Protocol of systematic reviews on implementation research on cardiovascular diseases, diabetes mellitus and mental ailments in India

Introduction

The burden of non-communicable diseases (NCDs) is a major public health concern across the world. Various initiatives have tried to address these with varying degrees of success.

Objective

The objective is to assess and collate existing evidence in implementation research done in India on three broad domains of NCDs namely, cardiovascular diseases (CVD), diabetes mellitus (DM), and mental health (MH) in India.

Materials and methods

Three systematic review protocols have been drafted to explore and collate extant evidence of implementation research on cardiovascular diseases, diabetes mellitus, and mental health in India, in accordance with the PRISMA-P statement. Academic databases including PubMed, Embase and Science Direct will be searched. Search strategies will be formulated in iterative processes and in accordance with the formats that are specific to the databases that will be searched. In addition, grey literature and non-academic databases will also be explored. Data extracted from the selected studies will be analysed and a narrative summary of the selected articles, using the SWiM (Synthesis without meta-analysis) guidelines will be produced.

Intended Outcomes

The outputs of these systematic reviews could help in a better understanding of implementation research gaps and also how to address them. Apart from giving insights into how healthcare initiatives for CVDs, diabetes and mental health could be implemented in a better way, the study could also advocate the need to build and consolidate capacity for implementation research in the country.

A Preliminary Study on the Impact of Household Air Pollution on Adult Respiratory Health in Urban and Rural Settings of Jaipur, India

Background

This study aimed to investigate the association between household air pollution and chronic respiratory illness (CRI) in Jaipur, India.

Materials and Methods

A total of 147 participants over 18 years of age from 45 households were randomly included in the study, and follow-up visits were conducted once every fortnight over a three-month period. Spirometry tests were conducted using a portable hand-held digital spirometer. A self-designed, pretested, semi-structured questionnaire was utilized to collect socio-demographic information from the participants. Statistical tests, such as t-tests were used to analyze the association between household air pollution and CRI.

Results

The prevalence of COPD and bronchial asthma was 2% and 4%, respectively. Various risk factors for CRI were identified within households, and only 4 episodes of acute exacerbation of chronic respiratory illness were observed, resulting in no incidence density calculation. The mean values of forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were significantly lower in females (P < 0.001) Also, the mean values of FVC and FEV1 were significantly lower in rural areas (P < 0.005) than urban areas.

Conclusion

Our findings highlight the importance of government and stakeholder action to implement clean air policies and protect respiratory health. Further studies are needed to expand on these findings and delve deeper into understanding the complex interactions between various risk factors and respiratory health in this population.

Assessment of thermal and temporal stability of SARS-CoV-2 samples using real-time qRT-PCR

BACKGROUND

As per the guidelines of the Indian Council of Medical Research, nasopharyngeal and oropharyngeal swabs in viral transport medium (VTM) are to be stored at 4 °C for less than 5 days and for more than 5 days at -70 °C. Samples are not transported or stored as per prescribed conditions because of the limitations, resulting in an apprehensive diagnosis. The aim of the study was to test the stability of the SARS-CoV-2 sample stored in VTM at different temperatures.

METHODS

In this study, the stability of 21 positive and 9 negative samples for SARS-CoV-2 was evaluated in commercial VTM at different temperatures (-80 °C, -20 °C, 4 °C, and 25 to 30 °C). Stability was checked for up to 50 days in the above storage conditions at different intervals. PathoDetect™ and Hi-PCR® kits were used for the detection of the four genes of SARS-CoV-2. The Cycle Threshold (Ct) value for determining the positivity of samples for PathoDetect™ was < 40 and for Hi-PCR® was < 38.

RESULTS

The SARS-CoV-2 confirmatory genes (RdRp and E genes) and the internal housekeeping gene remained detectable even on the 50th day of the study. The Ct of the RdRp and E genes were found to increase with storage duration, but all positive samples remained positive till the end of the study, or the Ct value remained below the cut-off level. The negative samples gave consistent results until the end of the study. When the differences in Ct values were compared between the days in a set of experiments, they were not significantly different except in a few samples.

CONCLUSION

The SARS-CoV-2 genetic materials in commercial VTM were stable at room temperature to -80 °C for 50 days.

Burden of sickle cell disease in tribal students in Maa-Baadi institutions in southern Rajasthan - A pilot study

Background & objectives

Sickle cell disease (SCD), an inherited disorder of erythrocytes, is highly prevalent in the tribal population of India. The tribal population of India is approximately 100 million and it is necessary to identify the magnitude of this problem. Furthermore, the prevalence of the disease is unknown among the five million tribal people of southern provinces of Rajasthan. In this study, we intended to determine the prevalence and characteristics of sickle cell disorder among the tribal inhabitants of southern Rajasthan.

Methods

This cross-sectional study was conducted among the tribal students of the Maa-Baadis and hostels situated in the five tribal sub-plan districts of Rajasthan. Maa-Baadi centres are located in every village, whereas for every four to five villages, one hostel is allocated to accommodate the tribal students. The screening for SCD was done by solubility test and electrophoresis was used for confirmation.

Results

A total of 36,752 tribal students were screened from 1,006 Maa-Baadi centres and 243 hostels. The prevalence of SCD among the tribal students was 5.8 per cent. The prevalence of heterozygous and homozygous conditions was 5.61 and 0.17 per cent, respectively. Among the five sub-plan districts, the highest prevalence was observed in Sirohi district (10.5%) followed by Banswara (7.42%), Udaipur (6.53%), Pratapgarh (5.51%) and Dungarpur (1.89%). Among the four major tribes belonging to these districts, the highest prevalence was recorded in Garasia tribes (13.81%). The history of leg ulcers and the mean pulse rate were significantly high in SCD individuals.

Interpretation & conclusions

SCD is a significant problem among the tribes of southern Rajasthan, with the highest prevalence among the Garasia tribe. The present study recommends that a structured screening programme targeting the entire tribal population with appropriate counselling as well as providing treatment through the existing health system is the need of the hour.

A Rare Case of Lateral Displacement of Median Nerve in a Dislocated Elbow and its Management

Introduction

Elbow dislocation usually presents with a deformity and swelling, yet it can also present with neurological complication. Nerve injury with dislocation is common in the pediatric age group and is reported infrequently among adults. The most common nerve involved with dislocation is the ulnar nerve followed by the median nerve. The median nerve usually slips medially during dislocation and gets entrapped posterior to the medial epicondyle or it can get entrapped between the fractured medial epicondyle. Here, we describe a unique case of posterolateral elbow dislocation in a 30-year-old female patient with having lateral displacement of the median nerve and the mechanism probably by which the nerve got displaced laterally.

Case Presentation

A 30-years-old female patient of right hand dominant came to us with a left elbow injury after a road traffic accident. Clinical and Radiological examination revealed a posterior-lateral dislocated elbow with a fracture of the radial head and lateral condyle avulsion. Clinically, there was a weakness and sensory hypoesthesia along the median nerve distribution over the left hand and forearm. Initially, closed reduction and splinting done. Later, a planned surgery with a lateral approach avulsed lateral condyle and radial head fixation done with relocation of the median nerve, which was displaced laterally.

Conclusion

There are numerous cases of elbow dislocation with nerve involvement and their complications have been previously described throughout literature. Here, we present a rare case of lateral displacement of the median nerve in a dislocated elbow and the possible mechanism with its management.

Better late than never: Clinical outcomes of delayed fixation in thoracolumbar spinal trauma

PURPOSE

To analyse factors influencing functional outcome and neurological recovery in patients undergoing delayed surgery for traumatic spinal cord injury (SCI) involving thoracolumbar spine.

METHODS

Retrospective analysis of 33 patients with thoracolumbar SCI who underwent delayed surgery (≥ 72hrs post-trauma) with a minimum follow-up of 1 year (average:32.55 months) was done. The parameters studied included age, sex, co-morbidities, mode of trauma, associated trauma, level and number of vertebrae involved, fracture morphology, thoracolumbar injury classification and severity score (TLICS), maximal spinal cord compression (MSCC), signal changes in the cord, neurological deficit as per the American Spinal Injury Association (ASIA) scale, lower extremity motor score (LEMS), bowel bladder involvement, time interval between trauma and surgery.

RESULTS

Mean time interval from injury to spine surgery was 24.45 days. At the end of 1-year follow-up, 17(51.5%), 12(36.36%), and 3(9.1%) patients had ≥ 1, ≥ 2, and ≥ 3-grade ASIA improvement, respectively. The mean LEMS rose to 33.86 from 17.09 (P < 0.001). 8 out of 20 patients with bladder involvement showed improvement. 4 patients succumbed, 22 were ambulatory, and 7 remained non-ambulatory. On comparing various parameters, pre-operative LEMS score (P-value: < 0.001), cord signal changes (P-value:0.002), and presence of cord transection (P-value:0.007) differed significantly in the above-mentioned three groups, while age (P-value:0.442), average TLICS (P-value:0.872), time from injury to surgery (P-value:0.386) did not differ significantly.

CONCLUSION

This study highlights that there is still a significant scope for neurological improvement even after delayed surgery in patients with thoracolumbar SCI. The lower the LEMS score at the time of presentation, signal changes in the cord and presence of cord transection have a significant influence on unfavourable clinical outcomes at the end of 1-year post-surgery.

Field evaluation of ZeroFly--an insecticide incorporated plastic sheeting against malaria vectors & its impact on malaria transmission in tribal area of northern Orissa

BACKGROUND & OBJECTIVES

Insecticide incorporated plastic sheeting is a new technology to control mosquitoes in emergency shelter places and also temporary habitations in different locations. Therefore, field studies were conducted to assess the efficacy of ZeroFly plastic sheeting treated with deltamethrin on prevailing disease vectors Anopheles culicifacies and An. fluviatilis and its impact on malaria transmission in one of the highly endemic areas of Orissa.

METHODS

The study was conducted in Birkera block of Sundargarh district, Orissa state. The study area comprised 3 villages, which were randomized as ZeroFly plastic sheet, untreated plastic sheet and no sheet area. ZeroFly plastic sheets and untreated plastic sheets were fixed in study and control villages respectively covering all the rooms in each household. Longitudinal studies were conducted on the bioefficacy with the help of cone bioassays, monitoring of the mosquito density through hand catch, floor sheet and exit trap collections and fortnightly domiciliary active surveillance in all the study villages.

RESULTS

In ZeroFly plastic sheeting area, there was a significant reduction of 84.7 per cent in the entry rate of total mosquitoes in comparison to pre-intervention phase. There was 56.2 per cent immediate mortality in total mosquitoes in houses with ZeroFly sheeting. The overall feeding success rate of mosquitoes in the trial village was only 12.5 per cent in comparison to 49.7 and 51.1 per cent in villages with untreated plastic sheet and no sheet respectively. There was a significant reduction of 65.0 and 70.5 per cent in malaria incidence in ZeroFly plastic sheeting area as compared to untreated plastic sheet and no sheet area respectively.

INTERPRETATION & CONCLUSIONS

Our study showed that introduction of ZeroFly plastic sheets in a community-based intervention programme is operationally feasible to contain malaria especially in the high transmission difficult areas.

Field evaluation of Olyset nets: a long-lasting insecticidal net against malaria vectors Anopheles culicifacies and Anopheles fluviatilis in a hyperendemic tribal area of Orissa, India

A village-scale trial was conducted on the efficacy of Olyset nets: a long-lasting insecticidal net (LLIN) factory treated with 2% wt:wt permethrin against malaria vectors Anopheles culicifacies Giles and Anopheles fluviatilis James, in Sundargarh District, Orissa, India. The study area comprised 22 villages that were randomized into three clusters and designated as Olyset net, untreated net, and no net clusters. Baseline studies showed that both vector species were 100% susceptible to permethrin. Results of wash resistance and bioefficacy of Olyset nets showed 100% mortality in An. culicifacies up to 11 washings, whereas 100% mortality was observed in An. fluviatilis even after 20 washings. The median knock-down time for these species ranged between 4.55-6.00 and 4.45-5.45 min, respectively, during 1 yr of intervention. In the Olyset net study area, there was a significant reduction of 80.6, 94.1, and 76.7% in the entry rate of An. culicifacies, An. fluviatilis, and other anopheline species, respectively, with an overall reduction of 63.5% in total mosquitoes. Floor sheet collections in houses with Olyset nets indicated 39% immediate mortality in total mosquitoes. The overall feeding success rate of mosquitoes in the trial village was only 18.0% in comparison to 44.2 and 79.1% in villages with untreated nets and no nets, respectively. A significant reduction was also recorded in parity rate and human blood index of vector species in the Olyset net area. This study showed that Olyset nets are an effective personal protection tool that can be used in a community-based intervention program.

Characterization of biochemical based insecticide resistance mechanism by thermal bioassay and the variation of esterase activity in Culex quinquefasciatus

Biochemical mechanisms of insecticide resistance of thermal exposed and unexposed Culex quinquefasciatus strains are evaluated, which were not studied earlier. The activity of alpha- and beta-carboxylesterases and acetylcholinesterase of malathion susceptible and resistant strains were compared after thermal treatment. Three-day-old adult females were used for the malathion susceptibility test and biochemical assays, and males were used only for the susceptibility test. Thermal exposure brought about increase in resistance levels from 85% to 90% in males and 91% to 96.6% in females of resistant strain. The resistance status of the susceptibility strain was unchanged after thermal exposure. The activities of alpha- and beta-carboxylesterase of susceptible mosquitoes were within 800 and 700 U/mg protein, respectively. The alpha-carboxylesterase activity of the thermal exposed malathion-resistant population was significantly (t test, P < 0.05) higher than the unexposed resistant population, and the reverse was recorded in beta-carboxylesterase. The alpha-carboxylesterase activity of susceptible population was lower than the resistant population. The activity of alpha-carboxylesterase was higher than the beta-carboxylesterase in both the strains. Among the malathion resistant C. quinquefasciatus population, 2.3% population exhibited 30-40% inhibition which increased to 5.8% after the thermal exposure. Thermal exposure of mosquitoes increased the activity of both alpha-carboxylesterases and acetylcholinesterase but decreased the activity of beta-carboxylesterase.

Evaluation of Tribulus terrestris Linn (Zygophyllaceae) acetone extract for larvicidal and repellence activity against mosquito vectors

Acetone extracts of leaves and seeds from the Tribulus terrestris (Zygophyllaceae) were tested against mature and immature different mosquito vectors under laboratory condition. The extract showed strong larvicidal, properties 100 per cent mortality in the 3rd-instar larvae was observed in the bioassays with An. culicifacies Giles species A, An. stephensi Liston, Culex quinquefasciatus Say and Aedes aegypti Linn, against 200 ppm of the leaf acetone extract and 100 ppm seed acetone extract. The LC50 values of leaf acetone extract estimated for 3rd-instars An. culicifacies species A, An. stephensi, Cx. quinquefasciatus and Ae. aegypti after 24 hour of exposure were 117, 124, 168 and 185 ppm respectively. The LC50 values of seed acetone extract estimated for 3rd-instars An. culicifacies species A, An. stephensi, Cx. quinquefasciatus and Ae. aegypti after 24 hour of exposure were 100, 72, 91 and 91 ppm respectively. It is confirmed from the LC50 values that the seed acetone extract of T. terrestris is more effective compared to leaf extracts. A significant (P<0.004) higher concentration of acetone extract leaf was required to kill equal number of larvae i.e. against acetone extract of seed. The seed acetone extract showed strong repellent activity against adults mosquitoes. Per cent protection obtained against Anopheles culicifacies species A 100% repellency in 1 h, 6 h; Anopheles stephensi 100% repellency in 0 h, 4 h, 6 h; and Culex quinquefasciatus 100% repellency in 0 h, 2 h, 4 h, at 10% concentration respectively. Against Deet- 2.5% An. culicifacies Giles species A has shown 100% repellency in 1 h, 2 h, 6 h, An. stephensi Liston 99% repellency in 4 h, and Culex quinquefasciatus Say has shown 100% repellency in 1 h, 2 h.

Effect of temperature on development, eclosion, longevity and survivorship of malathion-resistant and malathion-susceptible strain of Culex quinquefasciatus

Density of vectors and development of resistance against insecticides are two important aspects in the control of vector-borne diseases. Here, effect of temperature on different aspects of development of malathion-resistant and susceptible strains of Culex quinquefasciatus was evaluated in the laboratory. Fourth-instar larvae of C. quinquefasciatus were exposed to 37 degrees C, 39 degrees C, 40 degrees C, and 41 degrees C, and their LT(50) values calculated. The fourth-instar larvae were subjected to heat for 4 h at 39 degrees C and live larvae were reared until the completion of life cycle. The larvae of malathion-resistant strain were more tolerant to heat than the larvae of malathion-susceptible ones. The difference in mortality between 37 degrees C, 39 degrees C, 40 degrees C, and 41 degrees C of both the strains of C. quinquefasciatus were highly significant. Pupation percentage of heat-exposed larvae of both the strains was higher and delayed than the control ones. The percentage of adult emergence from the heat-exposed larvae was significantly lower than the control. The adult female of malathion-resistant strain showed increased longevity when exposed to heat at larval stage but reverse was true in case of malathion-susceptible. The highlights of the study would help in the management of resistance of mosquito vectors in the tropics where variable climatic condition is observed.

Infection in total joint replacements

A retrospective review of MRSA screening showed that of a total of 8911 patients screened pre-operatively between May 1996 and February 2001, 83 (0.9%) had MRSA isolated from one source or another. During the same period, 115 (13.6%) of 844 positive tissue samples taken during surgery grew Staphylococcus aureus. Of these only 1 (0.01%) was reported to be methicillin-resistant (MRSA). However, a total of 366 (43.4%) isolates from tissue samples were reported as coagulase-negative staphylococci (C-NS). Of these, 312 samples were tested for methicillin sensitivity, of which 172 (55.1%) were found to be resistant.

Staphylococcus epidermidis is the most prevalent and persistent species found on most skin and mucous membranes, constituting 65% to 90% of all staphylococci. Most isolates in tissue samples were found to be methicillin-resistant coagulase-negative staphylococcus (55.1%). Hence, it may be appropriate to undertake screening for methicillin-resistant Staphylococcus epidermidis in addition to that for MRSA.

Laboratory evaluation of Trichophyton ajelloi, a fungal pathogen of Anopheles stephensi and Culex quinquefasciatus

Trichophyton ajelloi, a fungus isolated from soil, caused high larval mortality in Anopheles stephensi and Culex quinquefasciatus in the laboratory. The efficacy and toxicity of T. ajelloi against An. stephensi and Cx. quinquefasciatus were evaluated at 6 different concentrations. At different concentrations of T. ajelloi, chitin synthesis in larval cuticle was adversely affected. Larvae of 3rd-stage An. stephensi were more susceptible to T. ajelloi than were larvae of 1st, 2nd, and 4th stages as calculated by probit analysis. Larvae of Cx. quinquefasciatus were relatively resistant to infection by T. ajelloi.

Kinetics of SO4(-2) reduction under different growth media by sulfate reducing bacteria

Sulfate Reducing Bacteria (SRB) were used to reduce the SO4(-2) concentration in waste water. The growth pattern of SRB was found by varying the concentration of nutrients and the biomass. The specific reaction constant was evaluated in each case.

Filarial lymphoedema and elephantiasis of lower limb: a review of 44 cases

Twenty patients with early lymphoedema due to filariasis and twenty-four patients with elephantiasis of the lower limb were subjected to lymph nodovenous shunt (LNVS) and Charles' operation respectively. In 62 per cent of cases subjected to LNVS operation, there was a rapid relief of lymphoedema followed by slow reduction, 24 per cent had slow and gradual reduction and 14 per cent had very slight reduction in volume and circumference. Patients subjected to Charles' operation had immediate volume and circumference reduction and skin graft 'take' was 88 per cent. There were no operative and a few minor postoperative complications in both the procedures, infection being most notable in those who had undergone Charles' operation. The hospital stay was 7-10 days in LNVS and 21-36 days in Charles' operation. There was no mortality. The long-term results of the present study in terms of volume and circumference reduction, skin condition and freeness of joint movement were encouraging. It is concluded that, while excisional surgery such as Charles' operation becomes necessary for late states of lymphoedema which have progressed to elephantiasis, nodovenous shunt alone is sufficient to relieve early stages of lymphoedema due to filariasis.

The incidence of Filaria as an aetiological factor for testicular hydrocele

Five hundred cases of hydrocele of the tunica vaginalis testis (TVT) have been studied in detail in order to ascertain their aetiology. In 43 per cent of cases hydrocele was found to be definitely due to filariasis, in 14 per cent it was highly likely that filariasis was responsible and in 16 per cent filariasis was suspected to be the aetiological factor. The remaining 27 per cent of cases were found to be non-filarial.