India has a large geriatric population (60+ years) of 77 millions, comprising 7.7% of its total population. One of the major handicaps in the elderly is loss of teeth, affecting their mastication, dietary intake and nutritional status. The present study was planned to assess the level of edentulousness, denture wearing and denture needs of the elderly in the community and to study the correlation between oral health parameters and socio-demographic variables, diet and body mass index (BMI). A total of 1240 (716 urban and 524 rural) elderly people were studied. It was found that 60% were dissatisfied with their function of mastication because of loss of teeth and lack of dentures. The level of edentulousness was found to be high, more so in rural than in urban people and more so in advancing age, with no significant difference between male and females. The striking finding of this study was the very low level of denture wearing. Only <50% of those needing complete dentures and <13% of those needing partial dentures were wearing dentures. The denture needs of the rural elderly were higher than those of the urban elderly. Vegetarians had a higher level of edentulousness compared with non-vegetarians. The BMI was not correlated with level of edentulousness.

Thirty-five patients with diffuse systemic sclerosis were studied in a randomized, placebo-controlled, double-blind study. Seventeen patients received intravenous dexamethasone "pulse" therapy, while 18 patients received placebo. Each "pulse" consisted of 100 mg dexamethasone in 250 ml 5% dextrose infused intravenously over 1 h. Pulse therapy was repeated every month for 6 months. Assessment of disease status with various parameters was done at entry and at completion of trial, i.e. after 6 months. Significant improvement in skin involvement was seen in the study group, with the total skin score (TSS) decreasing from 28.5 +/- 12.2 to 25.8 +/- 12.8, while in the control group, TSS increased from 30.6 +/- 13.2 to 34.7 +/- 10. Similarly, significant improvement was noted in the flexion index. Other parametres that included extension index, maximum oral opening, range of movement of joints, functional disability score, Raynaud's phenomenon (frequency and duration), ESR, proteinuria, chest X-ray, ECG, lung function tests, barium swallow and antinuclear antibody were unchanged. Adverse effects of therapy were limited to an increased incidence of minor chest infections. It is concluded that intravenous pulse dexamethasone may be useful in the treatment of diffuse systemic sclerosis.

The objective structured practical examination (OSPE) together with the classical practical examination (CPE) form the basis for evaluation of laboratory teaching at the All India Institute of Medical Sciences, New Delhi. Students' attitudes to OSPE and CPE were assessed by preparing a questionnaire containing 32 item statements on Likert's 5-point scale (LS) and 11 bipolar adjectives on Osgood's 7-point Semantic Differential Scale (OSDS). The questionnaire was administered to 50 medical undergraduates before their final examination. Forty-two (84%) students responded to the questionnaire. The LS showed high internal consistency and validity. Attitude scoring on LS and OSDS revealed a high degree of correlation. The majority of students showed a positive attitude to OSPE, and high-rank students had a greater intensity of positive attitude. OSPE was rated as a reliable, effective, useful, interesting and challenging examination, although considered taxing, mentally and physically. The students preferred a combination of OSPE and CPE as in the present system to a complete change-over to the OSPE. The item analysis of the questionnaire is discussed.

The efficacy of daily administration of a small dose of prednisolone was examined in 21 patients with corticosteroid-responsive, frequently relapsing nephrotic syndrome (FRNS). After induction of remission of a third or subsequent relapse with a 6-week course of prednisolone (standard therapy with prednisolone, STP), this drug was continued in a single daily dose of 0.25 mg/kg body weight (low-dose prednisolone, LDP) for 18 months. Relapses occurring during this period were treated with STP, following which LDP therapy was resumed. The historical controls comprised 14 patients with FRNS in whom relapses were treated with STP and who were observed over a minimum period of 30 months. The two groups were comparable for age at the onset of nephrotic syndrome and sex. Twenty patients completed LDP therapy, during which 12 had no relapse, 6 had infrequent and 2 frequent relapses (1 patient became steroid dependent and was taken off LDP). Twelve patients were followed for 12-42 months after stoppage of LDP; during this period 7 had no relapse, 4 had infrequent relapses and 1 showed steroid dependence. The number of relapses during LDP therapy (0.5/patient per year) was significantly less (P less than 0.001) than in the preceding 12 months (3.62/patient per year), and continued to remain low during the following 12 months (0.6/patient per year). Whereas the frequency of relapses in the LDP group was similar to that in the historical control group in the 1st year of comparison, it was significantly less during LDP therapy (0.5/patient per year versus 2.25/patient per year). No side effects were observed in patients on the LDP regimen, at the end of which the height percentiles improved in 6 patients and remained unchanged in 14. Our observations indicate that long-term therapy with a small daily dose of prednisolone can significantly reduce the number of relapses in patients with FRNS, and that the beneficial effect may continue even after its stoppage.

We compared clinical and angiographic features of nonspecific aorto-arteritis in children with those of adult patients. Digital subtraction angiography by i.v. and/or i.a. injection was carried out in 104 patients. In group 1, consisting of 32 patients aged 16 years and younger, hypertension (75%) was the most common clinical feature, followed by diminished pulse, bruit (72% each), congestive cardiac failure (38%), and limb claudication (1 3%). Obstructing arterial lesions were always present and commonly involved the abdominal aorta (75'%), descending thoracic aorta (41%), renal (63%)) and subclavian (41%) arteries. In Group 2, consisting of 72 patients more than 16 years of age, arterial bruit (91%), and diminished pulse (82%) were the most common symptoms. Hypertension occurred in 61%, congestive failure in 14%, and limb claudication in 30'%. Obstructing lesions were always seen and commonly involved the abdominal aorta (77%) and renal arteries (64%). Involvement of the descending thoracic aorta (26%) was less common but subclavian (57%) and carotid (24%)) arteries were more commonly involved than in group I. Arterial aneurysms and pulmonary involvement were uncommon in both groups. There were some clinical and angiographic differences in nonspecific aorto-arteritis between children and adults but these were statistically insignificant (chisquare test).