Study on Micro-Climate and its Effect on Growth and Yield of Mustard Crop under Prayagraj Conditions

A field experiment was conducted during Rabi season of 2022-2023 on the topic entitled “Study On Micro-Climate And Its Effect On Growth And Yield Of Mustard Crop Under Prayagraj Conditions” at field of collage of forestry in Prayagraj district of utter Pradesh. Keeping in this view experiment was conducted in Factorial RBD with three replications having two factors. The first factor comprised of three DOS (170ct. 3Nov. and 17 Nov.) whereas the second factor consisted of Four Indian mustard Cultivar viz: Jhalak, Kala Sona, Sriram, and Ratna Results showed that both dates and varieties 17 oct and Ratna were superior as compared to rest of treatment max. yield observed. However, the highest growth attributes Like plant height, number of leaves, no of branches yield, and yield attributes like No. of silique (cm) per plant, test weight, seed yield (q/ha) grain yield, dry matter, and length of siliqua was recorded under 17 Oct. growing crop Ratna variety, the Lowest yield and growth recorded under date 17 Nov. growing crop Jhalak followed by 3 Nov. growing Crop Jhalak.

Effect of Added Phosphorous and Organic Matter on the Availability of Phosphorous Fractions in Normal Soil under Field Capacity Moisture Tension

An Incubation study was conducted from January 2020 – May 2020 under "Laboratory conditions" at the Department of Soil Science and Agricultural Chemistry, Chandra Shekhar Azad Kanpur University of Agriculture and Technology, (U.P.) to study the “Effect of added phosphorous and organic matter on the availability of phosphorous fractions in normal soil under field capacity moisture tension”. To obtain a different fraction of phosphorus under the field capacity regime all three experiments were conducted under kankar soil conditions to determine Ca-P, Al-P and Fe-P as influenced by six different treatments. The results showed that with advancement in time of incubation, the availability of Ca-P (308.2 ppm and 235.3 ppm at 0 days and 90 days of incubation period, respectively), Al-P (89.5 ppm and 44.9 ppm at 0 days and 90 days of incubation period, respectively), while Fe-P (13.8 ppm and 13.1 ppm at 0 days and 90 days of incubation period, respectively) increased marginally at field capacity in kankar soil condition. Sunhemp (T2) proved more beneficial than FYM (T3) in increasing Fe-P, Al-P, and Ca-P as also Olsen’s P content in the soil. Therefore, the application of organic matter either in the form of sun hemp with phosphorus proved very useful in improving the avoidable content of the soil.

Integrated Effect of Inorganic Fertilizers and Biofertilizers on Growth and Yield of Onion (Allium cepa L.)

The present investigation was carried out during winter of 2018-2019 at the Horticulture Farm of Post Graduate College, Ghazipur. The experiment was laid out in Randomized Block Design with three replications. Ten treatment combinations viz. T1-Control (100% Recommended dose of NPK), T2-75% NPK + 25% Azotobactor, T3-50% NPK + 50% Azotobactor, T4-25% NPK + 75% Azotobactor, T5-75% NPK + 25% PSB, T6-50% NPK + 50% PSB, T7- 25% NPK + 75% PSB, T8-75% NPK + 25% Azotobactor + 25% PSB, T9-50% NPK + 50% Azotobactor + 50% PSB and T10-25% NPK + 75% Azotobactor + 75% PSB. It can be concluded that the maximum growth attributes, yield parameter and yield of onion may be obtained by the application of 75% NPK + 25% Azotobactor + 25%PSBtreatment (T8), while, the treatment T7, i.e. application of 25% NPK + 75% PSB was also found to be good for growth and yield parameter of onion. It was observed that the combination of inorganic fertilizers and bio-fertilizers influence the growth and yield attributes. . Therefore, from the present investigation, it can be concluded that the onion variety N-53 performed economically well by the application of 75% NPK + 25% Azotobacter+25% PSB as compared to rest treatment.

Gall bladder specimen histopathological findings after cholecystectomy

Background: Cholecystitis is a generally widespread problem in adult population. Multiple finding has been found in gross and microscopic examination of gallbladder. Existence of stones is one of the known causative factors that lead to histopathological changes in gallbladder. It is also responsible for the development of gallbladder carcinoma. The purpose of this study was to find out the histopathology of gall bladder specimens following surgical intervention. Methods: This observational study included 116 patients admitted in the department of general surgery, PMCH, Patna with acute or chronic cholecystitis from August 2018 to July 2019. Written and informed consent was taken from all the participants. Data was analyzed using SPSS version 20. Results: A total of 116 gallbladder specimens that presented for histopathological examination during the study period were included into the study, with male to female ratio of 1:3. The highest prevalence was found in the age group of 31-50 years. The results of histopathological examination of these gallbladder specimens showed that chronic cholecystitis was found in 93 (80.1%), acute cholecystitis in 17 (14.6%), and dysplasia was found in 5 (4.3%) patients, and gall bladder carcinoma was detected in 1 (0.8%) patients. On morphological analysis, the commonest gall stones were made up of cholesterol and the most common lesion was chronic cholecystitis by histopathology. Conclusions: This study concludes that the chronic calculus cholecystitis was dominant in our population. It is assumed that routine histopathological examination following cholecystectomies essential for all gallbladder specimens even in the non-existence of macroscopic signs of carcinoma, which was the case in our patients.

Analysis of presentation, etiology, management and outcome of perforation peritonitis in a tertiary care centre

Background: The most common surgical emergency in general surgery is perforation peritonitis. It is a serious condition with a mortality rate of up to 20%, and it is the third most common cause of surgical abdomen after appendicitis and intestinal obstruction. The aim of this study to discuss presentation, etiology, management and outcome of perforation peritonitis in our hospital. Methods: The 60 patients with features of perforation peritonitis admitted from September 2021 to August 2022 in the department of general surgery, PMCH, Patna were chosen. Descriptive statistics was used for analysis. Detailed history was taken, physical examination and X-ray was done. Signs and symptoms, duration of illness, age of presentation, intra-op findings regarding size and location, its management, post-op complications were documented. Results: Total 60 cases of perforation peritonitis were included in this study, among that 80% (48) were males and 20% (12) were females, with male to female ratio of 4:1. Pain abdomen was a universal symptom. Generalized pain abdomen was seen in 54 (90%) cases, followed by lower quadrant in 3 cases (5%) and epigastrium pain seen in 3 cases (5%). Radiation of pain to right iliac fossa was seen in 6 cases (10%). Blunt injury was seen in 9 (15%) case. 14 patients were treated with anti-ulcer medications. Three patients with duodenal ulcer perforation were treated with nonsteroidal anti-inflammatory drugs. Liver dullness was obliterated in 28 patients (47%). Bowel sounds were either sluggish or absent in most cases. Conclusions: Perforation peritonitis is a frequently encountered surgical emergency. Various factors like age, sex, duration, site of perforation, extent of peritonitis and delay in surgical intervention are associated with morbidity and mortality. A successful management depends upon early surgical intervention, source control and exclusive intraoperative peritoneal lavage.

Gall bladder specimen histopathological findings after cholecystectomy

Background: Cholecystitis is a generally widespread problem in adult population. Multiple finding has been found in gross and microscopic examination of gallbladder. Existence of stones is one of the known causative factors that lead to histopathological changes in gallbladder. It is also responsible for the development of gallbladder carcinoma. The purpose of this study was to find out the histopathology of gall bladder specimens following surgical intervention. Methods: This observational study included 116 patients admitted in the department of general surgery, PMCH, Patna with acute or chronic cholecystitis from August 2018 to July 2019. Written and informed consent was taken from all the participants. Data was analyzed using SPSS version 20. Results: A total of 116 gallbladder specimens that presented for histopathological examination during the study period were included into the study, with male to female ratio of 1:3. The highest prevalence was found in the age group of 31-50 years. The results of histopathological examination of these gallbladder specimens showed that chronic cholecystitis was found in 93 (80.1%), acute cholecystitis in 17 (14.6%), and dysplasia was found in 5 (4.3%) patients, and gall bladder carcinoma was detected in 1 (0.8%) patients. On morphological analysis, the commonest gall stones were made up of cholesterol and the most common lesion was chronic cholecystitis by histopathology. Conclusions: This study concludes that the chronic calculus cholecystitis was dominant in our population. It is assumed that routine histopathological examination following cholecystectomies essential for all gallbladder specimens even in the non-existence of macroscopic signs of carcinoma, which was the case in our patients.

Analysis of presentation, etiology, management and outcome of perforation peritonitis in a tertiary care centre

Background: The most common surgical emergency in general surgery is perforation peritonitis. It is a serious condition with a mortality rate of up to 20%, and it is the third most common cause of surgical abdomen after appendicitis and intestinal obstruction. The aim of this study to discuss presentation, etiology, management and outcome of perforation peritonitis in our hospital. Methods: The 60 patients with features of perforation peritonitis admitted from September 2021 to August 2022 in the department of general surgery, PMCH, Patna were chosen. Descriptive statistics was used for analysis. Detailed history was taken, physical examination and X-ray was done. Signs and symptoms, duration of illness, age of presentation, intra-op findings regarding size and location, its management, post-op complications were documented. Results: Total 60 cases of perforation peritonitis were included in this study, among that 80% (48) were males and 20% (12) were females, with male to female ratio of 4:1. Pain abdomen was a universal symptom. Generalized pain abdomen was seen in 54 (90%) cases, followed by lower quadrant in 3 cases (5%) and epigastrium pain seen in 3 cases (5%). Radiation of pain to right iliac fossa was seen in 6 cases (10%). Blunt injury was seen in 9 (15%) case. 14 patients were treated with anti-ulcer medications. Three patients with duodenal ulcer perforation were treated with nonsteroidal anti-inflammatory drugs. Liver dullness was obliterated in 28 patients (47%). Bowel sounds were either sluggish or absent in most cases. Conclusions: Perforation peritonitis is a frequently encountered surgical emergency. Various factors like age, sex, duration, site of perforation, extent of peritonitis and delay in surgical intervention are associated with morbidity and mortality. A successful management depends upon early surgical intervention, source control and exclusive intraoperative peritoneal lavage.

Role of closed subcutaneous drain in prevention of surgical site infection in perforation peritonitis

Background: Surgery for perforation peritonitis is associated with the highest rates of infective complications, especially surgical site infection. SSI occurs due to failure of obliteration of dead space during abdominal wound closure resulting in formation of hematoma and seroma collection in the surgical wound viz. abdominal wound in cases of perforation peritonitis. This acts as a good culture medium for bacterial organisms to grow and cause wound infection. The bacterial pathogens can be either from intra-abdominal sepsis or nosocomial in origin. Closed suction drains can be used effectively to eliminate dead space in the wound and evacuates the seroma or hematoma collection, thereby reducing chances of SSI and also helps in early detection of SSI by inspecting the nature of drain output. Aim was to evaluate the role of closed suction drains in prevention of SSI in cases of perforation peritonitis. Methods: Comparative study of 60 cases of perforation peritonitis divided into two equal groups (Group A patient with closed suction drain in subcutaneous space vs. Group B patient without closed suction drain). Outcomes of SSI were compared. Results: The incidence of SSI in Group A was 33% whereas in Group B was 70%. 40% cases in SSI in Group A whereas 76% cases of SSI in Group B developed wound dehiscence. Most cases of SSI was diagnosed on POD 2 for Group A and on POD 4 for Group B. Conclusions: The study supports use of closed suction drain in perforation peritonitis for prevention, early detection and appropriate management of SSI.

Role of oral antibiotic preparation in bowel preparation for colorectal surgery in reducing surgical site infection

Background: Mechanical bowel preparation for colorectal surgeries is thought to clear the bowel lumen of stool, thus decreasing intraluminal pressure of hard, potentially impacting stool and reduce ischemia at the new anastomosis. This reduces the dreaded complication of organ space surgical site infection (SSI) that leads to anastomotic leak which is most commonly seen in colorectal surgeries. Oral antibiotic preparation is thought to reduce the bacterial concentration of colonic mucosa which is thought to further bring down the incidence of organ space SSI in colorectal surgery. Aim of this study was to evaluate the role of oral antibiotics given preoperatively as an adjunct to mechanical bowel preparation and intravenous antibiotics, in reducing SSI in colorectal surgeries. Methods: Comparative study of 60 cases of colorectal surgery divided into two equal groups (group A-patients who received oral antibiotic preparations (OABP) with mechanical bowel preparations (MBPs) and ivAb preoperatively (oral antibiotic preparation and mechanical bowel preparation +intravenous antibiotic) versus group B-patients who only received MBP and ivAb preoperatively. Outcomes of SSI results were compared. Results: Incidence of SSI in group A was 16% whereas it was 40% in group B. Incidence of anastomotic leak in group A was 3.3% and in group B was 13.3%. E. coli was found in the pus culture of 60% cases of SSI in study groups whereas S. aureus was found to be the causative organism in rest of the cases that developed SSI. Conclusions: The study supports the use of OABP as an adjunct to MBP and ivAb preoperatively in colorectal surgery for the prevention of SSI and its related complications.

Role of closed subcutaneous drain in prevention of surgical site infection in perforation peritonitis

Background: Surgery for perforation peritonitis is associated with the highest rates of infective complications, especially surgical site infection. SSI occurs due to failure of obliteration of dead space during abdominal wound closure resulting in formation of hematoma and seroma collection in the surgical wound viz. abdominal wound in cases of perforation peritonitis. This acts as a good culture medium for bacterial organisms to grow and cause wound infection. The bacterial pathogens can be either from intra-abdominal sepsis or nosocomial in origin. Closed suction drains can be used effectively to eliminate dead space in the wound and evacuates the seroma or hematoma collection, thereby reducing chances of SSI and also helps in early detection of SSI by inspecting the nature of drain output. Aim was to evaluate the role of closed suction drains in prevention of SSI in cases of perforation peritonitis. Methods: Comparative study of 60 cases of perforation peritonitis divided into two equal groups (Group A patient with closed suction drain in subcutaneous space vs. Group B patient without closed suction drain). Outcomes of SSI were compared. Results: The incidence of SSI in Group A was 33% whereas in Group B was 70%. 40% cases in SSI in Group A whereas 76% cases of SSI in Group B developed wound dehiscence. Most cases of SSI was diagnosed on POD 2 for Group A and on POD 4 for Group B. Conclusions: The study supports use of closed suction drain in perforation peritonitis for prevention, early detection and appropriate management of SSI.

Role of oral antibiotic preparation in bowel preparation for colorectal surgery in reducing surgical site infection

Background: Mechanical bowel preparation for colorectal surgeries is thought to clear the bowel lumen of stool, thus decreasing intraluminal pressure of hard, potentially impacting stool and reduce ischemia at the new anastomosis. This reduces the dreaded complication of organ space surgical site infection (SSI) that leads to anastomotic leak which is most commonly seen in colorectal surgeries. Oral antibiotic preparation is thought to reduce the bacterial concentration of colonic mucosa which is thought to further bring down the incidence of organ space SSI in colorectal surgery. Aim of this study was to evaluate the role of oral antibiotics given preoperatively as an adjunct to mechanical bowel preparation and intravenous antibiotics, in reducing SSI in colorectal surgeries. Methods: Comparative study of 60 cases of colorectal surgery divided into two equal groups (group A-patients who received oral antibiotic preparations (OABP) with mechanical bowel preparations (MBPs) and ivAb preoperatively (oral antibiotic preparation and mechanical bowel preparation +intravenous antibiotic) versus group B-patients who only received MBP and ivAb preoperatively. Outcomes of SSI results were compared. Results: Incidence of SSI in group A was 16% whereas it was 40% in group B. Incidence of anastomotic leak in group A was 3.3% and in group B was 13.3%. E. coli was found in the pus culture of 60% cases of SSI in study groups whereas S. aureus was found to be the causative organism in rest of the cases that developed SSI. Conclusions: The study supports the use of OABP as an adjunct to MBP and ivAb preoperatively in colorectal surgery for the prevention of SSI and its related complications.

Experience of laparoscopic cholecystectomy in patients presenting with acute cholecystitis at different duration

Background: Acute inflammation of a gall bladder that contains stones is acute calculous cholecystitis, laparoscopic cholecystectomy is now the gold standard treatment for patients with gall stone disease. laparoscopic cholecystectomy for acute cholecystitis was initially considered technically challenging and potentially risky for the patient. Aim was to evaluate results of laparoscopic cholecystectomy in patients presenting with acute cholecystitis at different duration in a tertiary centre in eastern India. Methods: Comparative study of 71 cases of acute cholecystitis who presented at different days and were treated by laparoscopic cholecystectomy. Outcome was compared. Results: The incidence of conversion to open was 12.6%. Day of presentation 5 to 7 had the maximum 21% risk of conversion. Major intraoperative complications included 4 cases of common bile duct injury, 4 cases of vascular injury and 3 cases of bowel injury out of which vascular injury and one case of bowel injury was managed laparoscopically. 9 cases converted to open surgery. patient with DOP 1, 2 and 3 had an average hospital stays of 3 days. It was 5 for those with DOP 4 and 7 days for patients with DOP 5 to 7. Conclusions: The study supports laparoscopic cholecystectomy in acute cholecystitis specially in patients presenting within 72 hours of onset of pain. Laparoscopic cholecystectomy can be attempted in patients who present at DOP 4 and DOP 5 to7 after explaining them the risk and benefit of the procedure to the patient. Conversion to open surgery should not be stigmatized.

Role of BCG and Measles vaccination in protection against COVID-19 infection and severity of the disease: A pilot case-control study

Background: The role of BCG and MMR/Measles vaccination in reducing the burden of COVID-19 has been based on ecological data mostly. We planned this explorative pilot case-control study to understand the role of vaccination with Bacillus Calmette朑uerin (BCG) and measles administered as part of MMR vaccine on COVID 19. Methodology: A case-control study was conducted in AIIMS Patna during December 2020 and January 2021. A total of 100 COVID-19 patients confirmed by RT-PCR test were taken as cases, and for each case, age and gender-matched SARS-COV-2 negative individual was taken as control. A study tool containing a pre-tested semi-structured questionnaire was used. Results: The unadjusted odds of COVID-19 were found to be significantly higher among BCG vaccinated [1.88(1.03-4.4)] and MMR vaccinated individuals [5.06(2.34-10.90]. BCG vaccine was not found to have an independent effect on COVID-19 after adjusting for tobacco use, MMR vaccination status, unprotected contact with SARS-COV-2 positive patients, and co-morbidities. But Measles vaccine was found to independently increase the risk of COVID-19 [AOR: 4.505(1.8-11.3)]. Conclusion: BCG vaccination status was not found to be an independent predictor of COVID-19. Further studies with large sample size and better study design (cohort, randomized trials) need to be conducted.

A study on estimate of Iodine Deficiency Disorders and adequacy of Iodized Salt Consumption in Begusarai district of Bihar, India

Background: Iodine Deficiency Disorder is major public health problem causing increased perinatal mortality, mental retardation and goiter and all these morbidities are preventable. Most effective and inexpensive mode to prevent IDD is consumption of iodized salt. Objectives: To estimate the proportion of households using adequately iodized salt in Begusarai district, to assess the knowledge of households on consumption and storage of salt and to estimate Total Goitre Rate (TGR). Material and Methods: Community- based cross sectional study carried out on 412 household from 30 cluster in Begusarai district using cluster sampling technique. Children (6-12 years) were examined clinically for goitre status and sample of household salt was collected for testing iodine content. Iodine content estimation was done both quantitatively by titration and qualitatively by MBI kit. Statistical analysis was performed using SPSS version 22. Result: The respondents were mainly female (92.8%) of mean age 34 years. Three- fifth (61.6%) participants used packaged crushed salt for cooking purpose, followed by packaged crystal (30.5%). Only 12.1 % of the respondents gave affirmative answer for presence of label and logo. Storage of salt in container with lid was 78.5%. The proportion of household using adequately iodized salt was 78%. The sensitivity MBI kit was 61% and the Total goiter rate was 9.3%. Conclusion: The Begusarai district falls in mild public health problem for IDD as TGR is more than 5% and even after many decades of effort towards achieving an adequately salt iodization of more than 90%, it is 79% only.

Assessment of Cold Chain System for Routine Immunization of Primary Health centres of the Bhojpur district of Bihar

Background: Immunization is an important among activity in the Public Health Services. The vaccines are highly temperature sensitive and vaccine potency once lost cannot be restored. A well-managed cold chain will increase the efficiency of immunization and reduce vaccine wastage. An assessment of cold chain system for vaccine storage was done in the all PHCs of the study area. Aims & Objectives: To evaluate the cold chain practices, with particular reference to assessing the availability of cold chain equipment, vaccine storage practices, monitoring of cold chain in primary health centres (PHCs) of Bhojpur district. Material & Methods: A cross-sectional study was conducted at all the cold chain points of 14 PHCs of Bhojpur district during January to May 2015. A predesigned, pretested checklist was used by the trained investigators during their visits. The information was evaluated on the basis of important components related to the cold chain points. Results: All the PHCs had a dedicated cold chain room with sufficient number of cold chain equipment. Consolidated effective vaccine management score for cold chain points of 8 (57.1%) PHCs were average (60-79%). None of the PHCs have satisfactory score (≥ 80%). Vaccine storage practice and availability of complete RI micro-plan were found satisfactory at 12 (85.7%) PHCs. Maintenance of cold chain equipment were satisfactory at 10 (71%) PHCs. But, temperature monitoring. (5) (35.7%) and waste disposal related to routine immunization 3 (21.4%) PHCs were disappointing. Conclusion: The primary health centres had average performance related to the cold chain system, which is a matter of concern warranting for the cold chain monitoring. We recommend supportive supervision as the key measures in improvement of cold chain system.

Vector density and the control of kala-azar in Bihar, India

Bihar, India has been in the grip of kala-azar for many years. Its rampant and severe spread has made life miserable in most parts of the state. Such conditions require a comprehensive understanding of this affliction. The numbers coming out of the districts prone to the disease in the north and south Ganges have provided us with several startling revelations, as there are striking uniformities on both sides, including similar vegetation, water storage facilities, house construction and little change in risk factors. The northern areas have been regularly sprayed with DDT since 1977, but eradication of the disease appears to be a distant dream. In 2007 alone, there were as many as 37,738 cases in that region. In contrast, the southern districts of Patna and Nalanda have never had the disease in its epidemic form and endemic disease has been present in only some pockets of the two districts. In those cases, two rounds of spraying with DDT had very positive results, with successful control and no new established foci. In addition, an eleven-year longitudinal study of the man hour density and house index for the vector Phlebotomus argentipes demonstrated that they were quite high in Patna and Nalanda and quite low in north Bihar. Given these facts, an attempt has been made to unravel the role of P. argentipes saliva (salivary gland) in the epidemiology of kala-azar. It was determined that patchy DDT spraying should be avoided for effective control of kala-azar.

Aggressive angiomyxoma in men.

Aggressive angiomyxoma is an uncommon neoplasm that preferentially involves the pelvic and perianal regions of reproductive age females. These tumors are rare in men and merit a wider recognition in male urologic pathology. We report a case of a 65 year old male who presented with a swelling in the left perineal region since 2 years which gradually increased in size to 10 x 10 x 8 cms. CT scan revealed a well defined lobulated heterogenous minimally enhancing mass in the left ischiorectal fossa extending upto the subcutaneous plane. Microscopically stellate to spindle shaped cells arranged in a loose myxoid stroma with numerous thin to thick walled vessels were seen. There was no evidence of pleomorphism, hyperchromatism or mitotic activity. This case is reported because of its rarity in males. It is a benign tumor and requires a wide excisional surgery.

Magnitude of unresponsiveness to sodium stibogluconate in the treatment of visceral leishmaniasis in Bihar.

BACKGROUND: The Indian government proposes to eliminate kala-azar, which has been a serious public health problem in Bihar. This study aimed to assess the magnitude of unresponsiveness to sodium stibogluconate in the treatment of new cases of visceral leishmaniasis and to identify the associated factors. METHODS: Patients with clinically and parasitologically confirmed visceral leishmaniasis (n = 182) who had received no prior treatment, were enrolled for the study. The patients were treated with sodium stibogluconate (20 mg/kg body weight; upper limit 850 mg), intramuscularly for 30 days. The vital parameters and side-effects, if any, were monitored. Patients who developed toxicity during treatment were excluded from the study but were given rescue treatment with liposomal amphotericin B. All patients who completed the treatment were followed up for 6 months. RESULTS: Unresponsiveness to sodium stibogluconate at the end of treatment was 43%. It was higher in women (48%) compared to men (40%). A significant association was observed between unresponsiveness and level of endemicity (p = 0.0002), large spleen size (p = 0.04) and immune response (migration inhibition factor) (p = 0.00002). At the end of 6 months' follow up, 27% of patients relapsed, giving a total unresponsiveness rate of 58%. CONCLUSION: Unresponsiveness to sodium stibogluconate is a serious problem in the management of patients with visceral leishmaniasis. In patients with factors associated with nonresponse to sodium stibogluconate, alternative drugs such as miltefosine or amphotericin B should be considered as first-line drugs.

Epidemiological, clinical & pharmacological study of antimony-resistant visceral leishmaniasis in Bihar, India.

BACKGROUND & OBJECTIVES: Sodium antimony gluconate (SAG) is reported to be losing its efficacy in Bihar as a first line drug for treatment of visceral leishmaniasis (VL). Concerned with the increasing incidence of antimony-resistant VL patients in Bihar, we undertook an epidemiological, clinical and pharmacological study to formulate a scientific basis for choosing a suitable first line drug for VL. METHODS: Consecutive, fresh and parasitologically confirmed patients of VL from different geographical areas of Bihar were considered for inclusion in the study. Parasites isolated from patients were tested in vitro to assess their response to sodium antimony gluconate (SAG) to 20 microg/ml, response to 20 mg/kg of SAG for 5 days in experimentally induced VL in BALB/c mice from those isolates, and response to SAG in patients treated with SAG for 28 days. Similarly response in culture (1 microg/ml) to amphotericin B (AMB) of all 282 isolates, (1 mg/kg body wt for 20 days) in patients and infected BALB/c mice (1 mg/kg body wt for 5 days) was determined. Antimony levels of plasma were determined at 2, 8 and 24 h after intramuscular injection of SAG. Patients unwilling for SAG treatment or relapsed after SAG treatment and withdrawn from SAG group because of toxicity were treated with AMB. Plasma antimony levels were estimated by atomic absorption spectrometer. RESULTS: Though antimony sensitive and resistant patient were distributed in all 14 districts of Bihar studied, there was a significant variation from district to district. Of the 123 patients included in the SAG treatment group, 19 were withdrawn due to development of toxicity and 2 died; 178 patients were treated with AMB. No patient in AMB group developed any toxicity or died. Only 47 (46%) of 102 patients, 106 (37.6%) of 282 infected macrophages, 90 (52.9%) of 170 experimental infections were cured with SAG. Mc Nemar's test on paired comparisons showed statistical significance difference (P<0.01) between infected macrophage and experimental infection. AMB cured all patients, infected mice and cleared parasites from all isolates. INTERPRETATION & CONCLUSION: Antimony resistant strains of L. donovani were wide spread over different geographical areas in Bihar. SAG cured lesser percentage of VL cases clinically compared to AMB and should be replaced by AMB as a first line drug.

Evaluation of cholinesterase level in an endemic population exposed to malathion suspension formulation as a vector control measure

The manuscript describes a study on the blood cholinesterase (ChE) level in an exposed population at different interval of time after spraying with malathion suspension (SRES) use for kala-azar vector control in an endemic area of Bihar, India. The toxicity of a 5 percent malathion formulation in the form of a slow release emulsified suspension (SRES) was assessed by measuring serum ChE levels in spraymen and in the exposed population.The study showed a significant decrease in ChE levels in the spraymen (p < 0.01) after one week of spraying and in exposed population one week and one month after of spraying (p < 0.01), but was still within the normal range of ChE concentration, one year after spraying, the ChE concentration in the exposed population was the same as prior to spraying (p > 0.01). On no occasion was the decrease in ChE level alarming. A parallel examination of the clinical status also showed the absence of any over toxicity or any behavioural changes in the exposed population. Hence, it may be concluded that 5 percent malathion slow release formulation, SRES, is a safe insecticide for use as a vector control measure in endemic areas of kala-azar in Bihar, India so long as good personal protection for spraymen is provided to minimize absorption and it can substitute the presently used traditional DDT spray.