Reliability of transcutaneous bilirubinometry from shielded skin in neonates receiving phototherapy: a prospective cohort study.

OBJECTIVE: To determine the agreement between transcutaneous bilirubin (TcB) measured from shielded skin and serum total bilirubin (STB) in infants (34 to 41 weeks of gestation) with hyperbilirubinemia receiving phototherapy (PT). STUDY DESIGN: In this prospective cohort study, we shielded a small area of skin on sternum using a commercial photo-opaque patch (BilEclipseTM, Philips Respironics, Murrysville, PA, USA). The TcB from the shielded skin (TcBs) and STB were measured at four time points-before initiation, 12 and 24 h during and once after (12 h) cessation of PT. TcB was measured using multiwavelength transcutaneous bilirubinometer (BiliChek, Philips Children's Medical Ventures, Monroeville, PA, USA). The STB was measured in triplicate by spectrophotometry (Apel BR 5100, APEL, Japan). Bland and Altman plots were drawn to determine agreement between the TcBs and STB. RESULTS: The gestation and birth weight of enrolled neonates were 37.0 (1.0) weeks and 2750 (458) g, respectively. The age at initiation and duration of PT were 75 (27 to 312) and 25.3 (4.4) h, respectively. Bland and Altman plot showed poor agreement between TcBs and STB at all time points. The gradient (median, range) between TcBs and STB at 0, 12, 24 h and 12 h after cessation of PT were -0.2 (-4.9 to 3.5), 1.4 (-4.7 to 4.0), 1.5 (-3.8 to 9.4) and 2 (-2.9 to 5.8) mg dl-1. The proportions of TcBs values outside ±1.5 mg dl-1 of STB ranged from 47 to 64% at four time points. CONCLUSION: TcBs does not appear to be reliable for estimating serum bilirubin in late preterm and term neonates receiving PT.

Rapid culture of Mycobacterium tuberculosis on blood agar in resource limited setting.

INTRODUCTION: Sputum samples collected at a teaching hospital of Jodhpur, were processed at Desert Medicine Research Centre, Jodhpur. The aim was to assess the time required for primary isolation of Mycobacterium tuberculosis (Mtb) on locally prepared sheep blood agar slants as compared to Löwenstein-Jensen (LJ) medium. METHODS: Equal volume of homogeneous inoculums prepared from smear positive sputum samples processed with the N-acetyl L-cysteine sodium hydroxide method was inoculated on slants of locally prepared 7% sheep blood agar and LJ medium. These were incubated at 37 degrees C and were observed daily for growth visible with naked eyes. Time taken in growth of Mtb was compared. RESULTS: LJ medium recovered 68 of 70 isolates (97.1%) as compared to 66 by blood agar (94.2%). The difference was not significant. Mean time to detect macroscopic colonies of Mtb on blood agar was 13.6 + or - 5.2 days as compared to 20.4 + or - 5.1 days on LJ medium (p=0.0001). More colonies were observed on blood agar than on LJ medium. CONCLUSION: Blood agar slants may be a good substitute of LJ medium for rapid detection of Mtb from sputum in resource limited settings. It may save about one third of the time.

Role of vitamin A supplementation in the treatment of tuberculosis.

Vitamin A deficiency has been commonly observed in patients with tuberculosis. Low serum retinol levels return to normal after antituberculosis treatment even when no supplements are provided. The deficiency of vitamin A observed in patients with tuberculosis might have contributed to the development of tuberculous disease in them. Alternatively, deficiency could be the result of loss of appetite, poor intestinal absorption, increased urinary loss of vitamin A or acute phase reaction in TB. Vitamin A deficiency lowers immunity while vitamin A supplementation reduces morbidity and mortality, particularly from measles and diarrhoea. Vitamin A supplementation also decreases the mortality rate in HIV-infected children and delays the progression of HIV disease in infected subjects. A higher incidence of lung cancer and increased mortality have been observed in smokers after beta-carotene supplementation. Zinc deficiency is also common in tuberculosis, which may impose a secondary vitamin A deficiency. Clinical trials have shown conflicting results regarding the effect of supplementation of vitamin A, alone or with other micronutrients, on time taken to sputum conversion in patients with pulmonary tuberculosis. Supplementation with multiple micronutrients (including zinc) rather than vitamin A alone may be more beneficial in patients with tuberculosis, but clinical trials on such a combination are lacking.

A clinical scoring system as useful as FNAC in the diagnosis of tuberculous lymphadenitis in HIV positive patients.

Among HIV positive patients, Fine needle aspiration cytology (FNAC) or biopsy for diagnosis of tuberculous lymphadenopathy is often avoided due to an unspoken stigma. Earlier, we had developed a clinical scoring scale for the diagnosis of tuberculous lymphadenitis (TBLN), which had 88% sensitivity and detected no false positives. In the present study, we attempted to develop similar scale that could assist in diagnosing TBLN in AIDS. All 42 HIV positive patients of adenitis attending Ramdeo Hospital and Research Centre, Jodhpur between August 2001 and December 2004 were studied. History of past tuberculosis, age, history of rapid weight loss, site, size, consistency, and the presence of matting and sinus formation of enlarged lymph nodes, result of tuberculin test, sputum smear and findings in chest radiograph were compared between patients diagnosed as TBLN and those showing non-tuberculous lymphadenitis (Non-TBLN) on cytopathological examination of material obtained by fine needle aspiration. Based on the results, clinical scores from zero to two were assigned to different clinical features. The total clinical score was then calculated for each patient. A total clinical score of five or more included all TBLN cases and only 10.5% false positives. This scoring system can be used in remote peripheral areas, which do not have the facility for biopsy or FNAC.

Knowledge, attitude and practices related to occupational health problems among salt workers working in the desert of Rajasthan, India.

Workers in the salt industry are exposed to direct sunlight, salt dust and contact with brine. To assess their awareness, attitude and practices related to occupational health problems, 205 salt workers were interviewed about health hazards and problems related to their working conditions, usage of protective measures and suggestions for their improvisation. The brine workers had a fair knowledge of their occupational health problems (98.7%), protective measures (100.0%) and their benefits (100.0%) as compared to non brine workers for whom these figures were 89.0%, 85.8% and 78.7% respectively. The brine workers (29.5%) and non brine workers (31.5%) used unconventional measures to prevent contact with salty water, salt dust, raw salt and glare. There was a huge gap between their knowledge and practice with protective devices, though they suggested improvements in protective devices to increase their acceptability.

The risk of pterygium in salt workers.

PURPOSE: To find out if exposure to direct and reflected sunlight in brine pans (ground water rich in salt, kept in wide pans in open air for salt manufacturing), increases the risk of pterygium in exposed salt workers. METHODS: It was a cross sectional observational study, in which 865 salt workers were examined in the Free Occupational Health Check-up camps held near salt sites; 304 persons from the same area engaged in other work were examined as controls. The prevalence of pterygium in different age groups was compared between brine workers (who worked in the brine pans), dry salt workers, (who were engaged in the loading, weighing, milling, packing or transportation of the dry salt but never worked in brine pans) and non-salt-worker controls. RESULTS: The prevalence of pterygium was significantly higher in brine workers (21.0%) as compared to dry salt workers (9.1%) (Yates corrected chi(2) = 23.45, p = 0.000001) and non-salt-worker controls (9.4%) (Yates corrected chi(2) = 15.69, p = 0.00007). It increased with age and duration of employment in the salt industry. CONCLUSIONS: Brine workers have a higher risk of developing pterygium probably due to their exposure to sunlight reflected both from the surface of brine and from the surface of salt crystals.

Repeated episodes of endosulfan poisoning.

INTRODUCTION: A number of families in a rural area of Jabalpur District (Madhya Pradesh), India, were affected by repeated episodes of convulsive illness over a period of three weeks. The aim of this investigation was to determine the cause of the illness. METHODS: The investigation included a house-to-house survey, interviews of affected families, discussions with treating physicians, and examination of hospital records. Endosulfan poisoning was suspected as many villagers were using empty pesticide containers for food storage. To confirm this, our team collected blood and food samples, which were transported to the laboratory and analyzed with GC-ECD. RESULTS: Thirty-six persons of all age groups had illness of varying severity over a period of three weeks. In the first week, due to superstitions and lack of treatment, three children died. In the second week, symptomatic treatment of affected persons in a district hospital led to recovery but recurrence of convulsive episodes occurred after the return home. In the third week, 10 people were again hospitalized in a teaching hospital. Investigations carried out in this hospital ruled out infective etiology but no facilities were available for chemical analysis. All persons responded to symptomatic treatment. The blood and food samples analyzed by our team showed presence of endosulfan, which was confirmed by GCMS. One of the food items (Laddu) prepared from wheat flour was found to contain 676 ppm of alpha-endosulfan. CONCLUSIONS: Contamination of wheat grains or flour with endosulfan and its consumption over a period of time was the most likely cause of repeated episodes of convulsions, but the exact reason for this contamination could not be determined. This report highlights the unsafe disposal of pesticide containers by illiterate farm workers, superstitions leading to delay in treatment, and susceptibility of children to endosulfan.