Double burden of underweight and overweight among children (10–19 years of age) of employees working in Indian industrial units.

Background. Along with the existing problem of underweight, overweight in children is increasing in the developing world. However, there is little information on its magnitude and pattern in the Indian context. We aimed to study the pattern and correlates of overweight in Indian children and adolescents. Methods. A total of 3750 children in the age group of 10–19 years, who were family members of randomly selected employees from 10 different industrial sites in India, were surveyed using an interviewer-administered questionnaire. Results. The prevalence of underweight was highest in peri-urban areas (30.2% and 53.2% according to Indian and international criteria, respectively). In urban and highly urban areas, the prevalence of underweight was 14.1% and 9.8%, respectively, according to the Indian criteria, and 27.1% and 19.2%, respectively, according to international criteria. The proportion of overweight children was highest in the highly urban category (19.1% and 13.4% according to Indian and international criteria, respectively). The level of urbanization (OR 3.1 and 4.7 for overweight in urban and highly urban areas, respectively, compared with peri-urban areas, p<0.001), physical activity (OR 0.4, p<0.001, in children with physical activity score >75th percentile compared with a score <75th percentile) and frequency of meals outside the home (OR 12, p<0.001, if >25% weekly meals taken outside the home compared with <25% of weekly meals outside home) were significant predictors of overweight. Conclusion. There is a double burden of underweight and overweight among Indian children and adolescents.

A rare case of human trypanosomiasis caused by Trypanosoma evansi.

Human trypanosoma infections like the ones seen in Africa and South America are unknown in India. The only exception in literature is of two documented cases of a self-limiting febrile illness, being attributed to Trypanosoma lewisi like parasites. We are reporting an unusual case of trypanosomiasis from the rural parts of Chandrapur district in Maharashtra. An adult male farmhand who used to practice veterinary medicine also, presented with history of febrile episodes on and off since five months and drowsiness before admission to this Institute. Though routine blood and other investigations were within normal limits, the peripheral smear showed a large number of trypanosomes which morphologically resembled the species Trypanosoma evansi, the aetiological agent of surra - a form of animal trypanosomiasis. A battery of assays covering the spectrum of parasitology, serology, and molecular biology confirmed the infecting parasite to be T. evansi. Failure to demonstrate the central nervous system (CNS) involvement, as evidenced by the absence of parasite in cerebrospinal fluid (CSF) advocated the use of suramin - the drug of choice in early stage African trypanosomiasis without any CNS involvement. Suramin achieved cure in our patient. The case is being reported because of its unique nature as the patient was not immunocompromised and showed infestation with a parasite which normally does not affect human beings.

Effect of passive smoking on endothelial function in: healthy adults.

BACKGROUND: Active smoking predisposes to atherosclerotic vascular disease but recent evidence that inhalation of environmental tobacco smoke (passive smoking) may also have deleterious cardiovascular effects, has enormous public health implications. Endothelial dysfunction is an important early feature of atherogenic process, which may occur due to passive smoking. OBJECTIVE: To assess the effect of passive smoking on endothelial function (measured by flow-mediated dilatation, a marker of endothelium-dependent arterial dilatation) and compare it with non-smokers. STUDY DESIGN: Case control study. SETTING: Out-Patient Department of Medicine, Government Medical College, Nagpur. PARTICIPANTS: Seventy-five young, healthy, male adults between 15-30 years age were studied. There were three groups: (a) Non smokers (n = 25) (b) Passive smokers (n= 25) and (c) Active smokers (n = 25). Subjects with diabetes mellitus, hypertension and ischemic heart disease were excluded. Lipid profile was measured in all. Endothelial function was tested non-invasively by using high frequency linear vascular probe on brachial artery. Resting brachial artery lumen, flow at rest and after hyperemia, flow-mediated dilatation and nitroglycerine-induced dilatation were measured. RESULTS: The mean brachial artery lumen dilatation and flow at rest were similar in all the three groups. Flow-mediated dilatation (FMD%, a marker of endothelium-dependent dilatation and endothelial function) was significantly higher in non-smokers than passive smokers (8.9 +/- 4.8 Vs 5 +/- 2.3, p < 0.01) and also as compared with active smokers (8.9 +/- 4.8 Vs 6.6 +/- 2.2, p < 0.05). Nitroglycerine-induced dilatation, (a marker of endothelium-independent dilatation ) was similar in all the three groups. Serum lipids (mean cholesterol, LDL, and mean LDL/HDL ratio) were statistically significantly higher in passive and active smokers as compared with non-smokers (p < 0.05). CONCLUSION: Like active smoking, passive smoking was also associated with impaired endothelial function, (a key early event in atherogenesis) and altered lipid profile, in healthy young adults.

Reversible myocarditis in a patient receiving clozapine.

Myocarditis is a rare and potentially life-threatening complication of clozapine. We report the case of a 2 6-year-old patient who developed reversible myocarditis during treatment with clozapine for chronic resistant schizophrenia. The patient recovered rapidly on withdrawal of clozapine and with supportive management.

Factors precipitating congestive heart failure--role of patient non-compliance.

OBJECTIVE: This study was aimed to identify systematically the precipitating factors causing decompensation of heart failure and subsequent hospitalisation. We specially assessed the role of patient non-compliance with therapy as an important precipitating factor for heart failure, since it has not been systematically studied previously in an Indian setting where rheumatic heart disease is common. METHODS: In this cross-sectional analytical study, 125 cases of congestive heart failure hospitalized in Government Medical College, Nagpur, were studied. All the patients were thoroughly evaluated and investigated to identify the precipitating factors for heart failure. A patient was categorized as being non-compliant with therapy if he/she was consuming less than 80% prescribed drugs (assessed by pill count) or was non-compliant with dietary advice (assessed by an interviewer-administered questionnaire). RESULTS: Rheumatic heart disease was the commonest underlying heart disease (52.8%) followed by ischemic and/or hypertensive heart disease (27.2%). The most common precipitating factor was patient non-compliance with diet or drug therapy (49.6%) followed by arrhythmias (16.8%), uncontrolled hypertension (14.4%), infective endocarditis (13.6%), anemia (14.4%) and infections (11.2%). CONCLUSION: The results emphasize the importance of patient non-compliance with prescribed therapy as a leading precipitating factor for congestive heart failure in an Indian setting, which can be prevented by appropriate cost-effective strategies aimed to improve patient compliance.

Efficacy of intravenous magnesium sulphate in supraventricular tachyarrhythmias.

This study was conducted to evaluate the clinical efficacy of intravenous (i.v.) magnesium sulphate 2 gm bolus in sustained supraventricular tachycardia (SVT) and atrial flutter-fibrillation with fast ventricular rate of more than 160/min (AF-FVR) and to compare it with i.v. verapamil 5 mg. In this randomised controlled trial, 68 cases of SVT and 86 cases of AF-FVR were studied. Patients with evidence of renal dysfunction and systolic blood pressure less then 90 mm Hg were excluded. Response was considered when the heart rate fell to less than 100/min. In SVT, 33.3% (11 out of 33) responded to magnesium sulphate which was significantly less than verapamil (23 out of 35, 65.7%) p = 0.007. Similarly, in AF-FVR, response was more with verapamil (25 out of 45, 55.6%) than magnesium sulphate (8 out of 41, 19.5%) p < 0.0001. Response to magnesium sulphate was better in patients with IHD. There were no significant side effects, except flushing and sense of warmth with i.v. magnesium sulphate. Serum magnesium rose significantly after i.v. magnesium bolus. Though magnesium sulphate is a weaker antiarrhythmic drug than verapamil, further studies are needed to identify subgroups of supraventricular tachyarrhythmias which would respond to magnesium sulphate.

Blood pressure trends and life style risk factors in rural India.

A door to door survey of a random sample of 448 subjects (> or = 15 years of age) of Kodamendhi village (near Nagpur) revealed a prevalence of hypertension of 4% rising to 19% in more than 60 years age group. One of the main goals of the study was to search for social, behavioural and life style risk factors and provide baseline information on blood pressure distribution in rural Indian population, information regarding which is scarce from Central India. The relationship between alcohol consumption, smoking, obesity, education, income and diet (assessed by a questionnaire administered by trained interviewers) to blood pressure were studied, in multivariate context. Separate multiple linear regression analysis, performed in males and females with mean blood pressure (MBP) as dependent variable showed that the MBP increased significantly with age (p = 0.000) and males had significantly higher MBP than females (p = 0.002). In males, BMI (p = 0.000) and alcohol intake (p = 0.008) were significantly related to MBP while smokers had significantly lower MBP than non smokers (p = 0.004). Per capita income was a significant predictor of MBP in females (p = 0.000). There was no relationship with education and diet.