Evaluation of Acute Phase Reactants As Indicators of Activity in Leprosy

Acute phase reactants i. e. ESR, C-reactive proteins, alpha 1 antitrypsin, complement (C3) and circulation immune complexes were evaluated in relation with the activity of the disease in leprosy. Levels of all the acute phase reactants were significantly raised during the active plase (LL and ENL), while these were normal during the arrested phase of the disease. Appearance of, circulating immune complexes also followed the same pattern. It is concluded that raised levels of ESR (C-reactive proteins, alpha-1 antitrypsin, complement (C3) and circulating immune complexes suggest active phase (LL ENL) of the disease in leprosy.

A clinical study and classification of posterior spinal tuberculosis

Tuberculous involvement of the posterior elements of the spine is uncommon. Review of the literature reveals little information and there is scant mention of this subject in standard textbooks of orthopaedics. A study of 27 cases of such lesions seen over 6 years is presented, drawn from two separate centres, 21 from Central India and 6 from South Eastern Iran. The clinical presentation, investigations and treatment are analysed. A new four point classification is described based upon the site of the lesion, the stage of the lesion, associated lesions and neurological deficit.

Pharmacokinetic evaluation of cefoperazone in infants

The pharmacokinetics of cefoperazone were evaluated in 25 infants (mean age, 26 days) after intramuscular and intravenous routes of administration. The levels in blood that were achieved were severalfold higher than those required to inhibit common pathogens. The mean half-life of 240 min was one-half of that observed in 1- to 2-day-old infants but about twice that seen in adults. Further evaluation is needed to study the efficacy of the drug in infants and children.

Air weapon injuries in children: a case for education

The results of the first 6 months of a 2-year prospective study on the frequency, severity and methods of prevention of air weapon injuries to children are reported. Twenty-eight cases presenting to an urban paediatric accident and emergency department have been analysed. Nineteen of these were males between the ages of 10 and 16 years. At least 18 incidents occurred in public places. The five most serious injuries were of the orbit, face and abdomen. Another nine injuries were near vital structures. Education is needed on the existing guidelines for the safe use of air weapons.

Macrodactyly of the hand and foot

Five patients with macrodactyly are described. The foot was affected in 3 of them and the hand in 2. Two patients were operated on and the histological features are described. The literature is fully reviewed and the aetiology is discussed.

Deep brain stimulation for alleviating chronic intractable pain

The authors present their 4-year experience with 18 patients who had deep brain stimulation. Most were referred because of chronic pain of varied etiology. All conventional modalities of management had failed. Both the paraventricular gray matter and the sensory thalamus were target sites. The 18 patients underwent a total of 21 implants. Follow-up ranged from 6 months to 4 years with moderate relief of prestimulation pain in 14 patients (77%). Patients with failed back syndrome secondary to multiple disc operations fared well. Patients with pain secondary to progressive neurologic disorders or cancer had only short-lived benefits, while those with pain from cauda equina injury or vascular disease had a poor result. Deep brain stimulation appears to be an effective means of controlling chronic pain in selected cases.

Neuropathic plantar ulceration

Management of 111 trophic plantar ulcers existing in 100 patients of leprosy have been reviewed. Male preponderance with 4th and 5th decade of life predilection was observed. Most of the patients were of lepromatous type. Ulcers were grouped into superficial and deep. They were treated by various methods viz. plaster cast alone and in combination with curettage, posterior tibial neurovascular decompression and metatarsectomy. It was observed that ulcers heal faster if conservative plaster cast treatment is clubbed with surgical treatment of the ulcer. Indications of various surgical methods is defined. Role of proper footwear in the management of plantar ulcers has been emphasized.

Mild analgesics and the accident and emergency department--cost and safety more important than potency?

A prospective controlled trial involving over 1000 patients did not reveal any difference between four drugs commonly used in accident and emergency departments for the relief of mild to moderate pain. There were no significant variations in therapeutic effect, side-effects or patient compliance. When considering the supply of analgesics which may be no more potent than those available without prescription from retail chemists, cost and safety are more important than analgesic effect. By restricting the choice of analgesics available, the accident and emergency department should be able to increase awareness among its staff of the actions and side-effects of a small number of prescribed drugs and to contain costs.

Effect of the chemosterilant bisazir on the eggs of Earias fabia stoll

Bisazir-induced inhibition of nucleic acids and protein, and enhancement of free amino acids in the eggs of treated Earias fabia (Lepidoptera; Noctuidae) is reported. The degree of alterations in various crosses followed: T male X T female greater than UT male X T female greater than T male X UT female, which was also reflected in the weight loss of eggs. The alterations have been attributed to the abnormalities in the developing embryos due to genic imbalance in the spermatozoa, nurse cells and oocytes, ultimately leading to embryonic death.

Respiratory dysautonomia in leprosy

Autonomic neuropathy in leprosy has been reported recently. 25 cases of polar lepromatous leprosy with and without lepra-reaction and 25 normal control, have been studied for respiratory dysautonomia. In 12 cases out of 25 (48%) involvement of sympathetic respiratory reflexes has been observed. Possible causes of the same are discussed.

Squamous cell carcinoma developing in trophic ulcers in leprosy--a case report

Malignant transformation of trophic ulcer in leprosy, though not very uncommon, is ill reported in the literature. Not more than a dozen cases have been reported so far. A case of "Squamous Cell Carcinoma" developing in trophic ulcer in leprosy is presented. The histopathology has been discussed.

A study of leprosy in relation with HBsAg

In the present study presence of HBsAg in the serum of 130 leprosy patients (LL 50; ENL 30; TT 50) and its relationship with various complications has been studied. The HBsAg positivity in controls and various types of leprosy did not show any significant difference. Similarly complication also had no relation with HBsAg positivity. So we conclude that leprosy has no relation with HBsAg.

Effect of the chemosterilant bisazir on the testes of the spotted bollworm Earias fabia stoll

Studies indicate a time dependent action of bisazir on nucleic acids, proteins, amino acids and phosphatases in the testes of the spotted bollworm Earias fabia. Significant reductions in DNA, RNA, protein and alkaline phosphatase activity and an enhancement in total free amino acids and acid phosphatase activity have been observed.

Poly-syndactyly of hands and feet with talipes equino-varus. An unusual combination

A case of a fifteen year old male with unusual congenital anomalies of hands and feet (Poly-syndactyly) is presented. There was associated talipes equino-varus deformity of the left foot with bilateral duplication of great toes. Both hands appeared like a cup but the patient was able to carry out his routine activities. The purpose of this report is to document a unique 'isolated' congenital anomaly.

Evaluation of cefotaxime in bacterial infections

Cefotaxime, a third generation cephalosporin antibiotic, was evaluated in 26 infants and children for the treatment of documented or suspected bacterial infections, including pneumonia (10 cases), soft tissue skin infection (13 cases), and urinary tract infection (3 cases). An average daily dose of 60 mg/kg in 3 to 4 divided doses was administered parenterally for an average of 7 days. In 14 of the cases, primary pathogens, including Haemophilus influenzae b (resistant to ampicillin), Staphylococcus aureus, Staphylococcus pyogenes, Streptococcus pneumoniae and Escherichia coli, were eradicated. Clinical recovery occurred in each case. Blood levels at different time intervals and biological half-life were similar to those reported for adults. Mild and transient side effects observed were elevation of SGOT in two cases, alkaline phosphatase in one, and eosinophilia in one case.

Malathion toxicity: in vivo inhibition of acetylcholinesterase in the fish Brachydanio rerio (Cyprinidae)

Acetylcholinesterase (AChE) activity in the nervous tissue (brain) of the fish Brachydanio rerio was significantly inhibited by exposure to the organophosphorus (OP) pesticide, malathion. The inhibition was dose- as well as time-dependent. The fish survived even when the activity of the enzyme was inhibited by 90%. There was a significant recovery in the activity of AChE when malathion stress was lifted.

Reversible nephrotoxic reactions to a combined 2,3-dimercapto-1-propanol and calcium disodium ethylenediaminetetraacetic acid regimen in asymptomatic children with elevated blood lead levels

One hundred thirty children aged 1 to 8 years with blood lead levels greater than 50 micrograms/100 ml of whole blood (WB) and free erythrocyte protoporphyrin (FEP) concentration greater than 250 micrograms/100 ml of WB received 207 chelation treatments for plumbism. All chelation treatments consisted of CaNa2 ethylenediaminetetraacetic acid (EDTA) 25 mg/kg per dose every 12 hours and 2,3-dimercapto-1-propanol (BAL) 3 mg/kg per dose every four hours for five days. Seventeen children demonstrated transient doubling of pre-chelation treatment serum creatinine (less than or equal to 2.0 mg/100 ml) during or following chelation treatment; 5/17 also had mild proteinuria. Four children developed severe oliguric (greater than 250 ml/sq m/day) acute renal failure. Serum creatinine levels were elevated six to seven days after chelation treatment was started and reached maximal values of 3.9 to 8.4 mg/100 ml, three to six days later. Renal function returned to pre-chelation treatment values during the subsequent six to 18 days. In the 21 nephrotoxic patients and the 109 nontoxic patients there were no significant differences in age (3.8 +/- 0.6 vs 3.2 +/- 0.2 years), sex (61% vs 53% males), percent who received multiple chelation treatments (38% vs 30%), blood lead levels (85 +/- 5 vs 79 +/- 1 microgram/100 ml of WB), FEP (380 +/- 30 vs 382 +/- 18 micrograms/100 ml of WB), hemoglobin (11.5 +/- 0.4 vs 11.1 +/- 0.2 gm/100 ml, and pre-chelation treatment serum creatinine (0.46 +/- 0.06 vs 0.58 +/- 0.03 mg/100 ml). It was concluded that 13% of children with plumbism who received chelation treatments developed mild transient biochemical evidence of nephrotoxicity and another 3% developed acute renal failure characterized by oliguria four to eight days after chelation treatment was discontinued.

Surgical management of leprous ulnar neuritis

An analysis of the results of neurolysis with careful anterior transposition of the ulnar nerve in 17 cases of severe leprous neuritis is described. Pain and paresthesia were relieved in all patients within 48 to 72 hours after the operation. Recoverable cases showed some evidence of sensory and motor recovery within three weeks to three months, and six months of the operation, respectively. The amount of recovery was directly related to the extent and stage of involvement of the nerve. Results of prophylactic anterior transposition on the ulnar nerve in two patients with recurrent dislocation were encouraging.

Clinical and pharmacokinetic evaluation of moxalactam in infants and children

Moxalactam, a new beta-lactam antibiotic was evaluated in the treatment of 21 pediatric patients including 16 with clinical and radiological evidence of pneumonia and 5 with urinary tract infection (UTI). Clinical and radiological resolution of pneumonia occurred in all. Bacteriological efficacy in pneumonia, however, was assessed in only 1 patient whose blood culture grew H. influenzae type b. In patients with UTI, the therapy was successful, bacteriologically as well as clinically. The only side effects observed were mild transient elevation of SGOT and alkaline phosphatase in 6 cases. The peak and trough levels of the drug were manyfold higher than the known minimum inhibitory concentrations of common pathogens. The mean t1/2 projected of 95 and 124 min with intravenous and intramuscular route, respectively, were similar to those reported in adults.

Rapid laboratory diagnosis of infectious diseases

The countercurrent immunoelectrophoresis and latex particle agglutination tests are rapid, do not require expensive apparatus, and are easy to perform if specific antigens and antisera are available. Both tests have been shown to be of value in the diagnosis of bacterial infections (such as those caused by H. influenzae, Streptococcus pneumoniae, N. meningitidis, E. coli, Staphylococcus aureus and group B streptococcus) and of viral infections (HRVLA and hepatitis B); they may also be of value in fungal and parasitic infections. Etiologic diagnosis of commonly seen clinical conditions (such as pneumonia, meningitis, cellulitis, osteomyelitis, lymphadenitis, and arthritis) by practicing physicians can be made using these tests to detect antigens in various body fluids in a hospital laboratory.

Reversible neutropenia associated with ampicillin therapy in pediatric patients

Hematologic abnormalities associated with penicillin compounds are uncommon, and neutropenia associated with ampicillin is reported even less frequently. Neutropenia developed in three pediatric patients after high-dose (150-400 mg/kg) ampicillin therapy over a period of 3 to 12 days. In all cases, the white blood cell and neutrophil counts returned towards normal within 4 to 11 days after discontinuation of the antibiotic. Bone marrow examination revealed a maturation arrest in one and slight shift to the left in the maturation of granulocytic cells in another. Other marrow components were normal. Red blood cells, reticulocytes, platelets, and hemoglobin did not show any abnormal alteration in any of the patients. Physicians administering ampicillin, particularly in high doses, should be alert to the possible development of neutropenia; however, all reported neutropenias have been reversible.

Muscle phosphofructokinase deficiency: two cases with unusual polysaccharide accumulation and immunologically active enzyme protein

Two patients with phosphofructokinase (PFK) deficiency had exercise intolerance and increased serum activity of creatine kinase; one presented with hemolytic anemia, hyperuricemia, and gouty arthritis. The glycogen concentration in the muscle of these patients was about twice normal. PFK activity was virtually absent in muscle, but antibodies against the M subunits of the normal human PFK showed cross-reacting material in muscle from both patients. The PFK level in red blood cells, studied in one case, was lower than normal in the patient and both parents. Morphologically, there was extensive deposition of normal glycogen underneath the sarcolemma and in the intermyofibrillar space. In addition, 2% to 3% of the myofibers contained hyaline, PAS-positive, diastase-resistant inclusions that had a filamentous fine structure; histochemical reactions suggested an insoluble form of glycogen. Similar inclusions have not been described previously in PFK deficiency. Accumulation of an abnormal polysaccharide in muscle may be due to a second undiscovered enzymatic defect or may be a metabolic consequence of PFK deficiency.

Acute renal failure in battered child syndrome

Battered child syndrome, a not uncommon problem, may involve deep structures including the liver, spleen, and brain. While involvement of kidneys is extremely rare, such an association is illustrated by the following case which presented with azotemia and hypertension. Management should depend on the degree of renal failure and hypertension as well as the extent of any electrolyte imbalance.

Pharmacokinetics and safety of cefamandole in newborn infants

Cefamandole, a new parenteral cephalosporin antibiotic, was administered to 23 newborn infants with pustular skin infection due to Staphylococcus aureus for an average duration of 7.5 days. All the patients improved clinically. Elevation of serum glutamic oxaloacetic transaminase and eosinophilia were observed in nine infants each transiently during treatment. There were no abnormalities of renal functions and Coombs' test results remained negative. The levels of cefamandole in serum after either intravenous or intramuscular administration were higher and the mean life was longer than those previously reported in older infants, children, and adults.