Biomedical subjects
M Natarajan
Publications and source records attributed to M Natarajan.
Tissue response to experimental anthrax of sheep and goats.
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Pan-talar arthrodesis for post polio flail foot.
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Chemotherapy trial in paucibacillary leprosy using clofazimine.
In a double blind study, 300 PB patients (smear negative, indeterminate, tuberculoid and borderline tuberculoid) were randomly allotted to two regimens, the control subjects (150 patients) receiving the standard WHO multidrug regimen of six doses of once a month rifampicin with daily dapsone therapy for six months, while the study group (150 patients) receiving 50 mg of clofazimine daily for six months in addition to the WHO regimen. After stoppage of therapy all the patients were followed up on placebo. The regimens were well tolerated. In 7.5% of patients on clofazimine containing regimen, the lesions showed persisting activity at the time of stoppage of therapy, compared with 16% on the control regimen. This activity subsided spontaneously, more rapidly, in the study group (80% compared with 30% in the control group) in six months. Two patients in the control group and one patient in the study group developed late reaction. There were no relapses in the study group, whereas, two patients have relapsed in the control group during a follow-up of 2.5 to 3.5 years.
Treatment of paucibacillary leprosy with a regimen containing rifampicin, dapsone and prothionamide.
Ninety paucibacillary leprosy patients having indeterminate (I), tuberculoid (TT) and borderline tuberculoid (BT) type of leprosy with bacterial index (BI) of less than two on the Ridley scale were treated with rifampicin (RFM) 600 mg once a month, dapsone (DDS) 100 mg daily and prothionamide (PTH) 250 mg daily. Treatment was stopped at the end of six months. The patients tolerated the drugs fairly well and in only two patients the drugs had to be stopped (in one due to jaundice and in the other due to gastric intolerance). About 6% of patients had early reactions which subsided with additional steroid therapy. The inactivity rate was 60% at six months and this improved to 96% at 12 months. No cases of late reactions and relapses were encountered in the limited follow-up period of six months; and a longer follow-up is necessary for ascertaining the relapse rates. The preliminary results however suggest that the addition of prothionamide to the standard WHO paucibacillary regimen is well-tolerated with increased inactivity rate and fewer instances of late reactions.
An analysis of lumbar intervertebral disc prolapse.
Clinical findings and operative results of 212 operated cases of disc protrusion are analyzed in this paper. The maximum age incidence is between 21 and 40 years. In our series disc prolapse was most common between the L4-L5 disc space, mostly on the left side, whereas the L5-S1 is more common in white people. Anthropologic differences may account for the discrepancy. A careful search should be made for disc protrusion by flexing the spine and also exploring the intervertebral foramen during surgery.
Ocular side effects of antitubercular drugs - a focus on prevention, early detection and management.
Given the increasing prevalence of tuberculosis, antitubercular drugs frequently used are also associated with ocular toxicity. Ethambutol is the most commonly implicated drug. It is generally well tolerated, but known to cause optic neuritis, more specifically retro bulbar neuritis causing blurred vision, decreased visual acuity, central scotomas, and loss of red-green color vision. The exact mechanism of toxicity is not understood. Though optic neuritis due to ethmabutol is generally considered to be reversible upon prompt discontinuation of the drug, there are reports of reversible toxicity, particularly in the elderly population. Isoniazid can rarely cause retro bulbar neuritis. Dose relationship is usually not seen. Streptomycin is known to cause pseudo tumorcerebri. Thiacetazone can produce severe cutaneous reactions including Steven Johnson Syndrome affecting the skin and mucosa including conjunctiva. Educating the patients for early detection of the ocular manifestations and regular follow-ups are very essential.
CD1 positive epidermal Langerhans cells in indeterminate leprosy.
Langerhans cells (LC) in the skin lesions of 10 untreated indeterminate leprosy patients were defined by indirect immunofluorescence using monoclonal antibodies. No difference was observed in the numbers and distribution of epidermal LC in the indeterminate lesions and controls. However, the infiltrates of these lesions contained CD1+ cells. Most cells in the infiltrates HLA DR antigens.
Report on a study of cerebral biopsy in general paretics.
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Epidermoids of the central nervous system.
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Decompression of the perioptic meninges for relief of papilloedema in benign intracranial hypertension.
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Reduction in CD1 positive epidermal Langerhans cell numbers in leprosy lesions following epicutaneous application of 2:4 dinitrochlorobenzene.
A study was made on Langerhans cells (LC) in the dermal lesions of leprosy after epicutaneous application of 2:4 dinitrochlorobenzene (DNCB) to the lesion. LC were quantitated with OKT6 monoclonal antibody and indirect immunofluorescence. A depletion or reduction in the numbers of CD1+ epidermal LC was observed at both 4 and 24 hours after the application of DNCB in the lesions of both tuberculoid and lepromatous leprosy, compared to untreated lesions.
Studies on microbial aerobic flora of skin in leprosy patients.
This study reports the isolation and identification of aerobic organisms from biopsies/slit-skin smears/scrapings from 129 leprosy patients and 50 healthy controls. These include 56 paucibacillary (PB) and 73 multibacillary (MB) cases. Thirty-six isolates from the specimens from 21 patients and 15 healthy controls were grown. The non-mycobacterial isolates from clinically PB leprosy (TT/BT/I) patients were: (1) Gram-positive cocci: Staphylococcus aureus(1), Staphylococcus albus(1); (b) Gram-positive bacilli: Bacillus subtilis(1), Corynebacterium xerosis(1); (c) Gram-negative bacilli: Escherichia coli(1), Proteus mirabilis(2), Klebsiella pneumoniae(1) and Pseudomonas aeruginosa(1). The isolates from clinically MB leprosy (BB/BL/LL) patients were: (a) Gram-positive cocci: Micrococci(1), Staphylococcus aureus(1) and Staphylococcus albus(1); (b) Gram-positive bacilli: Corynebacterium xerosis(1); Corynebacterium hofmanni(1) and Bacillus cereus(1). (c) Gram-negative bacilli: Escherichia coli(2), Klebsiella pneumoniae(1) and Proteus mirabilis(2). The specimens from healthy controls yielded similar organisms. These were (a) Gram-positive cocci: Staphylococcus albus(2), Staphylococcus aureus(2) and Micrococci(2); (b) Gram-positive bacilli: Corynebacterium xerosis(1), Bacillus subtilis(2), Corynebacterium hofmanni(1) and Bacillus cereus(1); (c) Gram-negative bacilli: Escherichia coli(3), Proteus vulgaris(1) and Proteus mirabilis(1). While these results show no significant differences in the species types of non-mycobacterial aerobic organisms isolated from healthy skin and PB/MB types of leprosy, these isolates need to be characterized by immunological/molecular methods to find out subtypes if any.
Isolation and characterization of cultivable mycobacteria from leprosy skin.
Attempts were made to isolate cultivable mycobacteria from 129 biopsies/slit-skin scrapings from the skin of leprosy patients (73 multibacillary-BB/BL/LL and 56 paucibacillary-TT/BT/I) as well as 50 healthy controls. Among the 19 isolates obtained, 17 were from specimens from leprosy cases whereas two were from healthy controls. 14 of the 17 isolates were from multibacillary cases and three were from paucibacillary patients. The mycobacteria isolated were: M.scrofulaceum (4 = all LL cases); M.avium (3 = 2 from LL cases and 1 from healthy control); M.avium-intracellulare complex (1 LL); M.gordonae (2 = 1 from BT and BB each); M.flavescens (1 BL); M.smegmatis (2 = both LL); M.phlei (4 = 1 LL, 1 BL, 1 BT and 1 healthy control); M.fortuitum (1 BL); and M.chelonei (1 BT relapse). The results of this study suggest a preferential colonization of skin of lepromatous leprosy cases by M.scrofulaceum and M.avium. As such isolates have been reported by the investigators from other parts of the world, independent confirmation of such trends in Indian patients is significant and casual relationship (if any) between such colonization and development of lepromatous disease merits further investigation.