Knowledge and attitude towards Tuberculosis amongsandstone quarry workers in desert parts of Rajasthan.

Aim: The present study was conducted to test the knowledge and attitude of sand-stone quarry workers of Jodhpur on tuberculosis. Material and Methods: Nineteen sand-stone quarry sites were selected randomly in Jodhpur district from which 376 quarry workers were interviewed who consented to participate in the study. Results: Their literacy rate was 28.5%. More than half (50.5%) had heard about tuberculosis from neighbours followed by friends (42.6%) and family members (37.2%). Only 1.6% knew that tuberculosis was caused by germs and 45.2% respondents had misconception that TB was a hereditary disease. Literates were more aware than illiterates about symptoms of tuberculosis. Only 6.9% knew about the need of treatment for 6-8 months and 0.8% knew about the use of BCG vaccine for prevention of tuberculosis. Tendency to discriminate TB patients was evident as 72.6% respondents opined to isolate TB patients from the family and 80.6% opined to avoid sharing food with these patients. Conclusion: Extensive health education directed towards bringing a change in attitude among sandstone quarry workers is needed to create awareness and remove myths about tuberculosis in such groups of people in the community.

Acute Intermittent Porphyria in a Kumhar community of Western Rajasthan.

OBJECTIVE: To know the current magnitude of the occurrence of Acute Intermittent Porphyria in Kumhar community of a part of Western Rajasthan. MATERIAL AND METHODS: This is a cross sectional study of rural community of Kumhars of Bikaner district of Western Rajasthan. The households of kumhar community were approached. Besides recording other information and examination details, their urine samples were subjected to Watson-Schwartz Test. RESULT: 1237 subjects out of a total of 2385 kumhar population distributed among 20 randomly selected villages of Bikaner district could be studied. The prevalence of AIP was estimated to be 1.16%. (CI=0.012 +/- 0.0005), showing higher prevalence than the earlier reported studies. The cases exhibited varied symptomatology. Overall preponderance was in favor of females (2:1) and majority of cases (38.9%) were found in the age group of 20-29 years. Average age of manifestation was 24.5 +/- 4.8 years. A follow up was also done to know the disease consequences, if any. CONCLUSIONS: The study finds higher prevalence of the disease and as such warrants a need for generating awareness among the families of cases in the specific caste group in the study area for early detection and better management of the disease.

Cryptococcal infection in patients with clinically diagnosed meningitis in a tertiary care center.

A retrospective analysis of 326 clinically diagnosed cases with meningitis over a period of five-and-a-half years was carried out to determine the prevalence of cryptococcal infection, its associated risk factors and therapeutic outcome. Fifty-four (16.6%) patients with cryptococcal meningitis were identified by smear examination, culture and/or cryptococcal antigen latex agglutination test. Records of 45 cryptococcal meningitis patients were available; 18 (40%) of them were apparently healthy immunocompetent individuals, 13 (28.9%) had human immunodeficiency virus (HIV) infection, 9 (20%) were renal transplant recipients, 4 (8.9%) were diabetic and 1 (2.2%) had systemic lupus erythematosus. Ten (22.2%) patients died and 11 (24.4%) patients (all HIV-positive) left against medical advice. The present study indicates that cryptococcal infection is associated with high mortality. Presenting symptoms being indistinguishable from other causes of central nervous system infection, all patients with a clinical diagnosis of meningitis, irrespective of their immune status should be investigated for cryptococcal infection.

Candidaemia in patients of a tertiary health care hospital from north India.

BACKGROUND & OBJECTIVES: Candidaemia is an important cause of mortality in hospital settings. Limited information is available from India on nosocomial candidaemia. The objective of the present study was to isolate and identify yeasts from patients suspected to have nosocomial bloodstream infection (BSI) and to determine the carriage rate of Candida species, risk factors for acquisition of infection and mortality in this group of patients. METHODS: Blood samples from 4871 patients suspected to have BSI at least 48 h after admission were cultured following standard protocol to isolate and identify the pathogens. Clinical details, possible risk factors and outcome of all candidaemic patients were recorded and analysed. Samples of hand washings and throat gargles from these patients were also cultured to determine the carriage rate. Candida albicans isolated from patients and their carriage sites were genotyped by randomly amplified polymorphic DNA (RAPD) analysis to study strain relatedness. RESULTS: Twenty one patients with candidaemia were detected with mortality of 55 per cent. Candidaemia per 1000 admissions was 1.61. Isolation of non-C. albicans Candida species was significantly higher than C. albicans (14/21 vs 7/21: P < 0.05). Use of broad-spectrum antibiotics (43%), gastrointestinal surgery (23%), immunosuppressive therapy (23%), protein calorie malnutrition with parenteral hyperalimentation (23%) and neutropaenia (14%) were identified as probable risk factors. The seven C. albicans strains isolated from patients with BSI were typed into 6 genotypes. Yeast carriage rate among the patients was 71.4 per cent. C. albicans isolated from the hand, throat and blood of two patients had identical genotype. INTERPRETATION & CONCLUSION: BSI due to non-C. albicans Candida species is more common than C. albicans in our patients and candidaemia is associated with high mortality. RAPD appears to be a simple method to study strain relatedness for C. albicans. There is a need for early diagnosis and systematic surveillance to meet the challenges of nosocomial candidaemia.

Campylobacter species associated with diarrhoea in patients from a tertiary care centre of north India.

BACKGROUND & OBJECTIVES: Most laboratories do not routinely distinguish the various Campylobacter species, though almost all Campylobacter species have been isolated from human faeces. The epidemiological and clinical aspects of its infection and the species involved in genesis of diarrhoea are least understood in the developing countries. The aim of the present study was to find out frequency of Campylobacter species isolated from patients with diarrhoea over a 12-year period and to analyse their features. METHODS: Campylobacter strains isolated from stool samples of patients with diarrhoea were identified to the species level on appropriate media at 42 degrees C micro-aerobically. Patients' demography and clinical data were analyzed retrospectively; 25 Campylobacter jejuni strains were tested for toxin production and 23 strains were typed by Penner scheme. RESULTS: A total of 62 strains were isolated from 59 patients and the various species were C. jejuni 51 (82.3%), C. coli 8 (12.9%), C. lari 2 (3.2%), and C. upsaliensis 1 (1.6%). Children < 5 yr of age were most affected (34/59; 57.6%), followed by patients in 15-30 yr of age (12/59; 20.3%). Presentation of watery diarrhoea was significantly more common than inflammatory diarrhoea (50/59, 84.7% vs 9/59, 15.3%; P < 0.001). Recurrence occurred in 3 (5.1%) patients. Majority of the infections resolved within one week; one HIV-positive patient had chronic diarrhoea. Two patients developed Guillain-Barré syndrome following Campylobacter infection. Twenty (80%) of 25 strains were toxigenic and 20 (87%) of 23 strains could be typed by Penner scheme. INTERPRETATION & CONCLUSION: In our patients, 4 different Campylobacter species and various C. jejuni serotypes were involved in gastroenteritis. Majority of the infections were watery diarrhoea and in children < 5 yr of age. There is a need of a population-based systematic study to know the epidemiology of whole spectrum of campylobacters in India.

A study of forced vital capacity and its predictors among the sand stone quarry workers.

The study assesses the relationship of selected demographic, anthropometric, radiological, work-history and smoking-history related variables with Forced Vital Capacity (FVC) in a sample of 168 sand stone quarry workers in a desert environment. Except the variables related to smoking behaviour, all are found significantly associated with FVC. The predictors of FVC screened through the multiple regression analysis were age, weight, height, profusion of opacities in chest X-ray and duration of work. Mean FVC was found significantly lower as compared to the healthy adult population. On an average FVC% was 90% of predicted (Percentage deviation of 10%). A clear increasing trend in FVC% along age/duration of work was observed among the young workers, which may be due to building of muscles in this job. Percentage deviation of 20% or more in FVC was significantly associated with presence of radiological opacities suggestive of silicosis (odds Ratio = 3.3). The diagnostic utility of the same is also assessed.

Role of yeasts as nosocomial pathogens & their susceptibility to fluconazole & amphotericin B.

A total of 213 and 208 yeasts were isolated as nosocomial pathogens from various infected specimens during 1996 and 1997 respectively. Yeasts ranked fifth among uropathogens in both the years and from eighth to eleventh in other specimens. Increasing trend in nosocomial urinary tract yeast infection (11.9 in 1996 to 12.6 in 1997) and decreasing trend in wound and other infections (5.1 in 1996 to 2.9 in 1997) per 1000 patients' discharges were observed; blood stream infection remained unchanged (2/1000 discharges) in both the years. Eighty two (41 from each year) randomly selected yeasts were identified to species level following standard protocol and tested for antifungal susceptibility against fluconazole and amphotericin B by reference broth macrodilution technique and agar dilution (AD) method. The frequency of various yeast species identified was Candida albicans 39 (47.6%), C.tropicalis 29 (35.4%), C. krusei 4 (4.9%), C. glabrata 3 (3.7%), C. zeylanoides 2 (2.4%), C. guilliermondii 2 (2.4%), one strain (1.2%) each of C. kefyr, C. parapsilosis, and Trichosporon beigelii. Resistance to fluconazole (MIC > or = 64 micrograms/ml) as per NCCLS criteria was observed in 2 Candida sp. (2.4%). Significantly higher number of non-albicans Candida sp. (8/43; 18.6%) had MIC > 8 micrograms/ml as compared to C. albicans (2/39; 5.1%) (P < 0.05). Only one strain of C. tropicalis had MIC 8 micrograms/ml to amphotericin B and none had MIC > 8 micrograms/ml. Agreement between the reference and the AD methods for fluconazole was 88 per cent and for amphotericin B was 94 per cent. The present study indicates that Candida sp. are emerging as important nosocomial pathogens and the tendency of yeasts to develop resistance to antifungal agents appears to be a challenge for patient management.

Correlates of peak expiratory flow rate: a study of sand stone quarry workers in desert.

The study assesses the relationship between selected demographic, anthropometeric, radiological, work-history and smoking-history related variables with Peak Expiratory Flow Rate (PEFR) in a sample of 286 sand stone quarry workers from a desert region. Age, height, profusion of radiological opacities, age at beginning of work, duration of work and duration of smoking were found significantly associated with PEFR while duration of exposure to dust, nature of job and number of biries smoked per day failed to establish their significant association. Mean PEFR of these workers was found significantly lower than the same among healthy adults from the study area. The subset of predictors of PEFR only included age, height and profusion of radiological opacities as identified by multiple regression analysis.

Entomological studies in a dengue endemic area, Jalore, Rajasthan.

Entomological studies on prevalence of adult and immatures of Aedes aegypti along with associated ecological factors have been conducted in a dengue endemic area of Jalore, Rajasthan from 1992 to 1993. Studies in two areas; reportedly affected and unaffected revealed more adults and higher breeding indices in the affected area as compared to the unaffected one. Mosquitoes harbouring dengue antigen were found only in the affected locality. Presence of dengue antigen in field caught mosquitoes in the affected locality was observed mainly during the months of January to April in both the years. Statistical analysis of data has shown a correlation to be significant between adult house index and breeding index in the affected area while this association was found insignificant in the unaffected locality. Water storage practices of the population due to irregular water supply in the affected area is the possible cause for a higher vector concentration in the locality. Seasonality of occurrence of dengue fever patients in a particular period of the year is associated with a relatively higher vector density and the presence of infected mosquitoes which is due to favourable temperature, relative humidity, water temperature and pH.

Purification and characterization of ribulose-1,5-bisphosphate carboxylase from triticale.

Ribulose-1,5-bisphosphate carboxylase has been isolated from a synthetic cereal triticale and purified using a newly developed rapid procedure involving precipitation with ammonium sulphate (35-55% saturation), DEAE-cellulose (DE-52) chromatography and filtration through Sepharose CL-68. Molecular weights of the enzyme subunits are 15.5 and 52 kDa which corresponds to 540 kDa for the hexadecameric holoenzyme. Isoelectric focussing showed that the enzyme has a pI of 4.2. Various kinetic constants determined under aerobic conditions are: Km (CO2), 118 microM; Km (RuBP), 220 microM (at 20 mM NaHCO3) and Vmax, 690 nmole CO2 fixed/mg enzyme/min.

Psychosocial development of urban children (below 2 years) using culture appropriate indicators of development.

Six hundred essentially normal children 15 days-2 years were randomly assessed for their nutritional and developmental status. Measurement of the mid-upper-arm circumference using the Jellife's technique was employed for a quick nutritional survey. For developmental assessment, the WHO suggested culture appropriate psychosocial Basic Test Battery was used. Shakir's classification of the results did not reveal any malnutrition. Analysis of the data revealed 'at par' performances in Gross Motor, Hearing and Self Help skills and delays in Vision and Fine Motor, Language and Concept Skills. Social skills were particularly advanced.

Culture appropriate indicators for monitoring growth and development of urban and rural children below 6 years.

In this cross sectional study, 2000 apparently normal children aged 0-6 years (1200 urban and 800 rural), were nutritionally and developmentally assessed and their environment scrutinized for possible risk factors. Measurement of mid upper arm circumference (MUAC) using standard techniques revealed malnutrition in 44% of the rural and 24% of the urban children especially in the 2-6 years of age group. Culture appropriate indicators of psycho-social development picked up gross delays in gross motor (GM), vision and fine motor (V&FM) and language skills. Self help, concept hearing (SHCH) skills were recorded as normal while social skills were advanced particularly in the 0-2 years old urban group. By the use of the family protocols, low socio-economic status, malnutrition and 9 other risks factors have been generated for the urban group. No risk factor could be identified for the rural group. Better income emerged as the only real protective factor for the sample showing a direct positive relationship with the 45 skills tested, especially in the 2-6 years age group. Nineteen developmental skills were identified as powerful predictors of development. A prototype home based screening record was constructed for monitoring of growth and development which can be even used by minimally trained primary care worker.

In vitro activity of certain antibiotics against dermatophytes.

The in vitro effect of antibiotics i.e. Hamycin, Griseofulvin and Mycostatin against Microsporum gypseum and M. fulvum showed that hamycin was comparatively less inhibitory to M. fulvum. Complete inhibition in mycelial growth and sporulation of these two dermatophytes was observed by Mycostatin at its 1000 micrograms/ml conc. after 8 days. M. fulvum did not sporulate at higher concentration of griseofulvin. However, griseofulvin completely inhibited the sporulation in M. gypseum at all the concentration of this drug, but mycelial growth of M. fulvum and M. gypseum were significantly inhibited. Mycostatin was found more inhibitory to these dermatophytes in comparison to hamycin and griseofulvin.

Interaction of human alpha fetoprotein with bilirubin.

Human alpha fetoprotein (AFP) binds bilirubin with an affinity somewhat lower than albumin. Free bilirubin was found to have an extinction maximum at 440 nm with an extinction coefficient of 4.97 x 10(4) M-1cm-1. AFP binding with the bile pigment elicits a blue shift while albumin interaction produced red spectral shift.

Alpha fetoprotein levels in newborn infants with reference to sex, gestational age and birth weight.

Alpha fetoprotein (AFP) concentration was higher in the mature full term male infants than age matched females. An inverse correlation, at birth, between cord serum AFP level and duration of pregnancy was observed. In contrast no correlation between body weight and AFP levels exists in babies of either sex at identical gestational age.