Perception regarding quality of services in urban ICDS blocks in Delhi.

The good quality of the services is an important determinant for acceptance of a programme in a community. It not only enhances the credibility of a worker at the ground level but also generate the demand for the services. In this paper perception for the quality of the services was assessed through the exit interview of the beneficiaries at the Anganwadi centres (AWCs). 200 beneficiaries were included from 20 AWCs in a period of one and half month. 52.5% respondents were dissatisfied for the services provided from the AWC for one or more reason. The most common reason mentioned was the not easy accessibility of the AWC and less space available at the AWC (68.6%), followed by the poor quality of the food distributed (66.7%) and irregular pre school education (57.1%) from AWCs.

Glomerular basement membrane thickness in normal adults and its application to the diagnosis of thin basement membrane disease: an Indian study.

Microscopic hematuria of non-urologic origin warrants ultrastructural study of renal biopsy. Thinning and variations in the texture of glomerular basement membrane (GBM) are difficult to be recognized under light microscope; transmission electron microscope (TEM) therefore plays a vital role in identifying such changes. Ultrastructural morphometry is a valuable diagnostic aid when GBM is suspected of being abnormally thin. In an effort to determine the normal GBM thickness (GBMT) in Indian adults and to determine the cutoff value of GBMT for a diagnosis of thin basement membrane disease (TBMD), we determined GBM thickness in 25 normal adults. Postmortem biopsies of 25 normal adults (16 males and 9 females) aging between 18-58 years were included in the study. GBM thickness was determined through ultrastructural morphometry on accurately enlarged electron micrographs as harmonic mean of 50 orthogonal intercepts across the GBM in each case. Study revealed a mean GBM thickness of 321 nm with a standard deviation (SD) of 28 nm. Mean-2SD (321-56), that is 265 nm, was fixed as cutoff value of GBMT for the diagnosis of TBMD. A systematic split study of control subjects revealed thicker GBM (329+/-38 nm) in higher age group (35-60 years) as compared to GBMT (316+/-21 nm) in lower age group (18-30 years). Males in higher age group also revealed thicker GBM (males: 343+/-39 nm versus females: 300+/-12 nm). Ten patients with non-urologic hematuria and having GBMT<265 nm were diagnosed as cases of TBMD. Patients with TBMD revealed significantly attenuated GBM as compared to age and sex matched controls (214 +/- 40 nm versus 311 +/- 17 nm; p<0.0005). No overlap was observed in the distribution of GBMT in patients of TBMD and age and sex matched controls. Ultrastructural morphometry is the ultimate and appropriate method for diagnosing TBMD.

Incidence of lamivudine resistance associated mutations in pol-gene of HIV-1 in patients from north India: a preliminary report.

Screening of drug-resistant variants is very important for the effective clinical management of HIV-infected patients and development of new strategies. The present study was aimed to detect codon-184 mutations in the pol-gene of HIV leading to resistance to lamivudine (3-TC) by nested cum ARMS-PCR approach in 10 treated and 9 treatment naive patients. For correlation the whole blood CD4/CD8 cell counts and the soluble TNFRII levels in plasma were also determined. Of the 19 patients tested, mutant variants were observed in 2 patients (Met Val in one and Met Val & lle in second) both being treated with 3-TC. No mutations were detected in the treatment-naive patients. The results confirmed that, drug resistant variants of codon-184 emerge rapidly in patients receiving 3-TC containing regimens including our population, which is mainly infected with subtypeC of the virus that could be detected along with wild viral population using sensitive approaches such as ARMS-PCR.

Antimicrobial effect of protein(s) isolated from a marine mollusc Telescopium telescopium.

Ammonium sulfate precipitated protein (SF-50) isolated from the spermatheca gland of Telescopium telescopium, an invertebrate marine snail, showed antimicrobial effect on Escherichia coli. The antimicrobial effect varied with the concentration of "SF-50" used and the effect was found to be comparable to antibiotics like amikacin, contrimoxazole and gentamycin in disc diffusion test. The "SF-50" was devoid of erythrocyte haemolysis property.

Effect of heat stress on gastro-intestinal motility in young albino rats.

Motility of the gastrointestinal tract was studied by barium meal technique in control and heat exposed young and adult albino rats. As compared to the controls, the gastric emptying and the intestinal transit were significantly increased in heat exposed young rats, while in vivo intestinal absorption of D-glucose and L-proline was significantly decreased in heat exposed young rats. The rapid transit of meal through small intestine in heat exposed young rats could be responsible for decreased absorptive capacity of small intestine by reducing the exposure time for nutrients.

Immune functions in splenectomized thalassaemic children.

A prospective study to assess the immune functions in splenectomized thalassaemic children. Children were those registered in the Thalassemia major. There were 10 splenectomized children (Group 1), 10 non-splenectomized children and 6 age-matched control (Group 3). All children were shown to be HIV seronegative. The mean concentrations of serum IgG and IgA were higher in Group 1 as compared to Groups 2 and 3 but the differences were not statistically significant. Nitroblue tetrazolium (NBT) dye reduction by stimulated polymorphonuclear leukocytes was normal in both study and control groups and the differences were not statistically significant. However, NBT reduction in the unstimulated state was much higher in Group 2 as compared to Groups 1 and 3. Phytohaemagglutinin induced mitogen proliferation was normal in all 3 groups. Children in Group 1 not only had a significantly higher absolute lymphocyte count but also had a lower CD4/CD8 ratio as compared to Groups 2 and 3. Splenectomy does appear to alter the immune status of thalassemic children but the exact mechanism by which this occurrence is not clear.

Neutrophil functions in rheumatoid arthritis.

Neutrophils play an important role in the pathogenesis of rheumatoid arthritis by accumulation and liberation of active proteolytic enzymes. Despite the active participation of the neutrophils, the patients afflicted with rheumatoid arthritis are prone to multiple infections. We studied neutrophil functions in 20 rheumatoid arthritis patients in active disease and equal number in remission and 20 healthy normal controls. No change in neutrophil function was seen in patients in remission. Phagocytic capacity of the neutrophils in active disease was found to be significantly reduced (p < 0.05). This inversly correlated with the rheumatoid factor (r = -0.128, p = 1). Random migration and chemotaxis was statistically reduced when compared with either healthy controls (p < 0.01) or when compared with patients in remission (p < 0.01). The chemotaxis inhibition was further enhanced by autologus serum (p < 0.05). The serum from patients with active disease also reduced chemotaxis of neutrophils from normal individuals (p < 0.01), indicating reduced cellular response as well as inhibitors in serum. The positive correlation (r = 0.466, p < 0.01) with rheumatoid factor, suggests the inhibitory activity may be due to the circulating rheumatoid factor in the active disease. The postulate that prior saturation of neutrophil receptors with immune complexes lower phagocytosis as well as chemotaxis is sustained. Destruction of chemotaxis receptors by release of various strong oxidative enzymes by neutrophils may also be a factor. Normal leucocytes are seen to take up immunoglobulins from diseases serum but not from normal serum. This uptake of diseased serum may be responsible for reducing the chemotactic and phagocytic function of neutrophils and hence increased incidence of infection in these patients.

Clinico-immunological profile of juvenile rheumatoid arthritis at Chandigarh.

OBJECTIVE: To study the clinical and immunological profile of children with juvenile rheumatoid arthritis (JRA). DESIGN: Retrospective hospital based study. SETTING: Tertiary level center of North India. SUBJECTS:74 patients attending the Pediatric Rheumatology and Immunology Clinic over last 5 years. RESULTS: The patients were aged between 9 months to 12 years with male female ratio of 1.8:1. Eleven (14.9%) patients had systemic onset JRA, 28 (37.8%) had polyarticular onset type and 35(47.3%) had pauciarticular onset type JRA. Uveitis was present only in one patient and rheumatoid nodules were present in 4(5.4%) patients. Rheumatoid factor was positive in 2(2.7%) and antinuclear antibody was present in one patient only. HLA-B27 was positive in 4 children. Two patients developed amyloidosis. CONCLUSION:The clinico-immunological profile of JRA at Chandigarh appears to be some what different from that reported from other centers in India.

A study of the distribution of ABO and Rh(D) blood groups amongst Lodha tribe in Midnapore district of West Bengal.

Distribution of ABO and Rh(D) blood group was studied in 206 Lodha subjects living in the Midnapore district of West Bengal. It was observed that incidence of group A was maximum and incidence of group AB was minimum; 99.5% of the subjects were 'Rh' positive. The highest incidence of group A amongst Lodhas indicates that they might belong to the proto-Australoid group anthropologically.

Role of hyperphagia in structural changes of small intestine during lactation.

The present study was conducted to investigate the cause of the structural changes of small intestine during lactation in albino rats. Anatomical measurements (total length, total wet weight and total dry weight) and histological studies of small intestine were undertaken in virgin control rats, lactating control rats, lactating rats with restricted food intake and lactating rats with restricted litter size. Restriction of food intake prevented the growth of small intestine during lactation, while restriction of litter size had no effect. Results indicate that the structural changes in small intestine are due to work hypertrophy secondary to hyperphagia and not due to any hormonal factors.

Paraproteins and plasma cell dyscrasias.

Serum protein electrophoresis done on 1100 patients with various diseases in one year demonstrated M-band in 31 patients. Most (87%) had the classical features of plasma cell dyscrasia (PCD), however a few had unusual presentations which are highlighted. A 22-year-old male operated for a massive tumour of the scapula clinically diagnosed as chondrosarcoma revealed plasmacytoma with amyloid on histology. Another case of kala-azar presented with features akin to that of PCD and one case had dual malignancies. Such a high incidence of PCDs with varied picture in a short time is not usually seen in other parts of this country; a fact which may be due to lack of awareness.

Immunoglobulin deficiency.

Twenty three patients with primary immunoglobulin(Ig) deficiency were seen during the last ten years. Nine had hypogamma globulinemia (hypo-Ig) and the rest, selective Ig deficiency. Most were in pediatric age group. There was preponderance of males with only one female. Clinical symptoms pertaining to gastrointestinal and sinupulmonary infections were most common. Complete absence of B cells was not observed in any patient with hypogammaglobulinemia. They could be typed as physiological in one patient, X-linked immunodeficiency in 2 patients and common variable immunodeficiency in the remaining six. Three patients with selective IgA deficiency were above 20 years of age. Two had only secretory IgA deficiency, confirmed by jejunal fluid examination and the rest had both secretory and serum IgA deficiency. Low IgM was seen in one patient. We see a spectrum of immunoglobulin deficiencies varying from subtle defects like absence of secretory IgA only, to severe depletion of all immunoglobulins. Therapy is still not ideal due to economic reasons.

A search for immunocontraceptive agent from marine sources--role of antispermatheca globulin of Telescopium telescopium on fertility regulation in male rat.

Polyclonal antisera were developed in rabbits against 'spermatheca', the reproductive gland of T. telescopium, a marine mollusc. The gland contains spermatozoa. Antisera and its IgG fraction (ASTG) indicated common antigenic determinants by immunodiffusion and had titer values 81920 and 1280 against crude antigen extract. Cycling female rats when exposed to passively immunized male rats with different doses of ASTG, had reduction in implantation sites and litter size. Females had pseudopregnancy when exposed to higher doses of immunized males and had normal cycle after 20 days in average. ASTG in male rats caused decrease in weight of the reproductive glands, alteration in sperm concentration, motility and morphology, formation of multinucleated giant cells and vacuoles leading to arrest of spermatogenesis and reduction in seminiferous tubular diameter. The effects were dose dependent with reversible infertility. The results indicate presence of a common antigenic determinants which cross-react with vertebrates and existence of common relation through phylogenetic evolution and their immune responses.

Secondary immune defects in non-Hodgkin's lymphoma.

Changes in the humoral, cellular and phagocytic components of the immune system were investigated in 44 biopsy proven, untreated patients of non-Hodgkin's lymphoma (NHL). There was significant decrease in the total lymphocyte number, their subsets (T and B) and the T helper (T mu) population. Impaired leukocyte migration inhibition response and DNA synthesis following stimulation by phytohaemagglutinin were noted. Significant reduction of serum IgA was found in patients of both diffuse and nodular NHL. Phagocytic activity and nitroblue tetrazolium (NBT) reduction were unaltered, but chemotaxis was significantly reduced and bactericidal activity showed variable results.

Immune status in ataxia telangiectasia.

Immune status of 22 patients of ataxia telangiectasia was studied over a period of 8 yr (mean age of patients: 9.5 +/- 3 yr; 9 of 22 were siblings). Low T-cell number was observed in 14 of 19 patients but the response to PHA challenge done in 10 patients was normal and migration inhibition to BCG antigen was positive in 6 of 6 patients. IgM defect was seen in 2 out of 18 patients and serum IgA was deficient in 10 out of 18 patients. Salivary IgA was also absent in these children. Four children had high spontaneous NBT reduction. None of the patients had lymphoma, leukemia or any other malignancy at the time of presentation. Candida killing was normal in all patients. The presenting feature related to the CNS in almost all children and gross infections were not seen.

Non-organ specific & organ specific antibodies in rheumatoid arthritis.

Fifty patients of rheumatoid arthritis clinically diagnosed (by ARA criteria) were studied for both non-organ specific [rheumatoid factor (RF), anti-nuclear antibodies (ANA), extractable nuclear antibody (ENA), granulocyte specific anti-nuclear antibody (GS-ANA), anti-smooth muscle antibody (SMA) and anti-mitochondrial antibody (AMA)] and organ specific, [anti-adrenal (AAA), anti-islet cell (ICA), antithyroid antibody (ATA) and anti-parietal cell (PCA)] auto antibodies. RF was positive in 80 per cent of patients. ANA was positive in 44 per cent of patients, ENA in 62 per cent, SMA in 20 per cent, AMA in 18 per cent and GS-ANA in 68 per cent. Of the organ specific antibodies, PCA was demonstrable in 28 per cent of the patients and none of the other antibodies were present. Circumstantial evidence indicates that ANA and GS-ANA are not synonymous but independent, cross-reacting entities and the presence of both increase the sensitivity (94%) of diagnosis of RA.