Folie a deux and delusional disorder by proxy: an atypical presentation

Delusion of parasitosis is a rare condition characterised by an individual harbouring the delusion of being infested with insects or parasites. We report a rare and interesting case of delusion of parasitosis presenting as folie a deux, that is, the delusion is shared by both the parents of an 18‐month‐old child, with proxy projection of parental delusion on the child. The case highlights the rare concomitant occurrence of two psychocutaneous disorders and emphasizes the importance of early recognition and appropriate intervention to safeguard the well‐being of the child.     

Economic evaluation of seizures associated with solitary cysticercus granuloma

BACKGROUND: Patients with solitary cysticercus granuloma (SCG) develop acute symptomatic seizures because of the inflammatory response of the brain and the seizures are self-limiting. Thus seizure disorder associated with SCG provides a good model to study the total cost of illness (COI). MATERIALS AND METHODS: COI of new-onset seizures associated with SCG was studied in 59 consecutive patients registered at the epilepsy clinic. Direct treatment-related costs and indirect costs, man-days lost and wages lost were evaluated. The relative cost was calculated as the percentage of per capita gross national product (GNP) at current prices for the year 1997-1998. RESULTS: The total COI, for treating seizure disorder associated with SCG per the period of CT resolution of the lesion per patient was INR 7273.7 (US$ 174.66, I$ 943.16) and he/she would be spending 50.9% of per capita GNP The direct cost per patient was INR 5916 (US$ 137.14, 41.4% of per capita GNP). If the patient had received only AEDs for the period of resolution of CT lesion, the cost would be INR 5702.48 (US$132.2, 40% of per capita GNP). The extra expenditure on albendazole and steroid was INR 213.72 (US$ 4.95), 3.6% of the total direct cost and 20.7% of the medication cost. Indirect cost (average wage loss) per patient was INR 1312.7 (US$ 30.42) and it accounted for 9% of per capita GNP. The one-time expenditure at present costs (adjusted for inflation) to the nation to treat all the prevalence cases is to the tune of INR 1.184 billion (US$ 2.605) and 0.0037% of GNP. CONCLUSIONS: This study suggests that seizure disorder associated with SCG, a potentially preventable disorder, is a good model to study the total COI. The one-time expenditure at present costs to the nation to treat all the prevalence cases of seizure disorder associated with SCG is to the tune of INR 1.184 billion (US$ 2.605 million) and 0.0037% of GNP.     

Integrated model of primary and secondary eye care for underserved rural areas: The L V Prasad Eye Institute experience

Blindness is a major global public health problem and recent estimates from World Health Organization (WHO) showed that in India there were 62 million visually impaired, of whom 8 million are blind. The Andhra Pradesh Eye Disease Study (APEDS) provided a comprehensive estimate for prevalence and causes of blindness for the state of Andhra Pradesh (AP). It also highlighted that uptake of services was also an issue, predominantly among lower socio-economic groups, women, and rural populations. On the basis of this analysis, L V Prasad Eye Institute (LVPEI) developed a pyramidal model of eye care delivery. This article describes the LVPEI eye care delivery model. The article discusses infrastructure development, human resource development, and service delivery (including prevention and promotion) in the context of primary and secondary care service delivery in rural areas. The article also alludes to opportunities for research at these levels of service delivery and the amenability of the evidence generated at these levels of the LVPEI eye health pyramid for advocacy and policy planning. In addition, management issues related to the sustainability of service delivery in rural areas are discussed. The article highlights the key factors required for the success of the LVPEI rural service delivery model and discusses challenges that need to be overcome to replicate the model. The article concludes by noting the potential to convert these challenges into opportunities by integrating certain aspects of the existing healthcare system into the model. Examples include screening of diabetes and diabetic retinopathy in order to promote higher community participation. The results of such integration can serve as evidence for advocacy and policy.     

Isolation of a 33-kDa protein antigen from delipidified Mycobacterium tuberculosis H37Rv

A 33-kDa protein (TB33) was isolated from a delipidated cell sonicate (CS) of Mycobacterium tuberculosis H₃₇Rv (grown in Middlebrook 7H9 broth supplemented with glucose) using immobilized metal affinity chromatography (IMAC) on a nickel-nitrilotriacetic acid (Ni-NTA) column. TB33 could not be isolated from the culture filtrate (CF) of M. tuberculosis H₃₇Rv using Ni-NTA. TB33 was recognized by monoclonal antibodies (mAb) known to react with proteins of M. tuberculosis with a molecular mass of 33/34 kDa; namely, mAb F126-5, F67-1 and F126-2. The N-terminal amino acid sequence of TB33 was found to be Xaa-Xaa-Thr-Pro-Ala-Asp-Val-Ser/Cys-Asn-Val-Ala-Ile and thus, shows identity with the N-terminal of antigen 84 of M. tuberculosis except for two mismatches. Antibodies to TB33 could be raised in mice by administering four injections of TB33 (40 μg total protein). Sera from tuberculosis patients reacted with TB33, while those from normal healthy individuals did not. Received: 17 April 1996     

The incidence of public sector hospitalisations due to dog bites in Australia 2001–2013

Objective : To estimate the incidence of dog bite‐related injuries requiring public sector hospitalisation in Australia during the period 2001–13. Methods : Summary data on public sector hospitalisations due to dog bite‐related injuries with an ICD 10‐AM W54.0 coding were sourced from the Australian Institute of Health and Welfare for the study period 2001–2013. Results : In Australia, on average, 2,061 persons were hospitalised each year for treatment for dog bite injuries at an annual rate of 12.39 (95%CI 12.25–12.53) per 100,000 during 2001–13. The highest annual rates of 25.95 (95%CI 25.16–26.72) and 18.42 (95%CI 17.75–19.07) per 100,000 were for age groups 0–4 and 5–9 years respectively. Rates of recorded events increased over the study period and reached 16.15 (95%CI 15.78–16.52) per 100,000 during 2011–13. Conclusion : Dog bites are a largely unrecognised and growing public health problem in Australia. Implications for public health : There is an increasing public sector burden of hospitalisations for injuries from dog bites in Australia.     

Cutaneous Malignancies in Xeroderma Pigmentosum: Earlier Management Improves Survival

Xeroderma pigmentosum (XP) is a rare autosomal recessive disease, characterized by hypersensitivity of the skin to ultraviolet (UV) radiation leading to high incidence of skin cancer and progressive neurological complications. It results in premature development of neoplasias due to an exacerbated hypersensitivity to UV radiation causing premalignant and malignant lesions leading to death in early adulthood. Two cases of clinical features of xeroderma pigmentosa with skin lesions were managed in our department. One had multiple clusters of basal and squamous cell carcinomas and the other had malignant melanomas and right neck nodes. Both were treated with multiple wide excisions and the neck node were surgically managed with radical neck dissections. Skin malignancies were common in the sun exposed areas and patients were advised regular 3 months follow up. The disease is ultimately fatal, life can be prolonged by simple preventive measures to minimize sun exposure. Comprehensive multimodality management includes patient education and counselling for the psychosomatic disorder and genetic counseling remains the most important preventive measure.     

Bone metastasis in hepatocellular carcinoma: need for reappraisal of treatment

Bone is an uncommon site of metastasis in patients with hepatocellular carcinoma (HCC), and often overlooked. We report two cases that had isolated bone metastasis; one of them had prolonged disease-free survival. The present series, along with the literature review, reinforces the idea that HCC should be considered in the differential diagnoses in patients presenting with metastases in bone. The presence of isolated bone metastases need not necessarily indicate poor prognosis, and all such patients need to be offered chemotherapy and at least one of the bone-directed therapies (either local radiation in cases of localized disease or bisphosphonates in the presence of extensive disease) as they may have a better outcome with therapy.