Acute Hemiplegia in Children: A Prospective Study of Etiology, Clinical Presentation, and Outcome from Western India.

BACKGROUND: Hemiplegia/hemiparesis denotes the weakness of one side of the body. In contrast to adults, hemiparesis in children occurs secondary to a variety of etiological conditions. AIMS: The aim of this study was to assess the clinical, laboratory, and radiological features of children with acquired hemiparesis/hemiplegia of nontraumatic origin and intended to find its underlying etiology in the Indian children. SETTINGS AND DESIGN: This prospective, observational study was carried out at a tertiary care hospital in western India. MATERIALS AND METHODS: Children aged between 3 months and 14 years admitted to the in-patient department of a tertiary care hospital with acquired hemiparesis/hemiplegia were included over 2 years. Children with perinatal insult, preexisting neurological diseases, neurotrauma, hemiplegic migraine, and Todd's paralysis were excluded from the study. Detailed clinical examination, laboratory, and radiological investigations were done, and an attempt was made to find the underlying etiology. These children were also followed up after 1 month of discharge to look at short-term outcomes. All clinical information was recorded in a predesigned performa and was managed with Microsoft Excel spreadsheet. Frequency was presented as number (N) and percentage (%). RESULTS: Fifty-five children (male:female = 1.2:1), predominantly between 1 and 5 years of age were studied. Apart from weakness (92.8%), vomiting (70.9%), fever (58.2%), and seizure (58.2%) were the predominant presenting complaints. One-fifth of them had comorbidities; most commonly congenital heart disease. Cerebral infarction was the most common pathology in neuroimaging. Central nervous system infection (45.5%) was the most common identified etiology followed by vascular events (21.8%). Among those who could be followed up at 1 month, about 65% had some improvement in their power. CONCLUSION: Infections continue to be an important cause of neurodisability in the developing countries.

Review of sodium analysis proficiency test results.

Proficiency testing results for sodium analysis in foods raised concerns over the proportion of laboratories achieving satisfactory z-scores. Test materials for sodium analysis include fruit juice, canned meat meal, tomato sauce, cheese and pasta meal, and snack food. Fruit juice and tomato sauce data sets are the most problematic in deriving the assigned value with sufficiently low uncertainty to provide evaluative z-scores. The standard deviation for proficiency is derived from Horwitz, with a lack of collaborative trial data for these matrices to provide other guidance. The status of accreditation for the method/matrix does not appear to influence the observed variation in results. Microwave digestion is much less commonly used than simple acid digestion. The choice of determination method appears to be entirely matrix dependent (whether flame atomic absorption spectroscopy, flame photometry or inductively coupled plasma spectroscopy). Results for juice matrix may be overestimated if flame photometry is used, due to either potassium interference or careless reporting where potassium is also determined.

Laparoscopic management of left paraduodenal hernia.

Internal herniation of small bowel accounts for about 1% of all the patients with intestinal obstruction. Fifty percent of the patients with paraduodenal hernia will have bowel obstruction. Left paraduodenal hernia resulting from abnormal rotation of the midgut during embryonic development is the most common form of congenital internal hernia. A case of a young male presenting with chronic abdominal pain due to left paraduodenal hernia is being reported. A correct preoperative diagnosis of left paraduodenal hernia was made on computerised tomography (CT), and the patient was managed by laparoscopic surgery. The role of imaging in preoperative diagnosis is being highlighted with a brief review of literature.

Effect of Vasantic Vaman and other Panchakarma procedures on disorders of various systems.

Kapha is dominant and vitiated in Vasant ritu as it is described in Ayurveda. Acharya Chakrapani has said in chapter six, that not only Vaman, but all the five biopurification methods of the Panchakarma should be practiced in Vasant ritu. Out of the two best seasons in a year for purification, Vasant is better one. This pilot research study was carried out to see the effect of this biopurification process on different disorders. The results were marvelous, as symptomatically 58% relief was achieved.

Some furfural derivatives as nitrification inhibitors.

Three series of furfural derivatives, namely N-O-furfural oxime ethers, furfural Schiff bases (furfurylidene anilines), and furfural chalcones, have been synthesized and evaluated for nitrification inhibition activity in laboratory incubation studies in typic Ustocrept soil. Furfural oxime ethers and furfural Schiff bases showed potential activity, but furfural chalcones were only mildly active. N-O-ethyl furfural oxime among the oxime ethers, and furfurylidine-4-chloroaniline among the furfural Schiff bases, performed the best. These two compounds showed more than 50% nitrification inhibition on the 45th day at 5% dose as compared to 73% inhibition by nitrapyrin. Activity of furfural oxime ethers decreased with an increase in carbon atoms in the N-O-alkyl side chain. Introduction of a chlorine atom in the phenyl ring of furfurylidene anilines increased the persistence of their activity. N-O-Ethyl furfural oxime and furfurylidine-4-chloroaniline coated urea performed at par with their application in solution form. Ethyl and N-O-isopropyl oxime, as well as chloro- and nitro- substituted Schiff bases, did not reveal any phytotoxicity (adverse effect on germination) on chickpea seeds (Cicer arietinum) even at the highest dose (40 ppm, soil basis).

False-positive serological tests in acute malaria.

A range of serological tests, including rapid plasma reagin (RPR), Widal test, enzyme-linked immunosorbent assay (ELISA) for human immunodeficiency virus (HIV)-1 and -2, direct Coombs' test (DCT), and rheumatoid factor (RF) were performed in a well-characterised cohort of 100 patients with acute malaria (Plasmodium vivax infection: 31 patients; P. falciparum infection: 69 patients). Twenty-five healthy volunteers from a similar area were used as controls. Three patients from the severe P. falciparum group died, the remainder of the patients recovered completely. A large proportion of these patients showed false-positive serological reactions during the acute stage of infection, which became negative on re-testing, four weeks after recovery. In tropical countries such as India, where malaria is endemic, results of serological tests should be interpreted with caution in a patient with pyrexia of unknown origin (PUO).

Effect of emulsion size and shelf life of azadirachtin A on the bioefficacy of neem (Azadirachta indica A. Juss) emulsifiable concentrates.

In a study of 33 recipes of neem oil based emulsifiable concentrates, the specific surface area of the emulsions and cream plus oil layer separation in emulsions at 24 h revealed a correlation of -0.6874 between them and correlations of -0.8940 and 0.6972, respectively, with bioefficacy (LC(50)) against the 3-day-old second-instar larvae of the Bihar hairy caterpillar, Spilosoma obliqua Walker. Nearly 96-99% of azadirachtin A in emulsifiable concentrates (aza-A content = 617.93-1149.65 ppm) degraded during the heat stability test at 54 +/- 1 degrees C for 14 days with half-lives ranging between 1.84 and 4.53 days. The LC(50) values against S. obliqua were, however, statistically at par in both the pre- and the post-heat-treated samples, suggesting a similar effect of azadirachtin A and its degradation products on the bioactivity. The half-life of azadirachtin A could be enhanced by storing the concentrates at lower temperatures. A low pH of the formulation solvent did not check the degradation of azadirachtin A, as reported with aqueous solutions in the literature.

Stabilization of azadirachtin A in neem formulations: effect of some solid carriers, neem oil, and stabilizers.

Formulation of azadirachtin A on attapulgite, kaolinite, fuller's earth, hydrated calcium silicate, and fly ash revealed that it degraded to the tune of 70-95% on different solid carriers as compared to 56% in neem oil, during the 14 day heat storage studies at 54 +/- 1 degrees C in the laboratory. The degradation was reduced by 26-60% on different carriers by employing either anthraquinone or epichlorohydrin as stabilizer. Pyrogallol and hydroquinone enhanced the degradation. The cation exchange capacity and surface area of the carriers revealed a significant negative correlation with t(1/2) of azadirachtin A.

Stepwise approaches for estimating the intakes of chemicals in food.

Estimating intakes of chemicals in food requires residue data, giving the concentration of the chemical in food, and consumption data for foods which could contain the chemical. Residue data are often restricted to only a few foods and even then may not be representative of the foods of interest due to limitations in the sampling or analytical procedures. Obtaining reliable consumption data can also be complex. People normally eat a wide range of different foods, which may each contain a range of concentrations of the chemical of interest. Both sets of data can be combined using one of several approaches. This paper reviews the nature and relevance of the factors affecting the collection of these two data sets and the procedures available for combining them to estimate consumer exposure. Considerable expertise and judgment are necessary to obtain an estimate of exposure that is robust enough for risk management purposes.

Dynamic compatibility testing of DMP 840, an experimental antitumor agent.

The purpose of this study is to evaluate the potential for DMP 840, a novel experimental antitumor agent, to precipitate during injection or dilution with infusion solutions. The influence of predilution of the drug solution before injection and addition of buffers to the drug vehicle were also investigated. The compatibility of normal saline solution, pH 7.4 phosphate buffers, and human plasma with DMP 840 was examined in vitro under both static conditions and dynamic flow. The combination of DMP 840 solutions with normal saline solution resulted in conversion of the drug to an insoluble dihydrochloride salt. Under conditions of dynamic flow, precipitation, accompanied by large changes in turbidity, occurred at relatively high concentrations of the drug in the injection solution. Dilution of the injection solution below 2 mg/mL or slow injection avoided precipitation. As was the case with the normal saline system, turbidity changes after injection into protein-phosphate buffer (PPB) were dependent on the initial concentration of DMP 840 solution as well as the rate of administration. In addition, the maximum injection rate at which complete miscibility occurred increased exponentially as the drug injection solution was made more dilute. Buffering the DMP 840 injection solution with acetate buffer improved the miscibility of DMP 840 with PPB, which indicated that the turbidity increases were most likely due to conversion of the drug to its insoluble free base form. The observed effects of the buffer on the turbidity response agreed qualitatively with predictions from a graphical approach that considers the effects of dilution and pH changes on drug solubility. Despite these observations, no evidence for the formation of a solid precipitate could be found after injection of the unbuffered drug solution into PPB. Further investigation indicated that the presence of albumin in the PPB prevented the formation of a solid phase during injection. Likewise, fresh human plasma, spiked with 1 and 2 mg/mL solutions of DMP 840, showed no evidence for the formation of a solid precipitate.

Fibrinolysis, inhibitors of blood coagulation, and monocyte derived coagulant activity in acute malaria.

Different parameters of fibrinolytic systems like t-PA, PAI, D-dimer, and inhibitors of blood coagulation, i.e., protein C (PC), protein S(PS), and antithrombin III (AT-III), have been studied in cases of acute malaria due to Plasmodium falciparum and plasmodium vivax infection, and these patients were followed up. It was observed that the plasma PAI-1 was very high in cases of P. falciparum malaria infection as compared to normal controls and P. vivax infection. The changes in complicated cases of P. falciparum were remarkable as compared to uncomplicated ones. The PC, PS, and AT-III levels were also low in P. falciparum, particularly so in complicated cases, and were normal in P. vivax infection. The factor VIII R:Ag levels were invariably high in acute malaria. On follow-up of some of these cases the values came back to normal after the antiparasite treatment. The monocyte procoagulant activity was found to be significantly higher in P. falciparum infection as compared to that of P. vivax infection. All these findings therefore contribute towards the production of a hypercoagulable state in P. falciparum infection and partly explain the complications of P. falciparum infection like cerebral malaria.

Autoantibodies, immunoglobulins, complement and circulating immune complexes in acute malaria.

BACKGROUND: Malaria caused by Plasmodium vivax and Plasmodium falciparum is common in the Indian subcontinent. Studies conducted elsewhere have suggested that malarial infection causes intense immunostimulation. We screened patients with malarial infection for autoantibodies and measured the immunoglobulin, circulating immune complex and complement levels to determine the extent of immunological alterations in these patients. METHODS: One hundred adults with acute malarial infection confirmed by examination of the peripheral blood smear and 25 age- and sex-matched controls were studied. An autoantibody screen and serum immunoglobulin complement (C3 and C4) and circulating immune complex levels were measured at the time of admission and 4 weeks after they became afebrile. A direct Coomb's test was also done. RESULTS: Anti-ssDNA, anti-dsDNA and rheumatoid factor were positive at the time of admission in 51, 30 and 38 patients respectively. None of the controls were positive for these autoantibodies except for one who was positive for rheumatoid factor. The IgM, IgG and IgA levels were raised in 16, 25 and 36 patients respectively. Circulating immune complex levels were raised in 32 patients and complement C3 and C4 were low in 8 and 31 patients. Follow up studies at 4 weeks in 19 patients showed that the autoantibodies were negative. However, the immunoglobulin, C4 and circulating immune complex levels remained elevated. Six per cent of patients had a positive direct Coomb's test with reticulocytosis at the time of presentation. CONCLUSION: Acute malarial infection can cause false-positive results for anti-ssDNA, anti-dsDNA and rheumatoid factor and may also cause a rise in the serum immunoglobulin, complement and circulating immune complex levels.

False positive modified Widal test in acute malaria.

The present study reports results of modified Widal test carried out on 96 cases of acute malaria and 25 healthy controls. Out of the 96 patients studied, 30 had complicated P.falciparum (CPF), 36 had uncomplicated P.falciparum (UPF) and 30 had P.vivax (pv) malaria. Modified widal test was done to know the Widal titers due to Igm type of anti-salmonella antibodies, which is considered very specific for diagnosis of recent enteric fever. This test was positive in 14.58% and 10.41% of malaria patients for salmonella 'o' and 'H' titers respectively. On four weeks follow up most of the positive test become negative. Non-specific polyclonal B lymphocyte stimulation due to malaria was postulated to be responsible for this phenomenon.

Baclofen in trigeminal neuralgia--a clinical trial.

Baclofen is a new antineuralgic drug. A clinical trial with treatment by this drug on 20 patients of trigeminal neuralgia was done. The action of this drug is similar to that of carbamazepine, however the former gives less undesirable side-effects. Out of 20 patients under treatment by this drug, 45% were relieved completely from pain while in 20% intensity and/or number of attacks of pain was reduced to half and in 35% effectiveness of Baclofen could not be observed.

Klebsiella pneumoniae osteomyelitis in sickle cell anemia.

A case of Klebsiella pneumoniae osteomyelitis in a patient with sickle cell anemia is reported. The literature is briefly reviewed. The case is presented because of the rarity of Klebsiella pneumonia osteomyelitis in sickle cell disease.

A comparative study of biliary tract disease in Karachi (Pakistan) and Aylesbury (England).

A total of 134 patients with biliary tract disease were studied. Of these 94 patients were operated in Karachi (Pakistan) and 40 at Aylesbury (England). The age and sex incidence, clinical features and laboratory investigations were studied and compared in the two groups. It is concluded that biliary tract disease occurs at a much younger age in women of child bearing age in Karachi. The incidence of common bile duct stones appears to be low. Carcinoma of the Gall-bladder was recorded in 6.3 per cent in Karachi group.

Photodegradable formulatins of DDT.

The incorporation of diphenylamine and diethylaniline in commercial DDT-WDP formulations sprayed on Phaseolus aureus and Tabernaemontana coronaria revealed that both these chemicals enhanced the initial rate of loss of DDT. Both these sensitizers exhibited no immediate adverse effect on the storage stability, pH, sieve requirement and colour of the formulations and introduced no phytotoxicity. Diphenylamine addition, however, had some adverse effects on the suspensibility.