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It is possible that tuberculosis is transmitted from patients to healthcare workers (HCWs). However, there are few data on this from developing countries. The object of this study was to document the incidence of tuberculosis among HCWs in the Christian Medical College (CMC), Vellore, India during a 10-year period (January 1992-December 2001). Data were collected from records maintained in the staff and students health services of CMC. A total of 125 cases were diagnosed during the period of study. The overall incidence of sputum positive cases was similar to that observed in the general population, during most years. However, it appears that focal outbreaks occur with transmission between HCWs. The chance of developing extra-pulmonary tuberculosis was higher in HCWs compared with the general population.

Forty-five children (28 girls and 17 boys; mean age 4.5 years) with hypothyroidism referred to us from January 1989 to November 1990 were evaluated prospectively for the pattern of hypothyroidism by hormone assays, scintiscan and urinary iodine estimation. Among the 6 children from non-endemic areas, athyreosis and/or hypoplasia were seen in 3, ectopia in 2 and dyshormonogenesis in 1. Of 39 children from moderate to severe environmentally iodine deficient regions, 18 (46%) had athyreosis and/or hypoplasia and 10 (26%) ectopic thyroid. Iodine deficiency was seen in 4, dyshormonogenesis in 4, secondary/tertiary hypothyroidism in 2 and thyroiditis in 1. The mean age of these children at the onset of symptoms was 1.4 years and at clinical presentation 4.5 years. There was significant growth retardation with 54% of children being below the 5th centile of Indian standards. There was no significant difference in the age at onset of symptoms and presentation, clinical features and bone age for the different types. The levels of serum total T4 were significantly low in dysgenesis (athyreosis, hypoplasia and ectopia, p < 0,001). Dysgenesis of the thyroid is the most common type of childhood hypothyroidism in iodine deficiency endemias. We postulate that severe iodine deficiency in the intrauterine and early neonatal period may lead to dysgenesis of the thyroid.

Radionuclide gastro-esophageal scintigraphy was performed on 25 control and 183 children suffering from recurrent lower respiratory tract infection. Gastro-esophageal reflux (GER) of varying grades was observed in 135 patients. The severity of clinical symptoms in the patients was found to be directly related to the severity of reflux observed in the radionuclide study. In some patients an attempt was also made to quantitate GER by calculating the Gastro-esophageal reflux index. The results of the scintigraphic study were correlated with the results of the other commonly used and more conventional Barium swallow and fluoroscopy study. Gastro-esophageal scintigraphy was found to be much superior in terms of sensitivity, specificity and accuracy in detecting GER. It was also possible to objectively evaluate and monitor response to treatment following conservative or corrective surgical therapy using the radionuclide technique. The results of the study demonstrated a remarkably high incidence of GER in the patients. Whether GER is the cause of recurrent lower respiratory tract infection or not is difficult to establish firmly. But within the preview of the study the association seems to be very strong and cannot be easily ignored.

Free radical mediated injury is increasingly recognized in many metabolic diseases including Wilson's disease (WD). Use of antioxidants as an adjunctive therapy in WD may have therapeutic significance.The aim of the study was to correlate serum levels of tocopherols with serum copper and ceruloplasmin and clinical status of these patients.Serum levels of tocopherol of were measured spectrophotometrically using the Emmerie-Engel reaction in 34 patients from a large cohort of WD being followed up at a tertiary care center.Majority of patients were male (M/F=23:11). The mean serum copper was 43.6+/-26.2 microg/dl (range=10-121 microg/dl) and serum ceruloplasmin was 5.6+/-5.5 mg/dl (range=0-30 mg/dl). The mean serum tocopherol level was 0.68+/-0.18 mg/dl (range=0.23-1.14 mg/dl) and compared to the control (1.07+/-0.17 mg/dl), nearly 59% of patients had decreased levels (p0.001). No significant correlation was noted between low serum tocopherol levels and serum copper levels, Mini Mental Status Examination (MMSE) scores and CHU staging. However, serum tocopherol levels were lower in patients with relatively short duration of treatment (7.8 years vs. 12.4 years).Decreased levels of serum tocopherol were detected in 59% of patients compared to controls. However, low tocopherol levels did not correlate with clinical status or biochemical parameters of WD, except for relatively shorter duration of treatment. Further studies, especially in newly diagnosed patients, need to be done to validate the role of low tocopherol levels in Wilson's disease.

Vertebro basilar insufficiency (VBI) is a well known cause of vertigo. Brain Single Photon Emission Computed Tomography (SPECT) is an important diagnostic tool to detect and to quantitate the perfusion abnormalities in different areas of the brain. Effect of an antivertigo drug Betahistine on improving the hypoperfusion in different areas of the brain in vertigo patients was studied using brain SPECT. Betahistine at a dose of 16 mg three times daily was shown to improve perfusion in the hypoperfused areas of the brain resulting in relief from symptoms of vertigo. The cerebellar region, which is the most important area involved in vertigo patients with vascular pathology, showed almost complete normalisation of perfusion following Betahistine therapy.

Two cases of pulmonary alveolar microlithiasis showing intense pulmonary uptake of Tc-99m MDP are reported. Pulmonary alveolar microlithiasis, which is a relatively rare disorder of unknown etiology, is characterized by the presence of innumerable tiny calcispherytes within the alveoli of the lungs. A local defect of the calcium metabolism has been implicated as the possible etiologic factor of this disorder. The calcispherytes, ranging between 0.01 to 0.3 mm in diameter, are composed chiefly of calcium and phosphorus, with apatite as the major chemical state. This chemical composition of the microliths is most probably responsible for the uptake of the bone seeking radiopharmaceutical in the lungs.

The substantia nigra from rats of 16 and 17 gestational days grafted into the lateral ventricle of adult rats grew into isolated or partially integrated transplants in 80% of the rats. The morphological details of the transplants were studied at intervals of 30-360 days. The neurons grew, differentiated and were comparable to age-matched controls until 150 days. Thereafter, the neurons showed progressive aging changes like dendritic thickening, clear spaces, membrane-bound vacuoles and increase in lysosomes in the cytoplasm. The numerical density per unit volume (Nv) of normal neurons significantly decreased with simultaneous increase in Nv of glial cells by 360 days. These changes were slower to develop in the partially integrated transplants: it is concluded that target tissue interaction is necessary for prolonged survival of the grafted tissue.

Twenty patients with thoracic stomach were subjected to hepatobiliary scintigraphy for the diagnosis of duodenogastric reflux. The results of the radionuclide studies were correlated with those of endoscopy and biochemical estimation of total intragastric bile acid. Hepatobiliary scintigraphy was found to be more sensitive (91.6%) and accurate (95%) than endoscopy (25% and 55% respectively) and biochemical estimation of total intragastric bile acid content (66.6% and 80% respectively). Being noninvasive and physiological, radionuclide study appears suitable for routine clinical use in the diagnosis of duodeno-gastric reflux.

The conventional method of inducing status epilepticus by injecting pilocarpine 24 h after lithium chloride (LiCl) administration lacks kinetic correlate. Therefore, the present study was conducted to see the effect of altering the time schedule of lithium administration (from 2 to 72 h) on the convulsive behavior in response to pilocarpine challenge in rats. It was observed that reducing the pretreatment time of lithium from 24 to 2 h produced convulsions in 100% of the rats. However, incidence of convulsions decreased when lithium pretreatment time was increased to 48 h and no convulsions were recorded with 72-h lithium time schedule. The neuronal damage assessed histologically and the effectiveness of diazepam was similar irrespective of time schedule. This study provides evidence that LiCl pretreatment schedule can be adopted at any time between 2 to 24 h to suit the convenience and objectives of the experiment.

Fifty-five children with short stature were investigated for the aetiology of short stature with special reference to hypothyroidism. Clinical and laboratory parameters including anthropometry were determined to exclude any chronic systemic disorders. Thyroid function tests such as thyroxine (T4) and thyroid stimulating hormone (TSH) estimation by radioimmunoassay, radioactive iodine uptake and thyroid scan, using 131I and perchlorate discharge test, were performed. In addition, growth hormone was estimated under basal conditions and after insulin-induced hypoglycaemia. Thirty-five were boys and 20 were girls. The age at presentation in the boys was 3-12 years whereas in the girls it was 8-13 years. Forty-three of the 55 children had delayed bone age. Abnormal thyroid function was present in 25 children (45.45%). Of these, 11 (20%) had primary hypothyroidism with low or normal uptake, whereas 14 (25.45%) had glands with high uptake of 131I and elevated TSH. Three children with primary hypothyroidism had reduced growth hormone reserve. On follow-up with thyroxine, there was an increase in growth velocity in all. This study indicates that thyroid function tests should be performed routinely in children with undiagnosed short stature.

Vascularity of the thyroid gland was measured in twenty thyrotoxic patients (including Graves and multinodular goitres) and eight normal subjects by a new objective parameter--'Thyroid Vascularity Index' (TVI). The TVI was calculated by comparing the areas under the normalized thyroid and carotid artery curves up to the time of peak of the arterial curve caused by the first passage of a radioactive bolus. Compared to normal thyroid, all the toxic goitres had increased TVI (p less than 0.001); it being maximum in Graves disease (p less than 0.05). TVI in Graves disease was not affected by carbimazole therapy but decreased dramatically in eight out of ten patients (p less than 0.01) two weeks after Lugol's iodine was added. There was a sustained fall in TVI in all the ten patients (p less than 0.001) with chronic iodine therapy up to six weeks without any hormonal escape. TVI in multinodular goitres showed no significance change with carbimazole or iodine therapy.

From 1983-88, 157 patients were investigated in our clinic for thyroid disorders: 117 (75%) were hypothyroid, 10 (6%)-hyperthyroid, and 30 had euthyroid goiters. Average age of presentation of congenital hypothyroids was 4.07 years. Children with goitrous hypothyroidism (n = 19) were divided into: (i) thyroiditis: RAIU low and patchy, TMA positive: 2 children; (ii) dyshormonogenesis: RAIU high, family history positive, perchlorate discharge test positive: 2 children; (iii) iodine deficiency: RAIU high, urinary iodine low: 2 children, and (iv) cause unknown: RAIU normal or high, other investigations normal: 13 children. Ninety eight hypothyroid children without goiter were divided into 6 groups: (i) athyreosis: RAIU low, no thyroid tissue identifiable (n = 39); (ii) hypoplasia: RAIU low, gland small, in normal position (n = 7); (iii) ectopia: RAIU low, gland in ectopic position (n = 24); (iv) thyroiditis: TMA positive (n = 2); (v) iodine deficiency: low urinary iodine (n = 1); and (vi) cause unknown: RAIU and scan normal, other investigations normal and not done (n = 8). Proportionate short stature was present in 44.4% children. Twenty two children presented only with growth failure; 72% of them had dysgenetic glands. Early onset marked the group with hyperthyroidism (n = 10). Euthyroid goiter was present in 30 (19%). Hypothyroidism is still being diagnosed very late. All children with growth failure, even if proportionate, must have thyroid status evaluated.

A prospective study was conducted in 25 patients with essential hypertension to study the effects of sublingual administration of nifedipine on some renal functions. Glomerular filtration rate was estimated by radioisotope clearance techniques using Tc-99m diethylene triamine pentaacetic acid (DTPA). The change in urinary excretion of sodium and uric acid were also monitored. A basal estimation of these parameters was followed by repeat studies after lowering the blood pressure to normotensive levels by sublingual administration of nifedipine. It was observed that acute administration of nifedipine does not produce a significant change in the glomerular filtration rate, but causes marked and significant natriuresis and uricosuria.

The study was undertaken to assess the usefulness of transplant perfusion index (TPI) in the differential diagnosis of renal allograft dysfunction with special reference to acute rejection. It was observed that the TPI has a sensitivity of 100 per cent and specificity of 98.1 per cent in the diagnosis of acute rejection. It was also observed that the serial values of TPI provided valuable clues and guide in the management of transplant dysfunction and helped in the immediate and long term follow-up of patients with renal allografts.