Prognostic clinical variables in childhood tuberculous meningitis: an experience from Mumbai, India

BACKGROUND: In India, tuberculous meningitis (TBM) is still a major cause of neurological disabilities and death. AIM: To identify the clinical variables which predict the outcome in childhood TBM. SETTING: Tertiary teaching hospital. DESIGN: Prospective observational study. MATERIALS AND METHODS: Thirty-six clinical variables were analyzed in 123 consecutive children with TBM admitted between May 2000 and August 2003. The outcome was assessed in terms of survival or death. Survival meant that the patient was discharged from hospital having made a complete recovery, or with disability. RESULTS: Twenty-five (20%) children recovered completely, 70 (57%) survived with disability, and 28 (23%) died. Employing univariate analysis nine variables correlated with survival with disability outcome: presence of tonic motor posturing, cranial nerve palsy, focal neurological deficit, hypertonia, moderate to severe hydrocephalus, cerebral infarction on cranial CT, and requiring shunt surgery, and absence of extracranial tuberculosis and no antituberculous-related hepatotoxicity; two variables correlated with fatal outcome: presence of deep coma (Glasgow coma scale score P = 0.012, d.f. = 1, OR 0.12, 95% CI 0.02-0.62) correlated with survival with disability outcome, and presence of deep coma (P = 0.030, d.f. = 1, OR 0.35, 95% CI 0.14-0.90) with fatal outcome. CONCLUSION: In children with TBM, the presence of hypertonia at admission is an independent predictor of neurological sequelae in survivors, and deep coma is an independent predictor of mortality.     

High-dose follicle-stimulating hormone stimulation at the onset of the menstrual cycle does not improve the in vitro fertilization outcome in low-responder patients

In an attempt to improve their outcome with in vitro fertilization (IVF), 34 low-responder patients were stimulated with six ampules of follicle-stimulating hormone (FSH) daily starting on day 1 (n = 17) or day 2 (n = 17) of their menstrual cycles. The stimulated cycles showed a mean peak estradiol of 443 +/- 173 pg/mL, mean days of human chorionic gonadotropin of 7.6 +/- 1.4, 2.67 +/- 1.5 preovulatory oocytes per retrieval, and 2.56 +/- 1.3 oocytes per transfer. Three clinical pregnancies resulted after 25 embryo transfer cycles (12%). With paired analysis, we compared 8 patient cycles with prior six ampules of FSH stimulation starting on day 3; all parameters examined showed no significant differences. In a comparison of 22 patient cycles with prior 4 ampules of FSH stimulation on cycle day 3, no significant differences in any parameters were observed except in the higher number of ampules used in the present study. We conclude that high-dose FSH stimulation at the onset of the menstrual cycle does not improve the IVF outcome in low-responder patients.     

A STUDY OF METHODS USED FOR DISINFECTION OF ANAESTHETIC EQUIPMENT BETWEEN TWO SURGICAL OPERATIONS AT A LARGE TEACHING HOSPITAL

A prospective study on the growth of bacteria on certain commonly used anaesthetic equipment was undertaken in a large teaching hospital with a view to assess the effectiveness of disinfection/sterilization procedures. Samples for microbiological assessment were drawn by the worker using standardised procedures and tested in the laboratory by a microbiologist, blinded to the type of sample. Criteria for growth positivity was taken as > 25 colony forming units. A total of 90 observations were taken. 30 each for ’before use’, ’after use’ and ’after disinfection’. Overall 54.6% of the equipment showed growth “before use” with maximum growth being seen in Suction catheters (66.6%) and Guedal airways (60.0%). On the other hand, the proportion of equipment showing growth “after use” was quite high (84.6%), with suction catheters and endotracheal tubes showing 90.0% growth each. There was significant difference as regards “before” and “after” use growth on Endotracheal tubes, Guedel airways and Face masks (p < 0.05). Analysis of growth “after” disinfection” revealed that the probability of growth remains as high as 70% in suction catheters (95% CI=54% to 86%) and 60% in laryngoscopes (95% CI=43% to 78%). The study revealed gross inadequacies in methods of disinfection being followed at present.KEY WORDS: Anaesthetic equipment, Disinfection     

T HELPER SUBSETS AND INTERLEUKIN 12: ITS ROLE AS A POTENT IMMUNOMODULATOR OF CELL MEDIATED IMMUNITY

This article reviews Interleukin (IL) IL-12 a recently described cytokine secreted by monocyte/macrophages and its interaction with T cells. IL 12 is important in the immune response by providing a link between natural resistance mediated by phagocytic cells and NK cells and adaptive immunity mediated by T4, T8 and B cells. The article also evaluates the effect of IL12 in the evolution of T helper cell subsets, its action as a bridge between innate immunity and acquired immunity and the important role it plays in modulating the cellular and humoral immune response mechanisms. Its possible role as an immunomodulator of disease is postulated.KEY WORDS: CIMI, Immunomodulation, IL-12, T cells     

Analysis of the XRCC1 gene as a modifier of the cerebral response in ischemic stroke

Background  

Although there have been studies of the genetic risk factors in the development of stroke, there have been few investigations of role of genes in the cerebral response to ischemia. The brain responds to ischemia in a series of reactions that ultimately influence the volume of a stroke that, in general, correlates with disability. We hypothesize that polymorphisms in genes encoding proteins involved in these reactions could act as modifiers of this response and impact stroke volume. One of the pathways participating in the cerebral ischemic response involves reactive oxygen species which can cause oxidative damage to nucleic acids. DNA repair mechanisms are in place to protect against such damage and imply a role for DNA repair genes in the response of the brain to ischemia and are potential candidate genes for further investigation.     

A rapid method of epitope analysis using Superose 12 gel filtration. A study with monoclonal antibodies to chicken riboflavin carrier protein

A novel and rapid method is described for determining the epitope specificities of monoclonal antibodies. The method utilises a highly reproducible, wide range gel filtration medium, Superose 12. nmol of monoclonal antibodies are incubated with pmol quantities of radiolabelled antigen, and the mixture filtered through Superose 12. Fractions are collected and radioactivity monitored. The size of the resultant immune complex indicates whether two monoclonal antibodies (mixed with the antigen) recognise the same or different epitope(s) of the antigen. The applicability of the above analytical method is illustrated with monoclonal antibodies raised against chicken egg riboflavin carrier protein.     

The relationship between serum estradiol-17 beta concentrations and induced pituitary luteinizing hormone surges in postmenopausal women

The present study was designed to evaluate the effect of different serum concentrations of estradiol-17 beta (E2) on pituitary luteinizing hormone (LH) release in postmenopausal women. Serum E2 levels were evaluated in healthy postmenopausal women while they wore two, four, and six transdermal E2 delivery systems. The mean serum E2 levels at 48 hours after application of the devices were 185.5, 338.9, and 520.5 pg/mL, respectively, which were significantly different from each other. Serum E2 levels were stable throughout the first 48 hours of patch application but declined by a mean of 54% between 48 and 72 hours. Pituitary LH surges were induced with all three serum concentrations of E2 but were present more often with the higher serum values. There were no significant differences between the mean interval of device utilization and initiation, height, or duration of the induced pituitary LH surge at any of the three serum E2 concentrations studied.     

An evaluation of a communication skills course for health visitor students

This paper presents part of the findings of an extensive empirical evaluation of a communication skills training programme for health visitor students. The programme was designed to develop the health visitors' ability to communicate with clients. A wide range of interpersonal skills were addressed and the training format involved skill analysis, roleplay practice and video-recorded feedback. The method of evaluation included an appraisal of the health visitors' social behaviour in a roleplay of a home-visit to a pregnant client. Data were collected, both before and following training, in an attempt to assess changes in trainee behaviour. The analysis took the form of a detailed frequency measurement of behavioural elements of health visitor performance, and a global rating of social competence by independent judges. Results of the analyses indicated that 14 out of the 20 behavioural variables changed in the desired direction. Thus, for example, following training the health visitors used significantly more open questions and verbal encouragers, and significantly fewer multiple questions and interruptions when communicating with the client. They were also rated significantly higher on the rating scale for social competence following training. These findings would seem to suggest that the training programme had a considerable degree of success. The findings are discussed in terms of the implications for development of health visitors' social skills, the need for more sophisticated measures of social behaviour and for the formulation of a model of competent professional practice in this area.