A Clinicodemographic Study of Leprosy in Elderly: 8-Year Data from a Tertiary Care Centre in North India

The changing demographics of India due to better life expectancy has led to significant increase in the geriatric population. Physiological changes due to aging lead to altered biological response to disease as well as coping with it. There are very few published studies that have addressed the issue of geriatric leprosy. This was a retrospective record review of 8-year data from a tertiary care centre in North India of leprosy patients aged 60 years or more. Clinical and demographic details were noted. Data was compared with 154 other leprosy patients aged 18-59 years. Out of 1083 leprosy cases, 80 (7.4%) were elderly and 67.5% of these were males. Majority (92.5%) were in the multibacillary (MB) spectrum. Type 2 reactions were more commonly seen than type 1 reactions in this age group. Pre-existing co-morbidities were present in 52.5% of patients. Grade 2 disability (G2D) was noted in 13.8% of cases, all of whom were in MB spectrum. Comorbidities were significantly higher amongst the elders whereas nerve involvement and G2D rates were higher amongst other leprosy patients (18-59 years). The prevalence of geriatric leprosy is on the rise due to better life expectancy. The high MB rate and G2D rate in geriatric population is a cause of concern for ongoing disease transmission and leprosy control programs. Due to a higher proportion of patients having pre-existing co-morbid conditions and polypharmacy, this sub-group needs special attention and care after release from treatment

Early human safety study of turmeric oil (Curcuma longa oil) administered orally in healthy volunteers.

OBJECTIVE: Turmeric extract and turmeric oil have shown chemoprotective effect against chemically-induced malignancies in experimental animals. They can reverse precancerous changes in oral submucous fibrosis in humans. The use of turmeric or Curcuma longa Linn as a spice and household remedy has been known to be safe for centuries. In view of the long term administration required for cancer prevention a Phase I clinical trial of turmeric oil (TO) was designed to study the safety and tolerance of TO in volunteers for a period of 3 months. MATERIAL AND METHODS: Nine healthy volunteers between 20 and 33 years of age were tested for haemoglobin, blood counts, liver and kidney functions, bleeding and clotting time and serum electrolytes initially and at 1 and 3 months of treatment. They were administered 0.6 ml of TO three times a day for 1 month and 1 ml in 3 divided doses for 2 months. The acute tolerability study on Day 1 was conducted in a Clinical Pharmacology daycare Unit. Blood pressure and pulse were recorded frequently on Day 1 and at 24, 48, 72 and 96 hours and fortnightly till 12 weeks. Volunteers were daily supervised for TO intake as well as for any side effects throughout the study period. RESULTS: Nine volunteers were enrolled for the study. One discontinued on 3rd day for allergic skin rashes which, on discontinuation of TO, gradually disappeared by two weeks. Another discontinued on 7th day for intercurrent fever requiring antibiotic treatment. Seven volunteers completed the study. There was no effect of TO, in two doses, on pulse and blood pressure and no side effects in acute tolerability study on Day 1. There was no effect of TO intake on weight, blood pressure, symptoms and signs upto 12 weeks. There was no clinical, haematological, renal or hepatic-toxicity of TO at 1 month and 3 months. Serum lipids did not show significant change except in one volunteer (reversible). CONCLUSIONS: In view of the potential for reversing oral submucous fibrosis, a precancerous condition for oral cancer, TO, can be recommended directly for a Phase II trial in patients.

Comparison of absorption rate and bioavailability of two brands of carbamazepine.

OBJECTIVE: To assess the bioavailability of carbamazepine from two brands of carbamazepine--Tegretol 200 and Zen-200. METHODS: A two-way randomised cross-over bioavailability of carbamazepine was carried out in twelve healthy male volunteers. Coded plasma samples were analysed for levels of carbamazepine by high performance liquid chromatography (HPLC) method. Tegretol 200 and Zen-200 were tested for in-vitro dissolution profiles. RESULTS: The mean Cmax, Tmax and t1/2a for Tegretol 200 were: 2.17 +/- 0.42 mcg/mL, 11.67 +/- 6.37 h and 2.72 +/- 1.87 h; for Zen-200 were 3.10 +/- 0.05 mcg/mL, 3.50 +/- 2.11 h and 0.76 +/- 0.76 h respectively. These values were statistically significant. However AUC (0-96 h) value of 150.16 +/- 27.13 mcg/ml.h after Zen-200 was not statistically significant as compared to 128.68 +/- 20.22 mcg/ml.h after Tegretol 200. The in-vitro dissolution profiles of the two formulations were dissimilar. The fluctuations in CBZ levels after Tegretol 200 was significantly less as compared to Zen-200. The absorption profile as judged by parameter 'A' was 50.44 +/- 10.95 for Tegretol 200 and 42.49 +/- 18.89 for Zen-200. CONCLUSION: Based on parameter 'A' and other pharmacokinetic parameters, the marketed generic carbamazepine product, Zen-200 is not bioequivalent to Tegretol 200.

Comparative values of CSF-LDH isoenzymes in neurological disorders.

The present study was carried out to evaluate the usefulness of Cerebrospinal fluid (CSF) Lactate dehydrogenase (LDH) isoenzymes in the diagnosis in tuberculous meningitis (TBM), pyogenic meningitis (PM), viral encephalitis (VE) and hydrocephalus (HC). A characteristic dominance of isoenzymes in cerebrospinal fluid was observed: LDH4 in TBM while LDH3 in PM. However, in VE and HC, LDH2 and LDH1 were dominant respectively. The control subjects revealed the presence of isoenzymes LDH1 and LDH2 in very low concentrations. Pattern of LDH isoenzymes in CSF may serve as a diagnostic tool to differentiate these neurological disorders.

Comparative values of CSF-cholesterol and CSF-triglycerides along with other biochemical parameters in neurological disorders.

Different parameters in CSF which are routinely investigated for the diagnosis and prognosis of neurological disorders do not provide confirmation to the type of neurological disorder. The rise in protein level in CSF was found to be nonspecific and estimation of glucose and chloride in CSF has lost its significance. Therefore, determination of concentration of CSF cholesterol and triglycerides may aid in the diagnosis of tuberculous meningitis, pyogenic meningitis, viral encephalitis and hydrocephalus. The mechanism by which the levels of CSF cholesterol end triglycerides are altered in neurological disorders is not known. The rise cholesterol and triglycerides levels in CSF may be due to increased activity of brain cells or by altered function of blood brain barrier.