriti, a palm tree that grows wild in some regions of Brazil, contains beta-carotene in its oily fraction in a concentration 10 times higher than that of red-palm oil. The effectiveness of buriti sweet in the treatment and prevention of xerophthalmia was tested in 44 children aged 43-144 mo through daily supplementation with an amount corresponding to 134 micrograms retinol equivalent over 20 d. The results demonstrated that this natural food source of vitamin A can reverse clinical xerophthalmia and restore liver reserves of the vitamin, suggesting its possible utilization in intervention programs to combat vitamin A deficiency in countries where the fruit is available or has the potential for cultivation.
Assuntos
Frutas/análise , Vitamina A/análise , Xeroftalmia/dietoterapia , Brasil , Doces , Carotenoides/análise , Criança , Pré-Escolar , Humanos , Óleos de Plantas/análise , Vitamina A/sangue , Xeroftalmia/prevenção & controle , beta CarotenoRESUMO
In a controlled trial, fortification of commercially marketed monosodium glutamate (MSG) with vitamin A improved serum vitamin A levels of young children and the vitamin A content of breast milk of lactating women. These improvements in vitamin A indices were accompanied by dramatic changes in health and anthropometric status. During the course of the study, the prevalence of Bitot's spots among children in program villages fell progressively from 1.2% at base line to 0.2% 11 mo after introduction of the fortified product (p less than 0.001); xerophthalmia rates in control villages remained essentially unchanged. Linear growth was greater among program than among control children at every age. Hemoglobin levels among program children rose by approximately 10 g, from 113 +/- 16 g/L at base line to 123 +/- 16 by 5 mo (p less than 0.001); they remained essentially unchanged among children of control villages. Preschool children in control villages died at 1.8 times the rate of children in program villages.
Assuntos
Desenvolvimento Infantil , Serviços de Saúde Comunitária , Alimentos Formulados , Glutamatos/administração & dosagem , Glutamato de Sódio/administração & dosagem , Vitamina A/administração & dosagem , Antropometria , Feminino , Hemoglobinas/análise , Humanos , Indonésia , Lactação , Leite Humano/análise , Gravidez , Xeroftalmia/prevenção & controleRESUMO
Impact of 6-monthly massive dosings of preschool-age children with oral vitamin A (VAC: 200,000 IU of oil soluble retinyl palmitate with 40 IU vitamin E) was evaluated in Bangladesh. In 100 sites, 11,889 households were visited and eyes of 22,335 children aged 3-71 mo were examined. About half the rural target population and less than 20% urban slum population were being reached. Risk of night blindness was halved for children reportedly given VAC, although 2.5% of the reportedly protected population were still night blind. There was no significant reduction in prevalence of Bitot's spot. Risk of corneal ulcers or keratomalacia (X3A/B) was 2.7 times higher in children not given VAC. Based on reported coverage, efficacy of protection against potentially blinding corneal lesions was 63%. For maximum impact on eye lesions, massive dosing with vitamin A at ideally less than 6-monthly intervals needs to be combined with other nutrition and health interventions.
Assuntos
Cegueira Noturna/prevenção & controle , Vitamina A/administração & dosagem , Xeroftalmia/prevenção & controle , Bangladesh , Fenômenos Fisiológicos da Nutrição Infantil , Pré-Escolar , Relação Dose-Resposta a Droga , Feminino , Humanos , Masculino , Cegueira Noturna/epidemiologia , Saúde da População Rural , Deficiência de Vitamina A/epidemiologia , Xeroftalmia/epidemiologiaRESUMO
Xerophthalmia has been found to be an important cause of blindness in the Philippines. An earlier study had investigated its prevalence and epidemiology on the island of Cebu. The research now presented consists of an evaluation of the relative effectiveness of three different intervention strategies to control vitamin A deficiency in Cebu. These interventions were 1) a public health and horticulture intervention, 2) the provision of 200,000 IU of vitamin A to children every 6 months (the "capsule intervention"), and 3) the fortification of monosodium glutamate with vitamin A. A total of 12 areas or barangays were included. Each intervention was monitored in four different barangays, two urban and two rural, for almost 2 years. Similar examinations were performed before and after the interventions. The monosodium glutamate fortification was the only intervention that resulted both in a significant reduction in clinical signs of xerophthalmia and in a significant rise in serum vitamin A levels. Fortification is now being planned in three Philippine provinces.
Assuntos
Alimentos Fortificados , Glutamatos , Glutamato de Sódio , Deficiência de Vitamina A/prevenção & controle , Vitamina A/uso terapêutico , Xeroftalmia/prevenção & controle , Adolescente , Agricultura , Carotenoides , Criança , Pré-Escolar , Educação em Saúde , Humanos , Imunização , Lactente , Filipinas , Saúde Pública , População Rural , Saneamento , População Urbana , Vitamina A/sangueRESUMO
The effect of prophylactic vitamin A supplementation on child growth was studies in two randomized, placebo-controlled trials carried out in adjacent areas of northern Ghana between 1989 and 1991. In the Health Study, the midupper arm circumference (MUAC) and weight of the approximately 1500 children (aged 6-59 mo) in the trial were measured every 4 wk for up to 52 wk. In addition, MUAC, weight, and height were measured at each of the four potential vitamin A or placebo dosing times, which were at 4-mo intervals. In the Survival Study, MUAC and weight were measured at 4-mo intervals at each of seven dosing rounds in the approximately 15 000 children currently in the trial. Overall, there were > 90 000 observations of weight and MUAC in > 25 000 children, and 3347 observations of length/height in 1546 children. Within each study, the mean monthly weight, MUAC, and gains in length/height in each treatment group were compared by using multilevel modeling. There were no significant differences in either MUAC or gains in length/height. The only significant difference in weight gain was in the Survival Study: children in the vitamin A-supplemented group who were > or = 36 mo of age had a mean weight gain that was 3 g lower per month (95% CI: 0.4, 5.0, P = 0.02) than that in the placebo group; a difference that was unlikely to be functionally important in this age group. Vitamin A supplementation did not lead to any increased growth in this population of young children, in whom supplementation reduced mortality and severe morbidity substantially.
Assuntos
Crescimento/efeitos dos fármacos , Vitamina A/farmacologia , Antropometria , Estatura/efeitos dos fármacos , Estatura/fisiologia , Peso Corporal/efeitos dos fármacos , Peso Corporal/fisiologia , Criança , Pré-Escolar , Diarreia/sangue , Diarreia/epidemiologia , Diarreia/fisiopatologia , Relação Dose-Resposta a Droga , Alimentos Fortificados , Gana/epidemiologia , Crescimento/fisiologia , Transtornos do Crescimento/sangue , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/fisiopatologia , Humanos , Lactente , Pneumopatias/sangue , Pneumopatias/epidemiologia , Pneumopatias/fisiopatologia , Morbidade , Prevalência , Vitamina A/administração & dosagem , Vitamina A/sangue , Vitamina A/uso terapêutico , Deficiência de Vitamina A/complicações , Deficiência de Vitamina A/epidemiologia , Deficiência de Vitamina A/prevenção & controle , Xeroftalmia/epidemiologia , Xeroftalmia/etiologia , Xeroftalmia/prevenção & controleRESUMO
PURPOSE: To assess the impact of vitamin A supplementation at 4-month intervals on the prevalence and incidence of xerophthalmia among preschool-age children. METHODS: A stratified, random sample of 40 wards with 4766 children in Sarlahi district of Nepal was selected to participate in a randomized, controlled, community trial. In the vitamin A group, at 4-month intervals, neonates received 50,000 IU, 1- to 11-month-old infants received 100,000 IU, and children 1 through 4 years of age received 200,000 IU. Children underwent eye examination before the intervention and 16 months later. RESULTS: Before the intervention, 4318 children were examined for xerophthalmia. The prevalence was 2.3% in the vitamin A group and 3.3% in the placebo group. All children with xerophthalmia were treated with vitamin A at the time of the examination. Of those examined at baseline, 38 in the vitamin A group and 48 in the placebo group died in the 16 months after intervention. There were 1871 (84%) surviving children in the vitamin A group and 1711 (85%) in the placebo group examined at follow-up. After adjustment for the baseline prevalence of xerophthalmia, vitamin A reduced the prevalence at follow-up by 63% (95% confidence interval, 21% to 83%). The apparent incidence was 3.2/1000 per year in the vitamin A group and 9.2/1000 per year in the placebo group, an adjusted reduction of 62% (95% confidence interval, 0% to 86%). CONCLUSIONS: Supplementation was effective at reducing the prevalence and incidence of xerophthalmia.
Assuntos
Vitamina A/uso terapêutico , Xeroftalmia/epidemiologia , Xeroftalmia/prevenção & controle , Pré-Escolar , Feminino , Seguimentos , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Nepal , PrevalênciaRESUMO
The value of biannual distribution of 200,000 IU of vitamin A in preventing xerophthalmia was assessed in a randomized, controlled community-based trial involving 25,000 preschool children in 450 villages of northern Sumatra. Results indicate that distribution was associated with a dramatic decline in xerophthalmia prevalence; that concurrent controls were critical for distinguishing spontaneous from program-related changes; and that the apparent level of benefit depended on the choice of clinical indicator(s). Night blindness ceases to be an accurate reflection of impact when prevalence rates are low, and comparison of Bitot's spot rates should be confined to new cases of disease.
Assuntos
Vitamina A/administração & dosagem , Xeroftalmia/prevenção & controle , Pré-Escolar , Ensaios Clínicos como Assunto , Esquema de Medicação , Feminino , Humanos , Indonésia , Lactente , Masculino , Distribuição Aleatória , Vitamina A/uso terapêutico , Xeroftalmia/epidemiologiaRESUMO
A retrospective review of 3,490 adminissions to the major pediatric facility in El Salvador was undertaken to determine whether biannual administration of massive doses of vitamin A (200,000 international units) to all availabel 1- to 4-year-old children was effective in preventing keratomalacia. During the 12 months preceding and following initiation of the program, the number of children admitted with presumed vitamin-A-related corneal destruction (33 vs. 31) and proportion of all malnourished admissions with such destruction (26 vs. 25 per 1,000) were similar. The seasonal distribution of these cases remained unchanged, the usual summer peak closely following the first distribution. Unexpectedly, 48% of the children had been ineligible for participation in the program, the vast majority being under 1 year of age. Only 80% of eligible children had actually received the vitamin. Corneal destruction was invariably accompanied by severe, generalized malnutition. Mortality among girls with corneal destruction (28 per 1,000) was almost three times that of boys, or malnourished patients as a whole.
Assuntos
Doenças da Córnea/prevenção & controle , Deficiência de Vitamina A/prevenção & controle , Fatores Etários , Pré-Escolar , Doenças da Córnea/epidemiologia , Úlcera da Córnea/epidemiologia , El Salvador , Feminino , Humanos , Lactente , Masculino , Sarampo/epidemiologia , Distúrbios Nutricionais/complicações , Serviços Preventivos de Saúde , Estudos Retrospectivos , Estações do Ano , Fatores Sexuais , Vitamina A/administração & dosagem , Xeroftalmia/epidemiologia , Xeroftalmia/prevenção & controleRESUMO
In a three-year pilot project in the Philippines, the magnitude of vitamin A deficiency and its clinical manifestation (xerophthalmia) was determined, and three alternate programs for eliminating and preventing it in various ecologic zones were designed and implemented concurrently in separate areas in each ecologic zone. Results were evaluated, and costs and benefits of each program were determined. The results of the fortification program are reported. Monosodium glutamate (MSG) was selected as the ideal carrier was fortified at a level which provided 15,000 I.U. retinol palmitate to the average family each day. Significant increases in serum A, especially for children with more deficient vitamin A status, resulted. The program's economic benefits significantly outweighted the costs, and the MSG fortification program has been expanded to several additional pilot provinces in the Philippines.
Assuntos
Alimentos Fortificados , Glutamatos , Glutamato de Sódio , Deficiência de Vitamina A/prevenção & controle , Vitamina A/uso terapêutico , Adolescente , Cegueira/economia , Criança , Pré-Escolar , Análise Custo-Benefício , Estudos de Avaliação como Assunto , Humanos , Lactente , Masculino , Filipinas , Projetos Piloto , Características de Residência , Fatores Socioeconômicos , Vitamina A/sangue , Deficiência de Vitamina A/tratamento farmacológico , Deficiência de Vitamina A/epidemiologia , Xeroftalmia/prevenção & controleRESUMO
OBJECTIVES: To determine if the Simplified Dietary Assessment to Identify Groups at Risk of Inadequate Intake of Vitamin A developed by the International Vitamin A Consultative Group (IVACG) correctly classified a group of vitamin A-deficient children as being at risk, and to see if a food frequency questionnaire (FFQ) or 24-hour history (24HH) yielded estimated dietary vitamin A intakes most closely associated with vitamin A status. DESIGN: Forty-seven foods were identified as contributing most of the vitamin A to the diet of the study population. For each food, usual portion sizes were determined during a pilot study. Intake was calculated from data collected by FFQ and 24HH. Four modifications of the 24HH analysis were made to determine if this method of analysis could be simplified. SUBJECTS/SETTING: Subjects were 265 Indonesian children with or at high risk of developing xerophthalmia. RESULTS: Mean and median intakes of vitamin A based on the 24HH analysis were 50% and 27% of the US Recommended Dietary Allowance, respectively, which accurately identified the study sample as being at risk. Dietary intake based on the 24HH was significantly associated with serum retinol concentration (P = .01, trend test). Eliciting portion sizes during the 24HH was not necessary once the usual portion sizes consumed by the population were estimated in the pilot study. Mean and median intakes of vitamin A based on the FFQ were 150% and 118% of the Recommended Dietary Allowance, respectively, which suggests that the FFQ overestimated intake. Intake based on the FFQ was not correlated with serum retinol concentration. CONCLUSIONS: Our findings do not support the IVACG recommendation that the FFQ be regarded as more reliable than the 24HH when the 2 methods produce different conclusions, nor the recommendation of some users of the method that the 24HH be dropped from the assessment method.
Assuntos
Transtornos da Nutrição Infantil/diagnóstico , Registros de Dieta , Avaliação Nutricional , Deficiência de Vitamina A/diagnóstico , Vitamina A/administração & dosagem , Transtornos da Nutrição Infantil/epidemiologia , Pré-Escolar , Feminino , Análise de Alimentos , Humanos , Indonésia/epidemiologia , Lactente , Masculino , Necessidades Nutricionais , Estado Nutricional , Reprodutibilidade dos Testes , Fatores de Risco , Vitamina A/análise , Vitamina A/sangue , Deficiência de Vitamina A/epidemiologia , Xeroftalmia/prevenção & controleRESUMO
BACKGROUND: Chronic paralytic lagophthalmos is a condition that is often conservatively treated with ophthalmic ointments and eye drops, but usually requires definitive surgical correction. PURPOSE: An effective modification of the gold lid loading technique is described, which we have found to be the simplest and most reliable method for lid reanimation. MATERIAL: After empiric evaluations with lead fisherman's weights 'glued' to the eyelid, a custom-made gold lid weight is made by a jeweller on the basis of the tarsal dimensions of the individual patient, and then sutured to the tarsus under local anaesthesia and covered with a fine sheet of temporal galea. Other ancillary procedures (lower lid suspension, lateral tarsal strip, lateral tarsoplasty) are added as required. METHODS: Between 1990 and 1996, 27 patients underwent this type of surgery, of whom 24 were re-evaluated after a mean follow-up period of 73.2 months (range 36-96 months), 14 of these for a minimum of 5 years. RESULTS: None of the gold weights was extruded, all 24 patients experienced marked improvement of their dry-eye symptoms and expressed a high degree of satisfaction. Six patients underwent further minor surgery (lateral McLaughlin tarsorrhaphy) in order to improve relative underaction. Two patients had ptosis (less than 2 mm of asymmetry) of the affected side but refused further correction. CONCLUSION: The use of custom-made gold lid weights and a protective galeal layer is a simple, reliable and successful means for permanently rehabilitating paralysed eyelids.
Assuntos
Doenças Palpebrais/cirurgia , Paralisia Facial/cirurgia , Fáscia/transplante , Ligas de Ouro , Próteses e Implantes , Adulto , Idoso , Blefaroptose/etiologia , Doença Crônica , Doenças Palpebrais/reabilitação , Paralisia Facial/reabilitação , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Complicações Pós-Operatórias , Desenho de Prótese , Reprodutibilidade dos Testes , Técnicas de Sutura , Músculo Temporal , Resultado do Tratamento , Xeroftalmia/prevenção & controleRESUMO
The vast extent and the world wide distribution of vitamin A deficiency is discussed. Its epidemiology is reviewed and sources of vitamin A in diets recorded, along with the high requirements of children. Strategy for prevention is described under three headings--short, medium and long term steps. Strategies in many countries received notice.
PIP: Conservative estimates project over 500,000 cases/year of new active corneal lesions and 6-7 million cases of noncorneal xerophthalmia attributable to vitamin A deficiency on a worldwide basis. Vitamin A deficiency affects growth, the differentiation of epithelial tissues, and immune competence. The most dramatic impact, however, is on the eye and includes night blindness, xerosis of the conjunctiva and cornea, and ultimately corneal ulceration and necrosis of the cornea. Vitamin A deficiency occurs when body stores are exhausted and supply fails to meet the body's requirements, either because there is a dietary insufficiency, requirements are increased, or intestinal absorption, transport and metabolism are impaired as a result of conditions such as diarrhea. Vitamin A deficiency is the single most frequent cause of blindness among preschool children in developing countries. The younger the child, the more severe is the disease and the higher the risk that corneal destruction will be followed by death. The most important step in preventing vitamin A deficiency is ensuring that children's diets include adequate amounts of carotene containing cereals, tubers, vegetables, and fruits. An overall strategy designed to prevent and control vitamin A deficiency, xerophthalmia, and nutritional blindness may be defined in terms of action taken in the short, medium, and long term. A short-term, emergency measure includes the administration to vulnerable groups of single, large doses of vitamin A on a periodic basis. In the medium-term, the fortification of a dietary vehicle (e.g., sugar or monosodium glutamate) with vitamin A can be initiated. Increased dietary intake of vitamin A through home gardening and nutrition education programs comprises the longterm solution to this problem. The World Health Organization plans to launch a 10-year program of support to countries where vitamin A deficiency is a significant public health problem.
Assuntos
Cegueira/prevenção & controle , Países em Desenvolvimento , Deficiência de Vitamina A/prevenção & controle , Xeroftalmia/prevenção & controle , Cegueira/epidemiologia , Cegueira/etiologia , Aleitamento Materno , Criança , Pré-Escolar , Dieta , Feminino , Educação em Saúde , Humanos , Lactente , Masculino , Ciências da Nutrição/educação , Gravidez , Desnutrição Proteico-Calórica/complicações , Desnutrição Proteico-Calórica/prevenção & controle , Vitamina A/administração & dosagem , Deficiência de Vitamina A/complicações , Deficiência de Vitamina A/epidemiologia , Organização Mundial da Saúde , Xeroftalmia/epidemiologia , Xeroftalmia/etiologiaRESUMO
The undisputed long term solution to prevent nutritional blindness lies in changing the dietary habits of a given population through nutritional education, nutritional supplementation, and nutritional rehabilitation. Before such strategies can be successfully implemented, it becomes necessary to study the existing dietary pattern of the population and to identify locally grown foods rich in vitamin A. Seventy eight rural women were interviewed to determine the common dietary items in western Rajasthan. These items were then matched with their B-carotene contents, only to discover that, 100 grams of any of them would not provide the RDA for a 1-3 year old child, with the exception of Suva (Peucedanum graveolens) and Bathua (Chenopodium album) leaves. The B-Carotene contents of several food items is unknown at present and there is an urgent need to evaluate them.