With the increasing awareness of incipient and subclinical malnutrition in children several nutritional indices have been suggested for the early recognition of protein-energy malnutrition (PEM). We evaluated plasma albumin, transferrin, and fibronectin levels in 15 children with PEM and compared them with those of 10 well-nourished children. The results demonstrated that plasma albumin is a poor indicator of mild to moderate PEM. On the other hand, plasma transferrin and fibronectin are sensitive indicators of PEM as they were significantly decreased in our mild to moderately malnourished children whereas albumin was unchanged. Furthermore, malnourished children showed iron deficiency anaemia, which may interfere with the results of plasma transferrin determinations. Fibronectin is believed to have a functional role in coagulation, host immune defence, and wound healing. We suggest that the assay of fibronectin may provide a biochemical functional index of mild to moderate nutritional deficiency before overall depletion has occurred.

Secondary hyperparathyroidism hasbeen known t o occur in vitamin-D deficiency rickets and is considered t o be necessary t o maintain normal serum calcium in the presence of deficient gastrointestinal absorption of calcium [l, 51. Using intravenous calcium infusions t o maintain mild hypercalcaemia with the idea of suppressing parathyroid function, a marked drop in phosphate excretion was found in nine cases of vitamin-D deficiency rickets [3]. Using the same technique Scriver, et al. [19] reported the disappearance of hyperaminoaciduria in one case of vitamin-D deficiency rickets. However, it was shown by Lavender t Pullman [ 151 that calcium can directly affect the kidney tubules enhancing phosphorus transport, an effect not mediated by the parathyroids. No direct action of calcium on the hyperaminoaciduria is known. Our aim has been t o study the effect of parathyroid hormone on the aminoaciduria of vitamin-D deficiency rickets and to investigate the possible correlation between the aminoaciduria and the biochemical findings. _ _ _~ Present address: Paediatric Department, Alexandria Medical School, Alexandria, U.A.R. 29 -672888 -4ctn Paediat Scand 56 Material and MethodTen male patients showing vitamin-D deficiency rickets were chosen for the study. Their ages ranged from 10 to 24 months. Clinically all patients showed broad epiphyses, rickety rosary, varying degrees of generalised hypotonia with a history of delay in standing and walking. Radiologically all of them showed a classical rachitic picture. After admission, urine was collected for 6 hours, together with a blood sample. At the end of the sixth hour parathyroid hormone (Lilly) was adminstered subcutaneously in a dose of 5 units per kilogram body weight to all patients. Urine was collected separately for the following 6 hours. Another blood sample was taken two hours after the injection. Serum and urinary calcium and phosphorus were estimated in seven cases. Serum and urinary calcium were determined using the oxalate-permanganate method [13], serum and urine phosphorus by the method described by King & Wootton [13]. The glomerular filtration rate was measured in seven of the rachitic infants using the endogenous creatinine clearance technique [21]. Urinary amino acids were determined in seven cases using a qualitative and semiquantitative two-dimensional paper chromatography procedure as described by Wootton [21]. In the remaining three patients quantitative estimation of the urinary amino acids in the samples collected before and after parathyroid hormone administration was done, by

Hassanein, E. A., and Tankovsky, I. (1975). Archives of Disease in Childhood, 50, 308. Disseminated intravascular clotting in kwashiorkor. The role of disseminated intravascular clotting (DIC) in the pathogenesis of the bleeding diathesis kwashiorkor was investigated in 22 patients. According to the severity of the clinical and haematological findings, two grades of DIC were observed. A severe grade of DIC was shown in 6 cases (5 fatal) presenting with thrombocytopenia, hypofibrinogenaemia, and multiple coagulation defects, and with abnormally prolonged partial thromboplastin, prothrombin, and thrombin times. A second group of 16 patients (7 fatal) showed a less severe grade of DIC manifested by thrombocytopenia, low fibrinogen level, and a clotting factor defect shown by prolonged prothrombin and thrombin times.Multiple coagulation defects including factors II, VII, IX, and X have been reported in kwashiorkor (Dorantes et al., 1964). Deficiency of factor V, additionally, together with thrombocytopenia in one instance, was observed in cases of severe kwashiorkor complicated by infections, particularly gastroenteritis (Hassanein and Tankovsky, 1973). Disseminated intravascular clotting (DIC) has been reported in gastroenteritis (Lufti, 1971). The possibility of DIC being of importance in severe cases of kwashiorkor is the subject of this study. Material and methodsTwenty-two patients, 10 male and 12 female, suffering from severe kwashiorkor, bleeding diathesis, and thrombocytopenia were investigated. Their ages ranged from 9 months to 3 years. They were selected out of 132 cases of kwashiorkor admitted during the period of study. Dehydration of moderate or severe degree was present in the majority of cases and appropriate fluid and electrolyte replacement given. Other measures included antibiotics based on stools and urine culture, milk feeding often by gavage, multivitamin supplements; fresh blood transfusions were given to the majority of patients when there was bleeding and severe anaemia. Haematological investigations including partial thromboplastin, prothrombin, and thrombin times, and fibrinogen level were carried out as described by Dacie and Lewis (1968). Serum fibrin degradation products (FDPs) were estimated in 10 patients using the rapid slide screening test (Diagnostic Reagents Limited, Thame, Oxon, England). The normal value for serum Received 6 September 1974. FDPs was 8 ,ug/ml. Standard statistical methods were used and mean values were tested with Student's 't' test. The difference of the means was considered to be significant if P <0 05.

No abstract

Summary Study on tryptophan metabolism in eight children presenting with bilharzial hepatic fibrosis revealed a pattern reflecting vitamin B6 deficiency and which could be corrected by supplementing this vitamin. This finding was attributed to S. mansoni infection rather than parenchymal involvement. Similar study carried out on five children with non‐bilharzial hepatic cirrhosis showed low response to a tryptophan load which was not corrected by vitamin B6 supplementation. The difference between the patterns of tryptophan metabolites in bilharzial fibrosis and non‐bilharzial cirrhosis in children might be due to bilharziasis in the former group and to deranged protein synthesis in the latter.