Serum immunoglobulin E against PPD antigen in patients with pulmonary tuberculosis.

There is scant literature on the existence of IgE (type I allergic reactions) directed against Myocobacterium tuberculosis. To study this problem, total serum IgE (SIgE) and IgE specifically directed against the purified protein derivative of Myocobacterium tuberculosis (PPD-Sp IgE) was determined in 16 patients with AFB positive pulmonary tuberculosis (PTB) and their age and sex matched controls. Mean SIgE was significantly higher in PTB than in controls. Mild heating of the serum was necessary to detect the presence of PPD-Sp IgE which was positive in 81.3% PTB. One (6.3%) gave a class I, 9 (56.3%) gave class II and 3 (18.7%) gave class III RAST reactions. PPD-Sp IgE was absent in 3(18.7%). There were no class IV reactions. Control sera were negative for PPD-Sp IgE. Though the RAST test had a sensitivity of 80.1%, a specificity of 100% and a positive predictive value of 100%, we do not advocate this test as a diagnostic test. We have used this test to demonstrate the existence of PPD-Sp IgE and thus the existence of Type I allergic reactions against the PPD antigen of Mycobacterium tuberculosis. Its value in relation to clinical symptoms and its site of local production need further studies.

Congenital factor XIII deficiency.

Clinical and hematological data of 9 cases with factor XIII deficiency is highlighted. The age at first bleed ranged from 3 days of life to 1 year. Seven of these 9 cases had bleeding from the umbilicus, 3 had recurrent subcutaneous and muscle hematomas, while 4 cases had CNS bleeds of which 3 expired. Routine coagulogram was normal, while clot solubility in 5 molar urea solution was abnormal in all cases. Factor XIII assay was not done in any. Patients were treated with plasma transfusion during episodes of bleeding. No patient received plasma transfusion as prophylactic therapy. The cumulative Indian data so far documented, inclusive of this series, shows a very high incidence of CNS bleeds (33%) in patients with this inherited coagulation disorder.

Bronchial challenge with purified protein derivative of Mycobacterium tuberculosis in asthma.

Response to bronchial challenge (BC) with purified protein derivative of Mycobacterium tuberculosis (PPD), was studied in children with bronchial asthma and correlated with Mantoux test and serum immunoglobulin E (IgE) against PPD (PPD-Sp IgE). Nearly 59% patients with bronchial asthma and 12.2% patients with pulmonary tuberculosis gave positive BC. Children with extra-pulmonary tuberculosis and normal children did not show positive BC. In asthma, 25% gave early (EAR), 50% gave late (LAR) and 25% gave both early and late (DAR) asthmatic response. Forced expiratory flow volumes in 1 sec (FEV.1) of 13 age and sex matched asthmatic and normal children showed similar volumes before BC, however, the values were significantly lower in asthma at 20 min (p less than 0.005) and 24 h (p less than 0.005) after BC. There was no relationship between response to BC and the severity or chronicity of asthma. PPD-Sp IgE was estimated by the radioimmunoassay method (Pharmacia Diagnostics). It was detected in 75% with positive BC and none of the controls. The titre was of Phadebas RAST Class III in 66.7%, Class II in 22.2% and Class I in 11.1%. The presence of early Mantoux reactions, positive BC with PPD and serum PPD-Sp IgE suggest the existence of Type I or Arthus type of reactions to PPD, which could cause hyperreactive airways in some cases of asthma.

Fetal echocardiography--norms for M-mode measurements.

M-mode echocardiography was performed in 110 normal fetuses to study the norms for various cardiac parameters at varying gestational ages. The measurements were done in normal pregnancies with gestation varying from 14-38 weeks. The parameters studied were aortic root diameter, left atrial and right ventricular outflow tract dimensions, left and right ventricular cavity dimensions, and left ventricular, septal and right ventricular wall thickness. The values were analysed statistically by linear regression analysis and 95 per cent confidence limits were derived. It was found that values for right and left ventricles increased with gestation such that at term both ventricles were equal in size. The aorta and left atrium also increased with increasing gestation but the value for left atrium increased more than that of aorta giving increased left atrium to aorta ratio. These values could be utilised as norms for Indian fetuses and could help in detecting abnormalities of size.

A study of pulmonary function of competitive swimmers.

Pulmonary Function Tests (PFT) of 45 swimmers who swam a distance of 2 to 5 kms per day regularly were compared with age, sex, height and weight matched controls. VC, IRV, FVC, FEV1 and V25 were higher in swimmers (S) than controls (NS) by 20%, 25%, 37.4%, 30.1% and 15.1% respectively. The effect of the period of training on PFT's was also analysed. Inspiratory capacity was significantly higher in Gr IS than NS probably due to a reduction in FRC, FVC and FEV1 were higher in Gr. II than NS. Greater differences were seen between Gr. IV S and NS, where FVC, FEV1, V75 and PEFR were higher by 50.2%, 38.2%, 69.4% and 25% respectively in the S than NS. Probably the first parameter to increase is IC. The greater differences in PFT values of Gr. IV S and NS may be due to hypertrophy of the diaphragm which requires hard work for prolong period. Further longitudinal studies are needed to confirm these observations.

Cardiorespiratory response to stress test in normal Indian boys and adolescents.

Thirty-one boys between the ages of 9 and 17 years were subjected to submaximal exercise stress testing on a treadmill using the Bruce's protocol. All the children completed the test with the younger group (9-13) reaching Grade III and the older group boys (14-17) reaching Grade IV on an average. The heart rate, blood pressure and FEV1 during exercise compared well with other reported studies. On ECG analysis there were no significant ST segment changes or J junction depression. This study was conducted in well nourished boys from high-socio-economic group who regularly took part in sports.

Effect of chlorine gas leak on the pulmonary functions of school children.

Pulmonary function tests (PFT) were performed on 84 children studying in a Municipal School, near a plant manufacturing chemicals in Chembur, a suburb of Bombay, from where large amounts of chlorine gas leaked out on 30th August, 1985. It was found that only 23.8% had normal PFT's. 66.7% showed an obstructive pattern and 9.5% showed a restrictive pattern of PFT's. This is a preliminary report to establish the prevalence of lower PFT values in children staying in an area of air pollution in Bombay.

Prevalence of cryptosporidium in children with acute diarrhea.

Cryptosporidium is an intestinal protozoa known to cause diarrhea in animals and more recently has been recognised as a cause of diarrhea in humans. The present study was designed to determine the prevalence of cryptosporidium as a cause of diarrhea in children. Faecal samples of 180 children admitted to the hospital for acute gastroenteritis and from 100 normal children were analysed. Eight out of 180 (4.4%) stools from children with acute diarrhea and none from normal showed cryptosporidi. We conclude that this parasite does play a role in the etiology of human diarrhea.

Trial of ketotifen in childhood asthma.

An open trial of Ketotifen was conducted on 29 children suffering from asthma of varying duration. The drug was given orally in a dose of 1 mg twice a day. Children were followed up weekly for a period of 3 months. It was found beneficial (though the benefit was not statistically significant) in children having asthma of less than 2 years duration who were taking one drug regularly or were on occasional treatment. There was marginal effect in children taking salbutamol and theophylline together, but irregularly and no benefit in children taking prednisolone.