Noonan Syndrome Presenting with Stunted Growth: A Case Report.

Noonan syndrome is a genetic disorder of autosomal dominant inheritance that prevents normal development in various parts of the body. A spontaneous mutation without any family history may also result in the condition. Noonan syndrome can affect normal growth. Birth weight may be normal, but growth slows over time. The growth spurt usually seen during the teenage years may be delayed, and bone maturity also is delayed. In this case A 13 year's male admitted inpatient Department of Endocrinology, Mymensingh Medical College Hospital in April 2021 with not attaining appropriate height and delayed development of secondary sexual characteristics. His birth weight was normal; gestational and neonatal history was uneventful. He was diagnosed with severe pulmonary stenosis at four years and underwent cardiac surgery at his four and eleven years. He was noted to have growth failure from the age of 9 years onward. He had no family history of such type of disease. On examination, he was short statured, underweight, having an upper: lower segment ratio of 1.05 with an arm span of 126cm. He had craniosynostosis, high arched palate, the thick helix of ears (outer rim), small, upturned nose, depressed broad nose, deeply grooved philtrum, keratosis pilaris of the face and upper arm, slant eyes with proptosis, keloid scar over mid-chest, widely spaced nipple, shield chest, pectus excavatum and cubitus valgus. His sexual maturation score was A1, P1, B1. He had pulmonary stenosis with pulmonary hypertension. He had mild microcytic anemia with normal liver, renal, blood glucose, and calcium profile. His bone age was delayed (9 years), thyroid function was normal. The growth hormone dynamic test after clonidine stimulation was normal. His karyotype was 46XY. We have considered giving recombinant growth hormone therapy to accelerate his height.

Knowledge and Practice of Nurses on Pediatric Pain Management in Bangladesh.

Among nurses due to inadequate pain management knowledge and practice skills, children's pain is often under treated. This study aimed to examine the level of knowledge and practice on pediatric pain management among nurses in Bangladesh. This was a descriptive survey study involving total 150 clinical pediatric nurses from two Medical College Hospital and a University hospital in Bangladesh. The data collection tool consisted of demographic data form, 32-items nurses' knowledge. There were 32 true and false questions related to nurses' knowledge on pediatric pain management in Bangladesh. The response formats to each item for correct answer was 1 and incorrect answer 0. The total scores were categorized into three levels including low (0-20), moderate (21-23) and high (24 and above). The data collection tool consisted of demographic data form, 19-item practice related questionnaire on pediatric pain management. Nurses' practice on pediatric pain management contained 19 items with 5-points Likert's scale ranging from 1=Never practice to 5=constantly practice. For each item, a score of 5 was accorded for constantly and 1 for never. The score ranged from 19-95. The total scores were categorized into three levels including low (19-38), moderate (39-76) and high (77-95). The results demonstrated that most of the nurses' knowledge score on pediatric pain management was at moderate level (mean=21.50, SD=2.35). Nurses' practice on pediatric pain management was also at moderate level (mean=75.45, SD=8.24). The relationship between nurses' knowledge and practice was not significant. In addition, nurses' knowledge and practice with demographic variables; there was significant relationship between nurse's knowledge and existence of pain management protocol, nurses' practice and their current position in unit and with reading nursing journal. This study showed moderate level of knowledge and practice indicating that they need to be enhanced the knowledge and practice skills in pediatric pain management.

Neurologic abnormalities in HTLV-I- and HTLV-II-infected individuals without overt myelopathy.

BACKGROUND: Human T-lymphotropic virus (HTLV) type I is the causative agent of HTLV-associated myelopathy (HAM)/tropical spastic paraparesis, and a number of HAM cases with HTLV-II infection have also been reported. However, despite some reports, it is unclear whether HTLV-I or -II infection is associated with other neurologic manifestations. METHODS: An analysis of medical histories and screening neurologic examinations from a prospective cohort of 153 HTLV-I, 388 HTLV-II, and 810 HTLV-seronegative individuals followed up for means of 11.5, 12.0, and 12.2 years was performed. Participants diagnosed with HAM were excluded. We calculated odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for age, sex, race or ethnicity, income, educational attainment, body mass index, alcohol and cigarette consumption, injection drug use, diabetes, and hepatitis C virus status, using generalized estimating equations for repeated measures. RESULTS: HTLV-I and -II participants were more likely than seronegative participants to have leg weakness (ORs 1.67 [95% CI 1.28-2.18] and 1.44 [1.16-1.78]), impaired tandem gait (ORs 1.25 [95% CI 1.07-1.47] and 1.45 [1.27-1.64]), Babinski sign (ORs 1.54 [95% CI 1.13-2.08] and 1.51 [1.18-1.93]), impaired vibration sense (ORs 1.16 [95% CI 1.01-1.33] and 1.27 [1.14-1.42]), and urinary incontinence (ORs 1.45 [95% CI 1.23-1.72] and 1.70 [1.50-1.93]). For both HTLV-I and -II participants, higher odds of sensory neuropathy by monofilament examination were no longer significant after adjustment for confounding. CONCLUSIONS: These results provide strong evidence that human T-lymphotropic virus (HTLV)-I and -II are associated with a spectrum of predominantly motor abnormalities in patients without overt HTLV-associated myelopathy. Further investigation of the clinical course and etiology of these abnormalities is warranted.

Seasonal effects on the air-water carbon dioxide exchange in the Hooghly estuary, NE coast of Bay of Bengal, India.

Monthly variation of CO2 fugacity (fCO2) in surface water and related atmospheric exchanges were measured in the Hooghly estuary which is one of the most important estuaries, since it is fed by one of the world's largest rivers, the Ganges with a flow of 15,646 m3 s-1 (1.6% of the world's combined river flow). Carbon dioxide fluxes averaged over the entire estuary are in the range of -2.78 to 84.4 mmol m-2 d-1. This estuary acts as a sink for CO2 during monsoon months and seasonal variation of its flux is controlled by dilution of seawater by river water. Since the solubility of CO2 and the disassociation of carbonic acid in estuarine water are controlled by temperature and salinity, the observed variations of CO2 fluxes are compared with those predicted from seasonal changes in temperature, salinity and the ratio of gross primary production to community respiration using empirical equations with an explained variability of 55%.

Field trial of cyfluthrin as an effective and safe insecticide for control of malaria vectors in triple insecticide resistant areas.

Cyfluthrin (Solfac**) 10 wp, a synthetic pyrethroid was evaluated for its efficacy in malaria control through primary health centre approach, and for its acceptance by the community and effect on human health, and non target organisms, in predominantly tribal areas of Maharashtra and Gujarat from 1988 to 1990. Two dosage schedules; 2 rounds of indoor residual sparying a year, at 25 mg/sq. m2 in Maharashtra, and 3 rounds a year at 15 mg/sq. m2, in Gujarat were followed. There was significant reduction in per man hour densities of An. culicifacies the principal malaria vector, and collaterally of C. quinquefasciatus also. Significant reductions in slide positivity rates and slide falciparum rates were observed in both the areas as compared to the controls. The community acceptance of Cyfluthrin in terms of room coverage was 96% in Gujarat, and 89% in Maharashtra, as against average 68.5% and 55% in case of DDT and Malathion respectively. There were no reported ill-effects on humans or non-target organisms.

Hematologic and body fluid changes during simulated high altitude exposure in naproxen-treated rats.

Arterial blood oxygen saturation, body fluid and hematological parameters were studied in control, naproxen (a prostaglandin synthesis inhibitor)-treated control, altitude-exposed, and naproxen-treated altitude-exposed rats after intermittent exposure of 8 h/d for 6 consecutive days to a simulated high altitude of 6,100 m (barometric pressure 349 +/- 3 mmHg). Arterial blood oxygen saturation was reduced in altitude-exposed rats, but increased significantly to near control level in naproxen-treated rats. On the other hand, 2,3-diphosphoglycerate in erythrocytes increased in altitude-exposed rats, but naproxen prevented this increase. The red blood cell count, hemoglobin concentration and hematocrit ratio were reduced significantly in drug-treated altitude-exposed rats when compared to the altitude-exposed group (without drug). Red cell mass was increased in the altitude-exposed group in comparison with control. Both red cell mass and mean corpuscular volume of altitude-exposed rats were shifted towards the control value when they were treated with naproxen. Drug-treated high altitude-exposure reduced the thiocyanate space, intracellular fluid volume and total body water content compared to drug-treated control rats. On the other hand, thiocyanate space and total body water content were increased significantly in drug-treated control rats in comparison with the control group.

Malaria transmission during post-spray period of pirimiphos-methyl in Arunachal Pradesh.

Observations made for a period of four years from 1985 to 1988 on post-spray impact of pirimiphos-methyl (25 per cent Wp) on malaria vectors in Tirap district of Arunachal Pradesh showed that a low density (0.0 to 0.02 PMH) of Anopheles dirus was maintained in the areas sprayed with the insecticide at the dosages of 1 and 2 g/m2 from 1981 to 1984. The post-spray data (1985 to 1988) showed a reduction of 62.5 to 62.8 per cent in SPR, 55.6 to 64.7 per cent in SRF and 72.3 to 75.5 per cent decline in API as compared to baseline data of 1980 in areas sprayed with pirimiphos methyl.

Vector control through environmental management with special reference to India--approach prospectives.

The introduction of different types of pollutants like those from industrial effluence, bye-products from petro-chemical industries, pesticidal application, wastages of nuclear power industries, etc. is viewed seriously by the society. For the control of vectors of disease the adoption of environmental management is, therefore, imperative. The physical methods like drainage of excess and waste water, making water unsuitable for vector breeding by adopting various indigenous methods in vogue, the intra and inter-sectrol coordination and community based activities are identified as the basic approaches for achieving this goal. Minimising the potentiality of vector breeding through source reduction and water management is thought to be the simplest, cheapest and most permanent method. For the society having varying types of habitation and varying degree of habitational facilities like planned housing, water supply and disposal, sanitation and organized anti-vector measures, the adoption of environmental management to exercise check over vector population is a promising proposition. The suitability of such an approach has already been demonstrated by MRC, (ICMR), Delhi and V.C.R.C., Pondicherry. The implementation of these methods is to be initiated right from Primary Health Centre and district level onwards and community is to be motivated to the extent that the various methods of environmental management for vector control are adopted in the routine way of life. In the present article these ideas have been touched upon and various methods of environmental management described in brief. In addition what other Governmental agencies are required to do in order to effectively implement environmental management methods are briefly enlisted.

Studies on organ weights in naproxen treated rats after intermittent exposure to simulated high altitude.

Rats were exposed intermittently for 8 h per day over 6 days at simulated high altitude of 20,000 feet. One group of altitude-exposed animals was treated with naproxen, a prostaglandin inhibiting drug. Significant reduction in body weight gain was observed in both altitude-exposed and drug-treated altitude-exposed animals compared to the control group. Right and left ventricular weights and weights of the adrenal glands were increased significantly in altitude-exposed and altitude-exposed drug-treated animals. The weight of the spleen was increased significantly in altitude-exposed animals whereas no such increase of splenic weight was observed in drug-treated altitude-exposed group of animals. On the other hand, the weight of the liver was decreased significantly in both cases. In drug-treated altitude-exposed animals, the unaltered splenic weight was thought to be due to inhibition of the erythropoietic activity.

Success of integrated methods of control of mosquitoes in India--a review.

The integrated methodology for the control of vectors of diseases as well as mosquitoes has become an accepted concept amongst the public health experts. The feasibility of adopting this approach in different situations for mosquito control as per field trials by various institutions has been reviewed in this article. This concept, to some extent, has been in vogue under National Malaria Eradication Programme since long in a practicable way. Satisfactory results have been obtained wherever this approach has been applied carefully. The applicability of the integrated control methodology is not difficult provided various methods to be integrated are chosen and utilized in a rational way. Thorough health education is a prerequisite to awaken the community to accept the methods as part and parcel of routine life.

Filariasis control in rural areas through detection and treatment with diethylcarbamazine.

A pilot study for control of bancroftian filariasis through detection and treatment of microfilaria (mf) carriers and filaria disease cases with Diethylcarbamazine (DEC) undertaken in the rural areas of Srikakulam and Vizianagaram of Andhra Pradesh showed that this chemotherapeutic method of control of filaria in rural areas is feasible and acceptable to society. During first round of detection and treatment 20,300 mf carriers (90.6 per cent of detected) and 6,588 disease persons (86 per cent of detected) in Srikakulam and 7,097 mf carriers (94.8 per cent of detected) and 1,436 disease persons (93.4 per cent of detected) in Vizianagaram were treated with DEC tablets. These areas were again surveyed after five years and detected cases were treated with DEC with coverage of treatment ranging from 82.3 per cent to 95 per cent for both mf & disease cases and decline in mf and disease rate was noted to be 52.4 per cent and 50.9 per cent respectively in Srikakulam and 42.2 per cent for mf rate in Vizianagaram. The mf reduction was appreciably high (50 per cent or more) in 11 PHCs of Srikakulam and 4 PHCs of Vizianagaram. The mf rate reduction was the highest in the age group of 1 to 4 year indicating that the transmission has been cut down significantly. The vector infection rate showed reduction by 50 per cent during second round of detection and treatment as compared to first round, indicating significant reduction in transmission potential.

Effect of hypobaric hypoxia on spermatogenesis, Leydig cells and delta 5-3 beta-hydroxysteroid dehydrogenase activity in toad.

The effect of different grades of hypobaric hypoxia for 48 hours was studied on spermatogenesis, Leydig cells and delta 5-3 beta-hydroxysteroid dehydrogenase activity in toad (Bufo melanostictus). Maximum inhibition of testicular activity was noted in 7,315 m exposed animals. The impairment of testicular function at high altitude is possibly due to inhibition of gonadotrophin secretion.

Body fluid and hematologic changes in the toad exposed to 48 h of simulated high altitude.

Body fluid and hematologic changes were found in three groups of adult male toads that had been exposed to 48 h of continuous simulated altitudes of 12,000, 18,000, and 24,000 ft, respectively. Erythrocyte counts and hematocrit ratios were increased significantly in all the high-altitude-exposed animals compared with the control group of animals kept at sea level, whereas the hemoglobin concentrations were significantly increased only in the 18,000- and 24,000-ft-exposed animals. Exposure to high altitude generally caused a reduction of plasma volume, blood volume, extracellular fluid volume, and total body water. These reductions were markedly lower in the animals exposed to 24,000 ft. These simulated high-altitude effects on body fluids and hematology in the toad (Bufo melanostictus) were compared with those of the rat, birds, and humans acutely acutely exposed at various high altitudes and were found to be qualitatively similar.