Ultra-structural observations on the lymphoid organs of the freshwater catfish, Clarias batrachus (Linnaeus)

Light microscopic and ultra-structural studies of the lymphoid tissues such as blood immunocytes, spleen and pronephros of the freshwater catfish, Clarias batrachus, were carried out. The peripheral blood showed nucleated erythrocytes, total leucocytic count (TLC) more than that observed in mammalian blood and leucocytes with morphological appearance similar to the mammalian white blood cells (WBCs). The spleen and pronephros showed presence of numerous lymphocytes, monocytes and nucleated red blood cells (RBCs) along with hemosiderin-containing macrophages. The morphology of lymphoid organs of the catfish has been discussed in light of the evolution of the immune system in this class of vertebrates.

Estimation of thyroid mass in Graves' disease by a scintigraphic method

scintigraphic method for the estimation of the thyroid mass in patients with Graves' disease is described. The method was first standardized using thyroid phantoms with eight different volumes ranging from 5 to 110 cm(3). The planar and single photon emission computed tomography (SPECT) images of each phantom were acquired with four different activities [3.7 MBq (100 microCi), 11.1 MBq (300 microCi), 22.2 MBq (600 microCi) and 37 MBq (1.0 mCi) of 99mTc-pertechnetate] with a 20% window symmetrically placed over the photopeak of 99mTc. The thyroid lobes were enclosed with the help of regions of interest (ROI) tools and a threshold was selected to identify the thyroid boundaries. The same threshold was used in all slices of an image. In the phantom study, a 20% threshold for planar images and a 30% threshold for SPECT were found to be optimum for measuring the thyroid volume. The volume from planar images was calculated by the formula described by Allen and Goodwin (The scintillation counter as an instrument for in-vivo determination of thyroid weight. Radiology 1952; 58: 68-79), whereas, in SPECT images, the sum of the slice areas was multiplied by the slice thickness. The estimated volume of each phantom was compared and correlated with its actual volume. After standardization of the technique with phantom studies, planar scintigraphy (with 20% threshold) in 51 patients and SPECT (with 30% and 35% threshold) in 40 patients with Graves' disease were performed to estimate the thyroid size. The thyroid size was also estimated by ultrasonography, which showed good agreement with the scintigraphic method, particularly with SPECT.

Removal of chromium and reduction of toxicity to Microtox system from tannery effluent by the use of calcium alginate beads containing humic acid

Removal of chromium (Cr) from tannery effluents by recovery of metal also reduces the ecotoxicological impact. To develop such a process, columns packed with calcium alginate (CA) beads with or without humic acid (HA) have been used as an adsorbent and tannery effluent was passed through it. Concentration of Cr in beads and in different fractions collected after adsorption was measured. Change in total organic carbon content during the process was also noticed. The fractions were also tested for toxicity towards Microtox assay. EC(50) values were determined with the help of Microtox analyser 500. Data showed that the CA beads along with HA could be effectively utilised in removal of 54% Cr and also in reducing the toxicity (EC(50) (%) in 5 min=>100 in fractions collected after 72 h).

Role of humic acid entrapped calcium alginate beads in removal of heavy metals

Most of the available techniques for removal of heavy metals from solution such as leachates from waste sites are very expensive. The technique described in this paper is designed to study the removal of humic acid by alginate beads and the subsequent binding of the metals within the beads thus decreasing the leachability of heavy metals from a hazardous waste site. The entry of 500 mg/l humic acid into 3% calcium alginate beads in 24 h showed a distinct fluorescence as compared to the fluorescence shown by the entry of 100 and 250 mg/l of humic acid into alginate beads. Further, on treatment of calcium alginate beads containing 500 mg/l humic acid with metals such as Cu, Mn, Zn, Cr and Fe, quenching of fluorescence was noticed, which was maximum with Cu and minimum with Fe.

NEOSTIGMINE IN THE NEUROPARALYTIC EFFECTS OF SNAKE BITE

Abstract

Selective preconcentration and determination of chromium(VI) using a flat sheet polymer inclusion sorbent: potential application for Cr(VI) determination in real samples

A method for sorption preconcentration of Cr(VI) from aqueous samples was developed using a polymer inclusion sorbent (PIS). The PIS used in this method was prepared by physical inclusion of Aliquat-336 in the matrix formed by cellulose triacetate and 2-nitrophenyl octyl ether. This sorbent was found to be stable, cost-effective, efficient for preconcentration of Cr(VI) present in the aqueous samples, and amenable to direct quantitative analysis of Cr(VI) held in it by neutron activation analysis and spectrophotometry. The quantifying of Cr(VI) in PIS by spectrophotometry was carried out by developing color directly on the PIS after reacting it with 1,5-diphenylcarbazide. The distinct color developed on the PIS even at very low concentrations of Cr(VI) suggests its possible use for field determination of Cr(VI). The composition of PIS was optimized to obtain maximum uptake of Cr(VI) without sacrificing uniformity in terms of thickness and distribution of ion-exchange sites, stability, and time required for quantitative sorption of Cr(VI) from aqueous samples. The Cr(VI) species held in the PIS, mainly HCrO4- and CrO4(2-), were found to vary as a function of pH of the aqueous samples from which Cr(VI) was preconcentrated. A close agreement was found in the abundances of Cr(VI) species held in the PIS with those reported in the literature for aqueous solutions at different pH. The variation of Cr(VI) species as a function of pH was found to have a significant impact on the tolerance to anions on the uptake of Cr(VI) in the PIS. The high selectivity of PIS toward Cr(VI) from aqueous solution at pH = 2 was explained on the basis of hydration of anions. The uptake of Cr(VI) was found to be fairly constant (88 +/- 3%) up to nearly complete exchange of counterions present in the PIS. The method developed in the present work was successfully used for the preconcentration of Cr(VI) from tap water and seawater samples containing low levels of Cr(VI).

Microbial metabolites as eco-friendly agrochemicals for the next millennium

As a result of the increasing environmental and health-related problems caused by the synthetic agrochemicals currently used, suitable and non-hazardous innovative alternatives are being sought. Antagonism and allelopathy, both in nature and in agro-ecosystems, have attracted these researchers' attention, with the main goal of using these phenomena in the biological control of weeds. This article presents a review on the use and efficacy of microbial secondary metabolites which have potential as natural herbicides, either directly or as templates for bio-rational eco-friendly agrochemicals (allelochemicals). Their merits as alternatives to synthetic chemicals and biological control agents have been highlighted for an holistic approach in integrated pest/weed management.

Stability constants of metal-humic acid complexes and its role in environmental detoxification

Humic acid with hydroxyl-, phenoxyl-, and carboxyl-reactive groups can form coordination compounds with metals. The ion-exchange equilibrium method using Dowex AG 50W-X8, 20-25 mesh Na(+) form was used to determine stability constants of complexes formed between humic acid (isolated from the soil) 50-250 microg ( approximately 3x10(-5)-15x10(-5) mol/liter) and metal salts solution 200 microg at pH 3.5. The stability constant (log K) for different metal-humic acid complexes indicated the following order of the stabilities of complexes formed between humic acid and metal ions: Cu>Fe>Pb>Ni>Co>Ca>Cd>Zn>Mn>Mg. The data on stability constants demonstrated substantial deviation from Irwing-Williams series reported for divalent ions. The molar humic acid/metal ratios were also calculated. Some of the factors affecting the stability constants such as cation exchange capacity of humus soil, molecular radius, and molecular surface area of humic molecules were also estimated. The significance of the data to predict the behavior of these complexes in the environment is discussed.

A prospective randomized, comparative, open-label trial of the safety and efficacy of paromomycin (aminosidine) plus sodium stibogluconate versus sodium stibogluconate alone for the treatment of visceral leishmaniasis

Response to treatment with organic pentavalent antimonials, the standard first-line treatment for visceral leishmaniasis (VL), has been decreasing since their introduction into India. Combining sodium stibogluconate (SB) with paromomycin (PM) may be an efficient alternative to single-agent therapy. This trial was designed to assess the safety and efficacy of PM 12 or 18 mg/kg daily plus SB 20 mg/kg daily for 21 days compared to SB alone for 30 days. One hundred and fifty patients were randomly assigned in 1996 to 1 of the 3 treatments and followed-up for 180 days. At the end of treatment, 49 of 52 patients receiving PM12 + SB, 46 of 48 receiving PM18 + SB, and 27 of 49 patients receiving SB alone, were cured. During follow-up there was 1 relapse in each of the treatment groups, giving final cure rates of 48 of 52 (92.3%) for PM12 + SB, 45 of 48 (93.8%) for PM18 + SB, and 26 of 49 (53.1%) for SB. PM plus SB for 21 days at either 12 or 18 mg/kg daily was significantly more effective than SB alone for 30 days (chi 2 P < 0.001). One patient (SB alone) had experienced a serious adverse event: cardiotoxicity at day 8 (myocarditis and ECG changes) which caused withdrawal from the study. Only 19 of 100 patients enrolled in the PM treatment arms had a complete audiogram series conducted thus making it difficult to assess oto-toxicity. PM 12 or 18 mg/kg daily plus a standard dose of SB for 21 days was statistically more effective than SB in producing a final cure for patients with VL in Bihar, India.

Individual kidney glomerular filtration rate in the interpretation of non-diagnostic curves on captopril renography

Captopril renography is known to have low sensitivity in the detection of renovascular disease in patients with bilateral renovascular disease and in patients with unilateral renovascular disease with a small kidney. In these groups of patients, we have tried to make the standard captopril renogram more objective by simultaneously estimating the individual kidney glomerular filtration rate (IKGFR). Twenty-five patients (10 bilateral, 15 unilateral) with angiographically proven renal artery stenosis (RAS) were studied. Ten renal units in five hypertensive patients with normal renal arteries were used as controls. A fall of more than 10% in IKGFR post-captopril was considered a positive result. The sensitivities of renogram and IKGFR in patients with bilateral RAS were 52.9% and 88.2% respectively. In patients with unilateral RAS, the sensitivities of renogram and IKGFR were 30% and 80% respectively. A significant fall in IKGFR was noted in eight of the 15 'normal' renal units of the unilateral RAS group. In conclusion, individual kidney GFR estimation in combination with captopril renography improved significantly the sensitivity in patients with symmetrical bilateral RAS and unilateral RAS with a small, poorly functioning kidney. A fall in GFR in the normal counterpart of a unilateral RAS kidney may be indicative of ongoing damage in the non-involved kidney.

Dose-ranging studies on liposomal amphotericin B (L-AMP-LRC-1) in the treatment of visceral leishmaniasis

Efficacy and tolerability of liposomal amphotericin B (L-AMP-LRC-1; developed in India by the Liposome Clinical Pharmacology Centre, Mumbai, and the Liposome Research Centre, New Delhi) were assessed in 63 patients suffering from visceral leishmaniasis at centres in Mumbai and Patna. Patients were treated with different daily dose schedules ranging from 1 mg/kg for 21 days to 3.0 mg/kg for 7 days. L-AMP-LRC-1 was well tolerated by all 63 patients. Two patients on the 3.0 mg/kg dose developed bronchospasm on 4 occasions which reversed with standard treatment and could be prevented by increasing the duration of infusion to 3 h. Forty-three patients were freshly diagnosed cases while 20 were unresponsive to standard treatment. All 42 assessable freshly diagnosed cases responded completely to L-AMP-LRC-1 (1 patient died owing to pulmonary infection before completion of treatment), but 5 patients required additional doses for parasitological cure. All 20 patients unresponsive to standard therapy responded completely, but 3 patients required additional doses. The regimen of 2 mg/kg daily for 10 days was 100% effective; 3 mg/kg daily for 5 days was efficacious in 90.9% freshly diagnosed patients, and 3 mg/kg daily for 7 days was effective in 100% of the unresponsive cases of visceral leishmaniasis. L-AMP-LRC-1 is thus found to be safe and effective in freshly diagnosed as well as unresponsive cases of visceral leishmaniasis at dose schedules of shorter duration than used for conventional amphotericin B.

In vitro susceptibility of opportunistic Fusarium spp. to essential oils

The inhibitory effects of essential oils extracted from 10 Indian plants were evaluated against five fungi. The plants used for extraction of essential oils were six species of the genus Eucalyptus and Ocimum basilicum, Prosopis cineraria and Derris indica. The fungi used in the experiments were Fusarium solani, F. oxysporum, F. pallidoroseum, F. acuminatum and F. chlamydosporum. The susceptibility of the Fusarium species was tested by the paper disc method and the serial dilution technique. The results were compared with the inhibitory effects of miconazole on the fungi. The essential oils extracted from the Eucalyptus species markedly inhibited fungal growth. Prosopis cineraria did not show inhibiting properties. Among the fungi, F. oxysporum proved to be the most resistant species.

Decay of the GRB 990123 optical afterglow: implications for the fireball model

Broad-band (ultraviolet to near-infrared) observations of the intense gamma ray burst GRB 990123 started approximately 8.5 hours after the event and continued until 18 February 1999. When combined with other data, in particular from the Robotic Telescope and Transient Source Experiment (ROTSE) and the Hubble Space Telescope (HST), evidence emerges for a smoothly declining light curve, suggesting some color dependence that could be related to a cooling break passing the ultraviolet-optical band at about 1 day after the high-energy event. The steeper decline rate seen after 1.5 to 2 days may be evidence for a collimated jet pointing toward the observer.

Leprosy vaccine: influence of dissolved oxygen levels on growth of a candidate strain (Mycobacterium w), and storage stability of the vaccine

The growth of Mycobacterium w, a candidate strain for leprosy vaccine in submerged culture, was inhibited by the presence of over 40% oxygen saturation in the medium. Intracellular levels of superoxide dismutase and catalase were very low in the beginning. However, under controlled oxygenation, these levels increased with time. The augmentations of these antioxidant enzymes were associated with the elevated oxygen consumption by the culture. By maintaining the oxygen level below 20% during 6-day culture, it was possible to grow Mycobacterium w in five production batches up to a cell density of 3.7 +/- 0.70 x 10(9) bacilli ml-1. The shelf life of the vaccine produced in different batches was more than 2 years, both at 4 degrees C and at 26 degrees C. This provides a cost-effective, unit culture technology for the production of this candidate leprosy vaccine from a nonpathogenic organism, which will facilitate the widespread use of the vaccine.

Do the diminishing efficacy and increasing toxicity of sodium stibogluconate in the treatment of visceral leishmaniasis in Bihar, India, justify its continued use as a first-line drug? An observational study of 80 cases

Eighty parasitologically confirmed cases of visceral leishmaniasis (kala-azar) in Bihar, India, were treated daily with 20 mg sodium stibogluconate/kg for 30 days, to assess the current efficacy and toxicity of this 30-day regimen. Clinical and parasitological cure was obtained in 48 (60%) of the patients. However, 26 (33%) patients did not respond to the first course of treatment (primary unresponsiveness), two relapsed after initial clinical and parasitological cure, and two were withdrawn from the study (one on day 6 of treatment because of cardiotoxicity in the form of supraventricular tachycardia and the other on day 24 because of severe loss of appetite). All 30 patients who were not entirely cured with sodium stibogluconate were successfully treated with amphotericin B. Electrocardiographic changes occurred in many of the patients as the result of treatment with sodium stibogluconate. Diminution in the height of the T wave was seen in 32 (40%), inversion of the T wave (Minnesota code 5-1, 5-2) in seven (9%), elevation of the ST segment (Minnesota code 4-1) in three (4%), prolonged QT interval (compared with baseline findings) in six (8%), and diminution in the height of the P, R and T waves in two (3%). Cardiac arrhythmia occurred in five patients (6%), supraventricular arrhythmia (coarse atrial fibrillation) occurred in one patient and ventricular tachycardia, ventricular fibrillation, torsade de pointes and multifocal ventricular ectopics occurred in the four patients (5%) who died of cardiotoxicity. Minor side-effects, such as pain at the site of injection (two cases), mild diminution in appetite (12 cases), metallic taste in mouth (six cases), and joint pain (two cases), were also observed. It was concluded that the efficacy of sodium stibogluconate in the study area has declined over the years and that its toxicity has increased. A more efficacious, safer and cheaper, alternative drug is required as the first line of treatment of kala-azar.

Comparison of three treatment regimens with liposomal amphotericin B (AmBisome) for visceral leishmaniasis in India: a randomized dose-finding study

The efficacy and safety of 3 regimens of liposomal amphotericin B (AmBisome) in the treatment of Indian visceral leishmaniasis were compared in a prospective open randomized trial. Thirty parasitologically confirmed patients were randomly divided into 3 equal treatment groups; group 1 received AmBisome 2mg/kg on days 1, 2, 3, 4, 5, 6, and 10 (total dose 14 mg/kg); group 2 received AmBisome 2 mg/kg on days 1, 2, 3, 4, and 10 (total dose 10 mg/kg); group 3 received the same dosage on 1, 5 and 10 (total dose 6 mg/kg). Clinical cure resulted in all patients by day 24. Haemoglobin, white blood cell count, body weight and serum albumin level improved on day 24 and became normal by day 180. No patient relapsed within 12 months of follow-up. Side effects were minimal. One patient in group 2 died after 2 months from an unrelated disease. Liposomal amphotericin B is a promising new drug which is highly efficacious in the treatment of Indian kala-azar and produces minimal toxicity.

Comparison of regimens of amphotericin B deoxycholate in kala-azar

A total of 288 parasitologically proved patients of kala-azar were randomly allocated to three treatment groups. Patients in groups A, B and C received amphotericin B (AMB) in a dose of 1 mg/kg body weight (bw)/day, 0.75 mg/kg bw/day and 0.5 mg/kg bw/day for 20 days respectively. Apparent cure (afebrile at the end of therapy) occurred in all patients and parasitological cure in 96 (100%), 92 (96%) and 84 (88%) patients respectively in groups A, B and C. Ultimate cure (no relapse in six months of follow up) occurred in 95 (99%), 87 (91%) and 79 (82%) patients in groups A, B and C respectively. The difference between the ultimate cure in the three groups was significant (P < 0.05). The incidence of adverse events (rise in serum creatinine and fall in serum potassium, loss of appetite and shivering, rigor and fever during infusion indicative of renal, GIT and infusion related toxicities respectively) was similar in the three groups. This study showed that amphotericin B should be given at a dosage of 1 mg/kg bw/day for 20 days for Indian kala-azar patients to minimise relapses and prevent development of drug unresponsiveness.

Soft tissue release in clubfoot by double incision

A procedure for soft tissue release through double incisions in clubfoot is described. It has been practiced in 287 cases of severe, neglected, resistant, and relapsed clubfeet in the last 7 years. Generally, it has been found to be a useful approach without risking any skin necrosis.

Daily versus alternate-day regimen of amphotericin B in the treatment of kala-azar: a randomized comparison

Using a randomized study, we compared a daily and an alternate-day regimen of amphotericin B for the treatment of kala-azar, with respect to efficacy, adverse reactions, cost-effectiveness, and tolerance. The study subjects were 80 kala-azar patients, drawn from the first four decades of life and matched by age, sex, and parasite load. The patients were randomly allocated to treatment groups A and B (40 patients per group). Patients in group A received a daily regimen of amphotericin B, starting with an escalating dose of 0.05 mg/kg body weight per day until a daily dose of 1 mg/kg was reached; the latter dose was then given daily till a total dose of 20 mg/kg body weight had been administered. The patients in group B also started with an escalating dose of 0.05 mg/kg but when 1 mg/kg was reached the drug was given on alternate days. All 80 patients using the two treatment regimens were cured, no patient relapsed in either group in 6 months of follow-up, and their bone-marrow aspirates were free of amastigotes. Treatment of kala-azar patients with the daily regimen of amphotericin B at a dose 1 mg/kg body weight was as effective, not more toxic, equally well tolerated, and much more cost-effective than the alternate-day regimen and should be adopted for treatment of this condition.

Respiratory adaptation to high altitude in adolescent Bod girls of the Western Himalayas

The impact of high-altitude environment was studied on respiratory functions and body measurements in adolescent Bod girls of Ladakh, Jammu and Kashmir, India. Data were collected on 133 high-altitude and 141 low-altitude Bod girls in the age range 12-18 years. Lung functions were, age to age, higher in high-altitude girls than their coeval lowlanders. This has been explained as an adaptation to the stress of low atmospheric pressure at high altitude. This response is similar to the one observed in growing Bod boys living in the same area (Malik and Singh 1979, 1984). High-altitude girls were shorter and lighter, the difference was more pronounced in weight and especially after 14 years of age.

Evaluation of amphotericin B as a first line drug in comparison to sodium stibogluconate in the treatment of fresh cases of kala-azar

A total of 150 patients of kala-azar matched for age and sex and parasitologically proved were randomly allocated to two equal treatment groups. Patients in one group received amphotericin B(AMB) in a dose of 1 mg/kg body weight (BW) on alternate days starting with 0.05 mg/kg/bw on first day with daily increments, till a total dose of 20 mg/kg/bw was given; the patients in the second group received sodium stibogluconate (SAG) in the dose of 20 mg/kg/bw, im daily for 30 days. The efficacy, safety and cost-effectiveness of the two drugs were compared. Apparent cure (afebrile at the end of therapy) in 75 (100%) and 69 (92%) patients and ultimate cure (no relapse in six months of follow up) in 75 (100%) and 60 (80%) patients occurred in the AMB and SAG groups respectively. The difference between the ultimate cure in the two groups was significant (P < 0.001). Six (8%) and 9(12%) patients of SAG group showed primary (with no response to SAG during treatment) and secondary unresponsiveness (with no response to SAG after relapse) respectively and they were cured with amphotericin B.(ABSTRACT TRUNCATED AT 250 WORDS)

Amphotericin B in resistant kala-azar in Bihar

BACKGROUND

During the recent epidemic of kala-azar in Bihar, we identified a group of patients who were unresponsive to the two commonly used drugs--sodium stibogluconate and pentamidine. We evaluated the use of amphotericin B in these patients because it has been shown to be active in experimental animals against amastigotes and promastigotes, it has been found to be useful in South American patients and is now recommended by the World Health Organization as a second line drug.

METHODS

We selected 300 patients who were unresponsive to sodium stibogluconate and pentamidine (out of 500 patients with kala-azar confirmed by demonstration of Leishmania donovani bodies in their splenic aspirates). Amphotericin B was given in a dose of 1 mg/kg body weight on alternate days starting with 0.05 mg/kg body weight with daily increments till a 1 mg dose was reached. A total dose of 20 mg/kg was given initially and repeated if the parasites persisted. The investigations done before and after treatment were splenic or bone marrow aspiration, measurement of the spleen and liver size, body weight, total and differential white cell counts, haemoglobin level, total serum protein, blood urea, serum creatinine, serum potassium, blood sugar, serum alanine and aspartate transaminase, electrocardiography and a chest X-ray. The efficacy of treatment was assessed at the end of treatment and after 6 months of follow up.

RESULTS

After treatment with amphotericin B, 298 (99%) of the patients had been cured of their disease as evidenced by the disappearance of fever, reduction of hepatosplenomegaly, clearance of the parasites from the spleen and bone marrow and an absence of relapse on 6 months of follow up. Two hundred and sixty-eight (89%) patients required 1 g of the drug, 24 (8%) required 1.5 g and 6 (2%) required 2 g. All patients had shivering and fever during the infusion. Two had a cardiac arrest from which they could not be revived. Other complications included anorexia, stomatitis, jaundice, hypokalaemia and a rise in blood urea. However, these were only mild and improved after treatment was stopped.

CONCLUSION

Amphotericin B is an effective drug for patients with kala-azar unresponsive to treatment with sodium stibogluconate and pentamidine, but it should be administered under close medical supervision.

Efficacy of amphotericin B in multi-drug resistant kala-azar in children in first decade of life

Fifty children in the first decade of life, and suffering from multiple drug resistant kala-azar, confirmed by demonstration of amastigotes in aspirates of bone marrow or spleen were treated with amphotericin B in gradually increasing dosage to a total dose of 20 mg/kg. All patients had classical features of severe kala-azar, and had taken more than one course of antimony and pentamidine, and three patients had taken one additional course of ketoconazole besides many courses of antimony and pentamidine. The clinical response started just after first infusion in 8 patients, and the patients became afebrile. By 5th infusion, all looked better and 18 patients became afebrile. By 15th infusion all patients were afebrile and cheerful. Their spleens became smaller and body weights and total white cell counts increased. Forty eight patients had parasitological cure at the end of treatment, and only 2 patients required an additional 5 infusions for parasitological cure. All patients were ultimately cured. No one relapsed within six months of follow up. All patients had shivering, rigor and rise of temperature on the day of infusion, which could be minimized with prior administration of low dose of hydrocortisone, but could not be eliminated. Eighteen patients had loose motions during treatment, while 14 patients had decrease in appetite which improved quickly when the treatment was over. Fourteen patients had transient rise of blood urea, in six patients serum creatinine also increased and 16 patients had a minor fall in serum potassium.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of regimes of treatment of antimony-resistant kala-azar patients: a randomized study

Three hundred twelve patients with antimony-resistant kala-azar were randomized into three groups. The first group (A) received pentamidine isethionate intravenously three times each week until parasitological cure was achieved. Group B received pentamidine concomitantly with a 20-day regimen of sodium stibogluconate. Group C received pentamidine injections that were followed by 20 days of sodium stibogluconate therapy. All patients became afebrile after 10 injections of pentamidine. Parasitologic cure was achieved in approximately 98% of the patients who had 33 or more injections of this drug. The addition of the antimony compound did not appear to enhance the rate of parasitologic cure. Three patients continued to have parasites after 40 injections of pentamidine. After six months, the rate of parasitologic cure was significantly higher in Group C (pentamidine followed by sodium stibogluconate) than in either Group A or B. Forty patients relapsed after apparent parasitologic cure and were successfully treated with five additional injections of pentamidine, followed by a course of antimony therapy. Minor side effects with pentamidine included an uneasy feeling during intravenous injection (12%), intestinal disturbances (6%), cellulitis (5%), abscess formation (1%), and allergic manifestations (2%). Major reactions to this drug included hyperglycemia (10%; reversible in 6% and irreversible in 4%), and delayed hypoglycemia (8%). Four deaths were associated with the administration of this compound. It is concluded that pentamidine is an effective but toxic drug for the treatment of antimony-resistant kala-azar.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of efficacy of longer durations of therapy of fresh cases of kala-azar with sodium stibogluconate

The efficacy and safety of three regimens of treatment for kala-azar (visceral leishmaniasis) with sodium stibogluconate were evaluated in a randomised clinical trial to ascertain the optimal duration of treatment for Indian patients. The study included a total of 312 (226 male, 86 female) patients with fresh kala-azar, confirmed by demonstration of parasites in aspirates from bone marrow or spleen, who were randomly allocated into three treatment groups of 104 patients in each to receive sodium stibogluconate intramuscularly. The dose of the drug was 20 mg/kg/body weight/daily with a maximum of 8.5 ml for 20, 30 and 40 days (groups A, B, C respectively). The response of treatment was assessed under blind conditions and patients were followed up each month for a period of six months. The number of patients who were apparently cured (i.e., those whose temperature had returned to normal at the end of their respective regimen and aspirates were free of parasites) was 91 (87%) in group A, 98 (94%) in group B, and 102 (98%) in group C. The difference between groups A and C was significant (P less than 0.01). The number of patients who were ultimately cured at six months was 74 (71%) in group A, 86 (83%) in group B and 98 (94%) in group C. These patients had not relapsed and were cured as confirmed by a bone marrow aspirate which was free of parasites. The difference between groups A and C (P less than 0.001) and groups B and C (P less than 0.05) were significant. However, the difference between groups A and B was not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Further experiences of Küntscher's nailing for tibial shaft fractures

We present the experience of managing 429 fractures of the tibia fixed with straight Küntscher rods. The overall impression is quite encouraging because this method involves a short and easy operation with limited exposure and provides sound fixation. Complications have been negligible.

Results of partial patellectomy

We present an assessment of 200 patellar fractures treated mostly (175) by partial patellectomy. In 23 cases in which the quadriceps mechanism was 75% intact (MRC power approximately 4), the fractures were treated conservatively, with an overall acceptable result. The operative series with an average follow-up of 3 years has shown 80.3% excellent to good results. A classification of fractures of the patella, based on the anatomical fracture line and quadriceps functional loss as recorded in 690 case histories, is suggested.

Calcaneal osteotomy and tendon sling for the management of calcaneus deformity

A one-stage operation for severe post-poliomyelitic calcaneus deformity was done in seventy-seven feet of seventy-seven patients. The operation consisted of osteotomizing the calcaneus to increase the lever arm and to reshape the hind part of the foot and using a posterior sling formed from the peroneus brevis and tibialis posterior to provide plantar-flexion power. We were able to evaluate sixty-six patients more than three years after the operation. Most of the patients had improvement in the appearance and function of the foot as a result of the operation.

Rationalisation of regimens of treatment of kala-azar with sodium stibogluconate in India: a randomised study

The efficacy and safety of six regimens of treatment for kala-azar (visceral leishmaniasis) with sodium stibogluconate were evaluated in a prospective randomised study to ascertain the optimal treatment for Indian patients. Altogether 371 patients with kala-azar were randomised to receive sodium stibogluconate intramuscularly at a dose of 10 mg/kg body weight/day for 20 or 40 days (groups A and A1, respectively), 15 mg/kg body weight/day for 20 or 40 days (groups B and B1, respectively), or 20 mg/kg body weight/day for 20 or 40 days (groups C and C1, respectively). Patients were examined blind before and at the end of treatment and every month for six months. The number of patients who were apparently cured--that is, those whose temperature had returned to normal at the end of their regimen of treatment--was 45 (78%) in group A, 53 (87%) in group A1, 50 (81%) in group B, 60 (95%) in group B1, 58 (92%) in group C, and 62 (97%) in group C1. At six months 62 patients (97%) in group C1, 51 (81%) in group C, 54 (86%) in group B1, 42 (68%) in group B, 45 (74%) in group A1, and 33 (57%) in group A had not relapsed and were cured as confirmed by a bone marrow aspirate free of parasites. The differences between groups C1 and C, B1 and B, and A1 and A were significant. Logistic regression of the proportion cured with the dose and length of treatment showed that both factors were significant in improving the rate of cure; the highest dose for the longer time (group C1) had the best rate of cure. One patient in group C1, 12 in group C, nine in group B1, 18 in group B, 15 in group A1, and 23 in group A were cured with extended courses of 20 mg sodium stibogluconate. One patient in each of groups C1, B, A1, and A became unresponsive to antimony and were cured with pentamidine. One patient in each of groups C1, B, and A became unresponsive to both antimony and pentamidine. The patients tolerated the longer duration of treatment safely, and side effects were minor. Sodium stibogluconate should be given intramuscularly in the dosage of 20 mg/kg for at least 40 days, when patients should be assessed for further treatment if necessary. Such a regimen should achieve the highest rate of cure with low toxicity and low rates of relapse and unresponsiveness.

Gonadectomy and survival of Ancylostoma caninum (Nematoda) filariform larvae in mice

Gonadectomy reversed the susceptibility response of male and female Swiss mice to Ancylostoma caninum infection. Orchiectomy decreased the survival of filariform larvae (p greater than 0.001 to less than 0.25), whereas ovariectomy increased it significantly (p greater than 0.001 to less than 0.01).

Experimental ancylostomiasis in Swiss albino mice: adrenal and thyroid histopathology

Remarkable hypertrophic changes were observed in the adrenal and thyroid glands of male mice after 7 to 16 days of infection with the filariform larvae of Ancylostoma caninum, but not in females. The adrenal gland revealed enormous enlargement of cells in the zonae glomerulosa, fasciculata and medulla, and also the formation of big vacuoles in the glomerular zone, whereas the thyroid gland showed distinctly hypertrophied follicular epithelium with marked acolloidal condition and follicular mass formation. These changes in the cellular diameter were highly significant (P greater than 0.001 to less than 0.005). The possible reasons for hyperactivity of these glands are discussed.

Osseous haemangiomas

Osseous haemangiomas are rather rare. They usually present with vague symptoms and bizarre radiological pictures. Clinical suspicion and radiological speculation can only be confirmed by proper histopathological examination. Localised lesions are curable following excision. Others should be subjected to radiotherapy. This paper presents observation on 29 cases of osseous haemangiomas.

Effect of reserpine (Serpasil) and chlorpromazine (Largactil) on hypothalamic nuclei of adult female rat

The effects of reserpine (Serpasil) and chlorpromazine (Largactil) on preoptic area (POA), supraoptic nucleus (SON) and paraventricular nucleus (PVN) of hypothalamus were studied in female rats having 4-day normal oestrus cycle. 30 rats were treated with reserpine in three doses i.e. 0.5 mg, 1.0 mg and 1.5 mg/kg body weight, whereas 20 other rats were treated with chlorpromazine in two doses i.e. 5.0 mg and 10.0 mg/Kg body weight. Gomori positive neurosecretory neurons of the hypothalamus were studied by measuring the diameters of nuclei and cells of POA, SON and PVN. When compared to controls both drugs caused a significant (p less than 0.001 to p less than 0.05) decrease in the nuclear and cell size of the neurons.