Waldenström's macroglobulinemia: report of a case with pulmonary involvement and recurrent pneumococcal sepsis after pneumococcal vaccination

A patient with Waldenström's macroglobulinemia who presented with pleuropulmonary manifestations is described. The course was complicated by recurrent Streptococcus pneumoniae infections despite pneumococcal immunization.

Depression of erythrocyte glucose-6-phosphate dehydrogenase (G6PD) activity in enteric fever

Ninety adult Indian typhoid and paratyphoid fever (enteric fever, EF) patients and 91 controls were tested for glucose-6-phosphate dehydrogenase (G6PD) deficiency using the fluorescent spot test (FST) and the quantitative methaemoglobin reduction test ( QMRT ). There was a threefold higher incidence of G6PD deficiency in North Indian EF patients (10.6%) than in controls (3.6%) (P = 0.15) which may be attributable to the greater morbidity of the G6PD-deficient EF patients; six of nine had haemolytic anaemia. A transient depression of mean erythrocyte G6PD activity was observed in a subgroup of 49 non-deficient EF patients in whom the spectrophotometric G6PD assay was done. It did not appear to be related to reticulocyte count, chloramphenicol therapy, or differences in leucocyte contamination of the haemolysate used for the G6PD assay. If this depression of G6PD activity occurs in deficient patients as well, it may help to explain the haemolysis seen in them during EF. Of the three tests used, the QMRT and the spectrophotometric assay clearly identified G6PD deficiency in males during haemolysis, whereas the FST was unreliable in this situation.

A mobile internal medicine clinic

The Denver Veterans Administration Medical Center (DVAMC) established a mobile internal medicine clinic (MediVAn) to provide access to primary care for veterans living more than fifty miles from the center and to study the costs of such an outreach program. A fully equipped van staffed by an internist visited four Colorado cities weekly for scheduled appointments. In the first two years of operation there were 4,655 visits by 766 veterans with a mean age of 56 years, with 3.9 diagnoses, and receiving 3.0 medicines. The cost per MediVAn visit was $68, compared with $67 per outpatient visit at DVAMC. We conclude that a mobile medical clinic is a convenient method of delivering primary care over distances and is comparable in cost to outpatient hospital visits.

A new treatment of pthiriasis palpebrarum

Treatment of phthiriasis palebrarum so far is unsatisfactory and prolonged. It was an accidental finding that led us to try various strengths of fluorescein on head lice. It was seen from our study that 20% fluorescein resulted in the lice' instantaneous death. This percentage was used in all our subsequent cases of phthiriasis with excellent results. A new method for the treatment of phthiriasis palpebrarum from the eyelash by a single application of 20% fluorescein is described. This method required no sedation or anesthetic and can be carried out as an outpatient department procedure. It is nontoxic and not irritating. There is no risk of the physician being infested, as the lice and nits are killed instantaneously.

A simple method of assessment of gestational age in newborn infants

A simple method of assessment of gestational age based on only four characteristics, namely, the anterior vascular capsule of the lens, plantar creases, breast nodule, and ear firmness, is presented. Critical evaluation by appropriate statistical analyses has shown this to be a useful method of practical value with 95% confidence limits of 11 days. It is applicable to newborn infants, including sick babies, at any time within the first 2 days of life.

Intrathecal anti-tetanus serum (ATS) and parenteral betamethasone in the treatment of tetanus

217 cases of tetanus admitted to Christian Medical College and Brown Memorial Hospital, Ludhiana, from June 1977 to April 1980 were studied. Three treatment regimes were used during this period. The addition of intrathecal horse antitetanus serum (ATS) (Group II) to the routine treatment (Group I) reduced the mortality from 63% to 53% but this was not statistically significant. Following a further addition of parenteral betamethasone to the regimen (Group III) the mortality decreased to 27% which was significantly lower than in Groups I and II. A similar trend in mortality was demonstrated when the severe cases were analysed separately. Groups I and III were comparable in terms of various prognostic factors and the nursing care received but Group II had a higher incidence of unfavourable prognostic factors, which may have obscured the benefit of intrathecal ATS. The combination of parenteral betamethasone and intrathecal ATS seems to be beneficial in the treatment of tetanus.

Leprosy in Punjab - an analysis of 4 years O.P.D. data

185 new leprosy cases were seen, of whom 52 (28 2%) were Punjabis and 133 (71.8%) were Non-Punjabi patients. A minimum of 13 (25%) Punjabi leprosy cases were indigenous. The Punjabi cases were drawn from several districts in Punjabi. Among the Punjabi patients, the mean age at onset of leprosy was 43.6 years, and 30.8% of them had infectious type of leprosy. BT was the most common type of leprosy (38.5%), and the age at onset was also highest in BT (49.8 years), among the Punjabi patients. The migrant labourers from Bihar and Eastern U.P. are the probable source of leprosy in Punjab.

Lichen Planus Like Lesions Caused by Thiacetazone

Thiacetazone has been used as a standard antituberculous drug in several countries. Side effect& which include various VM of skin eruptions have been observed in about 10% of patients taking thiacetazone. We are reporting two' cases of lichen planus-like lesions presumably due to thiacetazone. Of these, one case had preexisting lichen planus hypertrophicus but the other one, did not have any past history of lichen planus.

A study of factors related to rural job preference among prospective nursing graduates

Four hundred and thirty prospective nursing graduates from ten schools and five colleges in India were studied to identify factors related to their preferences for work in urban or rural areas. Seventy per cent expressed a preference for urban work. Significant factors related to rural preferences were: religion and background (rural or urban); type of educational institution (government or non-government); and living in a rural setting during community nursing experience. Of the personal, professional and socio-cultural factors related to rural work preference, the most significant were: accomodation, sanitation and safe water; job availability for spouse, security, and school for children. Of the personal and professional factors, the most important were: continuing education opportunities, job satisfaction, and intellectual stimulation.