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CONTEXT: Promotional and educational programs relating to breast feeding are important for reversing the decline in this practice. Most programs are centered exclusively on breast feeding, although general knowledge about newborn health care may be important, especially among pregnant women. OBJECTIVE: To study pregnant women's knowledge about general health care of newborns, including breast feeding aspects. TYPE OF STUDY: Cross-sectional. SETTING: Prof. Samuel Barnsley Pessoa Health School Center, Faculty of Medicine, University of São Paulo, Brazil. PARTICIPANTS: All pregnant women who were registered in the prenatal care program during six consecutive months. MAIN MEASUREMENTS: Aspects of the current gestation, previous gestations and childbirth, knowledge of the general aspects of newborn health care and of breast feeding practices. RESULTS: The results show that only a little over half of the pregnant women had received any information on newborn health care. Misinformation was clearly present regarding proper care of the umbilical stump and the nature of jaundice, and worst regarding how to treat oral thrush and jaundice, and about vaccination. In relation to breast feeding, even though almost all the pregnant women declared their intention to breast feeding, less than half had a concrete response regarding how long to do it for. The low rates obtained in the topics dealing with the duration, nursing intervals and the attitude to be taken towards hypogalactia show unfamiliarity with the breast feeding technique. The "weak milk" belief, the misinformation about contraceptive methods during breast feeding and the cost of artificial formulas also have a negative impact on this practice. CONCLUSIONS: Pregnant women's knowledge of newborn health care is low, as much in the aspects of general care as in relation to the practice of breast feeding. These findings must be taken into consideration in educative programs promoting breast feeding.

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This report describes a relapse of Salmonella paratyphi B infection in a child with biliary atresia, following 2 weeks of treatment with ciprofloxacin. The recrudescence was complicated by the development of osteomyelitis and was treated with chloramphenicol, trimethoprim, ceftriaxone and ampicillin in succession.

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OBJECTIVE: To describe a new kindred with Clq deficiency and to identify the molecular lesions responsible for complete functional C1q deficiency in this and 2 other previously described kindreds. METHODS: The A-, B-, and C-chain genes of C1q were amplified by polymerase chain reaction, cloned, and sequenced. The DNA sequence was checked for mutations. RESULT: Patient 1 had a homozygous G-to-A change at codon 6 of the C chain, causing an amino acid change from Gly to Arg. Patient 2 had a homozygous deletion of a C nucleotide at codon 43 of the C-chain, causing a frame shift, leading to a premature stop codon at codon 108. Patient 3 had a homozygous C-to-T mutation at amino acid position 41 of the C chain, resulting in a premature stop codon. CONCLUSION: In the homozygous state, the mutations are sufficient to cause complete deficiency of Clq. The mutation in patient 1 has been previously reported in a patient of different ethnic origin. A survey of a series of 158 DNA samples from patients with systemic lupus erythematosus showed no other examples of this mutant allele.

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The results of the program for the evaluation of the curriculum of the graduation course of the Medical Faculty of the University of São Paulo are presented and discussed. Following disciplines received special attention: practice in a hospital for infections diseases, orthopedics and traumatology, medical imagery, propedeutics and preventive and social pediatrics. These disciplines were chosen in an aleatory way among those that correspond to the four models of the behaviour: increasing, decreasing, decreasing/increasing and increasing/decreasing.

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After some considerations about the particular situation of pediatric departments within the global context of the medical education, the authors discuss the graduate teaching of Social and Preventive Pediatrics (primary care), as carried out by the Department of Pediatrics, University of São Paulo Medical School. The following aspects are emphasized: locals or areas of training, academic programs, human resources, duration of training and it's time schedule, number of students and evaluation of the related social and preventive pediatric courses. They conclude pointing to the importance of these courses having in view the terminal performance of the undergraduate students after 1.155 hours of apprenticeship under the supervision of the Department of Pediatrics.

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Duration of breast-feeding was studied by the authors among a representative sample of families with children under one year of age that resided in the area of coverage of the Health Center-School Samuel B. Pessoa in the borough of Butantã, São Paulo. The data was obtained by means of home interviews in which respondents were questioned about what type of food the child was eating that day, so that they did not have to depend on memory. The median duration of breast-feeding was found to be 2.8 months (84 days), thus showing that in the area under study early weaning is still practiced. Nevertheless, the study confirms the trend observed in the city of São Paulo in the last few years of a return to breast-feeding. This conclusion is supported by the fact that, contrary to the pattern in the previous decade, longer duration of breast-feeding is associated with higher academic levels of the parents (both), i.e., the practice is on the increase among the higher social and economic segments of the population. The study shows that the father can play a significant role in breast-feeding patterns. No correlation was found between breast-feeding duration and number of siblings, per capita monthly income, academic level of the mother, or the regularity of health check-ups.

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The defense factors found in human breast milk and the correlation between shortened duration of breast feeding in low income populations, with gastroenteritis and diarrhea, are revised. The changes in intestinal flora and the morbidity and mortality caused by early weaning are detailed.

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In a family exposed to metallic mercury vapour two patients had acrodynia, one had the nephrotic syndrome, and one person remained well. Recognition of the variable manifestations of the disease and prevention of further exposure were the most important aspects of management. Recovery appeared to be complete as blood mercury levels fell to normal. Urinary mercury levels were too variable to be reliable as indications of progress.

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Cutaneous reflex responses have been recorded from forearm flexor and extensor muscles following electrical stimulation of the fingers. Recordings have been made from premature infants, term infants and children between the age of 6 weeks and 11 years. In the new-born, stimulation of the fingers elicits such a powerful reflex that, in general, individual stimuli will evoke a reflex synchronous action potential in both forearm flexor and extensor muscles. Individual stimuli delivered to the fingers also elicit reflex synchronous muscle action potentials in forearm flexor and extensor muscles in patients with clinical signs of upper motor neurone lesion affecting the upper limb; this has not been observed in normal adult subjects. The latency of the reflex response in the term infant is about 18 msec. Comparison of this value with the latency of the tendon jerk for these muscles would indicate a central delay for the cutaneous reflex of about 3 msec. The latencies of the cutaneous reflex and tendon jerk remain constant over the first 5 years of life. The size of the short-latency cutaneous reflex response decreases progressively over the first year of life. In the second year of life stimulation of the fingers produces long- as well as short-latency increases in recorded muscle electrical activity. The maturation of the cutaneous reflex response is discussed in terms of the maturation of function of the corticospinal tract.

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Serum-potassium and total body potassium (T.B.K.) were measured serially for 1 year in a group of eighteen patients with mild essential hypertension. The patients were receiving a single daily dose of 10 mg. bendrofluazide without potassium supplements. At 12 months the mean value for serum-potassium (3-86 mmol per litre) was significantly lower than the mean pre-treatment value (4-26 mmol per litre). There was no significant decrease in T.B.K. in the same period. Diastolic blood-pressure fell significantly, and there were no apparent side-effects from the medication. In the group as a whole, a reduction of about 1 mmol per litre in serum-potassium was associated with an average reduction of 10% in T.B.K., but there was a large individual variation. The amount of potassium loss during the period of study did not seem to be clinically significant. It is suggested that routine potassium supplements are not essential in the treatment of uncomplicated essential hypertension with thiazide diuretics.

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