Accelerated platelet activation in Asian Indians with diabetes and coronary artery disease--The Chennai Urban Population Study (CUPS-13).

AIM: To assess platelet activation in south Indian type 2 diabetic subjects with and without CAD. METHODS: Four groups of subjects were studied; Group 1 comprised of non-diabetic subjects without coronary artery disease (CAD) (n = 30). Type 2 diabetic subjects without CAD formed Group 2 (n = 30); Group 3 comprised of type 2 diabetic subjects with CAD (n = 30) and Group 4 consisted of non- diabetic subjects with CAD (n=14). CAD was diagnosed based on coronary angiographic evidence of severe double or triple vessel disease. Platelet activation was tested after an overnight fast in blood obtained from a bleeding wound at 1 minute post-incision (wound-induced activation) as well as venous blood stimulated in vitro with collagen, using whole blood flow cytometry. In subjects with CAD, aspirin was withdrawn for 7 days and nitrates for 24 hours. RESULTS: Collagen induced GP IIb/IIIa binding was significantly higher among diabetic subjects with (28.10 +/-19.89; p<0.05) and without CAD (21.02+/-19.62; p<0.05) and non-diabetic subjects with CAD (23.89+/-15.65; p<0.05) compared to non-diabetic subjects without CAD (11.69+/-13.69). Regression analysis showed collagen induced GP IIb/IIIa binding to be significantly associated with CAD [odds ratio (OR): 1.029, p = 0.025] and diabetes (OR: 1.037, p = 0.007). CONCLUSION: Increased platelet activation is seen in urban south Indians with diabetes and CAD.

Hepatitis B infection in prostitutes.

The prevalence of HBV markers in prostitutes is known to be higher than that of the normal population of similar age range in previous studies. This study showed a significant correlation between the duration of prostitution and the prevalence of HBV antibodies amongst the prostitutes. The prevalence of HBV antibodies doubled after the first year of prostitution. A two-year follow-up study of these prostitutes showed that 37% of HBsAg positive prostitutes lost the HBsAg. The seroconversion rate of HBsAg negative prostitutes was 10% during this two-year period. Early immunization against HBV infection should be considered in this high risk group in view of these findings.

Chemoprophylaxis and gonococcal infections in prostitutes.

The influence of chemoprophylaxis on gonorrhoea has not been reported recently. 777 prostitutes were interviewed and checked for evidence of chemoprophylaxis. The study showed that chemoprophylaxis does reduce the risk of gonococcal infections and that those who took penicillin chemoprophylaxis had a higher risk of Penicillinase producing Neisseria gonorrhoeae (PPNG) infections compared to those who took non-penicillin chemoprophylaxis and those who did not take any prophylaxis.

Freeze-etching observations of Fonsecaea pedrosoi.

The fine structure of Fonsecaea pedrosoi was studied by freeze-etching techniques. The structure of the cell wall as seen in Trichophyton groups was not observed. The invaginations were clearly shown in the plasma membrane. Three-dimensional views of the fine structure were presented.

The treatment of gonorrhoea--beta lactamase producers.

The high endemicity of PPNG in some regions preclude the continued routine use of procaine penicillin as treatment for gonorrhoea. The aminoglycosides, spectinomycin, second and third generation cephalosporins are highly effective and on epidemiological grounds, should replace penicillin as the first choice antibiotic. However, due cognizance has to be given to the impact of this recommendation on the non PPNG strains and the development of chromosomal resistance to the latter antibiotics. Also, the discontinuation of penicillin as the first line drug for gonorrhoea may see a resurgence of early syphilis. All future recommendations on the treatment of gonorrhoea should take these factors into consideration. Synergetic combination of beta lactam antibiotics and beta lactamase inhibitors or combination therapy may be the lines along which future research should head.

Oral retinoid (Tigason R etretinate) therapy in congenital disorders of keratinisation.

We report our experience in Singapore with the use of the new oral Retinoid-etretinate (Tigason RO 10-9359) in 23 patients suffering from various congenital disorders of keratinisation. In this study the drug was administered to 8 patients with Darier's disease, 7 patients with congenital ichthyosis, 4 patients with palmar plantar keratoderma, 2 patients with systematised epidermal naevus and 2 patients with progressive symmetrical erythrokeratoderma. The best results were obtained in patients with ichthyosis where complete clearance was possible. All patients with Darier's except one showed significant improvement. Palmar plantar keratoderma except for one patient gave only fair to minimal improvement. Etretinate was useful in systematised epidermal naevus and progressive symmetrical erythrokeratoderma. Pruritus and cheilitis were the commonest side effect. In two patients (both with Darier's disease) treatment was stopped because of side effects. The side effects were dose related. The histology showed a reduction of the keratin layer but remnants of the original features of the pathology were still present.

Current trends in the treatment of psoriasis.

New treatment modalities are now available in the management of psoriasis. We report our local studies on these new modalities. Application of dithranol for 1/2 hour is just as effective as when applied for 24 hours. This means less staining of the skin, clothes and no more burns. Oral retinoids gave more than 70% improvement in six of the seven patients with recalcitrant psoriasis. Oral retinoids produced more than 75% improvement in all eight patients with pustular psoriasis. PUVA therapy gave a complete clearance rate of 77% with an average of 25 sessions of treatment and an average total UVA dose of 346 J/cm2. However REPUVA (retinoids and PUVA) produced a complete clearance rate of 73% with an average of 18 sessions of treatment and an average total UVA dose of 142 J/cm2. The newer forms of treatment together with the established therapies have tremendously improved the total management of patients with psoriasis.

The use of photochemotherapy (PUVA) in the initial clearance phase of psoriasis--the local experience.

35 patients with extensive psoriasis were treated with meladinine and ultra violet A photo-chemotherapy. 77% cleared requiring 25 episodes of treatment, 42 days and an average total UVA dose of 346 J/cm2. The results are compared with other European and American studies.

An approach to urticaria.

As the problem of chronic urticaria is frustrating both to the physician and patient, an attempt to study its aetiology was made. 100 cases of chronic urticaria was studied in 1979. Patients having daily urticaria for more than 6 weeks, were included. There were 52 males and 48 females. A detailed history of the pattern of urticaria, drugs, physical causes, diet and illnesses were asked for, followed by physical examination. Each were then screened through a Diagnostic Tray including basic haematological tests, urinalysis, stools analysis, physical allergy tests, food provocation battery and further special tests. 17 patients had physical urticaria, cold (6), pressure (5), delayed dermographism (1), cholinergic (4), solar (1). 4 patients had severe reactions with aspirin, one with tetracycline; one had undiagnosed thyrotoxicosis. 36 of all the patients had a positive test on provocation with the food battery: aspirin (13), preservatives (3), colour dyes (6), yeast (1) and others (15). It has been suggested that these are not the immediate cause but are aggravating factors. 48% of patients showed dermographism. The number of idiopathic cases about 77% is consistent with the findings of others. We feel that an attempt to exclude treatable causes has brought reassurance to many of the patients. Long term antihistamine therapy was given in these cases.

Dermatomyositis in a skin clinic.

12 cases of dermatomyositis were seen in the Middle Road Hospital over a five year period. 2 cases were childhood dermatomyositis. Of the 10 adult patients, the majority (7) were in the younger age group between 21 to 40 years old. The incidence of underlying malignancy was 60% in adult patients and of all the malignancies, 66.7% were nasopharyngeal carcinoma. 4 of the 6 patients with underlying malignancy were in the younger age group of 21-40 years old which was previously reported as uncommon.

Treatment of chancroid with Bactrim.

Bacterim in either oral or intramuscular injection forms were given to 67 patients with Chancroid. It was found that after one week of treatment, clinical cure rate was 46.3% and bacteriological cure rate was 73.1%. After two weeks, the clinical cure rate was 77.6%. Three patients (4.5%) had persistent sores at the end of two weeks and only one of these (2.5%) was bacteriologically active. Twelve patients defaulted. Adverse side-effects were observed in five patients. The effectiveness of Streptomycin, Sulphonamide and Tetracyclines, the other commonly used therapeutic agents, was discussed and compared with Bactrim. It was concluded that Bactrim was a safe and effective drug to use, and recommended as an alternative to Streptomycin and Sulphonamides in the management of Chancroid.

The isolation of H. ducreyi in Singapore.

Using an enriched medium, H. ducreyi was isolated from 56 out of 670 patients with penile ulcers (8.3%). Their clinical, epidemiological characteristics and treatment responses to streptomycin, cotrimoxazole and other antimicrobial agents are analysed. 51% failed to respond to streptomycin.

The susceptibility of Neisseria gonorrhoeae isolated in Singapore to antimicrobial agents--studies on changes in susceptibility patterns over the years.

The results of antibiotic MIC determination on gonococci isolated in Singapore over several years were studied. 53.6% of the strains isolated in 1981 had penicillin MIC values of 0.5 microgram/ml or more. The implementation of a control programme was followed by an increase in the susceptibility of the gonococcus to penicillin, ampicillin and tetracycline. An outbreak of PPNG occurred in 1978 while the control programme was on. In the initial period the PPNG was less susceptible to tetracycline, kanamycin and spectinomycin than the non-PPNG. Later on, as the PPNG was subjected to the same antibiotic selective pressures as the non-PPNG, the differences were less obvious. Following the use of kanamycin as a front-line drug, the percentage of PPNG isolated was stabilized.

The susceptibility of Neisseria gonorrhoeae isolated in Singapore to ceftriaxone, cefotaxime, gentamicin and cotrimoxazole.

240 and 183 strains of non-PPNG and PPNG isolated in 1981 were studied for their susceptibility to ceftriaxone and cefotaxime respectively. All the strains were susceptible to 0.016 microgram/ml of either antibiotic. PPNG from males were less susceptible to cefotaxime than non-PPNG or PPNG from females. PPNG isolated in 1979 were less susceptible to gentamicin than non-PPNG. The relatively high MIC values of cotrimoxazole may account for the high treatment failure rate encountered with the drug.