Monitoring of Lead (Pb) Pollution in Soils and Plants Irrigated with Untreated Sewage Water in Some Industrialized Cities of Punjab, India.

Soil and plant samples were collected from sewage and tubewell irrigated sites from three industrially different cities of Punjab (India) viz. Ludhiana, Jalandhar and Malerkotla. The extent of lead (Pb) pollution was assessed with respect to background concentration of tubewell irrigation. In sewage irrigated surface soil layer (0-15 cm), the extent of Pb accumulation was 4.61, 4.20 and 2.26 times higher than those receiving tubewell irrigation sites in Ludhiana, Jalandhar and Malerkotla, respectively. Multiple regression analysis showed that soil pH, organic carbon, calcium carbonate and clay were significant soil parameters explaining the variation in available soil Pb. The mean Pb content in plants receiving sewage irrigation was 4.56, 5.48 and 2.72 times higher than tubewell irrigation in Ludhiana, Jalandhar and Malerkotla, respectively. The content of Pb in plants receiving sewage irrigation revealed that, assuming a weekly consumption of 500-1000 g of vegetables grown on sewage irrigated soils by an adult of 70 kg body weight, the Pb intake may far exceed the World Health Organization proposed tolerable weekly intake of Pb.

Monitoring of Cd pollution in soils and plants irrigated with untreated sewage water in some industrialized cities of Punjab, India.

The disposal of industrial and sewage water is a problem of increasing importance throughout the world. In India, and most of the developing countries untreated sewage and industrial wastes are discharged on land or into the running water streams which is used for irrigating crops. These wastes often contain high amount of trace elements which may accumulate in soils in excessive quantities on long term use and enter the food chain through absorption by the plants. Among the trace metals, Cd has received the greater attention because of its easy absorption and accumulation in plants and animals to levels toxic for their health. The objective of this study conducted in three industrially different cities viz., Ludhiana, Jalandhar and Malerkotla was to monitor the extent of Cd accumulation in soils and plants receiving untreated sewage water. Plant and soil samples were collected from sewage and tubewell irrigated areas. Soil samples were analysed for texture, pH, EC, organic carbon (OC), CaCO(3), bioavailable DTPA-Cd and plant samples were analysed for total Cd. In sewage irrigated soils, the mean values of pH were lower but organic carbon and electrical conductivity were generally higher both in surface and sub-surface layers of all the three cities as compared to tubewell irrigated soils. The mean DTPA- extractable Cd in sewage irrigated soil was 6.3- and 4.36-fold in Ludhiana, 3.38- and 1.71-fold in Jalandhar and 3.35- and 6.67-fold in Malerkotla in 0-15 and 15-30 cm soil depth, respectively, compared with the values in tubewell irrigated soils. The accumulation of DTPA-Cd in sewage irrigated soils was restricted to 30 cm depth after which the values were generally close to values in tubewell irrigated soils. Soil pH, OC, CaCO(3), clay and silt collectively accounted for 37.1%, 65.1% and 53.9% DTPA-extractable bioavailable Cd in soils of Ludhiana, Jalandhar and Malerkotla, respectively. Lower R(2) values in Ludhiana suggest that factors other than the ones mentioned may be affecting Cd availability. At all sites plants receiving sewage irrigation had elevated levels of Cd as compared to the plants receiving tubewell irrigation. The mean Cd content of sewage irrigated plants irrespective of the city was 5.96 microg g(-1) dry matter as compared to 0.98 microg g(-1) dry matter in tubewell irrigated plants. The results suggest that the intake of Cd obtained from consumption of crops grown on sewage irrigated soils would be much higher than the tolerable limits set by WHO and may, therefore, prove potentially toxic leading to various health ailments to humans and animals.

Renal assessment practices and the effect of nurse case management of health maintenance organization patients with diabetes.

OBJECTIVE: To examine baseline renal screening practices and the effect of nurse case management of patients with diabetes in a group model health maintenance organization (HMO). RESEARCH DESIGN AND METHODS: We performed both 1-year retrospective and 1-year prospective studies of renal assessment practices and ACE inhibitor usage in a cohort of 133 diabetic patients enrolled in a randomized controlled trial of a diabetes nurse case management program in a group model HMO. In accordance with American Diabetes Association recommendations, urine dipstick and quantitative protein and microalbuminuria testing rates were calculated. RESULTS: At baseline, 77% of patients were screened for proteinuria with dipsticks or had quantitative urine testing. Of patients with negative dipstick findings, 30% had appropriate quantitative protein or microalbumin follow-up at baseline. Baseline ACE inhibitor usage was associated with decreased follow-up testing (relative risk = 0.47). Nurse case management was associated with increased quantitative protein or or microalbumin testing and increased follow-up testing (relative risk = 1.65 and 1.60, respectively). CONCLUSIONS: We found a higher degree of adherence to recommendations for renal testing than has been reported previously. Nurse case management intervention further increased renal screening rates. The inverse association between ACE inhibitor usage and microalbumin testing highlights a potentially ambiguous area of current clinical pathways.

Clinico-haematological profile in acute and chronic Plasmodium falciparum malaria in children.

The clinicohaematological findings of acute state (Group A, 30 patients) and chronic state (Group B, 34 patients) of falciparum malaria in paediatric patients are compared. The children with chronic falciparum malaria were apyrexic and presented with features of moderate to severe anaemia with hepato-splenomegaly. Greater severity of anaemia and haemolysis, higher incidence and severity of neutropenia, atypical lymphocytosis, monocytosis and thrombocytopenia were observed in patients with chronic falciparum malaria as compared to patients with acute falciparum malaria despite lesser degree of parasitaemia in the former as compared to the latter. While mechanical destruction of parasitised RBC's, ineffective and dysplastic erythropoiesis either due to unmasking of border line dierty folic acid deficiency or otherwise, transient hypoplasia of bone marrow, impaired utilization of iron and immune destruction of RBCs with hypersplenism may be the mechanisms for anaemia, transient hypoplasia of bone marrow and hypersplenism may be the factors responsible for thrombocytopenia and neutropenia.

Emergence of Vibrio cholerae serogroup 0139 in Haryana in May-June 1993.

In an outbreak of acute watery diarrhoea, 11 strains of V. cholerae were isolated in May-June 1993 at Medical College, Rohtak. Eight of these belonged to serogroup Ogawa and three were identified as V. cholerae serogroup 0139. This is the first report of isolation of this novel serotype from this region.

Lipid-laden macrophages in bone marrow of leprosy patients.

While conducting a study to observe bone marrow cytomorphological changes in multibacillary leprosy, lipid laden macrophages as seen in sphingolipidoses were noted. The present study was planned to observe the occurrence and morphological characterization of these macrophages in various types of leprosy. Bone marrow records from 48 cases of paucibacillary and 72 cases of multibacillary leprosy were analysed. The macrophages accounting at the most for 3.5% of marrow cells were observed in 5 cases of paucibacillary and 43 cases of multibacillary leprosy with a maximum incidence being observed in patients with ENL (16/17). The lipid present in the cytoplasm of these cells could be derived from the lipid of the cell wall of Mycobacterium leprae. To the best of our knowledge, these cells have not been reported in leprosy so far.

Bacillaemia and bone marrow involvement in leprosy.

Fifty patients (24 new and 26 receiving specific treatment) of leprosy were investigated to study the concentration and morphological index (MI) of the lepra bacilli in skin, peripheral blood and bone marrow. The organisms were detected in 28 cases on skin slit smear examination, in 38 cases on bone marrow examination and in 38 cases on examination of smears made from buffy coat of peripheral blood. Out of 22 cases negative for the bacilli on skin slit smears, 15 had the organisms either in buffy coat or bone marrow or both. Acid fast bacilli in peripheral blood and bone marrow with skin smear negativity were mainly observed in patients with paucibacillary type of the disease and in those who were receiving treatment. Examination of buffy coat and bone marrow for presence of lepra bacilli is suggested to establish the diagnosis in doubtful cases.

Resistotyping as a new epidemiological marker for Klebsiella pneumoniae.

Resistogram typing was established with the help of 30 randomly chosen clinical isolates of K. pneumoniae using sodium arsenate, malachite green, boric acid, potassium tellurite, mercuric chloride, antimony potassium tartarate and sodium arsenite. The resistance to these chemicals was designated as A, B, C, D, E, F and G respectively. The technique was then applied to 152 clinical isolates of K. pneumoniae. A total of 35 patterns were obtained. Common patterns were ABEFG and ABFG. There was no clustering of the strains in any of the resistogram patterns as even the commonest pattern had only 10.5 per cent of the strains. When combined with klebocin typing, it provided better discrimination of strains as strains belonging to seven klebocin types could be subdivided into 68 resistogram patterns. The reverse was also possible, i.e., the strains belonging to seven resistogram patterns could be subdivided into 38 klebocin types. The former procedure thus offered better discrimination of the strains.

Association of R plasmids of Klebsiella pneumoniae with resistance to heavy metals, klebocin and beta lactamase production and lactose fermentation.

One hundred and fifty clinical isolates of Klebsiella pneumoniae were studied for beta lactamase production, Klebocin production and resistance to antibiotics and metals. 97.3 and 82.7 per cent strains produced beta-lactamase and klebocin respectively. Resistance to arsenite, antimony, tellurite, mercury and silver was observed in 91,66,6, 47.7, 44.8 and 33.3 per cent respectively and to ampicillin, tetracycline and nalidixic acid in 93.3,60, 41.3, 34.4, 28.2, and 1.3 per cent respectively. Forty eight antibiotic and metal resistant strains were then conjugated with Escherichia coli 711 F-Lac-Nxr. Transferable drug resistance, metal ion resistance, beta lactamase production, klebocin production and lactose fermentation was seen in 30, 21, 10, 11 and 5 isolates respectively.