Effect of ivabradine on heart rate, functional capacity and pulmonary artery pressure in patients of COPD with cor pulmonale.

We studied the effects of heart rate reduction by ivabradine to the ongoing therapy in patients with chronic obstructive pulmonary disease (COPD) and cor pulmonale.100 patients of COPD with cor pulmonale with sinus heart rate ≥ 90 bpm were randomly assigned to either ivabradine 5 mg twice daily (50 patients) or placebo (50 patients) alongwith standard therapy. Assessment was done at baseline and after 6 months which included 6 min walk test (6MWT), dyspnea scoring by modified borg scale, Lung function test by forced expiratory volume in 1 s (FEV1) and pulmonary artery systolic pressure (PASP) by echocardiogram. The drug group showed a significant reduction in heart rate from 95.1 ± 8.2 bpm to 71.1 ± 6.2 bpm (p < 0.001). This group also showed significant improvement in 6-min walk distance and dyspnea on modified Borg scale (p < 0.001) at 6 months follow up. However no significant difference was found between both groups regarding PASP or FEV1 at 6 months.

Suctioning First or Drying First During Delivery Room Resuscitation: A Randomized Controlled Trial.

OBJECTIVE: To compare the effect of suctioning first or drying first on the composite outcome of hypothermia or respiratory distress in depressed newborns requiring delivery room resuscitation. DESIGN: Open-label, randomized, parallel-group, controlled trial. SETTING: Delivery room and neonatal intensive care unit of a tertiary-care teaching hospital. PATIENTS: Depressed newborns (n=154) requiring initial steps of resuscitation at birth. Intervention: During delivery room resuscitation eligible new-borns were randomly allocated to receive either suctioning first or drying first (77 newborns in each group). MAIN OUTCOME MEASURE: Composite incidence of hypothermia at admission or respiratory distress at 6 hours of age. RESULTS: Both groups were comparable with regard to maternal and neonatal characteristics. Composite outcome was similar in both the groups [46 (59.7%) vs 55 (71.4%)] in suctioning first and drying first, respectively [RR (95% CI), 0.84 (0.66-1.05); P=0.13]. Incidence of hypothermia, respiratory distress at admission and oxygen saturation at 6 hours were also similar. On admission to NICU, hypothermia was observed in 26 (33.8%) neonates in suctioning first group and 33 (42.8%) neonates in drying first group but by one hour of age the proportion of hypothermic neonates was 13 (16.9%) and 14 (18.1%), respectively. CONCLUSION: In newborns depressed at birth, the sequence of performing initial steps, whether suctioning first or drying first, had comparable effect on composite outcome of hypothermia at admission or respiratory distress at 6 hours of age.

Assessment of Awareness Regarding Health Hazards of Plastic Chemicals and their Warning Label among a Sample Population of Varanasi City: A Cross-sectional Study.

BACKGROUND: Plastic containers are widely used to store and serve edibles. In the production of some types of plastic, chemicals such as bisphenol A (BPA) and bisphenol S (BPS) are used. These chemicals leach from the plastic containers into the edibles, get access into the biological systems, and cause a toxic impact on health. AIM: This cross-sectional survey was planned to assess the usage of food contact plastic and awareness regarding the health hazards of plastic chemicals and warning labels on plastic items among a sample population of Varanasi city. MATERIALS AND METHODS: Data were collected by interviewing the 556 adult participants, using a prevalidated structured questionnaire. Chi-square test was used to test the association and P < 0.05 was considered as significant. RESULTS: Most of the participants were found to be following routine practices during cooking and storage of edibles which may expose them to BPA and BPS through the gut. Although many participants were aware that plastic may contain some type of chemicals which may enter the human body and harm human health in some way, they lacked precise knowledge regarding warning label like "BPA free plastic" "plastic containing BPA" and "food grade plastic." Furthermore, none of the participants could recognize the "resin identification codes" correctly. CONCLUSION: Most of the participants had only elementary awareness of health risk of plastic usage. A significant number of participants lacked crucial information that can help them to make healthy choices as a consumer and use safe alternatives of plastic.

Echocardiography versus cardiac biomarkers for myocardial dysfunction in children with scorpion envenomation: An observational study from tertiary care center in northern India.

OBJECTIVE: This study was done to evaluate myocardial function by 2D Echocardiography and Cardiac biomarkers (cTnI, CK-MB, BNP) changes in patients of scorpion envenomation of grade II-IV and correlate mortality of envenomed children with myocardial dysfunction. METHODS: A total of 40 patients admitted consecutively with grade II and more scorpion envenomation from October 2015 to July2018 were enrolled in the study. The data included demographics, the time of presentation, clinical features, echocardiographic findings, electrocardiographic findings, cardiac biomarker levels at admission and discharge, use of inotropic medication, oral prazosin, time of discharge, and their outcome. RESULTS: The most common ECG abnormality was sinus tachycardia 28 (70%) followed by low voltage complex 13 (32.5%) which got normalized at the time of discharge in majority. Cardiac troponin I (cTnI) levels were more than 0.1 ng/mL, suggesting myocarditis was present in 25 (62.5%) and got normalized at discharge. CK-MB levels were increased in 26 (65%) patients suggesting myocardial involvement. BNP levels were also increased in 24 (60%) patients suggesting heart failure and its value got normalized at discharge. Abnormal 2D Echo findings as reduced left ventricular ejection fraction (LVEF) was present in 18 (45%) cases suggesting myocardial dysfunction and became normal at discharge. The sensitivity, specificity, positive predictive value and negative predictive value of Cardiac troponin I (cTnI) considering ECHO cardiograph as gold standard were 100, 68.1, 72 and 100% respectively. One patient had died whose Ejection fraction was less than 30%. CONCLUSION: Echocardiography and cTnI can identify subgroup of patients, who require early aggressive therapy. Echocardiography, if not available, cardiac troponin I level can guide early therapy and indicates the prognosis.

Completely Linear Stapled Versus Handsewn Cervical Esophagogastric Anastomosis After Esophagectomy.

Very limited data is present which compares completely linear stapled to handsewn cervical esophagogastric anastomosis. Primary objective was to determine whether linearly stapled (LS) anastomosis has lower clinically apparent leaks, when compared to handsewn anastomosis (HS). Secondary objectives were morbidity, mortality, overall leak and stricture rates, and presence of a symptomatic cervical stricture. This is a comparative study of 77 patients who underwent LS (n = 29) and HS (n = 48) cervical anastomosis. Anastomotic leak was found to be 19.4% (15/77). In the HS group, 27.08% (13/48) and in the LS group, 6.89% (2/29), respectively, leaked (p = 0.03), relative risk (RR)-3.93 (95% CI 1.21-15.25). 32.5% (23/77) patients remained admitted for more than 14 days. 52.1% (25/48) patients in the HS group were discharged within 14 days of surgery; whereas; 93.1% (27/29) were discharged in LS group (p = 0.001), RR-6.95 (95% CI 2.13-25.94). Overall, 90-day mortality was 7.8% (6/77). In the HS group, 8.3% (4/48) patients died while in the LS group, 6.8% (2/29) patients died (p = 0.82), RR-1.21(95% CI 0.27-5.53). In the HS group, 6.25% (3/48) patients were diagnosed with stricture compared to 6.8% (2/29) patients in the LS group (p = 0.9), RR-0.91 (95% CI 0.19-4.44). Overall stricture rate was 6.4% (5/77). Cervical anastomosis done with linear staplers has less leak rates compared to handsewn anastomosis.

Correlation of ABO Blood Group Phenotype and Rhesus Factor with Periodontal Disease: An Observational Study.

BACKGROUND: The knowledge of the ABO blood group phenotype of the patients and their correlation with the periodontal disease maybe important in the development of early treatment strategies, and it would be helpful to target non-responding areas to periodontal therapy of the susceptible individuals. AIMS: The present study was conducted to determine whether there was any correlation between periodontal diseases and ABO blood groups and Rh factor. MATERIAL AND METHOD: This study was carried out on 537 subjects attending Faculty of Dental Sciences OPD in BHU. Subjects were divided into three groups: group I (healthy subjects), group II (subjects with gingivitis), and group III (subjects with periodontitis) based on periodontal examination (Gingival index, Bleeding Index, Probing pocket depth and clinical attachment level). ABO Blood grouping were done and correlated with the periodontal status of study subjects. Statistical Analysis: Data was analyzed using the statistical software namely Statistical Package for the Social Sciences (SPSS, Version 16, IBM Analytics) and Systat 8.0. RESULTS: In this study, there was a greater prevalence of gingivitis in blood group O and periodontitis in blood group B. The blood group AB showed the least prevalence of periodontal diseases. Similarly gingivitis and peridontitis were significantly higher among Rhesus positive groups when compared with Rhesus negative groups. CONCLUSION: Considering the results of this study, it can be concluded that ABO blood groups and Rh factor could be a risk factor for the development of periodontal disease.

Metoprolol vs ivabradine in patients with mitral stenosis in sinus rhythm.

BACKGROUND: Severe mitral stenosis is usually symptomatic and is treated by BMV or surgery, whereas mild to moderate mitral stenosis is usually asymptomatic or mildly symptomatic and managed medically. Patients in the later group may become symptomatic during episodes of exercise and increased heart rate. Beta-blockers are frequently used in patients with mitral stenosis to control the heart rate and alleviate exercise-related symptoms. The objective of our study was to investigate the comparative efficacy of ivabradine versus metoprolol in patients with mitral stenosis in sinus rhythm. METHODS: We studied 97 patients of mitral stenosis in sinus rhythm presented with exertional symptoms. The effectiveness of Metoprolol was compared with ivabradine in alleviating these exertional symptoms in a randomized, open label non crossover study. We also assessed various stress ECG parameters, 24 hour Holter parameters and 2D Echo parameters to objectively compare the effects of ivabradine and metoprolol in these patients. RESULTS: Ivabradine and metoprolol both were effective in controlling exertional symptoms. Significant improvement in objective parameters like TMT (work capacity, baseline heart rate and maximal heart rate) and 2D echocardiography (right ventricular systolic pressure) are seen with both drugs. Ivabradine controls the exertional symptoms significantly more than metoprolol. On head to head comparison there was a significant benefit of working capacity and heart rate at maximal exercise in favour of ivabradine. CONCLUSIONS: Ivabradine should be strongly considered in medical management of mitral stenosis patients where beta blockers are contraindicated such as reactive airway disease. The cost of ivabradine is higher than metoprolol which might possess constraints as most of the rheumatic heat disease patients belong to low socio economic status.

Predictors of survival in hepatitis B virus related decompensated cirrhosis on tenofovir therapy: an Indian perspective.

Decompensated cirrhosis has low survival rate compared to compensated state. Effective viral suppression due to antiviral therapy (tenofovir) has been shown to slow disease progression and may delay the burden of liver transplantation. We aimed to evaluate the usefulness of various prognostic indicators in predicting the 24-months survival in HBV related decompensated cirrhosis after tenofovir therapy and to evaluate the post-treatment outcome. Ninety-six HBV related decompensated patients on antiviral (tenofovir) therapy were prospectively studied for 24months survival and mortality. Cutoff levels for several prognostic indicators were generated by ROC. Prediction of overall probability of mortality was also calculated. The overall probability of survival observed at 12months was 0.947 whereas at 24months it was found to be 0.833. According to Cox proportional hazards model, the univariate analysis revealed cutoff of >7.4logcopies/ml for HBV DNA, >1.2mg/dl for serum creatinine, >3.7mg/dl for total bilirubin, ⩽0.75 for platelets count, >10 for CTP and >20 for MELD as predictors of poor survival. Multivariate analysis showed MELD score of >20 was the most robust predictor of mortality, with 58 times higher risk (HR: 58.73, p<0.001). Post-treatment response with tenofovir for 24months significantly improved the hepatic functions and reverses decompensation and showed incredible efficacy in improvement of hepatic functional status with reduced viremia in a great majority of decompensated cirrhosis subjects having high MELD and HBV DNA level.

Hospital-acquired acute kidney injury in medical, surgical, and intensive care unit: A comparative study.

Acute kidney injury (AKI) is a common complication in hospitalized patients. There are few comparative studies on hospital-acquired AKI (HAAKI) in medical, surgical, and ICU patients. This study was conducted to compare the epidemiological characteristics, clinical profiles, and outcomes of HAAKI among these three units. All adult patients (>18 years) of either gender who developed AKI based on RIFLE criteria (using serum creatinine), 48 h after hospitalization were included in the study. Patients of acute on chronic renal failure and AKI in pregnancy were excluded. Incidence of HAAKI in medical, surgical, and ICU wards were 0.54%, 0.72%, and 2.2% respectively (P < 0.0001). There was no difference in age distribution among the groups, but onset of HAAKI was earliest in the medical ward (P = 0.001). RIFLE-R was the most common AKI in medical (39.2%) and ICU (50%) wards but in the surgical ward, it was RIFLE-F that was most common (52.6%). Acute tubular necrosis was more common in ICU (P = 0.043). Most common etiology of HAAKI in medical unit was drug induced (39.2%), whereas in surgical and ICU, it was sepsis (34% and 35.2% respectively). Mortality in ICU, surgical and medical units were 73.5%, 43.42%, and 37.2%, respectively (P = 0.003). Length of hospital stay in surgical, ICU and medical units were different (P = 0.007). This study highlights that the characters of HAAKI are different in some aspects among different hospital settings.

Prevalence and pattern of antiphospholipid antibody syndrome in a hospital based longitudinal study of 193 patients of systemic lupus erythematosus.

BACKGROUND: Antiphospholipid antibody syndrome (APS) is a systemic autoimmune disease characterised by thrombophilic state and obstetrical complications. Prevalence of APS varies in different parts of the world. So this study was conducted to find out the prevalence and pattern of APS in systemic lupus erythematosus (SLE) in this region. MATERIAL AND METHODS: In this hospital based longitudinal study from 2004 to 2011, we studied 193 patients of systemic lupus erythematosus (SLE) for prevalence of APS and its different characteristics. The diagnosis of SLE was made according to American College of Rheumatology (ACR) criteria and diagnosis of APS was made according to Sapporo criteria. RESULTS: Prevalence of APS in SLE was 25.38%. Mean age at study entry was 25.5 +/- 6.9 years and majority of APS patients were in the age group 21-30 yrs (44.89%). The most common clinical manifestation in both SLE with APS and SLE without APS was musuloskeletal involvement (79.59% and 84.72% respectively). Among 49 patients of SLE having APS, multisystem involvement was present in 16 patients and life threatening complications were present in 12 patients. Late foetal loss was the most common obstetrical manifestation of APS (26.53%) and deep vein thrombosis was most common thrombotic manifestation (16.32%). Anticardiolipin antibodies(IgG aCL) were the most common antibody (85.71%) detected. Lupus anticoagulant was present in 71.42% cases of SLE having APS. ANA and anti-dsDNA antibodies were present in 97.95% and 77.55% cases of SLE having APS. CONCLUSION: APS is a major cause of morbidity and mortality in patients of SLE. The incidence of secondary APS in SLE varies in different geographical regions and it was 25.38% in our study. Pregnancy morbidity and deep vein thrombosis were the most common complications of APS. IgG aCL was the most common antibody in APS patients. Screening for the presence of aPL antibodies in SLE patients and timely initiation of prophylactic treatment can prevent many of the complications.

An epidemiological study of dementia among the habitants of eastern Uttar Pradesh, India.

UNLABELLED: Dementia is one of the most serious health problems of the elderly and their caregivers. OBJECTIVE: The objective of this study was to estimate the prevalence of dementia in the community, its sociodemographic and behavioral associates to determine the risk factors among resident of two districts of eastern Uttar Pradesh, India. MATERIALS AND METHODS: This study was based on 2890 subjects aged 50 years and above, residing in rural areas of Mirzapur and urban areas of the Varanasi district of eastern Uttar Pradesh, India. Efforts were made to identify the subjects of age 50 years and above using cluster sampling. The Hindi Mental State Examination was used as the instrument tool to determine the score and a cut-off score of ≤23 was considered as the presence of dementia among the identified subjects. RESULTS: The overall prevalence of dementia was found to be 5.1%. This percentage was increasing with age and decreasing with educational level. Among females, the prevalence of dementia was observed (7.2%) to be double than that in males (3.8%). Widows/widowers/unmarried had a double prevalence (9.3%) as compared with married (4.3%) people. The age, gender, marital status, education, occupation, number of family members in the household and liquor addiction were found to be significantly associated with dementia. The relative risk for the above-mentioned variables was found to be more than 1.

Distribution of Hepatitis B virus genotypes among healthy blood donors in eastern part of North India.

AIM: We evaluated the distribution HBV genotypes among non-remunerated healthy blood donors in eastern North India. MATERIALS AND METHODS: During screening of donated blood, 176 consecutive HBsAg positive, samples comprised the study. HBV-DNA was quantitative detected in 150 samples by PCR. HBV genotype was determined by identifying genotype-specific DNA band using nested PCR. RESULTS: Majorities were of age group 31-40 yrs (65.3%). Males (92.7%) outnumbered females (7.3%) and were HbeAg-negative HBsAg carriers. Over all, genotype-A was the most prevalent (54%) followed by D (21.3%). We did not find genotype-G and H. Districts under study, divided into four zones: Zone-I genotype-A was most common (62.3%) followed by D (18.8%); Zone-II genotype-C (41.2%) was more frequent followed by D (20.6% and A (17.7%). Zone-III in adjoining Bihar state close to Zone-I, A was more prevalent (81.8%) followed by B and C (9.1%). In Zone-IV adjoining Zone- II had genotype-A (100%) only. Genotype-D had more sporadic distribution. Genotype-E and F were prevalent in Zone I and II (3/150, 2%). CONCLUSIONS: Among blood donors HBV genotype-A followed by D was the most prevalent in eastern North India. Genotype-A had pattern of distribution signifying common focus, while D was more sporadic and C had single large pocket (Zone-II) probably common focus but restricting to particular area. Evidences are suggestive of association of HBV genotype in liver dysfunction. An effective treatment and preventive strategies based of genotypes will reduce the disease burden and increase the blood safety.

Non-infectious complications of continuous ambulatory peritoneal dialysis and their impact on technique survival.

Data on non-infectious complications of continuous ambulatory peritoneal dialysis (CAPD) are sparingly reported from different centres of the country. We studied the non-infectious complications in patients of end stage-renal disease (ESRD) undergoing CAPD. Double-cuffed straight catheter was inserted in all patients using the surgical method and CAPD was started on the 15(th) day of catheter insertion. The nature of non-infectious complications was noted during follow-up in these patients. Forty-five (male 31, female 14) patients with the mean age of 54.5±11.6 years were studied. Diabetic nephropathy was the most common (59.5%) cause of ESRD. Overall, non-infectious complications were noted in 18/45 (40%) cases. Ultrafiltration failure was the most common (15.5%) followed by incisional hernia (6.6%), exit site leak (4.4%), hydrothorax (4.4%), catheter malposition (4.4%), scrotal swelling (2.2%) and hemoperitoneum (2.2%). Patients with ultrafiltration failure were either shifted to hemodialysis or underwent renal transplantation. The remaining (62%) non-infectious complications did not affect the catheter survival and CAPD could be continued. Non-infectious complications occurred in 40% of our CAPD patients and ultrafiltration failure was the most common (15.5%). A majority (62%) of the complications did not affect catheter survival.

Study of neurocognitive endophenotypes in drug-naïve obsessive-compulsive disorder patients, their first-degree relatives and healthy controls.

OBJECTIVE: Obsessive-compulsive disorder (OCD) is a debilitating heritable neuropsychiatric condition. Attempts to delineate genetic contributions in OCD have met with limited success, with an ongoing search for neurocognitive endophenotypes. In this study, an attempt has been made to study and compare the neurocognitive functioning of patients with OCD, their first-degree relatives (FDRs) and healthy controls. METHOD: A cross-sectional design study was carried out with thirty dyads of patients with OCD, their FDRs and thirty matched healthy controls and screened using Mini International Neuropsychiatric Interview, Verbal Adult Intelligence Scale, Yale Brown Obsessive-Compulsive Scale, Montgomery Åsberg Depression Rating Scale, International Personality Disorder Examination (Anankastic personality scale).Tests of National Institute of Mental Health and Neurosciences Neuropsychological Battery were used to assess domains of attention, verbal memory, visual memory, set-shifting, response inhibition, planning and visuoconstructive abilities. spss version 14.0 was used for descriptive and analytical data analysis. RESULTS: There were no statistically significant differences between patients with OCD and their FDRs on neurocognitive domains of delayed verbal recall, set-shifting, response inhibition and visuoconstructive abilities (P > 0.05) which were impaired compared with healthy controls. Significant differences (P < 0.05) on domains of attention, planning time and visual memory were noted between FDRs and patients. CONCLUSION: The present study supports set-shifting and inhibitory control and proposes visuoconstructive abilities and delayed verbal recall as potential endophenotypes for OCD.

Sex determination using mandibular ramus flexure: a preliminary study on Indian population.

Determination of sex by morphological assessment has been one of the oldest approaches in forensic anthropology. Loth and Henneberg(6) introduced a morphological trait "Mandibular Ramus Flexure" for sex identification with a high accuracy of 99% in African Blacks. However, the population specificity of sexually dimorphic features is well known. The purpose of this study is to test the reliability of this trait in Indian population. A total number of 112 adult mandibles (88 males and 24 females) were studied from the Department of Forensic Medicine, Institute of Medical Sciences, Banaras Hindu University, India. The mandibles were scored according to the original method by two observers in three different sessions. This was done to test inter and intra-observer errors in identifying the trait. The result shows that this trait can be used to diagnose sex with an average accuracy of upto 82%. Though, inter and intra-observer errors were present but could be minimized with extended practice. So, the trait has the potential to be relied upon as a single morphological trait for determination of sex in Indian population.

Assessment of contamination of soil due to heavy metals around coal fired thermal power plants at Singrauli region of India.

In the present study, an attempt was made to measure contamination of soil around four large coal-based Thermal Power Plants. The concentration of Cadmium, Lead, Arsenic and Nickel was estimated in all four directions from Thermal Power Plants. The soil in the study area was found to be contaminated to varying degrees from coal combustion byproducts. The soil drawn from various selected sites in each direction was largely contaminated by metals, predominantly higher within 2-4 km distance from Thermal Power Plant. Within 2-4 km, the mean maximum concentration of Cadmium, Lead, Arsenic and Nickel was 0.69, 13.69, 17.76, and 3.51 mg/kg, respectively. It was also observed that concentration was maximum in the prevalent wind direction. The concentration of Cadmium, Lead, Arsenic and Nickel was highest 0.69, 13.23, 17.29 and 3.56 mg/kg, respectively in west direction where wind was prevalent.

Sensory, cognitive and motor assessment of children with poor academic performance: an auditory evoked potential study.

The present study aims to evaluate the auditory sensory process in the brainstem, thalamocortical and cortical areas by using auditory evoked potentials [auditory brainstem response (ABR), mid latency response (MLR) and slow vertex response (SVR)], cognitive functions by P300 and motor response by reaction time in children with poor academic performance. Thirty children between 6-12 years of age were selected as subjects on the basis of poor academic school records. While thirty children with good academic performance served as controls. The recordings were done using a computerized evoked potential recorder by 10-20 electrode placement system. There was no difference in the anthropometric parameters and IQ of the two groups. There was a significant increase in latency of waves II, III, IV and V, and Inter-peak latency I-V of ABR in poor performer females. All the component waves of MLR and SVR showed increased latency in the subjects but could not reach the level of significance. There was a significant increase in latencies of P300 at Cz and Pz electrode positions with no change in amplitude in poor performer females. The reaction time was also increased in the poor performer females as compared to the controls. The latencies of all the waves of ABR, P300 and reaction time are also increased in male poor performers as compared to male controls but could not reach the level of significance. The conduction of impulses is slower in pontine and midbrain auditory pathway along with inefficient cortical processing of task relevant stimuli and motor response in female children having poor academic performance.

A study of bone marrow failure syndrome in children.

BACKGROUND: Bone marrow failure syndrome (BMFS), or aplastic anemia, includes peripheral blood single cytopenias, as well as pancytopenia due to inability of the marrow to effectively produce blood cells. AIM: To study the clinico-hematological profile and etiological factors of bone marrow failure syndrome in children. SETTING AND DESIGN: This prospective study was carried out in the Department of Pediatrics of a university teaching hospital over 36 months. MATERIALS AND METHODS: Children with pancytopenia (Hb 9 /L, platelet count<100x10(9)/L) and bone marrow cellularity<25% were included in the study. History of exposure to drugs, socioeconomic status, ethnicity and occupation of father were noted. Bone marrow aspiration; trephine biopsy; Ham test; viral studies for hepatitis A, B and C; and cytogenetic investigations were carried out. STATISTICAL ANALYSIS: Relative risk was estimated by odds ratio (OR) with 95% confidence interval (CI) in matched cases and controls. RESULTS: Of the 53 children studied, 6 (11.3%) were diagnosed as Fanconi anemia. Two cases had features of myelodysplastic syndrome. Forty-five children were labeled as acquired aplastic anemia, of whom one had evidence of hepatitis B infection and two patients (5.8%) had paroxysmal nocturnal hemoglobinuria. Aplastic anemia was more common in children from family with lower socioeconomic status; in Muslims; and where the father's occupation was weaving, dyeing and painting. However, the number was small to make statistically significant conclusions. No correlation could be established with exposure to drugs. CONCLUSION: Fanconi anemia was responsible for approximately one-tenth of the cases of bone marrow failure syndrome. Majority of the patients had acquired aplastic anemia. Hepatitis B infection was an uncommon cause of acquired aplastic anemia.

Comparative evaluation of 5-HIAA (5-hydroxy indoleacetic acid) and HVA (homovanillic acid) in infantile hydrocephalus.

BACKGROUND: Infantile hydrocephalus is a common congenital problem. Functional and behavioral disturbances associated with hydrocephalus may be due to altered neurotransmitters in the brain. The role of neurotransmitters has been established in various psychiatric and neurological conditions. Therefore, we decided to study the role of 5-hydroxy indoleacetic acid (5-HIAA) and homovanillic acid (HVA) in cerebrospinal fluid (CSF) of hydrocephalic patients as diagnostic and prognostic marker. MATERIALS AND METHODS: Ventricular CSF samples were taken from hydrocephalic patients peroperatively and at days 7 & 30. Control CSF samples were taken from nonhydrocephalic patients operated for other conditions. Samples were analyzed for 5-HIAA and HVA, and results were obtained accordingly. RESULTS: Values of 5-HIAA and HVA showed a highly significant decrease after shunt insertion. No significant difference in values of 5-HIAA and HVA were observed in relation to age and duration of disease. The CSF ventriculo-lumbar gradient for both 5-HIAA and HVA done in six patients was statistically significant only in the noncommunicating group. CONCLUSION: Both the neurotransmitter metabolites 5-HIAA and HVA are found to be significantly high in the hydrocephalus, but 5-HIAA is a more sensitive parameter. These markers levels decrease after shunt insertion. Thus, estimation of these metabolites could be valuable markers for its diagnosis and follow-up.

Estimation of CD4+ and CD8+ T-lymphocytes in human immunodeficiency virus infection and acquired immunodeficiency syndrome patients in Manipur.

PURPOSE: To estimate and stratify CD4 + and CD8 + T-lymphocyte levels in human immunodeficiency virus (HIV) infected (asymptomatic) and acquired immunodeficiency syndrome (AIDS) patients (symptomatic) and correlate the clinical features of the patients with CD4+ and CD8+ lymphocyte level. METHODS: Between April 2002 and September 2003, a total of 415 HIV seropositive adult patients (297 males and 118 females) attending Regional Institute of Medical Sciences (RIMS) hospitals were tested for CD4+ and CD8+ T-lymphocytes by fluorescent activated cell sorter (FACS) counter (Becton Dickinson). Symptomatic patients were diagnosed as per NACO clinical case definition. RESULTS: Ranges of 0-50, 51-100, 101-200, 201-300, 301-400, 401-500 and above 500 CD4+ T-lymphocyte per microlitre were seen in 68, 52, 101, 73, 47, 31 and 43 patients respectively whereas CD8+ T-lymphocyte ranges of 0-300, 301-600, 601-900, 901-1500, 1501-2000, 2001-3500 per microlitre were seen in 29, 84, 92, 145, 40 and 25 patients respectively. One hundred and fifty patients were asymptomatic and 265 were symptomatic. CD4/CD8 ratio in asymptomatics and symptomatics were 0.13-1.69 and 0.01-0.93 respectively. Tuberculosis and candidiasis occurred in CD4+ T-lymphocyte categories between 0-400 cells per mL in symptomatics. However, cryptosporidiosis, toxoplasmosis, herpes zoster, cryptococcal meningitis, Pneumocystis carinii pneumonia, penicilliosis and cytomegalovirus retinitis were seen in patients having CD4+ T-lymphocyte less than 200 per mL. CONCLUSIONS: CD4+ T-lymphocyte was decreased in both asymptomatic and symptomatic HIV patients, The decrease was greater in symptomatics while CD8+ T-lymphocyte was increased in both except advanced stage symptomatics. CD4:CD8 ratio was reversed in both groups. Opportunistic infections correlated with different CD4+ T-lymphocyte categories.