The medical care services at cross-roads

Our hospitals of all types and sizes present a dismal picture and have miserably failed to meet the rising demands of its consumers, in terms of technology, quality, quantity and cost of care. The situation prevailing has been documented in various press reports and cases registered to the consumer forums in the country. The author while presenting the maladies involving the hospitals has made an attempt to analyse the cause and effect relationship of the maladies and suggested remedial measures. More emphasis has been laid on economic use of resources, cost containment, training and motivation of all categories of staff, and introduction of quality management techniques to improve functional efficiency for better output, in terms of quality, quantity, cost of care and consumer satisfaction.

Mutational analysis of the conserved motifs of influenza A virus polymerase basic protein 1

Influenza virus polymerase complex is a heterotrimer consisting of polymerase basic protein 1 (PB1), polymerase basic protein 2 (PB2), and polymerase acidic protein (PA). Of these, only PB1, which has been implicated in RNA chain elongation, possesses the four conserved motifs (motifs I, II, III, and IV) and the four invariant amino acids (one in each motif) found among all viral RNA-dependent RNA or RNA-dependent DNA polymerases. We have modified an assay system developed by Huang et al. (T.-J. Huang, P. Palese, and M. Krystal, J. Virol. 64:5669-5673, 1990) to reconstitute the functional polymerase activity in vivo. Using this assay, we have examined the requirement of each of these motifs of PB1 in polymerase activity. We find that each of these invariant amino acids is critical for PB1 activity and that mutation in any one of these residues renders the protein nonfunctional. We also find that in motif III, which contains the SSDD sequence, the signature sequence of influenza virus RNA polymerase, SDD is essentially invariant and cannot accommodate sequences found in other RNA viral polymerases. However, conserved changes in the flanking sequences of SDD can be partially tolerated. These results provide the experimental evidence that influenza virus PB1 possesses a similar polymerase module as has been proposed for other RNA viruses and that the core SDD sequence of influenza virus PB1 represents a sequence variant of the GDN in negative-stranded nonsegmented RNA viruses, GDD in positive-stranded RNA virus and double-stranded RNA viruses, or MDD in retroviruses.

Status of nitric oxide free radicals in diabetic neutrophils: effect of diabetic serum factor on the generation of these species in normal neutrophils and their relation to lysosomal degranulation

Normal polymorphonuclear leukocytes (PMNL) in contrast to diabetic PMNL, generated significant amounts of .NO and NO2 when challenged with opsonised zymosan. Diabetic neutrophils, on the other hand, responded either weakly or insignificantly to the same stimulants. However, in resting state the levels of .NO and NO2 were higher in diabetic as compared to normal PMNL. Diabetic serum factor (DSF) provoked a significant generation of .NO and NO2 in normal PMNL, a phenomenon found parallel to the enhancement in cytosolic cathepsin D activity in normal cells on insult with DSF.

Effect of tri-ortho-cresyl phosphate on hen nervous system

Correlation of tri-ortho-cresyl phosphate (TOCP) toxicity with clinical symptoms and inhibition patterns of neurotoxic esterase (NTE) in different regions of the central nervous system was studied in hens. The total content of NTE in spinal cord and peripheral nerves was relatively much lower than that of the brain, about 29 and 4.8 per cent respectively. Brain and spinal cord NTE was inhibited to 75 and 67 per cent respectively on day 1 post-TOCP treatment, and 91 and 84 per cent respectively on day 2, while the activity of the enzyme in peripheral nerve was inhibited to 92 per cent on day 1. However, the clinical manifestations of paralysis appeared after 7-8 days of TOCP treatment. It can be concluded that the presence of NTE in very low quantities in the peripheral nerves and its almost complete inhibition as compared to that of brain and spinal cord, could be of great significance in the development of neurotoxicity.

Agenesis of posterior urethra in a male child and its operative reconstruction

An 8-year-old boy passing urine through both fecal and urinary outlets since birth is reported. Investigations showed absence of the posterior urethra. A surgical procedure for reconstruction of the posterior urethra is described. The embryological explanation is also discussed.

A 14-kilodalton inner membrane protein of Vibrio cholerae biotype e1 tor confers resistance to group IV choleraphage infection to classical vibrios

Choleraphage phi 149 differentiates the two biotypes, classical and el tor, of Vibrio cholerae. This phage cannot replicate in V. cholerae biotype el tor cells because the concatemeric DNA intermediates produced are unstable and cannot be chased to mature phage DNA. A V. cholerae biotype el tor gene coding for a 14,000-Da inner membrane protein which destabilizes the concatemeric DNA intermediates by hindering their binding to the cell membrane has been identified. Presumably, a 22,000-Da V. cholerae biotype el tor protein might also have a role in conferring phage phi 149 resistance to cells belonging to the biotype el tor. A nucleotide sequence homologous to the 1.2-kb V. cholerae biotype el tor DNA coding for both the 14,000- and 22,000-Da proteins is present in all strains of classical vibrios but is not transcribed. The nucleotide sequence of the gene coding for the 14,000-Da protein has been determined.

An unusual case of heteropagus twinning

A 3-day-old boy baby presented with a cystic umbilical swelling covered mostly by skin and partly by amnion. On the surface, an early embryo-like structure was attached (facial features and limb buds). The deeper aspect of it was composed of large cystic and tubular structures and solid organs resembling liver and spleen. It was labeled as acardiac amorphous parasitic twin, the first of its kind to be reported.

Urine level of trace elements in some adults in Bangladesh under a workplace environment

The urine level of trace elements has been investigated in some normal adults under different workplace environments in Bangladesh. The samples were collected from 58 subjects, randomly selected from about 500 adults working in 10 different workshops and factories located in Dhaka city. Samples were analyzed by the external beam PIXE method. Proton beams of 2.5 MeV energy and 20 nA intensity were used for sample irradiations. For 40 microC irradiations, the concentration of 14 elements in total (K, Ca, Ti, Cr, Mn, Fe, Ni, Cu, Zn, As, Br, Rb, Sr and Mo) in different groups were measured by comparison with a calibration curve obtained from the NBS Orchard Leaf standard (SRM 1571). The results from different workplaces are reported in terms of amount of excretion per unit volume of the sample collected. They, however, do not reflect the total daily excretion level of different subject groups.

Subtotal cystectomy and antirefluxing hepaticoduodenostomy for choledochus cyst in children

Total cystectomy with Roux-en-Y hepaticojejunostomy for choledochus cyst often causes malabsorption and other problems as a result of jejunal biliary diversion bypassing the duodenum. Restoration of near normal anatomy can only return the normal physiological harmony and assure normality. A simple antirefluxing hepaticoduodenostomy has proved successful.

Cultivation of Mycobacterium leprae in artificial culture medium

A novel procedure in the cultivation of M. leprae in combined Dubos-Lowenstein-Jenson medium after addition of thyroxine sodium is being reported. This has been found to be successful as the organisms, after multiplying vigorously in the thyroxine containing Dubos medium, have produced a visible colony on the surface of Lowenstein-Jensen medium during 8-16 wks of incubation at 37 degrees C. The enhanced growth of this recalcitrant organism is due to stimulating effect of thyroxine as well as supply of ready-made basic nutrients in the synthetic Dubos medium. Intradermal inoculation of the bacterial suspension from the subculture into the foot pad of cortisone treated mouse revealed an early appearance of specific histological lesion of leprosy with infiltration of nerve fibres by lepra cells. The methodology, described here for in-vitro cultivation, may open out a new era in the preparation of purified vaccine, the study of in-vitro drug sensitivity, and as such ensure rapid eradication of leprosy.

Abortive replication of choleraphage phi 149 in Vibrio cholerae biotype el tor

Choleraphage phi 149 adsorbed irreversibly to Vibrio cholerae biotype el tor cells, and 50% of the injected phage DNA bound to the cell membrane. Although no infectious centers were produced at any time during infection, the host macromolecular syntheses were shut off and the host DNA underwent chloramphenicol-inhibitable degradation. Synthesis of monomeric phage DNA continued similar to that observed in the permissive host. However, the concatemeric DNA intermediates produced were unstable and could not be chased to mature phage DNA. Pulse-labeling of UV-irradiated infected cells at different times during infection allowed identification of phage-specific proteins made in this nonpermissive host. Although most of the early proteins were made, only some of the late proteins were transiently synthesized.

Selective devascularisation of stomach and lienopulmopexy for prevention of bleedings in portal hypertension in children

Dissatisfied with different operative procedures for prevention of recurrent bleedings in childhood portal hypertension, many surgeons nowadays treat their patients conservatively during episodic attacks and advocate one of the shunt procedures in adolescence when the splenic vein becomes sufficiently widened (more than 1 cm). Even then mortality cannot be avoided in some bad risk patients especially those living in remote villages lacking facilities for blood transfusion and high speed transport service. In this situation thoracic transposition of spleen and lienopulmopexy was advocated by Nylander and Turumen, Auvert, M. Bettex and others. We prefer a further simpler procedure and perform selective devascularisation of stomach and lienopulmopexy. It allows rapid development of collaterals between splenic pulps on the portal side and subpleural venous plexus on the systemic side to achieve effective gastric devascularisation to prevent further bleeding without hindering the existing portal flow through the liver to avoid the possible occurrence of encephalopathy. Of 21 operated cases one died on the 5th postoperative day and the remaining 20 are doing well. 1/2-5 1/2 years' follow-up revealed negligible morbidity and no recurrence of bleeding in any of them. Both procedures work on the same principle.

Multielement proton-induced X-ray emission analysis of betel leaves, betel nuts, and lime

Proton-induced X-ray emission (PIXE) method was employed to study the concentration of heavy elements in betel leaves, betel nuts, and mineral lime consumed in Bangladesh. The samples were collected from different parts of Bangladesh and analyzed by the thicktarget external beam technique of the PIXE method. The samples were exposed to the proton beam as 1-mm thick pellets and irradiated with 2.0-MeV protons having 20-nA beam intensity. The concentration of some 15 elements (K, Ca, Ti, V, Cr, Mn, Fe, Ni, Cu, Zn, Se, Br, Rb, Sr, and Pb) was measured by comparison with a calibration curve constructed from the NBS orchard leaf standard SRM 1571. The validity of the procedure has been established by comparative measurements of Cu and Zn with atomic absorption spectrophotometry. The significance of the results is discussed in view of their implications in health and disease.

Multielement proton-induced X-ray emission analysis of Bangladeshi tobacco

The concentration of 12 different elements in cigarette tobacco of different brands, commercially made in Bangladesh, was determined using the proton particle-induced x-ray emission (proton PIXE) method. In all the present experiments, proton beams of 2.0 MeV (on the target in air) and about 30 nA current were used for characteristic x-ray excitation. The concentration of the elements (K, Ca, Ti, Cr, Mn, Fe, Ni, Cu, Zn, Br, Rb and Sr) was determined by comparison with a calibration obtained from the NBS orchard leaf standard, SRM 1571. The results have been compared with available data on some foreign brands of tobacco and the probable reasons for the difference in the contents of some of the elements found in the Bangladeshi brands are discussed.

Growth of Mycobacterium leprae in thyroxine treated culture medium--a preliminary report

A new approach in cultivation of Mycobacterium leprae in thyroxine treated Lowenstein-Jensen media is reported. The method has been proved to be successful as the organisms multiplied and remained viable in the thyroxine solution added at the bottom of the culture vial, for a period of 18 to 20 weeks of incubation at 37 degrees C. This has been possible due to metabolic stimulating action of thyroxine sodium solution as well as diffusion of nutrients into this solution from the medium. Intracutaneous inoculation of culture fluid on the surface of foot pad in cortisone treated mouse helped in rapid appearance of the specific lesion at the site within 20 days after injection. Both the intracutaneous method of inoculation and treatment of mouse with high doses of cortisone may play some role in shortening the period of development of such lesion.