Emerging geriatric challenge.

India is a vast country with diversity, both physical and cultural. 72% of World's second largest population live in rural experiencing varying degrees of socioeconomic change. However, there is no nationwide registry of older people and exact statistics about elderly population is not available. Community-based data on morbidity and disability are also not available. India is one of the few countries in the world where men out number women at all ages till about 70 years and only in very old age (80+) there are more women than men. One of the main social effect of extension of life in later years is the extended period of widowhood for women mainly due to cultural practice of men marrying younger women and widow marriage as well as divorce are uncommon. Much progress has been made in the health care services in the last 50 years giving much emphasis to mother and child programme with special emphasis on controlling population. But elderly population has been neglected, there is no separate ward for elderly in hospitals, no specialized courses in the Universities for training doctors and nurses for elderly care. Recently, Indian Medical Association has organized an ambitious project for rural elderly with emphasis on Geriatric care. Still recently, emphasis has been given for developing infrastructural facilities including creating training, courses on Geriatric Medicine and integrating with alternative system for better care of elderly. However, due to increasing awareness of policy makers to multiple issues related to aging, some progress has been made like old age pension scheme, income tax rebate for elderly, old homes and day care centers and law to help retired citizens in evicting tenants etc. but environment is not as elderly-friendly as in European countries, as the State is not likely to have adequate resources in the presence of other priorities in the country.

Allergen specific immunotherapy in nasobronchial allergy.

BACKGROUND: More than one antigen has been used for immunotherapy of allergic disorders. So far less than five antigens have been employed with variable results. AIM: To evaluate effect of multiple antigens up to six in the immunotherapy of nasobronchial allergy. SETTING AND DESIGN: Based on clinical history, symptoms present for at least 3 years with set criteria of immunomodulation for asthma and rhinitis: documented IgE mediated asthma and rhinitis, failure in allergen avoidance and moderate to severe clinical manifestations. MATERIAL AND METHODS: Five hundred cases of various allergic disorders attending allergy clinic of Bombay hospital were screened. Allergen specific immunotherapy was initiated in 131 subjects (56 -rhinitis and 75 asthma) with prior consent. Patients suffering from allergic disorders secondary to diseases or drug therapy were excluded. Multiple allergen immunotherapy was given at specific intervals up to a period of one year. Allergen extracts were prepared as per standard technique. For statistical analysis "students't test" was used. RESULTS AND CONCLUSIONS: Significant improvement in PEFR, reduction in skin sensitivity to allergens used in immunotherapy formulation and symptomatic relief without any untoward reaction show that multiple allergen immunotherapy is as effective as monoallergen immunotherapy in nasobronchial allergy.

Ethics in genetic research.

Studies of genetic variation should be conducted in developing countries only after community consultation where identifiable leadership exists and with the individual consent. Studies of particular genetic diseases require the consent of the individual, community consultation may be appropriate, but should not pre-empt the interests of the individuals at risk. Gene therapy trials should not be conducted in the developing world, at least until such therapy becomes effective and relatively inexpensive. Results of genetic tests should be provided to subjects only if the test has been demonstrated to have sufficient clinical validity. Results should never be disclosed to relatives, except as may be unavoidable in the context of pedigree research. Policies regarding disclosure of test results should be included in the informed consent process.

Effect of Saral meditation on intelligence, performance and cardiopulmonary functions.

Meditation is a mental exercise to improve mental faculty. Present attempt was to evaluate effect of Saral Meditation on development of intelligence, academic performance & cardiopulmonary functions. Results show significant improvement in development of intelligence and academic performance. There was apparent improvement in confidence and they were free from anxiety. There were also considerable changes in psychomotor ability and cardiopulmonary functions however, result was not significant.

Gender, aging, health and society.

There are more women than men at any elderly age group. Depression and osteoporosis are the commonest problems in elderly subjects. Some problems specific to males are hypogonadism, erectile dysfunction and enlargement of prostrate and to females are post-menopausal disturbances, urinary incontinence and breast and lung cancer. However, problems of special concern in both male and female elderly are malnutrition, falls and cognitive dysfunction. Men and women in general suffer from the same sorts of health problems but the frequency of these problems as well as the speed of the onset of death distinguishes them. Infact cultural and social forces act to separate the sexes in their personal health ethos and their sick propensity. The impact of old age on women is different from that of men because of differences in their status and role in society. This is specially so because proportion of widows in 60+ age group is considerably higher than that of widowers. Sexuality is often overlooked as a health status particularly in elderly women. Clinicians should recognise the importance of sexual functions to the overall health of older persons particularly women. Religious participation and involvement are associated with positive mental and physical health. Family life is the key to the health of elders specially older men. Lack of social support increases the risk of mortality and supportive relationships are associated with lower illness rates, faster recovery rates and higher levels of health care behavior.

Prevalence of hypertension in Mumbai.

There are few reports on prevalence of hypertension in India. We are presenting a study of its incidence in OPD of hospital patients in Mumbai. Prevalence of hypertension was 7.82% in all subjects, however, it was higher in females 10.5% than in males 6.1%.

Primitive society, health & elderly.

Mankind have been ravaged by diseases since primitive age and remedial measures were emprirical learnt either by accident, experience or superstition. But most elderly population were killed and hardly died of diseases. Fate of women were no better. Care for elderly came with civilization. They were little better in the East compared to the West. Although elderly population were better treated in India, China tops the list for elderly care. Even today the oldest man in the family is most respected. Civilized nations even today discriminate elderly population compared to children and adult, but apply the yardstick in a different manner, direct killing alone is not allowed.

Newer approaches in increasing life span.

Based on ideal conditions technical life span of human kind is approximately 110-120 years. Although number of studies including calorie restriction and antiparkinsonism drug (deprenyl) have indicated increased life span in animals, it is premature to expect them to increase life span in man. However, current studies like activation of immune system with DHEA in man and anticipation of antioxidant therapy contributing to increased life span are encouraging. Practice of meditation particularly TM and balanced diet might be contributory.

Physiology of aging.

Aging could be due to reduced ability to adapt to stress and/or aging of immune system. It is suggested that body cells (except germ cells and transformed cells) bear specific 'death' genes responsible for aging process. However, current concepts of free radicals (chemical intermediate) and aging, postulate that intermolecular linkages between degradation products of lipid oxidation (when free radical is a polysaturated fatty acid) results in inactive polymers interfering with cell activity which could be inactivated by natural or artificial antioxidants (e.g. vit.E, vit.C) With aging body composition and conformation changes resulting in diminished activity of vital organs and structural changes in the body involving skin, muscle, bones etc. with altered look, diminished movements, hearting, vision etc. However, changes in higher function cause decline in intelligence, memory, ability to take decision, slow reaction and decrease ability to learn new skills resulting in more rigid attitude in elderly. Balanced diet plays an important role in delaying aging process and sexual activity promotes active life span.

Health and aging.

Regular meditation is the key to health (mental, physical and social wellbeing). It elevates mind from gross level to finer aspect and makes the body and mind follow the law of nature achieving good health, preventing disease, improving performance and reducing aging process. Balanced diet (less sugar, less salt and less fat as age advances supplemented with vitamins and minerals) and mild to moderate exercise (walking etc.) are complimentary to the effects of meditation.

Cross reactivity of cephalosporins with penicillin.

Cross antigenicity of cephalosporins with penicillin has been studied experimentally and also by using serum from penicillin sensitive individuals. Definite hypersensitivity reaction was observed in all the animals sensitised with cephalosporins and challenged with penicillin except in rats. Cephalosporins could elicit reaction in tissues sensitised passively with serum obtained from penicillin sensitive individuals.

Effects of verapamil and nifedipine on psychomotor performance in human subjects.

The present study was undertaken to evaluate the effects of two structurally dissimilar calcium channel blockers, verapamil (a phenylalkylamine) in a single dose of 40 and 80 mg, and nifedipine (a dihydropyridine) in a single dose of 10 and 15 mg, on psychomotor performance and higher mental functions in human volunteers. Placebo and diazepam (5 mg) were used as negative and positive controls respectively. For evaluating these functions, tests employed were arithmetic ability, visual and auditory reaction time, letter (alphabet) cancellation, rapid fire arithmetic deviation and short term memory for playing cards. Careful record was kept of the heart rate, blood pressure and side effects of the therapy, each time the psychomotor tests were performed. Verapamil, both in 40 and 80 mg dose, was found to impair the performance of subjects to a significant extent in auditory reaction time, letter cancellation and short term memory. These effects were similar to those observed with administration of diazepam. With nifedipine, impairment in performance was observed only in rapid arithmetic deviation test. Thus, calcium channel antagonists, specially verapamil, impaired psychomotor performance of human subjects in our study.

Captopril--nifedipine interaction in hypertension.

Nifedipine, a calcium channel blocker exerts significant peripheral vasodilatory activity in hypertensive patients. It has been postulated that the antihypertensive effect of peripherally acting vasodilators is masked, by counter regulatory mechanism e.g. activation of renin-angiotensin aldosterone (RAA) axis. The present work was undertaken to study the effect of blockade of RAA axis using captopril, an angiotensin converting enzyme inhibitor on the blood pressure lowering activity of nifedipine. Pretreatment with captopril in a dose of 25 mg. bd was carried out for 4 weeks in one group of 10 patients before administering nifedipine 10 mg bd for 4 weeks. The other matched group of 10 patients received nifedipine alone in the same dose. It was observed that although captopril by itself had no appreciable effect on blood pressure in the dose used, it significantly enhanced the blood pressure lowering activity of nifedipine. It appears that counterregulatory mechanisms play an important role in determining the net antihypertensive effect of peripheral vasodilators.

Relative bioactivity of histamine and slow reacting substance of anaphylaxis released during anaphylactic reaction from different tissues of guinea pigs and rats.

Relative amount of histamine and SRS-A released during Schultz Dale reaction were indirectly estimated. Percent block produced by specific antagonists, mepyramine and FPL 55712, on antigen induced response in various tissues was compared with controls. The relative bioactivity of histamine and SRS-A released was 93% and 7%, respectively, in rat lungs: 37% and 63% in guinea pig lungs; 82% and 18% in guinea pig intestine, 59% and 41% in rat intestine and 100% and 0% in skin of guinea pig and rats. Expectedly, individual experiments showed gross variations because anaphylaxis is rarely dose related.