MANAGEMENT OF KALA AZAR – AN UPDATE

Kala azar continues to be a medical problem in India and with the increase in incidence of HIV Infection it is likely that kala azar will be encountered more frequently and in its atypical forms. To aid diagnosis, several immunological tests are now available and they are more sensitive and specific than the aldehyde test. Like many other diseases today, the treatment of kala azar is hampered by drug resistance. Newer drugs are available and so are new delivery systems. Kala azar develops frequently in the HIV infected person before development of AIDS. The presentation is atypical and leishmanial species other than L. donovani may also be the infecting agents. A combination of sandfly control, detection and treatment of patients and prevention of drug resistance continues to the ideal approach for the control of the disease.KEY WORDS: Kala azar, Leishmaniasis, HIVWHO estimates that more than 200 million people in the world are exposed to leishmanial parasites and more than 500,000 people develop clinical visceral leishmaniasis each year [1]. Major epidemics have occurred in the eastern part of our country and some other parts of the world [2]. Large scale drug failure has been the outstanding feature of the Indian epidemic of 1991, leading to increased morbidity and mortality. Certain clinical manifestations like lymphadenopathy which were not seen in Indian kala azar earlier, have been reported from Bihar and West Bengal [3]. With the increasing incidence of HIV infection, more atypical presentations are being noted [1]. Due to the development of widespread resistance to conventional drugs, several new drugs and other modalities of treatment have been developed and the conventional drugs are being tried in modified dosages with variable success.     

BENIGN COLONIC STRICTURES - A STUDY OF TWENTY CASES

An analysis of twenty cases of benign colonic strictures is presented. Thirteen (65%) had tubercular strictures, 3 (15%) had ulcerative colitis, one each had ischaemic colitis and Crohn''s disease. In 2 cases the cause could not be established. Eleven patients (55%) presented with subacute intestinal obstruction and 7 (35%) with diarrhoea. Specific diagnoses based on histopathology could be made in only 45 per cent of cases. Most of the patients responded to specific medical therapy. Seven patients (35%) required surgical intervention.KEY WORDS: Colonic strictures, Colonoscopy, Colitis, Tuberculosis     

AN EPIDEMIOLOGICAL STUDY OF BLOOD PRESSURE AMONG SCHOOL CHILDREN

Blood pressure was measured in 1170 school children between 5 and 15 years of age. Mean blood pressure was significantly higher in boys than girls in all age groups and a steady increase in blood pressure with age was seen in both the sexes. Mean blood pressure was significantly higher among children with positive family history of cardiovascular morbidity. Children from higher socio-economic strata and overweight children also showed higher blood pressure. Nine (0.77%) children had persistent hypertension. However, the degree of hypertension was mild and all these children were asymptomatic. Baseline investigations failed to detect any underlying pathology or target organ involvement. This study suggests that childhood could be a reasonably profitable time to look for such factors and to selectively screen children belonging to the high risk group for hypertension.KEY WORDS: Hypertension, Blood pressure, Epidemiology     

DRUG RESISTANT TUBERCULOSIS — THE EMERGING SCENARIO

During the period April 1992 to September 1994 a total of 2288 patients of pulmonary tuberculosis were treated at our centre. M. tuberculosis could be isolated from the sputa of 1037 patients (45.3%). All the isolates were subjected to indirect susceptibility testing using drug incorporated Lowenstein-Jensen medium slants. A total of 142 (13.7%) patients showed drug resistance. Single drug resistance was observed in 86 (8.3%) patients whereas resistance to two or more drugs was observed in 56 (5.4%) patients. Patients showing initial drug resistance were more in number (83 cases) than those showing acquired drug resistance (59 cases). Resistance to streptomycin was commonest (8.3% of isolates) followed by isoniazid (5.7%) and rifampicin (5.0%). Multiple drug resistance was mostly acquired (71.4% of drug-resistant isolates).KEY WORDS: Antitubercular agents, Drug resistance microbial, Tuberculosis     

A SIMPLE COLD STAINING METHOD FOR ACID FAST BACILLI

Sputum from 105 cases of pulmonary tuberculosis were studied. Direct and post concentration smears were stained by Ziehl – Neelsen (ZN) and cold staining methods. The cold staining method is simple, because it eliminates heatingof stain. For direct smear, the correlations of cold staining procedure with conventional ZN method was 93% and for post concentration smear it was 100%.KEY WORDS: Acid fast bacilli, Mycobacterial cold staining     

ALVEOLAR PROTEINOSIS (A Case Report)

A case of pulmonary alveolar proteinosis diagnosed by open lung biopsy is being reported and relevant literature is discussed.KEY WORDS: Alveolar proteinosis, Pulmonary alveolar lipoproteinosis     

Ultrasonographic changes in malignant neck nodes during radiotherapy in head and neck squamous carcinoma

Limited information is available about the sonomorphological changes in metastatic neck nodes during radiotherapy. The aim of this study was to evaluate the pattern of sonomorphological changes in metastatic neck nodes with radiotherapy. The study population consisted of 16 consecutive patients planned for radical radiotherapy to the head and neck. All patients were subjected to four ultrasound examinations: before therapy, at 46 Gy, at the conclusion of radiation and at first follow up. A total of 59 ultrasound examinations were performed on 16 patients. The difference between the mean number of nodes detected per patient before (10.6) and after (7.8) radiation was significant (P = 0.05). Sixteen nodes were categorized as malignant at first sonography, half of which reverted back to normal by the end of radiation. Changes in the sonomorphology of malignant cervical lymph nodes occur with radiotherapy with more that half demonstrating reversion to normal pattern. Future studies correlating this with histopathology should be considered.     

Pharmacokinetics and safety of green tea polyphenols after multiple-dose administration of epigallocatechin gallate and polyphenon E in healthy individuals.

PURPOSE: Green tea and green tea polyphenols have been shown to possess cancer preventive activities in preclinical model systems. In preparation for future green tea intervention trials, we have conducted a clinical study to determine the safety and pharmacokinetics of green tea polyphenols after 4 weeks of daily p.o. administration of epigallocatechin gallate (EGCG) or Polyphenon E (a defined, decaffeinated green tea polyphenol mixture). In an exploratory fashion, we have also determined the effect of chronic green tea polyphenol administration on UV-induced erythema response. EXPERIMENTAL DESIGN: Healthy participants with Fitzpatric skin type II or III underwent a 2-week run-in period and were randomly assigned to receive one of the five treatments for 4 weeks: 800 mg EGCG once/day, 400 mg EGCG twice/day, 800 mg EGCG as Polyphenon E once/day, 400 mg EGCG as Polyphenon E twice/day, or a placebo once/day (8 subjects/group). Samples were collected and measurements performed before and after the 4-week treatment period for determination of safety, pharmacokinetics, and biological activity of green tea polyphenol treatment. RESULTS: Adverse events reported during the 4-week treatment period include excess gas, upset stomach, nausea, heartburn, stomach ache, abdominal pain, dizziness, headache, and muscle pain. All of the reported events were rated as mild events. For most events, the incidence reported in the polyphenol-treated groups was not more than that reported in the placebo group. No significant changes were observed in blood counts and blood chemistry profiles after repeated administration of green tea polyphenol products. There was a >60% increase in the area under the plasma EGCG concentration-time curve after 4 weeks of green tea polyphenol treatment at a dosing schedule of 800 mg once daily. No significant changes were observed in the pharmacokinetics of EGCG after repeated green tea polyphenol treatment at a regimen of 400 mg twice daily. The pharmacokinetics of the conjugated metabolites of epigallocatechin and epicatechin were not affected by repeated green tea polyphenol treatment. Four weeks of green tea polyphenol treatment at the selected dose and dosing schedule did not provide protection against UV-induced erythema. CONCLUSIONS: We conclude that it is safe for healthy individuals to take green tea polyphenol products in amounts equivalent to the EGCG content in 8-16 cups of green tea once a day or in divided doses twice a day for 4 weeks. There is a >60% increase in the systemic availability of free EGCG after chronic green tea polyphenol administration at a high daily bolus dose (800 mg EGCG or Polyphenon E once daily).     

A study of maternal determinants and foetal weight

This study was conducted during 1991-93 to determine the effects of various maternal factors on fetal birth weight. 219 pregnant women aged 15-44 years and their children participated. Data pertaining to maternal and fetal anthropometry were collected. Results revealed that birth weight seemed to be affected by many variables. Maternal height could affect fetal weight either genetically or by environmental mechanism. It was also observed that the mean birth weight increased significantly with increasing maternal prepregnancy weight and height. In addition, maternal weight gain during pregnancy was a major determinant of fetal outcome and was found to be a primary indicator of infant morbidity and mortality. Newborn infants with birth weights of 2500 g and gestational ages of more than 34 weeks had a 99.8% survival rate, whereas babies born earlier than 26 weeks of gestation usually did not survive. In general, maternal prepregnancy weight and weight gain during pregnancy (P 0.0001) had a greater effect on birth weight than did maternal height and gestational age (P 0.01).