Mustard aphid infestation in India: development of forewarning models.

Aphid Lipaphis erysimi (Kaltenbach) infestation on mustard (Brassica juncea L.) account for considerable yield losses in India. Experimental data from six north Indian locations were used to study the role of weather on the incidence and development of mustard aphid. Temperature was found to regulate the aphid appearance and population build-up. In warm humid climate, time to attain peak population was relatively shorter than in cool climates. Aphids appeared mostly when the accumulated thermal time ranged between 810-847 degrees cd. Functional relations proposed in the present investigation between aphid incidence and peak population, using previous weeks weather and pest data for majority of the locations, could be used for taking any prophylactic/control measures.

Comparison of three screening tools to detect psoriatic arthritis in patients with psoriasis (CONTEST study).

BACKGROUND: Multiple questionnaires to screen for psoriatic arthritis (PsA) have been developed but the optimal screening questionnaire is unknown. OBJECTIVES: To compare three PsA screening questionnaires in a head-to-head study using CASPAR (the Classification Criteria for Psoriatic Arthritis) as the gold standard. METHODS: This study recruited from 10 U.K. secondary care dermatology clinics. Patients with a diagnosis of psoriasis, not previously diagnosed with PsA, were given all three questionnaires. All patients who were positive on any questionnaire were invited for a rheumatological assessment. Receiver operating characteristic (ROC) curves were used to compare the sensitivity, specificity and area under the curve of the three questionnaires according to CASPAR criteria. RESULTS: In total, 938 patients with psoriasis were invited to participate and 657 (70%) patients returned the questionnaires. One or more questionnaires were positive in 314 patients (48%) and 195 (62%) of these patients attended for assessment. Of these, 47 patients (24%) were diagnosed with PsA according to the CASPAR criteria. The proportion of patients with PsA increased with the number of positive questionnaires (one questionnaire, 19·1%; two, 34·0%; three, 46·8%). Sensitivities and specificities for the three questionnaires, and areas under the ROC curve were, respectively: Psoriatic Arthritis Screening Evaluation (PASE), 74·5%, 38·5%, 0·594; Psoriasis Epidemiology Screening Tool (PEST), 76·6%, 37·2%, 0·610; Toronto Psoriatic Arthritis Screen (ToPAS), 76·6%, 29·7%, 0·554. The majority of patients with a false positive response had degenerative or osteoarthritis. CONCLUSION: Although the PEST and ToPAS questionnaires performed slightly better than the PASE questionnaire at identifying PsA, there is little difference between these instruments. These screening tools identify many cases of musculoskeletal disease other than PsA.

A cross-sectional study of cutaneous drug reactions in a private dental college and government medical college in eastern India.

BACKGROUND: Cutaneous drug reactions are a common impediment in therapy, the incidence ranging from 2% to 8%. This cross-sectional study was designed to compare different trends of cutaneous drug reaction in two different socio-economic groups of patients in the same region. AIMS: The aim was to evaluate common drugs implicated in causing reactions, describe the adverse cutaneous drug reactions, study the characteristics of patients presenting with the reactions. STUDY DESIGN: This is an observational study of cross-sectional type. MATERIALS AND METHODS: The study was carried out in the department of Oral and Maxillofacial surgery in a Private dental College and department of General Medicine in a Medical College only on outdoor basis for 3 years. Out of 2000 patients observed in each college for their necessary treatment 75 patients in the dental College and 200 patients in the Medical College were reported to have various types of cutaneous drug reactions. Diagnosis was based on detailed history including temporal correlation between drug intake and onset of rash and thorough clinical examination Apart from history of drug intake, information regarding associated other allergy, comorbidity and severity (whether hospitalization was required or not) was recorded. Rechallenge with the drug was not possible due to ethical problem. RESULTS: Out of 2000 patients observed in each college 75 patients in dental College and 200 patients in Medical College were documented to have different kinds of cutaneous drug reactions. A total of 30 were male and 45 female in dental college whereas 90 male and 110 female patients were enrolled in Medical College. The age group of the patients in both the colleges ranged from 18 to 75 years. Common culprits observed in this study were antibiotics and NSAIDs. They had contributed 53% and 40% of the total skin reactions respectively in dental college and 47.5% and 45% in Medical College. We encountered 6 patients of systemic lupus erythematosus (SLE), 20 patients with allergic rhinitis and 12 patients with bronchial asthma in the whole proceedings. The duration of drug intake varied from 15 minutes to 2 weeks. The most common reaction noted was maculopapular rash 37 (50.5%), urticaria 15 (20%), fixed drug eruption (FDR) 15 (20%), angioedema 6 (8%) in dental College whereas a little different trend was observed in the medical college. Hospitalization was required in two cases of Steven--Johnson syndrome caused by NSAIDS in the dental College whereas 11 patients were hospitalized for the same indication in the medical College. Except for maculopapular rash, all other skin reactions were observed more frequently with NSAIDS in dental College whereas Steven--Johnson syndrome is predominantly observed in Medical College with anticonvulsants. In all the cases causative drugs were withdrawn. A total 40% of the patients required only antihistaminic, 35% required antihistaminic and topical corticosteroid and rest required a combination of antihistaminic, oral and topical corticosteroids. CONCLUSION: Commonest drugs causing drug reactions are antibiotics mainly beta lactams and quinolones. Severe reactions were seen in our series with anticonvulsants and NSAIDS. Association with other diseases could not be inferred due to this modest patient pool.

An assessment of psychiatric disturbances in Graves disease in a medical college in eastern India.

BACKGROUND: Graves' disease is a unique conglomeration of cardiovascular, neurological, ophthalmological, and other systemic manifestations. In this study we have tried to explore the psychiatric dimensions of this disease. AIMS: This study attempted to explore clinical features, types, and treatment outcome of psychiatric disturbances in Graves disease. STUDY DESIGN: This is a purposive study following the criteria of DSM IV. MATERIALS AND METHODS: A total of 36 adult patients of newly diagnosed Graves disease and 30 age- and sex-matched controls were included. Data enumerated were age, sex, date of admission, analysis of psychiatric signs, and symptoms by one independent observer, diagnostic categorization, effect of treatment, and outcome. Follow-up evaluation was done after 1 year. Statistical Analysis : Statistical analysis was done by the standard error of difference, the chi-square test, and paired Student's T-test. RESULTS: Among 36 patients 32 were female and 4 were male. Fifteen patients (41.67%) were diagnosed with generalized anxiety disorders (GAD), 6 (16.67%) with mood disorder, 6 (16.67%) with obsessive compulsive disorder (OCD), and 2 each with personality disorder and schizophreniform disorder. The common symptoms were insomnia, irritability, and anxiety. The frequency of GAD was statistically more significant in the Graves disease group in comparison to control. Fourteen patients agreed to take both antithyroid and antipsychotropic medications (group 1). The rest were treated with only antithyroid drug (group 2). There was significant improvement in both groups and no difference between the groups. CONCLUSION: The prevalence of certain psychiatric manifestations in Graves' disease was significantly higher than in the control group. There was no significant difference between therapy with antithyroid drugs and combination of antithyroid with psychotropic medications.

Comparative study on the effect of chemicals on Alternaria blight in Indian mustard--a multi-location study in India.

High severity of Altemaria blight disease is a major constraint in production of rapeseed-mustard in India. The aim of this study was to investigate the suppressive potential of chemicals viz., zinc sulphate, borax, sulphur, potash and calcium sulphate, aqueous extracts viz., Eucalyptus globosus (50 g l-1) leaf extract and garlic (Allium sativum) bulb (20 g l-1) extract, cow urine and bio-agents Trichoderma harzianum, Pseudomonas fluorescence in comparison with the recommended chemical fungicide (mancozeb), against foliar disease Alternaria blight of Indian mustard [Brassica juncea (L.) Czern. and Coss] under five different geographical locations of India. Mancozeb recorded the lowest mean severity (leaf: 33.1%; pod: 26.3%) of Alternaria blight with efficacy of garlic bulb extract alone (leaf = 34.4%; pod = 27.3%) or in combination with cow urine (leaf = 34.2%; pod = 28.6%) being statistically at par with the recommended chemical fungicide. Chemicals also proved effective in reducing Alternaria blight severity on leaves and pods of Indian mustard (leaf = 36.3-37.9%; pod = 27.5-30.1%). The effective treatments besides providing significant reduction in disease severity also enabled increase in dry seed yield of the crop (mancozeb = 2052 kg ha-1; garlic = 2006 kg ha-1; control = 1561 kg ha-1).

A case report of Nocardia cyriacigeorgica presenting as cellulitis with multiple discharging sinuses.

Nocardia spp. are filamentous Gram positive bacteria that are ubiquitous soil saprophytes. The majority of nocardial infections occur in severely immunocompromised patients who are particularly susceptible to pulmonary disease and dissemination. Extrapulmonary nocardiosis is relatively common and can occur through hematogenous dissemination or a contiguous spread of necrotizing pneumonitis. Primary cutaneous and soft tissue nocardiosis can result from traumatic injury to the skin that involves contamination with soil. After skin inoculation, a superficial abscess or localized cellulitis can develop. Co-trimoxazole is the drug of choice for all types of nocardiosis. We are reporting a case of Nocardia cyriacigeorgica presenting as cellulitis followed tooth extraction.

Generalized aphid population growth models with immigration and cumulative-size dependent dynamics.

Mechanistic models in which the per-capita death rate of a population is proportional to cumulative past size have been shown to describe adequately the population size curves for a number of aphid species. Such previous cumulative-sized based models have not included immigration. The inclusion of immigration is suggested biologically as local aphid populations are initiated by migration of winged aphids and as reproduction is temperature-dependent. This paper investigates two models with constant immigration, one with continuous immigration and the other with restricted immigration. Cases of the latter are relatively simple to fit to data. The results from these two immigration models are compared for data sets on the mustard aphid in India.

DNA variants of alpha-1-antitrypsin in rheumatoid arthritis with and without pulmonary complications.

Restriction fragment length polymorphisms (RFLPs) of alpha-1-antitrypsin were studied in 99 subjects with rheumatoid arthritis alone, 21 subjects with rheumatoid arthritis and pulmonary fibrosis, 26 subjects with rheumatoid arthritis and bronchiectasis, and 86 controls. No associations with either rheumatoid arthritis itself or with the associated pulmonary disorders were noted in this U.K. Caucasoid population.

Suprascapular nerve block for the treatment of frozen shoulder in primary care: a randomized trial.

BACKGROUND: Frozen shoulder is a common problem in general practice, but its treatment is difficult since none of the currently used therapies are proven to be effective. AIM: To assess the effectiveness of suprascapular nerve block to relieve pain and improve range of movement, and its suitability for use in primary care. This small study by a single practitioner aims to justify a larger multicentred trial. METHOD: A randomized trial of 30 patients to compare a single suprascapular nerve block with a course of intra-articular injections. Patients' pain levels and ranges of movement were assessed over a 12-week period. RESULTS: Suprascapular nerve block produced a faster and more complete resolution of pain and restoration of range of movement than a series of intra-articular injections. These differences were confirmed by statistical analysis using the Mann-Whitney U-test (P < 0.01 for pain levels and P < 0.05 for range of abduction and external rotation.) CONCLUSIONS: This study suggests that suprascapular nerve block is a safe and effective treatment for frozen shoulder in primary care, and justifies a larger multicentred trial using independent blinded assessment. Such a study should include a third group treated by suprascapular nerve block without steroid; a more comprehensive assessment of patient debility.

Musculoskeletal aspects of hypoadrenalism: just a load of aches and pains?

Musculoskeletal signs and symptoms of hypoadrenalism are less well described in the literature compared to other endocrine disorders such as diabetes mellitus and thyroid disease. This may in part be due to the difficulties associated with making a definitive diagnosis of hypoadrenalism where the general symptoms and signs can be very subtle. Hence, suspecting hypoadrenalism in a patient with mainly musculoskeletal features can be difficult and delayed. To illustrate this point, we present three cases of hypoadrenalism with varying degrees of rheumatological symptoms and signs. This article reviews all the cases of hypoadrenalism in the English, French and Spanish language medical literature, going back to the time of Thomas Addison. All the important clinical and laboratory features have been summarised to help clinicians diagnose and treat this disease.

Maternal expectations and birth-related experiences: a survey of pregnant women of mixed parity from Calcutta, India.

BACKGROUND: In India, as in other parts of the world with high birthrates, there is an imbalance between maternal expectations and provision of labor pain services. Maternal experience may have an impact on attitudes toward the mode of future deliveries and on cesarean section rates. Maternal expectations regarding labor and delivery, and attitudes towards cesarean section were assessed in women of mixed parity during an antenatal visit at a charitable non-governmental hospital in Calcutta. METHODS: Structured interviews based on a questionnaire were conducted with 205 women. RESULTS: The majority of the 205 women were nulliparous (71%); the average previous cesarean section rate among the parous minority (29%) was 38.8%. Expectation of labor pain was very common. In the absence of an idea of its severity (78%), a majority were ready to tolerate it as a natural phenomenon (71%). For most interviewees, information about epidural labor analgesia was new (97%), although they were prepared to ask for effective pain relief (98%) and pay for epidural analgesia, if available (95%). Nearly a quarter (24%) of subjects considered cesarean section as an option to avoid labor pain, while most (99%) perceived cesarean section to be safer for the baby than vaginal delivery. CONCLUSIONS: This study indicates that information on what to expect during labor and delivery, the potential role of epidural labor analgesia, and the impact of cesarean section on neonatal outcome should be the focus of services instituted to improve antenatal and perinatal care.

Secondary immunodeficiency in miliary tuberculosis.

Cell-mediated immune response was investigated in fifteen patients with miliary tuberculosis. Delayed hypersensitivity skin test with "recall" antigens PPD and SKSD was positive in two and one patients respectively. An irritant dose of DNCB failed to induce non-specific inflammatory response in the skin of thirteen patients and the same patients also did not develop contact sensitivity to DNCB. Leucocyte migration test in the presence of Mycobacterium tuberculosis was also negative in eight of eleven patients studied. The proportion of E rosette-forming cells was found to be significantly depressed, though the proportion of EAC rosette-forming cells did not show any abnormality. On repeat skin tests in five patients after 3 months of chemotherapy and clinical improvement four showed a positive PPD and DNCB response. It was concluded that there is a marked degree of secondary immunodeficiency in miliary tuberculosis.

Hyporesponsiveness to virus antigens in rheumatoid synovial and blood lymphocytes using the indirect leucocyte migration inhibition test.

Mononuclear cells (MNC) from rheumatoid synovial tissue and peripheral blood were tested plasma pneumonia by the indirect leucocyte migration inhibition test. MNC from the eleven rheumatoid synovial tissues tested had deficient leucocyte inhibitory factor production against all antigens tested for, and this was also the case in the peripheral blood of seven juvenile rheumatoid arthritis patients (JRA). In the peripheral blood of eight rheumatoid arthritis (RA) patients there was also generally low reactivity. However, significant differences in migration indexes were found with rubella viral antigen and with PPD at 5 micrigram/ml when zero-hour and overnight incubations of the culture were compared. In contrast, MNC of peripheral blood of control donors had significant responses to PPD (19/19), mumps virus (7/11), rubella virus (10/19), cytomegalovirus (4/11), and herpes simplex type 1 virus (4/11) antigen after zero-hour culture, and no differences was seen after overnight incubation.

Excessive suppressor T-cell activity of the rheumatoid synovial tissue in X-linked hypogammaglobulinaemia.

Patient K.L. with X-linked hypogammaglobulinaemia showed excessive suppressor T-cell activity both in the lymphocytes from the rheumatoid synovial tissue and in the peripheral blood lymphocyte compartment. This was in marked contrast to the findings in the lymphocytes from synovial tissue of patients with classical rheumatoid arthritis (RA), which were clearly deficient in suppressor T-cell activity. These findings further support the existence of distinctly different pathogenetic mechanisms in the two types of rheumatoid inflammation. It also demonstrates that patients with X-linked hypogammaglobulinaemia may have excessive suppressor T-cell activity not only in their peripheral blood lymphocytes but also in local chronic inflammatory tissue such as the rheumatoid joint inflammation.

The shoulder pain syndrome and soft-tissue abnormalities in patients on long-term haemodialysis.

Fifteen patients on long-term haemodialysis were studied. Twelve patients were symptomatic and ten of these patients had shoulder pain. Eleven patients had associated carpal-tunnel syndrome. A statistically significant correlation was observed between the soft-tissue abnormalities of the hands, carpal-tunnel syndrome and the shoulder pain. Radiological changes were also common and were noted in 14 patients; cysts and erosions were the commonest. The shoulder joint was the most commonly involved joint. No obvious correlation existed with either raised parathormone or calcium levels. The possible role of beta 2-microglobulin and associated amyloidosis in the causation of this syndrome is discussed.

Bone cysts and haemodialysis-related amyloidosis.

Carpal tunnel syndrome and arthropathy are frequent complications of long-term haemodialysis. Both are associated with cystic lesions of bone and are related to synovioarticular deposition of a new type of amyloid derived from circulating beta 2-microglobulin. Retrospective analysis of the radiographic skeletal surveys of all 58 patients on haemodialysis for 6 or more years revealed one or more cystic bone lesions in 36% of patients. Radiographic analysis indicated that a number of these cysts were due to hyperparathyroid bone disease or joint degeneration, but a majority showed features suggesting an arthropathy of another aetiology. We present evidence that the development of these latter cysts in an individual on long-term dialysis is an indicator of the presence of synovioarticular amyloidosis of the beta 2-microglobulin type. The radiographic characteristics and development of these cysts, which we believe are due to bony infiltration from synovioarticular amyloid are described.