Lepromatous leprosy treated with combined chemotherapy and immunotherapy (injection BCG): three case reports.

BACKGROUND: Lepromatous leprosy is associated with suppressed cell-mediated immunity (CMI). This results in failure of the body to mount an efficient immune response and may render chemotherapy ineffective. The lack of sufficient response may mimic drug resistance. Three case reports in which the immunity was stimulated by administering Injection BCG are presented. All three patients were initially anergic and showed no reaction at the Mantoux testing site, showing an inability to mount type IV hypersensitivity and characterized by live bacilli in smears. Following 1-4 doses of Injection BCG, all three showed dead bacilli in smears. CASE REPORTS: The first case, a 61-year-old man with lepromatous leprosy who continued to show live bacilli in smears after prolonged chemotherapy, was administered a total of four BCG injections, following which he achieved clearance. The second, a 40-year-old man with borderline lepromatous leprosy and severe type 2 reactions, achieved bacterial clearance and control of severe reactions following a single injection. The third, a 67-year-old man with histoid leprosy, achieved effective bacterial killing with a single dose of Injection BCG. RESULTS: All three patients achieved good results when chemotherapy was combined with Injection BCG. Following Injection BCG, all three showed a reaction at the Mantoux testing site. CONCLUSIONS: Suppressed CMI may be responsible for the lack of response in recalcitrant cases of lepromatous leprosy. These case reports would lead to the trend in combination therapy (immunotherapy combined with chemotherapy) for such cases, and help lower the tendency for inappropriate diagnosis of drug-resistant leprosy.

Effects of hard water on hair.

BACKGROUND: Hardness of water is determined by the amount of salts (calcium carbonate [CaCO3] and magnesium sulphate [MgSO4]) present in water. The hardness of the water used for washing hair may cause fragility of hair. OBJECTIVE: The objective of the following study is to compare the tensile strength and elasticity of hair treated in hard water and hair treated in distilled water. MATERIALS AND METHODS: 10-15 strands of hair of length 15-20 cm, lost during combing were obtained from 15 volunteers. Each sample was cut in the middle to obtain 2 sets of hair per volunteer. One set of 15 samples was immersed in hard water and the other set in distilled water for 10 min on alternate days. Procedure was repeated for 30 days. The tensile strength and elasticity of the hair treated in hard water and distilled water was determined using INSTRON universal strength tester. RESULTS: The CaCO3 and MgSO4 content of hard water and distilled water were determined as 212.5 ppm of CaCO3 and 10 ppm of CaCO3 respectively. The tensile strength and elasticity in each sample was determined and the mean values were compared using t-test. The mean (SD) of tensile strength of hair treated in hard water was 105.28 (27.59) and in distilled water was 103.66 (20.92). No statistical significance was observed in the tensile strength, t = 0.181, P = 0.858. The mean (SD) of elasticity of hair treated in hard water was 37.06 (2.24) and in distilled water was 36.84 (4.8). No statistical significance was observed in the elasticity, t = 0.161, P = 0.874. CONCLUSION: The hardness of water does not interfere with the tensile strength and elasticity of hair.