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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The potential efficacy of preventive interventions in Latin America to reduce perinatal morbidity and mortality is reviewed. The most important perinatal risk factors associated with pregnancy and delivery are young age of the mother, low socioeconomic status, low education, malnutrition, lack of prenatal care, pregnancy-induced-hypertension, perinatal infections, alcohol, smoking, and iatrogenic causes. Adequate data are lacking to determine the magnitude of these factors in Latin America. Iatrogenic causes of perinatal morbidity are increasing because of the tendency to institute neonatal intensive care before improvement in medical and nursing staff and procedures. Specific programs that have been effective include the 30-year effort in Chile to reduce the incidence of low birth weight. Infant death rates in Latin America fell between those in Asia and the West, correlated with the occurrence of low birth weights. Nutritional programs are mixed in their effect: they do not necessarily help unless targeted at women with clinical malnutrition or history of LBW or IUGR; they can harm overall food production in the community. Increasing institutionalization of labor and delivery is a mixed blessing. Efforts in Guatemala to reverse the worst aspects of hospital delivery have improved pregnancy and labor outcomes. These include permitting fathers to attend births, allowing women to deliver in kneeling position, and encouraging infant bonding and breast feeding. Other effective interventions include mothers meetings to encourage prenatal care, and detection and referral of high risk cases in a regionalized system of care.
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PMID:Emphasis on preventive perinatology: a suitable alternative for developing countries. 306 47

The effects of essential fatty acid deficiency (EFAD) on vascular reactivity to vasoconstrictor stimuli were studied in rat autoperfused hindquarters. Weanling male Sprague-Dawley rats (aged 21 days) were fed diets containing 8% (weight/weight) of stearax plus 2% safflower oil (control diet) or 10% stearax (EFAD diet) for 8 weeks. There was no difference in systemic blood pressure or body weight between the two groups. Basal production of immunoreactive 6-keto-PGF1 alpha by aortic segments was much less in EFAD aortae than in control aortae. In contrast, immunoreactive 6-keto-PGF1 alpha produced by incubating aortic segments with exogenous arachidonic acid (12 mumol/l) was much greater in EFAD aortae than in control aortae. Moreover, conversion of [14C]-arachidonate to [14C]-6-keto-PGF1 alpha was more pronounced in EFAD aortae than in control aortae. Vasoconstrictor responses to noradrenaline (0.01-1.0 mumol/l) and angiotensin II (0.001-1.0 mumol/l) infused into the blood perfused hindquarters were then examined. The rats on the EFAD diet were more sensitive to both noradrenaline and angiotensin II than rats on the control diet (P less than 0.05, two-way ANOVA). Thus, a deficiency of essential fatty acids can lead to increased vascular sensitivity to vasoconstrictor stimuli. Deficiency of arachidonic acid in phospholipid stores is also accompanied by augmented cyclo-oxygenase activity in the vessel wall, similar to that observed previously in spontaneously hypertensive rats (SHR) and rats with one kidney renovascular hypertension.
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PMID:Increased vascular reactivity induced by essential fatty acid deficiency in rat autoperfused hindquarters. 312 60

Records of 86 patients in Ruhengeri Hospital North of Rwanda (east Africa) during nine months, revealed that diabetes was present in about 4% of all these patients. First of all, malnutrition was noted in about 9% of these diabetics. But, features of the diabetes mellitus were usually as described by Sankale as the "Cosmopolitan Diabetes".--67% of all the patients were male persons from 31 to 49 years old--Typical symptoms as: thirst, polyuria and weight loss were noted in most all patients,--Insulin requirement was noted in 65% of the patients,--Only few patients were diabetic for more than 10 years,--Neuropathy, retinopathy were usually shown,--17.5% of the patients had abnormally high blood pressure (Hypertension). Diabetes mellitus cannot be considered as a preferred share in Africa but malnutrition and obesity, at the opposite side of the nutritional spectrum, are the striking originality of this disease in developing countries.
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PMID:[Clinical study of diabetes mellitus in hospital practice in Northern Rwanda (apropos of 86 case reports)]. 318 67

This paper discusses the possible pathogenesis of the cerebral atrophy (CA) observed in a large percentage of uraemic patients, taking the form of prevalently cortical damage (cortical atrophy) and/or subcortical enlargement of ventricular cavities (subcortical atrophy). This central nervous system pathology seems to share very little either with the better known 'dialysis encephalopathy' or with the 'acute encephalopathy syndrome', even though sporadic cases of both these forms have shown concomitant CA. Histopathologically it offers the picture of loss of neurons and nerve fibres and can thus be compared with uraemic peripheral nervous system damage. CA is unquestionably important because of its implications in terms of impairment of superior cortical functions, just as in CA of non-uraemic aetiology. A first aetiopathogenic hypothesis might include endogenous uraemic intoxication to the nerve tissue, believed responsible for peripheral uraemic neuropathy, but other possibilities merit consideration: vascular calcification secondary to hyperparathyroidism, blood lipid disorders, and systemic hypertension--factors that contribute to impairing the brain vasculature, with cascade effects on brain tissue oxygenation, neuronal metabolism, and energy exchanges. Tissue oxygenation is already jeopardized in the uraemic patient by the concomitant chronic anaemia and by cardiac insufficiency in cases with hypertensive heart disease. In dialysis patients with volume-dependent hypertension the brain may be further damaged by abrupt pressure changes produced by dialytic ultrafiltration; these constitute a severe challenge to cerebral blood flow autoregulation. Cyclic variations of brain tissue hydration connected with regular dialysis treatment may have adverse effects on neurotransmitter functions, particularly those mediated by neuropeptidergic systems. Chronic intoxication may result from oral Al(OH)3 of phosphorus-chelating agents: in animal studies and clinical observations in non-uraemic populations the neurotoxic potential of Al is indicated by a significant correlation between histological neuronal damage, impaired function, and Al concentration in brain tissues. In addition, a concausal role of malnutrition in central nervous system damage in the uraemic patient cannot be overlooked, since malnutrition is known to give rise to functional and structural alterations in non-uraemic human pathology. In the light of these clinical observations and experimental findings, it would appear that the prevention of CA in uraemia is today feasible.
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PMID:Pathogenesis of cerebral atrophy in uraemia. State of the art. 328 91

A survey of Hereros, Kavangos and Bushmen living in the rural districts of South West Africa/Namibia was undertaken in order to assess their dietary intakes, nutritional status and disease patterns. The results showed that Hereros were taller and heavier, with the highest incidence of obesity (15-30%) and hypertension. Their diet consisted chiefly of refined maize meal supplemented with sour milk, and their blood lipid levels were generally lower than Western standards. The diet of Kavangos, based on homeground millet supplemented with fish and fresh vegetables, was better balanced. However, malnutrition was more common particularly in hospital patients where 40% had infective disease. Finally, the diet of Bushmen was extremely poor consisting of whatever was available (generally maize meal) and excessive use of home-brewed alcohol. The majority were malnourished and 73% of those hospitalised had tuberculosis. The blood lipid levels of Bushmen and Kavangos were exceptionally 'favourable' by Western standards but associated with chronic malnutrition. The survival of Bushmen in modern society is a matter of grave concern.
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PMID:Nutritional status, dietary intake and disease patterns in rural Hereros, Kavangos and Bushmen in South West Africa/Namibia. 337 28

Peripartum heart disease is reviewed in the light of reports in the literature and personal experience from the University College Hospital, Ibadan. It is concluded that it is worldwide in distribution but appears most commonly in multiparous black women with a low socioeconomic background. The clinical features are the same as those of dilated cardiomyopathy, with the exception of cases from Zaria, northern Nigeria, where heart failure may be induced by high salt and fluid intake. The possible causes of peripartum heart disease are reviewed. Glomerulonephritis, toxemia of pregnancy, and malnutrition have not been shown convincingly to be causal, and infection, hypertension, and alcoholism have been suggested. Hypertensive heart failure and toxemia of pregnancy can induce peripartum heart disease. It is concluded that the myocardial disorder in peripartum heart disease is probably the same condition as dilated cardiomyopathy, and that infection may be an important element. However, diverse other factors may also play a part.
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PMID:Peripartum heart disease. 384 85

Calcium homeostasis is a complex process involving calcium, other involved ions, and three calcitropic hormones, parathyroid hormone, calcitonin, and 1,25-dihydroxyvitamin D3. The principal maternal adjustment during pregnancy is an increasing parathyroid hormone secretion which maintains the serum calcium concentration in the face of a falling albumin level, an expanding extracellular fluid volume, an increasing renal excretion, and placental calcium transfer. The placenta transports calcium ions actively, making the fetus hypercalcemic relative to its mother, which in turn stimulates calcitonin release and perhaps suppresses parathyroid hormone secretion by the fetus. A unique extrarenal system for 1 alpha-hydroxylation of 25-hydroxyvitamin D3 exists in the placenta and/or decidua, providing a source of 1,25-dihydroxyvitamin D3 for the fetus. With the abrupt cessation of the placental source of calcium at birth, the neonate's serum calcium level falls for 24 to 48 hours, then stabilizes and rises slightly. Hyperparathyroidism during pregnancy causes complications in both mother and infant and should usually be treated surgically as soon as diagnosed. Maternal hypoparathyroidism can be treated satisfactorily with high doses of supplemental calcium and vitamin D. Osteopenia accompanying long-term heparin administration may respond to 1,25-dihydroxyvitamin D3 (calcitriol) therapy. Diabetes in pregnancy is associated with disturbed neonatal calcium homeostasis, perhaps due to chronic hypomagnesemia. A possible etiologic role of calcium deficiency in pregnancy-related hypertension has been suggested. Dietary deficiency of calcium and/or vitamin D during gestation may lead to several adverse effects in the newborn infant.
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PMID:Calcium metabolism in pregnancy and the perinatal period: a review. 388 Oct 31

The rural population of many developing countries show an association between poor health and malnutrition, but little information is available on the urban communities. To investigate nutritional status there, the researchers chose Luveve, a black township of Zimbabwe. The heads of the household from each of 70 blocks were interviewed and the circumference of their families' mid upper arms were measured. Of the households visited, incomes ranged from US$30 to $300 per month. Food supplies were purchased from a grocer; the majority also maintained a vegetable garden. Diets were found to consist primarily of refined cereals, vegetables, soft drinks, and some milk and eggs. As regards infant feeding, the 66 mothers interviewed reported weaning their babies from the breast by 5 months. On the basis of arm circumference measurements, the population was not found to be undernourished. In fact, gross obesity was observed in 50% of the adults and many preschool children. Subnutrition was reported in only 3 members of the community. These measures vary considerably from those of the rural populations. The most significant finding was widespread obesity probably due to the high consumption of refined, starchy products. This could translate into obesity related diseases such as hypertension, diabetes, and cardiovascular disease.
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PMID:Nutritional status of an urban community in Zimbabwe. 401 9

A nutritional survey performed in the Senegal mid valley in 1983 including 610 individuals shows that mild to moderate protein-energy malnutrition, specific deficiencies and anemia are still present. In addition new health hazards such as overweight and perhaps high blood pressure, raise and may burden public health welfare in that area.
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PMID:[Nutrition studies in the mid valley of Senegal. 2. Nutritional health of the population and its trends]. 402 14

Estimated prevalence of diabetes mellitus in Malaysia was about 2%. Diabetes was most common in Indians especially males and least common in Chinese. There was a slight male preponderance seen in Malays and Indians. Positive family history was obtained in 14% of cases most commonly in Malays, almost 1/3 of whom had more than one family member with diabetes. Familial association was uncommon in Chinese. Over 50% of patients were overweight. Obesity was noted in nearly 70% of female Malays and Indians while the majority of Chinese were not overweight. More than 80% of patients were non insulin requiring. Youth onset diabetes was considered rare; those 10 years and below were estimated to be only 0.4% and below 20 years of age between 2%-4% of the diabetic population. Females were twice as common than males in this type of diabetes and familial association was greater. Malnutrition-related diabetes and pancreatic calcification were not well-documented but youth-onset non insulin requiring diabetics with mild symptoms but strong family history of diabetes were observed. More than half of hospital-based patients had evidence of complications, mainly amongst Malays and Indians. Hypertension was the most frequent associated disease followed by foot ulcers and ischaemic heart disease. Hypertension usually associated with chronic renal failure was most common amongst Malays while gangrenic ulcers and heart diseases were seen mainly in Indians. The major causes of death were chronic renal failure, myocardial infarction, ketoacidosis, stroke and septicaemia related to gangrene.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Diabetes mellitus in peninsular Malaysia: ethnic differences in prevalence and complications. 403 85


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