Combined role of casoni test and indirect haemagglutination test in the diagnosis of hydatid disease.

PURPOSE: To study the combined role of Casoni test and indirect haemagglutination (IHA) test in the diagnosis of hydatid disease. METHODS: Twenty eight suspected cases of hydatid disease were subjected to Casoni intradermal test using commercially available antigen (Span Diagnostics, India) after collecting pre-test serum samples. The serum samples were tested by IHA using an indigenously developed IHA test. RESULTS: Considering the clinical diagnosis of hydatid disease as the gold standard, the specificity of both Casoni test and IHA was 47%, however, the sensitivity of IHA was higher (81.8%) than Casoni test (63.8%). With the two tests considered together the sensitivity was 90.9%. CONCLUSIONS: Combined use of Casoni test and IHA test could establish presumptive and cost effective diagnosis in upto 90.9% of clinically suspected cases of hydatid disease.

Clinicopathologic study of lupus nephritis.

Needle biopsies of kidney were done in 35 cases of systemic lupus erythematosus (SLE) with renal lesions. The lupus nephritis were classified according to WHO classification and were correlated with response to therapy and prognosis. Detailed clinical features, routine haematological, biochemical tests (e.g., serum urea, creatinine, total protein and albumin, cholesterol, etc), examination of urine (degree of proteinuria and cells) and occurrence of various auto-antibodies e.g., antinuclear antibody (ANA), anti double stranded DNA (anti DsDNA) by enzyme immunoassay (EIA) method, LE cells and rheumatoid factor (RF) were studied in all cases. Clinically hypertension was present in 19 (54.3%) cases and nephrotic range of proteinuria was detected in 20 (57.2%) cases. ANA was found in 31 (88.5%) cases, anti DsDNA 24 (68.5%) and LE cells were detected in 25 (71.5%) cases. RF was detected in 2 (5.7%) cases. Histologically the most frequent lesions were class IV occurring in 15 cases (42.8%) with initial complete remission achieved only 4 cases by immunosuppressive therapy. Active lesions were also most frequent in this class. Class III lesions were found in 8 (22.8%) cases with 6 cases had complete remission. The best prognosis was noted in class II cases with 4 out of 5 (14.3%) cases had complete remission. Class V lesions were found in 6 (17.2%) cases with complete remission achieved in 3 cases. Only one patient presented with class VI lesion. RF positive cases had milder renal lesions.

Natural history of severe duodenal ulcer disease.

BACKGROUND: A subset of patients with chronic duodenal ulcer has severe ulcer diathesis in the form of frequent relapses and complications like perforation and hemorrhage. We observed the effect of drug treatment on the natural history of this subset. METHODS: Of 526 patients diagnosed to have chronic duodenal ulcer by endoscopy, 23 patients with severe diathesis were available for long follow-up (mean period 36 months). Each patient was assessed clinically and endoscopically every 2 months for at least 12 months and then every 3 months or when symptomatic. Helicobacter pylori status was assessed during endoscopy. The effect of antisecretory drugs and anti-H. pylori therapy on natural history was determined. RESULTS: Thirteen of 23 patients (56%) had refractory ulcers; six responded to double dose of H2-receptor antagonists (H2RA) for 8 weeks and six to omeprazole 40 mg daily for 4-8 weeks. Of 20 patients (87%) who were H. pylori-positive, 15 completed triple-drug therapy; of these, 10 patients eradicated H. pylori. These 10 patients were followed up for 24 months; there were no ulcer relapses within the first 12 months but 8 of them relapsed between 12 and 24 months (total number of relapses 8). Reinfection with H. pylori occurred in 3 patients. In the other 10 patients who remained H. pylori-positive, there were 19 episodes of ulcer relapse in 7 patients over 24 months, in spite of maintenance therapy with H2RA (p < 0.05). CONCLUSIONS: Refractoriness in patients with severe ulcer disease is usually episodic and amenable to larger doses of omeprazole or H2RA. Anti-H. pylori therapy improves the natural history but its effect in preventing ulcer relapse is short lasting (less than 12 months). Recurrence of infection is a problem in our population.

Pulmonary infection caused by Mycobacteria other than M. tuberculosis in and around Calcutta.

A study was undertaken to determine the prevalence rate of atypical mycobacteria in indolent fibrocavitary pulmonary diseases. 450 sputum specimens were examined and cultured, of which 15 were identified as atypical mycobacteria on repeated culture. No previous study was recorded from Calcutta. Compared to the results of previous workers from different regions of India, the prevalence rate seems high in this part of the country.

Comparative in vitro activity of fluoroquinolones against Mycobacterium tuberculosis.

Sixty clinical isolates of M. tuberculosis, 24 susceptible and 36 resistant to conventional primary antituberculous drugs, were tested against four fluoroquinolones (ciprofloxacin, ofloxacin, pefloxacin and norfloxacin). Ofloxacin and ciprofloxacin were found to be the most active, with minimum inhibitory concentration (MIC) of 0.6 mg/l or less to all strains tested. Strains resistant to isoniazid and other antitubercular drugs also showed more or less equal MICs for these two drugs. Mycobacterium tuberculosis H37 Rv showed MIC < 0.6 mg/l on each occasion. Other agents viz., norfloxacin and pefloxacin showed lesser activity against all these strains tested in comparison to ciprofloxacin and ofloxacin.

Comparative efficacy of fluoroquinolones, aminoglycosides, ureidopenicillins & newer cephalosporins against Pseudomonas species.

A total of 74 strains of Pseudomonas aeruginosa and 18 strains of Ps. putrefaciens were tested for sensitivity to 14 different antimicrobial agents. Ps. aeruginosa were mostly sensitive to netilmicin (81%), piperacillin (78%), amikacin (73%), azlocillin (70%), ceftazidime (69%) and pefloxacin (65%). Only 66 per cent strains of Ps. putrefaciens were sensitive to netilmicin, ceftazidime and ceftriaxone. The MIC values of the different drugs for the sensitive strains were comparable with the results of susceptibility testing. The Ps. putrefaciens strains showed greater resistance than Ps. aeruginosa.

Incidence of neonatal bacterial infection in cases of prolonged rupture of amniotic membrane.

Thirty cases of premature rupture of amniotic membrane were studied bacteriologically. Twenty cases showed growth of organisms from one or more sites at birth. From 20 control cases no pathogenic organism could be isolated. Out of these 20 cases showing growth of organisms 8 neonates developed clinical infection (deep and superficial) subsequently. The organisms grown from vaginal swab and umbilical swab culture showed maximum correlation to the organism from the infected neonates. Esch coli was found to be most common organism causing infections, next to it was Staph aureus. Growth of anaerobic organisms was found only in cases of prolonged rupture of membrane in mother, but not isolated from infected babies. So bacteriological studies of vaginal, placental, umbilical and nasal swabs and cord blood just after the birth of baby may be of some help in predicting the onset of neonatal infection.

Iodide transport in isolated cells of mouse submaxillary gland.

A method has been developed to isolate cells from the submaxillary gland of mouse by treatment with pronase. Three fractions of cells have been isolated having almost equal iodide concentrating activity. The isolated cells show time dependent uphill transport of iodide. The transport is substrate-saturable, having a Km value of 0·3 μΜ for iodide. The transport is sensitive to antithyroid drugs, metabolic inhibitors and to some extent to ouabain. Pseudohalide such as thiocyanate competes with the transport of iodide. Thyroid hormones or thyroid stimulating hormone have no significant effect on the iodide transport in these cells.