Endothelial dysfunction in a cohort of Indian patients with type-2 diabetes mellitus.

Introduction: Our aim was to study the endothelial functioning in type-2 diabetes mellitus and its correlation with factors commonly associated with type-2 diabetes mellitus like obesity and dyslipidaemia. Materials and methods: 40 patients of previously diagnosed type-2 diabetes mellitus were taken as cases and 40 matched healthy persons were taken as controls. Endothelial function was studied in both groups in accordance with the American College of Cardiology (ACC) guidelines for the ultrasound assessment of endothelial dependent flow-mediated dilation (FMD) of the brachial artery and endothelial independent flow using sublingual nitrate (GTN%). Comparisons were made and analysed statistically between the diabetics and non-diabetic matched controls. Sub-group analysis with respect to endothelial function, waist-hip ratio (WHR), body mass index (BMI), and lipid profile amongst the diabetic subjects was also made. Results: There was a statistically significant difference in the endothelial dependent dilation (4.57 ± 2.01 versus 10.38 ± 1.77 P value < 0.0001) as well as endothelial independent function (11.63 ± 2.01 versus 13.42 ± 1.92 P value 0.001) between the diabetics and non-diabetics. An inverse correlation with the endothelial function and BMI, WHR, and various parameters of the lipid profile amongst the diabetics was also demonstrated. Conclusion: Endothelial dysfunction by brachial ultrasound was found to be significantly higher in a cohort of Indian type-2 diabetics, with positive correlation with BMI and WHR as well as presence and degree of dyslipidaemia. The therapeutic and diagnostic implications of these findings need to be explored.

Prevalence of goitre among school children in Belgaum District.

Objective. A school survey was conducted to estimate the prevalence of goitre among schoolchildren in Belgaum district. Methods. A cross-sectional study was conducted in primary, middle and high schools of villages selected. All the children of the selected schools were examined for the presence of goitre and the salt samples obtained from their homes were tested for iodine content. Results. Overall prevalence of goitre was 16.7%. Prevalence of palpable goitre was 16.4 % and visible goitre was very low (0.3%). Higher prevalence was found among females (21.1%) when compared to that of male children (12.8 %). Prevalence of goitre increased significantly with advancement of age until 16-yr. 72.1 % children were consuming rock salt and only 27.9 % were consuming powdered salt at their homes. Estimation of Iodine content in the salt samples showed that 68.7 % of the sample had inadequate iodine content. Prevalence of goitre was significantly high among children who consumed rock salt (16.2%) as compared to those who used powdered salt (11%). Conclusion. Strict implementation of salt codization and marketing in rural area is desired. Also health education programme be showed.

Three-dimensional CT angiography in the evaluation of cerebral arteries in acute hemorrhage.

OBJECTIVE: We conducted this study to demonstrate the value of non-invasive three-dimensional CT angiography (3D CTA) in the detection of a cerebral aneurysm. MATERIAL AND METHODS: A helical CT acquisition was obtained using non-ionic contrast media in 50 patients with 1 mm per second table speed, 1 mm collimation, and pitch 1:1. Axial source images were transferred into a workstation console (Advantage windows GE) and CTA was obtained using MIP (Maximum Intensity Projection) reconstruction. Fourteen patients underwent conventional digital subtraction angiography (DSA) after 3D CTA prior to surgery. RESULTS: A total of 39 aneurysms were detected in 50 patients. All patients with an aneurysm were operated and the presence of aneurysms was confirmed. 3D CTA detected 38 of these 39 aneurysms. In 37 aneurysms, the origin of the aneurysm and aneurysm neck was adequately visualized. 3D CTA was found to be 100% specific and 97.2% sensitive in picking up cerebral aneurysms. 3D CTA was 97% specific in demonstrating the exact origin and showing the neck of the aneurysm. CONCLUSIONS: CT angiography is a simple, quick, and non-invasive technique and can replace DSA in most patients with acute subarachnoid hemorrhage aneurysm for the detection and characterization of aneurysms of the circle of Willis. The relation of the aneurysm with bony landmarks was clearly depicted.

Acute respiratory infections in children: a community based longitudinal study in south India.

A community based longitudinal study was conducted in Malpe, a coastal village of Udupi district, Karnataka state, to investigate acute respiratory infections (ARI) in children. A cohort of 91 children under 3 years of age were followed up for 1 year, leading to 2047 fortnightly observation. On an average every child had 11.3 months of follow up. The overall incidence of ARI was 6.42 episodes per child per year. On an average each episode lasted for 5.06 days. Mean duration of ARI during one year was 32.5 days per child. Most of the ARI episodes in children (91.3%) were of simple Cough & Cold (no pneumonia). However, 8.2% developed pneumonia and only 0.51% had severe pneumonia. Incidence of ARI was almost same in male and female children. There was no significant difference in incidence among various age groups. But the incidence of pneumonia was significantly higher among infants (p<0.00002). Children of poor housing with smoke producing conditions suffered more frequently (p,002).

Validity of mechanism of gene transfer in the process called conjugation in bacteria.

We have attempted a new evaluation of the process of conjugation in bacteria, because of some basic dissimilarities observed between this and that of eukaryotes, or plants and animals. Reference donor and recipient strains, widely used to prove conjugation in bacteria, were chosen; addition of DNase during the conjugation process, led to an unexpected but highly reproducible increase in the transconjugant colony counts (TCC; ca. > or = 1 log), when compared with that of the controls without DNase. Transconjugants were also obtained when the same live donors were substituted with the UV-killed ones although the TCC was very low initially. Contrarily, donors treated with DNA-intercalating agents, e.g. acridine orange or ethidium bromide, resulted in a complete failure to produce transconjugants. There was a quantitative relationship between the DNase used on donors and levels of DNA sugars/nucleotides/DNA, which possibly resulted from interaction between the DNase and DNA being present/produced on the donor surface. This may be indicative of what may actually happen in the donor-recipient mixtures in the conjugation test proper, where the recipient DNase may activate a donor DNA production cycle. The evidences presented did not suggest that the donor DNA in the conjugation process is actually vestibuled through any intercellular conjugation passages, and is susceptible to the action of DNase or the intercalating dyes.

Socio-demographic and maternal determinants of low birth weight: a multivariate approach.

A community based study was conducted in the rural areas of Udupi taluk, Karnataka state of South India to identify the socio-demographic, maternal and obstetric determinants of low birth weight. All singleton live births that occurred in the study area during a one year period (October 1991 to September 1992) were included. A total of 2919 singleton child-mother pairs formed the basis of the analysis. Information about social, demographic and economic conditions of the families; maternal factors such as age, parity, quality of antenatal care and previous obstetric history were collected by interviewing the mothers and family members and verifying the available medical records through the field investigators especially recruited and trained for this purpose. Data was analyzed using multiple logistic regression model. Primis, elderly mothers and mothers who had not received good quality antenatal care were found to be more at risk of having low birth weight babies. Other significant determinants were family custom, socio-economic status and environmental sanitation.

Atrial entrapment of flow directed pulmonary artery catheter-a technique for non-surgical removal.

A 43 year old patient who underwent mitral valve replacement had pulmonary artery catheter inserted before induction of anaesthesia. The catheter could no be removed postoperatively by routine manoeuvres in the intensive care unit. Fluoroscopy in the cardiac catheterization revealed a straight course of the catheter indicating the probability of its inclusion in the left atrial suture line. The pulmonary artery catheter was successfully removed percutaneously in the cardiac catheterization laborartory. The procedure is described.

Haemophilus influenzae type b vaccine in India: need and timing, immunogenecity and tolerance.

OBJECTIVE: (i) To assess the natural immunity and susceptibility to Haemophilus influenzae type b (Hib) infections in children in India. (ii) To study the immunogenecity and tolerance of Hib vaccine (ACTHIB) in young infants. DESIGNS: (i) Cross sectional study. (ii) Prospective trial. SETTING: Well baby and immunization clinics. METHODS: (i) PRP antibody titers against Hib estimated in 172 healthy infants and children aged 1 month to 10 years. (ii) Antibody titres estimated before and after ACTHIB vaccine given with primary immunization (age group 6 to 8 weeks) in 50 babies. RESULTS: (i) Naturally protective levels of Hib antibodies found in less than 20% of infants under one year, but in over 80% above 4 years. (ii) Seroconversion after ACTHIB vaccination was 100% with very high protective levels. There were no significant adverse reactions. CONCLUSIONS: ACTHIB vaccine proved to be safe and highly immunogenic. As susceptibility to Hib is highest in the first year of life, the vaccine should be recommended in the primary immunization schedule (combined with DPT). The very high titers achieved suggest the possibility of decreasing the number of doses or the amount of antigen to reduce the prevalent high cost.

Influence of parental literacy and socio-economic status on infant mortality.

The influence of parental literacy and socio-economic status (SES) on infant mortality rate (IMR) was studied. This report is only a part of much larger community-based prospective study conducted to determine the factors influencing infant mortality in Dakshina Kannada district of Karnataka, by the Department of Community Medicine, Kasturba Medical College, Manipal, with the financial assistance form IDRC, Canada. A total of 12,857 livebirths during the period of October 1, 1991, to September 30, 1992, where registered and followed up for one year. There were 391 infant deaths which gives an IMR of 30.4 per 1,000 livebirths. Univariate analysis and subsequent stepwise multiple logistic regression analysis revealed that, literacy and SES have a very significant role in reducing IMR.

In vitro & in vivo experimental susceptibility of Mycobacterium marinum to augmentin.

The effect of augmentin alone and in combination with various beta-lactam antibiotics was studied against a pathogenic Mycobacterium, M. marinum. The in vitro studies did not reveal any additional advantage over that found with augmentin alone and this antibiotic seemed considerably inhibitory to M. marinum at < 1 microgram/ml concentration. In vivo, the effects of augmentin on experimentally produced lesions in the mouse foot pads (MFPs) showed a significant regression of the lesions, which was compatible with an early disappearance of M. marinum from the MFP, in contrast with those of the untreated, control animals.

Evaluation of immunogenicity and tolerance of single dose haemophilus influenzae type B (PRP-T) vaccine.

OBJECTIVE: Evaluation of immunogenicity and acceptability of PRP-T vaccine among the Indian children. DESIGN: Multicentric, open, parallel group, comparative study of Haemophilus influenzae type B vaccine, given as single (Group I) or associated (Group II) with DPT vaccine. SETTING: Five different vaccination clinics. SUBJECTS: 125 children between the age group of 18-24 months. PARAMETERS: Measurement of (i) pre and post vaccination antibody titres of Haemophilus influenze type B specific antibody; (ii) Adverse events; and (iii) Tolerance as graded by the physician. RESULTS: Prevaccination antibody levels were > 0.15 mcg/ml in 56.3% in Group I and 35.7% in Group II. Post-seroconversion was seen in 97% in Group II receiving single and all in Group II (P > 0.05). The vaccine was well tolerated. CONCLUSIONS: The probability of subclinical infection or cross immunity is high in India. ACTHIB vaccine has a good immunogenicity and tolerance and association with DPT does not modify the immunogenicity of ACTHIB vaccine.

Role of metronidazole in radiation therapy (a review of 717 cancer cases).

The presence of Hypoxic cells in a tumor decreases their radiosensitivity; which blocks the efficacy of external tele cobalt irradiation. So a study was undertaken in various cancer patients to observe the role of metrnidazole as a selective radiosensitizer. 717 cancer cases were enlisted and were divided into a study and control group. The study group were given metronidazole at a dose of 2 grams orally, 4 hours before each irradiation, (5 days in a week) for 6-7 weeks. The control group were devoid of it. After completion of the treatment, as well as, after 3 years follow-up, it was observed that the patients receiving metronidazole had better treatment response and more number of recurrence free years. Since it is a cheaper drug it can be used freely in the form of a potential radiosensitizer, for external irradiation therapy.

An epidemiological study of paralytic poliomyelitis cases in Kasturba Hospital, Manipal.

An analysis of hospital records at Kasturba Medical College Hospital, Manipal for 8 years revealed a declining trend of paralytic poliomyelitis cases. A lameness survey carried out in children of 5-9 years age group in the community showed an incidence of 0.56 per 1000 children in 0-4 years age group. Vaccination survey carried out in the same community showed coverage of 70 per cent with OPV. Number of children with poliomyelitis having history of full immunization showed an increasing trend.

Effect of exogenous 5-hydroxytryptamine on pathogenicity of Entamoeba histolytica in experimental animals.

In an effort to find out the mechanism(s) operative in enhancing the pathogenicity of E. histolytica in hosts under heat stress reported earlier, effect of 5-hydroxytryptamine (5-HT) on the virulence of the parasite was examined in just weaned Charles Foster strain of albino rats. Pathogenicity of 10 strains of E. histolytica, from various forms of intestinal amoebiasis, grown in modified Boeck and Drbohlav's medium was assessed by caecal scoring. Administration of 5-HT in infected animals significantly enhanced the pathogenicity of all the seven strains tested. Treatment of the host with the 5-HT precursor L-tryptophan also increased the caecal scores examined with three strains of E. histolytica. Prior blocking of tissue 5-HT receptors by administration of methysergide almost completely abolished the pathogenicity enhancing effect of 5-HT treatment. This suggested that 5-HT itself and not any of its metabolites was responsible for the observed increase in pathogenicity of E. histolytica on 5-HT treatment of the host.

Drug interaction of promethazine & other non-conventional antimicrobial chemotherapeutic agents.

The antihistamine compound promethazine (Pz) showed significant antibacterial action when tested against 124 strains of aerobic and 13 strains of anaerobic bacteria belonging to both Gram positive and Gram negative genera. The range of MIC (micrograms/ml) of Pz varied between 50 and 200 micrograms/ml among most of the test organisms. Six Pz-sensitive strains were found to be simultaneously sensitive to similar non-conventional antimicrobics, e.g., methdilazine, bromodiphenhydramine, diphenhydramine, methyl-DOPA, promazine and the antibiotic augmentin. A high degree of synergism was observed in vitro when Pz was used in combination with methdilazine and bromodiphenhydramine.