Effect of Erythromycin on Gastric Emptying Time of Low Birth Weight Babies.

BACKGROUND: To study the promotility effects of low dose erythromycin on gastric emptying time in a population of normal low birth weight (LBW) neonates on breast feeds with or without nutritional supplements and human milk fortifier (HMF). METHOD: A randomised control trial involving 50 neonates was undertaken and they were given 6mg/kg/day of oral erythromycin or placebo in three divided doses for four consecutive days in the first two weeks of life. The gastric emptying time (GET) was assessed ultrasonographically by measuring the decrease in the antral cross sectional area (ACSA). The time taken for the ACSA to become half the prefeed value, was taken as t/2 or half GET. The babies were also assessed for pre and post intervention side effects of the drug. The results were analysed using SPSS ver 11.5. RESULTS: The test group showed a significant decrease in GET after the intervention. This effect was mainly seen in the preterm babies as compared to term Small for Gestational Age (SGA) babies. The decrease in GET was more in babies born after 34 weeks of gestation as compared to smaller babies. The reduction in GET was seen in babies on breast milk alone and nutritional supplements with breast milk but not when HMF was added. No side effects of the drug were noted. CONCLUSION: Low dose erythromycin is a safe way of decreasing gastric emptying in preterm babies born after 34 weeks of gestation in the first two weeks of life.

Maternal and Neonatal Factors Adversely Affecting Breastfeeding in the Perinatal Period.

BACKGROUND: Despite its known advantages, breastfeeding rates are low world over. Large number of factors affect breastfeeding. This study was designed to detect maternal and neonatal factors that adversely affect breastfeeding in the perinatal period. METHODS: A prospective, single-blinded study was conducted on randomly chosen mother-infant pairs in the maternity ward of a tertiary care service hospital. Only full term singletons born by normal vaginal delivery were studied. The B.R.E.A.S.T observation score and time spent by the infant at the mother's breast were primary outcome variables. Maternal age, gravida, para status and education level were recorded. Birth weight, sex, gestation age of the infant and time interval from birth to observation were also recorded. Initial univariate analysis followed by multivariate analysis was performed using SPSS ver 7.5 software. RESULTS: A total of 54 mother-infant pairs formed the study group; 19(35.2%) were primigravidas. Primigravidas status of the mother led to significantly lower scores (p<0.04; 95% CI 0.10 to 3.62) as did maternal age < 26 years (p<0.04; 95% CI 0.2. to 3.46) on univariate analysis. Low birth weight (<2500 g) was the only neonatal factor that significantly lowered breastfeeding scores (p<0.02;95%Cl 0.56 to 6.31). On multivariate analysis only primigravida status was significantly associated with lower scores (p<0.02). The alpha value of the study was 5% and the power was 74%. Time spent by infant on breast was not significantly different between primigravida and non-primigravida mothers. CONCLUSION: Primigravida status adversely affects breastfeeding scores; therefore counseling and support should be focused on this group. Extra care should also be taken to ensure adequate breastfeeding by younger mothers and in those with low birth weight infants. Larger studies with long-term follow up will be able to identify other factors and dertermine the effects of focused counseling and support in the perinatal period upon long-term breastfeeding rates.

Outbreak of Multi-drug Resistant Salmonella Typhi Enteric Fever in Mumbai Garrison.

BACKGROUND: There was an epidemic of enteric fever in Mumbai garrison during Nov-Dec 2000 with more than 150 cases admitted to a tertiary care service hospital. METHODS: All the cases presented with fever and some had splenomegaly, bradycardia, abdominal pain and diarrhoea. The epidemic was investigated by the station health organization (SHO) and the case and bacteriological study was carried out in pathology laboratory of the service hospital. The serological study was carried out at Armed Forces Medical College (AFMC), Pune and the Phage typing was carried out at Lady Harding Medical College, New Delhi. RESULTS: Blood cultures were positive in 92(63%) for Salmonella typhi and Widal test was positive in 83(55%). All strains were resistant to four primary drugs i.e. ampicillin, chloramphenicol, co-trimoxazole and tetracycline. All but two were treated successfully with ceftriaxone. The Salmonella typhi belonged to phage group E1 and biotype I. CONCLUSION: Extensive epidemiological investigation of cases and water sources of cantonment area pointed to a common source of the epidemic i.e. the well near 'Gurudwara'.

Neurocysticercosis--New Millennium, ancient disease and unending debate.

A spurt of cases of Neurocysticercosis (NCC) at our department reopened the debate on whether to treat or not and spurred us on to review the available literature for a viable solution. Despite the disease having been around for centuries a cogent treatment plan eludes us even as other ancient scources have been successfully engaged. Neurocysticercosis presents a peculiar problem as it is an end-stage infection, accidental in man, with a benign natural course and would have merited considerably less attention, had it not chosen to infest the brain. These unique and characteristic features are the fundamental reasons why so many different treatment strategies are continuously proffered; many or none seem to work, depending on the viewpoint. And the target organs of this otherwise unglamorous tapeworm cyst--the brain, eye and spinal cord-ensure that there is always pressure, and temptation to treat rather than let it be, even if the weight of evidence is to the contrary. An overview of the history of the disease and the most recent happenings is presented here, in which these issues are reviewed with special attention to the debate on treatment. From the facts that emerge, an attempt has been made to present a workable plan that would help practicing pediatricians in treating most encountered cases till such time we hear the last word on the issue.

Effectiveness of Teaching of Neonatal Resuscitation Programme at a Workshop for a Mixed Population of Medical Personnel.

We evaluated the effectiveness of teaching at a neonatal resuscitation programme (NRP) workshop held for 35 medical personnel (including postgraduate trainee doctors, general duty medical officers, nursing officers and probationer nurses) using a one-group pretest-posttest design. None of the participants had any formal exposure to the NRP guidelines. A pre-workshop test of 20 multiple-choice questions was administered to all the participants. At the end of the workshop, the same 20 questions were administered and the two scores compared using t-test for paired data on SPSS statistical software. The mean pre-workshop score was 9.03 (SD 2.66) which improved to a mean of 15.53 (SD 1.93) post-workshop. This improvement was highly significant with p < 0.0001 (two-tailed) and the 95% confidence interval being -7.41 to -5.59. Subgroup analysis revealed that nursing officers and probationer nurses showed highly significant improvement in the post-workshop scores while trainee doctors doing Medicine, Pediatrics and the general duty medical officers showed statistically significant improvement in the post-workshop scores. This study shows that a medical workshop is an effective means of imparting knowledge to a mixed group of medical personnel.

Population growth, human development, and deforestation in biodiversity hotspots.

Human population and development activities affect the rate of deforestation in biodiversity hotspots. We quantified the effect of human population growth and development on rates of deforestation and analyzed the relationship between these causal factors in the 1980s and 1990s. We compared the averages of population growth, human development index (HDI, which measures income, health, and education), and deforestation rate and computed correlations among these variables for countries that contain biodiversity hotspots. When population growth was high and HDI was low there was a high rate of deforestation, but when HDI was high, rate of deforestation was low, despite high population growth. The correlation among variables was significant for the 1990s but not for the 1980s. The relationship between population growth and HDI had a regional pattern that reflected the historical process of development. Based on the changes in HDI and deforestation rate over time, we identified two drivers of deforestation: policy choice and human-development constraints. Policy choices that disregard conservation may cause the loss of forests even in countries that are relatively developed. Lack of development in other countries, on the other hand, may increase the pressure on forests to meet the basic needs of the human population. Deforestation resulting from policy choices may be easier to fix than deforestation arising from human development constraints. To prevent deforestation in the countries that have such constraints, transfer of material and intellectual resources from developed countries may be needed. Popular interest in sustainable development in developed countries can facilitate the transfer of these resources.

Vital connections.

Biodiversity and Human Health edited by F. Grifo and J. Rosenthal Island Press, 1997. $29.95 pbk (xviii+379 pages) ISBN 1 55963 501 9.

The effect of ecological factors on the mating system of a South American shrub species (Helicteres brevispira).

Mating systems are influenced by several ecological factors, including plant density, number of flowers per plant, and pollinator movements. In this study, we investigated the simultaneous effects of these three factors on the mating system of a self-compatible Brazilian shrub species: Helicteres brevispira St. Hil. Outcrossing rate is directly correlated with plant density. Changes in the number of flowers per plant affect outcrossing rate through their effect on the density of flowers. Variation in foraging behaviour of hummingbird pollinators is a consequence of the interaction between plant density and number of flowers per plant. Territorialist pollinators are common in high density areas but visit few flowers on each plant, thereby promoting outcrossing. In areas of low plant density, trapliners and rare territorialists visit several flowers per plant, thus increasing selfing. Our results indicate that outcrossing rate is a dynamic parameter, with the extent of variation depending on a number of ecological factors. In successional species such as those in the genus Helicteres, demographic changes may be accompanied by alterations in mating system parameters, with concomitant effects on the genetic structure of populations.

Genetics of Brazil nut (Bertholletia excelsa Humb. & Bonpl.: Lecythidaceae) : 2. Mating system.

Here we report the results of a mating system analysis of an Amazonian population of Bertholletia excelsa, a tropical rain forest canopy tree species. Using progeny data from 29 seed parents, two highly polymorphic isozymes were analyzed to derive single locus and multilocus estimates of outcrossing, based on a mixed mating model. The two single locus estimates were very similar, and both were somewhat smaller than the multilocus estimate, indicating the possibility that the populations are genetically structured. The multilocus outcrossing estimate (tm=0.85±0.03) reveals that outcrossing is prevalent, but that a significantly low level of inbreeding may be occurring. The high outcrossing rate indicates that even though dispersion of individuals is very low within populations of this tropical rain forest tree, pollen dispersal mechanisms appear to be adequate to enable crosses with a relatively large number of potential mates.

Genetics of Brazil nut (Bertholletia excelsa Humb. & Bonpl.: Lecythidaceae) : 1. Genetic variation in natural populations.

We provide an estimate of genetic variation within and between two populations of Bertholletia excelsa (Brazil nut), a large canopy tree found in the rain forests of South America. Average heterozygosity is 0.190, and 54.3% of the sampled loci are polymorphic. The population structure deviates significantly from Hardy-Weinberg expectations for Fest2 and Pgm2 (F =0.405 and 0.443, respectively) in one population, and highly significantly (F=-0.341) for Gdh in the other population. Although allele frequencies of the two populations differ significantly for Aat2, Est5, Mdh1, and Mdh2B, Nei's coefficient of gene differentiation (Gst) indicates that the between-population component (Dst) of genic diversity represents only 3.75% of the size of the within-population component (Hs). The implications of these findings in terms of conservation genetics are that much of the genetic diversity of this species may be preserved within one or a few populations. However, such populations must be very large because it appears that the large amount of genetic variation in Brazil nut populations is maintained by extensive gene flow and bonds of mating over a large area. The genetic architecture of Bertholletia excelsa is similar to that expected for an extensively diploidized paleopolyploid species.