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Biomedical subjects

K N Agarwal

Publications and source records attributed to K N Agarwal.

At least 19 recordsLinked to original sources

Deciduous dentition and enamel defects.

Two hundred eighty children including wellnourished, malnourished and infants with intrauterine growth retardation (IUGR) were examined for dental eruption and enamel hypoplasia. In malnourished and IUGR children eruption of teeth was delayed. The prevalence of enamel hypoplsia in wellnourished children was 20% being significantly higher in females as compared to males in age group 1-2 years. Enamel hypoplasia was seen in 36.6% malnourished subjects. Breast-feeding was protective against enamel hypoplasia.

Dental Enamel Hypoplasia↗

Anemia prophylaxis in adolescent school girls by weekly or daily iron-folate supplementation.

OBJECTIVE: To examine the benefits of anemia prophylaxis in adolescent school.girls by weekly or daily iron-folate supplementation. DESIGN: Prospective study. SETTING: Government girl schools of northeast Delhi. SUBJECTS: 2088 subjects (with hemoglobin greater than 7.9 g/dL), including 702 on daily and 695 on weekly iron-folate administration; 691 girls served as controls. RESULTS: About 85% girls were iron deficient out of which 49.3% were anemic. Weekly administration took longer time to raise hemoglobin but was effective as well as practical. Plasma ferritin estimation in girls showed rise in level in both the treated groups. CONCLUSION: Weekly administration of iron-folate was a practical and effective strategy for anemia prophylaxis in adolescent school girls.

Adolescent↗

Effectiveness of nutrition education, iron supplementation or both on iron status in children.

OBJECTIVE: A community-based, randomized trial was designed to compare the effect of nutrition education and/or iron supplementation (weekly) on iron status of children in an urban slum in Delhi. METHODS: Four hundred and fifty one children, 9-36 months of age and their caretakers (mothers), assigned to one of the following groups were included in the cohort. Group 1, nutrition education. Group 2, supplementation (with 20 mg elemental iron). Group 3, nutrition education with supplementation (with 20 mg elemental iron) and Group 4, control given placebo. The intervention program was of four months duration, with a treatment phase of 8 wk followed by 8 wk of no treatment. RESULTS: Post intervention, at 8 wk and at 16 wk, the hemoglobin change in the nutrition education, supplementation, nutrition education with supplementation and control groups was 2.9, 1.9, 3.8 and -5.9%, respectively and 2.1, -1.9, 0 and -9.3%, respectively (as compared to initial values). There was no significant effect of any of the intervention at 8 weeks. At 16 wk, there was significant positive effect of nutrition education group (p less than 0.05). The percent change in serum ferritin value at 16 wk in the nutrition education, supplementation, nutrition education with supplementation and control groups was 5.7, -2.3, -3.4 and -40%, respectively. Serum ferritin values were significantly higher for the nutrition education group (p < 0.001) as compared to the control. At 16 wk, the nutrition education group mothers showed significantly higher nutrition knowledge and the dietary iron intake of children was significantly higher than their control group counterparts (p < 0.0001). CONCLUSION: The study suggests that nutrition education did have a positive effect on the iron status possibly by improving the dietary iron intake.

Analysis of Variance↗

Feasibility studies to control acute diarrhoea in children by feeding fermented milk preparations Actimel and Indian Dahi.

The aim of this work was to study feasibility of diarrhoea control in children (6 months to 5 y of age) by feeding fermented milk preparations. The design used was a randomized controlled clinical trial and the study was carried out at the Delhi University College Hospital providing tertiary care, and a nearby community centre Nand Nagri, a resettlement colony in East Delhi. Children suffering from acute diarrhoea (75 patients from the hospital and 75 from the community) were allocated to three groups by double-blind technique. Group 1 was given a fermented milk, Actimel, containing 10(8) of each Lactobacillus casei DN-114001, Lactobacillus bulgaricus and Streptococcus thermophilus per gram. Group 2 was given Indian Dahi (Lf 40) containing 10(8) of each Lactococcus lactis, Lactococcus lactis cremoris and Leuconostac mesenteroides cremoris per gram. Group 3 was given ultra-heat-treated yoghurt preparation (no live bacteria). Actimel was also used as a starter to prepare the curd in order to study the preventive effect of diarrhoea in children in a community. In the hospital study Indian Dahi and Actimel administration reduced mean duration of diarrhoea by 0.3 and 0.6 day (P<0.001), respectively. The corresponding figures in the community study were 0.2 and 0.5 day (P<0.05), respectively. The families using Actimel as a starter showed a reduction in diarrhoeal morbidity episodes by 40% of the children tested in a 3 month follow-up. In conclusion, Actimel, fermented milk containing Lactobacillus casei DN-114001, and Indian Dahi can significantly reduce the duration of diarrhoea in children; the former preparation being superior.

Acute Disease↗

Birth weight patterns in rural undernourished pregnant women.

OBJECTIVE: To study the birth weight pattern in chronic as well as currently undernourished pregnant women. DESIGN: Prospective study of rural pregnant women by following eligible women. SETTING: Two adjoining blocks of rural Varanasi. METHOD: 3700 pregnant women from rural areas of Varanasi for whom data for anthropometry, hemoglobin, dietary intake, birth weight, fundal height and abdominal girth at 16 +/- 2, 28 +/- 2 and 36 +/- 2 weeks of gestation were recorded. Outcome measure was birth weight pattern of newborns. RESULTS: Of the births, 7.2% were < 2250 g and 27.4% < 2500 g. The weekly birth weight increments in gestation 36-42 weeks were 5-53 g, only. The fundal height did not increase during 35-39 weeks of gestation (lower by 5 cm as compared to normal). Nutrition supplement in the third trimester significantly increased fundal height and abdominal girth. Fundal height below 24.5 cm at 28 weeks of gestation (1368 women) was associated with higher low birth weight deliveries. CONCLUSION: Birth weight and fundal height increments during later pregnancy are low in undernourished pregnant women. Fundal height < 24.5 cm at 28 weeks of gestation identified women with higher risk for lowbirth weight infants. The prevalence of low birth weight was 27.4% and of prematurity was 6.6%.

Adult↗

Impact of daily versus weekly hematinic supplementation on anemia in pregnant women.

OBJECTIVE: To compare the effectivity of weekly versus daily iron therapy in reducing maternal anemia and to evaluate the association of maternal hemoglobin and fetal growth. DESIGN: Prospective. SETTING: Tertiary care teaching hospital in an urban metropolis. METHOD: 40 pregnant women received daily and 40 pregnant women received weekly oral therapy (335 mg of ferrous sulphate and 500 g folic acid) for a period of 14 weeks. The age of each pregnant woman and their baseline anthropometric data (weight, height and body mass index) were estimated. Hemoglobin and hematocrit estimations were carried out during follow period at 4 wks, 8 wks and 14 weeks. Serum ferritin values as a marker of iron status were also calculated in both the groups initially, at 14 weeks and at the time of delivery. Fetal anthropometric indices of 137 full term neonates delivered to mothers included in either of the supplementation groups or admitted to the hospital were also studied in relation to maternal hemoglobin concentration. RESULTS: Forty subjects each were initially randomized into groups I and II. The age of pregnant women along with their baseline anthropometric data were similar in both groups. A total of 29 pregnant women in group I and 27 pregnant women in group II could be regularly followed up. The increase in hemoglobin and hematocrit values were similar in daily and weekly supplemented mothers. An intention to treat analysis also showed similar results. The ferritin values were similar at the start of supplementation and after 14 wks of weekly or daily iron therapy. Birth weight, crown heel length, head circumference of the neonate and placental weight increased significantly with rise in maternal hemoglobin levels. CONCLUSION: Weekly iron supplementation is an effective mode of treating anemia among pregnant women and maternal anemia during pregnancy is adversely associated with fetal growth.

Anemia↗

BCG vaccination reaction in low birth weight infants.

BACKGROUND & OBJECTIVES: About 30 per cent newborns (preterm and term) weigh < 2500 g at birth. The immunological system is less mature in low birth weight (LBW) babies compared to term and normal birth weight (NBW) babies. Bacille Calmettee Guerin (BCG) vaccine is given at birth under the national immunization programme. There is a paucity of information on the immunogenicity of BCG vaccine in preterm and LBW babies. It was, therefore, proposed to study the reaction of BCG vaccination in LBW, preterm and normal birth weight newborns. METHODS: A total of 143 newborns (90 term and 53 preterm; of these 78 were LBW) received during March to September 1998, 0.1 ml of BCG vaccine (Danish 1331 strain) intradermally on the left arm just above the insertion of the deltoid muscle within 7 days of life. At the same time trivalent oral polio vaccine was administered as per the national immunization programme. These babies were followed up in the immunization clinic at 4, 6, 8, 10 and 12 +/- 1 wk to observe reactions at the BCG vaccination site. RESULTS: After 4 wk reaction at the vaccination site was significantly (P < 0.001) delayed in preterm babies as compared to term infants, and in the LBW babies (P < 0.05) as compared to NBW babies. The reaction at the site of vaccination was not found to be different at 6, 8, 10, 12 wk. BCG scar was seen in 47.5 per cent infants (45.4% in < 2500 g birth weight and 50% in > or = 2500 g birth weight infants) at 12 wk. But 33 (42.3%) LBW and 24 (36.9%) NBW infants also showed papule, pustule, ulceration or scab at the BCG vaccination site. INTERPRETATION & CONCLUSION: The BCG reaction was seen in the sequential order from papule to scar formation. No significant difference was seen in the scar formation in infants studied with varying gestation and birth weights after 12 wk of BCG vaccination. Fifty seven (40.4%) babies still showed different stages of BCG reaction at 12 wk. BCG vaccine along with OPV administered in early neonatal life showed successful BCG reaction in 95.5 per cent infants.

BCG Vaccine↗

Hematological observations as diagnostic markers in dengue hemorrhagic fever--a reappraisal.

OBJECTIVE: To determine the utility of certain clinical and hematological parameters as diagnostic markers of dengue hemorrhagic fever (DHF), namely, (i) tourniquet test, (ii) association of bleeding manifestations with the platelet count, and (iii) "cut off" value of hematocrit diagnostic of DHF in Indian population. DESIGN: Prospective study. SETTING: Tertiary care hospital. SUBJECT: 304 children of DHF presenting between September 1996 to December 1996. RESULTS: The tourniquet test had a low sensitivity and was positive only in 61/239 (25.5%) cases. There was no statistical difference in the incidence of bleeding manifestations between thrombocytopenic and non-thrombocytopenic individuals highlighting poor association of thrombocytopenia with bleeding manifestations. A "cut off" hematocrit value of 36.3% diagnostic of DHF was estimated by discriminant analysis in Indian population. CONCLUSION: The study highlights tourniquet test as a less sensitive diagnostic marker of DHF, poor association of thrombocytopenia with bleeding manifestations and also defines the hematocrit value diagnostic of DHF in Indian population.

Child↗

Iron and the brain: neurotransmitter receptors and magnetic resonance spectroscopy.

Earlier studies show that in iron deficiency with anaemia and in latent iron deficiency neurotransmitters are altered. The changes induced in the fetal brain are irreversible on rehabilitation. The important alterations in glutamate metabolism in latent iron deficiency stimulated studies on gamma aminobutyric acid and glutaminate receptors. It was observed that binding of 3H-muscimol at pH 7.5 and 1 mg protein/assay increased significantly in synaptic vesicular membranes and under similar conditions 3H-glutamate binding showed reduction. Thus iron deficiency played a role in both excitatory and inhibitory neurotransmitter receptors. To elucidate the role of body iron status on the brain, anaemic children with thalassemia and iron deficiency were subjected to 'magnetic resonance spectroscopy' of globus pallidus, caudate and dentate nuclei and there was no change in iron content. The concentrations of creatinine and aspartate increased, with lowering of choline content. The findings were similar in thalassemia as well as iron deficiency anaemia, suggesting that in anaemia changes operate through reduced oxygen availability.

Anemia, Iron-Deficiency↗

Physical growth assessment in adolescence.

OBJECTIVE: To describe ponderosity indices body mass index--"BMI" and ponderal index "PI" and skin fold thicknesses (triceps, biceps, subscapular and suprailiac) for affluent Indian school going adolescents. DESIGN: Cross sectional. METHODS: Measurements were recorded in healthy affluent school going adolescents in public schools of 12 cities in India (boys=11,863 and girls 7,694). Means and percentiles of ponderosity indices and skinfold thicknesses at yearly intervals were derived for each sex and related to sexual maturity. RESULTS: BMI, PI and skin fold thickness (SFT) were higher in girls. There was lower variability of these parameters with sexual maturity rating (breast/genital development stages) as compared to age, suggesting use of these indices in relation to sexual maturity for assessment of adolescent growth. CONCLUSION: Pediatricians and endocrinologists can use these indices for assessment of thinness and obesity, in adolescent Indian children, in relation to sexual maturity for the age.

Adolescent↗

Impact of the integrated child development services (ICDS) on maternal nutrition and birth weight in rural Varanasi.

OBJECTIVE: To evaluate the impact of ICDS on maternal nutrition and birth weight. SETTING: 28 ICDS and 21 non-ICDS villages in two adjoining blocks of Varanasi. METHODS: 5289 pregnancies were registered during 1987-1993 in these two blocks. In the ICDS block 916 and 1453 nutrition supplemented and unsupplemented, respectively and 1748 of the non-ICDS live births with weight recorded within 48 h formed the study subjects. RESULTS: The ICDS supplemented mothers gained 100g more in pregnancy and birth weight was higher by 58 g (p < 0.05) as compared to unsupplemented ICDS mothers. Birth weight in unsupplemented ICDS areas was 25g higher as compared to non ICDS area. ICDS supplemented women had a significantly smaller proportion of low birth weight babies (14.4%) compared to ICDS unsupplemented (20.4%) and non-ICDS women (26.3%). The corresponding prevalence of preterm births was 2.0, 2.4 and 4.3%, respectively (P < 0.001). Multiple regression analysis showed that increased wight gain in pregnancy, length of gestation, caloric intake and term hemoglobin were significantly associated with birth weight. However, the length of gestation was not influenced by factors improving the birth weight. CONCLUSION: Undernourished pregnant women are benefitted by late pregnancy nutrition supplement

Adult↗

Effects of massage & use of oil on growth, blood flow & sleep pattern in infants.

BACKGROUND & OBJECTIVES: The present study was undertaken to investigate if massage with oils commonly used in the community for massage in infancy is beneficial. METHODS: Full term born healthy infants (n = 125), 6 +/- 1 wk of age, wt > 3000 g were randomly divided into five groups. Infants received (i) herbal oil, (ii) sesame oil, (iii) mustard oil, or (iv) mineral oil for massage daily for 4 wk. The fifth group did not receive massage and served as control. The study tools were anthropometeric measurements; microhaematrocrit; serum proteins, creatinine and creatine phosphokinase; blood flow using colour doppler and sleep pattern. RESULTS: Massage improved the weight, length, and midarm and midleg circumferences as compared to infants without massage. However, in the group with sesame oil massage increase in length, midarm and midleg circumferences by 1.0, 0.9 and 0.7 cm, respectively was significant (P < 0.05, < 0.01 & < 0.05). There was no change in microhaematocrit, serum: proteins, albumin, creatinine and creatine phosphokinase between both the groups. The femoral artery blood velocity, diameter and flow improved significantly by 12.6 cm/sec, 0.6 cm and 3.55 cm3/sec respectively in the group with sesame oil massage as compared to the control group. Massage improved the post massage sleep, the maximum being 1.62 h in the sesame oil group (P < 0.0001). INTERPRETATION & CONCLUSIONS: Massage in infancy improves growth and post-massage sleep. However, only sesame oil showed significant benefit.

Blood Circulation↗

Pregnancy wastage in rural Varanasi: relationship with maternal nutrition and sociodemographic characteristics.

OBJECTIVE: To study the relationship between pregnancy wastage and matrnal undernutrition and other sociodemographic factors in rural Indian women. SETTING: Rural community of Varanasi. DESIGN: Longitudinal observation. METHOD: In 49 villages during 1988-92, 8111 pregnancies were registered to observe for wastage. The pregnancy outcome was correlated with various factors. RESULTS: There were 1321 abortions and 141 still births. Women's income < Rs. 250 per month, education < 10th class and protein intake < 50 g/day had significantly higher relative risks (RR) (4.1, 2.9 and 2.8, respectively) for abortions. Poor maternal nutrition was in additional important risk factor, for still births (RR 5.1 and 4.2 for maternal weight and height, respectively). A pregnancy interval over 2 years reduced both. CONCLUSION: Low socioeconomic status, chronic undernutrition and illiteracy in rural India are associated with high pregnancy wastage.

Abortion, Spontaneous↗

Weight gain during pregnancy--a key factor in perinatal and infant mortality.

OBJECTIVE: To identify risk factors for high perinatal (PMR) and infant (IMR) mortality in a rural area. DESIGN: In 49 randomly selected villages from two adjoining blocks of rural Varanasi, all pregnant women and live births were followed for perinatal and infant mortality, during the years 1988-1992. SUBJECTS: 6790 births and their 6649 live births. RESULTS: The PMR was 90.7 per thousand births and IMR was 98.6/1000 live births. These mortalities were significantly higher if weight gain during pregnancy was less than 7.0 kg. Low weight gain during pregnancy was also associated with significantly higher low birth weight deliveries and to some extent increased still birth rate. PMR and IMR decreased with higher levels of hemoglobin in third trimester and socioeconomic index; however, the calculated RR were not significant. CONCLUSION: Low weight gain during pregnancy is an important risk factor for PMR and IMR.

Adult↗