Nitric oxide radicals in leucocytes and vaginal washes of Trichomonas vaginalis -infected symptomatic and asymptomatic women

The clinical spectrum of Trichomonas vaginalis infection varies from asymptomatic to mild, moderate or severe vaginitis. Nitric oxide and other reactive nitrogen radicals produced by immune effector cells are important cytotoxic and cytostatic mediators against several microorganisms including parasites. In the present study, inducible nitric oxide synthase (iNOS) and reactive nitrogen intermediates (RNI) were determined in leucocyte cultures (stimulated with T. vaginalis in vitro) and vaginal washes (VWs) of 22 symptomatic and 20 asymptomatic T. vaginalis-infected and 20 healthy women by immunoblotting and Griess method respectively. The iNOS protein was detected in leucocytes and VWs of all the symptomatic and asymptomatic women, but was not detected in any of the samples from healthy women. Mean iNOS protein band intensity was significantly higher in leucocytes as compared to VWs (P<0.001) of both symptomatic and asymptomatic women and was also higher in leucocytes of asymptomatic as compared to symptomatic women (P<0.05). Mean RNI concentration was also significantly higher in leucocytes (P<0.01) and VWs (P<0.05) of asymptomatic as compared to symptomatic women, and was also higher in samples of infected as compared to healthy women (P<0.001). These results suggest that reactive nitrogen radicals may have a role in limiting T. vaginalis infection in asymptomatic women.

Marine water quality assessment at Mumbai West Coast

In recent past, Mumbai Municipal corporation was not able to keep pace with required infrastructural facilities due to unprecedented population growth. Sewage disposal is one of the major issues, which needed immediate attention because huge quantity of sewage with only preliminary treatment is disposed into the nearby coastal areas and has deteriorated the water quality of the near coastal region. World Bank assisted Bombay Sewage Disposal Project (BSDP) undertaken by the Municipal Corporation of Bruhan Mumbai (MCBM) envisaged sewage discharges through marine outfalls at Worli and Bandra and treatment by aerated lagoons for other areas before disposal in creeks. During BSDP programme, studies were undertaken on water quality assessment along the west coast of Mumbai before and after commissioning of the Worli outfall. A pre- and post-commissioning water quality database for selected parameters was generated for near shore as well as west coast region up to 5 km seaward distance to assess the efficacy of the Worli outfall and delineate the areas affected around diffuser location of the outfall due to sewage disposal. This paper presents observations of the coastal studies at Mumbai and the impact zone of Worli outfall.

Kinetics of immunoglobulin G, M, A and IgG subclass responses in experimental intravaginal trichomoniasis: prominence of IgG1 response

Trichomoniasis, the most common nonviral sexually transmitted disease, is caused by infection with the protist Trichomonas vaginalis. The clinical spectrum varies from an asymptomatic state to mild, moderate or severe symptoms. However, the exact factors leading to varied symptomatology have not been well elucidated. The mouse is a useful experimental model for intravaginal trichomoniasis, for understanding the role of local immune responses in the pathogenesis and varied symptomatology of this disease. The present study reports anti-Trichomonas IgG, IgM, IgA and IgG subclass antibody responses on different post-infection days (3rd, 7th, 14th, 21st and 28th) in serum and vaginal washes of mice infected intravaginally with T. vaginalis isolates from 15 symptomatic and 15 asymptomatic women. Successful intravaginal infection was established by inoculating T. vaginalis in BALB/c mice pre-inoculated with Lactobacillus acidophilus and pretreated with oestradiol. A significant increase in parasite load was observed on the 14th post-infection day (p.i.d.) in mice inoculated with T. vaginalis isolates from symptomatic women as compared to asymptomatic women (P < 0.001), followed by reduction until the 28th p.i.d. (P < 0.05). A significant increase in specific IgG (P < 0.001) and in particular IgG1 (P < 0.001) and IgM (P < 0.01) responses was observed on the 14th p.i.d. in serum and vaginal washes of mice infected with T. vaginalis isolates from symptomatic women as compared to asymptomatic women. Significant increases in specific IgG, IgM and IgG1 responses was observed on the 14th p.i.d. in serum samples as compared with vaginal washes of mice infected with T. vaginalis isolates from symptomatic and asymptomatic women (P < 0.01), whereas no significant difference was observed in IgA, IgG2a, IgG2b and IgG3 antibody responses. The study indicates that specific IgG, particularly IgG1 and IgM, may be playing a role in establishing symptomatic infection.

Tocolytic therapy in conservative management of symptomatic placenta previa

OBJECTIVES

To study the effect of ritodrine therapy on maternal and perinatal outcome in cases of symptomatic placenta previa being managed conservatively.

METHODS

A prospective, randomized controlled clinical trial was made of a total of 60 women whose pregnancies ranged from 28 through 34 menstrual weeks who were randomly allocated to the two study groups using Tippet's random number table. Of these women, 30 were included in the study group where tocolysis with ritodrine was given whereas the other 30 in the control group did not receive tocolysis. Prolongation of pregnancy and birth weight of the newborn were evaluated. The unpaired t-test and chi-square test were used for statistical analysis.

RESULTS

Use of tocolysis in symptomatic placenta previa was associated with significant prolongation of pregnancy (25.33 vs. 14.47 days, P<0.05) and difference in birth weight (2270 g vs. 1950 g, P<0.05). There was no observed statistical difference between the two groups with regard to number of episodes of hemorrhage after admission, total amount of blood loss during stay in hospital, number of blood transfusions and maternal complications due to tocolysis in the study group.

CONCLUSIONS

The present prospective study suggests that ritodrine hydrochloride in patients with symptomatic placenta previa tends to prolong the pregnancy and result in an increase in birth weight of the babies without causing any adverse effect on the mother and fetus.

Specific IgA response, T-cell subtype and cytokine profile in experimental intravaginal trichomoniasis

Trichomoniasis caused by Trichomonas vaginalis may lead to either a complete absence of symptoms or to severe inflammatory manifestations in infected women. Studies of the role of immune responses in the pathogenesis and varied symptomatology of this disease are lacking. Mice may prove useful as an experimental model for intravaginal trichomoniasis in developing an understanding of the role of local immune responses in the pathogenesis and varied symptomatology of this disease. The present study reports the levels of anti-Trichomonas IgA antibodies in serum and vaginal washes, and T-cell subtype and cytokine profile in vaginal cervical tissues of mice infected intravaginally with T. vaginalis isolates from 15 symptomatic and 15 asymptomatic women. It also correlates the responses with symptomatology of the patients. Successful intravaginal infection was established by inoculating T. vaginalis in BALB/c mice preinoculated with Lactobacillus acidophilus and pretreated with oestradiol. A significant increase in specific IgA antibody levels was detected with enzyme-linked immunosorbent assay in vaginal secretions and serum samples collected on the 7th post-infection day from animals infected with isolates from asymptomatic women when compared with mice infected with isolates from symptomatic women. T-cell subset analysis showed significant differences, with increased CD4+ T-cell count in animals infected with isolates from asymptomatic women compared with animals infected using isolates from symptomatic women. No difference in CD8+ T cells was observed between the two groups. Cytokine profile revealed significantly higher (P < 0.001) production of gamma-IFN and IL-2 in mice infected with asymptomatic isolates compared with animals infected with symptomatic isolates, using T. vaginalis crude antigen extract and nonspecific mitogen (ConA) as stimulants for vaginal cervical lymphocytes. However, no difference in IL-4 levels was observed in the two groups of animals. In contrast, significant increase in tumour necrosis factor (TNF-alpha) levels was observed in animals infected with asymptomatic isolates compared with those infected with isolates from symptomatic women and controls, thereby indicating that TNF-alpha may play an important role in the inflammatory response to trichomoniasis. The study further suggests that specific IgA antibodies might help to protect asymptomatic individuals from severe infection and T-lymphocytes may play an important function in the eradication of the parasite. The cytokine profile indicated the involvement of Th-1 like responses in mice infected with asymptomatic isolates, compared with those infected with symptomatic isolates.

Effects of gum resin of Boswellia serrata in patients with chronic colitis

Patients studied here suffered from chronic colitis characterized by vague lower abdominal pain, bleeding per rectum with diarrhoea and palpable tender descending and sigmoid colon. The inflammatory process in colitis is associated with increased formation of leukotrienes causing chemotaxis, chemokinesis, synthesis of superoxide radicals and release of lysosomal enzymes by phagocytes. The key enzyme for leukotriene biosynthesis is 5-lipoxygenase. Boswellic acids were found to be non-redox, non-competitive specific inhibitors of the enzyme 5-lipoxygenase. We studied the gum resin of Boswellia serrata for the treatment of this disease. Thirty patients, 17 males and 13 females in the age range of 18 to 48 years with chronic colitis were included in this study. Twenty patients were given a preparation of the gum resin of Boswellia serrata (900 mg daily divided in three doses for 6 weeks) and ten patients were given sulfasalazine (3 gm daily divided in three doses for 6 weeks) and served as controls. Out of 20 patients treated with Boswellia gum resin 18 patients showed an improvement in one or more of the parameters: including stool properties, histopathology as well as scanning electron microscopy, besides haemoglobin, serum iron, calcium, phosphorus, proteins, total leukocytes and eosinophils. In the control group 6 out of 10 patients showed similar results with the same parameters. Out of 20 patients treated with Boswellia gum resin 14 went into remission while in case of sulfasalazine remission rate was 4 out of 10. In conclusion, this study shows that a gum resin preparation from Boswellia serrata could be effective in the treatment of chronic colitis with minimal side effects.

Prevalence of behavioral problems in school going children

The study was conducted on 957 school children using Rutter B scale which was to be completed by the class teachers in Ludhiana, India. One hundred and forty-one children (14.6%) scored more than 9 points and were included in the second part of the study. An equal number of sex matched children scoring less than 9 points served as controls. Both these groups were called for an interview with a child psychiatrist along with their parents. Only 117 and 124 children turned up and were included in the analysis. Based on the screening instrument results and parental interview, 45.6% of the children were estimated to have behavioural problems, of which 36.5% had significant problems. It was noticed that neither the screening instrument nor the interview was able to detect all the problems. Scholastic under-achievement was found to be associated with maximum problems. Scholastic under-achievement can be a useful starting point of identifying children with behavioural problems. Close cooperation between school teachers, parents, and health care providers is essential to ensure healthy development of children.

Behavioral problems in school-going children: implications for medical teachers in developing countries

A large number of children suffer from behavioral problems during their development. Many of these problems are transient and may not even be noticed. At times, however, the extent of these problems and their overall effects on a child's development can be serious (Morita et al., 1993). Further, children may exhibit these behaviors in one setting and not in others (e.g. at home or in school, but not both). In developed countries, parents tend to seek advice for even minor problems, such as persistent thumb sucking, while in developing countries, major problems, even childhood schizophrenia, may go unattended. An awareness of the prevalence of these problems is important so that appropriate mental health services can be planned and provided for affected children, to improve their prospects for leading healthy, productive lives. Such awareness can help enhance the teaching of graduate doctors, equipping them to deal with these problems effectively.

Oxidative stress in cucumber (Cucumis sativus L) seedlings treated with acifluorfen

Treatment of diphenyl ether herbicide acifluorfen-Na (AF-Na) to intact cucumber (Cucumis sativus L cv Poinsette) seedlings induced overaccumulation of protoporphyrin IX in light (75 mumole m-2 s-1). The extra-plastidic protoporphyrin IX accumulated during the light exposure disappeared within two hours of transfer of acifluorofen-treated seedlings to darkness. The dark disappearance was due to re-entry of migrated protoporphyrin IX into the plastid and its subsequent conversion to protochlorophyllide. In light, protoporphyrin IX acted as a photosensitizer and caused generation of active oxygen species. The latter caused damage to the cellular membranes by peroxidation of membrane lipids that resulted in production of malondialdehyde. Damage to the plastidic membranes resulted in damage to photosystem I and photosystem II reactions. Dark-incubation of herbicide-sprayed plants before their exposure to light enhanced photodynamic damage due to diffusion of the herbicide to the site of action. Compared to control, in treated samples the cation-induced increases in variable fluorescence/maximum fluorescence ratio and increase in photosystem II activity was lower due to reduced grana stacking in herbicide-treated and light-exposed plants.

Serum ferritin level as a marker of preterm labor

OBJECTIVE

To compare the serum ferritin levels in women with preterm labor (PTL) or preterm premature rupture of membranes with those in normal gravid women.

METHOD

The study group consisted of 50 consecutive subjects with preterm labor and 49 subjects with preterm premature rupture of membranes (PROM). The control group consisted of 50 subjects matched with the study group for hemoglobin (Hb) and gestation who did not have PTL or preterm PROM. Serum ferritin levels were assayed in both the groups.

RESULTS

Mean serum ferritin levels in patients with preterm labor and preterm premature rupture of membranes were 23.24+/-12.13 ng/ml and 29.44+/-28.41 ng/ml, respectively. The mean serum ferritin in control subjects was 8.69+/-3.7 ng/ml. The difference was evaluated by Student's t-test and was found to be statistically significant.

CONCLUSION

The serum ferritin level is significantly raised in pregnant women with preterm labor and preterm PROM.

Estimation of cord blood erythropoietin in pre-eclampsia and eclampsia

OBJECTIVE

The estimation of cord blood erythropoietin in subjects with pre-eclampsia and eclampsia.

METHOD

Erythropoietin was measured, using ELISA, in the cord blood of infants born to 83 mothers with pre-eclampsia, and 7 with eclampsia. Another 90 subjects with no evidence of pre-eclampsia or eclampsia were taken as control subjects. Maternal parity, gestational age, blood pressures, 24-h urine protein and Apgar scores of the infants delivered were also noted.

RESULT

Cord blood erythropoietin levels were statistically significantly higher (P<0.001) in infants born to mothers with pre-eclampsia and eclampsia. There was a significant positive correlation (P<0.01) between cord blood erythropoietin levels and maternal blood pressure (systolic and diastolic) and albuminuria. A negative correlation (P<0.01) was observed with the birth weights of infants.

CONCLUSION

Pre-eclampsia and eclampsia are associated with higher levels of cord blood erythropoietin.

Serial plasma fibronectin levels in pre-eclamptic and normotensive women

OBJECTIVE

Endothelial cell damage has been put forward as an underlying factor for development of pre-eclampsia. This study was carried out to see if fibronectin, which is a marker of endothelial damage, could be used as a marker of pre-eclampsia.

METHODS

A longitudinal study was conducted on 100 normotensive primigravidae registered before 20 weeks of gestation. These subjects were followed until delivery and three blood samples were collected, first at registration, i.e. before 20 weeks, second around 28 weeks and third at 36 weeks or later till delivery. Fibronectin levels were assayed by ELISA and women observed for any signs of pre-eclampsia.

RESULTS

Fourteen subjects developed pre-eclampsia. Fibronectin levels were observed to rise as pregnancy advanced but the rise was significantly higher in subjects who developed pre-eclampsia. The fibronectin levels were also significantly higher in these 14 subjects even in the first sample, i.e. before 20 weeks of gestation when compared with normotensive subjects (P < 0.01).

CONCLUSIONS

Fibronectin levels could be used as an early valuable biomarker for the development of pre-eclampsia.

Evaluation of serum creatine kinase as a diagnostic marker for tubal pregnancy

Forty women comprising of 20 each in study and control groups had their serum creatine kinase (CK) estimated. The study subjects were proven cases of ectopic pregnancy and the controls were either medical termination of pregnancy seekers or antenatal cases matched for gestational age and with a confirmed intrauterine pregnancy. Total serum creatine kinase levels were found to be significantly higher in the study group i.e. 34.15 +/- 1.17 IU/L compared to the controls 18.72 +/- 1.25 (p < 0.001). Creatine kinase is estimated routinely in cardiac patients even on an emergency basis. Our findings indicate that when in doubt the test could be used as a marker for the diagnosis of ectopic pregnancy.

Anticoagulation in atrial fibrillation in older people

There is controversy and apprehension regarding the routine use of oral anticoagulants in atrial fibrillation, especially in elderly people. Based on current evidence, however, patients with non-rheumatic atrial fibrillation who have no obvious contraindications to warfarin should receive prophylactic anticoagulant therapy for prevention of embolic stroke. Patients unable to tolerate warfarin would benefit from aspirin. It is poor clinical practice to await transient ischaemic attacks or a stroke before considering anticoagulation, and it should be remembered that cost–benefit values need to include the cost of rehabilitation and long-term care.

An unusual presentation of gestational trophoblastic disease

We report a case of gestational trophoblastic disease leading to an acute abdomen due to a haemoperitoneum in a young multipara.

Reactive oxygen intermediates and reactive nitrogen intermediates in copper intrauterine device users

The mechanism of action of copper in copper intrauterine devices (Cu IUD) as an antimicrobial agent is not well understood. Copper and iron are supposed to be responsible for release of reactive oxygen intermediates (ROI) and reactive nitrogen intermediates (RNI), which are very active in the presence of infection. The copper in a copper IUD could be responsible for limiting pelvic inflammatory disease. The present study was composed of 20 IUD seekers in whom ROI and RNI were studied before insertion of Cu IUD and then at 1, 4, and 12 weeks afterward. ROI showed a rise after insertion, whereas RNI showed a steady decline. Hence, it is presumed that the rise in ROI could be responsible for both the bactericidal effect of Cu IUD and also for the fall in RNI.

Effects of Boswellia serrata gum resin in patients with bronchial asthma: results of a double-blind, placebo-controlled, 6-week clinical study

The gum resin of Boswellia serrata, known in Indian Ayurvedic system of medicine as Salai guggal, contains boswellic acids, which have been shown to inhibit leukotriene biosynthesis. In a double-blind, placebo-controlled study forty patients, 23 males and 17 females in the age range of 18 - 75 years having mean duration of illness, bronchial asthma, of 9.58 +/- 6.07 years were treated with a preparation of gum resin of 300 mg thrice daily for a period of 6 weeks. 70% of patients showed improvement of disease as evident by disappearance of physical symptoms and signs such as dyspnoea, rhonchi, number of attacks, increase in FEV subset1, FVC and PEFR as well as decrease in eosinophilic count and ESR. In the control group of 40 patients 16 males and 24 females in the age range of 14-58 years with mean of 32.95 +/- 12.68 were treated with lactose 300 mg thrice daily for 6 weeks. Only 27% of patients in the control group showed improvement. The data show a definite role of gum resin of Boswellia serrata in the treatment of bronchial asthma.

Role of antigen specific circulating immune complexes in diagnosis of tuberculosis

SETTING

Tuberculosis is a public health problem worldwide. Early accurate diagnosis in patients with active disease is essential to reduce morbidity and mortality. Conventional methods for detection of Mycobacterium tuberculosis have given disappointing results.

OBJECTIVE

To evaluate the utility of detection of M. tuberculosis antigen in circulating immune complexes (CIC) for the diagnosis of tuberculosis.

METHOD

Eighty-four clinically diagnosed cases of mainly extra-pulmonary tuberculosis, 85 patients with diseases other than tuberculosis and 30 healthy controls, were evaluated for the presence of antigen of M. tuberculosis in CIC in serum using sandwich enzyme linked immunosorbent assay (ELISA).

RESULTS

In total, 22 out of 84 cases were positive for culture on Lowenstein Jensen medium; 76.5% (n = 65) of the clinically diagnosed patients (including 20 culture-positive cases) were found to be positive by ELISA. The difference in mean absorbance values of ELISA in cases of tuberculosis was significantly higher than in controls. The sensitivity of ELISA was 90.9% and the specificity was 93.04%.

CONCLUSION

Detection of M. tuberculosis antigen in CIC by ELISA has potential as a useful diagnostic tool for the rapid diagnosis of tuberculosis, especially extra-pulmonary forms where results of conventional methods of diagnosis are disappointing.

Immunohistochemical analysis of human embryos and fetuses: an insight into the mechanism of subversion of antigenic differentiation in neoplasia

OBJECTIVES

Immunohistochemical identification of intermediate filaments and other cell identity markers is of immense value in diagnostic tumor pathology. However, the literature contains many examples of inappropriate expression of markers by various tumors or coexpression of two or more markers supposedly specific for different cell types. The present study investigated this subversion of antigen differentiation in tumors by using developing tissues as a model.

MATERIALS AND METHODS

Twenty-five human embryos and fetuses of 4 to 24 weeks' gestation were studied. An indirect immunoperoxidase method was applied to formalin-fixed, paraffin-embedded sections using a panel of 13 commonly used cell identity markers including intermediate filaments.

RESULTS

During early development, vimentin was found to be coexpressed with cytokeratin in surface ectoderm, developing notochord, renal tubule epithelium, and intestinal mucosa. It coexpressed with glial fibrillary acidic protein in developing neuroglial tissue, with S100 in cartilage, and with skeletal muscle markers in myotubules. Hence, vimentin represents immaturity of tissues and is coexpressed with specific cell markers to be eventually replaced by the latter. Transbarrier expression of cytokeratin in smooth muscle was also noted.

CONCLUSION

The aberrant expression of antigens in neoplastic tissues, as reported in the literature, simulates the varying expression of antigens in immature tissues during development. Hence, it is proposed that the phenomenon of antigenic subversion in neoplasia is related to the process of maturation and differentiation.

Nitrites and L-citrulline levels in copper intrauterine device users

The mechanism of copper in limiting intrauterine infections in intrauterine device (Cu IUD) users is poorly understood. Copper ions may enhance the release of reactive oxygen radicals, which in turn decrease the release of reactive nitrogen intermediates (RNI). RNI are known to have bactericidal effect. The present study compares the levels of RNI prior to Cu-T insertion and at different post-insertion intervals up to 12 weeks. The decrease in RNI was evident by one week and continued until 12 weeks. Therefore, the bactericidal effect of copper in IUD is via reactive oxygen intermediates. The superoxide anion inactivates this active intermediate nitric oxide. Therefore, excess of superoxide radical will markedly shorten the half-life of nitric oxide but will not prevent its conversion to nitrites and nitrates.

Increasing toxoplasma seropositivity in women with bad obstetric history and in newborns

BACKGROUND

Most infants with congenital Toxoplasma gondii infection have no symptoms at birth but few may develop retinal diseases or neurological abnormalities later in life. The presence of significant titres of antitoxoplasma antibodies in women in the reproductive age group indirectly indicates that Toxoplasma gondii is the cause of such congenital abnormalities and also sporadic abortions in some women.

METHODS

We did a retrospective analysis of antitoxoplasma antibodies detected by indirect haemagglutination assay, in women with bad obstetrical history and in newborns clinically suspected of congenital toxoplasmosis during 1981-91.

RESULTS

A significant increase in seropositivity in women and newborns was seen during 1989-91 as compared to 1981-88. More seropositive patients were recorded between April-June and October-December. However, no significant correlation could be observed between rising incidence of seropositivity and the seasonal distribution or age of women.

CONCLUSION

Epidemiological studies are required to ascertain the reason for the increasing trend of toxoplasma seropositivity and to suggest appropriate control strategies as it is possible to prevent congenital infection.

Effects of Boswellia serrata gum resin in patients with ulcerative colitis

Ulcerative colitis is a chronic inflammatory disease of the colon where leukotrienes are suggested to play an important role for keeping inflammation active. Boswellic acids, the biologically active ingredients of the gum resin of Boswellia serrata (Sallai guggal), have been shown to be specific, nonredox and noncompetitive inhibitors of 5-lipoxygenase, the key enzyme of leukotriene biosynthesis. In patients suffering from ulcerative colitis grade II and III the effect of Boswellia serrata gum resin preparation (350 mg thrice daily for 6 weeks) on stool properties, histolopathology and scan microscopy of rectal biopsies, blood parameters including Hb, serum iron, calcium, phosphorus, proteins, total leukocytes and eosinophils was studied. Patients receiving sulfasalazine (1 g thrice daily) served as controls. All parameters tested improved after treatment with Boswellia serrata gum resin, the results being similar compared to controls: 82% out of treated patients went into remission; in case of sulfasalazine remission rate was 75%.

Midodrine efficacy and pharmacokinetics in a patient with recurrent intradialytic hypotension

Recurrent intradialytic hypotension, a complication of hemodialysis, is a consequence of an inadequate compensatory response or a paradoxic response to ultrafiltration-induced volume reduction. We report the use of midodrine, an alpha agonist, in an 18-year-old man with Bardet-Biedl syndrome and recurrent intradialytic hypotension. The clinical features of the intradialytic hypotensive spells are consistent with a paradoxic withdrawal of sympathetic activity, although an underlying abnormality in autonomic dysfunction cannot be excluded. Midodrine significantly increased the intradialytic blood pressure and decreased the intradialytic hypotensive episodes requiring intervention. The pharmacokinetic characteristics of the prodrug midodrine and the active metabolite de-glymidodrine in this patient with end-stage renal disease approximate those reported for patients with normal renal function. However, the prolonged terminal half-life for the active metabolite, de-glymidodrine, warrants careful administration in patients with renal failure.

A normative study of child development using a culture-appropriate test battery in rural Haryana, India

A culture-appropriate and simple test battery consisting of 67 test items was developed and field tested in Haryana, India, in 1987-89. Trained field workers administered the tests to 3731 preschool children in 47 randomly selected villages of a district, irrespective of their physical/mental status. Centile age values were constructed for various developmental milestones included in the cultural-appropriate test battery. The locally relevant, simple, and low cost developmental tests and reference values will be used for early detection of developmental disabilities at primary care level.

Hepatitis-B vaccination in pregnancy: safety and immunogenic response in mothers and antibody transfer to neonates

Hepatitis B infection during pregnancy causes increased, maternal morbidity and perinatal mortality. No specific therapy is available, hence neonatal immunoprophylaxis is recommended by WHO. However, the advantages of maternal immunization are manifold. Therefore, 15 pregnant HBsAg negative women were studied after 3 dozes of hepatitis B specific vaccine. No untoward effects of vaccine were observed and a good immunogenic response with very high antibody titres 178 IU/l and 184 IU/l at delivery and 3 months post delivery respectively were noted. Passive transfer of antibodies to the neonates was 100% at birth but these levels declined rapidly. Hence hepatitis B specific vaccine is safe and immunogenic in pregnant women and protects their babies in the immediate neonatal period.

Copper levels & reactive oxygen species in uterine flushings in copper intrauterine contraceptive device users

Copper levels were estimated in the uterine flushings in 15 copper 'T' 200 device acceptors. There was a statistically significant difference in the preinsertion and one week post insertion values (P < 0.001). This also corresponded to a high level of generation of reactive oxygen species. The levels of reactive oxygen species were similar to preinsertion values at 4 and 12 wk. The copper values declined over the 3 months but were still higher at 12 wk as compared to preinsertion levels and this difference was statistically significant. Hence addition of copper to the intrauterine device besides enhancing the contraceptive efficacy, perhaps also plays an important role in microbicidal activity and helps in overcoming the infection introduced at the time of insertion.

Study of T-lymphocyte subpopulation in HBsAg-positive pregnant women

Pregnancy can alter the immunologic status, especially it can suppress the cell-mediated immunity. The super-imposition of viral infection on the pregnant state leading to further immunosuppression was the subject of this study. 1109 pregnant women were enrolled and screened for hepatitis B surface antigen (HBsAg) carrier status; 25 HBsAg carriers were identified by reverse passive haemagglutination assay (RPHA) and their T-lymphocyte subsets were determined using monoclonal antibodies (MoAbs). It was observed that there was a significant fall in the total T-cells (CD3+) and T-helper cells (CD4+) in the pregnant HBsAg carriers accompanied by a rise in the T-suppressor cell (CD8+) population as compared to HBsAg-negative pregnant controls. These data demonstrate a weakening of immune status in pregnancy associated with HBsAg carrier state.

Active oxygen species in copper intrauterine device users

The mechanism of copper intrauterine device (Cu IUD) in limiting intrauterine infections is poorly understood. Copper ions may enhance the release of reactive oxygen species which are deleterious to the microbes. The present study compares the oxidative responses of adherent cell population of uterus prior to Cu-T insertion and at different post-insertion intervals. Increase in reactive oxygen intermediates was evident at 1 week post-insertion. However, the release of active oxygen species decreased thereafter. Further, these responses were only a local phenomenon as the peripheral blood monocytes failed to produce appreciable change following Cu-T insertion. Results suggest the protective role of active oxygen species in Cu IUD users which lasts for a brief period. The withering of respiratory burst activity later on may possibly prevent endometrial damage.

Prescription drug use in lactating mothers: an experience at a referral hospital and in a community in India

The aim of the study was to investigate the extent of prescription drugs administered for common disorders during the post partum period. This is a prospective survey of disorders and drug use in 1) immediate postpartum mothers (n = 200) admitted to the maternity wards, 2) in post-natal hospital follow-up clinic (n = 200) and in 3) the rural home based community (n = 100). A pretested questionnaire was filled in by medical officers after interviewing the mothers. The mean age of the mothers was 25 years and a literacy rate of 50% above the 10th grade. Over 80% of the women were multigravida in the entire sample; 45% underwent Caesarean Section in a hospital; 97.6% had a normal delivery in the community. In the hospital settings 4.1% infants had jaundice and 1% had congenital anomalies. In the community setting, diarrhoea and pneumonia was seen in 2.6% of the infants. Apart from the use of nutritional supplements, such as iron, calcium, multivitamins etc., most commonly prescribed drugs were analgesics (in 70% of patients in the hospital settings, 56% of the patients in the postnatal clinic and 37.6% patients in the community), and antibiotics (90% of the patients in the hospital settings, 86% of the patients in the postnatal clinic and 13% of the community based patients). Antihypertensives agents (2.5% of the patients), digoxin (1.5% of the patients), bronchodilators (1% of the patients) and sedatives (3.5% of the patients) were prescribed to admitted patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Multiple vascular profiles in the umbilical cord; an indication of maternal smoking habits and intrauterine distress

A total of 644 umbilical cords were examined over a period of 5 years, 40 cords (6.2 per cent) showed more than the normal three vascular profiles on cross-section. Both the umbilical arteries and vein showed multiple profiles, although arterial profiles were far more commonly multiple. Clinical data were correlated with the histological findings. Heavy smoking was significantly associated with multiple vascular profiles. Maternal age and rhesus group were not significantly related however, but there was some association with primiparity. Fetuses with a gestational age between 33 and 38 weeks were significantly more likely to have multiple vessels than either fetuses beyond 38 weeks or less than 33 weeks gestation. Multiple channels also occurred significantly more frequently in still birth than in live birth cords. We suggest that multiple vascular profiles represent a response to intrauterine hypoxia. Inflammation of the cord was associated with multiple channels and suggests linkage between these two indications of fetal distress.

Use of hepatitis B vaccine alone or in combination with hepatitis B immunoglobulin for immunoprophylaxis of perinatal hepatitis B infection

The efficacy of hepatitis B vaccine alone or in combination with immunoglobulin in neonates born to HBsAG positive mothers was investigated. Twenty-four infants were given three doses (at 0, 1, 2 months) of the vaccine alone, while 27 infants were given hepatitis B immunoglobulin (HBIG) and three doses of the vaccine. Fifty-eight infants born to HBsAg positive mothers who did not agree for vaccination or could not come for follow-up constituted the control group. The overall seroprotection rates (anti-HBS levels > or = 10 IU/l) were almost similar in both the groups at 6 months (81 and 76 per cent, respectively). However, the seroprotection rates in babies born to HBeAg positive mothers were better with combination of HBIG and vaccine (71 v. 57 per cent, respectively). It was also observed that seroprotection rates in babies born to anti-HBe positive mothers were even better (100 and 90 per cent in vaccine alone and combination group, respectively). No chronic carrier was detected in babies born to anti-HBe positive mothers.

Microbiological studies in mid-trimester abortion with Emcredil versus normal saline

In 40 mid-trimester abortion seekers, in whom abortion was induced by extra-amniotic normal saline or Emcredil, microbiological studies were carried out before induction and at 24 hours. It was observed that there was no difference in the isolation of organisms from vagina and cervix of these subjects between 0 hours and 24 hours. Thus, this study shows that leaving the catheter in the extra-amniotic space until it is expelled spontaneously does not increase the risk of ascending infection. At the same time, leaving the catheter in-situ until it is expelled spontaneously reduces the induction-abortion interval appreciably.

Hepatitis B vaccine alone or in combination with anti-HBs immunoglobulin in the perinatal prophylaxis of babies born to HBsAg carrier mothers

The efficacy of hepatitis B virus (HBV) vaccine alone (group I) or in combination with hepatitis B immunoglobulin (HBIG) (group II) for prevention of perinatal transmission of the virus was assessed in 21 and 24 neonates, respectively. 58 infants who could not be vaccinated constituted the control group. It was observed that in the unvaccinated group approximately 70% of the infants became infected. In both the vaccinated groups, the seroconversion and seroprotection rates (anti-HBs > or = 10 IU/1) were almost similar at 6 months of follow up, but, at 12 months, infants given HBIG and vaccine showed better seroprotection rate (85%) than those given vaccine alone (58.8%). Immune response to the vaccine was also better in both the groups if the mothers were anti-HBe positive. Despite immunization, 14.2% and 25% infants in group I and II, respectively, became chronic carriers if their mothers were HBeAG positive.

Calcium transport and Ca(++)-ATPase activity in spermatozoal plasma membrane vesicles of nifedipine-administered guinea pigs

Spermatozoal plasma membrane vesicles isolated from distal portion of the epididymis and vas deferens were found to contain Ca(++)-activated ATPase and calcium transport activities. Nifedipine was administered at two different doses (1.0 and 2.5 mg/kg b.w./day) and the effect was observed for both short- (4 week) and long-term (12 week) period. The cellular ionic calcium content and Ca(++)-ATPase activity were observed to be enhanced in the drug-treated animals. The recovery studies carried out after 4 and 6 weeks of withdrawal of the drug treatment exhibited partial to complete restoration of observed changes. The stimulatory rather than inhibitory effect of Nifedipine, a specific calcium channel blocker, on calcium uptake may suggest that voltage-sensitive calcium channels may be lacking in guinea pig spermatozoa. The stimulatory effect of the drug is speculated to be either by inhibition of Na(+)-Ca++ antiporter or G-protein activated agonistic effect or probably due to altered physicochemical properties of the drug-treated sperm plasma membranes.

Mycobacterium haemophilum osteomyelitis in an AIDS patient

Mycobacterium haemophilum is a fastidious species that has been isolated from skin and subcutaneous nodules. The authors describe a case of Mycobacterium haemophilum osteomyelitis and skin infection in an AIDS patient and successful treatment with minocycline.

Epidemiology of rheumatic and congenital heart diseases in school children

A stratified random sample of 10,263 school-going children in the age group of 6-16 years from government and private schools were screened for the prevalence of rheumatic fever, rheumatic heart diseases and congenital heart diseases. Fourteen children were found to have rheumatic heart disease with valvular lesions either single or in combination eg, pure mitral stenosis (6 cases), mitral regurgitation (4 cases), combined mitral stenosis and mitral regurgitation (3 cases) and aortic and mitral regurgitation (one case). Eight children had congenital heart diseases in the form of ventricular septal defect (3 cases), atrial septal defect (2 cases), patent ductus arteriosus (2 cases) and congenital bicuspid aortic valve (one case) while none had active rheumatic fever.

Asymptomatic axial torsion of the pregnant uterus: a cause of the failure of induction of mid-trimester abortion

Torsion of gravid uterus is a rare obstetric condition in which diagnosis is usually made only on laparotomy. A case of asymptomatic axial torsion of uterus during mid-trimester, because of an ovarian cyst is reported. This presented as a failure of induction of abortion by extra-amniotic isotonic saline instillation and oxytocin infusion.