Biomedical subjects
R Kumar
Publications and source records attributed to R Kumar.
Impact of oral rehydration therapy on maternal beliefs and practices related to acute diarrhea.
Maternal beliefs and practices related to acute diarrhea were evaluated in 69 villages of a district in Haryana. Oral rehydration therapy (ORT) programme was introduced in 47 villages; in 25 by health workers and in 22 by health volunteers. Twenty two villages served as control. Impact was assessed by interviewing 200 mothers initially and 210 each, one and two year after initiating the programme. Dehydration as a complication of diarrhea was perceived by 67.2% mothers in health worker and 71.4% in volunteer villages of Intervention area as compared to only 32.8% in control area (P less than 0.01). In Intervention area, 88.6% mothers had tried ORT as compared to 22.8% in control area and 85% of the mothers found it to be useful. The restriction of breast feeding during acute diarrheal episode was favoured by only 15.7% mothers in intervention area and by 47.1% in control area (P less than 0.01). The knowledge regarding use of home available fluids in increased amounts did not show an impressive change. There was no change as regards understanding of cause of diarrhea. Favourable change in beliefs and practices is possible by instituting ORT with culturally relevant health education.
Serum TNF-alpha and free radical scavengers in neonatal septicemia.
Tumor necrosis factor-alpha (TNF-alpha) and free radicals have been implicated in the pathogenesis of neonatal septicemia and its complications. This case control study was conducted between November 1996 to July 1997 to determine the levels of TNF-alpha and free radical scavengers viz. superoxide dismutase (SOD) and glutathione peroxidase (GPX) in the serum of 30 septic neonates and 20 healthy controls. Patients with neonatal sepsis registered significantly higher levels of TNF-alpha, SOD and GPX in comparison to controls (p < 0.05). The neonates with septic shock had five fold increase in TNF-alpha levels (2262 +/- 605.8 pg/ml) as compared to those without shock (738.8 +/- 728.8 pg/ml). There was no statistically significant difference in levels of antioxidant enzymes between neonates with shock and without shock. The levels of TNF-alpha and antioxidant enzymes were not affected by the type of organism isolated in blood culture.
Aggregative Escherichia coli, Salmonella, and Shigella are associated with increasing duration of diarrhea.
In order to relate etiology of diarrhea to the duration of the episode, a cohort of 452 children up to 36 months of age was visited once weekly at their households for 18 consecutive months to record diarrheal morbidity. Fecal specimens were obtained in 453 diarrheal episodes occurring in 354 children during this period. The common putative agents as single isolations associated with diarrhea were EA-AggEC (17.2%), ETEC (14.1%), EPEC (6.0%) and rotavirus (4.0%). The pathogens with higher median duration of diarrhea were Shigella (13.5; mean +/- SD 13.7 +/- 2.7), Salmonella (8.8: 15.3 +/- 4.5) and EA = AggEC (12.0: 15.1 +/- 1.8). Of 55 episodes with duration of greater than 14 days, the main pathogens isolated were EA-AggEC (32.7%), ETEC (9.0), Salmonella, G. lamblia (5.5% each) and Shigella (3.5%). These data provide a preliminary evidence to suggest that EA = AggEC may well be the main long sought microbial agent responsible for diarrhea of long duration.
Survey of village informants--an alternate method to estimate paralytic poliomyelitis prevalence in rural area.
Lameness surveys were conducted among children of 0-14 year age group in 60 villages of a Community Development Block of district Ambala in Haryana State. The methods used were: village informants survey and house-to-house survey. Village informants were village chief, school teachers, primary health care workers, traditional birth attendants and several prominent persons from each street/neighbourhood of the village. These informants located lame children in their locality. Subsequently, a house-to-house search for identification of lame children was made in all the 60 sampled villages. Physicians later on, examined the lame children to diagnose paralytic poliomyelitis. Estimate of the prevalence rate of lower extremity paralytic poliomyelitis in 0-14 year age group was found to be 7.9/1000 in village informants survey. This did not differ significantly from the rate of 8.8/1000 revealed by house-to-house survey in the same community (p greater than 0.05). Time required to complete village informants survey was almost one third and costs were also about half as compared to house-to-house survey. Therefore, village informants based lameness survey is a rapid and economical alternative for the estimation of poliomyelitis prevalence in rural communities.
Risk factors for stillbirths in a rural community.
To determine the risk factors for stillbirth, a case-control study was carried out in a rural community of Haryana. Stillbirths (cases) were identified retrospectively from a household survey, while the controls, matched individually with each case for the month of birth, were live born infants from the same neighbourhood as the case. The stillbirth rate in the study population was 26.8 per 1000 (68/2539) births. The distribution of socio-economic and environmental factors was similar in the cases and the controls (P > 0.05). Multivariate analysis indicated higher risk of stillbirth for first order births (Odds Ratio [OR] 7.9, Confidence Interval [CI] 2.1-29.2, P 0.002), history of prior stillbirths/child deaths (OR 15.2, CI 2.3-98.2, P 0.004), and absence of antenatal care (OR 3.3, CI 0.9-14.3, P 0.07). Mothers' age, birth interval (< 24 months), delivery place (hospital or home) and type of birth attendant (trained vs untrained) did not show significant influence on the risk of stillbirth. An improvement in the coverage of antenatal care in socio-economically weaker rural community is suggested as the most appropriate strategy for reducing the high stillbirth rate.
Laboratory diagnosis of plague.
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Role of protozoa as risk factors for persistent diarrhea.
A case control study including 175 children aged 0-36 months suffering from diarrhea of > or = 14 days duration was undertaken to determine whether there is an association between Giardia lamblia, Entamoeba histolytica or Cryptosporidium infection and persistent diarrhea (PD). Subjects were identified by ongoing household surveillance and enrolled as cases. For each case two controls were selected by survey of neighbouring households--a child with acute diarrhea and one without diarrhea. Both the controls were matched with the case for age and nutritional status. Two fresh stool samples were collected from all cases and controls at enrollment and examined for trophozoites of Giardia lamblia, Entamoeba histolytica and Cryptosporidium. Giardia lamblia trophozoites were detected in a significantly higher proportion of PD cases (20.0%) than acute diarrheal and non diarrheal controls (4.6% each, p < 0.0001). There were no significant differences in the proportion of cases and controls who passed E. histolytica trophozoites or cryptosporidium in their stools. There was a consistent trend towards poorer weight gain in PD cases who passed Giardia trophozoites in stool; the differences were statistically significant at days 14 and 21, after enrollment. Giardia lamblia infection is more prevalent in PD cases than in acute diarrhea or non-diarrheal controls. This prevalence is not high enough to warrant routine anti-giardia therapy in patients with PD. However, as giardiasis was observed to have adverse growth impact in PD cases, stool microscopy for detection and subsequent treatment of Giardia lamblia seems to be justified.
Viral encephalitis of public health significance in India: current status.
Japanese encephalitis (JE) and rabies are 2 viral encephalitis that are of public health importance in India. JE is a zoonosis with the primary cycle occurring in arthropods (mosquito vectors) and vertebrate animals (primarily the pig), man being only an incidental 'dead end' host. Out-breaks have been seen in most parts of India except the north west. The disease presents with a prodromal stage, an acute encephalitic stage with coma, convulsions and variable deficits and a convalescent stage. Diagnosis can be made by viral isolation from CSF or brain, or serologic tests such as haemagglutination inhibition test and IgM antibody capture ELISA in CSF and blood. There is no specific treatment. Mortality ranges from 20-50% and almost half the survivors have sequelae. The most effective control measure besides control of mosquitos is vaccination. A killed mouse brain vaccine is being prepared in India and is safe and effective but expensive. Rabies is a highly fatal encephalomyelitis primarily occurring in urban dogs and wild animals especially canines. It is endemic in India and affects an estimated 3 per 100,000 persons annually. The patient initially may display bizarre combative behaviour. The disease can be effectively prevented by post exposure vaccination. The nervous tissue vaccine is no longer recommended because of unacceptable neurotoxicity. Three cell culture vaccines are presently available with about equal efficacy.
Platelet aggregation in iron deficiency anemia.
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Circulating immune complexes in leukaemias and lymphomas.
Circulating immune complexes (ClC) were estimated in 78 patients of leukaemias and lymphomas by Clq deviation ELISA and PEG assay. In all leukaemias a significant elevation in ClC was seen at the time of first presentation. While in ALL a decrease occurred on therapy as partial or complete remission was achieved, no such fall was seen in AML or CML-BC when treated. ClC levels were much higher in non-Hodgkins lymphoma than in Hodgkins disease and showed a direct correlation with B symptoms and activity of the disease. The ClC levels were highest in null-ALL followed by those in common ALL and T-ALL. The mean duration of remission in patients of ALL without elevation in ClC was much longer than in those with ClC.
Effect of physical work during pregnancy on birth weight.
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HLA-B5 and B21 antigens in aortoarteritis.
The distribution of class I HLA antigens (HLA-A, B) were determined in 50 patients of Aortoarteritis in an Indian population. This included 29 females and 21 males. The difference in antigen frequency was observed between patients and controls with reference to HLA-A19, B5 and B21 antigens. A decreased frequency of HLA-A19 was observed in the patients as compared to controls (14% vs 33.25%, X2 = 6.81, P less than 0.025). Of the B locus antigens, an increased frequency of HLA B5 was observed in the patients as compared to controls (48% vs 29.5%, X2 = 6.2, P less than 0.025). HLA-B21 was also increased in the patients as compared to the controls (18% vs 6.5%, X2 = 6.67, P less than 0.025). These data suggest the involvement of genetic factor (s) in the aetiopathogenesis of this disease. Further, the observations indicate that HLA-B5 and B21 may be associated with Aortoarteritis.
Brainstem auditory evoked response (BAER) in childhood bacterial meningitis.
Brainstem auditory responses were recorded in 50 children of bacterial meningitis and age matched 50 normal children. Abnormal BAER was found in 32 (64%) patients of bacterial meningitis. These abnormalities included prolonged latency (56.2%); unilateral absent response (25%); bilateral absent response (25%) and prolonged interwave interval (25%). Follow-up could be done in 23 patients of 46 survivors. All the patients with prolonged latency either became normal or improved. In majority of the patients having absent response, the abnormality persisted. Abnormal BAER was significantly associated with age < 2 years (p < 0.02), Modified GCS Score < or = 8 (p < 0.001), Seizures (p < 0.02), raised Intracranial Pressure (ICP) (p < 0.02) and CSF sugar < 20 mg% (p < 0.05).
Abnormal migration of ascaris into the middle ear.
Ascaris in the middle ear is very rare with very few cases having been reported. We report here two such cases with different presentations.
Effect of training on the resuscitation practices of traditional birth attendants.
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The synthesis and biological activity of 22-fluorovitamin D3: a new vitamin D analog.
We synthesized 22-fluorovitamin D3 from (22S) cholest-5-ene-3 beta, 22-diol-3 beta-acetate 2. Compound 2 was treated with diethylaminosulfur trifluoride to give 22-fluorocholest-5-en-3 beta-acetate 3 and (E) 22-dehydrocholest-5-en-3 beta-acetate. Compound 3 was treated with N-bromosuccinimide to give a mixture of the respective 5,7- and 4,6-dienes. The 5,7-diene of 3 was separated from the 4,6-diene using the dienophile 4-phenyl-1,2,4-triazoline-3, 5-dione. 22-Fluoro-5 alpha,8 alpha-(3,5-dioxo-4-phenyl-1, 2,4-triazolino)-cholest-6-en-3 beta-acetate 4 was purified by flash chromatography and treated with lithium aluminum hydride to generate 22-fluorocholesta-5,7-dien-3 beta-ol 5. Photolysis of the diene 5, followed by thermal equilibration, resulted in the synthesis of 22-fluorovitamin D3 7. The vitamin 7 increased active intestinal calcium transport only at a dose of 50,000 pmol/rat, whereas vitamin D3 increased intestinal calcium transport at a dose of between 50 and 500 pmol/rat. 22-Fluorovitamin D3 7 did not mobilize bone and soft tissue calcium at a dose as high as 50,000 pmol/rat, whereas vitamin D3 was successful in doing so at a dose of 500 pmol/rat. When tested in the duodenal organ culture system, 22-fluorovitamin D3 7 had approximately 1/25th the potency of vitamin D3. It did not antagonize the activity of 1,25-dihydroxyvitamin D3. 22-Fluorovitamin D3 7 bound to the rat plasma vitamin D binding protein less avidly than vitamin D3. 22-Fluorovitamin D3 was bound very poorly to the chick intestinal cytosol receptor for 1,25-dihydroxyvitamin D3. We conclude that the introduction of fluorine at the C-22 position results in a vitamin D sterol with decreased biologic activity when compared to vitamin D3. The presence of a fluorine group at C-22 position inhibits the binding of the vitamin to rat vitamin D binding protein when compared to the binding of its hydrogen analog, vitamin D3.
Caesium levels in manic depressive psychosis.
Concentrations of caesium were estimated in hair, whole blood, serum and urine by neutron activation analysis, in samples from manic patients, depressed patients, recovered manic patients, recovered depressed patients and normal controls. There was no difference in the concentration of caesium measured between the various diagnostic categories. These results contradict the findings of previous reports.