Working With Parents Through a Devastating Experience-The Birth of a Mongoloid Child

The author believes that professional advice given the parents of a mongoloid infant determines their initial decision on institutionalization. Multidisciplinary counseling by the health team can help parents decide on a course of action that will prove satisfactory in the long run. Consultation should include health t e r n efforts to help parents work through the mourning process and presentation of a) an objective, comprehensive view of the child's condition, b) information on integrating a mongoloid into the family unit, and c) outside resources available to the parents. Deliberation with the parents to help them reach their own decision is essential.     

Difficulties in Immunohaematology : The Weak D Antigen

Background

The Rh blood system is one of the most polymorphic and immunogenic systems known to humans. The expression of Rh blood group antigen is complex. The Rh D antigen is the most important of the antigens that constitute the Rh antigen system. In most cases, D antigen can easily be detected. However, due to variability of expression, weak forms antigen are encountered. The reactivity of weak D with antisera is variable and presents as a problem in blood banking.

Methods

A retrospective analysis for a five-year period was done. Blood samples that were negative for Rh D by immediate spin tube method were tested for weak D antigen by additional lab tests.

Result

Of 34932 serial Rh grouping tests done in our Blood Bank, the incidence of weak D Rh antigen was 0.189%. All these were confirmed by the antiglobulin test.

Conclusion

These patients present as a problem for the blood banker and a curiosity to the clinician. Although uncommon, all health care workers should be aware of this entity to avoid anti D alloimmunisation.Key Words: Weak D, Rh Blood Group     

Expression of immunoglobin G on blood lymphocytes in chronic lymphocytic leukaemia.

A sensitive rosette test utilizing antibody-coated red cells has been applied to the study of the immunoglobulins on the surface of blood lymphocytes in chronic lymphocytic leukaemia (CLL). Contrary to other reports, IgG has been found to be a common surface membrane immunoglobulin (SmIg) on CLL cells. The reasons for this variation are discussed. Evidence is presented to show that (a) the anti-IgG-coated erythrocytes really are detecting IgG and not a cross-reacting substance, (b) the IgG is intrinsic to the cell and not cytophilically bound and (c) Fc-binding and other artefacts have been excluded. Expression of Ig by individual cells was studied by using mixtures of fluorescein- and rhodamine-labelled red cells coated with various anti-Ig. Fifty-one cases of untreated CLL were tested and the lymphocytes of thirty-eight of these cases bore Ig of a single light chain type. These cases could be classified on the basis of their lymphocyte SmIg as follows: eighteen expressing M and D and G, eleven expressing D and G but not M, six expressing M and D but not G, and three expressing G alone.     

Delirium Tremens

The varied clinical manifestations and management of 14 male patients with delirium tremens (DT) have been studied. Eight patients were initially hospitalised for diseases unrelated to ethanol abuse i.e. 2 each for gun shot wound, myocardial infarction and stroke, and one each for pneumonia and gastroenteritis. One patient was going through withdrawal because of prodrome of viral hepatitis before he was hospitalised for uncontrolled agitation and delirium. Two known cases of mild essential hypertension on dietary therapy reported for agitation, abnormal behaviour, a single episode of tonic clonic seizure and hypertensive encephalopathy as they could not/did not get alcohol for 3 days. Three patients presented denovo with DT without concomitant illness. The other features besides delirium and hallucinations were tremulousness in 10, tachycardia in 12, fever in 3, diaphoresis in 2 and tonic clonic seizures in 4 patients. The symptoms fluctuated markedly at short intervals and 2 patients did not have any features of sympathetic overactivity. Altered hepatic biochemical parameters and ketonuria with normal blood sugar were noted in 4 and one patients respectively. Other biochemical parameters including serum electrolytes were normal. CT scan brain done for 5 patients revealed subdural haematoma in one. Cerebro spinal fluid (CSF) and EEG findings were noncontributory. All made good recovery with heavy doses of intravenous vitamin B complex, glucose and oral benzodiazepine. Short course of haloperidol was used in 2 patients. Two patients developed pancreatitis during follow up. All patients made complete recovery, and 8 patients have been followed for 8 to 12 months without relapse. The reason for hospitalisation in such cases is often unrelated to alcohol abuse; hence a detailed history of alcoholism is mandatory to identify those at risk as well as for prompt treatment and decreasing the mortality.Key Words: Alcohol withdrawal, Concomitant illnesses, Delirium, Precipitating events     

Factors associated with sight threatening lesions of leprosy in patients on multidrug therapy

One hundred and six consecutive patients (old and newly diagnosed) attending the leprosy clinic at Guru Teg Bahadur Hospital, Delhi, underwent a detailed ophthalmic examination to identify factors associated with the prevalence of sight threatening lesions of leprosy so as to delineate a sub-group of patients who should continue under active ophthalmic surveillance to prevent blindness. All of them were receiving multidrug therapy as recommended by WHO. Demographic data, systemic parameters and ophthalmic lesions attributable to the disease were endorsed on to a proforma. The data were analysed by chi-square test, discriminant analysis and multivariate regression analysis to isolate factors that could be associated with sight threatening lesions of leprosy. In 106 leprosy patients 212 eyes were examined; sight threatening lesions were found in 37 eyes (17.4%). The comea was involved most commonly (78.3%). The lesions were still present in 15.8% of patients who had completed multidrug therapy. Leprosy related visual impairment was seen in 2.3% eyes and blindness in 0.9% eyes. Factors significantly associated with sight threatening lesions included female gender, multibacillary leprosy, increasing duration of leprosy, thickened corneal nerves, subepithelial punctate corneal opacities and presence of any academic lesion of leprosy. On multivariate and discriminant analysis, female gender, thickened corneal nerves and duration of leprosy > 7 years were significantly associated with sight threatening lesions.     

Clinical and cytopathologic correlation in chronic inflammations of the orbit and ocular adnexa: a review of 55 cases

Fine-needle aspiration cytology has been used for the diagnosis of neoplastic lesions of the orbit and ocular adnexa with some success. However, inflammatory conditions have not received much attention. This is a retrospective study of fine-needle aspirations of chronic inflammations of the orbit and ocular adnexa over a 15-year period from January 1988 through December 2002. Clinical records and stained smears were reviewed. There were 55 chronic inflammations, presenting as masses, cysts, abscesses, discharging sinuses and dermal plaques and nodules. Forty-two were granulomatous inflammations comprising chalazion (18), tuberculosis (5), Cysticercus cellulosae (3), ruptured epidermal cysts (2), actinomycosis (1) and leprosy (13). Thirteen patients had chronic non-specific inflammations. Fine-needle aspiration cytology is a useful diagnostic procedure in chronic inflammations of the ocular adnexa. Specific diagnosis is possible in many granulomatous inflammations, allowing appropriate, individualized therapy to be initiated.     

Prevalence of lower extremity pain and its association with functionality and quality of life in elderly women in Australia

OBJECTIVE: To determine the prevalence of self-reported lower extremity pain and the impact on functionality and quality of life in a population based study of elderly women in Western Australia. METHODS: One thousand four hundred eighty-six women, 6.2% of 24,800 women aged over 70 in Perth, were recruited. An index of relative socioeconomic disadvantage (SES) was derived from postcode. Self-reported lower extremity pain at the hip, knee, and foot was collected by questionnaire. The frequency of lower extremity pain was classified into 5 groups. Mobility was measured by the Timed Up and Go Test (TUG). Quality of life was measured using the Medical Outcome Study Short Form 36 (SF-36) summary statistics: physical and mental component scores (PCS and MCS). RESULTS: The prevalence of women reporting any hip, knee, and foot pain was 39%, 52%, and 34% respectively. Fourteen percent experienced pain at all sites whereas 28% had no pain. There was no age difference between the various pain groups. Women with more pain were heavier and had higher BMI scores. At all lower limb sites, women with more frequent pain had reduced mobility and lower quality of life as measured by TUG, PCS, and MCS. For the TUG test, significant determinants in stepwise regression were age, BMI, knee and hip pain. For the SF-36 PCS, significant predictors were age, SES, BMI, and foot, knee, and hip pain. For the SF-36 MCS, SES and foot pain were significant predictors. CONCLUSIONS: Our results confirm the high prevalence of lower extremity pain in elderly women in Australia. Lower extremity pain significantly reduced both physical and mental aspects of the quality of life as well as mobility. In view of the availability of effective interventions to reduce joint pain, more aggressive intervention in the most disabled is indicated.