A Qualitative Study on the Feasibility and Benefits of Foot Hygiene Measures Practiced by Patients with Brugian Filariasis

Disability alleviation is an important component of Global Programme for Elimination of Lymphatic Filariasis'. In Brugia malayi infection the disability is largely due to acute attacks of adenolymphangitis (ADL), which frequently prevent patients from attending their normal activities, causing much suffering and economic loss. The foot care programme has been shown to reduce the frequency and severity of these episodes. In the present study we used semi-structured interviews to evaluate the impact of the foot care in 127 patients with brugian filariasis. They were previously trained in this procedure and were advised to practice it regularly, unsupervised. All except one could recollect the various components of foot hygiene and were practicing it regularly. They were aware of the factors causing ADL attacks and were able to avoid them. Majority (95.2%) expressed their happiness with the relief provided by foot care, which prevented or reduced the ADL episodes. The motivation was such that they transmitted this knowledge to others suffering in the community and even physically helped them to carry out foot care. This study fully endorses the advocacy of foot care programme as an easy to carry out, effective, sustainable and economically feasible ,procedure to prevent acute ADL attacks

Immunology of occupational lung diseases caused by dust: an overview

The lungs are exposed to numerous injurious substances.Such injury may be the result of immunological or non-immunological mechanisms. The lung clears itself of inhaled particles by means of ciliated cells lining the airways and the macrophages.The latter play an important role in the immune process as well.Inorganic particles are ingested by macrophages and if found inert are transported for eventual expulsion.Particles such as silica are poorly handled by macrophages, they not only damage the macrophages but also impair their function. Others, such as asbestos, may stimulate fibrosis. Endogenous factors such as the presence of auto-antibodies (rheumatoid factor or anti-nuclear factor) alter the response of the host to inhaled particles.The pathological changes caused by handling inorganic dusts include intestitial fibrosis, nodular fibrosis or macule formation leading to emphysema.Occupational asthma a occurs when individuals are exposed to dusts during the course of their work. The lung responds differently to organic dust. T cells and complement are important elements in handling organic dust.The role of inhaled steroids which have no significant systemic effects in the prevention of certain occupational asthmas is worth evaluating, apart from control measures which minimise the exposure

Ivermectin in the treatment of Bancroftian filariasis infection in Orissa, India

Ivermectin treatment has evaluated for its efficacy and side reactions in sixty patients of Orissa with Bancroftian filarial infection and microfilaremia. Ivermectin was administered as a single oral dose at four dosage levels (20, 50. 100 and 200 μg/kg), and both microfilarial clearance and associated side reactions were monitored in a double blind fashion. Blood microfilariae were cleared in all patients at all dosages within 1 to 14 days. In most patients microfilariae reappeared by third month. The microfilaria appearance by third and sixth month averaged 12.2 to 44 percent of pretreatment values in the fourstudy groups. Side reactions were encountered in almost all patients, the commonest being fever. headache, weakness, myalgia and cough which occured most prominently 12 to 72 hours after treatment. Side reactions were more frequent and severe in patients with high microfilaria counts. Clinical reaction scores for each group were independent of the dose administered. The 200 μg dose group showed significantly more rapid microfilariae clearance and its delayed reappearance as compared with the other dosage groups and without inducing significantly greater clinical reaction scores

Treatment of the microfilaraemia of asymptomatic brugian filariasis with single doses of ivermectin, diethylcarbamazine or albendazole, in various combinations

Several new chemotherapeutic tools are now available for the control of lymphatic filariasis. Combinations of single doses of antifilarial drugs are generally superior to single drugs. The efficacy and safety of albendazole in combination with diethylcarbamazinc (DEC) or ivermectin, for the treatment of Brugia malayi infection, were investigated, for the first time, in an open, hospital-based study. Fifty-one asymptomatic microfilaraemics (with 108-4034 microfilariae/ml; median = 531) of both sexes and aged 14-70 years were randomly allocated to receive single-dose treatments of ivermectin (200 μg/kg) with diethylcarbamazine (DEC; 6 mg/kg), ivermectin (200 μg/kg) with albendazole (400 mg), DEC (6 mg/kg) with albendazole (400 mg), or albendazole (400 mg) alone. Albendazole alone had no effect on the microfilarial levels at the 1-year follow-up but both groups given DEC had significantly lower microfilaraemias ( P < 0.015 and P < 0.02) than that given ivermectin with albendazole. Overall, 47%-64% of those given DEC but only 14% of those given ivermectin with albendazole appeared to be amicrofilaraemic 1 year post-treatment. The adverse reactions seen in the study were mild, transient and qualitatively similar to those seen earlier with ivermectin and DEC. The combination of DEC and albendazole, both well tested drugs, offers a new option for countries such as India where there is no onchocerciasis or loiasis and where ivermectin may not be immediately available. The direct and indirect effects of albendazole on intestinal helminths would be additional benefits

Estimation of ASO titer as an indicator of streptococcal infection precipitating acute adenolymphangitis in brugian lymphatic filariasis

Recurrent episodes of acute adenolymphangitis (ADL) are important clinical manifestations of lymphatic filariasis which contribute significantly to the progression of lymphedema. It is increasingly being recognized that secondary bacterial infections play an important role in the etiology of ADL. We examined the role of streptococcal infection as a precipitating factor of ADL in brugian filariasis, by determining the anti-streptolysin O (ASO) titers and by isolating the causative organism wherever possible. The study population consisted of 30 patients with filariasis related ADL (Group A), 30 patients with chronic filarial edema (Group B) and 60 age and sex matched healthy adults (Group C). ASO titer was estimated by the latex agglutination method at the time of entry into the study, at the 15th day and at 3,6 and 12 months. ASO titers were persistently elevated in 90% of patients in Group A and a portal of entry for bacterial infection was detected in all of these patients. In Group B only six patients had persistently elevated ASO titers. These patients had grade III lymphedema and three of them had monilial infections in the affected limb. In the control group none had persistently elevated ASO titers. The elevated ASO titers and the detection of a site of entry for bacteria in patients with ADL supports a streptococcal etiology for this condition

Urticaria - some observations

Urticaria has been known from antiquity. The disorder was known to the Arabs as essera and it has found a place in the writings of Cesius (circa 30 BC–45 AD). Although the condition was recognised as an entity, its cause was a mystery to the physicians of those times. It was initially thought to be a manifestation of idiosyncrasy and later believed to be a form of neuroses. However, now the pathophysiological basis of urticaria is well understood. The development of antihistamine group of drugs, paved the way for the management of urticaria

Single Dose Pharmacokinetics of Efavirenzin Healthy Indian Subjects

Background & Objective: Access to antiretroviral therapy in India is improving. Efavirenz (EFV) is a commonly used non-nucleoside reverse transcriptase inhibitor used to treat HIV infection. No information is available on the pharmacokinetics of EFV in Indian subjects. The aim of this study was to obtain information on single dose pharmacokinetics of efavirenz (EFV) in healthy Indian subjects. Methods: Sixteen adult healthy volunteers (8 males and 8 females) were administered a single oral tablet of 600 mg EFV after an overnight fast. Blood samples were collected at 1, 2, 3, 4, 5, 6, 10, 24 and 48 hours post dosing. Plasma EFV concentrations were estimated by HPLC, and certain pharmacokinetic variables were calculated. Results: Plasma EFV concentrations were higher in females than males at all the time points, the differences being significant at 1 (p<0.001) and 2 (p=0.05) hours. Females had significantly higher peak concentration (Cmax) of EFV than males (p=0.05) (3.11 & 1.90 μg/ml). The inter-individual variability in Cmax and AUC0-48 were 42 and 45% respectively. Conclusions: This study provides basic information on the pharmacokinetics of EFV in Indian subjects. Females had higher peak levels of EFV than males. Inter-subject variability was high. Further studies are necessary to describe the pharmacokinetic profile of EFV under steady state conditions in Indian patients on antiretroviral treatment

Cell-mediated immunity in chyluria

Cellular immune response to mitogens phytohemaggluthin (PHA) and poke weed mitogen (PWM) was assessed in 13 patients with chyluria and 32 healthy controls. The mean stimulation Index of the patient group was significantly lower than the control group. The degree of depression was neither related to the duration of excretion of chyle nor to the microfilaraemic status

On the occurrence of buckler crab Cryptopodia angulata in the coastal waters of India

464-467The trend of marine non-indigenous species in India has been increasing, with more than half of the species probably being introduced by shipping. A live specimen of buckler crab Cryptopodia angulata was found along the west coast of India at 40 m depth. The recent new records at different Indian coastal locations suggest that the crab is widening its distribution. Shipping is thought to be the possible introduction vector (via ballast) for the spread of C. angulata in the coastal waters of India. Further, the favorable environmental conditions prevalent in the Indian coastal waters may facilitate the establishment and subsequent spread of C. angulata. The invasion of this buckler crab may have negative impact on the native species. Although not present in detectable numbers, C. angulata may pose a major threat to the native species, if it establishes. Information on the establishment and distribution of C. angulata from other locations along the Indian coast would be essential to comprehensively and effectively address the threat

Urine levels of rifampicin & isoniazid in asymptomatic HIV-positive individuals

Background & objectives: AIDS and its associated gastrointestinal complications may impair the absorption of anti-tuberculosis (TB) drugs. Impaired absorption of anti-TB drugs could lead to low drug exposure, which might contribute to acquired drug resistance and reduced effectiveness of anti-TB treatment. The aim of this study was to obtain information on the status of absorption of rifampicin (RMP) and isoniazid (INH) in asymptomatic HIV- positive individuals, who are less immunocompromised. The D-xylose absorption test was also carried out to assess the absorptive capacity of intestive. Methods: The absorption of RMP, INH and D-xylose was studied in 15 asymptomatic HIV- positive individuals with CD4 cell counts > 350 cells/mm3 and 16 healthy volunteers, after oral administration of single doses of RMP (450 mg), INH (300 mg) and D-xylose (5 g). Urine was collected up to 8 h after drug administration. Percentage dose of the drugs and their metabolites and D-xylose excreted in urine were calculated. Results: A significant reduction in the urinary excretion of INH and D-xylose in HIV-positive persons compared to healthy volunteers was observed. The per cent dose of RMP and its metabolite, desacetyl RMP was also lower in HIV-positive persons compared to healthy volunteers, but this difference was not statistically significant. Interpretation & conclusion: Decreased urinary excretion of D-xylose and INH are suggestive of intestinal malabsorption in HIV-positive individuals. HIV infection could cause malabsorption of anti-TB drugs even at an early stage of the disease. The clinical implications of these findings need to be confirmed in larger studies