Impact of Community-Based Lymphedema Management on Perceived Disability among Patients with Lymphatic Filariasis in Orissa State,India

Background

Lymphatic filariasis (LF) infects approximately 120 million people worldwide. As many as 40 million have symptoms of LF disease, including lymphedema, elephantiasis, and hydrocele. India constitutes approximately 45% of the world''s burden of LF. The Indian NGO Church''s Auxiliary for Social Action (CASA) has been conducting a community-based lymphedema management program in Orissa State since 2007 that aims to reduce the morbidity associated with lymphedema and elephantiasis. The objective of this analysis is to evaluate the effects of this program on lymphedema patients'' perceived disability.

Methodology/Principal Findings

For this prospective cohort study, 370 patients ≥14 years of age, who reported lymphedema lasting more than three months in one or both legs, were recruited from villages in the Bolagarh sub-district, Khurda District, Orissa, India. The World Health Organization Disability Assessment Schedule II was administered to participants at baseline (July, 2009), and then at regular intervals through 24 months (July, 2011), to assess patients'' perceived disability. Disability scores decreased significantly (p<0.0001) from baseline to 24 months. Multivariable analysis using mixed effects modeling found that employment and time in the program were significantly associated with lower disability scores after two years of program involvement. Older age, female gender, the presence of other chronic health conditions, moderate (Stage 3) or advanced (Stage 4–7) lymphedema, reporting an adenolymphangitis (ADL) episode during the previous 30 days, and the presence of inter-digital lesions were associated with higher disability scores. Patients with moderate or advanced lymphedema experienced greater improvements in perceived disability over time. Patients participating in the program for at least 12 months also reported losing 2.5 fewer work days per month (p<0.001) due to their lymphedema, compared to baseline.

Significance

These results indicate that community-based lymphedema management programs can reduce disability and prevent days of work lost. These effects were sustained over a 24 month period.     

Impact of a Community-Based Lymphedema Management Program on Episodes of Adenolymphangitis (ADLA) and Lymphedema Progression - Odisha State,India

Background

Lymphedema management programs have been shown to decrease episodes of adenolymphangitis (ADLA), but the impact on lymphedema progression and of program compliance have not been thoroughly explored. Our objectives were to determine the rate of ADLA episodes and lymphedema progression over time for patients enrolled in a community-based lymphedema management program. We explored the association between program compliance and ADLA episodes as well as lymphedema progression.

Methodology/Principal Findings

A lymphedema management program was implemented in Odisha State, India from 2007–2010 by the non-governmental organization, Church''s Auxiliary for Social Action, in consultation with the Centers for Disease Control and Prevention. A cohort of patients was followed over 24 months. The crude 30-day rate of ADLA episodes decreased from 0.35 episodes per person-month at baseline to 0.23 at 24 months. Over the study period, the percentage of patients who progressed to more severe lymphedema decreased (P-value  = 0.0004), while those whose lymphedema regressed increased over time (P-value<0.0001). Overall compliance to lymphedema management, lagged one time point, appeared to have little to no association with the frequency of ADLA episodes among those without entry lesions (RR = 0.87 (0.69, 1.10)) and was associated with an increased rate (RR = 1.44 (1.11, 1.86)) among those with entry lesions. Lagging compliance two time points, it was associated with a decrease in the rate of ADLA episodes among those with entry lesions (RR = 0.77 (95% CI: 0.59, 0.99)) and was somewhat associated among those without entry lesions (RR = 0.83 (95% CI: 0.64, 1.06)). Compliance to soap was associated with a decreased rate of ADLA episodes among those without inter-digital entry lesions.

Conclusions/Significance

These results indicate that a community-based lymphedema management program is beneficial for lymphedema patients for both ADLA episodes and lymphedema. It is one of the first studies to demonstrate an association between program compliance and rate of ADLA episodes.     

Evaluating the Burden of Lymphedema Due to Lymphatic Filariasis in 2005 in Khurda District,Odisha State,India

BackgroundOver 1.1 billion people worldwide are at risk for lymphatic filariasis (LF), and the global burden of LF-associated lymphedema is estimated at 16 million affected people, yet country-specific estimates are poor.SignificanceThese data highlight the magnitude of lymphedema in LF-endemic areas and emphasize the need to develop robust estimates of numbers of individuals with lymphedema in order to identify the extent of lymphedema management services needed in these regions.     

Comparative Analysis of 16S rRNA Gene Illumina Sequence for Microbial Community Structure in Diverse Unexplored Hot Springs of Odisha,India

Odisha (East India) is home to several hot springs, of which Atri and Taptapani are the two with variation in temperature and located in the Mahanadi geothermal province having altitude 120 and 1800 ft., respectively, above sea level. Average temperature of Atri hot spring is as higher as 58 ± 5°C as compared to 48 ± 5°C of Taptapani. In-depth analysis of the microbial diversity of these hot springs through 16S rRNA deep sequencing analysis, targeting V3 region was performed using Illumina bar-coded sequencing platform. Existence of higher microbial diversity in Atri hot spring (1662 OTUs; 2708 species) as compared to Taptapani (1561 Operational Taxonomic Units [OTUs]; 2045 species) is supported by higher value of diversity indices for Atri (6.24, Shannon; 0.95, Simpson) than Taptapani (4.03, Shannon; 0.79, Simpson), probably due to favorable influence of environmental parameters around it. Irrespective of the four databases (GREENGENE, M5RNA, Ribosomal Database Project [RDP], and Small Subunit [SSU] databases) used for understanding community structure, the dominant phyla in the Atri hot spring were different from the predominant populations in the Taptapani in terms of percentage representation in different databases. From Principal Coordinates Analysis [PCoA] analysis, Atri and Taptapani metagenome, on comparison with other three metagenomes, were found to be matching with the community structure of hot springs of Gujarat, India, but differed from that of saline desert. Furthermore, predicted functional analysis in both the hot springs were found to be affiliated with carbohydrate, amino acids, energy, vitamins and cofactor, nucleotide, membrane transport metabolic pathways, and the genes involved in them, although their intensity of occurrence was varying as analyzed through PICRUSt and Tax4Fun probably due to physicochemical parameters prevailing around each hot spring. The present study for the first time has revealed the differential microbial community structure and predicted functional diversity of Atri and Taptapani hot springs of Odisha in such a great detail.     

An Analysis of the Biotic Community in a Kumaun Himalayan Lake,Nainital (U. P.), India

A comprehensive study of phyto- and zooplankton and macrozoobenthic components in Lake Nainital showed that species richness was high for plankton and low for macrozoobenthos. The algal biomass was dominated by greens (54 %) and blue-greens (31 %), the zooplankton population by copepods (84 %), and the macrozoobenthic community by a Tubifex-Chironomus association constituting≥95 % of the annual number of the macrobenthic invertebrates. Respiration (807.5g C m⁻² year⁻¹) surpassed gross production (630.5 g C m⁻² year⁻¹). The mean annual ratio between phyto- and zooplankton biomass is 3.3 and between phytoplankton and herbivores it is 4.6. If biomass is treated as a measure of crude production, the relationship among the three trophic levels suggests that herbivory is inefficient while carnivory is efficient, because part of the primary production remains unutilized by dominant herbivorous zooplankters, whereas Mesocyclops leuckarti, the sole carnivore, feeds efficiently on rotifers and juveniles of other copepods. The low diversity of different biotic components and the P/R ratio of less than 1 perhaps suggest that the lake is passing through the stage of heterotrophic succession.     

Description of a new species of the genus Awaous Valenciennes, 1837 (Gobiiformes: Oxudercidae) from the middle stretch of the Mahanadi River,Odisha, India,with comments on the Awaous species from India

A new species of the genus Awaous (Oxudercidae), Awaous motla sp. nov., is described based on 18 specimens collected from the Mahanadi River near Sonepur, Subarnapur District, and 3 specimens from the same river near Boudh bridge, Boudh District of Odisha, India. This species is distinct from its congeners by having a combination of characteristics: relatively small eyes, diameter of 6.6–8.4 in head length (LH); robust and long snout, 2.0–2.6 in LH; eye diameter 2.7–4.1 in snout length; cephalic sensory pore system interrupted with eight pores; predorsal scales 13–15; longitudinal scale series 55–58; gill rakers 2 + 1 + (6–7) on the first gill arch; teeth small, conical, and in a single row on the upper jaw and multiserial (2–3) on the lower jaw. This species is also differentiated from some of its congeners in the nucleotide composition of the cytochrome c oxidase I gene by 8.3%–13.8% Kimura two-parameter (K2P) distance and belongs to a separate cluster in the maximum likelihood tree analysis. This finding is also supported by the species delimitation analysis based on Assemble Species by Automatic Partitioning. The new species holds high commercial value in its locality and needs special conservation attention for sustainable utilization.     

Caught in the Psychiatric Net: Meanings and Experiences of ADHD,Pediatric Bipolar Disorder and Mental Health Treatment Among a Diverse Group of Families in the United States

Based on a 13-month ethnographic meaning-centered study of the lived experience of behavioral and emotional disorders among children and families living in the United States, this article highlights the range of orientations to mental health problems and treatment among families from diverse backgrounds. Detailed case portraits of three families are presented to illustrate the various meanings that psychiatric diagnoses and mental health treatments take on within families, with medicalized perspectives holding less salience among African-American families relative to Euro-Americans in the study. The diverse orientations to problems among families in the study suggest that, despite the dominance of biochemical and neurological explanations for behavioral and emotional distress in contemporary U.S. culture, and especially U.S. psychiatry, nonpathological interpretations have not been wholly eclipsed by broad trends toward biologization and medicalization. Families’ experiences are positioned to reveal the allure, as well as the limitations, of biopsychiatric approaches to behavioral and emotional problems.

Utilization of a State Run Public Private Emergency Transportation Service Exclusively for Childbirth: The Janani (Maternal) Express Program in Madhya Pradesh,India

Background

In 2009 the state government of Madhya Pradesh, India launched an emergency obstetric transportation service, Janani Express Yojana (JEY), to support the cash transfer program that promotes institutional delivery. JEY, a large scale public private partnership, lowers geographical access barriers to facility based care. The state contracts and pays private agencies to provide emergency transportation at no cost to the user. The objective was to study (a) the utilization of JEY among women delivering in health facilities, (b) factors associated with usage, (c) the timeliness of the service.

Methods

A cross sectional facility based study was conducted in facilities that carried out > ten deliveries a month. Researchers who spent five days in each facility administered a questionnaire to all women who gave birth there to elicit socio-demographic characteristics and transport related details.

Results

35% of women utilised JEY to reach a facility, however utilization varied between study districts. Uptake was highest among women from rural areas (44%), scheduled tribes (55%), and poorly educated women (40%). Living in rural areas and belonging to scheduled tribes were significant predictors for JEY usage. Almost 1/3 of JEY users (n = 104) experienced a transport related delay.

Discussion

The JEY service model complements the cash transfer program by providing transport to a facility to give birth. A study of the distribution of utilization in population subgroups suggests the intervention was successful in reaching the most vulnerable population, promoting equity in access. While 1/3 of women utilized the service and it saved them money; 30% experienced significant transport related delays in reaching a facility, which is comparable to women using public transportation. Further research is needed to understand why utilization is low, to explore if there is a need for service expansion at the community level and to improve the overall time efficiency of JEY.     

Field trial of the effectiveness of indoor-spraying with pirimiphos-methyl emulsion for malaria control in a tribal area of Phulbani district, Orissa State, India

A field trial of malaria vector control was conducted in Phulbani district, Orissa, during 1984 and 1985. Indoor-spraying of pirimiphos-methyl emulsion formulation was undertaken at an application rate of 2 g/m2 in two sections (population 14,692) of Nuagaon Primary Health Centre. Houses in two adjacent sections (population 21,450) were sprayed with DDT a water dispersible powder (wdp) formulation at 1 g/m2 for comparison purposes. Operational problems in this area come from the tendency of tribal people to re-plaster over wdp applications. Pre-spray malariological indices in the trial area were 38% slide positivity rate, 37% slide falciparum rate and 12.1% annual parasite incidence. Densities of Anopheles annularis Van der Wulp, An. culicifacies Giles, An. fluviatilis Theobald and other potential malaria vectors were reduced in the pirimiphos-methyl trial area 2-35-fold more than in the area sprayed with DDT. Malariological indices were reduced by 65-68% in the pirimiphos-methyl sprayed area compared with only 26-35% reduction in the DDT sprayed area. Spraymen and villagers experienced no adverse side-effects from residual house-spraying with pirimiphos-methyl emulsion and it is concluded that this organophosphate product has advantages for malaria vector control, especially in operationally difficult situations.     

Impact of NGO Training and Support Intervention on Diarrhoea Management Practices in a Rural Community of Bangladesh: An Uncontrolled,Single-Arm Trial

Purpose/Objective

The evolving Non-Governmental Organization (NGO) sector in Bangladesh provides health services directly, however some NGOs indirectly provide services by working with unlicensed providers. The primary objective of this study was to examine the impact of NGO training of unlicensed providers on diarrhoea management and the scale up of zinc treatment in rural populations.

Methods

An uncontrolled, single-arm trial for a training and support intervention on diarrhoea outcomes was employed in a rural sub-district of Bangladesh during 2008. Two local NGOs and their catchment populations were chosen for the study. The intervention included training of unlicensed health care providers in the management of acute childhood diarrhoea, particularly emphasizing zinc treatment. In addition, community-based promotion of zinc treatment was carried out. Baseline and endline ecologic surveys were carried out in intervention and control villages to document changes in treatments received for diarrhoea in under-five children.

Results

Among surveyed household with an active or recent acute childhood diarrhoea episode, 69% sought help from a health provider. Among these, 62.8% visited an unlicensed private provider. At baseline, 23.9% vs. 22% of control and intervention group children with diarrhoea had received zinc of any type. At endline (6 months later) this had changed to 15.3% vs. 30.2%, respectively. The change in zinc coverage was significantly higher in the intervention villages (p<0.01). Adherence with giving zinc for 10 days or more was significantly higher in the intervention households (9.2% vs. 2.5%; p<0.01). Child''s age, duration of diarrhoea, type of diarrhoea, parental year of schooling as well as oral rehydration solution (ORS) and antibiotic usage were significant predictors of zinc usage.

Conclusion

Training of unlicensed healthcare providers through NGOs increased zinc coverage in the diarrhoea management of under-five children in rural Bangladesh households.

Trial Registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT02143921","term_id":"NCT02143921"}}NCT02143921     

An annotated checklist of Culicoides Latreille, 1809 (Insecta: Ceratopogonidae: Diptera) with incorporation of a vector species list from India

Culicoides Latreille, 1809 (Insecta : Diptera : Ceratopogonidae) are small nematocerous biological vectors of a wide range of pathogens of veterinary and medical importance. They are distributed worldwide but prefer warm, damp, and muddy areas. Female midges require blood for egg maturation. Studies on taxonomy, proper identification keys, and distribution patterns of these flies across different geographical regions of India of these flies are limited. This article provides an updated checklist of Culicoides spp. from India collected from various scattered publications, along with their synonyms and details on their subgenera, geographical distribution, and type locality. A compiled list of different Culicoides vectors from India has also been included separately in this article, along with the type of the diseases spread.     

p.Arg82Leu von Hippel-Lindau (VHL) Gene Mutation among Three Members of a Family with Familial Bilateral Pheochromocytoma in India: Molecular Analysis and In Silico Characterization

Various missense mutations in the VHL gene have been reported among patients with familial bilateral pheochromocytoma. However, the p.Arg82Leu mutation in the VHL gene described here among patients with familial bilateral pheochromocytoma, has never been reported previously in a germline configuration. Interestingly, long-term follow-up of these patients indicated that the mutation might have had little impact on the normal function of the VHL gene, since all of them have remained asymptomatic. We further attempted to correlate this information with the results obtained by in silico analysis of this mutation using SIFT, PhD-SNP SVM profile, MutPred, PolyPhen2, and SNPs&GO prediction tools. To gain, new mechanistic insight into the structural effect, we mapped the mutation on to 3D structure (PDB ID 1LM8). Further, we analyzed the structural level changes in time scale level with respect to native and mutant protein complexes by using 12 ns molecular dynamics simulation method. Though these methods predict the mutation to have a pathogenic potential, it remains to be seen if these patients will eventually develop symptomatic disease.     

冷胁迫诱导、咖啡因抑制的水稻根新基因片段的分离及表达分析

利用差异显示（Differential display）及H.Y-Yellow琼脂糖凝胶分离等方法,从冷胁迫和甘露醇共同处理的冷敏感水稻（Wase toitsu）根的总RNA中,分离出冷胁迫诱导的cDNA片段,经过测序和同源比较,发现它是一尚未报道的新基因片段。这一基因的表达对温度具有敏感的反应特性,4℃时表达水平明显增加,在正常温度（25℃）下,其表达水平又可快速降低。当幼苗根用0.5mol/L甘露醇预处理2h后,转入冷胁迫,其低温诱导的表达水平增加更为明显。在甘露醇预处理之前加入咖啡因处理根1h,其表达水平明显降低,几乎与正常温度下的对照相同。据此推测,这一基因可能参与了冷胁迫或水分胁迫诱导的耐冷过程中咖啡因敏感信号的传导。 