Audit of toxic effects of body paint in the tiger dancers (Hulivesha) of Mangalore, India: an investigational study.

INTRODUCTION: Tiger dancing or Hulivesha, where the volunteers paint their bare body like a tiger and dance in a ritual during the Navarathri festival in Mangalore, India. There are no scientific studies done with the Hulivesha dancers at all, and therefore, we investigated the adverse effects of painting body like a tiger and dancing in the volunteers. OBJECTIVE/AIM: In this study, we investigated the clinico-haematological effects of topical application of lead-containing paint and dancing for three consecutive days in these dancers to ascertain the toxic effects of whole body painting and dancing. MATERIALS AND METHODS: This was a case-control study and was conducted during the Dasara festival in 2013 in the Huliveshadaris (study group) and the accompanying drummers (controls). Clinical, dermatological, and musculoskeletal examination were done before (day 0) and after the three days of the function (day 3). Blood was also collected and examined for alterations in the hematological parameters, lead, antioxidant glutathione, and lipid peroxidation levels. RESULTS: The results indicated that the all Hulivesha volunteers had severe musculoskeletal pain, while few also complained of skin reactions (61.6%), headache (25%) and nausea, and vomiting (18.75%). The results also indicated that topical application increased the levels of blood lead, caused a change in the haematological profile, decreased glutathione and increased lipid peroxidation (p < 0.03-0.0001). CONCLUSIONS: The results from this study clearly shows that topical application of the acrylic paint increases lead, changes haematological parameters and imparts adverse skin reactions.

Relapses in multibacillary leprosy patients after multidrug therapy.

OBJECTIVES: To determine the magnitude of relapses in multibacillary leprosy patients after multi-drug therapy and to determine the factors influencing the relapse. DESIGN: A retrospective study pertaining to multibacillary leprosy patients treated with MBMDT as per WHO guidelines was carried out. The study included 300 MB patients who had successfully completed treatment during 1986-2002, of whom 163 patients were available for follow-up. Patients were examined clinically and bacteriologically to asses the present status of disease. RESULTS: A total of three cases relapsed at 2, 4 and 11 years after being released from treatment which gives a crude cumulative relapse rate of 1.84% for the 18 year period of follow-up with mean duration of follow-up 7.13 +/- 1.25 years. It also gives the total follow-up period of 1163 person-years with the relapse rate of 0.26/100 person-years of follow-up (95% confidence interval is 0.235-0.285). CONCLUSION: Relapse rate after WHO recommended MDT leprosy is low. High bacterial load before initiation of therapy is an important factor which determines the relapse.

Subcutaneous mycoses in coastal Karnataka in south India.

BACKGROUND: Subcutaneous mycoses are chronic, localized infections of the skin and subcutaneous tissue which occur following traumatic implantation of the etiological agent. The causative organisms are soil saprophytes of regional epidemiology with varying ability to adapt to the tissue environment and elicit disease. OBJECTIVES: This study was conducted to evaluate the various types of subcutaneous mycoses, including actinomycotic mycetomas, in south coastal Karnataka, India. METHODS: Between January 2005 and January 2013, a total of 25 patients were diagnosed with subcutaneous mycoses based on a detailed clinical history and presentation, histopathology, and culture of organisms. RESULTS: Chromoblastomycosis was the infection most commonly seen (n = 16 patients, 64%), followed by mycetoma (n = 4, 16%), sporotrichosis (n = 4, 16%), and rhinoentomophthoromycosis (n = 1, 4%). The extremities were the most common site of involvement, with the lower limb being most affected (64%). Males were more commonly afflicted (64%) than females (36%). Most patients were agricultural workers, although preceding trauma was noted in only three patients. The majority of patients responded well to therapy and were disease-free on follow-up. CONCLUSIONS: Subcutaneous mycoses are a rare group of disorders. Chromoblastomycosis is the most frequent subcutaneous fungal infection in south India. Morphologically, chromomoblastomycoses present as verrucous, ulcerative, nodular, or eczematous lesions. Clinical diagnosis is important as culture is often negative. The incidence of infection is higher among rubber tappers. It is important to clinically differentiate chromoblastomycosis from tuberculosis verrucosa cutis. Most of the subcutaneous mycoses respond well to treatment, with the exception of rhinoentomophthoromycosis, which is a rare form of deep mycosis with associated mutilation. Eumycetomas are not observed in this part of India.