Dexamethasone therapy for bacterial meningitis in adults: a double blind placebo control study.

Routine use of steroids in the treatment of bacterial meningitis remains controversial. A prospective placebo controlled double blind study of dexamethasone was carried out in 40 patients (age>10 years) of acute bacterial meningitis. The patients were randomly assigned to receive either placebo (n=20) or dexamethasone (n=20) in addition to injection ceftriaxone 100 mg/kg/day (maximum 4 gm/day) for 14 days. Dexamethasone sodium phosphate was given in dose of 0.6 mg/kg/day in 4 divided doses, for first 4 days of therapy. First dose of dexamethasone was given 15 minutes prior to first dose of ceftriaxone. Baseline demographics, clinical and laboratory features of the two groups were similar. Clinical improvement of signs of meningeal irritation was rapid in dexamethasone group than in the placebo group, but no significant difference was observed regarding resolution of fever, headache and vomiting. Secondary fever (mean+/-SD 15.00), gastrointestinal tract bleeding (mean+/-SD 15.00) and psychiatric manifestations (mean+/-SD 10.00) were more common in dexamethasone group. Neurological complications and hearing loss were more common and severe in placebo group as compared to the dexamethasone group (p<0.05). It is concluded that dexamethasone may be beneficial in some aspects of bacterial meningitis, in adults. A study with a larger number of cases in each group is recommended.

Outbreak of polyarthritis with pyrexia in Western Rajasthan.

AIM: To establish the etiology of recent out break of polyarthritis which occurred in Kanvari village of Churu district of Rajasthan in August, 1999. METHODOLOGY: Forty eight patients of polyarthritis were studied by Hb, TDLC, ESR, CRP, throat swab Gram's stain and culture, blood culture, ASO titer, rheumatoid factor, Rose Bengal plate agglutination test, standard tube agglutination test for brucellosis, widal test, urine examination, X-ray chest, ECG and X-ray of the affected joint. RESULTS: Forty eight patients presented with acute polyarthritis with low grade fever of 1-2 week duration. Most common joint involved was sacroiliac joint (52.08%). Most of patients had multiple joint involvement (93.75%). The Rose Bengal plate agglutination test and standard tube agglutination test for brucella were positive in high titres in 44 (91.60%) patients. All the patients were treated with therapy for brucellosis and followed up for 12 weeks and responded well without complications. CONCLUSION: In case of polyarthritis possibility of brucellosis should always be kept in mind.

Cardiac autonomic neuropathy and its correlation with QTc dispersion in type 2 diabetes.

This study was conducted on 50 patients of diabetes mellitus type 2 and 20 healthy controls to correlate severity of diabetic cardiac autonomic neuropathy with QTc interval and QTc dispersion. Five standard cardiovascular response tests were carried out (i.e. Valsalva ratio, expiration-inspiration ratio, immediate heart rate response to standing, fall of systolic blood pressure on standing and sustained hand grip test) to determine the severity of cardiac autonomic neuropathy by scoring system. QTc dispersion was determined by subtracting heart rate-corrected minimum QTc interval (QTc min) from maximum QT interval (QTc max) from standard electrocardiogram. Severity of cardiac autonomic neuropathy strongly correlated with QTc dispersion (r = 0.760; p = 0.0001). Correlation of severity of cardiac autonomic neuropathy with QTc max and QTc mean was also found but weaker than with QTc dispersion (r = 0.663, r = 0.542, p = 0.0001 each) and no correlation was found with QTc min (r = 0.177; p = 0.17). This shows that QTc dispersion is a better predictor of cardiac autonomic neuropathy than any of above three QTc intervals. QTc max, QTc mean and QTc dispersion were significantly higher (p < 0.001) in diabetics with autonomic neuropathy (450 +/- 23, 423 +/- 22 and 57 +/- 12 msec; n = 30) than without neuropathy (407 +/- 14, 397 +/- 15 and 20 +/- 7 msec; n = 20) and control subjects (408 +/- 20, 399 +/- 19 and 19 +/- 7 msec; n = 20) but QTc min remained same in the three groups (393 +/- 21, 387 +/- 12, 388 +/- 19 msec, respectively) (p > 0.05). Correlation of QTc dispersion was stronger with QTc max (r = 0.781; p < 0.001) than QTc mean (r = 0.625; p = 0.001) but not with QTc min (r = 0.097; p = 1.0) which suggests that regional increase in QT interval due to regional autonomic denervation leads to increased QTc dispersion. Thus, QTc dispersion is a sensitive, non-invasive, simple and cost-effective predictor of cardiac dysautonomia.

Value of clinico-psychiatric assessment in the diagnosis of chronic intractable pain in abdomen.

To evaluate the role of psychiatric illness in patients with chronic abdominal pain, 50 patients with this symptom were subjected to thorough clinical examination, detailed investigations and Goldberg's 60-item General Health Questionnaire. Those scoring 12 in this questionnaire were subjected to a detailed psychiatric evaluation. Sixteen (32%) patients had pure organic illnesses, 8 (16%) had organic illness with associated psychiatric factors and 26 (52%) had definite psychiatric illness. We conclude that chronic abdominal pain is often associated with psychiatric illness.

Coronary-prone behaviour pattern and myocardial infarction.

Seventy five patients with acute myocardial infarction (MI) and forty matched control subjects were assessed for coronary-prone behaviour pattern by a self administered scale. Analysis of the results showed a higher incidence (P < 0.001) of type A behaviour pattern in acute (MI) patients, as compared to controls.

Role of QT interval at onset of acute myocardial infarction in predicting early phase ventricular arrhythmia.

In this study, the QTc interval was determined in 51 patients of acute myocardial infarction and the incidence of ventricular arrhythmias in them was noted. It was found that the QTc interval was prolonged (more than 0.44 sec) in all the 33 patients who developed ventricular arrhythmias, while it was below 0.44 sec in all the 18 patients who did not develop ventricular arrhythmia.

An epidemiologic study of intermittent acute porphyria in Maheshwari community of Napasar, Bikaner (Rajasthan)

An epidemiologic study of intermittent acute porphyria in the Maheshwari community of Napasar, Bikaner (Rajasthan) was conducted. Twelve cases were detected among 1900 persons belonging to ten families surveyed (prevalence 1:408). The disease was more common in females and the maximum number (4 cases) was encountered in the age group 21-30 years. The disease was more common in Mundhra (4 cases) and Mohata (3 cases) subcastes.

Portal hypertension therapy with oral propranolol. A short-term study.

Thirty patients were evaluated in a blind fashion to study the effect of oral propranolol on portal hypertension of varied aetiology. The dose of oral propranolol (administered to 15 patients) was adjusted to reduce the resting heart rate by approximately 25%. Splenic pulp pressure served as the parameter for portal pressure. A matched group of 15 control subjects on placebo was also studied. The mean portal pressure in the propranolol group fell from 3.49 to 2.69 kPa saline (P less than 0.001) as compared to the control group where the mean pressure increased from 3.57 to 3.63 kPa saline. The propranolol group showed improvement in clinical symptomatology with a significant reduction in body weight and abdominal girth in patients with ascites. A significant positive correlation (r = 0.78; p less than 0.007) was obtained between the fall in portal pressure and the initial levels. Thus, oral propranolol proved useful in the conservative management of portal hypertension of varied aetiology.

Comparative value of glutamic oxaloacetic transaminase and lactic dehydrogenase enzyme pattern in serum and cerebrospinal fluid in acute cerebrovascular accidents.

A study of glutamic oxaloacetic transaminase (GOT) and lactic dehydrogenase (LDH) enzymes in serum and cerebrospinal fluid (CSF) was carried out on 30 cases of acute cerebrovascular accident (CVA) to determine their role in precise diagnosis and prognosis of the cases. The CSF GOT and LDH activities were well correlated with the severity, mortality and peak and proper timing in relation to infarct, same is about serum GOT. A characteristic rise of GOT and LDH was observed in cerebral haemorrhage especially in fatal cases. However, in cerebral thrombosis and embolism specially in non-fatal cases, the enzyme change was not so marked. GOT and LDH enzyme pattern in CSF and serum may, therefore, serve as an early, relatively easy and widely available tool for differential diagnosis and prognosis of cases of acute CVA.

Bactericidal power of neutrophils in protein calorie malnutrition.

The present study was undertaken to compare the disturbance in bactericidal power of neutrophils in 25 children having protein caloric malnutrition age and sex matched healthy control subjects. There was a highly significant reduction in the percentage of bacteria killed during incubation in children having PCM as compared to healthy control. A direct relationship existed between total serum proteins and bactericidal activity of neutrophils in children having PCM. The impaired bactericidal power of neutrophils can be attributed to impaired synthesis of lysosomal enzymes, glycolytic activity of neutrophils in children having PCM. The exact mechanisms still remain to be elucidated. Decreased bactericidal activity of neutrophils may be one of the mechanisms responsible for infection.

A study of incidence of Australia antigen and derangements in liver function tests in leprosy.

The present study was conducted in 50 patients of various subtypes of leprosy (Lepromatous, Tuberculoid, Borderline borderline) and 25 healthy control, for detection of Australia antigen and various liver function tests (serum protein, cholesterol, alkaline phosphates, SGOT, SGPT, bilirubin and liver biopsy) to see incidence of Australia Antigen and derangement in liver function. It was concluded that incidence of Australia antigen in study and control group was zero. Total serum protein and serum globulin was increased in lepromatous leprosy. A/G ratio was reversed in 34.3% and 50% in lepromatous and tuberculoid leprosy respectively. Granulomatous hepatitis was seen in 66.66% and 50% cases of lepromatous and tuberculoid leprosy respectively. No relationships was established between hepatic lesion, Australia antigen and liver function test.