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This study from southern India showed that proximal hip geometry was significantly impaired in postmenopausal women with femoral neck fracture. The trabecular bone score (TBS), which is reflective of bone microarchitecture, was also significantly impaired in patients with fracture.There is limited information with regard to comprehensive bone health in Indian postmenopausal women with neck of femur fracture. We studied the bone mineral density (BMD), trabecular bone score (TBS), proximal hip geometry, and bone mineral biochemistry in postmenopausal women with and without femoral neck fractures.This was a cross-sectional study conducted at a tertiary care center in South India. BMD, TBS, and hip structural analysis (HSA) were assessed using a dual-energy X-ray absorptiometry (DXA) scanner. Bone mineral biochemical profiles were also studied.A total of 90 postmenopausal women with acute femoral neck fracture with mean (SD) age of 63.2 (6.1) years and 90 age-matched controls were included. The prevalence of osteoporosis was higher among cases as compared to controls (83.3% vs 47.8%; P 0.001). Degraded bone microarchitecture (TBS value 1.200) was more frequent among women with hip fracture as compared to controls (46.7% vs 31.1%; P = 0.032). Cross-sectional moment of inertia (CSMI) was significantly lower at the narrow neck (NN) and inter-trochanteric (IT) region in cases (P 0.05) and buckling ratio (BR) was significantly higher at all three sites in postmenopausal women with femoral neck fracture as compared controls. Multivariate logistic regression analysis showed that femoral neck osteoporosis, low CSMI at NN and high BR at NN and femoral shaft emerged as factors significantly associated with femoral neck fractures.This study highlights that impaired parameters of proximal hip geometry and a low trabecular bone score may be significantly associated with femoral neck fractures in postmenopausal women.

In an urban setting, it is a difficult task to collect adult Anopheles stephensi, unlike the immature stages, due to various reasons. A longitudinal study was undertaken from January 2016 to April 2017, with CDC light traps to collect adult Anopheles stephensi and other mosquito species in houses located in a few slums of Chennai, India. A total of 203 trap collections were made indoors from human dwellings having different roof types, as well as outdoors. Three to four trap collections were made at night (18:00 to 06:00 h) once a week. Overall, Culex quinquefasciatus (64%) was the predominant mosquito species captured, followed by An. stephensi (24%). In 98 of the 203 trap collections (48.3%), at least one female An. stephensi was trapped. In all, 224 female An. stephensi were trapped, of which the majority were collected during monsoon and winter seasons. Compared to outdoors, 10% more An. stephensi, the majority of them unfed, were collected indoors, with relatively more contribution coming from asbestos-roofed houses (71.4%), followed by thatched-roof houses (47.3%). Overall, 2.2% positivity for Plasmodium vivax was detected in An. stephensi through Circumsporozoite-ELISA. Binary logistic regression model indicated that season (winter and monsoon), asbestos-roofed dwelling, lesser number of rooms in a house, and more members in a family were significant predictor variables for the odds of trapping an An. stephensi. The study brought out significant factors associated with the presence of An. stephensi in urban slums setting in Chennai, where malaria is declining. The findings would help in devising targeted, effective vector control interventions for malaria elimination in urban settings.

The study was an attempt to capture Anopheles stephensi from cattle sheds during dawn to understand the realistic density of the resting mosquitoes. A 2-year longitudinal study was carried out in cattle sheds in close proximity to the human dwellings to collect the resting vector mosquitoes. The man-hour density of An. stephensi ranged from 24.7 to 206.5. The vector incrimination results indicated 0.15% of An. stephensi infected with Pv210 in 2015 and 0.09% in 2016. The current study indicated that cattle sheds are still the preferred resting place of An. stephensi and that dawn is the perfect time to collect and estimate its densities. Hence, adult vector control may also be given due importance in addition to the routine larval source management measures to curb malaria transmission in an urban setting.

Background Household and environmental factors are reported to influence the malaria endemicity of a place. Hence, a careful assessment of these factors would, potentially help in locating the possible areas under risk to plan and adopt the most suitable and appropriate malaria control strategies. Methods A cross-sectional household survey was carried out in the study site, Besant Nagar, Chennai, through random sampling method from February 2014 to February 2015. A structured interviewer-administered questionnaire was used to assess selected variables of demography, structural particulars of a household, usage of repellents, animals on site, presence of breeding habitats and any mosquito/vector breeding in the household, malaria/vector control measures undertaken by government in each houses. The data was collected through one to one personal interview method, statistically analysed overall and compared between the households/people infected with malaria within a period of 1 year and their non-infected counterparts of the same area. Results Presence of malaria was found to be significantly associated with the occupation, number of inhabitants, presence of a separate kitchen, availability of overhead tanks and cisterns, immatures of vector mosquitoes, presence of mosquito breeding and type of roof structures (p

Background: Wells and overhead tanks (OHT) are the major breeding sources of the local malaria vector, Anopheles stephensi in the Indian city of Chennai; they play a significant role in vector breeding, and transmission of urban malaria. Many other man-made breeding habitats, such as cemented cisterns/containers, barrels or drums, sumps or underground tanks, and plastic pots/containers are maintained to supplement water needs, temporarily resulting in enhanced mosquito/vector breeding. Correlating breeding habitats with immature vector abundance is important in effective planning to strengthen operational execution of vector control measures. Methods: A year-long, weekly study was conducted in Chennai to inspect available clear/clean water mosquito breeding habitats. Different breeding features, such as instar-wise, immature density and co-inhabitation with other mosquito species, were analysed. The characteristics of breeding habitats, i.e., type of habitat, water temperature and presence of aquatic organisms, organic matter and green algal remnants on the water surface at the time of inspection, were also studied. Immature density of vector was correlated with presence of other mosquito species, malaria prevalence, habitat characteristics and monthly/seasonal fluctuations. All the data collected from field observations were analysed using standard statistical tools. Results: When the immature density of breeding habitats was analysed, using one-way ANOVA, it was observed that the density did not change in a significant way either across seasons or months. OHTs contributed significantly to the immature population when compared to wells and other breeding habitats of the study site. The habitat positivity of wells and OHTs was significantly associated with the presence of aquatic organisms, organic matter and algal remnants. Significant correlations of malaria prevalence with monthly immature density, as well as number of breeding habitats with immature vector mosquitoes, were also observed. Conclusions: The findings that OHTs showed fairly high and consistent immature density of An. stephensi irrespective of seasons indicates the potentiality of the breeding habitat in contributing to vector density. The correlation between vector breeding habitats, immature density and malaria prevalence indicates the proximity of these habitats to malaria cases, proving its role in vector abundance and local malaria transmission. The preference of An. stephensi to breed in OHTs calls for intensified, appropriate and sustained intervention measures to curtail vector breeding and propagation to shrink malaria to pre-elimination level and beyond.

Background Environmental temperature is an important driver of malaria transmission dynamics. Both the parasite and vector are sensitive to mean ambient temperatures and daily temperature variation. To understand transmission ecology, therefore, it is important to determine the range of microclimatic temperatures experienced by malaria vectors in the field. Methods A pilot study was conducted in the Indian city of Chennai to determine the temperature variation in urban microclimates and characterize the thermal ecology of the local transmission setting. Temperatures were measured in a range of probable indoor and outdoor resting habitats of Anopheles stephensi in two urban slum malaria sites. Mean temperatures and daily temperature fluctuations in local transmission sites were compared with standard temperature measures from the local weather station. The biological implications of the different temperatures were explored using temperature-dependent parasite development models to provide estimates of the extrinsic incubation period (EIP) of Plasmodium vivax and Plasmodium falciparum. Results Mean daily temperatures within the urban transmission sites were generally warmer than those recorded at the local weather station. The main reason was that night-time temperatures were higher (and hence diurnal temperature ranges smaller) in the urban settings. Mean temperatures and temperature variation also differed between specific resting sites within the transmission environments. Most differences were of the order of 1-3°C but were sufficient to lead to important variation in predicted EIPs and hence, variation in estimates of transmission intensity. Conclusions Standard estimates of environmental temperature derived from local weather stations do not necessarily provide realistic measures of temperatures within actual transmission environments. Even the small differences in mean temperatures or diurnal temperature ranges reported in this study can lead to large variations in key mosquito and/or parasite life history traits that determine transmission intensity. Greater effort should be directed at quantifying adult mosquito resting behaviour and determining the temperatures actually experienced by mosquitoes and parasites in local transmission environments. In the absence of such highly resolved data, the approach used in the current study provides a framework for improved thermal characterization of transmission settings.

Osteoarticular tuberculosis of the ankle joint is rare, and diagnostic delays are common with this condition. The aim of our report is to highlight the varied clinical and radiologic presentation of this entity. We present a retrospective review of 16 patients with tuberculosis in and around the ankle joint who were surgically treated during a 6-year period. The incidence of ankle joint involvement in extraspinal osteoarticular tuberculosis was 15.7% in our unit. The most common presentation in our series was chronic septic arthritis, followed by periarticular osseous lytic lesion. Tuberculous synovitis, tenosynovits, and retrocalcaneal bursitis were also seen. Osteopenia, the hallmark of osteoarticular tuberculosis, might not be seen in all forms of tuberculosis affecting this joint. Chemotherapy remains the mainstay of treatment. Adjuvant surgery is often required to establish the diagnosis and in the treatment of patients with deformity and widespread destruction of articular cartilage owing to delayed presentation.