Nursery outbreak of neonatal fungal arthritis treated with fluconazole.

Eight preterm infants with mean gestational age of 31.6 +/- 1.16 weeks and a mean birth weight of 1310 +/- 201.7 g presented at a mean postnatal age of 26 +/- 11.4 days with knee joint swellings and pedal oedema. There was no other clinical, haematological or microbiological evidence of bacterial sepsis. Fungal cultures yielded growth of Candida spp. from blood in five, from urine in four, from cerebrospinal fluid in one, and from all the three babies in whom the joints were aspirated. Radiographic changes of metaphysitis of the involved joints were noted in all. All infants had received prior antibiotic therapy. No infant had received total parenteral nutrition or had central lines inserted. All infants were treated with fluconazole in doses of 7.5 mg/kg/day for 6 weeks. Six of eight were thriving well at 3 months of age without any evidence of residual joint disease. One infant succumbed to disseminated disease and one was lost to follow-up. Candidial arthritis is an uncommon presentation of neonatal candidiasis. Fluconazole therapy proved effective.

Symptomatic atrial septal defect in infancy.

Isolated ostium secundum atrial septal defect (OS-ASD) may rarely lead to severe symptoms in infancy. Over a period of four years, 12 infants admitted to our hospital with severe congestive heart failure had an isolated OS-ASD. Their echocardiographic findings, clinical course, and outcome were outlined. All 12 infants had atypical findings including a holosystolic murmur parasternally and absence of wide fixed splitting of the second heart sound, and none were clinically suspected to have an ASD. M-mode echocardiography in all infants showed a greater than normal diastolic right ventricular internal diameter in the absence of pulmonary hypertension, indicating an increased right ventricular distensibility. Ten out of 12 infants responded well to medical decongestive treatment, and none developed pulmonary hypertension. Two infants who failed to improve with drugs, successfully underwent surgical closure, while two other infants revealed clinical and echocardiographic evidence of spontaneous closure.

Infants of diabetic mothers--an analysis of 50 cases.

In a prospective study of 50 infants of diabetic mothers, 40% were large, 44% appropriate and 16% small for gestational age, 36% were preterm, 24% of the mothers were managed by dietary modification, 62% received insulin, 10% were treated with oral hypoglycemic agents while 4% did not receive any treatment as they were diagnosed postpartum, 58% mothers, underwent cesarean section (38% elective and 20% emergency procedures), 34% had normal vaginal deliveries, 6% were delivered by forceps and 2% by vacuum. Sixty-four per cent were infants of gestational diabetic (IGDM) and 36% of preconceptional diabetic mothers (IPDM). The morbidity and mortality was lesser in IGDM compared to IPDM. Hypoglycemia was documented in 50%, polycythemia in 20%, birth asphyxia in 18%, respiratory distress syndrome and hypocalcemia in 14% each, transient tachypnea of the newborn in 12%, hyperbilirubinemia in 8%, congenital anomalies in 4% and cardiomyopathy, birth trauma and meconium aspiration in 2% each. Pretherapy serum insulin levels were estimated in 10 babies, and 6 babies were subjected to 2D-echocardiography. The overall mortality was 20%. Infants born to mothers on oral hypoglycemic agents had a poor outcome.

Saving environment for human survival.

PIP: The environmental crisis is complex, requiring many solutions. However, it is the responsibility of the State Government to protect and improve the environment. This can not be accomplished by merely writing legislation but by enforcing measures to save the natural world. The world environmental crisis has resulted in the ubiquitous poverty of developing nations (called the "pollution of poverty"). The growing control of resources has allowed a small consortium of powerful countries the ability to enjoy Earth's resources while other developing countries suffer in the abyss of the crisis. A redistribution of power and resources shared by the entire global community is needed. Although measures such as the Environmental Protection Act of 1986 have begun to set standards for a higher quality of living, not all industries have been regulated by the act, and no effective method of monitoring industrial pollution has been established in India. Factors such as depleting jungles, the squandering of natural resources such as soil, water and air and rapid urbanization have accelerated the need for stronger environmental laws and greater awareness and actions. A philosophy that emphasizes the inter-dependence of man and nature most be adopted globally if the augmenting crisis is to be abated.^ieng

Population problem in third world.

PIP: Since numerous variables influence this growth rate, a holistic approach to the problem is mandatory. Fertility rates in developing countries remain high, not as a result of irrational behavior on the part of the people living in these countries, but as a result of their rational response to high infant mortality rates. Fertility rates will remain high unless the educational, health, and social environment in which these families live is improved. Economic development and population growth are intimately related. Development reduces the death rate resulting in increased population growth, which in turn reduces per capita income. In the developed nations, economic development occurred along with the development of new technologies and the reduction in mortality; therefore, population growth created an effective demand which further stimulated economic development. In developing countries the situation is different. Reduced mortality, the introduction of labor saving technology, and the high consumption aspirations derived from contact with capitalistic countries, have preceded economic development. Given the highly complex nature of the population problem, efforts must be made on many fronts including: 1) family planning promotion; 2) improvements in education, health, and social conditions for high fertility populations; 3) enhancement of worker skills; 4) rapid progress in technology; 5) greater capital accumulation and 5) economic reorganization.^ieng