Predictors of birthweight--a cross sectional study.

This study was conducted to find out the anthropometric, biosocial and obstetric predictors of birthweight in Kerala. The study sample consisted of 599 consecutive liveborn babies delivered at SAT Hospital, Medical College, Thiruvananthapuram and their mothers in November 2001. Details of maternal history, anthropometry, and biosocial and demographic factors were recorded. Birthweight was primary outcome variable. Multivariate analysis revealed that the biologically acceptable predictors of birthweight of a baby in our population are maternal height (P <0.001), parity (P < 0.001) gestational age (P < 0.001), pregnancy induced hypertension(P=0.05) and history of low birthweight in the previous pregnancy(P=0.05).

Lactose intolerance in North and South Indians.

A multicenter study was carried out in India to determine the incidence of lactose intolerance in healthy volunteers from different parts of the country. The incidence was found to be 66.6% in the subjects from two South Indian centers at Trivandrum and Pondicherry. In contrast, the incidence in the subjects from a North Indian center in New Delhi was much lower, i.e., 27.4% (p less than 0.001). The lower incidence in the North Indian subjects may perhaps be due to the fact that they are descendants of the Aryans who have been dairying for long and are known to be lactose tolerant.

A case-control study on risk factors for pancreatic diseases in Kerala, India.

BACKGROUND/AIMS: We simultaneously conducted case-control studies, in Kerala of South India, on chronic calcific pancreatitis of the tropics (CCPT), pancreatic ductal adenocarcinoma (PDA) with CCPT, and PDA alone to assess similarity of and difference between their risk factors. METHODOLOGY: Cases with one of these diseases were identified at the Trivandrum Medical College (TMC) Hospital, in Kerala, from 1994 to 1996. Controls were selected from healthy hospital visitors of the TMC Hospital by individual age (within +/- 3 years) and sex-matched with the index case. Odds ratios and their 95% confidence intervals for potential risk factors were calculated. RESULTS: Frequent consumption of cassava was positively associated with the risk of PDA with CCPT. Heavy cigarette smoking and drinking large amounts of coffee and/or tea everyday were positively related to the risk of PDA alone. Frequent consumption of vegetables and/or fruits was correlated to the decreased risk of PDA alone. CONCLUSIONS: Risk factors as well as preventive factors seem to be different between PDA with CCPT and PDA alone. Further study is necessary, especially to clarify the prognostic factors which would induce pancreatic malignancy in patients with CCPT.

Ketotifen in prevention of indomethacin-induced gastropathy.

BACKGROUND: Therapeutic benefits of nonsteroidal anti-inflammatory drugs (NSAIDs) are offset by their gastrointestinal side effects. We evaluated whether oral ketotifen, which prevents experimental NSAID-induced gastric mucosal injury, is superior to placebo in preventing NSAID-induced gastropathy. DESIGN: Prospective, randomized, double-blind, placebo-controlled clinical trial. SETTING: Rheumatology clinic in a tertiary care hospital. PARTICIPANTS: A majority of the 53 subjects had rheumatoid arthritis (n = 36) or osteoarthritis (12). Those with comorbidity, gastrointestinal (GI) symptoms or abnormal endoscopic findings at entry were excluded. Persons on steroids or NSAIDs in the previous month were also excluded. The subjects were started on indomethacin 25 mg thrice daily. INTERVENTION: Subjects were randomly allocated to receive 2 mg ketotifen or placebo tablets. Compliance was measured by tablet count. OUTCOME MEASURE: At the end of every week a questionnaire was administered to elicit GI symptoms or adverse effects. Every patient underwent endoscopy after four weeks. RESULTS: Of 53 patients recruited (27 drug, 26 placebo), three (2 drug, 1 placebo) dropped out. The age, sex, NSAID use and clinical conditions were similar in the two groups. Eight in the drug group and 16 in the placebo group developed GI symptoms and/or endoscopic lesions (relative risk 0.51, 95% CI 0.27-0.95). The difference was significant on intention-to-treat analysis. CONCLUSIONS: Ketotifen significantly reduced the risk of GI side effects in patients on indomethacin.

A trial of Phyllanthus amarus in acute viral hepatitis.

The study was done to know whether the powders of Phyllanthus amarus plants favourably influence the duration of disease in patients with acute viraus B hepatitis when compared to placebo. The powders of the plant were given in capsule form (300 mg capsules--3 capsules--3 capsules thrice daily) and an antacid powder in similar capsule was used as placebo. Persons with encephalopathy, preexisting medical conditions or serum bilirubin above 350 iu/l were excluded from the study. Fifty seven patients were randomized to receive either the placebo (28 cases) or the drug (28 cases). The two groups were comparable at the time of entry. Two cases from the placebo and one from the placebo and one from the drug group dropped out of the study. The duration of disease (time taken for bilirubin to come to below 2 mg%) was taken as the outcome measure. The duration of disease in the two groups was compared by Cox's proportional hazards analysis after adusting for the variables that influence the duration of jaundice. Only initial serum bilirubin was an independent predictor of duration of jaundice. The an analysis showed that Phyllanthus amarus powders did not significantly reduce the duration of jaundice in persons with virus B hepatitis.

Prolonged brainstem auditory evoked potential latencies in tropical pancreatic diabetics with normal hearing.

Twenty patients with Tropical Pancreatic Diabetes (TPD) were evaluated by Brainstem Auditory Evoked Potentials (BAEP) in order to detect any possible subclinical involvement of auditory pathways. The latencies of BAEP Wave III (p < 0.009) and V (p < 0.47) as well as the Interpeak Latencies I-III (p < 0.002), and I-V (p < 0.019) were significantly prolonged in patients with TPD when compared to age and sex matched healthy volunteers. There was correlation between the abnormalities of BAEP and duration of diabetes (p < 0.006), male sex of patients (p < 0.05), and the presence of retinopathy (p < 0.003) and nephropathy (p < 0.38). There was no significant correlation with the age of the patients, type of treatment, blood sugar levels and presence of peripheral neuropathy. These changes suggest a subclinical involvement of the auditory pathways in TDP patients.

Chloramphenicol and ciprofloxacin in enteric fever--cost-effectiveness.

Clinical decision analysis is a technique which is used to deal with uncertainities in clinical medicine. We used this technique to compare the cost-effectiveness of chloramphenicol and ciprofloxacin in the treatment of enteric fever. The study shows that the most economical alternative can be predicted if the cost of hospital stay and the sensitivity of the organism to chloramphenicol are known. Thus if the hospital costs are Rs 50/- per day, chloramphenicol will be the drug of choice if more than 52% of the organisms are sensitive to the drug. At lower levels of sensitivity to chloramphenicol, ciprofloxacin will be the drug of choice.

Serum rhodanese in goitre and calcific pancreatitis of tropics.

Rhodanese is one of the enzymes concerned in the detoxification of cyanide. Cassava intake and consequent cyanide toxicity are incriminated in the pathogenesis of goitre and calcific pancreatitis of tropics. So we studied the activity of rhodanese in these patients. 14 controls, 13 patients with pancreatitis and 12 with goitre were studied. The median (and range) of rhodanese in these groups were 82 (50-144), 110 (64-180) and 71 (22-160) units respectively. The serum rhodanese was significantly higher (P less than 0.05) in patients with pancreatitis when compared to the other groups. There was no significant difference between the serum rhodanese in patients with goitre and the controls. The presence of adequate amounts of rhodanese indicates that goitre and chronic pancreatitis are not produced by impaired cyanide detoxification.

Reusable needles--a major risk factor for acute virus B hepatitis.

We conducted a case control study to find the extent to which acute virus B hepatitis was hospital acquired. One hundred and sixty consecutive cases of acute virus B hepatitis were compared with age (+/- 3 years) and sex matched healthy hospital visitors. Exposure to reusable needles, blood or blood products, therapeutic and diagnostic procedures, common razors and sexual practices were elicited by means of a questionnaire. Only exposures in the incubation period (6 weeks to 6 months before the onset of symptoms) were included in the analysis. The odds ratio (OR) for injections for reusable needles was 6.3 [95% confidence interval (CI) = 3.8-10.6]. The OR for single injection (OR = 3.9; 95% CI = 2.0-7.3) was less than that for multiple injections (OR = 9.8; 95% CI = 3.8-26.3), showing a dose response relationship. The proportion of cases of acute virus B hepatitis attributable to hospital related exposures was 67%. Proper aseptic techniques and sterilization practices can substantially reduce the incidence of acute hepatitis B in the population.

Influence of pharmaceutical marketing on prescription practices of physicians.

In India same drug molecules are sold under different brand names by different pharmaceuticals. To persuade the physicians to prescribe their brands pharmaceuticals engage in marketing techniques like giving samples, gifts, sponsoring travel etc. Many countries are striving to reduce the impact of incentives on prescription behaviour. This study explores the influence of pharmaceutical marketing on the prescription practices of doctors in India. There were 103 study subjects - 50 doctors and 53 sales personnel. Data collection was done by a self administered questionnaire. Data were collected on 36 variables which were supposed to influence prescription. The effectiveness of the promotional strategies on prescription behaviour was marked in a seven point Likert scale ranging from "not at all effective" (score=1) to "extremely effective" (score=7). Open ended questions were used to collect qualitative data. Good rapport with the doctor, launch meetings, reputation of the company, quality of the drug and brand names significantly influenced prescription behaviour, while direct mailers, advertisements in journals and giving letter pads and other brand reminders were less effective. Commonly used method of giving samples was not among the twenty most effective methods influencing prescription. Product quality and good company are still factors that influence prescription. Pharmaceutical marketing influences the choice of brands by a physician. The more expensive strategies involved in public relations are more effective. Sending mails and journal advertisements are less effective strategies. How expensive marketing strategies affect cost of the medicines has to be explored further.