Involvement of Non-allopathic Private Practitioners under DOTS in an urban area of north India.

Background: In an urban area of a north Indian district (population 150,000), nine private practitioners of non-allopathic medicine, including five with no qualification and two private paramedical staff, were trained as per programme guidelines before being involved as treatment observers in the DOTS-based Revised National TB Control Programme and supervised. They were not given any financial incentive. Material and Methods: During 2002, they managed 185 TB patients (85% of the cases in the urban area) and amongst the 63 new smear-positive patients, the cure rate was 84%. Over a 6 month period, 6% of the total new smear-positive patients detected in the area were referred by these private practitioners. Results: Results suggest that non-allopathic practitioners and paramedical staff from the private sector can make a significant contribution to TB control, by increasing case detection and treatment observation.

Dietary cholesterol induced changes in lipid profile in patients with nephrotic syndrome and chronic renal failure.

Fifteen patients with nephrotic syndrome (9 aged below 30 years), 6 patients with chronic renal failure and 26 healthy males (14 below 30 years) were studied. After estimating the basal serum levels of total cholesterol (STC), triglycerides (STG), high density lipoprotein (HDL) and low density lipoprotein (LDL), the patients were given a high cholesterol and high fat breakfast (containing 32 g fat and 527 mg cholesterol) for 7 days. Lipoprotein levels were again estimated on days 8 and 16. In the basal state, all patients with nephrotic syndrome had markedly elevated levels of STC and LDL. In patients aged below 30 years, STG and VLDL levels were also elevated, while HDL levels were similar in both the groups in comparison to their respective age group controls. In patients with renal failure, basal levels of all lipoproteins were similar to levels in controls. After the high cholesterol fat diet, there was an insignificant rise in all lipoprotein values in patients with nephrotic syndrome and renal failure. However, HDL levels rose significantly in patients with nephrotic syndrome aged below 30 years. Patients with nephrotic syndrome and chronic renal failure can safely be given high cholesterol and high fat diet despite abnormalities in lipid lipoprotein metabolism.

High density lipoprotein.

High density lipoprotein (HDL) is a discoidal particle comprising phospholipid, cholesteryl esters and several apolipoproteins. It serves in transporting cholesterol from the periphery to the liver by the process of "reverse cholesterol transport". Compatible with this is the finding that the mass of the tissue cholesterol pools is inversely related to plasma HDL concentration. The plasma levels of components of HDL are determined by various physiological and pathological factors. The serum HDL levels are lower with advancing age, male sex, and in genetically predisposed, obese, sedentary persons. The effect of diet on serum HDL levels is not established; mild to moderate alcohol intake is associated with high serum HDL level. The main diseases affecting serum HDL levels are uncontrolled diabetes mellitus, uraemia and hyperthyroidism. Anabolic steroids, sex hormones, oral contraceptives, hypocholesterolaemics and beta blockers have been shown to affect serum HDL level variably. There is increasing epidemiological evidence to show that high levels of HDL are protective against coronary heart disease (CHD). A low serum HDL cholesterol concentration (less than 35 mg/dl) is associated with a significant increase in coronary risk in both men and women. Guidelines published by the National Cholesterol Education Programme do not recommend routine measurement of HDL cholesterol and adaptation of therapeutic modalities aiming to raise the low HDL levels. They recommend hygienic means (i.e. smoking cessation, aerobic exercises and weight loss) to raise the HDL cholesterol levels.

A study of dietary cholesterol induced changes in serum lipid lipoproteins in healthy male children, adolescents and middle aged volunteers.

The present study comprised of 16 healthy male subjects of 8-12 years (Group A), 18 adolescent males (13-19 years) (Group B) and 20 middle aged volunteers (45-55 years) (Group C), who were fed a high cholesterol high fat diet (HCFD) consecutively for seven days. The serum lipid changes were noted. The diet was then withdrawn. Seven days later the lipid changes were again recorded. At basal stage, serum total cholesterol (STC), high density lipoprotein (HDL) and low density lipoprotein (LDL) were significantly higher in group C in comparison to Group A. LDL/HDL ratio was significantly lower in Group C than that of Group A. Seven days after feeding of HCFD significant elevations occurred in all the lipid subfractions of Groups AB. The rise in STC was mainly because of predominant rise in HDL leading to a significant fall in LDL/HDL ratio. In Group C, elevations occurred in all the lipid fractions except HDL that showed an insignificant rise. LDL/HDL ratio was insignificantly affected. After withdrawal of HCFD, all the lipid levels returned to normal except in Group A, where STC and LDL remained elevated. The LDL/HDL ratio again increased significantly. In conclusion, the serum lipid lipoprotein behaviour in response to HCFD is qualitatively different in young persons as compared to middle aged persons.

Post heparin lipoprotein lipase activity in patients of ischaemic heart disease and in controls.

A single high fat meal diet (66 gm fat) was given to 30 healthy males and 20 male patients of ischaemic heart disease (IHD). Ten minutes prior to the 4th postprandial hour, 500 units of heparin--a lipoprotein lipase (LPL) activator--was given, and its effect seen on serum triglyceride (STG) levels observed. Besides higher fasting STG levels, the decline in 4 hour post-prandial STG level was significantly lower in patients of IHD. One explanation for higher fasting STG values and prolonged postprandial lipaemia in these subjects could be deficient LPL activity.

Oral versus axillary temperatures in human volunteers.

We measured the oral and axillary temperatures of 100 individuals (including 40 females) in the medical wards. Twenty six had fever ranging from 37.3 degrees C to 40.5 degrees C while the rest had normal temperature. Although the oral temperature was higher than axillary temperature in all the cases, there was no correlation between the two; in one case the difference was as high as 1 degrees C. We conclude that while recording temperature the site must be clearly stated, and no attempt must be made to extrapolate the axillary to the oral temperature.

Effect of administration and withdrawal of oral contraceptive pills on serum lipids and lipoproteins.

We studied the effects of oral contraceptive pills (OCP) supplied by the Govt of India in its Family Welfare Campaign, on serum lipid levels of women. The OCP, containing 30 micrograms ethinyl estradiol and 1 mg of norethisterone acetate were administered to the women for six months continuously and serum lipid levels were estimated after three and six months of the treatment. There were no significant changes in serum cholesterol, high density lipoprotein (HDL), low density lipoprotein (LDL), serum triglycerides and very low density lipoprotein (VLDL). In a simultaneous study we also measured serum lipid levels at 3 and 6 months after withdrawal of the pills in women who had been receiving OCP containing 50 micrograms of ethinyl estradiol and 0.5 mg of one of the progesterones for the past 1 1/2 to 2 years continuously. Only serum LDL level fell significantly (P less than 0.01) on 3 months withdrawal period. It is concluded that 6 months of usage of the OCP marketed by the Govt. of India does not affect the serum lipid profile.