Are primary school students exposed to higher noise levels than secondary school students in Germany?

BACKGROUND

Noise, one of the major environmental nuisances, affects the learning ability of children negatively.

OBJECTIVE

With the assumption that in the existing German 4-type school system children are exposed to various noise levels in each type of school, we investigated the association between children's school type and environmental noise level.

METHODS

In this cross-sectional study, we included 550 children, primary and secondary school students, aged 8-12 years, and who lived in 4 Bavarian cities. The environmental noise level was assessed by personal 24-h dosimeter measurements. The associations of interest were assessed by linear regression.

RESULTS

The average day noise level of 80.0 dB(A) was relatively high, exceeding the threshold level of 60 dB(A). In the model adjusted for sex, socioeconomic status (SES), and place of residence, noise level was significantly higher for primary schools by almost 2.3 dB(A); however, after additional adjustments for age, this association was distorted. The mean night noise level of 43.7 dB(A) was not associated with the school level. We could not find any significant differences in the noise level between different types of secondary schools.

CONCLUSION

We found evidence that in Germany, children, especially of a younger age from primary school, are exposed to high noise levels during day in and outside the school environment. School administration and parents should work to make schools less noisy and more accomplished for learning to achieve a bright future for the children.

Annular vesiculobullous eruptions in type 2 reaction in borderline lepromatous leprosy: a case report

An untreated case of BL presented with clinical features of type 2 reaction (T2R) confirmed by histopathology. The case was a 18-year-old female with borderline lepromatous leprosy who developed annular vesiculobullous eruptions oversome of the pre-existing plaques on arms and upper back along with fever and severe neuritis after a short course of ofloxacin intake prescribed for urinary tract infection. In addition to the above lesions, some of the existing lesions showed acute exacerbation characterized by erythema, oedema, tenderness and vesiculobullous eruption. This can be considered as an example of leprous exacerbation as described in older literature. T2Rs are common in lepromatous leprosy and not so uncommonly are observed in borderline lepromatous leprosy. The vesiculobullous and crusted lesions developing over the existing borderline plaques, some of them presenting in an annular pattern in T2R in the form of leprous exacerbation, have been reported rarely in the literature.

Inoculation leprosy and HIV co-infection: a rare case with nerve involvement preceding development of skin patch and type 1 reaction as immune reconstitution syndrome following antiretroviral therapy

The transmission of leprosy has been universally accepted to be primarily, through nasal dissemination from multibacillary patients to the susceptible persons. However, the possibility of leprosy transmission through prolonged skin contact with abraded leprous skin or through skin inoculation can not be ruled out. We report a case of development of a paucibacillary leprosy patch close to the site of a local trauma, after an interval of about 13-14 years, in a HIV positive subject. Also discussed are the various hypotheses in the aetiopathogenesis of leprosy like entry route of lepra bacilli into the body, viability of lepra bacilli in the environment and evolution of skin and nerve lesions of leprosy.

Systemic sarcoidosis in a case of lepromatous leprosy: a case report

The clinical features of cutaneous sarcoidosis and leprosy are some times difficult to differentiate and there have been many reports where pulmonary sarcoidosis was treated as pulmonary tuberculosis or a case of sarcoidosis was treated with anti-leprosy multidrug therapy, before a correct diagnosis was made. So far there has been only one published case report of leprosy and sarcoidosis co-infection, where tuberculoid leprosy developed in a case of sarcoidosis, known for over a decade. We are reporting a case of dual affliction, where sarcoidosis was discovered (on routine screening) in a case of lepromatous leprosy, after administration of 2 years of multidrug therapy. The role of mycobacterial antigens (among a vast array of different animate or inanimate particles) in causation of sarcoidosis, is still speculative, as reviewed from literature.

Epidemiology of animal bites and rabies cases in India. A multicentric study

Rabies, a disease of antiquity continues to be a major public health problem in India. Multiple factors contribute to high mortality and morbidity due to animal bites. An effective strategy for control of rabies takes into account the epidemiology of animal bites, rabies and factors influencing post exposure treatment. The study was carried out as a part of Agreement for Performance of Work (APW) from World Health Organization (WHO) during the period April 2001 to September 2002. Two sets of proformae were developed and used after field testing to interview cases of animal bites and get retrospective information about rabies cases. The study was carried out at six selected centres across the country viz. Delhi, Hyderabad, Raipur, Jamnagar, Coonoor and Rajahmundry and was co-ordinated by National Institute of Communicable Diseases (NICD), Delhi. The officials engaged in the study work were thoroughly trained in the study methodology before the start of the study itself. To maintain quality and uniformity supervisory checks were done during the survey. A total of 1357 fresh animal bite victims were interviewed (exit interview) from the anti-rabies centres (ARCs). Dog bites caused maximum morbidity (92%). Second most common biting animal was monkey (3.2%), followed by cat (1.8%), fox (0.4%) etc. Most bites (64.3%) were unprovoked bites by stray (64.7%) animals. In this study 72.4% animal bite victims were males and 47.5% were children in age group of 2-18 years. 63% had Category III exposure as per the WHO classification. Before coming to ARCs 58.5% people had washed the wound with water/soap or water alone. Some of the bite victims (10.8%) had also applied chillies, salt, turmeric powder, lime, snuff powder, paste of leaves, acid, ash given by Peer Baba (magician) etc. These practices varied from one region to another. The practice of wound washing at the ARC which is an important component of animal bite management was being practiced at only one of the six centres. Of the six centres, Rabies Immunoglobulin (RIG) was available and was being used at only two centres. The study was conducted in public sector ARCs where Nervous Tissue Vaccine (NTV) was available free of cost. All the centres were using NTV except Coonoor, which is using indigenously produced Tissue Culture Vaccine along with NTV. Analysis of 192 case records of rabies cases, from two centres, revealed that dog bites caused maximum mortality (96.9%). Nearly 40% were children below 15 years of age and 78.6% were males indicating that it is an exposure related disease. In all cases, failure to seek timely and appropriate treatment led to development of disease. This paper provides an overview of epidemiology of animal bites and retrospective information about rabies patients. There is a need to strengthen Information, Education and Communication (IEC) programme regarding merits of local wound management including "do's and don'ts". ARCs should be strengthened in terms of facilities and availability of safe and effective anti rabies immunobiologicals. There is a need to create awareness regarding epidemiology and at-home and hospital management of animal bites among the service providers and general community.

Beriplex P/N: an alternative to fresh frozen plasma in severe haemorrhage

The management of Jehovah's Witnesses suffering from severe haemorrhage can be very difficult. Those patients who are taking oral anticoagulant therapy pose an additional risk and the difficulty may be compounded by the development of coagulopathy. Several alternatives to blood products have been reported to be useful in this situation. We report the successful management of an emergency postsurgical wound bleeding in a Jehovah's Witness using Beriplex (a concentrate of factors II, VII, IX and X). The patient, who was taking warfarin, presented 10 days after an elective laminectomy with significant bleeding from the surgical wound and coagulopathy. Despite early surgical measures, there was continuing haemorrhage. This was arrested by giving Beriplex intra-operatively. To our knowledge this is the first reported case of the use of Beriplex in a Jehovah's Witness for control of emergency haemorrhage and coagulopathy.

Oral ulcer as an unusual feature of visceral leishmaniasis in an AIDS patient

Leishmaniasis, a globally prevalent parasitic disease, occurs in three forms, viz, visceral, cutaneous and mucocutaneous. It is transmitted by female Phlebotomus sandflies. Human immunodeficiency virus (HIV) infection is increasing worldwide and several reports indicate a rising trend of VL / HIV co-infection, modifying the traditional anthroponotic pattern of VL transmission. India is one of the countries having the largest burden of leishmaniasis; nevertheless, there are very few HIV / leishmania co-infection cases reported so far. We report a 35-year-old homemaker infected with the human immunodeficiency virus; she presented with an oral ulcer. The investigations carried out on her revealed that she was afflicted by visceral leishmaniasis and the oral ulceration was a part of the same. This is only the second such case from the Indian subcontinent and more significantly from a non-endemic area.

Bacillus lehensis sp. nov., an alkalitolerant bacterium isolated from soil

A Gram-positive, endospore-forming, alkalitolerant bacterial strain, designated MLB2T, was isolated from soil from Leh, India, and was subjected to a polyphasic taxonomic study. The strain exhibited phenotypic properties that included chemotaxonomic characteristics consistent with its classification in the genusBacillus. Growth was observed at pH 7.0–11.0, but not at pH 6.0. The DNA G+C content was 41.4 mol%. The highest level of 16S rRNA gene sequence similarity was withBacillus oshimensisJCM 12663T(98.8 %). However, DNA–DNA hybridization experiments indicated low levels of genomic relatedness with the type strains ofB. oshimensis(62 %),Bacillus patagoniensis(55 %),Bacillus clausii(51 %) andBacillus gibsonii(34 %), the species with which strain MLB2Tformed a coherent cluster (based on the results of the phylogenetic analysis). On the basis of the phenotypic characteristics and genotypic distinctiveness of strain MLB2T, it should be classified within a novel species ofBacillus, for which the nameBacillus lehensissp. nov. is proposed. The type strain is MLB2T(=MTCC 7633T=JCM 13820T).

Safety and immunogenicity of the intradermal Thai red cross (2-2-2-0-1-1) post exposure vaccination regimen in the Indian population using purified chick embryo cell rabies vaccine

PURPOSE

To test the immunogenicity of the WHO recommended "2-2-2-0-1-1" post-exposure rabies vaccination regimen in Indian subjects to determine the feasibility of replacing crude sheep brain nerve tissue rabies vaccine with modern tissue culture rabies vaccine at major anti-rabies treatment centers throughout India.

METHODS

Purified chick embryo cell vaccine (PCECV) was administered in the dosage of 0.1 mL per site to 53 Indian subjects.

RESULTS

All subjects produced rabies antibodies above 0.5 IU/mL by day 14 post-vaccination. Only minor adverse reactions including swelling (6.6%), erythema (5.4%) and pain (1.4%) were observed for which no treatment was required.

CONCLUSIONS

This study demonstrated that PCECV is safe and highly immunogenic in Indian subjects when administered intradermally as 0.1 mL/site using the "2-2-2-0-1-1" post-exposure regimen.

Posttraumatic pseudocyst of the greater omentum: report of a case

Posttraumatic intra-abdominal cysts generally develop in relation to solid abdominal organs and most originate as a result of the organization of fluid or blood collection after trauma. They lack true endothelial lining and are hence called "pseudocysts." We report herein the rare case of a traumatic pseudocyst of the greater omentum in a 6-year-old child who was successfully treated by laparotomy and excision of the cyst.

Chronic sialadenitis with pleomorphic adenoma of the parotid: coincidental or causal?

A 12-year-old boy with a pleomorphic adenoma of the parotid is reported. The excised gland specimen also showed evidence of chronic sialadenitis. The co-existence of these two entities has not been previously reported in the literature surveyed by us. The authors feel that the two conditions may have a common underlying etiology.

Functional analysis of synchronous dichogamy in flowering rush, Butomus umbellatus (Butomaceae)

Dichogamy is one of the most widespread floral mechanisms in flowering plants and is thought to have evolved to reduce interference between pollen import and export within flowers, especially self-pollination. Self-pollination between flowers may also be reduced if dichogamy is synchronous among flowers on an inflorescence. The analysis of dichogamy at both levels requires that the sexual phases of individual flowers be defined functionally in terms of pollen deposition and removal. We conducted morphological and functional analyses to investigate the degree of dichogamy within flowers and the synchronicity of dichogamy between flowers within inflorescences in an emergent, aquatic monocot, flowering rush (Butomus umbellatus). Based on daily observations of the development of marked flowers, data on the schedule of anther dehiscence within flowers, and repeat surveys of floral sex ratios in three populations, individual flowers appear to be strictly protandrous. On average, each flower spends ∼1 d in each of male and female phases with an intervening 1-d neuter phase during which there is no available pollen in anthers and stigmas are not yet exposed to receive pollen. Morphological criteria used to delimit the beginning and end of each of these three sex phases were validated by quantifying the temporal schedule of pollen removal from anthers and pollen deposition on stigmas. Experimental pollinations showed that the morphological changes marking the end of female phase are hastened by pollen deposition. At the umbel level, synchronous development within sequential cohorts of flowers reduced overlap of male and female sexual phases between flowers. On average (±1 SE), 72 ± 3% of flowers completed their female phase while no other flowers on the same umbel were in male phase. Computer simulations of umbel development showed that this value is significantly higher than expected if the timing of flower development within umbels was random (30 ± 1%). Surveys of floral sex ratios in three populations revealed that 87% of umbels were either unisexual male or female at any given time. Pollinators usually visited more than one flower in sequence when foraging on umbels, suggesting that synchronous dichogamy may be an adaptation to avoid geitonogamy. The adaptiveness of both flower- and umbel-level dichogamy is also suggested because both traits are expressed to a lesser extent in obligately clonal, triploid populations, where flowers do not make seeds and hence floral adaptations are not maintained by natural selection.

Isonicotinic acid hydrazide induced anagen effluvium and associated lichenoid eruption

A 32 year-old woman developed generalised lichenoid eruptions on her body followed by diffuse loss of scalp hair of the anagen effluvium type. She was receiving several anti-tubercular drugs, including rifampicin, isonicotinic acid hydrazide (INH), pyrazinamide, and ethambutol, for abdominal tuberculosis. INH, which is a leading cause of drug eruptions in the above group of drugs was withdrawn. However, the other antitubercular drugs were continued along with 40 mg of prednisolone in a single daily morning dose. The latter was discontinued slowly over a period of 10 weeks. There was complete recovery of hair loss and the regrowth started after 12 weeks of alopecia. Such anagen effluvium with lichenoid eruption following INH therapy has not been observed previously. The complete recovery from anagen effluvium is difficult to explain, but it could have been because of the early initiation of corticosteroid.

Epidemic dropsy: a study of cutaneous manifestations with histopathological correlation

Clinical and histopathological features of epidemic dropsy were studied in 19 patients. Bilateral pitting pedal oedema, erythrocyanosis and tachycardia without fever were the predominant clinical features. Histology revealed deposition of hyaline material on the walls of dermal blood vessels.

Silent spread of dengue and dengue haemorrhagic fever to Coimbatore and Erode districts in Tamil Nadu, India, 1998: need for effective surveillance to monitor and control the disease

Dengue fever (DF) or dengue haemorrhagic fever (DHF) has not previously been reported in Coimbatore and Erode districts in Tamil Nadu in India. In 1998, 20 hospitalized cases of fever tested positive for dengue virus IgM and/or IgG antibodies. All of them had dengue-compatible illness, and at least four had DHF. Two of them died. Sixteen cases were below 10 years of age. The cases were scattered in 15 distantly located villages and 5 urban localities that had a high Aedes aegypti population. Although the incidence of dengue-like illness has not increased recently, almost 89% (95/107) of samples from healthy persons in the community tested positive for dengue IgG antibodies. The study showed that dengue has been endemic in the area, but was not suspected earlier. A strong laboratory-based surveillance system is essential to monitor and control DF/DHF.

Neurological evaluation and intelligence testing in the child with operated congenital heart disease

BACKGROUND

The immediate and intermediate-term neurodevelopmental outcome in infants undergoing open heart procedures using deep hypothermic cardiopulmonary bypass was assessed prospectively.

METHODS

One hundred consecutive infants (age 2 to 174 days) were operated on using either deep hypothermic bypass only (group A, n = 28), or with associated circulatory arrest (group B, n = 72). Early neurological outcome was recorded. Survivors underwent mental development evaluation after 31 to 55 months. Fifty other children of similar demographic profile but without heart disease were also tested as controls.

RESULTS

In group A, there were two neurological deaths. In group B, 5 patients had clinical seizures, 1 had monoparesis and 1 had hyperkinetic syndrome with decreased attention span. Mean mental performance quotient was 90.0+/-8.2 in group A, and 89.1+/-6.8 in group B, (group A vs. B, p = 0.60). Mean mental performance quotient in the control group was 101.4+/-8.4, which was significantly higher than the patient population (p << 0.001). No correlation was found between duration of circulatory arrest and postoperative mental performance quotient.

CONCLUSIONS

There was significant retardation of mental development in infants operated with deep hypothermic cardiopulmonary bypass. However, use of total circulatory arrest and its duration did not affect clinical outcome up to preschool age.