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All 749 deaths recorded by a rural hospital during 1983 were listed in five age groups according to the 9th revision of the International Classification of Diseases. The largest number of deaths were in adults aged 50 years and over and in children aged under 2 years, and the most frequent causes of death were malnutrition, hypertension, prematurity, heart failure and gastro-enteritis.
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PMID:Causes of death in a rural hospital in 1983. 404 75

From August 1978 to December 1983, 51 insulin-dependent diabetic patients with end-stage renal disease were selected for treatment by continuous ambulatory peritoneal dialysis. There were 27 male and 24 female patients, with a mean age of 52.3 +/- 13.5 years. Forty-five patients dialyzed themselves by continuous ambulatory peritoneal dialysis and six were treated by continuous cyclic peritoneal dialysis. All patients were treated at home. The cumulative duration of treatment was 65.6 patient-years; 14 patients were dialyzed for at least 24 months. Extrarenal complications were frequent at start of continuous ambulatory peritoneal dialysis, including hypertension in 48 patients, proliferative retinopathy in 50, and cardiovascular complications in 30. Age appeared to be the major risk factor, with success rates at 2 years of 78% in patients under age 50 years and only 50% in patients over age 50. The main cause of death was vascular and the main cause of transfer to other therapeutic modalities was abdominal complications or malnutrition or both. Excellent control of blood pressure, uremia, and blood glucose levels was obtained on a daily program of four exchanges. Improvement in visual status was frequently observed, mainly in the young population. In patients with juvenile diabetes, continuous ambulatory peritoneal dialysis should be part of an integrated program with transplantation, while in the elderly, the method offers a unique opportunity for them to treat themselves at home.
Hypertension
PMID:Continuous ambulatory peritoneal dialysis in diabetic patients. The relationship of hypertension to retinopathy and cardiovascular complications. 407 31

Dr. Grayson (February 21, p. 445) asks about changes in vital statistics of 3rd world populations as they develop. Of African populations, those in Johannesburg and other large South African cities, while still in transition, have now reached a relatively high level of sophistication. Their health pattern is likely to be that of other African countries as they prosper. The (IMR) infant mortality rate of blacks in Soweto, Johannesburg, is about 40/1000 live births, although nearer 30 in the regularly employed elite. This figure is similar to that for blacks in New York in 1965 and for class 5 persons in the United Kingdom. Small-town dwellers have higher IMRs and in rural areas the rates are higher still although they are decreasing everywhere. Family size is decreasing; in urban areas the average family has 3-4 children and the elite have 2-3. In Johannesburg during the 1960s, the birth rate was about 40/1000 and it is now 25. While the rate is higher in rural areas, it is falling. In the very young, gastroenteritis with or without malnutrition is still the leading cause of sickness and death in both urban and rural areas. Rates are however decreasing. Deficiency diseases, especially pellagra, remain a health problem in some areas. Tuberculosis still continues to be a major hazard although it is being dealt with. With the rise in socioeconomic status and associated changes in diet and lifestyle, obesity, especially in urban areas and especially among women, is becoming very prominent. Hypertension is more common and is the leading cause of natural death among urban dwellers. The toll from coronary heart disease and noninfective bowel disease remains inexplicably low, but diabetes is only somewhat less prevalent than it is among whites. Changes in cancar pattern and rates are slight; however, esophageal cancer in men and cervical cancer in women are the main causes of concern in the urban centers and some rural areas. Rising alcohol consumption is a major problem with its ramifications in pancreatic, liver, and heart problems. Cigarette smoking is now as common as among whites. Because of low rates for most degenerative diseases, blacks have, at middle age, a life expectancy exceeding that of whites. As sections of the 3rd world population prosper, the IMR decreases enormously as does family size. However, infections and malnutrition among the very young and tuberculosis in older groups remain important problems. Among adults, rises occur in some degenerative diseases but not in others, and diseases linked with hypertension and alcohol consumption have become formidably common, as they have in other developing and developed countries.
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PMID:Third World policies and realities. 611 Sep 78

South Africa is unique in many ways, including the state of health of its children. Discussion focuses on vital statistics -- perinatal and infant mortality rates, disease profiles, nutritional status; and demographic and socioeconomic data -- African communities, Indian communities, coloured communities, and social expenditure. The perinatal mortality rate for africans in Natal and Kwa Zulu varies from 19.7-51.9/1000 in the smaller hospitals. At the main teaching hospital in Durban, the King Edward viii, it was 75.8/1000 in 1980. The most common causes of death in the rural babies weighing more than 1500 gm were septicemia, asphyxia, meconium aspiration, and tetanus neonatorum. In those under 1500 mg the most common causes were respiratory distress, intracranial hemorrhage, and hypothermia. The main causes of the high perinatal mortality among Africans at King Edward viii Hospital were amniotic fluid infection syndrome, abruptio placenta, hypoxia, hypertension, and congenital syphilis. Accurate data for infant mortality rates for Africans are unavailable. Available data show considerable variation. The official infant mortality rates given by the State Health Department for 1975 for the country as a whole were 20.1/1000 for whites, 100.2/1000 for Africans, 104.0/1000 for coloureds, and 34.7/1000 for Asians. Black children under age 5 make up 16% of the total population but account for 55% of total deaths, whereas white children of this age make up 11% of the population and account for only 7% of total deaths. Of the 7688 admissions of African children to King Edward viii Hospital in 1980, more than 80% were due to infections, and the overall mortality in these patients was 20%. The percentage of children below the 3rd centile for weight was 6-12% for infants under 1 year old, 20-55% in children aged 1-6 years, and 30-70% in school age children. The percentage stunted (below 3rd centile for height) varied from 22-66% in preschool children. At King Edward viii Hospital, approximately 40% of children admitted are malnourished. In the main the majority of blacks are poor, illiterate, and living in overcrowded conditions. Many are unemployed or employed away from home, which causes serious disruption of family life with such consequences as teenage pregnancies and malnutrition. The mortality rates, disease profiles, and socioeconomic status of the whites in Sourh Africa are similar, and often superior, to those in Western countries. The reason for this discrepancy in the state of health and socioeconomic development of population groups is the government's policy of separate but unequal development; the policy of apartheid that reserves 87% of the land for 16% of the people, the white minority.
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PMID:The health of children in South Africa: some food for thought. 614 93

Bilateral nephrectomy is sometimes required for the control of severe hypertension or nephrotic syndrome. Surgical intervention in a patient with uncontrollable hypertension or the malnutrition and anasarca of nephrotic syndrome is associated with increased risk for the development of operative complications. We report 2 hemodialysis patients, 1 with uncontrollable hypertension and 1 with nephrotic syndrome, who were successfully treated with percutaneous renal infarction. Inflatable and detachable balloons were placed in each renal artery by percutaneous arterial catheterization. Neither patient experienced any significant complication from the procedure.
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PMID:Therapeutic percutaneous renal artery occlusion with a detachable balloon. 624 Sep 39

A 20-year-old woman presented with malignant hypertension, pulmonary edema, anemia, and azotemia. Blood pressure was adequately controlled only after progressively more intensive drug regimens, finally including minoxidil, nadolol, and furosemide. On these drugs, the patient developed progressive left and right heart failure, anasarca, and malnutrition. The control of hypertension, heart failure, and fluid retention, was accomplished by administration of captopril and furosemide. Captopril is a logical alternative to vasodilators in refractory hypertension complicated by congestive heart failure.
Hypertension
PMID:Efficacy of captopril in relieving congestive heart failure developing during management of hypertension. Case report. 634 Dec 22

Cadmium has been shown to manifest its toxicity in human and animals by mainly accumulating in almost all of the organs and kidney is the main target organ where it is concentrated mainly in cortex. Environmental exposure of cadmium occurs via food, occupational industries, terrestrial and aquatic ecosystem. At molecular level, cadmium interferes with the utilization of essential metals e.g. Ca, Zn, Se, Cr and Fe and deficiencies of these essential metals including protein and vitamins, exaggerate cadmium toxicity, due to its increased absorption through the gut and greater retention in different organs as metallothionein (Cd-Mt). Cadmium transport, across the intestinal and renal brush border membrane vesicles, is carrier mediated and it competes with zinc and calcium. It has been postulated that cadmium shares the same transport system. Cadmium inhibits protein synthesis, carbohydrate metabolism and drug metabolizing enzymes in liver of animals. Chronic environmental exposure of cadmium produces hypertension in experimental animals. Functional changes accompanying cadmium nephropathy include low molecular weight proteinuria which is of tubular origin associated with excess excretion of proteins such as beta 2 microglobulin, metallothionein and high molecular weight proteinuria of glomerular origin (excretion of proteins such as albumin IgG, transferrin etc.). Recent data has shown that metallothionein is more nephrotoxic to animals. Cadmium is also toxic to central nervous system. It causes an alterations of cellular functions in lungs. Cadmium affects both humoral and cell mediated immune response in animals. Cadmium induces metallothionein in liver and kidney but under certain nutritional deficiencies like protein-calorie malnutrition and calcium deficiency, enhanced induction and greater accumulation of cadmium metallothionein has been observed.
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PMID:Molecular basis of cadmium toxicity. 638 35

Historically, the sodium ion has been given prominence in relation to cardiovascular disease, perhaps to the exclusion of other ions. Recently, other ions, including chloride, potassium, magnesium and calcium have received increasing attention in relation to hypertension, cardiac arrhythmias, and metabolic derangements. Endocrine factors controlling these ions have also received increasing attention; they include classic hormonal actions as well as neurotransmission and paracrine hormonal actions. Studies indicate that control of the renin-angiotensin-aldosterone system resides in cytosolic calcium ion levels in the juxtaglomerular cell, as well as chloride ion and prostaglandins at the macula densa. Renin release is stimulated by hyperpolarisation of the juxtaglomerular cell induced by beta 1-agonists, parathyroid hormone, glucagon, magnesium and low cytosol calcium. Renin release is inhibited by high calcium, potassium and angiotensin II. Subsequent to renin release, hormonal regulation includes stimulation of converting enzyme activity by cortisol and prostaglandin (PGE2). Other hormonal control includes antidiuretic hormone producing dilution of extracellular electrolytes and augmented peripheral resistance. A recently identified natriuretic factor isolated from cardiac atria appears to be a potent diuretic with actions similar to that of frusemide (furosemide). Other electrolytes have received closer scrutiny. Chloride may play a dominant role in renal sodium reabsorption, responding to prostaglandin levels. Calcium has been recognised as a basic regulator of the secretion of such hormones as noradrenaline, renin, and aldosterone. As well, calcium ion changes are the means by which smooth muscle contraction is effected. Parathyroid hormone and vitamin D regulate the level of this ion in the body. In addition, a high dietary calcium intake appears to play a protective role against hypertension, while calcium channel blockers appear to reduce blood pressure. Endocrine systems play a major role in the protection against acute elevations in serum potassium by means of insulin action and adrenergic modulation of extrarenal potassium disposal. Aldosterone is recognised as the delayed regulator of potassium excretion. Magnesium levels fall in hyperaldosteronism, hyperparathyroidism, and diabetic keto-acidosis, as well as in malnutrition states. A coexisting potassium deficiency may be refractory to therapy until hypomagnesaemia is corrected. The integrated action of these hormones and electrolytes are thus of major importance in regulation of the cardiovascular system.
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PMID:Endocrine physiology of electrolyte metabolism. 638 78

There are two families of essential fatty acids, the linoleic and linolenic. Linoleic acid (C18:2n-6), found mainly in vegetable seed oils, is desaturated and elongated in the body, forming arachidonic acid (C20:4n-6). Linolenic acid (C18:3n-3), the main dietary source of which is leaves, is desaturated and elongated, forming two fatty acids that are prevalent in fish oils: timnodonic (C20:5n-3) and clupanodonic (C22:6n-3). EFA are very easily peroxidized in air, but vitamin E protects against this. There are three functions of EFA. The most important is as part of phospholipids in all animal cellular membranes: in deficiency of EFA faulty membranes are formed. A second is in the transport and oxidation of cholesterol: EFA tend to lower plasma cholesterol. A third function is as precursors of prostanoids which are only formed from EFA. Deficiency of EFA in experimental animals causes lesions mainly attributable to faulty cellular membranes: sudden failure of growth, lesions of skin and kidney and connective tissue, erythrocyte fragility, impaired fertility, uncoupling of oxidation and phosphorylation. In man pure deficiency of EFA has been studied particularly in persons fed intravenously. A relative deficiency (that is, a low ratio in the body of EFA to long-chain saturated fatty acids and isomers of EFA) is common on Western diets and plays an important part in the causation of atherosclerosis, coronary thrombosis, multiple sclerosis, the triopathy of diabetes mellitus, hypertension and certain forms of malignant disease. Various factors affect the dietary requirement of EFA.
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PMID:Essential fatty acids in perspective. 646 3

Throughout adult life, there is progressive alteration in body composition and tissue function. There is loss of lean body mass, notably by muscle, with a gain in body fat. We do not know whether nutritional factors affect these gross changes. In the case of loss of bone density (osteoporosis), however, there is evidence that the process is retarded by raising the intake of calcium and by exercise. Aging also adversely affects tissue function at the level of the whole organ and tissue as well as at the cellular and subcellular level. Animal models show similar age-related changes, and demonstrate further that alterations in nutrient intake or exercise can alter the rate of loss of tissue and cellular function. In addition to the effects of adult aging on tissue function, certain chronic diseases and disabilities are related to aging. These conditions include atherosclerosis, hypertension, coronary thrombosis, cancer, etc. Both human epidemiological studies and animal experiments on aging suggest strongly that nutrition plays a role in the onset and development of these conditions. There is a need for more accurate assessments of the nutrient needs of people over 65 years of age. A few selected nutrients are discussed. Studies of energy intake during adult life show a progressive reduction with increasing age, due mainly to reduced physical activity. Vitamin C levels in the white blood cells of elderly women can be half those of young adults; these respond to supplementary vitamin C without evidence of clinical benefit. Nitrogen balance studies suggest that the allowance of protein for older adults is not less than for young. Finally, surveys of elderly in whole populations and in selected groups show that, by the nutritional standards of young adults, there may exist a significant amount of malnutrition in people as they grow old, though we do not know whether this affects rate of loss of tissue function with age.
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PMID:Nutrition and the elderly: a general overview. 650 37


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