Premature epiphyseal closure in an adolescent treated by retinoids for acne: an unusual cause of anterior knee pain.

Retinoids are effective and widely prescribed in the treatment of severe acne. However their use can be associated with numerous side effects. Some rare cases of premature epiphyseal closure were reported. We present the case of a sixteen-year-old soccer player referred for progressive anterior pain in both knees, evoking a patellar problem. Careful pharmacological questioning revealed use of isotretinoin for several months. MRI findings showed an irregularity of the growth plate and an important metaphyso-epiphyseal oedema, more noticeable in the left knee. Retinoid-induced premature epiphyseal closure was diagnosed. The treatment was stopped, with a resolution of pain within two months. After recovery a persisting small sequelar thumbprint-like growth plate lesion was observed on the control MRI. Retinoids induce an invasion of the growth plate by osteoclasts and a decrease in proteoglycans synthesis. It seems that the knee is the most affected joint. This complication being rare, a radiological follow-up of the young patients treated by retinoids is not proposed.

Four whole-istic aspects of schistosome granuloma biology: fractal arrangement, internal regulation, autopoietic component and closure

This paper centers on some whole-istic organizational and functional aspects of hepatic Schistosoma mansoni granuloma, which is an extremely complex system. First, it structurally develops a collagenic topology, originated bidirectionally from an inward and outward assembly of growth units. Inward growth appears to be originated from myofibroblasts derived from small portal vessel around intravascular entrapped eggs, while outward growth arises from hepatic stellate cells. The auto-assembly of the growth units defines the three-dimensional scaffold of the schistosome granulomas. The granuloma surface irregularity and its border presented fractal dimension equal to 1.58. Second, it is internally regulated by intricate networks of immuneneuroendocrine stimuli orchestrated by leptin and leptin receptors, substance P and Vasoactive intestinal peptide. Third, it can reach the population of ± 40,000 cells and presents an autopoietic component evidenced by internal proliferation (Ki-67+ Cells), and by expression of c-Kit+ Cells, leptin and leptin receptor (Ob-R), granulocyte-colony stimulating factor (G-CSF-R), and erythropoietin (Epo-R) receptors. Fourth, the granulomas cells are intimately connected by pan-cadherins, occludin and connexin-43, building a state of closing (granuloma closure). In conclusion, the granuloma is characterized by transitory stages in such a way that its organized structure emerges as a global property which is greater than the sum of actions of its individual cells and extracellular matrix components.

The expansion of 300 CTG repeats in myotonic dystrophy transgenic mice does not induce sensory or motor neuropathy.

Although many studies have been carried out to verify the involvement of the peripheral nervous system (PNS) in dystrophia myotonica (DM1) patients, the results remain controversial. The generation of DM1 transgenic mice displaying the human DM1 phenotype provides a useful tool to investigate the type and incidence of structural abnormalities in the PNS. In the present study, the morphological and morphometric analysis of semi-thin sections of sciatic and sural nerves, lumbar dorsal root ganglia (DRG) and lumbar spinal cords revealed that in DM1 transgenic mice carrying 300 CTG repeats, there is no change in the number and diameter of myelinated axons compared to wild type. Only a non-significant reduction in the percentage of thin myelinated axons was detected in electron micrographs of ultra-thin sciatic nerve sections. Analysis of the number of neurons did not reveal a loss in number of either sensory neurons in the lumbar DRG or motor neurons in the lumbar spinal cord in these DM1 mice. Furthermore, in hind limb muscle sections, stained with a neurofilament antibody and alpha-bungarotoxin, the intramuscular axon arborization appeared normal in DM1 mice and undistinguishable from that in wild-type mice. Moreover, in DM1 mice, there was no irregularity in the structure or an increase in the endplate area. Also statistical analysis did not show an increase in endplate density or in the concentration of acetylcholine receptors. Altogether, these results suggest that 300 CTG repeats are not sufficient to induce axonopathy, demyelination or neuronopathies in this transgenic mouse model.

Distribuição Espacial da Susceptibilidade à Erosão Hídrica nas Bacias das Ribeiras de Picos e Seca (Santiago, Cabo Verde)

Os processos de erosão hídrica em Cabo Verde são os mais marcantes da dinâmica actual das vertentes, pois são os mais comuns e que afectam áreas extensasdurante a curta estação húmida de três meses. A ocorrência de episódios chuvosos concentrados no tempo e com uma evidente irregularidade espacial permitem umaacentuada erosividade das precipitações, marcada por uma forte irregularidade regional. A forte variabilidade das formas de relevo, a diversidade da natureza das unidadesgeológicas e a multiplicidade de ocupação do solo favorecem condições deerodibilidade muito contrastadas no espaço. O objectivo deste trabalho é estabelecer um modelo desusceptibilidade à erosão hídricaem função de factores geomorfológicos (declive, perfil e traçado das vertentes eerodibilidade das unidades litológicas e dos materiais de cobertura), climáticos(intensidade pluviométrica) e de ocupação do solo para as bacias das ribeiras dos Picose Seca. Os resultados foram obtidos com recurso ao ambiente de Sistemas deInformação Geográfica (SIG). Este trabalho surge na sequência de outros já realizadospelos autores, onde se apresentaram as condições de erodibilidade e erosividade paraáreas mais restritas da Ilha de Santiago. O modelo de susceptibilidade à erosão hídrica resultou do cruzamento dos mapas dedeclives, de perfil e do traçado das vertentes, obtidos a partir do modelo digital deterreno (DTM), do mapa geológico, da distribuição espacial da intensidadepluviométrica e da densidade de ocupação do solo, tendo em conta que são estas asprincipais condicionantes de erosão hídrica, referidas pelos autores que estudaram estaregião. Cada um destes mapas foi reclassificado com base numa análise qualitativa dograu de erodibilidade, sendo atribuído um número de ordem a cada classe, em função da sua susceptibilidade à erosão hídrica, conforme foi localmente reconhecido. Verifica-se que as áreas de maior susceptibilidade à erosão hídrica são as do sectorsudeste da bacia da Ribeira Seca e as vertentes dos principais vales da bacia da Ribeira dos Picos, onde se encontram as unidades geológicas mais friáveis, os declives mais acentuados e onde predominam sectores das vertentes de traçado côncavo, a que seassocia pontualmente a mais elevada intensidade pluviométrica.

Reconstruction of metal pollution and recent sedimentation processes in Havana Bay (Cuba): A tool for coastal ecosystem management.

Since 1998 the highly polluted Havana Bay ecosystem has been the subject of a mitigation program. In order to determine whether pollution-reduction strategies were effective, we have evaluated the historical trends of pollution recorded in sediments of the Bay. A sediment core was dated radiometrically using natural and artificial fallout radionuclides. An irregularity in the (210)Pb record was caused by an episode of accelerated sedimentation. This episode was dated to occur in 1982, a year coincident with the heaviest rains reported in Havana over the XX century. Peaks of mass accumulation rates (MAR) were associated with hurricanes and intensive rains. In the past 60 years, these maxima are related to strong El Niño periods, which are known to increase rainfall in the north Caribbean region. We observed a steady increase of pollution (mainly Pb, Zn, Sn, and Hg) since the beginning of the century to the mid 90s, with enrichment factors as high as 6. MAR and pollution decreased rapidly after the mid 90s, although some trace metal levels remain high. This reduction was due to the integrated coastal zone management program introduced in the late 90s, which dismissed catchment erosion and pollution.

Premature epiphyseal closure in an adolescent treated by retinoids for acne: An unusual cause of anterior knee pain

Introduction.- Retinoids are effective and widely used for the treatment of severe acne. Their use can be, however, associated with numerous side effects. For example, some rare cases of premature epiphyseal closure were reported.Observation.- A sixteen-year-old soccer player consulted for bilateral progressive anterior knee pain, since two months, evoking a femoro-patellar origin. After physiotherapy, the pain decreases on the right but remained on the left. The history taking brought out the use of isotretinoin for more than 6 months (0.5 mg/kg). Magnetic resonance imaging (MRI) findings showed an irregularity of the growth plate and an important metaphyso-epiphyseal oedema, more marked on the left. The diagnosis of retinoid induced premature ephysieal closure was retained. The treatment was stopped, with a resolution of symptoms within two months. The control MRI of the left knee present persisting small sequelar thumbprint-like growth plate lesion. Eighteen months later, neither limb-length discrepancy nor static disorder was noticed.Discussion.- Premature epiphyseal closure is a rare complication of retinoid treatment of acne. Retinoids induce an invasion of the growth plate by osteoclasts and a decrease in proteoglycans synthesis. The knee seems the most involved joint. The clinical presentation is aspecific, sometimes lightly symptomatic. A careful pharmacological history and an appropriate imaging are necessary. MRI is now the gold standard. It shows an irregularity of the growth plate with an oedema on both sides. In chronic phase, a thumbprint-like image may persist. The symptoms resolution arises in few weeks after the treatment interruption. A single case of static disorder was reported until now. The small size of the growth plate interruptions, insufficient to lead to a growth disorder if the medicament is stopped early enough, explains probably it. This complication being rare, a radiological follow-up of the young patients treated by retinoids is not proposed.

Label-free detection of tobramycin in serum by transmission-localized surface plasmon resonance.

In order to improve the efficacy and safety of treatments, drug dosage needs to be adjusted to the actual needs of each patient in a truly personalized medicine approach. Key for widespread dosage adjustment is the availability of point-of-care devices able to measure plasma drug concentration in a simple, automated, and cost-effective fashion. In the present work, we introduce and test a portable, palm-sized transmission-localized surface plasmon resonance (T-LSPR) setup, comprised of off-the-shelf components and coupled with DNA-based aptamers specific to the antibiotic tobramycin (467 Da). The core of the T-LSPR setup are aptamer-functionalized gold nanoislands (NIs) deposited on a glass slide covered with fluorine-doped tin oxide (FTO), which acts as a biosensor. The gold NIs exhibit localized plasmon resonance in the visible range matching the sensitivity of the complementary metal oxide semiconductor (CMOS) image sensor employed as a light detector. The combination of gold NIs on the FTO substrate, causing NIs size and pattern irregularity, might reduce the overall sensitivity but confers extremely high stability in high-ionic solutions, allowing it to withstand numerous regeneration cycles without sensing losses. With this rather simple T-LSPR setup, we show real-time label-free detection of tobramycin in buffer, measuring concentrations down to 0.5 μM. We determined an affinity constant of the aptamer-tobramycin pair consistent with the value obtained using a commercial propagating-wave based SPR. Moreover, our label-free system can detect tobramycin in filtered undiluted blood serum, measuring concentrations down to 10 μM with a theoretical detection limit of 3.4 μM. While the association signal of tobramycin onto the aptamer is masked by the serum injection, the quantification of the captured tobramycin is possible during the dissociation phase and leads to a linear calibration curve for the concentrations over the tested range (10-80 μM). The plasmon shift following surface binding is calculated in terms of both plasmon peak location and hue, with the latter allowing faster data elaboration and real-time display of the results. The presented T-LSPR system shows for the first time label-free direct detection and quantification of a small molecule in the complex matrix of filtered undiluted blood serum. Its uncomplicated construction and compact size, together with the remarkable performances, represent a leap forward toward effective point-of-care devices for therapeutic drug concentration monitoring.

Sharp mandibular bone irregularities after lower third molar extraction: Incidence, clinical features and risk factors

Objectives: The purpose of this study was to determine the incidence and clinical symptoms associated with sharp mandibular bone irregularities (SMBI) after lower third molar extraction and to identify possible risk factors for this complication. Study Design: A mixed study design was used. A retrospective cohort study of 1432 lower third molar extractions was done to determine the incidence of SMBI and a retrospective case-control study was done to determine potential demographic and etiologic factors by comparing those patients with postoperative SMBI with controls. Results: Twelve SMBI were found (0.84%). Age was the most important risk factor for this complication. The operated side and the presence of an associated radiolucent image were also significantly related to the development of mandibular bone irregularities. The depth of impaction of the tooth might also be an important factor since erupted or nearly erupted third molars were more frequent in the SMBI group. Conclusions: SMBI are a rare postoperative complication after lower third molar removal. Older patients having left side lower third molars removed are more likely to develop this problem. The treatment should be the removal of the irregularity when the patient is symptomatic

Distribuição dos Hydrozoa até agora conhecidos nas costas do Brasil

This work was done with the aim of computing all the species of Hydrozoa (Siphonophora excluded) that have been collected on the Brazilian coast, or in the pelagial, near the coast (some of the "Meteor" Stations). Nutting's (1900, 1904, 1915) and Mayer's (1910) monographs were taken as starting points and later papers and the Zoological Record used to check posterior findings. As a whole, 116 different valid names, among species and forms, have been mentioned from the Brazilian coast, distributed among 60 genera. Of the 116 species, 82 are represented by hydropolyps, 30 by hydromedusae (11 of which belong to the Trachylina and therefore lack a polypoid generation) and finally, by 4 species of which are known both polypoid and medusoid generations. The subdivision of the coast has been made at random, on account of the scarcity of the findings, except for the best known district, that goes from the latitude of Vitoria (State of Espirito Santo, at about 20ºlat.S.) to the bay of Santos (State of São Paulo, about 24ºlat.S.). The latitude of Cabo Frio (23ºlat.S.) was considered as a possible natural barrier, and the results of the global counting of the distribution of the hydropolyps North and South of 23ºlat.S. is the following: 29 species are known only North of Cabo Frio, 26 only from the same latitude (see direction of the coast, along parallel 23ºS.) or further South and 28 species are known both North and South of the coast (of these, 5 species are "cosmopolitan"). Therefore it seems quite possible that Cabo Frio really is a barrier to the distribution of 55 species. 26 species are endemic to the Brazilian coast, of these, only 5 are found both North and South of the Cape, while-14 are found only North and 7 only South. No studies can be done, on the bathymetric distribution in relation to the latitude. These results must be considered as provisory since more extensive researches will probably alter these figures. However, I believe that they are significative as a mean index of the condition of the hydrozoan fauna of the Brazilian coast. A tentative working hypothesis is presented as to the possible factors that confer such a zoogeographic importance to the region of Cabo Frio, a fact that has been foreseen by Ekman (1935, p. 73). Geographic position, currents, latitude and nature of the sea bottom between the continent and the oceanic island of Trindade have been taken in consideration, and all of them seem to be possible eficient factors of separation. Furthermore, according to the data obtained by the "Meteor" Expedition in July 2, 1926, at station 164 (23º8'lat.S. - 42º5'long.W.) and station 165 (23º35'lat.S. - 40º52'long.W.) and by what is known by hearsay and local experience of the region (exact continued study is urgently needed), it seems possible that, off from the sharp curve that the coast has at Cabo Frio, there may be an irregularity of the general scheme of the current and local upwelling may be present that would explain the local low temperature, low salinity and high density of the superficial layers as well as the abundance of fishes; these factors might contribute towards the establishement of a zoogeographical barrier. Further work is needed and nothing more than an hypothesis can be presented for the moment.

Asiantuntijapalveluiden kehittäminen isännöintialan yrityksessä

Isännöintiala on tämän päivän Suomessa yhä suurempien haasteiden edessä asiakkaiden ja yhteiskunnan asettamien vaatimusten kasvaessa mutta samalla käytössä olevien resurssien niukentuessa. Tämä työ toimii osana kokonaisvaltaisempaa asiantuntijapalveluprosessien kehittämiseen keskittyvää projektia, jonka keskipisteessä ovat isännöintipalvelut ja niiden kehittäminen kohdeyrityksen tarpeiden mukaisesti. Diplomityössä keskitytään isännöintipalveluiden kehittämiseen palveluiden paketoimisen ja hinnoittelun sekä asiakassegmentoinnin näkökulmasta. Työn tavoitteena oli löytää uusia ratkaisumalleja vastaamaan kohdeyrityksen tulevaisuuden tavoitteisiin samalla huomioiden toimintaympäristön muuttuvat tarpeet. Projekti jakautui kahteen osaan; nykytila-analyysiin ja sen pohjalta rakennettaviin ratkaisuehdotuksiin. Nykytila-analyysin avulla haluttiin löytää nykyisen toiminnan keskeisimmät ongelmakohdat, joihin haettiin sittemmin ratkaisua palveluiden uudelleenpaketoimisen myötä. Merkittävimpiä havaittuja ongelmatekijöitä olivat työn kuormittavuuden epätasainen jakautuminen ja se, ettei kuormittavuutta huomioitu tavassa tuottaa tai hinnoitella palveluita. Kuormittavuuden epätasainen jakautuminen otettiin lähtökohdaksi asiakassegmentoinnin ja palveluiden uudelleenpaketoinnin toteuttamisessa.

Linear and nonlinear analysis of heart rate variability in healthy subjects and after acute myocardial infarction in patients

The objectives of this study were to evaluate and compare the use of linear and nonlinear methods for analysis of heart rate variability (HRV) in healthy subjects and in patients after acute myocardial infarction (AMI). Heart rate (HR) was recorded for 15 min in the supine position in 10 patients with AMI taking β-blockers (aged 57 ± 9 years) and in 11 healthy subjects (aged 53 ± 4 years). HRV was analyzed in the time domain (RMSSD and RMSM), the frequency domain using low- and high-frequency bands in normalized units (nu; LFnu and HFnu) and the LF/HF ratio and approximate entropy (ApEn) were determined. There was a correlation (P < 0.05) of RMSSD, RMSM, LFnu, HFnu, and the LF/HF ratio index with the ApEn of the AMI group on the 2nd (r = 0.87, 0.65, 0.72, 0.72, and 0.64) and 7th day (r = 0.88, 0.70, 0.69, 0.69, and 0.87) and of the healthy group (r = 0.63, 0.71, 0.63, 0.63, and 0.74), respectively. The median HRV indexes of the AMI group on the 2nd and 7th day differed from the healthy group (P < 0.05): RMSSD = 10.37, 19.95, 24.81; RMSM = 23.47, 31.96, 43.79; LFnu = 0.79, 0.79, 0.62; HFnu = 0.20, 0.20, 0.37; LF/HF ratio = 3.87, 3.94, 1.65; ApEn = 1.01, 1.24, 1.31, respectively. There was agreement between the methods, suggesting that these have the same power to evaluate autonomic modulation of HR in both AMI patients and healthy subjects. AMI contributed to a reduction in cardiac signal irregularity, higher sympathetic modulation and lower vagal modulation.

The impact of drug-induced dyskinesias on rapid alternating movements in patients with Parkinson's disease

We investigated the likelihood that hypokinesia/bradykinesia coexist with druginduced dyskinesias (DID) in patients with Parkinson's disease (PD). The influence of dyskinesias on rapid alternating movements (RAM) was investigated in ten dyskinetic patients (DPD). Their motor performance was compared to that of ten age/gendermatched non-dyskinetic patients (NDPD) and ten healthy control subjects. Whole-body magnitude (WBM) and fast pronation-supination at the wrist were recorded using 6- degrees of freedom magnetic motion tracker and forearm rotational sensors, respectively. Subjects were asked to pronate-supinate their dominant hand for 10s. Pre- and postmeasures were taken in a neutral position for 20s. RANGE (measure of hypokinesia), DURATION (measure of bradykinesia). VELOCITY (measure of bradykinesia) and IRREGULARITY (measure of fluctuations in movement amplitude) were used to assess RAM performance. Results showed that DPD patients had greater WBM than NDPD and control groups during rest and RAM performance. There were no differences in performance between NDPD and DPD groups for RANGE, DURATION and VELOCITY, despite significant longer disease duration for the DPD group (DPD = 15.5 ± 6.2 years versus NDPD = 6.6 ± 2.6 years). However, both the NDPD and DPD groups showed lower RANGE, longer DURATION, and reduced VELOCITY compared to controls,, suggesting the presence of bradykinesia and hypokinesia. In the case of IRREGULARITY, DPD patients showed clear fluctuations in movement amplitude compared to the NDPD and control groups. However, the lack of correlation between WBM and IRREGULARITY within the DPD group (Spearman's rank order, Rho - 0.31, p > 0.05), suggests that DID was not the primary cause of the fluctuating movementamplitude observed in that group. In conclusion, these findings suggest that DID may coexists with bradykinesia and hypokinesia, but that they are not inevitably accompanied with worsening motor performance.

Limited sampling strategies for estimation of cyclosporine exposure in pediatric hematopoietic stem cell transplant recipients : methodological improvement and introduction of sampling time deviation analysis.

Le suivi thérapeutique est recommandé pour l’ajustement de la dose des agents immunosuppresseurs. La pertinence de l’utilisation de la surface sous la courbe (SSC) comme biomarqueur dans l’exercice du suivi thérapeutique de la cyclosporine (CsA) dans la transplantation des cellules souches hématopoïétiques est soutenue par un nombre croissant d’études. Cependant, pour des raisons intrinsèques à la méthode de calcul de la SSC, son utilisation en milieu clinique n’est pas pratique. Les stratégies d’échantillonnage limitées, basées sur des approches de régression (R-LSS) ou des approches Bayésiennes (B-LSS), représentent des alternatives pratiques pour une estimation satisfaisante de la SSC. Cependant, pour une application efficace de ces méthodologies, leur conception doit accommoder la réalité clinique, notamment en requérant un nombre minimal de concentrations échelonnées sur une courte durée d’échantillonnage. De plus, une attention particulière devrait être accordée à assurer leur développement et validation adéquates. Il est aussi important de mentionner que l’irrégularité dans le temps de la collecte des échantillons sanguins peut avoir un impact non-négligeable sur la performance prédictive des R-LSS. Or, à ce jour, cet impact n’a fait l’objet d’aucune étude. Cette thèse de doctorat se penche sur ces problématiques afin de permettre une estimation précise et pratique de la SSC. Ces études ont été effectuées dans le cadre de l’utilisation de la CsA chez des patients pédiatriques ayant subi une greffe de cellules souches hématopoïétiques. D’abord, des approches de régression multiple ainsi que d’analyse pharmacocinétique de population (Pop-PK) ont été utilisées de façon constructive afin de développer et de valider adéquatement des LSS. Ensuite, plusieurs modèles Pop-PK ont été évalués, tout en gardant à l’esprit leur utilisation prévue dans le contexte de l’estimation de la SSC. Aussi, la performance des B-LSS ciblant différentes versions de SSC a également été étudiée. Enfin, l’impact des écarts entre les temps d’échantillonnage sanguins réels et les temps nominaux planifiés, sur la performance de prédiction des R-LSS a été quantifié en utilisant une approche de simulation qui considère des scénarios diversifiés et réalistes représentant des erreurs potentielles dans la cédule des échantillons sanguins. Ainsi, cette étude a d’abord conduit au développement de R-LSS et B-LSS ayant une performance clinique satisfaisante, et qui sont pratiques puisqu’elles impliquent 4 points d’échantillonnage ou moins obtenus dans les 4 heures post-dose. Une fois l’analyse Pop-PK effectuée, un modèle structural à deux compartiments avec un temps de délai a été retenu. Cependant, le modèle final - notamment avec covariables - n’a pas amélioré la performance des B-LSS comparativement aux modèles structuraux (sans covariables). En outre, nous avons démontré que les B-LSS exhibent une meilleure performance pour la SSC dérivée des concentrations simulées qui excluent les erreurs résiduelles, que nous avons nommée « underlying AUC », comparée à la SSC observée qui est directement calculée à partir des concentrations mesurées. Enfin, nos résultats ont prouvé que l’irrégularité des temps de la collecte des échantillons sanguins a un impact important sur la performance prédictive des R-LSS; cet impact est en fonction du nombre des échantillons requis, mais encore davantage en fonction de la durée du processus d’échantillonnage impliqué. Nous avons aussi mis en évidence que les erreurs d’échantillonnage commises aux moments où la concentration change rapidement sont celles qui affectent le plus le pouvoir prédictif des R-LSS. Plus intéressant, nous avons mis en exergue que même si différentes R-LSS peuvent avoir des performances similaires lorsque basées sur des temps nominaux, leurs tolérances aux erreurs des temps d’échantillonnage peuvent largement différer. En fait, une considération adéquate de l'impact de ces erreurs peut conduire à une sélection et une utilisation plus fiables des R-LSS. Par une investigation approfondie de différents aspects sous-jacents aux stratégies d’échantillonnages limités, cette thèse a pu fournir des améliorations méthodologiques notables, et proposer de nouvelles voies pour assurer leur utilisation de façon fiable et informée, tout en favorisant leur adéquation à la pratique clinique.

Social Structural Determinants of Education among Tribes in Kerala

The study is focused on education of tribes particularly the problem of high dropout rate existing among the tribal students at school level. Scheduled Tribe is one of the marginalized communities experiencing high level of educational deprivation. The analysis of the study shows that the extent of deprivation existing among STs of Kerala is much higher compared to that of other communities. The present study covered tribes of three tribal predominant districts of Kerala such as Idukki, Palakkad and Wayanad. Out of the 35 tribal communities in the State, 17 of them are concentrated in these districts. Tribes concentrated in Idukki include Muthuvans, Malai Arayan, Uraly, Mannan and Hill Pulaya. The present study analyzed dropouts situation in tribal areas of Kerala by conducting Field Survey among dropout and non-dropout students at school level. High dropouts among STs persist due to many problems which are of structural in nature. Important problems faced by the tribal students that have been analyzed, this can be classified as economic, social, cultural and institutional. It is found that there exists high correlation between Income and expenditure of the family with the well-being of individuals. Significant economic factors are poverty and financial indebtedness of the family. Some of the common cultural factors of tribes are Nature of Habitation, Difference in Dialect and Medium of Instruction etc. Social factors analyzed in the study are illiteracy of parents, migration of family, family environment, motivation by parents, activities engaged in for helping the family and students’ lack of interest in studies. The analysis showed that all these factors except migration of the family, are affecting the education of tribal students. Apart from social, economic and cultural factors, there are a few institutional factors which will also influence the education of tribal students. Institutional factors analyzed in the study include students’ absenteeism, irregularity of teachers, attitude of non-tribal teachers and non-tribal students, infrastructure facilities and accessibility to school. The study found irregularity of students and accessibility to school as significant factors which determine the dropout of the students.