Systematic and ecological studies on Chlorophyceae of North India and their relationship with water quality.

In the course of systematic and ecological studies on algal flora of fresh water environment of three different agroclimatic zone of Uttar Pradesh revealed one hundred eighty two species represented by fifty-two genera inhabiting fresh water bodies having different physico-chemical properties. In both the regions members of order Conjugales were dominant and represented by ninety nine species belonging to fourteen genera. This is followed by Chlorococcales having fifty two species represented by nineteen genera and Chaetophorales with nine species of four genera only. In the central Uttar Pradesh a positive correlation was found between hydrogen ions concentration with temperature and species diversity, while in western Uttar Pradesh a highly positive correlation was found in electrical conductivity and total dissolved solids.

Fresh water blue green algae from three agro-climatic zones of Uttar Pradesh, India: distribution pattern with seasonal variation.

The paper deals with 45 species of 21 genera of fresh water blue green algae (BGA) from three different agro-climatic zones of Uttar Pradesh. Samples were collected from different habitats varying in physico-chemical properties. Out of 45 species, 13 species belonged to order Chroococcales, 31 to order Nostocales, while only 1 species belonged to order Stigonimatales i.e. Fischerella mucicola. The physico-chemical parameters like pH, temperature, dissolved oxygen, electrical conductivity, nitrate, nitrite and rainfall play an important role in the periodicity of BGA. A positive correlation was found between dissolved oxygen (DO) of different ponds and species diversity, except in the case of western region of Uttar Pradesh (Farukhabad and Mahoba districts) where a positive correlation was found in electrical conductivity and total dissolved solids.

Trends in poisoning in children: experience at a large referral teaching hospital.

BACKGROUND: Poisoning is a major problem in the paediatric population. The offending substances used vary from place to place. Information on poisoning trends in India is meagre and there is an impression among clinicians that there has been a change in the commonly used poisons over the years. This retrospective study aimed to determine the pattern of poisoning in children and to study the nationwide trend over the past five decades. METHODS: Case records of children (age group: 1 month and above) admitted to the Department of Paediatrics, King George's Medical College, Lucknow, Uttar Pradesh in three alternate calendar years, i.e. 1989, 1991 and 1993 were screened. All children were grouped into three categories based on the poison: (i) bites and stings, (ii) medicinal compounds, and (iii) non-medicinal compounds. The Indian literature on poisoning in children was reviewed and decade-wise data from a total of 22 studies (including the present study) were used to determine the changing trend. RESULTS: Childhood poisoning constituted 2.1% of the total paediatric admissions and 1.2% of total deaths. Non-medicinal compounds were the largest contributors (69.2%), of which kerosene alone was responsible for 47% of cases. Medicinal compounds, and bites and stings accounted for 21.6% and 9.2% of these cases, respectively. The case-fatality rate was 9.2%. Comparison of our data, after excluding bites and stings, with a previous study (1977-79) from our institution showed that kerosene poisoning continues to be responsible for a substantial part of the morbidity (51.8% v. 31.5%). Also, poisoning due to insecticides and pesticides has increased (13.7% v. 2.1%) while that due to plant poisons (primarily dhatura) has reduced markedly (4.8% v. 19.2%). CONCLUSION: Mortality due to poisoning in children has remained high over the last five decades (2.9%-4.7%). Kerosene has remained the single largest contributor to childhood poisoning (51.5% in the 1960s v. 52.8% in the 1990s).

Brainstem auditory evoked response in newborns with hyperbilirubinemia.

OBJECTIVE: To determine the initial Brainstem Auditory Evoked Response (BAER) abnormalities in neonates with hyperbilirubinemia and the possible reversibility of abnormal BAER after therapy. DESIGN: Prospective cohort study. SETTING: Tertiary care hospital. SUBJECTS: 30 term neonates with hyperbilirubinemia (S. bilirubin < 15 mg/dl) as cases and 25 normal term neonates as controls. METHODS: Duration of study was from August 1995 to August 1996. BAER were recorded before therapy at peak hyperbilirubinemia, after therapy, and the age of 2-4 months using electric response audiometer (Nihon Neuropack Four Machine). Denver Development Screening Test (Denver II) was performed at 1 year of age. RESULTS: Seventeen out of thirty (56.7%) neonates with hyperbilirubinemia showed abnormalities on initial BAER. Commonest abnormality seen was raised threshold of wave V in 12 neonates (40%). Other abnormalities observed were absence of all waves at 90 dB (23.3%), prolongation of latencies of various waves (26.7%) and prolongation of various intervals (26.7%). Abnormalities in BAER correlated significantly with bilirubin level. After therapy abnormalities reverted back to normal in 10 cases but persisted in 7 out of 17 (41.17%) cases with initial abnormal BAER. Development screening at 1 yr was abnormal in 3 infants all of whom had persistent abnormalities in BAER. CONCLUSION: Serial BAER is a useful, non invasive tool to detect neurodevelopment delay secondary to neonatal hyperbilirubinemia.

Pseudohypoparathyroidism-Albright hereditary osteodystrophy.

A 13 year old girl with short stature, and retarded mental growth with coarse facies and deranged thyroid function test was initially suspected as a case of hypothyroidism and was started on thyroxine. Lack of response to treatment and on further investigations it was diagnosed as a case of pseudohypoparathyroidism. High index of suspicion and careful evaluation is important to diagnose such an entity.

Cardiovascular responses to treadmill exercise testing in anemia.

OBJECTIVE: To study exercise performance on a treadmill in anemic children. DESIGN: Prospective case control study. SETTING: Department of Pediatrics and Intensive Care Unit, Department of Medicine, King George's Medical College, Lucknow. SUBJECTS: The study population consisted of 41 cases of anemia (10 mild, 21 moderate and 10 severe) and 11 normal age and height matched children aged between 7-12 years. METHODS: These subjects were exercise tested on Quinton Model Q5000 treadmill using Modified Naughton Q5000 protocol. Heart rate, systolic blood pressure, double product, ECG changes, exercise duration and metabolic equivalents achieved during peak exercise were studied. Statistical analysis was performed using analysis of variance (ANOVA) test. RESULTS: No significant difference was observed in values of resting heart rate, heart rate at peak exercise, recovery heart rate, blood pressure response, resting double product, double product at peak exercise, recovery double product and ECG changes in any of the study groups (p > 0.05). However, the gain in heart rate at peak exercise compared to basal value, and double product, total exercise duration and metabolic equivalent (MET) values at peak exercise were significantly low in anemic children on comparison to normal controls (p < 0.001). CONCLUSIONS: Cardiovascular responses are blunted in anemia, mainly because of depleted cardiac reserve.

Brainstem auditory evoked response in tuberculous meningitis.

Brainstem auditory evoked response (BAER) abnormalities in tuberculous meningitis (TBM) were determined in 50 cases of tuberculous meningitis (36 male and 14 female) and 50 normal healthy children. Fifty six per cent cases had abnormal BAER findings. The commonest BAER abnormality observed in 32% was a combination of prolonged latency and prolonged interval while unilateral and bilateral absent response was observed in 4% cases. Prolonged latency was observed in 16% patients. Seizure activities, modified glasgow coma scale (GCS), raised intracranial pressure (ICP) and TBM stage III were significantly correlated with abnormal BAER, while age, sex, duration of illness, depressed sensorium, neurological deficit and CSF findings did not have a significant correlation with abnormal BAER. Follow up could be done in ten patients only. All the three patients with only prolonged latency had a normal BAER on follow up, two out of four patients with prolonged latency and prolonged interval had normalization of BAER while in three patients, initial as well as follow up BAER was normal. The present study shows that BAER abnormalities are observed in more than fifty per cent of the patients of tuberculous meningitis.

Brainstem auditory evoked response in neonates with birth asphyxia.

OBJECTIVE: To determine the brainstem auditory evoked response (BAER) abnormalities and their reversibility in neonates with birth asphyxia. DESIGN: Prospective case control study. SETTING: Tertiary care teaching hospital. METHODS: 30 term Neonates with 5-min Apgar < 6 and hypoxic ischemic encephalopathy (HIE) underwent BAER testing with follow up at 3 months. An equal number of normal term neonates served as controls. RESULTS: 13 out of 30 (43.3%) neonates with birth asphyxia showed some abnormality in BAER wave form. The commonest type of BAER abnormalities seen were transient prolongation of latencies of various waves (69.2%) and prolonged interside latency difference (69.2%). Other abnormalities observed were prolonged interwave interval (23.1%) and prolonged interside interval difference (7.7%). Abnormalities in BAER were significantly associated with stages of HIE and duration of neurological abnormalities more than 5 days. On follow up of 16 cases at 3 months of age, BAER abnormalities reverted back to normal in all the neonates. The Denver Developmental Screening Test (DENVER II) was suspect in 4 cases but the BAER was normal. CONCLUSION: BAER abnormalities in asphyxic neonates are transient and revert back to normal at 3 months of age. BAER does not appear to be a useful tool for early detection of neurological handicaps.

Brainstem auditory evoked response (BAER) in childhood bacterial meningitis.

Brainstem auditory responses were recorded in 50 children of bacterial meningitis and age matched 50 normal children. Abnormal BAER was found in 32 (64%) patients of bacterial meningitis. These abnormalities included prolonged latency (56.2%); unilateral absent response (25%); bilateral absent response (25%) and prolonged interwave interval (25%). Follow-up could be done in 23 patients of 46 survivors. All the patients with prolonged latency either became normal or improved. In majority of the patients having absent response, the abnormality persisted. Abnormal BAER was significantly associated with age < 2 years (p < 0.02), Modified GCS Score < or = 8 (p < 0.001), Seizures (p < 0.02), raised Intracranial Pressure (ICP) (p < 0.02) and CSF sugar < 20 mg% (p < 0.05).

Perinatal mortality in urban slums in Lucknow.

OBJECTIVES: To determine the perinatal mortality rate (PNMR) in the urban slums of Lucknow DESIGN: Cross-sectional survey. SETTING: Twenty five Anganwadi centres of urban Lucknow, with a population of 25,901. METHODS: Data was collected on birth and early neonatal deaths, gestational age of the neonate (determined at birth) and maternal variables like socio-economic status, maternal age, parity, and bad obstetrical history from January 1992 to March 1993. RESULTS: There were 966 births with a still-birth rate of 37.2 and PNMR of 59.0 per 1000. The relative risk of perinatal mortality with lower socio-economic status was 1.87, bad obstetrical history 2.18, and gestational age < 37 weeks 1.95. CONCLUSIONS: Further reduction in PNMR may be possible with focussed medical services to women of low socio-economic status having bad obstetrical history and those delivering before term.

A comparative clinical trial of albendazole versus metronidazole in children with giardiasis.

The adverse effects and treatment failures to some of the currently recommended drugs for giardia infection have given rise to the need for alternative antigiardial agents. In an open, randomized parallel group study, the safety and efficacy of albendazole was compared with metronidazole for the treatment of giardiasis in children. Sixty four children of age ranging from 2-12 years was randomized to receive either albendazole suspension 400 mg daily for 5 days or metronidazole suspension 400 mg daily for 5 days or metronidazole suspension 7.5 mg/Kg thrice daily for 5 days. The mean days required for cure, as evident by absence of cysts and/or trophozoites in the stool specimen, were 3.7 +/- 1.4 and 4.5 +/- 1.1 days, respectively for children on albendazole and metronidazole therapy. Six children on metronidazole therapy developed anorexia 2 to 4 days after the treatment. Albendazole proved as effective as metronidazole in the treatment of giardia infection in children with the added advantage of the absence of anorexia.

Pulmonary function tests in normal Indian children and changes in respiratory disorders.

To document the normal values of pulmonary function tests in children and changes occurring in their values with various respiratory disorders, a study was carried over a period of one year in 95 healthy controls (39 females and 56 males) of 8-13 years of age and 51 cases with respiratory disorders (bronchial asthma-31, pneumonia-10, empyema-10) of matched age, sex and height distribution. The lung functions studied were FVC, FEV1, FEV1/FVC, PEFR and FEF25-75%. In children with bronchial asthma, the FEV1/FVC%, PEFR and FEF25-75% were reduced in accordance with the severity of the disease. A typical restrictive pattern of equivalent decrease in FVC and FEV1 along with insignificant lowering of flow rates, i.e., PEFR and FEF25-75% was observed in pneumonia whereas in patients of empyema a combined pattern of significantly decreased FVC and FEV1 along with mildly reduced FEV1/FVC%, PEFR and FEF 25 75% was observed.

A comparative clinical trial of albendazole versus metronidazole in giardiasis.

The adverse effects and treatment failures to some of the currently recommended drugs for giardia infection have given rise to the need for alternative antigiardial agents. In an open, randomized parallel group study, the safety and efficacy of albendazole was compared with that of metronidazole for the treatment of giardiasis in children. Sixty two children aged between 2-12 years were randomized to receive either albendazole suspension 400 mg daily for 5 days or metronidazole suspension 7.5 mg/kg thrice daily for 5 days. The mean days required for cure, as evident by absence of cysts and/or trophozoites in the stool specimen, was 3.7 + 1.4 and 4.5 + 1.1 days, respectively for children on albendazole and metronidazole therapy. Six children on metronidazole therapy developed anorexia 2 to 4 days after the treatment. Albendazole proved as effective as metronidazole in the treatment of giardia infection in children with the added advantage of absence of anorexia.

Outcome in relation to Apgar score in term neonates.

Sixty four asphyxiated term babies (Apgar score of 6 or less at 5 minutes) and 90 non-asphyxiated term babies (controls) were studied. Of these, 40 cases and 48 controls could be followed up. Mortality and neurodevelopmental outcome were studied in both the cases and controls. Mortality and poor neurodevelopmental outcome correlated inversely with the Apgar scores at 5 and 10 minutes. The outcome of babies with low 5 minute Apgar scores was significantly better than those with the same scores at 10 minutes. Symptomatic neonates when compared to asymptomatic neonates with same Apgar score showed significantly poorer outcome. Babies with Apgar scores of 6 at 5 or 10 minutes behaved like the controls both in terms of mortality and neurodevelopmental outcome.

Behavior development in normal neonates.

The behavior of normal neonates was studied on day 3, 10 and 30 of life with the help of Brazelton's Neonatal Behavioral Assessment Scale (NBAS). The behavior items were clustered and each cluster was scored. The cluster scores increased on subsequent observations in both term and preterm neonates, the increase usually being significant. The corresponding cluster scores were significantly higher in term babies than preterms. Preterms with questionable delay in development at 3 months of age had significantly lower 30th day scores in 3 of the 7 clusters.