Biomedical subjects
Publications and source records attributed to B Kumar.
Activity of the enzyme gamma-glutamyl transpeptidase (GGT) was measured in 21 patients of BL or LL disease and 10 age matched healthy controls. None of the patients had any systemic or hepatic diseases. Mean values in the patients (53.67 +/- 9.67 U/L) were significantly higher (p less than 0.05) compared to that of controls (34.2 +/- 5.69 U/L).
Nine patients of leprosy, 5 BL and 4 LL who developed jaundice during the course of disease were investigated. Two LL patients developed jaundice during ENL reaction. There was slight hepatomegaly in 5 patients and moderate splenomegaly in 3 only. There was significant alterations in liver enzymes and serum bilirubin in all patients. The abnormalities of the enzymes levels persisted for abnormally long periods even when the serum bilirubin had come down and the patients had become asymptomatic. Blood for HBsAg and anti-HAV IgM was negative in all the patients except one in whom HBsAg was positive. Drugs could not be implicated as the cause of jaundice, all patients maintained recovery even after restarting antileprosy drugs. The possibility of non A, non B viruses producing hepatitis during the course of disease is brought out. Course of prolonged jaundice in leprosy is compared with other diseases which could result in a similar situation.
68 patients with paucibacillary disease were started on various regimes of multi drug therapy, consisting of ethionamide, rifampicin or clofazimine administered with dapsone. Serial skin biopsies were taken from 32 patients at one, two and three years and even later after the initial pre treatment biopsy. Actual material was available for study from 9 patients. All regimens were tolerated well except the one with ethionamide. However the therapeutic response was equal in all combination therapies as supported by histopathology. Compared to that with dapsone monotherapy the response was quicker with combination. Dapsone plus rifampicin combination was best tolerated and it worked out to be economical as well. No relapse was noted in any group during two or more years follow up.
Swiss albino mice were inoculated in the footpads with Mycobacterium leprae obtained from untreated lepromatous patient. The kidneys obtained from the animals sacrificed during different periods were processed for histopathology, presence of AFB and immunofluorescence studies. Renal lesions, AFB and immune complex deposits were seen in the infected animals. Such findings have not been studied in great detail in experimental leprosy earlier.
Swiss albino mice (normal as well as thymectomised and irradiated were inoculated into the footpads with Mycobacterium leprae and divided into two main phases of study. Phase I comprised of animals not given preformed immune complexes (IC). Uninfected controls were however included. Phase II consisted of animals given in vitro prepared IC at zero day period (OdIC), three month period (3mIC) or six month period (6mIC) to both uninfected and infected groups. Splenic lymphocytes were isolated to quantify T and B cells and their responses to M. leprae antigen and four different mitogens. Significant decrease in T cell counts and blast transformation was seen in the M. leprae infected animals which were also administered with immune complexes. Immunosuppression by IC was therefore seen to be enhanced in the presence of M. leprae infection.
The prevalence of cutaneous, medical and surgical disorders was studied in 846 leprosy patients. Common cutaneous disorders among leprosy patients were pityriasis versicolor, tinea, pyodermas, warts, acquired ichthyosis, scabies, pediculosis and callosities. Only pityriasis versicolor had higher incidence when compared to general population. Common medical diseases were tuberculosis, infective hepatitis and diabetes mellitus. The epidemiological importance of their co-existence with leprosy is discussed and relevant literature of other diseases found to be frequently associated with leprosy is reviewed.
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Swiss albino mice were inoculated with Mycobacterium leprae obtained from untreated lepromatous patients. Histopathological study of sciatic nerves showed no abnormality. However a few free acid fast bacilli (AFB) were detected in the sciatic nerves taken from the inoculated limbs during the early stages of infection, suggesting the nerve-fibre route of travel as seen in humans in experimental leprosy, too.
Normal and immunosuppressed mice were inoculated with Mycobacterium leprae obtained from untreated lepromatous patients. Besides monitoring the AFB counts in the footpads at 3,6 and 9 months post inoculation, antibody dependent cellular cytotoxicity (ADCC) function was studied. The ADCC function seen to be largely unaltered in the M. leprae infected animals, comparable to the observation made in human leprosy.
Mycobacterium leprae infection was produced through the footpads in normal and immunosuppressed mice. Circulating immune complexes were detected by specific binding test and by conglutinin binding assay for specific and total immune complexes respectively in the sera of these mice during different periods of infection. Out of the total 30 samples tested from the infected groups, 3 were positive by specific binding test and 5 by conglutinin binding ELISA. The implications of the findings in relation to human leprosy are discussed.
25 cases of bacillary positive leprosy patients and 25 age and sex matched controls were investigated for assessment of cochleo-vestibular status. Impaired hearing was complained of by 4 patients. None had tinnitus, dizziness or vertigo. On testing 44% patients were found to have unilateral or bilateral perceptive deafness. Specialised tests of hearing indicated that the deafness was of cochlear type. The vestibular functions were not affected. Leprosy seems to selectively involve the cochlea.
Local and systemic side effects of clofazimine in 514 Leprosy and 26 vitiligo patients who had taken the drug in different doses (100 mg to 300 mg daily) for variable periods of time. The commonest side effect noted was reddish brown pigmentation of skin in 77.8% patients. In an equal number of patients, ichthyotic changes on the peripheral parts of the body were noticed. GIT symptoms occurred only in 0.04% patients in the form of abdominal pain, epigastric distress, mild transient nausea and anorexia. Other minor side effects noted were reddish coloration of sweat, urine and tears. Schilling's, d-xylose tests and faecal fat excretion were near normal in the 21 patients in whom these parameters were done. No abnormality in the Jejunal mucosal biopsy was observed after therapy. No abnormality in the EKG or serum biochemistry occurred even after prolonged therapy. We found the drug to be very safe in the usual doses.
Fifteen patients of lepromatous leprosy having type 2 lepra reaction were treated with colchicine. Seven had moderate, five mild and three had severe E.N.L., colchicine was found effective in all mild, six moderate and one case of pustular E.N.L.
35 lepromatous leprosy patients with recurrent trophic ulcers were analysed for tetanus antitoxin levels by passive haemagglutination test (PHA). 42.85% patients and 32% controls had protective levels of antitoxin in their serum (greater than or equal to 0.1). All the patients (100%) demonstrated measurable antitoxin levels. The findings indicate immunological protection from tetanus and support the clinical impression of it's rarity in leprosy patients.
The data of thirty patients who completed two years of multi-drug therapy (MDT) is analysed in regard to clinical improvement, occurrence of reactions, bacteriological response and compliance to therapy.
Normal uninfected (N) and M. leprae infected mice (NI) were given levamisole in the dose of 2.5 mg/kg body weight. The animals were observed over a period of nine months for bacillary load, T and B cell counts and blast transformation with PHA. Significant increase in B cell counts was observed in the levamisole treated normal (NL) compared to normal control (N) group. T cell counts and blast transformation, however, remained unaffected. However, T-cell counts and blast transformation improved significantly in the infected and levamisole treated (NIL) as compared to the infected group (NI) not given levamisole. Bacillary loads remained unaltered in both, the infected (NI) and levamisole treated (NIL) group.
20 carefully selected untreated patients of bacilliferous leprosy were investigated for primary dapsone resistance by foot pad inoculation. Mice were fed on 0.001 g% and 0.01 g% of dapsone during the period of study. Mice in the control group were given normal rodent feed only. Animals were sacrificed from 6 month onwards at 6 week intervals upto 9 months. In two animals the growth of M. leprae was not inhibited by 0.001 g% concentration of dapsone in diet, but was completely inhibited by 0.01 g% of dapsone.