Biomedical subjects
Publications and source records attributed to A Girdhar.
Out of 3350 leprosy patients attending the surgical outpatient department for various ulcerative lesions, 18 patients had typical symptoms of myiasis. Maggots were collected in 5 cases from the nose, in 3 cases from ulcers of the hand and in 10 cases from ulcers of the foot. It was possible to rear the maggots into flies in 8 out of 18 cases. The flies were identified as Sarcophaga ruficornis and Chrysomyia bezziana.
The length of treatment advocated for leprosy has been very long and arbitrary. During the past few years, attempts have been made to reduce the length of treatment required. World Health Organization (WHO) has recommended six months therapy for paucibacillary leprosy. The present study was undertaken to see the extent of histological changes that occur with this therapy. Thirty four untreated tuberculoid (TT/BT) leprosy patients were biopsied initially and after completion of fixed course of this treatment. Clinically, 50 percent of the patients showed regression of disease activity at the end of six months. Morphology of the lesions was studied, in clinically active and inactive cases on completion of therapy. It was found that after six month's therapy, histology of the lesions was similar, whether the case was active or not. After the prescribed treatment, biopsy showed marked reduction in the extent of granuloma, along with significant increase in lymphocytes and a increase in epithelioid cells in these granulomas.
A case of suspected giant nerve abscess near the radial nerve in the upper arm of a patient with borderline leprosy is reported. On exploration, it turned out to be a deep seated lipoma. Consideration should be given to exploring nerve masses in leprosy.
Two infants, one 4 months old and the other 2 months old, having histologically confirmed indeterminate leprosy are reported. The route of infection, mode of transmission, and incubation period are discussed with reference to these two cases of infantile leprosy.
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Sera from 478 persons (348 leprosy patients, 33 tuberculosis patients, 29 healthy contacts of leprosy patients, 38 normal healthy Indians, and 30 normal healthy Europeans) were screened for anti-HIV-1 IgG antibodies by ELISA. None was positive. In addition, 132 samples (from 43 leprosy patients, 21 tuberculosis patients, 5 healthy contacts of leprosy patients, 33 normal healthy Indians, and 30 normal healthy Europeans) were also tested by Western blot assay for anti-HIV-1 IgG antibodies. Only 1 of the 63 healthy subjects expressed a prominent p17 band. One or more bands were found in 44 (leprosy patients 33/43, tuberculosis patients 7/21, and leprosy contacts 4/5) of the remaining 69 sera. Antibody to the HIV-1-specific antigen p24 was expressed by 17 of these subjects (14/43 leprosy patients, 1/21 tuberculosis patients, and 2/5 leprosy contacts), either as a single band or in combination with other bands. This raises the possibility of a common antigenic pattern between HIV-1 and mycobacteria, especially Mycobacterium leprae.
Regularity of DDS intake among 366 leprosy patients attending our out patient department voluntarily was assessed by urine spot test. It was found that only 54.6% of them had taken their last dose of drug within the previous three days. Those who kept their appointment showed better compliance than those who did not. Urinary DDS positivity was found to be unrelated to sex, occupation or the type of the disease. In the younger age group the compliance was low, as also among the patients coming from nearby places as compared to those who were residing in far off districts.
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A case of Borderline Leprosy (BL) occurring in an infant of 1 year and 7 months, beginning at the age of 9 to 10 months is reported along with a brief review of literature on childhood leprosy.
With an aim to reduce the length of treatment of leprosy, as a first step an investigation has been undertaken to evaluate the efficacy of maintenance therapy in non-lepromatous cases. Relapse rates in a group of 47 cases, in whom treatment had been given only til the point of inactivity (the trial group) have been compared with a similar group of 27 cases who received additional 18 months maintenance therapy (the control group). No difference in relapse rates has been found (2.13 per 1000 patient months in trial group as against 2.58 per 1000 patient months in the control group). This suggests that additional 18 months maintenance therapy, as is currently recommended, does not offer any additional advantage in reducing the relapses.
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A quantitative estimation of discharge of M. leprae in the milk of 39 leprosy female patients has been made. Twelve of the 39 patients (10 LL/BL and 1 each of T/BT and BB) showed bacilli in their milk. Only one of these patients was on treatment. AFB count in 10 ml of milk was found to range from 4.3 X 10(4) to 4.3 X 10(5). Significance of discharge of such a large number of bacilli in breast milk is discussed.
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.
The present article is the result of a study of the leprosy caseload in Agra City and is based on a house-to-house survey conducted during April-July 2003 in 5 areas. During the survey 198,150 persons were examined, and 287 cases were detected, giving a prevalence rate of 14.5/10,000. A majority of them (92%) were new cases, detected and diagnosed for the first time. The patient load was found to be unevenly distributed with comparatively more number of patients in areas such as Jamuna Kinara, Shah Ganj and Lohamandi. Among the 264 newly detected cases, 14.8% were of MB type. Overall deformity of grade > or = 2 was seen in 2.8% of patients--0.4% in PB and significantly high at 18% in MB leprosy. The observations reveal that leprosy is endemic in slum areas of Agra City.
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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.