Immunonutrition.

Nutrition and immunology are interrelated. Several nutrients like arginine, glutamine, omega-3-fatty acids and nucleotides enhance cellular immunity, modulate tumor cell metabolism and improve clinical outcome in stress situations. Glutamine supplementation has been shown to decrease incidence of sepsis and to reduce length of hospital stay in bone marrow transplant patients, low birth weight infants, surgical and multiple trauma patients. Studies with arginine have shown a reduction in infectious complications and lower mortality, however a better understanding of the biology of arginine is needed. Omega-3-fatty acid supplimentation as in fish oil stimulates the immune system. The beneficial effects of immunonutrition in surgical patients has been demonstrated in several studies. It significantly reduces infectious complications and length of hospital stay. In critically ill patients immunonutrition may decrease infectious complications but it is not associated with a mortality advantage. Pediatric experience is limited, but the future is promising.

Spermicidal & contraceptive properties of Praneem polyherbal pessary.

BACKGROUND & OBJECTIVES: Though a number of barrier methods and potent spermicides are available, most of these have nonoxynol-9 (N-9) as the active ingredient which is observed to cause inflammation and genital ulceration on repeated use. The present study was undertaken to develop a safe spermicide with conjoint microbicidal properties. METHODS: A polyherbal pessary was formulated with purified ingredients from neem (Azadirachta indica) leaves, Sapindus mukerossi (pericarp of fruit) and Mentha citrata oil. Spermicidal action on human sperm was tested by Sander-Cramer slide test in vitro and by post coital tests in vivo. Contraceptive action was tested in rabbits. RESULTS: The combination of the three herbal ingredients resulted in the potentiation of the spermicidal action by 8-folds. The post coital tests confirmed the spermicidal properties of the Praneem polyherbal pessary (PPP) in women with high cervical mucous score around mid estrus. It also prevented in most women the migration of sperm into the cervical mucous. In 15 rabbits studied pregnancy was prevented by the intravaginal administration of PPP, whereas 13 of the 15 animals in the control group became pregnant. INTERPRETATION & CONCLUSION: The Praneem polyherbal pessary has potent spermicidal action on human sperm in vitro and in vivo. When applied in the vagina before mating, it prevented rabbits from becoming pregnant.

Product availability for pediatric parenteral nutrition.

Availability of parenteral nutrition (PN) products for use in pediatric patients is an important factor for popularity of PN in developing countries like India. The overall cost of PN supplementation in the adult patient works out to be approximately Rs. 2000 per day. It should be more cost effective in a child, working out to Rs. 750 per day on an average. However, it is not so because smaller bags of 100 ml capacity designed for pediatric use are not so readily available. The article provides detailed information regarding presently available PN products in Indian markets. All-in-one PN bags of 100 ml capacity (containing amino acids, lipids and dextrose), designed for use in adult patients, would not be cost effective for use in children. Opinions regarding PN mixing are divided and most of the practitioners in the developed countries do not favour mixing because higher concentrations of lipids and dextrose in the solution can cause metabolic derangements in the patients. In view of the problems related to availability of PN products, mixing PN solution may be ideal for India, if calorie content of the infusate is kept at a level just enough to sustain life but not high enough to cause metabolic disturbances.

Yeast colonisation & fungaemia in preterm neonates in a tertiary care centre.

Seventy consecutive preterm neonates who stayed in the hospital for more than seven days between March and October 1996, were studied for colonisation at oral, umbilical, groin, and rectal areas and for fungaemia. Overall, 71.4 per cent of the neonates were colonised and colonisation occurred within 24 h in 38 per cent preterm neonates. Neonates weighing less than 1500 g were colonised more frequently at more than one site and had higher load of yeast. Candida albicans (19%), Pichia (Hansenula) anomala (17.5%), C. tropicalis (13.2%), C. parapsilosis (12.3%) and Trichosporon cutaneum (10.0%) were the predominant colonising yeasts. Fungaemia was detected in 22.8 per cent of preterm neonates with predominance of P. anomala fungaemia (62.5%). Prematurity, male sex, broad spectrum antibiotic therapy, intubation and higher colonising rate were identified as significant risk factors for development of fungaemia. Except one strain of C. tropicalis, all yeast strains were sensitive to commonly used systemic antifungal agents. Study highlights the importance of routine surveillance of yeast colonisation of preterm neonates with identifying possible risk factors.

Role of intrapartum antibiotics in prevention of vertical transmission of neonatal sepsis.

The present study evaluates the role of prophylactic intrapartum antibiotics in the prevention of neonatal sepsis. Labour and delivery characteristics of 1478 women delivering at the Nehru Hospital, PGIMER, Chandigarh were recorded. Intrapartum antibiotics (ampicillin, with or without gentamycin) were given to 69 per cent women. The neonatal sepsis rate was 1.56 per cent. This was not significantly lower in the women who received intrapartum antibiotics (1.47 vs 1.75%). Though there was a lowering of neonatal sepsis rate with intrapartum antibiotic administration when the duration of labour was more than 12 h (1.67 vs 3.09%), duration of ruptured membranes was more than 6 h (1.93 vs 3.81%) and number of pelvic examination was 3 or more (1.63 vs 4.54%), it was not statistically significant. It was concluded that intrapartum antibiotics as per the existing protocol did not prevent neonatal sepsis.

Hyperuricemia and pregnancy induced hypertension--reappraisal.

Serum uric acid estimation was done in forty primigravidae with pregnancy induced hypertension and twenty normotensive primigravida in the third trimester of pregnancy, at delivery and six weeks postpartum. The mean serum uric acid levels in normotensive women in the antenatal period and at delivery were 4.65 +/- 0.33 and 4.88 +/- 0.23 mg% and in mild PIH were 5.42 +/- 0.55, 6.14 +/- 0.76 mg%, respectively. Level of serum uric acid in mild PIH was significantly higher than normotensive women (P). In severe PIH, the mean serum uric acid levels were 6.65 +/- 0.60, 8.24 +/- 1.09 mg% in antepartum and at delivery respectively which was significantly more than control group and mild PIH group women (P). However, no differences was observed, in the serum uric levels between these groups during the postpartum period. Serum uric acid level of 5.5 mg or more was observed to be an indicator of PIH. Levels of serum uric acid did show a high positive correlation with the severity of PIH in relation to hypertension and proteinuria. Hyper uricemia (more than 5.5 mg% is associated with increased perinatal morbidity and mortality.

Safety of intrauterine administration of purified neem seed oil (Praneem Vilci) in women & effect of its co-administration with the heterospecies dimer birth control vaccine on antibody response to human chorionic gonadotropin.

Praneem Vilci (PV), purified neem oil was reported to exercise a reversible antifertility effect after a single intrauterine instillation in rodents and primates without any adverse effects. After toxicology, drug regulatory and ethical clearances, a phase I clinical trial was conducted on PV. Eighteen healthy tubectomised women were enrolled to evaluate the safety of a single intrauterine instillation of PV and to determine the effect of its co-administration on anti-hCG response to the heterospecies dimer (HSD) hCG vaccine. Eight women received PV alone and ten women were given the HSD-hCG vaccine in addition. Base-line and post-treatment haematological and biochemical profiles were determined as also the mid-luteal serum progesterone. Endometrial biopsies were examined to assess ovulatory status and the effect of intrauterine treatment with PV on the endometrium. Anti-hCG antibody titres were estimated in women who were concurrently immunized with the HSD vaccine. No untoward reaction was observed in any woman. Menstrual pattern and ovulatory status remained unaltered. Endometrial biopsy after PV instillation in one woman showed non-specific endometritis but she remained asymptomatic. Mild eosinophilia was seen in two women and this reverted to normal on its own. All women receiving PV and the HSD vaccine generated antibodies against hCG. Our data show that intrauterine administration of PV is safe and does not prevent the antibody response to HSD-hCG vaccine.

Hyperuricaemia and perinatal outcome in pregnancy induced hypertension.

The effect of hyperuricaemia on perinatal outcome was evaluated in 40 primigravidae with pregnancy induced hypertension and 20 normotensive women in the 3rd trimester of pregnancy. Serum uric acid level was a better indicator than blood pressure as an index of foetal prognosis. Even severe hypertension without hyperuricaemia was associated with better prognosis for the foetus. Conversely when hypertension was mild and hyperuricaemia was severe, the prognosis for the foetus was poor. A rise in serum uric acid level > or = 5.5 mg% is associated with increased perinatal morbidity and mortality. Women in pregnancy induced hypertension group with serum uric acid level > or = 5.5 mg% had a higher incidence of intra-uterine growth retardation, low birthweight, and stillbirth making perinatal mortality rate of 200/1000 total births. The results of this study indicate that serum uric acid level > or = 5.5 mg% can reflect the perinatal outcome.