Clinical and Sociodemographic Associates of Remission from Positive Symptoms in Schizophrenia

OBJECTIVES

To determine factors associated with remission from positive symptoms in Indian patients with schizophrenia.

METHODS

We evaluated 151 patients (99 men and 52 women) aged 18 to 65 years who were diagnosed with schizophrenia and followed up for ≥6 months (with a minimum of two evaluations). We assessed psychopathology, the level of best functioning in the past year, premorbid functioning (up to 1 year), daily living skills, medication adherence, adverse effects to medications, the number of stressful events in the 6 months before illness onset, perceived social support, expressed emotion from family, and personal construct of empowerment. Remission from positive symptoms of schizophrenia was defined as simultaneous attainment of a score of ≤3 (mild) for ≥6 months in the following symptoms: delusions, concept disorganisation, hallucinatory behaviour, unusual thought content, mannerisms, and posturing. Patients were categorised as remitted and non-remitted.

RESULTS

Of 151 patients, 81 (53.64%) fulfilled the remission criteria. Compared with non-remitted patients, remitted patients had a shorter duration of untreated psychosis (t = -2.29, p < 0.05), better premorbid functioning in childhood (t = -1.99, p < 0.05) and general (t = -9.34, p < 0.001) subscale, higher medication adherence (t = 6.91, p < 0.001), higher daily living skills ( t = 8.65, p < 0.001), better perceived social support (t = 6.69, p < 0.001), higher empowerment (t = 5.64, p < 0.001), and received higher warmth (t = 1.99, p < 0.05) and lower hostility (t = -4.00, p < 0.001), dissatisfaction (t = -6.96, p < 0.001), and critical comments (t = -2.48, p < 0.05) from family members. Predictors of remission were duration of untreated psychosis (B = -0.020, p < 0.05), daily living skills (B = 2.063, p < 0.001), perceived social support (B = 0.084, p < 0.01), and dissatisfaction from family members (B = -0.621, p < 0.01).

CONCLUSIONS

53.64% of patients with schizophrenia achieved remission from positive symptoms. Remission was more likely to occur in patients with shorter duration of untreated psychosis, better daily living skills, higher perceived social support, and less dissatisfaction from family members.

Neurodevelopmental Outcomes of Very Low Birth Weight Infants at 18-24 Months, Corrected Gestational Age in a Tertiary Health Centre: A Prospective Cohort Study

OBJECTIVE

To determine the prevalence and risk factors for poor neurodevelopmental outcome in a cohort of very low birth weight (VLBW) infants.

SUBJECTS AND METHODS

Four hundred and twenty-two infants of a total of 643 VLBW survivors from a teaching hospital in South India were followed up to assess their neurodevelopmental outcomes.

RESULTS

Among the 422 children who completed the assessment, results of 359 children whose assessments were done between 18 and 24 months were analysed. Thirty-seven children (10.31%) had poor neurodevelopmental outcome, six children [1.67%] had cerebral palsy, one child had visual impairment and another had hearing impairment. Poor post-natal growth was independently associated with poor neurodevelopmental outcomes in the multivariate analysis (p = 0.045). Neonatal complications were not associated with the developmental outcome.

CONCLUSION

Despite lower rates of neonatal complications compared with Western cohorts, significant proportion of VLBW infants had poor neurodevelopmental outcomes. Poor post-natal growth was an important determinant of the developmental outcome.

Perinatal Risk Factors for Neonatal Early-onset Group B Streptococcal Sepsis after Initiation of Risk-based Maternal Intrapartum Antibiotic Prophylaxis-A Case Control Study

OBJECTIVES

To identify the perinatal risk factors for early-onset Group B Streptococcus (EOGBS) sepsis in neonates after inception of a risk-based maternal intrapartum antibiotic prophylaxis strategy in 2004.

DESIGN

Case control study.

METHODS

All newborn with early onset GBS sepsis (born between 2004 and 2013) were deemed to be "cases" and controls were selected in a 1:4 ratio.

RESULTS

More than three per vaginal (PV) examinations [odds ratio (OR) 8.57, 95% confidence interval (CI) 3.10-23.6] was a significant risk factors. Peripartum fever (OR 3.54, 95% CI 1.3-9.67), urinary tract infection (OR 2.88, 95% CI 1.08-7.63), meconium-stained amniotic fluid (MSAF) (OR 2.52, 95% CI 1.18-5.37) and caesarean section (OR 1.99, 95% CI 1.16-3.43) were also found to be associated with EOGBS sepsis.

CONCLUSION

Multiple vaginal examinations are the strongest risk factors for peripartum Group B Streptococcal (GBS) sepsis. The association of MSAF and caesarean section indicates that foetal distress is an early symptom of perinatal GBS infection.

A prospective observational study comparing cardiac function of small for gestational age with appropriate for gestational age babies using serial echocardiographic studies

BACKGROUND

Approximately 30% of babies born in India are low birth weight (LBW) and about 70% of LBW babies are small for gestational age (SGA). Though there are several trials that have evaluated cardiac function of intrauterine growth restricted (IUGR) babies in utero, there is limited data about postnatal cardiac function in SGA babies during early neonatal period. This study was conducted to evaluate the cardiac functions of SGA babies by serial echocardiographic measurements and compare this with appropriate for gestational age (AGA) babies during the early postnatal period.

MATERIAL AND METHODS

Seventy babies were enrolled in this prospective observational study with 35 each in the SGA and AGA groups. Echocardiography was performed for all babies on days 1, 2, and 3 of life. Myocardial performance index (MPI) was used as the primary measure to compare cardiac function. MPI was calculated for both ventricles using pulse wave Doppler and tissue Doppler.

RESULTS

MPI of the left ventricle was significantly higher in the SGA group as compared to AGA babies during all the three measurement periods with SGA babies having significantly higher MPI of right ventricle on day 1 and day 2 but not on day 3. Left ventricular internal diameter index during diastole and systole (LVIDD index and LVIDS index), left atrium: aortic root ratio (LA:AO ratio) were significantly increased in SGA babies on all the occasions. Fractional shortening, ejection fraction, and area shortening were similar in two groups.

CONCLUSIONS

Myocardial performance index of left and right ventricle, which evaluates both systolic and diastolic function of ventricles, was significantly increased in SGA babies in comparison to AGA babies during the first 3 days of life except MPI of the right ventricle on day 3. Thus, SGA babies have compromised cardiac function through all phases of the cardiac cycle with the performance improving spontaneously over time.

Depression and anxiety as potential correlates of post-transplantation renal function and quality of life

The objective of this study was to determine anxiety and depression and its relationship with quality of life (QOL) in renal transplant (RT) recipients. A total of 105 consecutive patients were assessed cross-sectionally at least 3 months after RT. Hospital Anxiety and Depression Scale was applied to assess anxiety and depression. QOL was assessed through the abbreviated version of World Health Organization QOL scale. Patients’ awareness of illness and treatment was assessed through Structured Interview for Renal Transplantation. Nine (8.57%) patients had syndromal anxiety and 9 (8.57%) had syndromal depression. Both these groups had significantly lower scores in almost all domains of QOL compared with their non-anxious and non-depressed counterparts. There were a higher number of hospitalizations and episodes of complication or rejection in post-RT patients with anxiety as compared to those without (P = 0.001). Syndromal depression and anxiety are associated with poor QOL and syndromal anxiety is associated with significantly higher number of hospitalizations, rejections and complications in post-RT patients.

Perinatal outcome of infants born to diabetic mothers in a developing country--comparison of insulin and oral hypoglycemic agents

OBJECTIVE

To study the perinatal outcomes of infants born to mothers with gestational diabetes treated with insulin or oral hypoglycemic agents in a developing country.

DESIGN

Prospective observational cohort study.

SETTING

Tertiary-care perinatal center in southern India.

PARTICIPANTS

Babies born to mothers with gestational diabetes.

METHODS

Maternal details were obtained and physical examination was performed on the neonates. Babies were given hourly feeds soon after birth and blood glucoses checked at 1, 3, 5, 9 and 12 hours of life; hematocrit and calcium levels were also measured. Perinatal outcomes were compared between mothers who required insulin or an oral hypoglycemic agent for treatment of diabetes.

RESULTS

Of the 10,394 mothers who delivered during the study period, 574 (5.5%) were diagnosed to have gestational diabetes. 137 were treated with insulin and 141 with oral hypoglycemic agents. 44 (15.8%) babies were born preterm, 97 (35%) were large for gestational age, 13 (4.7%) were small for gestational age and 9 (3.2%) were macrosomic. Hypoglycemia was seen in 26 (9.3%) babies, congenital anomalies in 15 (5.4%) and birth injuries in 7 (2.5%). There was no difference between the two groups in any of the outcomes except for hyperbilirubinemia, which was more in the insulin group (13.7% vs 6.5%, P=0.04).

CONCLUSIONS

There was no difference in the perinatal outcome whether the mother received insulin or an oral hypoglycemic agent for treatment of gestational diabetes other than the increased incidence of hyperbilirubinemia in the insulin group.

Potential of different white rot fungi to decolourize textile azo dyes in the absence of external carbon source

The decolourization of azo dyes by various white rot fungi was studied in the absence of an external carbon source. Although the decolourization abilities of strains used in this study are well documented, these strains have not been studied or compared for their decolourization abilities in the absence of an external carbon source. Decolourization of dyes was also studied in the presence of the external carbon source glucose. Daedalea flavida and Phanerochaete chrysosporium were able to decolourize the dyes in the absence of glucose. D. flavida exhibited a better ability to decolourize the dyes as compared with P. chrysosporium in the absence of glucose. Culture conditions were optimized to enhance the decolourization ability of D. flavida. Shaking of cultures inhibited the decolourization of Amaranth by D. flavida. The optimum culture conditions were 36 degrees C and pH 5.5 for decolourization of Amaranth in a stationary culture condition. We achieved 99% decolourization of Amaranth in 5 days under optimum conditions in the presence of glucose. D. flavida also decolourized the Amaranth with equal efficiency in the absence of glucose. To the best of the authors' knowledge, this is the first paper reporting the decolourization of dyes in the absence of an external carbon source by D. flavida.

A randomized control trial comparing two enteral feeding volumes in very low birth weight babies

Poor post-natal growth of preterm neonates is common and fortification is recommended. However, this is not always practical in low-resource areas. Hypothesizing that increasing the volume of feeds would be safe and lead to better post-natal weight gain, we randomized 64 babies with birth weight <1500 g, once they reached full feeds, to continue feeds at 200 ml/kg/day (standard volume) or increase to 300 ml/kg/day (high volume) of expressed breast milk. There was a significantly higher daily weight gain in the high-volume group as compared to the standard volume group (24.9 vs. 18.7 g/kg/day, p < 0.0001). There were no differences in complications like feed intolerance, tachypnoea, sepsis, patent ductus arteriosus or necrotizing enterocolitis. High-volume feeds at 300 ml/kg/day was safe and resulted in better weight gain than standard volume feeds in very low birth weight babies.

Microvillous inclusion disease diagnosed by gastric biopsy

Protracted diarrhea in neonates is uncommon and usually requires an intestinal biopsy for etiological diagnosis. Gastric biopsy has not been used in the routine diagnosis of this condition. We report the first documented patient with microvillous inclusion disease from India, where the diagnosis was established by a gastric biopsy.

Retrospective cohort study comparing neonatal outcomes of women treated with glyburide or insulin in gestational diabetes: a 5-year experience in a South Indian teaching hospital

OBJECTIVE

To assess the effectiveness of glyburide in preventing complications of gestational diabetes in neonates as compared to insulin.

MATERIALS AND METHODS

Information from birth register, maternal and neonatal records were obtained. Five hundred and seventy-seven gestational diabetics with moderate hyperglycemia i.e., with highest fasting plasma glucose value of ≤130 mg/dl and/or highest post-prandial value of ≤250 mg/dl treated with insulin or glyburide were included from a cohort of 769 women needing additional therapy to initial diet therapy during a 5-year period. Thus neonatal outcomes of 303 women treated with insulin and 274 women treated with glyburide were compared.

RESULTS

Baseline plasma glucose levels in the group treated with insulin were higher. The mean birth weight (SD) of the neonates in women treated with insulin was 3021.3 g (604.19) as compared to 3104.6 g (499.35, P = 0.07) in the group treated with glyburide. Neonatal outcomes such as hypoglycemia (4.9%, 3.6%, P = 0.44), hypocalcemia (1.3%, 0.7%, P = 0.48), polycythemia (1.7%, 0.7%, P = 0.31), macrosomia (11.6%, 8.7%, P = 0.26), congenital anomalies (2.1%, 2.3%, P = 0.87), birth trauma (1.4%, 1.2%, P = 0.79) were similar in both groups. Neonates of women treated with insulin were more likely to have hyperbilirubinemia (11.5%, 6.5%, P = 0.03).

CONCLUSION

Neonatal outcomes of women treated with glyburide were comparable to those in women treated with insulin. More number of neonates of mothers treated with insulin had hyperbilirubinemia compared to neonates of mothers treated with glyburide (11.5%, 6.5% P = 0.03).

Comparison of viral load and duration of virus shedding in symptomatic and asymptomatic neonatal rotavirus infections

A single rotavirus strain causing asymptomatic infections as well as severe gastrointestinal disease has been described in the neonatal nurseries of the Christian Medical College, Vellore. In this study, quantitative real-time RT-PCR was used to determine the association of viral load with the presence of gastrointestinal symptoms in neonates. Viral load was estimated in terms of the crossing point [C(t) value] at which the amplicon could be detected in the real-time PCR assay. The study was carried out on 103 neonates, including 33 asymptomatic neonates and 70 neonates with different gastrointestinal symptoms. The duration of virus shedding was also compared between five symptomatic and four asymptomatic neonates using real-time RT-PCR. There was no significant difference in viral load between symptomatic and asymptomatic neonates (P = 0.087). Among neonates with different gastrointestinal symptoms, those presenting with feed intolerance and abdominal distension had a significantly higher viral load than those with other gastrointestinal symptoms (P = 0.02). For the study on virus shedding, nine neonates were followed up for a median duration of 53 days, with a median of 31 samples tested per child. Extended shedding of low copies of rotavirus was found, with no significant differences in pattern of shedding between symptomatic and asymptomatic neonates. The lack of correlation between viral load and gastrointestinal disease demonstrates yet another difference between neonatal rotavirus infection and infection in older children where higher viral load correlates with severe disease.

Whole body cooling in newborn infants with perinatal asphyxial encephalopathy in a low resource setting: a feasibility trial

OBJECTIVE

To determine the feasibility and safety of whole body cooling in newborn infants with perinatal asphyxial encephalopathy in a low resource setting.

DESIGN

Feasibility trial.

SETTING

Tertiary care perinatal centre.

SUBJECTS

Infants born at > 35 weeks gestation with perinatal asphyxia were included in the study.

INTERVENTIONS

Infants were cooled to a rectal temperature of 33 ± 0.5°C for 72 hours using cloth-covered ice-gel packs. Vital parameters were monitored continuously.

OUTCOME MEASURES

The primary outcome was the achievement of target temperature within 1 hour of initiation of treatment and maintaining the target temperature for 72 hours. Adverse events and possible complications of hypothermia were the secondary outcomes measured.

RESULTS

Twenty infants were included in the study. The mean time taken to achieve target rectal temperature was 52 ± 25 minutes. The mean rectal temperature during cooling was 32.9 ± 0.11ºC. The target temperature could be maintained for 72 hours without difficulty in all babies. Adverse events observed during cooling were thrombocytopenia (25%), sinus bradycardia (25%), deranged bleeding parameters (20%), aposteatonecrosis (15%), hyperglycemia (15%), hypoglycemia (10%), hypoxemia (5%), life-threatening coagulopathy (5%) and death (5%). Shivering was noted in many of the babies, especially in the initial phase of cooling.

CONCLUSION

Whole body cooling in term infants with perinatal asphyxia is achievable, safe and inexpensive in a low-resource setting.

Development of corn starch based green composites reinforced with Saccharum spontaneum L fiber and graft copolymers--evaluation of thermal, physico-chemical and mechanical properties

In this paper, corn starch based green composites reinforced with graft copolymers of Saccharum spontaneum L. (Ss) fiber and methyl methacrylates (MMA) and its mixture with acrylamide (AAm), acrylonitrile (AN), acrylic acid (AA) were prepared. Resorcinol-formaldehyde (Rf) was used as the cross-linking agent in corn starch matrix and different physico-chemical, thermal and mechanical properties were evaluated. The matrix and composites were found to be thermally more stable than the natural corn starch backbone. Further the matrix and composites were subjected for biodegradation studies through soil composting method. Different stages of biodegradation were evaluated through FT-IR and scanning electron microscopic (SEM) techniques. S. spontaneum L fiber-reinforced composites were found to exhibit better tensile strength. On the other hand Ss-g-poly (MMA) reinforced composites showed maximum compressive strength and wear resistance than other graft copolymers reinforced composite and the basic matrix.

Whole genome characterization of reassortant G10P[11] strain (N155) from a neonate with symptomatic rotavirus infection: identification of genes of human and animal rotavirus origin

BACKGROUND

Rotavirus G10P[11] strains have long been associated with asymptomatic neonatal infections in some parts of India. We have previously reported G10P[11] strains associated with both asymptomatic infections and severe gastrointestinal disease in neonates from Vellore in southern India, with >90% partial nucleotide and amino acid identity to the VP4, VP6, VP7 and NSP4 genes of the exclusively asymptomatic G10P[11] strain I321.

OBJECTIVES

In this study, the whole genome of a G10P[11] isolate (N155) from a neonate with severe gastrointestinal disease was characterized to determine whether there were significant differences in its genetic makeup in comparison to G10P[11] strain I321 and to establish the origin of the G10P[11] strains in Vellore.

STUDY DESIGN

PCR amplification and complete genome sequencing was carried out for all 11 gene segments of symptomatic G10P[11] rotavirus isolate N155. Nucleotide and amino acid sequence similarity with I321, other human and bovine strains for each gene segment were determined. The origin of each gene was determined based on the degree of identity to bovine or human rotavirus strains.

RESULTS

N155 was found to be a reassortant between human and bovine rotaviruses. With the exception of NSP2, gene sequences of strain N155 showed >90% identity to published sequences of I321. Gene segments encoding NSP1, 2 and 3 were of human rotavirus origin for both strains; however, phylogenetic analysis of NSP2 sequences indicated that the human parental strain that led to the origin of these bovine-human reassortant strains was different. There were no significant differences between NSP2 sequences of strains from symptomatic and asymptomatic neonates in the same setting.

CONCLUSIONS

The study shows that the difference in clinical presentations in neonates may not be due to the limited variability in the genome sequence of G10P[11] strains and that G10P[11] strains in different parts of India could have evolved through reassortment of different parental strains.

Determination of extended-interval gentamicin dosing for neonatal patients in developing countries

BACKGROUND

Infectious diseases account for an estimated 36% of neonatal deaths globally. The purpose of this study was to determine safe, effective, simplified dosing regimens of gentamicin for treatment of neonatal sepsis in developing countries.

METHODS

Neonates with suspected sepsis in the neonatal intensive care unit (NICU) at Christian Medical College and Hospital (CMC), Vellore, India (n = 49), and Dhaka Shishu Hospital (DSH), Bangladesh (n = 59), were administered gentamicin intravenously according to the following regimens: (1) 10 mg every 48 hours for neonates <2000 g; (2) 10 mg every 24 hours for neonates 2000-2249 g; and (3) 13.5 mg every 24 hours for neonates > or =2500 g. Serum gentamicin concentration (SGC) at steady state and pharmacokinetic indices were determined. Renal function was followed while under treatment and hearing was examined 6 weeks to 3 months after discharge.

RESULTS

All neonates, except 1 weighing 2000-2249 g at DSH, had a peak SGC >4 microg/mL. Overall, 5 (10%) and 17 (29%) infants had a peak SGC level > or =12 microg/mL from CMC and DSH, respectively, and 10 (20%) and 4 (7%) cases from CMC and DSH, respectively, had a trough SGC level > or =2 microg/mL. However, no infant <2000 g had a trough SGC level > or =2 microg/mL. We found no evidence of gentamicin nephrotoxicity or ototoxicity.

CONCLUSION

Safe, therapeutic gentamicin dosing regimens were identified for treatment of neonatal sepsis in developing country settings. Administration of these doses could be simplified through use of Uniject, a prefilled, single injection device designed to make injections safe and easy to deliver in developing country settings.

Globe calcification in congenital toxoplasmosis

Various patterns of distribution of intracerebral calcification have been described in congenital toxoplasmosis. We report a case of congenital toxoplasmosis with a rare finding of calcification in the globe detected by CT scan that has not been described earlier.

Neonatal hydrothorax following migration of a central venous catheter

The use of a central venous catheter may occasionally be associated with complications like sepsis, effusions and thrombosis. Migration of the central catheter is an unusual complication that often goes unrecognized. This case report is of a neonate who developed hydrothorax resulting from a migrating central line and highlights the need for a high level of clinical suspicion in diagnosing catheter related problems.

Tyrosinemia type I: a clinico-laboratory case report

Progressive hepatocellular dysfunction in a neonate, resulting in elevated serum alpha-fetoprotein together with raised blood levels of tyrosine and methionine, a generalized amino aciduria and the absence of urinary delta-aminolevulinic acid and succinylacetone, suggests a diagnosis of tyrosinemia type Ib. Classical tyrosinemia type I arises from a deficiency of fumarylacetoacetate hydrolase while the variant tyrosinemia type Ib results from a deficiency of maleylacetoacetate isomerase.

Is C-reactive protein level useful in differentiating infected from uninfected neonates among those at risk of infection?

OBJECTIVE

To document effects of intrapartum risk factors for early onset sepsis (EOS) on CRP levels in neonates and to assess the suitability of this test in diagnosing EOS.

DESIGN

Cohort study.

SETTING

Labour and post natal wards in a tertiary level teaching hospital in India.

SUBJECTS

250 neonates at risk of developing infection.

METHODS

CRP levels in cord blood and neonatal blood at 24 hrs were estimated using commercial kits. Babies were observed for signs of sepsis for at least 48 hours.

RESULTS

Seven (2.8 Percent) neonates had elevated CRP levels in the cord blood. At 24 hours, 102 (40.8 Percent) babies had elevated levels. Elevated cord CRP levels was significantly associated with rupture of membranes for 24 hours (p =0.04), labour more than 12 hours (p = 0.002), and maternal fever (p = 0.01). At 24 hours, elevated CRP levels were associated with primiparity (p= 0.006), more than three vaginal examinations after membrane rupture (p=0.02), meconium staining of amniotic fluid (p =0.02) and amnioinfusion (p =0.02). Ten (4 Percent) babies developed EOS. The negative predictive value for elevated CRP levels at 24 h was 99 Percent.

CONCLUSION

Several intrapartum risk factors for EOS can cause elevation in CRP levels. However, this test may be useful in excluding infection.

Characterization of G10P[11] rotaviruses causing acute gastroenteritis in neonates and infants in Vellore, India

Rotavirus G10P[11] strains, which are commonly found in cattle, have frequently been associated with asymptomatic neonatal infections in India. We report the finding of G10P[11] strains associated with severe disease in neonates in Vellore, southern India. Rotavirus strains from 43 fecal samples collected from neonates with or without gastrointestinal symptoms between 1999 and 2000 were genotyped by reverse transcription-PCR. Forty-one neonates (95%) were infected with G10P[11] rotavirus strains, and 63% of the infections were in children who had gastrointestinal symptoms, including acute watery diarrhea. G10P[11] strains were also seen infecting older children with dehydrating gastroenteritis in Vellore. Characterization of the genes encoding VP7, VP4, VP6, and NSP4 of these strains revealed high sequence homology with the corresponding genes of the asymptomatic neonatal strain I321, which in turn is very closely related to bovine G10P[11] strains circulating in India. No significant differences were seen in the sequences obtained from strains infecting symptomatic neonates or children and asymptomatic neonates.

Short rib polydactyly syndrome-Type I

Short rib polydactyly syndrome (SRPS) consists of a group of lethal skeletal dysplasias presenting with short limbs and ribs, hypoplastic thorax and polydactyly with or without visceral abnormalities. The authors report a case of SRPS in a fresh stillborn baby who had these features along with dysplastic kidneys. Clinical and radiological findings in this baby were consistent with SRPS - Type I (Saldino-Noonan Type). The diagnosis of SRPS, as in this case, can be made by antenatal ultrasonography.

Acute fatty liver of pregnancy: a report of two cases

Acute fatty liver of pregnancy is an uncommon, potentially fatal disorder. Between 1998 and 2000, two patients with acute fatty liver of pregnancy presented at the Christian Medical College Hospital, Vellore. Both patients were in the thirty-sixth week of pregnancy. jaundice and encephalopathy were the predominant symptoms. Both the mothers died after they delivered a stillborn Infant each. The maternal deaths were due to multiorgan failure and/or postpartum haemorrhage and sepsis. The route of delivery was vaginal in both the patients. Extrahepatic and metabolic complications in both cases Included renal failure, sepsis, hypoglycaemia, disseminated intravascular coagulation and gastrointestinal bleeding. Liver biopsy done in both patients was consistent with the diagnosis of acute fatty liver of pregnancy. To the best of our knowledge, this is the first report from India on acute fatty liver of pregnancy.

Neonatal spinal cord injury

Neonatal spinal cord injury (SCI) is well described in the literature, though its diagnosis is often delayed or missed in the neonatal period. We present a neonate who was referred with upper gastrointestinal bleed and a diagnosis of spinal cord injury was subsequently made clinically and confirmed radiologically.

The effects of creatine on the retrogradely perfused isolated rat heart

Although the role of creatine in muscle metabolism is well understood, there is still uncertainty as to its effects at supplemented levels. With this in mind, this study was designed to investigate the direct effects of commercially available creatine on the isolated rat heart, retrogradely perfused and infused with varying concentrations of creatine (1.25, 2.5, 5 and 10 mM) to determine its effects on heart rate, coronary flow and ventricular pressure. Furthermore, tissue from these hearts was used to investigate the cardiotoxic potential of supplemented levels of creatine. Results indicate that creatine directly improves the functioning of the heart under normal conditions with respect to heart rate and ventricular pressure, but may be detrimental to the functioning of energy-deprived hearts. It also showed no cardiotoxic properties since it increased the baseline levels of adenosine triphosphate (ATP) and decreased the levels of isocitrate dehydrogenase (lCD), indicating a decrease in cellular death compared with non-supplemented control hearts.

Absorption spectra of 7, 7, 8, 8-tetracyanoquinodimethane in micellar solutions

The absorption spectra of 7, 7, 8, 8-tetracyanoquinodimethane (TCNQ) with nonionic surfactant. Triton X-100, anionic surfactant, SLS and cationic surfactant, CTAB in aqueous and nonaqueous media have been studied. The spectral studies show that TCNQ forms 1:1 charge-transfer (CT) complex with Triton X-100 in both media. The aqueous solution of TCNQ shows an absorption maxima at 610 nm, which is unperturbed in the presence of SLS but is shifted to 650 nm in the presence of CTAB, indicating the interaction of TCNQ with the cationic surfactant and not with the anionic surfactant. In addition to this, the stability of TCNQ-Triton X-100 complex has been determined and the probable site of CT interaction has been pointed out.

Total hip arthroplasty using porous-coated femoral components in patients with rheumatoid arthritis

We studied the results of total hip arthroplasty (THA) using AML porous-coated femoral components at a mean follow-up of 11 years in a non-selected, consecutive series of patients with rheumatoid arthritis. We reviewed 64 patients with 82 primary THAs using these components. There were seven men (8 hips) and 57 women (74 hips) with a mean age of 55.1 years (24 to 80) at the time of surgery. Nine patients (11 hips) died before the two-year follow-up. Of the remaining 71 hips, only one stem was revised for aseptic loosening. Survivorship for the stems was 98.1% (95% confidence interval (CI) 94.5 to 100.0) at ten years, using a life-table analysis, with revision for any reason as an endpoint. Of the 70 unrevised stems, 66 (94%) had bony ingrowth, while four (6%) were radiologically loose at the most recent follow-up (mean 11.4 years). Our study shows the excellent long-term results which can be achieved with porous-coated femoral components in patients with rheumatoid arthritis.

Neonatal Group B Streptococcal bacteraemia in India: ten years' experience

Group B Streptococcus (GBS) is an infrequent cause of neonatal septicaemia in many developing countries. In a perinatal centre in India with 60,119 live births between 1988 and 1997, GBS was isolated from blood cultures of 10 babies. Thus the incidence of GBS bacteraemia was 0.17 per 1000 live births. Lethargy, respiratory distress and poor perfusion were the presenting features in eight symptomatic babies. Two babies had meningitis, three required ventilatory support and one died. There were no cases of late onset disease. The low incidence could be due to the low rate of colonisation and high prevalence of protective antibody in the mothers.

T and Tk antigen activation in necrotising enterocolitis: manifestations, severity of illness, and effectiveness of testing

AIMS

To determine if T or Tk antigen activation is associated with different and more severe manifestations of illness in infants with necrotising enterocolitis (NEC); and if a policy of testing infants with suspected sepsis or NEC for T and Tk antigen activation is effective.

METHODS

A case-control study of infants with confirmed NEC, born after the introduction of screening, was undertaken:17 activated infants were compared with 28 non-activated controls, matched for gestation and weight. A historical control study compared the outcome of infants before and after the introduction of testing.

RESULTS

Of 201 infants with confirmed NEC, 27 were T or Tk antigen activated-10 (9%) before and 17 (19%) after the introduction of testing. T or Tk antigen activated infants had a significantly higher mortality (35% vs 7%); more frequent (71% vs 21%) and severe haemolysis, hyperkalaemia, renal impairment, acidosis; and they received more colloid for resuscitation. While only known activated infants in both time periods were managed with the use of low titre T antibody blood products, there was a significant increase in mortality (odds ratios 2.6; 95% CI 1.2, 5.6) and incidence of surgery (OR 2.7; 1.5, 4.9) after the introduction of testing. The increased mortality (OR 2.6; 0.8, 5.2) and incidence of surgery (OR 1.8; 0.9, 3.7) were no longer significant after adjustment for several perinatal risk factors.

CONCLUSIONS

In a retrospective case-control study, routine testing of at risk infants increased the detection rate of T and Tk antigen activation. The use of low titre T plasma products in these patients did not reduce mortality compared with historical controls. A randomised controlled trial of testing in at risk infants, or of the use of low titre T plasma products in babies with NEC and T activation, is warranted.

Randomized controlled trial of once vs. twice daily gentamicin therapy in newborn

OBJECTIVE

To compare the efficacy of once daily gentamicin administration to the conventional twice daily dosage schedule by estimation of serum gentamicin concentrations (SGC) in neonates.

DESIGN

Randomized controlled trial.

SETTING

Medical college hospital.

SUBJECTS

Seventy three neonates of gestational age>32 weeks at risk or with clinical features of sepsis.

METHODS

The subjects were divided into preterm and term groups. Babies in each of these groups were randomized to receive a single daily dose (4 mg/kg) or a twice daily dose (2.5 mg/kg) of injection gentamicin intravenously. Trough and peak SGC were estimated half an hour prior and one hour after the second dose. Statistical analysis was done using the equivalence method.

RESULTS

In preterm as well as term babies, the mean peak and trough gentamicin levels were comparable in the two regimens. There is statistically significant evidence to show that the effect of once daily and twice daily dosage is similar.

CONCLUSION

Once daily gentamicin administration is as effective as twice daily therapy and would be more cost effective.

Bacterial profile of sepsis in a neonatal unit in south India

OBJECTIVE

To study the pattern of sepsis in a neonatal unit in south India and assess the influence of maternal factors on early onset sepsis (EOS).

DESIGN

Prospective survey from 1995-1996.

SETTING

Medical College Hospital.

SUBJECTS

All inborn babies who had clinical signs of sepsis or were born to mothers with potential risk factors for infection were screened for sepsis. Neonatal septicemia was defined as a disease of infants who were younger than 1 month of age, were clinically ill, and had positive blood cultures.

RESULTS

Among 13,367 live births in the study period, there were 131 episodes of neonatal septicemia among 125 newborn infants, 18 (14.4%) of whom died. Thirty (24%) had EOS (< or = 48 hours) and 95 (76%) had late onset sepsis (LOS) (> or = 48 hours). Sepsis occurred in 9.8 per 1000 livebirths and 4.4% of all nursery admissions. E. coli and E. fecalis were the predominant organisms causing EOS, while Klebsiella and E. fecalis were the predominant organisms in LOS. The mean gestational age (GA) and birth weight (BW) of babies with EOS was significantly higher than those with LOS. Maternal factors significantly associated with EOS were meconium staining of liquor and multiple vaginal examinations.

CONCLUSIONS

The incidence of neonatal bacterial sepsis is 9.8 per 1000 livebirths. E. coli and Klebsiella were the most common organisms causing EOS and LOS, respectively. E. fecalis was also a major pathogen, both in EOS and LOS.

The induction of lipid peroxidation in liposomal membrane by ultrasound and the role of hydroxyl radicals

Ultrasonic radiation produced a dose-dependent linear increase in lipid peroxidation in the liposomal membrane as reflected in the measurements of conjugated dienes, lipid hydroperoxides, and malondialdehydes (MDA). Production of MDA was confirmed by spectrophotometric and spectrofluorometric methods including the detection of excitation (360 nm) and emission (435 nm) maxima characteristic of the MDA-glycine adduct formed after addition of glycine in the system. Ultrasound of frequencies 20 kHz (used for laboratory purposes) and 3.5 MHz (used for clinical purposes) produced MDA in an identical manner. Ultrasound-induced lipid peroxidation was enhanced synergistically by 2.5 X 10(2) microM ascorbic acid but inhibited significantly by 10(4) microM ascorbic acid. Ultrasound-induced production of MDA could not be inhibited to any significant degree by superoxide dismutase, histidine, dimethylfuran, or beta-carotene but was very significantly inhibited by cholesterol (93%), butylated hydroxytoluene (88%), alpha-tocopherol (85%), sodium benzoate (80%), dimethyl sulfoxide (80%), sodium formate (64%), and EDTA (64%). The scavenger studies indicated the functional role of OH radicals in the initiation of ultrasound-induced lipid peroxidation.

The role of thyroid in clinical disorders of hypothalamo-pituitary adrenocortical axis--a prelminary communication

The study of thyroid function in clinical conditions associated with the disorders of the hypothalamio-pituitary-adrenocortical axis indicated overt hypofunction of thyroid in all the three cases of Cushing's disease and subclinical hypo-or low normal function of thyroid in most of the cases of adrenogenital syndrome. It was suggested that hypo or low normal function of thyroid might facilitate excess elaboration of ACTH through CRF by swaying the balance of neurotransmitters at hypothalamus in favour of serotonin.