Previous reports of telemedicine consultations have demonstrated that the technology is effective but inefficient. Little attention has been directed to the use of telemedicine in a primary care practice, especially the use of the medical peripheral devices. We used a functioning primary care practice as a telemedicine test bed, providing unselected patients in the study group. The goal was to study the performance of a new generation of a compact set of medical peripheral devices specifically designed for telemedicine examinations. In a 3-week field trial, 2 second-generation camera systems were used by physician faculty and residents in family practice to examine the skin, ears, and pharynx of 34 patients, ranging in age from 10 months to 78 years. Evaluations by the clinicians and patients were obtained. The average duration of an examination using these systems was 2 minutes. Patients' response was uniformly positive. A "pistol grip" video otoscope obtained an acceptable image, unless canal debris obscured the view. The system that provided pneumatic otoscopy was preferred, with some modifications necessary to obtain an airtight seal. The preferred skin camera was one that provided an image of a size that clinicians were most accustomed to viewing, although stability of this handheld camera was a problem. This camera also worked well to visualize the pharynx, especially in children with symptoms of pharyngitis. Color was deemed important in all 3 anatomical areas, and using auto-white balance and excluding fluorescent lights were preferred. Thus, the second-generation telemedicine peripheral devices were effective for use in a group of unselected primary care patients. These camera systems can be used by nursing personnel and require a minimum of time per examination.

Adolescent↗

PubMedDate not supplied

Time course of reversal of anticoagulant effect of warfarin by intravenous and subcutaneous phytonadione.

BACKGROUND: Excessive anticoagulation increases the risk of hemorrhagic complications associated with oral anticoagulant therapy. Oral or parenteral phytonadione is used to reverse excessive anticoagulation. Intravenous (IV) phytonadione, while effective, is associated with a small risk of serious anaphylactic reactions. Subcutaneous (SC) administration is safer, but there is little information on its relative efficacy in small doses. METHODS: Twenty-two patients with asymptomatic prolongation of prothrombin time were prospectively randomized and treated with 1 mg of phytonadione IV or 1 mg SC. Prothrombin time was measured at baseline and at 8 and 24 hours after phytonadione administration and expressed as international normalized ratio (INR). RESULTS: Mean INR at baseline was 8.0 and 8.5 in the IV and SC groups, respectively (P = .70). At 8 hours, mean INR was 4.6 in the IV group and 8.0 in the SC group (P = .006), and at 24 hours, mean INR was 3.1 in the IV group and 5.0 in the SC group (P = .009). Mean decrease in INR 8 hours after administration of phytonadione was 3.4 in the IV group and 0.4 in the SC group (P = .02), and mean decrease in INR after 24 hours was 4.9 in the IV group and 3.4 in the SC group (P = .18). CONCLUSIONS: For patients who are excessively anticoagulated with warfarin, small doses of SC phytonadione may not correct the INR as rapidly or as effectively as when administered IV. Higher doses must be considered for more rapid and complete reversal of anticoagulation by the SC route.

Anticoagulants↗

PubMedDate not supplied

Biodegradation of fenitrothion in soil.

The biodegradation of fenitrothion (an organophosphorus pesticide) in garden soil of western Uttar Pradesh in northern India has been studied. Both natural and autoclaved soil were treated with 10 p.p.m. of fenitrothion at field capacity moisture and incubated for 90 days in glass containers at 25 and 40 degrees C. The soil samples were collected at various intervals between 0 and 90 days and analysed by HPLC for the residual pesticide and metabolites formed. At 0 days the recovery of the pesticide was 98% and the pesticide then degraded linearly with incubation time. The concentration of pesticide in the natural soil decreased with incubation time with concomitant formation of two metabolites at 25 degrees C and three metabolites at 40 degrees C. These metabolites were purified to homogeneity by HPLC and characterized by IR spectroscopy. The results showed oxidative desulphuration of the pesticide at the first step followed by hydrolytic cleavage of P-O-aryl linkage and demethylation at the second and third step, respectively.

Biodegradation, Environmental↗

PubMedDate not supplied

Biodegradation of a carbamate pesticide, Propoxur, in rat tissues.

Propoxur (Baygon, 2-isopropoxyphenyl N-methylcarbamate) is a carbamate pesticide commonly used against house insects. When the insecticide was administered intramuscularly in rats it was converted to a new metabolite which was found to be present in the serum, liver, kidney and brain 6 h after the administration of the pesticide. The metabolite was purified by high performance liquid to chromatography and comparison of the infrared spectra of Propoxur and the metabolite showed that a deamination reaction was responsible for the formation of the metabolite from the parent pesticide. The pesticide also induced haematological changes such as an increased level of total bilubrin, amylase and glutamic-oxalacetic transaminase and decrease of cholinesterase activity, indicating damage of the liver and nervous system in rats.

Animals↗

PubMedDate not supplied

Metabolic fate of fenitrothion in liver, kidney and brain of rat.

The metabolic fate of fenitrothion, O,O-dimethyl-O-(3-methyl-4-nitro phenyl) phosphorothioate, was investigated in rat tissues during the first 24 hours following the intramuscular administration of the pesticide in the animal. High performance liquid chromatography (HPLC) of the pesticide and its metabolites formed in liver, kidney and brain showed the time-dependent sequential conversion of the pesticide into three major metabolites. These metabolites were separated and purified to homogeneity by HPLC and characterized by IR spectroscopy as O,O-dimethyl-O-)3-methyl-4-aminophenyl) phosphorothioate (metabolite I), O,O-dimethyl phosphorothioate (metabolite II), and O,O-dimethylphosphate (metabolite III). These results indicated reduction of the nitro group in fenitrothion aas the first step, followed by the hydrolytic cleavage of the P-O-aryl bond in metabolite I and the oxidative desulphurylation of metabolite II. Fenitrothion was found to induce ultrastructural changes in liver cells especially after 12 h exposure nuclear membrane was completely distorted, nuclear intactness was totally lost and smooth endoplasmic reticulum and Golgi apparatus were abnormally enlarged. In 24 h, however, the regeneration of the nuclear material was observed.

Animals↗

PubMedDate not supplied

Possible role of calcium in the cardiovascular effects of prolonged administration of gamma-HCH (lindane) in rats.

Gamma-HCH (lindane) administered for long durations is reported to cause toxic cardiovascular effects. Present study was carried out to assess the changes in cardiovascular activity and cellular calcium homeostatic mechanisms in rats administered 3 mg kg-1 day-1 of gamma-HCH p.o. for 6 weeks. The changes in electrocardiogram were marked by a decrease in R-R interval and the amplitude of the P wave by 53% and 50%, respectively. The amplitude of R and T waves was increased by 65% and 58%, respectively. Calcium-45 influx was increased in atrial trabeculae (33%) and in papillary muscle (10%). The plasma calcium concentration was increased (32%) and Ca,K-ATPase activity in heart was decreased (50%). It is suggested on the basis of these findings that cellular calcium homeostatic mechanisms are involved in the cardiovascular effects of gamma-HCH administered chronically in rats.

Adenosine Triphosphatases↗

PubMedDate not supplied

Endometriosis of the urinary bladder: demonstration by sonography.

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Adult↗

PubMedDate not supplied

Impact of annual immunisation programme with oral polio vaccine on the prevalence of paralytic poliomyelitis.

Lameness survey was conducted in a rural community development block of Haryana in 1985. Enumerators contacted school teachers, anganwadi workers and several key informants in the community to identify lame children in 1-11 years age-group. Physician verified 219 lame cases to be due to poliomyelitis. Prevalence of poliomyelitis lameness was 7.3/1000 children born in 1974-76, 7.7/1000 children born in 1977-1980 and 2.3/1000 children born in 1981-1984 (expected to increase to 3.1/1000 when all children born in 1981-84 cross 5th year of life). Immunisation coverage with 3 doses of oral polio vaccine (OPV) was less than 10% during 1974-80 when immunisation was a clinic based activity. Coverage increased from 50 to 80% during 1981-85 when OPV was given in annual immunisation campaign. The results indicate that prevalence of paralytic poliomyelitis dropped at least by 60% after giving OPV in annual immunisation campaigns.

Child↗

PubMedDate not supplied

Acute encephalopathy associated with measles.

Thirty children presenting with acute encephalopathic illness within a month of measles were studied. A male preponderance was found and 83.3% of cases were below 5 years of age. The interval between onset of measles rash and that of encephalopathy ranged from 0 to 20 days. Fever (96.6%), convulsions (70%), and coma (90%) were found in a high percentage of cases, while focal neurological deficits and abnormal movements were found in a small number of patients (3.3% and 16.6% respectively). Signs of cerebellar or medullar involvement were not seen. Only 1 (3.3%) case had pleocytosis in the cerebrospinal fluid. Eleven (36.6%) patients died in hospital. The pathogenesis of acute encephalopathy following measles is discussed.

Brain Diseases↗

PubMedDate not supplied

Determinants of infant and child mortality in rural Haryana.

To identify the individual and household level variables associated with increased risk of mortality, 159 infant and 50 child deaths (cases) and equal number of age matched live infants and children (controls) and their families were studied in a rural area of Haryana. The social, economic, educational and environmental characteristics of the case and control families were similar. Increased risk of infant and child mortality was associated with maternal age less than 20 and more than 30 years, birth order 4th or higher, unclean cord care at the time of child birth, failure of breast feeding during the first 3 months of age, lack of immunizations, and previous infant or child death(s) in the family (Odds ratio greater than 2; P less than 0.05-0.01 by X2 test). An emphasis on the interventions directed at control of the above mentioned variables may prove most helpful in reducing infant and child mortality in a rural area.

Child, Preschool↗