PREVALENCE OF DRUG RESISTANT TUBERCULOSIS IN ARMED FORCES-STUDY FROM A TERTIARY REFERRAL CHEST DISEASES HOSPITAL AT PUNE

This study was conducted to find out the prevalence and pattern of primary and acquired resistance to antimycobacterial drugs among patients of pulmonary tuberculosis, in Armed Forces. Out of 2562 clinically diagnosed patients of tuberculosis, in a span of three years, 1146 were bacteriologically positive. The study included only 1120 smear and culture positive cases, and excluded 26 cases in which no growth was obtained on culture. 192 out of 1120 cases (17.14%), showed overall resistance to one or more antituberculous drugs (ATD). Primary drug resistance (PDR) was observed in 161 (14.37%) and acquired drug resistance (ADR) in 31 isolates (2.77%). Of the resistant cases on short course chemotherapy (SCC), single drug resistance was observed in 99 (51.56%), resistance to any two drugs in 63 (32.81%), and three or more drugs in 30 (15.62%) cases. Analysis of resistance to specific drug revealed 26.56% for streptomycin (S), 15.10% for rifampicin (R), 7.29% for isoniazid (H), 2.08% for pyrazinamide (P) and 0.52% for ethambutol (E). Resistance to H and R was present in 4.16% strain and their combination with other drugs resistance was in 16.14% of the drug resistant strains, thus constituting 2.76% of the total sputum positive cases. A group of 26 cases is also discussed, where there was discrepancy in clinical status and bacteriological parameters and treatment for multi-drug resistant tuberculosis (MDR-TB) was instituted.

Larval ecology and mosquito fauna of upper Brahmaputra valley, northeast India

Ninety-one mosquito species in 15 genera were collected from 22 habitat types of Upper Brahmaputra valley in Assam and bordering areas of Arunachal Pradesh. Nineteen species have been recorded for the first time in Assam including seven first records from the northeast region and three first country records. Jaccard's coefficient was used to quantify the similarity between 13 different geographical localities surveyed on the basis of their mosquito fauna. Group average sorting (UPGMA) cluster analysis was used to find out relationship between Jonai, Dhemaji, Dibrugarh, Tinsukia and north Lakhimpur (study zones) on the basis of their mosquito community. Immatures of three malaria vectors incriminated from the northeast India, viz. Anopheles dirus, An. minimus and An. philippinensis were collected exclusively from forest areas. Fourteen potential vectors of Japanese encephalitis incriminated from elsewhere in India were collected during the study.

MANAGEMENT OF LUNG ABSCESS WITH PERCUTANEOUS CATHETER DRAINAGE

Percutaneous catheter drainage was used to treat 12 among 34 cases of lung abscesses, who were refractory to medical therapy, severely ill and high risk cases for surgery. A complete clinical and radiological recovery was achieved in all the cases who underwent catheter drainage, thereby obviating the need for surgery. None of the cases had catheter or procedures related complications. From this study it is inferred that percutaneous transthoracic catheter drainage is a safe and an effective modality of therapy for patients with lung abscess in whom medical therapy has failed and those who are unsuitable for surgery.

MULTIDRUG RESISTANT TUBERCULOSIS - BIOMECHANISM, EPIDEMIOLOGY AND MANAGEMENT STRATEGIES

Muitidrug resistant tuberculosis has shown an alarming increase and this assumes added importance in view of the increasing number of HIV infected patients. This article reviews the biomechanism of resistance and discusses the present stategies that are available and recommended to tackle the rising incidence of tuberculosis due to resistant mycobacteria.

A computed tomographic study of schizophrenia

Fifty schizophrenic patients fulfilling DSM-III-R criteria, and group matched normal healthy controls were selected for the study The case and control groups have been compared in terms of VBR, WSF and WTF. In the study schizophrenics have been divided into positive, negative and mixed subgroups on basis of SAPS and SANS, and these subgroups are compared with each other for VBR, WSF & WTF. Tomographic abnormalities were noted in schizophrenics, particularly with negative and mixed subtypes, when compared to controls.

Revalidation and description of Aedes (Finlaya) Pallirostris from northeastern India (Diptera:Culicidae)

Aedes (Finlaya) pallirostris Edwards is resurrected from synonymy with Aedes (Fin.) formosensis Yamada and the female, male, pupa, and 4th-instar larva are described and compared with closely related species. The synonymy of Finlaya khasiana Barraud is transferred from Ae. formosensis to Ae. pallirostris.

Epidemiology of subperiodic Wuchereria bancrofti infection in the Nicobar Islands, India

Diurnally subperiodic filariasis due to Wuchereria bancrofti has been reported from tribal populations in the Nancowry group of islands in the Andaman and Nicobar Islands, India. This was confirmed in a survey carried out during the monsoon season in 1993. Microfilariae were detected in the peripheral blood throughout a 24 h period with a peak at 18:00. The microfilaria (mf) rate ranged from 1.2% to 18.7%, with a low disease rate (mean = 1.9%). Incidence of mf was low in children less than 10 years old (3.5%), but increased with increasing age. Culex (Culex) quinquefasciatus was present at a very low density. Aedes (Finlaya) niveus and Aedes (Stegomyia) malayensis were the only species commonly biting man. The former was incriminated as a vector, and found naturally infected with W. bancrofti (infection and infectivity rates 1.1% and 0.9% respectively). After experimental feeding on donors, W. bancrofti developed to L3 stage larvae in A. niveus but failed to develop in A. malayensis and A. aegypti.

Detection of haemagglutination inhibition antibodies against Newcastle disease virus in unvaccinated indigenous chickens in Maiduguri, Borno State, Nigeria

An examination of 200 serum samples from unvaccinated indigenous (local) chickens in Maiduguri, Borno State (Nigeria) using the haemagglutination inhibition (HI) test showed 73 sera to be positive and 127 to be negative for antibodies against Newcastle disease virus. The highest antibody titre observed was 1:128. The prevalence rate was higher (46.9%) in adult chickens than in young chickens of less than 12 weeks (23%). Presence of HI antibodies in unvaccinated indigenous chickens indicates that these birds had contracted infection and recovered thereafter.

An immunomodulator in the treatment of schizophrenia : a double-blind study

In a double blind study, the immunomodulator drug levamisole was administered along with chloropromazine to 18 schizophrenic patients, and efficiency of the combination was compared to that of chloropromazine along with placebo administered to 16 schizophrenic patients. The decrease in T suppressor cell count found in both groups at benchmark was found to be corrected in the patients receiving levamisole and this increase in T suppressor cell count was significantly correlated with the improvement in psychosis. The findings provide evidence in favour of the autoimmune hypothesis of schizophrenia.

Excessive polycythaemia of high altitude. Pulmonary function studies including carbon monoxide diffusion capacity

Pulmonary function studies were done in 21 soldiers (low landers) posted at high altitude (average height 4773 metres) for prolonged periods (average 77.09 months), who had developed excessive polycythaemia, mean haemoglobin concentration being 23.06 g/dl. Studies revealed significant reduction in diffusion capacity of lungs which gradually returned to normal on sojourn at low altitudes for 70 days. Both the degree of polycythaemia and reduction in lung diffusion capacity were much more pronounced in smokers than in non-smokers. Vital capacity did not show any difference in these subjects while forced expiratory volume in 1 sec and ratio of forced expiratory volume to vital capacity (FEV1/VC) revealed only obstructive features in smokers.

Pulmonary bullous disease in Marfan syndrome

Two young adults with marfanoid features who had pulmonary bullous disease are presented. One a young soldier, presented with increasing dyspnoea and an enlarging large pulmonary bulla on the right side. The bulla was under tension and was operated on. The other case was a young housewife who also presented with dyspnoea, and was found to have a cardiac murmur and multiple ectopic beats on initial examination. X-Ray chest revealed bilateral pulmonary bullous emphysema. Both the subjects had many features which are accepted as forme fruste of the Marfan syndrome.

Space-spraying with malathion as a supplementary measure for operational malaria control

Entomological studies showed that due to outdoor resting by the vector Anopheles culicifacies as well as poor spray coverage, indoor residual spraying with malathion was ineffective in malarious villages of the Thenpennai riverine tract in Tamil Nadu. Over a 4 yr period during which residual spraying was supplemented with ground applications of malathion space spraying, the slide positivity among patients with fever fell from 21.04 to 1.1 per cent. In mass blood surveys 0.7 per cent persons surveyed at the beginning of the study were positive for the malarial parasite, but no positives were detected in the last survey, in 1984. There was a rising trend in malaria incidence in riverine villages outside the programme.

Enlarging pulmonary histoplasmoma associated with pulmonary tuberculosis

Histoplasmosis is not a frequently reported infection from India. Similarity of its clinical and radiological features with pulmonary tuberculosis, may cause a difficult diagnostic dilemma when the two occur together. We report a case who initially presented with cavitary lesions over right lung responding well to anti tuberculosis chemotherapy but subsequently a small opacity present over the left upper zone showed a relentless increase till it attained a massive size few years later. Operative removal and histopathological examination of the mass confirmed it to be histoplasmoma. She became sputum AFB smear positive and culture negative for a short while during this period and this is explained on the basis of previous reports.

Bilateral recurrent haemorrhagic pleural effusion in asymptomatic chronic pancreatitis

In a case of bilateral recurrent haemorrhagic pleural effusion due to asymptomatic pancreatitis the diagnosis was suggested by the presence of amylase in the pleural fluid when other possible causes had been excluded. Abdominal computed tomography and laparotomy confirmed the diagnosis. No communications could be seen between the peritoneal and pleural space at laparotomy.

Osler-Rendu-Weber disease presenting as recurrent haemoptysis

A young adult male with a short history of recurrent haemoptysis due to vascular malformation of right lung is presented. Lesion was not visible in the chest radiograph, nor on bronchography. CT-scan of thorax, however, showed a bunch of circinate opacities in the upper lobe of the right lung. Histopathological examination of the resected lung tissue confirmed the diagnosis.

Necrobiotic pulmonary nodule leading to pyopneumothorax in a case of rheumatoid arthritis--a rare clinical presentation

A 49-year-old male patient, an active case of sero positive rheumatoid arthritis involving multiple joints with bilateral necrobiotic pulmonary nodules is presented. Initial symptoms were of progressively increasing dyspnoea. The nodule in the right lung subsequently cavitated leading to pyopneumothorax. The diagnosis of rheumatoid lung was confirmed by post-mortem.

Significance of transplant perfusion index in the diagnosis of acute rejection in live related renal allograft recipients

The study was undertaken to assess the usefulness of transplant perfusion index (TPI) in the differential diagnosis of renal allograft dysfunction with special reference to acute rejection. It was observed that the TPI has a sensitivity of 100 per cent and specificity of 98.1 per cent in the diagnosis of acute rejection. It was also observed that the serial values of TPI provided valuable clues and guide in the management of transplant dysfunction and helped in the immediate and long term follow-up of patients with renal allografts.

Malignant mesothelioma in the young (with prosthetic aortic valve an unusual association)

A case of malignant mesothelioma (MM) in a 15 year old boy is reported. He had a prosthetic aortic valve implanted in 1980 at our centre for rheumatic aortic regurgitation. Fever, weight loss and chest pain as initial symptoms suggested possibility of prosthetic valve endocarditis. Dysphagia as another initial symptom was interesting and caused further diagnostic dilemma. Role of Computerised Tomography (CT) scan in diagnosis of MM is highlighted.

A cytogenetic description of a new species of the Anopheles culicifacies complex

Cytogenetic observations on an extensive material of the Anopheles culicifacies complex from the Thenpennai river area, Tamil Nadu, South India show that the populations are made up of four cytologically distinct species. Three of these, labeled A, B and C have already been described. A fourth one, monomorphic for the inversion arrangement +a +b in the X chromosome and il + hl in the second chromosome, is designated as D, another morphologically indistinguishable sibling species. Each sibling species is characterized by a species-specific type of Y-chromosome. Both of these criteria, inversions and Y-chromosomes can be used to distinguish these important malaria vectors.