Early detection of renal damage caused by fumaric acid ester therapy by determination of urinary ß2-microglobulin.

BACKGROUND: Fumaric acid esters are considered efficacious and safe drugs for the treatment of psoriasis. Renal damage, caused either by acute renal injury or Fanconi syndrome, is a recognized side-effect of this therapy. OBJECTIVES: To investigate whether the measurement of urinary excretion of ß2-microglobulin, a marker of renal proximal tubular dysfunction, allows early detection of kidney damage before an increase in serum creatinine or significant proteinuria occurs. METHODS: Urinary ß2-microglobulin excretion was measured regularly in 23 patients undergoing fumaric acid ester therapy. RESULTS: Urinary ß2-microglobulin remained normal in all 10 male patients. Three (23%) out of 13 female patients experienced an increase in urinary ß2-microglobulin excretion. In two of these patients a sharp increase was observed in association with high doses. One further patient had moderately elevated levels on rather low doses of fumaric acid esters. After discontinuing treatment, urinary ß2-microglobulin levels returned to normal within a few weeks. CONCLUSION: Determination of urinary ß2-microglobulin possibly allows early detection of renal damage by fumaric acid esters. Female patients seem to be prone to this side-effect, especially when taking high doses.

A study on utilization and quality of coverage of antenatal care services at the subcentre level.

A community based cross-sectional study was done by interviewing a sample of 360 women of Anchuri Block in the district of Bankura, West Bengal to know the determinants of utilization and coverage quality of antenatal care services of subcentres using an appropriate scoring system for analysis. The study revealed underutilization of subcentres by the women and also sub-optimal performance of subcentres with regard to coverage quality of ANC services The main reason for under utilization of subcentres was found to be better service provision and easy accessibility of B.S. Medical College Hospital. Multiparous mothers were seen to be at a disadvantage both in terms of utilization of the source of choice as well as in terms of coverage of ANC services by subcentre ANMs.

A simple score predicts future cardiovascular events in an inception cohort of dialysis patients.

Vascular calcifications are very common in dialysis patients and have been shown to be associated independently with outcome. However, all of these studies used prevalent patients on dialysis since many years. We investigated vascular calcifications in an inception cohort of dialysis patients and followed them for cardiovascular disease outcomes during an average observation period of 66 months. One hundred and fifty-four Caucasian dialysis patients were enrolled in one Austrian dialysis center. Standardized plain radiographs from the pelvis and calves were carried out in all patients at the start of dialysis therapy. Vascular calcifications were assessed by a single radiologist. At the start of renal replacement therapy, 67.5% of the patients showed vascular calcifications. During follow-up, 29.9% of patients suffered a cardiovascular event. An additive 'vascular risk score', constructed from the presence of vascular calcifications and/or previous cardiovascular events before the start of dialysis treatment, showed the strongest independent association with cardiovascular events in the Cox regression model adjusted for various risk factors. The presence of each of these two conditions was associated with a hazard ratio of 2.03 (95% confidence interval 1.19-3.46) and a hazard ratio twice as high if both conditions were present. In summary, vascular calcifications on plain X-rays of pelvis and calves are largely present in incident dialysis patients. A history of a cardiovascular event in the predialysis period together with vascular calcifications at the beginning of dialysis therapy is a more powerful predictor of a cardiovascular event than age, smoking, diabetes, or other traditional risk factors.

A study of relapse after MDT in a district in West Bengal, India.

A study was undertaken to estimate the magnitude of the problem of relapse and to identify factors responsible for relapse in leprosy units that were delivering MDT in Purulia District of West Bengal. From records patients were classified as "Relapse" or "Not relapse". "Not relapse" patients were selected by simple random sampling from the Surveillance Register and were matched according to age, sex, and the leprosy control unit. 128 cases ("Relapse") and 128 controls ("Not relapse") were interviewed in the clinic using a pre-tested questionnaire. Details of methods to identify and confirm relapse were circulated to all reporting units for ensuring uniformity and reliability. NGOs covered 42% of the population, while the State Government covered the remaining. The patients had been followed up after completion of treatment for a period of two years in PB leprosy and for five years in MB leprosy. The study revealed that the relapse rate was 1.71/1000 person-years for original PB cases and 0.76/1000 person-years for original MB cases. The study also showed that history of contact with an active leprosy patient and irregular treatment led more PB cases to relapse than control cases. All patients with an initial BI of 3+ relapsed with a BI of 1+ or 2+.

Role of paucibacillary leprosy in the transmission of disease.

The objective of this study was to establish that paucibacillary leprosy also carried increased risk of infection to the community. All members of 100 families with an index paucibacillary case were clinically, bacteriologically and immunologically examined. The "comparison" group was sampled from suspect register. Fifty-six cases occurred among 944 contacts of index paucibacillary cases; of these, four were multibacillary and 52 were paucibacillary. In the "comparison" group, two contacts out of 760 developed paucibacillary leprosy. This difference, between the two groups, was statistically significant. All the 56 cases in the index case families were under 20 years of age; and 50 of them were aged under 15 years. Male/female ratio was 2.1:1. Of the 56 cases, 28 shared the same bed with the index patient, 20 shared the same room and eight lived in the same house. Lepromin positivity rate was higher in "comparison" families (92.2%) than in index case families (74.6%), the difference being statistically significant (x = 6.09, P < 0.001). Contacts of index case families, therefore, were immunologically at higher risk than contacts of "comparison" families.

Mass DEC campaign for filariasis in a hyper endemic district of West Bengal.

As a part of the on-going National Filaria Control Programme, National Filaria Day was observed in Purulia district of West Bengal on 26th Nov 2000 with an extensively organized mass DEC consumption campaign preceded by IEC activities and followed by mopping up operations. In all 81.07% of the targeted population was covered, females (84.3%) being more available than males (78.3%). Percentage of coverage declines with increase in age. Municipalities and notified areas had less coverage as well as supervised consumption than in other areas. Consumption was highest in Balarampur block (88.6%). Supervised consumption among surveyed population was highest in Bandwan (56.0%). Overall patient compliance was very good, with side effects of vomiting, dizziness, headache and fever being 2.12% only among surveyed population. Disease prevalence among population covered showed 0.1% hand swelling, 0.6 to 0.8% leg swelling, while 1.1% of males had hydrocele.

A controlled study on haemograms of malaria patients in Calcutta.

A study was carried out at the Urban Health Centre, Chetla, Calcutta to evaluate the efficacy of quantitative buffy coat (QBC) analysis of haemograms in malaria patients suffering from fever with bodyache and chill and/or rigour attending the Fever Treatment Depot during a three months period (March-June 1996) who had undergone both malaria parasite study and haematological investigation by the QBC method from blood samples collected by finger prick. To avoid bias, malaria parasite studies and haemograms were done separately, and investigators were kept 'blind' about the results of other investigations. The haematological findings obtained of 180 slide-positive malaria cases were compared with a sample of 177 age- and sex-matched slide-negative controls selected by random sampling. The results revealed that haemoglobin levels (g%), haematocrit values (%), WBC and platelet counts of malaria cases were significantly lower than in the matched controls. Thus, QBC estimation correlates well with existing knowledge about malarial haematology. This relatively easier, quicker and reliable method of taking haemograms may be recommended for field testing for assessing haematological parameters of malaria cases under field conditions, before its introduction for large-scale use.

MR imaging in graft-dependent recurrent hyperparathyroidism after parathyroidectomy and autotransplantation.

The purpose of this study was to compare the value of MR imaging versus sonography in the detection of hyperfunctioning transplanted parathyroid tissue. After parathyroidectomy and autotransplantation of parathyroid tissue to the forearm, 14 patients were examined with sonography and MR imaging. Five of these patients had recurrent hyperparathyroidism. In three of these five, sonography found one echolucent nodule. MR imaging in all three patients detected, in addition to this nodule, other small nodules of hyperplastic parathyroid tissue, which were confirmed intraoperatively. In the other two patients, sonographic and MR imaging findings were negative. Further investigations showed that both patients had a fifth parathyroid gland. In the patients without recurrent hyperparathyroidism, sonography showed scar tissue only, whereas MR imaging found some tiny, contrast-enhancing structures in two patients, probably autograft material. MR imaging seems to be more sensitive than sonography in detecting hyperfunctioning autotransplanted parathyroid tissue.