Blood pressure measurement: One arm or both arm.

Guidelines for measuring blood pressure includes measurement of blood pressure on both arms but it is often ignored. Our case report aims at highlighting the need follow the guidelines. A 60 year old 59 kg weighing male asymptomatic patient without any comobidities was posted for bilateral inguinal hernia repair. The interarm blood pressure difference was discovered incidentally during his preanaesthetic evalution. On further evaluation patient was found to be having subclavian stenosis on left side which was asymptomatic. Intraoperative and post operative period was uneventful. Blood pressure measurement should be done in accordance with the stipulated guidelines. Inter arm blood pressure difference should be noted in all patients as not only for diagnosis and treatment of hypertension but also as a tool to diagnose asymptomatic peripheral vascular disesase.

Risk factors of herpes simplex virus type 2 among STD clinic attenders in Delhi, India.

The present study was conducted to determine the seroprevalence and risk factors associated with HSV-2 infection among sexually transmitted diseases (STD) clinic attenders of Delhi in India. Out of 128 patients included, 76 were males and 52 were females. Antibodies to HSV 1 and 2 and HIV infection were determined by ELISA. Syphilis seropositivity was determined by VDRL test and confirm by TPHA test. Ulcer scrapping were stained by Giemsa for Herpes progenitalis and Donovan bodies and Grams for Haemophilus decreyi infection. The HSV-2 and HSV-I seroprevalence was found to be 85.2% and 77.3% respectively. 87.3% of HSV-2 seropositive patients were asymptomic. 10.7% of patients had coinfection of HSV-2 and HIV. STDs like syphilis, chancroid, gonococcal and non-gonococcal urethritis were significantly associated in HSV-2 infection. Thus the study demonstrates high prevalence of HSV-2 infection in Delhi city. Significant association of HSV-2 infection with previous history of STD (p < 0.02) and multiple sexual partners in males was found (p < 0.002).

Can general practitioners carry out drug delivery and periodic examination of leprosy patients in Raipur city?

An intervention study to improve the MDT coverage of leprosy patients by involving general practitioners (GPs) was carried out in Raipur city. Most of the GPs (84%) were willing to undertake drug delivery and periodic examination of the leprosy patients. After involving GPs, the proportion of the patients registered for treatment increased from 33% to 89.2%. The cohort regularity was 57% only which was lower than that found in the Upgraded Urban Leprosy Centre. Drug compliance as found out by the pill count was 91%. Most of the patients (87%) were happy with the services provided by the GPs.

Cellularity of macrophage granuloma and morphological index.

In the present study, morphological index (MI) and average macrophage count per microscopic field in skin sections of 94 lepromatous (LL) patients is correlated. The subjects included 14 cases with some histoid features. The MI in the lepromatous cases varied from less than one to 40 and the corresponding macrophage counts ranged from 40 to 156. In cases with histoid changes the MI varied from 30 to 60 and the cell count ranged from 215 to 360. The histoid cases showed a higher MI and cell count compared to the other lepromatous cases. There was a positive correlation between MI and macrophage count and the hypercellular state appears to depend on living and multiplying bacteria.

Non acid-fast fluorescent M. leprae (?) in skin smears from leprosy patients.

Smears from 74 known smear negative cases of leprosy were examined after staining with Auramine 'O'. 40.54% cases were positive for fluorescent bacilli. 60.52% of cases on treatment and 19.44% cases after RFT had fluorescent bacilli in the skin smears. Results suggest the possibility of a non acid-fast fluorescent positive variant of M. leprae.

Time lag between case registration and commencement of treatment in a leprosy control unit.

Analysis of client-based data as a part of computerised management information system in a Government leprosy control unit in Tamil Nadu reveals that there was delay in initiating treatment of leprosy patients. The mean and standard deviation of the period of delay for cases registered before, within 6 months and after 6 months of start of MDT in the Unit were 6.80 +/- 6.40, 1.97 +/- 3.60 and 0.90 +/- 2.21 months respectively. Further, the delay was longer in PB, female and child cases. Giving priority to therapy for backlog cases and an effective monitoring system with specific indicator for time lag in starting treatment is indicated.

Effect of dimethoate and fenvalerate on conditioned avoidance and passive avoidance responses.

Dimethoate at 24.75 and 49.5 mg/kg (i.e., 1/10 and 1/5th LD50 respectively) impaired the learning process and retrieval of memory in rats while it did not affect permanent memory. Fenvalerate / 10.12 and 20 mg/kg (i.e., 1/20 and 1/10th LD50 respectively) had no effect on learning process, retrieval of memory and permanent memory traces.

A computerized information system for evaluation of NLEP through monthly progress reports.

A computerized system for monitoring district-wise operational performance and epidemiological progress using existing regular and special monthly reports of the National Leprosy Eradication Programme (NLEP) is presented. The same system, with some minor modifications could be used for programme assessment at the Leprosy Control Unit level also. The advantage of the system is the speed with which it can generate output in the form of comparative tables and graphs for different regions for use by programme managers for making overall assessments in time and for sending feedback reports to workers at various levels, for self-assessment and for taking timely corrective action. The system presented provides immediate and easy access to the stored and/or processed information (indicators etc.,) at any time. The system has been pilot-tested using monthly reports from eighteen districts of Tamil Nadu.

Role of Dapsone in chemotherapy of leprosy--a comparison of responses to therapy in two cohorts in 1960s and 1970s.

Two cohorts of bacterio-positive cases registered and started on treatment during 1960-62 and 1968-70 were studied for differences in their response to DDS monotherapy. Proportion of male and female cases, mean Bacteriological Index (B.I.) and the distribution of cases according to the initial BI did not differ between the two cohorts. 49.7% of the patients in the II cohort were taking regular treatment against 27.4% in the I cohort. At the end of 7 years of treatment, proportion of the cases that were bacteriologically negative were 68.6% and 83.0% in I and II cohorts respectively. Relapse rates in I and II cohorts were 14.3% and 7.9% respectively, over a period of 7 years. The findings showed that Dapsone continued to be an effective antileprosy drug and must be included in all multidrug regimens in the therapy of leprosy.

An epidemiological study of leprosy disability in a leprosy endemic rural population of Pondicherry (south India).

The disability rate in this study was 16.23%. The highest disability rate of 30.76% was found in those aged 45 years and above. Disabilities were found to be more common among male leprosy patients with a disability rate of 21.05% compared to that of 11.45% found among female leprosy patients. None of the indeterminate leprosy patients showed any disabilities, whereas all the neuritic and lepromatous leprosy cases showed disabilities. The disability rate among tuberculoid leprosy patients and borderline leprosy patients were found to be 3.25% and 35% respectively. Persons whose monthly per capita income was less than Rs. 200/- constituted 93.50% of the cases with disabilities. Anaesthesia of the hand was seen in 67.4% of the cases. The mean disability index (DI-2 type) was 0.927.

An epidemiological study of leprosy in a rural community of Pondicherry.

In a rural area, endemic for Leprosy a total population survey had been undertaken in 6 villages covering a population of 5667. Out of the 5281 persons examined, 191 were found to be suffering from leprosy giving a prevalence rate of 36.16/1000. The prevalence was highest in children aged between 5 and 14 years., i.e., 41.61/1000. Among adults the highest prevalence was seen among those aged above 45 years, i.e., 45.66/1000. Both the sexes were found to be equally affected in this area. Tuberculoid leprosy was the most common type found with a prevalence rate of 23.29/1000, followed by Indeterminate type with a prevalence rate of 5.3/1000. Lepromatous rate was 3.69%. The disability rate was found to be 16.23%, with a mean disability index of 0.927.