RESUMO
Integrated Child Development Services (ICDS) scheme is world's largest community based programme. The scheme is targeted at children upto the age of 6 years, pregnant and lactating mothers and women 16-44 years of age. The scheme is aimed to improve the health, nutrition and education (KAP) of the target community. Launched on 2 October 1975, the scheme has completed 25 years of its operational age. The article describes in brief, the organisation, achievements and drawbacks of this national programme. It also suggests various thrust areas for its betterment and further improvement.
RESUMO
Four children aged 3 months to 14 years presenting with multiple mucosal neuromatosis (MMN) and having medullary carcinoma of the thyroid (MCT) along with various other associated features are reported. All patient had screening test for pheochromocytoma. Thyroid gland and Neuromatous growths were subjected to histological examination for confirmatory diagnosis. All patients were subjected to total thyroidectomy with removal of regional lymph nodes. They were evaluated periodically for a variable post-operative period at 2 to 4 years. The first degree relatives were also screened. One of the four children had left sided pheochromocytoma which responded satisfactorily to the adrenalectomy. Prophylactic total thyroidectomy with annual/biannual critical review to detect recurrence is advocated. It is recommended that first degree relatives of familial MMN Syndrome should also be subjected to annual screening in view of its autosomonal dominant transmission.
Assuntos
Carcinoma/patologia , Síndromes Neoplásicas Hereditárias/patologia , Neuroma/patologia , Neoplasias da Glândula Tireoide/patologia , Adolescente , Criança , Feminino , Humanos , Lactente , Masculino , Mucosa/patologia , Feocromocitoma/patologiaAssuntos
Neoplasias Encefálicas/fisiopatologia , Diabetes Insípido/fisiopatologia , Oftalmopatias/fisiopatologia , Pinealoma/fisiopatologia , Adulto , Humanos , Sistema Hipotálamo-Hipofisário/fisiopatologia , Masculino , Testes de Função Hipofisária , Sistema Hipófise-Suprarrenal/fisiopatologia , SíndromeAssuntos
Doenças do Sistema Endócrino/diagnóstico , Dobras Cutâneas , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Fatores SexuaisAssuntos
Osteocondrodisplasias/genética , Tórax/anormalidades , Humanos , Recém-Nascido , Masculino , SíndromeRESUMO
Forty subjects each were rapidly inducted by road to altitudes of 3200 and 3771 meters (m). Half of subjects at each altitude were maintained on digoxin and the other half received placebos. The digoxin group showed higher serum potassium at both altitudes. Serum sodium remained unaltered. When compared to control groups, urinary volume changes were less marked in the digoxin group. Similarly, the alterations in calcium and magnesium in serum and urine at 3771 m were less pronounced. However, none of these changes in the digoxin groups were statistically significant when compared with control groups.
Assuntos
Doença da Altitude/tratamento farmacológico , Digoxina/análogos & derivados , Hipóxia/tratamento farmacológico , Medigoxina/uso terapêutico , Potássio/sangue , Sódio/sangue , Adulto , Altitude , Doença da Altitude/metabolismo , Cálcio/sangue , Cálcio/urina , Humanos , Magnésio/sangue , Magnésio/urina , Masculino , Oligúria/prevenção & controle , Potássio/urina , Sódio/urina , UrinaAssuntos
Pressão Sanguínea , Hipertensão/epidemiologia , Adolescente , Fatores Etários , Peso Corporal , Criança , Pré-Escolar , Feminino , Humanos , Índia , Lactente , Masculino , Valores de ReferênciaAssuntos
Cetoacidose Diabética/sangue , Insulina/administração & dosagem , Adolescente , Adulto , Bicarbonatos/sangue , Glicemia/análise , Criança , Cetoacidose Diabética/tratamento farmacológico , Humanos , Infusões Parenterais , Insulina/uso terapêutico , Corpos Cetônicos/sangue , Pessoa de Meia-Idade , Potássio/sangue , Sódio/sangueAssuntos
Bromocriptina/farmacologia , Hormônio do Crescimento/metabolismo , Hiperpituitarismo/fisiopatologia , Acromegalia/tratamento farmacológico , Acromegalia/fisiopatologia , Adulto , Feminino , Humanos , Hiperpituitarismo/tratamento farmacológico , Hipoglicemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Hormônio Liberador de Tireotropina/farmacologiaRESUMO
Pituitary apoplexy or spontaneous pituitary necrosis is an ill-understood clinical syndrome. It may occur as a neurological emergency requiring urgent interference in a patient with a known pituitary dysfunction or it may be responsible for drawing attention to an as yet unrecognized pituitary pathology. It has a bizarre clinical profile and an unpredictable neurological and endocrine course. Patients may die at once or may recover with or without endocrine/neurological deficit. Six cases of pituitary apoplexy with varied clinical presentation are cited.
Assuntos
Transtornos Cerebrovasculares/etiologia , Doenças da Hipófise/etiologia , Adenoma Cromófobo/complicações , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Necrose , Neoplasias Hipofisárias/complicaçõesRESUMO
Bromocriptine (CB-154, Parlodel, Sandoz) was given to 35 acromegalic patients for a period of 6-36 months. Basal and post-therapy endocrine functions including estimation of serum growth hormone (GH) profile; and GH kinetics during oral glucose tolerance test, augmented insulin tolerance test and thyrotrophin releasing hormone test were determined. The pituitary tumour size was delineated by a pneumoencephalogram. The mean GH levels ranged from 14 micrograms/l to 316 micrograms/l. Bromocriptine suppressed GH values to 5 micrograms/l or less in 16 patients and less than 10 micrograms/l in a further 6 patients. In 33 patients GH values fell to 50% of the basal value or less. There was no significant GH reduction in 2 'nonresponders'. Bromocriptine did not block the stress-induced GH secretion. It did not disturb pituitary functions other than prolactin which was suppressed much earlier and was maintained with smaller doses. GH suppression on the other hand was shortlived and rebounded when the drug was omitted. It had no adverse effect on tumour size in 2 patients having suprasellar extension of the tumour. Bromocriptine improved carbohydrate tolerance and sexual function although it did not affect insulin and gonadotrophin values. It seems reasonable to offer a trial of bromocriptine in all patients with acromegaly where therapy is deemed necessary as it is well tolerated, has insignificant side effects and no adverse drug interactions. Its high cost and prolonged course are obvious disadvantages. Caution should be exercised in cases with suprasellar extension and visual field involvement.
Assuntos
Acromegalia/tratamento farmacológico , Bromocriptina/uso terapêutico , Acromegalia/sangue , Adulto , Bromocriptina/efeitos adversos , Feminino , Teste de Tolerância a Glucose , Hormônio do Crescimento/sangue , Humanos , Insulina/sangue , Masculino , Pessoa de Meia-Idade , Fatores de TempoAssuntos
Unidades Hospitalares , Unidades de Autocuidado , Feminino , Humanos , Masculino , Cuidados de EnfermagemRESUMO
The eye manifestations of Graves' disease are usually mild and self-limiting. Occasionally they follow a progressive course leading to visual loss and total blindness. The ocular manifestations bear no relationship to the metabolic state and may appear before, during or after onset of thyrotoxicosis. Characteristically they become evident at about the time of onset of hypermetabolism. Various factors responsible for the failure of visual acuity are discussed with case illustrations.
Assuntos
Doença de Graves/complicações , Transtornos da Visão/etiologia , Adulto , Distrofias Hereditárias da Córnea/complicações , Feminino , Doença de Graves/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Nervo Óptico/complicações , Transtornos da Visão/terapia , Acuidade VisualRESUMO
A syndrome comprising Addison's disease, renal microangiopathy and renal failure is described in two patients. The renal lesions manifested despite corticosteroid replacement therapy and were characterized by glomerular damage and thrombo-microangiopathic changes in afferent arterioles and intralobular arteries. Both patients died as a result of their renal disease.
Assuntos
Doença de Addison/complicações , Falência Renal Crônica/complicações , Rim/irrigação sanguínea , Adulto , Feminino , Humanos , Nefropatias/patologia , Pessoa de Meia-Idade , Síndrome , Doenças Vasculares/complicações , Doenças Vasculares/patologiaAssuntos
Carcinoma/diagnóstico , Neoplasias da Glândula Tireoide/diagnóstico , Adulto , Amina Oxidase (contendo Cobre)/sangue , Carcinoma/diagnóstico por imagem , Criança , Ensaios Enzimáticos Clínicos , Feminino , Humanos , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Radiografia , Neoplasias da Glândula Tireoide/diagnóstico por imagemRESUMO
The empty sella syndrome (ESS) presents a varied clinical and radiographic picture. It may remain asymptomatic or may stimulate an intrasellar growth thereby causing diagnostic and therapeutic problems. An air encephalogram (AEG) is required for diagnosis. The purpose of this paper is to review the clinical and radiological features of the ESS and to discuss the pathogenetic mechanisms involved.