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The premenstrual symptom complex many women experience in a moderate to severe form can be divided into four subgroups. Because there is more than one syndrome and nervous tension is one of the most common symptoms, the term premenstrual tension syndromes (PMTS) is used. The most common subgroup, PMT-A, consists of premenstrual anxiety, irritability and nervous tension, sometimes expressed in behavior patterns detrimental to self, family and society. Elevated blood estrogen and low progesterone have been observed in this subgroup. Administration of vitamin B6 at doses of 200-800 mg/day reduces blood estrogen, increases progesterone and results in improved symptoms under double-blind conditions. Women in this subgroup consume an excessive amount of dairy products and refined sugar, and progesterone may be of value in them. The second-most-common subgroup, PMT-H, is associated with symptoms of water and salt retention, abdominal bloating, mastalgia and weight gain. The severe form of PMT-H is associated with elevated serum aldosterone. Vitamin B6 at high dosage suppresses aldosterone and results in diuresis and clinical improvement. Vitamin E helps the breast symptoms. Methylxanthines and nicotine should be curtailed and sodium limited to 3 gm/day. PMT-C is characterized by premenstrual craving for sweets, increased appetite and indulgence in eating refined sugar followed by palpitation, fatigue, fainting spells, headache and sometimes the shakes. PMT-C patients have increased carbohydrate tolerance and low red-cell magnesium. Adequate magnesium replacement results in improved glucose tolerance tests and decreased PMT-C symptoms. Deficiency of the prostaglandin PGE1 may also be involved in PMT-C. PMT-D is the least common but most dangerous because suicide is most frequent in this subgroup. The symptoms are depression, withdrawal, insomnia, forgetfulness and confusion. In ten PMT-D patients the mean blood estrogen was lower and the mean blood progesterone higher than normal during the midluteal phase. Elevated adrenal androgens are observed in some hirsute PMT-D patients. Two PMT-D patients with normal blood progesterone and estrogens had high lead levels in hair tissue and chronic lead intoxication. This subgroups needs careful medical attention when the symptoms are severe. Therapy should be individualized according to the results of the evaluation.
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PMID:Nutritional factors in the etiology of the premenstrual tension syndromes. 668 67

Infection-induced malnutrition, the most common form of cytokine-induced malnutrition, results from the actions of proinflammatory cytokines, ie, tumor necrosis factor (TNF) and interleukins 1,6, and 8 (IL-1, IL-6, and IL-8). During acute generalized infections, these cytokines initiate the acute-phase reaction. This reaction is quite stereotyped, and includes fever, malaise, myalgia, headaches, cellular hypermetabolism, and multiple endocrine and enzyme responses. In addition, there is heightened catabolism of muscle proteins and many amino acids; flux of free amino acids into the liver; hepatic synthesis of acute-phase plasma proteins; sequestration of iron and zinc; gluconeo-genesis; insulin resistance; impaired cellular uptake of fatty acids from plasma triglycerides; sizable losses of body nitrogen, potassium, magnesium, phosphate, and zinc; retention of body salt and water; heightened metabolic degradation and/or loss of vitamins; and an activation of the immune system. The pathogenesis of cytokine-induced malnutrition is thus vastly different from the malnutrition caused by uncomplicated starvation. Cytokine-induced malnutrition can have a devastating effect on the immune system and its functions. Although proinflammatory cytokines are found in mucosal fluids, where they contribute to the pathogenesis of inflammatory bowel diseases, it is not known whether cytokines play a role in toxigenic, secretory diarrheas such as cholera, which cause huge losses of body water, electrolytes, and bicarbonate while exhibiting no systemic manifestations of an acute-phase reaction.
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PMID:Herman Award Lecture, 1995: infection-induced malnutrition--from cholera to cytokines. 757 15

Seven hundred and three Nigerian village children in their first six years of life were subjected to anthropometric measurements and physical examination in early 1988. The heights of 66.9% and weights of 60.5% of them fell below the third percentile of a Nigerian equivalent for international reference population standard. Mid upper arm circumference values indicated moderate to severe malnutrition in over 25% of all 1-5 year old children surveyed. Fever, cough, headache and diarrhoea were the commonest symptoms encountered in the children. Mild pallor of the conjunctival mucosa and physical signs of protein energy malnutrition were commonly seen. Fungal and septic skin lesions were present in 11.45 and 11.1% of the children respectively, whilst rhinorrhoea was seen in 4.7%, otitis media in 6% and pharyngotonsillitis in 3.3%. Thirty four (4.8%) of the children had haemic whereas five had pathological murmurs. Dental calculi were present in 15.8%, umbilical herniae in 18.2%, hepatomegaly in 48.2% and splenomegaly in 23% of the children. Seven (1%) had cerebral palsy. The implication is that malnutrition, sickle cell disease, malaria and other infections are the prevailing causes of morbidity in the preschool aged children surveyed. Desirable improvements include upgrading socio-economic and living conditions and instituting appropriate control measures.
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PMID:Anthropometric measurement in children aged 0-6 years in a Nigerian village. 758 49

Dietary cells and the vitamins B12 and folate are necessary for the production of the red blood cells (erythrocytes), which carry oxygen from the lungs to the tissues and carbon dioxide from tissues to lungs. Deficiency of either one results in anaemia, which is characterised by low haemoglobin concentration. Symptoms result from reduced tissue oxygenation and include weakness, lethargy, palpitation, headache and shortness of breath. The first-time laboratory test of all patients suspected of being anaemic is the full blood count. Results of a full blood count may suggest the anaemia is caused by a nutritional deficiency of B12 folate or iron. Laboratory measurement of the concentration in blood of iron and vitamin B12 and folate, along with several other tests described here, are useful in the differential diagnosis of the anaemic patients.
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PMID:Deficiency testing for iron, vitamin B12 and folate. 760 52

Despite having normal height and weight, a 6-year-old girl had frequent bowel movements and slight recurrent chest infections since the age of 4 years and headache for 1 year. The patient appeared healthy, but examination of the ocular fundus revealed papilledema. Cranial computed tomography appeared normal. Lumbar puncture disclosed an elevated opening cerebrospinal fluid pressure, with normal biochemical, cellular, and bacteriologic findings. Laboratory investigations indicated pathologic steatorrhea, elevated electrolytes in 3 sweat tests, and low serum levels of vitamins A and E. The diagnosis of pseudotumor cerebri in a patient with cystic fibrosis was made. After treatment with prednisone (1 mg/kg/day), pancreatic extracts, and vitamin supplements, headache and papilledema resolved and serum vitamin A and E levels subsequently became normal. Older children with cystic fibrosis rarely have benign intracranial hypertension, but when present it is often due to hypervitaminosis during correction of malnutrition. In this child, pseudotumor cerebri and associated hypovitaminosis improved after combined corticosteroid and vitamin treatment.
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PMID:Benign intracranial hypertension in an older child with cystic fibrosis. 760 62

In India, 110 boys, 6-13 years old, working in 23 carpet-weaving factories within a 2 km perimeter of the walls around Jaipur in Rajasthan were compared with 290 age- and neighborhood-matched male students (controls) to determine the health and nutritional status of the child laborers. The cases had worked nonstop for most days of the month for the past 6 months. They had been employed, on average, for 3.4 years (range, 0.5-6.5). They worked 10-14 hours/day and were allowed at least one short tea break. Common working conditions included overcrowding (20/23 factories), improper ventilation, and poor lighting (particularly in basement factories). The boys either squatted or crouched for long hours. Good personal hygiene was more common among the students than the weavers (94.8% vs. 76.4%). In all age groups except the 6-7 year and 7-8 year groups, the students had greater weight and height than the weavers (p 0.05) (e.g., 13-14 years, height = 146.9 vs. 139.9 cm; weight = 32.5 vs. 28.9 kg). They even had a bigger chest circumference (p 0.05) (e.g., 13-14 years, 62.3 vs. 58.8 cm). The weavers were more likely than the students to suffer from headaches (34.2% vs. 15.9%; p 0.001), backache (18.2% vs. 5.9%; p 0.001), lower limb pains (15.5% vs. 5.2%; p 0.001), and acute respiratory infections (26.4% vs. 15.2%; p 0.005). They were also more likely to have signs of nutritional deficiency (conjunctival pallor; angular stomatitis; Bitot's spots; lusterless hair; Koilonychia nails; and spongy gums). The controls were more likely to be immunized than the cases. These findings reveal that carpet weaving takes a heavy toll on the health status of the child laborers. They need frequent medical care.
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PMID:Health status of carpet weaving children. 787 89

The follow-up of an important number of patients during the last three decades has shown a substantial difference between the clinical description of pellagra in the 40's (the triad: dermatitis, diarrhea, dementia) and its clinical aspects today: sun-exposed teguments revealing erythema and rapidly becoming pigmented and parchment like, dried, parched lips, angular stomatitis, lead like sclera fine cornea vascularization; gastro-intestinal disturbances: constipation, unjustified diarrhea, strange migratory abdominal feelings accompanied by ubiquitous dysesthesias. Other characteristics of this form of disease are: unexpressive look, continuously concerned, thoughtful, anxious or frowning, labile mind, headaches, insomnia. Villager's neurosis sometimes may be considered, in an appropriate clinical context, as a facet of nutritional deficiency. It is considered that the "classical" features of pellagra have changed due to: protein ingestion slightly below the lowest normal limit, decrease of strenuous physical activity and some associated diseases (frequently gastrointestinal disorders, chronic alcoholism).
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PMID:Particular features of clinical pellagra. 792 Mar 32

Some 9% of deaths in Ghana are attributed to malaria, which also accounts for 30% of outpatient visits and 9% of hospital admissions. A survey conducted in four areas of Ghana revealed that the factors perceived as causing malaria included malnutrition, mosquitos, excessive heat, excessive drinking, flies, fatigue, dirty surroundings, unsafe water, bad air, and poor personal hygiene. Most adolescents had no idea how the disease was spread from person to person. The symptoms most frequently considered to be linked to malaria were yellowing of the eyeballs, chills and shivering, headache, a bitter taste, body weakness, and yellowish urine. Malaria was considered to be the most important disease in the communities of Kojo Ashong, Barekese, Barekuma and Oyereko. There was a widespread understanding that malaria adversely impacted the ability of adults to work and of children to attend school. Herbal preparations for self-medication included liquids for drinking, liquids for use as enemas, and potions for hot fomentation. Most people used the leaves of the neem tree (Adzadi rachta indica) to make such preparations. Most interviewees were aware of chloroquine used in the treatment of malaria. A few people sprayed their rooms with insecticide before going to bed in order to kill mosquitos, while others used repellent coils. Bednets were rarely used. There was little knowledge of how the transmission cycle of the parasite could be broken. One social implication of the disease is that if the breadwinner dies, the children may have to cease attending school. For Africa as a whole the annual economic burden of malaria was $ 0.8 billion in 1987; by 1995 it is expected to be $ 1.7 billion. The first step in any control program should be to educate the people about the cause and treatment of the disease. District assemblies should enact bylaws on the cleanliness of households, which inspectors should enforce.
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PMID:Socioeconomic factors in malaria control. 794 58

A 27-year-old woman suffered from a sudden onset of slight paralysis of the right side of her body and the inability to express herself by speech, writing, or signs. She was admitted to the National Rehabilitation Hospital in Washington, D.C., in the US. 6 months prior to these events, she had been in a motor vehicle accident and had since experienced headaches and generalized musculoskeletal pain. The only drug she took was an oral contraceptive (OC), which she took irregularly. Health workers could not arouse her upon admission. Clinical examination revealed symptoms consistent with a left hemispheric stroke. Cerebral computed tomography and magnetic resonance imaging revealed a left temporoparietal infarct. Her free protein S was only 27% on admission and 14% 11 days after admission (normal range, 55-125%). Over the next 72 hours, her physical condition deteriorated, entailing focal motor seizures, right Babinski's sign, loss of pain reflex response on her right side, and complete paralysis of the right side of her body. The left middle cerebral artery appeared to be constricted, which physicians first believed was caused by vasculitis but later found was the result of emboli. The patient developed right femoral vein deep thrombosis. The physicians treated her initially with heparin and followed with warfarin therapy. Nevertheless, embolus. Health workers placed a filter in her inferior vena cava and continued warfarin therapy. She did not experience any more thrombotic or embolic episodes during the rest of her hospital stay. OCs reduce circulating levels of free protein S which, along with activated protein C, inhibits clotting. OCs likely reduced her already existing low levels of free protein S. Deficiency of free protein S was likely responsible for the cerebral infarction and her thrombotic and embolic episodes.
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PMID:A case of cerebral infarction in association with free protein S deficiency and oral contraceptive use. 823 70

The combined effects of nutrition and illness on the physical activity of subsistence farmers were investigated in a sample of 226 adults (114 households) from Ethiopia's drought-prone Rift Valley. The mean energy expenditure was estimated at 2937 kcal for men and 1977 kcal for women. Sex, age, nutritional status, period prevalence, severity of diseases, and seasonality independently influenced energy expenditure. The highest energy expenditures occurred during the pre-harvest period for men and during the harvest for women. The mean body mass index was 19.7 for men and 20.0 for women. 31.4% of men and 28.5% of women were defined as malnourished on the basis of a body mass index less than 18.5. 18.8% of respondents (20.9% of men and 17.1% of women) reported an illness in the preceding 2 weeks. Fever, headache, muscle and joint pain, malaise, and diagnosed malaria were the illnesses most frequently described. Of the 57 adults who reported a recent illness, half had stayed in bed for a mean duration of 7.8 days. Suspected, in this rural population, is a cycle of malnutrition, disease, and activity restriction that begins in childhood. Needed are interventions that reduce the prevalence of childhood stunting and health services that provide adequate prevention and treatment of diseases such as malaria.
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PMID:Physical activity, illness and nutritional status among adults in a rural Ethiopian community. 855 56


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