Plasmodium falciparum gametocytaemia with chloroquine chemotherapy in persistent malaria in an endemic area of India.

BACKGROUND & OBJECTIVE: Gametocyte sex-ratio in Plasmodium falciparum malaria is an important determinant of transmission success and basis of disease epidemiology. Information on ratio of male to female gametocytes after an exposure of antimalarial regimens under field conditions is very limited. In this retrospective study we observed high densities of gametocytes along with high sex-ratio in P. falciparum cases, which may be responsible for persistent malaria transmission in this area. METHODS: Laksar PHC of Hardwar district, Uttarakhand State, India was selected because it contributed 90 per cent of the total malaria cases. A total of 568 uncomplicated P. falciparum malaria patients were assessed to investigate prevalence of gametocytes while 339 P. falciparum thick smears containing 5620 gametocytes were screened for measuring the gametocyte density for microgametocyte (male) and macrogametocyte (female). Homology of variance ('F' test) was checked on days 7 and 14 including the variables and risk factors namely fever, parasitaemia, gametocyte carriage in sensitive and resistant chloroquine treated P. falciparum cases. RESULTS: Slide positivity rate (SPR) increased drastically from 0.23 to 11.4 per cent with the predominance in P. falciparum infection after 1998. All 568 cases showed gametocytes in their peripheral blood, of which 109 (19%) were infected with rings and gametocytes and 459 (81%) had gametocytes stages in their peripheral blood while 422 (74.3%) cases were infected with ring stages only. Of the 339 P. falciparum positive blood smears, 5620 gametocytes were screened for their sex-ratio. The mean sex-ratio was 0.31 (3.22 female per male). Prevalence of gametocytaemia was significantly higher (P<0.05) in chloroquine (CQ)- resistant than in CQ-sensitive patients with days 7 and 14 follow up. The homology of variance with risk factors for gametocytes on days 7 and 14 were highly significant (P<0.001) in the study period but during the post-exposure period of days 3 and 5, these were insignificantly correlated. INTERPRETATION & CONCLUSION: A high density of P. falciparum gametocytes was observed at the time of preparation of blood slide on day 0. Improper chloroquine treatment along with poor patient compliance for radical treatment and the presence of chloroquine resistant P. falciparum malaria may have enhanced the prevalence and density of P. falciparum gametocytes which was instrumental in signaling the persistent malaria in this area.

Identification and association of ISSR markers for thermal stress in polyvoltine silkworm Bombyx mori.

Evaluation of genetic resources is an essential prerequisite for their effective utilization. In India, the tropical climate prevails in most of the sericultural belts, where temperature goes beyond the ambient during summer, adversely affecting the silkworm rearing. Although polyvoltine silkworms are poor in silk content, they are mostly tolerant to tropical conditions and diseases. With an aim to identify potential silkworm races/breeds specific to thermo-tolerance for their effective utilization in breeding programme, 15 selected polyvoltine silkworm races were studied for their thermo-tolerance behaviour. Their genomic DNA samples were analyzed for ISSR-PCR using 15 selected primers. The UPGMA analysis based on Nei and Li algorithm has clustered the 15 silkworm races into five groups and one isolate. ALSCAL-multidimensional scaling has not only supported the information generated by the dendrogram, but it has made the genetic distance among races more clear and substantiating their status in terms of thermal stress where pupation rate was taken as indicator. Further, discriminant function analysis (DFA) was done with three groups of silkworms classified for thermal stress viz. susceptible, moderately tolerant and tolerant. The canonical correlation value was estimated to be 0.987 (Wilk's lambda = 0.004; chi2 = 36.044, p < 0.05). DFA clearly discriminated the above three groups. Beta statistics with t value and its significance for the markers identified through stepwise multiple regression analysis (MRA) revealed a total of five bands (807(1300), 808(3000), 808(4000), 834(4000), and 834(3000)) showing correlation with pupation rate after thermal treatment. Out of them, marker 8083000 showed maximum and highly significant correlation (r = 0.757, p < 0.001, t = 4.182) with pupation rate among the silkworm races. The identified putative markers are being used to develop DNA marker to be used in evolving thermo-tolerant silkworm breeds using marker assisted selection programme.

Two cases of subungual glomus tumor.

Glomus tumors are uncommon, small, painful, and usually benign hamartomas arising from the arterial end of the glomus body. They often present early in the subungual stage because of intense pain. Two female patients with subungual glomus tumor are reported here. The intense pain associated with this tumor had led to disuse atrophy of the upper limb in one case. Hildreth's sign and Love's test were positive in both, but imaging did not help in preoperative diagnosis. Tumors were resected by transungual approach, leaving a 3-mm-wide margin. There was no recurrence after 1-year follow-up in both instances.

Genetic variability and genetic structure of wild and semi-domestic populations of tasar silkworm (Antheraea mylitta ) ecorace Daba as revealed through ISSR markers.

The genetic diversity in the wild and semi-domestic populations of Daba ecorace of Antheraea mylitta was studied to ascertain the distribution of variability within and among populations of semi-domestic bivoltine (DB), trivoltine (DT) and nature grown wild populations (DN) with inter-simple sequence repeat (ISSR) markers. A total of 138 markers were produced among 56 individuals of the three populations, of which 98% were polymorphic. For the individual populations, the percentage polymorphism was 58.69, 52.9 and 77.54 for DB, DT and DN, respectively. Average number of observed (1.791+/- 0.408) and effective alleles (1.389+/-0.348) was also high in the wild populations in comparison to the bivoltine and trivoltine semi-domestic populations. Genetic diversity (H(t)) in DB, DT and DN was 0.180+/- 0.033, 0.153+/- 0.032 and 0.235+/- 0.033, respectively and within-population genetic diversity (H(s)) ranged from 0.166 to 0.259 with a mean of 0.189. Mean gene differentiation (G(ST)) was found to be 0.25. Shanon's diversity index was 0.278, 0.237 and 0.361 for DB, DT and DN and overall it was 0.391. Gene flow (N(m)) among the populations was 1.509. The dendrogram produced by UPGMA with Dice's genetic distance matrices resulted in the formation of three major clusters separating the three populations. Considerable intra- and inter-population variability is found in all three populations. The population structure analysis further suggests that the semi-domestic populations of Daba ecorace are at the threshold of differentiating themselves. The high genetic variability present within wild Daba population of A. mylitta is of much importance for conservation as well as utilization in systematic breeding program.

Skin changes in internal malignancy.

BACKGROUND: Internal malignancies are accompanied by various skin changes which may be specific infiltrates or non-specific changes. This study is aimed at determining the frequency of such changes in malignant disease treatment center attendees in India. METHODS: A study of 300 confirmed cases of internal malignancy at a malignant disease treatment center was undertaken to evaluate these skin changes. Specific infiltrates were confirmed by histopathology. Statistical methods were employed to calculate significance in non-specific lesions by comparing with 300 controls not suffering from internal malignancy. RESULTS: Skin changes were present in 82 (27.3%). Cutaneous metastases were found in 19 (6.3%); non-contiguous in 5 (1.6%); contiguous in 14 (4.3%). Non-specific skin lesions numbered 74 (11.6%) in 52 patients. Statistically significant non-specific skin changes were acquired ichthyosis, herpes zoster and generalized pruritus. CONCLUSION: Metastases usually occurred late in internal malignancy (17, 5.6%) except in a case each of histiocytic lymphoma and non-Hodgkin's lymphoma (2, 0.7%) where the lesions preceded malignancy by 3 months and 1 month respectively. Contiguous nodules were a marker of relapse after surgery in 3 (1%).

Management of pemphigus vulgaris during acute phase.

We present our experience with 21 patients of pemphigus vulgaris seen over a period of 10 years managed in service hospitals during acute phase of the disease. Age groups of patients ranged from 25-45 years. Eighteen (85.7%) were young adults, 30-40 years of age. Fifteen (71.4%) were men and 6 (28.6%) were women. All the cases were hospitalized in ICU, till the acute phase of the disease subsided. Complete hematological profile, urinalysis, serum biochemistry and repeated bacterial cultures from the skin were carried out in all patients at the time of admission and thereafter weekly. The treatment comprised of potassium permanganate lotion bath (1:10,000) and 1 framycetin gauze dressing of the denuded areas, maintenance of fluid and electrolyte balance. All suspected infections and septicemia were treated with appropriate antibiotics. The corticosteroids were usually administered as a single dose of prednisolone 1 mg/kg/day. Cyclophosphamide was given at an initial dose of 50 mg/day and the dose was escalated to 100 mg/day. Once the bulk of the lesions were healed, the dose of corticosteroids was gradually lowered by approximately 50% every two weeks and cyclophosphamide was continued till patients were symptom-free. Out of 21 patients receiving corticosteroids, cyclophosphamide and other supportive therapy, 20 (95%) had undergone clinical resolution of the disease. During follow up study 15 (71.4%) patients remained symptom-free and undergone clinical remission. Five patients (23.8%) had relapse, out of which 4 (19%) remained symptom free, after subsequent treatment. There was one death (4.7%) in our study.

HIV prevalence in patients with herpes zoster.

To monitor HIV seroprevalence and to determine the sexual risk behaviour of men with herpes zoster (HZ), a study was conducted from Jan 98 to Dec 99 among 115 men of 21 to 55 years of age suffering from HZ. The diagnosis of HZ was clinical and relevant investigations when indicated were carried out to exclude immunodeficiency state. None of the cases were on immunosuppressive drugs. All cases were tested for HIV by immunocomb method and if found positive were confirmed by Western blot assay. Out of 115 cases of HZ 11 (9.5%) were found to be HIV positive. 11 (10.8%) of HIV positive cases were 21-40 years of age. More than one dermatome was involved in 7 (63.6%) HIV positive and in 2 (1.9%) HIV negative cases. 2 HIV positive cases had multiple cranial nerve involvement and one had generalized HZ. None of the cases showed evidence of progression to symptomatic HIV disease. Out of 11 HIV positive cases 9 (81.8%) gave history of multiple unprotected sexual exposures with female commercial sex workers and 2 (18.1%) with amateurs. None of our cases had used condom during sexual intercourse. None gave history of blood transfusion in the past or intravenous drug use.

NO nerves in trematodes, too! NADPH-diaphorase activity in adult Fasciolopsis buski.

The free radical nitric oxide (NO) is a unique molecule with an avidity to react with other molecules and is known to function as a neuronal messenger. This nitrergic transmitter with diverse functions in signal transduction, being a gas, is not stored in synaptic vesicles but is generated in various neuronal cells by a family of nitric oxide synthases (NOSs). The NADPH-d histochemical reaction is regarded as a selective marker for NOS in the neuronal tissue. With histochemical detection of NADPH-d, the presence of NOS is demonstrated in the digenetic trematode, Fasciolopsis buski. Strong NADPH-d staining was observed in the neuronal cell bodies in the two cerebral ganglia, the brain commissure and the nerve fibers in the main nerve cords. NADPH-d staining was also detectable in the innervation of the pharynx, the cirrus sac and the ventral sucker besides being observable sporadically in the nerve tributaries in the general parenchyma. NO released by the whole worm kept in PBS at 37 degrees C could also be measured biochemically. The NOS activity was assayed in the whole worm homogenate and also in the tissue homogenate containing only the anterior pre-acetabular part of the parasite body. The presence of NOS in this digenean parasite confirms that a nitrergic innervation occurs in the trematode group also as in other groups of exclusively parasitic helminths and that NO represents an old signal molecule in evolutionary scale.

A study of psoralen photochemotherapy with topical tar in the management of psoriasis vulgaris.

In a random study of 150 patients with psoriasis vulgaris, oral psoralen photochemotherapy using natural sunlight (PUVASOL) used alone was compared to PUVASOL plus adjunctive topical therapy with tar. The combined PUVASOL and topical therapy with tar in 75 patients (group-I) with 30 minutes sunlight exposure done in every alternate day showed complete clearing of lesions in 68 (90.6%) patients. The average rate of clearance of lesions started to appear 12-24 days with a mean of 18 days. Group I patients who received topical therapy in conjunction with PUVASOL, their skin lesions cleared more quickly with fewer treatments at a lower final 15 PUVASOL doses as compared to 22 PUVASOL doses in the control patients. Ninety percent of 51 patients using topical therapy on their scalp cleared their psoriasis in this area by the time their body psoriasis had cleared. Only 2 of the 45 (4.4%) patients with scalp involvement cleared receiving PU VASOL alone. All 7 patients with psoriatic arthritis cleared their psoriasis, but none of them noted any symptomatic alteration in the severity of their arthritis during the course of treatment in both the groups.

Vitiligo: a study of 120 cases.

Vitiligo is a common pigmentary disorder and of major social and cosmetic concern in India. Purpose of the study was to find out age at onset and sex incidence in vitiligo, role of hereditary factors and associations with other diseases. 120 self reporting vitiligo patients attending out patient department of a service hospital were selected for the study and this data was analysed. In the present series out of 120 cases 62 (51.6%) were males and 58(48.35%)were females. There was practically no difference in sex incidence. The lowest age of onset was two years and the oldest was 65 years. In the majority of patients,52(43.2%), disease started before twenty years of age.8 (6.6%) cases gave definite family history of vitiligo. Exposed areas of the body were commonly affected in majority (66.6%) of cases. The legs were commonest site of involvement in 60(50%) cases. Circumscript type of vitiligo (46.6%) was heading the list. Majority of patients (56.6%) had multiple lesions. Diabetes mellitus was found in 2 (2.6%) patients. Cause of vitiligo is still idiopathic. Hereditary factors hardly play any role in manifestation of vitiligo.

Chloroquine and desethylchloroquine concentrations in blood cells and plasma from Indian patients infected with sensitive or resistant Plasmodium falciparum.

The sensitivities of 61 Indian cases of Plasmodium falciparum malaria to chloroquine (CQ) were investigated using in-vitro and in-vivo methods. Concentrations of CQ and desethylchloroquine (DCQ) in blood cells and plasma from CQ-sensitive and -resistant cases were determined 2 and 7 days after initiation of treatment, by HPLC. On day 2, the mean CQ concentrations in the samples collected from the sensitive cases were higher than those in the samples from the resistant patients, in plasma (0.47 v. 0.32 microgram/ml; P < 0.02) and particularly in the blood cells (1.51 v. 0.46 micrograms/ml; P < 0.001). By day 7, however, the CQ concentrations in the two groups were similar. Although, on day 2, the mean ratio of the CQ to DCQ concentrations was significantly higher in the blood cells from the sensitive group than in those from the resistant cases (P < 0.01), the CQ/DCQ ratios for the plasma were similar for the two groups. Similarly, the mean ratio between the blood-cell concentration of CQ on day 2 and the concurrent plasma concentration (BPr) was also relatively high in the sensitive group (P < 0.001).

Investigation of malaria prevalence at National Thermal Power Corporation, Shaktinagar, Sonbhadra District (Uttar Pradesh), India.

Malaria in industrial complexes is promoted by extensive mosquitogenic potential generated by excavations and importation of parasite through migratory labor. The National Thermal Power Corporation (NTPC), Shaktinagar, Sonbhadra district was surveyed for malariogenic conditions from 1994 to 1996. The major mosquito breeding sites were drains, storm-water drains, lakes, outside tanks, overhead tanks, sluice-valve chambers, ornamental tanks, wells, pit wells and water reservoirs, etc. Anopheles culicifacies was the major vector of malaria in this area. Sibling species identification of An. culicifacies revealed that species C predominated during the transmission season and responsible to transmit malaria. Insecticide susceptibility tests against An. culicifacies sl showed that An.culicifacies population was 100% susceptible to malathion, fenitrothorn and deltamethrin while it was found 44% resistant to DDT. The malaria cases recorded in 1994, 1995 and 1996 were 847, 590 and 409 respectively. In vitro study on P. falciparum cases showed that 41, 70, 50% of the isolates tested were resistant to chloroquine in 1994, 1995 and 1996 respectively while an in vivo follow-up study showed 20-30% P. falciparum cases resistant to chloroquine. An integrated approach involving alternate vector control measures along with judicious use of insecticides has been suggested to bring down malaria in industrial complexes.

EVALUATION OF PUVASOL AND PUVASOL WITH TOPICAL BETAMETHASONE DIPROPIONATE PLUS SALICYLIC ACID LOTION IN THE TREATMENT OF SCALP PSORIASIS.

The efficacy and safety of betamethsone dipropionate 0.05% with salicylic acid 2% scalp lotion was evaluated in 60 patients with moderate to severe scalp psoriasis. Out of 120 patients with scalp psoriasis 60 patients received PUVASOL alone and 60 patients received PUVASOL alongwith lotion 0.05% betamethasone dipropionate with 2% salicylic acid scalp application for 3 weeks. The erythema, induration, scales and pruritus steadily improved in patients throughout the 3 weeks treatment course with betamethasone dipropionate with salicylic acid scalp application. At the end of therapy 84.3% of those patients receiving PUVASOL and betamethasone dipropionate-salicylic acid combination had 75% improvement of their scalp psoriasis versus 34.9% of those patients using PUVASOL alone. Complete clearing of the scalp was seen in 35% patients receiving therapy with topical betamethasone-salicylic acid and 11.6% with PUVASOL alone. Local side effects were primarily burning and stinging in 5 (83%) cases treated with topical betamethasone salicylic acid scalp application and 1 (1.6%) receiving PUVASOL alone. Combined therapy with PUVASOL and topical betamethasone dispropionate 0.05% with salicyclic acid 2% application appears to be safe and an effective treatment for scalp psoriasis.

Sexual behaviour and HIV prevalence in patients with sexually transmitted disease attending an STD clinic in north eastern state of India.

The study was done to determine the sexual risk behaviour and to monitor HIV seroprevalence among STD patients attending a STD clinic as a part of sentinel surveillance programme in North Eastern State of India. Face to face interviews, clinical and epidemiological investigations were carried out in all new patients. The frequency of condom use, and the number of sexual partners during the preceding 6 months were recorded. Out of 680 males, majority (66.4%) were aged 20-29 years. 89.2% men reported to have had sexual contacts with prostitutes. Being younger, single and staying away from home were independent risk factors for having sexual contact. 34.7% men used condom at all times, 27.2% reported inconsistent use and 38.1% did not use condoms. Eleven (1.6%) of the 680 STD patients tested were found to be HIV positive, did not use condom and had genitoulcerative disease.

A STUDY ON TREATMENT OF CHRONIC IDIOPATHIC URTICARIA WITH CETIRIZINE.

In a prospective study a comparison has been made between the clinical efficacy and safety of cetirizine, a third generation H1 receptor antagonist with chlorpheniramine and cyprohepatadine, the most widely used antithistamines in the treatment of chronic idiopathic urticaria. One hundred and five patients with chronic idiopathic urticaria were studied where the effects of chlorpheniramine, 4 mg and cyproheptadine, 4 mg administered twice daily were compared with cetirizine, 10 mg given once daily for 4 weeks or earlier till the relief of symptoms and regression of lesions. Local therapy consisted of calamine lotion in all cases. Out of 35 patients receiving chlorpheniramine excellent response was achieved in 9 (25.7%) cases by subjective evaluation (SE) and 11 (31.4%) by objective evaluation (OE). Out of 35 cases, 7 (20%) and 10 (28.5%) cases treated with cyproheptadine have shown excellent response by SE and OE respectively. Out of 35 patients taking cetirizine 25 (71.4%) had shown excellent response by SE and 22 (62.8%) cases by OE. Drowsiness was an important side effect observed in 19 (54.2%) cases receiving chlorpheniramine, 22 (62.8%) patients taking cyproheptadine and 1 (2.8%) case getting cetirizine. These results suggest that cetirizine has got superior antiallergic activity than chlorpheniramine and cyproheptadine in the treatment of chronic idiopathic urticaria.