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BACKGROUND: Besides the relief of symptoms, the main purpose of any treatment must be to ensure a better quality of life (QOL). Mere recording of symptoms reveals their severity and frequency, but gives scant information on its effect on QOL. AIM: The study was designed to assess QOL in Indian patients with chronic urticaia (CU). SUBJECTS AND METHODS: We used the validated CU-QOL by Bairadani et al., consisting of five domains and each domain consisting of several items. Each item was scored from 1 to 5 (score 5 = most affected, score 1 = not affected). CRITERIA FOR INCLUSION: Patients having symptoms of rash and pruritis on most of the days for at least 6 weeks were enrolled. CRITERIA FOR EXCLUSION: If the individuals had CU secondary to any other disease, they were excluded. RESULTS: We enrolled 48 patients. The means of the domains, the items, and the frequency of occurrence of an item were tabulated. The highest mean scores were in the domains of symptoms, followed by sleep disturbances, life activities, looks, and limits. The highest mean scores for the items were for pruritis and wheals followed by sleep disturbances, mood changes, nervousness, embarrassment, fatigue, loss of concentration, reduced work, and social relationships. We also observed a significant relationship among individual items. It is possible that they may have an additive effect. CONCLUSIONS: Even though CU significantly affected many items, patients were rarely aware of them. There was a significant inter-item correlation, suggesting that items might be aggravating each other. It is important to address the issues regarding QOL along with symptoms for better management of CU.

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There is scant literature on the existence of IgE (type I allergic reactions) directed against Myocobacterium tuberculosis. To study this problem, total serum IgE (SIgE) and IgE specifically directed against the purified protein derivative of Myocobacterium tuberculosis (PPD-Sp IgE) was determined in 16 patients with AFB positive pulmonary tuberculosis (PTB) and their age and sex matched controls. Mean SIgE was significantly higher in PTB than in controls. Mild heating of the serum was necessary to detect the presence of PPD-Sp IgE which was positive in 81.3% PTB. One (6.3%) gave a class I, 9 (56.3%) gave class II and 3 (18.7%) gave class III RAST reactions. PPD-Sp IgE was absent in 3(18.7%). There were no class IV reactions. Control sera were negative for PPD-Sp IgE. Though the RAST test had a sensitivity of 80.1%, a specificity of 100% and a positive predictive value of 100%, we do not advocate this test as a diagnostic test. We have used this test to demonstrate the existence of PPD-Sp IgE and thus the existence of Type I allergic reactions against the PPD antigen of Mycobacterium tuberculosis. Its value in relation to clinical symptoms and its site of local production need further studies.

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Response to bronchial challenge (BC) with purified protein derivative of Mycobacterium tuberculosis (PPD), was studied in children with bronchial asthma and correlated with Mantoux test and serum immunoglobulin E (IgE) against PPD (PPD-Sp IgE). Nearly 59% patients with bronchial asthma and 12.2% patients with pulmonary tuberculosis gave positive BC. Children with extra-pulmonary tuberculosis and normal children did not show positive BC. In asthma, 25% gave early (EAR), 50% gave late (LAR) and 25% gave both early and late (DAR) asthmatic response. Forced expiratory flow volumes in 1 sec (FEV.1) of 13 age and sex matched asthmatic and normal children showed similar volumes before BC, however, the values were significantly lower in asthma at 20 min (p less than 0.005) and 24 h (p less than 0.005) after BC. There was no relationship between response to BC and the severity or chronicity of asthma. PPD-Sp IgE was estimated by the radioimmunoassay method (Pharmacia Diagnostics). It was detected in 75% with positive BC and none of the controls. The titre was of Phadebas RAST Class III in 66.7%, Class II in 22.2% and Class I in 11.1%. The presence of early Mantoux reactions, positive BC with PPD and serum PPD-Sp IgE suggest the existence of Type I or Arthus type of reactions to PPD, which could cause hyperreactive airways in some cases of asthma.

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M-mode echocardiography was performed in 110 normal fetuses to study the norms for various cardiac parameters at varying gestational ages. The measurements were done in normal pregnancies with gestation varying from 14-38 weeks. The parameters studied were aortic root diameter, left atrial and right ventricular outflow tract dimensions, left and right ventricular cavity dimensions, and left ventricular, septal and right ventricular wall thickness. The values were analysed statistically by linear regression analysis and 95 per cent confidence limits were derived. It was found that values for right and left ventricles increased with gestation such that at term both ventricles were equal in size. The aorta and left atrium also increased with increasing gestation but the value for left atrium increased more than that of aorta giving increased left atrium to aorta ratio. These values could be utilised as norms for Indian fetuses and could help in detecting abnormalities of size.

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Pulmonary Function Tests (PFT) of 45 swimmers who swam a distance of 2 to 5 kms per day regularly were compared with age, sex, height and weight matched controls. VC, IRV, FVC, FEV1 and V25 were higher in swimmers (S) than controls (NS) by 20%, 25%, 37.4%, 30.1% and 15.1% respectively. The effect of the period of training on PFT's was also analysed. Inspiratory capacity was significantly higher in Gr IS than NS probably due to a reduction in FRC, FVC and FEV1 were higher in Gr. II than NS. Greater differences were seen between Gr. IV S and NS, where FVC, FEV1, V75 and PEFR were higher by 50.2%, 38.2%, 69.4% and 25% respectively in the S than NS. Probably the first parameter to increase is IC. The greater differences in PFT values of Gr. IV S and NS may be due to hypertrophy of the diaphragm which requires hard work for prolong period. Further longitudinal studies are needed to confirm these observations.

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Thirty-one boys between the ages of 9 and 17 years were subjected to submaximal exercise stress testing on a treadmill using the Bruce's protocol. All the children completed the test with the younger group (9-13) reaching Grade III and the older group boys (14-17) reaching Grade IV on an average. The heart rate, blood pressure and FEV1 during exercise compared well with other reported studies. On ECG analysis there were no significant ST segment changes or J junction depression. This study was conducted in well nourished boys from high-socio-economic group who regularly took part in sports.

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Cryptosporidium is an intestinal protozoa known to cause diarrhea in animals and more recently has been recognised as a cause of diarrhea in humans. The present study was designed to determine the prevalence of cryptosporidium as a cause of diarrhea in children. Faecal samples of 180 children admitted to the hospital for acute gastroenteritis and from 100 normal children were analysed. Eight out of 180 (4.4%) stools from children with acute diarrhea and none from normal showed cryptosporidi. We conclude that this parasite does play a role in the etiology of human diarrhea.

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Pulmonary function tests (PFT) were performed on 84 children studying in a Municipal School, near a plant manufacturing chemicals in Chembur, a suburb of Bombay, from where large amounts of chlorine gas leaked out on 30th August, 1985. It was found that only 23.8% had normal PFT's. 66.7% showed an obstructive pattern and 9.5% showed a restrictive pattern of PFT's. This is a preliminary report to establish the prevalence of lower PFT values in children staying in an area of air pollution in Bombay.

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An open trial of Ketotifen was conducted on 29 children suffering from asthma of varying duration. The drug was given orally in a dose of 1 mg twice a day. Children were followed up weekly for a period of 3 months. It was found beneficial (though the benefit was not statistically significant) in children having asthma of less than 2 years duration who were taking one drug regularly or were on occasional treatment. There was marginal effect in children taking salbutamol and theophylline together, but irregularly and no benefit in children taking prednisolone.

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