An epidemiological study of road traffic accident victims in medicolegal autopsies.

Unnatural deaths of any kind i.e. suicidal, homicidal, accidental can cause severe emotional reactions to the near relative of the victim immediately after the event and later. Of all types of unnatural deaths road-traffic accidental death probably has the highest incidence worldwide.

Common variable immunodeficiency (CVID) in northern India.

Fourteen patients with common variable immunodeficiency (CVID) were studied. The common clinical manifestations were recurrent sore throat, sinusitis, respiratory infections, diarrhea, and malnutrition. All had low IgG, with normal cell-mediated immunity. Treatment with immunoglobulin and/or plasma was effective in most of them. There were no severe adverse events with the therapy.

Methotrexate in psoriatic arthritis.

Thirty three patients with psoriatic arthritis were treated with starting dose of 7.5 mg of methotrexate orally, every week for a period of 6 months to 7 years (mean 2.2 years) along with non-steroidal anti-inflammatory agents. The dose of methotrexate during the course of therapy ranged 5 to 15 mg/week (mean 7.8 mg). There was complete to partial remission in arthritis and psoriatic skin lesions in 94% (31) patients. No response was noticed in 2 patients. Regular monitoring of haematological, renal and liver function tests was done. No significant side effects of the drug, requiring discontinuation of the therapy, were seen during the treatment. Methotrexate can be used early in the course of psoriatic arthritis with good results.

Pneumocystis carinii infection in patients of AIDS in India.

This is the first report of Pneumocystis carinii infection seen in patients with AIDS in India. Two of the three patients were of Indian origin while the third was an American tourist. This report indicates that the technical problem of demonstrating P carinii may be an important factor underlying the diagnosis of PCP.

Dapsone in cutaneous lesions of SLE: an open study.

This short report describes a possible beneficial effect of dapsone in the treatment of chronic unresponsive muco-cutaneous lesions of systemic lupus erythematosus (SLE) without any serious side effects.

Wegener's granulomatosis in northern India.

Till recently, Wegener's granulomatosis (WG) was considered a rare disease in India. Over the last 5 years we studied 13 proven cases of WG. This paper describes the details of the disease as seen in these patients, and response to corticosteroid and cyclophosphamide therapy, and compares these observations with a Western and an Indian study.

HBV--status in professional blood donors in north India.

Present study demonstrates the efficacy and significance of routine screening assays used for HBsAg testing in donor blood in different blood banks of Delhi city. Blood from professional donors already screened in blood banks were cross checked using micro-ELISA technique developed at All India Institute of Medical Sciences and the results were compared. HBsAg carrier rate in these professional donors was found to be 11.7% by micro ELISA as against only 6% reported in blood banks using RPHA and latex agglutination assays. Thus, assays used in blood banks were found to be missing nearly 50% HBsAg positive cases as compared to micro-ELISA. A small group of professional donors was also screened for anti-HBs and results explained in comparison of normal values.

Intermittent intravenous pulse cyclophosphamide treatment in systemic lupus erythematosus.

To determine the efficacy and safety of intermittent intravenous pulse cyclophosphamide in patients of severe systemic lupus erythematosus (SLE), 50 patients having severe/refractory lupus nephritis, vasculitis or neuropsychiatric manifestations were treated with 3 weekly pulses of cyclophosphamide for 6 such pulses. This treatment was found to be associated with significant and sustained improvement during a 2 yr follow up with respect to the mean renal activity score, individual renal parameters (proteinuria, erythrocyturia, and serum creatinine levels), focal neurological manifestations, vasculitic lesions, antinuclear antibody titers, complement component C3, anti-dsDNA antibodies levels and ESR. There was a sustained decrease in the overall mean disease activity score, and the mean daily dose of prednisolone (pretreatment 32.62 mg daily to 3.75 mg daily after 24 months). There was a significant decline in the percentage and absolute B cell count after 7, 14 and 21 days of this treatment. Effect on other lymphocyte subsets (CD3+, CD4+ and CD8+) was not marked. Pulse cyclophosphamide could therefore be an effective and less toxic form of treatment in patients with SLE having severe lupus nephritis, focal neurological lesions or vasculitis.

Hereditary angioedema in a family.

Hereditary angioedema is an uncommon clinical condition. Life-long episodic brawny and non-itchy swelling of the extremities, face and trunk, with episodic abdominal pain and familial occurrence are the typical features. Oedema causing obstruction of airways may lead to suffocation and even death. The diagnosis can be confirmed by finding low levels of C1 esterase inhibitor, C4 and C2. Therapy with synthetic androgenic agents can ameliorate the condition to a large extent.

HIV infection in Asian Indian patients with haemophilia & those who had multiple transfusions.

A total of 124 Indian patients with haemophilia and 185 multiple transfused patients with thalassaemia, haemoglobinopathies, patients on chronic haemodialysis and others were screened for HIV-1 infection by a commercially available competitive ELISA test and supplementary Western Blot (WB) test. The results showed that HIV-1 infection was mostly confined to the haemophiliacs where 15 (12.1%) were confirmed to be positive for HIV infection. All except one had received both foreign and Indian cryoprecipitate. However, one haemophilic seroconverted within 4 months of receiving a cryoprecipitate manufactured in India.

HIV antibody screening of commercially available blood products in India.

In a screening of 182 vials of various commercially available blood products in the Indian market, 32 (17%) were found to contain HIV-1 antibodies. The contamination with HIV-1 antibodies was detected in all types of blood products including immunoglobulin preparations, cryoprecipitates as well as albumin. Interestingly, the contamination was seen almost exclusively in the products manufactured in the Bombay-Pune area (32 of 92, 34%). It was very low in products manufactured near Delhi (1 of 90). A single vial of imported Factor VIII concentrate tested negative.

Clinical profile, therapeutic approach and outcome of gouty arthritis in northern India.

Thirty patients with gouty arthritis were studied over 3 years. The diagnosis was established with the help of polarised light microscopy. All the patients were males, with a median age of 45 years. They belonged to the middle or upper socio-economic class and were obese (mean body mass index 29.7). Chronic alcoholism, diabetes mellitus and hypertension were present in one patient each. No patient had symptomatic coronary artery disease. Although 6 patients had a history of renal colic, only one had gouty nephropathy with chronic renal failure. Six patients had a positive family history of gout. The disease involved mostly the joints of the lower extremity and podagra was observed in 70% of patients. Eight patients had tophi at various sites. There were 17 'over producers' and 13 'under excretors' of uric acid. The treatment consisted of patient education, symptomatic control with non steroidal anti-inflammatory drugs and/or colchicine and antihyperuricaemic therapy. The overproducers were treated with allopurinol while the under excretors were treated with [corrected] sulfinpyrazone. In general, there was a good response to therapy as indicated by lowering of serum uric acid and the number of painful episodes per year. The overall profile of the disease appears similar to that seen in the West.