Comprehensive Dental Management of a Medically Compromised Individual under Anticoagulant Therapy – A Victim of Rabid Dog Bite

In India, about 15 million people are bitten by animals, mostly dogs, every year and need post-exposure prophylaxis. Most animal bites in India (91.5%) are by dogs, of which about 60% are strays and 40% pets. The incidence of animal bites is 17.4/1000 population. Oral anticoagulants are usually prescribed for patients recovering from cardiovascular diseases, ischemic incidents such as myocardial infarction and angina pectoris followed by cerebrovascular accidents. Patients are usually placed under antiplatelet or oral anticoagulants increase the hemorrhage risk after oral surgical procedures. Here, we report a case of a patient on anticoagulants who, while seeking dental treatment, was bitten by a rabid street dog and shed light on the decisions faced by a dental professional while treating such patients.

Seasonal variations in water quality of four stations in the Periyar river basins.

Studies were conducted to evaluate the quality of water at four stations of the river Periyar with a view to utilise them for drinking purposes. These stations include Kanakkankadavu, Purappallikavu, Pathalam and Manjummal, which are in Emakulam District, Kerala, India. In the study, nutrient elements like Fe, Mn, Cu, and Zn were detected occasionally and found well below the maximum permissible limits. Mercury and lead were detected in the months of January and March of the sampling period at Kanakkankadavu. Trace levels of As, Se, Cr and Cd were detected in some samples during the particular months of the study period. Significantly higher levels of magnesium and calcium were detected during the summer season. The hydrographic data revealed that all the sources have acidic pH, turbidity, low salinity during monsoon and nitrate, sulphate and hardness were higher during the summer months. Kanakkankadavu and Purappallikavu had extreme salinity and the presence of certain toxic metals during the summer months while at other stations these were found well below the limits. The results that these water sources could be utilized for meeting the growing demands of drinking water for Cochin City after introducing certain water quality management measures.

Chromosome 12;15 rearrangements in patients with recurrent miscarriage.

Background: An abnormal karyotype in either partner, especially featuring a translocation and/or inversion is considered to be a cause of recurrent miscarriages. It is generally assumed that recurrent miscarriage might be due to recurrent chromosomal abnormalities in the fetus due to a balanced aberration in one of the parents being inherited by the offspring in an unbalanced form. Aim: Evaluation of chromosomal rearrangements in couples with recurrent miscarriages. Materials and Methods: Peripheral blood was collected and lymphocyte cultures were set up. Slides prepared from the cell suspension were stained and screened for metaphases followed by karyotyping. Result: Balanced translocation was observed in the male partner in one case and in the female partners in the three other cases. Conclusion: Couples with recurrent miscarriage should be investigated for chromosomal rearrangements, thus helping in genetic counseling and providing the options for future pregnancies.

Detecting mycobacteraemia for diagnosing tuberculosis.

BACKGROUND & OBJECTIVES: In human immunodeficiency virus (HIV) infected persons with pulmonary tuberculosis (TB), sputum may not always show acid fast bacilli (AFB). Moreover, in most cases of suspected extrapulmonary TB (irrespective of HIV status) mycobacteria-containing material is not readily available for investigation. This study evaluated whether blood culture for Mycobacterium tuberculosis bacteraemia (mycobacteraemia) help in diagnosing TB in such cases. METHODS: A total of 93 consecutive subjects with a clinical diagnosis of tuberculosis with or without laboratory confirmation, 42 with and 38 without coexisting HIV infection, and 13 patients with HIV infection without clinical evidence of TB were enrolled. Mycobacterial blood cultures were done using lysis centrifugation technique followed by subculturing onto the modified Lowenstein-Jenson medium (LJ-1) and Selective Kirchner's medium followed by subculturing onto the modified Lowenstein-Jenson medium (LJ-2, LJ-3). RESULTS: Of the 15 (16.2%) subjects with evidence of mycobacteremia in 4 (26.7%) blood was the first/ only source of diagnosing TB. Among 80 patients with clinical diagnosis of TB whether supported by laboratory tests or not, 14 (17.5%) had mycobacteraemia. Among the 21 HIV infected patients with laboratory proven TB, 9 (43%) had mycobacteraemia. INTERPRETATION & CONCLUSION: Blood culture appears to be a useful additional test to diagnose TB in persons with HIV infection. In patients without HIV infection, but with clinical picture compatible with TB, blood culture for mycobacteraemia may occasionally help in the diagnosis. We recommend the use of the lysis centrifugation technique followed by direct smear of the sediment along with inoculation of the sediment into both modified Lowenstein-Jenson medium and the Selective Kirchner's medium with subsequent subculturing onto the modified Lowenstein-Jenson medium for mycobacterial blood culture for detecting mycobacteraemia.

Resistance of Mycobacterium tuberculosis to the first line anti tubercular drugs--a twenty year review.

Tuberculosis and more so the multi drug resistant variety has been thrust into the forefront as a serious and life threatening illness in recent years. The advent of AIDS contributes to this substantially, especially in the developed world where it had become practically non- existent. We reviewed our data over the past 20 years with a view to determine when drug resistance began to manifest in the strains.

Apert syndrome variant with overlapping features of Crouzon syndrome.

A rare variant of Apert syndrome having overlapping features of Crouzon syndrome is described. The salient features of the two syndromes are briefly discussed and overlapping features are highlighted. A possible genetic explanation for the same is mentioned.

Bacteremia due to beta haemolytic streptococci.

The Beta haemloytic streptococci (BHS) are well recognised human pathogens causing a variety of infections, including septicemia. It is important to ensure their isolation from clinical specimens by using optimum media. Moreover, since the different groups have different pathogenic potential, it is equally important to routinely serogroup them; this is emphasized here. Since, BHS are uniformly will greatly decrease morbidity and mortality due to BHS infection.

Glutathione level and its relation to radiation therapy in patients with cancer of uterine cervix.

Glutathione functions as an important antioxidant in the destruction of hydrogen peroxide and lipid peroxides by providing substrate for the glutathione peroxidase and also promotes the ascorbic acid. Glutathione plays a vital role in detoxification of xenobiotics, carcinogens, free radicals and maintenance of immune functions. The study was aimed to determine plasma glutathione as well as erythrocyte glutathione and glutathione peroxidase in patients with invasive cervical carcinoma (n = 30) before initiation and after completion of radiotherapy and subsequently, at the time of first three monthly follow-up visit. The levels of plasma glutathione, erythrocyte glutathione and glutathione peroxidase activity were found to be lower in all cervical cancer patients as compared to age matched normal control women. The study indicates a change in antioxidant status in relation with the glutathione system among patients with invasive carcinoma of the uterine cervix. This study also demonstrates the effect of radiation therapy on this antioxidant system.

Primary drug resistance to Mycobacterium tuberculosis in renal transplant recipients.

BACKGROUND. After renal transplantation, patients have an up to 5% chance of being infected with Mycobacterium tuberculosis and there are reports from western countries of a 24% mortality if the infection is drug resistant. We investigated primary drug resistance in renal transplant recipients in Vellore, Tamil Nadu. METHODS. Between January 1987 and December 1993 we studied 695 patients (who had received 717 renal allografts) for evidence of tuberculosis, and performed drug sensitivity tests. RESULTS. Forty-three patients had culture-proven infection with Mycobacterium tuberculosis of whom 40 had drug sensitivity tests done. Initial drug resistance was seen from 1991. Rifampicin resistance was seen in 2, 1 and 4 patients and isoniazid resistance in 1, 2 and 2 patients in 1991, 1992 and 1993, respectively of the 23 isolates tested for drug susceptibility. Multi-drug resistance was seen in 1 and 2 patients in 1992 and 1993. CONCLUSIONS. This is probably the first report in India of primary drug resistance of Mycobacterium tuberculosis in renal allograft recipients. It is a cause for concern as it may indicate a large reservoir of drug-resistant patients in the community.

High prevalence of HTLV antibodies in wild-caught bonnet monkeys in southern India.

The prevalence of human T-lymphotropic virus (HTLV) type-1 antibodies was determined in the bonnet monkeys, living naturally, within about 30 km radius of Vellore (south India). Sera from 157 animals, collected between January 1982 and May 1993 were screened for the presence of HTLV-I infection by a particle agglutination test (PAT). When sera repeatedly reactive in PAT were subjected to indirect immunofluorescence and western blot tests, 63 (40%) were confirmed to be positive for HTLV-1 antibody. These findings are significant in the light of recent reports that HTLV infection is endemic to southern India.

In vitro stimulation of microsomal diethyl nitrosamine deethylase activity by vitamin K3 (menadione).

Vitamin K3 (menadione) has been found to stimulate diethyl nitrosamine (DEN)-deethylase activity in rat liver microsomes. The vitamin also takes care of the inhibitory effect of the anaerobic conditions as well as those of cytochrome poisons like sodium azide and sodium cyanide, possibly through production of active oxygen species. The enzyme was also stimulated by H2O2 and SOD and inhibited by catalase, thereby suggesting that H2O2 or some derivatives of it may be the active oxygen species involved in the reaction.

Immune response to purified chick embryo cell culture rabies vaccine manufactured in India.

The immunogenic efficacy of the first batch of indigenous purified chick embryo cell culture grown (PCEC) rabies virus vaccine has been measured in ten subjects. All of them were immunologically naive to rabies virus, and were given 5 doses of the vaccine in the post-exposure regime of injections on days 0, 3, 7, 14 and 30. On day 7, four subjects had developed very low levels of rabies virus neutralizing antibody, as detected and measured in the suckling mouse neutralization test. On day 14, all subjects had protective levels of antibody, which were maintained or enhanced by day 30. With the limited data presented here, the immunogenic efficacy of this batch of vaccine appeared similar to that of a batch of imported PCEC vaccine investigated earlier.

False resistance of salmonellae to trimethoprim-sulphamethoxazole in disc diffusion method.

Apparent resistance to trimethoprim-sulphamethoxazole (TMP-SMZ) in disc diffusion method was found in 14 strains of Salmonella typhi and 2 strains of S. paratyphi A grown on Mueller Hinton agar (MHA) of one manufacturer. On MHA from another manufacturer and on diagnostic sensitivity test agar (DSTA), these 16 strains were sensitive to TMP-SMZ. The minimum inhibitory concentration of trimethoprim (TMP) assayed by agar dilution method, on DSTA medium for these 16 strains was in the range of 0.01 to 0.04 micrograms/ml. Thus, the apparent resistance was a spurious result due to the unsatisfactory quality of the batch of MHA of the first manufacturer. Presumably the medium contained thymine or its derivatives which act as antagonists to TMP and sulphonamide drugs.

Coxsackie virus A 24 variant as the etiological agent of the acute haemorrhagic conjunctivitis epidemic at Vellore, in 1986.

Coxsackie virus A 24 variant (CA24v) was found to be the etiological agent of an epidemic of acute haemorrhagic conjunctivitis (AHC) in Vellore during the months of October and November in 1986. CA24v was isolated in 21 of 25 acutely ill patients. In addition, seroconversion was seen in 11 of the 16 patients from whom paired sera were collected.

Preliminary findings on skin conductance measures in schizophrenics & normal individuals in India.

Skin conductance measures were investigated during response paradigms, in 18 non medicated schizophrenics and 22 normal individuals. Basal, tonic and phasic skin conductance indices were studied in four experimental series consisting of auditory and visual stimuli differing in signal status. No differences were seen in skin conductance basal levels, tonic levels, phasic response or in the incidence of nonresponse in schizophrenics as compared to normal individuals.

Effects of ovulen-50, diethylnitrosamine and phenobarbital on liver regeneration in female rats.

Short term effects of ovulen-50, a combination type oral contraceptive agent and phenobarbital—an established hepatic tumour promoter, were examined in the livers of diethylnitrosamine-initiated and uninitiated female rats. Liver mitotic activity as judged by liver weight, [3H] thymidine incorporation into DNA and levels of DNA, RNA and protein were measured in non-regenerating and regenerating liver. Hepatic γ-glutamyl transpeptidase activity and hepatocyte agglutination with concanavalin A were examined in diethylnitrosamine- and/or phenobarbital-treated rats. The results indicate that diethylnitrosamine or ovulen-50 individually are mitoinhibitory in regenerating liver. Phenobarbital alone has a slight mitostimulatory effects in nonregenerating liver, but no effect on liver regeneration. Administration of ovulen-50 and phenobarbital to diethylnitrosamine initiated rats mitigated the mitoinhibition during regeneration. Contrary to the earlier observation with ovulen-50, neither phenobarbital nor diethylnitrosamine induced hepatocyte agglutination in the presence of concanavalin A. Like ovulen-50, diethylnitrosamine also increased the level of hepatic γ-glutamyl transpeptidase. Phenobarbital produced only insignificant rise and did not substantially exacerbate the effect diethylnitrosamine. The data show that though some of the effects of ovulen-50 resemble those of diethylnitrosamine or phenobarbital, the changes observed may not be related to the neoplastic phenomenon since they were not seen in an initiator-promoter combination regimen.