Anemia prophylaxis in adolescent school girls by weekly or daily iron-folate supplementation.

OBJECTIVE: To examine the benefits of anemia prophylaxis in adolescent school.girls by weekly or daily iron-folate supplementation. DESIGN: Prospective study. SETTING: Government girl schools of northeast Delhi. SUBJECTS: 2088 subjects (with hemoglobin greater than 7.9 g/dL), including 702 on daily and 695 on weekly iron-folate administration; 691 girls served as controls. RESULTS: About 85% girls were iron deficient out of which 49.3% were anemic. Weekly administration took longer time to raise hemoglobin but was effective as well as practical. Plasma ferritin estimation in girls showed rise in level in both the treated groups. CONCLUSION: Weekly administration of iron-folate was a practical and effective strategy for anemia prophylaxis in adolescent school girls.

Massive pancreatico-pleural effusion--an often unrecognised entity.

Massive haemorrhagic pleural effusion secondary to pancreatitis in a five year old girl is described. The diagnosis was established on the basis of an exudative pleural effusion with an amylase level above 4,000 IU/l. Management of effusion was by intercostal tube drainage and antibiotics.

Hematological observations as diagnostic markers in dengue hemorrhagic fever--a reappraisal.

OBJECTIVE: To determine the utility of certain clinical and hematological parameters as diagnostic markers of dengue hemorrhagic fever (DHF), namely, (i) tourniquet test, (ii) association of bleeding manifestations with the platelet count, and (iii) "cut off" value of hematocrit diagnostic of DHF in Indian population. DESIGN: Prospective study. SETTING: Tertiary care hospital. SUBJECT: 304 children of DHF presenting between September 1996 to December 1996. RESULTS: The tourniquet test had a low sensitivity and was positive only in 61/239 (25.5%) cases. There was no statistical difference in the incidence of bleeding manifestations between thrombocytopenic and non-thrombocytopenic individuals highlighting poor association of thrombocytopenia with bleeding manifestations. A "cut off" hematocrit value of 36.3% diagnostic of DHF was estimated by discriminant analysis in Indian population. CONCLUSION: The study highlights tourniquet test as a less sensitive diagnostic marker of DHF, poor association of thrombocytopenia with bleeding manifestations and also defines the hematocrit value diagnostic of DHF in Indian population.

Antipyretic effects of nimesulide, paracetamol and ibuprofen-paracetamol.

The antipyretic effect of nimesulide has not been adequately compared with paracetamol and ibuprofen-paracetamol combination in children. Hence, a randomized, double blind, and parallel groups' design and multicenter study was conducted on children with respiratory tract infections. Eighty-nine patients with temperatures above 38.5 degrees C were randomly administered nimesulide (1.5 mg/kg/dose), paracetamol (10.0 mg/kg/dose), or ibuprofen-patients combination (10.0 mg/kg/dose), thrice daily for five days. The axillary temperature was recorded at the baseline and at different time intervals post administration of drugs. The hematological and biochemical investigations were performed at the basal level and at the end of the treatment period. The adverse drug reactions were monitored during the trial. All the drugs produced a significant fall in temperature as compared to their respective basal values (p < 0.001). However, on looking at the change in temperatures at different time intervals from the respective basal levels, no significant difference was found among all the drugs. Surprisingly, nimesulide had a tendency to raise serum glutamate pyruvate transaminase and serum glutamate oxaloacetate transaminase levels as compared to its baseline values. There was no marked adverse effect of the drugs on other hematological and biochemical parameters investigated. No other serious adverse reaction occurred in the study. Ibuprofen-paracetamol combination, nimesulide, and paracetamol had almost similar antipyretic effects in children.

Brainstem auditory evoked potential responses in iron-deficient anemic children.

Iron deficiency is a major health problem in developing countries manifesting not only as overt anemia but also involving the CNS resulting in cognitive and behavioral deficits. Iron is an important nutrient and essential element involved in myelin formation and neurotransmitter synthesis and thus contributes to normal neurological activity. Hypomyelination has been reported in iron deficient states with possible neural conduction defects. The brainstem auditory evoked potential response is used extensively to identify lesions associated with various demyelinating diseases and hence has been used in the present study to observe the effect of iron deficiency on sensory brain function. A trend of increased absolute and interpeak latencies and reduced amplitudes of the waves leading to a definite linear correlation between the severity of anemia and the degree of neurophysiological deficit suggests a subclinical involvement of the auditory pathway in the brainstem of iron deficient children.

Prevalence & etiology of nutritional anaemias in early childhood in an urban slum.

The present study was carried out to find out the prevalence and etiology of nutritional anaemia among preschool children from an urban slum. Randomly selected 300 children aged 3 months-3 yr were analysed over a period of one year for estimating prevalence of nutritional anaemia. Prevalence was also assessed by the rise in haemoglobin after 8 wk of haematinic supplementation in 159 of the 300 subjects. Ninety anaemic children were evaluated for the etiology of anaemia. Prevalence of anaemia, as judged by WHO recommended 'cut-off' value of haemoglobin < 11 g/dl, was 76 per cent while comparable value of 74.8 per cent was derived by response to haematinic supplementation. Pure iron deficiency anaemia (IDA) was detected in 41.4 per cent (37/90) of anaemic children. Vitamin B12 deficiency alone or in combination with iron was diagnosed in 14.4 and 22.2 per cent anaemic children respectively. Similarly folate deficiency, IDA with infection and anaemia of chronic diseases (ACD) was diagnosed in 2.2, 3.3 and 12.2 per cent cases respectively. Childhood anaemia continues to be a significant public health problem in preschoolers and iron deficiency is by far the commonest nutritional cause of anaemia. Vitamin B12 deficiency per se or in combination with iron is an important yet not commonly recognised cause of anaemias in preschool children in the community.

Polio eradication--target 2000.

Poliovirus an enterovirus is of 3 types (1, 2 & 3). The 1 poliovirus is most often the cause of paralysis. Poliomyelitis can be eradicated from human soil as man is the only reservoir of this infection and effective vaccines are also available for its control. Inactivated poliovirus vaccine (IPV) confers mainly the humoral immunity in comparison to oral polio vaccine (OPV) which gives the intestinal immunity as well. OPV has been recommended by the WHO as the vaccine of choice for global eradication of polio because of its superior ability to inhibit spread of wild polio virus, low cost and its ease of administration. 70-90% of polio cases occur in children less than 3 year of age. Each paralytic case which is the tip of an iceberg probably represents 100 to 1,000 infected persons in the community. The incidence of poliomyelitis is on the decline with 145 of 213 countries today report 0 case of polio. Central Africa & South Asia are the principal reservoirs of wild poliovirus with nearly two thirds of cases being reported from Indian subcontinent. Components of eradication strategy are: sustained high levels of immunisation, annual mass vaccination campaigns of OPV to all children under 5 years of age, establishment of extremely sensitive surveillance systems and targeted immunisation to areas and populations where poliovirus transmission is likely to persist. The task of global eradication of poliomyelitis is uphill but well within our reach. A strong will and political commitment by the Government of India is leading the nation to the goal of polio-free world by the year 2,000.

Congenital deficiency of factor VII.

A case of congenital factor VII deficiency in a five-year-old child is reported. The patient, born of a non-consanguineous marriage, presented with repeated bouts of epistaxis since childhood. The prothrombin time (PT) was markedly prolonged with a normal bleeding time (BT), partial thromboplastin time with Kaolin (PTTK) and platelet count. The patient has been on follow up for the last four years and is doing apparently well.

Awareness of pulse polio immunisation.

Mass polio immunisation campaign was launched in the national capital territory of Delhi with 2 doses of polio vaccine to be administered to children upto 3 years of age on October and December 4, 1994 respectively. Massive information, education & communication (IEC) efforts through mass media and interpersonal communication preceded the dates of the campaign. A study to assess the awareness of general population was carried out by interviewing 225 adult residents of Delhi using a structured questionnaire. These were drawn by two stage stratified random sampling. Zonewise assembly segments in the first stage and census enumeration blocks in the second stage formed the sampling frame. The study, carried out 3 days prior to date of administration of first dose of oral polio, revealed that 60.4% of population was aware of the programme being launched and 31.6% about aim of the programme. None of the respondents were aware of all the specific parameters put together correctly viz., objective, immunisation days, age group & immunisation status of children. The higher level of awareness was directly proportional to the level of education. The overwhelming success of the programme was indicated by immunisation of > 90% children upto 3 years of age all over Delhi in the first phase of the programme. The key to success of the programme despite low awareness is explained on the basis of unflinching efforts put in by vaccine centre level committees, integrated child development scheme (ICDS) and urban basic service (UBS) functionaries in mobilising people to reach various vaccination centres. Other states planning to launch such mass campaigns should pay attention to social mobilisation in addition to IEC efforts for successful completion of the programme.

Epidemic dropsy in Trans Yamuma areas of Delhi and U.P.

Thirty patients of epidemic dropsy from seven families scattered in different areas of East Delhi and UP were studied. The age group of the affected individuals varied from 2 years to 55 years. Argemone oil contamination was found in mustard oil used for cooking. Sanguinarine was detected in all suspected oil samples. Pitting edema of legs was the most consistent feature present in all cases. Other prominent features like local erythema and tenderness were present in 80% and 70% cases, respectively. In contrast to earlier epidemics, two striking features were presence of persistent tachycardia without any pyrexia in all the cases and absence of any ocular problems. There was one death due to congestive heart failure and partial recovery in all others in a 2 months follow up.