Ascites: a guide to diagnosis in the district hospital

Successful treatment of antimony-resistant visceral leishmaniasis with liposomal amphotericin B (L-AmpB-LRC) in a child

Visceral leishmaniasis continues to be a major health problem in Bihar and West Bengal states of India. In Bihar almost 44 million people in 28 districts and in West Bengal 5.5 million people in eight districts are at risk of visceral leishmaniasis1. Pentavalent antimonial (Sbv) compounds are the first-line drugs, and amphotericin B is used when failure to respond to antimony occurs2. We report the case of a 7-year-old boy with advanced antimony-resistant visceral leishmaniasis who was successfully treated by liposomal amphotericin B (L-AmpB-LRC) manufactured in our institute. This case report documents the efficacy of L-AmpB-LRC in such a patient and highlights the need for a longer duration of treatment.

Low-cost refractometer for measurement of protein concentration and specific gravity of body fluids

The measurement of protein concentration in serum and other body fluids can be helpful in disease diagnosis and prognosis. It is commonly helpful to know whether a collection of fluid is transudate or exudate. The specific gravity of fluids, including urine, can also be a useful diagnostic tool. The estimation of protein concentration is usually possible only in hospitals where costly chemistry analysers are available. Specific gravity can be measured by standard methods only if large volumes of fluid are available: it is often not possible to measure the specific gravity of cerebrospinal, pleural, pericardial, or pancreatic fluids, or of urine if the volume is less than 50 μl. Recently, we have obtained a small and very handy device by which one can measure both the specific gravity of fluids in small volumes and also their protein content. The method is based on the refraction of light. Both purchase and running costs are very low by comparison with standard laboratory techniques.

We describe the use of this instrument and compare its performance with other available methods.