Case report

Case report
A Patient with G6PD Deficiency and Falciparum Malaria
* M Nateghpour 1, A Miahipour 1, M Yousefi1, A Mohammadiha 1, Y Fagani 2
1Dept. of Medical Parasitology and Mycology, School of Public Health & Institute of Public Health
Research, Tehran University of Medical Sciences, Iran
2Infections Diseases Ward, Bou-Ali Hospital, Tehran, Iran
(Received 3 Nov 2006; accepted 3Mar 2007)
Abstract
A 20 year old male patient from Afghanistan with a history of G6PD deficiency and clinical manifestations of
malaria referred to Bou-Ali Hospital in Tehran, capital of Iran. Giemsa stained thick blood films revealed an
infection of Plasmodium falciparum with 33700 parasite/μL of blood. The patient was successfully treated
according to malaria treatment guideline.
Key words: G6PD deficiency, Falciparum, Malaria, Iran
Introduction
lucose-6-phosphate-dehydrogenase
(G6PD) is a cytoplasmic enzyme
that is essential for a cells capacity to
withstand oxidant stress. The geographic
correlation of G6PD deficiency distribution
with the endemicity of malaria suggests
that such enzymopathy has risen in
frequency through natural selection by
falciparum malaria.
Motulsky and Allison (1, 2) suggested
that individuals with G6PD deficiency
trait might be more than normally resistant
to falciparum malaria. These authors
and later some others found a notable
correlation between the prevalence of
such enzymopathy of human and the endemicity
of Plasmodium falciparum malaria
in some areas of the world. The suggestion
of such inherent relative resistance
to falciparum malaria in the enzyme
deficient subjects has been supported by
low parasitaemia and low mortality in
G6PD deficient patients (3-5). Nevertheless,
this hypothesis does not seem to
constitute the whole story. Some evidences
have been put forward by the
some researchers (6-8).
Case report
In this report, we introduce a twenty year
old Afghani worker resident in Tehran,
capital of Iran with a history of traveling
to some villages located on the southeast
borderland of Iran, three weeks before to
feel clinical signs. The patient with typical
malaria symptoms (chilliness, fever,
and sweating), headache, and hemoglobinuria
referred to Bou-Ali Hospital in
Tehran. The laboratory analysis of blood
revealed as: G6PD partial deficiency (using
colorimetry and fluorescence activity
methods), WBC 3100/ micro/L, eosinophils
3%, RBC 3.47 million/μl, SGOT 173 IU/L,
G
*Correspondent author: Tel: +98 21 88989130,
E-mail: nateghpourm@sina.tums.ac.ir
M Nateghpour et al: A Patient with G6PD…
44
SGPT 147 IU/L, hemoglobin 10.2 g/dl
and hematocrit 29.6%. Giemsa stained
thick and thin blood films indicated P.
falciparum malaria infection with high
parasitaemia of 33700/ μl. The patient
was successfully treated according to malaria
treatment guideline.
Discussion
Malaria-protection hypothesis of G6PD deficiency
seems to be a conflicting negotiation
between relevant investigators.
While Powell and Brewer (9) showed no
significant difference between corresponding
mean levels of parasitaemia in G6PD
deficient people compared to G6PD normal
individuals, Gilles and co-workers
found that the incidence of G6PD deficiency
in children with sever malaria is
significantly lower than that of control
children (5). In another investigation, 700
children of both sexes from a rural area of
holoendemic malaria (P. falciparum) were
studied (10). The investigators found that
there was no evidence that enzyme-deficient
subjects had any greater resistance
against malaria. In three cross-sectional
studies using IFA and the blue dye, decolorization
G6PD tests by Edrissian et
al. in Hormozgan Province, a malarious
area in southern Iran; different results were
found out. In the first study, the G6PD
deficient individuals had significantly lower
seropositive rate and considerably lower
total geometric mean of reciprocal titers
with P. falciparum antigen as compared
to the G6PD normal subjects, but not in
P. vivax antigen. However, in the second
and third studies no such distinct serological
differences between G6PD deficient
patients with falciparum malaria and
G6PD normal subjects were observed
(11). Our reported case, parasitologically,
was alike to those were found out by Edrissian
et al. in the second and third studies.
Acknowledgements
Authors would like to thank Mrs A Motavali
Haghi and staffs of medical lab of
Bou-Ali Hospital for their technical assistance.
References
1. Motulsky AG. Metabolic polymorphism
and the role of infection disease
in human evolution. Hum Biol.
1960; 32, 28.
2. Allison AC. Glucose-6-Phoshate dehydrogenase
deficiency in Red
blood cells of East Africans Nature.
1960; 186, 531.
3. Gilles HM, Taylor BG. The existence
of the glucose-6- phosphate
dehydrogenase deficiency tract in
Nigeria and its clinical implications.
Ann Trop Med Parasit. 1961; 55:
64.
4. Harris R, Gilles HM. Glucose-6-
phosphate deyhdrogenase deficiency
in the people of the Niger Delta.
Ann. Hum. Genet. 25:199. Quoted
from: Jranian J Publ Health (1983).
1962; 12(1-4): 9-25.
5. Gills HM, Fletecher KA,
Hendrickse RG, Lindne R, Reddy S,
Allan N. Glucose-6-phosphate-dehyrogenase
deficiency, Sickling, and
Malaria in African children in South-
Western Nigeria. The lancet. 1967;
139-40.
6. Krautrachue M, Charoenlarp P,
Chongsuphajaisiddhi T, Harinaluta
G. Erythrocyte glucose-6-phosphate
dehydrogenase and malaria in Thailand.
Lancet. 1962; 11: 1343.
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7. Bienzle U, Guggenmoss-Holzmann
I, Luzzaltto L. Malaria and erythrocyte
glucose-6- Phospate dehydrogenase
variants in West Africa. Am
J Trop Med Hyg. 1979; 28: 619.
8. Martine SK, Miller LH, Alling D,
Okoye VV, Esan GJF, Osunkoya
BO, Deane M. Sever malaria and
glucose-6-phosphate dehydrogenase
deficiency: A reappraisal of the malaria
G-6- PD hypothesis. Lancet.
1979; 524.
9. Powell RD, Brewer GJ. Gloucose-6-
phosphate dehyolrogenase deficiency
and faciparam malaria. Am J
Trop Med.1965; 14: 3.
10. Bienzle V, Ayeni O, Lucas AO,
Luzzato L. Glucose-6-phosphate dehydrogenase
and Malaria. Lancet.
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11. Edrissian GhH, Montazemi K, Nasseri
AR, Afshar A. Malaria antibodies
and glucose-6-phosphate deydrogenase
(G-6-PD) deficiency. Iranian
J Publ Health. 1983; 12(1-4): 9.

anxiety . fear

Everyone, from the youngest child to the oldest adult, experiences anxieties and fears at one time or another. Feeling anxious in a particularly uncomfortable situation never feels very good. However, with children, such feelings are not only normal, they're also necessary. Experiencing and dealing with anxieties can prepare young people to handle the unsettling experiences and challenging situations of life.

Anxieties and Fears Are Normal
Anxiety is defined as "apprehension without apparent cause." It usually occurs when there's no immediate threat to a person's safety or well being, but the threat feels real. Anxiety makes a person want to escape the situation - fast. The heart beats quickly, the body might begin to perspire, and "butterflies" in the stomach soon follow. However, a little bit of anxiety can actually help people stay alert and focused.

Having fears or anxieties about certain things can also be helpful because it makes kids behave in a safe way. For example, a kid with a fear of fire would avoid playing with matches.

The nature of anxieties and fears change as children grow and develop:

Babies experience stranger anxiety, clinging to parents when confronted by people they don't recognize.
Toddlers around 10 to 18 months experience separation anxiety, becoming emotionally distressed when one or both parents leave.
Children ages 4 through 6 have anxiety about things that aren't based in reality such as fears of monsters and ghosts.
Kids ages 7 through 12 often have fears that reflect real circumstances that may happen to them, such as bodily injury and natural disaster.
As a child grows, one fear may disappear or replace another. For example, a child who couldn't sleep with the light off at age 5 may enjoy a ghost story at a slumber party years later. And some fears may extend only to one particular kind of stimulus. In other words, a child may want to pet a lion at the zoo but wouldn't dream of going near the neighbor's dog.

Recognizing the Signs of Anxiety
Typical childhood fears change with age. They include fear of strangers, heights, darkness, animals, blood, insects, and being left alone. Children often learn to fear a specific object or situation after having an unpleasant experience, such as a dog bite or an accident.

Separation anxiety is common when young children are starting school, whereas adolescents may experience anxiety related to social acceptance and academic achievement.

If anxious feelings persist, they can take a toll on the child's sense of well being. The anxiety associated with social avoidance can have long-term effects. For example, a child with fear of being rejected can fail to learn important social skills, causing social isolation.

Many adults are tormented by fears that stem from childhood experiences. An adult's fear of public speaking may be the result of embarrassment in front of peers many years before. It's important for parents to recognize and identify the signs and symptoms of their children's anxieties so that fears don't get in the way of everyday life.

Some signs that a child may be anxious about something may include:

becoming clingy, impulsive, or distracted
nervous movements, such as temporary twitches
problems getting to sleep and/or staying asleep longer than usual
sweaty hands
accelerated heart rate and breathing
nausea
headaches
stomachaches
Apart from these signs, parents can usually tell when their child is feeling excessively uneasy about something. Lending a sympathetic ear is always helpful, and sometimes just talking about the fear can help the child move beyond it.

What's a Phobia?
When anxieties and fears persist, problems can arise. As much as a parent hopes the child will grow out of it, sometimes the opposite occurs, and the cause of the anxiety looms larger and becomes more prevalent. The anxiety becomes a phobia, or a fear that's extreme, severe, and persistent.

A phobia can be very difficult to tolerate, both for kids and those around them, especially if the anxiety-producing stimulus (whatever is causing the anxiety) is hard to avoid (e.g., thunderstorms).

"Real" phobias are one of the top reasons children are referred to mental health professionals. But the good news is that unless a child's phobia hinders his or her everyday ability to function, the child sometimes won't need treatment by a professional because, in time, the phobia will be resolved.

Focusing on Your Child's Anxieties, Fears, or Phobias
Try to answer the following questions honestly:

Is your child's fear and the behavior he or she is exhibiting typical for your child's age? If the answer to this question is yes, it's a good bet that your child's fears will resolve before they become a serious cause for concern. This isn't to say that the anxiety should be discounted or ignored; rather, it should be considered as a factor in your child's normal development.

Many children experience age-appropriate fears, such as being afraid of the dark. Most kids, with some reassurance, and perhaps a night-light, will overcome or outgrow it. However, if they continue to have trouble, or there's anxiety about other things, the intervention may have to be more intensive.

What are the symptoms of the fear, and how do they affect your child's personal, social, and academic functioning? If symptoms can be identified and considered in light of your child's everyday activities, adjustments can be made to alleviate some of the stress factors.

Does the fear seem unreasonable in relation to the reality of the situation; and could it be a sign of a more serious problem? If your child's fear seems out of proportion to the cause of the stress, this may signal the need to seek outside help, such as a counselor, psychiatrist, or psychologist.

It's a good idea for parents to look for patterns. If an isolated incident is resolved, parents shouldn't make it more significant than it is. However, if a pattern that's persistent or pervasive emerges, you should intervene. If you don't, the phobia will most likely impact your child over time.

You can contact your child's doctor and/or a mental health professional who has expertise in working with children and adolescents.

How to Help Your Child
Parents can help children develop the skills and confidence to overcome fears so that they don't evolve into phobic reactions. Here are some steps that may help guide you in helping your child deal with his or her fears and anxieties:

Recognize that the fear is real. As trivial as a fear may seem, it feels real to your child and it's causing him or her to feel anxious and afraid. Being able to talk about fears helps - words often take some of the power out of the negative feeling. If you talk about it, it can become less powerful.
Never belittle the fear as a way of forcing your child to overcome it. Telling your child, "Don't be ridiculous! There are no monsters in your closet!" may get your child to go to bed, but it won't make the fear go away.
Don't cater to fears, though. If your child doesn't like dogs, don't cross the street deliberately to avoid one. This will just reinforce that dogs should be feared and avoided. Provide support and gentle care as you approach the feared object or situation with your child.
Teach your child how to rate fear. If your child can visualize the intensity of the fear on a scale of 1 to 10, with 10 being the strongest, he or she may be able to "see" the fear as less intense than first imagined. Younger children can think about how "full of fear" they are, with being full "up to my knees" as not so scared, "up to my stomach" as more frightened, and "up to my head" as truly petrified.
Teach coping strategies. Try these easy-to-implement techniques. Using you as "home base," the child can venture out toward the feared object, and then return to you for safety before venturing out again. The child can also learn some positive self-statements, such as "I can do this" and "I will be OK," which your child can say to himself or herself when feeling anxious. Relaxation techniques are helpful as well, including visualization (of floating on a cloud or lying on a beach, for example) and deep breathing (imagining that the lungs are balloons and letting them slowly deflate).
The key to resolving fears and anxieties is to overcome them. Using these suggestions, you can help your child better cope with life's situations.

toilet teaching your child

"Mommy, I did it! I went in the potty!"

Are these the words you long to hear from your child? But how do you know when your child is ready, and what's the best way to teach your child to use the toilet (also known as the potty)?

Is My Child Ready?
Many parents are unsure about when to start potty training. (Although the term toilet teaching better reflects the process of helping your child learn to use the toilet instead of urinating - peeing - or passing bowel movements - pooping - in diapers, most parents refer to it as potty training.)

Not every child will be ready at the same age, so it's important to watch your child for signs of readiness, such as stopping an activity for a few seconds or clutching his or her diaper. Most children show these signs between 18 and 24 months, although some may be ready earlier or later than that. And boys typically start later and take longer to learn to use the potty than girls.

Instead of considering your child's age as a readiness indicator, it's a good idea to look for some of these other signs that your child may be ready to start heading for the potty, such as the ability to:

follow simple instructions
understand words about the toileting process
control the muscles responsible for elimination
express a need to go verbally
keep a diaper dry for 2 hours or more
get to the potty, sit on it, and then get off the potty
pull down diapers, disposable training pants, or underpants
Is There a Good Time of Year to Start?
Not really. But there are some more stressful or difficult times when you may want to put off starting the toilet-teaching process - when traveling, around the birth of a sibling, changing from the crib to the bed, moving to a new house, or when your child is sick (especially if he or she is having diarrhea). Take these factors into consideration when you plan to introduce toilet teaching. It may be better to postpone it until your child's environment is stable and secure.

Also, though some experts may recommend starting the process during summer because children wear less clothing, it is not a good idea to wait to start if your child is ready.

How Long Does Toilet Teaching Usually Take?
Of course, teaching your toddler to use the potty isn't an overnight experience. The process typically takes between 3 and 6 months, although it may take more or less time for some children.

And although some little ones can learn to both make it through the night without wetting or soiling themselves (or the bed) and use the potty around the same time, it may take an additional 6 months to 1 year to master staying dry at night.

What Kind of Potty Should We Use?
There are two basic potty options:

a stand-alone, toddler-size potty chair with a bowl that can be emptied into the toilet
a toddler-size seat that can be placed on top of your toilet seat that will let your child feel more secure and not feel like he or she is falling in
If you opt for the modified toilet seat, you may also want to invest in a stepping stool so that your child can reach the seat comfortably. Stools can also help kids to be able to push with their legs when having a bowel movement. But for boys who feel awkward - or scared - about standing on a stool to pee in the toilet, a potty chair may be a better option.

Buy a training potty for every bathroom in your house. You may even want to keep one in the trunk of your car for emergencies. When traveling long distances, be sure to take a potty seat with you and stop every 1 to 2 hours. Otherwise, it can take more time than your child may have to find a discreet location or restroom.

What About Training Pants?
Experts sometimes disagree about whether to use disposable training pants. Some people think that they're just bigger diapers and that they might make kids think that it's OK to use them like diapers, thus slowing the toilet-teaching process.

However, because kids' nighttime bladder and bowel control often lags behind their daytime control, it isn't unreasonable to use training pants at night or when you're out and about with your child. Once the training pants remain dry for a few days, kids can make the switch to wearing underwear.

Ask your child's doctor for his or her opinion about whether your child would benefit from using disposable training pants as a transitional step.

Common Problems
It isn't uncommon for a previously toilet-taught child to have some trouble with using the potty during times of stress. For example, a 2- or 3-year-old dealing with a new sibling may regress (or return to a previous level of development).

But if your child was previously potty trained and is having problems, talk with your child's doctor just to be on the safe side and to rule out things like chronic diarrhea or constipation, encopresis (soiling), urinary tract infection, diabetes, etc.

If your child is 3 years or older and is not yet potty trained, talk to your child's doctor, who can likely help you figure out what might be the problem and hopefully offer advice to make the process easier for both you and your child.

Tips for Toilet Teaching
Even before your child may be ready to be taken to the potty, you can start to prepare your little one by teaching him or her about the process:

Use words to express the act of using the toilet (for example,"pee," "poop," and "potty").
Ask your child to let you know when a diaper is wet or soiled.
Identify behaviors (i.e., say, "Are you going poop?") so that your child can associate the urge to pee or poop with going to the potty.
Get a potty chair your child can practice sitting on. At first, your child can sit on it with his or her clothes on. Then, he or she can sit on the chair with a diaper. And when ready, your child can go bare-bottomed.
If you've decided that your child is ready to start learning how to use the potty, here are some things you can try that may help:

Set aside some time (say, a weekend) to devote to the potty-training process.
Don't make your child sit on the toilet against his or her will.
Show your child how you sit on the toilet and explain what you're doing (because your child learns by watching you). You can also have your child sit on the potty seat and watch while you - or one of his or her siblings - use the toilet.
Establish a routine. For example, you may want to begin toilet teaching by having your child sit on the potty after he or she wakes up with a dry diaper.
Try catching your child in the act. Children often give clear cues that they need to use the bathroom - their faces turn red, and they may grunt or squat. And many kids are regular as to the time of day they tend to have a bowel movement.
Have your child sit on the potty within 15 to 30 minutes after meals to take advantage of the body's natural tendency to have a bowel movement after eating (this is called the gastro-colic reflex).
Remove a bowel movement (poop) from your child's diaper, put it in the toilet, and tell your child that poop goes in the potty.
Make sure your child's wardrobe is adaptable to potty training. In other words, avoid overalls and shirts that snap in the crotch. Simple clothes are a must at this stage and children who are potty training need to be able to undress themselves.
Let your child have some time during the day without a diaper (if you want). If he or she urinates without wearing a diaper, your child may be more likely to feel what's happening and express discomfort. (But if you opt to keep your child's bottom bare for a little while, you'll probably need to keep the potty close by, protect your rugs and carpet, and be willing to clean up.)
Have "target practice" with your little boy. Show him how to stand so that he can aim his urine stream into the toilet. Some parents use things like cereal pieces as a sort of bull's-eye for their little guys to try aiming at.
Offer your child small rewards, such as stickers or time reading with Mommy, every time your child goes in the potty. To help keep track of your child's successes, you might want to keep a chart. Once your little one appears to be mastering the use of the toilet, you might want to let him or her pick out a few new pairs of big-kid underwear to wear whenever your child puts the pee or poop in the potty.
Make sure all of your child's caregivers - including babysitters, grandparents, and child-care workers - follow the same routine. Let them know how you're handling the issue and ask that they use the same approaches so your child won't become confused.
Above all, be sure to praise your child's attempts to use the toilet, even if nothing happens. And remember that accidents will happen. It's important not to punish potty-training children or show disappointment when they wet or soil themselves or the bed. Instead, tell your child that it was an accident and offer your support. Reassure your child that he or she is well on the way to using the potty like a big kid.

And if you're torn about when to start the toilet-teaching process altogether, let your child be your guide. Don't feel pressured by others (your parents, in-laws, friends, siblings, coworkers, etc.) to begin. Many parents of past generations started potty training much sooner than many parents do today. And it all depends on the child. Yours will let you know when he or she is ready.

Osteoporosis Treatment — Without Estrogen

Drugs called bisphosphonates has become the new mainstay treatment for postmenopausal women diagnosed with osteoporosis.
Taking just one pill a week, or even one a month, may prevent, slow or stop the breakdown and progress of this bone-thinning condition.
Bisphosphonates work by slowing the breakdown and reabsorption of old bone, an ongoing process that accelerates as estrogen levels fall during the first few years after menopause. By slowing the process, bisphosphonates help preserve bone density and reduce the risk of fractures.
Bisphosphonates available to treat osteoporosis include alendronate (Fosamax), ibandronate (Boniva) and risedronate (Actonel).

Patients should talk with a doctor about the best ways to prevent and treat osteoporosis.






7 myths about osteoporosis




 MYTH: Only women get osteoporosis
In fact, roughly 2 million men suffer from osteoporosis, accounting for 20 percent of those diagnosed with the disease.
MYTH: Osteoporosis is a normal part of aging
It is a fact that you lose bone density with aging,But you should continue to have good bone strength, and you should not develop osteoporosis.
MYTH: Osteoporosis is only a concern for the elderly
It is never too early to begin thinking about strong bones. Your bones begin building density from infancy through young adulthood. Most people have reached maximum bone density by age 35. If maximum bone density is not achieved during that time, you will be at risk for developing osteoporosis
MYTH: Osteoporosis is strictly hereditary
While women with a family history of osteoporosis are at an increased risk of developing the disease, not having a family history does not mean that you are immune to having this condition. Everyone is susceptible. However, there are several factors that can make an individual more likely to develop osteoporosis.Certain kidney diseases, vitamin D deficiency, some hormonal diseases such as some thyroid disorders, Cushing’s syndrome, individuals who are treated with steroids for certain medical conditions, and certain types of cancer can contribute to osteoporosis.
MYTH: Broken bones are the only way to tell if you have osteoporosis
Because osteoporosis has no symptoms, most people are not aware that they have it until something happens, like a bone fracture. However, this is not the only indicator of the disease. Even people who don’t have broken bones may develop osteoporosis. Many people may not even know they had a broken bone, and they may develop a change in their posture or a loss in height. To help determine whether bone loss has begun, it is important to get a bone density test every few years, especially for women who have entered menopause. The most common method of measuring bone density is a DEXA scan, which is a painless X-ray of your hip and spine.
MYTH: Osteoporosis cannot be prevented
Building strong bones during childhood and adolescence is the best defense against developing osteoporosis later in life. Adults can take steps too to lower their risk of developing the disease. In order to prevent osteoporosis, it’s very important that one has adequate nutrition, good calcium intake, exercise, and adequate vitamin D supplementation.Weight-bearing exercises such as walking, jogging, lifting weights and dancing are the best for building strong bones. People who already have osteoporosis should avoid these exercises, as they increase the risk of breaking a bone. Calcium intake is very important, too. Douyon recommends calcium supplementation throughout the entire lifespan, especially for women. Avoiding smoking and excessive alcohol intake also will lower your chances of developing osteoporosis.
MYTH: Only osteoporosis medications can prevent future bone loss
The FDA has approved certain medications to prevent and/or treat the disease. Most of the drugs inhibit the cells that break down bone, and one actually stimulates the growth of new bone. Unfortunately, these drugs haven’t been available for very long, so their long-term effects are not known and people should not rely on them alone.









New medicine for osteoporosis








Scientists from the USA and Great Britain inform on successful end of tests of a new medicine for osteoporosis which needs to be entered once a year. Scale research has shown, that application of a preparation for the women with menopause, reduces risk of fractures of bones dangerous to a life on 40 %.
Osteoporosis - age disease which leads to depression of density of osteal substance and the increased fragility of bones. Fractures of large bones, first of all femoral, are especially dangerous to elderly patients. According to the British statistics, one of five patients with such fracture perishes from accompanying complications and infections within several months after a trauma.
Modern medicines for an osteoporosis are calculated on regular, daily or weekly reception, therefore their efficiency often decreases because of an indiscipline of patients.
The new preparation , which active substance is a zoledronic acid, acts an extent of 12 months after a unitary intravenous injection. The previous researches of a preparation have shown, that its{his} application leads to restoration of osteal mass. The new tests, proceeded three years, should show, that the medicine really reduces risk of fractures of bones.
In research it has been involved 8000 women . Within three years the participant have three injections contained 5 mg of a zoledronic acid.
As a result, among patients has been 70 percent reduction of risk of fractures of spinal column.
Frequency of fractures of a femur has decreased on 41 %, frequency of other, less dangerous fractures - on 25 %.

Sunlight, cancer and vitamin D

A new study suggests that the benefits of moderately increased exposure to sunlight - namely the production of vitamin D, which protects against the lethal effects of many forms of cancer and other diseases - may outweigh the risk of developing skin cancer in populations deficient in vitamin D.

Ultraviolet A (UVA) radiation and visible light are the primary causes of malignant melanoma, the deadliest form of skin cancer. But solar radiation is also a major, if not the main, source of vitamin D in humans. In the presence of sunlight, the body converts certain precursor chemicals to active vitamin D.

In the current study scientists used a model incorporating information on solar radiation intensity and a vertical cylinder shape to represent the human body’s skin surface to calculate the relative production of vitamin D via sunlight as a function of latitude, or distance from the equator. The cylindrical model more realistically represents human body sun exposure than flat surface exposure measurements used in previous models. The scientists also examined the incidence of and survival rates for various forms of cancer by latitude.

According to the calculations, people residing in Australia (just below the equator) produce 3.4 times more vitamin D as a result of sun exposure than people in the United Kingdom, and 4.8 times more than people in Scandinavia.
In populations with similar skin types, there is also a clear increase in the incidence of all forms of skin cancer from north to south.
The scientists also found that the incidence rates of major internal cancers such as colon cancer, lung cancer, and cancers of the breast and prostate also increased from north to south. However, when the scientists examined the survival rates for these cancers, they found that people from the southern latitudes were significantly less likely to die from these internal cancers than people in the north.

Melanoma is triggered by UVA (the long UV wavelengths) and visible light. Vitamin-D production in the body, on the other hand, is triggered by UVB (the short UV wavelengths at the earth’s surface).

Vitamin D is easily accessible in many foods and liquids, such as cod liver oil and milk, and in dietary supplements.

Anemia

Anemia, one of the more common blood disorders, occurs when the level of healthy red blood cells (RBCs) in the body becomes too low. This can lead to health problems because RBCs contain hemoglobin, which carries oxygen to the body's tissues. anemia can cause a variety of complications, including fatigue and stress on bodily organs.

Anemia can be caused by many things, but the three main bodily mechanisms that produce it are:

excessive destruction of RBCs
blood loss
inadequate production of RBCs
Among many other causes, anemia can result from inherited disorders, nutritional problems (such as an iron or vitamin deficiency), infections, some kinds of cancer, or exposure to a drug or toxin.

Anemia Caused by Destruction of RBCs
Hemolytic ("hemo" means blood, "lytic" means destroying) anemia occurs when red blood cells are being destroyed prematurely. (Normally, the lifespan of RBCs is 120 days. In hemolytic anemia, they have a much shorter lifespan.) And the bone marrow (the soft, spongy tissue inside bones that makes new blood cells) simply can't keep up with the body's demand for new cells. This can happen for a variety of reasons. Sometimes, infections or certain medications - such as antibiotics or antiseizure medicines - are to blame.

In a condition known as autoimmune hemolytic anemia, the immune system mistakes RBCs for foreign invaders and begins destroying them. Other children inherit defects in the red blood cells that lead to anemia. Common forms of inherited hemolytic anemia include sickle cell anemia, thalassemia, and glucose-6-phosphate dehydrogenase deficiency.

Sickle cell anemia is a severe form of anemia found most commonly in people of African heritage, although it can affect those of Caucasian, Saudi Arabian, Indian, and Mediterranean descent. In this condition, the hemoglobin forms long rods when it gives up its oxygen, stretching red blood cells into abnormal sickle shapes. This leads to premature destruction of RBCs, chronically low levels of hemoglobin, and recurring episodes of pain, as well as problems that can affect virtually every other organ system in the body. About 1 out of every 625 African-American children is born with this form of anemia.
Thalassemia, which usually affects people of Mediterranean, African, and Southeast Asian descent, is marked by abnormal and short-lived RBCs. Thalassemia major, also called Cooley's anemia, is a severe form of anemia in which RBCs are rapidly destroyed and iron is deposited in the skin and vital organs. Thalassemia minor involves only mild anemia and minimal red blood cell changes.
Glucose-6-phosphate dehydrogenase (G6PD) deficiency most commonly affects men of African heritage, although it has been found in many other groups of people. With this condition the RBCs either do not make enough of the enzyme G6PD or the enzyme that is produced is abnormal and doesn't work well. When someone born with this deficiency has an infection, takes certain medicines, or is exposed to specific substances, the body's RBCs suffer extra stress. Without adequate G6PD to protect them, many red blood cells are destroyed prematurely.
Anemia Caused by Blood Loss
Blood loss can also cause anemia - whether it's because of excessive bleeding due to injury, surgery, or a problem with the blood's clotting ability. Slower, long-term blood loss, such as intestinal bleeding from inflammatory bowel disease (IBD), can also cause anemia. Anemia sometimes results from heavy menstrual periods in teen girls and women. Any of these factors will also increase the body's need for iron because iron is needed to make new RBCs.

Anemia Caused by Inadequate Production of RBCs
Aplastic anemia occurs when the bone marrow can't make enough RBCs. This can be due to a viral infection, or exposure to certain toxic chemicals, radiation, or medications (such as antibiotics, antiseizure drugs, or cancer treatments). Some childhood cancers can also cause aplastic anemia, as can certain chronic diseases that affect the ability of the bone marrow to make blood cells.

High levels of hemoglobin and RBCs help fetal blood carry enough oxygen to developing babies in the relatively oxygen-poor environment in utero. Thus, infants are born with some protection from iron deficiency. After the child is born, more oxygen is available and the baby's hemoglobin level normally drops to a low point at about 2 months of age, a condition known as physiologic anemia of infancy. This temporary and expected drop in the blood count is considered normal and no treatment is required because the infant's body soon starts making red blood cells on its own.

Anemia also occurs when the body isn't able to produce enough healthy RBCs because of an iron deficiency. Iron is essential to hemoglobin production. Poor dietary iron intake (or excessive loss of iron from the body) can lead to iron deficiency anemia, the most common cause of anemia in children. Iron deficiency anemia can affect children at any age, but is most commonly seen in those younger than 2 years old.

Girls going through puberty also have a particularly high risk for iron deficiency anemia because of the onset of menstruation; the monthly blood loss increases the amount of iron they need to consume in their diets.

Signs and Symptoms of Anemia
If your child has anemia, the first symptoms might be mild skin paleness, and decreased pinkness of the lips and nailbeds. These changes happen gradually, though, so they may be difficult to notice. Other common signs of anemia include:

irritability
fatigue
dizziness, lightheadedness, and a rapid heartbeat
Depending on what's causing the anemia, symptoms may also include jaundice (yellow-tinged skin), a yellowing of the whites of the eyes, an enlarged spleen, and dark tea-colored urine. In infants and preschool children, iron deficiency anemia can result in developmental delays and behavioral disturbances, such as decreased motor activity and problems with social interaction and attention to tasks. Recent research indicates that developmental problems may persist into and beyond school age if the iron deficiency is not properly treated.

Diagnosing Anemia
In many cases, doctors don't diagnose anemia until they run blood tests as part of a routine physical examination. A complete blood count (CBC) may indicate that there are fewer red blood cells than normal. Other diagnostic tests may include:

Blood smear examination: Blood is smeared on a glass slide for microscopic examination of RBCs, which can sometimes indicate the cause of the anemia.
Iron tests: These include total serum iron and ferritin tests, which can help to determine whether anemia is due to iron deficiency.
Hemoglobin electrophoresis: Used to identify various abnormal hemoglobins in the blood and to diagnose sickle cell anemia, the thalassemias, and other inherited forms of anemia.
Bone marrow aspiration and biopsy: This test can help determine whether cell production is happening normally in the bone marrow. It's the only way to diagnose aplastic anemia definitively and is also used if a disease affecting the bone marrow (such as leukemia) is a suspected cause of the anemia.
Reticulocyte count: A measure of young RBCs, this helps to determine if production of red blood cells is at normal levels.
In addition to running these tests, your child's doctor may ask about a family history of anemia and your child's symptoms and medications. This may lead the doctor to perform other tests to look for specific diseases that might be causing the anemia.

Treating Anemia
Treatment for anemia depends on its cause. It's important not to assume that any symptoms your child may be having are due to iron deficiency. Be sure to have your child checked by a doctor.

If your child does have iron deficiency anemia, the doctor may prescribe medication as drops (for infants) or as a liquid or tablet (for older children), and also may recommend adding certain iron-rich foods to your child's diet.

If your teenage daughter is anemic and has heavy or irregular menstrual periods, in some cases her doctor may prescribe a birth control pill to help regulate the bleeding.

Folic acid and vitamin B12 supplements may be prescribed if the anemia is traced to a deficiency of these nutrients, although this is rare in children.

If a certain medication appears to be the cause, your child's doctor may discontinue it or replace it with something else - unless the benefit of the drug outweighs this side effect.

Anemia caused by an infection will usually improve when the infection passes or is treated.

Depending on the cause, treatment for more severe or chronic forms of anemia may include:

transfusions of normal red blood cells taken from a donor
removal of the spleen or treatment with medications to prevent blood cells from being removed from circulation or destroyed too rapidly
medications to fight infection or stimulate the bone marrow to make more blood cells
Bone marrow transplantation may be considered in some cases of sickle cell anemia, thalassemia, and aplastic anemia. This procedure involves taking bone marrow cells from a donor and injecting them into the child's vein; the donated cells then travel through the bloodstream to the child's bone marrow, where they begin producing new blood cells.

Caring for a Child With Anemia
The type, cause, and severity of your child's anemia will determine what kind of care is needed. Rest assured, though, that children often tolerate anemia much better than adults.

In general, a child with significant anemia may tire more easily than other children and therefore need to limit activity levels. Make sure that your child's teachers and other caregivers are aware of the condition. If iron deficiency is the cause, follow the doctor's directions about dietary changes and taking any iron supplements.

If the spleen is enlarged, your child may be prohibited from playing contact sports because of the risk that the spleen could rupture or hemorrhage if your child is hurt. Certain forms of anemia, such as sickle cell anemia, require other more specific kinds of care and treatment.

Preventing Anemia
Whether anemia can be prevented depends on its cause. Currently, there is no way to prevent anemia due to genetic defects affecting the production of RBCs or hemoglobin.

However, you can take steps to help prevent iron deficiency, the most common form of anemia. Before following any of these suggestions, be sure to talk them over with your child's doctor.

Cow's milk consumption. During the first 6 months of life, babies are usually protected against developing iron deficiency by the stores of iron built up in their bodies pre-birth. But after month 6, as infants continue to grow, they often don't get enough iron through breast milk alone or regular cow's milk (which contains less iron than fortified infant formula). Regular cow's milk can also cause some infants to lose iron from their intestines, and drinking lots of it can make an infant less interested in eating other foods that are better sources of iron. For these reasons, regular cow's milk is not recommended for children until they reach 1 year of age and are eating an iron-rich diet. In addition, your child should not drink more than 24-32 ounces (709-946 ml) of milk each day. If you can't get your child to eat more iron-rich foods, speak with your child's doctor about giving your child an iron supplement.
Iron-fortified cereal and formula. These products can help ensure that your baby is getting enough iron, especially during the transition from breast milk or formula to solid foods.
Well-balanced diet. Make sure that your child or teen regularly eats foods that contain iron. Good choices include iron-fortified grains and cereals, red meat, egg yolks, leafy green vegetables, yellow vegetables and fruits, potato skins, tomatoes, molasses, and raisins. If your child is a vegetarian, you'll need to make an extra effort to ensure sufficient iron sources because iron found in meat, poultry, and fish is more easily absorbed than iron found in plant-based and iron-fortified foods. Also, be aware that certain food combinations can inhibit or promote absorption of iron. For example, drinking coffee or tea (including iced tea) with a meal can significantly lower the amount of iron absorbed. On the other hand, vitamin C helps the body absorb iron.
If you have any questions about anemia, or you think your child might have the condition, talk with your child's doctor.

G6PD deficiency

G6PD deficiency is an inherited condition in which the body doesn't have enough of the enzyme glucose-6-phosphate dehydrogenase, or G6PD, which helps red blood cells (RBCs) function normally. This deficiency can cause hemolytic anemia, usually after exposure to certain medications, foods, or even infections.

Most people with G6PD deficiency don't have any symptoms, while others develop symptoms of anemia only after RBCs have been destroyed, a condition called hemolysis. In these cases, the symptoms disappear once the cause, or trigger, is removed. In rare cases, G6PD deficiency leads to chronic anemia.

With the right precautions, a child with G6PD deficiency can lead a healthy and active life.

About G6PD Deficiency
G6PD is one of many enzymes that help the body process carbohydrates and turn them into energy. G6PD also protects red blood cells from potentially harmful byproducts that can accumulate when a person takes certain medications or when the body is fighting an infection.

In people with G6PD deficiency, either the RBCs do not make enough G6PD or what is produced cannot properly function. Without enough G6PD to protect them, RBCs can be damaged or destroyed. Hemolytic anemia occurs when the bone marrow (the soft, spongy part of the bone that produces new blood cells) cannot compensate for this destruction by increasing its production of RBCs.

Causes of G6PD Deficiency
G6PD deficiency is passed along in genes from one or both parents to a child. The gene responsible for this deficiency is on the X chromosome.

G6PD deficiency is most common in African-American males. Many African-American females are carriers of G6PD deficiency, meaning they can pass the gene for the deficiency to their children but do not have symptoms; only a few are actually affected by G6PD deficiency.

People of Mediterranean heritage, including Italians, Greeks, Arabs, and Sephardic Jews, also are commonly affected. The severity of G6PD deficiency varies among these groups — it tends to be milder in African-Americans and more severe in people of Mediterranean descent.

Why does G6PD deficiency occur more often in certain groups of people? It is known that Africa and the Mediterranean basin are high-risk areas for the infectious disease malaria. Researchers have found evidence that the parasite that causes this disease does not survive well in G6PD-deficient cells. So they believe that the deficiency may have developed as a protection against malaria.

G6PD Deficiency Symptom Triggers
Kids with G6PD deficiency typically do not show any symptoms of the disorder until their red blood cells are exposed to certain triggers, which can be:

illness, such as bacterial and viral infections
certain painkillers and fever-reducing drugs
certain antibiotics (especially those that have "sulf" in their names)
certain antimalarial drugs (especially those that have "quine" in their names)
Some kids with G6PD deficiency can tolerate the medications in small amounts; others cannot take them at all. Check with your doctor for more specific instructions, as well as a complete list of medications that could pose a problem for a child with G6PD deficiency.

Other substances can be harmful to kids with this condition when consumed — or even touched — such as fava beans and naphthalene (a chemical found in mothballs and moth crystals). Mothballs can be particularly harmful if a child accidentally swallows one, so ANY contact should be avoided.

Symptoms of G6PD Deficiency
A child with G6PD deficiency who is exposed to a medication or infection that triggers the destruction of RBCs may have no symptoms at all. In more serious cases, a child may exhibit symptoms of anemia (also known as a hemolytic crisis), including:

paleness (in darker-skinned children paleness is sometimes best seen in the mouth, especially on the lips or tongue)
extreme tiredness
rapid heartbeat
rapid breathing or shortness of breath
jaundice, or yellowing of the skin and eyes, particularly in newborns
an enlarged spleen
dark, tea-colored urine
Once the trigger is removed or resolved, the symptoms of G6PD deficiency usually disappear fairly quickly, typically within a few weeks.

If symptoms are mild, no medical treatment is usually needed. As the body naturally makes new red blood cells, the anemia will improve. If symptoms are more severe, a child may need to be hospitalized for supportive medical care.

Diagnosing and Treating G6PD Deficiency
In most cases, cases of G6PD deficiency go undiagnosed until a child develops symptoms. If doctors suspect G6PD deficiency, blood tests usually are done to confirm the diagnosis and to rule out other possible causes of the anemia.

If you feel that your child may be at risk because of either a family history or your ethnic background, talk to your doctor about performing a screening with blood tests to check for G6PD deficiency.

Treating the symptoms associated with G6PD deficiency is usually as simple as removing the trigger — that is, treating the illness or infection or stopping the use of a certain drug. However, a child with severe anemia may require treatment in the hospital to receive oxygen, fluids, and, if needed, a transfusion of healthy blood cells. In rare cases, the deficiency can lead to other more serious health problems.

Caring for Your Child
The best way to care for a child with G6PD deficiency is to limit exposure to the triggers of its symptoms. With the proper precautions, G6PD deficiency should not keep your child from living a healthy, active life.

Preparation of 11C-labelled methanol on

E. Sarkadi, Z. Kovacs, P. Lehikoinen and G. Horvath
 Abo Academy, Turku, Finland
 PET Center, University School of Medicine, Debrecen
The [11C]methyl iodide is an important intermedier to synthesize 11C-labelled
radiopharmaceuticals for medical diagnostics in positron emission tomography.
As a rst step of the [11C]methyl iodide preparation [1, 2] the classical ra-
diomethanol production has been applied in our laboratory earlier [3]. Recently
we have developed a new method to produce [11C]methanol intermedier.
[11C]carbon dioxide was produced by the 14N(p,)11C nuclear reaction, irradi-
ating nitrogen gas (containing oxigen in ppm level) with 15 MeV protons at the
Debrecen and Turku compact MGC-20 cyclotrons. Trapping of the [11C]carbon
dioxide, produced and previously concentrated in a freezing unit, was carried out at
room temperature on an alumina column properly impregnated with lithium alu-
minum hydride dissolved in tetrahydofuran. The whole alumina column had to be
impregnated, otherwise the dry part of the alumina would adsorb the [11C]carbon
dioxide without complex formation (lithium aluminum [11C]methylate) and, after
heating the column up to 180 C in order to eliminate the solvent, the unreacted
[11C]carbon dioxide would leave with the helium carrier gas.
After the elimination of tetrahydrofuran the [11C]methanol was produced by
hydrolyzing of the complex (with introduction of water) at 180 C. Conversion of
the released [11C]methanol into [11C]methyl iodide was carried out by the hydrogen
iodide { alumina method described in [4].
The advantage of this method of radiomethanol preparation is the application of
an alumina column at room temperature instead of a complicated cooling unit used
with the conventional reaction vessel. The big surface of the alumina wetted with
lithium aluminum hydride assures the shorter reaction time. The construction of this
synthesis system is simple and more reliable. The yield and purity of radiomethanol
was the same as in the previous methods.
[1] D. Comar, M. Maziere, Radiopharm. Lab. Comp. Vol. 1, IAEA, Vienna (1974)
461
[2] G. Berger, M. Maziere, Appl. Radiat. Isot. 30 (1979) 393
[3]  E. Sarkadi, Z. Kovacs, ATOMKI Annual Report (1994) 78
[4]  E. Sarkadi, Z. Kovacs, Radiochimica Acta 76 (1997)