Micronutrient Deficiency in Pregnancy: Time to Think Beyond Iron and Folic Acid Supplementation.

Background: Micronutrients play an important role in influencing pregnancy outcomes. Anemia is common among pregnant women against which iron and folic acid supplementation programs are already in action. The study aimed to estimate the prevalence of anemic and selected micronutrient status among pregnant women. Materials and Methods: It is a community-based cross-sectional study. The study was carried out among pregnant women registered in Primary Health Center, Kallur, Tirunelveli district, Tamil Nadu, India, using a semi-structured data capture tool. The blood samples were collected following standard procedure. Results: The micronutrient status among 139 pregnant women were selenium <1%, copper <1%, zinc 11.5%, iodine 14.4%, Vitamin B12 41.7%, and ferritin 42.4%. Vitamin B12, zinc, and selenium levels showed a significant difference with reference values among the three trimesters. Iron and folic acid supplementation was followed by 58.7% of pregnant women. Multiple micronutrient deficiency with anemia was found among 54.6%. Conclusion: Anemia and micronutrient deficiency are high among pregnant women in this region. Since iron and folic acid supplementation strategies are already being implemented by the government, it is high time that we extend our health policy beyond that and plan for micronutrient supplementation as well.

Is there any perceptiveness about the mode of transmission of human immunodeficiency virus/acquired immune deficiency syndrome? An analysis among the adolescent tribal students in Tamil Nadu.

BACKGROUND: Cognizance about human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) among the community is still lacking. Seldom studies done in tribal area and to indentify the awareness about HIV/AIDS among the adolescent tribal students in Jawadhu hills of Tamil Nadu, with the objectives includes on social, demographical, and knowledge about HIV/AIDS were taken. For primary data, survey method and secondary data from various literatures gathered. MATERIALS AND METHODS: Schedule tribe adolescent students, between the age groups of 13-21 years, from 8th to 12th standard, exclusively from Vellore and Tiruvannamalai educational districts, were taken, by applying STRATA method. RESULTS: A total of 938 students from various tribal schools participated. Amongst them, 507 (54%) were males and 431 (46%) were females. Half of the respondents (50%) agreed that blood transfusion, intravenous drug use, and sharing infected needles are the major modes of transmission. Nearly 35% agreed that HIV/AIDS is transmitted by hugging, tattooing, dirty hands, breastfeeding, kissing on cheeks, shaving at the barber shop, shaking hands with AIDS patients, homosexuality and are food and waterborne. CONCLUSIONS: Formal HIV/AIDS education should be mandatory in their curriculum, where teachers get an opportunity to deliver the scientific information about HIV/AIDS. To acquire better knowledge about HIV/AIDS, sex education should be included in the mainstream of curriculum with the assistance of educational consultants, professional social workers, and also local non-governmental organizations to conduct further mindfulness camps about the HIV/AIDS.

Does the morbidity management and disability prevention (MMDP) clinic serve the filarial lymphedema (FLE) patients' preeminent expectation?

Advocacy and training on "Home care" for filarial lymphoedma (FLE) patients are provided through morbidity management and disability prevention (MMDP) clinic commonly known as filariasis clinic and clinical improvement is assessed by follow-up visits. While the physicians aim at reducing the recurrent ADL (coined as ADLA in 1997) episodes, the patients expect reduction in LE volume. The objective of the present study was to know whether the MMDP clinic serves the primary expectation of the FLE patients. LE patients who attended the clinic for at least four follow-up consultations and had LE volume measurements at three points of time during the one year period of observation were considered for analysis. Clinical assessment was done for LE grading and LE volume was measured by water displacement volumetry. Sixty-three patients who fulfilled the follow up criteria were included. It was observed that the median LE volume was 914ml (IQR 269 - 1935) at first visit of the observation period which reduced to 645ml (IQR 215- 1666) and 752ml (IQR 215 - 1720) at first and second follow-up visits respectively. Over all, in short span of one year, 21 of the 63 patients (33.3%) who visited MMDP clinic at least four times in a year were benefitted through the MMDP advocacy and the National filariasis control programme need to emphasise on the importance of follow up visits to FLE patients.

Does the morbidity management and disability prevention (MMDP) clinic serve the filarial lymphedema (FLE) patients’ preeminent expectation?

@#Advocacy and training on “Home care” for filarial lymphoedma (FLE) patients are provided through morbidity management and disability prevention (MMDP) clinic commonly known as filariasis clinic and clinical improvement is assessed by follow-up visits. While the physicians aim at reducing the recurrent ADL (coined as ADLA in 1997) episodes, the patients expect reduction in LE volume. The objective of the present study was to know whether the MMDP clinic serves the primary expectation of the FLE patients. LE patients who attended the clinic for at least four follow-up consultations and had LE volume measurements at three points of time during the one year period of observation were considered for analysis. Clinical assessment was done for LE grading and LE volume was measured by water displacement volumetry. Sixty-three patients who fulfilled the follow up criteria were included. It was observed that the median LE volume was 914ml (IQR 269 – 1935) at first visit of the observation period which reduced to 645ml (IQR 2151666) and 752ml (IQR 215 – 1720) at first and second follow-up visits respectively. Over all, in short span of one year, 21 of the 63 patients (33.3%) who visited MMDP clinic at least four times in a year were benefitted through the MMDP advocacy and the National filariasis control programme need to emphasise on the importance of follow up visits to FLE patients.

First Report of "Candidatus Liberibacter solanacearum" Associated with Psyllid-Affected Carrots in Sweden.

Carrot (Daucus carota) plants with symptoms resembling those associated with the carrot psyllid Trioza apicalis and the bacterium "Candidatus Liberibacter solanacearum" (1-4) were observed in 70% of commercial fields in southern Sweden in August 2011, with approximately 1 to 45% symptomatic plants per field. T. apicalis, a pest of carrot in northern and central Europe, including Sweden, can cause as much as 100% crop loss and is associated with "Ca. L. solanacearum" (1-4). Symptoms on affected plants include leaf curling, yellow and purple discoloration of leaves, stunted growth of shoots and roots, and proliferation of secondary roots (3). Carrot plant and psyllid samples were collected from fields in the province of Halland. Total DNA was extracted from petiole and root tissues of 33 symptomatic and 16 asymptomatic plants (cvs. Nevis and Florida), with the cetyltrimethylammonium bromide (CTAB) buffer extraction method (2,3). DNA was also extracted from 155 psyllids (3). DNA samples were tested by PCR using primer pairs OA2/OI2c (5''-GCGCTTATTTTTAATAGGAGCGGCA-3'/5'-GCCTCGCGACTTCGCAACCCAT-3') and CL514F/R (5'-CTCTAAGATTTCGGTTGGTT-3'/5'-TATATCTATCGTTGCACCAG-3'), to amplify a portion of 16S rDNA and rplJ/rplL ribosomal protein genes, respectively, of "Ca. L. solanacearum" (2,3). A 1,168-bp 16S rDNA fragment was detected in the DNA from all 33 symptomatic and two asymptomatic plants, and a 668-bp rplJ/rplL fragment was amplified from the DNA of all 33 symptomatic and four asymptomatic plants, indicating the presence of liberibacter. DNA from 23 and 49 psyllid samples yielded similar amplicons with OA2/OI2c and CL514F/R primer pairs, respectively. Amplicons from the DNA of four carrot roots and three T. apicalis with each primer pair were cloned (pCR2.1-TOPO; Invitrogen, Carlsbad, CA) and three clones of each of the 14 amplicons were sequenced (MCLAB, San Francisco, CA). BLAST analysis of the 16S rDNA consensus sequences from carrot (GenBank Accession No. JN863095) and T. apicalis (GenBank Accession No. NJ863096) showed 100% identity to those of "Ca. L. solanacearum" previously amplified from carrot (GU373048 and GU373049) and T. apicalis (GU477254 and GU477255) from Finland (2,3). The rplJ/rplL consensus sequences from carrot (GenBank Accession No. JN863093) and T. apicalis (GenBank Accession No. JN863094) were 99% identical to the sequences of rplJ/rplL "Ca. L. solanacearum" ribosomal protein gene from carrots in Finland (GU373050 and GU373051). To our knowledge, this is the first report of "Ca. L. solanacearum" associated with carrot and T. apicalis in Sweden. The disease associated with this bacterium caused millions of dollars in losses to potato and several other solanaceous crops in North and Central America and New Zealand (1). This plant pathogen is also associated with significant economic damage to carrot crops observed in Finland (2,3). References: (1) J. E. Munyaneza. Southwest. Entomol. 35:471, 2010. (2) J. E. Munyaneza et al. Plant Dis. 94:639, 2010. (3) J. E. Munyaneza et al. J. Econ. Entomol. 103:1060, 2010. (4) A. Nissinen et al. Entomol. Exp. Appl. 125:277, 2007.

Effect of annual mass administration of diethylcarbamazine and albendazole on bancroftian filariasis in five villages in south India.

Annual mass drug administration (MDA) is the recommended strategy for lymphatic filariasis (LF) elimination. We assessed the effect of six rounds of mass administration of diethylcarbamazine (DEC) and albendazole (ALB) on microfilaria (Mf) prevalence and intensity and vector infection and infectivity rates and circulating filarial antigenaemia (CFA) in a group of five villages in south India, endemic for Culex-transmitted bancroftian filariasis. During different rounds of MDA, 60-70% of the eligible population (>15 kg body weight) was treated. The MDA reduced the Mf prevalence from 8.10% (CI 6.18-10.01) to 1.01% (CI 0.31-1.71) (P<0.05) and geometric mean intensity of Mf from 0.31 (CI 0.22-0.40) to 0.02 (CI 0.00-0.04) (P<0.05), equivalent to a fall of 86% and 94% respectively. The vector infection and infectivity rates declined from 13.11% (CI 11.52-14.70) to 0.78% (CI 0.16-1.40) (P<0.05) and 1.04% (CI 0.56-1.52) to 0.13% (CI 0.00-0.39) (P<0.05), respectively. Four out of the five villages recorded <0.5% Mf prevalence and 0% vector infection rate. Circulating filarial antigenaemia (CFA) fell by 86% in the total population and 100% in 1-10 year old children. One of the five villages, which showed the highest baseline vector infection rate, showed >1.0% Mf rate. The results suggest that six rounds of mass administration of DEC and ALB, with 60-70% treatment coverage, is likely to achieve total interruption of transmission and elimination of LF in the majority of villages.

Impact of seven rounds of mass administration of diethylcarbamazine and ivermectin on prevalence of chronic lymphatic filariasis in south India.

OBJECTIVE: To evaluate the impact of seven rounds of mass administration of diethylcarbamazine (DEC) and ivermectin on the prevalence of chronic lymphatic filariasis and to compare it with that observed in a placebo arm in a community-level trial. METHODS: Cross-sectional clinical surveys were carried out before and after seven rounds of mass drug administration (MDA). About 54-75% of the target population were treated at each round of MDA. RESULTS: After seven rounds, the hydrocele prevalence had declined from the pre-intervention level of 20.5-5.1% (P < 0.05) in the DEC arm, from 23.9% to 10.4% (P < 0.05) in the ivermectin arm and from 20.4% to 10.9% (P < 0.05) in the placebo arm, equivalent to reductions of 75.3%, 56.6% and 46.6%, respectively. The lymphoedema/elephantiasis prevalence declined only marginally and without statistical significance from 3.7% to 3.2%, 4.6% to 3.9% and 2.9% to 2.3% in the DEC, ivermectin and placebo arm. After the seventh MDA, none of the sampled people in the 0-20 age group was found with hydrocele and there was a statistically significant decline in hydrocele prevalence in all other age groups in the communities treated with DEC, the drug known to have macrofilaricidal effect. The impact was relatively less in ivermectin arm. CONCLUSION: Repeated DEC administration has the potential to prevent incidence of new hydrocele cases and may resolve the manifestation at least in a proportion of affected people. Apart from reducing the microfilaraemia prevalence and transmission of infection, MDA also results in significant public health benefits by reducing the burden of hydrocele in treated communities.

Pattern of community compliance with spaced, single-dose, mass administrations of diethylcarbamazine or ivermectin, for the elimination of lymphatic filariasis from rural areas of southern India.

Current programmes to eliminate lymphatic filariasis (LF) are largely based on annual mass administrations of single doses of antifilarial drugs. The level and pattern of compliance by the target population are important determinants of the success of such mass drug administrations (MDA). Community compliance was therefore investigated during a study in southern India of the effects, on Wuchereria bancrofti microfilaraemia and transmission, of spaced MDA based on diethylcarbamazine (DEC) or ivermectin (IVM). During six rounds of MDA, the frequency of compliance in the target populations, in the five study villages given DEC and the five given IVM, ranged from 55%-77%. Analysis of the relevant cohort data indicated that about 30% of the villagers had complied with treatment during all six rounds, but 3.5% of those in the DEC arm and 4.0% of those in the IVM arm had never complied with treatment. Most of the villagers (>90%) had received treatment at least once, however, and >60% had each received treatment in at least four of the six rounds. Overall, there was a significant negative correlation (r=-0.78; P=0.008) between the size of the village, in terms of the number of villagers, and the mean frequency of compliance over the six rounds of MDA. The pattern of community compliance was found to be 'semi-systematic', laying between random and systematic. In terms of the elimination of LF, a semi-systematic pattern of compliance is worse than random compliance but better than systematic. The relevance of the levels and patterns of compliance to LF control or elimination is discussed.

Detection of day blood filarial antigens by Og4C3 ELISA test using filter paper samples.

BACKGROUND: The launching of the global filariasis elimination programme has necessitated the use of highly sensitive and specific diagnostic tests. The Og4C3 monoclonal antibody-based ELISA test has been found to be highly specific and sensitive for the diagnosis of filariasis using night blood samples. However, it requires a serum sample which poses problems of transport and storage. Collection of blood samples on filter paper the will greatly circumvent these problems. Therefore, we evaluated the utility of the Og4C3 assay on filter paper samples collected during daytime. METHODS: Blood samples were collected from 63 microfilariae (mf) carriers during different time periods in a day on filter paper discs as well as venous blood for sera. The mf carriers and chronic (hydrocele n = 20; lymphoedema n = 120) and acute filariasis (adenolymphangitis n = 39) patients were from the endemic areas and the non-endemic normals were from Uthagamandalam district of Tamil Nadu, India. The filarial antigens in the samples were determined using the Og4C3 filarial antigen assay as per the manufacturer's instructions (JCU TrapBio, Australia). The sensitivity of the assay on sera and filter paper samples collected during night and also on filter paper samples collected during different time intervals of the day were compared with those of the membrane filtration technique, which was used as a gold standard. RESULTS: The geometric mean titre of the sera samples collected during night was 11 units/ml for non-endemic normals and 601.2 units/ml for mf carriers. The specificity of the assay on sera samples collected during night was 100% and the sensitivity 96.8% and the positive and negative values were 100% and 95.2%, respectively. The antigen positivity of the filter paper samples collected during morning hours was 93.3% while it was 76.6% and 86.7% for afternoon and evening hours. A significant association was observed between antigenaemia levels and mf density in the blood samples collected during the night. CONCLUSION: The samples collected on filter paper during the day can be used as an alternative to sera samples for detection of filarial antigens employing Og4C3 ELISA. Also, samples collected during morning hours yield a higher positivity. The assay when applied to serum samples will be useful especially when quantitative results are required.

The effect of six rounds of single dose mass treatment with diethylcarbamazine or ivermectin on Wuchereria bancrofti infection and its implications for lymphatic filariasis elimination.

Annual mass treatment with single-dose diethylcarbamazine (DEC) or ivermectin (IVM) in combination with albendazole (ALB) for 4-6 years is the principal tool of lymphatic filariasis (LF) elimination strategy. This placebo-controlled study examined the potential of six rounds of mass treatment with DEC or IVM to eliminate Wuchereria bancrofti infection in humans in rural areas in south India. A percentage of 54-75 of the eligible population (> or =15 kg body weight) received treatment during different rounds of treatment - 27.4% in the DEC arm and 30.7% in the IVM arm received all six treatments, 4.8% and 5.6% received none, and the remainder received one to five treatments. After six cycles of treatment, the microfilaria (Mf) prevalence in treated communities dropped by 86% in the DEC arm (P < 0.01) (n = 5 villages) and by 72% in the IVM arm (P < 0.01) (n = 5 villages), compared with 37% in the placebo arm (P < 0.05) (n = 5 villages). The geometric mean intensity of Mf fell by 91% (t = 8.11, P < 0.05), 84% (t = 6.91, P < 0.05) and 46% (t = 2.98, P < 0.05) in the DEC, IVM and placebo arms, respectively. The proportion of high-count Mf (>50 Mf per 60 mm(3) of blood) carriers was reduced by 94% (P < 0.01) in the DEC arm and by 90% (P < 0.01) in the IVM arm. Among those who received all six treatments, 1.4% in the DEC arm and 2.4% in the IVM arm remained positive for Mf. Two of five villages in the DEC arm and one of five in the IVM arm showed zero Mf prevalence, but continued to have low levels of transmission of infection. The results also indicate that DEC is as effective as or slightly better than IVM against microfilaraemia. Results from this and other recent operational studies proved that single-dose treatment with antifilarials is very effective at community level, feasible, logistically easier and cheap and hence a highly appropriate strategy to control or eliminate LF. Higher treatment coverage than that observed in this study and a few more than six cycles of treatment and more effective treatment tools/strategies may be necessary to reduce microfilaraemia to zero level in all communities, which may lead to elimination of LF.

Placebo-controlled community trial of four cycles of single-dose diethylcarbamazine or ivermectin against Wuchereria bancrofti infection and transmission in India.

A double-blind placebo-controlled trial was carried out in 1994-98 to compare the effects of 4 cycles of single-dose diethylcarbamazine (DEC) or ivermectin on prevalence and geometric mean intensity (GMI) of microfilaraemia in the human population, infection rates in the vector population, and transmission intensity of Culex-transmitted Wuchereria bancrofti in rural areas in Tamil Nadu state, south India. Fifteen villages (population approximately 26,800) were included in the study: 5 villages each were randomly assigned to community-wide treatment with DEC or ivermectin or placebo. People over 14 kg bodyweight received DEC 6 mg/kg, ivermectin 400 micrograms/kg or a placebo, all identically packaged. After 2 cycles of treatment at a 6-month interval, the code was broken and the study continued as an open trial, with third and fourth cycles of treatment at a 12-month interval; 54-77% of eligible people (20,872) received treatment during the 4 cycles. Microfilaraemia prevalence and GMI fell by 48% and 65% with DEC and 60% and 80% with ivermectin respectively after 4 cycles of treatment. There was no change in the incidence of acute adenolymphangitis. Infection in resting mosquitoes fell significantly in all arms: 82%, 78% and 42% in the ivermectin, DEC and placebo arm, respectively. Landing mosquitoes also showed the same trend. The decline in infectivity was significant for resting (P < 0.05) and landing mosquitoes (P < 0.05) with ivermectin and DEC (P < 0.05), and for neither in the placebo group (P > 0.05). Transmission intensity was reduced by 68% with ivermectin and 63% with DEC. Transmission was apparently interrupted in 1 village with ivermectin, but infected resting mosquitoes were consistently found in this village. Single-dose community-level treatment with DEC or ivermectin is effective in reducing W. bancrofti infection in humans and mosquitoes, and may result in total interruption of transmission after several years of control. There is an immediate need to define the role of vector, parasite and community factors that influence the elimination of lymphatic filariasis, particularly the duration of treatment vis-à-vis efficacy of drugs, treatment compliance and efficiency of vectors.

Quantifying mosquito biting patterns on humans by DNA fingerprinting of bloodmeals.

A major debate in infectious disease epidemiology concerns the relative importance of exposure and host factors, such as sex and acquired immunity, in determining observed age patterns of parasitic infection in endemic communities. Nonhomogeneous contact between hosts and vectors is also expected to increase the reproductive rate, and hence transmission, of mosquito-borne infections. Resolution of these questions for human parasitic diseases has been frustrated by the lack of a quantitative tool for quantifying the exposure rate of people in communities. Here, we show that the polymerase chain reaction (PCR) technique for amplifying and fingerprinting human DNA from mosquito bloodmeals can address this problem for mosquito-borne diseases. Analysis of parallel human and mosquito (resting Culex quinquefasciatus) samples from the same households in an urban endemic focus for bancroftian filariasis in South India demonstrates that a 9-locus radioactive short-tandem repeat system is able to identify the source of human DNA within the bloodmeals of nearly 80% of mosquitoes. The results show that a person's exposure rate, and hence the age and sex patterns of exposure to bites in an endemic community, can be successfully quantified by this method. Out of 276 bloodmeal PCR fingerprints, we also found that on average, 27% of the mosquitoes caught resting within individual households had fed on people outside the household. Additionally, 13% of mosquitoes biting within households contained blood from at least 2 people, with the rate of multiple feeding depending on the density of humans in the household. These complex vector feeding behaviors may partly account for the discrepancies in estimates of the infection rates of mosquito-borne diseases calculated parasitologically and entomologically, and they underline the potential of this tool for investigating the transmission dynamics of infection.

Evaluation of the ICT whole blood antigen card test to detect infection due to nocturnally periodic Wuchereria bancrofti in South India.

The commercially available ICT Card Test for bancroftian filariasis was evaluated for its sensitivity and specificity in detecting microfilaria carriers among 189 individuals each in filariasis-endemic and nonendemic areas in South India, and compared to both conventional night blood finger prick thick blood smear examination and venous blood membrane filtration. Though the specificity of the test was 100% in comparison to both, the sensitivity was 98.5% against the finger prick thick blood smear and 71.9 compared to the membrane filtration technique. Similarly, the positive predictive value was 100% against both techniques, but the negative predictive values were 99.5% against the finger prick thick blood smear and 88.3% compared to the membrane filtration technique. The test's lower sensitivity compared to the filtration technique requires further investigation.

Factors influencing response to lymphonodovenous shunt in filarial lymphoedema.

BACKGROUND: Although several studies have been published on lymphonodovenous shunt, there are no objective data either on the outcome of lymphoedema or on various parameters likely to influence the results. METHODS: A trial of lymphonodovenous shunt was carried out in 75 patients with unilateral filarial lymphoedema. The primary aim of the trial was to identify a cohort of responders as against non-responders and to correlate the outcome with various factors such as age, gender, duration and preoperative grade of lymphoedema, number of preoperative attacks of adenolymphangitis, operative impression of the lymph node, effect of venous reflex and type of nodovenous anastomoses. Change in oedema volume was measured objectively by water displacement method using the normal limb as a control. RESULTS: There was no operative mortality. Predominant postoperative complications included wound haematoma (8.5%), wound infection (13.6%) and transient lymphorrhoea (13.6%). In the immediate postoperative period, a reduction of 25%-50% in the oedema volume was recorded in 46.7% of cases and of more than 50% in 17.3% cases. The difference in response with respect to the type of lymphonodovenous shunt was not statistically significant, although the end-to-side type of shunt showed marginally better results. The response was significantly higher in patients with preoperative oedema volume more than 2 L. There was a significant reduction in postoperative attacks of adenolymphangitis, irrespective of the reduction in oedema volume. Of the 75 patients, 22 showed regression of oedema volume to preoperative or higher levels in the postoperative phase. A majority (21/22) could be identified as non-responders within 3 months of surgery. CONCLUSION: The best results of lymphonodovenous shunt were seen in patients with large-volume lymphoedema. The results are better when combined with early excisional surgery. Other factors did not significantly affect the outcome. Non-responders could be identified within 3 months after surgery. Even in patients who did not respond well, a significant decrease in the frequency of adenolymphangitis attacks was observed. Higher initial oedema volume and history of higher frequency (25-50 per year) of adenolymphangitis attacks can be considered as indicators for good response to lymphonodovenous shunt.

Omentoplasty in the management of filarial lymphoedema.

A trial of omentoplasty was carried out on 20 patients with unilateral filarial lymphoedema to assess its role in the reduction of oedema volume after failed lymphonodo-venous shunt (LNVS) or as a primary procedure. Omentoplasty was done through a midline laparotomy. The omentum was mobilized from the colon, preserving both gastroepiploic vessels, and transferred to the thigh either through the lower end of the laparotomy incision or through a separate stab and placed subcutaneously in the upper third of the thigh. There was no operative mortality. Morbidity was mainly incisional hernia and superficial wound infection. Fourteen of 18 patients had more than 25% reduction in oedema volume during the immediate postoperative period, and 5 of the 18 had more than 50% reduction. However, there was a gradual loss of response with time. Age, gender, grade of lymphoedema, duration, and previous surgery did not influence the outcome. The incidence of incisional hernia could be reduced by transferring the omentum through the midline. There was a statistically significant reduction in postoperative adenolymphangitis attacks whether or not the oedema volume was reduced. In some patients the oedema was reduced sufficiently to permit subcutaneous excision of the lymphoedematous tissue. There appears to be a definite but limited role for omentoplasty in patients who have failed LNVS.

Tropical vaginal hydroceles: are they all filarial in origin?

Hydrocele of the tunica vaginalis testis has been conventionally used as an absolute indicator of filarial disease in most clinical surveys. The prevalence of filarial etiology in 100 consecutive hydroceles was studied using clinical, parasitological, histopathological and immunological parameters. Filarial etiology could be proved in 57% of hydrocele cases using major criteria: presence of microfilaria in hydrocele fluid, presence of chyle in hydrocele fluid, demonstration of adult worm in tunica, ratio of fluid antibody titer to serum antibody titer more than 2 and presence of filarial antigen in hydrocele fluid. The results of other tests in these 57 cases were used to define the minor criteria. In the other 43 cases, based on the minor criteria, 12 hydroceles could be classified as likely to be due to filariasis and the rest were probably non-filarial. Thus only 69% of hydroceles were definitely or probably filarial.

Limb circumference measurement for recording edema volume in patients with filarial lymphedema.

To evaluate the impact of therapy and monitor the progression of filarial lymphedema, it is necessary to measure accurately the changes in limb edema volume. In this communication, we report the reliability of circumference measurements for recording volume changes. The measurements included the distal parts of limbs important for filarial lymphedema. In a series of 100 patients with unilateral lower limb lymphedema, both water displacement and circumference measurements were done. The results showed a significant correlation (r = 0.91; P = 0.0000) between the actual volume and that estimated by circumference measurement. Not only could volume of edema be calculated by circumference measurements, but the simple measurement of average circumference difference between the affected and normal limb accurately reflected the volume of actual edema.

Episodic adenolymphangitis and lymphoedema in patients with bancroftian filariasis.

In order to explore the relationship between acute and chronic disease, age-specific data on the frequency and duration of episodic adenolymphangitis (ADL) in patients with 3 defined grades of lymphoedema in bancroftian filariasis were examined. The age distribution of grades I and II exhibited a convex age profile, but that of grade III showed a monotonic increase. The mean duration of oedema increased with its grade (grade I, 0.3 years; grade III, 9.9 years). The mean number of ADL episodes in the previous year for all cases was 4.2 and it increased with grade (grade I, 2.4 and grade III, 6.2). The mean duration of each ADL episode for all cases was 4.1 d and it was independent of grade and age. The mean period lost to ADL episodes in the previous year was 17.5 d; it increased from 9.4 d with grade I to 28.5 d with grade III. The results imply that there is a dynamic progression through the grades of lymphoedema and that the frequency of ADL episodes is positively associated with this progression. However, the study design could not separate cause from effect.