Primary actinomycosis of the breast: a clinical review and a case report

An uncommon situation of primary actinomycosis of the breast is reported in a 40-year-old woman who presented with a lump, clinically simulating malignancy, in the right breast. Diagnosis of actinomycosis was established by incision biopsy. Resolution of infection, while conserving the breast, was achieved by timely diagnosis, limited surgery, and effective antibiotic therapy. Diagnostic failures leading to avoidable mastectomies have not been uncommon in cases previously reported in the literature. It is, therefore, imperative that this condition be considered in the differential diagnosis of intractable breast abscess and malignancy.

Influence of alcohol intake on high density lipoprotein cholesterol levels in middle-aged men

To study the influence of alcohol (ethanol) intake on high density lipoprotein cholesterol (HDLC) levels, we studied 210 healthy middle-aged men (age 45 +/- 8 years). Other factors influencing HDLC (physical exercise, diet, smoking and body mass index) were also studied. Individuals were classified according to daily ethanol consumption. There were 39 teetotallers, 29 took drink, 30 took 1-1.9, 25 took 2-2.9, 26 took 3-3.9, 28 took 4-4.9 and 33 took 5 or more drinks per day (1 drink = 14 gm ethanol). The overall mean serum total cholesterol was 191.4 +/- 53 mg/dl and HDLC was 46.4 +/- 9 mg/dl. Total cholesterol in teetotallers was not different from those consuming different amounts of alcohol. HDLC in teetotallers (44.5 +/- 8 mg/dl) was significantly lower than in those taking 1-1.9 drinks (46.7 +/- 11 mg/dl, p < 0.05) and 2-2.9 drinks/day (51.4 +/- 9 mg/dl, p < 0.01) but was not different from those consuming > or = 3.0 drinks. There was a weak positive linear correlation between ethanol and HDLC (r = 0.016). HDLC levels were significantly lower in smokers (43.5 +/- 9 vs 47.2 +/- 11 mg/dl in non-smokers), in non-vegetarians (43.5 +/- 10 vs 46.2 +/- 9 mg/dl in vegetarians) and in those with sedentary habits (42.4 +/- 7 vs 46.1 +/- 10 mg/dl in physically active). Low level ethanol consumption (< 3 drinks or 42 gm per day) is associated with increased HDLC levels.

Bungee jumping and intraocular haemorrhage

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Awareness of cholesterol as coronary risk factor among general practitioners at Jaipur

Widespread information about preventive measures has decreased incidence of coronary artery disease (CAD) in developing countries. However this trend is not seen in India. Cholesterol and other lipoproteins play important role in CAD. In order to assess whether this information has reached General Practitioners (GP's) and their action regarding the recommendations of the US National Cholesterol Education Programme (NCEP), G.P.'s were assessed with the help of a questionnaire. The response rate to the questionnaire was 78.4% of the total G.P.'s of the city. The findings of the study were compared to the NCEP guidelines. Results indicate that, "Ideal", "High" and cholesterol levels dietary needing precautionary measures intervention (ie. 198.2 +/- 13 mg/dl, 256.1 +/- 32 mg/dl and 247.9 +/- 26 mg/dl respectively) were similar to the NCEP guidelines. Levels where therapy is recommended (ie 293.9 +/- 34 mg/dl) is significantly more than NCEP guidelines. Though 77.1% of doctors were aware of protective effect of HDL cholesterol (ie 51.1 +/- 6 mg/dl), routine measurement of lipid profile was undertaken by only 57.1% doctors with mean age of recommendation being 34.1 +/- 11.6. Routine dietary advice and cholesterol estimation was done in 71.4% patients with CAD and 67.3% of patients with hypertension and diabetes. Analysis of action taken falls short of the NCEP recommendations and indicates a need for intensive training of the G.P.s.

Stool electrolytes in acute dehydrating gastroenteritis

Stool electrolytes were studied in 100 cases of gastroenteritis. The duration of illness was 24-48 hours in 32% and 72-96 hours in 28% of the cases. On stool culture, 43% children had no growth, 23% had Enteropathogenic E. coli and 10% had cholera and rotavirus each. The stool sodium loss was more in cholera and shigella cases, diarrhea of shorter duration and in children between 24-30 months of age. Potassium loss in the stool was more in shiegella cases, diarrhea of short duration and in children between 30-36 months of age. In cases of gastroenteritis with severe malnutrition, stool sodium loss was less; stool potassium loss was not affected by the nutritional status. Total electrolytes lost in stools can be estimated by knowing purging rate and rehydration therapy can be planned accordingly.

Mitral valve prolapse: two dimensional echocardiography reveals a high prevalence in three to twelve year old children

The prevalence of mitral valve prolapse (MVP) appears to be age related, MVP being commoner in children as compared to adults. This suggests that asymptomatic MVP may be most frequent in children who are very young. In this study, to better define the prevalence of MVP in young children, we used two dimensional echocardiography and prospectively surveyed 213 healthy urban school children between 3 and 12 years of age. MVP was diagnosed when prolapse of mitral leaflet/s was demonstrated by both two-dimensional and M-mode echocardiography at parasternal long-axis views. Overall, MVP was found in 28 of 213 (13.1%) children. MVP was similarly prevalent in all age groups studied (3-5.9 years: 13 of 83 (13.5%); 6-8.9 years: 9 of 71 (11.2%); and 9-12 years: 6 of 31 (16.2%) children; Chi square = 0.57, p greater than 0.5). Univariate analysis showed that the prevalence of MVP was independent of sex, birth weight, resting heart rate and systolic or diastolic blood pressure. A mid systolic murmur was present in 50.6% of the children although it correlated with echocardiographic diagnosis of MVP in only 39.3%. The left ventricular size or wall thickness and mitral EF and DE slopes were similar in children either with or without MVP. Our results indicate that asymptomatic MVP is frequent in children upto 12 years of age. As a diagnostic test of MVP, presence of apical systolic murmur is considerably inferior to echocardiography. No morphological left ventricular correlates were identified in MVP.

Spectrum of psychiatric symptomatology in children in high and low socio-economic groups in Ludhiana

A door to door survey was conducted to study the spectrum of psychiatric symptomatology in children aged 1-12 years belonging to high and low socio-economic groups. One hundred families in each group were studied. Symptom prevalence rate was comparable in the two groups, i.e., 479/1000 in the high socio-economic (HSE) group and 487/1000 in the low socio-economic (LSE) group. However, there were significant differences in the spectrum of symptomatology. Symptoms like quarrelsomeness, disobedience, abusive language, stealing, truancy, pica, school refusal, enuresis, mental subnormality and poor scholastic performance were significantly more in the LSE group. In the HSE group, symptoms like nail biting, food refusal, food fads and temper tantrums were significantly more.

Coexisting tuberculosis and carcinoma of the colon

Four cases of coexisting tuberculosis and carcinoma of the colon (CTCC) are reported. All the patients were female and the mean age was 49 +/- 11 years. The tumour involved the right colon in three patients and the distal transverse colon in the other. The two lesions coexisted at the same site in two patients. Mucinous carcinoma was the predominant type seen in three patients. The characteristics of patients with CTCC were compared with those of 54 patients who had carcinoma of the colon (CC) and 17 patients with tuberculosis of the colon (TC) seen during the same period. All the four CTCC patients were female, compared with 13 of 54 patients with CC (P less than 0.001). These two groups were similar in mean age, anatomic sites and histopathological tumour types. The CTCC patients were significantly older than the TC patients (49 +/- 11 years vs 34 +/- 10 years, P less than 0.05). The sex distribution of TC patients was similar to that of CTCC patients, 14 of 17 patients being female. All TC lesions were confined to the right colon. The present study showed a high frequency of carcinoma in patients with colonic tuberculosis, signifying the need for epidemiological and histopathological investigations into the aetiological relationship between the two diseases, the possibility of which was suggested recently by Japanese researchers. The relevant literature on 58 previously reported patients with CTCC was reviewed.

Norms and clinical correlates of echocardiographic left ventricular mass in 3-12 year old children

To determine norms for left ventricular mass (LVM) and correlate it with various demographic and clinical parameters 213 school children were examined using two dimensional echocardiography. The data of 183 children (108 boys, 75 girls) where no cardiovascular abnormality was found has been analysed. The mean age +/- SEM was 6.79 +/- 0.15 years. The mean LVM was 40.47 +/- 1.12 gm (40.05 +/- 1.45 gm in males; 41.06 +/- 1.79 gm in females; p greater than 0.6). Mean LVM index (grams/metre height) was 34.30 +/- 0.80 (male = 33.46 +/- 1.06; female = 35.45 +/- 1.22; p = 0.9). On univariate analysis, a significant positive correlation of LVM with age, (r = 0.57), height (r = 0.57), weight (r = 0.58) and chest size (r = 0.23) was observed. No correlation was seen with resting pulse rate, or with systolic and diastolic blood pressure.

Extent of occurrence of the six vaccine preventable diseases in vaccinated/unvaccinated children

Sixty two children who were diagnosed to be suffering from any of the six vaccine preventable diseases were studied to know their vaccination status prior to the occurrence of these diseases. A total of 33.9% of these children had developed these diseases inspite of full immunization. Nearly 75% of immunized children had received the vaccine from Government sources. The break-up diseases among the children studied was tetanus (35.5%), poliomyelitis and pulmonary tuberculosis (22.6% each), measles (11.3%), diphtheria (6.4%) and pertussis (1.6%). The vaccinated children who developed poliomyelitis belonged to a relatively higher age group. Seventy one per cent of measles cases developed bronchopneumonia as a complication. Seventy five per cent of the mortality in the children studied was due to tetanus neonatorum. Since one third of the children studied had developed diseases inspite of full immunization, it is inferred that closer monitoring of the Cold Chain System and intensive surveillance at peripheral levels are required.

Sucking on the 'emptied' breast: non-nutritive sucking with a difference

A simple method to promote the use of human milk and subsequent breast feeding in low birthweight infants was evaluated in 32 babies. In the 'intervention' group (n = 16; mean (SD) weight 1559 (228) g and length of gestation 33.2 (1.8) weeks), infants were allowed to suckle at the breast when their general condition permitted after as much milk as possible had been expressed, and were then given the full required feeds by tube. Full breast feeding was started as soon as the infant could suck adequately. Sixteen control infants (mean (SD) weight 1605 (198) g and length of gestation 34.1 (2.4) weeks), were breast fed in the conventional manner only after it had been established that they could suck well; until then they received all their feeds by tube. After discharge the mean (SD) periods of exclusive and total breast feeding were longer in the group that had received the intervention (3.7 (1.3) and 5.1 (2.2) months, respectively) than among the controls (1.9 (0.6) and 3.3 (1.9) months, respectively). This 'intervention' method helps to promote milk formation, provides sucking experience for low birthweight infants without interfering with their nutritional intake and consequent weight gain, and encourages subsequent breast feeding with its well recognised advantages.