Megaloblastic anaemia of infancy

Summary A clinical and haematological study of 210 infants with megaloblastic anaemia stresses its frequency among hospitalized children. The probable etiological factors of MAI seemed to be maternal malnutrition during pregnancy and lactation, prolonged breast feeding, inadequate breast milk intake, poor weaning diet and repeated chest/gastrointestinal infections. The occurrence of MAI even during the first six months of life in full term newborns on breast milk was seen though the most frequent age period was 9 to 12 months. The characteristic, clinical profile of MAI as well as the unusual modes of its presentation and physical findings have been stressed. Anaemia was macrocytic in 73.8%, normocytic in 16.2% and microcytic in 10.0%. Iron deficiency as judged from serum iron studies and marrow haemosiderin estimation was met with in 24.8% and 44.3% respectively. The therapeutic approach for the advanced and complicated cases has been presented and a few suggestions about its prevention made There was a mortality of 7.1% and 18.6% cases had an unsatisfactory response, implying that MAI is a serious diseae, and if advanced and complicated, offers a challenge to therapeutic skill. From the Department of Pediatrics, Medical College, Amritsar.     

Cerebral infarction in association with Ecstasy abuse.

A previously fit 35 year old man presented with a right hemiparesis and dysphasia 36 hours after abuse of Ecstasy (3,4-methylenedioxymethamphetamine). Computerized axial tomography scan demonstrated an extensive acute left cerebral infarction and carotid digital subtraction angiogram, 2 days after admission, revealed left middle cerebral artery occlusion. There were no other known risk factors and all other investigations were negative. The patient made a partial recovery. We propose an association between Ecstasy abuse and cerebral infarction.     

Real Time-PCR HBV-DNA Analysis: Significance and First Experience in Armed Forces

Background

HBV DNA quantitation is used extensively world wide for the diagnosis and monitoring of treatment of Hepatitis B virus (HBV) infection. However, it has still to be popular in India. The aim of this study was to quantitate HBV – DNA by Real time – PCR method in Hepatitis B and in immuno-compromised patients, to compare the results with HBeAg detection and to monitor the response to therapy of chronic Hepatitis B patients to antivirals.

Methods

Ninety one serum samples of Hepatitis group of patients (all HBsAg positive), 41 samples from immuno-compromised patients (all HBsAg negative) and 49 patients of Chronic Hepatitis B group (all HBsAg positive) were the subjects of this first ever study in Armed Forces. Twenty serum samples from healthy volunteers and non-hepatitis B patients served as negative controls. The amplification detection was carried out in a Rotor-Gene 2000-sequence detector

Results

Amongst Hepatitis B group, 33% (30/91) of the samples were positive for HBV-DNA and 26% (24/91) of samples were positive for HBeAg. In the immuno-compromised group of patients 14.6% (6/11) of samples were positive for HIV-DNA and 9.7% (4/41) were positive for HBeAg. Of the Chronic Hepatitis B patients on treatment, all (100%) were positive by HBV-DNA, whereas 29/49 (59.2%) were positive by HBeAg before treatment. After treatment with antivirals, 06/49 (12.2%) were positive by both tests and 11/49 (22.5%) were positive only by HBV-DNA. 32/49 (65.3%) patients became negative serologically after therapy.

Conclusion

HBeAg status did not necessarily reflect HBV-DNA level in the serum, as 10/91 (11%) in the Hepatitis B group, 2/41 (4.9%) in the immuno compromised group and 20/49 (40.8%) patients in the Chronic Hepatitis B group were positive for HBV-DNA but negative for HBeAg. HBV-DNA was not found to be positive amongst any of the negative controls. Real time – PCR is a sensitive and reproducible assay for HBV-DNA quantitation and may be started in Armed Forces referral centers in the near future.Key Words: Real time – PCR, Chronic Hepatitis B, HBV – DNA, Antivirals     

Premorbid adjustment in first episode schizophrenia and schizoaffective disorders: a comparison of social and academic domains

OBJECTIVE: Recent evidence suggests that premorbid adjustment in schizophrenia and related disorders can be separated into social and academic domains. In this paper, we examine the correlates of and prognostic significance of social and academic premorbid adjustment in a sample of 113 patients. METHOD: Premorbid adjustment, symptoms and cognitive functioning were assessed at presentation for treatment and symptoms were re-assessed after a year of treatment. RESULTS: Females and those with a diagnosis of schizoaffective disorder were found to have better premorbid adjustment in the academic domain, but not in the social domain. Neurocognitive functioning was more consistently related to academic than social adjustment. Better social and academic premorbid adjustment was correlated with lower negative symptoms after 1 year of treatment, but neither was a significant predictor of positive symptoms. CONCLUSION: Social and academic premorbid adjustments show different relations to gender, specific diagnosis and neurocognitive functioning in schizophrenia and related disorders.