Treatment Planning With Unflattened as Compared to Flattened Beams for Bilateral Carcinoma of the Breast

Aim:

To evaluate the plan quality of 6MV unflattened (UFB) and flattened beam (FB) photon energy using AAA dose calculation algorithms for volumetric arc therapy.

Materials and Methods:

Plans were generated for bilateral carcinoma of breast and the dose prescribed was 50.4Gy in 28 fractions. Two different plans were made for each patient using 6MV FB and 6MV UFB. Dose calculations were performed on an AAA dose calculation algorithm. Plans were generated on Eclipse TPS and were capable of being delivered with a true beam STx linear accelerator. The homogeneity index (HI), conformity index (CI), normal tissue integral dose (NTID), and effect of low dose volume on normal tissue and monitor units (MU) were noted.

Results:

All the plans were clinically acceptable. The HI and CI of 6MV UF rapid arc (RA) plans were higher than with the 6MV FB plan (1.16±0.05 and 0.12±0.00 respectively). There was no appreciable difference observed in Organ at risk (OAR) doses. The mean NTID and low dose volume were significantly low with 6MV RA UFB as compared to FB. 6MV RA UFB required a 35% higher MU than with the 6MV RA plan (p<0.05).

Conclusion:

RA plans generated with UFB on Eclipse TPS achieved target volume coverage and preserved OAR’s essentially similar to 6MV RA FB plans. However RA plans generated in Varian Eclipse of UFB were superior with respect to mean NTID and low dose volumes in normal tissue.

Evaluation of Xpert MTB/RIF assay performance in the diagnosis of abdominal tuberculosis

Background/Aims

The use of genetic probes for the diagnosis of pulmonary tuberculosis (TB) has been well described. However, the role of these assays in the diagnosis of intestinal tuberculosis is unclear. We therefore assessed the diagnostic utility of the Xpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) assay, and estimated the prevalence of multidrug-resistant (MDR) TB in the Indian population.

Methods

Of 99 patients recruited, 37 had intestinal TB; two control groups comprised 43 with Crohn's disease (CD) and 19 with irritable bowel syndrome. Colonoscopy was performed before starting any therapy; mucosal biopsies were subjected to histopathology, acid-fast bacilli staining, Lowenstein-Jensen culture, and nucleic acid amplification testing using the Xpert MTB/RIF assay. Patients were followed up for 6 months to confirm the diagnosis and response to therapy. A composite reference standard was used for diagnosis of TB and assessment of the diagnostic utility of the Xpert MTB/RIF assay.

Results

Of 37 intestinal TB patients, the Xpert MTB/RIF assay was positive in three of 37 (8.1%), but none had MDR-TB. The sensitivity, specificity, positive predictive value, and negative predictive value of the Xpert MTB/RIF assay was 8.1%, 100%, 100%, and, 64.2%, respectively.

Conclusions

The Xpert MTB/RIF assay has low sensitivity but high specificity for intestinal TB, and may be helpful in endemic tuberculosis areas, when clinicians are faced with difficulty differentiating TB and CD. Based on the Xpert MTB/RIF assay, the prevalence of intestinal MDR-TB is low in the Indian population.

Isolated Renal Mucormycosis

Mucormycosis in humans has been described as early as 1885 in literature. Isolated renal mucormycosis is rare as it has been mainly described in developing countries like India and China. It is rarer still to find this entity in immunocompetent young males without any risk factors. Specific guidelines on the treatment is not yet known but combined surgical and medical therapy is considered the best modality for its management. We describe a young male who presented with bilateral hydroureteronephrosis. He was initially treated as a case renal tuberculosis which is relatively more common in TB endemic country like ours. However when he did not respond to the anti-tuberculosis drug (ATT), a biopsy revealed mucormycosis. He was treated with nephrectomy and liposomal amphotericin B and oral posaconazole. On follow up of 2 years he is healthy and leading his normal life.

Index-TB guidelines: Guidelines on extrapulmonary tuberculosis for India

Extrapulmonary tuberculosis (EPTB) is frequently a diagnostic and therapeutic challenge. It is a common opportunistic infection in people living with HIV/AIDS and other immunocompromised states such as diabetes mellitus and malnutrition. There is a paucity of data from clinical trials in EPTB and most of the information regarding diagnosis and management is extrapolated from pulmonary TB. Further, there are no formal national or international guidelines on EPTB. To address these concerns, Indian EPTB guidelines were developed under the auspices of Central TB Division and Directorate of Health Services, Ministry of Health and Family Welfare, Government of India. The objective was to provide guidance on uniform, evidence-informed practices for suspecting, diagnosing and managing EPTB at all levels of healthcare delivery. The guidelines describe agreed principles relevant to 10 key areas of EPTB which are complementary to the existing country standards of TB care and technical operational guidelines for pulmonary TB. These guidelines provide recommendations on three priority areas for EPTB: (i) use of Xpert MTB/RIF in diagnosis, (ii) use of adjunct corticosteroids in treatment, and (iii) duration of treatment. The guidelines were developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria, which were evidence based, and due consideration was given to various healthcare settings across India. Further, for those forms of EPTB in which evidence regarding best practice was lacking, clinical practice points were developed by consensus on accumulated knowledge and experience of specialists who participated in the working groups. This would also reflect the needs of healthcare providers and develop a platform for future research.

Systemic Inflammatory Response Syndrome following Gastrointestinal Surgery

INTRODUCTION

Systemic inflammatory response syndrome symptoms immediately after surgery have lately been regarded as potential warnings of impending post-operative complications and multiple organ failure. This study was conducted to find out the clinical significance of systemic inflammatory response syndrome in postoperative patients and to investigate the relationship between the duration of post-operative systemic inflammatory response syndrome and the post-operative morbidity and mortality.

METHODS

Total 30 patients who received different gastrointestinal surgery and fulfilled the diagnostic criteria for systemic inflammatory response syndrome between 2006 and 2008 at Kathmandu Medical College Teaching Hospital were included. Patients were analyzed for preoperative physiologic status, surgical stress parameters, and postoperative status of systemic inflammatory response syndrome, complications, and end-organ dysfunction.

RESULTS

Duration of systemic inflammatory response syndrome or positive criteria's number of systemic inflammatory response syndrome after surgery significantly correlated with surgical stress parameters (blood loss/body weight and operation time). Septic complications and prolongation of systemic inflammatory response syndrome were associated with multiple organ dysfunction syndrome and increased mortality.

CONCLUSIONS

Systemic inflammatory response syndrome is a useful criterion for the recognition of postoperative complications and end-organ dysfunctions. Early recovery from systemic inflammatory response syndrome may arrest the progression of organ dysfunction, thus reducing the mortality.

Pyomyositis Complicated by Deep Venous Thrombosis - A Unique Case of Reverse Lemierre's Syndrome

We report a case of a young individual who presented with fever and swelling of right upper and lower limbs for 3 weeks. Subsequently he developed shortness of breath and decreased urine output and had to be mechanically ventilated. Ultrasound screening of the lower limb had shown deep venous thrombosis (DVT) and thus the diagnosis of pulmonary thromboembolism (PTE) seemed probable. However the workup for PTE was negative and patient's fever continued and his condition deteriorated. Evaluation for an infective locus led to the diagnosis of pyomyositis and DVT appeared to have developed secondary to the muscle inflammation as a part of Reverse Lemierre's syndrome. Thus this case highlights the importance of considering this diagnosis in a similar setting and not to ascribe every case of respiratory failure in a background of DVT to be due to PTE.

In vitro assessment of the acaricidal activity of Piper longum, Piper nigrum, and Zingiber officinale extracts against Hyalomma anatolicum ticks

Ticks and tick-borne diseases are a major constraint for the sustainable cattle industry in the tropical and subtropical regions including the Indian subcontinent. The development of resistance to most of the commonly used acaricides leads to an attempt to screen plant extracts and their combinations for their possible acaricidal activity to develop an eco-friendly tick control alternative. An alcoholic and various aqueous extracts of Piper longum, Piper nigrum and Zingiber officinale and their combinations were evaluated for acaricidal activity against the three-host ixodid tick, Hyalomma anatolicum by larval immersion test using 14-21 days old unfed larvae. The efficacy was assessed by measuring larval mortality (%) and the lethal concentrations for 50% (LC50) and 95% (LC95) with their 95% confidence limits (CL) values were estimated by applying regression equation analysis to the probit transformed data of mortality. A concentration-dependent mortality response was recorded in all extracts prepared from seeds of P. longum and P. nigrum and their combinations. The highest acaricidal property was exhibited by the alcoholic extract of P. longum seeds with the minimum LC50 and LC95 (95% CL) values of 0.071% (0.07-0.072) and 0.135% (0.13-0.14), respectively, followed by alcoholic combinations. Interestingly, no acaricidal activity was recorded in extracts prepared from the rhizome of Z. officinale. The results indicated that the ethanolic extracts of P. longum and P. nigrum and their combinations can be used effectively for tick control in an integrated format.

Consensus on Insulin Dose Modification During Fasting in Type 2 Diabetes

INTRODUCTION

Fasting for patients with type 2 diabetes mellitus (T2DM) carries a risk of an assortment of complications. The decision of T2DM patient to fast should be made after sufficient discussion with physician regarding the risks involved. The current consensus is developed to help physicians manage T2DM patients during fasting.

OBJECTIVE

To provide simple and easily implementable guidelines on insulin dose modification during fasting in T2DM patients.

METHODS

The expert group committee discussed and proposed six recommendations for the use of insulin regimens during fasting. The recommendations were proposed on diet, exercise and categorization of risks during fast, breaking fast, dose modification of basal insulins, premix insulins and prandial insulins. All these recommendations were based on established guidelines and published scientific literature. These evidences were then factored into the national context based on the expert committee representative's patient-physician experience in their clinical practice and common therapeutic practices followed in India to successfully achieve optimal glucose control. The final consensus-based recommendations were proposed and collectively recorded for each insulin regimen.

RESULTS

Recommendations based on insulin dose modification during fasting in T2DM patients has been developed. Patients with diabetes, who fast are recommended to keep themselves hydrated, consume low glycaemic and high fibre food but, avoid sugary and caffeinated drinks along with fried foods. The main goal of insulin therapy during fasting is to provide adequate insulin to prevent post meal hyperglycaemia and prevent hypoglycaemia during fast.

CONCLUSIONS

We hope that the consensus based recommendations mentioned in this paper will be a useful reference tool for health care practitioners to initiate and intensify insulin therapy in T2DM patients in order to successfully complete fasting without much complication.

Carcinoma of Unknown Primary Presenting as Peripheral Symmetric Gangrene

Cancer of unknown primary accounts for almost 4-5% of all invasive cancers and consists of tumors from various primary sources with considerable heterogeneity in biology and behaviour. Most of these tumors present with symptoms due to distant metastasis. Histology, immunohistochemistry and molecular profiling is the mainstay for diagnosis. In most cases of adenocarinoma associated with paraneoplastic acral vascular syndrome (PAVS), a site in the lung, ovary or uterus is discernible. Here we report a case of metastatic adenoarcinoma of unknown primary presenting as PAVS, a case which to the best of our knowledge has not been reported in published literature.

Comparison of TST and IGRA in Diagnosis of Latent Tuberculosis Infection in a High TB-Burden Setting

Background

There are currently two tests for diagnosing latent tuberculosis infection (LTBI); TST and IGRA. However, it is still unclear that which one of these tests performs better in high TB-burden settings.

Methods

1511 household contacts of pulmonary TB patients were enrolled to compare the performance of TST and IGRA for LTBI. At baseline all participant underwent testing for IGRA [QuantiFERON-TB® Gold In-tube (QFT-GIT) assay] and TST [2 tuberculin unit (TU), purified protein derivative (PPD), RT23, Staten Serum Institute (SSI), Copenhagen, Denmark]. All the household contacts were followed-up for two years for incident TB cases.

Results

Active TB was diagnosed in 76 household contacts at an incidence rate of 2.14 per 1000 person-years. Both, TST [Hazard Ratio (HR): 1.14, 95% confidence interval (CI): 0.72–1.79, p = 0.57], as well as QFT-GIT assay (HR: 1.66, 95% CI: 0.97–2.84, p = 0.06) results at baseline were not significantly associated with subsequent development of active TB among household contacts of pulmonary TB patients.

Conclusion

Neither TST nor IGRA predicted subsequent development of active TB among household contacts of pulmonary TB patients during follow-up. However, keeping in view the cost, and other logistics, TST remains the most preferred method for LTBI diagnosis in resource-limited, high TB-burden settings.

Seasonal variations and source profile of n-alkanes in particulate matter (PM10) at a heavy traffic site, Delhi

Delhi is one of the most polluted cities in the world. The generation of aerosols in the lower atmosphere of the city is mainly due to a large amount of natural dust advection and sizable anthropogenic activities. The compositions of organic compounds in aerosols are highly variable in this region and need to be investigated thoroughly. Twenty-four-hour sampling to assess concentrations of n-alkanes (ng/m³) in PM₁₀ was carried out during January 2015 to June 2015 at Indira Gandhi Delhi Technical University for Women (IGDTUW) Campus, Delhi, India. The total average concentration of n-alkanes, 243.7 ± 5.5 ng/m³, along with the diagnostic tools has been calculated. The values of CPI₁, CPI₂, and CPI₃ for the whole range of n-alkanes series, petrogenic n-alkanes, and biogenic n-alkanes were 1.00, 1.02, and 1.04, respectively, and C _max were at C₂₅ and C₂₇. Diagnostic indices and curves indicated that the dominant inputs of n-alkanes are from petrogenic emissions, with lower contribution from biogenic emissions. Significant seasonal variations were observed in average concentrations of n-alkanes, which is comparatively higher in winter (187.4 ± 4.3 ng/m³) than during the summer season (56.3 ± 1.1 ng/m³).

Seasonal characteristics of water-soluble inorganic ions and carbonaceous aerosols in total suspended particulate matter at a rural semi-arid site, Kadapa (India)

To better understand the sources as well as characterization of regional aerosols at a rural semi-arid region Kadapa (India), size-resolved composition of atmospheric particulate matter (PM) mass concentrations was sampled and analysed. This was carried out by using the Anderson low-pressure impactor for a period of 2 years during March 2013-February 2015. Also, the variations of organic carbon (OC), elemental carbon (EC) and water-soluble inorganic ion components (WSICs) present in total suspended particulate matter (TSPM) were studied over the measurement site. From the statistical analysis, the PM mass concentration showed a higher abundance of coarse mode particles than the fine mode during pre-monsoon season. In contrast, fine mode particles in the PM concentration showed dominance over coarse mode particle contribution during the winter. During the post-monsoon season, the percentage contributions of coarse and fine fractions were equal, whereas during the monsoon, coarse mode fraction was approximately 26 % higher than the fine mode. This distinct feature in the case of fine mode particles during the studied period is mainly attributed to large-scale anthropogenic activities and regional prevailing meteorological conditions. Further, the potential sources of PM have been identified qualitatively by using the ratios of certain ions. A high sulphate (SO₄) concentration at the measurement site was observed during the studied period which is caused by the nearby/surrounding mining activity. Carbon fractions (OC and EC) were also analysed from the TSPM, and the results indicated (OC/EC ratio of ~4.2) the formation of a secondary organic aerosol. At last, the cluster backward trajectory analyses were also performed at Kadapa for different seasons to reveal the origin of sources from long-range transport during the study period.

Nosocomial infection of CCHF among health care workers in Rajasthan, India

BACKGROUND

Ever since Crimean-Congo hemorrhagic fever [CCHF] discovered in India, several outbreaks of this disease have been recorded in Gujarat State, India. During the year 2011 to 2015 several districts of Gujarat and Rajasthan state (Sirohi) found to be affected with CCHF including the positivity among ticks and livestock. During these years many infected individuals succumbed to this disease; which subsequently led to nosocomial infections. Herein, we report CCHF cases recorded from Rajasthan state during January 2015. This has affected four individuals apparently associated with one suspected CCHF case admitted in a private hospital in Jodhpur, Rajasthan.

CASE PRESENTATION

A 30-year-old male was hospitalized in a private hospital in Jodhpur, Rajasthan State, who subsequently had developed thrombocytopenia and showed hemorrhagic manifestations and died in the hospital. Later on, four nursing staff from the same hospital also developed the similar symptoms (Index case and Case A, B, C). Index case succumbed to the disease in the hospital at Jodhpur followed by the death of the case A that was shifted to AIIMS hospital, Delhi due to clinical deterioration. Blood samples of the index case and Case A, B, C were referred to the National institute of Virology, Pune, India for CCHF diagnosis from the different hospitals in Rajasthan, Delhi and Gujarat. However, a sample of deceased suspected CCHF case was not referred. Subsequently, blood samples of 5 nursing staff and 37 contacts (Case D was one of them) from Pokhran area, Jaisalmer district were referred to NIV, Pune.

CONCLUSIONS

It clearly indicated that nursing staff acquired a nosocomial infection while attending the suspected CCHF case in an Intensive Care Unit of a private hospital in Jodhpur. However, one case was confirmed from the Pokhran area where the suspected CCHF case was residing. This case might have got the infection from suspected CCHF case or through other routes. CCHF strain associated with these nosocomial infections shares the highest identity with Afghanistan strain and its recent introduction from Afghanistan cannot be ruled out. However, lack of active surveillance, unawareness among health care workers leads to such nosocomial infections.

Prognostic Factors in Indian Patients Operated for Soft Tissue Sarcomas-a Retrospective Cross-sectional Analysis

Soft tissue sarcomas are a rare entity. While surgery is established as the mainstay of treatment, the exact role and sequencing of adjuvant therapy is not well defined. Literature on Indian patients with soft tissue sarcoma with respect to clinical profile and prognostic factors is scarce. We retrospectively analysed the data of 112 patients operated for soft tissue sarcoma of extremity or trunk (excluding retroperitoneal and mediastinal sarcomas, round cell histology) at our institute from 1 January 2009 to 31 December 2013. Around half the patients were less than 50 years of age and around a third had size more than 10 cm. Oncological outcome was correlated with various demographic, tumour-related and treatment-related factors using SPSS 22. Overall survival at 5 years was 73.2 % and event-free survival at 5 years was 42.2 %. At final follow-up (mean of 44.85 ± 4.64 months), local recurrence was seen in 31.9 % and distant metastasis was seen in 30.1 % of the patients. Using both univariate and multivariate analysis, younger age (<50 years), larger size (>10 cm, but not >5 cm) and pathologically positive lymph nodes were the only factors found significantly affecting overall survival. The clinical profile and prognosis of Indian patients with soft tissue sarcoma were found to be different from that reported in Western literature. The impact of established prognostic indicators for soft tissue sarcoma also differed in Indian patients, which may have both prognostic and therapeutic implications.

Malignancies in human immunodeficiency virus infected patients in India: Initial experience in the HAART era

Background & objectives:

Limited data are available on malignancies in human immunodeficiency virus (HIV)-infected patients from India. We undertook this study to assess the frequency and spectrum of malignancies in HIV-infected adult patients during the first eight years of highly active antiretroviral therapy (HAART) rollout under the National ART Programme at a tertiary care centre in New Delhi, India.

Methods:

Retrospective analysis of records of patients registered at the ART clinic between May 2005 and December 2013 was done.

Results:

The study included 2598 HIV-infected adult patients with 8315 person-years of follow up. Malignancies were diagnosed in 26 patients with a rate of 3.1 (IQR 2.1-4.5) cases per 1000 person-years. The median age for those diagnosed with malignancy was 45 (IQR 36-54) yr, which was significantly (P<0.01) higher compared with those not developing malignancies 35 (IQR 30-40) yr. The median baseline CD4+ T-cell count in patients with malignancy was 135 (IQR 68-269) cells/µl compared to 164 (IQR 86-243) cells/µl in those without malignancies. AIDS-defining cancers (ADCs) were seen in 19 (73%) patients, while non-AIDS-defining cancers (NADCs) were observed in seven (27%) patients. Malignancies diagnosed included non-Hodgkin's lymphoma (16), carcinoma cervix (3), Hodgkin's lymphoma (2), carcinoma lung (2), hepatocellular carcinoma (1), and urinary bladder carcinoma (1). One patient had primary central nervous system lymphoma. There was no case of Kaposi's sarcoma.

Interpretation & conclusions:

Malignancies in HIV-infected adult patients were infrequent in patients attending the clinic. Majority of the patients presented with advanced immunosuppression and the ADCs, NHL in particular, were the commonest malignancies.

Cavitating Lung Lesions with Encephalopathy in a Patient with Long Standing Sjogren's Syndrome: An Elusive Cause

A known case of primary Sjogren's syndrome with chronic kidney disease presented with respiratory symptoms and subsequent altered sensorium. Chest imaging suggested cavitating lung lesions in both the lungs. Serum c-ANCA was positive without any upper respiratory tract involvement or active urinary sediments. Treatment with appropriate anti-microbials produced no improvement in the respiratory or neurological parameters. MRI brain revealed tell-tale signs of CNS vascultis. A diagnosis of GPA was made as per European Medical Agency algorithm and the patient was started on immune-suppressants to which there was dramatic response. Her respiratory and neurological parameters started recovering steadily. However her stay at hospital was complicated by severe hospital acquired pneumonia to which she succumbed. We review the intricacies of the case, discussing the diagnostic conundrum and treatment dilemma we faced, as well as the systematic approach employed to manage the patient.

A Study of Effects of Pioglitazone and Rosiglitazone on Various Parameters in Patients of Type-2 Diabetes Mellitus with Special Reference to Lipid Profile

OBJECTIVES

To study the complete fasting lipid profile and other parameters (weight, body mass index, HbA1c, fasting blood sugar and postprandial blood sugar)in Type 2 diabetes mellitus patients on OHA/insulin, to study the effect of addition of pioglitazone on lipid profile and other parameters in Type 2 diabetes mellitus patients on OHA/insulin, to study the effect of addition of rosiglitazone on lipid profile and other parameters in Type 2 diabetes mellitus patients on OHA/insulin and to compare the effect of pioglitazone and rosiglitazone on lipid profile and other parameters in Type 2 diabetes mellitus patients on OHA/insulin.

MATERIAL AND METHODS

In the study, 100 Type 2 diabetes cases on oral hypoglycemic agent/insulin with deranged lipid profile were chosen and divided into 2 groups 50 and 50 in group A and group B respectively.Pioglitazone was given initially 15mg/day then if required increasing upto 45mg/day in group A for period of 18 weeks and rosiglitazone was given initially 2 mg/day then if required increasing upto 8 mg/day in group B for period of 18 weeks. Detailed clinical history was obtained and thorough physical examination was done and following parameters were established-Age, Height, Weight, Body mass index, Fasting and Postprandial blood sugar, HbA1c levels and fasting complete lipid profile done at 0 and 18 weeks. Each patient itself served as a control for this study.

RESULTS

Maximum no. of patients were in sixth decade (53.30%) and minimum patients were in seventh decade (6.6%). Males were 63.3% and females were 36.8%. Fasting blood sugar levels decreased by 23% with pioglitazone in group A and 14.07% with rosiglitazone in group B. The postprandial blood sugar levels decreased by 29.9% with pioglitazone in group A and 20.17% with rosiglitazone in group B.The mean HbA1c decreased by 2.13 % pioglitazone in group A and 3.8% with rosiglitazone in group B after 18 weeks of therapy. The effects of both drugs on BMI and weight were not significant. In group A the total cholesterol level decreased by 8.62% with pioglitazone but in group B there was no significant decrease in total cholesterol level after 18 weeks of therapy with rosiglitazone. There was no significant reduction in mean LDL cholesterol level in both groups. HDL-c level increased by 17.14% with pioglitazone in group A and decreased by 1.2% with rosiglitazone in group B. Triglycerides levels decreased by 12.33% with pioglitazone in group A and 6.16% with rosiglitazone in group B.

CONCLUSIONS

Treatment with pioglitazone and rosiglitazone both were associated with reduction in fasting and postprandial blood sugar levels but more with pioglitazone. There was significant reduction in HbA1c with both pioglitazone and rosiglitazone but more with rosiglitazone. The total cholesterol level decreased by pioglitazone significantly but not with rosiglitazone. The LDL levels were not affected much by both drugs, while HDL levels were significantly increased with pioglitazone. Triglycerides levels were decreased with both pioglitazone and rosiglitazone but more with pioglitazone. Both drugs are useful but pioglitazone proved to be more beneficial on deranged lipid profile as compared to rosiglitazone in Type 2 Diabetes mellitus patients on OHA/insulin.

Spatio-temporal variation in chemical characteristics of PM10 over Indo Gangetic Plain of India

The paper presents the spatio-temporal variation of chemical compositions (organic carbon (OC), elemental carbon (EC), and water-soluble inorganic ionic components (WSIC)) of particulate matter (PM10) over three locations (Delhi, Varanasi, and Kolkata) of Indo Gangetic Plain (IGP) of India for the year 2011. The observational sites are chosen to represent the characteristics of upper (Delhi), middle (Varanasi), and lower (Kolkata) IGP regions as converse to earlier single-station observation. Average mass concentration of PM10 was observed higher in the middle IGP (Varanasi 206.2 ± 77.4 μg m(-3)) as compared to upper IGP (Delhi 202.3 ± 74.3 μg m(-3)) and lower IGP (Kolkata 171.5 ± 38.5 μg m(-3)). Large variation in OC values from 23.57 μg m(-3) (Delhi) to 12.74 μg m(-3) (Kolkata) indicating role of formation of secondary aerosols, whereas EC have not shown much variation with maximum concentration over Delhi (10.07 μg m(-3)) and minimum over Varanasi (7.72 μg m(-3)). As expected, a strong seasonal variation was observed in the mass concentration of PM10 as well as in its chemical composition over the three locations. Principal component analysis (PCA) identifies the contribution of secondary aerosol, biomass burning, fossil fuel combustion, vehicular emission, and sea salt to PM10 mass concentration at the observational sites of IGP, India. Backward trajectory analysis indicated the influence of continental type aerosols being transported from the Bay of Bengal, Pakistan, Afghanistan, Rajasthan, Gujarat, and surrounding areas to IGP region.

Source Apportionment of PM2.5 in Delhi, India Using PMF Model

Chemical characterization of PM2.5 [organic carbon, elemental carbon, water soluble inorganic ionic components, and major and trace elements] was carried out for a source apportionment study of PM2.5 at an urban site of Delhi, India from January, 2013, to December, 2014. The annual average mass concentration of PM2.5 was 122 ± 94.1 µg m(-3). Strong seasonal variation was observed in PM2.5 mass concentration and its chemical composition with maxima during winter and minima during monsoon. A receptor model, positive matrix factorization (PMF) was applied for source apportionment of PM2.5 mass concentration. The PMF model resolved the major sources of PM2.5 as secondary aerosols (21.3 %), followed by soil dust (20.5 %), vehicle emissions (19.7 %), biomass burning (14.3 %), fossil fuel combustion (13.7 %), industrial emissions (6.2 %) and sea salt (4.3 %).

The use of mosquito repellents at three sites in India with declining malaria transmission: surveys in the community and clinic

Background

Repellents such as coils, vaporizers, mats and creams can be used to reduce the risk of malaria and other infectious diseases. Although evidence for their effectiveness is limited, they are advertised as providing an additional approach to mosquito control in combination with other strategies, e.g. insecticide-treated nets. We examined the use of repellents in India in an urban setting in Chennai (mainly Plasmodium vivax malaria), a peri-urban setting in Nadiad (both P. vivax and P. falciparum malaria), and a more rural setting in Raurkela (mainly P. falciparum malaria).

Methods

The use of repellents was examined at the household level during a census, and at the individual level in cross-sectional surveys and among patients visiting a clinic with fever or other symptoms. Factors associated with their use were examined in a multivariate analysis, and the association between malaria and the use of repellents was assessed among survey- and clinic participants.

Results

Characteristics of participants differed by region, with more people of higher education present in Chennai. Use of repellents varied between 56–77 % at the household level and between 32–78 % at the individual level. Vaporizers were the main repellents used in Chennai, whereas coils were more common in Nadiad and Raurkela. In Chennai and Nadiad, vaporizers were more likely to be used in households with young male children. Vaporizer use was associated with higher socio-economic status (SES) in households in Chennai and Nadiad, whereas use of coils was greater in the lower SES strata. In Raurkela, there was a higher use of coils among the higher SES strata. Education was associated with the use of a repellent among survey participants in Chennai and clinic study participants in Chennai and Nadiad. Repellent use was associated with less malaria in the clinic study in Chennai and Raurkela, but not in the surveys, with the exception of the use of coils in Nadiad.

Conclusions

Repellents are widely used in India. Their use is influenced by the level of education and SES. Information on effectiveness and guidance on choices may improve rational use.

Electronic supplementary material

The online version of this article (doi:10.1186/s13071-016-1709-9) contains supplementary material, which is available to authorized users.

Six months versus nine months anti-tuberculous therapy for female genital tuberculosis: a randomized controlled trial

OBJECTIVE

To compare six months versus nine months anti-tuberculous therapy in patients of female genital tuberculosis.

STUDY DESIGN

It was a randomized controlled trial in a tertiary referral center teaching institute on 175 women presenting with infertility and found to have female genital tuberculosis on clinical examination and investigations. Group I women (86 women) were given 9 months of intermitted anti-tuberculous therapy under directly observed treatment short course (DOTS) strategy while Group II (89 women) were given 6 months of anti-tuberculous therapy under DOTS. Patients were evaluated for primary end points (complete cure, partial response, no response) and secondary end points (recurrence rate, pregnancy rate) during treatment. All patients were followed up further for one year after completion of therapy to assess recurrence of disease and further pregnancies.

RESULTS

Baseline characteristics were similar between two randomized groups. There was no difference in the complete clinical response rate (95.3% vs 97.7%, p=0.441) between 9-months and 6-months groups. Four patients in 9-months group and two patients in 6-months group had recurrence of disease and required category II anti tuberculous therapy (p=0.441). Pregnancy rate during treatment and up to one year follow up was also similar in the two groups (23.2% vs 21.3%, p=0.762). Side effects occurred in 27(31.4%) and 29(32.6%) in 9-months and 6-months of therapy and were similar (p=0.866).

CONCLUSIONS

There was no difference in complete cure rate, recurrent rate and pregnancy rate for either 6-months or 9-months of intermittent directly observed treatment short course anti-tuberculous therapy in female genital tuberculosis.

CLINICAL TRIAL REGISTRATION

The trial was registered in clinicaltrials.gov with registration no: CTRI/2009/091/001088.