ICMR BULLETIN VOL.19-No.-12-DECEMBER-1989.pdf
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ISSN 0377-4910
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Vol.19 No.12
SPEECH REHABILITATION BY LATE SURGICAL REPAIR
IN CHILDREN WITH CLEFT LIP AND PALATE ANOMALY—
Although communicable diseases still constitute the
major cause of ill health, in developing countries
noncommunicable diseases are also posing important
public health problems in these countries due to various
reasons. The noncommunicable diseases constitute a
group of heterogenous disorders, many of which are
associated with variations in life style, behaviour, socio
economic, environmental, population and genetic
factors. Congenital abnormalities also form an important
group of noncommunicable diseases. Various dental/ oral
disorders are being recognised, and treated and attempts
are also being made to rehabilitate those afflicted with
varying degrees of disability.
hospitals catering to such children and providing
physical, functional and psychological rehabilitation, are
still not adequate in terms of qualified personnel,
investigative and management facilities. Keeping the
above factors in view and the quantum of the problems
faced in our country, multidisciplinary. Cleft Palate
Clinics should be planned and organised at many centres
in the country where collaborative and concerted efforts
should be put in by the Cleft Palate Team to go into all
aspects of this anomaly viz diagnosis, treatment and
rehabilitation of these handicapped children.
Congenital cleft lip and or cleft palate anomaly is an
important condition in terms of the epidemiological
factors, racial and ethnic group variations, etiology.
@surgery, orthodontics, speech pathology and prosthetic
rehabilitation. Children afflicted with this anomaly are
handicapped right from birth with respect to breast
feeding, deglutition, recurrent nasobronchial infection.
defective speech, improper growth and development of
the maxillary arch and overall face development affecting
the total personality of the individual. Most of the Indian
population (about 76%) live in the villages, some of which
are located in the interior and not easily approachable by
any mode of transport. The low level of literacy, lack of
proper health education and in many the low socio
economic status are some of the factors which contribute
towards improper or inadequate rehabilitation of these
children. The advanced medical centres/institutions/
The anomaly can present in a number of waysand in
different combinations of varying severity. The cleft can
be of the primary and/or of the secondary palate.
Clinically, there is great variability in the degree of cleft
formation. There could be a minimal degree of
involvement such as linear lip indentations, bifid uvula
and submucous cleft of the palate. The cleft palate may be
limited to the uvula or it may be more extensive involving
the soft palate or both soft and the hard palate as well as
alveolar ridge and the lip. Although the clefts have been
classified in various ways, only two or three classifications1
are well accepted all over the world and these are based
upon the embryology or the nomenclature.
Types of Cleft Anomaly
Incidence
in a country like India with a population over 800
million, it is pertinent to know the quantum of the
Division of Publication & Information, ICMR, New Delhi
- 1 1 () 029
problem of this anomaly for purposes of planning the
manpower required and development of centres for
investigations and rehabilitation as well as community
health education. In India, though no regular epidemio
logical surveys have been conducted, a large number of
studies2-17 on newborns for congenital malformations
including this anomaly, have been reported during the
past two or three decades. From these reports, the pooled
incidence of major malformations in total births at 26
large hospitals from big cities and towns from different
parts of the country is estimated to be 14.82 per 1000
births (2695 total malformations from amongst 1,81,798
births). Of these malformations, the incidence of cleft lip
and palate is 1.25 and that of cleft palate alone is 0.46 per
1000 births. In other parts of the world, the incidence of
this anomaly is reported to be the highest in Afghans
(4.9)IX and American Indians (3.6)19 and lowest in the
Negroid population (0.4 per 1000 live births)20.
Cleft lip and or cleft palate anomaly constitutes
nearly one-thirteenth of all congenital malformations,
thus making the most conservative incidence of this
anomaly as 1.7 per 1000 live births excluding the
associated syndromes.1^21/22 These figures indicate that
the problem is rather large for a population of over 800
million people and its management becomes much more
complex because of the involvement of so many factors.
The population growth rate is very high ie over 22 million
children arc born each year. Thus the magnitude of
rehabilitation of the affected children poses a great
problem in terms of manpower and budgetary inputs.
one and a half times more than females (267; 41.08%);
giving a M:F ratio of 1.4:1.
Table I. Distribution of propositi according to caste amongst
Hindus (N-490)
Caste/sub caste
No.
%
Agarwal
89
25.36
Brahmin
88
25.07
Khatri
40
11.39
Rajput
10.82
Kayasth
29
8.26
Arora
27
7.70
SC/ST
22
6.27
Jat
18
5.13
Total
351
100.00
W
SC/ST—Schedule caste/Schedule tribe.
139 subjects could not be classified.
Side Distribution
In the unilateral clefts of the lip with or without cleft
of the palate the left side was found to be affected more
than twice that of the right side (2.3:1; Table II).
Table II. Side involvement in unilateral clefts out of 650 patients
Community Distribution
Cleft Type
Patients attending the All India Institute of Medical
Sciences (Al I MS), New Delhi, are mainly from north
India ie from Delhi and the adjoining states. India is a
country which has all the major religions of the world,
hence it offers a unique population for a genetic study.
The marriages in this country as a rule take place within
the same religion, caste and sub caste but amongst
different gotras (among Hindus). It will be seen that the
prevalence of the anomaly is more or less on the pattern of
the population ratio in the country, except among
Muslims and Sikhs. Amongst the-Hindus which is the
largest population group (around 82%), the Agarwals and
Brahmins have the highest incidence (Table 1).
Sex Distribution
It has been reported that males are affected more
than females. Among the 650 patients with this anomaly
analysed at the AI I MS, males (383; 58.92%) were affected
136
Total
Side
Right
Left
CL only
12
12
CL+AL
15
38
CL+PP
2
1
3
CL+PP+SP
79
195
274
Total
108
246
354
24
•
AL—alveolus; PP—primary palate: SP—secondary palate
It was observed that around 14 per cent of the
children had cleft lip with or without alveolus, 68 percent
had cleft lip with cleft palate (either unilateral or bilateral)
and about 18 per cent had isolated cleft palate. This
indicates that about two thirds23 of the children had a
severe type of cleft which created real problems in the
management.
Etiology
in spite of available literature on the etiology of cleft
lip and or cleft palate anomaly, confusion still exists on
account of the failure to distinguish between cleft of the
lip and other parts of the primary palate (with or without
a cleft of the secondary palate) and cleft of the secondary
palate without cleft of the primary palate. The develop
mental basis for clefts of the lip is still poorly understood
and is controversial.
The anomaly is said to be of multifactorial inheri
tance and mostly occurs due to an interaction of both
genetic and environmental factors. A number of
etiological factors have been put forth such as the
seasonal effect, social status, malnutrition, infectious
diseases during pregnancy, parental age and effects of
fclipse etc. Some workers have assumed that the patients
with a positive family history have a genetic etiology and
those with a negative history do not. This assumption is
unjustified, as even when an autosomal recessive gene is
known to be the cause many patients will have a negative
history. Hence these genetic factors could be considered
as single mutant genes, chromosomal aberrations,
environmental teratogensand multifactorial inheritance.
On the basis of etiology, the clefts as seen at the
AI l MS were classified as follows:
(i)
Familial: When this anomaly also had occurred in a
close relative (second cousin only).
(ii)
Teratogenic: When there was a definite history of
exposure to teratogenic drugs during the first
trimester of pregnancy.
Giii) Sporadic: Those which did not fall into the other
two groups.
The distribution of clefts on the basis of this
classification is shown in Table III.
The teratogenic group was further analysed on the
basis of steroidal and non-steroidal drug therapy
administered to the mothers during the first trimester of
pregnancy. The steroidal drugs24 were used to control
threatened abortion or for confirmation of pregnancy or
for treatment of irregularity of menstruation and sterility,
and also for oral contraception. These constituted a
major group of steroidal drug therapy. In the non
steroidal group the drugs used were abortifacients,
antinauseants, tranquillizers, anticonvulsants etc.
Table III. Distribution of propositi on the basis of etiology
Group
No.
%
Familial
65
10.83
Teratogenic
90
15.00
Syndromes and associated
malformations
20
3.33
Sporadic
425
70.84
Total
600
100.00
Information was inadequate in 50 patients who were not included in the
analysis.
Development of Maxillary Arch Segments
A cephalometric and dental cast study was
conducted on children with this anomaly who had
undergone late surgical repair or had not undergone any
surgery till the second decade. The study was made on
unilateral as well as bilateral cleft lip with palate with
regard to different parameters such as masticatory
function, speech performance, procumbancy of the pre
maxilla and irregular placement of the teeth25. The arch
width, arch length and occlusion relationship of the teeth
were also taken into account. These were compared with a
matched control group. It was found that the growth and
development of the maxillary arch segments in patients
who had had late surgical repair was near normal and the
occlusion was good in the posterior segments2627.
However, the pre-maxilia in most of the subjects
protruded markedly, invariably the surgical repair in
these children left an anterior fistula and a short soft
palate.
Rehabilitation
The speech was found to be defective and un
intelligible in about 90 per cent of the children with
complete unilateral or bilateral cleft lip and palate who
had undergone late surgical repair or no repair at all. The
masticatory function was fair and the children had
adapted to deglutition quite well.
Meaningful speech production occurs principally
within the pharyngeal, oral and nasal cavities. For the
majority of sounds, the nasal cavity and nasopharynx are
closed off by the elevation of the soft palate against the
posterior wall of the pharynx. The degree of elevation
varies between sounds. When the nasal cavity cannot be
sealed off during speech, there is a resulting nasal escape
137
of air and an inability to build up intra-oral pressure. This
manifests as improper articulation of speech hence the
importance of replacing the missing teeth and reshaping
the malformed anterior teeth. The primary objective of
using orthodontic prosthesis in velopharyngeal incompe
tency is to assist the soft palate and the pharynx in the
production of good speech.28*29
Children with this anomaly have problems of
hypernasality, improper articulation of speech, food and
liquids getting into the nasal cavity etc. To overcome
these problems, different orthodontic appliances have
been designed at the AHMS, New Delhi and these are:
(i) feeding appliances with whiskers to be used in early
infancy; (ii) obturators for patients with palatal fistulae;
(iii) obturator cum partial denture to be used where teeth
are also missing along with the presence of fistulae;
(iv) expansion appliances for collapsed maxillary arch
which restricts tongue space and hampers proper speech
performance; (v) retraction of the markedly protruded
premaxilla by retraction cum expansion appliances;
(vi)appliances for correction of anterior crossbite and
rotated incisors; and (vii)speech bulb appliances for
patients with short and shrunken soft palate and
submucous cleft palate.
All these appliances were planned, devised and
prepared indigenously in hot cure polymethyl methacry
late (PMMA) with necessary clasps/attachments. The
posterior extension in speech bulb appliances was done in
stages. These are the removable non-hinge type of
appliances. After the patients have adapted to these
appliances, they are given speech therapy with the
appliances in position. Patients are required to use these
appliances during the day and these could be removed
while sleeping. Patients require a three monthly check for
changes/adjustments or modifications of the appliances.
Proper oro-dental hygiene as well as cleanliness of the
appliances are important.
These appliances in conjunction with orthodontic
treatment of irregular teeth have given quite satisfactory
results in rehabilitating these handicapped children at the
All MS. This plan of rehabilitation with a minimal input
for training of personnel and laboratory facilities can
assist in improving upon the functions of speech, deglu
tition and mastication. This, however, requires colla
boration with other members of the cleft palate team.
References;
I.
138
Berlin. A J. Classification of cleft lip and palate. In: Cleft Lip
and Palate. Eds. W.G. Graff. S.W. Rosenstein and K.R. Bzoch.
Little Brown Co. Boston, p.69, 1971.
2.
Sharma, B., Bajpai, P.C. and Sharma, N.L. Some observations
on congenital malformations. Indian J Pediatr 39: 286. 1972.
3.
Kamla, K.G., Raghavendra, V.D. and Krishnamurthy, K.A.
Congenital malformations in the newborn in Madurai. In:
Medical Genetics in India, (Vol.l) Eds. I.C. Verma and R.K.
Puri. Auroma Enterprises, Pondicherry, p.53, 1978.
4.
Puri, R.K., Verma, I.C. and Bhargava, I. Effects of
consanguinity in a community in Pondicherry. In: Medical
Genetics in India, (Vol. 2) Eds.I.C. Verma and R.K. Puri.
Auroma Enterprises, Pondicherry, p.129, 1978.
5.
Goravaligappa, J.P. and Nashi, H.K. Congenital malformations
in a study of 2398 consecutive births. Indian J Med Res 69:140,
1979.
6.
Aiyer, R. R. and Agarwal, J. R. Observations on the newborn: A
study of 10,000 consecutive live births. Indian Pediatr 6: 729,
1969
Hemrajani, K.M., Ohri, U.K., Mehta, I.B. and Saxena, S.
Congenital malformations in newborn. Pediatr Clin 6:51,1971.
7.
8.
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10.
Ghosh, S. and Bali, L. Congenital malformations in the
newborn. Indian J Child Hlth 12: 448, 1963.
Nair, N.S. and Mathai, N.M. Congenital malformations in the (
newborn at Calicut—A preliminary report. Antiseptic 61:823,
1964.
Kolah, PJ„ Master, P.A. and Sanghvi, L.D. Congenital
malformations and perinatal mortality in Bombay. Am J Obstet
Gynecol 97: 400, 1967.
11.
Gupta, B.M., Mathur, H.C. and Sharda, D.C. A study of
congenital malformations in central Rajasthan (Ajmer). Arch
Child Hlth 13: 30, 1971.
12.
Dash Sharma, P. The incidence of major congenital
malformations in Mysore. Indian J Pediatr 37: 618. 1970.
13.
Tibrewala, N.S. and Pai, P.M. Congenital malformations in the
newborn period. Indian Pediatr 11:403, 1974.
14.
Mital. V.K. and Grewal, R.S. Congenital anomalies in
neonates. Indian J Pediatr 36: 356. 1969.
Saifullah, S., Chandra. R.K., Pathak. I.C. and Dhall. G.I.
Congenital malformations in newborn, A prospective longitudi
nal study—A preliminary report on 1000 consecutive births.
Indian Pediatr 4: 251, 1967.
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15.
16.
Khanna. K.K. and Prasad. L.S.N. Congenital malformations in
the newborn. Indian J Pediatr 34: 63. 1967.
17.
Singh. M. and Sharma, N.K. Spectrum of congenital
malformations in the newborn. Indian J Pediatr 47: 239, 1980.
18.
Singh. M., Jawadi, M.H.. Arya, L.S. and Fatima. Congenital
malformations at birth among live born infants in Afghanis
tan—A prospective study. Indian J Pediatr 49: 331, 1982.
19.
Chung, C.S. and Myrianthopoulos, N.C. Racial and prenatal
factors in major congenital malformations. Am J Hum Genet
20: 44, 1968.
20.
Neal, J.V. A study of major congenital defects in Japanese
infants. Am J Hum Genet 10: 398, 1958.
21.
Grewal, M.S., Sidhu, S.S. and Mehta, S. Genetic studies ofcleft
lip and palate in north Indian population. J Indian Orthod Soc
9: 15, 1978.
22.
23.
Grewal, M.S. and Sidhu, S.S. Risks of recurrence and ethnic
variations in cleft lip and palate anomaly. In: Medical Genetics
in India. (Vol.1), Eds. I.C. Verma and R.K. Puri. Auroma
Enterprises. Pondicherry, p.59, 1978.
Grewal, M.S. and Sidhu, S.S. Cleft lip and palate anomaly—A
genetic study. In: Proceedings oj International Symposium on
Recent Trends in Medical Genetics, (first -edition). Eds.
Marimuthu and P.M. Gopinath. Pergamon Press, Oxford,
p.155, 1986.
24.
Sidhu, S.S. and Grewal, M.S. Steroid therapy in pregnancy and
cleft lip ± palate anomaly. Indian Med Gazt 113: 78, 1979.
25.
Bergland. O. and Sidhu, S.S. Occlusal changes from the deci
duous to the early mixed dentition in unilateral complete clefts.
Clejt Palate J11: 317, 1974.
26.
Sidhu, S.S. and Bergland, O. Cranio-facial pattern in boys with
unilateral complete clefts at 10-12 years of age. Trans Eur
Orthod Soc 48: 159, 1972.
27.
Sidhu, S.S., Mehta, S. and Grewal, M.S. Changes in dental
arches of unoperated adult clefts. Eur J Orthod 4: 139, 1982.
28.
Sidhu, S.S. History of cleft lip and cleft palate management. J
Indian Orthod Soc 16: 16, 1986.
29.
Sidhu, S.S. and Deshmukh, R.N. Submucous cleft palate
anomaly in India—A hospital based study. J Pierre Fauchard
Acd 1:61, 1987.
This write-up is based on the M.N. Sen (1987) Oration (of ICMR)
delivered by Dr. S.S. Sidhu, Professor & Head, department of Dental
Surgery, All India Institute of Medical Sciences, New Delhi; at the
43rd Indian Dental Conference, Pune, (December 29, 1988).
ABSTRACTS
Some Projects Completed Recently
Immunobiological properties of mannophosphoinosi
tides of mycobacteria
The present investigation was undertaken to study
the immune responses (both humoral and cell mediated)
induced by mannophosphoinositides antigens of myco
bacteria; the role of these antigens in affording protec
tion against tuberculosis and the adjuvant effect of other
glycolipid antigens in enhancing the protective effect as
well as the mechanism of protection.
It was observed that mannophosphoinositides
(mannosides), isolated from M.tuberculosis H37Rv by
thin layer/dry column chromatography, induced signifi
cant humoral as well as cell mediated immune response
when injected subcutaneously in experimental animals
as mannoside-methylated bovine serum albumin (MBSA)
complexes emulsified with equal amounts of Freund’s
incomplete adjuvant. Immunisation with mannosideMBSA complexes elicited significant protection against
challenge with LDso dose of M.tuberculosis H37 Rv as
revealed by high survival rate, low values of root specific
lung weight, lung densities and colony forming units
recovered from lung, liver and spleen, as compared to
non-immunized group. These observations were further
substantiated by histopathological studies. The protec
tive immunity elicited by mannoside-MBSA complexes
against challenge with M.tuberculosis H37Rv was
mediated by the cooperation of T and B cells, as shown
by the passive transfer of immune cells/sera into syn
geneic sublethally irradiated recipient mice.
Combination of other glycolipids like cord blood
factor did not enhance the protective efficacy of
mannoside-MBSA complexes.
Although anti-mannoside antibodies did not induce
any protection in vivo but macromolecular biosynthesis
and growth of mycobacteria was partially inhibited in
presence of anti-mannoside antibodies in vitro.
P.K. Mehta
G.K. Khullar
Department of Biochemistry
Postgraduate Institute of Medical
Education and Research
Chandigarh.
Publications:
1.
Mehta. P.K. and Khullar. G.K. Protective immunity to experi
mental tuberculosis by mannophosphoinositides of mycobac
teria. Med Microbiol Immunol 177: 265. 1988.
2.
Mehta. P.K. and Khullar. G.K. Suppression of macromolecu
lar biosynthesis in M.tuberculosis Hu Rv by antimannophosphoinositides. FEMS Microbiol lett 51: 61. 1988.
Immunological profile of non-cirrhotic portal fibrosis
patients
The present investigation was carried out in 43
patients with non-cirrhotic portal fibrosis (NCPF) and
equal numbers of patients with compensated cirrhosis of
liver and healthy controls matched for age, sex and
139
socio-economic status, to study the cellular and humoral
immunity in NCPF patients and to see whether immu
nological mechanisms have a role in the pathogenesis of
NCPF.
Serum IgA and complement (C3,C4) levels were sig
nificantly lower in NCPF patients compared with con
trols and cirrhotics. There was no significant difference
between the total quantity as well as the relative concen
trations of the immunoglobulis and complements in the
circulating immune complexes between NCPF patients
and healthy controls, but in patients with cirrhosis con
centration of all the immunoglobulins was higher.
difference from cirrhotics and controls was not signifi
cant. A decrease in the suppressor/cytotoxic (Ta) pheno
type of lymphocytes in the peripheral blood and an
increase in the ratio of helper/inducer (T4) and Ts lym
phocytes was seen in NCPF and cirrhotic patients.
NCPF patients had a significantly higher frequency of
malarial antibody positivity and the antibody titres were
significantly higher as compared to controls. Though
the results indicate definite immunological abnormali
ties in NCPF patients, their role in the pathogenesis of
NCPF remains obscure.
S.K. Sarin
Department of Gastroenterology*
G.B. Pant Hospital
New Delhi
The cutaneous response, to dinitrochlorobenzene
was comparatively poor in NCPF patients, however, the
ICMR NEWS
Meetings of the following Project Review
Committees (PRCs)/Expert Group (EG) of the Council
were held at New Delhi during the month:
PRC on Cholera and
Enteric Diseases
December 12, 1989
PRC on Environmental &
Occupational Health,
Biomedical Engineering, Mental
Health, Neurology, and
Accident, Disability and
Rehabilitation
December 12, 1989
EG of the Task Force
Project on Feasibility
Module for Dental Carries
December 14, 1989
PRC on Pharmacology
December 14, 1989
PRC on Malaria, Filariasis
and Kala-azar
December 14, 1989
***
***
Dr. Usha K. Luthra, Addl. Director-General,
ICMR, delivered the Sixth Annual State Bank of India
Lecture on “Road Traffic Injuries and Deaths in India”,
at New Delhi (December 1, 1989).
Dr. Kalyan Banerjee, Director, National Institute of
Virology, Pune, visited Thailand, South Korea and
Japan to study the Control Measures of Japanese
Encephalitis (December 4-24, 1989).
***
An Indo-US Workshop on Major Advances in
Tuberculosis Research was held at Madras (December 47, 1989).
The first ICMR Workshop on Preparation of
“Good Research Proposals'1 for submission to various
research funding agencies was held one day prior to the
XXII Annual Conference of Indian Pharmacological
Society,at Calcutta (December 28, 1989).
Participation of ICMR Scientists in Scientific Events:
Dr. S.P. Tripathy, Addl. Director-General, ICMR,
participated in the Annual Conference of the Indian
140
Society of Haematology and Blood Transfusion, at
Berhampur (December 1-3, 1989).
Dr. Tripathy participated in the Joint Indo-US
Workshop on Major Advances in Tuberculosis Research
and chaired a Scientific Session, at Madras (December 47, 1989). He also participated in a Workshop on AIDS, at
Chandigarh (December 13-15, 1989).
Dr. M.D. Gupte, Dy. Director, CJIL Field Unit for
Epidemiology of Leprosy, Avadi, Madras, took up an
assignment as a Short-term WHO Consultant on
Epidemiology of Leprosy, at Seoul, South Korea
(December 10-22, 1989).
Dr. S.P. Pani, Asstt. Director, Vector Control
Research Centre, Pondicherry and Dr. V. Kumaraswami, Senior Research Officer, Tuberculosis Research
Centre, Madras, participated in a Workshop on DNA
Diagnostics and Filariasis, at Jakarta (December 18-20,
1989).
Dr. Luthra delivered the Keynote address on “Risk
Factors Associated with Biological Behaviour of
Precancerous Lesion of Uterine Cervix”, at the XII
Annual Cell Biology Conference, at Hyderabad
(December 27, 1989).
ICMR AIDED SYMPOSIA/SEMINARS/WORKSHOPS/COURSES/CONFERENCES
Symposium/Seminar/ Workshop/
Course/ Conference
Date & Place
Contact Address
IV Workshop and Technology Transfer
Programme on Head and Neck Cancer.
December 2-6, 1989;
Bombay
Seminar on Biochemistry and Modern Bio
logy.
December 4-14, 1989;
Lakshadweep
ference.
Workshop on Paediatric Urological Re
constructive Surgery.
December 23-25, 1989;
Chandigarh
/
Dr. S.K. Mitra, Professor & Head, Department of
Paediatric Surgery, Postgraduate Institute of Medi
cal Education and Research, Chandigarh.
Symposia on Cytogenetics; Plant Cell Bio
logy; Mammalian Systems; and Microbial
Systems, and Annual Meeting of the Indian
Society of Cell Biology.
December 27-29, 1989;
Hyderabad
Dr. M.R. Das, Deputy Director, Centre for Cellular
and Molecular Biology, Hyderabad.
XXXIII All India Obstetric and Gynaecologi
cal Congress.
December 28-30, 1989;
Patna
Dr. J. Mishra, Department of Obstetrics and Gynaecology. Hospital for Women, Patna Medical College,
Patna.
Symposium on Current Advances in Mole- *
cular Biochemistry: Applications in Health,
Environment, and Agriculture.
December 28-31, 1989;
Lucknow
Dr. G.G. Sanwal, Professor and Head, Department
of Biochemistry, Lucknow University, Lucknow.
Ill International Congress on Traditional
Asian Medicine.
January 4-7, 1990;
Bombay
Dr. K.M. Parikh, Chairman, Organising Committee,
III International Congress on Traditional Asian
Medicine, C/o Zandu Pharmaceutical Works Ltd.,
Dadar, Bombay.
International Symposium on Updates in Viral
Hepatitis.
January 9, 1990;
Madras
Dr. S.P. Thyagarajan. Professor and Head.
Department of Microbiology, ALM Postgraduate
Institute of Basic Medical Sciences, Madras.
Seminar on Indian Speech, Language and
Hearing Tests—the proposed IS HA battery.
February 8-9, 1990;
New Delhi
Dr. S.K. Kacker, Professor & Head, Department of
Otorhinolaryngology, All India Institute of Medical
Sciences, New Delhi.
National Symposium on Application of Re
combinant DNA Technology in Disease
Diagnosis.
March 23-25. 1990;
Hyderabad
Prof. P.P. Reddy, Director, Institute of Genetics
and Hospital for Genetic Diseases, Osmania Univer
sity, Hyderabad.
IV National Conference on Biomaterials and
Artificial Organs.
April 13-14, 1990;
Hyderabad
Dr. Prabha R. Chatterjee, Scientist. Room No.247,
Organic Coatings and Polymer Division, Indian
Institute of Chemical Technology, Hyderabad.
Dr. Ashok R. Mehta, President, Indian Society of
Head and Neck Oncology, and Surgeon & Chief of
Head and Neck Service "C", Tata Memorial
Hospital, Bombay.
Prof. S.P. Modak, Convenor, Guha Research ConDepartment of Zoology, University of
Poona, Pune.
COUNCIL’S TRAINING PROGRAMMES
Nutrition
Haematology
At the National Institute of Nutrition, Hyderabad:
At the Institute of Immunohaematology, Bombay:
Annual Certificate Course in Nutrition (December
1, 1989 to February 28, 1990).
Laboratory Course on
(April 9-20. 1990).
Anti-nuclear Antibody
COMMUNITY HEALTH CELL
326, V Mrin, 1 Block
141
SOME AVAILABLE ICMR PUBLICATIONS
Price
Rs.
Growth & Physical Development of Indian Infants and Children (1972), Reprinted 1989
10.00
Studies on Weaning & Supplementary Foods (1974), Reprinted 1984
6.00
Studies on Pre-School Children (1974), Reprinted 1984
6.00
A Manual of Nutrition (1973), Second Edition 1974, Reprinted 1984
2.50
Low Cost Nutritious Supplements (1972), Second Edition 1975, Reprinted 1977
1.50
Menus for Low Cost Balanced Diets and School Lunch Programmes Suitable for South India
(1959), Third Edition 1977, Reprinted 1984
2.00
Menus for Low Cost Balanced Diets and School Lunch Programmes Suitable for North India
(1959), Third Edition 1977, Reprinted 1984
2.00
Some Common Indian Recipes and their Nutritive Value (1964), Fourth Edition 1977,
Reprinted 1984, by Swaran Pasricha and L.M. Rebello
6.00
Nutrition for Mother & Child (1962), Third Edition 1978, Reprinted 1983, by P.S. Venkatachalam
and L.M. Rebello
5.00
Japanese Encephalitis in India (Revised Edition 1980)
5.00
Some Therapeutic Diets (1969), Fourth Edition 1981, Reprinted 1983, Revised 1988,
by Swaran Pasricha
2.00
Recommended Dietary Intakes for Indians (1981), Reprinted 1984
4.60
Lathyrism: A Preventable Paralysis (Revised Edition 1983)
1.50
A Manual of Laboratory Techniques (1983), Edited by N. Raghuramulu, K. Madhavan Nair
and S. Kalyanasundaram
30.00
Fruits (1983), by Indira Gopalan and M. Mohan Ram
2.50
Count What You Eat (1989), by Swaran Pasricha
4.50
The Anophelines of India (Revised Edition 1984), by T. Ramachandra Rao
150.00
Depressive Disease (1986), by A. Venkoba Rao
58.00
Medicinal Plants of India, Vol. 2 (1987)
136.00
Unpriced Publications
(for limited distribution)
Collaborative Study on Short-term Sequelae of Induced Abortion (1981)
Proceedings of the Indo-UK Workshop on Leishmaniasis. (1983)
Peoples of India—Some Genetic Aspects (1983)
Management of Acute Diarrhoea (1985)
Plague Conquest and Eradication in India (1987) by S.C. Seal
Laboratory Manual for the Diagnosis of Haemophiloid Disorders (1989),
by Manorama Bhargava and Dinesh Jain
These publications are available on prepayment of cost by cheque or postal order (bank and postal charges will be extra) drawn in favour of the
Director-General, Indian Council of Medical Research, New Delhi. Money orders are not acceptable. All correspondence in this regard should
be addressed to the Chief, Division of Publication and Information, Indian Council of Medical Research, Post Box No.4508, Ansari Nagar,
New Delhi-110029.
142
Some available publications of the Institute of Immunohaemstology, Bombay
Techniques in Blood Banking, by H.M. Bhatia
Price
Rs.
12.00
Genetic Atlas of the Indian Tribes, by H.M. Bhatia and V.R. Rao
125.00
These publications are available on prepayment of cost by money order or bank drakt, from Director, Institute of
Immunohaematology, 13th floor, New Multistoreyed Complex, KEM Hospital Campus, Parel, Bombay-400012.
INDIAN COUNCIL OF MEDICAL RESEARCH
International Research Fellowships of National Institutes of Health(USA)
Applications (on prescribed form) are invited from candidates for award of
International Research Fellowships of the National Institutes of Health, USA for specialised
training in that country.
ELIGIBILITY REQUIREMENTS
To be eligible for an International Research Fellowship, an applicant must:
1.
hold an earned doctoral degree (PhD, MD, DO, DDS, DVM, OD, DPM, SeD, EngD,
Dr PH, or DNS) or the equivalent in a health science field at the time of submission of
an application to the Nominating Committee;
2.
have earned the doctoral degree within 10 years of the application receipt date (should
have received their doctoral degree on August 1, 1980 or thereafter);
3.
have demonstrated the ability to engage in independent basic or clinical research;
4.
submit a research proposal in an area of one of the biomedical or behavioural sciences;
5.
have a sponsor in the United States at a nonprofit institution who has agreed to accept
the applicant for research on the applicant’s proposed project;
6.
have assurance from a nonprofit institution in the home country that there is a position
to which the applicant can return after completion of the fellowship;
7.
be proficient in spoken and written English;
8.
should not have been in the United States on J-1 visa for more than two months if they
apply for a two year fellowship or for more than 14 months if they apply for a one year
fellowship;
9.
not be a US citizen or a permanent US resident.
Application forms and details of the fellowship can be obtained before February 20,
1990 from the Director-General, Indian Council of Medical Research (Room No.406), Post
Box No.4508, Ansari Nagar, New Delhi 110029. The last date for receipt of completed
application form by ICMR is March 5, 1990. Application forms received after the closing
date will not be considered.
___________ _ ____________________ __ _____________________________________ I
143
ICMR BULLETIN SUBJECT INDEX
Vol. 19, 1989
Main Feature
Page No.
Month
A Study on Mental Health Care of the Aged
1
January
Recent Advances in Serodiagnosis of Tuberculosis
11
February
Highlights of ICMR Research on Communicable Diseases (1987-88)
Part 1
21
March
Highlights of ICMR Research on Communicable Diseases (1987-88)
Part II
37
April
&
49
May
Highlights of ICMR Research on Noncommunicable Diseases (1987-88)
61
June
ELISA for the Detection of Cell Membrane Antigens of Spermatozoa
73
July
Intravenous Immunoglobulin Therapy in the Treatment of Idiopathic
Thrombocytopaenic Purpura
83
August
Immunology of Solid Tumours and Premalignant Lesions
91
September
Training of Non-Psychiatrist Primary Care Doctors in Psychiatry
103
October
HIV Infection—ongoing Studies and Future Research Plans
115
November
Speech Rehabilitation by Late Surgical Repair in Children with Cleft Lip
and Palate Anomaly
135
December
Highlights of ICMR Research
Contraception (1987-88)
on
Reproductive
Biology
EDITORIAL BOARD
Chairman
Dr. A.S. Paintai
Director-General
Chief, Publications
Dr. G.V. Satyavati
Members
Dr. Usha K. Luthra
Dr. Badri N. Saxena
Dr. S.P. Tripathy
Editor
Dr. N. Medappa
Printed and Published by Shri G.P. Kulshreshth for the Indian Council of Medical Research, New Delhi
at the ICMR Offset Press, New Delhi
R.N. 21813/71
4
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