Aural hygiene practices among underprivileged children of Delhi.

BACKGROUND: Though ear hygiene is important for proper hearing, it is usually neglected. Improper ear care practices may have serious consequences such as loss of hearing. In childhood, loss of hearing may affect learning and development. There is scarcity of information on ear care practices in the community in India. We aimed to ascertain the magnitude of problems related to aural hygiene and assess ear care practices among children of schoolgoing age in a resettlement colony of Delhi. METHODS: A cross-sectional community-based survey was done among 1398 children 5-14 years of age. The houses were selected by systematic random sampling and all eligible children in the selected house were interviewed and examined. The data were analysed using SPSS version 12 and chi-square test was used to ascertain significance between two variables. RESULTS: Almost two-thirds (60%; 834) of the children gave a history of themselves or an elder cleaning the ear using unhealthy methods. Earbuds were used by 21.7% (304) of children. Match and broomsticks were used for cleaning by 18.3% (256) and 3% (43) of children, respectively. One hundred and fifty-nine children (11.3%) were applying oil to clean the ear canal. Ear cleaning with unhealthy means was significantly higher (56% v. 44%, p<0.03) among children belonging to low socioeconomic strata. There was a significant association between unhealthy ear cleaning practices and middle ear infection (p<0.001). CONCLUSION: A majority of children practised unhealthy/ not recommended methods for cleaning their ear. There is a need to raise awareness about healthy ear cleaning practices in the community.

Prostacyclin stimulation of the activation of blood coagulation factor X by platelets.

When platelets were incubated with prostacyclin, prostaglandin E1, or prostaglandin D2 at concentrations insufficient to increase the level of adenosine 3',5'-monophosphate (cyclic AMP), coagulation factor X was activated by a platelet cysteine protease. Prostacyclin or prostaglandin E1 at higher concentrations increased the cyclic AMP level and inhibited the activation of factor X by platelets. Inhibition of platelet adenylate cyclase by 2',5'-dideoxyadenosine allowed the activation of the protease at higher concentrations of the autocoids. Prostaglandins A1, A2, B1, B2, E2, F2 alpha, 6-keto-prostaglandin F1 alpha, and thromboxane B2, which do not affect platelet cyclic AMP level, did not stimulate the protease.

Magnitude and Correlates of Anemia in Elderly Women of a Resettlement Colony of Delhi.

BACKGROUND: Anemia of any degree contributes significantly to morbidity and mortality and has a significant effect on the quality of life of elderly women. Despite its clinical importance, anemia in the elderly women is underrecognized. OBJECTIVES: The objective of this study was to assess the magnitude and correlates of anemia in elderly women of a resettlement colony of Delhi. MATERIALS AND METHODS: A community-based, cross-sectional study for the duration of 1 year was conducted among 512 geriatric women (≥60 years). Demographic characteristics, dietary assessment, and behavioral risk factors were determined by interview, and the participants underwent physical examination followed by hemoglobin estimation by HemoCue. Anemia was defined using the WHO criteria of hemoglobin <12 g/dl. Chi-square test was employed to study the association between sociodemographic factors and anemia followed by multivariate regression analysis. RESULTS: The prevalence of anemia was 79.9% according to the WHO criteria of hemoglobin <12 g/dl in females. Age, education, marital status, financial dependence, diagnosed chronic disease, diet, calorie intake, history of worm infestation, and body mass index (BMI) were significantly associated with anemia on univariate analysis. In multivariate analysis, age, marital status, financial dependence, diagnosed chronic disease, diet, calorie intake, and BMI were significant explanatory variables for anemia. CONCLUSION: Our study points out high prevalence of and some of the major factors associated with anemia in elderly women. The need of the hour is to include our elderly women under the gamut of National Anemia Prophylaxis Program.

Studies on the phosphorylated intermediates of a K+-stimulated ATPase from rabbit gastric mucosa.

A density gradient-purified microsomal membrane preparation from rabbit fundic gastric mucosa was used for a detailed study of the K+-stimulated ATPase and associated intermediate reactions. Membranes incubated with gamma-[32P]ATP show the rapid incorporation of 32P into phosphoprotein. Phosphoprotein levels were markedly reduced (1) when ATP hydrolysis went to completion or (2) upon addition of unlabeled ATP, thus suggesting the participation of a rapid turnover phosphorylated intermediate in the gastric microsomal ATPase. Addition of K+, Rb+ or Tl+ greatly reduced the level of the intermediate while stimulating ATPase activity; the observed affinities of these cations were similar for the effects on both ATPase and intermediate levels, with Tl+ greater than K+ greater than Rb+. Neither ATPase nor intermediate were stimulated by Na+, and ouabain was without effect on the reactions, thus differentiating this system from the (Na+ + K+)-ATPase. Addition of various inhibitors showed differential effects on the partial reactions of the gastric ATPase system. N-ethylmaleimide and Zn2+ showed characteristics of completely abolishing the K+-stimulated component of ATPase as well as the effects of K+ in reducing the level of intermediate, thus suggesting that these agents exert their inhibitory effect on a phosphoprotein phosphatase partial reaction. F- abolished the K+-stimulated ATPase, but its more complex effects on the intermediate suggested an additional reaction step within the domain of the phosphorylated intermediate. Results are consistent with a model system for the gastric microsomal ATPase involving a Mg2+-dependent protein kinase, a phosphorylated intermediate(s), and a K+-stimulated phosphoprotein phosphatase.

Characterization of gastric mucosal membranes. II. Lipid compositions of purified gastric mitochondria from pig, rabbit and frog.

1. The lipid composition of purified mitochondrial fractions from the fundic mucosa of pig, rabbit and frog were determined. 2. The total lipids expressed as mg lipid per 100 mg mitochondrial protein were approx. the same in pig and rabbit (13.4 and 15.5, respectively) and much higher than in frog (8.5). 3. The levels of phospholipids were about the same in pig and frog (approx. 61% of the total lipid) and lower than rabbit (78%). However, the levels of cholesterol were significantly different in the three species and constituted 22, 9 and 18.2% of the total lipids in pig, rabbit and frog mitochondria, respectively. 4. The glycolipid content in the mitochondrial lipids from pig, rabbit and frog were 7, 5.6 and 10.5%, respectively. 5. Cardiolipin contributed from 5.6 to 7.5% of the total phospholipids in the various species. Phosphatidylethanolamine and phosphatidylcholine together accounted for 80 90% of the total phospholipids in the various species; the contribution of phosphatidylcholine being always higher than that of phosphatidylethanolamine. Small but significant amounts of phosphatidylinositol were present in all species. 6. Generally, the predominant saturated fatty acid in the phospholipids was 16:0 from all species (except in phosphatidylethanolamine from pig and frog), and 18:1 and 18:2 were the predominant unsaturated fatty acids from all species. Sphingomyelin contained the highest amount of saturated fatty acids (over 80%) in both the species (pig and rabbit) studied.

Endogenous protease mediated manifestations of a Ca2+-stimulated ATPase in purified dog gastric microsomes.

An endogenous soluble protease has been demonstrated to unmask a Ca2+-stimulated ATPase activity in purified dog gastric microsomes. The presence of ATP during protease treatment appears essential for the manifestation of the gastric Ca2+-stimulated ATPase activity. The endogenous protease appears to have trypsin-like activity, since soybean trypsin inhibitor completely blocks the protease effect. Manifestation of the Ca2+-stimulated ATPase occurs without affecting the microsomal (H+ + K+)-ATPase activity and associated H+ uptake ability. The unmasked Ca2+-stimulated ATPase appears insensitive to calmodulin. Possible roles of the enzyme in the regulation of gastric H+ transport have been discussed.

Studies of gastric Ca2+-stimulated adenosine triphosphatase. I. characterization and general properties.

Gastric microsomes do not contain any significant Ca2+-stimulated ATPase activity. Trypsinization of pig gastric microsomes in presence of ATP results in significant (2-3 fold) increase in the basal (with Mg2+ as the only cation) ATPase activity, with virtual elimination of the K+-stimulated component. Such treatment causes unmasking of latent Mg2+-dependent Ca2+-stimulation ATPase. Other divalent cations such as Sr2+, Ba2+, Zn2+, and Mn2+ were found ineffective as a substitute for Ca2+. Moreover, those divalent cations acted as inhibitors of the Ca2+-stimulated ATPase activity. The pH optimum of the enzyme is around 6.8. The enzyme has a Km of 70 microM for ATP and the Ka values for Mg2+ and Ca2+ are about 4 x 10(-4) and 10(-7) M, respectively. Studies with inhibitors suggest the involvement of sulfhydryl and primary amino groups in the operation of the enzyme. Possible roles of the enzyme in gastric H+ transport have been discussed.

Regulation of insulin receptor activity of human erythrocyte membrane by prostaglandin E1.

Incubation of human erythrocyte membrane with low concentration of prostaglandin E1 or prostacyclin increased the binding of 125I-labeled insulin to the membrane. The binding of the radioiodinated hormone was maximally stimulated at 3 nM prostaglandin E1 and the use of higher concentrations (above 8 nM) of the autacoid tended to reverse its own effect at lower concentrations. While prostaglandins A1, A2, B1, B2, D2, F1 alpha, F2 alpha or 6-keto-prostaglandin F1 alpha had no effect on the binding of insulin to the erythrocyte membrane, prostaglandin E2 at similar concentrations decreased the binding of the hormone. The effect of prostaglandin E1 on the increased binding of the insulin was found to be reversible and depended on the occupancy of the autacoid molecules on the membrane and showed positive cooperativity. Scatchard analysis of the binding of 125I-labeled insulin to the erythrocyte ghosts indicated that in the presence of the autacoid, the binding capacity of the insulin receptor increased 2-fold (from 207 to 424 fmol/mg protein) without any change in the ghosts affinity for the ligand (Kd 2.4 X 10(-9) versus 2.49 X 10(-9) M). As a consequence of increased binding of insulin to the erythrocyte membrane in the presence of prostaglandin E1 (3.0 nM), the optimal concentration of the peptide hormone for the maximal reduction of the membrane microviscosity decreased from approx. 1.6 to approx. 0.4 nM. Addition of prostaglandin E1 alone at the above concentration to the assay mixture had no effect on the membrane microviscosity.

Control of erythrocyte membrane microviscosity by insulin.

The human erythrocyte membrane binds insulin through high-affinity, low-capacity binding sites (dissociation constant Kd1 2.45 X 10(-9)M; capacity n1 207 fmol/mg protein) and low-affinity, high-capacity binding sites (Kd2 0.63 X 10(-6) M; n2 37 pmol/mg protein). Treatment of the erythrocyte membrane or the intact cells with the physiological concentration of insulin, which is within the range of Kd value of the high-affinity sites, results in a significant reduction of the membrane microviscosity and the filtration time of the intact cells. Use of supraphysiological concentrations of the hormone reverses the effect of the lower concentration of insulin on the membrane microviscosity and the filtration time.

Carbohydrate oxidation and storage in obese non-insulin-dependent diabetic patients. Effects of improving glycemic control.

We have determined total body carbohydrate and lipid oxidation rates in response to a standard breakfast in nine obese patients with non-insulin-dependent diabetes mellitus (NIDDM) and in seven age- and weight-matched controls. The patients with NIDDM were studied twice, once while in poor glycemic control (fasting blood glucose concentration 267 +/- 24 mg/dl, urinary glucose excretion 28.9 +/- 6.3 g/24 h) and again after modest glycemic improvement following 2 mo of fiber treatment (fasting blood glucose 227 +/- 19 mg/dl, urinary glucose excretion 10.7 +/- 1.9 g/24 h). Basal carbohydrate (CHO) oxidation rates were normal in patients with NIDDM before and after fiber treatment. However, in patients before fiber treatment the rise in CHO oxidation rates, the reciprocal fall in lipid oxidation rates, and the rise in serum insulin and C-peptide concentrations after the breakfast were all severely blunted. In addition, storage of ingested CHO was significantly reduced (from 55% to 32%, P less than 0.05). After fiber treatment, postbreakfast CHO oxidation rates had improved and were no longer significantly lower than control values. In contrast, CHO storage remained suppressed. We conclude that (1) basal CHO oxidation remained normal but that postbreakfast CHO oxidation was impaired in our obese patients with NIDDM. This impairment, however, appeared to be a relatively late event, occurring only during severely uncontrolled NIDDM. (2) Inability to dispose of CHO by storage appeared to be an earlier defect with a greater impact on glucose tolerance than the impairment of CHO oxidation.

Effects of anti-insulin receptor antibodies on in vivo insulin metabolism.

The effects of anti-insulin receptor antibodies (AIRA) on receptor binding and insulin metabolism were studied in two patients with the type B, severe insulin resistance syndrome. Insulin binding was determined using rat hepatocytes in primary culture and the patient's own red blood cells. Plasma and urinary insulin concentrations and metabolic clearance rates (MCR) were determined in the two patients and in four normal controls in response to infusions of insulin for 60-120 min at rates ranging from 1 to 925 mU/kg/min. In patient 1, basal insulin concentration was 1400 microU/ml. After infusion of 1, 10, and 925 mU/kg/min of insulin it rose to 3800, 5500, and 225,000 microU/ml, respectively. Respective MCRs were 19, 110, and 186 ml/min. In patient 2, basal insulin concentration was 440 microU/ml. After infusion of 1, 10, and 100 mU/kg/min of insulin it rose to 720, 2500, and 18,800 microU/ml, respectively. Respective MCRs were 193, 262, and 294 ml/min. In controls, basal insulin concentration was 4 +/- 0.3 microU/ml. After infusion of 1 and 10 mU/kg/min of insulin, it rose to 82 +/- 17 and 1288 +/- 50 microU/ml. Respective MCRs were 950 and 630 ml/min. These data showed that, in patients with AIRA: (1) insulin metabolism took place at the same rate but at higher insulin concentrations than in normal controls, and (2) MCR increased with rising insulin concentration but remained subnormal even at the highest insulin concentrations. In contrast, MCR in normal controls decreased with increasing insulin concentrations. The data suggest that prevention of insulin binding prevents insulin metabolism at physiologic insulin concentrations and that supraphysiologically elevated insulin concentrations are needed to activate nonreceptor mechanisms.

Economic burden of tuberculosis in patients attending DOT centres in Delhi.

Tuberculosis inflicts a negative impact on global socioeconomic prosperity. Though India carries one third of the global burden of the disease, few studies have focussed in the country on this aspect. The present study was therefore, framed to estimate economic loss amongst TB patients. A total of 156 patients attending two DOT centres were interviewed in depth, regarding economic loss due to tuberculosis, using a semi structured pretested interview schedule during a period of 5 months. More than 75% of the subjects belonged to the age group of 15-44 years of which 71.6% were males. 34.6% of patients were housewives and 10.9% were students. Mean expenditure before registration in DOT centre was Rs. 3385.5 irrespective of all socioeconomic classes. The upper lower socio-economic class of patients incurred maximum mean expenditure of Rs. 9782.0. Mean duration of wage loss was found to be 47.1 days. Study participants incurred economic loss both in terms of direct and indirect costs, more so in lower socio-economic group, besides delay in attending DOT centres for treatment. Awareness campaign focussing on treatment availability and DOT centre could help in reducing such economic loss.

In vivo and in vitro effects of antiinsulin receptor antibodies.

We studied a patient with Acanthosis nigricans and the type B syndrome of severe insulin resistance. The patient's rates of basal glucose disappearance and appearance were both normal (2.2 and 1.7 mg/kg . min, respectively). FFA, betahydroxybutyrate, and acetoacetate concentrations were stable at 0.8, 1.0, and 0.3 mM, respectively, during a 2-h saline infusion after an overnight fast, indicating continued presence of insulin-like activity (ILA) in her serum. Infusion of insulin at rates of 2.7 and 27 U/h, raising peripheral insulin concentrations from 1400 to 4000 and 6000 microU/ml, respectively, had no effect on glucose disappearance and appearance or plasma concentrations of beta-hydroxybutyrate, acetoacetate, and FFA, suggesting that the observed ILA was not caused by the patient's plasma insulin. To determine the source of the ILA we used the patient's serum containing antiinsulin receptor antibodies (AIRA) to study its acute (2 h) and chronic (24 h) effects on insulin binding and glycogen synthesis in rat hepatocytes in primary culture. Preincubation of hepatocytes with AIRA serum (diluted 1:100) inhibited insulin binding by 84% and 88% after 2 and 24 h, respectively. It increased U-[14C]glucose incorporation into glycogen by 40% and 52% after 2 and 24 h, respectively. These effects were not caused by insulin present in the patient's serum. We conclude that AIRA serum, in addition to causing severe insulin resistance through inhibition of insulin binding, also exerted strong and long lasting insulin-like effects. These findings are compatible with the patient's clinical features of absence of ketoacidosis despite severe insulin resistance, decrease in glucose concentrations during fasting, and postprandial hyperglycemia.

Modulation of gastric H+,K+-transporting ATPase function by sodium.

Gastric H+,K+-ATPase activity is not affected by Na+ at pH 7.0 but is significantly stimulated by Na+ at pH 8.5. For the stimulation at the latter pH, the presence of both Na+ and K+ were essential. Contrary the H+,K+-ATPase, the associated K+-pNPPase was inhibited by Na+ at both pH values. Sodium competes with K+ for the K+-pNPPase reaction. Also, unlike the H+, K+-ATPase activity the ATPase-mediated transport of H+ within the gastric microsomal vesicles was inhibited by Na+. For the latter event only the extravesicular and not the intravesicular Na+ was effective. The data suggest that the K+-pNPPase activity does not represent the phosphatase step of the H+,K+-ATPase reaction. In addition, the observed inhibition of vesicular H+ uptake by Na+ appears to be due to the displacement by Na+ of a cytosolic (extravesicular) H+ site responsible for the vectorial translocation of H+.

Long-term effects of dietary fiber on glucose tolerance and gastric emptying in noninsulin-dependent diabetic patients.

Effects of long-term (2 months) supplementation of diet with 20 g of guar gum and 10 g of wheat bran on metabolic control was studied in 12 obese, poorly controlled noninsulin-dependent diabetic patients. Addition of fiber reduced urinary excretion of glucose from 30.5 +/- 6 to 8.3 +/- 2 g/24 h, (p less than 0.025), fasting plasma glucose concentration from 301 +/- 24 to 184 +/- 15 mg/dl (p less than 0.025), and plasma cholesterol concentration from 277 +/- 24 to 193 +/- 9 mg/dl (p less than 0.025). No significant changes were observed in the patients weight and serum concentrations of triglycerides, high-density lipoproteins, free fatty acids, and insulin. Addition of fiber also delayed gastric emptying of liquids and solids. This effect became statistically significant 60 and 90 min after intake of a test meal for liquids and solids, respectively. We conclude that addition of guar and bran to the diet resulted in long-term improvement of metabolic control in these patients and that delayed gastric emptying may be one of the mechanisms responsible for this beneficial effect.

Mebendazole and insulin secretion from isolated rat islets.

In a preliminary communication we reported that mebendazole, a vermicide, decreased plasma glucose and free fatty acid concentrations and increased plasma C peptide concentrations in both type II diabetic patients. Therefore, we suggested that mebendazole was an insulin secretagogue. However, these were uncontrolled studies, and improved metabolic control in these patients due to spontaneous remission rather than drug-induced insulin secretion was a possibility. To investigate the direct effect of mebendazole on insulin secretion we used intact islets isolated from normal rat pancreata. Mebendazole in concentrations as low as 10 to 20 mumol/L caused a twofold to threefold increase in acute-phase insulin release from isolated perifused rat islets. This heightened insulin release occurred in the presence of glucose-stimulated insulin secretion.

The annual risk of tuberculous infection in Orissa State, India.

SETTING: Rural and urban areas of eight selected districts of Orissa State, India. OBJECTIVES: To estimate the average annual risk of tuberculous infection (ARTI) in the state. DESIGN: A community-based, cross-sectional tuberculin survey was conducted among children aged 1-9 years residing in a sample of rural and urban areas of eight districts of Orissa State. A stratified sampling was adopted for selection of clusters. Highly trained designated tuberculin testers administered 0.1 ml (1 TU) of PPD RT 23 with Tween 80 by the Mantoux method to 10 626 children. Transverse tuberculin reaction sizes were measured about 72 h later by trained designated tuberculin readers. The number of children satisfactorily test-read was 10 191. RESULTS: Based on the frequency distribution of tuberculin reaction sizes, the average ARTI in the state was estimated at 1.7-1.8%. The children residing in urban areas were observed to be at a significantly higher risk of infection than those in rural areas. CONCLUSION: The study in Orissa State suggests high rates of transmission of tuberculous infection and calls to attention the need for intensification of concerted and sustained tuberculosis control efforts.

Comparison of cotton wool swab and cytobrush for detection of chlamydial infection in women attending a genitourinary medicine clinic.

Endocervical specimens obtained by cytobrush and conventional cotton wool swabs from 90 women attending a genitourinary medicine clinic were compared for their efficiency in detecting chlamydial infection. Isolation of Chlamydia trachomatis and detection of the chlamydial lipopolysaccharide antigen were attempted on each specimen. Antigen was detected in 18% of cytobrush and 17% of swab specimens. The cytobrush proved less suitable than swabs for isolation because 8 cytobrush specimens (9%) were toxic to the McCoy cells. Toxicity was significantly associated with an infected endocervix (2P = 0.004). Cytobrush therefore appeared to have little advantage over the much cheaper alternative, the cotton wool swab.

Prevalence of occult human papillomavirus infection, determined by cytology and DNA hybridization, in heterosexual men attending a genitourinary medicine clinic.

One hundred and five heterosexual men without evidence of clinical anogenital warts and attending a genitourinary medicine clinic were studied. Three separate specimens for cytology were taken from (i) the distal urethra including the perimeatal area, (ii) the penile shaft and glans penis including the sub-preputial area, and (iii) from the anorectal area using a proctoscope. Pooled specimens of exfoliated cells from these sites were also taken for the detection of human papillomavirus (HPV) by DNA hybridization. Twenty-eight (27%) of the men had cytological evidence suggestive of HPV infection. HPV genome was detected in 21 (20%) of the men by DNA hybridization and 95% of them were carrying HPV 16 genotype either alone or in combination with other genotypes. A total of 42 (40%) of patients had evidence of occult HPV infection using cytology and/or DNA hybridization techniques collectively. None of the epidemiological risk factors were significantly associated with occult HPV infection in this study. The significance of this high incidence of sexually transmissible HPV genomes, mostly HPV16 in the anogenital area of heterosexual men attending genitourinary medicine clinics requires further study.