Community perspective and healthcare assessment in malaria endemic states of India: a cross-sectional study protocol.

INTRODUCTION: India's contribution to the malaria burden was highest in South-East Asia Region in 2021, accounting for 79% of the estimated malaria cases and 83% of malaria-related deaths. Intensified Malaria Control Programme supported by Global Funds to Fight against AIDS, Tuberculosis and Malaria has deployed crucial interventions to reduce the overall burden of malaria in India. Evaluation of utilisation of malaria elimination interventions by the community and assessment of the healthcare system is underway in eleven high malaria endemic states in India. Health system preparedness for malaria elimination, logistics, and supply chain management of diagnostic kits and anti-malarial drugs in addition to the knowledge, attitude and practice of the healthcare workers is also being assessed. METHODS AND ANALYSIS: The study is being undertaken in 11 malaria endemic states with a variable annual parasite incidence of malaria. In total, 47 districts (administrative unit of malaria control operations) covering 37 976 households are to be interviewed and assessed. We present here the protocol following which the study is being undertaken at the behest and approval of Ministry of Health and Family Welfare in India. ETHICS AND DISSEMINATION: No patients were involved in the study. Study findings will be shared with Institutional ethics board of National Institute for Malaria Research New Delhi (NIMR) in a timely, comprehensive, accurate, unbiased, unambiguous and transparent manner and to the National Vector-borne Disease (Malaria) Control Programme officers and the Community public who participated. Important findings will be communicated through community outreach meetings which are existing in the Health system. Results will be informed to study participants via local fieldwork supervised by District Malaria Officers. Also findings will be published in reputed journals based on Indian Council of Medical Research (ICMR) publication policy.The ICMR-NIMR ethics committee approved the study via letter No. NIMR/ECM/2023/Feb/14 dated 24 April 2023 for version 5. All standard ethical practices will be followed.

Ascaris lumbricoides eggs or artefacts? A diagnostic conundrum.

Due to the presence of artefacts in stool samples, the copromicroscopic diagnosis of Ascaris lumbricoides is not always straightforward, particularly in the case of fertilized decorticated eggs. A total of 286 stool samples from 115 schoolchildren in India and 171 adult immigrants in Italy were screened for the presence of A. lumbricoides eggs by both Kato-Katz thick smear and Mini-FLOTAC. If the outer layer of A. lumbricoides eggs was absent, two aliquots of each stool sample were preserved: one for coproculture to identify larvae after development and one to compose a pool of stool for molecular analysis. A total of 64 stool samples (22.4%) were positive for A. lumbricoides using the Kato-Katz thick smear; 36 (56.3%) of these showed mammillated A. lumbricoides eggs, 25 (39.1%) showed elements resembling fertilized decorticated eggs, while three samples (4.7%) showed both mammillated and decorticated eggs. By Mini-FLOTAC, 39 stool samples (13.6%) were positive, while decorticated A. lumbricoides-like eggs were identified as artefacts. These results were confirmed by negative coprocultures and quantitative polymerase chain reaction. Mini-FLOTAC can be used for a reliable diagnosis of A. lumbricoides, thanks to the flotation and translation features which allow a clearer view, resulting in the correct identification of A. lumbricoides eggs.

Mumps outbreak investigation in Jaisalmer, Rajasthan, India, June-September 2016.

Mumps, a vaccine-preventable disease, cause inflammation of salivary glands and may cause severe complications, such as encephalitis, meningitis, deafness, and orchitis/oophoritis. In India, mumps vaccine is not included in the universal immunization program and during 2009 to 2014, 72 outbreaks with greater than 1500 cases were reported. In August 2016, a suspected mumps outbreak was reported in Jaisalmer block, Rajasthan. We investigated to confirm the etiology, describe the epidemiology, and recommend prevention and control measures. We defined a case as swelling in the parotid region in a Jaisalmer block resident between 23 June 2016 and 10 September 2016. We searched for cases in health facilities and house-to-house in affected villages and hamlets. We tested blood samples of cases for mumps immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA). We found 162 cases (60% males) with a median age of 9.4 years (range: 7 month-38 years) and 65 (40%) were females. Symptoms included fever (70%) and bilateral swelling in neck (65%). None of them were vaccinated against mumps. Most (84%) cases were school-going children (3-16 years old). The overall attack rate was 2%. Village A, with two hamlets, had the highest attack rate (hamlet 1 = 13% and hamlet 2 = 12%). School A of village A, hamlet 1, which accommodated 200 children in two classrooms, had an attack rate of 55%. Of 18 blood samples from cases, 11 tested positive for mumps IgM ELISA. This was a confirmed mumps outbreak in Jaisalmer block that disproportionately affected school-going children. We recommended continued surveillance, 5-day absence from school, and vaccination.

Biomarkers to enhance accuracy and precision of prediction of short-term and long-term outcome after spontaneous intracerebral haemorrhage: a study protocol for a prospective cohort study.

BACKGROUND: Several studies reported prognostic value of biomarker in intracerebral hemorrhagic (ICH) but they are either preliminary observation or inadequately powered to analyse independent contribution of biomarkers over and above clinical and neuroimaging data. OBJECTIVE: To examine whether the biomarker can significantly add to the predictive accuracy of prognosis of ICH. METHOD/DESIGN: In a multi-centric prospective cohort study, 1020 patients with ICH within 72 hours of onset are being recruited. After obtaining written informed consent from patients/proxy, venous blood sample (10 ml) is being collected and analysed for C-reactive protein (CRP) level, S100B, Glial fibrillary acidic protein (GFAP), Troponin, change in leukocyte count and Copeptin levels. The patients are telephonically followed using stroke scales (Barthel Index and modified Rankin Scale) at 3, 6, 12 months and 2 years after the recruitment. DISCUSSION: This protocol will aim at predicting the short term or long term prognosis with the use of clinical, neuroimaging and biomarkers in order to help clinician to stratify patients for early referral or intervention.

Relationship among circulating tumor cells, CEA and overall survival in patients with metastatic colorectal cancer.

BACKGROUND: We previously reported results of a prospective trial evaluating the significance of circulating tumor cells (CTCs) in patients with metastatic colorectal cancer (mCRC). This secondary analysis assessed the relationship of the CTC number with carcinoembryonic antigen (CEA) and overall survival. PATIENTS AND METHODS: Patients with mCRC had CTCs measured at baseline and specific time points after the initiation of new therapy. Patients with a baseline CEA value ≥ 10 ng/ml and CEA measurements within ± 30 days of the CTC collection were included. RESULTS: We included 217 patients with mCRC who had a CEA value of ≥ 10 ng/ml. Increased baseline CEA was associated with shorter survival (15.8 versus 20.7 months, P = 0.012). Among all patients with a baseline CEA value of ≥ 25 ng/ml, patients with low baseline CTCs (<3, n = 99) had longer survival than those with high CTCs (≥ 3, n = 58; 20.8 versus 11.7 months, P = 0.001). CTCs added prognostic information at the 3-5- and 6-12-week time points regardless of CEA. In a multivariate analysis, CTCs at baseline but not CEA independently predicted survival and both CTCs and CEA independently predicted survival at 6-12 weeks. CONCLUSIONS: This study demonstrates that both CEA and CTCs contribute prognostic information for patients with mCRC.

Vitamin D receptor (FokI, BsmI and TaqI) gene polymorphisms and type 2 diabetes mellitus: a North Indian study.

BACKGROUND: The vitamin D receptor (VDR) gene is a candidate gene for susceptibility to several diseases. Studies on association between VDR polymorphisms and risk of type 2 diabetes (T2DM) in different ethnic populations are yet inconclusive. AIMS: This study was conducted to evaluate association between VDR polymorphisms and genetic susceptibility to T2DM in the north Indian population. SETTINGS AND DESIGN: One hundred clinically diagnosed T2DM patients and 160 healthy controls from the north Indian population were recruited for genetic association study. MATERIALS AND METHODS: Genomic DNA was extracted from blood and genotyped for the single nucleotide polymorphism SNPs of FokI (T/C) [rs2228570], BsmI (A/G) [rs1544410] and TaqI (C/T) [rs731236] by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) analysis. STATISTICAL ANALYSIS USED: Genotype distribution and allelic frequencies were compared between patients and controls. Mean values and odds ratios (ORs) with 95% confidence interval (CI) were calculated using SPSS software (version 15.0). RESULTS: The genotype distribution, allele and haplotype frequencies of VDR polymorphism did not differ significantly between patients and controls. Mean age and waist-hip ratio of patients were found to be associated with VDR polymorphism. Combination studies showed FFBbtt increased the risk of T2DM in north Indians. CONCLUSIONS: Our data suggest that VDR gene polymorphism in combination of genotypes is associated with the risk of T2DM and thus requires further studies as a probable genetic risk marker for T2DM.

Entomo-epidemiological investigations on chikungunya outbreak in the Lakshadweep islands, Indian Ocean.

BACKGROUND & OBJECTIVE: An outbreak of chikungunya fever characterized by prolonged incapacitation in the Lakshadweep islands in Indian Ocean occurred in November 2006. We undertook the entomological and epidemiological investigations on the Chikungunya outbreak in the Lakshadweep islands, Indian Ocean. METHODS: Epidemic information in the affected places was obtained from the local hospital records. Entomological observations like larval survey and the adult resting/landing collections by the hand collection methods were individually conducted in the two affected islands Andrott and Kalpeni in November and December 2006. RESULTS: The main breeding sources of the mosquitoes were the rodent-devoured coconuts, coconut shells, areca nut soaking mud and plastic pots, discarded containers, grinding stones, metal containers and plastic containers. Aedes albopictus was pre-dominantly present in the Lakshadweep islands. INTERPRETATION & CONCLUSION: It is concluded that the routine campaigns need to be organized regularly within the community highlighting the potential breeding grounds of mosquitoes and the possible control methods. Source reduction strategies like destruction of coconut shells and rodent-devoured coconuts by burning or by burying them inside the ground. Ae. albopictus played major role as the vector mosquitoes responsible for the chikungunya transmission.

Glial choristoma.

Glial choristoma is a developmental malformation of heterotopic central nervous tissue with limited growth potential. It is considered to be one of the very rare choristomatous lesions involving the oral cavity. This report details the morphological characteristics of glial choristoma arising from the palate in a newborn. Bulk of the tissue comprised of mature neuroglial tissue with astrocytes representing developing brain, cystic spaces lined by cuboidal epithelium indicating ependymal layer. Clinical features, associated malformations and histomorphology of this lesion is discussed.

Knowledge, attitudes and practices of newly diagnosed sputum positive cases of pulmonary tuberculosis.

Lack of awareness of risk posed to the community by a sputum positive case of Pulmonary Tuberculosis (PTB) is an impediment in the control of Tuberculosis. A study involving 212 newly diagnosed sputum positive patients aged 15 years or more, revealed that only 9% of the patients knew correctly the cause of PTB. Knowledge about mode of spread of the disease was not known to 49% of patients. Awareness regarding the investigations like chest X-ray and sputum examination was high as 70% but utility of sputum examination was known to only 29% of the patients. Awareness of harmful sequelae of inadequate and incomplete treatment was as high as 93% but knowledge per se of adequate duration of treatment was poor in a half (50%) of the subjects. Attitude towards domiciliary treatment was generally positive (88%) Practices regarding safe sputum disposal and preventive measures practised in the families were poor in nearly two third's of patients. Health education efforts need to be strengthened to create better awareness of these important aspects of tuberculosis diagnosis, treatment and control.

Epidemiology and control of malaria.

Malaria is essentially a local and focal disease since its transmission depends greatly on local eco-environmental conditions. In India, the incidence of total malaria cases has been contained to around 2-3 million cases per year. However, with the occurrence of outbreaks in different parts of the country since 1994, mortality due to malaria has increased. The challenges posed by changing epidemiological paradigms of malaria, occurrence of outbreaks, increasing trends of P. falciparum cases, spreading resistance to available anti-malarials and development of resistance of vectors to insecticides are areas for major concern. The National Anti-Malaria Programme has made necessary modifications/adjustments in the malaria control strategy with the adoption of the Global Malaria Control Strategy.

Incidence of diarrhoea and some related environmental and behavioural factors in Jhuggis of Delhi.

A total of 6285 persons residing in 1090 households in three Jhuggi clusters of Delhi were studied for incidence of diarrhoea by 2 weeks recall method and environmental and behavioural factors affecting it. Overall incidence of Diarrhoea was 29.1 per thousand persons, and was selectively predominant among under fives (60.2 per thousand). This low incidence of diarrhoea could be attributed to safe drinking water availability and common practice of handwashing by most of the people. But unsafe storage of drinking water at household level (70.5%) and peridomestic open air defaecation by children (22.9%) are potential threat for transmission of the disease.

PIP: The incidence of diarrhea was assessed in a survey conducted among 6285 persons living in 1090 households in 3 Jhuggi clusters in Delhi, India. The survey revealed an overall incidence of diarrhea in the 2 weeks preceding the interview of 29.1/1000. This rate was higher among children under 5 years of age (60.2/1000) than among adults (13.8/1000). Dysentery was present in 13.1% of cases. Drinking water sources identified by respondents were community tap (53.0%), municipal water tankers (34.4%), and hand pumps (12.6%). Water was stored in open buckets kept on the floor without a ladle to draw it in 70.5% of households. 68.9% of adults were using public latrines and 22.9% defecated in open fields. Only 20.8% of children used latrines, however. Hand washing after defecation was practiced by 96.2%, while 76.5% washed their hands before meals. Although this survey documented substantial improvements in sources of water supply and hand-washing practices, the unsafe household storage of water and defecation by children in fields and drains remain problematic.

Diarrhea management in some Jhuggi clusters of Delhi.

PIP: In India, a survey was conducted of 6285 persons living in 1090 households in the Jhuggi clusters of Sanjay Amar Colony, Hathi Park, and Jai Prakash Colony in New Delhi to identify diarrhea management practices at home and at a health facility and to determine knowledge levels about preparation of oral rehydration solution (ORS) and sugar salt solution (SSS). 183 (2.9%) persons experienced diarrhea in the previous 2 weeks. 68.3% were younger than 5 years old. 13.1% of all diarrhea cases had blood in their stool. Oral rehydration therapy (ORT) was provided to 3.3% in ORS form, 10.4% in SSS form, 5.5% as dal water, and 5.5% as shikanji. Correct preparation of SSS via finger pinch, scoop, or spoon and glasses was performed in 36.6% of households. Only 11.5% could correctly measure the water needed to make 1 liter of ORS. The first action against the diarrhea was often taken on day 2 (13.1%) and day 3 (18%). 55.7% of diarrhea cases sought treatment at a private practice. 7.1% went to a government health facility. 79.1% of cases taken to a medical practitioner received a drug (e.g., antidiarrheals and antimicrobials). Yet, antimicrobials were indicated in only 13.1% of diarrhea cases taken to a health facility. These cases had dysentery. Only 31.3% received ORS or home-available fluids. Government health facilities were more likely to provide ORT than private practitioners (61.5% vs. 27.4%). All diarrhea cases experiencing dehydration received ORT or intravenous fluids. These findings stress the need for reorientation training of physicians on appropriate case management of diarrhea and rational use of drugs in cases of acute diarrhea. Families also need training in correct preparation and use of ORT and in restriction on the use of drugs.^ieng

Encephalopathy due to inorganic lead exposure in an adult.

A 30 years old male presented with acute gastrointestinal symptoms and encephalopathy. History, investigations and the response to chelator therapy led to the diagnosis of lead poisoning. Encephalopathy in an adult resulting from industrial exposure to inorganic lead are the main features of the case.