Central Jalma Institute for leprosy, Agra.
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Biomedical subjects
Publications and source records attributed to G Ramu.
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Protein-Bound Fucose (PBF) content in sera from normal persons and untreated lepromatous or near lepromatous leprosy patients was measured and statistically analysed. Normal serum gave a mean value of 8.15 +/- 2.7 mg% and the sera of leprosy patients gave a value of 13.3 +/- 3.38%. The fucose contents in the glycoprotein and mucoprotein fractions were determined and found to increase in untreated leprosy patients. The values for ratio of fucose to protein also were found to be high in the sera of patients studied.
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101 patients belonging to different types of leprosy were investigated for PHA-induced lymphocyte transformation in peripheral blood. There was a significant depression (P < 0.05) in blastogenesis in borderline (BB), borderline lepromatous (BL) and lepromatous (LL) patients. On the other hand, tuberculoid (TT) and borderline tuberculoid (BT) patients did not show any alteration in PHA-induced blastogenesis (P > 0.05) when compared to normal. The significance of these findings have been discussed.
Spurr's resin mixture has been found to be the embedding material most suitable for electron microscopic studies of lepromata at present. Like methacrylate, it can penetrate well into foamy structures and the leprosy bacilli within foamy structures. On the other hand, like Epon 812, it is stable against the electron beam and can preserve ultrafine structures. Additionally, we have found that the use of dimethylformamide or dimethylsulfoxide instead of propylene oxide as substituter improves the preservation of the ultrafine structures of leprosy bacilli.
In this study early lepromin reaction has been used to detect delayed hypersensitivity reaction to a prior infection with M. leprae, recent studies indicate that a certain number of contacts who develop sub-clinical infection remain anergic to the lepromin test. This is indicated by the Fluorescent leprosy antibody absorption (FLA-ABS) test of Abe (1979) which detects antibodies in the sera of infected individuals. Correlation of this serological test with lepromin response in contacts is in progress in the CJIL, Agra. These anergic contacts are likely to be susceptible to leprosy, a finding which would help in taking prophylactic measures.
Studies on the interactions of the drugs used in combination therapy of leprosy were attempted at this Institute. INH supplementation with clofazimine, therapy appeared to lower the skin levels of clofazimine, raising the plasma and urinary content of clofazimine. Concurrent administration of clofazimine with DDS does not appear to exert any influence on the excretion of DDS. The plasma DDS lowering effect of Rifampicin does not vary between fast and slow acetylators for DDS.
Scrotal biopsies were obtained from 38 cases of lepromatous leprosy who were clinically subsided and had negative skin smears. Twenty six (68.4%) of these cases revealed bacilli in the dartos muscle. None except one showed a specific lesion in the dartos. Bacilli obtained from 2 out of 7 cases multiplied in the mouse foot-pad. Bacilli were found to be persisting in the dartos muscle despite prolonged treatment before as well as after clinical subsidence of the disease. The persisting bacilli in this situation could be a cause of relapses.
IgG levels were significantly high in sera of all types of leprosy. House-hold contacts of lepromatous leprosy (LL) cases also showed significantly higher values for IgG when compared to that of control. Except polar tuberculoid (TT) cases and house-hold contacts other types of leprosy revealed a significant rise in IgA levels in their sera. IgM was only raised in borderline tuberculoid (BT) cases. C-reactive protein (CRP) was present in the sera of all types of leprosy. Highest positivity (97%) was shown by sera from erythema nodosum leprosum (ENL) cases. Rose-Waaler antibody (RA) was noted in BT, borderline leprosy (BL), LL and ENL cases. Significance of these findings is discussed.
In this study 0.1 ml of Dharmendra antigen was injected intradermally into the normal skin and lesions of 35 leprosy patients. The response was measured at 24 hrs., 48 hrs. and 21 days. It was found that the maximum response to Dharmendra antigen occurred at the end of 24 hrs. and started wanning by 48 hrs. In tuberculoid leprosy, there was significantly greater response in the lesion as compared with the nearby normal skin. It has been suggested that this could reflect an increased immunological activity at the site of the lesion. In the borderline tuberculoid cases with annular lesions, Dharmendra antigen was injected into the peripheral infiltrated area and into the apparently normal centre of the lesion, and a greater response was found at the centre. This might be the site of a previous lesion. The late reaction at the end of 21 days did not show much significant difference.
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Dharmendra antigen with different bacterial counts (16, 12.5, 10, 7.5, 5 and 2.5 million/ml) have been utilized for determination of skin delayed hypersensitivity in leprosy patients. It has been noted that antigen with 10 million acid fast bacilli (AFB)/ml mounts a standard early (24 hrs) as well as late (3 weeks) reaction in patients. Lepromatous patients do not show any skin reaction with this dilution. Thus, a standard Dharmendra antigen has been prepared using a considerably smaller number of organisms as compared to the International standards for Mitsuda antigen.
Four fractions each from Dharmendra and Mitsuda antigen have been obtained by step-wise centrifugation and sonication of the antigen. These fractions have been assessed for their capacity of inducing skin delayed hypersensitivity response. While, it has been noted that all fractions of both types of antigens can induce a good early reaction, the late skin reaction is only mounted by intact bacilli of both types of antigen. When compared at a constant bacillary concentration, Dharmendra antigen has produced better early skin reaction than Mitsuda antigen, whereas the intensity of late skin reaction is almost equal with both the antigens. The hypothesis has been put forward that the early, as well as the late reaction are produced by the same antigen and this antigen is located in the protoplasm of M. leprae.
22 Adult Male Lepromatous patients suffering from recurrent lepra reaction have been allotted to either a regimen of combined treatment with Clofazimine and Thalidomide alone. The initial dosage of either of the drugs was 300 mg daily administered in divided doses of 100 mg three times a day. The preliminary assessment of the ongoing study, indicates that the combined treatment controls the reactional state more rapidly than monotherapy with Thalidomide alone. Results of treatment as regards relief of neuritis and arthritis are particularly gratifying. Four month.ases relapsed into reactional status from 2 days to 15 days. 5 cases on the combined therapy relapsed from one to three months. Three other cases required six months and three cases 8 months treatment before clofazimine could be withdrawn. It would appear that a maintenance therapy of 6 months with flofazimine would be necessary for maintaining the control of reactional episodes while employing this combined therapy.