II. Самостоятельная работа
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PEDIATRIC AS A SCIENCE
The major developments in pediatrics, the special branch of medical science that deals with the prevention and treatment of diseases of children, took place after the turn of the 20th century. Prior to that time there existed but little exact knowledge of the special problems of child health. Infants and young children were regarded merely as miniature adults whose physical, mental and emotional disorders required no special consideration beyond that afforded mature persons.
As a result of this attitude and the undeveloped state of medical science and practice, the incidence of disease and mortality rates among children were appalling: 20% to 40% of all infants born alive died during the first year of life. Of the total deaths in the entire population 3 out 4 occurred in children under 12 years. However, as a result of revolutionary advances in the field of pediatrics and intensive application of sound public health principles, death rates among children in the more advanced parts of the world had been reduced.
One of the most important steps in the progress of modern pediatrics was the recognition by medical practitioners of certain fundamental differences between the child and the adult. Because of his state of immaturity, the infant or young child differs from the mature person physiologically, psychologically, immunologically and anatomically. The constant changes in functional patterns incident to growth and development impose different standards for health appraisal and for nutritional medicinal and other health requirements in the very young throughout the wide range of diseases affecting infants and children, the concept of prevention predominates that the treatment in the mind of the properly oriented physician.
Fortunately, advances in the sciences of genetics, nutrition, microbiology, immunology, epidemiology, hygiene and sanitation made it possible for medical practitioners and public health officers to exercise a large measure of control over many of the most devastating physical diseases. Improvements in diagnostic laboratory techniques together with revolutionary developments in pediatric surgery and treatment with drugs and immune blood serums reduced the dire effects of certain nonpreventable diseases to a minimum as well.
The diseases that affect infants and children may be classified according in the nature of their cases, the particular organ systems primarily involved or a combination of these methods.
Since pediatrics is based upon the concepts of growth and development of the individual, the pediatric physician must take into account all factors known to influence the orderly course of these normal processes from the moments of conception throughout the periods of infancy, childhood, and adolescence. For example, such determining factors as heredity, prenatal influences (including maternal illness) and injuries incident to the process of birth explain most cases referred to as diseases of the newborn.
SOME NOTIONS OF THERAPEUTICS
The first essential point to be in mind is that the child is not to be treated in the same way as an adult. Children vary far more than adults, both physically and mentally. Each child presents an individual problem; fixed rules cannot be applied. In the treatment of children, the physician’s methods must be flexible and adaptable.
The use of drugs particularly requires much judgement. The possible harm that may result from a given prescription should always be considered.
But good prescriptions are by no means the only objective. The physician who orders the medicine indicated for his little patient, and then dismisses the case from his mind, will find his results frequently disappointing, for details play a large role in the treatment of children.
The parents must be made to understand the results cannot always be immediate. Delicate, nervous children, or those who have serious digestive trouble, may require many months of careful supervision, with little evidence of improvement. The physician, on the other hand, should not permit himself to be too easily encouraged by slow results. Patience and persistence must be combined with a thorough understanding of the problems involved. Without these factors, success in the treatment of children will be difficult to achieve.
Hygiene and sanitation are such familiar subjects that it is only necessary to emphasize their relation to treatment. The patient’s surroundings should be clean, well ordered, and cheerful. This accomplishes not only the obvious purpose of avoiding infection as much as possible, but also reacts beneficially on the child’s mental attitude.
In any infectious disease, extreme care should be taken to prevent spread of the infection. Fresh air and sunlight are valuable disinfectants, and should be used abundantly. Contact with other people should be avoided.
Rest is an important aid, both as a preventive and as a cure. Adequate sleep at night, and a quiet period after dinner, should be insisted upon. A child with fever, however slight, ought to be kept in bed until his temperature becomes normal, sometimes for several days thereafter. This will often avert a serious disease.
An adequate diet is one of the essentials of good health. Its importance in illness is likely to be even greater. Some conditions can be controlled, and many others improved, by changes in diet alone.
In any illness, one of the first considerations is the maintenance of nutrition without causing gastro-intestinal disturbance. Only those foods which are easily assimilated and do not produce distention should be permitted. Fluids should be given liberally, as they dilute toxins and increase elimination. It is advisable to keep the bowels open, if possible, by laxative food such as fruit juices and vegetables. The mineral content of the diet should be adequate. The vitamins should be liberally supplied, particularly vitamin A, as this food factor is thought to build resistance to respiratory infections.
MEDICAL AND NURSING CARE
Nowadays babies are born in a hospital. There the doctor is closer at hand when needed, and he is assisted by interns, nurses, technicians and consultants. A hospital offers all the complicated equipment, like incubators and oxygen tents, to cope with sudden emergencies. All this makes the mother feel very safe and well cared for. The babies are usually in a nursery, where they can be cared for. The babies are usually in a nursery, where they can be efficiently watched and cared for by the nurses. The mother begins taking care of her baby holding him, feeding him. She has the chance to practice these things while she is among experienced people who can explain things to her and help her. She learns about her baby’s hunger patterns, his sleep, his cry, his bowel movements.
When the mother takes her baby home she is visited by a visiting nurse who will show how to make the formula, bathe the baby, diaper him, help her in other practical child-care matters, and follow directions of the doctor.
The way to be sure that your baby is doing well is to have him checked by a doctor regularly. The visits should be once a month in the early months. The doctor will want to weigh and measure the baby to see how he is growing, examine him to see that he is developing well, give him his inoculations. The mother will have five or ten questions that she wants to ask, with her first baby anyway. It’s a good idea to have a little notebook for writing down questions when they come to your mind at home and also for noting developments, such as teething or a rash, that you may want to know the date of later.
There are hundreds of different diseases and injuries such as fever, colds, hoarseness of voice, difficulty in breathing, vomiting, pain, diarrhea, rashes and so on which should always be reported to the doctor immediately.
By far the most important rule is to consult the doctor promptly if a baby or a child looks differently. By this it is meant such signs as unusual paleness, unusual tiredness, unusual drowsiness, lack of interest, unusual irritability, anxiousness, restlessness, prostration.
PREVENTING IRON DEFICIENCY ANAEMIA
The role of follow-on formulae
Many studies have indicated that iron deficiency is common in Britain. It is particularly prevalent in areas of social deprivation, typically inner cities and in children who are members of an ethnic minority group. In 1986 Ehrhardt showed that 28% of Asian children and 12% of Caucasian children admitted to hospital in Bradford were anaemic. A further study completed in 1990 in an inner city practice in Nottingham showed an overall incidence of anaemia of 25%, rising to 39% in Asian children.
The clinical consequences of iron deficiency anaemia are well documented. However, there is growing evidence to suggest that iron has a vital role to play beyond the red blood cell. The non-haematological effects of a lack of iron are not fully understood. Evidence from several studies would suggest that iron deficiency anaemia is associated with behavioural and cognitive changes. If these behavioural changes are related to tissue deficiency and not to haemoglobin concentration, they may be important before iron deficiency has been clinically detected.
The association of iron deficiency during infancy with changes in behavioural development has been shown in at least five independent studies conducted in five separate cultures. All five studies used careful definitions of iron status and included comparison groups without anaemia. All showed that infants with anaemia scored lower on tests of mental development than infants without anaemia; on average 6-14 points lower on the Bayley Scales of Infant Development. Four of the studies showed that anaemic infants’ scores on motor development tests were lower.
In intervention studies, anemic infants treated with iron did not show a significant improvement in the development tests after 1-2 weeks of iron therapy. The potential consequences of these findings have far reaching effects and the need to prevent iron deficiency in early infancy becomes a priority for the health professional. The use of appropriate weaning foods in conjunction with infant formula is widely recommended in the first year. Although the tendency for mothers to keep their infants on infant formula for longer is increasing, some mothers still change their infants to doorstep cow’s milk before the age of 12 months. The 1990 survey indicated that as many as 36% of infants were given cow’s milk as the main drink at nine to ten months. In addition, even if the older infant is maintained on infant formula, it is usual to find low intakes of milk as little as 300-400ml daily. This supplies less than 50% of the infant’s iron requirements. It seems reasonable, therefore, to encourage follow-on formula for infants over six months of age who are on low volumes of infant formula and those infants who have already changed to cow’s milk.
Unfortunately, most follow-on formula is not available on milk tokens, which severely limits its usage. Other than this, it does not appear to have any disadvantages over standard infant formula for infants over the age of six months, and there is little evidence of parents misusing it by giving it to babies below this age. As we concluded in our leader in last month’s Professional Care of Mother and Child, it is probably time to reappraise our thinking on follow-on formulas, as they may be one of the many resources we can use to help prevent iron deficiency.
Words:
Follow on formulae – дополнительные смеси
Token – ярлык, информация о составе
Caucasian: of a proposed human racial classification distinguished by light and brown skin colour and including peoples indigenous (native) to Europe, N. Africa, W. Asia and India.
Hemophilia
TELEMEDICINE IN PRACTICE
Telemedicine is defined as the “delivery of health care and sharing of medical knowledge over a distance using telecommunication systems.” The concept of telemedicine is not new. Beyond the use of the telephone, there were numerous attempts to develop telemedicine programs in the 1960’s mostly based on interactive television. The early experience was conceptionally encouraging but suffered inadequate technology. With a few notable exceptions such as the telemetry of medical data in the space program, there was very little advancement of telemedicine in the 1970s and 1980s. Interest in telemedicine has exploded in the 1990s with the development of medical devices suited to capturing images and other data in digital electronic form and the development and installation of high speed, high bandwidth telecommunication systems around the world. Clinical applications of telemedicine are now found in virtually every specialty. Teleradiology is the most common application followed by cardiology, dermatology, psychiatry, emergency medicine, home health care, pathology and oncology. The technological basis and the practical issues are highly variable from one clinical application to another. Teleradiology, including telenuclear medicine, is one of the more well-defined telemedicine services. Techniques have been developed for the acquisition and digitization of images, image compression, image transmission, and image interpretation. The American College of Radiology has promulgated standards for teleradiology, including the requirement for the use of high resolution 2000 x 2000 pixel workstations for the interpretation of plain films. Other elements of the standard address image annotation, patient confidentiality, workstation functionality, cathode ray tube brightness, and image compression. Teleradiology systems are now widely deployed in clinical practice. Applications include providing service from larger to smaller institutions, coverage of outpatient clinics, imaging centers, and nursing homes. Teleradiology is being used in international applications. Unresolved issues in telemedicine include licensure, the development of standards, reimbursement for services, patient confidentiality, and telecommunications infrastructure and cost. A number of states and medical boards have instituted policies and regulations to prevent physicians who are not licensed in the respective state to provide telemedicine services. This is a major impediment to the delivery of telemedicine between state. Telemedicine, including teleradiology, is here to stay and is changing the practice of medicine dramatically. National and international communications networks are being created that enable the sharing of information and knowledge at a distance. Technological barriers are being overcome leaving organizational, legal, financial and special interest issues as the major impediments to the further development of telemedicine and the realization of its benefits.
BANKING ON CORD BLOOD
Umbilical ‘waste’ is gradually becoming an alternative to bone marrow for transplants.
When H.Baker entered the world on Dec.30, his parents shelled out an extra $1200 to have blood from their son’s umbilical cord collected and processed through a private cord blood bank in California.
They’ll continue to pay about $100 a year to store the frozen extract until their son is 18, on the outside chance that Harrison or an immediate family member might one day need a bone marrow transplant.
Cord blood remains in the umbilical cord and placenta after birth. It contains the same building blocks of the immune system as bone marrow – stem cells that are capable of restoring a damaged blood system and repopulating the body’s red and white blood cells and platelets.
Scientists discovered in 1988 that cord blood, long discarded as medical waste, was the only known substitute for bone marrow transplantation. So far, cord blood has been used to restore bone marrow that’s been ravaged by about 30 different illnesses, including certain cancers, leukemias, blood diseases and immune system disorders.
Harrison’s banked cord blood would be an identical match to his own bone marrow. The boy’s close relatives could also benefit, because the odds of a good match are increased within families.
Cord blood’s overlooked wealth has been called the ultimate in recycling, as research and technology rescue from medical waste a treasure trove of life-giving stem cells. The Harvard Health Letter named umbilical cord blood “recycling” as one of the top 10 medical advances of 1996.
The odds that Harrison will ever need his cord blood could be as long as 1 in 200,000. But a growing number of commercial cord blood banks are flourishing, given life by the fact that if there’s a way to protect children from life’s caprice, parents who can afford a little biological insurance are often eager to pay.
Although the first successful cord blood transplant occurred a decade ago, the opportunity for families to collect and store umbilical cord blood privately has been widely available only since about 1995. Many expectant mothers have never heard of it.
Harrison’s mother was unaware of cord-blood retrieval and his life-saving potential until she read about umbilical cord blood banking in a Dear Abby column about three weeks before her son’s birth. She showed the column to her husband and “it just grabbed them”.
The frozen vials of Harrison’s blood will become his property at age 18. At that point, Harrison could donate the blood to a federally financed cord-blood bank – now few in number – that would make the blood available to anyone in need. Or, Harrison or his parents could continue to pay to store it for themselves or other family members who might be an acceptable match.
BLOOD
Stem cells are the progenitors of all the body’s specialized cells. Previously found only in bone marrow, stem cells contain the essential ingredients for healthy blood and immune systems.
When bone marrow is weakened or destroyed by disease or by chemotherapy and radiation administered to fight disease, the therapy of last resort is a bone marrow transplant.
But there isn’t enough bone marrow available through national and international registries to meet the need. Each year, up to 15,000 people are unable to find a suitable bone marrow donor.
Cord blood transplants are helping meet the demand. So far, about 2,000 cord blood transplants have been performed worldwide, mostly on children. About a quarter of them used cord blood from siblings, while the reminder were from donated cord-blood samples, according to the Cord Blood Donor Foundation, a not-for-profit organization backed by private donations.
About 2 ½ years ago, the National Heart, Lung and Blood Institute, part of the National Institutes of Health, began a five-year, $30 million study on the effectiveness of cord-blood transplants from unrelated donors. Scientists hope that the work will help advance a national cord-blood registry.
The study is gathering evidence on the appropriate dose of cord-blood cells needed for patients of different weights. Because there is only a small amount of blood contained in the umbilical cord, the sample is often insufficient to treat someone who weighs more than about 110 pounds, according to Dr. S.Y., a hematologist, oncologist and medical director of the bone-marrow transplant program at Virginia Commonwealth University’s Medical College of Virginia.
However, while cord blood contains a lower volume of stem cells than the amount available from bone marrow donors, the cells are more concentrated and adaptable. The ‘naïve’ cells have not yet committed to specific tasks, as they have in an adult bone marrow donor. So cord blood from unrelated donors doesn’t have to match as specifically as unrelated bone marrow.
The young cells also are less likely to trigger a potentially lethal immune system reaction known as graft-vs.-host disease, which causes the donor cells to attack the recipient’s tissue. That has fueled hope that cord blood transplants could make a big difference for minorities who are underrepresented in bone marrow donor pools.
For now, though, there are government-financed cord-blood collection and storage programs at only a handful of U.S. medical teaching centers. Cord-blood donation for public use, meaning that it is available to any patient who needs a transplant, is unavailable in most communities. The National Marrow Donor Program, which maintains a national registry of bone-marrow donors, is also collecting data for a cord-blood registry.
So far, only about 15000 to 20000 cord blood samples are publicly available, Yanovich said. By comparison, more than 3 million people have signed up to donate their bone marrow if it’s needed to save a life.
“If we don’t find a bone-marrow donor in the registry, we pursue the cord blood,” said Yanovich.
Building a cord-blood collection and storage program is an expensive proposition, and the federal government has not yet committed itself to a nationwide effort that would collect, test, preserve, and store umbilical cords. However, the Cord Blood Donor Foundation, a not-for-profit group, is building an ethnically balanced stem cell bank through private donations.
While government input is limited, the Nov.26 issue of the New England Journal of Medicine reported that 562 cord-blood transplants had been performed with cord blood banked at government expense at the New York Blood Center. The article showed that the procedure can be effective even when the donor is unrelated and does not have a complete antigen match. Antigens are part of every cell, and they’re capable of stimulating an immune response. So blood is typed according to antigens, a critical consideration in all types of transplants, to help prevent the foreign substance from attacking its host.
The big breakthrough in cord-blood transplantation occurred in October 1988, when a Paris doctor performed the first cord-blood transplant on a 6-year-old American boy, Matthew Farrow. Matthew was at the end of his options after a lengthy international bone-marrow search had failed to turn up a suitable match. He was losing his battle against a genetic blood disease called Fanconi’s anemia, which usually kills its victims by age 12.
That’s when Matthew’s parents decided to conceive their third child a little ahead of schedule, in hopes that the infant’s bone marrow would be an acceptable match for their dying son. Doctors knew that if the infant’s bone marrow matched Matthew’s, so would her umbilical cord blood.
In utero tests showed that it did, and little Dorothy Farrow helped save her brother’s life soon after her birth.
Seven years later, there was still no sign of the deadly disease, and a new era in cord-blood transplantation was under way.
Since September 1997, the University of Virginia Medical Center has performed six cord-blood transplants from unrelated donors. Three died from infections after the transplant – a not-uncommon outcome whenever one’s damaged bone marrow is destroyed so healthy stem cells can take root.
Some scientists criticize commercial banks, saying they prey on the fears of protective parents.
“They’re just basically using a scare tactic,” Yanovich said. “I think they’re playing with the fear just to make more money.”
Because the likelihood is so remote that a particular child will require a transplant, Yanovich thinks cord blood should be collected and distributed for the public good, “saved for everybody.”
J.Kurtzberg of Duke University, an early pioneer in cord blood transplant, agrees that very few children whose cord blood is stored at private banks will ever need it.
“The public bank, in contrast, makes units available to anyone who matches,” she said in a recent article in the Duke University Research Magazine. “It seems to be a better use of resources.”
HEPATITIS
Generally speaking, hepatitis is any inflammation of the liver. Although it is often caused by a virus, other causes may include alcohol, medications and that have a harmful effect on the liver, toxins, or autoimmune disorders.
In total, there are at least 7 known viral hepatitis strains: A,B,C,D,E,F, and G. Of these viral forms, hepatitis C may be the leading infectious cause of chronic liver disease in the Western world, affecting more than 170 million people worldwide. Hepatitis A, which is not blood-borne, and hepatitis B, which is blood-borne, are also very widespread. Only these viral forms of hepatitis, including hepatitis C, can be spread directly from one person to another.
Examples of nonviral forms of hepatitis include alcoholic hepatitis (caused by excessive drinking), toxic/drug induced hepatitis (caused by inhaling or swallowing certain toxins or medications such as acetaminophen), and autoimmune hepatitis (which occurs when the body Ts immune system attacks its own liver cells).
About Hepatitis A
Hepatitis A, often abbreviated as HAV (hepatitis A virus), is extremely prevalent (widespread) in the U.S. population. In fact, 1 out of 3 Americans has been infected at some point. However, most people who are infected with hepatitis A recover completely without treatment and, once the infection has subsided, develop lifelong immunity to the disease.
Hepatitis A is transmitted primarily by the fecal-to-oral route through contaminated food or water, or because of poor hygiene habits. Hepatitis A can also be contracted by eating shellfish from contaminated water sources. In the U.S., people who live in communities with high rates of hepatitis A infection are considered at risk for contracting the disease.
People who are infected with hepatitis A generally develop flu-like symptoms, such as low-grade fever, aches, and mild abdominal pain within 10 to 40 days after exposure. In some individuals, these flu-like symptoms can be followed by jaundice (a yellowing of the eyes and skin). Hepatitis A is an acute condition and most people clear the virus on their own without treatment. However, in fewer than 1% of cases, severe acute infections may lead to liver failure and to a need for liver transplantation. Hepatitis A does not lead to the development of chronic hepatitis, cirrhosis, or liver cancer.
A vaccine is available to protect against hepatitis A. It is recommended for anyone who may be going to an area where there are increased rates of hepatitis A, including Mexico, Central America, Sub-Saharan Africa, Southeast Asia, and the Middle East. The vaccine is also recommended for people who might become seriously ill if they are infected with the virus.
Hepatitis A can be avoided by washing hands with warm water and soap, particularly after using the toilet or changing diapers, and before preparing and eating food. Good hygiene practices are particularly important for anyone who works with food.
About Hepatitis B.
Hepatitis B, often abbreviated as HBV (hepatitis B virus), is transmitted through blood or blood products, through sexual contact, or from mother to child during pregnancy or childbirth.
In the U.S. an estimated 1.25 million people are infected with hepatitis B. According to the U.S. Centers for Disease Control and Prevention (CDC), about 30% of people who are infected with HBV do not have any symptoms of the disease. Others may experience flu-like symptoms, including low-grade fever, aches, and mild abdominal pain.
Although individuals with healthy immune systems usually recover from HBV after about 6 months, 5% to 10% of those who are infected develop the chronic (long-term) form of the disease. Often those with long-term infection have no symptoms, or they may suffer from fatigue, malaise and periods of jaundice. If left untreated these individuals may be at risk for serious complications of liver damage such as cirrhosis, liver failure or liver cancer.
A highly effective vaccine has been developed to help protect against hepatitis B. Currently, the CDC is supporting a universal childhood vaccination program with the goal of eliminating the spread of hepatitis B altogether. In addition, the vaccine is recommended for adults who are at a higher risk for contracting hepatitis B due to their occupations (eg. Healthcare workers and emergency medical personnel), lifestyle choices or health conditions.
Hepatitis B can be prevented by carefully cleaning up blood and blood products, practicing safe sex, and not sharing needles, razors, or other personal care items (such as toothbrushes and nail clippers) that might come into contact with blood. To help prevent mother-to-child transmission, all pregnant women should be tested for the hepatitis B virus. Newborns of mothers who test positive can be vaccinated against the condition and receive other precautionary treatments.
ALLERGIC MANIFESTATIONS IN CHILDREN
Within recent years numerous apparently diverse conditions such as asthma, hayfever, eczema, urticaria, migraine and other minor affections have been shown to have a similar etiologic basis, a hypersensitivity on the part of the sufferer to many usually harmless articles commonly encountered in his diet or environment. To this group of diseases the term ‘allergic’ has been applied; the individuals manifesting such an exaggerated susceptibility to substances innocuous to normal persons in the amounts commonly encountered are said to be ‘allergic’ to those articles; and the agents giving rise to those reactions in such apparently minute doses are termed ‘allergens’. When we analyse the origin of these allergic responses we find that they arise in one of two ways: either as a definite inheritance of a predisposition to manifest specific hypersensitiveness, or acquired as the result of tissue damage or excessive irritation.
Though the allergic tendency is prenatal in origin the actual manifestations and causative allergens generally depend upon postnatal factors. The site and type of reaction are frequently consequent upon some local strain or injury, and selectivity of the allergen generally follows repeated or continuous contact with some factor of diet or environment.
Allergic diseases have several characteristics in common the determination of which proves of the utmost importance in diagnosis. They are essentially periodic in nature with apparent intervals of freedom. The symptoms frequently have their onset at night or are most distressing during those hours.
With the exception of hayfever the different manifestations have their maximum onset during childhood or adolescence, and each manifestation appears to have definite sex and seasonal variations. In addition, allergic conditions are definitely affected by varied states of health of the sufferer, by intercurrent diseases, such as fever, exanthemata or climatological factors, locality, altitude or environment.
Varied manifestations of disease in childhood have been shown to fall into the allergic category. The commoner of these include such respiratory symptoms as recurrent bronchitis and asthma; such cutaneous eruption as eczema, flexural pruritis, urticaria including the popular and giant types, and purpura; such abdominal conditions as food-upsets, colic and recurrent vomiting, hayfever, migraine, enuresis and reactions to therapeutic serums and physical agents
Much can be done to prevent the development of allergic symptoms in children, especially children of allergic parents. The homes should be as free from dust and allergens as possible. New foods should be tried one at a time, at least a week apart, to see if symptoms occur. Asthmatic children should be guided away from dusty occupations. Exposure to colds should be minimized. Psychosomatic factors, if present, should be given proper attention.
HEMOPHILIA
The hemophilias are a group of inherited disorders characterized by decreased clotting factor activity, with prolonged and often spontaneous bleeding. Hemophilia A, or classic hemophilia, is by far the most common form of disease and results from subnormal factor VIII activity. Until recently it was thought that factor VIII was absent., but it is now recognized that material identified antigenically as factor VIII is present, although procoagulant activity is reduced. It is currently believed that factor VIII has two components. Measuring each component independently permits detection of carriers, as well as a clear delineation from von Willebrand’s disease. In the latter, procoagulant activity is present disproportionate to the amount of protein antigen, and platelet abnormalities are present as well. Hemophilia B (Christmas disease) results from deficient factor IX activity. Both hemophilias A and B are sex-linked disorders; however, the mutation rate for hemophilia A is said to be upward of 25%, one of the highest known in human disease, von Willebrand’s disease is autosomally transmitted and thus affects both sexes equally.
For reasons that remain unclear, hemophilia is rarely manifested on the first day of life, even after a difficult delivery. Factor VIII does not cross the placenta, yet the newborn with hemophilia does not experience increased bruising or unusually severe cephalhematomas. Even after circumcision, 75% of affected neonates have only mild or no bleeding; a complication from the procedure implies severe disease, defined as less than 1% normal activity. The first few months of life are usually a benign period during which the only clinical clues to the diagnosis may be exaggerated bruising from contact with crib slats. When walking – and falling – begins, excessive bruising and bleeding, particularly of the lip and tongue, are noted. Ecchymoses and soft-tissue bleeding remain common in childhood.
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AIDS PATIENT GIVEN BABOON BONE MARROW
San Francisco. A pioneering experiment involving the first-ever transplantation of bone marrow into a human being is proceeding well, according to researchers from the University of California at San Francisco and the University of Pittsburgh.
Last week, J.Getty, a 38-year-old AIDS patient, received baboon bone marrow, in the hope that a mixture of baboon and human marrow could help to reconstitute his damaged immune system. Baboons are not susceptible to HIV, and, if experiment is successful, the chimaeric bone marrow will begin producing immune system cells resistant to the virus.
Several days after the transplant, Getty was reported to be doing well. But doctors said he would remain vulnerable to neutropenia – a decrease in the number of neutrophilic leukocytes in the blood – and opportunistic infections for several weeks.
Researchers should be able to measure how well the baboon cells have taken in about four weeks, but doubt they will see any immune reconstitution in under six months.
The protocol for the experiment had been given strict scrutiny by federal authorities, partly because of concern that the introduction of baboon cells into a human might trigger the development of new viruses. S.Ildstad, a researcher involved in the experiment, said that monitoring for such organisms has already begun, with samples being collected weekly for examination by collaborators throughout the world.
Formal guidelines for xenotransplantation are being developed by the Food and Drug Administration and the Centres for Disease Control. Ildstad praised Getty’s brevity and said many patients might ultimately benefit.
ALCOHOL’S YOUNGEST VICTIMS
Drinking during pregnancy is riskier than many women realize.
Everyone in the US should know by now that drinking alcohol during pregnancy can cause serious physical and mental problems in the unborn child. Most doctors have told their patients, television announcements have dramatized the danger, and warning signs have gone up in restaurants and bars. But too many mothers-to-be are not getting the message. More than 50,000 babies are born in the US each year with alcohol-related defects. In about one-fourth of these cases, the damage – ranging from facial deformities to heart abnormalities – is severe enough to be classified as fetal alcohol syndrome.
Many people still do not realize how common FAS is and how devastating it can be. According to some researchers, FAS is responsible for an estimated 20% of all US cases of mental retardation. That makes FAS the country’s No.1 threat to children’s mental health, greater than either Down syndrome or spina bifida.
Unlike such drugs as barbiturates and opiates, which affect the nervous system, alcohol can attack virtually any of the body’s cells. It can cause stunted growth, distorted faces, poor eyesight, learning disabilities and hyperactivity. In the recently published book “The Broken Code” , the author Michael Dorris tells the heartbreaking story of his adopted son Adam, whose Sioux parents dies of alcohol abuse. Adam was institutionalized and diagnosed as retarded before he turned three. At five, he still wore diapers, could not count consecutively or even identify color. “Adam’s birthdays are reminders for me,” writes Dorris. “For each celebration commemorating that he was born, there is the pang, the rage, that he was not born whole”.
The tragedy of FAS is that it is entirely preventable. If a woman, even an alcoholic one, stops drinking before she tries to become pregnant, her fetus will not develop FAS or any alcohol-related birth defects. But pregnancies are not always planned. If a woman does not realize for several weeks that she is pregnant, she may not stop drinking in time to prevent harm to the fetus.
Researchers believe the damage is probably minimal in the first two weeks, but during the rest of the first trimester, when the fetus’ organs are forming, the effects may be especially severe. If the drinking continues, additional damage can occur, since the brain develops during all nine months and rapid body growth does not occur until the third trimester. Even after the baby is born, abstinence may be advisable. A study in “New England Journal of Medicine” suggests that when mothers have one or more drinks a day, their children ingest alcohol in breast milk, which may impede the infant’s motor development.
Nearly all known cases of FAS involve children whose mothers have chronic alcohol problems. The more a woman drinks while she is pregnant and the longer she drinks, the higher the risk of FAS . Even so, moderate drinking is not considered safe. But our best evidence is that we cannot detect adverse consequences to very light drinking. And that does not mean they don’t exist. Beer, wine and hard liquor do not seem to differ in their impact on the fetus.
Studies conducted in Boston, Atlanta and Scandinavia indicate that at least some of the injuries to the fetus may be corrected in the womb if a mother gives up alcohol before her third trimester. It’s pretty clear if a woman stops drinking in her second trimester, the size and the healthiness of the baby will improve, but there is no evidence that its intelligence will improve. Moreover, even the improvement in appearance may be deceptive. The babies definitely are bigger and look healthier but that does not mean that all the effects go away.
Scientists still do not know why FAS strikes the children of some alcoholic mothers but not others, and why susceptibility varies among different ethnic groups. Native Americans, for example, are 33 times as likely as Caucasians to have a child with FAS; for blacks, the rate is 6.7 times as high as for Caucasians. Women who give birth to a child with FAS have a greater-than-average risk of bearing additional children with the affliction. Such evidence suggests there may be a genetic predisposition to FAS, but scientists have not been able to identify the offending genes.
Researchers are also trying to determine whether fathers’ drinking habits play any role in FAS. At Wayne State, studies of male laboratory rodents have shown that alcohol exposure affects their sperm as well as the immune system and behaviour of their offspring. The possibility of the father’s effect can not be written off. Researchers are not saying the baby would have FAS, but it’s possible there may be some impact on how the kid comes out.
There is no treatment for FAS, and so the only way health officials can fight the scourge is to step up educational efforts. The couple must read a pamphlet on FAS before they can obtain a marriage licence / in New Hampshire/. Beginning in November, liquor bottles will carry a warning label advising women that alcohol and pregnancy do not mix. But for women who are addicted to alcohol, the need to drink often overcomes caution and reason. Until better ways are found to identify and treat alcoholics, they will continue to inflict a devastating toll on their children.
VITA MEANS LIFE
For centuries, scurvy was a real scourge among seamen and explorers, and no one knew how to combat it. Rickets, which afflicted small children, pellagra, beriberi and other diseases also remained an enigma.
In 1881, Nikolai Lunin, a Russian physician, put forward the hypothesis of the existence of some substances that are essential for life. These substances were isolated in their pure form more than 30 years later by K.Funk, a Polish researcher, who called them vitamins - “carriers of life”. Today we know some 30 vitamins and vitamin-like substances. Scurvy, rickets, beriberi and pellagra have been established to be all avitaminoses, i.e., diseases caused by the lack or deficiency of one vitamin or another in the organism.
Nowadays doctors come across avitaminoses comparatively rarely. Other problems connected with vitamins attract much more attention.
Our scientists are of the opinion that nucleic acids play the main part in the process of growth and propagation of cells. They proved that vitamin C (ascorbic acid) regulates one of the stages in the formation of desoxyribonucleic acid – the famous DNA.
Vitamin K, one of the “youngest” vitamins, discovered only some 30 years ago, is of great importance for the proper coagulation of blood. It is essential for the formation of prothrombin, a proteic substance necessary for clotting a blood vessel to stop a hemorrhage.
In 1942, Academician Al.Palladin, a prominent Russian biochemist, and his staff synthesized vikasol, a new preparation, which contains an analogue of vitamin K. During World War II, vikasol won a good repute for itself among army doctors. Injected intramuscularly or intravenously, it quickly stops various hemorrhages.
Now it is used as a preparation against inflammation and as a means for increasing the resistance of organisms to radioactive irradiation. But vitamin K is essential not only for blood clotting. It plays an active role in the so-called tissue breathing of the organism’s cells, in the metabolism. It is as necessary for each living cell as air is vital for man.
The doctors use vitamins on a wide scale of treatment – with the aid of vitamins they influence the metabolism in the direction they want, and increase the resistance of the organism to various diseases.
For instance, orotic acid, a substance which possesses vitamin-like properties, and which is a factor for growth, is used to intensify the contracting function of the myocardium, when the latter has been disrupted by prolonged stress.
The preparation Kalium orotium is used to treat such a grave and dangerous disease as a large-focal infarct of the myocardium (heart failure). The use of this preparation (in combination with folic acid and vitamin B12) at the clinic made it possible to decrease the number of deaths from this disease. Apart from this, the patients’ blood pressure improves and they recover much more quickly and are even able to go back to their usual work.
Good results have been obtained by administrating Kalium orotium to patients with other cardio-vascular disorders.
The researchers think, that this preparation will possibly be used to treat ulcers of the stomach and duodenum, to speed up the healing of wounds and burns and also other diseases and traumas, when the organism needs an accelerated synthesis of protein.
Active words and expressions.
Scurvy, beriberi, pellagra, deficiency, avitaminosis, to inject, to play an active role, inflammation, to obtain, wound, burn, to improve, to accelerate, resistance.