Effects of BCG Vaccination on Evolution of Leprosy

Background

BCG vaccine is considered to have immunoprophylactic potential in leprosy. However controversy exists about the extent of prophylaxis it provides. In view of this, a study was undertaken to see the evolution of disease in established cases of leprosy who were already vaccinated with BCG and to compare it with the cases of leprosy who were not vaccinated with BCG.

Methods

114 newly diagnosed cases of leprosy were studied. Patients were divided into two groups-BCG vaccinated and non-vaccinated. Clinical diagnosis of leprosy was confirmed by bacteriological and histopathological studies in each case. All patients were given standard anti leprosy treatment and were evaluated monthly for a minimum period of one year.

Results

All the cases were males in the age group of 20 to 50 years. 25.4% of cases had received BCG vaccine and 74.6% were not vaccinated for the same. No significant difference was observed in the incidence of different types of leprosy in vaccinated and non-vaccinated groups. 25.9% cases in non-vaccinated group developed lepra reaction as compared to 13.8% in vaccinated group. The incidence of deformities and disabilities in vaccinated group was only 10.3% as against 18.8% in non-vaccinated group. The rate of bacillary clearance appeared faster in vaccinated group.

Conclusions

Although there is no significant difference in the pattern of different types of leprosy in BCG vaccinated and non-vaccinated cases, there is reduction in the incidence of reactions as well as deformities and disabilities in BCG vaccinated cases as compared to non-vaccinated cases.Key Words: BCG Vaccine, Leprosy     

Scintigraphic diagnosis of tricuspid regurgitation

The authors describe a simple technique for diagnosis of tricuspid regurgitation. Red blood cells were labeled in vivo with 99mTc and 22 patients were studied with ECG-gated blood-pool imaging of the liver. A single region of interest was manually drawn around the liver and a time-activity curve obtained. The per cent change in liver counts during the cardiac cycle was found to be significantly higher in the 12 patients with tricuspid regurgitation (Group I) (mean, 4.04 +/- 1.6%; range, 1.3-21.4%) compared with the 10 controls (Group II) (mean, 0.35 +/- 0.16%; range, 0.013-1.3%) (p less than 0.05). Using a 1% change in liver counts as the criterion of a positive study, all 12 cases in Group I were diagnosed correctly, but there was one false positive in Group II; thus the sensitivity was 100% and the specificity 90%.     

Fibrin sealant enables tubeless percutaneous stone surgery

Purpose:

Fibrin sealant has been demonstrated to be safe and effective as a hemostatic agent and urinary tract sealant. We assessed the ability of fibrin sealant to facilitate tubeless management after uncomplicated percutaneous nephrolithotomy (PCNL).

Materials and Methods:

Eight consecutive patients underwent single access tubeless PCNL for renal calculi in a total of 9 renal units in a 2-month period. An additional patient with distal ureteral obstruction underwent antegrade ureteroscopy for an 8 × 8 mm distal ureteral stone. Average patient age was 47 years and mean stone size was 3.37 cm² (range 0.64 to 9.90). Following complete stone clearance a Double-J (Medical Engineering Corp., New York, New York) ureteral stent was placed antegrade and 2 cc HEMASEEL APR (Haemacure Corp., Sarasota, Florida) fibrin sealant was injected under nephroscopic or fluoroscopic visualization into the parenchymal defect just within the renal capsule. Preoperative and postoperative hematocrit (HCT) was determined. Computerized tomography was performed on postoperative day 1 or 2 to evaluate retained stone fragments, perinephric fluid and urinary extravasation.

Results:

In the 10 renal units treated via this tubeless technique no intraoperative or postoperative complications were noted. Average hospital stay was 1.1 days. All patients were discharged home on postoperative day 1 except 1 undergoing asynchronous bilateral PCNL on consecutive days. The mean intraoperative change in HCT was 2.8%. There was no significant change in HCT on postoperative day 1. No patient required transfusion. Seven renal units and 1 ureteral unit had no residual stone fragments for a complete stone-free rate of 80%. No gross leakage was observed on dressings and postoperative computerized tomography failed to demonstrate urinary extravasation.

Conclusions:

Tubeless PCNL using fibrin sealant at the renal parenchymal defect appears to be safe and feasible. Further experience is necessary to determine the role of fibrin sealant in percutaneous renal surgery.     

Nonbronchoscopic evaluation of ventilator-associated pneumonia

The method to diagnose ventilator-associated pneumonia (VAP) ranges from physical examination to invasive procedures. In this section, the use of nonbronchoscopic techniques are reviewed. These include the traditional methods of reviewing the patient's clinical presentation and chest roentgenogram. Although these techniques are not specific, they are useful in helping the clinician in determining when to proceed with more tests to diagnose pneumonia. Methods for sampling lower respiratory tract secretions in an intubated patient include endotracheal aspirates as well as deeper samples obtained by protected brush or a nonbronchoscopic bronchoalveolar lavage catheter. Respiratory cultures can be useful in determining what is causing the pneumonia. However, the distinction between colonization and true infection is best understood if the samples are handled so that semiquantitative culture results can be reported. By using this approach, the physician should be able to better direct therapy and reduce mortality from pneumonia in the intensive care unit (ICU).