A comparative study of salivary and serum calcium and alkaline phosphatase in patients with osteoporosis

Background: This study was undertaken to investigate the changes in salivary and serum calcium and alkaline phosphatase in osteoporosis patients. The objective was to compare the change in serum levels with those in saliva.Methods: The study was conducted in the department of biochemistry, National Institute of Medical Sciences and Hospital, Shobha Nagar, Jaipur, Rajasthan, India. Subjects were selected from department of orthopedics, National Institute of Medical Sciences and Hospital, Shobha Nagar, Jaipur, Rajasthan, India. At the same time one hundred adult osteoporosis patients confirmed by DEXA were taken. Calcium and alkaline phosphatase were measured in serum and saliva of each patient. The data obtained was statistically analyzed.Results: Serum calcium has strong positive correlation with salivary calcium (r=0.726) while serum ALP and salivary ALP had weak positive correlation (r =0.453).Conclusions: Saliva can be used to measure calcium level instead of serum as it is non-invasive, quick and easy method.

Spectral analysis of heart rate variability in bronchial asthma patients.

The study was carried in the Departments of Physiology and Medicine at S.M.S. Medical College, Jaipur. Thirty patients of bronchial asthma, aged 20-30 years attending outpatient clinics of S.M.S. Hospital and thirty healthy volunteers were recruited in the present study for spectral analysis of Heart Rate Variability (HRV) using impedance peripheral pulse in the right forearm. Two spectral components were recorded namely high frequency (HF) component (0.15–0.4 Hz), an indicator of vagal efferent activity and low frequency (LF) component (0.04–0.15 Hz), replicator of composite sympatho-vagal interplay. These components were analyzed as LF nu (Low Frequency normalized unit), HF nu (High Frequency normalized unit) and LF/HF ratio. Low frequency component in absolute units of the asthmatic patients differed insignificantly (P>0.05) from LF of the subjects, whereas the same calculated as normalized units was found to be significantly low in the patient group (P<0.01), as compared to that of the control group. The High Frequency (in absolute units) index of HRV was significantly high in asthmatics (P<0.01) as compared to the HF (absolute units) of controls. Similar trend was observed in the normalized units of HF (P<0.01). LF/HF ratio was not significantly different in patient and control groups (P>0.05). It was concluded that a significantly raised central vagal outflow and a concomitant significantly low central sympathetic efferent could be appreciated in asymptomatic asthmatic patients as compared to that in the control group. This deranged sympathovagal interplay with parasympathetic dominance could be a plausible pathophysiological mechanism leading to airway obstruction, the hallmark of bronchial asthma.

Is there a need of extra fluoride in children.

The issues related to fluoridation of water or fortification of tooth paste with compounds of fluorides are controversial. Fluoride is stored mainly in the bones, where it increases the density and changes the internal architecture, makes it osteoporotic and more prone to fractures. Fluoride consumption by human beings increases the general cancer death rate, disrupts the synthesis of collagen and leads to the breakdown of collagen in bone, tendon, muscle, skin, cartilage, lungs, kidney and trachea, causing disruptive effect on various tissues in the body. It inhibits antibody formation, disturbs immune system and makes the child prone to malignancy. Fluoride has been categorized as a protoplasmic poison and any additional ingestion of fluoride by children is undesirable.

Clinical profile and outcome of stroke in relation to glycaemic status of patients.

The present study was undertaken in 50 patients of acute stroke to assess the role of glycaemic status on clinical profile and outcome of stroke. Subjects were divided into two groups: Group 1--Comprising of 25 patients of acute ischaemic stroke; Group 2--Comprising of 25 patients of acute haemorrhagic stroke. Each group was subdivided into euglycaemics, stress hyperglycaemics, newly diagnosed diabetics and known diabetics subgroups (stress hyperglycaemics, newly diagnosed diabetics and known diabetics together were called hyperglycaemics). Hyperglycaemics of both the groups had larger sized stroke. Neurological assessment done at day 1 and day 10 by Gillory's scoring system showed statistically significant improvement (P < 0.01) in all neurological functions in the euglycaemic subgroup in both the groups while in the hyperglycaemic subgroup improvement in higher mental function and motor function was insignificant (P > 0.05). There was statistically significant mortality (P < 0.05) (up to 10th day) with the hyperglycaemic subgroup in both the groups as compared to the euglycaemic subgroup.

Prevalence of acid fast bacilli in Ajmer: A retrospective analysis of eight years data.

To assess prevalence of acid fast bacilli (AFB) in Ajmer, a retrospective analysis of 8 years was done in 1905 AFB cultures in various clinical specimens. All specimens were cultured on Lowenstein-Jensen slants after decontamination and concentration using modified Petroff's method. Smears were stained by Ziehl-Neelsen technique with acid and alcohol to exclude rapid growers. Four hundred and twenty eight AFB positive cultures were reported using morphological, staining and microscopic characteristics. Over all, AFB positive culture rate was 22.46%. Maximum positive cultures were from urinary system (253) followed by respiratory system (151), female genital systems (9), reticuloendothelial system (6), CNS (6), GIT (2), and CVS (1).

Primary tuberculosis of soft palate.

Primary tuberculosis of upper respiratory tract including oral cavity is a rare disease. One such unusual case is reported.

Compensatory hyperparathyroidism following high fluoride ingestion - a clinico - biochemical correlation.

OBJECTIVE: To evaluate the effect of varying ingestion of drinking water containing high fluorides and its effect on serum parathyroid hormone. DESIGN: Cross sectional clinical study. SETTING: S.M.S. Medical College, Jaipur. SUBJECT: 200 children were selected from four areas (50 from each area) consuming water containing 2.4, 4.6, 5.6 and 13.5 mg/l of fluoride. All children were in an age group of 6 to 12 years. METHODS: All children were graded for clinical, radiological and dental fluorosis and biochemical estimations were made for serum calcium, serum and urinary fluoride and serum parathyroid hormone. RESULTS: Serum calcium levels were well within normal range in the patients of all areas but an increase in serum parathyroid levels (S. PTH) was noted. The increased S. PTH was well correlated with increase in fluoride ingestion. The severity of clinical and skeletal fluorosis was observed to increase with increase in S. PTH concentration. CONCLUSIONS: High Fluoride ingestion has a definite relationship with increased parathyroid hormone secretion, which may be responsible for maintaining serum calcium levels and may have a role in toxic manifestations of fluorosis.

Development of pleural effusion in patients during anti-tuberculous chemotherapy: analysis of twenty-nine cases with review of literature.

Twenty-nine cases of tuberculosis developing pleural effusion (PE) during antituberculous chemotherapy (ATT) were analysed for clinical presentation and management outcome. Sixteen (55%) patients had pulmonary tuberculosis alone while rest had associated or isolated extrapulmonary tuberculosis. Thirteen (44.8%) patients developed PE during the 5th-8th week of chemotherapy and nine (31%) during 9th-12th week. Eighteen (62%) patients were on either HRZE or HRE while five (17.2%) were on SHRZ regimen before developing PE. All cases had exudative PE. Pleural fluid centrifuge was smear positive for AFB in two (6.8%) cases and culture positive for Mycobacterium tuberculosis in four (13.7%) cases. Pleural biopsy sections were negative for either AFB or tuberculous histology in 15 out of the 24 biopsies done. Twenty-four (82.7%) patients showed good response on the same ATT without modification. Development of PE during successful ATT seems to be an extension of paradoxical events having an immunological basis, which does not necessarily require any modification in chemotherapy.

Sclerosing hemangioma of the lung.

An extremely rare case of sclerosing hemangioma lung is described in a patient who presented as right sided pleural effusion with recurrence.

Methaemoglobinaemia in areas with high nitrate concentration in drinking water.

BACKGROUND: An epidemiological investigation was undertaken in all age groups to assess the prevalence of methaemoglobinaemia in areas with high nitrate concentration in drinking water. METHODS: Five areas were selected with an average nitrate concentration (as nitrate) of 26, 45, 95, 222 and 459 mg nitrate ions/litre in drinking water. These areas were visited and the house schedule (containing name, age, sex and weight of the family members) prepared in accordance with the statistically designed protocol. In all, 178 persons, matched for age and weight, were selected and arranged in five age groups. They constituted 10% of the total population of each of these areas. A detailed history of the selected population was taken, medical examination conducted and blood samples taken to ascertain the level of methaemoglobin. The collected data were subjected to statistical analysis to ascertain a relationship between nitrate concentration and methaemoglobinaemia. RESULTS: High nitrate concentrations cause severe methaemoglobinaemia (7%-27% of Hb) in all age groups, especially in the age group of less than 1 year and above 18 years. The lower levels of methaemoglobin in the age group of 1-18 years is probably due to better reserve of cytochrome b5 reductase activity and its adaptation to increasing nitrate concentration in water to compensate for methaemoglobinaemia in this age group. CONCLUSION: We conclude that high nitrate ingestion causes methaemoglobinaemia in all age groups. Cytochrome b5 reductase activity and its adaptation with increasing water nitrate ingestion plays a role in compensating for the methaemoglobinaemia.

Postbronchoscopy expectoration of tumour tissue in lung cancer.

A case of undifferentiated giant cell type bronchogenic carcinoma in an old man is reported. Following bronchoscopy, the patient expectorated tumour mass tissue in his sputum and was relieved of breathlessness to a great extent.

Experimental pulmonary fluorosis.

An experimental study was undertaken to observe effects of fluoride ingestion on lung tissue. The study was conducted on 15 albino rabbits of either sex and experimental fluorosis was induced by daily oral administration of sodium fluoride (NaF) solution. Rabbits were divided into three groups according to the quantity of fluoride ingestion: Group A: rabbits fed with 10 mg/kg/day NaF, Group B: 20 mg/kg/day NaF; and Group C: controls. After six months, the rabbits were sacrificed and their lung tissue was submitted for histopathological examination and fluoride content estimation. On gross examination, pale areas on the surface and dark brown congested areas on cut-section of lungs were seen in rabbits of groups A and B. Histopathological changes of alveolar haemorrhage, congestion, edema fluid, necrosis of alveolar epithelium, distortion of alveolar architecture and desquamation of epithelium of respiratory tract with damage to tracheal cartilage were observed in these groups. These changes were more marked in group B rabbits. Fluoride content of lung tissue homogenate was significantly higher in groups A and B (mean 1.206 ppm and 1.978 ppm respectively) as compared to control (0.1585 ppm). It was concluded that prolonged fluoride ingestion damages pulmonary tissues of rabbits. To the best of our knowledge, effect of chronic fluoride ingestion on lungs has not been reported in the literature, therefore, we had undertaken this study to analyse the effect of chronic fluoride ingestion on lungs.

Primary bronchogenic carcinoma: clinical profile of 279 cases from mid-west Rajasthan.

The present retrospective study was undertaken to study the clinical profile of primary bronchogenic carcinoma seen during last eight years in a teaching hospital. Out of a total of 279 diagnosed cases, 86% were males with an average age of 57 years, smoking was the risk factor in 81.6%. Forty percent of female patients were smoker with a significant overlap in use of smoking objects. Twenty four (8.8%) patients were less than 40 years of age at the time of diagnosis. Average duration of illness was 4.5 months. Weight loss (77%) and fever (34%) were the commonest general symptoms. Other chest symptoms include cough (68%), dyspnoea (59%), chest pain (22%), hemoptysis (20%) and dysphagia (6%). Fiberoptic bronchoscopy (FOB) (75%) and fine needle aspiration cytology (FNAC) (74.8%) were found to be the most efficient diagnostic procedures. Histologically, squamous cell carcinoma, adenocarcinoma, large cell carcinoma and small cell carcinoma were seen in 42%, 20%, 18% and 14% cases, respectively. Six percent patients showed malignant cells only and marked as unclassified. Radiologically, obstructive pneumonitis was the commonest presentation (59.5%) followed by mass lesion (31.8%) and rib destruction (5.1%). Inspite of its limitation, this study for the first time reports lung cancer pattern from mid-west Rajasthan.

Primary tuberculosis of nose.

An extremely rare case of primary tuberculosis of nose is being reported. Possible modes of infection are also discussed.

A study of autonomic neuropathy in diabetes mellitus in relation to its metabolic control.

50 Patients of diabetes mellitus (both IDDM and NIDDM) were selected with typical symptoms, signs and positive bed side tests of autonomic neuropathy. All the patients were followed for three months during which strict metabolic control was achieved by routine treatment with oral hypoglycaemic agents and/or insulin, simply by change in their previous treatment dosages and better attention to diet and physical activity. 22% patients showed significant improvement in symptoms of autonomic neuropathy. 42% showed partial improvement and 36% patients did not show any improvement. Improvement in objective test score was significant in 18%, partial in 46% and insignificant in 36%. Improvement in neuropathy did not correlate with HbA1C levels. 36% patients did not show any subjective or objective improvement in autonomic neuropathy inspite of good glycaemic control as indicated by normal HbA1C levels in them.

Pancreatic xenograft survival in diabetic rabbits.

Prolonged survival of pancreatic xenografts in the muscles of diabetic rabbits was achieved. The mean graft survival time (assessed by euglycemic status) in nonimmunosuppressed (Group A) was 10 days and in immunosuppressed (Group B) was 36 days (P < 0.05). Adequate immunosuppression helps pancreatic xenograft to normalize blood glucose level (BGL) by prolonging survival time. Our study demonstrates that xenotransplantation of islet cells in their natural environment (pancreatic tissue in four of thin slices) survive and function adequately in immunosuppressed recipients. This discordant Xenotransplantation model may be useful for future xenotransplantation studies.