Iodine Nutrition in Upper Socioeconomic School Children of Delhi.

We assessed the iodine nutrition of upper socioeconomic strata school children from Delhi to identify its association with goiter, thyroid autoimmunity or thyroid function. After informed consent of parents, all assenting students (n=997) from one randomly selected section of each class from five private schools representing all the zones of Delhi) were evaluated for goiter, urinary iodine excretion, thyroid function and antibody status. Median urinary iodine was 35.28μg/dL. Goiter was present in 123 (12.3%) and positive anti-TPO antibodies in 17 (2.6%). Increased urinary iodine was associated with thyroid dysfunction, though not with goiter.

Detection of Enterobacteriaceae producing CTX-M extended spectrum beta-lactamases from a tertiary care hospital in south India.

A total of 23 clinical isolates (15 Escherichia coli and 8 Klebsiella pneumoniae), resistant to cefotaxime and ceftazidime recovered during 2002 and 2003, were investigated for production of CTX-M extended spectrum beta-lactamase (ESBL) by phenotypic and molecular methods. The presence of ESBL was tested by NCCLS phenotypic confirmatory test using cephalosporin/clavulanate combination discs and E-test ESBL strips. Determination of MIC of cefotaxime and ceftazidime was done with and without the presence of clavulanic acid by agar dilution technique. Polymerase chain reaction revealed the presence of CTX-M type ESBLs in 19 isolates. Further sequencing resulted in identification of CTX-M-15 ESBLs. This is the first report identifying CTX-M type ESBL from clinical isolates of E. coli and K. pneumoniae from a tertiary care hospital in south India.

Cancer in women in Kerala--a transition from a less-developed state.

An epidemiologic assessment of the problem of cancer in women in Kerala based on 3 Population Cancer Registry data and a Hospital Based data is presented. Kerala's Socio-economic and demography presents an intermediate development from a less developed to a better-developed state. As yet, the women follow a tradition-based life style. Cancer incidence rate in Kerala was only 80% of urban rates than seen in Urban Metropolis in India. The pattern of site distribution has shown that GI, Breast and Cervix cancers are the predominant cancers. Oral cavity cancers also show a high frequency. Thyroid cancer has a higher incidence rate in Kerala compared to other areas. Lung cancer among women has higher incidence rate in Karunagappally women. A high prevalence of tobacco use is reported among the men in the above area. Breast cancer incidence rate in the rural areas was only 60% of the rate seen in Urban Trivandrum. Unlike in other rural and urban areas of India Cervix cancer has a low incidence rate in Kerala women. This may be due to better education and also due to the changes in marital and other life style practices. Only 15% of cancer patients attend for medical assistance in localized stage of disease. The need for public education is highlighted and focusing on tobacco use control, self-examination and screening.

Prevalence and antimicrobial susceptibility pattern of methicillin resistant Staphylococcus aureus: a multicentre study.

PURPOSE: Methicillin resistant Staphylococcus aureus (MRSA) is an important nosocomial pathogen. We report the prevalence and antibiotic susceptibility pattern of MRSA in major southern districts of Tamilnadu. METHODS: A total of 7172 clinical specimens and 1725 carrier screening samples were collected from different centers and subjected to MRSA screening using conventional microbiological methods. Subsequently the antibiotic sensitivity test was performed for the confirmed MRSA isolates. RESULTS: Out of 906 strains of S. aureus isolated from clinical and carrier samples, 250 (31.1%) and 39 (37.9%) were found to be methicillin resistant respectively. Almost all clinical MRSA strains (99.6%) were resistant to penicillin, 93.6% to ampicillin, and 63.2% towards gentamicin, co-trimoxazole, cephalexin, erythromycin, and cephotaxime. All MRSA strains (100%) of carrier screening samples had resistance to penicillin and about 71.8% and 35.9% were resistant to ampicillin and co-trimoxazole respectively. Multidrug resistance was observed among 63.6% of clinical and 23% of carrier MRSA isolates. However, all strains of clinical and carrier subjects were sensitive to vancomycin. CONCLUSION: The determination of prevalence and antibiotic sensitivity pattern of MRSA will help the treating clinicians for first line treatment in referral hospitals.

Valvular dysfunction in uraemia.

Regurgitation of the pulmonary, mitral, tricuspid and aortic valves have been observed frequently in chronic renal failure (CRF) and dialysis patients. Two dimensional, M mode and doppler echocardiography were performed on 35 CRF patients and 37 end stage renal failure (ESRD) patients on maintenance haemodialysis. Though structurally normal, valvular dysfunction was noted in 50 per cent of the patients with renal failure. Mitral regurgitation was the commonest abnormality, occurring in 36.1 per cent of the patients. Calcification of the valve was observed in only 5.6 and 16.7 per cent of CRF and dialysis patients respectively. Multiple regression analysis underscored the large contribution of diabetic status in the development of valvular dysfunction. Though end systolic volume was higher in patients with valvular abnormalities, the ejection fraction was well preserved. However, follow up studies are required to assess the significance of the functional valvular regurgitation on the cardiac function of the patients.

Optimal cyclosporine therapy--an Indian experience.

Thirty consecutive adult patients who underwent renal transplantation were prospectively studied. The immunosuppression consisted of cyclosporine, azathioprine and prednisolone. Oral Cyclosporine CyA was initiated at a dose of 7 mg/kg/Day and reduced by 1 mg/kg/month. Blood level of CyA was monitored by monoclonal RIA (Cyclo-Trac-NS) method on 3rd, 10th, 30th, 60th, 90th and 180th days. The dose was titrated according to the blood level and the renal function. In spite of progressive reduction in the dose of CyA, the blood level did not show any significant change, probably because of increased absorption or decreased metabolism. Though the percentage change in CyA dose was significant, the CyA level and serum creatinine remained relatively stable during the follow up period. Our patients required relatively lesser dose to achieve optimum blood level. Though the blood level of CyA ranged between 387 and 2120 ng/dL. There was no evidence of rejection or irreversible nephrotoxicity.

Low dose radiation--a curse or a boon?

The increased use of nuclear technology has created fear in the minds of people regarding its possible adverse effects on living systems. This fear is heightened by press reports of nuclear fallouts and of high levels of natural background radiation in geographical areas in a number of countries. The International Commission on Radiological Protection and the United Nations Scientific Committee on the Effects of Atomic Radiation estimate the risk of cancer from high dose exposure to be 4.5% to 7.1% per sievert depending on the projection model used. However, when the exposure is to low dose background radiation, the available data does not show an increased risk. This is possibly due to the effectiveness of the inherent repair capacity of the living cell. These observations have given rise to the 'hormesis' hypothesis. Low dose radiation has in fact been found to be immunostimulatory and this is now being exploited as a possible treatment modality in cancer patients.

Blood pressure levels in south Indian adolescents.

The present study was undertaken to develop normative data for the blood pressure (BP) levels in adolescent boys and girls aged 10-17 years residing the rural and urban areas of North Arcot Ambedkar District, Tamil Nadu State. Blood pressures were evaluated as part of an ongoing study on growth and development in adolescents. A total of 7028 BP measurements collected cross-sectionally were subjected to statistical analysis. The mean systolic (SBP) and diastolic (DBP) blood pressure levels were elevated in rural children as compared to that in urban children of respective sexes during 10 and 15 years of age. The mean BP levels were higher in both the rural and urban girls as compared to their male counterparts till the age of 15, after which the trend was reversed. While the mean SBP and DBP levels for rural children of either sex were stable over the age range considered, those for urban children exhibited consistent increase with age. In urban boys, the yearly mean increments in SBP and DBP were 2.5 mm Hg and 2.0 mm Hg and that in urban girls 2.4 mm Hg and 1.7 mm Hg, respectively. It is suggested that perhaps stress factors are responsible for the elevated mean BP levels among the rural adolescents as they are generally engaged in activities that exert considerable physical and psychological stress.

Acquired toxic methaemoglobinaemia.

Eighty Six adult males presented with central cyanosis and constitutional symptoms 2 to 4 hours following ingestion of meal from a common kitchen. On spectrometry methaemoglobin was detected. All recovered fully in 12 to 36 hours on symptomatic treatment. Epidemiological study and toxicological examination revealed that metanil yellow used for colouring the rice was responsible.