Zinc supplementation in young children with acute diarrhea in India

BACKGROUND

In developing countries the duration and severity of diarrheal illnesses are greatest among infants and young children with malnutrition and impaired immune status, both factors that may be associated with zinc deficiency. In children with severe zinc deficiency, diarrhea is common and responds quickly to zinc supplementation.

METHODS

To evaluate the effects of daily supplementation with 20 mg of elemental zinc on the duration and severity of acute diarrhea, we conducted a double-blind, randomized, controlled trial involving 937 children, 6 to 35 months of age, in New Delhi, India. All the children also received oral rehydration therapy and vitamin supplements.

RESULTS

Among the children who received zinc supplementation, there was a 23 percent reduction (95 percent confidence interval, 12 percent to 32 percent) in the risk of continued diarrhea. Estimates of the likelihood of recovery according to the day of zinc supplementation revealed a reduction of 7 percent (95 percent confidence interval, -9 percent to +22 percent) in the risk of continued diarrhea during days 1 through 3 and a reduction of 38 percent (95 percent confidence interval, 27 percent to 48 percent) after day 3. When zinc supplementation was initiated within three days of the onset of diarrhea, there was a 39 percent reduction (95 percent confidence interval, 7 percent to 61 percent) in the proportion of episodes lasting more than seven days. In the zinc-supplementation group there was a decrease of 39 percent (95 percent confidence interval, 6 percent to 70 percent) in the mean number of watery stools per day (P = 0.02) and a decrease of 21 percent (95 percent confidence interval, 10 percent to 31 percent) in the number of days with watery diarrhea. The reductions in the duration and severity of diarrhea were greater in children with stunted growth than in those with normal growth.

CONCLUSION

For infants and young children with acute diarrhea, zinc supplementation results in clinically important reductions in the duration and severity of diarrhea.

A study on estimation of age from pubic symphysis

The present study has been carried on 82 pairs of pubic symphysis collected from fresh male cadavers. Various features were noted on the symphyseal surface--ridges and furrows, dorsal margin, ventral bevelling, lower extremity, ossific nodule, upper extremity, ventral rampart, dorsal plateau and symphyseal rim. Varying combination of these features were used as criteria for age estimation of the subjects.

Dopamine D3-preferring ligands act at synthesis modulating autoreceptors

Several compounds exist that demonstrate a binding preference for cloned dopamine D3 receptors vs. D2 receptors, including (+/-)7-OH DPAT, (+)-UH232 and (+)-AJ76. Inasmuch as recent evidence suggests that the dopamine D3 receptor may function as a dopamine autoreceptor, we have investigated the ability of these D3-preferring ligands to act at synthesis modulating dopamine autoreceptors using the gamma-butyro-lactone model in vivo to isolate the presynaptic effects of (+/-)7-OH DPAT, (+)-UH232 and (+)-AJ76. Further, given the discrete anatomical distribution of the D3 receptor, the striatum, n. Accumbens, and olfactory tubercles were examined for comparative analyses. (+/-)7-OH DPAT displayed agonist characteristics at synthesis modulating dopamine autoreceptors with a greater potency in the olfactory tubercle vs. either the striatum or the nucleus accumbens (ED-50 values were 31.8, 38.1 and 10.2 micrograms/kg for the striatum, nucleus accumbens and olfactory tubercles, respectively). Further, (+)-UH232 and (+)-AJ76 attenuated the effects of (+/-)7-OH DPAT (60 micrograms/kg s.c.) in all three regions examined. However, the effects of (+/-)7-OH DPAT were antagonized to a lesser extent in the olfactory tubercles than in either the striatum or the nucleus accumbens. Given the relative abundance of D3 receptors in the olfactory tubercles, the data are consistent with the notion that (+/-)7-OH DPAT may exert its autoreceptor effects preferentially through dopamine D3 receptors.

Purification, characterization and antitumor activity of L-asparaginase isolated from Pseudomonas stutzeri MB-405

An L-asparaginase produced by Pseudomonas stutzeri MB-405 was isolated and characterized. After initial ammonium sulfate fractionation, the enzyme was purified by consecutive column chromatography on Sephadex G-100, Ca-hydroxylapatite, and DEAE-Sephadex A-50. The 665.5-fold purified enzyme thus obtained has the specific activity of 732.3 units mg protein-1 with an overall recovery of 27.2%. The apparent M(r) of the enzyme under nondenaturing and denaturing conditions was 34 kDa and 33 kDa respectively, and the isoelectric point was 6.38 +/- 0.02. It displayed optimum activity at pH 9.0 and 37 degrees C. The enzyme was very specific for L-asparagine and did not hydrolyze L-glutaminate. The Km of the L-asparaginase was found to be 1.45 x 10(-4) M towards L-asparagine and was competitively inhibited by 5-diazo-4-oxo-L- norvaline (DONV) with a Ki of 0.03 mM. Metal ions such as Mn2+, Zn2+, Hg2+, Fe3+, Ni2+, and Cd2+ potentially inhibited the enzyme activity. The activity was enhanced in the presence of thiol-protecting reagents such as DTT, 2-ME, and glutathione (reduced), but inhibited by PCMB and iodoacetamide. The tumor inhibition study with Dalton's lymphoma tumor cells in vivo indicated that this enzyme possesses antitumor properties.

Death Acceptance: A two-Component Formulation and Scale

A formulation of death acceptance involving two components, confrontation and integration, is presented and discussed in the light of the literature on death attitudes. A proposed scale (Klug Death Acceptance Scale) to measure the two-component concept is also provided, including data on the scale's reliability and validity, along with some suggested norms. The contribution of this research is the clarification of the theoretical rationale for a multi-dimensional approach to death acceptance, an operationalization of the theory, and a proposed scale to measure it. Additional research on diverse populations, and a variety of measurement approaches, is needed to further establish the reliability and validity of the instrument.

Complementary effects of pravastatin and nicotinic acid in the treatment of combined hyperlipidaemia in diabetic and non-diabetic patients

BACKGROUND

Given that treatment with a single drug is frequently unsuccessful in patients with combined hyperlipidaemia, there is a rationale for the study of regimens using drugs that have complementary therapeutic profiles. We therefore set out to compare the efficacy of a combined pravastatin and nicotinic acid regimen with higher dose monotherapy using either drug in patients with non-insulin-dependent diabetes and in non-diabetic patients with combined hyperlipidaemia.

METHODS

Forty-four patients with total-cholesterol levels of 6.5 mmol/l or higher and triglyceride levels of 2.5 mmol/l or above were randomly assigned to receive either pravastatin alone (40mg/day) or nicotinic acid alone (1500mg/day) for 12 weeks. At the end of this period, the participants received a combination of pravastatin (20mg/day) and nicotinic acid (1000mg/day) for a further 12 weeks. The lipid parameters measured included levels of total cholesterol, triglycerides, low-density-lipoprotein (LDL) cholesterol and high-density-lipoprotein (HDL) cholesterol.

RESULTS

Thirty-three patients (22 without and 11 with diabetes) completed the protocol. Monotherapy with pravastatin was more effective than that with nicotinic acid in reducing levels of total cholesterol (-24.9 versus -9.8%, P<0.001) and LDL cholesterol (-32.1 versus -16.9%, P < 0.01), similar in reducing levels of triglyceride (-28.0 versus -31.8%, NS) and tended to be less effective in elevating levels of HDL cholesterol (+16.4 versus +30.8%, P = 0.06). Combination therapy was more effective than pravastatin monotherapy in reducing levels of triglyceride (-39.3 versus -28.0%, P < 0.05) and elevating those of HDL cholesterol (+35.6 versus +16.4%, P < 0.001) and was equally effective in reducing total-cholesterol (-22.3 versus -24.9%, NS) and LDL-cholesterol (-27.1 versus -32.1%, NS) levels. Combination therapy was more effective than nicotinic acid monotherapy in reducing levels of total cholesterol (-23.8 versus -9.8%, P < 0.001), triglyceride (-39.4 versus -31.8%, P < 0.05) and LDL cholesterol (-35.7 versus -16.9%, P < 0.05) and equally effective in elevating HDL-cholesterol levels (+33.6 versus +30.8%, NS). Diabetic and non-diabetic participants responded similarly to combination therapy. Eleven patients (25%) were withdrawn from the study: nine as a result of nicotinic acid intolerance (flushing and nausea) and one through pravastatin intolerance (nausea); one patient died of a myocardial infarction. Combination therapy elevated glycosylated haemoglobin A1c levels in non-diabetic patients (5.5 to 5.8%, P < 0.001); in diabetic patients, however, the observed rise (7.4 to 7.9%) was not statistically significant. Fasting plasma glucose levels, liver function tests and levels of creatine kinase or uric acid were unaffected by either monotherapy or by combination therapy, with the exception of an elevation of the glucose level in diabetic patients receiving nicotinic acid monotherapy.

CONCLUSION

Pravastatin and nicotinic acid in lower-dose combination are more effective than pravastatin alone in reducing levels of triglyceride and elevating those of HDL cholesterol and are more effective than nicotinic acid alone in reducing total-cholesterol triglyceride and LDL-cholesterol levels. Combination therapy is equally effective in type-II diabetic and non-diabetic people. The complementary effects of the combination therapy on lipid levels suggest that this regimen should be considered as a therapeutic option in patients with combined hyperlipidaemia who tolerate the side effects of nicotinic acid.

Significance of spina bifida occulta in children with diurnal enuresis

We reviewed retrospectively 456 patients with diurnal enuresis to determine the relationship between spina bifida occulta and attainment of continence. Of these patients 127 had undergone x-rays of the spine and 48 children (48%) had spina bifida occulta. The clinical course of these patients was compared to 79 enuretic children with normal spine films. All patients were initially treated with a timed voiding program and 28 with persistent enuresis were given anticholinergic medication. Findings on urodynamic studies were similar for both groups. Uninhibited bladder contractions were found in the majority of patients and 2 children in each group had hypertonic filling curves. Of 10 children with spina bifida occulta magnetic resonance imaging or ultrasound of the spine revealed lipoma and tethering of the cord in 1. Mean followup for both groups was 3 years. The outcome for enuretic children with spina bifida occulta was comparable to those with normal spine x-rays. The majority of patients had resolution of the enuresis with conservative management. Spinal ultrasound or magnetic resonance imaging may be warranted in those children with abnormal neurological findings on examination or hypertonic filling curves, or those who fail to respond to medical treatment. However, neurosurgical intervention to achieve continence appears necessary in only a small percentage of enuretic children with spina bifida occulta.

Osteomyelitis

Osteomyelitis can be difficult to treat. Current trends emphasize early diagnosis and aggressive treatment. Imaging has improved with nuclear scans and magnetic resonance imaging, and recent modifications in technique have enhanced the specificity. Treatment depends on debridement of necrotic bone and tissue, obtaining accurate cultures, and administration of culture- and sensitivity-directed antibiotics. Antibiotic delivery has expanded to include effective oral agents and local agents mixed with polymethylmethacrylate or a biodegradable substance. Success rates in treating this disease have improved with a systematic approach, making outcome more predictable.

Cryptococcal meningitis (C. neoformans var. gattii) leading to blindness in previously healthy Melanesian adults in Papua New Guinea

Cryptococcal meningitis is a common cause of chronic meningitis in Papua New Guinea, affecting apparently immunocompetent people. The majority of infections are believed to be due to Cryptococcus neoformans var. gattii. We have reviewed the records of 49 Melanesian adults who presented with proven cryptococcal meningitis to the University teaching hospital in Port Moresby, and compare our findings with other published studies of cryptococcal meningitis in the tropics and sub-tropics. None of the patients had an obvious cause of immunosuppression. Visual disturbances and fundoscopic changes of papilloedema or papillitis were particularly common. The in-hospital case fatality rate for patients treated with amphotericin B and flucytosine was 22.4%. Of the fully treated patients, 31% became completely blind before being discharged from hospital. Therapy directly aimed at reducing intracranial pressure may improve outcome.

Progressive decline in renal function in diabetic patients with and without albuminuria

This study describes patterns of progression of albuminuria and renal function in a subgroup of 40 patients from a total cohort of 211 diabetic patients (118 type I, 93 type II) followed over a period of 8-14 years. Forty patients (18 with type I diabetes, 22 with type II diabetes) showed progressive increases in albumin excretion rate (AER) and/or decreases in creatinine clearance (CC) during the study period. Of these, AER alone increased in 15 patients, AER increased and CC decreased in 13 patients, and CC alone decreased in 12 patients, with a similar distribution of type I and type II diabetic patients in each group. Of the 28 patients who showed an increase in albuminuria, AER increased at an annual rate of 30-40%, resulting in a 4- to 8-fold increase in AER to > 20 micrograms/min during the study. Of the 25 patients who showed a decrease in renal function, CC decreased at an annual rate of 4-5 ml/min, resulting in an approximate halving of CC to < 90 ml/min during the study. The rate of fall in CC was not related to the presence or absence of concomitant increases in albuminuria. However, a significant preponderance of women in the group showed a decline in CC alone. The decline in CC was associated with an increase in plasma creatinine as well as a progressive decrease in urinary creatinine excretion, but the underlying mechanisms remain unexplained. These data support the concept that a subgroup of diabetic patients may show a decline in renal function in the absence of significant increases in AER.(ABSTRACT TRUNCATED AT 250 WORDS)

Congenital fistula of the penile urethra

Congenital fistula of the penile urethra is rare. We report a case associated with glandular hypospadias without chordee, and discuss the possible etiology and management of this unusual anomaly.

A field trial of Billings' ovulation method for spacing and limitation of birth

In spite of constant efforts by health and social workers, existing family planning measures are not used by a vast majority of eligible couples. This is because of the fear that the method may affect their health and happiness. Billings' ovulation method is based on the scientific observation that by noting the changes in cervical mucus, which is clear, slippery and copious in periovulatory period, it is possible to prevent pregnancy by avoiding intercourse during this period. As this method does not require the use of drugs or devices it was decided to promote this method in the urban areas and slums of Patna, Bihar where couples were not using other methods. This is not a comparative study of the cost-effectiveness of Billings' ovulation method versus other contraceptive measures at all. An analysis of 501 cases (267 in urban and 234 in slums) over a period of 2 1/2 years has been presented and it is gratifying to note that the couples from all religions and strata of the society (nearly 47% were slum dwellers) agreed to continue this method.

Relationship of progressively increasing albuminuria to apoprotein(a) and blood pressure in type 2 (non-insulin-dependent) and type 1 (insulin-dependent) diabetic patients

This study has explored the temporal relationship between apoprotein(a), blood pressure and albuminuria over a mean interval of 11 years in a cohort of 107 diabetic patients of whom 26 (14 Type 2 (non-insulin-dependent), 12 Type 1 (insulin-dependent) had progressively increasing albuminuria ('progressors'). In Type 2 diabetic patients, no significant differences were noted for HbA1, blood pressure, creatinine clearance or serum lipids between progressors and non-progressors. In Type 1 diabetic patients, final systolic and diastolic blood pressures were higher in progressors compared with non-progressors and progressors showed impairment of renal function in association with a rise in blood pressure at the macroalbuminuric stage. Initial apoprotein(a) levels were similar in progressors and non-progressors of either diabetes type. Apoprotein(a) levels increased exponentially with time in 12 of 14 Type 2 progressors but only in 5 of 12 Type 1 progressors (p < 0.01). In Type 2 diabetic patients, the annual increase in apoprotein(a) levels was 9.1 +/- 2.4%, which was significantly greater than in non-progressors, 2.0 +/- 1.2% (p < 0.01) and also exceeded the rates of increase of apoprotein(a) in progressors with Type 1 diabetes, 4.0 +/- 1.4%, (p < 0.05). Apoprotein(a) levels correlated significantly with albuminuria in 8 of 14 Type 2 progressors but only in 3 of 12 Type 1 progressors (p < 0.05). The rate of increase of apoprotein(a) levels was not related to mean HbA1, creatinine or creatinine clearance levels, or to albuminuria.(ABSTRACT TRUNCATED AT 250 WORDS)

Fertility and reproduction following inversion of uterus

Puerperal inversion of the uterus is itself a rare occurrence. Records of fertility and reproduction following an episode of uterine inversion are even rarer. The reproductive outcome following correction of uterine inversion in 6 cases seen over a span of 35 years is being reported here. One case of acute inversion was managed by manual replacement and the remaining 5 of chronic inversion were corrected by Haultain's operation. The only patient managed by manual replacement conceived thrice. She aborted once, but delivered 2 healthy live babies subsequently by caesarean section done for uterine inertia each time. Out of the 5 patients treated by Haultain's technique, 3 conceived later. One did not come for follow-up after the 5th month. Each of the other 2 had full-term normal delivery of living baby under supervision. None of the cases had any complications. It is concluded that even after operative correction of inversion, uncomplicated delivery may be anticipated. Conservative surgical management is ideal even in apparently neglected and chronic cases, as most of these women were primipara or multipara with only one or 2 living children and had a desire of future child bearing.

Dermal complication of the bowel bypass syndrome: a case report

Bowel bypass surgery, which involves shortening the small bowel to about 45 cm, is a modality of treatment for morbid obesity. Although this procedure is not routinely performed today, patients with complications from this procedure are still seen by physicians. The case of a patient who had bowel bypass surgery and experienced subsequent complications is discussed.

Effect of Vibrio cholerae-L-asparaginase on surface structure of splenic lymphocytes

The surface ultrastructure of splenic lymphocytes and rosetting properties of lymphocytes of Swiss mice were studied under scanning electron microscope following transplantation of Dalton's lymphoma and ascites fibrosarcoma tumour cells and administration of Vibrio cholerae-L-asparaginase. The results were compared to those obtained with the standard Escherichia coli-L-asparaginase. The surface structure of the lymphocytes (T cells) following L-asparaginase administration was not so different from that of normal lymphocytes. V. cholerae-L-asparaginase did not cause higher number of rosette formation in T cells as compared to the normal group. The study thus revealed that V. cholerae-L-asparaginase did not have a significant stimulatory or non-immunosuppressive effect on the lymphocyte functions.

Induction of specific enzymes of the oxidative pentose phosphate pathway by glucono-delta-lactone in Saccharomyces cerevisiae

Growth of Saccharomyces cerevisiae on D-glucono-delta-lactone (delta gl) was found to be associated with a specific coordinate induction of the synthesis of two enzymes of the oxidative pentose phosphate pathway--6-phosphogluconate dehydrogenase and 6-phosphogluconolactonase--together with that of a third enzyme, gluconokinase. The gnd1 mutation, responsible for an approximately 80% loss of 6-phosphogluconate dehydrogenase activity and the inability of the cells to grow on delta gl, completely abolished the induction of all three enzymes, while the gnd2 mutation affected this only partially. One class of gnd1 revertants, selected for growth on delta gl, was found to have recovered normal dehydrogenase activity and the ability to synthesize the three enzymes when induced by delta gl. Another class of delta gl-positive revertants possessed constitutively elevated levels of gluconokinase. In contrast, glucose-positive revertants of gnd1, with restored constitutive dehydrogenase activity, continued to remain deficient in induction of the three enzymes and also failed to grow on delta gl. Induction of 6-phosphogluconate dehydrogenase activity was associated with increased transcription of the gene coding for the major isoenzyme; the transcript remained undetectable in the gnd1 mutant. Induction of these specific enzymes thus appears to be essential for growth of S. cerevisiae on delta gl.

Induction of L-asparaginase synthesis in Vibrio proteus

Studies on L-asparaginase synthesis in V. proteus showed increased synthesis in cultures grown under conditions of moderate aeration (P less than 0.005) after oxygen had been used up from the medium. Addition of sodium lactate to the medium at a concentration of 80 mu mole/ml, stimulated L-asparaginase synthesis (2.2 times over control) in moderately-aerated cultures (P less than 0.001). The substrate L-asparagine induced enzyme synthesis when growth conditions were made anaerobic or lactate was incorporated into the medium (3.8 times increased enzyme synthesis over control).

Sheep erythrocytes provide metabolic triggers for tumour phagocytosis in polymorphonuclear neutrophils: a possible mechanism of tumour inhibition in mice

Intraperitoneal (i.p.) injection of 7% Sheep Erythrocytes (SRBC) was found to inhibit growth of a transplanted tumour and exhibit a consequent increase in total survival compared to untreated tumour controls. In an attempt to probe into the mechanism(s) involved, functional aspects of Polymorphonuclear Neutrophils (PMNs) were investigated in terms of their 'metabolic (respiratory) burst' during tumour phagocytosis. Both NADPH-Oxidase mediated superoxide anion (O2-.) formation (NBT reduction) and Myeloperoxidase (MPO) mediated oxidisable halide incorporation (131I incorporation) were found to be highly stimulated by SRBC in normal (CS) and tumour bearing counterparts (TS). A little tumour mediated residual inhibition persists on the MPO system in PMNs of animals with tumour plus SRBC (TS) which, however, showed an obvious bonus effect over the tumour controls (TC). The results suggest a possible mechanism of tumour inhibition by SRBC in mice with the involvement of highly stimulated phagocytic metabolism in PMNs.