Role of faecal leucocytes in the diagnostic evaluation of acute diarrhoea

The value of faecal leucocyte examination was assessed in 400 infants with acute diarrhoea and 40 normal healthy infants. Enteropathogens were isolated from 28.75%. Escherichia coli was the commonest (16.5%) followed by Salmonella typhimurium (7%), Vibrio cholerae (3.25%) and Shigella flexneri (1.5%). Exudative response was observed in 57.1% of stools with Salmonella and 66.6% each with Shigella and E.I.E.C. infections. 81.3%, 89.5% and 87.7% of stools from which EPEC and ETEC and no enteropathogens respectively were isolated showed minimal or no Leucocytic response. The test is useful to recognise probable invasive bacterial diarrhoea and to decide the cases in which stool culture could be advantageous.

A study of high fat and cholesterol induced lipoprotein changes in first degree relatives of patients of myocardial infarction

The effect of seven days feeding of high cholesterol and high fat breakfast (HCFB) (79.5 g fat, 1655 mg cholesterol) and its withdrawal was studied on 20 first degree relatives of patients of myocardial infarction (Group A) and 18 controls (Group B). All subjects were young (30 years of age) and had no other risk factor for ischaemic heart disease (IHD). At basal level the first degree relatives had significantly lower values for all lipid fractions except that of HDL. In the control group seven days after giving HCFB a significant rise occurred in all lipid fractions except LDL. The rise of HDL was dominant which led to a significant reduction in LDL/HDL ratio. However, in the first degree relatives no significant change could be observed in any lipid fraction. Seven days after the withdrawal of HCFB there was a significant reduction in all lipid fractions in controls but in first degree relatives the cholesterol level increased significantly from its basal value. However, other lipid fractions showed no significant change, and LDL/HDL ratio remained constant throughout. These different types of behavioural responses to cholesterol could be helpful in identifying high risk hereditarily predisposed persons at early age when basal lipid values are inconclusive.

Focal spared area in fatty liver simulating a mass. Scintigraphic evaluation

The characterization of focally spared areas in a fatty liver may at times be problematic. This report illustrates the unique diagnostic role that combined xenon-133/technetium-99m sulfur colloid scintigraphy can play in such cases.

Modulation of morphine induced antinociception by intracerebroventricularly administered captopril

Captopril when administered intracerebroventricularly (icv) in doses of 100, 300, 500 and 1000 micrograms induced a dose dependent antinociceptive effect in rats. Naloxone pretreatment (10 mg/kg, ip) completely antagonised antinociceptive effect of captopril, suggesting thereby the involvement of brain enkephalinergic system. Captopril 300 micrograms, icv potentiated the antinociceptive effect of morphine in intact animals. The bilateral adrenalectomy did not have any effect on this potentiation as against the reported blockade of potentiation in adrenalectomized animals when captopril was administered by systemic route. Thus potentiation of morphine induced antinociception by icv captopril is unlikely to be exerted through an effect on adrenal function and is most likely due to increased brain enkephalin levels.

Calcium absorption in elderly subjects on high- and low-fiber diets: effect of gastric acidity

In vitro studies suggest that the effect of fiber in inhibiting calcium absorption is pH dependent. In nine normal, elderly control subjects and eight elderly subjects with achlorhydria, 47Ca was ingested with three test meals: a low-fiber meal (0.5 g dietary fiber), a high-fiber meal (10.5 g), and a high-fiber meal with 120 mL of 0.1 mol HC/L. In control subjects calcium retention, measured in a whole-body counter, was 25.7 +/- 4.0% (mean +/- SD) with the low-fiber meal, 19.1 +/- 1.9% with the high-fiber meal (P less than 0.002 vs low fiber), and 18.9 +/- 3.3% with the high-fiber-plus-acid meal (P less than 0.002 vs low fiber, NS vs high fiber). Calcium absorption in achlorhydric subjects was not different from control subjects: 26.2 +/- 8.0% with low fiber, 19.6 +/- 4.1% with high fiber (P less than 0.04 vs low fiber), and 21.0 +/- 5.8% with high fiber plus acid (P less than 0.04 vs low fiber, NS vs high fiber). We conclude that, in humans, the reduction in calcium absorption with high fiber intake is unaffected by gastric pH.

Relation of childhood malnutrition to parental education and mothers' nutrition related KAP

Severely malnourished children (26), weight for age 55.27 +/- 3.17, were identified in a colony of predominantly Muslim urban slum dwellers of low economic status. An equal number of normally nourished children matched for age, sex and per capita income were identified. A strong relation was found between nutritional status of the subjects and educational level of their mothers (P less than 0.025). Father's education was unrelated to childrens' nutritional status. A thirty seven point questionnaire was administered to the mothers to record their nutritional knowledge, attitudes and practices (KAP). Analysis revealed that better KAP in relation to 16 of these 37 questions was not associated with better nutritional status. Seven questions were found to have only a weak association. The remaining 14 questions were identified as important for a nutrition education programme. Comparison of nutritional KAP score based on these 14 questions in case of mothers of normal and severely malnourished children revealed a significantly higher score in the former. Questions related to growth monitoring and breast feeding were not found to be important. No significant association was found between mothers' KAP and educational level. It is concluded that (i) Maternal education and KAP are significantly and independently associated with childrens' nutritional status. (ii) The content areas of knowledge, attitudes and practices significantly associated with nutritional status pertain to nutritional requirements of children, nutritional value of foods, immunisation, hygiene, oral rehydration and diarrhea.

A study of dietary cholesterol induced changes in serum lipid lipoproteins in healthy male children, adolescents and middle aged volunteers

The present study comprised of 16 healthy male subjects of 8-12 years (Group A), 18 adolescent males (13-19 years) (Group B) and 20 middle aged volunteers (45-55 years) (Group C), who were fed a high cholesterol high fat diet (HCFD) consecutively for seven days. The serum lipid changes were noted. The diet was then withdrawn. Seven days later the lipid changes were again recorded. At basal stage, serum total cholesterol (STC), high density lipoprotein (HDL) and low density lipoprotein (LDL) were significantly higher in group C in comparison to Group A. LDL/HDL ratio was significantly lower in Group C than that of Group A. Seven days after feeding of HCFD significant elevations occurred in all the lipid subfractions of Groups AB. The rise in STC was mainly because of predominant rise in HDL leading to a significant fall in LDL/HDL ratio. In Group C, elevations occurred in all the lipid fractions except HDL that showed an insignificant rise. LDL/HDL ratio was insignificantly affected. After withdrawal of HCFD, all the lipid levels returned to normal except in Group A, where STC and LDL remained elevated. The LDL/HDL ratio again increased significantly. In conclusion, the serum lipid lipoprotein behaviour in response to HCFD is qualitatively different in young persons as compared to middle aged persons.

Effect of giardia infection on nutritional status of preschool children

Nutritional status of 34 children aged 24-72 months and infected with giardia was compared with that of 92 children matched for age, sex and income and 34 children matched for age, sex, income as well as birth order. Children without giardiasis were found to have better nutritional status in both comparisons. The difference was more pronounced in the second instance. Of the seven anthropometric parameters used for comparison, four were significantly lower (weight, weight for age, midarm circumference and midarm circumference for age), while two (height for age and weight for height) showed nonsignificant childhood malnutrition and that matching for birth order enhances the utility of case-control studies in children.

Post heparin lipoprotein lipase activity in patients of ischaemic heart disease and in controls

A single high fat meal diet (66 gm fat) was given to 30 healthy males and 20 male patients of ischaemic heart disease (IHD). Ten minutes prior to the 4th postprandial hour, 500 units of heparin--a lipoprotein lipase (LPL) activator--was given, and its effect seen on serum triglyceride (STG) levels observed. Besides higher fasting STG levels, the decline in 4 hour post-prandial STG level was significantly lower in patients of IHD. One explanation for higher fasting STG values and prolonged postprandial lipaemia in these subjects could be deficient LPL activity.

Capnocytophaga infection involving a portal-systemic vascular shunt

Capnocytophaga sp., a microaerophilic gram-negative isolate of the human oral cavity, has previously been reported to cause sinusitis, empyema, wound infections, conjunctivitis, subphrenic abscess, osteomyelitis, bacteremia, cervical abscess, and endocarditis. We report the unusual case of infection with this organism at the anastamotic site of a splenorenal portosystemic vascular shunt. In this case, the pathogenesis is presumed to be bacteremia related to mucosal trauma from endoscopic injection sclerotherapy or bacteremia secondary to dental infection. The characteristics and antibiotic sensitivities of Capnocytophaga are reviewed.

Recurrent acute pancreatitis as a manifestation of Wegener's granulomatosis

We report a case of recurrent acute pancreatitis in a 57-year-old man with reactivation of Wegener's granulomatosis. An association between acute pancreatitis and Wegener's granulomatosis has not been reported previously. Six episodes of abdominal pain and hyperamylasemia occurred and were complicated by development of a pancreatic pseudocyst. New cavitary lung lesions typical of Wegener's granulomatosis led to treatment with increased glucocorticoid dosage, resulting in rapid resolution of the pancreatitis and pulmonary lesions. Acute pancreatitis may be a clinical manifestation of the histologic pancreatic vasculitis observed in Wegener's granulomatosis. Reactivation of Wegener's granulomatosis should be considered when a patient with the disorder develops otherwise unexplained acute pancreatitis.

Anaerobic bacterial flora of wound sepsis

Two hundred specimens from wound infection (surgical and non-surgical) were cultured for the isolation of anaerobic and aerobic bacteria. Positive cultures were obtained in 174 (87%) and 26(13%) were sterile. Anaerobes were isolated from 31(17.8%), as single culture in 6(3.4%) and as mixed culture with aerobes in 25(14.3%). Amongst anaerobes, anaerobic cocci were predominant (45.9%). Of aerobes Staph pyogenes (35%) was predominant. Metronidazole was the most effective drug against anaerobes and gentamicin against aerobes. No significant difference was noted in antimicrobial susceptibility of anaerobes of surgical and non-surgical wounds. Among aerobes high resistance was observed in surgical wounds.

Haemagglutination antibody titres & immunoglobulin levels in cases of Plasmodium infection

Malarial antibody estimation was done in patients with malaria (50), and fever (malaria negative, 50) and in 50 healthy controls who gave no history of malaria for the last one year, using the indirect haemagglutination test (IHA). Seropositivity was 78, 32 and 4 per cent respectively. Levels of IgG and IgM were found to be significantly higher in patients as compared to controls and a significant fall was observed in IgA levels in patients of malaria. Although the malarial antibody titre showed good correlation with IgG (P less than 0.01) and IgM (P less than 0.05) not all patients with a negative haemagglutination antibody titre had normal immunoglobulin levels.

Effect of age on tests of intestinal and hepatic function in healthy humans

We studied intestinal function and hepatic microsomal phase I monooxygenase function in healthy, free-living subjects, aged 19-91 yr. In subjects (n = 114) given a diet including 100 g/day of fat, fecal fat in a 72-h collection did not increase with advancing age. D-Xylose excretion (n = 54) following a 25-g oral load significantly declined with increasing age, but a concomitant decline in creatinine clearance suggested a decrease in renal function rather than an absorptive defect. Furthermore, there was no evidence for an age-associated increase in bile salt deconjugation by intestinal bacteria as shown by the glycocholate breath test (n = 60). Finally, there was no evidence for a decrease in hepatic microsomal function with advancing age as measured by the aminopyrine breath test (n = 60). We conclude that digestive/absorptive and hepatic microsomal phase I monooxygenase function are well preserved in healthy humans throughout life.

Effect of administration and withdrawal of oral contraceptive pills on serum lipids and lipoproteins

We studied the effects of oral contraceptive pills (OCP) supplied by the Govt of India in its Family Welfare Campaign, on serum lipid levels of women. The OCP, containing 30 micrograms ethinyl estradiol and 1 mg of norethisterone acetate were administered to the women for six months continuously and serum lipid levels were estimated after three and six months of the treatment. There were no significant changes in serum cholesterol, high density lipoprotein (HDL), low density lipoprotein (LDL), serum triglycerides and very low density lipoprotein (VLDL). In a simultaneous study we also measured serum lipid levels at 3 and 6 months after withdrawal of the pills in women who had been receiving OCP containing 50 micrograms of ethinyl estradiol and 0.5 mg of one of the progesterones for the past 1 1/2 to 2 years continuously. Only serum LDL level fell significantly (P less than 0.01) on 3 months withdrawal period. It is concluded that 6 months of usage of the OCP marketed by the Govt. of India does not affect the serum lipid profile.

Primary sclerosing cholangitis and low-dose oral pulse methotrexate therapy. Clinical and histologic response

Two patients with sclerosing cholangitis responded to low-dose methotrexate treatment. A 40-year-old man who had previously undergone total colectomy for ulcerative colitis presented with refractory erythroderma and sclerosing cholangitis. Both disorders were alleviated and have remained in remission on methotrexate, 5 mg every 12 hours three times each week (15 mg/wk). Liver function improved, bile duct scarring did not worsen, and repeat liver biopsy samples have shown striking improvement. A 60-year-old man with long-standing ulcerative colitis and repeated exacerbations of sclerosing cholangitis had a similar response to low-dose methotrexate, 2.5 mg every 12 hours three times each week (7.5 mg/wk), during a 6-year period. Recurrent episodes of cholangitis have disappeared, liver function has become normal, bile duct scarring has not worsened, and liver histologic findings have become normal. Because of the potential hepatotoxicity of methotrexate, we suggest that a prospective, randomized trial be done.

Cellular immune response following thermal injury in human patients

Cellular immune response was studied longitudinally for a period of 1 month in a group of 51 patients sustaining burns between 20 and 55 per cent of their body surface area. The results indicated lymphocytopenia and significant depression in the total T cells in all the patients. T cells showed a significant rise in their levels in those patients who showed clinical improvement. Further, the loss of expression of 'E' receptor correlated with the lowering of the protein-synthesizing capacity of the mononuclear cells. The functional integrity of the lymphocytes also showed an inability to recognize and stimulate normal alloantigens in an MLR reaction. Investigation of the mechanisms responsible for immunosuppression revealed the generation of T suppressor activity.

Cellular immune mechanisms in thermally injured mice

An attempt was made to establish an animal model for analysing the cellular immune alterations following thermal injury and to correlate the results with those obtained in humans. A standard burn involving 20 per cent of the body surface area was established in C57 black mice (b1). The results revealed a loss of total T cells until post-burn day 10 and an increase in B cells only during post-burn day 1. The lymphocyte proliferative response to PHA was elevated with the appearance of null cells on post-burn day 10. This observation revealed a generalized depression in the immune responses which was significant until post-burn day 10. However, the results were not comparable with the human studies.

Partial purification and some properties of a latent CO2 reductase from green potato tuber chloroplasts

We have partially purified the CO2 reductase, present in green potato tuber chloroplasts, as a latent form. Illumination of the chloroplasts in the absence of substrate, bicarbonate, activated the enzyme, which could then be obtained in soluble forms. Purification of the enzyme was achieved by (NH4)2SO4 fractionation (0-30%) and adsorption and elution from a DEAE-Sephadex A-50 column. The final preparation showed 15-fold purification and 50% recovery of the activity. The pH optimum for CO2 reductase was 8.0. Hepes and Tricine buffers showed maximum activity whereas Tris/phosphate or borate failed to show any activity. The enzyme reaction was sensitive to the presence of metal ions like Fe3+, Hg2+, Cu2+, Mo6+ and Zn2+, however, a threefold activation was observed with Fe2+. The metal requirement for CO2 reductase was evident from the observed inhibition by metal chelators like o-phenanthroline, alpha, alpha'-dipyridyl, bathocuproine, 8-hydroxyquinoline etc. Out of these o-phenanthroline was the strongest inhibitor and its concentration for 50% inhibition was 40 microM. The presence of Fe2+ ions in the reaction mixture protected the enzyme from heat denaturation upto 50 degrees C. Maximum enzyme activity was observed at 15 degrees C. The enzyme activity showed a 30-s lag period and the maximum was reached in 90 s. Supplementation of sodium dithionite in the reaction activated enzyme activity threefold, suggesting involvement of dithiol groups in the catalytic activity. There was strong inhibition by -SH inhibitors like 5,5'-dithiobis(2-nitrobenzoic acid) and N-ethylmaleimide and -SH reagents like dithiothreitol, 2-mercaptoethanol and cysteine. Various nucleotide coenzyme tried inhibited the enzyme strongly.

Burn sera mediated effects on the E-rosetting property of normal active T1 cells

This study investigates the suppressive effects of burn sera on normal active T1 cells. The results revealed that burn sera collected from survivors and non-survivors during the initial 'shock' phase caused varied effects on the 'E' rosetting properties of normal active T1 cells. However, unlike non-survivor sera convalescent or recovery sera failed to block the 'E' rosetting property of T1 cells. Furthermore, cold incubation in fetal calf sera (FCS) failed to abrogate the loss of T1 cells which were exposed to non-survivor (early) sera; these samples also revealed the presence of antigenic factors. Our experiments were extended to investigate the mechanisms resulting in the irreversible change, and showed that the inhibiting factors could be acting at the microtubular level of the cell cortex.

"Malignant" contracture of the eye socket

A new method for reconstruction of "malignant" contracture of the eye socket is described using a simple procedure based on the principle of epithelial inlay. The lining consists of a free skin graft. No cumbersome external appliances for the prevention of contraction of the graft are used; hence the hospitalization is minimized. The results have been satisfactory.

Fc and complement receptor integrity of polymorphonuclear (PMN) cells following thermal injury

In patients sustaining thermal injury, a sequential study was formulated to evaluate Fc and complement receptor expression of polymorphonuclear cells (PMN). Additionally, the role of factors in burn sera and maturity of PMN cells in the circulation were studied. The salient features of the study were: Marked reduction in Fc receptor expression by the 5th day of injury in both survivors and non-survivors. Thereafter levels gradually increased in survivors, though they were still below the normal range. In non-survivors, the depression was severe and persistent. In contrast to Fc receptor expression, complement receptor integrity was not grossly affected in both survivors and non-survivors. Burn sera collected from survivors on the 5th and 13th post-burn day showed reduction in Fc receptor expression of normal PMN cells, whereas sera obtained a month after the injury exhibited no inhibitory effect. Non-survivors sera inhibited Fc receptor expression of normal PMN cells on 5th, 13th and 21st post-burn days. The appearance, increase and disappearance of immature PMN cells in the circulation was correlated with the clinical progress of the patient. Mechanisms involved in the aberrations and its implications are discussed.

Intracranial venous aneurysms: vein of Galen and other similar vascular anomalies

Aneurysmal dilatation of the vein of Galen is peculiar to arteriovenous malformation around the midbrain. Similar venous aneurysms may rarely occur in other regions. This paper deals with the radiographic findings in three cases of vascular malformation associated with giant venous aneurysms. The pathophysiology resulting in aneurysmal venous dilatation is discussed based on our material and those previously reported.

Dermatosis papulosa nigra

The incidence and natural history of dermatosis papulosa nigra was assessed in eighty-two black patients. The overall incidence in the study population was 77 percent, with a predominance in women of almost 2:1. Fifty-four percent of these patients reported that other members of their families were also affected. The peak incidence and number of lesions occurred in those patients in their sixties. Fair-complexioned blacks had the lowest frequency of involvement. These findings confirm those of other investigators; however, we report a higher than average incidence of involvement in the population we studied.

Microglioma--unusual computed tomographic appearance and course of neoplasm

Microglioma accounts for 0.8-1.5% of primary brain tumors. Eight cases of primary lymphoma of brain are presented. 50% of the patients demonstrated unusual computed tomographic appearances. These patients were divided into three groups depending on clinical outcome. Survival seems to be related to treatment modality. Longest survival times were in patients treated with radiation alone or radiation following biopsy.

Epidermoid tumor of the fourth ventricle: use of metrizamide-computed tomography

This report describes two cases of epidermoid tumor of the fourth ventricle diagnosed with metrizamide computed tomography. They both presented as a low-density lesion in the region of the fourth ventricle on computed tomography. They did not show any enhancement after intravenous injection of contrast medium and had no hydrocephalus. Metrizamide-enhanced computed tomography demonstrated the irregular fourth-ventricular filling defect characteristic of epidermoid tumors.

Accidental overdose intoxication: a hazard of drug smuggling

Three patients involved in illicit drug smuggling via the swallowing of high dose, high purity drugs packed in multiple condoms are reported. Two of these patients experienced drug overdose symptoms due to leakage or rupture of the condoms in the GI tract. They were treated successfully.

Failure of acetyl salicylic acid (aspirin) to reduce experimental myocardial ischaemic damage

Rats fed on acetylsalicylic acid (aspirin) 1.5 mg/100 g body weight for a period of three weeks were subjected to myocardial infarction by s.c. administration isoprenaline hydrochloride 8.5 mg/100 g of body weight on two consecutive days. Heart specimens were taken for histological examination at 24 hr, on 5th day and 12th day. An equal number of rats were given saline to serve as control. As compared to controls aspirin-treated rats were found to have macroscopically bigger infarcts and microscopically showed persistent oedema on the 12th day. Further, no histological evidence of favourable action of aspirin was seen on the fifth day and after twenty-four hr.

The long-term use of garlic in ischemic heart disease--an appraisal

The hypocholesterolemic and fibrinolysis-enhancing properties of garlic were assessed in patients with ischemic heart disease (IHD) and in healthy control subjects. The peak of blood fibrinolytic activity (BFA) achieved at the 4th week of garlic therapy was not sustained despite its continuous use and returned to about the pre-garlic values at the 12th week. Garlic withdrawal did not cause any further change in BFA. Under the same conditions serum total cholesterol (STC) values did not show any significant change. Both of the foregoing features were observed in the IHD as well as in the control group. Garlic therapy for 12 weeks did not cause any appreciable changes in serum triglyceride, beta-lipoprotein, plasma fibrinogen levels or coagulation time in either IHD or control subjects. The evidence cited above does not appear to substantiate the prevalent popular belief in the efficacy of garlic in the management of IHD either as a hypocholesterolemic or as a fibrinolytic agent.