Severely malnourished children (26), weight for age 55.27 +/- 3.17, were identified in a colony of predominantly Muslim urban slum dwellers of low economic status. An equal number of normally nourished children matched for age, sex and per capita income were identified. A strong relation was found between nutritional status of the subjects and educational level of their mothers (P less than 0.025). Father's education was unrelated to childrens' nutritional status. A thirty seven point questionnaire was administered to the mothers to record their nutritional knowledge, attitudes and practices (KAP). Analysis revealed that better KAP in relation to 16 of these 37 questions was not associated with better nutritional status. Seven questions were found to have only a weak association. The remaining 14 questions were identified as important for a nutrition education programme. Comparison of nutritional KAP score based on these 14 questions in case of mothers of normal and severely malnourished children revealed a significantly higher score in the former. Questions related to growth monitoring and breast feeding were not found to be important. No significant association was found between mothers' KAP and educational level. It is concluded that (i) Maternal education and KAP are significantly and independently associated with childrens' nutritional status. (ii) The content areas of knowledge, attitudes and practices significantly associated with nutritional status pertain to nutritional requirements of children, nutritional value of foods, immunisation, hygiene, oral rehydration and diarrhea.

Attitude to Health↗

PubMedDate not supplied

Evaluation of knowledge and efficiency of Anganwadi workers.

Explore the source record for details and available documents.

Adult↗

PubMedDate not supplied

Complications of esophageal variceal band ligation.

Explore the source record for details and available documents.

Acute Disease↗

PubMedDate not supplied

Functional outcome in the elderly following lower extremity amputation.

Data regarding functional outcome in the elderly following major lower extremity amputation (LEA) are minimal. In the general diabetic population there is a significant mortality associated with these procedures, with the 5-year survival rates approaching only 40%. Contrasts between this group and the nondiabetic population will help to clarify the morbidity of these procedures and substantiate efforts at limb salvage. The authors review their experience with patients 80 years of age and above undergoing major LEA between 1990 and 1995 with a specific focus on postoperative mortality and functional status. Forty-one patients were studied, 67% of whom had diabetes mellitus. Postoperative functional status remained unchanged in 40% and worsened in 55% of patients, while residential status was unchanged in 68% and worsened in 32%. The median survival for patients with and without diabetes was 19 and 49 months, respectively. The 5-year survival for the entire group was 25% and was not statistically different in the two subgroups. The authors conclude that major LEA in the very elderly is associated with a considerable mortality and deterioration of functional and residential status.

Aged↗

PubMedDate not supplied

Isolated tubercular tenosynovitis in children: report of seven cases.

Isolated tubercular tenosynovitis is a rare entity, and is extremely rare in children. Seven cases of isolated tubercular tenosynovitis are presented, all in children in their second decade of life. There were no primary detectable lesions elsewhere in the body. Diagnosis in all the cases was obtained by fine-needle aspiration cytology. All patients were treated by antitubercular drugs for 18 months and achieved complete healing and full function. Use of fine-needle aspiration cytology in tubercular tenosynovitis is discussed.

Adolescent↗

PubMedDate not supplied

Reverse arterial blood flow as a pathway for central nervous system toxic responses following injection of local anesthetics.

In baboons, lidocaine HCl was injected into the lingual (3 mg/kg), brachial (7 mg/kg), or femoral (7 mg/kg) arteries. Blood samples were taken from the internal carotid artery (ICA), internal jugular (IJV), external jugular (EJV), brachial (BV), or femoral (FV) vein, depending on the injection site, 6, 30, and 180 seconds after injection. Subsequently, radioactive microspheres (20 micron in diameter) were injected into the lingual artery, and the brains were obtained 48 hours later at postmortem to locate the microspheres. Six seconds after injection into the lingual artery, lidocaine concentration in ICA was 28 microgram/ml, whereas peak levels in IJV and EJV occurred at 30 seconds, being 51 and 25.7 microgram/ml, respectively. After injection into the brachial artery, peak average ICA levels were 105.5 microgram/ml at 6 seconds, while only 20.6 microgram/ml concentration was noted in ICA after injection into the femoral artery. Seventy-four precent of the Sr90 labeled microspheres were found lodged in the ipsilateral cerebral hemisphere. Local anesthetic drugs accidentally injected into arteries may reach the cerebral circulation following a centripetal pathway and thus produce central nervous system toxic responses.

Anesthesia, Local↗

PubMedDate not supplied

Methotrexate in Crohn's disease: results of a randomized, double-blind, placebo-controlled trial.

BACKGROUND/AIMS: Immunosuppression with methotrexate may be useful in the treatment of Crohn's disease. We tested the efficacy of methotrexate in refractory Crohn's disease in a randomized, controlled trial. METHODOLOGY: Randomized, double-blind placebo-controlled trial of methotrexate in 33 patients with steroid-dependent Crohn's disease, 33% of whom had previously failed therapy with 6-mercaptopurine. Patients were given placebo or oral methotrexate 15 mg/week, or adjusted up to 22.5 mg/week, for up to 1 year or until treatment failure. Outcome was assessed by reduction in prednisone dosage, Crohn's Disease Activity Index, hospital admission, and laboratory parameters. RESULTS: Four patients were dropped from the study for non-compliance and one because of intercurrent illness, and 28 patients could be evaluated. Fewer methotrexate-treated patients (6/13 or 46%) had flares of Crohn's disease as compared to placebo-treated patients (12/15 or 80%), but this did not achieve statistical significance (p<0.1). There was a non-significant trend toward an increased number of significant side effects in the methotrexate-treated patients (3/13 or 23%) as compared to the placebo-treated patients (0/15 or 0%) (p<0.2). Laboratory indices of inflammation did not differ between the two groups. CONCLUSIONS: The methotrexate-treated group showed a trend toward fewer Crohn's disease flares, balanced by an increased number of significant side effects.

Administration, Oral↗

PubMedDate not supplied

Prenatal diagnosis of Duchenne muscular dystrophy.

BACKGROUND: Duchenne muscular dystrophy (DMD) is one of the most common X-linked genetic disorders seen in children. Mutations in the DMD gene coding for the protein dystrophin causes the severe muscle-wasting disorder leading to death in the second decade of life. In the absence of a cure, prenatal diagnosis (PND) appears to be the best approach to reduce the burden of this disease on the individual family and ultimately on society. There are few published reports worldwide on PND and very few from the developing countries. We report our experience with PND for families with DMD using multiplex polymerase chain reaction (PCR) and microsatellite polymorphic marker analysis. METHODS: From August 1997 to October 1999, PND was offered on request to 23 families with one or two boys affected with DMD. A total of 26 foetuses were screened for DMD. Initially the deletions in the DMD gene in the affected child were identified by multiplex PCR screening for 23 exons in 6 sets. In patients where deletions were not identified, microsatellite repeat analysis was carried out to follow the inheritance of the mutant allele. DNA was extracted from chorionic villus samples obtained by chorionic villus biopsy performed at 10-15 weeks of gestation in 17 families, and at 16-20 weeks in 6 families. RESULTS: Deletions were identified in 20 affected boys. In 2 families, microsatellite repeat analysis was done to identify the mutant allele. Of the 26 foetuses, 5 were found to be affected with DMD and the parents opted for termination of pregnancies. CONCLUSIONS: Multiplex PCR technology and microsatellite repeat analysis can be used effectively for PND of DMD.

Female↗

PubMedDate not supplied

Prenatal diagnosis of haemoglobinopathies.

BACKGROUND: Haemoglobinopathies constitute a major health problem in the Indian subcontinent. In the absence of any method for achieving complete cure and treatment being expensive, prenatal diagnosis and selective termination of an affected foetus is a feasible option to decrease the disease load. We report our experience with prenatal diagnosis of haemoglobinopathies over a two-and-a-half year period in 257 pregnancies. METHODS: Amplification refractory mutation system (ARMS) was used to detect beta-thalassaemia, haemoglobin E and sickle cell mutations. RESULTS: Five mutations in the beta-globin gene which are common in the Indian population were detected in 92.3% of mutant chromosomes, whereas 3.1% of chromosomes carried rare mutations followed by 0.8% haemoglobin E and 0.4% sickle cell mutations. Mutations in 3.3% chromosomes were uncharacterized. The prenatal procedure, carried out early in pregnancy, was a chorionic villus sampling in most cases. A confirmed diagnosis based on ARMS-PCR was given in 241 (93.8%) cases. In 10 cases (3.9%) linkage analysis was required to confirm the foetal status, as mutations in both parents were not identified or the chorionic villus sample carried the single identified mutation. Four families with haemoglobin E-beta thalassaemia and one family with sickle cell disease were also included. Of the study population, 91.25% of the couples had a previous child with haemoglobinopathy, whereas 8.75% of the couples came before the birth of the first affected child. CONCLUSION: We conclude that ARMS-PCR is a highly sensitive technique for detecting mutations in the beta-globin gene and its efficacy in the prenatal diagnosis of haemoglobinopathies is proven.

Abortion, Induced↗

PubMedDate not supplied

Dietary cholesterol induced changes in serum lipoproteins in healthy females.

We studied the effect of high cholesterol fat breakfast containing approximately 527 mg cholesterol and 33 gm fat given for seven days in 10 healthy females of young age (18 to 21 years) and in healthy older females of age group (48 to 60 years). Serum total cholesterol and low density lipoprotein did not alter significantly after feeding and after withdrawal of high cholesterol fat breakfast. Serum high density lipoprotein increased significantly in young females after feeding and further increased after withdrawal for seven days, while in older females no appreciable change occurred. Serum triglyceride showed a significant decline in young persons after feeding but gradually increased after withdrawal while in older females no significant change occurred.

Adolescent↗

PubMedDate not supplied

Macula off retinal detachments. How long can they wait before it is too late?

PURPOSE: To determine the association between the duration of macula off detachment and the visual outcome following corrective surgery. METHODS: Retrospective review of the medical records of patients who underwent surgery for macula off detachment over a 5 year period (April 1994- March 1999). RESULTS: There were 104 patients in the study. Patients with macula off detachments wait a mean of 2.6 weeks (+/-0.3 SE mean) before presentation and 1.8 weeks (+/-0.2 SE of mean) thereafter before surgery. The mean duration of detachment prior to surgical repair was 4.2 weeks (+/-0.3 SE mean). 78% of patients achieved a postoperative improvement in visual acuity. 36.5% achieved functional visual success of 6/12 at 3 months, which increased to 51% at final discharge. There was no significant difference in visual outcomes for patient undergoing internal vs external procedures (p=0.188). The preoperative visual acuity was the most significant predictor of post operative visual acuity (p<0.0005). Less than 40% of macula off detachments of > or =6 weeks duration will achieve a vision of 6/12 or better compared with 68.2% of patients with macula off detachments of < or =1 week. CONCLUSIONS: The best mean postoperative vision (LogMAR 0.35) was seen in patients with detachment of <1 week duration. Patients <60 years are more likely to achieve visual improvement despite the duration of the detachment. Macula off detachments of >6 weeks duration have a significantly poor postoperative visual prognosis. Awareness of this visual prognosis can assist in planning the timing of surgery to ensure an acceptable result.

Adolescent↗

PubMedDate not supplied

A comparative study of three different test diets in change in plasma total cholesterol in young healthy individuals.

The effect of single dose of three different types of high cholesterol diet on plasma total cholesterol (PTC) in 24 young healthy subjects (male:female = 1:1) aged 15 to 35 years was studied. One group (n1 = 8) was given a butter and milk diet (300 mg cholesterol and 95 g fat). In the first postprandial hour PTC level increased significantly in all but one subject (mean +/- S.D., 4.96 +/- 0.57 m mol/l to 5.61 +/- 0.60 m mol/l, P < 0.005). Second group (n2 = 8) was given a single egg diet (300 mg cholesterol and 6 g fat). In the first hour the PTC level decreased significantly in all but 2 subjects (4.82 +/- 0.58 m mol/l to 4.42 +/- 0.63 m mol/l, P < 0.02). Third group subjects (n2(3) = 8) were given a test diet consisting of crystalline cholesterol with 200 ml milk (1020 mg cholesterol and 14 g fat). The PTC level increased insignificantly. In the first hour in all but 2 subjects (4.94 +/- 0.43 m mol/l to 5.35 +/- 0.88 m mol/l, P > 0.10). In the third postprandial hour the PTC values in all the 3 groups showed a tendency to return to fasting values. Therefore, we conclude that the effect of dietary cholesterol on PTC depends not only on the amount of cholesterol content in the diet, but on the type of diet (cholesterol vehicle) as such and probably also on the fat content of the diet.

Adolescent↗