Kwashiorkor: A Prospective Ten-Year Follow-up Study

The physical status of 123 cases of kwashiorkor, followed up longitudinally for 10 years, was analysed. Their status was compared with that of 97 control siblings who had never suffered from kwashiorkor, but who had grown up under the same environmental conditions as the expatients. It was found that 10 years after the episode of kwashiorkor about half of the children had reached international growth standards in weight and height, thus demonstrating the capacity for complete physical recovery. No significant anthropometric or biochemical differences were found between ex-patients and control siblings at the 10-year follow-up examination. This is adequate proof that the episode of kwashiorkor per se cannot be held responsible for the growth retardation that occurred in some of the children. The children who were most severely retarded in weight and height on admission tended to remain the most severely retarded in growth after 10 years. The children who were the oldest on admission were more retarded in weight after 10 years than the children who were admitted at a younger age. Although these facts may imply that the severity and possibly the duration of the malnutrition episode adversely affected subsequent physical growth, a high current incidence of hypoalbuminaemia was found in both ex-patients and control siblings, indicating continuing malnutrition, the effects of which cannot be separated from possible deleterious effects of thil original malnutrition episode. Linear growth also correlated significantly with midparental height and a complex of adverse social circumstances.Failure to attain international growth standards in some of the children was therefore apparently due to a combination of factors and at present it is impossible to distinguish any single one of these as being more important than the others. Since about half of the children did reach adequate growth standards despite their poor living conditions, it is clearly worth while to treat every case of malnutrition. At the same time public health supervision and preventative social measures should be greatly increased to protect the child population throughout the growing period. S. Afr. Med. J., 45, 1427 (1971

Accommodating Ontologies to Biological Reality—Top-Level Categories of Cumulative-Constitutively Organized Material Entities

BACKGROUND: The Basic Formal Ontology (BFO) is a top-level formal foundational ontology for the biomedical domain. It has been developed with the purpose to serve as an ontologically consistent template for top-level categories of application oriented and domain reference ontologies within the Open Biological and Biomedical Ontologies Foundry (OBO). BFO is important for enabling OBO ontologies to facilitate in reliably communicating and managing data and metadata within and across biomedical databases. Following its intended single inheritance policy, BFO's three top-level categories of material entity (i.e. ‘object’, ‘fiat object part’, ‘object aggregate’) must be exhaustive and mutually disjoint. We have shown elsewhere that for accommodating all types of constitutively organized material entities, BFO must be extended by additional categories of material entity. METHODOLOGY/PRINCIPAL FINDINGS: Unfortunately, most biomedical material entities are cumulative-constitutively organized. We show that even the extended BFO does not exhaustively cover cumulative-constitutively organized material entities. We provide examples from biology and everyday life that demonstrate the necessity for ‘portion of matter’ as another material building block. This implies the necessity for further extending BFO by ‘portion of matter’ as well as three additional categories that possess portions of matter as aggregate components. These extensions are necessary if the basic assumption that all parts that share the same granularity level exhaustively sum to the whole should also apply to cumulative-constitutively organized material entities. By suggesting a notion of granular representation we provide a way to maintain the single inheritance principle when dealing with cumulative-constitutively organized material entities. CONCLUSIONS/SIGNIFICANCE: We suggest to extend BFO to incorporate additional categories of material entity and to rearrange its top-level material entity taxonomy. With these additions and the notion of granular representation, BFO would exhaustively cover all top-level types of material entities that application oriented ontologies may use as templates, while still maintaining the single inheritance principle

An Anatomico -physiological Principle Governing the Direction of the Gastro-intestinal Mucosal Folds During Life

The mucosa, being the innermost layer of the gastrointestinal tract, is intimately concerned with digestion and absorption, and, presumably, also with the transport of intestinal contents. In anatomical, physiological and motility studies, possible movements of the mucosa and its folds are neither considered nor investigated. Dogmatic statements about the direction of the folds are often made. Radiologists have long been aware of mucosal movements, but after the fundamental work of Forssell, no further views have been put forward. Radiological procedures have been used to investigate the normal, macroscopic, physiological movements of mucosal folds. A general rule follows. Normally, when the intestine is filled, but inactive, the folds are circular; when the walls contract, the folds change in direction, to become longitudinal. This phenomenon is confirmed by in vivo baboon studies and elucidated by wire spirals. It is seen to be an inherent characteristic of 'peristaltic' and 'segmental' contractions. In this manner longitudinal mucosal furrows are formed simultaneously with the contraction wave of the walls, thus facilitating transit. Were this not so, peristalsis would be an ineffective mechanism, with contraction waves acting against the resistance of circular folds.S. Afr. Med. J., 48, 441 (1974

Is Clinical Tolerance Possible after Allergen Immunotherapy?

There is a growing evidence that allergen immunotherapy (AIT) can provide significant and long-lasting clinical benefit for a number of allergic individuals. However, it is less clear if AIT results in clinical tolerance, which is characterized by a persistent state of clinical non-reactivity to allergens after therapy is finished. Addressing this knowledge gap is particularly relevant for patients undergoing AIT for food allergies, as anything less than complete tolerance could have potentially devastating consequences. An increasing number of studies, in particular those involving oral immunotherapy, are attempting to assess tolerance induction following AIT. Clinical tolerance does appear to be achievable in a subset of patients undergoing AIT, but whether this is equivalent to the type of tolerance observed in nonallergic individuals remains unknown. Developing established criteria for assessing tolerance induction, as well as the use of consistent terminology when describing clinical tolerance, will be important for determining the disease-modifying potential of AIT