Audiometric and Tympanometric Assessment in Patients with Oral Submucous Fibrosis.

Background: Oral submucous fibrosis (OSMF) is regarded as a potentially malignant condition. It is characterized by a mucosal rigidity of variable intensity because of the fibroelastic changes of the juxta epithelial layer, resulting in a progressive inability to open the mouth. Oral submucous fibrosis can cause fibrosis and degeneration of tubal and paratubal muscles extending to nasopharynx causing alteration in eustachian tube function. So, this study was carried out with an aim to determine the effect of OSMF on the function of the eustachian tube. Materials and Methods: 80 ears of 40 patients with OSMF and 40 ears of 20 normal persons had undergone audiometry and tympanometry after a thorough history taking and clinical examination. Results: Out of the 80 ears in the OSMF group, Type A curve in 44 (55%) ears. Type As 13 (16.3%) ears, type Ad in 7 (8.8%) ears, type B in 9 (11.3%) and type C in 7 (8.8%) ears (Table 3, Graph 2). The control group showed type A curve in all individuals. On pure tone audiometry (PTA) of study group hearing was found to be normal in 47 (58%) ears; mild hearing loss was found in 28 (35%) ears and moderate hearing loss in 5 (6.3%) ears while it was normal in all subjects in the control group. When tympanometry curves were compared in different groups of oral submucous fibrosis (according to Khanna et al), a significant relation was found. Type A curve was decreased as the group progress from 1 to 4 while reverse was true for type As, Ad and C curve with significant value of .0009. Conclusion: The data obtained were analyzed statistically using chi-square test, which suggested a significant association between different stages of OSMF and eustachian tube function. Therefore, it can be concluded that eustachian tube function may be affected in OSMF.

Non‑syndromic bilateral condylar aplasia: A rare case.

The temporomandibular joint is one of the most complex joints of the human body. It consists of the mandibular condyle, glenoid fossa and the articular eminence of the temporal bone. Aplasia of the condyle is usually seen as part of a syndrome otherwise it is rare. We report a case of bilateral condylar aplasia in a 20‑year‑old male not associated with any syndrome. The patient reported to the department with a chief complaint of the underdeveloped lower jaw. Clinical examination, conventional radiographs, and 3D computer tomography images revealed a complete absence of condyle on the right and left sides.

Triple X syndrome with rare phenotypic presentation.

Triple X syndrome is a rare numerical chromosomal anomaly, occurring as a result of non dysjunction in meiosis I. Most cases have neurodevelopmental defects and functional problems. We report two cases diagnosed in our centre. The first was a fetus with cleft lip and palate, 47, XXX was identified by Fetal Blood Sampling. The second was a child with multisystem anomaly including cleft lip and palate, whose karyotype also revealed 47, XXX. Though isolated cases of associated abnormalities have been reported there have not been consistent phenotypic changes reported with this condition.

Tropical infections in the ICU.

Certain arthropod-borne infections are common in tropical regions because of favorable climatic conditions. Water-borne infections like leptospirosis are common due to contamination of water especially during the monsoon floods. Infections like malaria, leptospirosis, dengue fever and typhus sometimes cause life threatening organ dysfunction and have several overlapping features. Most patients present with classicial clinical syndromes: fever and thrombocytopenia are common in dengue, malaria and leptospirosis; coagulopathy is frequent in leptospirosis and viral hepatitis. Hepatorenal syndrome is seen in leptospirosis, falciparum malaria and scrub typhus. The pulmonary renal syndrome is caused by falciparium malaria, leptospirosis, Hantavirus infection and scrub typhus. Fever with altered mental status is produced by bacterial meningitis, Japanese B encephalitis, cerebral malarial, typhoid encephalopathy and fulminant hepatic failure due to viral hepatitis. Subtle differences in features of the organ failure exist among these infections. The diagnosis in some of these diseases is made by demonstration of antibodies in serum, and these may be negative in the first week of the illness. Hence empiric therapy for more than one disorder may be justified in a small proportion of cases. In addition to specific anti-infective therapy, management of organ dysfunction includes use of mechanical ventilation, vasopressor drugs, continuous renal replacement therapy and blood products. Timely transfer of these patients to well-equipped ICUs with experience in managing these cases can considerably decrease mortality and morbidity.

Anti-neutrophil cytoplasmic antibodies (ANCA) in systemic lupus erythematosus: prevalence, clinical associations and correlation with other autoantibodies.

AIM: This study was undertaken to clarify the nature of anti-neutrophil cytoplasmic antibodies (ANCA) along with other autoantibodies in lupus nephritis (LN) patients and in systemic lupus erythematosus (SLE) patients without nephritis and to know their correlation with clinical manifestations and presence of other autoantibodies. MATERIAL AND METHODS: Fourty one LN patients and 18 SLE patients without nephritis were studied. LN patients were subdivided into diffuse proliferative glomerulonephritis (DPGN), focal proliferative glomerulonephritis (FPGN), rapidly progressive glomerulonephritis (RPGN) and membranoproliferative glomerulonephritis (MPGN). Anti-neutrophil cytoplasmic antibodies (ANCA) were detected by indirect immunofluorescence and confocal laser scanning microscope using PMN and HL60 cells. ANCA specificities like anti-myeloperoxidase (anti-MPO), anti-proteinase 3 (anti-PR3), anti-lactoferrin (anti-LF) and anti-cathepsin G (anti-CG) were detected by ELISA. Other autoantibodies like anti-nuclear antibodies (ANA), anti-double stranded DNA (anti-dsDNA), anti-single stranded DNA(anti-ssDNA), anti-ribonucleoproteins (anti-nRNP), anti-Smith antibodies (anti-Sm) and rheumatoid factor (RF) were also tested. RESULTS: ANCA was detected in 37.3% patients. The predominant ANCA pattern was perinuclear (p-ANCA). ANCA positivity was higher in LN patients and when confirmed by ELISA, 54.5% ANCA positives had anti-myeloperoxidase (anti-MPO). The cytoplasmic ANCA (c-ANCA) pattern was not seen in any patient. Two patients having FPGN with crescents showed atypical 'X-ANCA' pattern with dual specificity to anti-MPO and anti-PR3 by ELISA. The titers of ANCA were more in LN as compared to SLE without nephritis. LN cases having DPGN, FPGN, RPGN with crescents had higher titer p-ANCA positivity with corresponding anti-MPO antibodies, along with ANA, anti-dsDNA, anti-ssDNA and anti-Sm + anti-nRNP and also high SLEDAI scores. CONCLUSION: ANCA in SLE may be used as a serological marker along with clinical and histopathological assessment to differentiate vasculitides in LN cases from SLE without nephritis.

Urinary fluoride levels and prevalence of dental fluorosis in children of Jhajjar District, Haryana.

A study was conducted in the Jhajjar district of Haryana to assess the fluoride excretion in the population exposed to environmental fluoride and efforts were being made to correlate the results with dental fluorosis. The mean fluoride concentration in drinking water samples of Bahadurgarh, Beri, Jhajjar, Matanhail and Sahalawas blocks of Jhajjar district were 2.05 mg/L, 2.14 mg/L, 2.05 mg/L, 2.14 mg/L and 1.93 mg/L respectively. The mean urinary fluoride concentration was 1.58 mg/L in Bahadurgarh, 1.48 in Beri, 1.50 in Jhajjar, 1.51 in Matanhail and 1.56 in Sahalawas. The mean prevalence of fluorosis on the basis of stage of dental fluorosis was highest of yellowish brown type and on the basis of TSIF score, score 4 type fluorosis was highest in most of the blocks of Jhajjar district. The study revealed that more than 50% of the individuals were found to be affected with flurosis in this district.

Antibodies to Ro/SS-A and La/SS-B in systemic lupus erythematosus and other autoimmune disorders.

AIM: 1. To study the presence of anti-Ro/SS-A, anti-La/SS-B, anti-Sm and anti-nRNP in diagnosed antinuclear factor (ANF) positive systemic lupus erythematosus (SLE) cases and their association with various organ involvement. 2. To study autoantibodies in other autoimmune disorders. MATERIAL AND METHODS: A total of 4050 suspected cases of autoimmune disorders referred for serological work up were evaluated for ANF by indirect immunofluorescence technique, anti-dsDNA by PHA, autoantibodies to Ro-SS-A and La/SS-B by ELISA and rheumatoid factor was tested by latex agglutination using commercial kits. RESULTS: Out of 4050 patients 19.5% were ANF positive and 5% were anti-dsDNA positive. Out of these 50 diagnosed ANF positive cases of SLE, an incidence of anti-dsDNA 54%, anti-Sm 25.9%, anti-nRNP 29.6%, anti-Ro/SS-A 10% and anti-La/SS-B was 22% was observed. In rheumatoid arthritis, 17.4% positivity of anti-Ro/SS-A and 39.1% positivity for anti-La/SS-B was observed. In SLE with renal involvement, joint complaints and skin or malar rash were seen in 66%, 56% and 46%, respectively. CONCLUSION: Determining anti-Ro/SS-A and anti-La/SS-B antibody could be important in evaluating patients with suspected connective tissue disorders, who usually show diverse clinical presentations like skin, kidney and joint manifestations. The most prominent feature in anti-Ro/SS-A and anti-La/SS-B positive patients was skin involvement and sicca complex in 60% of SLE patients.

Evaluation of analgesic, antipyretic and anti-inflammatory activity of spirobarbitunylphenothiazines in rodents.

Analgesic, antipyretic and anti-inflammatory activities of newly synthesized spirobarbitunylphenothiazines viz 10-[7, 11-Di(4-4' dimethoxphenyl)-3-oxo-9-methylaminoimino-2, 4-diazaspiro [5.5] undecane 1, 5 dione] acetylphenothiazine (test drug A) and 10-[7, 11-Di (N.N-dimethylaminophenyl)-3-oxo-9-methylaminoimino-2, 4-diazaspiro [5, 5] undecane-1, 5 dione] acetylphenothiazine (test drug B) have been screened in Swiss mice and Wistar rats. The peripheral analgesic activity of test drugs A and B was investigated by acetic acid induced writhing test in Swiss mice while the central analgesic action was assessed by hot-wire (tail flick test) of the analgesiometer and tail-clip test in Wistar rats. Antipyretic activity was assessed on Brewer's yeast induced pyrexic model while antiinflammatory activity was seen on carrageenan induced hind paw oedema. Analgesic activity was found to be only of peripheral type as there was reduction of 66% in writhing responses by test drugs A and B in dose of 80 mg/kg in mice. No change in the tail flick responses was observed on analgesiometer or by tail clip by both the test drugs. Reduction of 1.5 to 2.0 degrees C in rectal temperature was observed in pyretic rats by test drugs A and B in dose of 80 mg/kg. 80% reduction in paw volume was noted in 80 mg/kg dose of both the test drugs which was comparable to the anti-inflammatory activity of 300 mg/kg, p.o. of phenylbutazone.

Breast feeding practices among female health functionaries.

Fifty-nine married Female Health Functionaries, which included forty-eight ANMs and eleven LHVs working in District Kangra of H. P. have been interviewed through self-administered questionnaire during August 1999. Breast Feeding (BF) practice is universal. Average duration of initiation BF after delivery is six hours. It is continued for 23 months on an average. Practice of prelacteal feed and bottle-feeding is prevalent. In 17% of respondents difficulty has been experienced in initiating breast-feeding.

Glucose-6-phosphate dehydrogenase deficiency in blood donors: screening by micromethaemoglobin reduction test.

500 blood donors were screened for G6PD deeiciency using micromethaemoglobin reduction (microMRT) test. Most of the blood donors were young adult males (95.8%). The overall incidence of G6PD deficiency was found to be 0.8%. There, was apparently decreased frequency of G6PD deficient blood donors with increasing age, and no relation could be ascertained between G6PD) deficiency and blood groups.

Beneficial effects of Allium sativum, Allium cepa and Commiphora mukul on experimental hyperlipidemia and atherosclerosis--a comparative evaluation.

Oral administration of petroleum ether extract of Allium sativum, Allium cepa and ethylacetate extract of Commiphora mukul in albino rats significantly prevented rise in serum cholesterol and serum triglyceride level, caused by atherogenic diet. All the three agents were also found to confer significant protection against atherogenic diet induced atherosclerosis.

Modification of glybenclamide hypoglycaemia by verapamil in rabbits.

The study was designed to demonstrate the interaction between verapamil and glybenclamide on blood glucose in rabbits. Glybenclamide (0.05 mg/kg, po) induced hypoglycaemia was observed 1 h after treatment and persisted till 3 h. Verapamil (8 mg/kg, sc) per se produced hyperglycaemia which lasted for 2 1/2 hr. Concurrent administration of verapamil was found to impair significantly the hypoglycaemic response of glybenclamide.

Hyperglycaemic effect of verapamil--an experimental study.

Verapamil in doses of 2, 4, 8 mg/kg produces hyperglycaemia of 1 to 2 hr duration and impairs glucose tolerance in rabbits. The probable mechanism of this hyperglycaemic response is discussed.