Exercise induced proteinuria as an early indicator of diabetic nephropathy.

Diabetic nephropathy is a life threatening microvascular complication of diabetes characterized by presence of proteinuria and progressive impairment of renal function. This study was carried out on 25 patients of diabetes mellitus and 25 healthy individuals who served as controls. All the persons were asked to perform certain programmed amount of exercise and protein excretion rates were measured in urine collected over following three periods: just before exercise, just after exercise and one hour post exercise. It was observed that basal urinary protein excretion rate as well as exercise induced urinary protein levels were significantly higher in diabetics than in control (p < 0.001). Values were significantly higher in uncontrolled diabetes as compared to those with good metabolic control. Urinary protein values were also related to the duration of diabetes. Higher values were observed in patients having diabetes of more than 5 years as compared to those with less than 5 years duration. This test is good and easy to perform for early detection and management of diabetic nephropathy which is essential to reduce long term morbidity and mortality in diabetics.

Effect of enalapril therapy on ventilatory pulmonary function tests in hypertensive patients.

Fifty newly diagnosed nonsmoker patients suffering from mild to moderate hypertension (diastolic BP 90 to 114 mmHg), randomly selected and not having respiratory or other systemic diseases which may affect pulmonary functions were subjected to thorough interrogation and clinical examination. Twenty five normal age and sex matched healthy volunteers served as control. All patients and controls were subjected to ventilatory pulmonary function tests (VPFT), done by computerized spirometer. Hypertensive patients were put on oral enalapril, doses were titrated and maintained on 2.5 to 10 mg once daily. Twenty percent of the total hypertensive patients reported mild to moderate dry cough and was more frequently observed among females (27%). Significant decline was observed in MEF 50% and MEF 25% of vital capacity values (p 0.0204 and 0.0001) after 10 days of enalapril therapy. These two VPFT parameters showed significantly higher decline among patients who developed cough as compared to patients who did not develop cough. Decline in VPFT parameters were directly related to doses of enalapril.

Herpes zoster and post-herpetic neuralgia--a clinical trial of aspirin in chloroform for anodyne.

Pain associated with Herpes Zoster (HZ) and Post-herpetic Neuralgia (PHN) has been a challenging task to manage with ease. Topical aspirin dissolved in chloroform is an effective means of reducing pain due to HZ and PHN in most patients. The locus of pain origin and analgesia induced by topical aspirin is supposed to be at cutaneous free nerve ending pain receptors. The present study was conduced in fifty two patients of HZ and PHN. Pain intensity before and after the application of drug was measured with help of Sort Form McGill Pain Questionnaire (SE-MPQ). Most of the patients experienced relief of pain within 1-5 minutes after the aspirin-chloroform application. Maximum relief was achieved in about 30-40 minutes and persisted for 5-6 hrs. In the beginning 3-4 applications were required but frequency decreased gradually as the pain abated.

Association of cerebral palsy with epilepsy.

Fifty patients of various types of cerebral palsy were studied to find out an association between cerebral palsy, EEG abnormalities and development quotient. Seventy-six per cent patients had spastic cerebral palsy. Hypotonic cerebral palsy was the next common type (14%). Athetosis and ataxic forms were found to be rare (2% each). Epilepsy was associated with 56% patients. Clinical types of seizures observed were: Generalised tonic-clonic (43%), myoclonic (17.9%), generalised tonic (10.7%), partial simple (10.7%) and partial complex (17.9%). The incidence of seizures was highest in hypotonic type in which 85.7% had epilepsy. Mean developmental quotient of cerebral palsy patients was 34.9% with maximum retardation in hypotonic cerebral palsy (25.14%). Sixty per cent of patients had abnormal EEG, out of these hypotonic patients had maximum (70%) chances of EEG abnormality followed by spastic patients (55%). Developmental retardation was more severe statistically in the patients with abnormal EEG than normal EEG.

Severe and complicated malaria in Bikaner (Rajasthan), western India.

Severe and complicated malaria is an important cause of mortality in Plasmodium falciparum infection. We describe in this study the details of 532 cases of such syndromes admitted to hospital during an outbreak of malaria between September-December 1994. Increase in the annual rain fall, collection of water around Indra Gandhi Canal, forestation of shrubs around it and migration of labor, adaptation of Anopheles stephensi to desert climate and favorable breeding of An. culicifacies in the areas under impact of irrigation were presumptive causes of the outbreak in this region. Cerebral malaria (25.75%), hepatic involvement (11.47%), spontaneous bleeding (9.58%), hemoglobinuria (7.89%), severe anemia (5.83%), algid malaria (5.26%), ARDS (3%) and renal failure (2.07%) were the important manifestations. The overall mortality was 11.09%, which was high because of infection in the non-immune population of this area. Ignorance about the severity of this disease and lack of transportation facility was another important factor. Morality was highest in ARDS (81.25%) followed by severe anemia (70.97%), algid malaria (46.43%), renal failure (45.45%), jaundice (36.06%) and cerebral malaria (33.57%). Pregnancy was an important determinant increasing the mortality in female patients. Mortality was very high (82.35%) in those persons who presented with more than 3 syndromes together.

Clinicosocial aspect of osteo-articular tuberculosis.

The study constituted clinicosocial analysis of 194 cases of osteo-articular tuberculosis. The disease was common in 1st and 2nd decades of life but not rare in old age with male preponderance. Majority of the patients were from rural area belonging to lower economic classes. Lesions were usually solitary (96.4%) situated in the weight bearing bones and joints (88.66%). Spinal tuberculosis was commonest (48.97%). The onset of disease was insidious in 94.8% cases. Chronic pain, swelling, impaired movements, deformities, sinus and cold abscess were found to be salient features of disease. Negligence and secondary infection were common.

Nerve injuries in neonates.

A clinical study of 40 cases of nerve injuries in neonates with one-year follow-up is presented. The total incidence of such injuries was 1.50%. Thirty-three cases sustained nerve injury due to obstetrical trauma and in 7 cases it was due to postnatal trauma like intragluteal injection and tight splintage. Almost in all cases there was history of prolonged or obstructed labour. Upper limb nerve injuries were commonest followed by facial palsy. Twenty-three cases (76%) showed complete recovery while 17% had partial and 7% no recovery at all. Hence nerve injuries are not uncommon in neonates. If managed properly the recovery is good. Intragluteal injection in the neonatal period should not be recommended.