Immunosuppressive Therapy for Aplastic Anaemia.

Immunosuppressive therapy is the standard of care in aplastic anaemia in younger patients who do not have a matched sibling donor, and also in adults and older patients. Hence, a large population of patients with aplastic anaemia undergo this treatment. In patients who have responded to the first course of ATG, and have had a relapse, a second course of ATG can be administered with reasonable response rates. Response rates to first course of ATG vary from 50-85% in both children and adult. Indian data also suggests similar response rates.

Emerging clinico-epidemiological trends in melioidosis: analysis of 95 cases from western coastal India.

OBJECTIVES: To study the clinico-epidemiological trends in melioidosis, an emerging disease in the western coastal region of India. METHODS: Data of 95 patients with melioidosis in the western coastal region of India were retrospectively analyzed with respect to monthly rainfall, risk factors, clinical presentations, and outcome. RESULTS: A strong linear correlation was seen between average monthly rainfall and the occurrence of cases (p=0.002). Mortality was seen only in patients with bacteremia (p<0.001). Nine (40.9%) patients with septic shock died (p<0.001). Age ≥ 40 years and diabetes mellitus were seen in 75.8% of cases, each. Pneumonia was the most common clinical presentation (32.6%), followed by musculoskeletal disease (20%), melioidotic lymphadenopathy (7.4%), and dental abscess (6.3%). Only 36.8% of patients had exposure to wet soil/surface water. CONCLUSIONS: Melioidosis is quite prevalent in the western coastal region of India, and is strongly associated with rainfall, age, and diabetes mellitus. Higher proportions of musculoskeletal, dental, and lymph node melioidosis were seen in this region as compared to endemic areas. Bacteremic melioidosis has a poorer prognosis than non-bacteremic melioidosis. The presence of septic shock is a strong predictor of mortality. Percutaneous inoculation may not be the main portal of entry for Burkholderia pseudomallei in this region.

Tuberculosis mimicked by melioidosis.

BACKGROUND: In regions endemic for tuberculosis (TB) such as India, presumptive anti-tuberculosis treatment is often prescribed. Melioidosis, caused by Burkholderia pseudomallei, is underdiagnosed in India, due to lack of awareness and a low index of suspicion. SETTING: A tertiary care hospital in south India. OBJECTIVE: To present our analysis of a series of 22 cases of suspected TB that was later confirmed as melioidosis. DESIGN: Twenty-two patients with culture-proven melioidosis, who were initially given empirical anti-tuberculosis treatment, were retrospectively analysed regarding clinical presentation, laboratory findings and epidemiological features, with a view to determining any significant discriminatory parameter/s that would help distinguish the two diseases. RESULTS: Eight cases mimicked pulmonary TB, five tubercular arthritis, three tubercular spondylitis, two tubercular lymphadenitis, two splenic abscess, and one each mimicked tubercular pericarditis and parotid abscess. Fever was the chief presenting complaint; all had high erythrocyte sedimentation rate (ESR) values (mean 111 mm +/- 23.7 SD); 15 (68.2%) had neutrophilic leuco-cytosis, 20 (90.9%) had diabetes mellitus. Subsequent to laboratory culture reports confirming melioidosis, appropriate treatment was instituted. CONCLUSION: Fever in a diabetic patient with high ESR and neutrophilic leucocytosis should raise suspicion of melioidosis while instituting presumptive anti-tuberculosis treatment in areas where both diseases are prevalent.

Pre-transplant reduction of isohaemagglutinin titres by donor group plasma infusion does not reduce the incidence of pure red cell aplasia in major ABO-mismatched transplants.

Major ABO incompatibility in stem cell transplant recipients has been associated with pure red cell aplasia (PRCA). Reduction of incompatible isohaemagglutinin titres pre-transplant by various methods has been thought to reduce the incidence of PRCA. Our data suggest that pre-transplant reduction of incompatible isohaemagglutinin titres by donor group plasma infusion does not reduce the incidence of PRCA. We also failed to find any relationship between pre-transplant ABO isohaemagglutinin titre and the risk of developing PRCA.

The prevalence and correlates of hazardous drinking in industrial workers: a study from Goa, India.

AIMS: This study aimed to describe the prevalence and associations of hazardous drinking in a male industrial worker population in India. METHODS: A total of 984 subjects from a randomly selected sample of 1013 workers from four industries in Goa, India, were recruited. Interviews included the 10-item Alcohol Use Disorders Identification Test (AUDIT) as an indicator of hazardous drinking and the 12-item General Health Questionnaire (GHQ12) as a measure of common mental disorders (CMDs). RESULTS: The prevalence of hazardous drinking, defined as an AUDIT score of more than 8 was 21%. There was a significant association with CMD (OR 2, P = 0.003). Hazardous drinking was significantly associated with severe health problems, such as head injuries and hospitalization, whereas CMD was found to be a confounder in its association with adverse economic outcomes. CONCLUSIONS: Hazardous drinking is common among male industrial workers in Goa. Interventions in the workplace must target both drinking problems and CMDs, since they often co-exist and are associated with different types of adverse outcomes.

Evaluation of acridine-orange staining of centrifuged parasites in malarial infection.

A total of 18,845 blood samples were tested by the Acridine Orange (AO) quantitative buffy coat (QBC) method, under white light and UV light and compared with thick blood films, for the detection of malarial parasites. The positivity rate was 25% by the AO-QBC technique and was 18% by the thick film technique. The increased sensitivity, combined with the rapidity and simplicity of the AO-QBC technique, establishes its superiority over the conventional thick film method, in the sentinel surveillance of malaria, in endemic areas. The comparative unit price of the AO-QBC test and conventional microscopy is Rs. 38.00 and Rs. 14.00 respectively. But, the ancillary advantages of the AO-QBC method over the conventional method more than offset the cost difference.

A preliminary audit of practice--antibacterial prophylaxis in general surgery in an Indian hospital setting.

As a major proportion of antibacterials used in hospital practice are for surgical prophylaxis, an audit of practice in relation to antibacterial prophylaxis in general surgery was undertaken over a four week period in a teaching hospital to assess the extent to which principles governing surgical antibacterial prophylaxis were practised and to provide a feedback to the clinicians. The extent of use of anti-bacterial agents in surgical prophylaxis was 90%. The timing of administration was more than 2 h before surgery in 21% of the cases. Intravenous route was used in 97% of the cases. The duration of prophylaxis was more than 72 h in 48% of cases. Cefazolin was the most frequently prescribed either alone or in combination with metronidazole. The study indicated inappropriateness in the timing and duration of administration of surgical antibacterial prophylaxis.