Biomedical subjects
Publications and source records attributed to G Ramu.
Total population survey covering 28055 persons living in 34 villages of eastern Rajasthan was carried out. Out of 28055 persons 20276 (72.27%) were actually examined and 218 cases of leprosy were detected. Prevalence of leprosy was found to be 10.75/1000, which is very high and contrary to earlier observations regarding leprosy prevalence in Rajasthan. Leprosy problem in Rajasthan has been discussed.
The occurrence of lesions over the scalp in an Indian lepromatous patient has been reported. The scalp lesion had histological features consistent with lepromatous leprosy.
56 lepromatous leprosy patients with an initial average BI of 4.45 were administered once a month 600 mg of Rifampicin, 100 mg of Clofazimine on alternate days and 100 mg of Dapsone daily. None of these patients became smear negative in 2 years, and the same regimen was continued further. Two patients have become negative in 3 years and treatment has been stopped in them. The study indicates that highly bacilliferous LL/BL patients are likely to need 3 years or more of MDT for achieving bacterial negativity.
Serum protein pattern was studied in the leprosy spectrum, their contacts and in normal individuals by employing polyacrylamide gel electrophoresis. Sera from 80% of untreated BL/LL, 70% of untreated TT/BT patients and 67% of contacts have shown dysproteinaemia either for 232 kD or for 175 kD or for both these proteins together. Tendency of these proteins to return to normal levels was observed after treatment. But both these proteins come back to normal levels only after subsidence of the disease.
A study has been undertaken wherein (TT/BT) cases with less than 5 lesions have been given DDS for 12 months alone or in combination with steroids for initial 1 month or rifampicin for initial one week. It has been found that only about three fourths of the cases become disease inactive in 12 months period. Follow up of 15 to 21 months in the post treatment period has shown a relapse rate of 6.33 per 1000 patient months. There was no difference in number of relapses occurring in the three regimens i.e. with or without rifampicin. Half the relapses were primarily in the nerves. During the course of treatment, a slightly higher number of patient in the DDS group had nerve problems as compared to group wherein additional steroids had been given.
Different regimens containing Rifampicin have been tried in treating paucibacillary leprosy patients. In our study we have studied three regimens. Regimen I consists of treating patients with Rifampicin 600 mg once a month for six months combined with Dapsone 100mg daily and treatment is stopped at six months. Regimen II is same as regimen I except that instead of stopping treatment at the end of six months the treatment was continued with dapsone 100 mg daily for another six months and treatment was stopped at one year. Regimen III is the same as recommended by I.A.L. in which treatment is started with Rifampicin 600 mg daily for seven days in the first month to be followed by Rifampicin 600 mg once a month for five more months. This is combined with dapsone 100mg daily for one year. Treatment in this group is also stopped at one year. Eighty one patients in Regimen I, thirty five patients in Regimen II and sixty three patients in Regimen III completed the six month treatment. It was found that the inactivation index in all the three regimens was nearly the same.
A sample survey of the Dharmapuri Leprosy Control Project was undertaken in 1983; a population of 60855 was enumerated out of which 51205 was examined. The sampling procedure which was followed consisted of stratifying the sub-centres according to prevalence and classifying the villages by the size of the population. Villages were selected by random allocation. 10 leprosy inspectors participated in the survey examining 626 to 774 persons per day. 859 active cases were detected giving a prevalence of 16.77 per thousand. The child prevalence was 6.19 per thousand. The number of lepromatous and BL cases detected were 70 giving an infectivity rate of 8.15%. The prevalence of leprosy as found in the last survey conducted in the different areas in the project approximate to those of the sample survey. Therefore it could be said that the prevalence has decreased in this project from 19.94 per thousand as observed in the first survey. The child prevalence has likewise decreased from 9.40 to 4.09 in the project.
A study of 195 patients attending the out patient department with regard to regularity is reported. 71 patients or 36.41% were found to be irregular. The causes of irregularity were found to be predominently socio-economic factors. Since irregularity may lead to emergence of drug resistance due to irregular, inadequate and interrupted drug compliance, socio-economic factor require amelioration.
In a sample survey of the ELEP Dharmapuri Leprosy Control Project out of a population of 62984, 51205 was examined i.e. 81.3%. Subsequently out of the enumerated unexamined population of 11779, 5761 were examined and 67 cases were detected giving a prevalence of 11.62 which was less than the prevalence in the sample survey. With an examination of 90.45% of the population there was not much of an alteration in the gross and child prevalence rates as also the lepromatous rate. A sample survey with examination of 80% of the population gives a representative view of the leprosy situation in an area.
A group of 100 leprosy patients consisting of 50 lepromatous (BL/LL) and 50 tuberculoid (BT/TT) were investigated for metric analysis of the patterns present on their palms. Hundred normal persons were also selected from the families of patients to serve as controls. BT/TT patients and controls did not show any significant difference in their palmar patterns. On the other hand, significant differences were observed in the patterns between BL/LL patients and controls.
The quantity of clofazimine absorbed from the gastrointestinal tract when administered to lepromatous leprosy patients at varying single doses of 600 mg., 400 mg., 300 mg., and 100 mg. has been worked out by determining the amount of clofazimine present in total faecal excreta. Except in 100 mg. dose where the percentage absorption was 62.5 +/- 17 in all other case the values were around 45%. The efficacy of daily administration of 100 mg. clofazimine is discussed in this first article.
Dapsone has been used as a monotherapy and in well organised control units, the prevalence of leprosy has come down. The relapse rates presented in this communication are quite low compared with those reported by various authors quoted in this paper. Relapse rates appear to remain steady at about 5/1000 for each following year after R.F.C. for 7 years. This relapse rate does not appear to be related to regularity of treatment. The relapse rate appears that longer the duration of treatment, the earlier relapse due to severity of the disease of those who had longer treatment. Health education for R.F.C. cases on signs of relapse is a must before they are declared R.F.C. The levels of Sulphone in the blood remain above MIC for as much as ten days after the last dose and therefore Dapsone allows self-administration. It is expected that with the introduction of bacteriocidal drugs in the treatment of paucibacillary leprosy, the relapse rates would go down. As observed from a study conducted in Jalma, maintenance treatment as advocated by the NLCP (1964) and WHO (1970) does not seem to be necessary. The necessity of such maintenance treatment may be obviated with the use of multi-drug regimen in paucibacillary leprosy. This would enable a large number of cases to be released from control thereby reducing patient load considerably and making the supervised treatment of multibacillary cases more easy.
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A study was made on the in situ characteristics of dermal infiltrates in the early and late lepromin reaction with monoclonal antibodies defining T cell subsets, Langerhan cells and Ia like antigens. The early reaction (24 hrs) was elicited either with standard Dharmendra lepromin or leprosin-A and the late reaction (3-4 weeks) was elicited with standard Dharmendra lepromin. In all, 15 biopsies were studied. Most lymphocytes in the infiltrates of both the lepromin and leprosin reactions were positive for OKT 11, Leu 3a, OKT 8 and Ia like antigens indicating thereby the presence of activated T cells. A high proportion of OKT6 + cells were also noticed in the infiltrates of these reactions. In the late reaction, the lymphocytes in the granulomas were predominantly activated T lymphocytes expressing OKT 11, Leu 3a, OKT 8 and Ia like antigens. Leu 3a + cells were scattered diffusely amidst the epithelioid cells. In contrast, OKT 8 + cells were present mainly in the peripheral region of the granuloma. A small proportion of OKT6 + cells were also seen in these granulomas. Ia like antigens and T6 antigens were not discernible on the epithelioid cells. No difference in the number of OKT6 + epidermal langerhan cells was observed in the various types of reactions.
An evaluation of leprosy control project was undertaken in Dharmapuri and A. Pallipatti areas of Tamil Nadu to study the prevalence rate of drug resistance among the leprosy patients. At the end of 5 years of assessment 266 patients were still found to be bacteriologically positive among whom 25 patients were suspected to be clinically dapsone resistant. By mouse foot pad technique the drug resistant prevalence rate was found to be 1.1 per cent in these two areas.
An attempt has been made to screen the resistant strains of M. leprae in lepromatous patients from the eight northern States of India. By using the mouse foot pad technique it was found that in a total of 69 clinically suspected patients 33 (47.8%) harboured M. leprae with some degree of dapsone resistance. A detailed epidemiological study in these parts of the country may reveal the prevalence rate.
91 healthy contacts of leprosy patients were studied for subclinical infection and possibly the pre-clinical stage of the disease using a battery of tests. It was observed that the test based on competitive inhibition of monoclonal antibody binding to the MY2 a determinant of M. leprae identifies a preclinical stage of the disease.
Soft cystic swellings are noticed in leprosy patients during the course of disease and are seen all through the spectrum. The commonest site for these is the dorsum of wrist. At times these are seen over the dorsum and the lateral aspects of ankle as well. These contain straw colored sticky but clear fluid. On exploration these appear to arise from the synovial covering of the extensor tendons of wrist and fingers and have no communication with the wrist joint. Histology of the synovium suggests these swellings to be of inflammatory nature.