ICMR BULLETIN VOL.19-No.-8-AUGUST-1989
Item
- Title
- ICMR BULLETIN VOL.19-No.-8-AUGUST-1989
- extracted text
-
quolcate 1ssue
VoL19 No.8
August, 1989
INTRAVENOUS IMMUNOGLOBULIN THERAPY
IN THE TREATMENT OF IDIOPATHIC
THROMBOCYTOPAENIC PURPURA
Idiopathic thrombocytopaenic purpura (ITP) is a
disease characterised by a severe reduction in the
number of platelets in the peripheral blood. In most
cases, there is an autoimmune antibody mediated
process leading to the destruction of platelets, the
antibody being of IgG type. The demonstration of the
antibody is often not possible. The main presenting
features include purpura and bleeding from mucous
membranes, haematuria, haematemesis and melaena.
Intracranial haemorrhage is the most serious complica
tion that may occur, which is heralded by headache,
dizziness and confusion.
.
Diagnosis of the disease is established by finding
WWevere thrombocytopaenia with normal or increased
numbers of megakaryocytes in the bone marrow.
Steroids, immunosuppressive drugs or splenectomy
usually induce lasting remission, but some patients
remain refractory to each of these treatment modalities.
Ever since the initial report1 in 1981, of the rapid
reversal of acute and chronic thrombocytopaenia in
children by high dose intravenous immunoglobulin
(1VIG), numerous reports have appeared in literature
regarding its effectiveness in the treatment of ITP.
However, being a relatively new therapy, many aspects
of I VIG therapy are still not clearly understood. Further,
the efficacy of this mode of treatment is still not
confirmed as conflicting reports have appeared in
literature3,4. Available data on the choice of patients,
effectiveness of therapy and mechanism of action of IgG
have been reviewed in the present write-up.
Characteristics of ITP
ITP is usually associated with the occurrence of
platelet antibodies (auto- or allo-immune type and/
or of platelet bound complement (C3)1, and is
characterized by low platelet count (<30x 109/1),
bleeding disorders and perhaps by rash and petechiae. A
lowered platelet count is the result of sequestration and
lysis of antibody sensitized platelets by cells of the
reticuloendothelial system either in the spleen or liver5.
Circulating immune complexes may also be present6.
Another feature of ITP is increased megakaryopoiesis in
the bone marrow of most patients.
The acute form of ITP which is more common in
children usually occurs after viral infection and responds
to conventional treatment. The chronic form, more
frequently found in adults, is generally of autoimmune
type and sometimes resistant to all forms of treatment. It
has a female : male ratio of 2:1—4:17.
Indication for IVIG Therapy
Steroids, immunosuppressives and splenectomy are
the usual modes of treatment. Recently the use of
danazol. an androgenic preparation has been advocated8*9.
Divi si on of P ublicat i o n & Information, I C M R, N e w De I h i - 110 029
However, some patients particularly of chronic ITP do
not respond to conventional treatment. Moreover, the
long-term usage of steroids and cytotoxic drugs is not
without serious risks10. If a bleeding crisis is precipitated,
with the danger of intracranial haemorrhage pre- or
post-operatively or when a patient refractory to steroids
is to be, prepared for surgery, one may opt for I VIG
therapy2*4, in such situations.
Choice of Patients
Both children and adults with chronic/acute ITP
have been subjected to IVIG therapy1-4. Elderly patients
above 60 years of age, were also subjected to this
treatment though with not much success11. Patients with
chronic autoimmune thrombocytopaenic purpura asso
ciated with other diseases such as HIV carriage, NHL,
cancer and Wiskott-Aldrich syndrome were also given
IVIG with success1,4,12. Pregnant women with ITP have
also been treated with IVIG13.
IVIG Preparations
IgG is prepared from pooled human plasma usually
by the classical Cohn’s fractionation method14. Fraction
II which consists mainly of IgG is generally used. Titres
of IgA and IgM antibodies are maintained below 1:16 to
avoid complications similar to transfusion15. IgG
aggregates which can cause severe anaphylactic reactions
in recipients are also removed by one of several methods
available16.
Most IVIG preparations are monomeric with intact
recognition and effector functions, the subclass distri
bution, function and biological half-life of these
products are very similar to normal serum IgG.
Mode of Treatment
A dose of 0.4 g/kg body wt/day to be administered
iv for 5 days has been advocated1*3 but higher doses upto
2.4 g/kg body wt have also been administered in patients
who do not respond to low doses12. Maintenance doses,
if necessary consisted of 0.4 g/kg body wt every 1-6
weeks1.
Supplementary therapy of steroids, immuno
suppressives1 and splenectomy associated with IVIG
infusion has been reported4.
platelet bound immunoglobulin and complement4,2021.
In general, children responded better particularly those
with acute ITP and long-term response was also better in
them3.16.
Bussel and Phaml who reviewed the literature on
chronic adult ITP treated with IVIG. reported that
unmodified immunoglobulin was better than modified
one. Greater percentage of patients were refractory
among those who had ITP for more than 3 years prior to
IVIG treatment. A higher peak platelet count
immediately after IVIG infusion was correlated with a
longer duration of platelet response. Female patients
respond better to IVIG than males. Patients above 60
years of age showed weaker responses than the younger
ones. Splenectomized patients following IVIG fared
better4-18. Non responders included certain patients with
aplastic anaemia or haemolytic anaemia and adult
patients of chronic ITP1.
IgG therapy did not interfere with other treatments
and patients with malignancies continued either withe
radiotherapy or chemotherapy4.
V
Platelet function tests
Platelet function was mostly restored to normal as
measured by bleeding and clotting time2. Platelet
aggregation tests employing ADP. collagen, adrenaline
and ristocetin on platelet rich plasma were found to be
normal in most responders2#4.
Correlation between platelet antibodies and IVIG
therapy
There was no correlation between the presence of
autoantibodies and the Ig class of antibody and pattern
of response to infusion4. IgG and IgM antibodies were
detected though combination of IgM and IgG were also
found4. In certain patients an inverse relation was
observed between antibody on platelets and success of
IgG therapy2#19. Individuals with autoantibodies haw
better recovery than those with alloantibodies21. In a
patient who was a non-responder, there was a five-fold
increase in platelet antibodies after infusion4.
Serum immunoglobulin levels
Response to Treatment
Serum IgG levels showed a significant increase1*4*19
after treatment. IgA levels remained unaltered while
reports about IgM levels are contradictory34.
Clinical
Adverse Effects of IVIG Therapy
Following IVIG administration, a significant
increase in platelet count has been reported in acute as
well we chronic ITP in adults24,12,19 including pregnant*
women13, and children1,19. There was a decrease in
The usual anaphylactic reactions were not observed
in most patients1*3 though a few patients experienced
chills, headache, fever and nausea4#12. Wooduff et aPv
reported association between fatal thrombocytic event
84
and IgG therapy in patients older than 60 years with
atherosclerotic disease especially if the infused IVIG
possessed the agonist properties. Development of non-A
non-B hepatitis in several patients and haemolytic
anaemia in one patient15 has been documented after
IVIG therapy.
References:
1.
Imbach, P., Barandun, S., d’Apuzzo, V.. Baumgartner, C..
Hirt, A., Morell, A.. Rossi, E., Schoni, M., Vest, M. and
Wagner, H.P. High dose intravenous gammaglobulin for
idiopathic thrombocytopaenic purpura in childhood. Lancet i:
1228, 1981.
2.
Fehr, J., Hofmann, V. and Kappeler, U. Transient reversal of
Thrombocytopenia in idiopathic thrombocytopenic purpura
by high dose intravenous gammaglobulin. N Eng J Med 306:
1254, 1982.
3.
Bussel. J.B., Kimberly, R.P., Inman, R.D.. Schulman, I.,
Cunningham - Rundles, C.. Cheung, N.. Smithwich, E.M.,
O'Malley, J.. Barandun. S. and Hilgartner, M.W. Intravenous
Gammaglobulin treatment of chronic idiopathic thrombocyto
penic purpura. Blood 62: 480, 1983.
4.
Newland, A.C., Treleaven. J.G., Minchinton, R.M. and
Waters, A.H. High dose intravenous IgG in adults with
autoimmune thrombocytopenia. Lancet i: 84, 1983.
5.
McMillan, R. Chronic idiopathic thrombocytopenic purpura.
N. Engl J Med 304: 1135, 1981.
6.
Lurhuma, A.Z., Riccomi, H. and Masson, P.L. The
occurrence of circulating immune complexes and viral antigens
in idiopathic thrombocytopenic purpura. Clin Exp Immunol
.28: 49, 1977.
7.
McMillan, R.. Tani, P. and Mason, D. The demonstration of
antibody binding to platelet associated antigens in patients
with immune thrombocytopenic purpura. Blood 56:993, 1980.
8.
Ahn, Y.S., Harrington, W.J.. Simon. S.R.. Mylvaganam. R..
Pall, L.M. and So, A.G. Danazol for the treatment of
idiopathic thrombocytopenic purpura. N Engl J Med 308:
1396, 1983.
9.
Schreiber. A.D.. Chien. P.. Tomaski, A. and Cines. D.B.
Effect of danazol in idiopathic thrombocytopenic purpura. N
Engl J Med 316: 503. 1987.
10.
Karpatkin. S. Autoimmune thrombocytopenic purpura. Blood
56: 329; 1980.
11.
Wooduff. R.K.. Grigg. A.P., Firkin, F.C. and Smith, I.L.
Fatal thrombocytic events during treatment of autoimmune
thrombocytopenia with intravenous immunoglobulin in
elderly patients. Lancet ii: 217, 1986.
12.
Bierling, P.. Inbert, C., Wallet. P. and Duedari, N. Intravenous
plasmin treated immunoglobulin therapy in adult autoimmune
thrombocytopenic purpura (Abstract). Proc VI Asian and
Pacific Conference of Hematology. p.89. 1987.
13.
Besa, E.C.. MacNab, M.W., Solan, A.J.. Lapes, MJ. and
Marfatio, U. High dose intravenous IgG in the management of
pregnancy in women with idiopathic thrombocytopenic
purpura. Am J Hematol 18: 373, 1985.
Mechanism of Action of IVIG
Many hypotheses have been put forward for the
mechanism of action of IVIG. These include blockade of
Fc (IgG) receptors of macrophages, decreased synthesis
of antibodies and interference with the binding of
platelet specific antibodies to the target antigen.
Several workers2-4,14 have concluded that immediate
response to IVIG therapy may be due to transient
blockade of IgG-Fc receptors on the macrophages of the
reticuloendothelial system. Competitive binding and
saturation by erythrocytes coated with IgG derived from
the infusion together with the sensitized platelets affect
Pie blockade of Fc receptors on macrophages23. A role
of low affinity Fc receptors in ITP has also been
shown24.
According to Hassig16 the beneficial effect of IVIG
seen in children with acute ITP was probably due to
repletion of a selective deficiency of antibodies specific
for viral epitopes, since acute ITP at least in children,
was almost always the result of inefficient immune
response to a virus infection.
Some workers have suggested that high dose
gammaglobulin was immunomodulatory in vivo either
by alteration of the anti-idiotype network or modulation
of suppressor T-lymphocytes, thereby leading to
depressed immunoglobulin production including the
production of any platelet specific antibodies25*26. Others
have suggested that high dose gammaglobulin may
irectly interfere with the binding of platelet specific
ntibodies to the target antigens20.
(
However, Barbano et alt9 did not find any evidence
for a decrease in platelet specific antibodies in both the
adult and pediatric ITP patients undergoing an acute
response to therapy and have supported the Fc blockade
hypothesis for the short-term effect of high dose
gammaglobulin.
The guidelines for the proper use of IVIG therapy
have been provided27 in the WHO report of 1983.
At present, IgG therapy is expensive. However, with
simpler automated methods of plasma fractionation
IVIG therapy will be more cost effective and put to
widespread use.
85
Cohn. E.J., Oncley, J.L., Strong, L.E., Hughes Jr, W.L. and
Armstrong Jr., S.H. Chemical, Clinical and immunological
studies on the products of human plasma fractionation. 1. The
characterization of the protein fractions in human plasma. J
Clin Invest 23: 417, 1944.
14.
Brox, A.G. Cournoyer, D., Sternbach, M. and Spurll, G.
Hemolytic anaemia following intravenous gammaglobulin
administration. Am J Med 82(Special issue): 633, 1987.
15.
16.
Hassig, A. Intravenous immunoglobulins: Pharmacological
aspects and therapeutic use. Vox Sang 51: 10, 1986.
17.
Barandun, S., Kistler, P., Jeunet, F. and Isliker, H.
Intravenous administration of human y-globulin. Vox Sang 7:
157, 1962.
18.
Bussel, J.B. and Pham, L.C. Intravenous treatment with
gammaglobulin in adults with immune thrombocytopenic
purpura : Review of the literature. Vox Sang 52: 206, 1987.
19.
Barbano, G., Saleh, M.N., Mori, P.G., LoBuglio, A.F. and
Shaw, D.R. Effect of intravenous gammaglobulin on
circulating and platelet bound antibody in immune thrombo
cytopenia. Blood 73: 662, 1989.
20.
Winiarski, J., Kreuger, A., Ejderhamn, J. and Holm. G. High
dose intravenous IgG reduces platelet associated immuno
globulins and complement in idiopathic thrombocytopenic
purpura. Scand J Hematol 31: 342, 1983.
21.
Lee, E.J., Norris, D. and Schiffer, C.A. Intravenous immune
globulin for patients alloimmunized to random donor platelet
transfusion. Transfusion 27: 245, 1987.
22.
Workshop in the safety of intravenous immunoglobulin
preparations with respect to transmission of hepatitis and
AIDS viruses. Vox Sang 51: 253. 1986.
23.
Salama, A., Muller-Eckardt, C. and Kiefel. V, Effect of
intravenous immunoglobulin in immune thrombocytopenia.
Lancet ii: 193. 1983.
24.
Clarkson, S.B., Bussel, J.B., Kimberly, R.P., Valinsky, J.E.,
Nachman, R.L. and Unkeless. J.C. Treatment of refractory
immune thrombocytopenic purpura with an anti-Fcy-receptor
antibody. N Engl J Med 314: 1236, 1986.
25.
Delfraissy. J.F.. Tchernia. G., Laurian, Y., Wallon. C..
Galanaud. P. and Dormont, J. Suppressor cell function after
intravenous gammaglobulin treatment in adult chronic
idiopathic thrombocytopenic purpura. Br J Hematol 60: 315.
1985.
26.
Dammaco, F., lodice, G. and Campobasso, N. Treatment of
adult patients with idiopathic thrombocytopenic purpura with
Intravenous immunoglobulins: Effects on circulating T cell
subsets and PWM - induced antibody synthesis in vitro. Br J
Hematol 62: 125, 1986.
•
27.
IUIS/WHO Notice. Appropriate uses of human immuno
globulin in clinical practice. Clin Exp Immunol 52:417, 1983.
This write-up is based on an article entitled “Intravenous immunoglobulin
therapy- An alternate approach in the treatment of idiopathic thrombocytopaenic purpura”, by P Sharma. published in Immunohaematology Bulletin.
19(2)-1988.
ABSTRACTS
Some Projects completed Recently
B Cell alloantigen markers in patients with rheumatic
fever and rheumatic heart disease.
The study was undertaken on 208 patients of
rheumatic heart disease (RHD) of both sexes and 156
matched controls representing north Indian population
to clarify the role of genetic susceptibility to rheumatic
fever (RF)/RHD following streptococcal pharyngitis.
Of the 208 RHD patients, 60 were typed for 883*
alloantigen, 50 for 256* alloantigen and 98 for D 8/17
alloantigen. Out of 156 controls 50, 50 and 56
individuals were typed for 883*, 256* and D 8/17
alloantigens respectively.
Frequencies of B cell alloantigens 883* and 256*
were found to be 66.6 per cent (40 of 60) and 20 per cent
(10 of 50) respectively in RHD patients as compared to
12 per cent (6 of 50) and 8 per cent (4 of 50) respectively
in controls. Sixty three (64.2%) of the 98 RHD patients
were positive for alloantigen D8/17 as compared to 10.7
86
per cent (6 of 56) of the controls. Positivity for D8 17
alloantigen increased with age, both in RHD patients
and controls, upto the fifth decade, thereafter it declined.
Of the three B cell alloantigens. the high predicti®
value of genetic markers 883 and D8/17 is of interest
and provides evidence for the value of B cell alloantigens
as genetic determinants for disease associations. This
study revealed that the relative risk of developing RF
and subsequently RHD in north Indian individuals
bearing D 8/17 marker is approximately 9 per cent of
the normal population.
P.L. Wahi
Department of Cardiology
Postgraduate Institute of
Medical Education &
Research
Chandigarh.
Role of mycobacterial RNA in immunoprophylaxis of
experimental tuberculosis.
The present investigation was carried out to
examine the role and mechanism of action of RNA
isolated from Mycobacterium tuberculosis H37Ra and its
different fractions in inducing immune responses (both
humoral and cell mediated), as also antituberculous
protection.
Whole mycobacterial RNA was isolated with low
protein and DNA as contaminants; the ratio of protein
and RNA and DNA and RNA being 1:7.19 and 1:67.72
respectively. RNA was fractioned over sepharose CL4/B and out of 3 fractions (Fi, F2 and F3) Fi constituted
the major part of the RNA. Fi and F2 fractions had
comparable immunoreactivity while that of F3 was low
significantly higher litre (P<0.01) of RNA antibodies
could be detected during the second weak post
immunization. However, significant cellular immune
responses were observed which were directed specifically
against mycobacterial RNA. Immunized mice exhibited
a significant level of protection against challenge with
LD50 dose of M. tuberculosis H37Rv on the basis of per
cent survival, lung density, root specific lung weight and
viable counts in different organs. The protection induced
by RNA-F1A complex was comparable to that of BCG,
except that BCG vaccinated mice revealed a greater
decrease or clearance of bacterial load. Further,
protection was found to be mediated by immunocompe
tent T-cells, while the role of immune sera in imparting
protection was minimal.
P. Kapur
G.K. Khuller
Department of Biochemistry
Postgraduate Institute of
Medical Education & Research
Chandigarh.
Mycobacterial RNA was complexed with Freunds
incomplete adjuvant (FIA) in the ratio of 1:3 and
administered to mice at the dose of 150 ug per mouse.
GNA-FIA complexes elicited weak humoral response
which could only be detected by ELISA. But a
ICMR NEWS
The following meetings of various Scientific
Advisory Committees/Expert Groups/Project Review
Committees/Scientific Advisory Groups/Task Forces of
the Council were held during the month:
Meetings of the Scientific Advisory Committees (SACs)
of the Permanent Institutes/Centres:
SAC of the Institute for
Research in Reproduction,
Bombay.
August 21-22, 1989
(at Bombay)
SAC of the ICMR Genetic
Medical Research Centre,
August 22, 1989
(at Bombay)
Gombay
Meetings of the Expert Groups (EGs)/Project Review
Committee (PRC)/Task Force (TF)/Scientific Advisory
Groups (SAGs), held at New Delhi:
EG on Longitudinal Study of
Haematological and Clinical
Profile of People Infected
with AIDS Virus.
August 7, 1989
PRC on Virology and HIV
infection.
August 8, 1989
EG on Indian Journal of
Medical Research.
August 8, 1989
TF on Venoms and Toxins
August 9, 1989
SAG of the Division of NonCommunicable Diseases.
August 28-29, 1989
SAG of the Division of
Human Resources Develop- .
ment Research.
August 30-31, 1989
Participation of ICMR Scientists in Scientific Events:
Dr. B. Ravindran, Senior Research Officer,
Regional Medical Research Centre, Bhubaneswar and
Dr. M.M. Mehta, Research Officer, Institute of
Immunohaematology, Bombay, participated in the VII
International Congress of Immunology, at West Berlin
(July 30 to August 5, 1989).
Dr. B.K. Tyagi, Senior Research Officer, Desert
Medicine Research Centre, Jodhpur, participated in the
X International Symposium of Odonatology, at
Johnson City, USA (August 6-12, 1989).
Dr. A.S. Paintai, Director-General, ICMR, delivered
the eighth Prof. V. Ramakrishna Memorial Lecture on
“Evaluation of Work by Scientists", at the Indian
Institute of Technology, New Delhi (August 10, 1989).
Dr. Mehtab S. Bamji, Director Grade Scientist,
National Institute of Nutrition, Hyderabad, participated
in the V International Congress of the Federation of
Asian and Oceanian Biochemists, at Seoul (August 1318, 1989). She also participated in a symposium on New
. .. ...
- CELL
COMM!’’ "E
326. V Main. 1 Block
Koramingila
p/
Bancov. 5 r1
Indis
87
Trends in Biological Chemistry, at Nagoya, Japan
(August 22-23, 1989).
Five Scientists of National Institute of Nutrition,
Hyderabad, viz Dr. Vinodini Reddy, Director; Dr. K.
Krishnaswamy, Dy. Director, Dr. Gafoorunissa and Dr.
K. Satyanarayana, Asstt. Directors; and Dr. V.
Jagadeesan, Sr. Research Officer, participated in the
XIV International Congress of Nutrition, at Seoul
(August 20-25, 1989).
Sh. B. Bhattacharya, Financial Adviser, ICMR,
relinquished his charge to take over as Joint Secretary
(Finance), Ministry of Urban Development on August
11, 1989. On the same day Sh. P.B. Saxena took over as
the Financial Adviser of the ICMR.
**♦
***
***
The Council’s Desert Medicine Research Centre at
Jodhpur has been renamed as Regional Medical
Research Centre.
ICMR AIDED SYMPOSIA/SEMINARS/WORKSHOPS/COURSES/CONFERENCES
Sy mposium/ Seminar/ Workshop/
Course/Conference
Date & Place
Contact Address
National Conference on Recent Trends in
Physical Chemistry.
August 2-3. 1989;
Calcutta
Dr. R.V. Gopala Rao, Department of Chemistry,
Jadavpur University, Calcutta.
Continuing Medical Education Programme
on Rheumatology Update.
August 12-13, 1989;
Hyderabad
Dr. Kakarla Subbarao, Director, The Nizam’s Instig
lute of Medical Sciences, Hyderabad.
"
VII IMA/CGP National Conference on
General Practice.
August 18-20, 1989;
Varanasi
Dr. S.P. Gupta. Organising Secretary, 7th IMA/
CGP National Conference. IMA House. 7/31,
Chetganj. Varanasi.
National Seminar on Strategies for Optimal
Management of Cancer in Developing Coun
tries.
August 24-27, 1989;
Srinagar
Dr. Shad S. Akhter. Department of Medical Onco
logy, Sher-I-Kashmir Institute of Medical Sciences,
Srinagar.
V National Conference on Aerobiology.
August 28 to September,1.1989;
Srinagar
Dr. A.H. Munshi, Department of Botany, Univer
sity of Kashmir, Srinagar.
National Seminar on Newer Challenges in
Medicine.
September 9-10, 1989;
Jabalpur
Dr. B.N. Shrivastava, Professor & Head, Depart
ment of Medicine., and Dean, Medical College,
Jabalpur, Jabalpur.
Symposium on Early Breast Cancer, and
Workshops on Laser in Cancer Surgery; and
Epidemiology of oral cancer.
September 9-10, 1989;
Indore
Dr. S.K. Shukla, Organizing Secretary, VI National
Cancer Convention, M.G.M. Medical College,
Indore.
XV Mid Term Conference of Indian Associa
tion of Paediatric Surgeons.
September 28-30, 1989;
Srinagar
Dr. Mahmooda Khan, Professor & Head, Depart
ment of Surgery, Government Medical College,
Srinagar.
Seminar on New Trends in Methodology for
Social and Population Research.
October 1-3, 1989;
Tirupati
Prof. K. Mahadevan, Department of Population
Studies, S.V. University, Tirupati.
National Workshop on Burns Injuries and
their Sequele.
October 7-8, 1989;
Chandigarh
Dr. C.P. Sawhney, Professor & Head, Department
of Plastic Surgery. Postgraduate Institute of Medi
cal Education and Research, Chandigarh.
XVI Annual Conference of Indian Immuno
logy Society and Symposium on Tropical
Immunology.
October 12-14, 1989;
Sevagram
Dr. B.C. Harinath. Professor & Head, Department
of Biochemistry, Mahatma Gandhi Institute
Medical Sciences, Sevagram, Wardha.
Symposium on Reproductive Biology and
Fertility Control.
October 12-14, 1989;
Imphal
Dr. B.K. Omar. Professor & Head, Department
Anatomy, and Secretary, Anatomical Society of
India, Regional Medical College, Imphal.
Symposium on Respiratory Allergy and
Applied Immunology.
October 14-16, 1989;
Hyderabad
Dr. M. Sundaramma, Professor & Chest Physician,
Osmania Medical College and A.P. Chest Hospital.
Hyderabad.
XXII Annual Convention of the Indian
Dietetic Association.
October 19-20, 1989;
Hyderabad
Dr. Indira Ray. Reader. Home & Social Science
Department, Calcutta University. Calcutta.
88
Sy mposium / Seminar/ Workshop/
Course/Conference
Contact Address
Date & Place
Brachytherapy Workshop for Cancer Cervix.
November, 1989;
Betul (M.P.)
Dr. Anand Vijay Kumar, Secretary, Paramedical
Section, Christian Medical Association of India,
Smruti Theatre Compound, Nagpur.
All India Symposium on Biophysics of Cell
Structure and Function.
November 6-8, 1989;
Chandigarh
Dr. P.C. Mangai, Chairman, Department of BioPhysics, Punjab University. Chandigarh.
Seminar on Zoonoses.
November 9-10, 1989;
Dibrugarh
Dr. L.P. Datta, Director, Regional Medical Research
Centre (ICMR), P.B. No. 105, Dibrugarh.
XVI Biennial Conference of the Indian Asso
ciation of Leprologists.
November 9-12, 1989;
Trichur
Dr. P. Vijay Shanker, Damien Institute,
Ayyappankavu, Trichur.
Seminar on Pathology of Cardiomyopathies.
November 11, 1989;
Bhubaneswar
Professor L.N. Mohapatra, Convenor, Indian Asso
ciation of Pathologists and Microbiologists (Orissa
Chapter) and Director, Regional Medical Research
Centre (ICMR), Bhubaneswar.
Conference on Health Care for the Villagers •
and Urban Slums.
November 23-25, 1989;
Calcutta
Dr. Ashok Sahani, Professor & Hony. Executive
Director, Indian Society of Health Administrators,
104 (13/37), Cambridge Road Cross, Ulsoor,
Bangalore.
National Seminar on Squint and Amblyopia.
Novemer 25-27, 1989;
New Delhi
Dr. Vimla Menon, Dr. Rajendra Prasad Centre for
Ophthalmic Sciences, All India Institute of Medical
Sciences, New Delhi.
All India Symposium on Reproductive Bio
logy and General Endocrinology.
November 26-28, 1989;
Baroda
Prof. P.M. Ambedkar, Department of Zoology,
M.S. University of Baroda, Baroda.
Workshop on Recent Advances in Intensive
Care.
November 26-30, 1989;
New Delhi
Dr. H.K. Kaul, Professor & Head, Department of
Anaesthesiology, All India Institute of Medical
Sciences, New Delhi.
XXXIII All India Obstetric and Gynaecologi
cal Congress.
December 28-30, 1989;
Patna
Dr. J. Mishra, Department of Obstetrics and Gynae
cology, Hospital for Women, Patna Medical College
Hospital, Patna.
Seminar on Indian Speech, Language and
Hearing Tests - the proposed IS HA battery.
February 8-9, 1990;
New Delhi
Dr. S.K. Kacker, Professor & Head, Department of
Otorhinolaryngology, All India Institute of Medical
Sciences, New Delhi.
COUNCIL’S TRAINING PROGRAMMES
Leprosy
Endocrinology
At the Central Jalma Institute for Leprosy, Agra:
At the National Institute of Nutrition, Hyderabad:
...
Training Course on Leprosy for Medical Officers
(August/September, 1989).
Annual Training Course on Endocrinological Tech
niques and their Application (August/September,
1989).
Virology
At the National Institute of Virology, Pune:
...
Short-term Course on Detection and Isolation of
Arboviruses Using Mosquito Inoculation and Mos
quito Cell Culture (October, 1989).
Nutrition
At the National Institute of Nutrition, Hyderabad:
Annual Certificate Course in Nutrition (December
1, 1989 to February 28, 1990).
89
Occupational Health
Haematology
At the National Institute of Occupational Health,
Ahmedabad:
At the Institute of Immunohaematology, Bombay:
Refresher Course for Industrial/ESIS Medical Offi
cers (October 9-14, 1989).
Training Course on Disaster Management of
Hazarduous Chemicals in Industry for Industrial
Physicians, Chemists, Safety Officers, Hygienists
(November 6-10, 1989).
Training Course in Blood Banking Technology and
Immunohaematology for Medical Officers (August
1 to September 30, 1989).
Laboratory Animal Technology
At the Laboratory Animal Information Service Centre,
National Institute of Nutrition, Hyderabad:
Training Course for Laboratory Animal Super
visors (September 1 to November 30, 1989).
Cytology
At the Institute of Cytology and Preventive Oncology,
New Delhi:
Indo-US Workshop on Chemoprevention of the
Uterine Cervical Dysplasia with Nutrient Inter
vention (December, 1989).
Clinical Pharmacology
At the Seth G.S. Medical College, Bombay:
Training Course in Clinical Pharmacology (Novem
ber/December, 1989).
EDITORIAL BOARD
Chairman
Dr. A.S. Paintai
Director-General
Chief, Publications
Dr. G.V. Satyavati
Members
Dr. Usha K. Luthra
Dr. Badri N. Saxena
Dr. S.P. Tripathy
Editor
Dr. N. Medappa
Printed and Published by Shri G.P. Kulshreshth for the Indian Council of Medical Research, New Delhi
at the ICMR Offset Press, New Delhi
R.N. 21813/71
Position: 1458 (20 views)