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This study identifies the actin-binding protein, coronin-1a, as a novel and effective immunohistochemical marker for microglia in both cell cultures and in formaldehyde-fixed, paraffin-embedded tissue. Antibodies to coronin-1a effectively immunostained microglia in human, monkey, horse, rat, and mouse tissues, even in tissues stored for long periods of time. The identity of coronin-1a-immunoreactive cells as microglia was confirmed using double immunolabeling with cell type-specific markers as well as by morphological features and the distribution of immunoreactive cells. These properties are shared by another actin-binding protein, IBA-1. Unlike IBA-1, coronin-1a immunoreactivity was also detected in lymphocytes and certain other hematopoietic cells. The results indicate that both coronin-1a and IBA-1 are robust markers for microglia that can be used in routinely processed tissue of humans and animals. Because both coronin-1a and IBA-1 are actin-binding proteins that play a role in rearrangement of the membrane cytoskeleton, it suggests that these proteins are critical to dynamic properties of microglia.

In recent years, the use of aluminium foils to wrap foodstuff and commodities has been increased to a great extent. Aluminium was found to leach out from the foil in different simulants particularly in distilled water, acidic and alkaline medium at 60 +/- 2 degrees C for 2 hours and 40 +/- 2 degrees C for 24 hours. The migration was found to be above the permissible limit as laid down by WHO guidelines, that is of 0.2 mg/L of water. The protocol used for this study was based on the recommendation of Bureau of Indian Standard regarding the migration of chemical additives from packaging materials used to pack food items. Migration of the aluminium metal was found significantly higher in acidic and aqueous medium in comparison to alcoholic and saline medium. Higher temperature conditions also enhanced the rate of migration of aluminium in acidic and aqueous medium. Leaching of aluminium metal occurred in double distilled water, acetic acid 3%, normal saline and sodium carbonate, except ethanol 8%, in which aluminium migration was below the detection limit of the instrument where three brands of the aluminium foil samples studied.

Anopheles culicifaciessensu lato comprises five sibling species. We report the isolation of an An. culicifacies species B strain which is completely refractory to Plasmodium vivax sporogonic development and partially refractory to P. falciparum. Parasite development in this strain is arrested by a melanotic encapsulation mechanism in the mid-gut. We compare the infectivity of this refractory strain and four other species B strains from different epidemiological zones of India with P. vivax in the laboratory.

Objectives: The objectives of the study were to define the infectious reservoir of malaria with particular reference to transmission dynamics of Plasmodium falciparum, and to ascertain the disease trends in view of the existing containment practices and treatment seeking behavior in malaria endemic communities of Assam, India., Methods: Cross-sectional surveys were conducted in population groups of malaria endemic districts of the state to determine parasite prevalence, and data were analysed retrospectively for the years 1991-2003 to ascertain the disease trends. Structured questionnaire based surveys were conducted to study the treatment seeking behavior and practices of healthcare providers., Results: P. falciparum and P. vivax were the only two parasite species encountered, the former being in the majority (>60%). Malaria transmission was persistent, and a seasonal peak of P. falciparum was consistently observed during the months of heavy rainfall (April to September). Among children (5-15 years) there was a significantly higher malaria parasite rate as compared to the <5 years age group and adults (>15 years). There was a decline in parasite rates for all age groups over the years of the study that could not be attributed to vector control intervention intensities and/or meteorological factors., Conclusions: The persistence of P. falciparum is attributed to the emergence of drug resistant varieties, inadequate interventions and treatment seeking patterns, and for its containment focused intervention measures are advocated in partnership with the communities.

Malaria was a major problem in a sericulture area of Karnataka, south India, where Anopheles culicifacies s.l. and A. fluviatilis s.l. were considered to be the main vectors. Sibling species complexes of these two species were analysed in three ecologically different villages. Among A. culicifacies, only sibling species A and B were found. In Puram, a village with 22 wells, species A predominated; species B predominated in a village with four wells and a stream, and in a village with a stream and no wells. Poecilia reticulata fish were introduced into all wells and streams in the villages, and after one year no vectors were found in Puram, and all, or nearly all, A. culicifacies were species B in the other two villages. All A. fluviatilis belonged to the sibling species T. Blood meal analysis indicated that a few of the A. culicifacies collected had fed on humans while all the A. fluviatilis had fed on bovines. Before the introduction of fish, the annual parasite incidence for malaria was high in Puram, but much lower in the other two villages. From 1998 (over one year after release of fish) until 2003, no malaria cases were detected in the three villages.

Four xanthones were isolated from the roots of Andrographis paniculata using a combination of column and thin-layer chromatographic methods. They were characterized as (i) 1,8-di-hydroxy-3,7-dimethoxy-xanthone, (ii) 4,8-dihydroxy-2,7-dimethoxy-xanthone, (iii) 1,2-dihydroxy-6,8-dimethoxy-xanthone and (iv) 3,7,8-trimethoxy-1-hydroxy xanthone by IR, MS and NMR spectroscopic methods. In vitro study revealed that compound 1,2-dihydroxy-6,8-dimethoxy-xanthone possessed substantial anti-plasmodial activity against Plasmodium falciparum with its IC(50) value of 4 microg ml(-1). Xanthones bearing hydroxyl group at 2 position demonstrated most potent activity while xanthones with hydroxyl group at 1,4 or 8 position possessed very low activity. In vivo anti-malarial sensitivity test of this compound on Swiss Albino mice with Plasmodium berghei infection using Peters' 4-day test gave substantial reduction (62%) in parasitaemia after treating the mice with 30 mg kg(-1) dose. In vitro cytotoxicity against mammalian cells revealed that 1,2-dihydroxy-6,8-dimethoxy-xanthone is non-cytotoxic with its IC(50) > 32 microg ml(-1).

Fever surveys were conducted in several districts of the Indian state of Assam to ascertain the prevalence of malaria in relation to vector abundance, entomologic inoculation rates (EIRs), and geographic location of human settlements. Anopheles minimus were incriminated, but their relative abundance and biting rates varied among districts, and no significant correlation was observed between these two indicators (r = 0.43, P = 0.34). Plasmodium falciparum was the predominant parasite species except in two districts where P. vivax was the majority parasite. The EIRs per person/night were 0.46-0.71 in P. falciparum-predominant areas and 0.12 in the district where P. vivax predominated. The correlation of percentage of fever cases positive for malaria infection in each district with the corresponding EIR was not significant (r = 0.6, P = 0.21). Malaria cases were detected in all months of the year but peaked during May-June, which corresponded to the months of heavy rainfall. These were also the months with highest incidence of infection with P. falciparum. Malaria cases were observed in all age groups of both sexes, and there was clustering of cases in villages near the vector-breeding habitat (perennial seepage streams), and foothill villages. However, malaria incidences were consistently lower in villages within 5 km of the nearest health care facility, which were in town areas. The data presented are indicative of low-to-moderate levels of malaria transmission by An. minimus, and would be of value for developing future intervention strategies.

A normal-phase high-performance liquid chromatographic method using dichloromethane- methanol-1M perchloric acid (100:10:0.9, v/v/v) at a flow rate of 1.0 ml min(-1) on a LiChrospher Si column with UV (254 nm) detection has been developed for the determination of amodiaquine and its metabolites desethyl amodiaquine and bisdesethyl amodiaquine in plasma. The limit of quantification was 5 ng ml(-1). Mean within-day and day-to-day coefficients of variation (CV) were 4.10 and 6.27% for amodiaquine, 3.43 and 4.80% for desethyl amodiaquine and 3.53 and 5.23% for bisdesethyl amodiaquine, respectively. Mean extraction recovery of amodiaquine, desethyl amodiaquine and bisdesethyl amodiaquine from plasma were 82.48, 74.50 and 69.65%, respectively. Chloroquine and its metabolite desethyl chloroquine, quinine, sulfadoxine and primaquine do not interfere in the detection of amodiaquine, desethyl amodiaquine and bisdesethyl amodiaquine in plasma.

Owing to the paucity of accurate information on the burden of malaria in urban India, a retrospective, epidemiological study was carried out in Ahmedabad city, which has a population of about 3 million. Surveillance data for the years 1965-1998 showed a gradual resurgence of malaria between 1967 to 1976, followed by waves of low and high incidences. Plasmodium vivax always predominated but the proportion of cases attributed to P. falciparum increased markedly from 1983. When the surveillance data and health records of the major public and private health facilities in the city were analysed, for the period between 1991 and 1998, P. vivax was found to account for 69% of all malaria cases and P. falciparum for the other 31%. The incidence of infection with each Plasmodium species showed seasonal variation, with that of P. vivax increasing from January to September but then declining as the incidence of P. falciparum increased. The age-specific differences seen in incidence were not statistically significant (P=0.7). The annual numbers of malaria-attributable deaths were strongly correlated with the incidence of P. falciparum (r=0.88). The malaria incidence detected (37431 cases, representing a mean annual incidence of 12.2 cases/1000) was nine times greater than that officially reported (4119 cases, or 1.3 cases/1000 each year). Similarly, the annual malaria-attributable mortality detected (22 deaths/million) was far higher than that officially notified (0.3 death/million). The results of the retrospective analysis not only provide a more accurate, baseline estimate of the burden of malaria in an urban area of India but also clearly indicate the need for a much more efficient health-information system, for recording and managing malaria in such a setting.

The susceptibility of 23 cases of Plasmodium falciparum malaria from the Sonapur primary health center in the Kamrup district of Assam, India to different antimalarials was investigated using the 28-day World Health Organization in vivo test. Whole blood concentrations of chloroquine, sulfadoxine, and quinine were determined at different intervals and at the time of parasites recrudescence after completion of treatment with the respective drugs to confirm the status of drug sensitivity. A case of multi-drug resistant P. falciparum malaria was found where recrudescence occurred, despite standard oral treatment with chloroquine, sulfadoxine/pyrimethamine, and quinine sequentially. Whole blood concentrations of chloroquine, sulfadoxine, and quinine at the time of recrudescence were 0.35 microg/ml (day 7), 18 microg/ml (day 14), and 0.009 microg/ml (day 14), respectively. Therefore, monitoring of drug-resistant P. falciparum malaria and its proper treatment should be intensified to check the spread of multi-drug resistant strains in other parts of the country.

Somatosensory evoked potentials are employed in the intraoperative monitoring but there is paucity of information about the motor evoked potentials (MEP) in spinal cord ischaemia. Two patients aged 9 and 4 years developed paraplegia following surgery for coarctation of aorta. The aortic cross clamping time in these patients was 100 min and 30 min. respectively. The patient with longer clamping time had flaccid paraplegia and lower limb MEPs were not recordable; whereas the patient with shorter clamping time had spastic paraparesis and prolonged CMCT to right lower limb. The latter patient improved significantly. Tibial SEPs were normal in both the patients. Our results suggest that MEP may have a greater role than SEP in documenting and prognosticating ischaemic myelopathy.

Background: The adolescent age group is particularly prone to nutritional rickets/osteomalacia due to an increased demand for nutrients, especially calcium and vitamin D. Osteomalacia presents with non-specific signs and symptoms because of which diagnosis may be delayed. Vitamin D deficiency is unexpected in India, which is a tropical country with abundant sunshine., Methods: We prospectively studied the clinical presentation, aetiology and social factors contributing to adolescent rickets/ osteomalacia in our region., Results: We saw 21 symptomatic adolescents with osteomalacia during the study period (November 2000-July 2002). All were girls. Only 1 practised purda and 4 belonged to a low socioeconomic class. The mean (SD) duration of illness before correct diagnosis was 2.8 (2.1) years. Bone pains and muscular weakness were universally present. Non-specific complaints (especially limb pains being mistaken for joint involvement) led to a delay in diagnosis with consequent morbidity. All but 1 patient had low serum 25-hydroxyvitamin D levels (<10 ng/ml), with the mean (SD) being 4.9 (2.7) ng/ml. Their mean dietary calcium intake was low 1265 (199) mg/day, range 40-810 mg/day]. Restricted outdoor activities (n = 19) and the traditional dress code (n = 21) were contributory factors, as they led to poor exposure to sunshine., Conclusions: Nutritional osteomalacia among adolescents is a poorly recognized entity. Even in non-purda practising communities in the tropics, poor exposure to sunshine due to social factors, compounded by low dietary calcium intake, can lead to osteomalacia in adolescents.

Five compounds formed by peroxydisulfate oxidation of primaquine were isolated using chromatographic methods and evaluated for antimalarial activity in vitro. One compound 6-methoxy-5,8 bis(4'-amino-1'-methylbutylamino)quinoline [P(1)] was found to have good gametocytocidal activity against Plasmodium yoelli infected mice at 10mg kg(-1) dose in vivo.

Objectives: The performance of a new indigenous rapid diagnostic test, Paracheck Pf was evaluated in detection of Plasmodium falciparum in asymptomatic children in remote forest villages of Mandla district, central India to determine the lower limits of sensitivity and specificity of rapid test., Methods: A finger prick blood sample was collected to prepare blood smear and for testing with the Paracheck test. The blood smears were read by an experienced technician blinded to the Paracheck results. The figures for specificity, sensitivity, accuracy and predictive values were calculated using microscopy as gold standard., Results: The new diagnostic test had a sensitivity of 94% and a specificity of 89%. The positive and negative predictive values were 71% and 98%, respectively. The J -index was 0.83%., Conclusion: The rapid test was found to be very easy to perform and the result could be read reliably by field workers. The field evaluation with this new inexpensive test, ($0.65/test) indicates that it could be used as an epidemiological tool in the management of malaria particularly in areas where microscopy is not operationally feasible to attain the goal of the roll back malaria initiative.

Some recent outbreaks of Plasmodium falciparum malaria have been attributed, at least in part, to increases in the intensity and duration of rainfall caused by the El Niño southern oscillation (ENSO), a periodic climatic phenomenon. Since it takes time for unusually heavy rainfall to translate into unusually high densities of the vector mosquitoes, it has been suggested that data on recent rainfall might be used to predict climate-related epidemics of malaria. This possibility was explored by comparing the patterns in the incidence of malaria in (1) Dungaria, a highly malarious village in the central-Indian district of Mandla, and (2) Mandla district as a whole, for the periods 1986-2000 and 1967-2000, respectively, with data on rainfall for the same areas and periods. Unfortunately, no clear relationship was observed between rainfall and malaria incidence, although a major development project to improve water resources in the study area (which resulted in local villages being partially or completely submerged in water) may have masked any significant association. A useful method for predicting which years are going to be high- or low-risk years for malaria epidemics, in the present and other epidemiological settings, remains a future goal.

Haptoglobin (Hp) polymorphism analysed among P. vivax and P. falciparum patients and malaria negative subjects from areas with different epidemiological situations had shown high incidence of ahaptoglobinemia (HpO) among malaria patients. A definite association of HpO with P. vivax as well as P. falciparum malaria in Indian subjects had been observed. However, low sensitivity and reliability of HpO index indicates that it can not be a good indicator for determination of malaria endemicity. About 75 per cent of HpO subjects with P. vivax infection when treated with chloroquine showed typable Hp polymorphs by 8-9 days of post-treatment.

In an investigation of relapse patterns, 5541 cases of Plasmodium vivax malaria, from four major industrial complexes, each received at least one, 5-day course of primaquine (at 15 mg/day). Any subject relapsing was retreated with the same course. Overall, 511 (9.2%) of the P. vivax cases relapsed after the first course and 99 (1.78%), 25 (0.45) and three (0.05%) cases relapsed two, three and four times, respectively. Most cases of relapse occurred within 1 year of treatment. Clearly, a 5-day primaquine regimen is inadequate to control relapses among P. vivax cases and there is therefore an urgent need to review the treatment strategy. It may now be appropriate to implement the 14-day regimen recommended by the World Health Organization, although this is much less feasible under field conditions.

To understand the transmission dynamics of malaria in three different ecotypes, namely watershed (forest), seepage (Nanak Matta Dam) and plain (non-forest, non-dam) areas of Nainital and Udham Singh Nagar districts of Uttaranchal, entomological and parasitological investigations were carried out from July 1996 to June 1997. In the three ecotypes, average per man hour densities of adult vector species in human dwellings and cattlesheds recorded were high for Anopheles culicifacies from April to September and October to March for An. fluviatilis. Prevalence of both An. culicifacies and An. fluviatilis was higher in the forest area as compared to other two areas. Observations on gonotrophic condition revealed endophilic tendency of both vector species. Higher number of both vector species were found in outdoor than indoor during night human bait collections. Out of 864 specimens of An. fluviatilis dissected, one showed natural infection of sporozoites in salivary glands in the month of November from the forest area only. Sibling species study of An. fluviatilis revealed the presence of species S for the first time in the forest area. Parasitological investigations also depicted high incidence of malaria in the forest area as compared to other two areas. Overall results from the study indicated active malaria transmission in the forest area.

Data from a double-blind randomized clinical drug trial were analyzed to find the comparative responses of two antirelapse drugs, bulaquine and primaquine, against different relapsing forms of Plasmodium vivax infection. A 1-year follow-up study strongly suggests that the duration of preerythrocytic development of P. vivax is a polymorphic characteristic, exhibited by two strains of hypnozoites responsible for early and late manifestations after primary infection. Short-term relapses were significantly higher in the first half year than long-term relapses, and the reverse was true in the second half year. Clinical drug response data showed that the hypnozoites characterized for short-term relapse were not susceptible to either of the antirelapse drugs in the currently administered dose, whereas hypnozoites characterized for long incubation were significantly susceptible.

Study on bionomics of malaria vectors was carried out in riverine and non-riverine areas, on account of tremendous ecological changes in the topography of Delhi. The densities of adult anophelines were estimated by two techniques, hand catch and total catch index. Percentage of An. stephensi (15.68) collected by both the techniques was more than An. culicifacies (3.16) in both the areas. Day-time resting preferences of vector species in human dwellings and cattlesheds did not differ significantly. Preferred larval habitats of An. culicifacies in riverine area shifted to large lakes, channels and ponds. In malaria transmission, An. culicifacies played a role only in the northern part of the riverine area where water pollution was at minimal level, while An. stephensi played an equal role in the malaria transmission in both the areas. High sporozoite rates were found in type form of An. stephensi in localities where its proportion was high, thus confirming its active role in malaria transmission. The overall sporozoite rate of vectors was 0.7 per cent and P. falciparum sporozoite infections of the vectors were detected in An. stephensi only. P. vivax and P. falciparum infections were found in the ratio of 68:32. The non-riverine area was more malarious than the riverine area.

In a malaria endemic area in Orissa state in eastern India baseline (November 1989 to October 1990) malaria incidence ranged front 215 to 328 cases/1,000 population/yr in different groups of villages. In November 1990, nylon bednets treated with deltamethrin at 25 mg/m2 were given out in two villages (population 1062), untreated bednets were given out in five villages (population 1,226) and in one village (population 786) nets were not given. Nets were retreated in October 1991 and June 1992 in treated-net villages. The trial continued until October 1992. The treated nets caused significant reduction in indoor resting density, biting (landing), light trap catches, human engorgement rate, and parous rate of malaria vector Anopheles culicifacies Giles as compared with untreated nets or no nets. Untreated nets also caused reductions in biting and indoor density. Treated nets retained insecticidal action well over 6 mo. In the final year, malaria incidence was reduced 8.9% in the no-net village, 34.9% in the villages with untreated nets, and 59.1% in villages with treated nets. The relative risk of malaria and parasite rates declined significantly in villages with treated nets. Pediatric splenomegaly rate did not change in the no-net village, increased significantly in villages with untreated nets, but decreased significantly in those with treated nets. Treated nets also reduced pediatric anemia rates, but Hb concentration increased in all villages. Considering the benefits of treated bednets and development of resistance among vectors to DDT and malathion, bednets treated with deltamethrin could be an effective alternative strategy to control malaria in forested areas in India.

Introduction: This study was undertaken to evaluate the bone mineral density (BMD) in patients with complex regional pain syndrome type-I (CRPS-I) after stroke, and to correlate it with various clinical and neurophysiological parameters., Patients and Methods: Twenty patients with CRPS-I after stroke were included and a detailed neurological evaluation was carried out. The severity of CRPS-I was graded on the basis of shoulder hand syndrome score. All the patients underwent bone mineral densitometry of paralysed and non-paralysed forearm by dual energy x ray absorptiometry. The BMD of paralysed forearm was also compared with that of age matched healthy controls. Neurophysiological tests included sympathetic skin response in both upper and lower limbs and median somatosensory evoked potentials., Results: The mean age of patients was 57.2 (45-75) years and eight were females. Eight patients had severe weakness and 12 had moderate weakness of grade 2 on the hemiplegic side. There was significant reduction in BMD in the patients compared with controls (p<0.01). The bone density reduction correlated well with duration of illness (r = -0.673, p<0.01), shoulder hand syndrome score (r = -0.804, p<0.01), and Canadian neurological scale score (r = -0.738 p<0.01). Sympathetic skin response was not recordable bilaterally in all patients. Median somatosensory evoked potentials were not recordable in seven out of 20 patients who also had higher grade of CRPS-I., Conclusion: Our results show significant reduction of BMD in patients with CRPS-I after stroke. The reduction in BMD correlates with the severity of shoulder hand syndrome score, degree of weakness, duration of hemiplegia, and the severity of stroke.

Cytotoxic potential of four plastic biomedical devices (intravenous transfusion sets, IV sets; dextrose normal saline bottles, DNS bottles; Ringer lactate bottles, RL bottles; and Ryle's tubes) including 17 different brands was evaluated by investigating growth inhibition, percent survival, mitotic index and colony-forming ability (cfa) in L929, an adherent type mouse fibroblast cell line. Experimental sets were exposed with leachates of biomedical products in serum-free minimum essential medium (MEM) for 1 h at 37 degrees C in a CO2 incubator. After 1 h, medium was replaced with serum rich MEM containing essential amino acids and reincubated up to 96 h. Cells in serum-free MEM only were processed under identical conditions and served as the control. The leachates from all types of biomedical devices evaluated exhibited reduction in the growth and survival of the cell line in the first 12 h postexposure followed by their gradual recovery up to 96 h. A significant reduction in cell growth was apparent in the six brands of IV sets from 24 h onwards up to 36 h (59% growth inhibition). Though the cfa was also reduced in all the brands tested, the magnitude of reduction was less compared to growth inhibition. The results indicate that leachates of IV sets were more toxic compared to other biomedical devices screened, and growth inhibition assay was found to be more sensitive and suitable for cytotoxicity evaluation of biomedical devices.

Two hundred and sixty seven patients of uncomplicated P. falciparum malaria completed study in a multicentric phase III clinical trial of Arteether. Arteether was given intramuscularly in a dose of 150 mg daily for three consecutive days. Each patient was followed upto 28 days of alpha, beta arteether therapy. The cure rate was 97% with fever clearance time between 1-7 days (24-168 hours) and parasite clearance time between 1-3 days (24-72 hours). Parasite reappearance rate was found to be 3% and reported at only three of the centres. Following the treatment no adverse effect was observed on haematological, biochemical and vital clinical parameters.

Malaria in industrial complexes is promoted by extensive mosquitogenic potential generated by excavations and importation of parasite through migratory labor. The National Thermal Power Corporation (NTPC), Shaktinagar, Sonbhadra district was surveyed for malariogenic conditions from 1994 to 1996. The major mosquito breeding sites were drains, storm-water drains, lakes, outside tanks, overhead tanks, sluice-valve chambers, ornamental tanks, wells, pit wells and water reservoirs, etc. Anopheles culicifacies was the major vector of malaria in this area. Sibling species identification of An. culicifacies revealed that species C predominated during the transmission season and responsible to transmit malaria. Insecticide susceptibility tests against An. culicifacies sl showed that An.culicifacies population was 100% susceptible to malathion, fenitrothorn and deltamethrin while it was found 44% resistant to DDT. The malaria cases recorded in 1994, 1995 and 1996 were 847, 590 and 409 respectively. In vitro study on P. falciparum cases showed that 41, 70, 50% of the isolates tested were resistant to chloroquine in 1994, 1995 and 1996 respectively while an in vivo follow-up study showed 20-30% P. falciparum cases resistant to chloroquine. An integrated approach involving alternate vector control measures along with judicious use of insecticides has been suggested to bring down malaria in industrial complexes.

In a malaria-endemic region in northwestern Orissa, India, a longitudinal study was undertaken to delineate information on the sibling species of Anopheles fluviatilis and Anopheles culicifacies and their bionomics and role in malaria transmission in forested and deforested ecosystems. In forested villages, An. fluviatilis sibling species S (97.97%) and T (2.02%) were present. The former was highly anthropophagic (human blood index 0.88). Among the sibling species of An. culicifacies, species B (27.96%), C (71.1%), and B/C heterozygotes (0.94%) were present and were highly zoophagic. In deforested riverine villages An. fluviatilis was nearly absent and An. culicifacies sibling species A (0.48%), B (21.1%), C (77.94%), and B/C heterozygotes (0.48%) were present. In forested villages, the annual parasite incidence (269 cases/1,000) and the slide positivity rate (45%) were significantly higher than those in deforested areas, which had values of 39 cases/1,000 and 27%, respectively. The study showed that the high endemicity of malaria in the forested villages was due primarily to 2 vectors, the high rate of anthropophagy of An. fluviatilis species S, and also the more favorable ecological conditions for this vector.

The sensitivities of 61 Indian cases of Plasmodium falciparum malaria to chloroquine (CQ) were investigated using in-vitro and in-vivo methods. Concentrations of CQ and desethylchloroquine (DCQ) in blood cells and plasma from CQ-sensitive and -resistant cases were determined 2 and 7 days after initiation of treatment, by HPLC. On day 2, the mean CQ concentrations in the samples collected from the sensitive cases were higher than those in the samples from the resistant patients, in plasma (0.47 v. 0.32 microgram/ml; P < 0.02) and particularly in the blood cells (1.51 v. 0.46 micrograms/ml; P < 0.001). By day 7, however, the CQ concentrations in the two groups were similar. Although, on day 2, the mean ratio of the CQ to DCQ concentrations was significantly higher in the blood cells from the sensitive group than in those from the resistant cases (P < 0.01), the CQ/DCQ ratios for the plasma were similar for the two groups. Similarly, the mean ratio between the blood-cell concentration of CQ on day 2 and the concurrent plasma concentration (BPr) was also relatively high in the sensitive group (P < 0.001).

Anopheles philippinensis mosquitoes were collected from 5 states in India: Assam, Meghalaya, Arunachal Pradesh, Manipur, and Nagaland. Half-gravid females were examined for variations in wing venation using the presector dark mark on vein I and polytene chromosomes derived from ovarian nurse cells. Polytene chromosomes were examined for diagnostic inversions, t on chromosome arm 2 and I on arm 5. Based on wing characteristics, both An. philippinensis and An. nivipes were identified. Polytene chromosome examinations revealed that all specimens from these 2 populations had 2t; 51 inversion genotype, a diagnostic character for An. nivipes. The wing character was not diagnostic; therefore, it was concluded that all the specimens examined were actually An. nivipes and not An. philippinensis. Further, the X chromosome was of x+b type, that is, the standard arrangement with reference to the inversion b, reported in the An. nivipes population in Thailand. This is the 1st report that unequivocally establishes the occurrence of An. nivipes in India and also shows that the adult wing character is not reliable in distinguishing An. philippinensis from An. nivipes, as has been observed in Thailand.

Microscopical examination of blood films produced from samples collected, over a 9-year period (1987-1995), from the inhabitants of four tribal villages of Mandla district, Madhya Pradesh (central India) revealed that malaria was highly endemic and probably transmitted perennially. Both Plasmodium vivax and P. falciparum were prevalent in all age-groups but their prevalence was highly seasonal: longitudinal studies showed an autumn (October-November) peak for P. falciparum and a summer (April-May) peak for P. vivax. However, both the incidence and prevalence of infection with each Plasmodium species showed inter-village variations. Analysis of the malariometric parameters investigated revealed that there had been no improvement in the malaria situation over the study period, and that, since 1992, there had been a shift in the predominant parasite, from P. vivax to P. falciparum, in each village.

Background: In off-pump coronary bypass grafting (CABG), invasiveness is reduced but technically perfect anastomosis is jeopardized by cardiac motion and the need to hurry to reduce the time of ischemia. Also, a major cause of postoperative morbidity and mortality is ungrafted circumflex coronary artery disease. We have devised a means of overcoming these shortcomings and performing multivessel CABG. The objective of this study was to assess the safety and efficacy of our technique., Methods: One hundred patients with severe triple-vessel disease underwent multivessel off-pump CABG. For cardiac stabilization, a combination of local pericardial stabilization sutures and lifting and rotating the heart by means of posterior pericardial sutures were used. For myocardial perfusion, a technique of retrograde coronary sinus perfusion by arterial blood from the ascending aorta was used., Results: Each patient received an average of 3.8 grafts (range 3 to 5). Complications included conversion to cardiopulmonary bypass (CPB) in 1 patient and a perioperative myocardial infarction in the same patient. In all other patients we were able to perform a satisfactory grafting in all territories with no operative mortality. Rapid recovery allowed 95% of our patients to resume normal activity within 1 month. A predischarge graft angiogram in 35 patients showed 97.8% patency., Conclusions: These results suggest that off-pump CABG with our techniques is effective and safe. Early clinical outcome and excellent patency rates suggest its more widespread use in selected cases.

Nadiad taluka, Kheda district, Gujarat State, India, comprising of 100 villages with unstable malaria and periodic epidemics, was selected for the study. Using topo sheets and satellite imageries thematic maps on water table, water quality, hydro-geomorphology, soil type, relief, irrigation channels, were prepared, overlaid and integrated sequentially using Arclnfo software. The composite map resulted in 13 stratification classes. Stratification classes 1-12 fell in non-irrigated tracts and exhibited 95% matching of areas of high receptivity as revealed by geographical information systems (GIS) and annual malaria parasite incidence (API). Stratification class 13, an irrigated area, showed poor matching but the ground verification established low receptivity of the area. Thus the study resulted in complete reconciliation of cause and effect relationship as established as per GIS in explaining malaria epidemiology. In general, the study revealed that high malaria in villages of Nadiad is mainly due to high water table, soil type, irrigation and water quality. Based on local malaria transmission determinants, a revised malaria control strategy has been suggested.

Female Anopheles culicifacies Giles from Ramanathapuram district, Tamil Nadu state, India, were examined for oocysts and sporozoites and their larval progeny for mitotic karyotype. Collections were made from Mandapam and Uchipuli on the mainland, and Thangachimadam and Pamban on Rameshwaram Island. Of the 451 An. culicifacies females that were collected and dissected, 24 were found positive for Plasmodia (21 for sporozoites and 3 for oocysts). Both acrocentric and submetacentric Y-chromosome karyotypes were observed among the progeny of females from all villages. All 11 iso-female lines whose parental females were positive for sporozoites or oocysts had progeny with submetacentric Y-chromosomes. Total absence of sporozoite-positives among mothers of acrocentric males was evidence of assortative mating between these 2 sympatric populations (i.e., 2 species). We propose that the nonvector population with acrocentric Y-chromosome sons retain the original designation of species B and that the vector population with the submetacentric Y-chromosome sons be designated as species E, a new species.

The Indian National Malaria Eradication Programme (NMEP) is reporting 2.5 to 3 million malaria cases, and about 1,000 malaria deaths annually. Malaria in the northeastern states is stable and in the peninsular India unstable. There are six major and three minor malaria vectors, of which Anopheles culicifacies transmits malaria in rural areas and An. stephensi in the towns. Other vectors are of local importance. Plasmodium vivax is the dominant infection and accounts for 60-65% cases whereas P. falciparum contributes 30-35% cases. Field operations to control malaria are impeded by resistance and/or exophilic vector behavior, parasite resistance to antimalarial drugs, operational problems in spraying, failure to search breeding of mosquitoes at weekly intervals, staff shortages and financial constraints. Resurgent malaria invaded new ecotypes created by green revolution, industrial growth and urban development resulting in paradigm shift towards man-made malaria. NMEP has launched a world bank-assisted enhanced malaria control project with primary emphasis to protect 62.2 million high risk population in 7 states.

Studies were carried out in District Jodhpur of the Thar region of Rajasthan. Epidemiological investigation revealed high slide positivity rate in the canal irrigated area (54.5 per cent), sand dunes area (67.54 per cent), stone quarry area (26.66 per cent) and in the desert plain area (41.5 per cent). Similarly, slide falciparum rates were 7.10, 4.38, 6.66 and 5.6 per cent respectively. Entomological studies showed An. stephensi and An. culicifacies as major species and their densities ranged between 2 to 14.58 and 0 to 0.9 pmh respectively. Resistance in malaria vectors to insecticides, poor surveillance and suppressive treatment of cases appear to be the factors for persistent transmission in the study area.

A longitudinal study (1993-94) on malaria was conducted in Dungaria, a typical forest fringe tribal village in Mandla district of central India (Madhya Pradesh). Our initial objective was to obtain in-depth baseline data on malaria transmission in the tribal village to elucidate the factors responsible for persistent malaria in the area and thereby to help in formulating an improved malaria control program. Anopheles culicifacies Giles was the predominant vector of malaria, although Anopheles fluviatilis James were recorded in small numbers. The transmission season was from May to November. Analysis of the malaria cases revealed hyperendemic malaria, with Plasmodium falciparum the predominant species. The prevalence of Plasmodium vivax was mainly in the summer and that of P. falciparum in autumn. The study suggested that a number of factors were responsible for the continuation of malaria transmission in the village.

The largest river-valley development to be proposed in India is that in the Narmada valley. The building of the Bargi dam, a multi-purpose irrigation and hydro-electric project, in Jabalpur, in central India, formed part of the first phase of the development of this valley (1974-1988). Many villages and several hectares of land in three districts were submerged as the waters rose behind the dam, the worst affected area being the catchment area of the primary health centre (PHC) at Narayanganj, in Mandla district. Until recently, cases of malaria were relatively rare in Narayanganj. However, an epidemic of malaria in late 1996 claimed hundreds of lives in the area and the outbreak spread, during 1997, to new villages in the region. A review of the records collected by the National Malaria Eradication Programme (NMEP) not only indicated that the slide positivity rate (SPR) for Narayanganj increased > 7.45-fold between 1979 and 1997 but also that the slide falciparum rate (SFR) increased > 32-fold over the same period. The NMEP data available for Mandla district as a whole indicated a doubling in mean SPR and SFR between 1979 and 1997. There is no evidence that a new species of vector has established since 1979. In fact, indoor-resting densities of anophelines and of the most established vector, Anopheles culicifacies, have fallen since the dam was built, but densities of another vector, An. fluviatilis, have increased.

A survey was conducted to find chloroquine concentration profile in the community of Mewat region district Gurgaon (Haryana) of India. 88 P. falciparum and 3 P. vivax cases were detected out of 148 blood slides examined with a SPR of 61.48. Plasma chloroquine and desethylchloroquine concentrations were determined in 55 P. falciparum and 2 P. vivax patients and 29 persons whose blood slides were negative for malaria parasite before giving any treatment. Mean chloroquine concentrations in cases with P. falciparum parasites and without malaria parasites were 0.018 and 0.016 microg ml(-1) respectively. Chloroquine to desethyl chloroquine ratio was between 2 and 3 in both groups. Only 10 malaria parasite negative cases out of 29 had plasma chloroquine concentrations above 0.016 microg ml(-1) required for malaria chemoprophylaxis. Chloroquine was undetectable in plasma samples of 8 out of 55 P. falciparum cases. Chloroquine plasma concentrations in 21 P. falciparum cases were below therapeutically effective concentration of 0.016 microg ml(-1) suggesting improper treatment while in 29 P. falciparum cases, parasitemia recurred despite required chloroquine concentration confirming chloroquine resistant status. Irregular prophylaxis and lack of proper treatment was one of the major causes of malaria outbreak in this area.

Balloon angioplasty followed by stenting of the thoracic aorta is reported in a 5-year-old girl with Takayasu's arteritis, who presented with severe hypertension and congestive heart failure. Her aortogram showed severe long segment stenosis of the descending thoracic aorta, which was successfully treated by balloon angioplasty on two occasions, but developed recurrences after 6 and 7 months of angioplasty. Balloon dilatation of the stenosed aorta, followed by sequential implantation of three 30-mm long Palmaz stents in tandem, bridging the full segment of the angioplastied aorta were performed successfully without any complications. The aortic diameter increased from 3.3 mm to 7.7 mm and the peak systolic pressure gradient decreased from 75 mmHg to 3 mmHg. There was no recurrence on clinical follow-up of 13 months.

Analysis of three years of data from a malaria clinic operated by the Indian Council of Medical Research (ICMR) in the Government Medical College Hospital in Jabalpur, central India, showed a high malaria prevalence among pregnant women, which was statistically highly significant (P < 0.0001) compared with the situation among nonpregnant women. Cerebral malaria was a common complication of severe Plasmodium falciparum infection, with a high mortality during pregnancy, requiring immediate attention. The study also showed that malaria infection was more frequent in primigravidae, falling progressively with increasing parity. Mean parasite densities were significantly higher in pregnant women compared with nonpregnant women for both P. falciparum (P < 0.001; df = 137) and P. vivax (P < 0.05; df = 72) infection. Pregnant women with falciparum or vivax malaria were significantly more anaemic than noninfected pregnant women or infected nonpregnant women. The average weight of 155 neonates from infected mothers was 350 g less than that of 175 neonates from noninfected mothers. This difference in birth weight was statistically significant for both P. falciparum (P < 0.0001; df = 278) and P. vivax (P < 0.0001; df = 223) infection. Congenital malaria was not recorded. We conclude that pregnant women from this geographical area require systematic intervention owing to their high susceptibility to malaria during pregnancy and the puerperium.

In malaria endemic forested villages in Orissa State, India, a 3-year comparison of nylon nets treated with lambdacyhalothrin at 25 mg/m2, untreated nets, and no nets was carried out. Treated nets retained high insecticidal efficacy for more than 7 months. Nets washed after 3 months of use gave 98% kill in a bioassay with a 3-min exposure. Based on these bioassays during the first year, nets were later reimpregnated at 6-monthly intervals with participation of the users. Compliance with the use of nets was good. Eighty-eight percent of nets were usable even after 3 years. The main benefits perceived by treated net users were reductions in malaria, mosquito bites, head louse infestations, and other nuisance insects. The trial was well accepted by the community. Issues related to social marketing and promotion of nets are discussed.

Bacillus sphaericus has a potential of use as a larvicide in water storage practices but no such study has been done against Anopheles stephensi. Baseline susceptibility status of eleven wild and three mutant strains of An. stephensi to Spherix, a formulation of B. sphaericus, strain B-101 (serotype H5a, 5b) was determined to find the variations in the degree of their response to B. sphaericus toxins and to study the possibility of development of resistance. The LC50 and LC90 values of different strains of An. stephensi to B. sphaericus formulation varied from 0.088 to 1.42 mg/l and 0.314 to 10.98 mg/l, respectively. Among all the strains tested, Sarojini Nagar, Delhi strain of An. stephensi (a wild type strain) was least susceptible. Laboratory selection of Sarojini Nagar strain of An. stephensi with B. sphaericus at a concentration of 4 mg/l resulted in the development of a high degree of resistance (LC50 > 1600 mg/l) to B. sphaericus within four generations.