Progressive multifocal leukoencephalopathy--as a presenting manifestation of AIDS.

Progressive multifocal leukoencephalopathy (PML) is an opportunistic demyelinating disease caused by the ubiquitous, usually non pathogenic JC Polyomavirus. We report a case of PML as a presenting manifestation of AIDS in a forty five year old man on the basis of clinical features and neuroradiology.

Sex determination in north Indians using mandibular canine index.

Teeth are an excellent material in living and non-living populations for anthropological, genetic, odontologic and forensic investigations. Amongst all teeth, the mandibular canines are found to exhibit greatest sexual dimorphism. Rao et al (1989) used the mandibular canine index for sex determination and found it to give satisfactory results. Muller et al (2001) concluded that Rao et al’s method can only be used in case of correct lower anterior dental alignment and by using the standard mandibular canine index of the local population. The present study endeavors to establish the effectiveness of mandibular canine index in predicting sex in North Indian population taking correct dental alignment into consideration. It was seen that with the standard mandibular canine index, it was possible to detect sex in North Indian population to an extent as high as 75%. This study establishes the existence of a statistically significant sexual dimorphism in the morphometry of mandibular canines in North Indian population.

Role of KATP channels in reduced antinociceptive effect of morphine in streptozotocin-induced diabetic mice.

The nociceptive effect was measured using withdrawal latency in tail flick test in mice rendered diabetic by administering streptozotocin (200 mg/kg, i.p.). The antinociceptive effect of morphine (4 and 8 mg/kg, s.c.) and cromakalim, a KATP channel opener, (0.3, 1 and 2 micrograms, i.c.v.) was significantly reduced in diabetic mice. Moreover, co-administration of cromakalim(0.3 microgram) did not alter the reduced antinociceptive effect of morphine(4 mg/kg) in diabetic mice. Spleenectomy in diabetic mice restored the decrease in antinociceptive effect of morphine and cromakalim. Multiple dose treatment with insulin to maintain euglycaemia for 3 days in diabetic mice prevented the decrease in antinociceptive effect of morphine and cromakalim. However, hyperglycaemic tyrode's buffer did not alter the pD2 value of morphine in isolated guinea pig ileum suggesting that hyperglycaemia does not interfere with mu receptor mediated responses in vitro. The results suggest that hyperglycaemia induced decrease in antinociceptive effect of morphine and cromakalim may be due to alteration in KATP channels. Some unknown factor from spleen in diabetic mice may be responsible for this alteration in KATP channels in diabetic mice.

Effect of intrauterine growth retardation on postnatal changes in body composition of preterm infants.

To find the effect of intrauterine growth retardation on postnatal changes in body composition, we studied nine preterm small for date (SFD) and 9 gestation matched appropriate for gestational age (AGA) infants (mean +/- SD birth weight - SFD : 1431 +/- 16I g, AGA : 1904 +/- 223 g, gestational age - SFD; 237 +/- 9 days, AGA : 236 +/- 7 days). Total body water (TBW) and extracellular water (ECW) were measured at birth, on the day of maximum weight loss and on regaining of birth weight. Body solids were calculated from the difference between TBW and body weight. SFD infants had significantly less postnatal weight loss (64 +/- 19 g) than AGA infants (135 +/- 49 g; P < 0.01) and showed a significant gain in body solids (19 +/- 12 g) during this period which was not seen in AGA infants (-4 +/- 14 g; P < 0.05). The subsequent weight gain occurred at similar rates in SFD (16 +/- 4 g/day) and AGA (18 +/- 6 g/day) infants, but a significantly higher ratio of the weight gain consisted of solids in SFD as compared to AGA infants (P < 0.05). Per unit of body weight, SFD infants had significantly less body solids (213 +/- 12 g/kg) than AGA infants (228 +/- 18 g/kg; P < 0.05) at birth, but by the time birth weight was regained the two groups of infants had similar probody solids (SFD: 248 +/- 7 g/kg, AGA : 255 +/- 12 g/kg). These results suggest that in SFD infants catch-up growth starts early, during the period of apparent weight loss.

Body water distribution in newborn infants appropriate for gestational age.

Total body water (TBW), extracellular water (ECW) and intracellular water (ICW) were measured within 6 h of birth in 99 appropriate for gestational age (AGA) infants. The two groups of infants included were term (mean +/- SD gestation 272 +/- 7 days) and preterm (mean +/- SD gestation 238 +/- 11 days) infants. The mean TBW +/- SD was 777 +/- 26 ml/kg in preterm infants and 737 +/- 26 ml/kg in term infants. The corresponding ECW was 349 +/- 26 ml/kg and 331 +/- 30 ml/kg respectively. Weight was the best correlate of TBW (r = 0.98) and ECW (r = 0.92) volumes. TBW per unit of body weight showed significant decline with increasing gestation (r = -0.54) and birth weight (r = -0.51). ICW per kg showed a moderate correlation with TBW (r = 0.63), whereas ECW per kg had a low correlation (r = 0.35) with it. TBW/kg in our infants was comparable to infants from other ethnic groups. ICW/kg, however, was consistently higher and ECW/kg lower at all stages of maturation in Indian infants as compared to Caucacian and Negroid infants.

Composition of postnatal weight loss & subsequent weight gain in preterm infants.

To investigate the changes in body composition corresponding to postnatal weight loss and regaining of birth weight, total body water (TBW) and extracellular water (ECW) were measured at birth, on the day of maximum weight loss and on regaining of birth weight in 23 preterm appropriate for gestational age (AGA) infants (mean +/- SD birth weight 1902 +/- 242 g, gestational age 236 +/- 7 days). Intracellular water (ICW) was determined by the difference between TBW and ECW and body solids by the difference between TBW and body weight. Almost 90 per cent of early postnatal weight loss of 132 +/- 38 g (6.9% of birth weight) was because of loss of body water (117 +/- 30 ml; 7.9% of TBW at birth). ECW loss (mean +/- SD 106 +/- 35 ml) accounted for 90 per cent of the TBW loss. Of the subsequent weight gain (134 +/- 40 g) till regaining of birth weight, 48 per cent (64 +/- 28 ml) was TBW and 52 per cent (70 +/- 13 g) body solids. The major gain in body water was in ICW (47 +/- 21 ml). A gradual decrease in TBW and ECW, and a gain in ICW and body solids per kg body weight was observed throughout the study period. These findings favour the concept that in preterm (31-36 wk) infants (i) postnatal weight loss is primarily a reflection of ECW loss and subsequent weight gain is because of cellular growth, (ii) postnatal loss of ECW continues even when weight gain and accumulation of body solids has started.

Urban parents' understanding of fever in children: its dangers, and treatment practices.

One hundred urban parents were interviewed for their knowledge, attitude and treatment practices towards fever in children. Only 55% parents were aware of the normal body temperature and 23% of the febrile temperature. A total of 58% considered fever as a disease, 91% felt that fever could go on rising if unchecked, and 60% believed that if it is brought down the child would be cured. As home treatment, paracetamol was used by 57% parents, and cold sponging by 29%. Sixty three per cent were of the opinion that a doctor must be consulted for any fever. The understanding of fever and home treatment practices were significantly better in highly educated parents. Above points must be considered while counselling parent of a febrile child, and for formulating health education package for the parents.

Height and weight of 'well-to-do' school children in Haryana.

A study was conducted in five public schools of Haryana. Height and weight of 4405 well-to-do school children (both sexes) between the ages of 5 to 15 years were measured using standard accepted technique. Height and weight of children were compared with the Indian Council of Medical Research (ICMR) standards; the values of mean height and weight of the Haryana children were significantly higher for both sexes at all ages.

Reliability of subjective assessment of fever by mothers.

To evaluate reliability of mother's subjective assessment of fever, we measured actual body temperature of 301 children and correlated these with assessment of fever (presence or absence) by the mother. Mothers could identify 88.9% (104/117) of febrile children and 88.6% (163/184) afebrile children correctly (positive and negative predictive values 83.2 and 87.6%, respectively). Palpation of more than one anatomical site for subjective assessment had a sensitivity of 100% and a specificity of 92.2%. The accuracy of the assessment was maximum in infants, and was not influenced by sex of the child, mother's educational status and the use of thermometer at home. In the situation where accurate measurement of temperature by thermometer is not available, mother's assessment about presence or absence of fever in her child can be relied upon by health-workers and physicians.

Skinfold thickness in well-nourished school children in Haryana.

Skin fold thickness of 4405 (2212 male and 2193 female) well-nourished school children between 5 to 15 years of age in five public schools of Haryana was measured by standard accepted technique. The findings of the present study were comparable with earlier studies conducted in well-nourished Indian school children at Hyderabad and with the British children. Children belonging to low income groups had smaller fat folds at all ages as compared to the present study.

In vitro sensitivity of antifungal agents.

In vitro sensitivity tests indicated econazole to be the best drug against all 30 isolates of Trichophyton species followed by miconazole, clotrimazole and tolnaftate. Econazole inhibited the growth of all isolates of Trichophyton species in low concentrations of 2-4 micrograms/ml except one isolate of T. rubrum which was inhibited by a concentration of 8 micrograms/ml. Miconazole was also able to inhibit growth of 73.3 per cent isolates of Trichophyton species in low concentrations of 2-4 micrograms/ml. On the other hand, only 13.3 per cent isolates were found sensitive at 2-4 micrograms/ml concentration to tolnaftate and clotrimazole. Relative resistance was encountered by 7 isolates (23.3%) to tolnaftate and 2 isolates (6.6%) to clotrimazole. Isolates of T. tonsurans were resistant to tolnaftate, whereas, the isolate of T. mentagrophytes was sensitive to all the drugs in low concentrations.