Preliminary survey of leptospirosis amongst febrile patients from urban slums of East Delhi.

AIM: To determine the possibility of leptospirosis among patients from urban slums presenting with febrile illness during monsoon and post-monsoon season. METHODS: Evidence of leptospirosis in 180 patients with febrile illness was determined by looking for presence of immunoglobulin M (IgM) antibodies by leptospiral IgM enzyme linked immunosorbent assay (ELISA). The test was carried out on 160 Widal test negative and 20 Widal test positive sera received from febrile patients during June to September 2001. RESULTS: Twenty-seven out of 180 (15%) sera were positive for leptospiral IgM antibodies. CONCLUSIONS: This preliminary survey indicates that leptospirosis could be an important cause of febrile illness in patients from urban slums during monsoon and post-monsoon season.

Intensive care--a cost effective option for developing countries?

The estimation of cost-effectiveness of pediatric critical care services is an extremely relevant issue for both developing and industrialized nations. Pediatric critical care is expensive and the long outcomes are still relatively unclear. From the perspective of patients who receive the benefits of these services, there may be little controversy regarding cost-effectiveness. However, the issue becomes very complex when attempts are made to identify which patients will benefit most. This also needs to be considered while developing public policy when decisions for allocation of limited resources need to be made within health care systems, and choices need to be made between the provision of health care and other public services. This article addresses the complex issue of economic evaluations and describes various type of cost analyses. The difference between charges and costs is defined, and a discussion of the measurement of costs and benefits, and their relationship to outcomes research is provided. Although there is not a unique answer to the issue of cost-effectiveness for pediatric critical care services, the available literature particularly from the United States is summarized, and the ethical implications explored.

Perioperative management of the pediatric transplant patient.

With advances in surgical techniques, an increasing number of children are becoming transplant candidates. Pediatric critical care physicians may need to manage both transplant donors and recipients in the pediatric intensive care unit. Care of such patients needs to be performed aggressively with complete attention to details in order to obtain successful transplant outcomes. The postoperative management of the transplant recipient includes the basic intensive care monitoring and management of postoperative patients who are critically ill. Besides this, there are some unique features among these patients which may complicate the postoperative stay in the pediatric intensive care unit and these are discussed here. It is important to remember that the successful management of a transplant patient includes the pediatric critical care physician's abilities of not only taking care of acute issues but also of coordinating care between subspecialists. The pediatric critical care physician must always continue to provide support to families of these transplant patients during their intensive care unit stay.

Nutritional status of school age children of salt-workers in Rajasthan.

Nutritional status of 1044 school age children (6-18 yr) of salt workers in various salt manufacturing sites of Rajasthan, was assessed using anthropometry. Heights and weights of girls were observed to be better than in boys in the menarcheal age groups. Children of the present study showed reduced growth in comparison to National Centre for Health Statistics (NCHS), World Health Organisation (WHO), well-to-do Indian children and Rajasthan reference values of the same age groups. The prevalence of stunted with severe wasting was 4.5 per cent in the children of salt workers. Higher prevalence of severe wasting was observed in girls than the boys (P < 0.01).

Morbidity profile of desert population engaged in salt production in Rajasthan.

A total 2120 salt workers were examined in 8 camps organised at different salt sites in Rajasthan. These camps were organised to find out the morbidity conditions among salt workers and to provide preventive and curative treatment for the ailments. The majority of salt workers who attended the camps were males (79.0%) in comparison to females (21.0%). The majority of workers belonged to Scheduled Castes followed by Backward Class and Scheduled Tribes at all sites. The major morbidity disorders observed during these camps were dermatological, respiratory, musculoskeletal, gastro-intestinal and ophthalmological in both the sexes. The prevalence of hypertension was 4.3% among both sexes. The morbidity pattern in male workers was agreeing among Sujangarh and Kuchaman and after that Pokran and Didwana were agreeing with highest rank correlation, whereas in female workers it was agreeing among Nawa and Sujangarh and after that Phalodi and Pokran were agreeing with highest correlation.

Impact of nutrition counselling and supplements on the mineral nutriture of rural pregnant women and their neonates.

Sixty six young women from low and lower middle income groups selected from 8 villages of Ludhiana district in the first trimester of pregnancy were divided equally into Experimental (E) and Control (C) Groups, out of which only 60 subjects reached to the term. Folifer and calcium tablets were supplied to E group from second trimester till delivery along with regular medical supervision and nutrition education about additional nutrient needs. Intake of all the nutrients were less than the Recommended Dietary Allowances in the E and C groups during the third trimester. However, the requirement of iron, calcium, folic acid, vitamin B12, Vitamin D and ascorbic acid were met in group E due to supplementation. The Fe, Ca and Cu levels improved significantly during the third trimester in group E. The cord serum levels of Fe, Ca and Cu were also significantly higher in Group E. The relationships between maternal and cord blood levels of Fe, Ca and Cu were also significantly higher in Group E. The relationships between maternal and cord blood levels of Fe, Ca, Cu and Zn were significant, the co-efficients of correlation being 0.67, 0.92, 0.97 and 0.43, respectively. Serum Mn had an insignificant correlation with other minerals. The results indicated that 86.7, 94.7 and 44.8% variation (r2) in cord serum Ca, Cu and Fe levels was determined by the corresponding maternal serum levels. It is concluded that regular medical supervision, supplementation and nutrition education significantly improved the nutriture of the pregnant women and their neonates.

Impact of nutrition education and medical supervision on pregnancy outcome.

Sixty Punjabi women from low and lower middle income groups were selected from eight villages of Ludhiana district. The supplements of iron, folic acid and calcium in the form of Folifer and Calcium Sandoz tablets were regularly supplied to experimental (E) group from second trimester onwards. A pamphlet about the diet during pregnancy was distributed to the E group along with four individual and three group contacts during the second half of pregnancy. The control (C) group was provided iron and folate supplements as per Government practice. Body height, weight, mid-upper arm circumference (MUA) and skinfold thickness of the subjects were recorded. Weight gained during pregnancy and post partum weight were also recorded and body mass index was calculated. In addition, crown heel length (CHL), birth weight (BW), skinfold thickness, MUA, head circumference (HC), Chest circumference (CC) and ponderal index (PI) of the neonates were recorded within eight hours of their birth. The gain in weight during pregnancy was 6.30 and 5.7 kg in E and C groups respectively. The study revealed that BW, CHL, skinfold thickness and PI of the newborns were significantly (p < 0.01) higher in E group. The mean BW of newborns in E and C groups was 2700 g and 2300 g, respectively. Weight gained during pregnancy had significant (p < 0.05) correlation to MUA, BW and skinfold thickness of the newborn.