Adverse reactions to cosmetics and methods of testing.

Untoward reactions to cosmetics, toiletries, and topical applications are the commonest single reason for hospital referrals with allergic contact dermatitis. In most cases, these are only mild or transient and most reactions being irritant rather than allergic in nature. Various adverse effects may occur in the form of acute toxicity, percutaneous absorption, skin irritation, eye irritation, skin sensitization and photosensitization, subchronic toxicity, mutagenicity/genotoxicity, and phototoxicity/photoirritation. The safety assessment of a cosmetic product clearly depends upon how it is used, since it determines the amount of substance which may be ingested, inhaled, or absorbed through the skin or mucous membranes. Concentration of ingredients used in the different products is also important. Various test procedures include in vivo animal models and in vitro models, such as open or closed patch test, in vivo skin irritation test, skin corrosivity potential tests (rat skin transcutaneous electrical resistance test, Episkin test), eye irritation tests (in vivo eye irritancy test and Draize eye irritancy test), mutagenicity/genotoxicity tests (in vitro bacterial reverse mutation test and in vitro mammalian cell chromosome aberration test), and phototoxicity/photoirritation test (3T3 neutral red uptake phototoxicity test). Finished cosmetic products are usually tested in small populations to confirm the skin and mucous membrane compatibility, and to assess their cosmetic acceptability.

A simple, cost-effective quality assurance model for measurement of lipids in a large epidemiological study.

Background. Laboratory measurements are an integral part of epidemiological studies in cardiovascular disease. Standardization and quality assurance is of utmost importance in the context of multicentre studies. Methods. We evaluated a simple and cost-effective method of quality assurance for measurement of total cholesterol, high density lipoprotein (HDL) cholesterol and triglycerides in a study involving 10 centres. Three methods for quality assessment were used for the study that involved measurement of cholesterol, triglycerides and HDL cholesterol and included internal quality control, external quality control and 10% repeat analysis in addition to a uniform standardized protocol developed for the 10 centres. External quality control material was prepared and circulated by the coordinating laboratory. Results. External quality control material was distributed 20 times during the study. The mean variance index suggested a substantial improvement in the performance of participating laboratories over a period of time for cholesterol and triglycerides. This was also evident in the improvement in per cent technical error as a measure of bias and a higher correlation between replicates of samples analysed in the coordinating laboratory and the participating centres for cholesterol, triglycerides and HDL cholesterol. Conclusion. A cost-effective quality assurance model for laboratory measurement using local capacities was developed and implemented in a multicentre epidemiology study. Such a programme would be useful for developing countries where cost-cutting is important.

Fine needle aspiration cytology in reactional and non-reactional leprosy.

BACKGROUND: Histopathological evaluation of skin lesions is not feasible in many leprosy endemic areas. Fine needle aspiration cytology (FNAC) is a simpler tool compared to histopathology for the evaluation of the cytomorphology of skin lesions. AIMS: To study the cytomorphology of leprosy lesions in fine needle aspirates and correlate it with the histopathology. METHODS: Seventy leprosy patients diagnosed and classified according to Ridley Jopling scale were included. Fine needle aspirates were taken from the lesion followed by a skin biopsy from the same site for histopathological examination after H/E staining. RESULTS: Borderline leprosy patients with Type I reaction showed significantly large numbers of giant cells, collagen and elastin in their smears as compared to those without reaction. The smears were more heavily cellular with fragmented collagen and elastin along with significant increase in neutrophils in patients with Type II reaction while foamy macrophages with fatty background were common in non-reactional lepromatous leprosy patients. A complete correlation between histopathological and cytomorphological findings was observed in 77.3% of cases. CONCLUSION: FNAC may be used as an alternative tool to assess leprosy lesions in areas where histopathological services are not readily available.

AIDS vaccine: present status and future challenges.

Development of a preventive vaccine for HIV is the best hope of controlling the AIDS pandemic. HIV has, however, proved a difficult pathogen to vaccinate against because of its very high mutation rate and capability to escape immune responses. Neutralizing antibodies that can neutralize diverse field strains have so far proved difficult to induce. Adjuvanting these vaccines with cytokine plasmids and a "prime-boost," approach is being evaluated in an effort to induce both CTL and antibody responses and thereby have immune responses active against both infected cells and free viral particles, thereby necessitating fewer doses of recombinant protein to reach maximum antibodies titers. Although obstacles exist in evaluation of candidate HIV vaccines, evidence from natural history studies, new molecular tools in virology and immunology, new adjuvants, new gene expression systems, new antigen delivery systems, recent discoveries in HIV entry and pathogenesis, and promising studies of candidate vaccines in animal models have provided reasons to hope that developing a safe and effective AIDS vaccine is possible and within reach.

Serum adenosine deaminase levels in reactional and non-reactional leprosy.

BACKGROUND AND AIMS: Altered serum adenosine deaminase (ADA) levels have been recorded in various diseases involving lymphocytes and/or lymphoreticular system including leprosy. The study was planned to evaluate alterations in serum ADA levels, if any, in reactional and non-reactional leprosy. METHODS: Eighty patients of leprosy, comprising 60 patients of non-reactional leprosy and 20 patients of reactional leprosy were studied along with 20 normal healthy controls. Five milliliters of venous blood was collected and ADA levels were estimated by the method of Giusti (1974). RESULTS: There were 54 males and 26 females. The age of the patients ranged from 5 years to 62 years. The duration of leprosy ranged from 15 days to 3 years. The mean serum ADA level in normal controls was 10.31 +/- 0.58 u/L. The serum ADA levels were raised in leprosy patients, significantly so in multibacillary patients. The serum ADA levels were higher in patients of leprosy with reaction. CONCLUSIONS: The study showed significantly high serum ADA levels in multibacillary leprosy and this was further increased in patients of leprosy with reaction. This may be because of increased lymphoreticular activity during the reactional phases.

Pattern of dermatoses in diabetics.

Two hundred diabetics comprising of 125 males and 75 females were studied for the presence of cutaneous lesions and type of infective organism, if any, in them. 70.2% of patients with uncontrolled diabetes mellitus showed some form of cutaneous involvement while only 51% of the patients with controlled diabetes had it. Infections with bacterial (16%) and fungal (10.5%) agents were the most common manifestation. Among bacterial infections, Staph. aureus was the most frequent causative agent in 65.6% cases. Pruritus was present in 4.5% of cases only.

Hepatic involvement and hepatitis B surface antigen (Hbs Ag) in leprosy.

Hepatic involvement and hepatitis B surface antigenemia was studied in 80 leprosy patients and results were compared with 50 normal healthy controls. HbsAg was detected in 7.54% of lepromatous leprosy patients as compared to 2% of the normal healthy controls. There was a decrease in albumin and increase in globulin levels with significant decrease in A: G ratio. SGPT levels were significantly raised in lepromatous leprosy patients. Histopathological changes were present in 57.1% of lepromatous leprosy and 23.8% of tuberculoid leprosy patients.

Leprosy in low endemic areas of India: an appraisal and suggested measures for control.

Prevalence of leprosy in the low endemic areas of India is described based on the observations of patients attending an Urban Leprosy Centre in the Union Territory of Delhi from the neighbouring states. The rising incidence in these so-called low to moderate endemic places is closely linked to factors related to urbanisation, movement of people in search of employment, etc., which necessitate fresh surveys in these areas. A significant number of leprosy patients attending the Centre were irregular (37.7%) in therapy and many absconded after the initial visit (35.3%), the reasons for which are discussed. These figures are compared to that from similar low endemic areas and known high endemic parts of the country. Suitable modifications to the control programme in these areas are suggested under the purview of the National Leprosy Eradication Programme.

Rifampicin induced uterine bleeding.

A case of uterine bleeding after intake of rifampicin is reported in a 35-year-old female. Provocation test was also positive. The underlying mechanism whether it was a hypersensitivity phenomenon like fixed drug eruption or due to induction of uterine acyl-hydrolase enzyme, is not clear. Uterine bleeding has not been observed as a side-effect of rifampicin in the past.

Terry's nails in a case of leprosy.

First case of Terry's nails following onset of Borderline Tuberculoid leprosy without any other involvement in a 40 year male is reported. This condition is, however, well known in cirrhosis of liver.