Developmental Delay: Timely Identification and Assessment.

This paper outlines the prevalence of developmental delay in children and discusses the recent literature regarding the benefits of early identification and evidence based strategies for developmental surveillance and screening. We describe a systematic approach to the child with developmental delay and the optimal methodology for arriving at the etiologic basis for the delay. A review of the most up-to-date and relevant literature was completed using Pub Med, online databases, and texts. The medical evaluation with specific emphasis on the most recent recommendations for genetic, laboratory and imaging studies is described. The American Academy of Pediatrics algorithm for developmental surveillance and screening is discussed with consideration for the importance of culturally relevant screening tools across populations. In addition, specific screening tools are briefly discussed that may prove beneficial to the primary care provider as he/she implements routine surveillance and screening.

Polyclonal antibody-mediated mitotic inhibition in Chinese hamster ovary cells.

The nucleus of a mammalian cell undergoes profound reorganization when the cell enters mitosis and a number of proteins involved at various levels of the cell cycle have been characterized. The presence of mitotic-specific proteins has been reported and their roles are important in understanding the mechanics of cell division. The ability of antibodies to recognize mitotic protein antigens and further inhibit mitosis is potentially valuable in their role as therapeutic and diagnostic agents in cancer therapy. In this study, we have aimed to analyze proteins isolated from mitotic cells of Chinese hamster ovary (CHO) cells and their significant role in inhibiting mitosis. The proteins extracted from mitotic cells were processed and antibodies produced. It was observed that the secondary response that yielded an antiserum of 1:8 titer was predominantly IgG. The antiserum was effective in inhibiting mitosis in CHO cells in culture in a dose-dependent manner. Although inhibition of mitosis was apparent by cell proliferation studies, there was no apparent effect of the antiserum on other cell morphology and culture characteristics. The unique molecular structure of the antibody by which it bivalently binds to a broad array of antigenic epitopes serves as the foundation of its utility. These antibodies, being polyclonal in nature, are targeted against a whole range of proteins; and their multiple epitopes involved in process of cell division might hence mediate recognition or inhibition of function of such proteins in a wholesome manner and thus accomplish inhibition of mitotic progression.

Cutaneous manifestations of non-Hodgkin's lymphoma.

Thirty-two confirmed cases of non -Hodgkin's lymphoma (NHL) were examined for cutaneous manifestations for a period of 2 years from November 1998 in KMC Hospital Attavar, Mangalore. Cutaneous manifestations in the study group were compared to a control group of 32 patients. Specific infiltrates were present in all (5/5) CTCL patients and one out of twenty-seven patients with low grade NHL. Morphologically they presented as papules, plaques, nodules and erythroderma. Infective conditions seen in the study group were superficial fungal (7/32) and viral infections (2/ 32). Non-infective conditions were acquired ichthyosis (10/32), generalised pruritus (5/32), insect bite reaction (1/32) and drug eruption (1/32). When compared to control patients only acquired ichthyosis and generalised pruritus were found to be statistically significant. The study group also showed changes due to chemotherapy like diffuse alopecia (24/29), bluish pigmentation of proximal part of nail (4/29), localised pigmentation of palms and soles (1 /29), diffuse pigmentation at injection site (1 /29), pigmentation at scar site (1 /29) and stomatitis (4/29).

Med estimation for narrow band UV-B on type IV and type V skin in India.

With an aim to determine minimum erythema dose of narrow band UV-B, 30 subjects, 20 with type I V skin and 10 with type V skin were subjected to graded incremental doses of 311-narrow band UV-B phototherapy cabinet by Daavlin. Barely perceptible erythema 24 hrs after exposure was taken as MED. 33.3% developed erythema at 745mj, 26.6% at 620mj, 23.3% at 1075mj, and 10% at 1290mj. The average MED for narrow band UV-B exposure for type I V skin was 600mj, [range 515-755mj] and for type V skin 1100 mj [range 895-1290mj] Better therapeutic response can be obtained by approximately 360 -450mj as initial irradiation dose for type IV skin and 600-825mj for type V skin.

Comparison of ELISA for antibody detection and biopsy urease test against H. pylori in cases of gastoduodenal disorders.

Out of 156 cases of various gastro duodenal disorders studied H. pylori was diagnosed in 119 (76.28%) as indicated by Biopsy urease test and IgG ELISA. Biopsy urease test detected higher number of cases 119 when compared to IgG ELISA 107 cases. ELISA being a non invasive technique can be used successfully for the diagnosis of H. pylori infections.

Evaluation of newborns with skeletal dysplasias.

Skeletal dysplasia are a relatively common and distinct group of genetic disorders. Even though abnormalities of bone growth are the major clinical manifestations, the pathological process may involve in any body system. Many of these disorders have dire consequences such as neonatal death and most will have life-long physical and psychosocial morbidity associated with them. Recent advances in genetic research have identified the genes underlying the primary defects in several common skeletal dysplasias such as achondroplasia and diastrophic dysplasia. While these advances are clearly important in developing better therapy and a cure for those conditions, the role of the pediatrician as the diagnostician has remained unchanged. In this article we describe how a systematic approach using the simplest of tools--clinical assessment and radiograph--can arrive at a diagnosis in most instances of newborns with skeletal dysplasias. The key features that are essential for establishing a diagnosis for most of the entities encountered in the newborn are described along with our general approach to the evaluation of the radiographs.

Diagnostic approach to children with birth defects.

Clinical genetics deals with the diagnosis, management and prevention of genetically determined disorders. Our current understanding of the role genes play in the pathogenesis of everything from fetal malformation to neurodegenerative and malignant disorders of late adulthood make it somewhat difficult to draw a clear boundary for this rapidly expanding specialty. With the recent completion of a preliminary draft of the entire sequence of the human genome it is not unreasonable to dream of novel therapeutic approaches such as "gene therapy", to cure disorders heretofore treatable with supportive measures only. Nevertheless, the clinical assessment of the patient will continue to be the cornerstone of good practice of medicine. In this article we review a clinical approach to the diagnostic challenge presented by children with birth defects. The principles we illustrate apply to other aspects of "genetic medicine" as well.

Occurrence and severity of alopecia in patients on combination chemotherapy.

The aim of the study was to evaluate the occurrence and severity of alopecia resulting from combination chemotherapy on cancer patients. The study was conducted during the period 1994-1996 on 58 confirmed cases of malignancies attending the Kasturba Medical College Hospital, Mangalore, South India. The treatment regimens followed were standard protocols recommended for those malignancies and which are widely adopted. Specific drug combinations, their dosage and routes and schedules of administration were studied. The influence of 20 different treatment regimens, most of them in combination chemotherapy, were studied. The patients studied were not receiving any other medication which could have caused alopecia as observed in the present study. The pathophysiology of the hair, as influenced by the treatment regimens, were studied by examination of samples of the affected hairs under a Leica compound microscope. Alopecia was the most dominant side effect influencing 35 of the 58 patients undergoing the treatment (60%). The severity of alopecia was assessed by grouping them in four distinct grades. Specific drugs and their combinations causing varying degrees of severity were identified. The initiation of hair loss in different treatment regimens were analysed. It is seen that alopecia is an early manifestation of cutaneous side effects of cancer chemotherapy. In a majority of patients, the manifestation initiated after the first or the second cycle of administration of the rapeutic regimen, indicating a time interval of 1 to 8 weeks after the start of chemotherapy. Single agent drugs, when used alone or in combination with immunomodulator drugs seem to cause much less side effects, including alopecia, when compared to multiple drug regimens. Microscopic examination of the affected hair showed trichorrhexis, fragmentation, decrease in diameter and depigmentation of the hair shaft.

Infantile and childhood types of atopic dermatitis--a clinical comparison.

Atopic Dermatitis also known as infantile eczema in infants, is a chronic endogenous eczema which manifests with different characteristic distribution in infants, children and adults. Absence of any reliable laboratory investigation to confirm the diagnosis makes it very difficult to differentiate it from other eczemas especially in infantile and childhood types. This study compares a small group to patients belonging to infantile and childhood types of atopic dermatitis and documents the changes observed in these category of patients.