Chemotaxis, random mobility, and mobilization of polymorphonuclear leucocytes in malnutrition.

Neutrophil mobilization following administration of Pseudomonas polysaccharide was significantly reduced in malnutrition, especially during infection. The random mobility of polymorphonuclear leucocytes (PMNs) was slightly decreased in undernutrition. Chemotactic migration of PMNs was depressed and correlated more with the presence of infection than with nutritional deficiency. It is possible that these abnormalities of PMN mobilization and mobility in malnourished individuals contribute to suboptimal amount, kinetics, and pattern of tissue inflammatory response to bacteraemic challenge.

Safety of oral rehydration solutions in non-cholera diarrhoea.

PIP: The safety of 2 oral rehydration solutions (ORS) containing 60 and 90 mEq/1 of sodium respectively was evaluated in 50 children with mild to moderate dehydration secondary to noncholera diarrhea. Hypernatremia developed in 1 patient (3.7%) on high sodium formula. The risk of hypernatremia and hyponatremia in the 2 groups did not differ significantly. 3 patients (6.1%) showed hypokalemia 24 hours after oral rehydration was initiated. While these data confirm that ORS containing 90 mEq/1 of sodium is safe, an increase in potassium content should be considered.^ieng

Treatment of acute diarrhoea with wide use of ORS packets or sugar salt solution in a rural community.

PIP: An oral rehydration therapy program was introduced in a rural community in India. During the initial 20 months (phase 1), packeted oral rehydration solution (ORS) was promoted and made available through the dispensary and also through 5 village health workers for treatment of all diarrheal illness, regardless of the severity. In the subsequent 11 months (phase 2), the supply of ORS packets was restricted only to cases of obvious dehydration when treatment was sought at the local dispensary. Preparation and correct use of the sugar-salt solution for early treatment of diarrhea were explained to all of the mothers in the villages. The diarrheal episodes and use of ORS were monitored through household visits by data collectors throughout the 31-month period. In phase 1, ORS packets were used in 68.6% of the diarrheal episodes whereas in phase 2, sugar-salt solution was used for 79.3% of the episodes. The mean intake (in liters)/diarrheal episodes was higher (p0.05) for sugar-salt (1.9 +or- 1.6) as compared to the ORS solutions prepared from packets (1.2 +or- 0.7). The percentage of samples with sodium concentration 120mE q/1 was 4.9% with ORS packets and 20% with sugar and salt (0.05). The diarrheal deaths/100 episodes were 0.73 (ORS packets phase) and 0.50 (sugar-salt phase), respectively (p0.05).^ieng

Intracranial tuberculoma. Evaluation and treatment.

We used computerized tomography (CT) to screen 83 patients with partial seizures who had 1) increased intracranial pressure; 2) evidence of systemic tuberculosis; or 3) focal neurological deficit. We found intracranial tuberculoma in 20 (24%). In addition, of 55 patients with tuberculous meningitis, 12 had associated tuberculoma. The image morphology on CT scans showed ring lesions (14), discs (10), and irregular coalescing masses (8). Perilesional edema frequently was present. After appropriate antitubercular therapy, clinical outcome for seizures, neurological deficit, and increased intracranial pressure was satisfactory. CT lesions regressed within 12 weeks of inauguration of medical therapy in most patients. Medical management of tuberculoma is advocated, with surgery limited to those in whom such treatment is ineffective.

Strategies to reduce infant mortality rate in India.

PIP: As a systems approach is needed to develop strategies to reduce the infant mortality rate (IMR), it is appropriate to analyze the present situation in India, reasons for low IMR in some Indian states vis-a-vis others, the status in some neighboring countries, and the cost effectiveness of various available technological interventions and their organizational constraints. A 1981 survey revealed 1) a low IMR for the state of Kerala, one which was comparable with Western nations, despite the fact that nearly half of the population in Kerala lived below the poverty line; 2) a very high IMR for the state of Uttar Pradesh, even though the number of people living below the poverty line was not significantly by different from the state of Kerala; and a moderate IMR reduction in the state of Punjab, even though only 15% of the population was below the poverty line. Favorable factors for low IMR appear to be a high female literacy rate, good medical and educational facilities close to the place of residence, and an excellent transportation and communication system. To significantly reduce IMR in a short period of time, it is necessary to adopt certain immediate measures. Nearly 55% of infant deaths occur in the 1st month of life, and these generally are not amenable to general measures and technological interventions. The problem is difficult, but a solution can be found by reaching a broad consensus among professionals and administrators. The major recommendations of a seminar on the Strategies for Reducing infant Mortality in India, held during January 1984, were: provide antenatal care to 100% of pregnant women; work for early registration of pregnancy and identification of high risk pregnancies; immunize 100% of pregnant women with tetanus toxoid; make available intrapartum care for all pregnant women; delineate anticipated job requirements, duties, and functions of village level health workers; make presterilized packaged delivery kits available to all female health workers; and implement secondary level perinatal care.^ieng

Blood lead levels of children with pica and surma use.

Blood lead levels of 253 Delhi children were estimated by dithizone method. In 82 (controls) children with no symptoms mean blood lead level was 9.6 micrograms/dl (+/- SD 6.8: median 10 micrograms); only 6 had high levels between 30-33 micrograms/dl. In 88 children with pica, the mean blood lead level was 23.0 micrograms/dl (+/- SD 13.82; median 17 micrograms) which was significantly higher than the control; 26 had high levels between 30-92 micrograms/dl. Sixteen children with pica and surma-use and 46 children suspected of lead poisoning showed lead level patterns like the pica group. However, 21 surma-using children without pica resembled the control group. Children with pica were significantly more anemic than the controls and showed higher prevalence of abdominal-neurological symptoms. Because, in India, blood lead cannot be estimated in most of the hospitals, it is suggested that children with severe pica, anemia, abdominal-neurological symptoms and exposure to surma or lead, be suspected of lead poisoning, kept in lead-free environment with corrected nutrition, and be given a short cautious therapeutic trial with oral penicillamine.

Multi drug resistant Salmonella typhi infection: clinical profile and therapy.

Multiple drug resistant Salmonella typhi infection was observed in thirty five recent cases among forty eight children with bacteriologically proven enteric fever. Incidence of complications such as shock, myocarditis, encephalopathy and paralytic ileus was higher among these. A combination of cephalexin and gentamicin was successfully used in the management of these children.