Determinants of night blindness in Bangladesh

A cross-sectional study was conducted to evaluate the effect of a community-based health education intervention programme and to study the determinants of night blindness in Bangladesh. The intervention programme was implemented to reduce the morbidity of nutritional blindness (night blindness) in the northern part of Bangladesh (Ranjpure district) during 1986-1989. A baseline study in 1986 covered 2010 households with a total population of 11,600, and the evaluation study in 1989 covered 2011 households with a total population of 10,456. Prevalence of night blindness was studied among children aged < 9 years in these households. The prevalence of night blindness per 1000 children was reduced significantly during the intervention period from 50.7 in 1986 to 26.7 in 1989. However, the post-intervention prevalence varied significantly between areas. Multivariate analyses showed that consumption of fish, meat, milk or eggs, dark green leaf vegetables, yellow fruits and vitamin A capsules were significant predictors of night blindness. In addition, family income, mother's literacy, family size and area of residence exhibited strong and statistically significant associations with night blindness in the 1989 cross-sectional study. The prevalence of night blindness was highest among 4-6 year old girls and 7-8 year old boys. The sex difference was, however, not statistically significant.

Hydroxyurea treatment for chronic myeloid leukaemia during pregnancy

A patient being treated for chronic myeloid leukaemia with hydroxyurea became pregnant. Despite an increase in the dose of hydroxyurea (to 3 g per day) during the pregnancy, her white blood cell count could only be controlled at about 150 x 10(9)/l. A healthy baby girl was born at 37 weeks with normal blood counts and no evidence of congenital abnormality. There are now five reports of the use of hydroxyurea in pregnancy, and where leukapheresis is not available it may be the treatment of choice.

Improvement of cardiac function impaired by repeated ischemic arrests in isolated rat hearts

We investigated the effects of coenzyme Q10 and verapamil, either alone or in combination, on cardiac function impaired by repeated ischemic arrests and reperfusion in the isolated rat heart. In the group with a single ischemic arrest, the aortic flow, cardiac output, stroke volume, coronary flow, and heart rate recovered well (72% to 100% of the prearrest values). In the repeated-arrest group, the recovery of aortic flow (24%), cardiac output (30%), stroke volume (40%), or coronary flow (63%) was much poorer than that in the single-arrest group. Pretreatment with coenzyme Q10 given intraperitoneally improved aortic flow, cardiac output, stroke volume, coronary flow, and heart rate. The addition of verapamil to the reperfusion solution also protected the cardiac function with a decrease in heart rate. However, combination therapy with coenzyme Q10 and verapamil further increased the recoveries of aortic flow, cardiac output, stroke volume, and coronary flow to 57%, 61%, 77%, and 84%, respectively, which were better than the values after treatment with coenzyme Q10 or verapamil alone. We, therefore, suggest that treatment with coenzyme Q10 or verapamil, alone or in combination, in addition to St. Thomas' Hospital solution effectively protects cardiac function impaired by repeated ischemic arrests and reperfusion.

Aberrant retrotracheal goiter: report of a case

A case of intrathoracic retrotracheal goiter in a 40-year-old woman is herein described. A computed tomographic scan, magnetic resonance imaging and endoscopical ultrasonography all confirmed the existence of a retrotracheal encapsulated lesion, which was suspected to be aberrant mediastinal goiter. Radioiodine scintigraphy, however, demonstrated little uptake in the mass. A large (7 x 6 x 4 cm), encapsulated adenomatous goiter was then easily removed via a right thoracic approach.

Performance evaluation of a draw-over vaporizer with a nonbreathing circuit during simulated adverse conditions

STUDY OBJECTIVE

Performance evaluation of a draw-over vaporizer with a nonrebreathing circuit during simulated adverse conditions.

DESIGN

Open laboratory study.

SETTING

University hospital laboratory.

MATERIALS AND INTERVENTIONS

The output (%) of a temperature-compensated Ohmeda Cyprane PAC (portable anesthesia complete) draw-over vaporizer (Ohmeda, Madison, WI) using isoflurane attached to a nonrebreathing circuit was tested in the laboratory during manual ventilation under normal and simulated adverse conditions. The adverse conditions tested were high ambient temperature and static and dynamic positional variation.

MEASUREMENTS AND MAIN RESULTS

The results show that the output bias of the PAC vaporizer has a generally consistent profile as tested, except when placed in the 180 degrees full-inversion or 90 degrees anterior-tilt position. We also conducted trials with the Penlon ventilator (Ohmeda, Abingdon, Oxford, U.K.) attached to the circuit at each of its input ports. Ventilation at one input port produced dangerously high airway pressures (within the circuit), thus supporting the manufacturer's recommendation against the use of this port for positive-pressure ventilation. Using the recommended port, the test lung was seen to inflate and deflate appropriately, but, surprisingly, no vapor output was detected by the agent monitor at any vaporizer setting when using the ventilator at the recommended port.

CONCLUSION

Anesthetists should be aware of the pitfalls and possible problems that may be associated with this type of anesthetic delivery system.

A multicenter study of the treatment of childhood chronic idiopathic thrombocytopenic purpura with anti-D

We evaluated the effects of the intravenous administration of anti-D, an immune globulin directed at the D antigen on erythrocytes that is purified from plasma from sensitized persons, on patients with idiopathic thrombocytopenic purpura. To determine the most effective dose, the duration of response, and the side effects of this therapy in children, we performed a multicenter cohort study of escalating doses of intravenously administered anti-D in children aged 1 to 18 years with chronic idiopathic thrombocytopenic purpura, defined as idiopathic thrombocytopenic purpura persisting for more than 6 months with a platelet count of less than 50 x 10(9) cells/L. Twenty-five Rh-positive children received increasing doses of anti-D as follows: day 1, 25 micrograms/kg; day 2, 25 micrograms/kg; day 7, 35 micrograms/kg; day 14, 45 micrograms/kg; and day 21, 55 micrograms/kg. Administration of anti-D was stopped after day 21 or when the platelet count rose to greater than 150 x 10(9) cells/L or the hemoglobin level was 100 gm/L. Platelet count was less than 50 x 10(9) cells/L in all children before treatment. A response was defined as an increase in the platelet count to more than 50 x 10(9)/L and a doubling of the pretreatment platelet count. Of 25 children, 23 (92%) had responses by day 7 of the initial treatment protocol. Eighteen children (72%) had platelet counts greater than 150 x 10(9) cells/L by day 7 after two doses of anti-D. Median duration of response was 5 weeks (range 1 to 24 weeks). Average drop in hemoglobin level was 13.7 gm/L; in one child (a nonresponder) hemoglobin value fell to less than 100 gm/L. No other untoward side effects were seen. Of the 23 children who responded, 21 were retreated with one dose of anti-D when platelet counts returned to baseline values of less than 50 x 10(9) cells/L; all but three of the children who underwent retreatment showed a response the second time. Sixteen children continued to receive intermittent anti-D therapy after completion of the study, and all continued to have excellent responses. We conclude that anti-D is a safe, effective, and relatively inexpensive therapy for childhood chronic idiopathic thrombocytopenic purpura.

Status epilepticus. Recent experience at the Port-of-Spain General Hospital, Trinidad

In this retrospective study, experience in status epilepticus (SE) over an 18-month period at the Port-of-Spain General Hospital is reported. Sixty-three episodes in 41 patients were studied. Fifty-one per cent of patients were under 10 years of age. Fifty-one per cent of patients were classified as remote symptomatic, 29% idiopathic, 15% acute symptomatic and 5% febrile. Bolus doses of diazepam were used in 62 of 63 episodes, phenytoin in 18, diazepam infusion in 9, paraldehyde in 12 and phenobarbitone in 9. Seizures were controlled within half-hour of starting treatment in 55 episodes (87%). In 3 episodes in 2 patients (5%), control was poor and exceeded 18 hours. No deaths were recorded. Two neurological deficits and 8 other morbid events were recorded. Mean hospital stay was 2.9 days. No patient was ventilated or admitted to the Intensive Care Unit. Current drug therapy is highly effective in SE even in institutions where modern intensive care technology is limited. Prognosis is excellent in patients in whom the underlying aetiology is benign.

Soybean leaves contain multiple lipoxygenases

Chromatofocusing of soybean (Glycine max L.) leaf lipoxygenases revealed three distinct peaks of activity. Based on their isoelectric points (pls), pH optima, and mutant analysis it appears that the leaf isozymes are different from those described from mature soybean seed. At least one leaf lipoxygenase appears to differ from those found in hypocotyls. The pls of the main bands of the three leaf lipoxygenase peaks are 6.67, 5.91, and 5.67. The pH optima curves of three active fractions exhibit peaks at pH 6.2, 5.5, and 8.5, respectively. One of the fractions has two polypeptides with slightly different molecular weights, both of which react to soybean seed lipoxygenase antibodies. The other two fractions contain a polypeptide of unit molecular weight reacting with the lipoxygenase antibodies.

Health survey of students of a primary school

A pilot study has been conducted in 227 students in a primary school stiuated in the Dacca city. The study indicates that the height, weight of urban children has become a little improved since the Nutrition Survey of East Pakistan was done in 1962-64. A high percentage of enlarged tonsil and caries teeth were observed in the study group.

Hypokalaemic periodic paralysis complicating thyrotoxicosis

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