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.

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.

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%.

Association of HLA B27 antigen in Indian patients of ankylosing spondylitis and other autoimmune diseases.

One thousand three hundred and forty clinically suspected patients of Ankylosing Spondylitis (AS) and other autoimmune diseases and 5000 controls were studied to detect the association of HLA B27 antigen amongst them. Other alleles studied include HLA B7, B40 (B60), B22(B55), B13, etc. Our findings show a considerable and consistent association of HLA B27 with AS irrespective of the community to which the patient, belonged his hygiene or socio-economic conditions. We also found that people in the age group of 21-39 were the most vulnerable, when number of affected individuals or severity of the disease were taken into consideration. Male members showed a preponderance over females in HLA B27 positivity. Detection of HLA B27 could help in the diagnosis of AS. Patients suffering from other autoimmune diseases such as rheumatoid arthritis, psoriasis, Reiter's syndrome and uveitis and patients with inflammatory bowel disease, colitis, eczema, bacillary or fungal infection were also found to be HLA B27 positive. A study of other alleles shows that even they sometimes associate AS and other autoimmune diseases.

Early indicators of deteriorating renal efficiency in elderly subjects.

Renal functions decline with age. Only after considerable renal reserves are lost, the traditional clinical tests of urine, blood or clearance levels reveal the defect. The urine quantity & contents passed in 24 hrs both by young and elderly, show little differences between the two groups. Their creatinine clearances are also comparable. Earlier Studies on water dilution test had shown significant differences between the performance of the young and elderly subjects, indicating decrease in renal efficiency on ageing. In the present study 4 hourly collections of urine showed that the night collections in elderly subjects were comparatively larger in volume, electrolytes and other components as compared with younger subjects. The kidneys of the elderly seem to compensate by labouring at night, while the young have their restful phase. Thus in addition to water dilution test, comparison of day/night outputs of urine can be taken as an early indicator of renal deterioration in elderly.

Pulmonary functions of the elderly Indian subjects: trends of decline with age.

Respiratory Functions mainly vital capacity, FEV1, MBC and breath holding time, of 400 healthy elderly persons, 328 men and 72 women, aged 60+, sedentary and belonging to upper middle class from Bombay were studied. The findings are examined in each sex in 5 yearly age groups and are obviously low. An attempt is made to link the age-wise averages of VC in younger subjects in India reported by other workers with our data on elderly. The values from Northern groups are comparatively much higher than those from the rest of India. The connecting link in graphs shows a sudden fall when the data of northern Indians and that of our elderly are joined, but it is smooth when those of rest of India are connected.

Blood cardioplegia--a comparative clinical and laboratory study.

A prospective comparative study was undertaken to determine quality of myocardial preservation during open heart surgery by crystalloid and blood cardioplegic solutions. Total 55 consecutive patients were studied. Alternate patients received blood and crystalloid cardioplegia at random. Group I had 30 patients who received crystalloid cardioplegia, and group II, with 25 patients, received blood cardioplegia. The efficacy of two solutions was assessed by serum enzyme estimation of creatinine phosphokinase, M.B. fraction of creatinine phosphokinase and serum glutamate oxalate transferase (CPK, CPK-MB, SGOT), electron microscopic study of Left Ventricular biopsy and clinical assessment of post anoxic cardiac performance. Group II patients had lower serum enzyme levels, lesser microscopic myocardial damage, and better cardiac performance during immediate post-operative period, thus proving superiority of myocardial protection by blood cardioplegia.

Ascending aortic aneurysm with aortic valve incompetence--surgical management.

Aneurysm of ascending aorta with aortic valve incompetence is a formidable pathological entity having a relentless course. Etiological factors include syphilitic aortitis, dissection of aorta, Marfan's syndrome and similar conditions. With the advance in operative technique and extra corporeal circulation, now it is possible to treat these conditions by surgery. Surgical intervention includes replacement of entire ascending aorta along with aortic valve by an artificial valve conduit. Basically, two procedures are described, namely, the conventional method and Bentall's operation, both involving a great technique challenge. Our experience with both these techniques is being described in four consecutive cases in the last one year.

Indican, ethereal and other forms of S eliminated in 24 hours urine by elderly Indian subjects.

Average daily excretion of Indican in urine of 42 healthy elderly men, av. age 69.9 +/- 5.0 years, (60 observations) was 60.7 +/- 17.4 mg/24 hrs. This is slightly higher than reported values for younger subjects. Average ethereal S elimination by Indian subjects has varied from 72-150 mg/day. Indican is the chief ethereal S eliminated in urine. Other forms of S excreted by elderly subjects were: Inorganic S 720 +/- 150 mg; Ethereal S 74 +/- 22 mg. Indican in them was 53.8 +/- 17.4 mg. This shows that the remaining 20 mg or about 1/4 of the ethereal S is eliminated in urine in other forms. Relationship with age, diet, common disorders along with findings in literature etc. are discussed.

Effects of age on renal efficiency.

Renal efficiency of 70 healthy subjects, 20 young av. age 27.2 +/- 5.8 yrs and 60 elderly av. age 68.2 +/- 4.7 yrs was studied by simple water elimination test in the monitoring under standard conditions. After drinking 2 litre of water, hourly samples of urine upto 4 hrs were collected for volume, sp. gr. urea, creatinine etc. The younger group passed 77% of the extra water drunk in 2 hrs and 92.5% in 4 hrs, whereas the elderly could throw out only 33% in 2 hrs and 56% in 4 hrs. The elderly showed much delayed and poorer elimination. The sp. gr., urea and creatinine in each sample of urine were less in the old indicating their inefficient elimination ability. Av. blood urea was 20.2 +/- 3.8 mg+ in young and 25.4 +/- 7.0 mg% in elderly, respectively. Calculated av. urea clearance value was 61.3 ml/mt in the young, while it was 39.4 ml/mt in the elderly. How well this simple test reflects the decreasing renal efficiency on ageing and compares with more elaborate tests like urea clearance is discussed.