Our experience with epidural steroid injections in management of low backpain and sciatica.

BACKGROUND: Low back pain and sciatica is a common clinical condition. It is a most common orthopaedic complaint in the Kaski region of Nepal. The reason for its increased incidence may be hilly terrain, difficult working and living environment of the region. The initial treatment of Low back pain is conservative. Epidural steroid injection is being slowly established as are liable mode of conservative management in many orthopaedic centres of the world. This is a preliminary report of on-going study of the use of epidural steroid in the management of low back pain cases coming to the orthopaedic department of Manipal Teaching Hospital. METHODS: Prospective clinical trial was carried out on the patients reporting with low back pain and sciatica not responding to other modes of conservative treatment. Pre and post injection evaluation was done clinically. The level of pain, improvement in physical signs and ability to do activities of daily living were noted. RESULTS: Fifty two patients were observed for the average duration of 2.87 months. Average duration of symptoms was for 10 months. After first epidural steroid injection 83% of patients reported relief on day one. In some cases the onset of analgesia was delayed. Four patients reported no relief after first injection. Fifteen patients were given two injections and four received three injections. The average duration between two injections was three weeks.Average duration of pain relief was 20 days. At the end of 3 months, good results were seen in 39%, fair in 33% and bad results in 27%. Overall 59% of patients were able to do activities of daily living. Three patients (5.76%)required operation for disc prolapse. Postoperatively two patients reported back with back pain. Most common complaint of patients after injection was pain at the injection site. No major complications were encountered. CONCLUSION: Epidural Steroid Injection is a safe and effective mode of treatment of Low Back Pain. It provides painfree period to enable the patient for physiotherapy which helps in early recovery.

Vectorial efficacy of Phlebotomus argentipes in Kala-azar endemic foci of Bihar (India) under natural and artificial conditions.

Ability of Phlebotomus argentipes to acquire Leishmania donovani the causative agent of Indian Kala-azar was evaluated in the laboratory. Flies were fed artificially on infected blood suspensions, using a chick-skin-membrane feeding apparatus, and naturally on Leishmania donovani infected mice. In addition flies collected from different endemic areas were dissected and examined for natural infection. Flies fed on infected mice showed significantly higher feeding rate (14.4%, p < 0.01) compared to that of other experiments (9%, 8.75%) but the percentage of infection was very low (2.43%). No Chi-square comparison was made between infection rate and feeding rate because of low value in infection rate (less than 5). Flies dissected for natural infection showed only 0.1% infection. Not much difference was observed in the intensity of Leishmania donovani infection in the mid gut of sandflies examined from any of these experiments. These observations have confirmed that Phlebotomus argentipes has ability to acquire infection and it provides the final piece of evidence that Phlebotomus argentipes is the vector of Leishmania donovani in Bihar State.

Field trial of an ecological approach for the control of Phlebotomus argentipes using mud & lime plaster.

A pilot study for the control of Ph. argentipes, a known vector of kala-azar in India, was carried out using an ecological approach. Of the 15 houses selected for the study 10, including the cattle sheds and latrines, were plastered with a mixture of mud and lime, up to a height of 1.22 m taking care to seal all cracks and crevices. The remaining five houses were left unplastered and were considered as control areas. The pre-treatment and post-treatment resting densities of the sandfly were monitored both in treated and untreated houses. A sudden drop in the sandfly density was noticed in the treated houses, whereas there was no significant reduction in the check houses, suggesting an effective control.

Effect of propranolol on ECG of Myna, Acridotheres tristis, and Goh, Varanus bengalensis.

Effect of propranolol (1 and 3 mg/kg body wt), a sympathetic blocking agent, on ECG patterns was studied in Varanus and Acridotheres. ECG was recorded before and after 5 min (immediate), 15 min and in some cases 25 min of drug infusion. All animals responded to propranolol with bradycardia. The effectiveness is dose dependent and it is also associated with the high heart rate both in Acridotheres and in Varanus. The P-R or P-S interval increased in all cases of Varanus after infusion. In Acridotheres height and duration of P-wave were increased slightly with the lower dose and decreased with the higher dose. The Q-S shortened with the lower dose and widened late with the higher dose in Varanus whereas in Acridotheres it is widened with lower and higher doses of propranolol. The Q-T interval has been increased in both groups of animals. An increased amplitude of T-wave height was observed in Varanus after 5 and 15 min of drug infusion. But it was noted with decrease in amplitude under high dose after 15 min of drug infusion. In Acridotheres it was on increase with lower dose and decrease with higher dose. The delta-wave disappeared after the administration of propranolol in Acridotheres.(ABSTRACT TRUNCATED AT 250 WORDS)

Purification and characterization of chymotrypsin inhibitors from marine turtle egg white.

The egg white of marine turtle (Caretta caretta Linn.) contains two chymotrypsin inhibitors and one trypsin inhibitor. The two chymotrypsin inhibitors were purified to homogeneity, as judged by ion-exchange chromatography, Polyacrylamide gel and sodium dodecyl sulphate-gel electrophoresis, isoelectric focusing, immunochemical tests and sedimenttation in the ultracentrifuge. Their sedimentation coefficient values were independent of protein concentration. Their amino acid composition was similar, and contained seven disulphide bonds, and methionine and carbohydrate moiety were absent. Each inhibitor consisted of a single polypeptide chain of 117 amino acids. The average molecular weight of each inhibitor, calculated from sedimentation and diffusion coefficient values, amino acid composition and sodium dodecyl sulphate-gel electrophoresis was 13000. Both the inhibitors were stable over the pH range of 2–11. They inhibited α-chymotrypsin by forming enzymeinhibitor complexes at a molar ratio of unity. The dissociation constant of each complex was 1·06 × 10–10 M. Both the inhibitors were indistinguishable in their physical, chemical and inhibitory properties except for their isoelectric points which were pH 5·23 for inhibitor A and pH 6·0 for inhibitor B. Chemical modification of all amino groups with trinitrobenzene sulphonate had no effect on their inhibitory activity.