Current status of periodontitis and its association with tobacco use amongst adult population of Sunsari district, in Nepal.

BACKGROUND: Tobacco products are considered significant, but preventable factors related to initiation and progression of periodontal diseases. We assessed the prevalence of periodontitis and evaluated its association with tobacco use and other factors amongst the adult population of Sunsari district in eastern Nepal. METHODS: A community-based, cross-sectional study was conducted in rural municipalities in the province one of eastern Nepal. A total of 440 adults were interviewed with a set of a pre-tested semi-structured questionnaire. Data on social demographics, adverse oral habits followed by periodontal clinical examination were recorded. Prevalence of periodontitis was assessed by a case definition provided by CDC-AAP. Univariate and multivariate logistic regression analysis was done to measure the association between tobacco use and other factors with periodontitis. RESULTS: The overall prevalence of periodontitis was found to be 71.6%. Majority (85.4%) of tobacco users had periodontitis and they were significantly associated with the disease and its severity. The study identified age groups, 45-65 years (AOR = 7.58, 95% CI 3.93-14.61), plaque accumulation (AOR = 1.01, 95% CI 1.00-1.02), smoking (AOR = 3.14, 95% CI 1.36-7.27), khaini users (smokeless tobacco, AOR = 2.27, 95% CI 1.12-4.61) and teeth loss (AOR = 2.02, 95% CI 1.21-3.38) as the significant factors associated with periodontitis. CONCLUSION: The prevalence of periodontitis is high in the surveyed rural adult population. Cigarette smoking along with the use of smokeless tobacco in the form of khaini were identified as significant factors associated with periodontitis.

Stability of Vaccines.

Vaccines are considered the most economical and effective preventive measure against most deadly infectious diseases. Vaccines help protect around three million lives every year, but hundreds of thousands of lives are lost due to the instability of vaccines. This review discusses the various types of instability observed, while manufacturing, storing, and distributing vaccines. It describes the specific stability problems associated with each type of vaccine. This review also discusses the various measures adopted to overcome these instability problems. Vaccines are classified based on their components, and this review discusses how these preventive measures relate to each type of vaccine. This review also includes certain case studies that illustrate various approaches to improve vaccine stability. Last, this review provides insight on prospective methods for developing more stable vaccines.

Unusual Presentation of Necrotic Erythema Nodosum Leprosum on Scalp: A Case Report.

Lepra reactions are acute episodes occurring during the disease process of leprosy and are of 2 types: type 1 or reversal reaction and type 2 reaction or erythema odosumleprosum (ENL). In the episodes of lepra reaction several parts are affected including face and extremities like oral cavity. In the present case report we reported a rare case of lepromatous leprosy with necrotic ENL involving scalp apart from the usual sites. A 58 year old married male presented to us with complaints of spontaneous onset, recurrent eruption of multiple reddish raised painful lesions. Biopsy from the infiltrated skin over the back showed atrophic epidermis, free Grenz zone, diffuse and periadnexal macrophage granulomas with predominant mononuclear infiltrate, appandageal atrophy, fibrosis around the neural structures and leukocytoclastic vasculitis. Fites stain showed strong positivity for M. leprae. His routine blood investigations showed anemia (Hb = 7.8 gm%), neutrophil leukocytosis (TLC = 17,600, DLC = P66L28M4E2) and raised ESR (80 mm in the first hour). These bullous and necrotic lesions in leprosy may be a manifestation of severe type II reactions in patients with very high bacillary load.

Lepromatous leprosy with an uncommon presentation: a case report.

28 yr old male presented with asymptomatic nodules and few well to ill defined papules on ears, asymmetrical nerve enlargement and evanescent tender nodules on the extremities without any infiltration of the skin and madarosis. Slit skin smear done from normal skin was BI 6+. Skin biopsy showed features of lepromatous leprosy.

Hyperthyroxinemia due to the coexistence of two raised affinity thyroxine-binding proteins (albumin and prealbumin) in one family.

The T4-binding proteins of a euthyroid subject with persistent hyperthyroxinemia (T4, greater than 20 micrograms/dl) were present in normal concentrations. Abnormal transport of both T4 and rT3 was demonstrated by reverse flow paper electrophoresis; excess T4 was bound to albumin and prealbumin, while increased binding of rT3 was confined to prealbumin. The three T4-binding proteins in the serum of the subject were isolated by affinity chromatography and characterized. Equilibrium dialysis experiments demonstrated a 20-fold increase in affinity of the albumin for T4 (Ka, 5.1 X 10(6) M-1) and a 4-fold increase in affinity of prealbumin for T4 (Ka, 3.0 X 10(8) M-1); T4-binding globulin affinity was normal. Nine other members of the family were also studied. Two sisters of the propositus have both the abnormal albumin and the variant prealbumin, while a brother has normal T4-binding proteins. The mother has the abnormal albumin alone. The father, his sister, and one of his three brothers have the variant prealbumin only. Despite the presence of the variant prealbumin in some of the paternal relatives of the propositus, their total iodothyronine concentrations were within the normal ranges; the condition may, therefore, often go undetected. The characteristics of the albumin found in the affected members of this kindred are those we have defined for familial dysalbuminemic hyperthyroxinemia type I, which is inherited as an autosomal dominant trait. The pattern of inheritance of the variant prealbumin is also consistent with a dominant mode with strong penetrance. The presence of two separately inherited abnormal T4 transport proteins in the same family suggests that both conditions may be more common than has been thought.

Effects of single and repeated electroconvulsive therapy sessions on plasma ACTH, prolactin, growth hormone and cortisol concentrations.

To study the effects of electroconvulsive therapy (ECT) on hormone release, we measured circulating concentrations of adrenocorticotropic hormone (ACTH), prolactin (PRL), growth hormone (GH) and cortisol (CORT) immediately before and at 2 min, 5 min, 15 min, and 30 min following ECT. Compared to pre-ECT concentrations, there were significant increases in post-ECT plasma ACTH, PRL and CORT. GH did not change consistently. No significant difference between unilateral and bilateral ECT was observed. Compared to the first ECT, repeated treatments were associated with a significant decrease in the magnitude of hormone surge. These hormonal changes induced by ECT may reflect changes at the neurotransmitter level.

Haematological and biochemical characteristics of Heteropneustes fossilis under the stress of Congo Red (diphenyl disazo binaphthionic acid).

The effects of the sublethal concentration (0.012%) of Congo Red on Heteropneustes fossilis were studied after 30 days exposure. The RBC count haemoglobin (Hb)% and PCV decreased significantly. The total WBC count, MCV, MCH, and MCHC showed a significant increase. Serum calcium, serum cholesterol and blood urea nitrogen (BUN) were significantly elevated, whereas serum phosphorus was significantly reduced. The activities of serum alkaline phosphatase (AlPase), acid phosphatase (AcPase). RNase, GOT, GPT and amylase were also significantly elevated. The possible reasons for these changes are discussed.

Monarticular juvenile rheumatoid arthritis.

Seven out of 22 children with monarticular juvenile rheumatoid arthritis (MJRA) developed involvement of other joints between six months and three and a half years from the onset. In the other 15 patients the disease has remained monarticular for between one and 16 years (mean six years). Chronic iridocyclitis was seen in three of the five boys, two with antinuclear antibodies. Children with MJRA and antinuclear antibodies should have periodic ophthalmic assessment. Synovial biopsy was of value primarily in excluding other cases of arthritis, but there was only limited correlation between the histological findings and the subsequent course of the disease.

Histochemical study of the activity of acid and alkaline phosphatases and lipase in the gastro-intestinal tract of Cirrhinus mrigala.

The sites of the activity of acid and alkaline phosphatases and lipase have been localized in the gastro-intestinal tract of the fresh water fish, Cirrhinus mrigala. All the three enzymes experimented have been recorded to be active in the mucosal epithelium of all the portions of the alimentary canal. Muscularis and serosa of all the parts of alimentary canal show negative sign for the presence of these enzymes. In the pancreas, both intra-hepatic and extrahepatic, strong activity of these enzymes is dicernible in the acinar cells. Hepatic cells also show intense reaction for these enzymes. In comparison to acid phosphatase, the activity of alkaline phosphatase is more pronounced in all the portions of the alimentary tract. The positive reaction for lipase in the blood and lymph vessels present in the tissues of the alimentary canal signifies the hydrolysis of fats during their transportation.

Histochemical study of the activity of lipase in the digestive system of some teleost fishes.

The distribution of lipase (EC 3.1.1.3) in the different parts of the digestive system of Bagarius bagarius, Mastacembelus armatus, Glossogobius giuris and Rohtee cotio has been studied. In the stomach of Mastacembelus, Bagarius and Glossogobius the lipase activity has been found in the mucosa and gastric glands. The intestinal pulb and the intestine of herbivorous Rohtee and in the intestine of the rest of the three fishes show the enzymatic activity in the mucosal epithelium. However, in Mastacembelus and Glossogobius the lipase activity is more pronounced in the intestinal mucosa than that in Bagarius and Rohtee. In the liver, the enzyme is distributed in polyhedral hepatic cells in all the fishes studied specially around the nuclei of the hepatic cells. In the pancreas of Rohtee, the enzyme is distributed in the acinar cells and the cells of islets of Langerhans. The serosa and muscularis of the different portions of digestive system of the four fishes studied are devoid of any lipolytic activity.

A comparative histochemical study of the distribution of esterase in the gastro-intestinal tract of some Indian teleosts.

The investigations on the distribution of esterase (EC 3.1.1.1) activity in the gastro-intestinal tract of four Indian fresh water teleost fishes, namely Mastacembelus, Bagarius, Glossogobius and Rohtee showed that the highest esterase activity occurred in the case of Mastacembelus. No notable esterase activity was recorded in the stomach of Bagarius and Glossogobius and in the intestinal bulb of Rohtee. The distribution of the esterase activity in the tissues of the intestine of all the fishes studied suggests the clue for the production of the enzyme in the intestine of the fishes as well. The sites of the distribution of the enzyme through the gastro-intestinal tract of the four fishes have been discussed.

Histochemical study of the distribution of a few enzymes in the digestive system of Indian parrot.

Acid-and alkaline phosphatase, 5-nucleotidase and lipase have been localized histochemically in the gizzard, intestine liver and pancreas of Indian parrot, Psittacula krameri. In the gizzard and intestine, the mucosal epithelial cells are the main sites for the enzyme production. The tubular glands of the gizzard show intense reaction for all the enzymes tested. The hepatic sinusoid cells of the liver and the acinii of pancreas give positive reaction. Like pancreas, the intestine has also been found responsible for the production and secretion of lipase. Functional significance of phosphatases in the tissues tested has been discussed.

Antimicrobial activity of extracts of eastern North American hardwood trees and relation to traditional medicine.

Wood and bark extracts of 14 eastern North American hardwood tree species which were used traditionally as medicine by First Nation's people were screened for antimicrobial activities with eight strains of bacteria and six strains of fungi. Eighty-six percent of the bark extracts were active against methicillin sensitive Staphylococcus aureus; 71% against Bacillus subtilus and 79% against Mycobacterium phlei. The bark extract of Juglans cinerea was active against Pseudomonas aeruginosa 187, Salmonella typhiumurium, and Klebsiella pneumoniae. The wood extracts were less active: 72% were active against S. aureus (methicillin-sensitive), 36% against B. subtilus and 43% against M. phlei. Results from antifungal tests indicated that 36% of the extracts were active against at least one fungal strain and that bark extracts were more active than wood extracts. The bark extract from Juglans cinerea had the broadest spectrum of activities against Candida albicans, Saccharomyces cerevisiae, Cryptococcus neoformans, Trichophyton mentagrophytes, Microsporum gypseum, and Aspergillus fumigatus. In general, the extracts were more active against gram positive bacteria than gram negative bacteria and against filamentous fungi than yeast-like fungi. The study also demonstrated a correlation between frequency of traditional medicinal use by the First Nations people and antimicrobial activity of extracts indicating that the traditional knowledge encompasses an understanding of aspects of chemical ecology.

Kawasaki syndrome in 18 children in the west of Scotland.

Analysis of the case records of 18 children admitted to the Royal Hospital for Sick Children, Glasgow between June 1981 and May 1990 satisfied the diagnostic criteria of Kawasaki syndrome as published by Japan's Kawasaki disease research committee in September 1984. No aetiological agents were implicated. All children had cardiological work-ups including chest x-ray, ECG, 2-D echocardiography. Two children had gammaglobulin therapy and 16 had treatment with aspirin. All children except one recovered without sequelae. The child with right coronary artery aneurysm has since had successful coronary bypass surgery.

Toxic shock syndrome (TSS) in children.

Toxic shock syndrome is uncommon in the prepubertal age group. Two children presented with pyrexia, macular erythroderma, vomiting, hypotension and rapid deterioration of consciousness. One child had severe neurological involvement. The diagnosis of toxic shock syndrome was established in both cases by the exclusion of other causes and by culturing staphylococcus aureus. We postulate that the neurological manifestations were caused by a direct neurotoxic action of the staphylococcal-produced toxin. Both children made a complete recovery.

Dermatomyositis-polymyositis in children.

Sixteen cases of dermatomyositis-polymyositis in children (dermatomyositis 15; polymyositis 1) have been reviewed. Proximal muscle weakness with a characteristic skin rash was vital for diagnosis in the majority of children. The positive laboratory tests such as creatine phosphokinase (CPK), electromyography (EMG) and muscle biopsy were helpful but results were normal in some cases even in the acute phase of the illness. All but one had been treated initially with high dose corticosteroids followed by a low dose maintenance for a prolonged period. Two in addition had had cytotoxic agents. Thirteen of the sixteen were currently in remission. In the other three cases, one with polymyositis only, the disease remained active and the two with dermatomyositis died. Only three of the patients were incapacitated by residual fixed contractures and extruding calcinosis. On the whole the prognosis of dermatomyositis is good.

Tuberculous meningitis in children: a review of 15 cases.

Tuberculosis meningitis (TBM) is the most serious form of infection with Mycobacterium tuberculosis. Between 1968 and 1986 15 children (five boys and 10 girls) were seen at the Royal Hospital for Sick Children, Glasgow, because of TBM. Fourteen children were Caucasian and one was Asian. The mean age at presentation was two years. None had been given BCG vaccination. In 12 children close contact with other cases of tuberculosis was reported. The signs and symptoms which helped in the diagnosis are discussed together with the initial CSF findings, results of mantoux testing and chest X-rays. Three children had unusual modes of presentation. All children were treated with chemotherapy though the drug combinations, route of administration and therapy varied from case to case. Steroids were used in nine children. Five children required neurosurgical intervention. Two children died and of the survivors six had serious sequelae. Five children made a complete recovery. The outcome of TBM depended on the duration of symptoms prior to the onset of therapy, on the neurological status reached at the time of diagnosis and the age of the child. The roles of chemotherapy, steroids and neurosurgery in the management of TBM are discussed. The need for routine BCG vaccination of all neonates is examined.

Normal linear growth in hypophosphataemic bone disease.

A case of hypophosphataemic bone diseases is described. Despite prescribed phosphate (PO4) supplement and 1.25 dihydroxycholecalciferol therapy, serum PO4 levels have remained low with associated diminished theoretical renal threshold for phosphate (TmPO/GFR) over a seven and a half year follow up period. Linear growth, however, has been normal.

Paracetamol overdose in children.

The severity of paracetamol poisoning varies but in general, children are considered less susceptible to its toxic effects compared to adults. In this report we describe the relatively benign ingestion of paracetamol in children and also highlight a case of intrauterine exposure to a potentially toxic dose of paracetamol.