Epidemic dropsy in New Delhi.

Forty-five cases of epidemic dropsy were studied from an epidemic in New Delhi. Argemone oil contamination was found in the mustard oil used for cooking. Sanguinarine was detected in the eight urine samples collected within 2-3 weeks of onset of dropsy and its concentration ranged from 0.4 to 3.6 mug/100 ml. Three of the 18 sera were positive for sanguinarine, the concentration being 1.2, 1.6 and 3.6 mug/100 ml. The clinical manifestations and epidemiological factors were studied. Edema of the legs was the most consistent clinical finding, and was present in all the patients. In contrast to the earlier epidemics, three striking features were pigmentation in 33%, hair loss in 77.7% and nontender hepatomegaly in 24.4% of cases. A follow-up of 10 months showed almost complete recovery in all.

Vitamin A nutritional status of rural community of Khol block in Haryana, North India. A collaborative study.

A nutritional and diet survey was carried out in 2,192 persons belonging to all age groups in a rural community. Vitamin A consumption was less than the recommended daily allowance in persons of all age groups. Bitot's spots and night blindness were detected in 7.1% and 7.2% of the population, respectively. Ocular signs of vitamin A deficiency were more frequently observed in age groups above 5 years as compared to the preschool children. There was no association of vitamin A deficiency with different grades of protein-calorie malnutrition in preschool children. Keratomalacia was extremely rare and was observed only in one child. The study suggests that the rural area studied was a high prevalence zone for vitamin A deficiency which did not have its serious consequences due to relatively adequate protein-calorie nutritional status of the population.

An enzyme-linked immunosorbent assay (ELISA) for the detection of IgG and IgM anti-idiotypes directed against anti-HBs molecules.

A simple and specific enzyme-linked immunosorbent assay (ELISA) has been developed to detect circulating IgG and IgM anti-idiotypic antibodies directed against anti-HBs molecules using 96-well polyvinyl microtitre plates as the solid phase and HRPO-labelled goat anti-HBs as conjugate. Anti-idiotype reactions were observed in the supernatant portion after precipitation of immune complexes from sera with polyethylene glycol 6000 (PEG). Both IgG and IgM with anti-idiotype activity were detected concurrently in HBsAg-positive sera from HBV-infected patients and asymptomatic HBV carriers. Anti-idiotype activity was absent in HBsAg-negative sera from healthy persons, and in patients with non-A, non-B hepatitis and viral hepatitis A. However, such antibodies could be demonstrated in the sera of two out of eight HBsAg vaccine recipients negative for anti-HBs but in none of 11 recipients positive for anti-HBs after receiving a booster immunising dose of HBsAg vaccine. Those sera showing positive anti-idiotype reactions were free from rheumatoid factor and HBsAg/IgM or HBsAg/IgG complex activity. An analysis of anti-idiotype positive sera for anti-HBs, HBeAg and HBV-specific DNA-polymerase activity demonstrated these markers in 20%, 30% and 60% of cases, respectively. The presence of anti-idiotypic antibodies was presumed to permit a more active multiplication of hepatitis B virus.

An international perspective on child day-care health.

If we are committed to the health and development of children, we need to recognize that the vast majority of the world's women are working women. In Africa, 80% of the women are actively engaged in economic activities outside the home. The "economic miracle" in Southeast Asia was made possible by the nimble fingers of thousands of women working in textile and electronics factories. There is need for pre-day-care advocacy for infants, through promotion of breast feeding and maternity leave. When the mother returns to work, the standard of the International Labor Organization should be applied, namely" ...the care of children while the parents are working cannot be ignored because it forms a focal point on which three main concerns of development policy--work, health, and education--converge." Several principles emerged from the presentations in the international panel: 1. Child-care programs must be community based, using the resources of the families and the community organizations themselves. 2. Programs require the active involvement of the communities, women's groups, and other partners. 3. Programs are modified by innovations created by community organizations, universities, and other groups. 4. Programs require the mobilization of trained young men and women into the field of early childhood education and development. This international panel provided an overall uniting theme, that throughout the world the hope for the survival and better life for children unites parents of every country and every creed. This is one of the most powerful and strongest motivational resources in the world.(ABSTRACT TRUNCATED AT 250 WORDS)

Amebic liver abscess and circulating immune complexes of Entamoeba histolytica proteins.

An enzyme-linked immunosorbent assay (ELISA) has been developed to detect amebic antigen in polyethylene-glycol-precipitable circulating immune complexes. Seventy-nine percent of 191 patients with amebic liver abscesses and 46% of 26 Entamoeba histolytica cyst passers had positive tests. None of the samples from 43 apparently healthy controls, 8 patients with past amebic liver abscesses or 31 patients with Giardia lamblia infections were positive. One patient out of 32 with viral hepatitis and 1 patient out of 27 with intestinal tuberculosis had positive tests.

An unusual outbreak of hookworm disease in North India.

An unusual outbreak of hookworm disease occurred after a game of "kabaddi" (a local game which results in much body contact with the ground) in 27 young males from one village. It was characterized by an immediate incapacitating dermatitis, followed by severe pulmonary symptoms. Progressive weakness, abdominal pain, weight loss and anemia developed within a few months. Ancylostoma duodenale was found in all except four patients who had received antihelminthic treatment. Specific treatment for hookworm resulted in complete clinical recovery. Features of the outbreak were: 1) the hitherto unrecorded mode of infection; 2) severe dermatitis; 3) pulmonary symptoms lasting more than 3 mo; 4) abdominal symptoms suggestive of subacute obstruction starting 4-6 mo after exposure; and 5) severe disability with weight loss for a period of 1 yr until specific treatment was administered.

Studies on HBsAg binding with polymerised human serum albumin by ELISA.

A simple and sensitive ELISA was developed to characterize the interaction between polymerised human serum albumin (pHSA) and HBsAg, using pHSA-coated polyvinylmicrotitre plates as solid phase and anti-HBs-coupled HRPO as the conjugate. The interaction was found to be specific and dependent on the size of albumin polymer. pHSA-binding activity (pHSA-BA) was studied in both HBsAg-negative and HBsAg-positive sera from various liver diseases including acute viral hepatitis, fulminant hepatitis, cirrhosis of liver, chronic active hepatitis, and healthy HBsAg carriers. pHSA-BA was detected only in HBsAg-positive sera. Analysis of HBsAg-positive sera indicated pHSA-BA in high proportions of patients sera as compared to sera from healthy HBsAg carriers. pHSA-BA was detected both in the presence and absence of HBe markers, though the mean BA was relatively high in presence of HBeAg. The effect of human serum immunoglobulins (IgG, IgA, and IgM) on the BA was investigated and a correlation between pHSA-BA and HBsAg-IgM complex positivity in sera was established. Finally, the probable role of human serum IgM in facilitating the binding process was discussed.

Enzyme linked protein-A: an ELISA for detection of amoebic antibody.

Enzyme linked protein-A was used to develop an enzyme linked immunosorbent assay (ELISA) system for the detection of circulating antibodies to amoebic antigen. The specificity of protein-A to bind IgG only through Fc receptors, makes the test more specific for the detection of IgG antibodies to amoebic antigen. The ELISA system was used to detect amoebic antibody in control subjects (56), patients with amoebic liver abscess (79) and Entamoeba histolytica cyst-passers (10) and the results compared with those of indirect haemagglutination assay (IHA). The ELISA was more sensitive and detected 74.7% of cases with amoebic antibody in amoebic liver abscess compared with 66.7% detected by IHA. The test was more specific, sensitive and easy to perform and is recommended as a test of choice for the serological diagnosis of amoebic liver abscess.

Entamoeba histolytica: elevated nitroblue tetrazolium reduction activity in polymorphs during amoebic liver abscess.

Peripheral blood polymorphonuclear leucocytes (PMN) from patients with invasive amoebiasis, i.e. amoebic liver abscess (ALA) and acute amoebic dysentery, showed marked elevation of nitroblue tetrazolium dye (NBT) reduction. This dramatic change was not observed in PMN from patients with non-invasive amoebiasis, i.e. non-suppurative hepatic amoebiasis, or in asymptomatic Entamoeba histolytica cyst passers. A small number (12%) of patients with viral hepatitis displayed increased NBT reduction. 10 to 12 days after recovery following treatment, the majority (75%) of ALA patients failed to show increased NBT reduction. Our results suggest that the PMN-NBT reduction test could be useful as an aid to the diagnosis of ALA.

Treatment of subacute hepatitis with Lamivudine and intravenous Glycyrrhizin: a pilot study.

Subacute hepatitis is a common and distinct clinicopathological entity due to Hepatitis B and E viruses in India. Lamivudine has been established as a safe and effective antiviral agent for the treatment of chronic HBV hepatitis. This drug was administered orally along with intravenous (I/V) Glycyrrhizin, an immunomodulator drug, in an open pilot trial to assess its efficacy in the treatment of subacute hepatitis. The results establish the safety and efficacy of Lamivudine in combination with I.V. Glycyrrhizin in subacute Hepatitis.

Clinical spectrum of acute sporadic hepatitis E and possible benefit of glycyrrhizin therapy.

The aim of the present study was to record the spectrum of sporadic hepatitis due to hepatitis E virus infection with special reference to moderate and severe liver disease, described as sub-acute hepatitis. Further, efficacy of glycyrrhizin therapy was studied as an open trial. Sixty-two consecutive patients were registered for the study. The clinical and laboratory profile of the patients was recorded on a preplanned proforma. Moderate and severe hepatitis was arbitrarily defined on the basis of clinical symptoms and serum bilirubin (total) of 10-15 mg% and 16 mg% or higher, respectively, at the time of presentation. It was noted that 22 (36.1%) of acute sporadic hepatitis E patients had moderate or severe liver disease. Glycyrrhizin was administered to these 22 patients by intravenous (IV) route in the dose of 60 ml daily. Therapy was tapered and stopped once significant clinical and biochemical improvement was noted. All patients showed clinical improvement by the seventh day of therapy. Total bilirubin was reduced by 68.9% by the end of 2 weeks of treatment and at this time, reduction in AST and ALT levels was to the tune of 94 and 97%, respectively. Normalization of AST and ALT levels was recorded in 19 patients (86.4%) and total bilirubin in 13 (59.1%) patients within 30 days of commencement of therapy. There were no side effects of IV glycyrrhizin therapy. It is concluded from the results of the present study that over one-third patients with acute sporadic hepatitis E in India have either moderate or severe liver injury. IV glycerrhizin therapy in this group of patients is well tolerated and effective.

A study of iron and protein deficiency in hookworm infestation.

PIP: 104 patients with positive stool for hookworm ova were studied in detail with regard to anemia, iron and protein deficiency, and their relation to hookworm ova load. A variable degree of anemia was seen in 80 of 104 patients. Hypochromia was noticed in 66 (64%). In 48 (46%), morphological changes due to vitamin B12 and/or folic acid deficiency were recorded. Iron deficiency was most common in anemic patients. Less than 15% saturation of transferrin was the most sensitive biochemical index of iron deficiency in these patients. Severity of anemia was significantly associated with iron deficiency. Hypoalbuminemia (serum albumin less than 3.25 g%) was found in 33 (32.6%) of the patients. Anemia and hypoalbuminemia were both significantly associated with the hookworm load. However, the association of hookworm load was seen with severe anemia (hemoglobin less than 5 g%) and hypoalbuminemia (serum albumin less than 2.75 g%). It has been suggested that besides parasitic factors, nutritional deficiencies of vitamin B12 and/or folic acid and protein are contributory factors in the pathogenesis of anemia and hypoalbuminemia respectively found in these patients.^ieng

A simple spot-test for circulating Entamoeba histolytica antigen-antibody complexes in patients with amoebic liver abscess.

An enzyme linked immunosorbent assay (ELISA) is described for the detection of E. histolytica immune complexes in serum. Antiamoebic antibody purified by affinity chromatography was used both to precoat strips of nitrocellulose membrane and as an enzyme carrier. These strips were incubated with samples of concentrated test serum and the enzyme conjugate. Following treatment with the peroxidase substrate 3-amino-9-ethylcarbazole the presence of E. histolytica antigens was visualized as red spots. Blocking of positive test sera with excess antibodies inhibited this reaction. Serum samples from 47 patients with amoebic liver abscess, 43 patients with other enteric diseases and 35 healthy controls were investigated. The spot test was positive in 75 per cent of patients with amoebic liver abscess, and in 12 per cent diseased controls whereas all the healthy controls were negative. The spot test is simple and sensitive and does not require prior separation of the immune complexes. The test is recommended as an aid to the diagnosis in patients suspected to have amoebic liver abscess.

Prevalence of HBsAg & anti-HBs in children & strategy suggested for immunisation in India.

The prevalence of HBsAg and anti-HBs was studied in sera from 982 children of different age groups below 5 yr. HBsAg was detected in 0.9, 2.3, 4.1, 2.3 and 1.6 per cent children of 0-1, 2-6, 7-12, 13-36 and 37-60 months age groups respectively. Anti-HBs in these five groups was noted in 17.0, 12.9, 18.4, 14.2 and 13.7 per cent children, respectively. The findings suggest that the carrier pool is built up in the preschool age group, particularly, below the age of 6 months. Perinatal transmission and the relative role of transplacental need re-evaluation. Cost analysis does not permit inclusion of HBV in the Expanded Programme of Immunisation.

A preliminary open trial on interferon stimulator (SNMC) derived from Glycyrrhiza glabra in the treatment of subacute hepatic failure.

The efficacy of the interferon stimulator named Stronger Neo Minophagen-C (SNMC) derived form the plant G. glabra was studied at a dose of 40 or 100 ml daily for 30 days followed by thrice weekly intravenously for 8 wk in 18 patients of subacute hepatic failure due to viral hepatitis. The survival rate amongst these patients was 72.2 per cent, as compared to the earlier reported rate of 31.1 per cent in 98 patients who received supportive therapy (P < 0.01). Death in four of the five patients was due to associated infections leading to hepatorenal failure and terminal coma. Further studies are necessary to standardize the dose and duration of therapy with SNMC in subacute hepatic failure.

Animal transmission of enteric non-A, non-B hepatitis infection to Macaca mulatta by faeco-oral route.

M. mulatta monkeys were inoculated faeco-orally by enteric non-A, non-B virus to study the development of clinical, biochemical, histopathological and serological changes in the blood and liver. Pooled stool samples positive for putative non-A, non-B viral antigen by micro-ELISA and aggregated viral particles by immune electron microscopy, were administered in two M. mulatta monkeys. Biochemical, histopathological and serological changes were seen in the blood and liver and excretion of 27 nm virus like particles around 27 days of inoculation in the experimental monkey but not in the control animal.

Role of immune serum globulin in post transfusion virus B infection.

Fifty four blood recipients were administered prophylactic immune serum globulin (31) or hepatitis B immune globulin (23) and followed up for six months. None of the patients developed either acute hepatitis B or HBsAg carrier state. However, 7 (14%) had anicteric self limiting non-B post-transfusion hepatitis. Twenty (40%) of the blood recipients developed anti-HBs during the follow up period suggesting either HBV exposure by subdetectable levels of HBsAg present either in blood or immunoglobulin preparation or due to passive transfer by administration of immunoglobulins.

A simple and inexpensive clinical whole body counter.

The conventional radioisotope scanner has been used as a whole body counter. The background index of the system is 10.9 counts per minute per ml of sodium iodide crystal. The sensitivity and derived sensitivity parameters have been evaluated and found to be suitable for clinical studies. The optimum parameters for a single detector at two positions above the lying subject have been obtained. It has been found that for the case of 131I measurement it is possible to assay a source located at any point in the body with coefficient of variation less than 5%. To add to the versatility, a fixed geometry for in-vitro counting of large samples has been obtained. The retention values obtained by the whole body counter have been found to correlate with those obtained by in-vitro assay of urine and stool after intravenous administration of 51Cr-albumin.

Epidemic of toxic hepatitis in India of possible mycotoxic origin.

An epidemic of liver disease, characterized by onset with high fever, rapidly progressive jaundice, and ascites occurred in a rural area of India. Several hundred people were affected and mortality was high. The epidemic was heralded by the appearance of similar features in the village dogs. Liver biopsy specimens from eight cases and autopsy material from one human case and two dogs were studied. Characteristic features were centrizonal scarring, hepatic venous occlusion, ductular proliferation and cholestasis, focal syncytial giant-cell tr-nsformation of hepatocytes, and pericellular fibrosis. Toxic quantities of aflatoxin B1 were found in samples of corn, the staple food grain of the people, that was obtained from the domestic food stores. The etiology of the disease could not be unequivocally established, but aflatoxins, perhaps in combination with other factors, may have been the cause.

Prevalence of hepatitis B virus infection in healthy persons in North India.

BACKGROUND: There is scant information on the main methods through which hepatitis B virus infection is transmitted in India. We, therefore, studied the prevalence of hepatitis B surface antigen and antibody to hepatitis B surface antigen in voluntary blood donors as well as in those healthy groups who have a high risk of contracting this infection. METHODS: The groups at risk studied included commercial sex workers (635), eunuchs (28), truck drivers (217), professional blood donors (1117) and health care workers (1313). In addition, 20,435 voluntary blood donors were also studied. RESULTS: Hepatitis B surface antigen (and its antibody) was positive in 2.6% (14%) of voluntary blood donors, 3.6% (19%) of commercial sex workers, 5% (16%) of truck drivers, 12% (9%) of professional donors, 1.4% (19%) of health care workers and none (18%) of the eunuchs. Except professional donors and truck drivers, none of these groups had a higher positivity than the normal population (2.6%). CONCLUSIONS: Our results indicate that in India the so-called high risk groups, other than truck drivers and professional blood donors, are unlikely to represent major sources of infection.