Kala-azar in Tamil Nadu state during 1945-75--a retrospective and prospective study.
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Biomedical subjects
Publications and source records attributed to R G Roy.
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The effects of surgical and nonsurgical therapy on the development of osteoarthritis were compared in 12 dogs with bilateral medial patellar luxation and unilateral surgical repair. Evaluations included severity of lameness and patellar luxation, ligamentous stability, range of motion, and radiographic evidence of osteoarthritis before surgery and at a mean of 33 months after surgery. Stifles without surgical treatment served as controls for the contralateral stifles with surgery. All stifles treated surgically had reduced patellofemoral joints, normal range of motion, and improved limb use. Osteoarthritis progressed significantly and comparably in both groups of stifles. Progression of osteoarthritis was not correlated with luxation grade, body weight, or interval from surgery to follow-up. Age at surgery was correlated positively with severity of osteoarthritis in the stifles treated surgically.
Inguinal hernia was associated with trauma in five dogs and was considered nontraumatic in 30 dogs. There were 11 males, 13 intact females, and six spayed females with nontraumatic inguinal hernia. Six dogs had bilateral hernias. Five dogs were younger than 4 months at the time of diagnosis. In 11 older dogs with nontraumatic inguinal hernia, the hernias were identified less than 7 days before surgical repair; in 14 older dogs, the hernias had been recognized for 1 to 60 months. Clinical signs in dogs without small intestinal incarceration were usually limited to a visible or palpable mass without pain or systemic illness. Herniorrhaphy approaches included inguinal, midline with contralateral ring evaluation, and celiotomy with or without inguinal exposure. Fat and omentum were the most common hernial contents. Small intestine was within the hernias of 12 dogs. Six dogs had nonviable small intestine. Postoperative complications included two incisional infections, one incisional dehiscence, two cases of peritonitis and sepsis associated with bowel leakage after intestinal resection and anastomosis, and one hernia recurrence. The overall prevalence of postoperative complications was 17%, and the mortality rate was 3%. Vomiting for 2 to 6 days was predictive of nonviable small intestine. Dogs younger than 2 years were at 11 times greater risk for nonviable small intestine than dogs older than 2 years. Four of five dogs with nontraumatic inguinal hernia and nonviable small intestine were intact males, whereas none of 13 intact females were affected. Only one of 14 dogs with longstanding hernias had nonviable small intestine.
Twenty subpolar lepromatous leprosy patients under multidrug therapy for a period of 1 to 3 years, who continued to be bacteriologically positive (BI 2 to 1 in Dharmendra's grade) were taken in the study. Ten cases (trial group) were given levamisole as an immuno-stimulator for 1 year along with chemotherapy. Another 10 cases (control group) continued to take chemotherapy alone. There was no conversion of Mitsuda reactivity in any of the cases from both the groups. There was no improvement of leucocyte migration inhibition in either group. In both trial and control groups, statistically significant clinical and bacteriological improvements and increase of E. rosette counts are found at the end of one year. However, only the bacteriological improvement in the trial showed statistical significance, when the improvements were compared with those of the control group. No adverse effect due to levamisole therapy was encountered.
Hepatotoxicity in two drug regimens was studied at Central Leprosy Teaching and Research Institute, Chengalpattu (Tamil Nadu) during 1983-84. In 'P' regimen-prothionamide 350 mg daily, dapsone 100 mg daily and rifampicin 600 mg at monthly intervals were given. In' C' regimen-dapsone 100 mg daily, rifampicin 600 mg once a month and clofazimine 300 mg once a month and 100 mg alternate day were given. Trial was started with fifty multibacillary adult leprosy patients in each group. Enzymatic hepatic dysfunction was noted in 52-58 per cent of the cases even before the therapy was started. In 'P' regimen, four cases of clinical jaundice and six cases of high bilirubinaemia was noticed during the trial as against two cases each of clinical jaundice and high bilirubinaemia in 'C regimen. Of the two cases of clinical jaundice in 'C' regimen, one turned out to be a case of HBV infection. The study which is in progress, indicated higher hepatotoxicity in 'P' regimen which is probably explained by the simultaneous use of two hepatotoxic drugs. Viral hepatitis is endemic in this area and might have aggravated the hepatotoxicity observed.
Recently W.H.O. recommended further serological studies on leprosy using samples collected on filter paper strips. A study was therefore taken up at C.L.T. and R.I., Chengalpattu, to find out the relative efficiency of the serological tests conducted on sera and filter paper eluates. FLA-ABS and FA-BCG tests were carried out on 100 paired samples. With the former, exactly the same titres were obtained in 42% and with the latter in 52% cases. Most of the others showed positivity at one-dilution-low titres. In 6-8% cases only, the filter paper technique showed negativity. The correlation co-efficient was +0.87 with FLA-ABS and +0.85 with FA-BCG test. The filter paper technique was operationally more convenient and was acceptable without substantially loosing the efficacy.
Material from 108 trophic ulcers from leprosy cases were studied bacteriologically. 4 cases showed growth of pure anaerobes and 69 showed mixed growth of aerobic and anaerobic bacteria. The predominant anaerobes were Fusobacteria (41), anaerobic cocci (30) and Bacteroides (25). Clostridia were isolated only in 10 cases. Metronidazole, chloramphenicol, penicillin and ampicillin were found effective against anaerobes in in-vitro studies.
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