Modified Temporal Incision for the Management of Zygomatic Arch fractures-A Retrospective Study for 7 Years

Study Design

Retrospective cross-sectional study.

Objective

The objective of this retrospective study was to evaluate the clinical outcomes of Modified temporal incision in the management of zygomatic arch fractures (ZAF).

Patients and Methods

Records of 34 patients who underwent open reduction for zygomatic arch fractures were retrieved and included in the study between 2011 and 2018. These patients were followed up at 4 weeks, 8 weeks and 12 weeks respectively. Clinical parameters such as post-operative infection, hematoma, scarring, degree of mouth opening, palpability of plates, alopecia and weakness of temporal branch of Facial nerve recorded were analyzed for complications of modified temporal incision in the management of ZAF.

Results

A thorough analysis of the clinical parameters revealed that at the end of 4 weeks scarring was present in 4 patients and temporal branch of Facial nerve weakness was present in 21 patients. None of the patients had hematoma, infection or palpability of miniplates. At the end of 8 weeks the only complication recorded was weakness of temporal branch of Facial nerve in 21 patients. By 12 weeks, all patients had complete recovery and none of the patient had weakness of temporal branch of Facial nerve.

Conclusion

The results obtained proved that the Modified temporal incision can be considered as a reliable method in the management of zygomatic arch fractures. The incision can be adopted with confidence in suitable cases of zygomatic arch fractures without any permanent morbidity.

Efficacy and evaluation of environmental management system to control sandfly vector of Kala-azar

The established vector for visceral leishmaniasis, Phlebotomus argentipes (Diptera: Psychodidae) breeds inside the human dwellings and cattle shed under crevices at the base of the wall. P. argentipes was controlled by plastering the base of wall (9″height × 9″base). The study was conducted in two phases: (i) Screening of plastering materials (ii) validation of the most suitable material. During the first phase (2014); four intervention materials were evaluated in four different arms: (i) cement (ii) brick chimney fly ash (BCFA i.e. waste material from an oven for backing raw earthen brick in charcoal) mixed with lime (95:5) (iii) wire mesh (25 holes/cm²) and (iv) glazed tiles. Ten houses were selected as test and same as control in four different villages for each arm having similar ecotype and similar density of sandflies. The pre and post intervention density of sandflies were evaluated. Significant reduction in sandfly density was found with cement (46.2%) and BCFA (29.6%) plastering (P < 0.05). In the second phase of the study (2015); the two most effective interventions were validated at village level with one control. A significant reduction in the density of P. argentipes was found with cement; 60.2% (Mean ± S.D. = 2.48 ± 2.78, 95% CI = 1.93-3.02) and BCFA; 48.2% (Mean ± S.D. = 1.98 ± 2.20, 95% CI = 1.55-2.41) (P < 0.05). BCFA was found easily accessible, acceptable and cost effective that can be used in any type of wall materials at own cost. This can be implemented as one of the integrated vector control approach in the programme.

Fecundity and life table of different morphotypes of Phlebotomus argentipes (Diptera: Psychodidae)

Phlebotomus argentipes Annandale and Brunetti (Diptera: Psychodidae), the established vector for Visceral Leishmaniasis (VL) have shown some morphological variations in India and its subcontinents. The variable egg laying capacity was found in different morphotypes of P. argentipes with maximum in type III followed by type I and II. The fecundity was enhanced by providing 25% glucose soaked filter paper surface in all types. However, significant increase was found in type-I (P < 0.05). The differences in fecundity indicate the biological variations among P. argentipes population. The findings will be helpful in searching out the sibling species among P. argentipes population.

A report on the indoor residual spraying (IRS) in the control of Phlebotomus argentipes, the vector of visceral leishmaniasis in Bihar (India): an initiative towards total elimination targeting 2015 (Series-1)

BACKGROUND & OBJECTIVES

Visceral leishmaniasis, commonly known as kala-azar is endemic in Bihar state, India. Current vector control programme in Bihar focuses mainly on spraying the sandfly infested dwellings with DDT. The Government of India in collaboration with WHO has fixed the target 2015 for total elimination of kala-azar. The present study was carried out to see the impact of DDT and improved IEC in the containment of vector density vis-à-vis disease transmission.

METHODS

Before the start of the spraying operations training was imparted to all the medical and paramedical personnel regarding the methods of spraying operations. Pre- and post-sandfly density was monitored in four selected districts. Incidences of kala-azar cases were compared for pre- and post-spray periods. Social acceptability and perceptions of households was collected through questionnaires from 500 randomly selected households in the study districts.

RESULTS

House index in three study districts reduced considerably during post-spray when compared to pre-spray. Kala-azar incidence in many districts was reduced after the DDT spray. Either partial or complete refusal was reported in 14.4%, while 35% were not satisfied with the suspension concentration and coverage; and 46.6% were found satisfied with the spraying procedure.

INTERPRETATION & CONCLUSION

Strengthening the IEC activities to sensitise the community, proper training of health personnel, monitoring of spray, good surveillance, proper treatment of cases and two rounds of DDT spray with good coverage in the endemic districts up to three years are essential to achieve the desired total elimination of kala-azar in Bihar state.

The efficacy of indoor CDC light traps for collecting the sandfly Phlebotomus argentipes, vector of Leishmania donovani

The efficacy of light traps for collecting sandflies (Diptera: Psychodidae) varies both inter-specifically and intra-specifically (by gender and physiological status) as a result of significant differences in phototropic and other behavioural characteristics. The efficacy of miniature CDC light traps for collecting Phlebotomus argentipes Annandale & Brunetti, a vector of Leishmania donovani Laveran & Mesnil (Kinetoplastida: Trypanosomatidae), was assessed in the Indian state of Bihar. Sandflies were collected during the night from 16 houses in each of three villages over 3 months (four times at fortnightly intervals) using CDC light traps indoors, and by aspirator collection (carried out by one person for 30 min/house) from the walls of the same houses the following morning. Incidence rate ratios (IRRs) between CDC light trap collections and aspirator collections were obtained through a negative binomial regression with household as random effect. CDC light traps were especially effective in catching males (IRR 3.08, 95% confidence interval [CI] 2.12-4.46) and unfed females (IRR 3.50, 95% CI 2.37-5.16) of P. argentipes, and to a lesser extent gravids (IRR 1.77, 95% CI 1.07-2.93). However, only a relatively small proportion of all blood-fed P. argentipes were collected by light trap (IRR 0.45, 95% CI 0.28-0.73). Despite its limitations in collecting blood-fed female sandflies, the CDC light trap appears to trap a sufficient proportion of the indoor population of sandflies for sampling purposes, and as this light trap is also more convenient and more easily standardized than the aspirator method, we conclude that it is the most efficient method for monitoring P. argentipes populations in the Indian subcontinent.

Dual culture method to determine the relationship of gut bacteria of sandfly (Phlebotomus argentipes) with promastigotes of Leishmania donovani

A simple dual culture agar plating technique has been developed and evaluated for its efficiency in determining the relationship of gut bacteria of sandfly with Leishmania donovani promastigotes. There are about twenty morphologically distinct bacterial colonies have been isolated from the gut homogenate of Phlebotomus argentipes. In dual culture method, each bacterial isolate was inoculated in one half of the plate and the promastigotes of Leishmania was inculcated in the other half by streaking. After incubation, the type of association was determined based on the presence or absence of promastigotes colonies. The reliability of this method was compared with broth dilution method in 96 well plate.

Vector control in leishmaniasis

Indoor residual spraying is a simple and cost effective method of controlling endophilic vectors and DDT remains the insecticide of choice for the control of leishmaniasis. However resistance to insecticide is likely to become more widespread in the population especially in those areas in which insecticide has been used for years. In this context use of slow release emulsified suspension (SRES) may be the best substitute. In this review spraying frequencies of DDT and new schedule of spray have been discussed. Role of biological control and environment management in the control of leishmaniasis has been emphasized. Allethrin (coil) 0.1 and 1.6 per cent prallethrin (liquid) have been found to be effective repellents against Phlebotomus argentipes, the vector of Indian kalaazar. Insecticide impregnated bednets is another area which requires further research on priority basis for the control of leishmaniasis. Role of satellite remote sensing for early prediction of disease by identifying the sandflygenic conditions cannot be undermined. In future synthetic pheromons can be exploited in the control of leishmaniasis.

A pilot study on the status of lymphatic filariasis in a rural community of Bihar

A pilot study of lymphatic filariasis was conducted in two contiguous villages of Patna district in Bihar situated at the side of the river Ganges, known to be endemic for lymphatic filariasis, to study present status of transmission parameters of filariasis. Of the 1872 persons examined, 8.4% were found asymptomatic but microfilaraemic. Morbidity pattern due to filarial infection showed an increase with advancement of age and significantly high in males as compared to female (p < 0.001). Acute and chronic filarial disease was observed as 0.5% and 9% respectively. Microfilaria was found in 10% of acute and 11.2% of chronic filarial cases. The Mf rate was found to be 9.9% in males and 9.0% in females respectively. The parasite species was identified as W. bancrofti. The vector fauna surveyed show highest prevalence of vector species of Cx. quinquefasciatus (43%) in both domestic as well as predomestic area in the community. Other species like Cx. vishnui and Ma. uniformis were also seen. Each household and predomestic area was searched for mosquito fauna at night. The infection rate in vectors was found to be 14% and infectivity rate (L3) was 8%. The filariasis cases detected in the study were treated with 12 days course of DEC 6 mg/kg body weight.

Morphological variations in Phlebotomus argentipes (Diptera: Psychodidae) Annandale and Brunetti

Morphological variations were observed in Phlebotomus argentipes, the vector for visceral leishmaniasis reported from the endemic states of Bihar, West Bengal and Uttar Pradesh. The taxonomic features distinguishing vector and nonvector species of P. argentipes were relative length of ascoid and antennal segment IV. Three morphotypes were characterized as <0.4, = 0.4 and >0.4 respectively. Other characteristics of wing width, wing length, eye, style, antennal segment III, IV, V was found statistically significant (p<0.05) and eleven other morphological measurements were not significant. This study suggests three different morphotypes of P. argentipes in these three endemic states. The genetic and reproductive isolation among such morphotypes will establish the variability in further studies.

Seasonal and nocturnal landing/biting behaviour of Phlebotomus argentipes (Diptera: Psychodidae)

The nocturnal activity of Phlebotomus argentipes (Diptera: Psychodidae), the main vector of Leishmania donovani in India, was studied throughout a year, with monthly collections, between 18.00 and 06.00 hours, of the sandflies landing on 15 humans and 15 cows in the village of Bahapur, Patna district. The cattle appeared to be better as bait, since more than five female P. argentipes were caught on them for each one caught on the human bait. Overall, although P. argentipes were caught during each collection hour from 18.00--06.00 hours, the numbers caught landing/biting peaked at 23.00--24.00 hours. There were, however, slight seasonal variations in the timing of this peak in activity. The numbers of P. argentipes caught/collection night also varied with season, being significantly higher during the summer than during the rainy season or winter (P < 0.01 for each), and apparently inversely correlated with rainfall. Male P. argentipes were caught in much higher numbers than the females of this species, with female:male ratios of 1:8 for the flies caught on human bait and of 1:13 for those collected from cattle. If the probability of a female P. argentipes being infected with L. donovani does not vary with season, peak transmission of this parasite to humans probably occurs between February and May, at the middle of night.

Screening sandflies for natural infection with Leishmania donovani, using a non-radioactive probe based on the total DNA of the parasite

Digoxigenin-labelled total, Leishmania donovani DNA was used as a probe to detect the parasite in Indian Phlebotomus argentipes. The probe was quite sensitive, detecting as little as 0.3 pg parasite DNA, equivalent to approximately 100 parasites. Positive signals could be detected in 12 (32%) of the 38 small (two- to 30-fly) pools of the wild-caught P. argentipes investigated and in a pool of 10 laboratory-bred P. argentipes fed on a patient with post-kala-azar dermal leishmaniasis. None of the wild-caught P. papatasi, P. sergenti or Sergentomyia sp. or of the newly emerged, laboratory-bred P. argentipes investigated were positive by this probe. The results indicate that such a probe may be very useful in screening sandflies for L. donovani, and so detecting the main vectors and transmission pathways of this parasite, in India and elsewhere.