Laboratory evaluation of the efficacy of deltamethrin-laced attractive toxic sugar bait formulation on Anopheles stephensi.

BACKGROUND: Attractive toxic sugar bait (ATSB) is a promising "attract and kill"-based approach for mosquito control. It is a combination of flower nectar/fruit juice to attract the mosquitoes, sugar solution to stimulate feeding, and a toxin to kill them. Selecting an effective attractant and optimizing concentration of toxicant is significant in the formulation of ATSB. METHODS: Current study formulated an ATSB using fruit juice, sugar and deltamethrin, a synthetic pyrethroid. It was evaluated against two laboratory strains of Anopheles stephensi. Initial studies evaluated comparative attractiveness of nine different fruit juices to An. stephensi adults. Nine ASBs were prepared by adding fermented juices of plum, guava, sweet lemon, orange, mango, pineapple, muskmelon, papaya, and watermelon with 10% sucrose solution (w/v) in 1:1 ratio. Cage bioassays were conducted to assess relative attraction potential of ASBs based on the number of mosquito landings on each and the most effective ASB was identified. Ten ATSBs were prepared by adding the identified ASB with different deltamethrin concentrations (0.015625-8.0 mg/10 mL) in 1:9 ratio. Each ATSB was assessed for the toxic potential against both the strains of An. stephensi. The data was statistically analysed using PASW (SPSS) software 19.0 program. RESULTS: The cage bioassays with nine ASBs revealed higher efficacy (p < 0.05) of Guava juice-ASB > Plum juice-ASB > Mango juice-ASB in comparison to rest of the six ASB's. The bioassay with these three ASB's ascertained the highest attractancy potential of guava juice-ASB against both the strains of An. stephensi. The ATSB formulations resulted in 5.1-97.9% mortality in Sonepat (NIMR strain) with calculated LC30, LC50, and LC90 values of 0.17 mg deltamethrin/10 mL, 0.61 mg deltamethrin/10 mL, and 13.84 mg deltamethrin/10 mL ATSB, respectively. Whereas, 6.12-86.12% mortality was recorded in the GVD-Delhi (AND strain) with calculated LC30, LC50, and LC90 values of 0.25 mg deltamethrin/10 mL, 0.73 mg deltamethrin/10 mL and 10.22 mg deltamethrin/10 mL ATSB, respectively. CONCLUSION: The ATSB formulated with guava juice-ASB and deltamethrin (0.0015625-0.8%) in 9:1 ratio showed promising results against two laboratory strains of An. stephensi. Field assessment of these formulations is being conducted to estimate their feasibility for use in mosquito control.

Laboratory evaluation of a new alphacypermethrin long-lasting insecticidal net against Anopheles culicifacies s.l.

Long-lasting insecticidal nets (LLINs) are being promoted by World Health Organization (WHO) as key vector control tool for the prevention and control of malaria and other vector-borne diseases. A laboratory study was conducted to evaluate the bio-efficacy of a new alphacypermethrin LN (HILNET®) against insecticide-susceptible Anopheles culicifacies s.l.. This study presents the observations on (a) regeneration time, the period required to regenerate insecticide in the LLIN after three consecutive WHO standard washes in a single day to deplete the insecticide on the net surface, and (b) wash resistance of the LLIN to retain bio-efficacy up to 20 repeated washes at intervals corresponding to the regeneration time in days. In the present evaluation, the regeneration time of HILNet® was determined as 2 days. Wash resistance studies of HILNet® showed a knockdown rate of 100% up to 15 washes and 97% at the 20th wash and complied with the criteria of WHO knockdown rate of ≥ 95%. The mean active ingredient content from 0 to 20 washes was in the range of 5.8 to 6.04 g/kg and met the WHO criteria of the product claim (± 25% g/kg). The insecticide un-impregnated control net has shown no detectable levels of alphacypermethrin. In this evaluation, HILNet® fulfilled the WHO laboratory (phase I) efficacy criteria based on the rates of knockdown up to 20 standard WHO washes.

COVID-19 associated viral myocarditis: does it exist?

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is a lethal pandemic that has claimed millions of lives worldwide. While respiratory involvement is the most common and most virulent manifestation of COVID-19, there is enough data to suggest that myocardial injury reflected through elevated troponin levels is seen in around 7-28% of patients and is related with increased morbidity and mortality.

A laboratory simulation study on suppression of resistance genes by differential exposures to an insecticide in Anopheles stephensi Liston population.

BACKGROUND & OBJECTIVES: : Insecticide applied at optimum dosage and coverage delays the development of resistance in disease vectors. The study was aimed to test the hypothesis whether decrease in exposure to insecticide leads to decrease in selection of insecticide resistance in mosquitoes. The mosquitoes were variably exposed to insecticide in the laboratory by simulating the variations in insecticide sprays applied in the field. METHODS: : The study was carried out on DDT resistant adults of Anopheles stephensi. Mosquitoes were differentially exposed to impregnated papers of DDT (4%), that were differentially masked to 25, 50, and 75% area with an unimpregnated Whatman No.1 filter paper, and to a positive control without any masking, i.e. 100% exposure area. The study was conducted for five generations and at each generation mosquitoes were exposed to differentially masked impregnated papers, and percent mortality was calculated. RESULTS: : The observed survival rate in differential exposures was more with the increase in heterozygous genotype resistance-susuceptible (RS) frequency. Resistant gene frequency with differential exposures (25 to 75%) was in the range of 0.38-0.54 for the F0 generation, which increased to 0.84-0.93 for the F4 generation. In 100% exposure it was 0.18 in F0 generation, which increased to 0.58 in the F4 generation. The resistant gene frequencies in the population showed increasing trend with decrease in exposure in contrast to complete exposure. INTERPRETATION & CONCLUSION: : Variable simulated exposures resulted in precipitation of increased resistance while complete exposure resulted in lower levels of resistance, signifying the importance of optimum dosage and coverage in the indoor residual spray in delaying/avoiding the development of insecticide resistance in the disease vectors.

Esterases are responsible for malathion resistance in Anopheles stephensi: A proof using biochemical and insecticide inhibition studies.

BACKGROUND & OBJECTIVES: Increase in prevalence and intensity of insecticide-resistance in vectors of vector-borne diseases is a major threat to sustainable disease control; and, for their effective management, studies on resistance mechanisms are important to come out with suitable strategies. Esterases are major class of detoxification enzymes in mosquitoes, which confers protection against insecticides in causing resistance. This study was aimed at biochemical characterization of esterases responsible for malathion resistance in Anopheles stephensi mosquitoes, along with its validation through biochemical techniques and native-PAGE assays. METHODS: Laboratory maintained susceptible and resistant An. stephensi mosquitoes were used for assessing the activity and effect of α - and ß -esterases on malathion. Bioassay, synergist bioassay, biochemical assay and native- PAGE were employed to characterize the role of esterases in conferring malathion-resistance. RESULTS: Notably significant (p < 0.0001) enhancement in α - and ß -esterases activity was observed with 2-fold increase in resistant An. StephensiGOA compared to susceptible An. StephensiBB. native-PAGE depicted two major bands 'a' (Rf = 0.80) and 'b' (Rf = 0.72) in susceptible An. stephensiBB , while one intense band 'b' (Rf = 0.72) was visible in resistant An. stephensiGOA. Inhibition assay revealed complete inhibition of α - and ß -esterases activity in presence of 1 mM malathion in susceptible strain compared to observed partial inhibition in resistant strain on native-PAGE. INTERPRETATION & CONCLUSION: This study provides a better understanding on the role of esterase enzyme (carboxylesterase) in conferring malathion-resistance in An. stephensi mosquitoes, as evident from the native-PAGE assay results. The study results could be used in characterizing the resistance mechanisms in vectors and for suggesting alternative chemical insecticide based resistance management strategies for effective vector-borne disease control.

Temporo-spatial distribution of insecticide-resistance in Indian malaria vectors in the last quarter-century: Need for regular resistance monitoring and management.

The Indian vector control programme similar to other programmes in the world is still reliant on chemical insecticides. Anopheles culicifacies is the major vector out of six primary malaria vectors in India and alone contributes about 2/3 malaria cases annually; and per se its control is actually control of malaria in India. For effective management of vectors, current information on their susceptibility status to different insecticides is essential. In this review, an attempt was made to compile and present the available data on the susceptibility status of different malaria vector species in India from the last 2.5 decades. Literature search was conducted by different means mainly web and library search; susceptibility data was collated from 62 sources for the nine malaria vector species from 145 districts in 21 states and two union territories between 1991 and 2016. Interpretation of the susceptibility/resistance status was made on basis of the recent WHO criteria. Comprehensive analysis of the data indicated that An. culicifacies, a major vector species was resistant to at least one insecticide in 70% (101/145) of the districts. It was reported mostly resistant to DDT and malathion whereas, its resistant status against deltamethrin varied across the districts. The major threat for the malaria control programmes is multiple-insecticide-resistance in An. culicifacies which needs immediate attention for resistance management in order to sustain the gains achieved so far, as the programmes have targeted malaria elimination by 2030.

Adulticidal & larvicidal efficacy of three neonicotinoids against insecticide susceptible & resistant mosquito strains.

BACKGROUND & OBJECTIVES: Due to ever growing insecticide resistance in mosquitoes to commonly used insecticides in many parts of the globe, there is always a need for introduction of new insecticides for the control of resistant vector mosquitoes. In this study, larvicidal and adulticidal efficacies of three neonicotinoids (imidacloprid, thiacloprid and thiamethoxam) were tested against resistant and susceptible populations of Anopheles stephensi Liston 1901, Aedes (Stegomyia) aegypti Linnaeus, and Culex quinquefasciatus Say (Diptera: Culicidae). METHODS: Laboratory-reared mosquito species were used. Insecticide susceptibility tests were done using standard WHO procedures and using diagnostic dosages of insecticide test papers and larvicides. Adulticidal efficacy of candidate insecticides was assessed using topical application method and larval bioassays were conducted using standard WHO procedure. RESULTS: The results of topical application on 3-5 day old female mosquitoes indicated that resistant strain of An. stephensi registered lower LC 50 values than the susceptible strain. Among the three insecticides tested, thiacloprid was found more effective than the other two insecticides. Culex quinquefasciatus registered lowest LC 50 for imidacloprid than the other two mosquito species tested. In larval bioassays, the LC 50 values registered for imidacloprid were in the order of Cx. quinquefasciatus < An. stephensi (SS) < An. stephensi (RR) < Ae. aegypti. In case of thiacloprid, the order of efficacy (LC 50 ) was Cx. quinquefasciatus < An. stephensi (SS) < An. stephensi (RR), whereas in case of thiamethoxam, the larvicidal efficacy was in the order of An. stephensi (RR) < An. stephensi (SS) < Cx. quinquefasciatus. INTERPRETATION & CONCLUSIONS: The present study indicated that insecticide resistant strains of mosquito species tested showed more susceptibility to the three neonicotinoids tested, and the possibility of using neonicotinoids for the control of resistant mosquitoes should be explored.

Chlorfenapyr: irritant effect compared to other insecticides and its intrinsic toxicity in multiple-insecticide-susceptible and -resistant Anopheles stephensi (Diptera: Culicidae).

BACKGROUND & OBJECTIVES: For effective management of vector resistance there is a need for new insecticide molecules with novel modes of action. For desired toxic effect of an insecticide, apart from other behavioural aspects, toxicity and chemical nature of the molecule are important that may cause irritability in the mosquito to the insecticide affecting the uptake. In this study, a pyrrole class insecticide, chlorfenapyr (a late acting insecticide) was tested for its irritability against multiple-insecticide-susceptible and -resistant strains of Anopheles stephensi Liston 1901 (Diptera: Culicidae). METHODS: Studies were conducted to assess the irritability due to chlorfenapyr, DDT, malathion, deltamethrin and permethrin and intrinsic toxicity of chlorfenapyr in multiple-insecticide-susceptible and -resistant laboratory strains of An. stephensi following standard WHO methods. RESULTS: Chlorfenapyr molecule has shown least irritant effect against susceptible and resistant strains among all the insecticides tested allowing more landing time to the vector species on the impregnated surfaces to pick-up lethal dose. CONCLUSION: Chlorfenapyr could be an ideal insecticide for management of multiple-insecticide-resistance including pyrethroids.

Standardization of a bottle assay--an indigenous method for laboratory and field monitoring of insecticide resistance and comparison with WHO adult susceptibility test.

The WHO adult susceptibility test is in use for insecticide resistance monitoring. Presently, materials are being imported from the Universiti Sains Malaysia, Malaysia and sometimes it is cost prohibitive. As an alternative, we present here a method of bottle bioassay using indigenous material. Different aspects related to the assay were studied and validated in the field. Bottle assay was standardized in the laboratory by using locally sourced material and laboratory-maintained insecticide-susceptible Anopheles stephensi and Aedes aegypti strains against technical grade deltamethrin and cyfluthrin insecticides dissolved in ethanol in a range of different concentrations. The frequency of use of the deltamethrin-coated bottles and shelf-life were determined. Discriminating dose for deltamethrin and cyfluthrin was 10 µg against An. stephensi and 2 µg against Ae. aegypti females. Insecticide-coated bottles stored at 25 to 35 °C can be used for three exposures within 7 days of coating. The study carried out in the laboratory was validated on wild caught An. culicifacies in the states of Odisha and Chhattisgarh against deltamethrin-coated bottles in comparison to WHO adult susceptibility test. Results of the study indicated that deltamethrin-coated bottles were effective up to three exposures within 7 days of coating for field population and 100% mortality was recorded within 35 min as observed in laboratory studies for field collected susceptible population. Also in the WHO adult susceptibility test, 100% knock-down within 35 min and 100% mortality after 24 h holding period were observed in susceptible population, while in it was 50% knock-down in 1 h and 64% mortality after 24 h holding period for resistant population (50% mortality in bottle assay in 60 min). The bottle assay can be used as an alternative to the WHO adult susceptibility test both in the laboratory and field for monitoring insecticide resistance in mosquito vectors using locally sourced material.

Development of Deltamethrin-Laced Attractive Toxic Sugar Bait to Control Aedes aegypti (Linnaeus) Population.

Background: The attractive toxic sugar bait (ATSB) is a promising strategy for controlling mosquitoes at the adult stage. The strategy is based on the use of a combination of fruit juice, sugar, and a toxin in order to attract and kill the adult mosquitoes. The selection of the components and optimization of their concentrations is significant for the formulation of an effective ATSB. Methods: The present study formulated nine ATSBs and evaluated their efficacy against two laboratory strains (AND-Aedes aegypti and AND-Aedes aegypti-DL10) and two wildcaught colonized strains of Aedes aegypti (GVD-Delhi and SHD-Delhi). Initially, nine attractive sugar baits (ASBs) were prepared using a mixture of 100% fermented guava juice (attractant) with 10% sucrose solution (w/v) in 1 : 1 ratio. ATSBs were formulated by mixing each ASB with different concentrations of deltamethrin in the ratio of 9 : 1 to obtain final deltamethrin concentration of 0.003125-0.8 mg/10 mL ATSB. Cage bioassays were conducted with 50 mosquitoes for 24 h in order to evaluate the efficacy of each ATSB against the four strains of Ae. aegypti. The data were statistically analyzed using PASW software 19.0 program and 2-way ANOVA. Results: The ATSB formulations registered 8.33-97.44% mortality against AND-Aedes aegypti and 5.15-96.91% mortality against AND-Aedes aegypti-DL10 strains of Ae. aegypti, while GVD-Delhi strain registered 2.04-95.83% mortality and SHD-Delhi strain showed 5.10-97.96% mortality. The administration of 0.8 mg of deltamethrin within 10 mL of attractive toxic sugar bait (ATSB) has led to the maximum mortality rate in adult mosquitoes. Conclusions: The ATSBs formulated with guava juice-ASB and deltamethrin (9 : 1) showed toxin dose-dependent toxicity by all the four strains of Ae. aegypti. Most effective dosage was found as 0.8 mg deltamethrin/10 mL ATSB which imparted 96% to 98% mortality in adult mosquitoes. The investigations demonstrated the efficacy of deltamethrin-laced ATSB formulations against Ae. aegypti and highlighted the need for conduct of structured field trials and investigating the impact on disease vectors and nontarget organisms.

Finite Element Analysis to Study Tensile Strength Differences between Free and Attached Ear Lobules.

Recurrent ear lobule deformity is a chronic condition with aesthetic implications. The problem is normally addressed by certain improvisations of the traditional lobuloplasty technique. These include introduction of autologous tissue components like cartilage pieces to improve the structural integrity. Certain authors also advocate a different site for repiercing of the ear hole away from the lobuloplasty scar. Our study tries to understand the differences in the tensile strength between free and attached ear lobules, using finite element analysis. Eighteen healthy female volunteers with attached (eight subjects) and free ear lobules (10 subjects) were chosen, and the lobules were scanned using Artec 3D scanner. The model was then converted to free form or attached form (opposite to the form in which it was present originally) by decreasing or increasing the area of contact using geomagic software. Finite element analysis was then performed on both the models, and their yield max and, hence, the maximum load at the yield max at 0.7 strains according to previous studies were estimated and compared. The yield max and the corresponding load were found to be lesser in the free variety than in the attached variety. This experiment helps us to understand that when a structural difference in the ear lobule surgically may bring about a change in the tensile strength of the lobules. However, further clinical trials are required to clinically translate the same.

Phytofabrication and characterization of Alchornea cordifolia silver nanoparticles and evaluation of antiplasmodial, hemocompatibility and larvicidal potential.

Purpose: The recent emergence of Plasmodium falciparum (Pf) parasites resistant to current artemisinin-based combination therapies in Africa justifies the need to develop new strategies for successful malaria control. We synthesized, characterized and evaluated medical applications of optimized silver nanoparticles using Alchornea cordifolia (AC-AgNPs), a plant largely used in African and Asian traditional medicine. Methods: Fresh leaves of A. cordifolia were used to prepare aqueous crude extract, which was mixed with silver nitrate for AC-AgNPs synthesis and optimization. The optimized AC-AgNPs were characterized using several techniques including ultraviolet-visible spectrophotometry (UV-Vis), scanning/transmission electron microscopy (SEM/TEM), powder X-ray diffraction (PXRD), selected area electron diffraction (SAED), energy dispersive X-ray spectroscopy (EDX), Fourier transformed infrared spectroscopy (FTIR), dynamic light scattering (DLS) and Zeta potential. Thereafter, AC-AgNPs were evaluated for their hemocompatibility and antiplasmodial activity against Pf malaria strains 3D7 and RKL9. Finally, lethal activity of AC-AgNPs was assessed against mosquito larvae of Anopheles stephensi, Culex quinquefasciatus and Aedes aegypti which are vectors of neglected diseases such as dengue, filariasis and chikungunya. Results: The AC-AgNPs were mostly spheroidal, polycrystalline (84.13%), stable and polydispersed with size of 11.77 ± 5.57 nm. FTIR revealed the presence of several peaks corresponding to functional chemical groups characteristics of alkanoids, terpenoids, flavonoids, phenols, steroids, anthraquonones and saponins. The AC-AgNPs had a high antiplasmodial activity, with IC50 of 8.05 µg/mL and 10.31 µg/mL against 3D7 and RKL9 Plasmodium falciparum strains. Likewise, high larvicidal activity of AC-AgNPs was found after 24 h- and 48 h-exposure: LC50 = 18.41 µg/mL and 8.97 µg/mL (Culex quinquefasciatus), LC50 = 16.71 µg/mL and 7.52 µg/mL (Aedes aegypti) and LC50 = 10.67 µg/mL and 5.85 µg/mL (Anopheles stephensi). The AC-AgNPs were highly hemocompatible (HC50 > 500 µg/mL). Conclusion: In worrying context of resistance of parasite and mosquitoes, green nanotechnologies using plants could be a cutting-edge alternative for drug/insecticide discovery and development.

A new WHO bottle bioassay method to assess the susceptibility of mosquito vectors to public health insecticides: results from a WHO-coordinated multi-centre study.

BACKGROUND: The continued spread of insecticide resistance in mosquito vectors of malaria and arboviral diseases may lead to operational failure of insecticide-based interventions if resistance is not monitored and managed efficiently. This study aimed to develop and validate a new WHO glass bottle bioassay method as an alternative to the WHO standard insecticide tube test to monitor mosquito susceptibility to new public health insecticides with particular modes of action, physical properties or both. METHODS: A multi-centre study involving 21 laboratories worldwide generated data on the susceptibility of seven mosquito species (Aedes aegypti, Aedes albopictus, Anopheles gambiae sensu stricto [An. gambiae s.s.], Anopheles funestus, Anopheles stephensi, Anopheles minimus and Anopheles albimanus) to seven public health insecticides in five classes, including pyrethroids (metofluthrin, prallethrin and transfluthrin), neonicotinoids (clothianidin), pyrroles (chlorfenapyr), juvenile hormone mimics (pyriproxyfen) and butenolides (flupyradifurone), in glass bottle assays. The data were analysed using a Bayesian binomial model to determine the concentration-response curves for each insecticide-species combination and to assess the within-bioassay variability in the susceptibility endpoints, namely the concentration that kills 50% and 99% of the test population (LC50 and LC99, respectively) and the concentration that inhibits oviposition of the test population by 50% and 99% (OI50 and OI99), to measure mortality and the sterilizing effect, respectively. RESULTS: Overall, about 200,000 mosquitoes were tested with the new bottle bioassay, and LC50/LC99 or OI50/OI99 values were determined for all insecticides. Variation was seen between laboratories in estimates for some mosquito species-insecticide combinations, while other test results were consistent. The variation was generally greater with transfluthrin and flupyradifurone than with the other compounds tested, especially against Anopheles species. Overall, the mean within-bioassay variability in mortality and oviposition inhibition were < 10% for most mosquito species-insecticide combinations. CONCLUSION: Our findings, based on the largest susceptibility dataset ever produced on mosquitoes, showed that the new WHO bottle bioassay is adequate for evaluating mosquito susceptibility to new and promising public health insecticides currently deployed for vector control. The datasets presented in this study have been used recently by the WHO to establish 17 new insecticide discriminating concentrations (DCs) for either Aedes spp. or Anopheles spp. The bottle bioassay and DCs can now be widely used to monitor baseline insecticide susceptibility of wild populations of vectors of malaria and Aedes-borne diseases worldwide.

Attractive Sugar Bait Formulation for Development of Attractive Toxic Sugar Bait for Control of Aedes aegypti (Linnaeus).

Background: Attractive toxic sugar bait (ATSB), based on "attract and kill" approach, is a novel and promising strategy for mosquito control. Formulation of an attractive sugar bait (ASB) solution by selecting an efficient olfaction stimulant and preparation of an optimized sugar-attractant dosage is a significant component for the success of the approach. Methods: Current study evaluated relative potential of nine ASBs, formulated by combination of sugar and fresh fruit juices (guava, mango, muskmelon, orange, papaya, pineapple, plum, sweet lemon, and watermelon) in attracting Aedes aegypti adults. Freshly extracted and 48-hour-fermented juices were combined with 10% sucrose solution (w/v) in 1 : 1 ratio. Cage bioassays were conducted against two laboratory strains (susceptible: AND-Aedes aegypti; deltamethrin-selected: AND-Aedes aegypti-DL10) and two field-collected strains (Shahdara strain of Aedes aegypti: SHD-Delhi; Govindpuri strain of Aedes aegypti: GVD-Delhi). Each of the nine ASBs was assayed, individually or in groups of three, for its attraction potential based on the relative number of mosquito landings. The data were analysed for statistical significance using PASW (SPSS) software 19.0 program. Results: The prescreening bioassay with individual ASB revealed significantly higher efficacy of ASB containing guava/plum/mango juice than that containing six other juices (p < 0.05) against both the laboratory and field strains. The bioassay with three ASBs kept in one cage, one of the effective ASBs and two others randomly selected ASBs, also showed good attractancy of the guava/plum/mango juice-ASB (p < 0.05). The postscreening assays with these three ASBs revealed maximum attractant potential of guava juice-sucrose combination for all the four strains of Ae. aegypti. Conclusion. Guava juice-ASB showed the highest attractancy against both laboratory and field-collected strains of Ae. aegypti and can be used to formulate ATSB by combining with a toxicant. The field studies with these formulations will ascertain their efficacy and possible use in mosquito management programs.

Insecticide resistance status of malaria vectors in the malaria endemic states of India: implications and way forward for malaria elimination.

Background: In 2012, the World Health Organization (WHO) released the Global Plan for Insecticide Resistance Management in malaria vectors to stress the need to address insecticide resistance. In a prospective multi-centric study commissioned by the Indian Council of Medical Research (ICMR), we assessed the insecticide susceptibility status of the primary malaria vectors in India from 2017 through 2019. Methods: The insecticide susceptibility status of the prevalent primary malaria vectors - An. culicifacies, An. fluviatilis, An. stephensi, An. minimus and An. baimaii and secondary malaria vectors - An. aconitus, An. annularis and An. philippinensis/nivepes from 328 villages in 79 districts of 15 states of India were assessed following the WHO method mainly to insecticides used in vector control, organochlorine (DDT), organophosphate (malathion), and other pyrethroids (alpha-cypermethrin, cyfluthrin, lambda-cyhalothrin and permethrin). The study sites were selected as suggested by the National Vector Borne Disease Control Programme. Results: The primary malaria vector An. culicifacies showed resistance to DDT (50/50 districts including two districts of Northeastern India), malathion (27/44 districts), and deltamethrin (17/44 districts). This species was resistant to DDT alone in 19 districts, double resistant to DDT-malathion in 16 districts, double resistant to DDT-deltamethrin in 6 districts, and triple resistant to DDT-malathion-deltamethrin in 9 districts. An. minimus and An. baimaii were susceptible in Northeastern India while An. fluviatilis and the secondary malaria vector An. annularis was resistant to DDT in Jharkhand. Conclusion: In this study we report that among the primary vectors An. culicifacies is predominantly resistant to multiple insecticides. Our data suggest that periodic monitoring of insecticide susceptibility is vital. The national malaria program can take proactive steps for insecticide resistance management to continue its push toward malaria elimination in India.

Occipitofrontal switch for correction of anterior plagiocephaly planned through virtual mock surgery.

BACKGROUND: Unilateral coronal synostosis causing anterior plagiocephaly can result in restricted brain development and severe facial deformities. Various surgical procedures have been described for the correction of this deformity. Cranial vault remodeling, however, is associated with several complications. Occipitofrontal switching is a novel technique which utilizes a part of the contralateral occipital bone to reconstruct the frontal area. This is the first such case reported from India and first report where virtual mock surgery has been utilized for precision and improving outcome in this elegant procedure. CASE DESCRIPTION: A 5-year-old girl presented with left anterior plagiocephaly. 3D image of her skull was reconstructed using Geomagic Freeform software (3D Systems, Rock Hill, SC). Measurements were accurately drawn and the procedure was practised virtually before performing the occipitofrontal switch on the patient. There were minimal blood loss and postoperative morbidity. One year follow-up of the patient showed optimal correction of the defect in the forehead region, symmetrical shape of the frontal and occipital region and symmetrical brows. CONCLUSION: The technique of occipitofrontal switch for correction of anterior plagiocephaly is an elegant procedure with good functional and aesthetic outcome.

Efficacy and safety of next-generation tick transcriptome-derived direct thrombin inhibitors.

Despite their limitations, unfractionated heparin (UFH) and bivalirudin remain standard-of-care parenteral anticoagulants for percutaneous coronary intervention (PCI). We discovered novel direct thrombin inhibitors (DTIs) from tick salivary transcriptomes and optimised their pharmacologic activity. The most potent, ultravariegin, inhibits thrombin with a Ki of 4.0 pM, 445-fold better than bivalirudin. Unexpectedly, despite their greater antithrombotic effect, variegin/ultravariegin demonstrated less bleeding, achieving a 3-to-7-fold wider therapeutic index in rodent thrombosis and bleeding models. When used in combination with aspirin and ticagrelor in a porcine model, variegin/ultravariegin reduced stent thrombosis compared with antiplatelet therapy alone but achieved a 5-to-7-fold lower bleeding time than UFH/bivalirudin. Moreover, two antibodies screened from a naïve human antibody library effectively reversed the anticoagulant activity of ultravariegin, demonstrating proof-of-principle for antidote reversal. Variegin and ultravariegin are promising translational candidates for next-generation DTIs that may reduce peri-PCI bleeding in the presence of antiplatelet therapy.

Persistence of DDT, malathion & deltamethrin resistance in Anopheles culicifacies after their sequential withdrawal from indoor residual spraying in Surat district, India.

BACKGROUND & OBJECTIVES: Under the national antimalaria programme DDT was introduced in early 1950s for vector control and later hexachloro cyclohexane (HCH) followed by malathion and recently synthetic pyrethroids in 1990s to manage the insecticide resistance in Anopheles culicifacies. Subsequent replacement led to development of multiple resistances in An. culicifacies in Surat district in Gujarat State. Indoor residual spray (IRS) was completely withdrawn in southern villages in Surat in 2002. This study was undertaken in these areas to study the persistence of resistance to DDT, malathion and deltamethrin after sequential withdrawal of IRS with these insecticides at different times. METHODS: Susceptibility tests on An. culicifacies were conducted using standard WHO methods and kits. Mortality, knockdown time and lethal times were calculated for An. culicifacies exposed to WHO prescribed diagnostic concentrations of different insecticide impregnated papers. RESULTS: Persistence of DDT-resistance was observed even after 30 yr of its withdrawal from IRS. Similarly, persistence of malathion resistance was also observed after 9 yr of its withdrawal from IRS, while reversal of deltamethrin-resistance was observed very fast within 2-3 yr after its withdrawal from IRS in 2002. INTERPRETATION & CONCLUSION: Present data indicate that the quantum of reversion of insecticide resistance in a population is relative and depends on the genetic stability of the respective resistance genes in the mosquitoes. In the present study withdrawal of pyrethroid-IRS resulted in increased susceptibility against pyrethroids alone and was independent of existence of resistance to insecticides of other groups. This study emphasizes that appropriate rotation of different insecticides; including carbamates may prevent or delay the onset of resistance.

Emulsion PCR made easy.

Emulsion PCR (ePCR) is an important technique that permits amplification of DNA molecules in physically separated picoliter-volume water-in-oil droplets, and thus avoids formation of unproductive chimeras and other artifacts between similar DNA sequences. However, the recovery of ePCR products involves repeated extraction with hazardous organic solvents followed by purification using silica-based columns, making the overall process cumbersome. In this benchmark, we have described a quick ePCR extraction protocol for the purification of ePCR products, which directly employs silica-based DNA purification columns; products purified using this method have been found to be compatible with gene cloning and next-generation sequencing applications. The method described here makes ePCR easy, safe and within the reach of every laboratory.