ICMR BULLETIN VOL. 26-No.-2-FEBRUARY-1996.pdf
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ISSN 0377-4910
NEURITIC LEPROSY
Leprosy is a chronic disease which mainly aSects skin
and nerves. The outcome of infection depends upon the cell
mediated immunity (CMI) of the host. Individuals with
adequate cellular immunity develop tuberculoid disease
while those who lack this get lepromatous disease with
varied system organ affection. In most instances, it has been
considered that the skin is the primary site of invasion with
secondary centripetal spread into the nerves, the pathology
stopping short at the dorsal nerve root ganglion. However,
in many individuals, the infection primarily afiects the
nerves with resultant initial lesion inside one or more of
the nerves bundles. Thus, at least for some time, these
patients have nerve involvement without obvious primary
skin lesions. The type ofdisease where.patients have clinical
evidence of nerve deficit and involvement in the form of
nerve thickening with or without tenderness but without
signs of skin inflammation or historical evidence of having
had a skin lesion is termed 'neuritic* or 'polyneuritic，
leprosy.
The very existence of this form of leprosy has been
debated by many workers in the field who were of the the
view that these patients must h&ve had initial skin lesion
which over the years may have regressed. In recent years,
there has been a rsurgence of interest in this type of disease
since the number of these patients is not insignificant.
Among the south Indian population, their proportion has
been reported to be as high as one sixth of all leprosy
patients with the number increasing with age1. Among the
self reporting patients, workers from Bombay have reported
that of the 11581 patients registered at Acworth Leprosy
Hospital in 2 years, 4.3 per cent had neuritic leprosy2. In
a retrospective study among army personnel 10.7 per cent
of all patients with paucibacillary leprosy seen in an in
stitution, were ofneuritic type3. Though, there is a complete
lack of epidemiological information from other centres or
parts of the world, it is mentioned that pure neural leprosy
occurs in under one per cent of black patients in Africa4.
Clinic based observations at the Central JALMA Institute
for Leprosy (CJIL), Agra, suggest that among the self
reporting cases, about 6 per cent patients have this type
of disease (unpublished observations). A recent report also
indicates occurrence of neuritic type of disease among
experimentally infected monkeys5.
It is, thus, clear that neuritic type of disease occurs
frequently yet till recently these patients had not been
studied in detail. Apart from a few case reports6^, pub
lished information is limited. Of the available reports, two
are from south India9,10, one from Bombay11 and one from
north India12. Whereas the studies from south India9-10 and
Bombay11 have focussed on the classification and the
diagnostic value of nerve histology in neuritic leprosy
respectively, studies from CJIL, in addition have brought
out* the clinical and immunological profile of disease,
determination of parameters, if any, that can indicate the
severity of disease12 and also the course of this type of
leprosy under specific .chemotherapy.
Division of P u b 1 i ca t i o n. & Information, I C M R, New Delhi -'110()7.
The first series studied in south India consisted of
17 patients with clinical evidence ofneuritic leprosy9. Jacob
and Mathai10 in their work on diagnostic value of nerve
biopsy in neuritic leprosy, studied 77 patients of peripheral
neuropathy who did not have skin lesions, positive skin
smears fbr acid fast bacilli (AFB) or skin histology con
sistent with leprosy. Researchers from Bombay11 on the
other hand had 12 selected patients with thickened nerves
for their histopathological investigation. The CJIL study
was on 108 consecutive untreated patients with neuritic
leprosy, who in addition to having some evidence of nerve
deficit, had definite nerve thickening of one or more nerves
but no evidence of any skin lesion or history of any skin
patch in the past12.
The age range and sex .distribution of patients with
neuropathy in the above reports is shown in Table I. The
findings clearly indicate that the disease afiects males more
than females and it is in the 20 to 40 years age group that
the disease manifests more frequently.
Table L
in other types of peripheral neuropathy. Symptoms in the
form of abnormal sensations (paraesthesia), were the pre
senting features in a quarter of patients. Two patients of
neuritic leprosy have been reported to present with initial
symptoms of acute neurologic pain in the distribution of
trigeminal nerve1
Eighteen per cent patients came with
deformities, whereas only 5 per cent jpresented with pain
in the nerve trunks. Several of the patients had more than
one presenting symptom.
The extent and pumber of clinically involved nerves
vary among neuritic patients. It is seen from Table II that
in all the studies more than 40 per cent patients had
thickening of only one nerve and almost 50 to 55 per cent
of patients of neuritic leprosy had thickening of multiple
nerves. In a significant proportion, this thickening ofmultiple
nerves was symmetrical and was associated with peripheral
sensory deficit.
Table IL Nerve involvement in patients with peripheral
neuropathy
Age range and sex distribution of patients with
peripheral neuropathy
Pannikar
et aP
Age (years)
Mean
Pannikar et aP
Range
All adults
Male
Female Tot^i
15
2
17
Uplekar and Antia11
15-55
11
1
12
•Jacob and Mathai10
16-60 •
57
20
77
8-65
102
6
108
Kaur et aln
37.19
±11.3
•Several patients with peripheral neuropathy due to other causes also
included.
Superscript numbers refer to the serial number in the list of refer•ences.
As with other types of leprosy, most of the patients
remain asymptomatic and hence there is a tendency to
ignore the sensory deficit. Thus, by the time the patient is
detected in the field or reports to the clinic, a significant
delay in time occurs. In the CJIL study, - on untreated
patients, the mean duration of illness, at the time of pre
sentation was 29±31 months. Some patients, however,
present much earlier, specially, if they have problems like
nerve pain and/or suddenly appearing deformities which
could be paralytic or secondary to sensory loss. It was
observed by CJIL workers that 85 per cent patients pre
sented with only sensory impairment. This loss of senory
perception ranged from localized impairment to glove and
stocking type of sensory deficit, similar to what is observed
14
Uplekar
and
Antia11
Kaur
et aZ12
Jacob*and
Mathai1*
No. of patients
Only one nerve
thickened
6
10
49
Mononeuritic
multiplex 25
Multiple nerve
thickening
7
2*
59”
Distal poly
neuropathy 48
No nerve
thickening
4
-
一
Motor.
neuropathy 5
•One patient had 2 and another multiple nerve thickening.
••Localized and asymmetrical in 42 and symmetrical in 17.
In all the reports, the ulnar and common peroneal were
two most frequently affected nerves, similar to what is
observed in patients across the leprosy spectrum. Though
these are the nerves usually examined in patients、the
problem is in the confirmation of diagnosis as biopsying
these nerves is not without the hazard of causing motor
deformities and/or increased sensory deficit.
One ofthe important features ofneuntic leprosy is skin
smear negativity. Response to lepromin has been studied
witii the aim of delineating the CMI status of these patients.
In our series12 using Dharmendra antigen, approximately
50 per cent of the patients showed positive response after
24 to 48 hours. A similar venation was found in leucocyte
migration inhibition test (LMIT) using Dharmendra antigen
sonicates. Both lepromin and LMIT response showed no
correlation with the extent of disease as measured in terms
of the number and distribution of affected nerves. Similar
observations had earlier been reported with regard to
lepromin response and M. leprae induced lymphocyte
blastogenesis14. Three weeks response to Mitsuda antigen
has also been studied. A higher positivity using this reagent
has been found by some workers possibly becuase of a
higher proportion of patients with single nerve afifection9,11.
Nerve conduction studies undertaken in neuritic pa
tients, have shown that the affected nerves have abnormally
slow conduction velocities and low compound motor action
potentials, suggesting axonal degeneration, as has been
observed in other sensory/motor neuropathies4.
The most important investigation in patients with
neuritic leprosy is the histology of the affected nerves. In
all the studies where thickened nerves were taken for
histological assessment, almost all patients showed definite
evidence of leprosy; the entire leprosy spectrum having
been observed in the nerves (Table III). It is seen from
the table that a significant proportion of patients show
Tabic III. Nerve involvement in patients with neuritic leprosy
No. of Leprosy TT/
nerves confir BT
biopsied
med
BB
BL/
LL
I
Non- AFB
specific posi
tive
6
一
5
10
Pannikar
et aP
17*
11
一
Uplekar
and Antia11
12f
12
9
Jacob and
Mathai10
77**
38
10
10
7
11
18
Kaur
et aln
39***
34
10
14
10
0
36
More significant is the observation of finding of AFB
in the nerves in practically all patients of neuritic disease.
The bacilli were found in large numbers in almost half the
patients. In contrast, none of the skin biopsies taken from
areas with sensory deficit showed any histological abnor
malities and presence of AFB.
All the available reports thus, indicate that in a very
large proportion of patients with thickened nerves, the
diagnosis of leprosy can be confirmed if nerve biopsy is
done. Conversely, it is also evident that there is a fair
amount of certainty in diagnosis of leprosy on the basis
of the neural deficit together with clinical thickening of
nerve. CJIL figures show that of 39 nerve biopsies taken,
34 had unequivocal evidence and classifiable leprosy within
the nerve12? Of the remaining 5, two showed AFB despite
the absence ofspecific infiltrate again suggestive of leprous
infection. In only 3 was the histology normal in spite of
the nerves being thick. Even here, it is possible that either
the site chosen was not proper or the affected fasicles were
missed. Similar concurrence has been reported between
clinical findings and histology by others also911.
To find whether clinically observed differences in the
number and distribution of nerve involvement,
symptomatology and/or immune status ofpatients give.any
indication of underlying severity or spectral classification
the data were analysed accordingly. The CJIL findings
(Table IV) reveal that no parameter other than histology
helps in grading the severity of these patients because even
3tt
♦Only radial cutaneous nerve biopsied.
fAfiected nerves.
••Regional cutaneous nierves (whether thick or not) taken.
* ••Affected thickened cutaneous neryes biopsied.
ff2 showed upgrading reaction.
lepromatous histology. Detailed analysis of results of the
above studies revealed that even when patients have just
one thickened nerve, finding of lepromatous morphology
(BL/LL) in the nerve is not uncommon. In addition to these
reports, lepromatous histology in nerve biopsies from pure
neuritic patients has earlier also been reported15. Results
of Uplekar and Antia11 showed that in the majority, the
histology was towards the tuberculoid pole. In this series
10 of the 12 patients had only one affected nerve.
Tabic IV. Clinical vs histological classificatidn of patients with
neuritic leprosy
CLASSIFICATION
No. of
patients
biopsied
I
TT/BT
BL/LL
Norma!/
Regressed
I
14
5
3
6
3(2，)
n
m
13
2
5
3
0
5
1
1
2
1
IV
7
2
1
3
1
Group
Groups indicate number of nerves affected and their distribution.
I-only one nerve thickened, H-two or more nerves thickened but
localized to one.part. HI-lwo or more nerves thickened, distant but
asymmetrical. IV-multiple and symmetrical nerve thickening.
♦Occasional AFB present but without any tissue reaction.
AFB contcnl-few in 12, several in 10 and numerous in 14.
15
when only one nerve was thickened, 40 per cent patients
had BULL histology with several having &ir amount of
bacteria. The converse was also seen. In patients with
thickening of multiple symmetrically placed nerves, inde
terminate or Tf/BT histology was not uncommon and so
was lepromin and/or LMIT positivity. Thus, in the absence
of any dear clinical criteria to split this group into pauciand multib衣illary categories, it seems appropriate to
maintain the neuiitic type as a separate entity for purposes
of management.
In the National Leprosy Eradication Programme,
patients belonging to this class of leprosy have been in
cluded in the paucibacillary group based on the
observations that all these patients are skin smear negative,
many are lepromin (Mitsuda) positive and in several earlier
case reports, nerve histology showed tuberculoid picture6,7.
However, it may be more appropriate to include these
patients in the multibacillary group rather than group them
with paucibacillary patients as more thM 90 per cent of
patients with neuritic leprosy have demonstrable, bacilli.
Further, more than half the patients have significant bac
terial load as revealed in the biopsy sections. An argument
against this could be that even though bacilli are seen in
the nerve biopsies, the total number of organisms within
the whole body may still be small. But with the revised
definition of paucibacillary leprosy16 it is to be seen
whether neuiitic patients have a total load less than that
in 1+ or 2+ positive patients. Ah earlier work iii this regara
may also be significant, wherin it has been shown that
distant uninvolved nerves, too, show evidence of disease17.
Follow up studies have also been done to assess the
course of these patients under treatment. In the study by
Paimikar et aP, 4 of 17 patients under a two year follow
up showed skin lesions. These lesions were clinically clas
sified as tuberculoid and borderline tuberculoid type,
although 2 of them had been classified as BL and 2 as
indeterminate on nerve histology. Two of the 12 patients
in the series reported by Uplekar and Antia11 likewise
developed skin lesions after. 3 and 3 1/2 months of MDT.
Observations of workers at the CJIL, Agra, on a series of
another 40 patients observed for over 3 and a half years
indicate that about 35 per cent of neuritic patients develop
skin lesions of mostly BT leprosy (unpublished observa
tions). Further, in the CJIL study on evolution of disease,
it has been found that almost two-thirds of patients with
suspicious disease pass through a short lived phase of
neuritic disease before developing skin manifestations18.
Talwar et aP also came across 8 patients (among 62) who
after 2.6 to 3 months of the start of treatment developed
cutaneous lesions. In 7 patients the lesions were I, TT or
16
BT while one had BL leprosy. In addition, few otiicr case
reports139 of similar transition are also available in litera
ture. A possible explanation for this could be that under
specific treatment, some patients undergo reversal reactions
and shift towards the tuberculoid pole, in the process any
skin site which has the, antigen develops the lesions.
In conclusion, neuritic leprosy which is a defined type
of leprosy occurs in a significant proportion of patients and
. in some patients evolves into typical spectral disease. There
is a need to critically review the subjects from treatment
point ofview as these patients have a rather large but hidden
load of bacilli, irrespective of the fact whether there is one
or multiple nerve affection.
References:
1.
Noordeen, S.K. Epidemiology of (poly) neuritic type of leprosy.
Lepr India 44: 90, 1972.
2.
Dongre, V.V., Ganapati, R. and Chulawala, R.G. A study of
mono-neuritic lesions in a leprosy clinic. Lepr India 48: 132,
1976.
3.
Talwar, S.» Jha, P.K. and Tiwari, V.D. Neuritic leprosy:
epidemiology and therapeutic responsiveness. LeprRev 63:263,
4992.
4.
Mafbyane, N.A., Jacyk, W.K. and Lotz, B.P. Primary neuritic
leprosy in a black South-Afncan. Lepr Rev 63: 277, 1992.
5.
Gormtis, B.J., Xu,K.» Baskin, G.B., Martin, L.M., Bohm, R.P.,
Blanchard, J.L., Mack, P.A., Ratterree, M.S., McClure, H.M.,
Meyers, W.M. and Walsh, G.P. Experimental leprosy in
monkeys. I： Sooty mangabey monkeys: transmission,
susceptibility, clinical and pathological findings. Lepr feev 66\
96, 1995.
6.
\ Jopling, W.H. and Morgan-Hughes, J. A., Pure neural tuberculoid
■ leprosy. Br Med J ii: 799, 1965.
7.
Dharmendra, Ramanujam, K. and Ramu, G. Pure polyneuritic
leprosy of tuberculoid type. Lepr India 38: 152, 1966.
8.
Chand i, S.M. Studies on the pathology ofleprous neuritis. Ph.D.
Thesis. Madras University, Madras, 1984.
9.
Pannikar, V.K., Arunthathi, S.» Chacko, C.J.G. and Fritschi,
E.P. A clinico-pathological study of primary neuritic leprosy.
Lepr India 55: 212, 1983.
10.
Jacob, M, and Mathai, R. Diagnostic efHcacy ofcutaneous nerve
biopsy in primary neuritic leprosy. Int J Lepr 56: 56, 1988.
11.
Uplekar, M.W., and Antia, N.H. Clinical and histopathological
observations on pure neuritic leprosy. Indian J Lepr 58: 513,
1986.
12.
Kaur, G.,Girdhar,B.K., Girdhar,A. Malaviya, G.N.,Mukherjee,
-A., Sengupta, U. and Desikan, K.V. A clinical, immunological
and histological study of neuritic leprosy patients. Int J Lepr
59: 385, 1991.
13.
Mishra,B.,Malaviya, G.N., Girdhar,A.,Husain,S. andGirdhar,
B.K. Trigeminal neuralgia-a presenting feature of facial leprosy.
Lepr Rev 64: 255, 1993.
14.
Natli, L, Narayanan, R.B., Sathish, M., Ahuja, G.K., Bhutan),
L.K. and Singh, R. Selective loss of Mycobacterium leprae
responsiveness of circulating lymphocytes in primary neuritic
leprosy. Lepr Rev 52: 79, 1981.
15.
Basombrio, G., and Bosq, F.J. Lepra lepromatosa de comienzo
oligoneuritico puro (Lepromatous leprosy with pure neural
onset). Leprologia 5: 31, 1960. English abstract in Int J Lepr
29: 535, 1961.
16.
WHO Expert Committee on Leprosy. Classification (of leprosy)
for control programmes. WHO Tech Rep Ser 768: 14, 1988.
17.
Antia, N FI., Mehta, L., Shetty, V. and Irani, P.F. Clinical,
electrophysiological, quantitative histologic and ullrastructural
studies of the index branch of radial cutaneous nerve in leprosy.
1. Preliminary report. Int J Lepr 43: 106, 1975.
18.
Mishra, B., Mukherjee, A., Girdhar, A., Husain, S., Malaviya,
G N. and Girdhar, B.K. Evolution of early lesions in leprosy.
Lepr Rev 64: 259, 1993.
19.
Shenoi, S.D. and Padhee, A. Polyneuritic leprosy changing in
borderline tuberculoid (BT). Indian J Lepr 62: 363, 1990.
This write-up has been contributed by Dr. B.K. Girdhar,
Dy. Director, Central JALMA Institute for Leprosy, Agra.
85TH ANNIVERSARY CELEBRATIONS OF ICMR
AIDS was the theme selected for the dissemination of
scientific information in the month of December, 1995.
All the Bombay-based ICMR Institutes/Centres viz, the
Institute for Research in Reproduction, the Institute of
Immunohaematology, Enterovirus Research Centre and the
ICMR Genetic Research Centre jointly organised an aware
ness programme on AIDS at the Hafifldne Institute, Bombay
on December 22, 1995. The programme included a talk on
"Shared Rights and Shared Responsibilities by Dr. J.J.
Rodrigues, screening of video films and a poster exhibition
on the subject. College students and staff ofHaffkine Insti
tute as well as the staff of all the. four ICMR Institutes
participated in the programme.
The National Institute of Cholera & Enteric Diseases,
Calcutta, in collaboration with the ICMR Unit for Research
on AIDS in North-Eastern States oflndia, organized an open
house on December 29, 1995 highlighting the activities of
ICMR in the field of AIDS. Doctors and students from
various medical colleges and nursing staff from the Infec
tious Diseases Hospital, Calcutta, participated in the
programme. Lectures/discussions were followed by an ex
hibition on difierent aspects of AIDS and screening of video
films.
The Central Jalma Institute for Leprosy, Agra,
oiganised an AIDS awareness camp in the Sadar Bazar of
Agra on December 20 and 21, 1995. An open day was also
oiganised in RBS Degree College, Agra, on December 22,
1995 for creating awareness regarding AIDS.
The Victor Control Research Centre, Pondicherry,
oi^anized a lecture on AIDS by Dr. Venkateswaralu, Project
Director, AIDS Cell, Pondicherry on December 8, 1995 for
the benefit of the VCRC staff. Another lecture by
Dr. Raghavan, Chief of the District AIDS Cell, Allepey was
arranged on December 27, 1995 for the members of the
Bhagat Singh Arts and Sports Club Omkareswaram,
Shertalli. Screening of a video film on AIDS was oi^anized
at the Tagore Arts College, Pondicherry on December 12,
1995.
At Pune, the National AIDS Research Institute (NARI)
organised several awareness programmes on AIDS. Dr. JJ.
Rodrigues, Director-in-Charge, NARI, delivered a talk on
“Shared Rights and Shared Responsibilities''on December
1, 1995 which was followed by screening of a video film
entitled46Karate Khiladi". The Institute put up an exhibition
at Shree Ganesh Kala Krida Rangmanch on December 1,
1995. The Institute also organised an exhibition and a talk
on
Subtype Identification by Heteroplex Analysis"
by Dr. D.A. Gadkari, Dy. Director, at the Poona University
on December 27, 1995, and a talk on 44Paediatric AIDS"
by Dr. Mridula Phadke, Dean, BJ. Medical College, Pune,
at theLokamanya Hospital, Chinchwad, Pune on December
28, 1995. A poster competition was also organized by the
Institute on the topic “Impact of HIV on the Society".
The National Institute of Nutrition, Hyderabad, orga
nized a lecture on "Social Aspects of AIDS** in December,
1995.
Institute of Cytology and Preventive Oncology, New
Delhi, organized a lecture on “Pathological and Microbio
logical Aspects of AIDS and its Laboratory Diagnosis" by
Dr. Shobha Broor, Addl. Professor, Dept, of Microbiology,
All India Institute of Medical Sciences, New Delhi on
December 18, 1995.
The Institute of Pathology, New Delhi, organized a
lecture on “AIDS : National and International Scenario"
by Dr. Sudershan Kumari from the South-East Asia office
of the WHO, New Delhi on February 9, 1996.
The Rajendra Memorial Research Institute of Medical
Sciences, Patna, organized a symposium on AIDS on
December 19,1995. This was followed by a debate and quiz
competition for school .children.
17
CJIL Field Unit at Avadi, Madras, organised an AIDS
awareness programme for general public in Somangalam
town of Sriperumbudhur taluk of Chengai-MGR district on
January 4, 1996. Audio and video programmes were also
screened for the benefit of the public.
The Regional Medical Research Centre for Tribals,
Jabalpur, oi^anized AIDS awareness programmes at Govt.
Medical College, Mahakaushal Arts College, Mankuwarbai
Women's College and Home Science College of Womens,
Jabalpur on December 1, 7, 8 & 11, 1995 respectively. The
programmes included talks, question-answer sessions and
screening of video films.
The Desert Medicine Research Centre, Jodhpur orga
nized an open house on AIDS awareness and prevention
at the premises of the Jodhpur Truck Union in Basani
Phase-I area of Jodhpur on December 15, 1995.
ICMR NEWS
The 51st meeting ofthe Scientific Advisory Board ofthe
ICMR was held on January 30-31, 1996, at the ICMR
Headquarters, New Delhi.
***
***
率**
Meetings of the Expert Group/Scientific Advisory
Committee held at New Delhi.
Expert Group on Otolaryngology
January 29, 1996
Scientific Advisory Committee of
the ICMR-NIC Centre for Bio
medical Information, New Delhi.
February 6, 1996
Dr. S.P. Pani, Dy. Director, %ctor Control Research
Centre (VCRC), Pondicherry, participated in the HI meeting
of the WHO Steering Committee of the Applied Field
Research on Tropical Diseases at Geneva (February 5-9,
1996).
Dr. S.P. Pani and Dr. P.K. Das, Dy. Director (Senior
Grade), VCRC, Pondicherry, participated in the consultative
meeting on the Application of Modelling to Control Strate
gies in Lymphatic Filariasis at Geneva (February 14-16,
1996).
Participation of ICMR Scientiits in Scientific Events:
Dr. S.K. Subbarao, Dy. Director, Malaria Research
Centre, Delhi, participated in a Task Force meeting on
Malaria Vxtor Control Research in Africa at Nairobi
(February 4-8, 1996)
***
***
***
The Indian Council of Medical Research participated in
the 12th World Book Fair held at New Delhi (February
3-11, 1996).
ICMR AIDED SYMPOSIA/SEMINARSAVORKSHOPS/COVRSES/CONFERENCES
Symposium/Seminar/Workshop/
Course/Conference
Date & Place
Contact Address
Symposium on Casava in Nutrition and Health.
February 10-11, 1996;
(at Thiruvanantapuram).
Dr. K. T. Shenoy, Organising Secretary of the
Symposium, Department of Gastroenterology,
Medical College, Thiruvanantapuram.
XI National Pain Conference and IQ International
Palliative Care Conference.
February 11-14, 1996;
(at Cuttack)
Dr. S. Nayak, Organising Secretary of the Con
ference, Acharya Harihar Regional Cancer Cen
tre, Cuttack.
National Symposium on Molecular and Cellular Bio
physics.
February 18-21, 1996;
(at New Delhi)
Dr. V. Kothekar, Convenor of the Symposium,
Department of Biophysics, All India Institute
of Medical Sciences, New Delhi.
V National Conference of Biomechanics.
February 22-24, 1996;
(at Madras)
Dr. S. Radhakrishna, Organising Secretary of
5NCB, Department of Applied Mechanics,
Indian Institute of Technology, Madras.
Intemationl Conference on Current Status and
Challenges in Medical and Veterinary Microbio
logical Research particularly in Third World Coun
tries.
February 26-28; 1996;
(at Jabalpur)
Prof. S.M. Singh, Organising Secretary of the
Conference, Department of Biological Sciences,
R.D. University, Jabalpur.
Symposium on Schizophrenia: The Indian Scene
March 22-23; 1996;
(at Chandigarh)
Dr. P. Kulhara, Additional Professor, Department
of Psychiatry, Postgraduate Institute of Medical
Education and Research, Chandigarh.
18
COUNCIL'S TRAINING PROGRAMMES FOR 1996-97
Leprosy
Medical Entomology
At the Central Jalma Institute far Leprosy, Agra:
At the Vector Control Research Centre, Pondicherry:
,
Mi|itidrug Therapy Orientation Course in Leprosy for
Medical Officers (March 11-22, September 9-^20,1996).
•.
M.Sc. in Medical Entomology (from August 1996;
for 2 years).
Virology
Laboratory Animal Technology
At the National Institute of Virology, Pune:
At the National Centrefor Laboratory Animal Science,
National Institute of Nutrition, Hyderabad:
•
Diploma in Medical Virology (June 1996-May 1997).
・
Training Course for Laboratory Animal Technicians
(June 15-July 31, 1996).
•
Training Course for Laboratory Animal Supervisors
(September 1-November 30, 1996.
Reproductive Biology
At the Institute far Research in Reproduction, Bombay:
•
•
Training Course on Immunoassay Techniques (June 3-15,
1996).
Training Course on Current Trends in Management of
Infertility and Reproductive Disorders (September 2-13,
1996).
Endocrinology
Haematology
At the Institute of Immunohaematology, Bombay:
•
Training Course in Transfusion Medicine for Blood
Bank Medical Officers (August 5-October4,1996).
•
Training Course in Blood Group Serology and Blood
Bank Methodology, fbr Technicians (August
5-September 4, 1996).
At the National Institute of Nutrition, Hyderabad:
•
Annual Training Course on. Endocrinological Techniques
and their Applications (August 1, 1996-September 15,
1996).
• Training Course in Advanced Haematdlogy and
Immunohaematology (September 17-October 4,
1996).
Nutrition
Biostatistical Techniques
At the National Institute of Nutrition, Hyderabad:
At the Institute for Research in Medical Statistics,
Madras:
•
•
M.Sc. in Applied Nutrition (June 1, 1996-Febmary 28,
1997).
Annual Training Course, in Nutrition (December
1996-February 28, 1997).
1,
•
Training Course for Doctors in Biostatistical
Techniques in Controlled Clinical Trials (March
4-15, 1996).
INDIAN COUNCIL OF MEDICAL RESEARCH
Grant-in-aid fbr organising Seminars/SymposiaAVorkshops
The Council provides partial financial assistance fbr organising Seminars/Symposia/Wbrkshops. Applicaticxis
fbr grant of financial assistance (complete in all respects in the prescribed proforma), will be considered only
if furnished at least four months before the date of commencement of the Seminar/Symposium/Workshop, etc.
19
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Statement about ownership and other particulars of the ICMR Research Information Bulletin as required under
Rule 8 of t^e Registration of Newspapers (Central) Rules 1956.
Place of Publication
Indian Council of Medical Research
Ansari Nagar, New Delhi-110 029.
Periodicity of Publication
Monthly
Printers Name,
Shri J.N. Mathur
Nationality
Indian
Address
Press Manager
Indian Council of Medical Research
Ansari Nagar, New Delhi-110 029.
Publisher's Name
Nationality
Address
Same as above
Editor's Name
Dr. N. Medappa
Nationality
Indian
Address
Indian Council of Medical Research
Ansari Nagar, New Delhi-110 029.
I, J.N. Mathur； hereby declare that the particulars given above are true to the best of my knowledge and belief
Sd/- J.N. Mathur
Publisher
EDITORIAL BOARD
..Chairperson
Dr. G.V. Satyavati
Dr. Badri N. Saxena
.
Dr. N. Medappa
. ..Editor
Member
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