Role of Serum Cardiac Markers in Myocardial Infarction.

Background: Acute Myocardial Infarction (AMI) has become one of the major causes of mortality in the world at present, and it is for this reason various researches are being done for its diagnosis and prognostic assessment. Serum enzyme estimation is an important tool for it. Aim: To study changes in serum cardiac markers, after acute attack of MI Before & 2 hours after reperfusion and to establish usefulness of enzymes in early diagnosis of AMI. Methodology: A study of changes in serum cardiac markers CK-MB, LDH and AST, after acute attack of MI-before and 2 hours after reperfusion was conducted at govt. hospital. Total 100 patients were studied. All the patients were confirmed cases of AMI, admitted in the intensive care unit of hospital. Blood samples were collected in plain bulb, at the time of admission and at 90 minutes (i.e. after reperfusion) and enzyme estimation was done for all 3 enzymes. Result: It was found that the serum CK-MB is the first and earliest enzyme released in compare to AST and LDH, and after reperfusion it increases 6-7 folds. The mean levels of all enzymes were higher after reperfusion, suggestive of good prognosis in case of early reperfusion after an attack of AMI.

Continuing medical education on antiretroviral therapy in HIV/AIDS in India: Needs assessment and impact on clinicians and allied health personnel.

Background. Clinicians and associated health professionals charged with prescribing antiretroviral therapy (ART) deal with continuously evolving new drugs and combinations. To meet the needs of clinicians in India for ongoing education in this field, continuing medical education (CME) programmes on ART for HIV/AIDS were developed, conducted, evaluated and revised. Over a 2-year period, 2005–2007, 3 CME programmes for ART were conducted for physicians and a fourth (predominantly) for paediatricians. Methods. Both 1- and 2-day CME programmes on various aspects of ART were held on weekends for professionals treating patients with AIDS in Delhi and adjacent states. Topics included characteristics of ART drugs, their dosages, monitoring and toxicity management, adherence, complications of therapy, dealing with treatment failure and HIV co-infections. These topics were addressed in lectures and group discussions and via case presentations. Programmes were evaluated by anonymous response to questionnaires, by a 1-year follow up of participants and by informal discussions with participants and faculty. Detailed analyses and a recommended format for these programmes are presented. Results. The CMEs were attended primarily by clinicians (physicians and paediatricians). Nurses, laboratory scientists, and others involved in the treatment of AIDS also attended the programmes. An interactive workshop format was evolved with substantial time devoted to discussions and case analyses. Oneday programmes such as the one included here can be comprehensive and effective. The educational needs of healthcare professionals who provide care and support to patients receiving ART were similar to those of the prescribing doctors. Because of new drugs being made available and with continued clinical experience, updated programme content was required each year. Participants preferred case-based interactive discussions rather than didactic lectures. Participants suggested that there should be more time for discussion after each talk. Conclusion. Annual CME programmes focused on ART are required to meet the professional needs of clinicians in India for providing quality care management to patients with AIDS.

Chediak-Higashi syndrome--a case report with ultrastructural and cytogenetic study.

We report the ultrastructural abnormalities of the leukocyte granules and the cytogenetic findings in a patient of Chediak-Higashi syndrome (CHS), who presented with cutaneous melanosis as the only clinical feature. The diagnosis of CHS was established by peripheral smear and bone marrow examination. Chediak-Higashi syndrome, a rare autosomal recessive disorder is characterized by enlarged abnormal organelles in leukocytes and other cells. An interesting aspect of our patient was the absence of recurrent infections or any other clinical stigmata. Ultrastructurally, the leukocytes and their precursors in the bone marrow showed characteristic homogenous and heterogenous giant inclusions of variable sizes and shapes. These represent the primary granules which enlarge to attain the giant abnormal size by fusion with other primary or secondary granules. Cytogenic study of the bone marrow cells showed monosomy of chromosomes 8 and 17 in 20 percent of the metaphases. Neither the gene nor the chromosomal abnormalities specific for CHS have been identified as yet and thus the significance of our cytogenetic finding is presently not clear.

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.

Neonatal sepsis due to vertical transmission from maternal genital tract.

High vaginal swabs (HVS) of 1792 expectant mothers were sent for culture at the time of delivery, prior to first vaginal examination. The newborns were followed-up for development of superficial or deep infections. Appropriate cultures of the babies who developed infections were sent. Bacterial growth of predominantly gram-ve organisms was obtained in 1026 (57%) HVS. Infection developed in 48 (27%) babies in 1st 72 hours of life, of which 28 had deep infection while the rest had superficial infection. Vertical transmission of organisms was documented in 24 (1.3%) mother-baby dyads and the same was 72% in newborns who were at risk of developing sepsis by septicemia scoring, showing a significantly higher incidence of vertical transmission and subsequent sepsis in high risk newborns.

Footlength measurement in the neonate.

In 353 neonates, foot length were recorded along with birth weight, crown heel length and head circumference. Foot length correlated well with all three indices (p less than .01). Highest correlation in preterm babies was with crown heel length and weight, and in term babies with head circumference. The formula, length = footlength x 6.5 +/- 20 mm could be correctly used in 95% of babies. When it is difficult to weigh or measure the length accurately, foot length can serve as a useful measurement to assess a baby quickly.

A study of serum zinc levels in cord blood of neonates and their mothers.

Serum zinc was estimated in the cord blood of 60 neonates of different gestational age and birth weight, and their mothers. Mean serum zinc levels in neonates FTGA, PTAGA and term SGA were 128.88 +/- 14.37, 94.32 +/- 17.79 and 111.8 +/- 9.2 ug/dl respectively. The maternal serum zinc levels in corresponding groups was 96.28 +/- 19.48, 115.44 +/- 15.41 and 93.8 +/- 7.62 ug/dl. Thus mean serum zinc level in cord blood of FT AGA newborns was significantly higher than that in PT AGA and FT SGA. Mean serum zinc level in mothers of FT AGA was significantly lower than that in mothers of PT AGA. However, there was no significant difference between the maternal serum zinc levels of FT AGA and FT SGAs. There was positive correlation between gestational age and serum zinc level in cord blood of AGAs while correlation was negative in case of their mothers. There was positive correlation between weight (keeping gestational age constant) and serum zinc level in case of neonates while corresponding maternal zinc levels did not vary. (FT AGA and FT SGA).

Urolithiasis in childhood.

Clinical and laboratory findings in 41 cases of urolithiasis in children are presented. Males were more than females (9.25:1). Five patients had family history of urolithiasis. Clinical presentation was highly variable. Most of the stones were of mixed variety composed of calcium, phosphates and oxalates.

Knowledge, attitude and practice of immunization in an urban educated population.

A KAP evaluation of urban educated parents revealed suboptimal, superficial transfer of immunization knowledge. Poorer dose-related knowledge as compared to vaccine awareness contributed to partial immunization. Non-availability of vaccine contributed to 18.7% unprotected children, and therefore all logistics must be overcome to remedy service default. The unacceptable level of knowledge found in final year nursing and medical students, points out the need to restructure immunization related teaching in our hospitals. Incorporation of immunization based knowledge in high school curriculum is also recommended. It is important that areas of relevant information and education must be delineated time to time with increasing vaccination coverage.

Cardiomyopathy in children in Ahmedabad.

A clinical study and follow up of 20 children with cardiomyopathies upto age of 16 years are presented. The DCM was most common variety followed by RCM and HCM in pediatric age group. SHMD presenting with cardiomyopathy were common in infancy and early childhood. Cardiomyopathies presented most frequently between 2-5 years and 10-16 years age group with DCM having almost equal distribution. Clinical presentation of various types is described, despite of vigorous decongestive and vasodilator treatment in advanced cases, course was rapidly downhill and prognosis is poor in general.