Assessing Strategy and Equity in the Elimination of Malaria

Naman Shah critiques the malaria elimination agenda, arguing that it may only be feasible and equitable in limited settings

Research options for controlling Zoonotic disease in India, 2010-2015

BACKGROUND: Zoonotic infections pose a significant public health challenge for low- and middle-income countries and have traditionally been a neglected area of research. The Roadmap to Combat Zoonoses in India (RCZI) initiative conducted an exercise to systematically identify and prioritize research options needed to control zoonoses in India. METHODS AND FINDINGS: Priority setting methods developed by the Child Health and Nutrition Research Initiative were adapted for the diversity of sectors, disciplines, diseases and populations relevant for zoonoses in India. A multidisciplinary group of experts identified priority zoonotic diseases and knowledge gaps and proposed research options to address key knowledge gaps within the next five years. Each option was scored using predefined criteria by another group of experts. The scores were weighted using relative ranks among the criteria based upon the feedback of a larger reference group. We categorized each research option by type of research, disease targeted, factorials, and level of collaboration required. We analysed the research options by tabulating them along these categories. Seventeen experts generated four universal research themes and 103 specific research options, the majority of which required a high to medium level of collaboration across sectors. Research options designated as pertaining to 'social, political and economic' factorials predominated and scored higher than options focussing on ecological, genetic and biological, or environmental factors. Research options related to 'health policy and systems' scored highest while those related to 'research for development of new interventions' scored the lowest. CONCLUSIONS: We methodically identified research themes and specific research options incorporating perspectives of a diverse group of stakeholders. These outputs reflect the diverse nature of challenges posed by zoonoses and should be acceptable across diseases, disciplines, and sectors. The identified research options capture the need for 'actionable research' for advancing the prevention and control of zoonoses in India

Histomorphological evaluation of colon lesions

Background: Both macroscopic and microscopic appearance helps in identification of the colon lesion which supports in the treatment of the patient in a better way. The authors were aimed at the prevalence of various colon lesions site wise distribution of various neoplastic and non-neoplastic lesions of the patients and to compare the distribution according to their age, sex and site.Methods: A retrospective study was designed to study of various intestinal biopsies sent for histopathological examination at Department of Pathology, N.H.L. Municipal Medical College and V.S. Hospital, Ahmedabad, from January 2015 to December 2016 for period of 2 years. The study was based on the histomorphological evaluation of colon lesions received during the study period.Results: A male preponderance was seen in the incidence of tumors irrespective of tumor type and site of tumor and M:F ratio was 1.64:1. In the large intestine, adenocarcinomas were the commonest malignant tumor. 46 cases (62.61%) were reported. The highest occurrence of appendicitis is in the 2nd and 3rd decade.Conclusions: The study revealed that various types of lesions in large intestine along with the age group and gender affected more. Male patients were majorly affected. Morphological identification helped to diagnose the type of lesion for early diagnosis. This study focuses the role of histopathological identification in early diagnosis of the disease so that the survival rates in such cases will be increased

Reducing Malaria Transmission: The Epidemiology and Treatment of Plasmodium falciparum Gametocytemia

Gametocytes are the sexual stage of the Plasmodia life cycle which render malaria cases infectious to mosquitoes. The proportion of P. falciparum malaria cases with gametocytemia and the duration of gametocytemia are varied. Interventions for detecting and treating gametocytemia also differ from those used against asexual parasitemia. In areas of low transmission, such as most of India, the size of the infectious reservoir drives transmission. The purpose of this dissertation was to 1) determine the epidemiology and risk factors for gametocytemia in order to better target interventions, and 2) estimate the effect of primaquine in addition to artesunate+sulphadoxine-pyrimethamine (AS+SP) to guide policy for reducing post-treatment malaria transmission. Using data from therapeutic efficacy studies conducted through the National Antimalarial Drug Resistance Monitoring System from 2009 to 2010, we measured the prevalence of gametocytemia in relation to various clinical and demographic factors. We found that all age groups, including adults, contribute substantially to the reservoir for potential transmission. We identified four risk factors - younger age group, previous antimalarial drug intake, sex, and region - from which we created a clinical algorithm for predicting gametocytemia. The predictive power of the model was low, suggesting the need for a universal approach for anti-gametocyte interventions. We compared trial sites which used primaquine to sites which did not to estimate the additional effect of primaquine. AS+SP with primaquine increased the rate of gametocyte clearance, prevented the development of new gametocytemia, and reduced the area under the gametocyte density over time curve over the study follow-up compared to AS+SP alone. Primaquine was well tolerated and no serious adverse events were reported. Adding primaquine to AS+SP for the treatment of P. falciparum infection in India would decrease the potential for post-treatment malaria transmission.Doctor of Philosoph

Retinal Vasculitis: A Case Study

Purpose: To describe a case of idiopathic retinal vasculitis. Methods: Case report and literature review. Case: A healthy 25-year-old female presented with a one-week history of a large floater in her right eye. Patient’s subjective complaint of floaters, including the scotoma on VF and the FA findings were most consistent with retinal vasculitis displaying predominant venous involvement. However, findings for acute macular neuroretinopathy and multiple evanescent white dot syndrome (MEWDS) were present as well. Autoimmune and infectious disease panels were negative. Neuro consult and brain MRI showed nonspecific, non contributory findings. Several weeks later, following Medrol dose pack, patient reported significantly improved visual field and this was consistent with improved clinical and diagnostic findings. Conclusion: Although cases of retinal vasculitis have been linked to infectious, neoplastic, systemic and autoimmune diseases, idiopathic cases can present concurrently with other retinopathies

Risk factors for malaria deaths in Jalpaiguri district, West Bengal, India: evidence for further action

BACKGROUND: In 2006, a cluster of malaria deaths in the highly endemic Jalpaiguri district, West Bengal, India, led to assignment of additional resources. Malaria deaths decreased, but continued to occur. A study was conducted to identify the risk factors for residual malaria deaths. METHODS: Malaria death was defined as a death from fever with microscopically confirmed Plasmodium falciparum among residents of Jalpaiguri during 2007–2008. For each case, three age-, sex- and locality-matched controls were recruited among microscopically confirmed falciparum malaria patients cured during the same period. Clinical and treatment information was abstracted from records. Information about knowledge about malaria, presence of bed nets and DDT spraying was collected through interviews of the close relatives of study subjects. Odds ratio (OR) were calculated using multivariate methods. RESULTS: 51 malaria deaths were matched with 153 controls, which did not differ by age (median: 35 versus 36 years) and proportion of males (63% versus 63%). On multiple logistic regression analysis, compared with survivors, malaria deaths were more likely to have been admitted with already existing complications [OR = 4.1, 95% confidence interval (CI) = 1.6–10)], treated at a private facility (OR = 3.7, 95% CI = 1.2–12), received treatment after 48 hours of fever onset (OR = 14, 95% CI = 2.9–64), received chloroquine (OR = 13.3, 95% CI = 3.7–47). Households of the deceased were also more likely to miss bed nets (OR = 6.3, 95% CI = 1.9–24) and DDT spraying (OR = 9.2, 95% CI = 2.8–31). CONCLUSION: Elimination of malaria deaths will require education of providers for prompt referral before complications, engagement of the private sector, community awareness for early treatment as well as scaled-up use of bed nets use and DDT. Use of newer generation anti-malarials must to be generalized