Comparative study of short term results in two multidrug regimens in multibacillary leprosy.

Thirty lepromatous and Borderline lepromatous leprosy patients were treated with multidrug therapy in an open trial. Fifteen of them received the standard WHO multidrug regimen ie., rifampicin 600 mg and clofazimine 300 mg monthly, supervised, and dapsone 100 mg daily and clofazimine 100 mg on alternate days as self administered; the other 15 received a modified multidrug therapy regimen comprising of rifampicin 600 mg, clofazimine 100 mg and dapsone 100 mg daily for 21 days as suggested by the Indian Association of Leprologists, followed by the standard WHO regimen. The observation period was six months. Clinical, bacteriological, histological and immunological parameters were studied. The fall in morphological index was much faster in patients receiving modified multidrug therapy regimen compared to those receiving the standard WHO regimen. Otherwise, there was no difference between the two groups of patients. Five patients developed type I (upgrading) reaction with one developing ulnar nerve paralysis. No untoward effects of drugs were noted in the study subjects except for darkening of skin colour of all the patients.

Drug eruptions (a series of 148 cases).

A total number of 148 patients, comprising of 101 males and 47 females diagnosed as drug eruptions were reviewed. The youngest patient was eight and the oldest 73 years. The mean age was 34 years. 75(50.7%) patients were in the age group of 20 to 40 years. In 88(59.5%) pruritus was the chief associated symptom. 116(78.4%) developed eruptions within 2 weeks. 29(19.6%) had single site involvement, 92(62.2%) had lesions at more than one site and 25(16.9%) patients had generalised skin and mucous membrane involvement. The commonest skin reactions were fixed drug eruptions in 39(26.4%) cases. Almost all types of drug eruptions were observed. The eruptions were caused by 37 different drugs, the commonest being sulphonamides in 28(18.9%) cases. Systemic side effects were recorded in 13(8.8%) patients. 76(51.4%) were treated with topical medicaments. Out of the remaining, 33(22.3%) were managed by antihistamines and 26(17.6%) by steroids in addition to topical therapy. No treatment was required in 13(8.8%). 117(79.1%) were treated as out patients and 31(20.9%) were hospitalised. One (0.7%) patient died of toxic epidermal necrolysis due to penicillamine.

Scrofuloderma with inguinal and genital syndrome--a case report.

A case of scrofuloderma presented as lymphogranuloma venereum closely mimicking its inguinal and genital syndrome. A lymph node biopsy confirmed the diagnosis.

Evaluation of two multidrug regimen in hospitalised multibacillary cases.

Fifty three multibacillary leprosy cases were treated with two regimens of MDT L1 consisting of Rifampicin, Dapsone and Ethionamide and L2 consisting of Rifampicin, Dapsone and clofazimine. The results were compared at regular intervals and at the end of the study (24 months). Clinical inactivity, bacteriological negativity, ENL reactions, upgrading reactions were seen in L1 group in 65%, 4.54%, 50% and 41% of cases respectively while 65%, 25.8%, 30% and 45% respectively in L2 regimen group. Zero percent morphological Index was achieved in all cases in L1 regimen 90% in L2 regimen cases. No viability was found on mouse foot pad inoculation after 6 months in L1 while after 18 months in L2 cases.

Multiple synovial swellings in BT leprosy. A case report.

A case of Leprosy with multiple synovial swellings has been reported. Rarely these swellings may be an initial presentation and at sites other than dorsum of hand or ankle as was in this case. The literature on the subject is briefly reviewed.

Bilateral involvement of sole and palm in leprosy. A case report.

A case of BT leprosy in reaction with lesions over uncommon (immune) sites like palm and sole has been reported.

Dyskeratosis Congenita with Adenocarcinoma of Stomach.

A 32 years old male had dyskeratosis congenita with adenocarcinoma of stomach along with occurrence of carcinoma of stomch in four affected family members. The patient presented with progressive reticulate hyperigmentation of the face, neck, upper trunk and arms, hypopigmented macules, lacrimation and epigastric pain.

Primary hyperpigmented cutaneous lesions in tuberculoid leprosy.

Two cases of tuberculoid leprosy with primary hyperpigmented anaesthetic lesions are reported and subject is reviewed.

Unilateral Psoriasis.

Unilateral distribution of psoriasis lesions was observed in a boy aged 15 years involving the right half of body.

Minutes Therapy in Psoriasis.

Thirty one cases of widespread psoriasis were treated with daily short-term.

Multidrug Therapy in Pemphigus Vulgaris.

Twenty four patients having pemphigus vulgaris were treated with combined drug therapy consisting of oral prednisolone 1 mg per Kg body weight, cyclophosphamide 2.5 mg per Kg body weight and methotrexate 2.5 mg biweekly. The drugs were gradually tapered off to achieve a minimum maintainence dose of 10-15 mg prednisolone on alternate days at the end of 2 years of observation. The age groups of patients varied from 15 to 78 years. Maximum cases were between 31 to 50 years. There were 15 males and 9 females. T he duration of disease varied from 4 months to over 36 months at the time of reporting. Number of episodes recorded at the time of first presentation were one episodes in 6( 25%) and mutiple episodes in 18 (75%). The period of observation varied from 6 months to 27 months. Two patients relapsed at the time of observation. There has been remarkable response to treatment in the form of quick recovery from lesions without any significant side effects.

Clinico-histopathological evaluation of modified pilocarpine test in early diagnosis of leprosy.

Modified pilocarpine test was done in 112 patients of which 89 cases were under investigation (Group I) and 23 cases were confirmed tuberculoid leprosy cases (Group II). In group I, 70 cases (78.6%) showed deficient sweating of varying degree and 36 cases (40.4%) showed definite histopathological changes of paucibacillary leprosy in skin. 22 cases (95.6%) in Group II showed deficient sweating. 24 cases under investigation who had deficient sweating but did not show definite histopathological changes of leprosy initially were followed up for one year and at the end of one year 10 cases (41.6%) showed confirmatory changes of leprosy on histopathological examination. The modified pilocarpine test has been found to be a simple and very useful test in early diagnosis of leprosy.

Immunotherapy in leprosy: a new approach.

An immunotherapeutic agent prepared from patient's own affected skin was tried in 30 leprosy cases. 53.6% cases of lepromatous and borderline lepromatous group showed lepromin conversion from lepromin negativity to positivity after 12 weeks of immunotherapy. The clinical and bacteriological improvement was also good. 88.1% cases of borderline tuberculoid also showed fair to good clinical recovery following 12 weeks of immunotherapy.

Experience with multidrug therapy in paucibacillary leprosy.

Eighty paucibacillary leprosy cases were randomly put on two different multidrug regimens for 6 months followed by dapsone monotherapy. Regimen I was according to WHO (1982) recommendations consisting of Dapsone and six once a month rifampicin. In regimen II in addition to above two constituents, clofazimine was added 100 mg on alternate days. Dapsone thereafter was continued in both the regimens upto one year. The efficacy, acceptability and side effects of multidrug regimens were observed for a period of one year. Histopathological assessment was done on completion of multidrug therapy in all cases. A comparative evaluation of effect of two multidrug regimens in paucibacillary leprosy patients is reported. Addition of clofazimine over WHO (1982) recommended regimen appears to have no added benefit. The duration of WHO (1982) recommended regimens was found to be inadequate in many cases.

[Comparative cytologic studies on the effect of cetyltrimethylammonium bromide on bacterial cells]. / Vergleichende cytologische Untersuchungen zur Wirkung von Cetyl-trimethyl-ammoniumbromid auf Bakterienzellen.

Growing cultures of Pseudomonas aeruginosa and Bacillus megaterium show after treatment with cetyltrimethylammonium bromide (CTAB) typical concentration-dependent alterations of envelope. In Ps. aeruginosa low doses of the detergent cause perforations and lesions of the cytoplasmic membrane, by 0.016% CTAB the formation of extracellular vesicles of the outer membrane ("blebs") and the intracellular assembly of lamellar structures can be detected. These intracellular lamellar structures are artifacts of the cytoplasmic membrane after detergent application. In this case the conglomeration of bacterial cells can be demonstrated with the scanning electron microscope. The results are discussed in connection with the use of CTAB in inactivation and permeabilization of bacteria.

Value of pilocarpine test in early diagnosis of leprosy.

Modified Pilocarpine Test was carried out in 48 patients under investigation for Leprosy. 37 cases showed deficient sweating of varying degree. Many of these patients did not reveal confirmatory histopathological changes and were bacteriologically negative. In the absence of other causes of neuropathy this finding of deficient sweating by modified pilocarpine test, was significant. Same test was carried out in 8 confirmed cases of Tuberculoid leprosy. All cases showed positive results.