Measles encephalitis

Summary A detailed clinical study of 25 cases of post-measles encephalitis has been presented. Male preponderance was evident, male: female ratio being 3:2. The Maximum number of patients (84%) were below 5 years of age. The symptoms of encephalitis were noticeable in 88% of cases between the 3rd to 15th day of appearance of the rash. The mortality rate was 8% only but if 5 patients who left against medical advice and were in a moribund condition, are included, it increases to 28% which is quite significant. Residual sequelae developed in 8% of cases who were followed up for a few months.     

Estimated nutrient intakes and adequacies in Bangladesh change when newer values for vitamin A,iron and calcium in commonly consumed foods are applied

A food consumption survey was conducted in rural Bangladesh in January–March 1996 using a 24-h food weighing method. Intakes and adequacies of energy, vitamin A, vitamin C, iron and calcium were estimated for 81 children (aged 24–71 months) and 182 women (aged 18–45 years) using three sets of food composition tables. The local food composition table was modified with newer values for nutrient contents of foods identified as important for the contribution of vitamin A and iron. Significant differences in estimated dietary intakes and adequacies were found for vitamin A and iron when different sets of food composition values were used. This study shows that up-to-date chemical analyses of foods selected on the basis of a high frequency of consumption and a large contribution of the nutrients in focus is a useful approach in improving the quality of food composition tables, resulting in greater accuracy of estimates of nutrient intakes and adequacies.     

Head and neck teratomas in children: a case series

Teratomas of the head and neck due to their obscure origin, bizarre microscopic appearance, unpredictable behaviour and often dramatic clinical presentation are a clinical surprise. This article focuses on pediatric head and neck teratomas and on their diversity and rarity and also reviews the recent terminology of this group of tumours.     

Cardiovascular aspect of Beta-thalassaemia

Beta-thalassaemia major is a genetic blood disorder caused by the reduced synthesis of beta globin chain. The consequences of the resulting chronic anaemia are also common and include growth retardation, bone marrow expansion, extramedular hematopoiesis, splenomegaly, increased intestinal iron absorption, susceptibility to infections, and hypercoagulability. Transfusional iron overload can affect heart function by directly damaging tissue through iron deposition or via iron-mediated effects at other sites. Cardiac dysfunction is common in patients with thalassaemia and is the leading cause of mortality. The main cardiac abnormalities reported in patients with thalassaemia major (TM) and iron overload are left ventricular systolic and diastolic dysfunction, pulmonary hypertension, valvulopathies, arrhythmias and pericarditis. These cardiac abnormalities are a consequence of the general co-morbid conditions in thalassaemia but are closely related to concomitant endocrine deficiencies, hypercoagulability state and inflammatory milieu. Iron's toxicity within cells arises from its capacity to catalyse the production of reactive oxygen species that cause lipid peroxidation and organelle damage, which lead ultimately to cell death and fibrosis. With the introduction of new technologies such as cardiac magnetic resonance T2* , the early detection of cardiac iron overload and associated cardiac dysfunction is now possible, allowing time for reversal through iron chelation therapy.     

Effect of thermal processing and γ-irradiation on allergenicity of legume proteins

Legumes are implicated in IgE mediated food allergy in different countries. The present study aimed to investigate the effect of different processing methods on allergenicity of legume proteins. The extracts were processed by boiling, γ-irradiation or by combination of both. The changes in soluble protein content, specific IgE binding and allergenic potential of legume proteins were assessed. Thermal processing resulted in a 3- to 4-fold reduction in soluble protein. Specific IgE binding was reduced 74 ± 6.5%, 83 ± 11.6% and 62 ± 7.2% in the soluble protein of kidney bean, black gram and peanut, respectively, after boiling (p < 0.01) whereas there was 34 ± 5.2%, 74 ± 15.6% and 44 ± 11.1% IgE binding reduction in the insoluble protein fraction of respective legumes. Boiling followed by γ-irradiation reduced IgE binding significantly (p < 0.05). Biopotency of soluble protein of kidney bean, black gram and peanut was reduced 7-, 3- and 26-folds (p < 0.001), respectively, and that of insoluble protein decreased 6-, 4- and 8-folds (p < 0.001), respectively, after boiling. Combination treatment was effective in reducing the potency of both soluble and insoluble protein significantly as compared to boiling alone (p < 0.001). However, γ-irradiation alone did not bring any change in allergenicity. In conclusion, boiling followed by γ-irradiation is effective in attenuating allergenicity of legume proteins.     

Evolution of ventricular outpouching through the fetal and postnatal periods: Unabating dilemma of serial observation or surgical correction

Ventricular outpouching is a rare finding in prenatal sonography and the main differential diagnoses are diverticulum, aneurysm, and pseudoaneurysm in addition to congenital cysts and clefts. The various modes of fetal presentation of congenital ventricular outpouching include an abnormal four-chamber view on fetal two-dimensional echocardiogram, fetal arrhythmia, fetal hydrops, and pericardial effusion. Left ventricular aneurysm (LVA)/nonapical diverticula are usually isolated defects. Apical diverticula are always associated with midline thoracoabdominal defects (epigastric pulsating diverticulum or large omphalocele) and other structural malformations of the heart. Most patients with LVA/congenital ventricular diverticulum remain clinically asymptomatic but they can potentially give rise to complications such as ventricular tachyarrhythmias, systemic embolism, sudden death, spontaneous rupture, and severe valvular regurgitation. The treatment of asymptomatic LVA and isolated congenital ventricular diverticulum is still undefined. In this review, our aim is to outline a systematic approach to a fetus detected with ventricular outpouching. Starting with prevalence and its types, issues in fetal management, natural course and evolution postbirth, and finally the perpetual dilemma of serial observation or surgical correction is discussed.     

Acrocephalosyndactyly (Apert’s syndrome)

Summary A case of Apert’s syndrome in a male child of fourteen years is described and the literature briefly reviewed. From the departments of pediatrics, orthopedics and surgery, Sardar Patel Medical College and Associated Group of Hospitals, Bikaner, Rajasthan.     

Day-to-day variation in iron-status measures in young iron-deplete women

In intervention and observational studies, it is necessary to determine the number of blood samples required to estimate the true value of Fe-status measures. The aim of the present study was to determine the number of days for blood sampling required in order to measure the 'true value' of five Fe-status parameters in young Fe-depleted women and to investigate the effect of menstrual cycle on these measures. Twelve women (aged 23-30 years), non-anaemic but with low Fe stores, participated in the study. Venous blood samples were collected under standardised conditions on fifteen non-consecutive days during a 5-week period. All blood samples were analysed for Hb, serum ferritin (SF), serum transferrin receptors (sTfR), red blood cell volume distribution width (RDW) and reticulocytes (RET), and body Fe stores were calculated as the ratio between sTfR and SF. No systematic changes were found in the investigated parameters during the study. When analytical variations were accounted for, the day-to-day variations (CV%) were as follows: Hb 2.9 %, SF 8.2 %, RET 26.0 %, RDW 2.4 % and sTfR 8.1 %. Calculating the 'true value' with a 5 % significance level and 80 % power showed that one blood sample was sufficient for Hb, SF, sTfR and RDW, whereas seven blood-sampling days were needed for RET. In this study, no significant differences in Fe status were found across the menstrual cycle. The conclusions from this study are valid for studies conducted under similar strict conditions.     

Outcome of Endoscopic Sinus Surgery in Patients with Symptomatic Chronic Rhinosinusitis with Minimal Changes on Computerised Tomography

This study was designed to assess the efficacy of functional endoscopic sinus surgery (FESS) in chronic rhinosinusitis (CRS) patients with minimal radiological findings, and based on one centre, prospective randomized controlled study, conducted in the Department of Otorhinolaryngology, Lady Hardinge Medical College, New Delhi. All the CRS out-patients (>18 years) refractory to 3 weeks of medical therapy were radiologically evaluated with computerised tomographic scan (CT) of nose and paranasal sinuses. These patients were grouped based on CT scoring (Lund Mackay staging system): group A (CT score 0–6) and group B (CT score 7–24); with 35 patients in each group. All the patients underwent FESS using Messerklinger technique. Symptom scoring of all the patients was done using visual analog scale preoperatively and postoperatively at 1-, 3-, 6- and 12-month follow-up. CRS patients with minimal evidence of disease on CT showed statistically significant improvement in symptom scores after FESS. There was no significant difference noted in the overall symptom score improvement as well as for improvement in specific symptoms in both the groups. Further, there was no correlation between the pre-operative symptoms and CT scores. A good subjective outcome in terms of symptom improvement can be obtained with FESS in patients with CRS with minimal evidence of disease on CT.