A comprehensive health risk assessment associated with bioaccumulation of heavy metals and nutrients in selected macrophytes of Loktak Lake, Manipur, India

The Loktak Lake, a Ramsar site in Northeast India, is known for its rich biodiversity that includes a variety of macrophyte species, most of which have not been studied for their phytoremediation capacities and potential toxicity via consumption of the edible species. Therefore, a comprehensive assessment was conducted to evaluate the accumulation of selected heavy metals and nutrients in 10 dominant macrophyte species growing in Loktak Lake and to assess the potential health risks associated with consumption of the edible plants. The concentrations of nutrients such as total phosphorus (TP), total nitrogen (TN), potassium (K), calcium (Ca), magnesium (Mg), and heavy metals such as copper (Cu), manganese (Mn), zinc (Zn), and iron (Fe) were found to be in the order of plant > sediment > water. The bioaccumulation factors (BAFs) revealed high efficiency of most plants to accumulate heavy metals and nutrients in their tissues from the lake water and sediments, indicating their potential to be used as phytoremediators. Translocation factors (TFs) were also estimated to determine the efficiency of the plants to translocate elements from root to shoot. Colocasia esculenta and Polygonum perfoliatum exhibited the highest BAF values, whereas Colocasia esculenta, Hedychium flavum, Phragmites karka, and Oenanthe javanica exhibited the highest TF values for most elements. Target hazard quotients (THQs) revealed potential health risks associated with one or more heavy metals in the plants, except for Zn, whose THQ values were below the level of concern in all the edible plant species. The hazard index (HI) signifying potential non-carcinogenic health risk from the combined effects of all the heavy metals was highest for Polygonum perfoliatum, indicating a potentially higher risk to health if this edible macrophyte is regularly consumed in higher quantities and may pose long-term health effects to the exposed population.

Bioactivity and nutritional quality of nutgall (Rhus semialata Murray), an underutilized fruit of Manipur

Introduction

Underutilized fruits plays a significant role in socio economic, cultural, nutritional and ethnomedicinal status of tribal people. However, scientific studies on the nutritional and other pharmaceuticals/biological activities of these fruits are meagre. Hence, the present study dealt with the quantification of nutritional quality and deciphering the bioactivity of nutgall (Rhus semialata Murray syn. Rhus chinensis Mill.), an underutilized fruit crop mainly found in foothill tracks of Eastern Himalaya, India, China, Japan, Korea and other South East Asian countries.

Methods

The Rhus semialata Murray fruits were collected from five different locations in Purul sub-division, Senapati district, Manipur, India. The nutritional composition of the fruit pulp was analysed. Further the fruit pulp was extracted in methanol and water. The methanol and water extracts were studied for bioactivity properties such as antioxidant, antihyperglycemic, antihypertensive, antihyperuricemia, anti-tyrosinase, and antimicrobial activity.

Results and discussion

The fruit was rich in essential fatty acids. The presence of linoleic and oleic acids, along with traces of docosahexaenoic acid and eicosapantaenoic acid, revealed the potential food value of the fruit. 59.18% of the total amino acid composition of the protein present was constituted by essential amino acids. The IC₅₀ value of methanolic extract (MExt) and Water extract (WExt) of the fruit were recorded as 4.05 ± 0.22 and 4.45 ± 0.16 μg/mL, respectively, in the DPPH assay and 5.43 ± 0.37 and 11.36 ± 2.9 μg/mL, respectively, in the ABTS assay as compared to Ascorbic acid (3 and 5.4 μg/mL in DPPH and ABTS assay, respectively). The CUPRAC assay also showed a high antioxidant potential of MExt and WExt (1143.84 ± 88.34 and 456.53 ± 30.02 mg Ascorbic Acid Equivalent/g, respectively). MExt and WExt of the fruit were more active against α-glucosidase (IC₅₀ of 1.61 ± 0.34 and 7.74 ± 0.54 μg/ mL, respectively) than α-amylase enzyme (IC₅₀ 14.15 ± 0.57 and 123.33 ± 14.7 μg/mL, respectively). In addition, the methanolic fruit extract showed low to moderate pharmacological potential in terms of antihypertensive (Angiotensin converting enzyme-I inhibition), antihyperuricemia (xanthine oxidase inhibition), anti-tyrosinase, and antimicrobial activity. The IC₅₀ values of angiotensin-converting enzyme I inhibition, xanthine oxidase inhibition and tyrosinase inhibition were recorded as 13.35 ± 1.21 mg/mL, 93.16 ± 4.65 mg/mL, and 862.7 ± 12.62 μg/mL, respectively. The study evidently indicates that nutgall fruit is a potential source of phytonutrients, bestowed with commercially exploitable, multifaceted health benefits.

Effect of ivabradine on heart rate, functional capacity and pulmonary artery pressure in patients of COPD with cor pulmonale

We studied the effects of heart rate reduction by ivabradine to the ongoing therapy in patients with chronic obstructive pulmonary disease (COPD) and cor pulmonale.100 patients of COPD with cor pulmonale with sinus heart rate ≥ 90 bpm were randomly assigned to either ivabradine 5 mg twice daily (50 patients) or placebo (50 patients) alongwith standard therapy. Assessment was done at baseline and after 6 months which included 6 min walk test (6MWT), dyspnea scoring by modified borg scale, Lung function test by forced expiratory volume in 1 s (FEV1) and pulmonary artery systolic pressure (PASP) by echocardiogram. The drug group showed a significant reduction in heart rate from 95.1 ± 8.2 bpm to 71.1 ± 6.2 bpm (p < 0.001). This group also showed significant improvement in 6-min walk distance and dyspnea on modified Borg scale (p < 0.001) at 6 months follow up. However no significant difference was found between both groups regarding PASP or FEV1 at 6 months.

Suctioning First or Drying First During Delivery Room Resuscitation: A Randomized Controlled Trial

OBJECTIVE

To compare the effect of suctioning first or drying first on the composite outcome of hypothermia or respiratory distress in depressed newborns requiring delivery room resuscitation.

DESIGN

Open-label, randomized, parallel-group, controlled trial.

SETTING

Delivery room and neonatal intensive care unit of a tertiary-care teaching hospital.

PATIENTS

Depressed newborns (n=154) requiring initial steps of resuscitation at birth. Intervention: During delivery room resuscitation eligible new-borns were randomly allocated to receive either suctioning first or drying first (77 newborns in each group).

MAIN OUTCOME MEASURE

Composite incidence of hypothermia at admission or respiratory distress at 6 hours of age.

RESULTS

Both groups were comparable with regard to maternal and neonatal characteristics. Composite outcome was similar in both the groups [46 (59.7%) vs 55 (71.4%)] in suctioning first and drying first, respectively [RR (95% CI), 0.84 (0.66-1.05); P=0.13]. Incidence of hypothermia, respiratory distress at admission and oxygen saturation at 6 hours were also similar. On admission to NICU, hypothermia was observed in 26 (33.8%) neonates in suctioning first group and 33 (42.8%) neonates in drying first group but by one hour of age the proportion of hypothermic neonates was 13 (16.9%) and 14 (18.1%), respectively.

CONCLUSION

In newborns depressed at birth, the sequence of performing initial steps, whether suctioning first or drying first, had comparable effect on composite outcome of hypothermia at admission or respiratory distress at 6 hours of age.

Echocardiography versus cardiac biomarkers for myocardial dysfunction in children with scorpion envenomation: An observational study from tertiary care center in northern India

OBJECTIVE

This study was done to evaluate myocardial function by 2D Echocardiography and Cardiac biomarkers (cTnI, CK-MB, BNP) changes in patients of scorpion envenomation of grade II-IV and correlate mortality of envenomed children with myocardial dysfunction.

METHODS

A total of 40 patients admitted consecutively with grade II and more scorpion envenomation from October 2015 to July2018 were enrolled in the study. The data included demographics, the time of presentation, clinical features, echocardiographic findings, electrocardiographic findings, cardiac biomarker levels at admission and discharge, use of inotropic medication, oral prazosin, time of discharge, and their outcome.

RESULTS

The most common ECG abnormality was sinus tachycardia 28 (70%) followed by low voltage complex 13 (32.5%) which got normalized at the time of discharge in majority. Cardiac troponin I (cTnI) levels were more than 0.1 ng/mL, suggesting myocarditis was present in 25 (62.5%) and got normalized at discharge. CK-MB levels were increased in 26 (65%) patients suggesting myocardial involvement. BNP levels were also increased in 24 (60%) patients suggesting heart failure and its value got normalized at discharge. Abnormal 2D Echo findings as reduced left ventricular ejection fraction (LVEF) was present in 18 (45%) cases suggesting myocardial dysfunction and became normal at discharge. The sensitivity, specificity, positive predictive value and negative predictive value of Cardiac troponin I (cTnI) considering ECHO cardiograph as gold standard were 100, 68.1, 72 and 100% respectively. One patient had died whose Ejection fraction was less than 30%.

CONCLUSION

Echocardiography and cTnI can identify subgroup of patients, who require early aggressive therapy. Echocardiography, if not available, cardiac troponin I level can guide early therapy and indicates the prognosis.

Impact of Sociodemographic Factors and Nutrition on the Duration of Induction Phase of Chemotherapy in children with Acute lymphoblastic leukemia: A Tertiary Center Experience from North India

Background: Immunocompromised patients are at increased risk of infections, especially those living in poor hygienic conditions. Aims and Objectives: This study aims to assess the effect of weight, immunization status of the child at the start of treatment along with the socioeconomic status (SES), and demographic parameters, i.e., type of house, sanitary facility (SF), and source of drinking water on the duration of induction phase of chemotherapy (delayed if the patient received chemotherapy for >29 days). Materials and Methods: 110 pediatric acute lymphoblastic leukemia patients aged 1.5–14 years who underwent induction of remission from June 2015 to February 2018 were included. The immunization status and weight of the child were recorded at the start of treatment. SES was assessed using modified Kuppuswami scale and a questionnaire was used to determine various sociodemographic parameters. Results: The patients not immunized as per age (P = 0.000) and having poor demographic parameters, i.e., mud house (P = 0.000), absence of SF (P = 0.013), and nonfiltered drinking water (P = 0.005), had significant delay. The duration of induction phase of chemotherapy was not delayed with poor SES (P = 0.832). Although the duration was delayed in patients with weight ≥10 percentile, it was not statistically significant (P = 0.079). On analyzing the three demographic parameters together as Water-Sanitary Facility-Housing (WaSH) Score (0–4), the duration was also significantly delayed if the patients had WaSH score <2. Conclusion: The duration of induction phase of chemotherapy is delayed with inadequate immunization status and poor hygiene of the child.

Completely Linear Stapled Versus Handsewn Cervical Esophagogastric Anastomosis After Esophagectomy

Very limited data is present which compares completely linear stapled to handsewn cervical esophagogastric anastomosis. Primary objective was to determine whether linearly stapled (LS) anastomosis has lower clinically apparent leaks, when compared to handsewn anastomosis (HS). Secondary objectives were morbidity, mortality, overall leak and stricture rates, and presence of a symptomatic cervical stricture. This is a comparative study of 77 patients who underwent LS (n = 29) and HS (n = 48) cervical anastomosis. Anastomotic leak was found to be 19.4% (15/77). In the HS group, 27.08% (13/48) and in the LS group, 6.89% (2/29), respectively, leaked (p = 0.03), relative risk (RR)-3.93 (95% CI 1.21-15.25). 32.5% (23/77) patients remained admitted for more than 14 days. 52.1% (25/48) patients in the HS group were discharged within 14 days of surgery; whereas; 93.1% (27/29) were discharged in LS group (p = 0.001), RR-6.95 (95% CI 2.13-25.94). Overall, 90-day mortality was 7.8% (6/77). In the HS group, 8.3% (4/48) patients died while in the LS group, 6.8% (2/29) patients died (p = 0.82), RR-1.21(95% CI 0.27-5.53). In the HS group, 6.25% (3/48) patients were diagnosed with stricture compared to 6.8% (2/29) patients in the LS group (p = 0.9), RR-0.91 (95% CI 0.19-4.44). Overall stricture rate was 6.4% (5/77). Cervical anastomosis done with linear staplers has less leak rates compared to handsewn anastomosis.

Correlation of ABO Blood Group Phenotype and Rhesus Factor with Periodontal Disease: An Observational Study

Background:

The knowledge of the ABO blood group phenotype of the patients and their correlation with the periodontal disease maybe important in the development of early treatment strategies, and it would be helpful to target non-responding areas to periodontal therapy of the susceptible individuals.

Aims:

The present study was conducted to determine whether there was any correlation between periodontal diseases and ABO blood groups and Rh factor.

Material and Method:

This study was carried out on 537 subjects attending Faculty of Dental Sciences OPD in BHU. Subjects were divided into three groups: group I (healthy subjects), group II (subjects with gingivitis), and group III (subjects with periodontitis) based on periodontal examination (Gingival index, Bleeding Index, Probing pocket depth and clinical attachment level). ABO Blood grouping were done and correlated with the periodontal status of study subjects. Statistical Analysis: Data was analyzed using the statistical software namely Statistical Package for the Social Sciences (SPSS, Version 16, IBM Analytics) and Systat 8.0.

Results:

In this study, there was a greater prevalence of gingivitis in blood group O and periodontitis in blood group B. The blood group AB showed the least prevalence of periodontal diseases. Similarly gingivitis and peridontitis were significantly higher among Rhesus positive groups when compared with Rhesus negative groups.

Conclusion:

Considering the results of this study, it can be concluded that ABO blood groups and Rh factor could be a risk factor for the development of periodontal disease.

Predictors of survival in hepatitis B virus related decompensated cirrhosis on tenofovir therapy: an Indian perspective

Decompensated cirrhosis has low survival rate compared to compensated state. Effective viral suppression due to antiviral therapy (tenofovir) has been shown to slow disease progression and may delay the burden of liver transplantation. We aimed to evaluate the usefulness of various prognostic indicators in predicting the 24-months survival in HBV related decompensated cirrhosis after tenofovir therapy and to evaluate the post-treatment outcome. Ninety-six HBV related decompensated patients on antiviral (tenofovir) therapy were prospectively studied for 24months survival and mortality. Cutoff levels for several prognostic indicators were generated by ROC. Prediction of overall probability of mortality was also calculated. The overall probability of survival observed at 12months was 0.947 whereas at 24months it was found to be 0.833. According to Cox proportional hazards model, the univariate analysis revealed cutoff of >7.4logcopies/ml for HBV DNA, >1.2mg/dl for serum creatinine, >3.7mg/dl for total bilirubin, ⩽0.75 for platelets count, >10 for CTP and >20 for MELD as predictors of poor survival. Multivariate analysis showed MELD score of >20 was the most robust predictor of mortality, with 58 times higher risk (HR: 58.73, p<0.001). Post-treatment response with tenofovir for 24months significantly improved the hepatic functions and reverses decompensation and showed incredible efficacy in improvement of hepatic functional status with reduced viremia in a great majority of decompensated cirrhosis subjects having high MELD and HBV DNA level.

Prevalence and pattern of antiphospholipid antibody syndrome in a hospital based longitudinal study of 193 patients of systemic lupus erythematosus

BACKGROUND

Antiphospholipid antibody syndrome (APS) is a systemic autoimmune disease characterised by thrombophilic state and obstetrical complications. Prevalence of APS varies in different parts of the world. So this study was conducted to find out the prevalence and pattern of APS in systemic lupus erythematosus (SLE) in this region.

MATERIAL AND METHODS

In this hospital based longitudinal study from 2004 to 2011, we studied 193 patients of systemic lupus erythematosus (SLE) for prevalence of APS and its different characteristics. The diagnosis of SLE was made according to American College of Rheumatology (ACR) criteria and diagnosis of APS was made according to Sapporo criteria.

RESULTS

Prevalence of APS in SLE was 25.38%. Mean age at study entry was 25.5 +/- 6.9 years and majority of APS patients were in the age group 21-30 yrs (44.89%). The most common clinical manifestation in both SLE with APS and SLE without APS was musuloskeletal involvement (79.59% and 84.72% respectively). Among 49 patients of SLE having APS, multisystem involvement was present in 16 patients and life threatening complications were present in 12 patients. Late foetal loss was the most common obstetrical manifestation of APS (26.53%) and deep vein thrombosis was most common thrombotic manifestation (16.32%). Anticardiolipin antibodies(IgG aCL) were the most common antibody (85.71%) detected. Lupus anticoagulant was present in 71.42% cases of SLE having APS. ANA and anti-dsDNA antibodies were present in 97.95% and 77.55% cases of SLE having APS.

CONCLUSION

APS is a major cause of morbidity and mortality in patients of SLE. The incidence of secondary APS in SLE varies in different geographical regions and it was 25.38% in our study. Pregnancy morbidity and deep vein thrombosis were the most common complications of APS. IgG aCL was the most common antibody in APS patients. Screening for the presence of aPL antibodies in SLE patients and timely initiation of prophylactic treatment can prevent many of the complications.

Hospital-acquired acute kidney injury in medical, surgical, and intensive care unit: A comparative study

Acute kidney injury (AKI) is a common complication in hospitalized patients. There are few comparative studies on hospital-acquired AKI (HAAKI) in medical, surgical, and ICU patients. This study was conducted to compare the epidemiological characteristics, clinical profiles, and outcomes of HAAKI among these three units. All adult patients (>18 years) of either gender who developed AKI based on RIFLE criteria (using serum creatinine), 48 h after hospitalization were included in the study. Patients of acute on chronic renal failure and AKI in pregnancy were excluded. Incidence of HAAKI in medical, surgical, and ICU wards were 0.54%, 0.72%, and 2.2% respectively (P < 0.0001). There was no difference in age distribution among the groups, but onset of HAAKI was earliest in the medical ward (P = 0.001). RIFLE-R was the most common AKI in medical (39.2%) and ICU (50%) wards but in the surgical ward, it was RIFLE-F that was most common (52.6%). Acute tubular necrosis was more common in ICU (P = 0.043). Most common etiology of HAAKI in medical unit was drug induced (39.2%), whereas in surgical and ICU, it was sepsis (34% and 35.2% respectively). Mortality in ICU, surgical and medical units were 73.5%, 43.42%, and 37.2%, respectively (P = 0.003). Length of hospital stay in surgical, ICU and medical units were different (P = 0.007). This study highlights that the characters of HAAKI are different in some aspects among different hospital settings.

An epidemiological study of dementia among the habitants of eastern Uttar Pradesh, India

Dementia is one of the most serious health problems of the elderly and their caregivers.

Non-infectious complications of continuous ambulatory peritoneal dialysis and their impact on technique survival

Data on non-infectious complications of continuous ambulatory peritoneal dialysis (CAPD) are sparingly reported from different centres of the country. We studied the non-infectious complications in patients of end stage-renal disease (ESRD) undergoing CAPD. Double-cuffed straight catheter was inserted in all patients using the surgical method and CAPD was started on the 15^th day of catheter insertion. The nature of non-infectious complications was noted during follow-up in these patients. Forty-five (male 31, female 14) patients with the mean age of 54.5±11.6 years were studied. Diabetic nephropathy was the most common (59.5%) cause of ESRD. Overall, non-infectious complications were noted in 18/45 (40%) cases. Ultrafiltration failure was the most common (15.5%) followed by incisional hernia (6.6%), exit site leak (4.4%), hydrothorax (4.4%), catheter malposition (4.4%), scrotal swelling (2.2%) and hemoperitoneum (2.2%). Patients with ultrafiltration failure were either shifted to hemodialysis or underwent renal transplantation. The remaining (62%) non-infectious complications did not affect the catheter survival and CAPD could be continued. Non-infectious complications occurred in 40% of our CAPD patients and ultrafiltration failure was the most common (15.5%). A majority (62%) of the complications did not affect catheter survival.

Study of neurocognitive endophenotypes in drug-naïve obsessive-compulsive disorder patients, their first-degree relatives and healthy controls

OBJECTIVE

Obsessive-compulsive disorder (OCD) is a debilitating heritable neuropsychiatric condition. Attempts to delineate genetic contributions in OCD have met with limited success, with an ongoing search for neurocognitive endophenotypes. In this study, an attempt has been made to study and compare the neurocognitive functioning of patients with OCD, their first-degree relatives (FDRs) and healthy controls.

METHOD

A cross-sectional design study was carried out with thirty dyads of patients with OCD, their FDRs and thirty matched healthy controls and screened using Mini International Neuropsychiatric Interview, Verbal Adult Intelligence Scale, Yale Brown Obsessive-Compulsive Scale, Montgomery Åsberg Depression Rating Scale, International Personality Disorder Examination (Anankastic personality scale).Tests of National Institute of Mental Health and Neurosciences Neuropsychological Battery were used to assess domains of attention, verbal memory, visual memory, set-shifting, response inhibition, planning and visuoconstructive abilities. spss version 14.0 was used for descriptive and analytical data analysis.

RESULTS

There were no statistically significant differences between patients with OCD and their FDRs on neurocognitive domains of delayed verbal recall, set-shifting, response inhibition and visuoconstructive abilities (P > 0.05) which were impaired compared with healthy controls. Significant differences (P < 0.05) on domains of attention, planning time and visual memory were noted between FDRs and patients.

CONCLUSION

The present study supports set-shifting and inhibitory control and proposes visuoconstructive abilities and delayed verbal recall as potential endophenotypes for OCD.

Sex determination using mandibular ramus flexure: a preliminary study on Indian population

Determination of sex by morphological assessment has been one of the oldest approaches in forensic anthropology. Loth and Henneberg(6) introduced a morphological trait "Mandibular Ramus Flexure" for sex identification with a high accuracy of 99% in African Blacks. However, the population specificity of sexually dimorphic features is well known. The purpose of this study is to test the reliability of this trait in Indian population. A total number of 112 adult mandibles (88 males and 24 females) were studied from the Department of Forensic Medicine, Institute of Medical Sciences, Banaras Hindu University, India. The mandibles were scored according to the original method by two observers in three different sessions. This was done to test inter and intra-observer errors in identifying the trait. The result shows that this trait can be used to diagnose sex with an average accuracy of upto 82%. Though, inter and intra-observer errors were present but could be minimized with extended practice. So, the trait has the potential to be relied upon as a single morphological trait for determination of sex in Indian population.

Assessment of contamination of soil due to heavy metals around coal fired thermal power plants at Singrauli region of India

In the present study, an attempt was made to measure contamination of soil around four large coal-based Thermal Power Plants. The concentration of Cadmium, Lead, Arsenic and Nickel was estimated in all four directions from Thermal Power Plants. The soil in the study area was found to be contaminated to varying degrees from coal combustion byproducts. The soil drawn from various selected sites in each direction was largely contaminated by metals, predominantly higher within 2-4 km distance from Thermal Power Plant. Within 2-4 km, the mean maximum concentration of Cadmium, Lead, Arsenic and Nickel was 0.69, 13.69, 17.76, and 3.51 mg/kg, respectively. It was also observed that concentration was maximum in the prevalent wind direction. The concentration of Cadmium, Lead, Arsenic and Nickel was highest 0.69, 13.23, 17.29 and 3.56 mg/kg, respectively in west direction where wind was prevalent.

Sensory, cognitive and motor assessment of children with poor academic performance: an auditory evoked potential study

The present study aims to evaluate the auditory sensory process in the brainstem, thalamocortical and cortical areas by using auditory evoked potentials [auditory brainstem response (ABR), mid latency response (MLR) and slow vertex response (SVR)], cognitive functions by P300 and motor response by reaction time in children with poor academic performance. Thirty children between 6-12 years of age were selected as subjects on the basis of poor academic school records. While thirty children with good academic performance served as controls. The recordings were done using a computerized evoked potential recorder by 10-20 electrode placement system. There was no difference in the anthropometric parameters and IQ of the two groups. There was a significant increase in latency of waves II, III, IV and V, and Inter-peak latency I-V of ABR in poor performer females. All the component waves of MLR and SVR showed increased latency in the subjects but could not reach the level of significance. There was a significant increase in latencies of P300 at Cz and Pz electrode positions with no change in amplitude in poor performer females. The reaction time was also increased in the poor performer females as compared to the controls. The latencies of all the waves of ABR, P300 and reaction time are also increased in male poor performers as compared to male controls but could not reach the level of significance. The conduction of impulses is slower in pontine and midbrain auditory pathway along with inefficient cortical processing of task relevant stimuli and motor response in female children having poor academic performance.

A study of bone marrow failure syndrome in children

BACKGROUND

Bone marrow failure syndrome (BMFS), or aplastic anemia, includes peripheral blood single cytopenias, as well as pancytopenia due to inability of the marrow to effectively produce blood cells.

AIM

To study the clinico-hematological profile and etiological factors of bone marrow failure syndrome in children.

SETTING AND DESIGN

This prospective study was carried out in the Department of Pediatrics of a university teaching hospital over 36 months.

MATERIALS AND METHODS

Children with pancytopenia (Hb 9 /L, platelet count<100x10(9)/L) and bone marrow cellularity<25% were included in the study. History of exposure to drugs, socioeconomic status, ethnicity and occupation of father were noted. Bone marrow aspiration; trephine biopsy; Ham test; viral studies for hepatitis A, B and C; and cytogenetic investigations were carried out.

STATISTICAL ANALYSIS

Relative risk was estimated by odds ratio (OR) with 95% confidence interval (CI) in matched cases and controls.

RESULTS

Of the 53 children studied, 6 (11.3%) were diagnosed as Fanconi anemia. Two cases had features of myelodysplastic syndrome. Forty-five children were labeled as acquired aplastic anemia, of whom one had evidence of hepatitis B infection and two patients (5.8%) had paroxysmal nocturnal hemoglobinuria. Aplastic anemia was more common in children from family with lower socioeconomic status; in Muslims; and where the father's occupation was weaving, dyeing and painting. However, the number was small to make statistically significant conclusions. No correlation could be established with exposure to drugs.

CONCLUSION

Fanconi anemia was responsible for approximately one-tenth of the cases of bone marrow failure syndrome. Majority of the patients had acquired aplastic anemia. Hepatitis B infection was an uncommon cause of acquired aplastic anemia.

Role of steroids on the clinical course and outcome of meconium aspiration syndrome-a randomized controlled trial

BACKGROUND

Meconium aspiration syndrome (MAS) is one of the major causes of severe respiratory distress in the newborn and there is no uniform protocol of management after the development of MAS.

OBJECTIVE

The objective of the study was to determine whether systemic and inhalational steroid therapy can alter the clinical course of MAS and improve the outcome without causing any serious adverse effects.

METHODS

A randomized controlled trial was conducted in three groups of MAS over a period of 1 year. Group A (n = 33) served as controls, Group B (n = 34) received systemic methyl prednisolone and Group C (n = 32) received nebulized budesonide both for a period of 7 days starting after 24 h of age. Details of clinical progress were noted during the hospital stay. Follow up for a minimum period of 3 months was done in all. Data were analysed by SPSS 10 software. Student's t and ANOVA were used to assess statistical significance.

RESULTS

Patient profile was similar in all the three groups. Period of oxygen dependency and duration of hospital stay was significantly less in the steroid treated groups. Similarly full enteral feeding and radiological clearance of chest could be achieved earlier in groups B and C. No difference between the steroid treated groups could be appreciated by Student's Newman Kuel (SNK) test. Development of sepsis was similar in all the groups and no serious adverse effects were noted in steroid treated groups.

CONCLUSION

Steroids are effective in the management of MAS and route of administration does not have a bearing on the efficacy.

Estimation of CD4+ and CD8+ T-lymphocytes in human immunodeficiency virus infection and acquired immunodeficiency syndrome patients in Manipur

PURPOSE

To estimate and stratify CD4 + and CD8 + T-lymphocyte levels in human immunodeficiency virus (HIV) infected (asymptomatic) and acquired immunodeficiency syndrome (AIDS) patients (symptomatic) and correlate the clinical features of the patients with CD4+ and CD8+ lymphocyte level.

METHODS

Between April 2002 and September 2003, a total of 415 HIV seropositive adult patients (297 males and 118 females) attending Regional Institute of Medical Sciences (RIMS) hospitals were tested for CD4+ and CD8+ T-lymphocytes by fluorescent activated cell sorter (FACS) counter (Becton Dickinson). Symptomatic patients were diagnosed as per NACO clinical case definition.

RESULTS

Ranges of 0-50, 51-100, 101-200, 201-300, 301-400, 401-500 and above 500 CD4+ T-lymphocyte per microlitre were seen in 68, 52, 101, 73, 47, 31 and 43 patients respectively whereas CD8+ T-lymphocyte ranges of 0-300, 301-600, 601-900, 901-1500, 1501-2000, 2001-3500 per microlitre were seen in 29, 84, 92, 145, 40 and 25 patients respectively. One hundred and fifty patients were asymptomatic and 265 were symptomatic. CD4/CD8 ratio in asymptomatics and symptomatics were 0.13-1.69 and 0.01-0.93 respectively. Tuberculosis and candidiasis occurred in CD4+ T-lymphocyte categories between 0-400 cells per mL in symptomatics. However, cryptosporidiosis, toxoplasmosis, herpes zoster, cryptococcal meningitis, Pneumocystis carinii pneumonia, penicilliosis and cytomegalovirus retinitis were seen in patients having CD4+ T-lymphocyte less than 200 per mL.

CONCLUSIONS

CD4+ T-lymphocyte was decreased in both asymptomatic and symptomatic HIV patients, The decrease was greater in symptomatics while CD8+ T-lymphocyte was increased in both except advanced stage symptomatics. CD4:CD8 ratio was reversed in both groups. Opportunistic infections correlated with different CD4+ T-lymphocyte categories.

Serotonin and 5-hydroxy indole acetic acid in infantile hydrocephalus

The concentration of metabolites of neurohormones in cerebrospinal fluid (CSF) is an index of turnover of substances in brain parenchyma. The raised intracranial pressure in hydrocephalic children may cause alteration in the metabolism of neurohormones. Serotonin and its metabolite 5-HIAA have been studied extensively in CSF of patients with neuropsychiatric diseases. Hence we studied the neurohormones serotonin and its end product 5-hydroxy indole acetic acid (5-HIAA) in CSF of hydrocephalus infants before and after ventriculoperitoneal (VP) shunt. Ventricular CSF samples form 50 hydrocephalic infants were obtained serially at the time of shunt insertion, and then on day 8 and day 30 postoperatively by direct puncture from shunt chamber using 26G needles. Control CSF samples were taken from otherwise healthy children operated under spinal anesthesia. The samples were analyzed for serotonin and 5-HIAA by spectrofluorophotometric method. At the time of shunt insertion, serotonin was significantly decreased (P<0.05) while 5-HIAA was significantly increased (P<0.001) in hydrocephalic infants. On day 8 and day 30 values of serotonin and 5-HIAA approached the baseline values. In patients who developed VP shunt blockade there was again a rise in levels of 5-HIAA. However, no correlation could be established between the levels of serotonin, 5-HIAA and the duration of hydrocephalus and the type of hydrocephalus. Our study shows increased 5-HIAA concentration in CSF indicating increased turnover of serotonin to its metabolite due to pressure changes in hydrocephalus. Long-term follow-up is required to assess if they could be of prognostic significance as regards to long term attainment of brain functions in hydrocephalic children.

Maternal anthropometry as predictors of low birth weight

The usefulness of maternal anthropometric parameters i.e. maternal weight (MWt), maternal height (MHt), maternal mid-arm circumference (MMAC) and maternal body mass index (MBMI) as predictors of low birth weight (LBW) was studied in 395 singleton pregnancies. The maternal anthropometric parameters were measured in the first trimester of pregnancy and were plotted against the birth weight of the newborns. Significant positive correlations were observed among MWt and birth weight (r=0.38), MHt and birth weight (r=0.25), MMAC and birth weight (r=0.30) and MBMI and birth weight (r=0.30). The most sensitive being MWt (t=7.796), followed by MMAC (t=5.759), MHt (t=4.706) and MBMI (t=5.89). For prediction of LBW, the critical limits of MWt, MHt, MMAC and MBMI were 45 kg, 152 cm, 22.5 cm, 20 kg/m2 respectively. From these observations, the use of colour-coded weighing machines, height rods and tapes may be devised for use by peripheral health workers and traditional birth attendants for detection of mothers at risk of delivering low birth weight babies (Table 5). Mothers who have anthropometric parameters in the 'red zone' are at risk of delivery LBW infants.

Artemether vs quinine therapy in Plasmodium falciparum malaria in Manipur--a preliminary report

Qinghaosu and its derivatives are rapidly effective antimalarial drugs derived from a Chinese plant (sweet worm wood). Preliminary studies suggest that these drugs may be more effective than quinine in the treatment of Plasmodium falciparum malaria. A randomised double blind trial was conducted in 52 cases of Plasmodium falciparum malaria cases. In all 26 cases were given artemether and another 26 were given quinine. There were 2 (7.5%) deaths in artemether group and 4 (15%) deaths in quinine group. The parasites were cleared more quickly from the blood in artemether group when compared to quinine group (mean-72 hrs vs 96 hrs). Resolution of fever was comparable in both artemether and quinine group (mean-84 hrs vs 78 hrs) and also the average time of recovery from coma was more earlier in artemether group (mean-60 hrs vs 72 hrs). The only side effect noticed with artemether therapy was gastrointestinal (GI) intolerance while quinine therapy was associated with myocarditis, hypotension, hypoglycemia and GI intolerance.

Perceptual development in relation to nutritional status

The present study was conducted on 180 children in the age group 5-10 years. These children were divided accordingly their ages into 3 sub-groups i.e. 5-6, 7-8 and 9-10 years respectively. In each group 60 children were studied. For the assessment of perceptual skills each child was tested with the help of Picture Ambiguity Test. Responses to the ambiguous cards were scored with respect to time taken to react in each card and ability of the child to perceive figure and ground relationship i.e. centration and decentration. The observations showed that with increase in age, centration effect reduces and majority of the children start decentring their perception by middle childhood. Further, children in higher age group took lesser time to respond on different ambiguous cards. When the responses of well-nourished and undernourished children were compared for perceptual flexibility in terms of part-whole perception i.e. centration and decentration; no difference was observed between the two groups. There was a significant difference in the performance of well-nourished and undernourished children when time to respond on ambiguous card was compared. Well-nourished children took lesser time to respond on different ambiguous cards. These observations in general suggest that poor nutrition may result in impaired perceptual abilities in children.

Impact of the integrated child development services (ICDS) on maternal nutrition and birth weight in rural Varanasi

OBJECTIVE

To evaluate the impact of ICDS on maternal nutrition and birth weight.

SETTING

28 ICDS and 21 non-ICDS villages in two adjoining blocks of Varanasi.

METHODS

5289 pregnancies were registered during 1987-1993 in these two blocks. In the ICDS block 916 and 1453 nutrition supplemented and unsupplemented, respectively and 1748 of the non-ICDS live births with weight recorded within 48 h formed the study subjects.

RESULTS

The ICDS supplemented mothers gained 100g more in pregnancy and birth weight was higher by 58 g (p < 0.05) as compared to unsupplemented ICDS mothers. Birth weight in unsupplemented ICDS areas was 25g higher as compared to non ICDS area. ICDS supplemented women had a significantly smaller proportion of low birth weight babies (14.4%) compared to ICDS unsupplemented (20.4%) and non-ICDS women (26.3%). The corresponding prevalence of preterm births was 2.0, 2.4 and 4.3%, respectively (P < 0.001). Multiple regression analysis showed that increased wight gain in pregnancy, length of gestation, caloric intake and term hemoglobin were significantly associated with birth weight. However, the length of gestation was not influenced by factors improving the birth weight.

CONCLUSION

Undernourished pregnant women are benefitted by late pregnancy nutrition supplement

Neurobehavioural assessment of newborns

Twenty-one full term appropriate for gestational age (FT-AGA), 18 full term small for gestational age (FT-SGA), 18 preterm appropriate for gestational age (PT-AGA) and 15 babies who suffered birth anoxia constituted study subjects. They were subjected to neurobehavioural assessment using Brazelton neurobehaviour assessment scale. FT-SGA babies performed significantly poorly on motor and interactive processes only. No differences were found in terms of overall state organisation. PT-AGA also performed poorly on interactive and motor processes but were placed better than SGA babies. Here also no definite pattern was observed in organisational dimension. No significant effect of asphyxia on behavioural pattern of FT-AGA babies was observed when compared to FT-AGA non-anoxic babies.

Psycho-social dysfunctions in patients after recovery from mania and depression

Contrary to popular opinion, complete functional recovery does not occur in approximately 25% of patients with a diagnosis of mood disorders. The current study aimed at finding the recovery status in major mood disorders. A sample group of 122 patients (77 bipolar and 45 major depression) was selected from the outpatient department, fulfilling the DSM-IV diagnostic criteria. All patients had their index episodes at least one year prior to their date of inclusion and were either asymptomatic or mildly symptomatic during that time. Manics and depressives were rated with the Bech Raefelson Mania Scale (BRMS) and Hamilton Depression Rating Scale (HDRS) respectively. All the patients were also rated on the Brief Psychiatric Rating Scale (BPRS), Dysfunction Analysis Questionnaire (DAQ) and Global Evaluation Scale of Disability Assessment Schedule by WHO (GES/DAS). They were compared with 40 age and sex matched normal controls. It was found that the symptomatic recovery was better than the functional recovery in both manics and depressives and patients with major depression were marginally more dysfunctional compared to those with mania. It is concluded that a majority of patients of both mania and depression do not achieve complete functional recovery and are in need of on-going psychosocial rehabilitation.

Significance of Cryptosporidium in acute diarrhoea in North-Eastern India

In a hospital-based study, stool samples from 2095 patients of all ages were examined for different fungal, protozoal and bacterial enteropathogens over a period of 2 years (July 1994-June 1996). Cryptosporidium was detected in 151 specimens (7.2%) and was the third commonest pathogen found. The highest prevalence of this organism was in the group aged 16-45 years and during the rainy months (July-Oct.). Diarrhoea caused by the protozoon was of mild to moderate severity and features of dysentery were absent. Amongst other enteropathogens, Candida albicans was the most frequently isolated, followed by enteropathogenic and enterotoxigenic Escherichia coli, Salmonella spp., Campylobacter jejuni, Entamoeba histolytica, Giardia duodenalis (lamblia), Shigella spp., Vibrio cholerae and Aeromonas spp.

Diarrhoea associated with Candida spp.: incidence and seasonal variation

To study the incidence and seasonal variation of diarrhoea associated with Candida, 978 diarrhoeal stool specimens from patients of all age groups were examined by microscopy and culture. Candida spp. was the sole pathogen (unassociated with other diarrhoeagenic bacteria, protozoa, or helminths) in 15.3% of the total cases. Candida albicans (94.9%) was the predominant species isolated. The incidence was highest among the infants aged 0-12 months (37.1%), followed by a decline in the rest of the children aged less than 5 years with a second peak in the people aged over 5 years, including adults. The paediatric age group had a significantly higher incidence in the summer season compared to the rainy (p < 0.05) or winter (p < 0.01) months. Thus, there was a definite age and seasonal variation in the incidence of diarrhoea caused by the overgrowth of Candida in the Varanasi region of the Indian subcontinent.

Epidemic of herpes zoster following HIV epidemic in Manipur, India

Since 1989, injecting drug use (IDU) related HIV infection has affected thousands of young adults in Manipur, a north eastern state of India bordering Myanmar following a similar kind of epidemic in adjoining countries like Thailand and Myanmar. During a clinical surveillance of a group of HIV positive IDUs for a natural history study at Manipur, herpes zoster (HZ) emerged as the most specific early HIV related illness (positive predictive value of 100%) in patients belonging to the age group of 12-45 years. Data collected from the dermatology departments of the two main hospitals of the state revealed that there had been an epidemic of HZ since 1990 (rate of 1990 being 11.3/1000 compared to 6.5/1000 in 1989, P value < 0.0001) among males of 12-45 years. The epidemic of HZ has been attributed to the preceding epidemic of IDU related HIV in the same age and gender group occurring 1 year earlier. HZ should be recognised as a marker condition similar to tuberculosis indicating the necessity of screening for HIV in regions where the dual problem of IDU and HIV exist in young adults.