Groundwater Arsenic Contamination in the Ganga River Basin: A Future Health Danger

This study highlights the severity of arsenic contamination in the Ganga River basin (GRB), which encompasses significant geographic portions of India, Bangladesh, Nepal, and Tibet. The entire GRB experiences elevated levels of arsenic in the groundwater (up to 4730 µg/L), irrigation water (~1000 µg/L), and in food materials (up to 3947 µg/kg), all exceeding the World Health Organization’s standards for drinking water, the United Nations Food and Agricultural Organization’s standard for irrigation water (100 µg/L), and the Chinese Ministry of Health’s standard for food in South Asia (0.15 mg/kg), respectively. Several individuals demonstrated dermal, neurological, reproductive, cognitive, and cancerous effects; many children have been diagnosed with a range of arsenicosis symptoms, and numerous arsenic-induced deaths of youthful victims are reported in the GRB. Victims of arsenic exposure face critical social challenges in the form of social isolation and hatred by their respective communities. Reluctance to establish arsenic standards and unsustainable arsenic mitigation programs have aggravated the arsenic calamity in the GRB and put millions of lives in danger. This alarming situation resembles a ticking time bomb. We feel that after 29 years of arsenic research in the GRB, we have seen the tip of the iceberg with respect to the actual magnitude of the catastrophe; thus, a reduced arsenic standard for drinking water, testing all available drinking water sources, and sustainable and cost-effective arsenic mitigation programs that include the participation of the people are urgently needed.

Arsenic in groundwater of the Kolkata Municipal Corporation (KMC), India: Critical review and modes of mitigation

This study represents the first comprehensive report of groundwater arsenic contamination status in the Kolkata Municipal Corporation (KMC). During the past 23 years, 4210 groundwater samples were analysed from all 141 wards in the KMC: 14.2% and 5.2% samples had arsenic >10 μg/l and >50 μg/l, respectively, representing 77 and 37 wards. The study shows that the number of arsenic contaminated samples (and wards) in the southern part of the KMC exceeds that of other parts of the city. The daily intake of arsenic from drinking water was estimated as 0.95 μg per kg bw and the cancer risk was estimated as 1425/10⁶. Analyses of biological samples (hair, nail and urine) showed elevated concentrations of arsenic indicating the presence of subclinical arsenic poisoning, predicting an enhanced lifetime cancer risk for the population in southern part of the KMC. In the KMC, groundwater is not a sustainable source of freshwater due to arsenic, high iron, hardness and total dissolved solids. Its continued use is impelled by the lack of an adequate infrastructure to treat and supply surface water and in some wards the unaccounted for water (UFW) is even >45% incurred during distribution. The rare imposition of a water tax makes the water supply systems unsustainable and fosters indifference to water conservation. To mitigate the arsenic problem, continuous groundwater monitoring for pollutants, a treated surface water supply with strict policy implications, rainwater harvesting in the urban areas and introduction of water taxes seem to be long-term visible solutions.

Fate of over 480 million inhabitants living in arsenic and fluoride endemic Indian districts: Magnitude, health, socio-economic effects and mitigation approaches

During our last 27 years of field survey in India, we have studied the magnitude of groundwater arsenic and fluoride contamination and its resulting health effects from numerous states. India is the worst groundwater fluoride and arsenic affected country in the world. Fluoride results the most prevalent groundwater related diseases in India. Out of a total 29 states in India, groundwater of 20 states is fluoride affected. Total population of fluoride endemic 201 districts of India is 411 million (40% of Indian population) and more than 66 million people are estimated to be suffering from fluorosis including 6 million children below 14 years of age. Fluoride may cause a crippling disease. In 6 states of the Ganga-Brahmaputra Plain (GB-Plain), 70.4 million people are potentially at risk from groundwater arsenic toxicity. Three additional states in the non GB-Plain are mildly arsenic affected. For arsenic with substantial cumulative exposure can aggravate the risk of cancers along with various other diseases. Clinical effects of fluoride includes abnormal tooth enamel in children; adults had joint pain and deformity of the limbs, spine etc. The affected population chronically exposed to arsenic and fluoride from groundwater is in danger and there is no available medicine for those suffering from the toxicity. Arsenic and fluoride safe water and nutritious food are suggested to prevent further aggravation of toxicity. The World Health Organization (WHO) points out that social problems arising from arsenic and fluoride toxicity eventually create pressure on the economy of the affected areas. In arsenic and fluoride affected areas in India, crisis is not always having too little safe water to satisfy our need, it is the crisis of managing the water.

Arsenic groundwater contamination and its health effects in Patna district (capital of Bihar) in the middle Ganga plain, India

We investigated the extent and severity of groundwater arsenic (As) contamination in five blocks in Patna district, Bihar, India along with As in biological samples and its health effects such as dermatological, neurological and obstetric outcome in some villages. We collected 1365 hand tube-well water samples and analyzed for As by the flow injection hydride generation atomic absorption spectrometer (FI-HG-AAS). We found 61% and 44% of the tube-wells had As above 10 and 50 μg/l, respectively, with maximum concentration of 1466 μg/l. Our medical team examined 712 villagers and registered 69 (9.7%) with arsenical skin lesions. Arsenical skin lesions were also observed in 9 children of 312 screened. We analyzed 176 biological samples (hair, nail and urine). Out of these, 69 people had arsenical skin lesions and rest without skin lesions. We found 100% of the biological samples had As above the normal levels (concentrations of As in hair, nail and urine of unexposed individuals usually ranges from 20 to 200 μg/kg, 20-500 μg/kg and <100 μg/l, respectively), indicating many people are sub-clinically affected. Arsenical neuropathy was observed in 40.5% of 37 arsenicosis patients with 73.3% prevalence for predominant sensory neuropathy and 26.7% for sensor-motor. Among patients, different clinical and electrophysiological neurological features and abnormal quantitative sensory perception thresholds were also noted. The study also found that As exposed women with severe skin lesions had adversely affected their pregnancies. People including children in the affected areas are in danger. To combat As situation in affected areas, villagers urgently need (a) provision of As-safe water for drinking and cooking, (b) awareness about the danger of As toxicity, and (c) nutritious food.

Arsenic contamination of groundwater and its induced health effects in Shahpur block, Bhojpur district, Bihar state, India: risk evaluation

The objective of this study was to determine the magnitude of groundwater arsenic contamination in Shahpur block of Bhojpur district, Bihar state, India and its health effects such as dermal, neurological, obstetric effects, and cancer risk. The School of Environmental Studies (SOES) collected 4704 tube-well water samples from all 88 villages of Shahpur, which were analyzed for arsenic. We found 40.3 and 21.1 % of the tube-wells had arsenic above 10 and 50 μg/l, respectively, with maximum concentration of 1805 μg/l. The study shows that 75,000, 39,000, and 10,000 people could be exposed to arsenic-contaminated water greater than 10, 50, and 300 μg/l, respectively. Our medical team examined 1422 villagers from Shahpur and registered 161 (prevalence rate, 11.3 %) with arsenical skin lesions. Arsenical skin lesions were also observed in 29 children of 525 screened. We analyzed 579 biological samples (hair, nail, and urine) from Shahpur and found that 82, 89, and 91 % of hair, nail, and urine, respectively, had arsenic above the normal levels, indicating many people in the study area are sub-clinically affected. Arsenical neuropathy was observed in 48 % of 102 arsenicosis patients. The study also found that arsenic exposed women with severe skin lesions had adversely affected their pregnancies. The carcinogenic and non-carcinogenic risks were also estimated based on the generated data. Safe drinking water supply is urgently required to combat arsenic situation in affected villages of Shahpur.

Current Perceptions and Practices (KAP) about Leprosy among Leprosy Patients: A Comparative Study between High Prevalent & Low Prevalent Districts of West Bengal

A cross sectional observational study was conducted to assess knowledge, attitude and practices about leprosy among leprosy patients in six districts of West Bengal. Total patients selected for the study were 300; of them 185 patients were from three high prevalent districts and 115 from three low prevalent districts of West Bengal. 56.33% patients were male and 43.67% were female. Most of the patients (85.67%) belonged to Hindu community and 60% from socially backward group. 64.33% patients lived below poverty line. Thirty five percentage of patients had correct knowledge that leprosy is caused by a bacteria. Patients from high prevalent districts (41.62%) have better knowledge than those from low prevalent areas (26.09%). Difference was found to be statistically significant (p = 0.006). Correct knowledge about spread of leprosy through cough & sneezing, of the patients from high prevalent districts (30.81%) was more than those from low prevalent districts (14.78%) (p = 0.001). 74.05% patients from high prevalent districts could tell one or other forms of clinical presentation of a leprosy patients, while 56.52% from low prevalent areas could mention it correctly (p = 0.01). About infectiousness, duration of treatment, complications, patients from high prevalent districts showed better knowledge that those from low prevalent districts. Similarly, Attitude of the patients towards leprosy was found to be more adverse in low prevalent areas. 90% patients have idea that leprosy was curable, but only 51.67% patients heard about MDT. Place of residence (high prevalent districts) & level of education (secondary & above) attributed to better knowledge score of the patients, whereas Place of residence (high prevalent districts) & age (younger age group) attributed to better attitude score of the patients.

Groundwater arsenic contamination in Bangladesh-21 Years of research

Department of Public Health Engineering (DPHE), Bangladesh first identified their groundwater arsenic contamination in 1993. But before the international arsenic conference in Dhaka in February 1998, the problem was not widely accepted. Even in the international arsenic conference in West-Bengal, India in February, 1995, representatives of international agencies in Bangladesh and Bangladesh government attended the conference but they denied the groundwater arsenic contamination in Bangladesh. School of Environmental Studies (SOES), Jadavpur University, Kolkata, India first identified arsenic patient in Bangladesh in 1992 and informed WHO, UNICEF of Bangladesh and Govt. of Bangladesh from April 1994 to August 1995. British Geological Survey (BGS) dug hand tube-wells in Bangladesh in 1980s and early 1990s but they did not test the water for arsenic. Again BGS came back to Bangladesh in 1992 to assess the quality of the water of the tube-wells they installed but they still did not test for arsenic when groundwater arsenic contamination and its health effects in West Bengal in Bengal delta was already published in WHO Bulletin in 1988. From December 1996, SOES in collaboration with Dhaka Community Hospital (DCH), Bangladesh started analyzing hand tube-wells for arsenic from all 64 districts in four geomorphologic regions of Bangladesh. So far over 54,000 tube-well water samples had been analyzed by flow injection hydride generation atomic absorption spectrometry (FI-HG-AAS). From SOES water analysis data at present we could assess status of arsenic groundwater contamination in four geo-morphological regions of Bangladesh and location of possible arsenic safe groundwater. SOES and DCH also made some preliminary work with their medical team to identify patients suffering from arsenic related diseases. SOES further analyzed few thousands biological samples (hair, nail, urine and skin scales) and foodstuffs for arsenic to know arsenic body burden and people sub-clinically affected. SOES and DCH made a few follow-up studies in some districts to know their overall situations after 9 to 18 years of their first exposure. The overall conclusion from these follow-up studies is (a) villagers are now more aware about the danger of drinking arsenic contaminated water (b) villagers are currently drinking less arsenic contaminated water (c) many villagers in affected village died of cancer (d) arsenic contaminated water is in use for agricultural irrigation and arsenic exposure from food chain could be future danger. Since at present more information is coming about health effects from low arsenic exposure, Bangladesh Government should immediately focus on their huge surface water management and reduce their permissible limit of arsenic in drinking water.

Efficacy and safety of topical nadifloxacin and benzoyl peroxide versus clindamycin and benzoyl peroxide in acne vulgaris: A randomized controlled trial

Background:

Topical therapy with comedolytics and antibiotics are often advocated for mild and moderate severity acne vulgaris. Nadifloxacin, a new fluoroquinolone with anti-Propionibacterium acnes activity and additional anti-inflammatory activity, is approved for use in acne. This randomized controlled assessor blind trial compared the clinical effectiveness and safety of eight weeks therapy of nadifloxacin 1% versus clindamycin 1% as add-on therapy to benzoyl peroxide (2.5%) in mild to moderate grade acne.

Materials and Methods:

The efficacy parameters were changes in the total, inflammatory and non-inflammatory lesion counts, Investigator Global Assessment (IGA), and Cardiff Acne Disability Index (CADI) scales from baseline to study end (eight weeks). All treatment emergent dermatological adverse events were evaluated for safety assessment.

Results:

Out of 84 randomized subjects (43-nadifloxacin arm) and (41-clindamycin) 42 in nadifloxacin group, 37 in clindamycin group completed the study. Reduction from baseline of total, inflammatory and non-inflammatory lesion counts were highly significant in both the groups (P<0.0001), but between group differences were not significant. Significant improvement in CADI and IGA scales were noted in both groups. Between-group comparison showed no significant differences. The safety and tolerability profile of both regimens were good and statistically comparable.

Conclusions:

Topical nadifloxacin, a new fluoroquinolone is effective, tolerable, and safe for mild o moderate facial acne. Its clinical effectiveness is comparable to clindamycin when used as add-on therapy to benzoyl peroxide.

Skin lesions in lupus erythematosus: a marker of systemic involvement

BACKGROUND

Lupus erythematosus (LE) is an autoimmune disorder with diverse clinical manifestation ranging from mild cutaneous disorder to life-threatening systemic illness (SLE). In some patients, it remains to persist in the skin-limited form while in others it evolves into SLE. Here comes the role of identifying the markers of systemic involvement, which could determine the course and prognosis of the disease.

AIM

To identify those manifestations that could be used to identify the activity of the disease SLE.

MATERIALS AND METHODS

An institution based, descriptive, cross-sectional study carried out over 1 year period. Sixty patients (male : female 1 : 4) with cutaneous LE were recruited for the study. The patients were classified in two groups depending on the presence or absence of ARA criteria of SLE. Detailed account of LE-specific and nonspecific lesions were noted. Statistical significance of the results was compared between the two groups using the chi-square test.

RESULTS

Among the different cutaneous manifestations, highly significant (P value <0.001) was found between SLE and nonscarring alopecia, photosensitivity, oral ulcer, malar rash (in decreasing order of odds favoring the association with SLE). Dimorphic skin lesions (P value=0.0326) also showed significant association where as discoid lesion (especially localized variant) predicted toward a skin limited form of the disease with high probability of not developing SLE (P value <0.0001). No significant association was found between SLE and papulosquamous lesions, Raynaud's phenomenon or scarring alopecia.

CONCLUSION

Identification of lesions with high degree of association with SLE can alert the physician of the unfavorable prognosis and allow timely intervention and institution of appropriate management strategies.

Pyodcerma gangrenosum on glans penis: an unusual site

Pyoderma gangrenosum is a rare, destructive, inflammatory disorder, which presents with progressively enlarging ulcers, single or multiple, mostly involving the lower extremities. It may occur alone or in association with other system diseases like inflammatory bowel disease, polyarthritis, gammopathy, etc. A case of pyoderma gangrenosum in a young male presenting with a single ulcer on the glans penis, an unusual site, without any systemic association is being reported. The prolonged history, typical raised, tender, undetermined border along with histopathological confirmation helped in clinching the diagnosis. The unusual site made it imperative to differentiate it from the common sexually transmitted ulcerative disorders and also from lupus vulgaris and squamous cell carcinoma of the penis. The ulcer showed improvement with a combination of systemic steroid and dapsone.

Multiplex PCR technique could be an alternative approach for early detection of leprosy among close contacts--a pilot study from India

Background

Implementation of Multi drug Therapy (MDT) regimen has resulted in the decline of the total number of leprosy cases in the world. Though the prevalence rate has been declining, the incidence rate remains more or less constant and high in South East Asian countries particularly in India, Nepal, Bangladesh, Pakistan and Srilanka. Leprosy, particularly that of multibacillary type spreads silently before it is clinically detected. An early detection and treatment would help to prevent transmission in the community. Multiplex PCR (M-PCR) technique appears to be promising towards early detection among contacts of leprosy cases.

Methods

A total of 234 paucibacillary (PB) and 205 multibacillary (MB) leprosy cases were studied in a community of an endemic area of Bankura district of West Bengal (Eastern India). They were assessed by smear examination for acid-fast bacilli (AFB) and M-PCR technique. These patients were treated with Multidrug Therapy (MDT) as prescribed by WHO following detection. A total of 110 MB and 72 PB contacts were studied by performing M-PCR in their nasal swab samples.

Results

83.4% of MB patients were observed to be positive by smear examination for AFB and 89.2% by M-PCR. While 22.2% of PB patients were found to be positive by smear examination for AFB, 80.3% of these patients were positive by M-PCR. Among leprosy contacts (using M-PCR), 10.9% were found to be positive among MB contacts and 1.3% among PB contacts. Interestingly, two contacts of M-PCR positive MB cases developed leprosy during the period of two years follow up.

Conclusion

The M-PCR technique appears to be an efficient tool for early detection of leprosy cases in community based contact tracing amongst close associates of PB and MB cases. Early contact tracing using a molecular biology tool can be of great help in curbing the incidence of leprosy further.

A study on the etiological agent and clinico-mycological correlation of fingernail onychomycosis in eastern India

Background:

Onychomycosis manifests itself in various forms, notably onychodystrophy, onycholysis, subungual hyperkeratosis, or nail-plate discoloration. Not necessarily nail changes mentioned here should always be of fungal origin.

Objective:

The present study is planned to get an idea about etiological agent and clinical correlation in fingernail onychomycosis.

Materials and Methods:

Nail-clipping and subungual debris of patients with above mentioned nail changes were subjected to KOH preparation. Culture was done on SDA and SDCCA media. Species identification was done by colony character, pigment production, LCB staining, and some special tests like germ tube test, etc.

Results:

Out of 85 cases, 44 cases showed the growth of fungus, amounting to 51.76% positivity. Among those 44 cases, the infective fungal agents were predominantly dermatophytes (50%), and the rest were due to yeasts (27.27%) and moulds (22.72%). Among the different species, Trichophyton rubrum (29.54%) accounted for the majority of dermatophytes; Candida albicans (11.78%) was the predominant yeast; and Aspergillus niger (18.18%) the commonest mold. No significant association could be established between the different fungal species and various clinical manifestations. Positive results were found more with fungal culture (95.45%) than KOH preparation (63.64%).

Conclusion:

The results show that nail changes are not always a reliable marker for predicting the causative organism, and relying only on the clinical manifestation (i.e., pattern of nail changes) in the diagnosis of onychomycosis is often misleading. The present study highlights the need for microbiological confirmation in case of onychomycosis.

Murshidabad—One of the Nine Groundwater Arsenic-Affected Districts of West Bengal, India. Part II: Dermatological, Neurological, and Obstetric Findings

INTRODUCTION

To understand the severity of related health effects of chronic arsenic exposure in West Bengal, a detailed 3-year study was carried out in Murshidabad, one of the nine arsenic-affected districts in West Bengal.

METHODS

We screened 25,274 people from 139 arsenic-affected villages in Murshidabad to identify patients suffering from chronic arsenic toxicity for evidence of multisystemic features and collected biological samples such as head hair, nail, and spot urine from the patients along with the tubewell water they were consuming.

RESULTS

Out of 25,274 people screened, 4813 (19%) were registered with arsenical skin lesions. A case series involving arsenical skin lesions resulting in cancer and gangrene were noted during this study. Representative histopathological pictures of skin biopsy of different types of lesions were also presented. Out of 2595 children we examined for arsenical skin lesions, 122 (4%) were registered with arsenical skin lesions, melanosis with or without keratosis. Different clinical and electrophysiological neurological features were noticed among the arsenic-affected villagers. Both the arsenic content in the drinking water and duration of exposure may be responsible in increasing the susceptibility of pregnant women to spontaneous abortions, stillbirths, preterm births, low birth weights, and neonatal deaths. Some additional multisystemic features such as weakness and lethargy, chronic respiratory problems, gastrointestinal symptoms, and anemia were also recorded in the affected population.

DISCUSSION

The findings from this survey on different health effects of arsenic exposure were compared to those from previous studies carried out on arsenic-affected populations in India and Bangladesh as well as other affected countries.

CONCLUSION

Multisystemic disorders, including dermal effects, neurological complications, and adverse obstetric outcomes, were observed to be associated with chronic arsenic exposure in the study population in Murshidabad, West Bengal. The magnitude of severity was related to the concentration of arsenic in water as well as duration of the exposure.

Comparative evaluation of the efficacy of four topical medications individually or in combination to treat grade I acne vulgaris

A randomised study was carried out to evaluate the efficacy of four topical medications individually and in combination to treat grade I acne vulgaris which is characterised by mild lesions (< 10 in one side of face) consisting of predominantly comedones with occasional pustules in oily skin. Maintaining the inclusion and exclusion criteria 100 patients were selected and divided into 5 groups to receive different topical drugs at random basis in the dermatology OPD. Topical medication given to them is mentioned below against each group: Group I--retinonic acid, group II--benzoyl peroxide, group III--clindamycin, group IV--cleanser and group V--all the four medications. The patients were observed for reduction in number of comedones, suppression of papulopustules with healing rate, effects on facial skin, and rate of recurrence. Results were observed according to the groups. In group I old acne was reduced in size and gradually cleared off (80%). Recurrence was few with appearance of new microcomedones which were cleared off within short time. Skin became smoother and fresh. Texture became lighter in colour. In group II whiteheads were reduced at about 70% in number. Rate of recurrence was normal. Skin became rough and dry. In group III pustular acne healed better and faster. In group IV acne of oily skin healed better and faster. Rate of recurrence was normal. Skin became fresh and oil-free. In group V reduction of lesions was very much significant (90%) with quick healing rate of the comedones. Recurrence was normal but delayed. Skin became smoother, finer and fresher. So, combination therapy is better. Cleanser is always helpful even without medications.

Development and application of a new efficient and sensitive multiplex polymerase chain reaction (PCR) in diagnosis of leprosy

India contributes about 80% of the global leprosy case load including case of fresh infection and reinfection. Due to lack of gold standard, diagnosis is done mainly based on routine clinical signs and symptoms, smear and histopathological evidences. There is a lot of lacunae in early confirmatory diagnosis in terms of sensitivity and specificity, especially in paucibacillary tuberculoid type. Moreover, the classification of different classes of leprosy is very important for selection of proper therapeutic schedule. Hence this study was undertaken to develop a multiplex polymerase chain reaction for the diagnosis and strain differentiation of M leprae. A multiplex polymerase chain reaction was developed using the primers R1 and R2 (a) amplifying 372bp DNA target from a repetitive sequence of M leprae and this repetitive sequence (372bp) that was used as a target DNA for amplification was reported to be specific for M leprae was not present in 20 mycobacterium species other than M leprae and primers TTCA and TTCB (b) amplifying (201bp) DNA target of variable sizes from the regions flanking TTC repeats of M leprae genome. This multiplex polymerase chain reacton developed in our laboratory revealed that the number of repeats at each locus might be variable among M leprae but they are found mostly in multibacillary (as the bacterial load is higher in multibacillary) type.

Arsenic groundwater contamination and its health effects in the state of Uttar Pradesh (UP) in upper and middle Ganga plain, India: a severe danger

This communication presents results of our 2-year survey on groundwater arsenic contamination in three districts Ballia, Varanasi and Gazipur of Uttar Pradesh (UP) in the upper and middle Ganga plain, India. Analyses of 4,780 tubewell water samples revealed that arsenic concentrations in 46.5% exceeded 10 microg/L, in 26.7%, 50 microg/L and in 10% 300 microg/L limits. Arsenic concentrations up to 3,192 microg//L were observed. The age of tubewells (n=1,881) ranged from less than a year to 32 years, with an average of 6.5 years. Our study shows that older tubewells had a greater chance of contamination. Depth of tubewells (n=3,810) varied from 6 to 60.5 m with a mean of 25.75 m. A detailed study in three administrative units within Ballia district, i.e. block, Gram Panchayet, and village was carried out to assess the magnitude of the contamination. Before our survey the affected villagers were not aware that they were suffering from arsenical toxicity through contaminated drinking water. A preliminary clinical examination in 11 affected villages (10 from Ballia and 1 from Gazipur district) revealed typical arsenical skin lesions ranging from melanosis, keratosis to Bowens (suspected). Out of 989 villagers (691 adults, and 298 children) screened, 137 (19.8%) of the adults and 17 (5.7%) of the children were diagnosed to have typical arsenical skin lesions. Arsenical neuropathy and adverse obstetric outcome were also observed, indicating severity of exposure. The range of arsenic concentrations in hair, nail and urine was 137-10,900, 764-19,700 microg/kg, and 23-4,030 microg/L, respectively. The urine, hair and nail concentrations of arsenic correlated significantly (r=0.76, 0.61, and 0.55, respectively) with drinking water arsenic concentrations. The similarity to previous studies on arsenic contamination in West Bengal, Bihar and Bangladesh indicates that people from a significant part of the surveyed areas in UP are suffering and this will spread unless drives to raise awareness of arsenic toxicity are undertaken and an arsenic safe water supply is immediately introduced.

Detection of beta-thalassaemia mutations in eastern Indian population by polymerase chain reaction

We report here the application of a non-radioactive amplification refractory mutation system (ARMS) for the direct detection of beta-thalassaemia using polymerase chain reaction. Seven beta-thalassaemia mutations accounting for 89 per cent (71 of 80) of the alleles in eastern Indian population have been identified and majority (67.5%) were due to IVS-1 nt 5 (G-C) mutation. Interestingly, 9 cases did not reveal any of the 17 common mutations reported so far from Indian population.

Observations on the breeding habitats of Aedes aegypti in Calcutta following an episode of dengue haemorrhagic fever

A year-long (Nov. 1990-Oct. 1991) search for Ae. aegypti larvae was made of all water containers in and around fixed 100 houses at Bowbazar area in Calcutta following an episode of DHF. Out of 10151 containers searched, 615 (6%) were positive. Masonry tanks were the major (64.2%) and preferred (17%) breeding sites of Ae. aegypti. Indoor containers (6.7%) were more conducive to breeding of the vector species than the outdoor ones (3%). Breteau index showing wide variation (25 in December '90 to '93 in August 1991) proved to be the best for measurement of density of larval population of Ae. aegypti and paralleled the fluctuation in both rainfall and humidity. Role of temperature was not pronounced. It was noted that cases of DHF occurred even with the lowest Breteau index in December.

An echo-cardiographic (M-mode & 2D) analysis of thalassaemia major

25 cases of thalassaemia major were studied by 2D and M-mode echocardiography. A significantly increased (p less than 0.001) mean value (100.8 +/- 27.37 msec, range 80 to 140 msec) of A2-E (early relaxation period) interval on M-mode was observed in thalassemia in comparison to mean level (82.6 +/- 5.7, range 60 to 100 msec) of control population. No significant differences were noted in FS % (fractional shortening) and EF% (ejection fraction) when compared to corresponding normal values respectively. Mean serum iron concentration (142.2 +/- 29.1 micrograms/dl, range 102 to 192 micrograms/dl) was significantly higher in thalassaemia as compared to normal population (mean 106.3 +/- 11.4 micrograms/dl, range 75 to 120 micrograms/dl). There was also a direct correlation between serum iron concentration and A2-E interval. 11 patients (44%) showed abnormal A2-E interval but only 3 patients (12%) showed abnormal percentage of FS and EF. It is therefore concluded that A2-E interval will help to detect early left ventricular dysfunction much before overt and irreversible heart failure becomes manifest and which will also help to optimise transfusion and chelation therapy.

In vivo distribution of lithium in plasma and brain

A single administration of LiCl (0.5, 2 and 4 mmol/kg) to adult male albino rats produced a dose dependent increase of Li level in plasma, whole brain and brain regions. The concentration of Li in whole brain and brain regions was much less than that in plasma. Further, it is also found that concentration of Li in plasma reached a peak at 8 hr while that of Li in whole brain and brain regions reached a peak at 12 hr after the administration. The distribution and retention of Li was found to be highest in hypothalamus followed by striatum, pons-medulla, cerebellum and cerebral cortex. Daily administration of LiCl at a dose of 0.5 and 2 mmol/kg/day showed a time and dose dependent increase in plasma Li level up to a period of 21 consecutive days. But at higher dose (4 mmol/kg/day), on the other hand, under similar condition showed a time dependent increase in plasma Li level up to a period of 14 consecutive days and then gradually decreased with prolongation of treatment to 21 consecutive days. In brain there was no such decrease, rather increase in Li level was observed with the prolongation of duration of treatment, highest concentration of Li was found in hypothalamus and striatum than the rest of the brain regions. These results suggest that under short term treatment with LiCl, the clearance rate of Li in brain cell is much slower than that in plasma. Both single and long-term exposure of LiCl produces a dose dependent increase of Li in plasma, whole brain and brain regions.(ABSTRACT TRUNCATED AT 250 WORDS)

Reversal reaction in patients with lepromatous leprosy after transplantation of human fetal thymic grafts

An attempt has been made to reconstitute impaired cell-mediated immunity in 1 patient with indeterminate, 4 patients with borderline and 2 patients with polar lepromatous leprosy by grafting three thymus glands obtained from human fetuses of 14--19 weeks gestation. Most of these patients had severe ulcerative erythema nodosum leprosum (ENL) and were intolerant to dapsone. After thymus transplantation these patients were followed for 1 1/2 years. During this period, all conventional chemotherapy had been withdrawn. In most cases, there was dramatic improvement of the clinical condition, resolution of skin lesions, subsidence of ENL, clearance of bacteria from skin and reconstitution of several immunologic deficits; but late lepromin reactivity returned in none, which indicated permanent lose of resistance to Mycobacterium leprae.

Immunologic aspects of leprosy with special reference to the study of immunoglobulin E

The serum levels of IgG, IgM, IgD and IgE have been determined in normal subjects, individuals suffering from ascariasis and filariasis, and in leprosy patients. Allergic and parasitic diseases were excluded in these normal subjects and in leprosy patients before they were taken for the study of their serum IgE. The circulating IgG was significantly raised in both tuberculoid and lepromatous forms of leprosy and also in filariasis; IgM was significantly elevated in only the lepromatous form of leprosy, ascariasis as well as in filariasis; while IgA was exclusively raised in both forms of leprosy. IgD was detected in the sera of more subjects with ascariasis and filariasis than in normal individuals and leprosy patients. The mean level of serum IgE in 35 normal Indian subjects was 1,025 I.U. per ml, 9 of them (25%) having serum IgE concentrations above 700 I.U. per ml. The highest mean level of serum IgE was found in ascariasis (7,328 I.U. per ml), followed by leprosy (5,180 I.U. per ml), and filariasis (4,244 I.U. per ml). Furthermore, no significant difference between the mean serum IgE levels of tuberculoid and lepromatous leprosy patients was observed. Although the rise of serum IgE level in these parasitic diseases, as well as in leprosy, was spectacular, the augmented synthesis of this unique class of immunoglobulins was not invariably present in all patients. The results have been discussed on the basis of recent ideas on immunoglobulin synthesis.

Immunologic aspects of leprosy as related to leucocytic isoantibodies and platelet aggregating factors

The incidences of various iso- and autoantibodies in a random population of 112 unselected leprosy patients is presented. Low titers of leucocytic isoantibodies and platelet aggregating factor were detected in the sera of a variable number of such patients. The leucoisoagglutinins were found in 8% of the sera of tuberculoid as well as lepromatous leprosy patients, whereas the leucoisocytotoxins were detected in a larger percentage of the lepromatous (40%) as well as tuberculoid (28%) cases. The platelet aggregating factors (PAF) were positive in 51.2% and 45% of lepromatous and tuberculoid cases respectively. Of the 21 positive sera for PAF, the antiplatelet factor by antihuman globulin consumption test could be demonstrated only in 66.6% and 50% of lepromatous and tuberculoid sera respectively. To study the frequencies of these newly detected antibodies or antibody-like factor and to compare their occurrences with other well-documented autoantibodies present in the sera of leprosy patients: cryoglobulins, antinucleoprotein antibody and thyroglobulin autoprecipitin were also studied in the sera of the same population of leprosy patients. It has been observed that the simultaneous occurrence of all these auto- and isoantibodies in the serum of one patient is a rare phenomenon. Leucocytic and platelet counts of these patients having antibodies against leucocytes and platelets were found to be within normal limits. Accordingly, it is suggested that the low levels of antileucocyte antibody and antiplatelet factor are probably harmless to the hosts. On the other hand, it is postulated that these antibodies may act as enhancing factors by being specifically adsorbed on the lymphoid cells, thus rendering them unresponsive to mitogenic stimulus in vitro. From these studies it seems that leprosy, especially the lepromatous type, is associated with some of the serological features suggestive of an autoimmune aberration.