Uterine rupture after induction of labour for intrauterine death using the prostaglandin E2 analogue sulprostone.
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Biomedical subjects
Publications and source records attributed to R N Prasad.
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Many deaths were recorded in village Baniyani of Talgram PHC of District Farrukhabad, U.P. during August to November 1991, which is the malaria transmission season in this area. Integrated measures, like one-round spraying of DDT and HCH, six-round fogging of malathion and six-time application of Baytex in mosquito breeding sites, were adopted by the Health Department of the U.P. government to avert an epidemic. Investigations carried out by the Malaria Research Centre during November and December 1991 showed low mosquito densities and larval positivity but very high incidence of malaria in the village. No malaria case was recorded by the surveillance worker of the Health Department of the state government before the outbreak of the disease. However, high slide falciparum rate (51.57), child parasite rate (40.0), infant parasite rate (66.66) and spleen rate (82.90) in the village clearly indicated hyperendemic conditions in the area and hence deaths recorded in the village during the malaria transmission period could be due to malaria only. Major factors responsible for the deaths due to malaria in the village were poor surveillance, faulty diagnosis, and low literacy and socio-economic status of the villagers.
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In villages of District Shahjahanpur, 122 decentralized Gambusia multiplication ponds were established to cover the need of the entire district. Profuse breeding of Gambusia was observed in these ponds. The fishes are being successfully used in mosquito control all over the district. In July 1990 there was a widespread flood due to which 70 Gambusia multiplication ponds were affected and the fish was washed away in large numbers, leaving only a scanty population in the flood-affected ponds. We utilized this opportunity to study the natural dispersal and colonization of Gambusia in different aquatic habitats. The study revealed that Gambusia was either not found in most habitats or was present in very small numbers, and on its own Gambusia was unable to eliminate the local fauna to become a dominant species. Predatory fishes and birds played a major role in eliminating Gambusia. Gambusia is therefore unlikely to pose any ecological hazard in vector-control programmes.
Very few studies have been carried out on the role of liver macrophages (Kupffer cells) during the course of hepatic amoebiasis. The kinetics of phagocytic activity of Kupffer cells and blood monocytes was studied in guinea pigs intra-mesenterically infested with Entamoeba histolytica. The phagocytic capacity of blood monocytes of normal animals was comparatively lower than Kupffer cells for both latex and haemolysin coated sheep red blood cells. Significant decline in phagocytic response of Kupffer cells and blood monocytes of infected animals was observed right from 2nd post infection day and it kept on decreasing with the progress of infection. Depression in phagocytic response of Kupffer cells and blood monocytes was more marked in those animals who had higher grades of pathological lesions. Hence, an inverse correlation was obtained between the phagocytic capacity and severity of amoebic lesions (P less than 0.01). The significance of depression in phagocytic response of Kupffer cells and blood monocytes may be responsible for the development of hepatic lesions.
Studies on ecological succession and association of anophelines in selected paddy fields of Dadraul PHC were carried out in 1988 during the paddy cultivation period from June to October. Breeding of five anophelines was observed in paddy fields. Out of the adults that emerged from larval collections the percentage of An. subpictus was the highest followed by An. nigerrimus, An. culicifacies, An. annularis and An. barbirostris. Further, An. culicifacies and An. subpictus breeding occurred in the early stage of rice cultivation and stopped before the breeding of An. nigerrimus started i.e., nearly 30 days after rice transplantation. An. nigerrimus breeding continued till harvesting. An inverse correlation between larval density of both An. culicifacies and An. subpictus and the height of the rice plants was observed.
In an endemic area relapse and reinfection in Plasmodium vivax cases poses serious problems for the malaria control program. We have studied the relapse/reinfection patterns of P. vivax infection in 26 villages of District Shahjahanpur, a malaria endemic area of UP, India for a period of four years (May, 1986 to October, 1988). All the P. vivax cases were given a complete course of radical treatment and were followed-up for relapse/reinfection. There were 8,914, 2,484, 1,439 and 883 P. vivax cases in 1986, 1987 and 1989 respectively, our of which 2,066, 141, 58 and 18 cases in the respective years showed relapse/reinfection. The maximum number of relapse/reinfection was recorded from a 47 year old male patient, who suffered from P. vivax infection eight times. The percentage occurrence of relapse/reinfection was much higher (70.2%) in males compared with females (29.8%). Relapses were more common among 16-30 years old patients. In conclusion it was felt that in 1986 relapse/reinfection in vivax cases was higher due to improper treatment of these cases. This situation may have occurred due to lack of awareness among the public, poor surveillance by the National Malaria Program or higher density of the vector mosquitos in the area.
The mosquito control potential of Gambusia affinis, a mosquito fish, was evaluated in rice fields in the Shahjahanpur district of Uttar Pradesh. This fish, at a stocking rate of 5 fishes/sq m, significantly reduced the larval and pupal densities in experimental fields as compared to control fields during the entire observation period of 42 days. Control of mosquito breeding in rice fields through this fish seems to be promising.
Culture of Gambusia affinis along with carps in fish culture practice in village ponds in Shahjahanpur distt., U.P., has revealed very little difference in fish productivity (1539 kg/ha in ponds with Gambusia, 1572 kg/ha in ponds without Gambusia). The growth and survival of Gambusia were found to be good in most of the composite fish culture ponds. Culture of Gambusia along with edible fish in village ponds is, therefore, recommended to get the dual benefit of fish production and control of mosquito proliferation in village ponds.
Humoral immune response of normal rhesus monkeys was studied after giving a standard dose of primaquine. The drug did not effect the level of complement (C3) and its haemolytic activity. Levels of Immunoglobulin i.e. IgG, IgM & IgA and number of immunoglobulin secreting cells also remained unaffected. Results of this study suggested that primaquine did not suppress the immune status of the host and could be given safely to the malaria patients.
Studies on seasonal prevalence, resting behaviour, gonotropic conditions and breeding habits of Anopheles culicifacies were carried out from January 1987 to December 1989 in riverine villages of Dadraul PHC in Shahjahanpur district, Uttar Pradesh. Man hour densities of An. culicifacies varied from 11.3 to 125.1 during the study period. The species showed two peaks of high prevalence: one during March to June and the other during October to December. The first peak was higher than the second. The collection revealed a higher proportion of freshly fed to semi-gravid females thus indicating the outdoor resting behaviour of the species. From the immatures collected from riverbed pools, 7 anopheline species were identified. Of the 955 specimens identified, An. culicifacies constituted the highest number (62.1%). The study indicates that low rainfall and drought did not affect An. culicifacies densities or malaria transmission in riverine areas.
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A simplified in-vivo test system was applied to detect chloroquine resistance in malaria patients in Shahjahanpur district (Uttar Pradesh) in India. In 27.6% of cases RIII resistance was observed. This in-vivo method is a simple and useful test for the early detection of chloroquine-resistant falciparum infections and for the management of these patients with alternative therapy.
An attempt was made to detect multiple invasion of erythrocytes by Plasmodium vivax in district Shahjahanpur, India. Out of 33,027 P. vivax cases examined, 84 showed multiple invasion of erythrocytes. There were 14 cases who showed more than five rings in an erythrocyte. Maximum invasion of an erythrocyte was observed in a 50 year old male patient, a single erythrocyte was harbouring 12 rings. In 5 patients more than one schizonts were present in single erythrocyte. The number of merozoites per schizont varied from 2-28. In some of the cases erythrocytes were having more than one stage of the malarial parasite. Such variations are probably related to the P. vivax strain found in this area.
The present study was carried out to examine the comparative efficacy of sucralfate and ranitidine in the treatment of duodenal ulcer. Sixty-six patients with endoscopically diagnosed duodenal ulcer were studied in a 4-6 weeks randomised, single blind trial comparing sucralfate 1 gm T.D.S. one hour before meal and 1 gm nocte (34 pts) with ranitidine 300 mg nocte (32 pts). Six patients (four on sucralfate and 2 on ranitidine) failed to complete the study. Endoscopy after four weeks of treatment showed an ulcer healing rate of 57% in the sucralfate group compared with 73% in ranitidine group (p greater than 0.1). At six weeks these figures had risen to 87% and 90% respectively (p less than 0.5). After one year followup study 69% of sucralfate treated ulcers relapsed whereas the relapse rate was 82% in ranitidine treated ulcer group (p less than 0.1). It was observed that the relapse was earlier in the ranitidine group as compared to sucralfate group (p less than 0.01 at 3 months and p less than 0.05 at 6 months). Asymptomatic recurrence was seen in 15% (6/40) patients. Sucralfate was not only as effective as ranitidine in short term healing of duod. ulcer but also delayed the relapse of ulcer in long term followup after initial healing with the drug.
The effect of primaquine on the cellular immune responses (lymphocyte subpopulations and their proliferative responses with PHA, Con-A and LPS, and phagocytosis by monocytes) of normal rhesus monkeys was studied under both in-vivo and in-vitro conditions. When the lymphocytes and monocytes from normal animals were treated in-vitro with primaquine, at concentration normally attainable during therapy, a significant inhibition in blastogenic response of lymphocytes and phagocytic capacity of monocytes was noticed after 4 hours of treatment. In contrast, the in-vivo effect of primaquine treatment on these cells was innocuous. From this study it is clear that the primaquine does not act as an immunosuppresant and can be given safely to any type of malaria patient.
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Generation of reactive oxygen species (ROS) by blood monocytes and Kupffer cells of normal and Plasmodium berghei infected mice treated at different levels of parasitaemia with chloroquine, were studied. Cells isolated at lower level of parasitaemia (less than 2%) produced ROS within the range of normal animals, whereas ROS production by the cells isolated from the animals at higher level of parasitaemia (greater than 20%), was significantly higher even without stimulation with latex particles. The ROS generation capacity of both normal and infected animals was less after the chloroquine treatment. This inhibitory effect of chloroquine may be beneficial in protecting the host from the adverse effect of reactive oxygen species by controlling their overproduction.