Profile of Disease in Leprosy Patients Diagnosed in a Tertiary Care Centre in Kolkata during 2014-2017

Study of profile of leprosy in a Tertiary care Centre in an Urban Metropolitan settings has important epidemiologically relevant messages. This study has been carried out to find out the profile of leprosy patients attending a Tertiary Care Centre at Kolkata and to interpret data in respect to different epidemiological variables. The cases attending R.G. Kar Medical College for the year 2014-2017 and who were referred to Microbiology Department for slit skin smear examination were studied. Their profile analyzed according to age, sex, type of disease, past treatment, presentation of disease, deformity status, presence of reactions, bacteriological status of the patients and treatment history. Diagnosis was based on the clinical assessment and slit skin smear for Bacteriological Index (BI) as well as Morphological index (MI). Among 2380 cases 720 (30.25%) were females and 1660 (69.75%) were males. Maximum patients (74%) belong to upper lower (Class IV) socio-economic class. 20-40 years age group was reported as peak age of onset with average onset of age as 35 years, 7.56% were children below 15 years of age. Maximum patients (63.87%) were in reproductive age group. Multibacillary (BL/LL) cases are more prevalent (71.47%). 21% of cases were bacteriologically positive with 10.9% having >3+ BI. MI upto 25% was observed in 92% of 360 smears examined for this purpose. Proportion of type 1 reaction was more than type 2 in both males and females. 440 (18.5%) had reactions, 12.6% had type 1 and 5.9% type 2 reactions. Reactions in females were more associated with pregnancy/ lactation. 24% of cases had grade I disability whereas grade II disability was present in 14% of cases which indicates delayed diagnosis and inadequate management or both. Both grade 1 and grade 2 were more in males. Leprosy was found to be more prevalent in males, more prevalent in upper lower (Class IV) socioeconomic class and more commonly of borderline type. Strategy need to be fine tuned to improve early detection, more focus on females during the reproductive years and appropriate intervention to reduce overall morbidity and deformity/disability

Ataxia and deafness in a young male: an unusual aetiology.

We report here a case of 18 year old male with tremors of hands, deafness, tendency to fall while walking, drowsiness and double vision of total duration 1(1/2) years. He had internuclear ophthalmoplegia, broken saccades, hypertonia and hyperreflexia of all four limbs, intention tremors, signs of gait and limb ataxia. Pupillary reactions and fundus examination were normal and signs of meningeal irritation or sensory neurological deficit were absent. MRI head and cervical spine with gadolinium enhancement revealed demyelination as evident from multiple oblong foci isointense on T1-weighted images and hyperintense on T2-weighted and fluid attenuated inversion recovery sequences in corpus callosum, sub-cortical white matter, right thalamus, pons and periaqueductal region of midbrain. Ill-defined linear hyperintense signals were observed in cervical spinal cord. No skeletal abnormality was noted in the skull or cervical spine. Oligoclonal bands were present in the cerebrospinal fluid. Brainstem auditory evoked potentials were abnormal, although visual evoked potentials were in normal range. A diagnosis of primary progressive multiple sclerosis (PPMS) was made fulfilling the revised criteria as laid down. In view of its presentation, it is a unique case of PPMS from India.

Candidemia--an under-recognized nosocomial infection in Indian hospitals.

OBJECTIVE: To study the occurrence of candidemia as a nosocomial infection in a large Indian teaching hospital and to evaluate the predisposing factors for development of such infections. METHODS: One hundred and one hospitalized patients that developed signs and symptoms of nosocomial bloodstream infections were screened for candidemia and were analyzed for the various predisposing factors like the age of the patient, the duration of hospitalization before the development of fever, neutropenia, use of chemotherapeutic agents, central venous catheters, broad spectrum antibiotics, infection with HIV, diabetes mellitus, use of corticosteroids, administration of total parenteral nutrition, haemodialysis, use of mechanical ventilation, hematological or other malignancies, underlying disease, and any surgical procedure performed on the patient. Candidemic patients were followed up for outcome and the effect of nosocomial candidemia on mortality was assessed and analyzed statistically. RESULTS: Out of the 101 patients, seven patients had candidemia, an incidence in study population of 6.9%. Three (42.8%) were infected with albicans and the rest with non-albicans candidemia. All the patients with candidemia were admitted in the Intensive Care Units. Amongst the risk factors, the length of hospitalization (p = 0.018), broad-spectrum antibiotics (p = 0.045), central venous catheters (p = 0.005), mechanical ventilation (p = 0.0139) and total parenteral nutrition (p = 0.001) were found to be significantly related to acquisition of nosocomial candidemia. Mortality in the candidemic patients was influenced only by the age of the patients (p = 0.001). Although the mortality amongst the candidemic patients was twice as much as that of the patients not having this infection, still the difference did not reach significance (p = 0.117). CONCLUSION: Candidemia is an important problem in Indian hospitals. Diagnostic delays could be shortened by more active screening for candidemia especially in the intensive care settings. The rising incidence of non-albicans candidemia in the United States probably is true here as well. There should be a concerted effort to control known risk factors especially in intensive care units.

Smokeless tobacco and premalignant and malignant lesions of the oral cavity.

The paper compares the prevalence of oral carcinoma and dysplasia in smokeless tobacco users and non users. A total of 3205 subjects were studied. Of the smokeless tobacco users, 1.96 percent had oral carcinoma compared with 0.36 percent of non-users. The prevalence of oral dysplasia in the users' group was 14.4 percent as compared with 6.85 percent in the group of non-users.

Clostridium difficile and its cytotoxin in hospitalized children with acute diarrhea.

A total of 498 children, aged 0-14 years, admitted at the B.C. Roy Memorial Hospital for Children, Calcutta, were investigated for the occurrence of Clostridium difficile and its cytotoxin. Of the children in the investigation, 369 suffered from acute diarrhea. Only 8.4% of these children had C. difficile in fecal samples and in vitro cytotoxin was demonstrated in 7%. In 27 (7.3%) of the patients with acute diarrhea C. difficile was isolated as the only pathogen. In contrast, among 129 control children not suffering from acute diarrhea, only 4 (3.1%) harboured C. difficile. Isolation of C. difficile was significantly higher in children under one year of age. None of these patients had any history of prior antibiotic therapy.

Studies on the effect of various parameters on crotalarin-fetuin interaction.

With a view to optimise the interaction of crotalarin, a blood group A-specific lectin from the seeds of Crotalaria striata with fetuin the effect of various parameters on the reaction has been studied turbidimetrically. The formation of crotalarin-fetuin complex was dependent on time, temperature, pH and the ionic strength of the medium. The maximum turbidity appeared in 30 min at 20 degrees C and the pH optimum was 3.5. The binding constant (Ka) for crotalarin-fetuin interaction was 5.58 x 10(4) M-1 (pH 3.5) at 20 degrees C. Among the different inorganic salts tested, the cations with increasing concentrations had pronounced effect on binding. KCNS and KI, however, were noninhibitory. The turbidity slightly increased in presence of different sodium salts, whereas periodate and urea reduced the interaction. The different alcohols had no remarkable effect on the above reaction.