Severe orthostatic hypotension in a diabetic patient may not be due to diabetic autonomic neuropathy.

This lesson describes an unusual case of a man who was recently diagnosed with type 1 diabetes and who presented with severe orthostatic hypotension. As his diabetes was recent in onset, well controlled, and he had no other signs of microvascular disease, other causes of orthostatic hypotension were sought. His serum and cerebrospinal fluid were strongly positive for Borrelia burgdorferi IgG, suggesting a diagnosis of Lyme neuroborreliosis. Autonomic instability in Lyme, while rare, has been previously reported.

Epidemiology of campylobacteriosis in a cohort of rural population near Calcutta.

Over a 2-year period, 25 families comprising of 181 individuals of all ages were longitudinally observed for the excretion of Campylobacter species. Faecal samples were taken from all persons with diarrhoea. Specimens were also taken from apparently healthy individuals and from domestic animals living within the confines of the study families at monthly intervals. The overall diarrhoea attack rate was 19 episodes per 100 person-years with peak incidence in the 1- to 4-year-old age group (76/100 person-years). Eight (11.5%) of the total episodes were campylobacter-associated and the overall rate of campylobacter positive diarrhoeal episodes were 2.2 per 100 person-years. Of the 1002 stool samples from healthy individuals 32 (3.2/100 samples) were positive for campylobacter. The organism was most frequently isolated from children under 1 year of age both during diarrhoeal episodes (11.5 per 100 person-years) and non-diarrhoeal (11.1 per 100 samples). Multiple infections in a family were rare. In 19.4% of the occasions one or more animals were campylobacter positive. However, only in 7.7% of these occasions was a human infection recorded within 1 month after the animal was found to be positive. The study showed that the epidemiology of campylobacteriosis in this community was distinct compared to that observed in developed countries.

Newer applications of the histological stain prepared from Pterocarpus santalinus.

A histological stain prepared from the heartwood of Pterocarpus santalinus Linn. has been found to be an excellent nuclear stain for various cells of animal and plant origin. As an elastic tissue stain, the results are comparable to standard elastic tissue stains. The striations of voluntary muscle fibers are well shown. The Nissl granules and fibers of cranial nerves in the pons are visualized. When counterstained with light green, it differentially stains muscle and fibrous tissue. The stain can be used as counterstain with certain histochemical procedures with satisfactory results. The preparation and use of this versatile stain are described.

A controlled field trial of an aluminum phosphate-adsorbed cholera vaccine in Calcutta.

A controlled field trial to determine the efficacy of a single dose of an aluminium phosphate-adsorbed cholera vaccine was conducted in Calcutta during 1975-77. An aluminium phosphate-adsorbed tetanus toxoid was used as the placebo. Follow-up of the immunized volunteers for a period of two years showed that the adsorbed cholera vaccine provided 100% protection to children under five years of age for 6 months, 88.9% for 12 months, and 91.7% for 18 months (P<0.05). The overall protection for all age groups was 58.5% for 18 months. There were no serious side effects following the anti-cholera inoculations.

Malnutrition, fertility and family planning.

PIP: Data derived primarily from published reports is used to assess the relationship between malnutrition and reproductive capacity in India. Findings of numerous studies support the conclusion that improvements in nutritional status are associated with increased fertility in the absence of contraception. Nutritional programs should therefore be provided in conjunction with family planning services in order to avoid an increase in population growth. Improvements in the nutritional status of members of a community may help motivate the community toward family planning. A recent Indian study demonstrates that higher caloric intake is associated with smaller family size, and other studies reveal a relationship between malnutrition and pregnancy failure, stillbirth, and infant mortality. The high infant mortality rate in India at the present time may serve to increase family size since couples tend to over produce in order to insure that some of their children will survive. The hypothesis that an inadequate diet is compensated for by an increase in sexual appetite, and hence, in fertility is not substantiated by recent investigations. For example, Indian states with higher protein intake/person have higher birth rates than those states with lower protein intake/person. Tables provide data on 1) birth rates, death rates, infant mortality rates, % of population increase, and sex ratios for each decade from 1921-1970 for India; 2) the relationship between diet and birth rates in several countries; 3) the relationship between various dietary factors and birth, death, and infant mortality rates forIndia; 4) fertility rates observed in several populations where contraception was not practiced; and 5) the relationship between family size and diet in India.^ieng

Noma neonatorum: Its aetiopathogenesis.

Noma neonatorum, a gangrenous process affecting the nose, lips, mouth, anal region, and occasionally the scrotum and eyelids, affects neonates, especially low-birth-weight and premature ill babies, and is usually fatal 1-3 days after onset. In 35 cases of noma neonatorum Pseudomonas aeruginosa was isolated from blood-culture (86.3%), gangrenous areas (96.0%), rectal swabs (58.3%), and cerebrospinal fluid (60.0%). Blood-vessels in the deep cutis or subcutis were affected and the gangrenous process extended superficially. Noma in older children and adults is caused by fusospirochaetosis but noma neonatorum appears to be due to P. aeruginosa septicaemia.