In vitro and in vivo anthelmintic response of the seeds of Amomum subulatum roxb and Vitex negundo

Abstract The current study was designed to check the anthelmintic activities of some local plants. Seeds of Amomum (A.) subulatum and Vitex (V.) negundo in different solvents were subjected to in vitro (adult motility assay; AMA and egg hatch assay; EHA) and in vivo (faecal egg count reduction test; FECRT) anthelmintic activity testing protocols using Haemonchus (H.) contortus as an experimental model. The results of AMA, EHA, and FECRT were statistically analysed through linear regression and Duncan multiple range test. In AMA test, at 50 mg mL-1 concentration, the percent mortality of H. contortus was higher in A. subulatum than V. negundo, whereas, in EHA test, A. subulatum was proven better ovicidal (LC50=14.2 µg mL-1) than V. negundo (LC50= 65.7405 µg mL-1). The FECRT also indicated the better efficacy of A. subulatum than V. negundo against natural infection of gastrointestinal (GI) parasites. The crude powder of plants used in this study showed 29.6% to 57.7% anthelmintic. The reduction rate was found higher for A. subulatum (3 g kg-1) as compared to V. negundo (7 g kg-1). Reagrding efficacy analysis of solvents used for plants extract, ethyl acetate and chloroform were found better in increasing ovicidal activity in adult worms (in vitro testing), whereas, the crude aqueous methanol was found better than the crude powders in in vivo testing. It will be beneficial to document the indigenous knowledge to standard scientific procedures for their validation. This study will help to motivate the farmers to make a better choice of cultivation of the indigenous plants because of their varying efficacies as an alternative preventive approach against the GI parasitic infections.

Workplace mistreatment and mental health in female surgeons in Pakistan

Background

Despite workplace mistreatment, which includes harassment, bullying and gender discrimination(GD)/bias, being serious problems for female surgeons, there are limited data from lower–middle-income countries like Pakistan. This study explored harassment and GD/bias experienced by female surgeons in Pakistan, and the effects of these experiences on mental health and well-being.

Methods

A nationwide survey was conducted between July and September 2019 in collaboration with the Association of Women Surgeons of Pakistan, an organization consisting of female surgeons and trainees in Pakistan. An anonymous online survey was emailed directly, disseminated via social media platforms (such as Facebook, Twitter and Instagram), and sent to surgical programmes in Pakistan.

Results

A total of 146 women surgeons responded to the survey; 67.1 per cent were trainees and the rest attending surgeons. Overall, 57.5 per cent of surgeons reported experiencing harassment, most common being verbal (64.0 per cent) and mental (45.9 per cent), but this mostly went unreported (91.5 per cent). On multivariable analysis adjusted for age and specialty, workplace harassment (odds ratio 2.02 (95 per cent c.i. 1.09 to 4.45)) and bullying (odds ratio 5.14 (95 per cent c.i. 2.00–13.17)) were significantly associated with severe self-perceived burnout, while having a support system was protective against feelings of depression (odds ratio 0.35 (95 per cent c.i. 0.16 to 0.74)). The overwhelming majority (91.3 per cent) believed that more institutional support groups were needed to help surgeons with stress reduction (78.8 per cent), receiving mentorship (74.7 per cent) and work–life balance (67.8 per cent).

Conclusion

Workplace mistreatment, in particular harassment and bullying, has a damaging impact on the mental well-being of female surgeons, particularly trainees. The absence of support groups in Pakistan should be urgently addressed so that surgeons, especially trainees, may cope better with potentially harmful workplace stressors.

P89 Role of inflammation as a risk factor for atrial fibrillation in rheumatic mitral stenosis and its correlation with atrial late gadolinium enhancement (LGE) on cardiac MRI

Funding Acknowledgements

ICMR

Aims

Association of atrial fibrillation (AF) is a common cause of morbidity and mortality in patients with rheumatic heart disease (RHD). Association of Atrial Fibrillation with inflammation is well delineated in nonvalvular AF as compared to Rheumatic AF. This study evaluated the presence of atrial inflammation, in patients with AF and rheumatic mitral stenosis (MS), using cardiac MRI and its correlation with inflammatory markers.

Methods and Results

Twenty RHD patients with predominant mitral stenosis were recruited for the study. Ten patients had persistent AF, three had paroxysmal AF and seven were in sinus rhythm. Patients with AF had lower mitral valve areas. Cardiac MRI showed evidence of late gadolinium enhancement (LGE) in the atrial wall in 61.54% (8/13) of patients with AF as compared with only 20% (1/5; p < 0.05) of patients in sinus rhythm. Mean levels of IL-6 were also significantly higher in patients with AF (10.62 ± 5.92 pg/mL versus 4.37 ± 2.68 pg/mL; P= 0.017). IL6 with a cutoff of ≥ 6.5 pg/mL was associated with a sensitivity of 76.92 % and specificity of 71.43 % for prediction of AF. There was also significant association between high IL-6 levels and LGE on MRI (13.13 ± 5.75 pg/mL vs 5.29 ± 3.23pg/mL; P < 0.05)

Conclusion

Patients with MS who developed AF show evidence of atrial inflammatory sequelae in the form of fibrosis as suggested by LGE on cardiac MRI. Systemic inflammation in the form of elevated IL-6 levels correlated significantly with atrial fibrosis and AF.

Table 1: MS patients with or without AF Clinical Features Rhythm P-Value NSR (n = 7) AF (n = 13) Mean Valve Area (cm2) 1.28 ± 0.35 0.83 ± 0.26 < 0.01 Mean Diastolic Gradient (mmHg) 6.29 ± 2.2 11.92 ± 5.65 <0.01 Wilkin Score 7 ± 0.816 8.46 ± 1.66 0.04 LVEF % (non indexed) 59.57 ± 1.13 58.77 ± 2.89 0.49 LA Volume with MRI (ml) 127.50 ± 51.32 284.33 ± 133.12 <0.01 Inflammatory Markers hs-CRP (mg/L) 5.59 ± 3.89 3.94 ± 3.47 0.34 IL6 (pg/mL) 4.37 ± 2.68 10.62 ± 5.92 0.017 sCD-40L (ng/mL) 3.72 ± 3.73 4.77 ± 2.80 0.48 Atrial LGE 0 (0%) 8 (61.5%) 0.04

Abstract P89 Figure. Image 1: Cardiac MRI showing LGE

Endoscopic Management of Vesicoureteral Reflux and Long-term Follow-up

OBJECTIVE

To report our experience with endoscopic management of vesicoureteral reflux (VUR) by injection of a tissue bulking substance - Dextranomer/ hyaluronic acid co-polymer at vesicoureteric junction.

DESIGN

Retrospective analyses of case records.

SETTING

Pediatric Surgery department in a tertiary care government Institute.

PARTICIPANTS

500 children (767 renal units) consecutively referred to the out-patient department with vesicoureteral reflux noted on micturating cysto-urethrogram (MCU) over a period of 13 years (2004-2016).

INTERVENTION

Preoperative VUR grading and renal scars on radionuclide scans were documented. Dextranomer hyaluronic acid copolymer was injected through a cystoscope at the vesicoureteral junction as a day care procedure under short anesthesia. Patients were followed (average duration 27.3 mo) with clinical assessment, periodic urine cultures and renal scans.

MAIN OUTCOME MEASURE

Cessation of VUR and symptomatic relief / clinical success postoperatively at 3 months.

RESULTS

Complete symptomatic relief was obtained in 482 (96.4%) patients. In 681 units where MCU was available, 614 (90%) units showed resolution of VUR.

CONCLUSIONS

Endoscopic injection of tissue bulking substances at vesicoureteric junction to stop VUR seems to be an effective intervention.

Seroprevalence of human brucellosis in and around Jammu, India, using different serological tests

AIM

Brucellosis is a disease of zoonotic importance as it affects both human as well as animal's health, and therefore, directly affects animal productivity and human efficiency. Therefore, a study was conducted to estimate the seroprevalence of brucellosis in humans in Jammu and surrounding areas.

MATERIALS AND METHODS

A total of 121 sera samples from humans occupied with professional related to animals were collected and tested for anti-Brucella antibodies by Rose Bengal plate test (RBPT), modified RBPT (mRBPT), standard tube agglutination test (STAT), and indirect enzyme-linked immunosorbent assay (I-ELISA). Sampling was done keeping in view with the occupation, sex, and age.

RESULTS

The overall seroprevalence of brucellosis recorded was 4.96%. The test-wise seroprevalence was 9.91% by RBPT, 9.91% by mRBPT, 9.09% by STAT, and 16.52% by I-ELISA. The prevalence of brucellosis was higher in >35-50 years age group compared to >20-35 years and >50-65 years. Sex-wise seroprevalence was higher in males than females. Taking I-ELISA as standard, the relative sensitivities of mRBPT, RBPT, and I-ELISA were in the order of mRBPT=RBPT>STAT. All the tests revealed high specificity values; however, among different serological tests, I-ELISA detected a maximum number of positive sera samples.

CONCLUSIONS

The prevalence of brucellosis was found to be approximately 5%. The adult (>35-50 years) age male group was most vulnerable. The routine diagnosis of brucellosis involved the conventional serological tests, viz., RBPT and STAT, but each was associated with drawbacks which could give either false-positive or false-negative interpretation. Therefore, it is always recommended to use a battery of tests in the diagnosis of brucellosis.

Antibacterial efficacy of a novel plasma reactor without an applied gas flow against methicillin resistant Staphylococcus aureus on diverse surfaces

The use of nonthermal plasma in the clinic has gained recent interest, as the need for alternative or supplementary strategies are necessary for preventing multi-drug resistant infections. The purpose of this study was to evaluate the antibacterial efficacy of a novel plasma reactor based on a high current version of sliding discharge and operated by nanosecond voltage pulses without an applied gas flow. This modification is advantageous for both portability and convenience. Bacterial inactivation was determined within a chamber by direct quantification of colony Jing units. Plasma exposure significantly inhibited the growth of Escherichia coli and Staphylococcus epidermidis following a 1-min application (p<0.001). S. epidermidis was more susceptible to the plasma after a 5-min exposure compared to E. coli. Temperature and pH measurements taken immediately before and after plasma exposure determined neither heat nor pH changes play a role in bacterial inactivation. Because of the notable effect on S. epidermidis, the effect of plasma exposure on several isolates and strains of the related opportunistic pathogen Staphylococcus aureus was quantified. While S. aureus isolates and strains were efficiently inactivated on an agar surface, subsequent testing on other clinically relevant surfaces demonstrated that the inactivation level, although significant, was reduced. This reduction appeared to depend on both the surface texture and the surface moisture content. These findings suggest this novel plasma source lacking an applied gas flow has potential application for surface bacterial decontamination.

Impact of method of application and concentration of potassium on yield of wheat

A field experiment was conducted to study the effect of different levels and methods of potassium application on yield, K uptake and forms of potassium in wheat crop at experimental field of Division of Soil Science, Sher-e-Kashmir University of Agricultural Sciences and Technology, Kashmir. The treatment consisted of 5 levels of potassium (0, 20, 40, 60 and 80 kg K2O ha(-1)) and two methods of application viz Single basal and split (1/2 basal+1/2 at tiller initiation stage). Out of various treatments, split application of potassium @ 80 kg K2O ha(-1) was found superior to single basal application in terms of grain yield (43.20 q ha(-1)) and K uptake (22.89 kg ha(-1)) by grains at harvest. However, it was at par with split application of 60 kg K2O ha(-1). All forms of potassium viz water-soluble, exchangeable, available, boiling HNO3 extractable and lattice increased with increasing levels of potassium and were found maximum (3.20, 62.80, 66.00 ppm 0.723 and 1.440% respectively) when potassium was applied @ 80 kg K2O ha(-1) in two equal splits except for lattice K which was maximum (1.440%) when potassium was applied @ 60 kg K2O ha(-1).

N-alkyldithiocarbamato complexes [Cd(S2CNHR)2] (R = C2H5, C4H9, C6H13, C12H25); Synthesis, Characterisation and Deposition of II/VI Nanoparticles

A series of N-alkyldithiocarbamato complexes of cadmium have been synthesised and characterized. [Cd(S2CNHC12H25)2] complex was used as a single source precursor to synthesize CdS nanoparticles. Synthesis of CdS nanoparticles was carried out at various thermolysis temperatures and concentration of the precursor to observe the morphological changes. At moderate or high temperature the 1D nanostructures (single-rods, bend rods or multi-rods) are generated. The shape of CdS nanocrystals varied from longer rods to shorter rods with increased width (average size: 4nm wide and 27nm long vs. 9nm wide and 27nm long) by simply increasing the quantity of precursor in the bulk solution from 0.05g/8ml HDA to 1g/8ml HDA at 250°C.

Comparison of the C-MAC videolaryngoscope with the Macintosh, Glidescope, and Airtraq laryngoscopes in easy and difficult laryngoscopy scenarios in manikins

The C-MAC comprises a Macintosh blade connected to a video unit. The familiarity of the Macintosh blade, and the ability to use the C-MAC as a direct or indirect laryngoscope, may be advantageous. We wished to compare the C-MAC with Macintosh, Glidescope and Airtraq laryngoscopes in easy and simulated difficult laryngoscopy. Thirty-one experienced anaesthetists performed tracheal intubation in an easy and difficult laryngoscopy scenario. The duration of intubation attempts, success rates, number of intubation attempts and of optimisation manoeuvres, the severity of dental compression, and difficulty of device use were recorded. In easy laryngoscopy, the duration of tracheal intubation attempts were similar with the C-MAC, Macintosh and Airtraq laryngoscopes; the Glidescope performed less well. The C-MAC and Airtraq provided the best glottic views, but the C-MAC was rated as the easiest device to use. In difficult laryngo-scopy the C-MAC demonstrated the shortest tracheal intubation times. The Airtraq provided the best glottic view, with the Macintosh providing the worst view. The C-MAC was the easiest device to use.

Facial tuberculoid leprosy: case report

Leprosy is a chronic, infectious, systemic disease caused by Mycobacterium leprae and is classified as paucibacillary and multibacillary types. It is contagious and has an insidious onset. Clinical presentation is characterised by hypopigmented skin lesions with reduced sensation. Presence of acid-fast bacilli in tissue specimens is regarded as a gold standard for diagnosis. Treatment is based on multi-drug regimens. We report a case of borderline tuberculoid leprosy in a 31-year-old woman.

Determination of the optimal stylet strategy for the C-MAC videolaryngoscope

The C-MAC videolaryngoscope is a novel intubation device that incorporates a camera system at the end of its blade, thereby facilitating obtaining a view of the glottis without alignment of the oral, pharyngeal and tracheal axes. It retains the traditional Macintosh blade shape and can be used as a direct or indirect laryngoscope. We wished to determine the optimal stylet strategy for use with the C-MAC. Ten anaesthetists were allowed up to three attempts to intubate the trachea in one easy and three progressively more difficult laryngoscopy scenarios in a SimMan manikin with four tracheal tube stylet strategies: no stylet; stylet; directional stylet (Parker Flex-It); and hockey-stick stylet. The use of a stylet conferred no advantage in the easy laryngoscopy scenario. In the difficult scenarios, the directional and hockey-stick stylets performed best. In the most difficult scenario, the median (IQR [range]) duration of the successful intubation attempt was lowest with the hockey-stick stylet; 18 s (15-22 [12-43]) s, highest with the unstyletted tracheal tube; 60 s (60-60 [60, 60]) s and styletted tracheal tube 60 s (29-60 [18-60]) s, and intermediate with the directional stylet 21 s (15-60 [8-60]) s. The use of a stylet alone does not confer benefit in the setting of easy laryngoscopy. However, in more difficult laryngoscopy scenarios, the C-MAC videolaryngoscope performs best when used with a stylet that angulates the distal tracheal tube. The hockey-stick stylet configuration performed best in the scenarios tested.

Lack of influence of DNA repair gene OGG1 codon 326 polymorphisms of gastric cancer risk in the Kashmir valley

Damage to DNA may lead to carcinogenesis but is repaired through activation of pathways involving polymorphic enzymes, including human 8-oxoguanine glycosylase 1 (OGG1). The present study aimed to assess the role of genetic variants of DNA repair gene OGG1 Ser326Cys in susceptibility to gastric cancer in Kashmir valley. A case control study was performed in 303 subjects (108 gastric cancer and 195 healthy controls), all genotyped through the polymerase chain reaction (PCR). Data were statistically analyzed using the chi-square test and the logistic regression model. The distribution of OGG1 genotypes among controls and gastric cancer cases did not show any significant differences. Although smokers and high salted tea drinkers themselves were at higher risk for gastric cancer (OR=8.975, P=0.0001; OR=14.778, P=0.0001), interaction with OGG1 Ser326Cys did not further modulate the risk. In conclusion, our findings suggest that the OGG1 polymorphism does not influence either gastric cancer risk independently or by interaction with smoking or salted-tea consumption in the Kashmir valley.

Randomized controlled trial of the Pentax AWS, Glidescope, and Macintosh laryngoscopes in predicted difficult intubation

BACKGROUND

The purpose of this study was to determine the potential for the Pentax AWS and the Glidescope to reduce the difficulty of tracheal intubation in patients at increased risk for difficult tracheal intubation, in a randomized, controlled clinical trial.

METHODS

Seventy-five consenting patients presenting for surgery requiring tracheal intubation, and who were deemed to possess characteristics indicating an increased risk for difficult tracheal intubation, were randomly assigned to undergo intubation using a Macintosh, AWS, or Glidescope laryngoscope (n=25 patients per group). All patients were intubated by one of three anaesthetists experienced in the use of each laryngoscope.

RESULTS

Both the Glidescope and the AWS significantly reduced the intubation difficulty score compared with the Macintosh. The rate of successful tracheal intubation was lower with the Macintosh (84%) compared with the Glidescope (96%) or the AWS (100%). There were no differences in the duration of tracheal intubation attempts between the devices. Both the Glidescope and the AWS significantly reduced the need for additional manoeuvres and improved the Cormack and Lehane view obtained at laryngoscopy, compared with the Macintosh. Tracheal intubation with the AWS but not the Glidescope reduced the degree of haemodynamic stimulation compared with the Macintosh laryngoscope.

CONCLUSIONS

The AWS and the Glidescope laryngoscopes reduced the difficulty of tracheal intubation to a similar extent compared with the Macintosh laryngoscope, in patients at increased risk for difficult tracheal intubation.

Knowledge, Attitudes and Practices of Patients Attending West Bay Health Center Towards Upper Respiratory Tract Infections

Upper respiratory tract infections (URI) are very com-mon in general practice. Although viruses cause the ma-jority of URI, many patients expect antibiotic treatment. At one Primary Health Care Center in Qatar; during October - November 2004, eleven hundred and eleven adult patients completed a short questionnaire on demographics, knowl-edge, attitudes, practices towards URI, and patient satis-faction. Four hundred and forty eight (40.3%) recognized viruses as the most common cause of URI; seven hundred and eighty-eight (70.9%) chose consulting a physician as the first line of action when contracting URI; 721 (64.9%) stated that management should be based on physician's diagnosis while 28% expected antibiotics. A majority of participants acknowledged the importance of counseling in their satisfaction but 49.6% reported dissatisfaction if antibiotics were not prescribed and 31.6% reported seek-ing antibiotics when not prescribed. Participants expect-ing antibiotics differed significantly regarding knowledge of causes of URI (p = 0.004). There was no significant dif-ference regarding factors affecting satisfaction based on antibiotic expectation. Results highlight the need for public education and counseling on etiology, course, and management of URI by physicians.

Knowledge, Attitudes and Practices of Patients Attending West Bay Health Center Towards Upper Respiratory Tract Infections

Upper respiratory tract infections (URI) are very com-mon in general practice. Although viruses cause the ma-jority of URI, many patients expect antibiotic treatment. At one Primary Health Care Center in Qatar; during October - November 2004, eleven hundred and eleven adult patients completed a short questionnaire on demographics, knowl-edge, attitudes, practices towards URI, and patient satis-faction. Four hundred and forty eight (40.3%) recognized viruses as the most common cause of URI; seven hundred and eighty-eight (70.9%) chose consulting a physician as the first line of action when contracting URI; 721 (64.9%) stated that management should be based on physician's diagnosis while 28% expected antibiotics. A majority of participants acknowledged the importance of counseling in their satisfaction but 49.6% reported dissatisfaction if antibiotics were not prescribed and 31.6% reported seek-ing antibiotics when not prescribed. Participants expect-ing antibiotics differed significantly regarding knowledge of causes of URI (p = 0.004). There was no significant dif-ference regarding factors affecting satisfaction based on antibiotic expectation.

Results highlight the need for public education and counseling on etiology, course, and management of URI by physicians.

Nutrients as trophic factors in neurons and the central nervous system: role of retinoic acid

In multicellular organisms, death, survival, proliferation, and differentiation of a given cell depend on signals produced by neighboring and/or distant cells, resulting in the coordinated development and function of the various tissues. In the nervous system, control of cell survival and differentiation is achieved through the action of a distinct group of polypeptides collectively known as neurotrophic factors. Recent findings support the view that trophic factors also are involved in the response of the nervous system to acute injury. By contrast, nutrients are not traditionally viewed as potential trophic factors; however, there is increasing evidence that at least some influence neuronal differentiation. During development the brain is responsive to variations in nutrient supply, and this increased sensitivity or vulnerability of the brain to nutrient supply may reappear during neuronal repair, a period during which a rapid membrane resynthesis and reestablishment of synthetic pathways occur. To further evaluate the potential of specific nutrients to act as pharmacologic agents in the repair of injured neurons, the effects of retinoic acid, an active metabolite of vitamin A, and its role as a trophic factor are discussed. This literature review is intended to provide background information regarding the effect of retinoic acid on the cholinergic phenotype and the differentiation of these neurons and to explain how it may promote neuronal repair and survival following injury.

A one-step synthesis of cadmium selenide quantum dots from a novel single source precursor

A new approach to the one-step synthesis of cadmium selenide (CdSe) quantum dots is reported using the air stable complex cadmium imino-bis(diisopropylphosphine selenide); the ligand is readily prepared from elemental selenium and the precursor, quantum dots of comparable quality to those prepared by conventional methods are obtained.

Significance of thyrotrophin and thyroxine estimations in type 1 diabetes

OBJECTIVE

To investigate whether estimation of thyrotrophin (TSH) and thyroxine (T4) is significant to assess the thyroid status of diabetic patients.

MATERIALS AND METHODS

Fifty patients with type 1 diabetes (25 male and 25 female) aged 9-50 years were included. The mean duration of diabetes was 6.7 +/- 4.3 years. Clinically they were not suffering from any systemic disease or endocrine ailment. Twenty-six, age and sex matched, normal controls were also included. The TSH and and T4 were estimated in the sera of all the subjects using the commercially available ELISA kits.

RESULTS

The mean +/- SD concentration of TSH was raised significantly (p < 0.001) in the patients as compared to the controls, whereas the T4 concentration was comparable. Furthermore, 30% diabetics showed significantly elevated TSH concentration than the controls.

CONCLUSION

It is proposed that the estimation of TSH in the patients with type 1 diabetes may be useful in the early identification of thyroid dysfunction.

Cholinergic differentiation triggered by blocking cell proliferation and treatment with all-trans-retinoic acid

This study determined whether the effect of all-trans-retinoic acid (t-RA) on markers of cholinergic differentiation in a murine septal cell line, SN56.B5.G4, differed depending upon the cell's proliferative status. To develop a model of non-proliferating cells, aphidicolin, a DNA alpha-polymerase inhibitor, was used. Cessation of proliferation by aphidicolin increased intracellular choline and acetylcholine (ACh) levels in the absence of change to choline acetyltransferase (ChAT) activity and mRNA and vesicular ACh transporter (VAChT) mRNA. Importantly, the response to t-RA differed depending upon proliferative status. Consistent with previous reports, t-RA increased ChAT and VAChT mRNA, ChAT activity and intracellular ACh levels in proliferating SN56 cells with no effect on intracellular choline levels. When cells were treated with t-RA while undergoing proliferative arrest, an additive effect of combined treatment was observed on ACh levels; nevertheless, this was only accompanied by an increase in choline levels, VAChT and ChAT mRNAs, but not ChAT activity. Indeed, aphidicolin treatment completely suppressed the t-RA-induced increase in ChAT activity observed in proliferating cells. To explore the response to t-RA in post-mitotic cells, a sequential treatment of aphidicolin and t-RA was employed. t-RA treatment was ineffective in increasing ACh and choline levels, over and above that observed with the aphidicolin treatment alone. Comparable to the combined treatment, sequential treatment lead to an increase in ChAT mRNA without any increase in ChAT activity. In conclusion, both the magnitude and the mechanism(s) of action whereby t-RA enhances the cholinergic phenotype of SN56 cells is dependent upon the cell's proliferative status.

Outcome of cases of persistent diarrhea after discharge

After recovery from persistent diarrhea, some children have recurrent episodes of diarrhea and associated problems. We undertook this study to identify the risk factors responsible for this relapse. All patients reporting at 1 month follow up since discharge, with > 7 diarrheal days, or inadequate weight gain compared to the weight at discharge, constituted the failure group. All others constituted the non-failure group. Various risk factors were studied in 21 cases (failure group), and 42 controls (non-failure group). Univariate analysis revealed a significant association of hospital stay < 5 days (OR 10.6; 95% CI 3.13-36), working mothers (OR 8.5; 95% CI 2.5-27), poor socioeconomic status (OR 4.5; 95% CI 1.4-14) and presence of younger sibling (OR 3.69, 95% CI 1.1-12.6) with failed outcome. On logistic regression analysis, only hospital stay < 5 days (OR 11.7; 95% CI 1.02-134.68) and female children (OR 17.65; 95% CI 1.26-246) remained significant. We therefore conclude, that a short hospital stay, limited optimal contact and limited health education adversely affects the outcome. Pediatricians should be more cautious while managing female children.

Charge-transfer photochemistry of bis(diethyl-diselenocarbamato)copper(II)

The photochemical reactions of bis(diethyl-diselenocarbamato)copper(II), Cu(Et2dsc)2, complex have been studied in toluene, CH2Cl2, CHCl3 and chloroalkane/EtOH mixed solvents. Charge-transfer irradiation induces intramolecular oxidation of the ligand and reduction of copper(II) to copper(I) as evidenced by EPR and UV-Vis spectra of the complex as well as quantum yield results. When photolysis is carried out in CHCl3 or CH2Cl2 or in the solvent mixture CHCl3/EtOH resp. CH2Cl2/EtOH of lower than 1:1 EtOH content, the primary photoproduct CuI(Et2dsc) is further oxidised in a dark reaction with the chloroalkane producing the corresponding paramagnetic mixed-ligand CuII(Et2dsc)Cl complex in equilibrium with its chloride-bridged and EPR silent, dimeric form Cu2(Et2dsc)2Cl2. At low concentration of EtOH the equilibrium is shifted to the dimeric form whereas at higher than 1:1 EtOH content in the mixed solvent CHCl3/EtOH it is shifted to CuII(Et2dsc)Cl. A reaction mechanism is proposed and the role of ethanol is discussed.

Ventilatory function of healthy, urban, non smoking, Pakistani young adults aged 18-24 years

Age may have a different contribution to normal lung function values in those aged less than 25 years, as compared to older individuals. We report regression equations predicting ventilatory parameters in this age group, as none have been reported from Pakistan. The study was conducted on students of King Edward Medical College Lahore, Pakistan. Participants had never smoked and reported no respiratory symptoms. In addition to anthropometric data, forced expiratory volume in 1 sec (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF) and forced expiratory flow at 50% of FVC (FEF50) were measured. Equations predicting normal values of these parameters were derived using SPSS (Chicago, Illinois, U.S.A.) P < or = 0.05 was treated as statistically significant. Of the students, 519 took part in the study. All four parameters correlated significantly (P < 0.001) and positively with height. FEF50 had a negative correlation with age in both sexes (P < 0.05). The correlation of other parameters with age was variable and not statistically significant. On multiple regression, height featured as an independent predictor in equations for all parameters. The contribution of age as an independent predictor of ventilatory function was, once again, variable. Independent variables were retained in the raw form as their transformation did not improve the goodness of fit of the derived equations. Only height and age emerged as independent predictors of ventilatory function. Values derived from the equations presented in this study were less than those for height and age matched white Caucasians. Such differences were greater than the 'Asian correction factors'.

Lead exposure in papier mâché workers

Lead exposure was assessed in a random cohort of 70 male papier mâché workers and compared with 35 age and sex matched controls. Blood-lead levels in workers were significantly higher than in controls (Mean 68.07 +/- 44.64 ug/dl vs 25.52 +/- 16.56 ug/dl respectively; P < 0.001). Urinary lead was also higher in workers (128.53 +/- 52.61 ug/l) compared to controls (91.18 +/- 27.06, P < 0.001), but excretion of urinary coproporphyrin in the two groups was not significantly different (102.78 +/- 153.42 vs 70.03 +/- 27.06 ug/l, P > 0.05). Blood levels bore a significant correlation with age but did not bear any correlation with the duration of exposure. Various modes of exposure to lead included hand mixing of paints, skin application of the paint to match shades and making point of the brush using lips and the tongue.

Asthma in chemical workers exposed to aliphatic polyamines

Following the identification of an index case of occupational asthma, we assessed the respiratory morbidity in 12 workers exposed to aliphatic polyamines in a chemical factory and in 60 unexposed workers in three other workplaces. Many amine workers reported symptoms of chronic cough (7/12), chronic phlegm (9/12), wheezing (4/12) and exertional breathlessness (3/12). These were significantly more frequent in exposed than in unexposed workers (P < 0.01). They also had significantly greater diurnal variation in peak expiratory flow rates (DV-PEFR) than the unexposed workers (P < 0.01). All four amine workers with wheezing reported onset of symptoms after employment at the factory, and all had DV-PEFR greater than 15%, compared to only one control worker (P < 0.01). A second case of occupational asthma was confirmed by bronchial challenge test. The study indicated a very high risk of asthma and chronic airways disease and a need for stringent measures to protect the health of industrial workers exposed to aliphatic amines in Singapore.

Significance of thyroid microsomal antibody in Graves' disease

Thyroid microsomal antibody (MsAb) was estimated in 48 patients with Graves' disease (15 newly diagnosed, 15 on drugs for about 4 weeks and 18 euthyroid with drug treatment) and twenty age and sex matched controls. The diagnosis of Graves' disease (GD) was based on clinical history, physical examination and thyroid function tests, viz. 131I uptake, thyroid scintigram and serum T3, T4 and TSH levels. MSAb was positive in 93.3% of newly diagnosed as well as hyperthyroid GD patients on drugs. Eighty-three percent euthyroid GD patients and 20% normal controls also showed MSAb positivity. The titres of newly diagnosed patients were significantly raised (P < 0.05) than those of euthyroid patients and controls indicating the diagnostic as well as prognostic significance of MSAb in Graves' disease.

Glycaemic index of Pakistani staple foods in mixed meals for diabetics

Glycaemic index of local staple foods was determined. In first phase, the post prandial blood glucose response of isocaloric portion of wheat chapati and gram flour (baisen) chapati, were compared in 11 type II diabetic patients as a part of mixed meal in fasting state, alternately. The glycaemic index of baisen chapati was 39 as compared with wheat chapati. In second phase of the study, 22 type II diabetic patients were given isocaloric portions of wheat chapati and boiled rice as a part of mixed meal alternately. The glycaemic index of rice was 98 as compared with wheat chapati. This study favours the belief that baisen chapati is better and refutes that rice is bad for diabetics. It also upholds that glycaemic index is useful for planning a diabetic diet.

Osteoblasts on hydroxyapatite, alumina and bone surfaces in vitro: morphology during the first 2 h of attachment

The morphological responses of individual osteoblasts as they attached and spread on hydroxyapatite, bovine bone, alumina with rough and polished surfaces, and tissue culture polystyrene in vitro were examined with scanning electron microscopy. Depending on the surface tested two different morphological sequences were observed during 2 h of adhesion. On alumina, both rough and smooth, bone, and tissue culture polystyrene the cells were round after 0.5 h, and spread radially during the next 1.5 h until they were almost flat, with a nuclear bulge. On hydroxyapatite, however, the cells were flat and circular at 0.5 h, and the edge of the cytoplasm was hardly discernable. This morphology did not change much during the subsequent 1.5 h. The observed cellular morphological response may be related to the bioreactivity of hydroxyapatite.

Reactive hypoglycemia and A-cell ('pancreatic') glucagon deficiency in the adult

Serum glucose, A-cell (IRGA) and total glucagon (IRGT), insulin, growth hormone, cortisol, triiodothyronine, and thyroxine values were measured in the fasting state and in response to oral glucose, intravenously administered arginine, and a meal of pan-broiled ground beef in 31 symptomatic patients and 11 normal subjects. Twenty-four patients and 11 control subjects had normal glucose tolerance (group 1); seven patients had reactive hypoglycemia (group 2). Under all conditions, serum IRGA value was significantly lower in group 2 than in group 1. Glucose, arginine, or meat increased serum IRGT levels. This response did not differ significantly in the two groups, nor did the secretion of the other measured hormones. We conclude that A-cell insufficiency can contribute to reactive hypoglycemia in the adult.