Rheumatic fever prophylaxis in South Africa - is bicillin 1,2 million units every 4 weeks appropriate?

Rheumatic fever is a major health problem in South Africa. Although intramuscular benzathine penicillin (bicillin) 1,2 million units (MU) every 4 weeks is widely used for secondary prophylaxis, studies in other countries have shown a recurrence rate of 3 - 8% over 5 - 6 years in patients on this regimen. It has been recommended that serum penicillin concentrations should be maintained above 0,02 mg/ml to prevent such recurrences. The World Health Organisation (WHO) and the American Heart Association have recommended since 1988 that patients in high-risk areas for the development of rheumatic fever should receive benzathine penicillin 1,2 MU every 3 weeks rather than every 4.The aims of this study were, firstly, to determine the prevalence of serum penicillin concentrations below 0,02 μg/ml in rheumatic fever patients on benzathine penicillin 1,2 MU 4-weekly and, secondly, to study the effect of increasing the dose to 1,8 MU 4-weekly in patients with subtherapeutic concentrations.Forty-five of 51 rheumatic fever patients (88%) in this study on benzathine penicillin 1,2 MU 4-weekly had low serum penicillin concentrations (< 0,02 μg/ml) at the end of the 4th week after the injection. Penicillin was detected in the urine of 30 of the 45 patients (67%) with low concentrations, suggesting that such patients have tissue   bound penicillin which might be important in preventing rheumatic fever. The 15 patients (33%) with subtherapeutic serum penicillin concentrations and no detectable penicillin in the urine could be at very high risk for recurrent attacks of rheumatic fever.Fourteen of 29 patients (48%) given the higher dose of benzathine penicillin (1,8 MU 4-weekly) had subtherapeutic serum penicillin concentrations at the end of the 4th week after the injection, but in all 29 penicillin was detected in the urine.Review of our present policy of secondary prophylaxis for rheumatic fever is necessary. Concentrated preparations of benzathine penicillin (600 000 U/ml) are not available in South Africa; administration of a higher dose (1,8 MU) 4-weekly would therefore require a double injection, which could affect compliance adversely. We recommend that rheumatic fever patients in our area should receive benzathine penicillin 1,2 MU 3-weekly as recommended by the WHO until strategies for secondary prophylaxis have been evaluated further

Preliminary characterisation of gonad inhibiting hormone (GIH) gene and its expression pattern during vitellogenesis in giant tiger shrimp, Penaeus monodon Fabricius, 1798

Farming of giant tiger shrimp is one of the most important and relatively recent coastal food production sectors in India. Although great strides have been made in shrimp husbandry practices in growout systems, management of reproduction in captivity has not kept pace. Although several hormones are involved in crustacean reproduction, the inhibitory effect of gonad inhibiting hormone (GIH) is thought to be more intense than any other hormones. As an essential component of understanding the reproduction of Penaeus monodon, we characterised the expression pattern of GIH gene in the sinus gland in relation to the female gametogenic cycle. A 633 bp sequence was cloned from the eyestalk of P. monodon by RT PCR. The sequence comprises an open reading frame (ORF) of 291 bp that encodes a protein of 96 amino acids. The deduced protein was used to search the GenBank database using BlastP. Protein alignment with all known crustacean GIH revealed that homology of P. monodon GIH shares 61, 48, 46, 46 and 35% identity with Metapenaeus ensis, Nephrops norvegicus, Homarus americanus, Rimicaris kairei and Armadillidium vulgarae respectively. The RT PCR analysis shows that GIH mRNA is expressed mainly in the eyestalk of female. In order to find the expression profile of GIH during different reproductive cycle, P. monodon female was categorised into four major stages of maturation, using light microscopical observations as well as morphological characteristics. Eyestalk of all animals from different stages of maturation indicated that GIH is expressed in all stages of maturation, although the expression of GIH mRNA changes during different stages of vitellogenesis. In animals with immature ovary, the relative GIH mRNA level was found to be less, which peaked in previtellogenic phase and diminished in subsequent phases. Low GIH mRNA level during the immature (oogonial) phase is particularly intriguing and has application in the commercial aquaculture to select the brooder

DNA sequence information resolves taxonomic ambiguity of the common mud crab species (Genus Scylla) in Indian waters

For several years, mud crabs of genus Scylla have been misidentified owing to their high morphological plasticity and the absence of distinct morphological diagnostic characters. The taxonomic confusion of genus Scylla de Haan is considered to be a primary constraint to the development of aquaculture. Although genus Scylla was revised using morphological and genetic characteristics, taxonomy of Scylla species occurring in India is still not clear. In this study, partial sequences of two mitochondrial genes, 16S rRNA and CO1 (Cytochrome C oxidase subunit I) in populations of Scylla spp. obtained from eleven locations along the Indian coast were used to differentiate and resolve taxonomical ambiguity of the mud crab species in India. The sequences were compared with previously published sequences of Scylla spp. Both trees generated based on 16S rRNA and CO1 indicated that all S. tranquebarica morphotypes obtained during this study and S. tranquebarica sequences submitted previously from Indian waters reciprocally monophyletic with reference sequence of S. serrata. Both sequence data and morphological characters revealed that the species S. serrata (Forskal) is the most abundant followed by S. olivacea. Further, the 16S rRNA and COI haplotypes of Indian S. tranquebarica obtained in the study significantly differed with the known S. tranquebarica by 6.7% and 10.6% respectively whereas it differed with known S. serrata by 0.0–0.7% only, a difference that was not statistically significant. From these studies it is clear that ‘‘S. tranquebarica’’ commonly reported from India should be S. serrata (Forskal)

A rare case of pigmented villonodular synovitis after unicompartmental knee replacement: a case report

Pigmented villonodular synovitis is a benign proliferative disease involving the synovium. Pigmented villonodular synovitis is rare after replacement arthroplasty and has not been recognised and reported as a cause of failure of unicompartmental knee replacement in the literature

Theories and Practices of Hurkiya Theatre in

ABSTRACT The present paper is an effort to analyze Uttarakhand's HURKIYA THEATRE in the light of traditional concepts, theories and practices, vis a vis the culture of hill state in which thi

Theories and Practices of Beda Theatre in Uttarakhand

ABSTRACT Radhkhandi Raas by Beda Wome