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This study examines the rainfall-induced change in soil microroughness of a bare smooth soil surface in an agricultural field. The majority of soil microroughness studies have focused on surface roughness on the order of ∼ 5–50 mm and have reported a decay of soil surface roughness with rainfall. However, there is quantitative evidence from a few studies suggesting that surfaces with microroughness less than 5 mm may undergo an increase in roughness when subject to rainfall action. The focus herein is on initial microroughness length scales on the order of 2 mm, a low roughness condition observed seasonally in some landscapes under bare conditions and chosen to systematically examine the increasing roughness phenomenon. Three rainfall intensities of 30, 60, and 75 mm h−1 are applied to a smoothened bed surface in a field plot via a rainfall simulator. Soil surface microroughness is recorded via a surface-profile laser scanner. Several indices are utilized to quantify the soil surface microroughness, namely the random roughness (RR) index, the crossover length, the variance scale from the Markov–Gaussian model, and the limiting difference. Findings show a consistent increase in roughness under the action of rainfall, with an overall agreement between all indices in terms of trend and magnitude. Although this study is limited to a narrow range of rainfall and soil conditions, the results suggest that the outcome of the interaction between rainfall and a soil surface can be different for smooth and rough surfaces and thus warrant the need for a better understanding of this interaction.

One hundred and fifty healthy children in the age group of 0–12 years were studied to establish normal levels of lipid profile. They were divided into six equal groups viz., newborns, 0–1 year, 1–4 years, 4–7 years, 7–10 years and 10–12 years. The mean values ± SD for total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides were 70 ± 14.48 mg/dl, 35.1 ± 8.04 mg/dl, 23.8 ± 10.62 mg/dl and 50.9 ± 20.77 mg/dl respectively for male neonates and 71.8 ± 13.96 mg/dl, 34.6 ± 6.55 mg/dl, 25.5 ± 9.29 mg/dl and 57.2 ± 18.57 mg/dl respectively for female neonates. These values increased to 158.7 ± 21.23 mg/dl, 60.7 ± 11.70 mg/dl, 80.3 ± 19.26 mg/dl, 86.7 ± 28.80 mg/dl in males and 161.6 ± 23.09 mg/dl 66.7 ± 8.75 mg/dl, 75.8 ± 20.26 mg/dl and 93.2 ± 44.09 mg/dl in females respectively between 10–12 years of age, The various lipid fractions were at the lowest level at birth and increased significantly during first year of life, there after showing a much slower rise in levels. There was no significant difference in values between male and female children.

Intracranial infections still constitute a significant neurosurgical problem. The classical triad of headache, focal neurological deficit and fever is found only in 25% cases [1], Diagnostic techniques like CT and MRI result in early and efficient diagnosis of brain abscess. Antibiotics have revolutionized the management of brain abscess and early institution of specific treatment has reduced mortality as well as sequelae. Case Report 8 year old boy was admitted with complaints of low-grade intermittent fever, without chills and rigor of 5 days duration and excessive but easily arousable sleepiness of 2 days duration. A practitioner prior to admission treated him with cloroquine and ciprofloxacin. Examination revealed an average built boy weighing 21 Kg(< 5th%ile), drowsy, with pulse 70/minute, respiration 30/minute, temp 98°F and BP 100/60mm Hg right arm supine phase IV. There was no pallor, icterus, rash, cyanosis, and lymphadenopathy. There was no neurological deficit; pupils were of normal size and reacting to light. Fundus was normal. Other systems were essentially within normal limit. Haematological parameters were essentially normal. LFT, blood urea and serum creatinine values were within normal range. He was being treated symptomatically. Lumbar puncture (LP) was done which was found to be under intense pressure and only few drops were collected which showed lymphocytes as the predominant cells. Other tests could not be done. However, within six hours of admission, the child developed bradycardia and hypertension of 120/90 mm of Hg. Urgent CT scan showed hypo dense ring enhancing lesion in the left tempora parietal region measuring 3×4.5 cm in size, suggesting cerebral abscess with significant mass effects (Fig-1). Child was then treated with Inj Sodium Penicillin 10 lac IV 4 hourly, Inj Gentamycin 50 mg IV 12 hourly and Inj Chloromycetin 150 mg IV 8 hourly (Inj Cefotaxime and Inj Amikacin could not be afforded by the patient). Child was also continued on Inj Dexamethasone and Inj Sodium Dilantin. Abscess was drained with twist drill method and 20-ml thick brown pus was aspirated. Repeat aspirations were dry. The pus was sterile. Antibiotics were continued for 4 weeks. Child improved gradually within 48 hours and was later subjected to detailed ENT, dental and cardiovascular checkup. Dental caries was found without odontogenous cyst. No septic focus from otologic or cardiovascular source was detected. Fig. 1 Hypodense ring enhancing lesion in temporo parietal region Discussion Sir William Macewen of Glasgow performed surgery on 19 patients of brain abscess out of whom 18 recovered [3]. Amongst 384 cases of brain abscess treated at All India Institute of Medical Sciences (AI-IMS). New Delhi. 472 at Post Graduate Institute of Medical Sciences (PGI) Chandigarh and 480 at Medical College Trivandrum. nearly 40% were reported to be otogenic and etiology could be established in 15.8% cases [4]. Brain abscess can also occur spontaneously [5]. The presenting symptoms and neurological features in brain abscess depend upon factors like location, size, number, virulence of organisms, degree of cerebral edema and host response to infection. Intractable headache, unresponsive to therapy due to rapidly expanding intra-cranial mass lesion, is the most common presenting symptom [4]. Other presenting features being vomiting, papilloedema, focal deficits, convulsion, meningism and altered sensorium. This child presented with fever and excessive sleepiness. Fundus was normal. There was no neurological deficit and no history of convulsion. The classical triad of headache, focal neurological deficits and fever was missing. In temporal lobe abscess, the sign earliest to appear, but often not looked for, is a homonymous hemi-anopia commencing in the superior quadrant. This is easily detected in conscious cooperative patients, but is more difficult to demonstrate when the patients are drowsy. Symptoms are present for less than a week in more than 50% of patients and for less than 2 weeks in 75% cases [6], Rapid onset and progression is the hallmark of brain abscess. This case had only drowsiness, and within 6 hours of hospitalization developed hypertension and bradycardia. This emphasizes the importance of careful and frequent clinical monitoring in children. A brain abscess causes an expanding intra-cranial mass effect due to cerebritis. Hence, LP should be approached cautiously and patients with brain abscess have been noted to die shortly after LP [7], In a known case of brain abscess, LP is not only hazardous but pointless also. In this case, there was no pointer to cerebral abscess, hence, LP was attempted and no more than a few drops could be collected. Urgent CT scan clinched the diagnosis. MRI and CT are appropriate and definitive tests during the stage of cerebritis. Magnetic resonance spectroscopy may be useful in differentiation of an abscess from a neoplasm [8]. Majority of brain abscess arise by direct spread from para nasal sinuses, middle ear or mastoid infections [9]. The more common primary sites of infections include skin pustules, dental or tonsillar abscess, chronic pulmonary infections, septicemia and bacterial endocarditis. The vite is unknown in 20 to 37% of patients [9], In a review of 1200 cases of brain abscess, 40% were otogenic in origin. Our case had dental caries but no odontogenous cyst. Steroids should be used in the treatment of brain abscess to help reduce cerebral edema and so an altered level of consciousness. Aspiration and excision are perfect mode of treatment. The former can be performed at any stage of brain abscess and excision is advised when the abscess is encapsulated [9]. Because of difficulty in diagnosis and management of brain abscess, mortality is high and sequelae are frequent [7]. Serial imaging will definitely reduce the morbidity and morality. Chronic seizure disorders are common after brain abscess.

Congenital cutaneous candidiasis is an extremely rare disorder that usually presents within the first 6 days of life. We report 8 neonates who presented with generalized skin eruptions within first 6 days of life, characterized by erythematous macules, papules, vesicles, bullae and pustules. Candida albicans was demonstrated on direct KOH smear, fungal culture and skin biopsy. The disease implies a congenital intrauterine infection and is different from neonatal candidiasis, which manifests as thrush or diaper dermatitis.Although congenital cutaneous candidiasis is a rare diagnosis and the predisposing factors like prematurity,candidial infection in the mother are not obvious, a high index of suspicion is required to diagnose the neonates with this condition and it is very evident that congenital cutaneous candidiasis has got a good prognosis. This article apart from revealing the atypical presentations of cutaneous congenital candidiasis, also emphasizes the need to screen all pregnant women for vaginal candidiasis.

The gastric emptying of pellets and single units of different densities has been followed in healthy subjects using the technique of gamma scintigraphy. The gastric emptying of the light pellets was affected by their buoyancy in the upper part of the stomach. However, the mean gastric emptying rates of pellets and single units were not significantly affected by density. Floating or buoyant delivery systems may have little advantage over conventional systems. The presence of food in the stomach was found to be the major factor in determining the gastric emptying of single units.

A study has been undertaken to assess the feasibility of three-dimensional imaging of the dispersion of a non-absorbable tracer released into the colon of normal subjects. Six healthy volunteers were selected who were participating in a scintigraphic study designed to assess the spreading of 1 MBq indium-111 Amberlite resin delivered from a delayed capsule system targeted to release in the ascending colon. In each case subjects were imaged using a rotating gamma camera over a data collection period of approximately 20 min. Three-dimensional volume rendered images demonstrated good visualisation of the dispersion of the tracer throughout the ascending, transverse and descending colon and provided good anatomical visualisation of the shape of the colon, not previously apparent from the planar views. The present study demonstrates for the first time, the successful three-dimensional imaging of a radiolabelled tracer dispersed throughout the colon and opens up the prospects for more detailed study of quantification of the volume and distribution of tracers contained within the colon.

One hundred cases of enteric fever in the age group of 6 months to 12 years were analysed with respect to culture sensitivity pattern and treatment outcome. Patients were divided into 5 treatment groups – chloramphenicol, amoxycillin, trimethoprim-sulfamethoxazole + furazolidine, gentamicin + cephalexin and ciprofloxacin. Out of 91 culture positive cases, 100% were sensitive to ciprofloxacin followed by gentamicin (84.9%), cephalexin (83.6%), furazolidine (36.6%), trimethoprim-sulfamethoxazole (34.1%), chloramphenicol (34.0%) and amoxycillin (23.8%). In 60 cases resistant to chloramphenicol, resistance to other drugs varied from 20 to 88.3%. The treatment response was 100% to ciprofloxacin, 72.7% to chloramphenicol, 50% to gentamicin + cephalexin, 38.5% to trimethoprim-sulfamethoxazole + furazolidine and 12.5% to amoxycillin. Out of 48 cases who did not respond to initial regimen, 33 were treated successfully with ciprofloxacin and remaining with other drug regimens. Time taken for defervescence was shortest with gentamicin + cephalexin (4.6±2.0 days) followed by ciprofloxacin (6.1±2.5 days) and chloramphenicol (6.4±3.5 days). There were 3 deaths in this study.

Intermittent hypoxic episodes are typically a consequence of immature respiratory control and remain a troublesome challenge for the neonatologist. Furthermore, their frequency and magnitude are commonly underestimated by clinically employed pulse oximeter settings. In extremely low birth weight infants the incidence of intermittent hypoxia [IH] progressively increases over the first 4 weeks of postnatal life, with a subsequent plateau followed by a slow decline beginning at weeks six to eight. Over this period of unstable respiratory control, increased oxygen-sensitive peripheral chemoreceptor activity has been associated with a higher incidence of apnea of prematurity. In contrast, infants with bronchopulmonary dysplasia [chronic neonatal lung disease] exhibit decreased peripheral chemosensitivity, although the effect on respiratory stability in this population is unclear. Such episodic hypoxia/reoxygenation in early life has the potential to sustain a proinflammatory cascade with resultant multisystem, including respiratory, morbidity. Therapeutic approaches for intermittent hypoxic episodes comprise careful titration of baseline or supplemental inspired oxygen as well as xanthine therapy to prevent apnea of prematurity. Characterization of the pathophysiologic basis for such intermittent hypoxic episodes and their consequences during early life is necessary to provide an evidence-based approach to their management.

The World Health Organization has estimated that 90 million cases of tuberculosis will occur throughout the world in the 1990s and 30 million people will die from the disease [1]. Drug resistance is emerging as a major obstacle to tuberculosis control in the world and is exacerbated by the growing epidemic of Human Immunodeficiency Virus (HIV) [2]. Treatment of drug-resistant tuberculosis is complex, requiring the use of several toxic drugs over 9 to 18 months. Here we present a case of multidrug resistant tuberculosis in a child.

Solutions of hydroxypropylmethylcellulose (HPMC) and polyvinyl alcohol (PVA) are widely used as artificial tears. However, their usefulness is limited by the short duration of their effect. Dilute sodium hyaluronate (SH) solutions exhibit non-Newtonian rheology with high viscosities at low shear rates, which would be expected to enhance their ocular surface residence time. Using quantitative gamma scintigraphy, estimates of the ocular surface residence times of 0.3% HPMC, 1.4% PVA, and 0.2% SH were made in six patients with keratoconjunctivitis sicca. The sodium hyaluronate solution had a mean half-life on the ocular surface of 321 s, significantly longer than hydroxypropylmethylcellulose (44 s; p = 0.012) and polyvinyl alcohol (39 s; p = 0.013).

Eighteen patients were diagnosed and treated for Stage IV-S neuroblastoma at The Hospital for Sick Children, Toronto between January 1971 and December 1988. All patients were 6 months of age or younger at diagnosis. Nine patients (50%) have remained disease free with a mean follow-up of 9.3 years. Of the seven patients under 6 weeks of age at presentation, four presented in the early neonatal period and died, three due to mechanical complications related to progressive disease, and one due to late recurrence. The remaining three patients under 6 weeks of age, two of whom had skin involvement at diagnosis, are alive and disease free. Six of the 11 patients over 6 weeks of age at presentation survived, combined modality therapy (CMT) being more effective than single modality treatment. N-myc was studied from tumor tissue at diagnosis in four patients and was amplified in three (25x, 25x, 100x), all of whom had late disease progression and died. The patient with a single gene copy has no evidence of disease 24 months following diagnosis. Our study confirms the heterogeneity described in this clinically defined group of patients. Because of it, management of Stage IV-S neuroblastoma cannot be uniform and until further development of a subclassification, or a reclassification based on molecular biologic markers is developed, pediatric oncologists will regularly be confronted with a decision whether or not to treat a newly presenting patient that fits into the clinical classification IV-S.

Sodium hyaluronate solutions have been advocated in the management of a variety of dry-eye states. By virtue of their non-Newtonian rheological properties, formulations exhibiting high zero-shear viscosities may be used as an artificial tear with the expectation of prolonged precorneal residence times and improved tolerance. Quantitative gamma scintigraphy was used to evaluate the residence times of 0.2% and 0.3% sodium hyaluronate solutions and a polymer-free solution of buffered saline in 12 patients with keratoconjunctivitis sicca and a group of six normal volunteers. Using several indices of residence time, mean values for the sodium hyaluronate solutions were significantly longer than those for buffered saline. Parallel changes in tear film thickness were also demonstrated using a technique based on laser interferometry.

Buccal bioadhesive tablet formulations of nicotine hydrogen tartrate (NHT) for nicotine replacement therapy (NRT) were developed using chitosan and carbomer at different ratios. Magnesium hydroxide was incorporated into the formulations as pH increasing agent. In vitro release and bioadhesion properties of the tablets were investigated. Release of NHT from the tablets was increased with the increasing amount of chitosan in formulations whilst the bioadhesion of the tablet was decreased. In vivo studies were carried out in healthy, non-smoker volunteers in comparison to a commercially available transdermal patch. Plasma nicotine and cotinine levels were determined using gas chromatography-mass spectrophotometry. No significant difference was found between the maximum plasma nicotine concentrations (Cmax) obtained with the buccal tablet and the transdermal patch (p0.05). Time to reach the Cmax was 2.9 +/- 0.2 h and 11.5 +/- 1.3 h, and AUC0-24 values were 59.3 +/- 5.1 ng x h x mL(-1) (0-12 h) and 204.1 +/- 31.2 ng x h x mL(-1) for buccal tablet and transdermal patch, respectively.

In a prospective study a total of hundred neonates who fulfilled the American College of Obstetrics and Gynecology's (ACOG) criteria for probable sepsis admitted to NICU of tertiary care armed forces hospital were investigated for evidence of sepsis. The investigation protocol included sepsis screen, blood culture and 1 mL of venous blood for molecular analysis by polymerase chain reaction (PCR) for bacterial DNA component encoding 16 s RNA in all cases. 100 newborns with probable sepsis were studied to evaluate the molecular diagnosis of sepsis using PCR amplification of 16 S RNA in newborns with risk factors for sepsis or those who have clinical evidence of sepsis. We compared the results of PCR with blood culture and other markers of sepsis screen (total leucocyte count (TLC), absolute neutrophil count (ANC), immature/total neutrophil count ratio (I/T ratio), peripheral blood smear, micro ESR and C reactive protein (CRP). Controls consisted of 30 normal healthy newborns with no overt evidence of sepsis. Sepsis screen was positive in 24 (24%) of cases in study group with sensitivity and specificity of 100% and 83.5% respectively. Blood culture was positive in 09(9%t) with sensitivity of 69.2% and specificity of 100%. PCR was positive in 13(13%) of cases (9% are both blood culture and sepsis screen positive and 4% are positive by sepsis screen); the sensitivity of PCR was 100% and specificity was 95.6%. Blood culture is the most reliable method for diagnosis of neonatal sepsis. Polymerase chain reaction is useful and superior to blood culture for early diagnosis of sepsis in neonates.

It is considered by many that caesarian section is a safe mode of delivery. However, in certain difficult cases, injury may be sustained by the newborn as a result of the mechanics of delivery. In these situations, it is useful to have a high index of suspicion so as to detect the same. We report one such case sustaining fracture of the humerus in caesarian delivery.

The International Association for the Study of Pain, has defined pain as “an unpleasant sensory and emotional experience connected with actual or potential tissue damage or described in terms of such damage”. It was thought that the newborn baby does not experience pain because of incompletely developed nervous system. However, it has been shown that neurological system known to be associated with pain transmission and modulation, is intact and functional. A study was conducted in our center to study the analgesic effect of administration of oral glucose in various concentrations, in neonates undergoing heel punctures, for collection of blood for investigations. This was compared with the analgesic effects of breast milk (which contains lactose). 125 full term normal neonates with no history of birth asphyxia or underlying neurological abnormality, requiring heel punctures for collection of blood for various investigations were selected for the study. They were matched for gestational age, birth weight and sex distribution and divided into 5 groups of 25 each. One group comprised control subjects and was administered sterile water. 3 groups were administered 1 ml of varying strengths of glucose solutions i.e. 10%, 25% and 50% respectively. The last group was given 1 ml of expressed breast milk (EBM). Prior to heel pricks, state of arousal, baseline heart rate (HR) and transcutaneous oxygen saturation (SpO2) were recorded by pulse oximeter in each neonate. Autolet, a mechanical device for capillary sampling, was used for heel pricks to give equal strength of painful stimulus in each procedure. Audio tape recorder was used to record the cry. The oral solution was administered slowly over 30 seconds by means of a syringe placed in the mouth. Heel puncture was done after 2 minutes, taking all aseptic precautions. HR and SpO2 were monitored using pulse oximeter. Pain response was assessed, by recording duration of crying, change in HR, change in SpO2 and facial action score after the procedure. Mean duration of cry and total cry over 5 minutes was significantly less in groups given 25% and 50% glucose solutions as compared to the control group and babies given EBM. Difference in mean increase in HR, fall in SpO2 were statistically significant between control group, EBM group and neonates given 25% and 50% glucose solutions respectively. Compared to control group, all other administered solutions (10%, 25%, 50% glucose and EBM) were found to reduce physiological and behavioral responses in neonates undergoing heel punctures. 25% and 50% glucose solutions were found to have maximal analgesic effect and both were found to be equally effective. EBM and 10% glucose solution have an equal analgesic effect but less than 25% or 50% glucose. This simple, cheap and safe method of oral analgesia can be easily used in neonates undergoing heel prick procedures during routine neonatal care.

Bronchial asthma is an inflammatory condition. The inflammatory actions of leukotrienes (LT) B4, C4, D4, and E4 have been shown experimentally to play a role in inflammatory mechanisms, producing asthma. Antileukotrienes (ALT) or leukotrienes antagonists (LA) is a new class of anti-asthma drugs with anti-inflammatory role. LT modifiers from the groups of 5 lipoxygenase inhibitor and Cys LT1 receptor antagonists, are found useful in asthma therapy. LAs are of main use in young infants and toddler with recurrent wheezing, children with moderate to severe chronic asthma on steroid therapy and in allergic rhinitis. In chronic asthma they are required to be used for prolonged periods with other anti-asthma agents. Except for Montelukast and Zafirlukast, which can be used in children above two and six years of age respectively, the paediatric use of other agents is yet to be established. However, these agents are essentially safe. The cost of LAs is reasonably high. At present, with available evidence, these drugs are considered promising in management of asthma in children. However, there is need to do more long term clinical trials for ascertaining their effectivity in different types of asthma to compare their effects with long acting B2 agnoists and chromones, so as to optimally explore their utility.

The topical route is the most commonly utilized method of administering a medication to the eye. Theoretically, it is adequate for the treatment of most external conditions of the eye and those of the anterior segment, which includes the iris and ciliary muscle. Introducing the drug directly to the conjunctival sac should in theory localize the drug effect, facilitate drug entry which is otherwise hard to achieve by systemic delivery and avoids first-pass metabolism. In practice, topical application frequently fails to establish a therapeutic drug level for a desired length of time within the target ocular tissues and fluids. Inefficient ocular treatment is a result of many factors, including the rapid precorneal clearance, the highly selective absorptive properties of the corneal barrier, the unproductive drug loss via the conjunctival route and the difficulty that many people, particularly the elderly, have in dosing eyedrops to the eye. Typically, less than 5% of the instilled dose reaches the aqueous humour (Jarvinen and Jarvinen, 1996).

This is a manual that supports the Integrated Management of Childhood illness (IMCI). It is meant for use by doctors, nurses and other senior health workers. The manual provides resource material for common childhood illness and strategy for treating children in both inpatient and outpatient departments in small hospitals having basic laboratory facilities and essential drugs. Many countries have adopted the IMCI strategy and once India adopts it, this manual becomes a must for all health care providers. The manual has various chapters describing the process right from the admission of a sick child, prioritization of care, assessment of the child and dealing with specific common diseases like ARI, diarrhoea, malnutrition etc. It also deals with supportive care and has appendices giving information on practical procedures, drug dosages etc. There is one drawback in the manual, that, it does not cover the early neonatal period when neonatal and infant mortality is quite high. However, many WHO publications have been incorporated to give useful information for common illnesses with appropriate illustrations. The manual is recommended for all those caring for children at the first referral level in developing countries like India.

Imaging procedures are of immense help in arriving at a diagnosis in paediatric practice. However, after initial radiographic or ultrasound examination, differential diagnosis may often elude the paediatrician. A systematic and practical approach to the findings can help arrive at a diagnosis earlier, often obviating the need for costlier procedures. In this book, eminent radiologists have pooled their years of experience. This will definitely help Paediatricians and Radiologists to co-relate the clinical features with results of imaging studies. The book is divided into seven sections on anatomy and subdivided into many chapters covering major childhood disorders. Illustrations are very lucid and biometric data very useful. Format and organisation of chapters is extremely logical and it is easy to locate a particular condition in differential diagnosis. Great emphasis has been laid on radiographic and ultrasonographic findings which are very useful guides for a clinician. Contrast studies, computed tomography and magnetic resonance imaging have been illustrated wherever required. Photographic illustrations have been given in some sections to illustrate congenital and genetic disorders. However, the book lacks in certain areas. Disorders which are more common in developing countries have not been given the attention they deserve. In fact, they have been listed as rare disorders and only texts have been provided eg. Tuberculosis. Meningitis. Cysticecrosis etc. Vitamin deficiency disorders like rickets and scurvy deserve better images than provided. All in all, a good reference book in paediatric radiology for Paediatricians and Radiologists alike and is certainly recommended for departmental libraries.

Risedronate sodium is a pyridinyl bisphosphonate, proven effective for the treatment and prevention of postmenopausal osteoporosis and glucocorticoid-induced osteoporosis and Paget's disease of the bone.To compare the oesophageal transit, disintegration and gastric emptying of the commercial film-coated risedronate tablet in subjects with gastro-oesophageal reflux disease (GERD) and normal control subjects.A total of 30 subjects, 15 patients with GERD and 15 age- and sex-matched, normal control subjects, participated in a single-centre, open-label, comparative gamma scintigraphy study. The GERD subjects had active erosive oesophagitis within 4 weeks prior to dosing.The mean oesophageal transit (GERD, 4.4 s; controls, 3.1 s), mean disintegration (GERD, 21.8 min; controls, 19.2 min) and mean gastric emptying (GERD, 15.9 min; controls, 15.0 min) were similar in the two subject groups. The oesophageal transit is rapid and given the rapid disintegration and gastric emptying, oesophageal contact occurring via reflux of risedronate was unlikely since most, if not all, of the dosage form exited from the stomach within 30 min.The oval shape and film-coating on the commercial risedronate tablet promotes rapid oesophageal transit and minimizes oesophageal contact, even in the high-risk GERD population.

Hepatic and Biliary diseases in children are becoming increasingly common and Paediatric Hepatology is establishing itself as a distinct speciality in Paediatrics owing to the peculiarities of liver and biliary diseases in children. This book is likely to fulfill the long felt need of students and teachers to share their global experiences in this field and to focus on certain clinical problems in day to day practice. This book covers a wide range of topics - from genetic disturbances of bilirubin and bile salt transport in neonates to psychology of parents of children on transplantation waiting lists. The highlight of the book includes number of useful algorithms and provides a practical approach to paediatric liver disease. Information on hepatitis has been updated, and non-viral Hepatitis and liver abscesses have been described well. Disorders of Copper metabolism also includes Indian Childhood Cirrhosis. There are chapters on liver and intestinal transplantations, useful investigations, altered drug and protein metabolism in liver diseased which are very lucid and interesting. Neonatal liver disorders are also well covered. The academic quality is enhanced by a collection of 75 photographs. This book fills a real gap in our knowledge of liver disease and is a well needed addition of a reference material which will be very useful for postgraduate students. Paediatricians and Paediatric Hepatiologists.

Widespread dieback of the introduced noxious weed Mimosa pigra was observed during the dry months in monsoonal northern Australia. Stems were girdled by reddish-brown lesions that generally originated from leaf axils. Botryodiplodia theobromae was consistently isolated from the lesions and was shown to cause the symptoms. It is suggested that the occurrence of dieback is linked with the establishment of a stem-boring moth introduced as a biological control agent for M. pigra.

Active distal ulcerative colitis is often resistant to topically acting oral formulations. We speculated that the left side of the colon is underexposed to orally-dosed topical agents in patients with active distal colitis.Twenty-two healthy volunteers (12 males, aged 22-47 years), and 10 patients (6 males, aged 33-73 years) with active left-sided ulcerative colitis ingested a Eudragit-coated gelatine capsule containing 111In-labelled amberlite resin on four successive days. Regional colonic distribution, transit times and percentage of daily dose resident were calculated from the average of four serial gamma camera images on the 4th day.(mean [95% CI]). When compared to controls, patients with colitis had significantly faster total colon transit (24.3 h [9.5-39.1] vs. 51.7 h [41.1-62.3]) as well as faster proximal colon transit (18.7 h [9.1-28.3] vs. 36.7 [28.5-44.9]), and distal colon transit (3.1 h [-0.5 to 6.8] vs. 15.0 h [10.5-19.5]), respectively (all P0.01). Material was asymmetrically distributed in health (proximal colon 69% [63-76] vs. distal colon 31% [24-37]). This asymmetry was more extreme in colitis, with corresponding values of 91% [85-96] vs. 9% [4-15]. As a result colitics had less material in the left-sided colon (9% [4-15] vs. 31% [24-37]), P0. 001. Colitics had a significantly lower percentage of the daily dose resident within the left side of the colon compared to controls (13% [-2 to 28] vs. 63% [44-81]), P0.01.Delayed release oral formulation is asymmetrically distributed within the colon in health. This asymmetry is exaggerated in active left-sided ulcerative colitis and, together with faster colonic transit, results in reduced exposure of the distal colon to orally-dosed topical agents.

Screening of 1986 consecutive live births was done for evidence of Respiratory Distress by administering Downe's scoring in a prospective study at level II nursery of a medical college. A detailed antenatal, natal and postnatal history along with detailed examination supported by relevant investigations was carried out to arrive at the etiological diagnosis of Respiratory Distress Syndrome (RDS). Results: 48 newborns developed RDS during the observation period. The incidence of RDS was 2.42%. Out of these 40.4% were

By varying stool water content using lactulose and codeine, we investigated the influence of luminal water content on the absorption of quinine, a transcellular probe, and 51Cr-EDTA, a paracellular probe, from the distal gut.Sixteen volunteers entered a three-way cross-over trial in which absorption of probe markers from a timed-release delivery system was determined following treatment with lactulose 20 mls tds (increasing water content), or codeine 30 gms qds (decreasing water content), and compared with control untreated values. Stool water content was assessed by freeze drying stool samples. Site of release was determined by gamma scintigraphy, and absorption was measured by plasma levels and urinary recovery of the marker probes.Lactulose accelerated ascending colon transit (3.7 +/- 0.8 vs 4.5 +/- 1.4 hrs, p0.05), increased stool water content (75 +/- 2 vs 71 +/- 2%, p0.01), caused greater dispersion of released material (dispersion score 3.4 +/- 0.3 vs 1.8 +/- 0.2, p0.01), and enhanced absorption of the transcellular probe quinine (4.66 +/- 0.78 vs 3.02 +/- 0.63%, p0.05) compared to control. Conversely codeine slowed ascending colon transit (8.9 +/- 1.8 hrs), reduced stool water content (61 +/- 2 vs 71.2%, p0.05), and tended to diminish absorption (2.60 +/- 0.77 vs 3.02 +/- 0.63%, p = 0.20). Within the ascending colon specifically, there was a significant trend for treatments increasing luminal water content to enhance quinine absorption (medians: codeine = 1.2%, [n = 81control = 2.3%, [n = 5]lactulose = 3.2%, [n = 71, p0.01). Delivery site also had an important influence on absorption, with more distal release resulting in less absorption in the control arm (medians: small intestine = 4.4% [n = 5]ascending colon = 2.3% [n = 5]transverse colon = 1.5% [n = 6], p0.005).Lactulose accelerates transit, increases stool water content, and enhances drug absorption from the distal gut whilst codeine slows transit, decreases stool water content, and tends to diminish absorption, compared to controls. We conclude that water content may be an important determinant in colonic drug absorption.

To investigate the regional absorption characteristics of the distal gut using two markers of permeability, quinine (a transcellular probe) and 51CrEDTA (a paracellular probe).The permeability markers were delivered to the undisturbed gastrointestinal tract in 39 healthy volunteers using an oral timed-release delivery vehicle which allowed pulsed release within a particular site of the gut. Site of release was identified using gamma scintigraphy. Absorption of quinine and 51CrEDTA was assessed by measuring the percent excretion in the urine using HPLC and gamma counting respectively. Serial plasma samples allowed time-concentration curves for quinine to be plotted.There was a significant trend for diminished absorption with more distal delivery of the transcellular probe, quinine, which was: 6.26 +/- 0.87% (small intestine, n = 10); 4.65 +/- 0.93% (ascending colon, n = 16); and 2.59 +/- 0.52% (transverse colon, n = 10) of the ingested dose excreted respectively (p0.001). No such gradient was seen with the paracellular marker, 51CrEDTA.These results suggest that delayed release formulations should aim for release in the distal small bowel and proximal colon if absorption is to be maximised. Absorption by the transcellular route diminishes in the more distal colon, a fact which has implications for delayed or sustained release formulations.

In spite of its frequent use in the treatment of irritable bowel disease little is known about mebeverine's mode of action in man.To examine mebeverine's effect on transit though the gut during lactulose-induced diarrhoea.Nine healthy volunteers undertook a two-way randomized crossover study. Diarrhoea was induced using lactulose pre-treatment (20 m t.d.s., 4 days) and subjects received either mebeverine (135 mg t.d.s.) or no treatment. Transit of two enteric-coated capsules containing radiolabelled 8.4 mm tablets and 180-250 microM ion exchange resin were followed using gamma scintigraphy. Stool frequency and symptoms were assessed by diary cards.Mebeverine reduced mean daily stool frequency associated with lactulose ingestion from a median of 2.25 (interquartile range (IQR) 1.75-2.75) to 1.5 (IQR 1.25-2.25) movements. Mebeverine significantly reduced the number of mass movements observed in the colon during the 11 h of the study from 2 (2-2) to 1 (1-2), and the number of retrograde movements from 1 (0-2) to 0 (0-0) (P0.05). Mebeverine did not significantly alter the gastric emptying rate of the intact capsule (2.9 (1.9-3.2) to 2.8 (2.6-4.0) h) however it induced a small but significant acceleration in small intestinal transit of the capsule (1.6 (0.8-2.0) h to 1.0 (0.52-1.32) h, P=0.02).Mebeverine reduces the diarrhoeal effect of lactulose by decreasing the mass movements induced in the ascending colon. This effect may contribute to its clinical effect in irritable bowel syndrome.

The established clinical role of radionuclide imaging includes the diagnosis and monitoring of a wide range of clinical conditions. The therapeutic use of radionuclides has centred on a relatively small number of pathological conditions, particularly within the field of oncology. More recently there has been growing interest in the use of radionuclide imaging in drug evaluation and research (RIDER). Studies have been undertaken in order to increase the understanding of the in in vivo behaviour of pharmaceutical dosage forms in addition to the in vivo behaviour of molecular and cellular anti-tumour agents. The imaging facilities required for such undertakings are available in most nuclear medicine departments, although the expertise for radiolabelling and the requirements for the production of drug conjugates and pharmaceutical formulations are limited to a small number of centres. This paper discusses the application of radionuclide imaging in drug research with particular reference to the role of gamma-scintigraphy in monitoring the biodistribution and pharmacokinetics of immune mediated drug conjugates intended for the treatment of malignant disease. Examples described include the evaluation of oral and inhaled drug delivery systems and the biodistribution and in vivo kinetics of parenteral administrations.

Glomerular function of neonates (25 full term and equal number of preterm neonates) at birth, on day seven and day fourteen were estimated by endogenous Creatinine clearance (CCr). The Preterm were divided into three groups viz. Group I (Gestation age (GA) 30-32 weeks), Group II (GA 33-34 weeks) and Group III (GA 35-36 weeks). Group IV consisted of 25 term neonates. Serum creatinine (in mg/dl) in all the groups of preterm ranged from 0.92 ± 0.153 to 1.204 ± 0.154 and in term neonate from 0.562 ± 0.175 to 1.148 ± 0.247 showing that the levels were inversely proportional to the period of gestation. Besides the Serum Creatinine levels in all groups of Preterm as well as term neonates were found to fall significantly (p 0.05). The increase in GFR in Group I on the three occasions was linear but insignificant (p > 0.05). The rise was more rapid & significant (p < 0.001) during the second week in Groups II & III. On the contrary the rate of improvement of GFR in full terms was quite rapid during the first week and gradual over the second week of life.

A scintigraphic and pharmacokinetic study of the behaviour of (Bronchoretard forte, CAS 58-55-9) was carried out in 8 healthy male volunteers to evaluate the sensitivity of the preparation to changes in gastric pH. Volunteers were pretreated with ranitidine (CAS 66357-35-5) (150 mg b.d.) or placebo for three days prior to and on the study day to reduce gastric acidity. The effect of the pretreatment with ranitidine on gastric pH was measured on the prestudy day and the mean pH was significantly reduced compared to the placebo (ranitidine pH 2.2 +/- 2.4; placebo pH 1.6 +/- 2.0, p less than 0.01 Wilcoxon Signed Rank test). All subjects were pretreated with theophylline for 3 days (500 mg b.d.) to achieve steady-state. On the study day the volunteers swallowed two theophylline sustained release capsules radiolabelled by inclusion of indium-111 micronised Amberlite resin and the gastrointestinal transit followed continuously for 14 h using gamma scintigraphy with a further image at 24 h. Blood samples were taken from each subject throughout the study to determine the pharmacokinetic profile of theophylline when presented in the sustained release formulation. No significant differences were found in the gastrointestinal transit of the labelled microparticulates between the data obtained from the group when treated with ranitidine or placebo. Plasma theophylline concentration profiles were identical for the two treatments. These data indicate that the theophylline sustained release formulation is not sensitive to the effects of major changes in gastric H+ concentration.

The deposition of particulate suspensions delivered from a metered dose inhaler has been investigated extensively. The distribution of propellant, delivered from a metered dose inhaler, was studied by radiolabelling it with technetium-99m hexamethylpropyleneamine oxime. Andersen sampler measurements indicated that half of the dose was associated with particles in the size range 0.5-5 microns diameter. The preparation was administered to healthy subjects by inhalation and deposition was monitored with a gamma camera. Each lung image was divided into an inner, mid, and peripheral zone. The effects on deposition of varying the size of the delivery orifice (0.46, 0.61, and 0.76 mm internal diameters) and the effect of attaching a spacer were assessed. Lung deposition was independent of the orifice size within the actuator. Without the spacer the average dose deposited in the lungs was 39%, with 15% penetrating into the peripheral part of the lungs. Attachment of the spacer to the mouth-piece increased the mean lung deposition to 57% and reduced oropharyngeal deposition. The study has shown that propellant soluble drugs can be delivered efficiently to the lungs from a metered dose inhaler.

Studies of the rate of clearance of a gellan gum formulation (Gelrite) radiolabelled by the inclusion of technetium-99m labelled diethylenetriaminepentaacetic acid were carried out in volunteer subjects and in rabbits. Disposition was followed by gamma scintigraphy and compared with 0.5% w/v hydroxyethylcellulose (HEC) solution and isotonic saline administered to the same subjects. Clearance of all solutions was found to follow bi-exponential kinetics with differences in clearance rates between the two species studied. A significant retention of the gellan gum formulation compared to HEC (p = 0.006) or saline (p = 0.009) was noted in man, but not in the rabbit. In this latter species the HEC showed greater retention compared to Gelrite. The species-specific differences in the precorneal residence of the formulations are attributed to the different physiological responses following instillation of solutions into the eye.