Persistent diarrhea: risk factors and outcome

OBJECTIVE

To identify risk factors associated with Persistent diarrhea (PD) and deaths due to PD.

METHODS

This prospective case control study included 60 children with PD (cases) and 60 children (controls) with acute diarrhoea (AD). Detailed history, examination and appropriate investigations were done for all children. Crude Odds ratio was calculated for each risk factor by univariate analysis and adjusted odds ratio was calculated by multivariate logistic regression.

RESULTS

Prior antibiotic use, steroid use, anemia, vitamin A deficiency, malnutrition, LRI, UTI, oral candidiasis, and hyponatremia, were statistically significant risk factors by univariate analysis. Prior antibiotic use, vitamin A deficiency, malnutrition and LRI were independently associated with PD by multivariate logistic regression analysis. The risk factors for mortality were stool frequency more than 10 times per day, severe malnutrition, oral candidiasis, hypoalbuminemia and HIV positivity.

CONCLUSIONS

The presence of these risk factors should alert the clinician to take appropriate measures, to decrease the mortality.

Absorbable or non-absorbable sutures? A prospective, randomised evaluation of aesthetic outcomes in patients undergoing elective day-case hand and wrist surgery

INTRODUCTION

We prospectively evaluated aesthetic outcomes in a group of randomised patients who underwent elective day-case hand and wrist surgery using either absorbable or non-absorbable sutures.

PATIENTS AND METHODS

A cohort of 100 adult patients were randomised using sealed envelopes to receive either absorbable or non-absorbable sutures for their wound closure. Clinical review was carried out at 6 weeks. A postal questionnaire was sent to all patients 3 months following surgery comprising a visual analogue scale (VAS) for wound satisfaction, a validated 6-point patient scar assessment tool and the shortened version of the disabilities of the arm, shoulder and hand questionnaire (QuickDASH).

RESULTS

From the postal questionnaire, 70 responses were received. There was no statistically significant difference between the two groups in terms of VAS, patient scar assessment tool and quick DASH.

CONCLUSIONS

For elective day-case hand and wrist surgery, either suture material can be used confidently with respect to overall aesthetic appearance in such patients.

Evidence-based National Vaccine Policy

India has over a century old tradition of development and production of vaccines. The Government rightly adopted self-sufficiency in vaccine production and self-reliance in vaccine technology as its policy objectives in 1986. However, in the absence of a full-fledged vaccine policy, there have been concerns related to demand and supply, manufacture vs. import, role of public and private sectors, choice of vaccines, new and combination vaccines, universal vs. selective vaccination, routine immunization vs. special drives, cost-benefit aspects, regulatory issues, logistics etc. The need for a comprehensive and evidence based vaccine policy that enables informed decisions on all these aspects from the public health point of view brought together doctors, scientists, policy analysts, lawyers and civil society representatives to formulate this policy paper for the consideration of the Government. This paper evolved out of the first ever ICMR-NISTADS national brainstorming workshop on vaccine policy held during 4-5 June, 2009 in New Delhi, and subsequent discussions over email for several weeks, before being adopted unanimously in the present form.

Median cleft lip: A new method of surgical repair

The aim is to discuss a new method of muscle repair in midline cleft lip. Three patients with midline cleft lip were repaired with our technique of muscle repair and the results evaluated. Our new method of muscle repair in the form of ‘Z’ helps in forming the philtral dimple.

Synthesis and insect antifeedant activities of some substituted styryl 3,4-dichlorophenyl ketones

Sixteen substituted styryl 3,4-dichlorophenyl ketones [(2E)-1-(3,4-dichlorophenyl)-3-phenyl-2-propen-1-ones] were synthesized using eco-friendly benign stereoselective crossed-aldol reaction. They are characterized by their analytical, infrared, NMR and mass spectral data. The insect antifeedant activities of these chalcones were evaluated using Caster semilooper and Achoea janata L.

Measurements on thermodiffusion in ternary hydrocarbon mixtures at high pressure

Experimental investigations on thermodiffusion have been conducted for five different ternary mixtures of methane, n-butane, and n-dodecane at a high temperature and pressure. While the mole fraction of methane was fixed at 0.2 the mole fraction of n-dodecane was varied from 0.7 to 0.2. The experiments were performed in a microgravity environment on board the satellite FOTON-M3. It was found that in all mixtures, n-dodecane separated to the cold side whereas methane segregated to the hot side. n-butane, the species with an intermediate density, showed a change in sign as its mole fraction was increased. At low concentrations it collected on the cold side but moved in the opposite direction with an increase in its mole fraction. The role of the relative density coupled with the species concentrations has been used to explain the thermodiffusion factor in each mixture. Computational investigations showed a similar behavior. However, the theoretical model was not able to capture the sign change of n-butane accurately. The inadequate representation of the significance of the relative densities and the mole fraction of the species has been found as the reason for this.

Persistent pneumonia: Underlying cause and outcome

OBJECTIVE

To identify the causes and contributing factors of persistent pneumonia in children.

METHODS

41 cases with persistent pneumonia were investigated (biochemical, microbiological, histopathological, immunological and radiological tests) to find out the underlying cause.

RESULTS

Out of 41 cases, 8 had pulmonary tuberculosis and 12 had Gram negative bacterial infections, 12 had aspiration due to gastroesophageal reflux disease or oil instillation, 3 had immunodeficiency due to HIV infection, 2 had congenital lung malformation, 2 had cardiac disorders and one had foreign body aspiration as causes of persistent pneumonia. The etiology could not be established in one case.

CONCLUSION

The most common underlying cause of persistent pneumonia were persistent infection followed by aspiration and acquired immunodeficiency.

Hybrid thermoreversible gels from covalent polymers and organogels

This paper reports on experiments intended for investigating the feasibility of preparing hybrid thermoreversible gels from covalent polymers and noncovalent self-assembling pi-conjugated molecules. The formation and the degree of dispersion of these hybrid gels have been studied with polystyrenes of various tacticities and oligo(p-phenylenevinylene) molecules (OPV) in different nonpolar organic solvents. Detailed investigations of the systems have been carried out by DSC, SAXS, and AFM. It is shown that no liquid-liquid phase separation is involved, indicating that the systems are highly compatible, and that the growth of one type of gel does not interfere with the other. These studies reveal that the resultant hybrid gels are composed of the intermingled fibrillar architectures of both gels.

Salubrious Effect of Vitamin E Supplementation on Renal Stone Forming Risk Factors in Urogenital Tuberculosis Patients

The incidence of renal calculi has been evaluated to be 25% in urogenital tuberculosis patients. The stone could be caused due to the host, the pathogenic organism, or possibly by the treatment. Studies were carried out to find out the efficacy of vitamin E supplementation in reducing the risk of stone formation in renal tuberculosis patients. The study constituted four groups, Group I with 30 normal volunteers, the second group comprised of 36 renal tuberculosis patients (GuTb) a day before treatment. Third group comprised of 24 patients with regular anti tuberculosis drug regimen for sixty days. In the fourth group, 12 patients were treated with anti tuberculosis drug regimen along with supplementation of antioxidant vitamin E (200 mg/day) for sixty days. Hyperuricosuria and hypercalciuria were observed in group II and group III patients, along with increased excretion of oxalate and creatinine, accompanied by decreased excretion of inhibitors such as citrate and glycosaminoglycans (GAGs). Renal damage was evident with increased leakage of Lactate dehydrogenase (LDH), Alkaline phosphatase (ALP) and gamma-Glutamyl transferase (gamma-GT) in renal tuberculosis patients. From the results of the above study, it is obvious that increased urinary oxalate levels leads to cellular damage in GuTb patients, which is a prerequisite for crystal retention as revealed by the elevated urinary marker enzymes. Antioxidant therapy prevents membrane injury thereby reducing the risk of stone formation. Hence vitamin E supplementation has a salubrious effect in preventing stone forming tendency with routine anti tuberculosis drug regimen.

Pulmonary function after whole lung radiation in pediatric patients with malignant solid tumors

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Background: Pediatric malignant solid tumors are increasingly curable; whole lung irradiation (WLI) may be used to treat pulmonary tumor involvement. Few studies have addressed long-term pulmonary function after WLI during childhood. Methods: We conducted a retrospective review of pulmonary function tests (PFTs) in 1 year survivors of pediatric malignant solid tumors treated with WLI. We assessed PFT changes over time and the relationship of abnormal values to clinical parameters (diagnosis, radiation dose, and presence or absence of boost lung irradiation or surgical resection). Results: We evaluated 164 PFTs performed on 49 patients with the diagnoses of Wilms tumor (38), rhabdomyosarcoma (5), Ewing sarcoma (3), synovial sarcoma (2), and thymoma (1). Median age at radiation was 6.3 years (range, 0.5–20.2 years); median WLI dose was 12 Gy (range, 10.5–18 Gy). Seventeen (34.7%) had focal pulmonary boost irradiation and 21 (42.9%) had partial lung resection. Across the entire population, forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) declined after irradiation with a median follow-up of 9.3 years. The odds of having a normal FEV1 and FVC decreased by a factor of 0.90 (p = 0.0387) and 0.91 (p = 0.0445), respectively, every year, indicating that the proportion of patients with normal values of FEV1 and FVC decreases over time. FEV1/FVC ratio and forced expiratory flow (FEF25%-75%) remained stable. Abnormal FEV1/FVC and FEF25%-75% were more likely in patients who received boost irradiation than in patients who did not (p = 0.0034 and 0.0233, respectively). Conclusions: Pulmonary function worsened over time in this cohort of childhood cancer survivors treated with WLI. Boost irradiation further impaired pulmonary function. Further studies are planned to assess the clinical consequences of these progressive PFT abnormalities and to identify risk factors associated with clinically significant pulmonary dysfunction after WLI.

No significant financial relationships to disclose.

The association of birth weight with arterial stiffness at mid-adulthood: the Bogalusa Heart Study

BACKGROUND

Birth weight has been found to predict cardiovascular morbidity and mortality. Pulse wave velocity (PWV), a marker of arterial stiffness, has been associated with cardiovascular risk factors. An association between birth weight and blood pressure (BP) has previously been reported. In this study, the association of birth weight with PWV, and the relationship between birth weight, pulse wave velocity and BP in mid-adulthood were investigated.

METHODS

The Bogalusa Heart Study (BHS) is a population-based longitudinal study to investigate the natural development of cardiovascular risk factors. In the 2001 survey, brachial-ankle PWV (baPWV) was measured as an indicator of arterial stiffness. Of the 1203 participants in that survey, 707 had complete data on birth weight and PWV, which were utilised for this study.

RESULTS

In this study, birth weight was inversely correlated with baPWV, pulse pressure, and systolic and diastolic BP (r = -0.10; r = -0.10; r = -0.13 and r = -0.09, respectively; p< or =0.01 for all). After adjustment, birth weight was inversely associated with baPWV. On average, baPWV decreased by 0.23 m/s (95% CI -0.44 to -0.03 m/s) for each 1 kg increase in birth weight. Birth weight (inversely) and baPWV were independently associated with systolic BP (B = -2.05; 95% CI -3.27 to -0.84 and B = 2.99; 95% CI 2.58 to 3.40 respectively).

CONCLUSIONS

Lower birth weight is associated with higher baPWV. The link between birth weight and systolic BP may be partially explained by the association of birth weight with PWV.

A Low-Dimensional Sagittal-Plane Forward-Dynamic Model for Asymmetric Gait and Its Application to Study the Gait of Transtibial Prosthesis Users

This paper presents an extension of a recently developed low-dimensional modeling approach for normal human gait to the modeling of asymmetric gait. The asymmetric model is applied to analyze the gait dynamics of a transtibial prosthesis user, specifically the changes in joint torque and joint power costs that occur with variations in sagittal-plane alignment of the prosthesis, mass distribution of the prosthesis, and roll-over shape of the prosthetic foot being used. The model predicts an increase in cost with addition of mass and a more distal location of the mass, as well as the existence of an alignment at which the costs are minimized. The model’s predictions also suggest guidelines for the selection of prosthetic feet and suitable alignments. The results agree with clinical observations and results of other gait studies reported in the literature. The model can be a useful analytical tool for more informed design and selection of prosthetic components, and provides a basis for making the alignment process systematic.

Low-Dimensional Sagittal Plane Model of Normal Human Walking

This paper applies a robotics-inspired approach to derive a low-dimensional forward-dynamic hybrid model of human walking in the sagittal plane. The low-dimensional model is derived as a subdynamic of a higher-dimensional anthropomorphic hybrid model. The hybrid model is composed of models for single support (SS) and double support (DS), with the transition from SS to DS modeled by a rigid impact to account for the impact at heel-contact. The transition from DS to SS occurs in a continuous manner. Existing gait data are used to specify, via parametrization, the low-dimensional model that is developed. The primary result is a one-degree-of-freedom model that is an exact subdynamic of the higher-dimensional anthropomorphic model and describes the dynamics of walking. The stability properties of the model are evaluated using the method of Poincaré. The low-dimensional model is validated using the measured human gait data. The validation demonstrates the observed stability of the measured gait.

A Kir6.2 mutation causing severe functional effects in vitro produces neonatal diabetes without the expected neurological complications

AIMS/HYPOTHESIS

Heterozygous activating mutations in the pancreatic ATP-sensitive K+ channel cause permanent neonatal diabetes mellitus (PNDM). This results from a decrease in the ability of ATP to close the channel, which thereby suppresses insulin secretion. PNDM mutations that cause a severe reduction in ATP inhibition may produce additional symptoms such as developmental delay and epilepsy. We identified a heterozygous mutation (L164P) in the pore-forming (Kir6.2) subunit of the channel in three unrelated patients and examined its functional effects.

METHODS

The patients (currently aged 2, 8 and 20 years) developed diabetes shortly after birth. The two younger patients attempted transfer to sulfonylurea therapy but were unsuccessful (up to 1.1 mg kg(-1) day(-1)). They remain insulin dependent. None of the patients displayed neurological symptoms. Functional properties of wild-type and mutant channels were examined by electrophysiology in Xenopus oocytes.

RESULTS

Heterozygous (het) and homozygous L164P K(ATP) channels showed a marked reduction in channel inhibition by ATP. Consistent with its predicted location within the pore, L164P enhanced the channel open state, which explains the reduction in ATP sensitivity. HetL164P currents exhibited greatly increased whole-cell currents that were unaffected by sulfonylureas. This explains the inability of sulfonylureas to ameliorate the diabetes of affected patients.

CONCLUSIONS/INTERPRETATION

Our results provide the first demonstration that mutations such as L164P, which produce a severe reduction in ATP sensitivity, do not inevitably cause developmental delay or neurological problems. However, the neonatal diabetes of these patients is unresponsive to sulfonylurea therapy. Functional analysis of PNDM mutations can predict the sulfonylurea response.

Contamination of community water sources by potentially pathogenic vibrios following sea water inundation

Potentially pathogenic members of the Vibrionaceae family including Vibrio cholerae and Vibrio parahemolyticus were isolated from domestic sources of drinking water in coastal villages following sea water inundation during the tsunami in Southern India. Phenotypic and genotypic studies were done to confirm the identity and detection of toxins. Vibrio-gyr (gyrase B gene) was detected in all sixteen vibrio isolates. Toxin regulating genes i.e.: ctx gene, tdh gene, and trh gene, however were not detected in any of the strains, thereby ruling out presence of toxins which could endanger human life. Other potentially pathogenic bacteria Aeromonas and Plesiomonas were also isolated from hand pumps and wells, in a few localities. There was no immediate danger in the form of an outbreak or sporadic gastroenteritis at the time of the study. Timely chlorination and restoration of potable water supply to the flood affected population by governmental and nongovernmental agencies averted waterborne gastroenteritis. Assessment of quality of water and detection of potential virulent organisms is an important public health activity following natural disasters. This work highlights the importance of screening water sources for potentially pathogenic microorganisms after natural disasters to avert outbreaks of gastroenteritis and other infectious diseases.

Diabetes and the enteric nervous system

Diabetes is associated with several changes in gastrointestinal (GI) motility and associated symptoms such as nausea, bloating, abdominal pain, diarrhoea and constipation. The pathogenesis of altered GI functions in diabetes is multifactorial and the role of the enteric nervous system (ENS) in this respect has gained significant importance. In this review, we summarize the research carried out on diabetes-related changes in the ENS. Changes in the inhibitory and excitatory enteric neurons are described highlighting the role of loss of inhibitory neurons in early diabetic enteric neuropathy. The functional consequences of these neuronal changes result in altered gastric emptying, diarrhoea or constipation. Diabetes can also affect GI motility through changes in intestinal smooth muscle or alterations in extrinsic neuronal control. Hyperglycaemia and oxidative stress play an important role in the pathophysiology of these ENS changes. Antioxidants to prevent or treat diabetic GI motility problems have therapeutic potential. Recent research on the nerve-immune interactions demonstrates inflammation-associated neurodegeneration which can lead to motility related problems in diabetes.

An adaptable connectionist text-retrieval system with relevance feedback

This paper introduces a new connectionist network for certain domain-specific text-retrieval and search applications with expert end users. A new model reference adaptive system is proposed that involves three learning phases. Initial model-reference learning is first performed based upon an ensemble set of input-output of an initial reference model. Model-reference following is needed in dynamic environments where documents are added, deleted, or updated. Relevance feedback learning from multiple expert users then optimally maps the original query using either a score-based or a click-through selection process. The learning can be implemented, in regression or classification modes, using a three-layer network. The first layer is an adaptable layer that performs mapping from query domain to document space. The second and third layers perform document-to-term mapping, search/retrieval, and scoring tasks. The learning algorithms are thoroughly tested on a domain-specific text database that encompasses a wide range of Hewlett Packard (HP) products and for a large number of most commonly used single- and multiterm queries.

A rare case of diphyllobothriasis from Pondicherry, South India

Diphyllobothriasis is an intestinal parasitic infection caused by the ingestion of raw fresh-water fish containing the infectious larvae of Diphyllobothrium spp. This infection is uncommon in India. We report a case of diphyllobothriasis that occurred in Pondicherry, India, in a 5-year-old boy hailing from a fishing community. He attended the Pediatric OPD with spontaneous discharge of segments of the adult parasite. The segments (macroscopically and microscopically) were identified as those of Diphyllobothrium latum. The stool examination also revealed characteristic oval eggs.

The association of birth weight with developmental trends in blood pressure from childhood through mid-adulthood: the Bogalusa Heart study

Low birth weight has been found to be associated with cardiovascular mortality and morbidity and with an adverse profile of several cardiovascular risk factors. The inverse association between birth weight and blood pressure was consistently reported from many populations. Using longitudinal data from the Bogalusa Heart Study (Louisiana), the authors investigated the association between birth weight and progression of blood pressure through early adulthood, comparing that relation between African Americans and Whites. Birth data of 2,275 participants, screened two or more times in the Bogalusa Heart Study between 1973 and 2001, were retrospectively obtained from birth certificates and were linked to their clinical, laboratory, and socioeconomic and lifestyle data in the Bogalusa Heart Study data sets. Birth weight was inversely associated with systolic blood pressure, diastolic blood pressure, and pulse pressure (p<or=0.01 for all). For every 1-kg increase in birth weight, systolic blood pressure dropped by 1.9 mmHg (95% confidence interval: -2.6, -1.3), diastolic blood pressure by 0.7 mmHg (95% confidence interval: -1.2, -0.2), and pulse pressure by 1.2 mmHg (95% confidence interval: -1.7, -0.7). The interaction of birth weight with ethnicity was not significant for any outcome. Birth weight was inversely associated with later blood pressure. The strength of that association did not differ between African Americans and Whites.