Functional Outcome in Fractures of the Lower End Radius in Elderly Patients Treated by Static External Fixator

Background: Fractures of the distal end radius represent the most common upper extremity fracture in elderly. The treatment problem includes not only achieving union in right anatomical position but also good functional results as far as joint mobility is concerned. Many types of external fixation devices are described to achieve reduction and fixation of the fragments without loss of position and acceptable functional results. The ligamentotaxis is the basic principle used by external fixation. The aim of the study was to assess the functional outcome in fractures of the lower end radius in elderly patients treated by static external fixator (Modified JESS). Materials and Methods: A total of 52 wrists in 51 patients (24 males and 27 females), aged more than 50 years with intra-articular distal end radius fracture were treated with Modified Joshi’s External Stabilization System from 2003 to 2016. The patients were followed up at 2 weeks, 3 weeks, between 6 and 8 weeks, 6 months, 1 year and at 2 years after the surgery. The assessment of pain, range of motion, grip strength and activity were assessed at 6th month, one year and two years follow- up and scored according to Green and O’Brien scoring system. Results: Result was excellent in 42 (80.76%), good in 6 (11.54%) and poor in 4 (7.69%) at 2 years post operatively. Conclusion: Ligamentotaxis using external fixator has been the traditional mode of treating unstable distal radius fractures and is still used by many as the preferred technique due to its acceptable results, easy application and cost-effective.

Biology & control of Anopheles culicifacies Giles 1901.

Malaria epidemiology is complex due to multiplicity of disease vectors, sibling species complex and variations in bionomical characteristics, vast varied terrain, various ecological determinants. There are six major mosquito vector taxa in India, viz. Anopheles culicifacies, An. fluviatilis, An. stephensi, An. minimus, An. dirus and An. sundaicus. Among these, An. culicifacies is widely distributed and considered the most important vector throughout the plains and forests of India for generating bulk of malaria cases (>60% annually). Major malaria epidemics are caused by An. culicifaices. It is also the vector of tribal malaria except parts of Odisha and Northeastern states of India. An. culicifacies has been the cause of perennial malaria transmission in forests, and over the years penetrated the deforested areas of Northeast. An. culicifacies participates in malaria transmission either alone or along with An. stephensi or An. fluviatilis. The National Vector Borne Disease Control Programme (NVBDCP) spends about 80 per cent malaria control budget annually in the control of An. culicifacies, yet it remains one of the most formidable challenges in India. With recent advances in molecular biology there has been a significant added knowledge in understanding the biology, ecology, genetics and response to interventions, requiring stratification for cost-effective and sustainable malaria control. Research leading to newer interventions that are evidence-based, community oriented and sustainable would be useful in tackling the emerging challenges in malaria control. Current priority areas of research should include in-depth vector biology and control in problem pockets, preparation of malaria-risk maps for focused and selective interventions, monitoring insecticide resistance, cross-border initiative and data sharing, and coordinated control efforts for achieving transmission reduction, and control of drug-resistant malaria. The present review on An. culicifacies provides updated information on vector biology and control outlining thrust areas of research.

Mosquito-borne diseases in Assam, north-east India: current status and key challenges.

Mosquito-borne diseases, including malaria, Japanese encephalitis (JE), lymphatic filariasis and dengue, are major public health concerns in the north-eastern state of Assam, deterring equitable socioeconomic and industrial development. Among these, malaria and JE are the predominant infections and are spread across the state. The incidence of malaria is, however, gradually receding, with a consistent decline in cases over the past few years, although entry and spread of artemisinin-resistant Plasmodium falciparum remains a real threat in the country. JE, formerly endemic in upper Assam, is currently spreading fast across the state, with confirmed cases and a high case-fatality rate affecting all ages. Lymphatic filariasisis is prevalent but its distribution is confined to a few districts and disease transmission is steadily declining. Dengue has recently invaded the state, with a large concentration of cases in Guwahati city that are spreading to suburban areas. Control of these diseases requires robust disease surveillance and integrated vector management on a sustained basis, ensuring universal coverage of evidence-based key interventions based on sound epidemiological data. This paper aims to present a comprehensive review of the status of vectorborne diseases in Assam and to address the key challenges.

Battling malaria iceberg incorporating strategic reforms in achieving Millennium Development Goals & malaria elimination in India.

Malaria control in India has occupied high priority in health sector consuming major resources of the Central and State governments. Several new initiatives were launched from time to time supported by foreign aids but malaria situation has remained static and worsened in years of good rainfall. At times malaria relented temporarily but returned with vengeance at the local, regional and national level, becoming more resilient by acquiring resistance in the vectors and the parasites. National developments to improve the economy, without health impact assessment, have had adverse consequences by providing enormous breeding grounds for the vectors that have become refractory to interventions. As a result, malaria prospers and its control is in dilemma, as finding additional resources is becoming difficult with the ongoing financial crisis. Endemic countries must contribute to make up the needed resources, if malaria is to be contained. Malaria control requires long term planning, one that will reduce receptivity and vulnerability, and uninterrupted financial support for sustained interventions. While this seems to be a far cry, the environment is becoming more receptive for vectors, and epidemics visit the country diverting major resources in their containment, e.g. malaria, dengue and dengue haemorrhagic fevers, and Chikungunya virus infection. In the last six decades malaria has taken deep roots and diversified into various ecotypes, the control of these ecotypes requires local knowledge about the vectors and the parasites. In this review we outline the historical account of malaria and methods of control that have lifted the national economy in many countries. While battles against malaria should continue at the local level, there is a need for large scale environmental improvement. Global Fund for AIDS, Tuberculosis and Malaria has provided huge funds for malaria control worldwide touching US$ 2 billion in 2011. Unfortunately it is likely to decline to US$ 1.5 billion in the coming years against the annual requirement of US$ 5 billion. While appreciating the foreign assistance, we wish to highlight the fact that unless we have internal strength of resources and manpower, sustained battles against malaria may face serious problems in achieving the final goal of malaria elimination.

Influence of physico-chemical factors on leaching of chemical additives from aluminium foils used for packaging of food materials.

In recent years, the use of aluminium foils to wrap foodstuff and commodities has been increased to a great extent. Aluminium was found to leach out from the foil in different simulants particularly in distilled water, acidic and alkaline medium at 60 +/- 2 degrees C for 2 hours and 40 +/- 2 degrees C for 24 hours. The migration was found to be above the permissible limit as laid down by WHO guidelines, that is of 0.2 mg/L of water. The protocol used for this study was based on the recommendation of Bureau of Indian Standard regarding the migration of chemical additives from packaging materials used to pack food items. Migration of the aluminium metal was found significantly higher in acidic and aqueous medium in comparison to alcoholic and saline medium. Higher temperature conditions also enhanced the rate of migration of aluminium in acidic and aqueous medium. Leaching of aluminium metal occurred in double distilled water, acetic acid 3%, normal saline and sodium carbonate, except ethanol 8%, in which aluminium migration was below the detection limit of the instrument where three brands of the aluminium foil samples studied.

Photographic appraisal of crystal lattice growth technique.

Concept of creating mechanical retention for bonding through crystal growth has been successfully achieved in the present study. By using polyacrylic acid, sulphated with sulphuric acid as etchant, abundant crystal growth was demonstrated. Keeping in view the obvious benefits of crystal growth technique, the present SEM study was aimed to observe and compare the changes brought about by different etching agents (phosphoric acid, polyacrylic acid and polyacrylic acid sulphated) and to evaluate their advantages and disadvantages in an attempt to reduce iatrogenic trauma caused due to surface enamel alteration. Control and experimental groups were made of 24 and 30 premolars, respectively, for scanning electron microscopic appraisal of normal unetched and etched enamel surface and fracture site and finished surface evaluation. When compared with conventional phosphoric acid and weaker polyacrylic acid, investigations indicated that crystal growth treatment on enamel surface caused minimal iatrogenic trauma and surface alteration were restored to the original untreated condition to a large extent.

Aetiology and clinical profile of osteomalacia in adolescent girls in northern India.

BACKGROUND: The adolescent age group is particularly prone to nutritional rickets/osteomalacia due to an increased demand for nutrients, especially calcium and vitamin D. Osteomalacia presents with non-specific signs and symptoms because of which diagnosis may be delayed. Vitamin D deficiency is unexpected in India, which is a tropical country with abundant sunshine. METHODS: We prospectively studied the clinical presentation, aetiology and social factors contributing to adolescent rickets/ osteomalacia in our region. RESULTS: We saw 21 symptomatic adolescents with osteomalacia during the study period (November 2000-July 2002). All were girls. Only 1 practised purda and 4 belonged to a low socioeconomic class. The mean (SD) duration of illness before correct diagnosis was 2.8 (2.1) years. Bone pains and muscular weakness were universally present. Non-specific complaints (especially limb pains being mistaken for joint involvement) led to a delay in diagnosis with consequent morbidity. All but 1 patient had low serum 25-hydroxyvitamin D levels (<10 ng/ml), with the mean (SD) being 4.9 (2.7) ng/ml. Their mean dietary calcium intake was low 1265 (199) mg/day, range 40-810 mg/day]. Restricted outdoor activities (n = 19) and the traditional dress code (n = 21) were contributory factors, as they led to poor exposure to sunshine. CONCLUSIONS: Nutritional osteomalacia among adolescents is a poorly recognized entity. Even in non-purda practising communities in the tropics, poor exposure to sunshine due to social factors, compounded by low dietary calcium intake, can lead to osteomalacia in adolescents.

A multicentric study with arteether in patients of uncomplicated falciparum malaria.

Two hundred and sixty seven patients of uncomplicated P. falciparum malaria completed study in a multicentric phase III clinical trial of Arteether. Arteether was given intramuscularly in a dose of 150 mg daily for three consecutive days. Each patient was followed upto 28 days of alpha, beta arteether therapy. The cure rate was 97% with fever clearance time between 1-7 days (24-168 hours) and parasite clearance time between 1-3 days (24-72 hours). Parasite reappearance rate was found to be 3% and reported at only three of the centres. Following the treatment no adverse effect was observed on haematological, biochemical and vital clinical parameters.

Investigation of malaria prevalence at National Thermal Power Corporation, Shaktinagar, Sonbhadra District (Uttar Pradesh), India.

Malaria in industrial complexes is promoted by extensive mosquitogenic potential generated by excavations and importation of parasite through migratory labor. The National Thermal Power Corporation (NTPC), Shaktinagar, Sonbhadra district was surveyed for malariogenic conditions from 1994 to 1996. The major mosquito breeding sites were drains, storm-water drains, lakes, outside tanks, overhead tanks, sluice-valve chambers, ornamental tanks, wells, pit wells and water reservoirs, etc. Anopheles culicifacies was the major vector of malaria in this area. Sibling species identification of An. culicifacies revealed that species C predominated during the transmission season and responsible to transmit malaria. Insecticide susceptibility tests against An. culicifacies sl showed that An.culicifacies population was 100% susceptible to malathion, fenitrothorn and deltamethrin while it was found 44% resistant to DDT. The malaria cases recorded in 1994, 1995 and 1996 were 847, 590 and 409 respectively. In vitro study on P. falciparum cases showed that 41, 70, 50% of the isolates tested were resistant to chloroquine in 1994, 1995 and 1996 respectively while an in vivo follow-up study showed 20-30% P. falciparum cases resistant to chloroquine. An integrated approach involving alternate vector control measures along with judicious use of insecticides has been suggested to bring down malaria in industrial complexes.

Geographic information system as a tool to study malaria receptivity in Nadiad Taluka, Kheda district, Gujarat, India.

Nadiad taluka, Kheda district, Gujarat State, India, comprising of 100 villages with unstable malaria and periodic epidemics, was selected for the study. Using topo sheets and satellite imageries thematic maps on water table, water quality, hydro-geomorphology, soil type, relief, irrigation channels, were prepared, overlaid and integrated sequentially using Arclnfo software. The composite map resulted in 13 stratification classes. Stratification classes 1-12 fell in non-irrigated tracts and exhibited 95% matching of areas of high receptivity as revealed by geographical information systems (GIS) and annual malaria parasite incidence (API). Stratification class 13, an irrigated area, showed poor matching but the ground verification established low receptivity of the area. Thus the study resulted in complete reconciliation of cause and effect relationship as established as per GIS in explaining malaria epidemiology. In general, the study revealed that high malaria in villages of Nadiad is mainly due to high water table, soil type, irrigation and water quality. Based on local malaria transmission determinants, a revised malaria control strategy has been suggested.

Chloroquine concentration profile in the community of Mewat region, district Gurgaon (Haryana), India.

A survey was conducted to find chloroquine concentration profile in the community of Mewat region district Gurgaon (Haryana) of India. 88 P. falciparum and 3 P. vivax cases were detected out of 148 blood slides examined with a SPR of 61.48. Plasma chloroquine and desethylchloroquine concentrations were determined in 55 P. falciparum and 2 P. vivax patients and 29 persons whose blood slides were negative for malaria parasite before giving any treatment. Mean chloroquine concentrations in cases with P. falciparum parasites and without malaria parasites were 0.018 and 0.016 microg ml(-1) respectively. Chloroquine to desethyl chloroquine ratio was between 2 and 3 in both groups. Only 10 malaria parasite negative cases out of 29 had plasma chloroquine concentrations above 0.016 microg ml(-1) required for malaria chemoprophylaxis. Chloroquine was undetectable in plasma samples of 8 out of 55 P. falciparum cases. Chloroquine plasma concentrations in 21 P. falciparum cases were below therapeutically effective concentration of 0.016 microg ml(-1) suggesting improper treatment while in 29 P. falciparum cases, parasitemia recurred despite required chloroquine concentration confirming chloroquine resistant status. Irregular prophylaxis and lack of proper treatment was one of the major causes of malaria outbreak in this area.

Effectiveness of alpha-beta arteether in clearing Plasmodium falciparum parasitemia in central India (Madhya Pradesh).

Forty-six patients (25 Females + 21 Males) of uncomplicated Plasmodium falciparum in districts Jabalpur and Mandla of central India (Madhya Pradesh) were administered alpha-beta arteether (an ethyl derivative of qinghaosu), intramuscularly for 3 consecutive days (150 mg once a day). The results revealed that there was rapid control of fever in all the patients without administration of any antipyretic drug. The mean parasite clearance time was 30.78 +/- 10.92 hours and recrudescence/reinfection rate was 6.7% within 28 days. Study indicates that arteether, besides being a potent and fast acting schizontocidal drug, also exhibited gametocytocidal action on P. falciparum.

Studies on malaria during pregnancy in a tribal area of central India (Madhya Pradesh).

In tribal villages of central India where malaria is highly prevalent (mesoendemic), this preliminary study was undertaken to determine the effects of malaria infection in a group of 456 pregnant women with or without fever. Only 96 women were found infected with malaria, of which Plasmodium falciparum accounted for 64% of the detected parasites, while P. vivax for the remaining 36%. There were no instances of cerebral malaria or death however, one abortion and four still births were recorded among 38 primigravid women. Only one neonate was found infected with P. falciparum on day 21 though parasitemia was not high. Anemia was commonly present in most of the women (80%). Failure to clear P. falciparum parasitemia after a chloroquine regimen (25 mg/kg of body weight) was commonly observed. Persistent P. falciparum parasitemia was recorded in 8% cases. Poor response to chloroquine suggests the need to change the drug policy.

Laboratory evaluation of the biocontrol potential of Mesocyclops thermocyclopoides (Copepoda: Cyclopidae) against mosquito larvae.

Biocontrol potential of Mesocyclops thermocyclopoides against first instar larvae of Anopheles stephensi, Aedes aegypti and Culex quinquefasciatus was studied under laboratory conditions. It was found that M. thermocyclopoides had the highest predation efficacy against Ae. aegypti followed by An. stephensi and Cx. quinquefasciatus. There was a significant reduction in the predation efficacy of M. thermocyclopoides against Cx. quinquefasciatus in the presence of alternate food (p < 0.01). The cage simulation trial indicated that M. themocyclopoides has the potential to control Ae. aegypti breeding effectively in a container type of habitat.

Anopheline species complexes & malaria control.

Species complexes comprising morphologically indistinguishable biological species that are reproductively isolated, are of common occurrence among anophelines. A list of anopheline species complexes identified so far in the world has been given. To demonstrate the importance of species complexes in malaria control, we report the Anopheles culicifacies complex as a case study. An. culicifacies is a major vector of malaria in India and neighbouring countries. This complex comprises four sibling species, A, B, C and D. Stratification of U.P. state and district Allahabad has been shown taking into consideration the biological differences among sibling species, viz., sibling species composition and vectorial potential- species B is a non-vector while others are vectors. To achieve cost effective vector control, microlevel stratification at least at the block level has been suggested. Implications of differential responses of sibling species to DDT and malathion in field operations have been discussed. To achieve selective and sustainable control, and to reduce the unnecessary selection pressure of insecticides, an insecticide spray strategy to control An. culicifacies has been provided.

Role of geographic information system in malaria control.

In this paper we provide an account of our experience in the application of remote sensing (RS) and geographic information system (GIS) in understanding malaria transmission dynamics at the local level. Two studies have been briefly reviewed. One is the application of RS on the mosquito production in the Sanjay lake and surrounding areas in Delhi. Studies are demonstrated that remote sensing data were useful in assessing relative mosquito abundance from large water bodies. The second study was carried out in Nadiad taluka, Kheda district, Gujarat on the application of RS and GIS in a village-wise analysis of receptivity and vulnerability to malaria. For this study, remote sensed data and topo sheets of 1:50,000 and 1:125,000 were used in preparing thematic maps. Digitised overlaid maps were subjected to computer analysis using ARC/INFO 3.1 software. Malaria annual parasite incidence (API) showed relationship with water table followed by soil type, irrigation and water quality, other parameters also contributed to malaria receptivity but less significantly. Based on GIS analysis location specific malaria control strategy was suggested to achieve cost effective control of malaria on a sustainable basis.

Estimation of larval production in Sanjay Lake and its surrounding ponds in Delhi, India using remote sensing technology.

A feasibility study to use remote sensing techniques for estimation of mosquito production in Sanjay lake in east Delhi was carried out. Besides the Sanjay lake, larval production for 12 surrounding remote sensing identifiable ponds was also estimated. Inspite of some limitations the technique is very useful for rapid mapping of major breeding sites, recording temporal changes and estimation of larval production in a cost effective manner in terms of survey cost and time.