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Biomedical subjects

S N Dwivedi

Publications and source records attributed to S N Dwivedi.

At least 19 recordsLinked to original sources
PubMed2007

Apparent diffusion coefficient of the prostate in men prior to biopsy: determination of a cut-off value to predict malignancy of the peripheral zone.

Determination of the apparent diffusion coefficient (ADC) of the prostate in men (n = 60) with raised prostate-specific antigen (PSA) or an abnormal digital rectal examination (DRE) prior to transrectal ultrasound (TRUS) guided biopsy using endorectal DWI is reported. Patients were categorized into different groups based on their PSA levels. The mean ADC was calculated from a number of regions of interest (ROIs) for the whole of the peripheral zone (PZ) and the central gland (CG). A total of 1108 ROIs were analyzed from 60 patients. The mean ADC value of the PZ was higher than that of the CG in controls. A total of 23 out of 60 patients were positive for malignancy on biopsy, and the mean ADC of the PZ was lower in these patients compared with those who were negative. Moreover, the mean ADC obtained for the whole of the PZ of the prostate in different groups of patients and controls showed a decreasing trend. A plot between PSA and mean ADC for the PZ showed non-linear association with logarithmic decrease in ADC. The mean ADC of the CG was not significantly different in patients who were positive or negative for malignancy in biopsy. In addition, a cut-off value of 1.17 x 10(-3) mm2/s (sensitivity = 73% and specificity = 74%, area under the curve = 0.83) for the mean ADC for the whole of the PZ of patients was determined by using the receiver operating characteristic curve (ROC) to predict malignancy of the PZ.

Adult↗
PubMed2006

Monitoring the therapeutic response of locally advanced breast cancer patients: sequential in vivo proton MR spectroscopy study.

PURPOSE: To evaluate the use of the water-to-fat (W-F) value obtained from in vivo proton ((1)H) MR spectroscopy (MRS) as a response indicator of cytologically confirmed patients with locally advanced breast cancer (LABC), and to monitor the therapeutic response of such patients to neoadjuvant chemotherapy (NACT). MATERIALS AND METHODS: Serial (1)H MR spectra were recorded both before and after the completion of chemotherapy in 33 LABC patients (with infiltrating ductal carcinoma (IDC)) at 1.5T. In addition, spectra from normal breast tissues of 28 healthy volunteers were recorded. RESULTS: Malignant breast tissues showed elevated W-F values compared to normal breast tissues of controls. Statistically significant higher pretherapy W-F value (P < 0.01) was observed in patients compared to controls. In patients who received NACT resulting in the reduction of the primary tumor size, the W-F value showed a decrease that was statistically significant (P < 0.01). Analysis of the MR data further indicates that the W-F value had no correlation with the menstrual status of the patients. A comparison of pretherapy W-F value with pretherapy tumor volume showed a fair correlation (P = 0.05), while the posttherapy W-F value showed no such correlation with the posttherapy tumor volume. CONCLUSION: This study demonstrates that simple, conventional in vivo (1)H MRS is a useful technique for monitoring the therapeutic response of breast cancer patients. The observed trend in the reduction of W-F value provides a noninvasive response indicator to monitor the clinical outcome of locally advanced breast cancer patients to NACT.

Analysis of Variance↗
PubMed2006

A prospective clinical trial to assess the efficacy of radioiodine ablation as an alternative to completion thyroidectomy in patients with differentiated thyroid cancer undergoing sub-total thyroidectomy.

We conducted a prospective clinical trial to evaluate whether radioiodine ablation can be an effective alternative to completion thyroidectomy in patients undergoing sub-total thyroidectomy and if yes, the optimum activity of 131I and frequency of ablation. A total of 85 patients (F--63; M--22) with mean age of 37.9+/-12.3 years were recruited in this study. The pre-ablation mean 24 hour radioiodine neck uptake, effective half-life, residual thyroid tissue weight and TSH values were 13.9+/-8.5%, 4.5+/-0.9 days, 9.6+/-3.6 g and 11.7+/-6.4 microIU/ml, respectively. Thyroid tissue was completely ablated in 50 patients (58.8%, 95% CI:50-68%) after mean 1st administered activity of 32.3+/-10.7 mCi of 131I and the cumulative ablation rate was 91.8% after two doses of 131I. During mean follow-up duration of 49 months no local/distant recurrence has been observed so far in this cohort. It appears that radioiodine ablation may be an attractive alternative to completion thyroidectomy and an activity as low as 35 mCi may achieve reasonable ablation.

Adult↗
PubMed2005

Tumor necrosis factor-alpha levels in patients with HIV with wasting in South Asia.

Tumor necrosis factor (TNF)-alpha is thought to play an important role in wasting; but TNF-alpha levels have not been consistently found to be high in AIDS wasting. We conducted this study to determine any correlation between TNF-alpha levels and wasting in HIV-positive patients in a developing country. TNF-alpha levels were measured in four groups of patients: Group 1, HIV/AIDS with wasting (n = 25); group 2, HIV/AIDS without wasting (n = 47); group 3, HIV-negative patients with tuberculosis with wasting (n = 25); and group 4, healthy controls (n = 25). Wasting was defined as a body bass index (BMI) </=16.0 kg/m(2). TNF-alpha was measured by a solid-phase sandwich enzyme linked immunosorbent assay (ELISA) kit. The mean BMI in HIV-positive patients with wasting (group 1) and without wasting (group 2) was 15.192 +/- 1.142 and 19.507 +/- 2.457, respectively, while group 3 and 4 had a BMI of 14.878 +/- 3.234 and 21.862 +/- 2.763 kg/m(2). The mean TNF-alpha level in group 1 was 50.864 +/- 99.13 pg/mL and 43.39 +/- 66.372 pg/mL in group 2. There was no significant difference between the two groups. TNF-alpha was significantly higher in the HIV/AIDS groups (group 1 and 2) compared to the tuberculosis group (10.74 +/- 7.854) and healthy controls (5.846 +/- 3.40) at p = 0.01. TNF-alpha was significantly (p = 0.002) higher in symptomatic patients compared to asymptomatic patients (16.03 +/- 7.61 versus 64.70 +/- 98.70). In conclusion, TNF-alpha levels were higher in HIV patients, regardless of the presence of wasting, compared to normal healthy controls of patients with tuberculosis with wasting.

Adolescent↗
PubMed2004

Is chest x-ray or high-resolution computed tomography scan of the chest sufficient investigation to detect pulmonary metastasis in pediatric differentiated thyroid cancer?

We reviewed the clinical characteristics, pattern of disease at presentation, histopathologic subtype, treatment, course, and outcome of differentiated thyroid cancer (DTT) in children and adolescents presenting with pulmonary metastasis and tried to assess the effectiveness of routine chest x-ray and high-resolution computed tomography (CT) scan of the chest vis-à-vis 131I whole-body scan (WBS) in revealing pulmonary metastasis. In our series of 1754 patients, 122 (7%) were 20 years of age or younger, of whom 28 (23%) had pulmonary metastasis. Mean age was 13.9 +/- 4.4 years (F:M ratio = 12:16). All but 2 patients had undergone near-total thyroidectomy with some form of neck dissection. Histopathologic examination was papillary in 89% and follicular in 11% cases, with confirmed nodal metastasis in all. Twenty-one (75%) patients had normal chest x-ray. However, WBS revealed pulmonary metastasis in all cases. In 15 (54%) children pulmonary metastasis was detected by first postsurgery 2-3 mCi 131I WBS and in 4 (14%) patients by postablation 131I WBS. Seven cases (25%) and 2 cases were detected by first and second posttherapy 131I WBS, respectively. No statistically significant difference was observed in any of the demographic or clinical parameters in patients in whom pulmonary metastasis was detected by first postsurgical low-dose WBS versus those in whom metastasis was discovered at a later stage. When chest x-ray-positive children were compared to x-ray-negative children, a statistically significant difference was observed only for mean first dose, cumulative dose, and total number of doses of 131I, which were significantly higher in x-ray-positive children. Eighteen of 21 children who had normal chest x-ray also underwent CT scan of the chest. CT could detect micronodular pulmonary shadows in 5 (28%) children only. Complete radioiodine treatment and outcome information was available in 20 patients. Mean first dose and cumulative doses of administered 131I were 75.4 +/- 39.5 mCi and 352 +/- 263 mCi, respectively. After an average number of 3.3 doses of (131)I and mean duration of 33.2 +/- 28.5 months, pulmonary lesions disappeared in 14 (70%) patients and thyroglobulin (Tg) becoming undetectable. In 4 children, however, there was no radiologic or scintigraphical evidence of pulmonary metastasis, Tg was high and in 2 patients, disease was persisting clinically. To conclude, a large majority of pediatric patients with DTC have x-ray- and even high-resolution-negative pulmonary metastasis. However, these metastases are 131I avid, and thus are amenable to detection and treatment with radioiodine. Therefore, postsurgical evaluation with 131I is recommended in all children and adolescents.

Adolescent↗
PubMed2004

Comparison of efficacy of spironolactone with metformin in the management of polycystic ovary syndrome: an open-labeled study.

We compared the efficacy of spironolactone (50 mg/d) with metformin (1000 mg/d) after random allocation in 82 adolescent and young women with polycystic ovary syndrome (PCOS) on body mass index (BMI), waist-to-hip ratio, blood pressure, menstrual cyclicity, hirsutism, hormonal levels, glycemia, and insulin sensitivity at baseline and at the 3rd and 6th months of treatment. Sixty-nine women who completed the follow-up had a mean age of 22.6 +/- 5.0 yr and mean BMI of 26.8 +/- 4.0 kg/m2. The number of menstrual cycles in the spironolactone and metformin groups increased from 6.6 +/- 2.1 and 5.7 +/- 2.3 at baseline to 9.0 +/- 1.9 and 7.4 +/- 2.6 at 3rd month and to 10.2 +/- 1.9 and 9.1 +/- 2.0/ year at the 6th month (P = 0.0037), respectively. The hirsutism score decreased from 12.9 +/- 3.2 and 12.5 +/- 4.9 at baseline to 10.1 +/- 3.1 and 11.4 +/- 4.1 at the 3rd month and to 8.7 +/- 1.9 and 10.0 +/- 3.3 at the 6th month, respectively. Both groups showed improvement in glucose tolerance and insulin sensitivity, although the metformin effect was significant in the latter. Serum LH/FSH and testosterone decreased in both groups. BMI, waist-to-hip ratio, and blood pressure did not change with either drug. We conclude that both drugs are effective in the management of PCOS. Spironolactone appears better than metformin in the treatment of hirsutism, menstrual cycle frequency, and hormonal derangements and is associated with fewer adverse events.

Adolescent↗
PubMed2003

Pro CR global: an effective screening test for thrombophilia.

In the present study, the Pro C(R) Global test was evaluated as a screening test for estimation of the activity of the main plasma components of the anticoagulant protein C (PC) / protein S (PS) pathway; 300 patients with a history of thrombosis were investigated for Pro C(R) Global. It was positive in 74 patients. Tests for estimation of PC, PS, activated protein C resistance (APCR), and lupus anticoagulant (LAC) were performed in all the patients with abnormal Pro C(R) Global and in 10 patients with normal Pro C(R) Global. In all, 66 of the 74 patients had a defect in PC/PS/APCR or LAC; 18 patients had both PC and PS deficiency, 25 had PS deficiency alone, 10 had PC deficiency alone, one had APCR alone, eight had PS, PC deficiency with APCR, and four had PS deficiency with APCR. In the 10 patients who tested negative with the Pro C(R) Global test, PC, APCR, and LAC were negative in all. However, PS deficiency was seen in two of them. The sensitivity and specificity of Pro C(R) Global, calculated with respect to positivity of PC, PS, LAC, or APCR as the gold standard, were 97% and 50%, respectively. The diagnostic accuracy of the assay was 88.1%. It is thus recommended that Pro C(R) Global can be used effectively as a screening test to detect abnormality in the PC/PS/APCR/LAC pathway.

Case-Control Studies↗
PubMed2003

Serum magnesium level among pregnant women in a rural community of Haryana State, India.

OBJECTIVE: Assessment of serum magnesium levels among pregnant women in a rural community. DESIGN: A community-based cross-sectional study. SETTING: Investigation was conducted in six villages of a rural block of District Faridabad, Haryana State, India. SUBJECTS: In total, 283 pregnant women with pregnancy duration of 28 weeks and more were enrolled for the detailed study. Blood from the antecubital vein was drawn and serum magnesium levels were estimated by the atomic absorption spectrophotometric method. RESULTS: In all, 44% of the pregnant women had serum levels less than the normal level (1.80 mg/dl). There was a significant decrease (P=0.01) in serum magnesium levels with the increase in parity. CONCLUSION: A high prevalence of magnesium deficiency was found among the pregnant women.

Adult↗
PubMed2003

Balance and gait in total hip replacement: a pilot study.

OBJECTIVE: Evaluation of balance, gait changes, sexual functions, and activities of daily living in patients with total hip replacement in comparison with healthy subjects. DESIGN: A total of 30 patients were included in the study after total hip replacement. Balance was examined using dynamic posturography, and gait evaluation was done clinically. Sexual functions and activities of daily living were also assessed. A total of 30 healthy subjects of comparable age and sex served as a control group. RESULTS: Dynamic balance and gait differed significantly in both the groups. Despite capsulectomy, no significant difference was observed on testing proprioception. In the sensory organization tests with difficult tasks, patients needed more sensory input from vision and vestibular sense, despite normal proprioceptive sense. Significant difference was observed for limits of stability, rhythmic weight shifts, and for gait variables other than walking base. Some of the patients had major difficulties with sexual functions and activities of daily living. CONCLUSIONS: Compared with the healthy age- and sex-matched controls, patients with total hip replacement did not have any proprioceptive deficit. Patients required extrasensory input, and there was a delayed motor response. Gait and dynamic balance results also indicated the motor deficit and required a compensatory strategy. Restoration of the postural control in these patients is thus essential. Necessary training is required for balance, gait, and activities of daily living, and proper sexual counseling is necessary in postoperative care.

Activities of Daily Living↗
PubMed2003

Spectrum of beta-haemolytic streptococcal soft tissue infections at a tertiary care hospital of north india.

BACKGROUND & OBJECTIVES: An increase in the incidence of invasive beta haemolytic streptococcal infections has been observed in many Western countries. However, the role of beta-haemolytic streptococci in soft tissue infections is not well documented in developing countries. A retrospective study was carried out to review the spectrum of soft tissue infections caused by beta-haemolytic streptococci (betaHS) in a tertiary care hospital of north India. METHODS: The laboratory records of all patients with betaHS isolated from soft tissues between January 1996 and December 2000 were reviewed. Detailed clinical, laboratory and demographic data were recorded for all patients. RESULTS: A total of 39288 samples from soft tissue infections were received in the bacteriology laboratory for bacterial culture during the study period. betaHS were recovered from 205 samples. Of these, 56 per cent isolates were obtained from patients of suspected osteomyelitis. A seasonal pattern was observed with maximum isolation occuring in the winter months. Group A was the commonest isolate (75%), followed by group B Streptococcus (11%). Group C and G betaHS together accounted for about 3 per cent of all the isolates. All the isolates were sensitive to penicillin. INTERPRETATION & CONCLUSION: Soft tissue infections due to betaHS are common in our country. Group A streptococci were encountered most frequently with these infections though other groups of betaHS also contributed substantially. Since these infections are life threatening, there is a need to develop preventive, diagnostic and therapeutic strategies against betaHS.

Adolescent↗
PubMed2001

Evaluation of total choline from in-vivo volume localized proton MR spectroscopy and its response to neoadjuvant chemotherapy in locally advanced breast cancer.

Results of the proton magnetic resonance spectroscopy carried out on normal, benign breast disease and locally advanced breast cancer patients are presented. The in-vivo MR spectra of malignant breast tissue of patients (n = 67) suffering from infiltrating ductal carcinoma are dominated by the water resonance, while the spectra of the unaffected contralateral breast tissue of these patients are mainly dominated by resonance arising from lipids which is similar to the spectra of normal breast tissue obtained from volunteers (controls, n = 16). In addition to the water and lipid peaks, in majority of the patients (approximately 80%) the water suppressed spectra showed a resonance at 3.2 ppm due to choline containing compounds (TCho) before treatment. In patients receiving neoadjuvant chemotherapy, absence/reduction in choline was observed in 89% of the patients. TCho was also observed in 2 of 14 benign lesions. The sensitivity and specificity of in-vivo MRS in detecting TCho in malignant tumours was 78% and 86%, respectively. Observation of TCho before treatment and its disappearance (or reduction) after treatment may be a useful indicator of response of locally advanced breast cancer to neoadjuvant chemotherapy.

Adult↗
PubMed2001

National Family Health Survey and children.

This article aims to describe the National Family Health Survey (NFHS) being carried out in India with its first round during 1992-93 (NFHS-I) and second round during 1998-99 (NFHS-II), with special reference to information available in relation to children. The survey was on lines of the existing systems of Demographic Surveys (DHS) in various developed as well as developing countries. Another important objective of the survey was to provide quality data to the researchers to carry out analytical work on various aspects. Further, the survey has paved the way to carry out comparative studies not only between states in India but also between countries. An attempt has also been made here to present salient features of comparative results under NFHS-I and NFHS-II.

Child↗
PubMed2001

Manometric evaluation of postoperative patients of esophageal atresia and tracheo-esophageal fistula.

Symptoms related to esophageal dysmotility are common following successful repair of esophageal atresia (EA) and tracheo-esophageal fistula (TEF). Esophageal manometry was performed in 27 survivors of EA/TEF at a mean age of 30.5 +/- 30.3 months and in 25 age-matched controls (mean age 36.8 +/- 22.6 months). The patients were also evaluated clinically to grade them into 3 result-oriented groups "Excellent", "Good" and "Fair", depending on pre-existing criteria evaluating the ability and ease of swallowing. Gastroesophageal reflux (GER) was evaluated with the help of a radionuclide scan. The mean esophageal and peak esophageal pressures and therefore also the lower esophageal sphincter (LES) pressure were lower in the patients (12.4 +/- 5.5, 34.9 +/- 20.4 and 12.2 +/- 6.8 mm Hg, respectively) compared to the controls (21.1 +/- 6.9, 62.3 +/- 19.3 and 16.8 +/- 4.3 mm Hg, respectively). The mean body pressures were highest with "Excellent" results and lowest with "Fair" results and the LES pressures followed a similar trend. Likewise, in the patients with GER, LES pressure was 12.0 +/- 7.1, 12.3 +/- 3.7, 11.0 +/- 5.7 and 6.9 +/- 5.6 mm Hg with nil, mild, moderate and severe GER, respectively. The pressure and contractility profile of the esophagus was abnormal in the majority of patients, even in the absence of symptoms.

Case-Control Studies↗
PubMed2001

Lung function tests in asthma: which indices are better for assessment of severity?

Pulmonary function tests are objective evidence of the severity of asthma. A cross-sectional study was carried out to determine the sensitivity of various pulmonary function indices in picking up clinically diagnosed mild and severe asthma. Three groups, each with 60 subjects between 5 and 15 years all of either sex, with mild asthma, severe asthma, and without asthma, respectively, were studied. Pulmonary function tests were performed using a portable spirometer. FEV1 and FVC could differentiate mild asthma from non-asthmatic children in 38 (63 per cent) and 35 (58 per cent), respectively. FEF25% and FEF75% could identify 46 (77 per cent), and 47 (78 per cent) of mild asthmatic children. In children with severe asthma, FEV1, FVC, FEF25%, and FEF75% were abnormal in 54 (90 per cent), 48 (80 per cent), 58 (97 per cent) and 56 (94 per cent), respectively. Peak expiratory flow rate was abnormal in 77 per cent of mild and 87 per cent of severe asthmatics. The FEV1/FVC ratio showed no significant difference between asthmatics and non-asthmatics. It is concluded that FEF25% and FEF75% are better indices for assessment of severity of asthma than FEV1 and FVC. The ratio FEV1/FVC is not useful.

Adolescent↗
PubMed2001

Nosocomial infections due to Acinetobacter baumannii in a neurosurgery ICU.

Invasive infections caused by Acinetobacter baumannii in a post-operative neurosurgery ICU were studied. Sixty one patients admitted during a span of 11 months were culture positive for acinetobacter species from blood and/or CSF samples. They were followed up prospectively for evidence of infection and clinical outcome. 40 cases had clinical evidence of infection due to acinetobacter species while in 21 patients, the isolation of the organism was considered a contaminant. Acinetobacter baumannii was the most common organism associated with invasive infections. Respiratory tract was found to be the most common primary source of infection in patients with bacteraemia or meningitis. The age, sex and pre-operative hospital stay were not significantly different in the two groups (p>0.05), while post-operative hospital stay and mortality was significantly higher in patients with invasive infection (p<0.05). Acinetobacter baumannii was isolated from multiple sites (p<0.05) and repeatedly from the same site (p<0.001) in a significantly higher number of patients with invasive infections. Mortality was high in the patients infected with Acinetobacter baumannii. Even amongst the infected group, the patient shaving meningitis showed a higher mortality as compared to the patients having bacteraemia.

Acinetobacter↗
PubMed2001

Uropathogenic Escherichia coli causing urinary tract infections.

BACKGROUND & OBJECTIVES: The information on the characteristics of Escherichia coli causing urinary tract infections is limited. We have characterised the urovirulence factors of Esch. coli isolated from symptomatic patients of urinary tract infections (UTI) in order to determine their pathogenic potential and the antibiotic sensitivity profile. METHODS: Semi-quantitative urine culture was done on 370 symptomatic patients suffering from urinary tract infections. Phenotypic characterization of the urovirulence factors of Esch. coli was undertaken and the antibiotic susceptibility was determined. RESULTS: Esch. coli was responsible for 45.5 per cent of infections. Resistance to amoxycillin, cotrimoxazole, nalidixic acid, norfloxacin and ciprofloxacin among Esch. coli isolates ranged from 70-95 per cent. Serotype O101 was found to be the commonest serotype (7/26). The virulence factors associated with uropathogenic Esch. coli were haemolysin production (5/30), presence of mannose resistant P-fimbriae (5/30), presence of mannose sensitive type 1 fimbriae (6/30) and the presence of mannose resistant F-fimbriae (2/30). Siderophores production was seen in all the isolates causing UTI. INTERPRETATION & CONCLUSION: Esch. coli was found to be the commonest cause of UTI in our study population. Antibiotic resistance was high among the strains circulating which emphasises the need for judicious use of antibiotics. Certain virulence factors like haemolysin production and presence of fimbriae in the Esch. coli may be associated with the urovirulence.

Anti-Bacterial Agents↗
PubMed2000

Hepatitis B and C viral infections in Indian kala-azar patients receiving injectable anti-leishmanial drugs: a community-based study.

BACKGROUND: Human immunodeficiency virus (HIV) and hepatitis B and hepatitis C viruses have emerged as major blood-borne infections. Several cases of infections through the use of unsterile injection needles also are on record. Kala-azar, or visceral leishmaniasis, is a hemoparasitic disease caused by Leishmania donovani. All the anti-kala-azar medications require multiple intramuscular injections of the anti-leishmanial drugs. To find whether these patients were at higher risk of contracting blood-borne infection, than those who were not on medication, a community-based study was conducted in the kala-azar-endemic state of Bihar, India. METHODS: Five villages (4050 families) of three highly endemic districts of Bihar were included in this study. The sociodemographic data of the affected families and their annual income were determined as per Government of India guidelines. The diagnosis of kala-azar and its sequelae, post-kala-azar dermal leishmaniasis (PKDL), was made, and their therapeutic details were noted. All the leishmania-infected patients, their spouses, family members, and villagemates were tested for hepatitis B surface antigen, hepatitis C virus antibodies, and anti-HIV (1 + 2) antibodies, using commercially available kits. RESULTS: Of the 4050 families, 61 (1.5%) were found affected with kala-azar or PKDL. These 61 families had 77 cases of leishmaniasis, of which 64 (83%) had kala-azar and 13 (17%) PKDL. The most affected (4.5%) age group was 11 to 40 years. Of the 61 families, 57 (93.4%) families belonged to so-called untouchable castes, and 9 of them could not afford to have any anti-kala-azar treatment. Only 64 patients received treatment in the form of injectables. The number of injections received by these patients ranged from 3 to 120. Hepatitis B and C viral infections were found to be significantly more prevalent in those who received multiple injections. Compared to their male counterparts infected with L. donovani, females who received injectable medicines were at higher risk of contracting hepatitis B infections (20% vs. 11.3%) and hepatitis C virus infection (26.7% vs. 18.9%). Overall, hepatitis C virus infections were more common (20.6%) than hepatitis B virus infection (13.2%) in this group of patients. Villagemates with a history of injections for other ailments also were found to have a high rate of infection with hepatitis viruses. One patient with kala-azar was found to be co-infected with HIV, although probably not related to injections. CONCLUSIONS: The treatment of Indian kala-azar and post-kala-azar dermal leishmaniasis consists of multiple intramuscular injections of sodium stibogluconate, pentamidine, or amphotericin B. Though the original disease gets cured, all these therapeutic regimens were found to carry a significantly high risk of transmitting yet more dangerous blood-borne infections, such as HIV and hepatitis B and C viruses, through the shared use of unsterile injection needles. All needles should be appropriately sterilized, if they are to be re-used.

Adolescent↗