Topical phenytoin suspension and normal saline in the treatment of leprosy trophic ulcers: a randomized, double‐blind, comparative study

OBJECTIVE

To evaluate and compare two strengths of topical phenytoin sodium suspension (2% and 4%) with normal saline in the healing of acute trophic ulcers in leprosy patients.

METHODS

A prospective, parallel, double-blind, randomized study was conducted in 45 leprosy inpatients with acute trophic ulcers. Patients were randomized to receive 2%, 4% or normal saline dressing on their ulcers once daily for 4 weeks. Efficacy parameters such as a reduction in the surface area of the ulcer, bacterial culture of the ulcer swab, appearance of healthy granulation tissue, cessation of ulcer discharge and overall gradation of clinical healing and safety were assessed at weekly intervals.

RESULTS

The ulcer area reduction was greater in the 2% and 4% phenytoin groups compared with the normal saline group (p<0.001). Appearance of healthy granulation tissue and cessation of ulcer discharge was also observed earlier in the two phenytoin groups. At the end of 4 weeks, 11 ulcers each had healed completely in both the 2% and 4% phenytoin groups compared with none in the control group. There were no statistical differences between the 2% and 4% phenytoin groups. No side effects were reported by any patient.

CONCLUSION

Topical phenytoin appears to be an effective, safe and cheap therapeutic option for the healing of trophic ulcers in leprosy patients.

Guidelines for sedation and/or analgesia by non-anaesthesiology doctors

BACKGROUND AND OBJECTIVE

Postoperative nausea and vomiting after craniotomy may increase intracranial pressure and morbidity in children. This prospective, randomized, placebo-controlled and double-blinded study was designed to evaluate the antiemetic efficacy of prophylactic ondansetron after intracranial tumour resections in children.

METHODS

Ninety children were divided into three groups and received saline (Group 1), ondansetron 150 microg kg-1 intravenously at dural closure (Group 2) or two doses of ondansetron 150 microg kg-1 intravenously, the second dose repeated after 6 h (Group 3). Episodes of nausea, emesis and side-effects were noted for 24 h postoperatively.

RESULTS

Overall 24 h incidence of postoperative nausea and vomiting was not significantly different among the three groups (9 (37.5%) in Group 1 vs. 7 (27%) in Group 2 and 8 (32%) in Group 3, P = 0.73). No difference in rescue antiemetic treatment or postoperative nausea and vomiting at specific time intervals (0-6 and 6-24 h postoperative period) was seen among the three groups. No significant side-effects were noted in any of the three groups.

CONCLUSIONS

Ondansetron, in this study of 90 children, was not very effective in preventing nausea and vomiting after neurosurgical operations.

Expression of cytokeratin 20 in urine cytology smears: a potential marker for the detection of urothelial carcinoma

BACKGROUND

Urine cytomorphology is one of the oldest methods for screening and monitoring patients with transitional cell carcinoma (TCC). Sensitivity of urine cytology is relatively low. Ancillary techniques on urine sample may increase the sensitivity.

AIM

To explore the utility of cytokeratin 20 (CK20) immunostaining in identifying malignant cells in urine cytology smears.

MATERIALS AND METHODS

Fourteen cases each of confirmed TCC and benign urinary cytology along with five cases of atypical cells in urine were immunostained with a monoclonal CK20 antibody. Of 14 cases of TCC, 12 showed strong positive staining with the antibody. All benign cases were negative except for a few cases in which the umbrella cells were weakly to moderately positive. In all five cases of atypical urine cytology the atypical cells stained positive with the antibody. These cases were later confirmed as TCC on histopathology of bladder wall biopsy.

CONCLUSION

CK20 is an important biomarker that can be used to identify TCC in urine cytology smears. It is particularly useful in those cases where malignancy cannot be confirmed by morphology alone.

Comparative cytomorphology of skin, lymph node, liver and bone marrow in patients with lepromatous leprosy1

OBJECTIVE

The aim of this study was to compare the cytological changes in skin, lymph nodes, liver and bone marrow in patients with lepromatous leprosy.

METHODS

Skin lesion, lymph node, liver and bone marrow aspirates were analysed. May-Grunwald-Giemsa (MGG) and Ziehl-Neelsen (Z-N) stains were employed. Comparative cytomorphology was studied.

RESULTS

Twenty patients with lepromatous leprosy were studied. Lepra cells (LC) predominated in the skin aspirates of 12 patients with lepromatous leprosy (LL), lymphocytes accompanied LC in eight patients with borderline-lepromatous (BL) leprosy. Three patients of LL leprosy and two of BL leprosy in type 2 reaction additionally had numerous neutrophils. Two patterns of lymph node aspirates were seen: partial replacement with few LC in a reactive lymphoid background (10), complete replacement with either only LC or LC in a background of degenerating neutrophils (10), the latter a feature of type 2 reaction. Liver aspiration was performed in seven patients and of bone marrow in eight patients. Occasional LC were present in five liver-aspirated patients, steatosis and Kupffer cell hyperplasia in four patients, and myelopoiesis in two patients. Bone marrow smears invariably had occasional LC and a relative increase in mature plasma cells; sea-blue histiocytes were seen in six patients.

CONCLUSION

Lepra cells predominated in skin and lymph node aspirates with complete replacement. In comparison, liver, bone marrow and lymph node aspirates with partial replacement were dominated by a preponderance of cells native to these organs with only few or occasional LC.

Recurrent spinal meningioma: a case report with review of the literature

Spinal meningioma generally responds favourably to surgical excision and has a low rate of recurrence. However, follow-up data on patients under 50 years of age are limited. We report a recurrence of intraspinal meningioma 18 years after the initial surgery in a 45-year-old woman. She presented with weakness in both lower limbs that had gradually progressed over the previous 8 months, and difficulty in walking for the last 2 months. She had no history of sensory loss or visceral involvement, but had undergone a major surgical intervention of the upper spine for a similar episode of weakness in both lower limbs 18 years earlier. She underwent a second surgery at the same site, and a greyish-white tumour was excised, which was histopathologically confirmed as recurrent psammomatous meningioma. The patient demonstrated complete neurological recovery in 8 months.

Invasive aspergillosis in an immunocompetent host

Invasive aspergillosis is an uncommon opportunistic infection usually seen in immunocompromised patients. Despite extensive therapeutic measures the outcome is usually unfavourable. We report a case of invasive aspergillosis in an immunocompetent individual.

Impact of post-methanation distillery effluent irrigation on groundwater quality

Molasses-based distilleries generate large quantities of effluent, which is used for irrigation in many countries including India. The effluent is rich in organic and inorganic ions, which may leach down and pollute the groundwater. An on-farm experiment was conducted to assess the impact of long-term irrigation with post-methanation distillery effluent (PMDE) on nitrate, sulphate, chloride, sodium, potassium, and magnesium contents in the groundwater of two sites in northwest India. Electrical conductivity (EC), pH, total dissolved solids (TDS), sodium adsorption ratio (SAR) and colour were also determined to assess the chemical load in the groundwater. Nitrate content in the groundwater samples ranged from 16.95 mg L(-1) in the unamended fields to 59.81 mg L(-1) in the PMDE-amended fields during the 2-year study (2001-2002). Concentrations of TDS in water samples from tubewell of the amended field was higher by 40.4% over the tubewell water of the unamended field. Colour of the water samples of the amended fields was also darker than that of the unamended fields. The study indicated that the organic and inorganic ions added through the effluent could pose a serious threat to the groundwater quality if applied without proper monitoring.

Citrus Black Rot is Caused by Phylogenetically Distinct Lineages of Alternaria alternata

ABSTRACT Phylogenetic analysis revealed that isolates of Alternaria alternata causing black rot of citrus were associated with six well-supported evolutionary lineages. Isolates recovered from brown spot lesions on Minneola tangelo, leaf spot lesions on rough lemon, and healthy citrus tissue and noncitrus hosts were related closely to isolates from black-rotted fruit. Phylogenies estimated independently from DNA sequence data from an endopolygalacturonase gene (endoPG) and two anonymous regions of the genome (OPA1-3 and OPA2-1) had similar topologies, and phylogenetic analysis was performed on the combined data set. In the combined phylogeny, isolates from diverse ecological niches on citrus and noncitrus hosts were distributed in eight clades. Isolates from all lineages, regardless of ecological or host association, caused black rot in fruit inoculation assays, demonstrating that small-spored Alternaria isolates associated with different ecological niches on citrus and other plant hosts are potential black rot pathogens. These data also indicated that the fungi associated with black-rotted fruit do not form a natural evolutionary group distinct from other Alternaria pathogens and saprophytes associated with citrus. The use of the name A. citri to describe fungi associated with citrus black rot is not justified and it is proposed that citrus black rot fungi be referred to as A. alternata.