The Response Evaluation Criteria in Solid Tumors, or RECIST criteria (one-dimensional [1D] measurement), are widely used to measure response in tumors, but there are few studies evaluating these criteria in brain tumors. We compared linear and volumetric measurements in adult high-grade supratentorial enhancing gliomas to determine the agreement between measurements, in defining responses and in their subsequent relation to survival. We hypothesized that the 1D RECIST criteria maybe suitable for response assessment in adult high-grade gliomas. Tumor size on MRI scans in 104 patients with high-grade enhancing gliomas treated on clinical trial protocols was measured by using 1D (greatest length), 2D (two-dimensional: product of the two longest perpendicular diameters), 3D (three dimensional: product of the longest perpendicular diameters in one plane and the longest orthogonal diameter to that plane), enhancing volume (EV), and total volume (TV). A total of 388 T1 postgadolinium MRI scans (104 baseline and 284 follow-up scans) were evaluated. Volumetric analysis (EV and TV) was performed with commercially available software. Intraobserver and interobserver correlations (rho) were high for all modalities (rho > 0.92 and rho > 0.71, respectively). Correlation was excellent (rho > 0.9) among all modalities except for 3D (rho < 0.6). Patient response rates ranged from 12% to 26%. Median progression-free survival (mPFS) and six-month progression-free survival (6mPFS) were not significantly different among the methods (range, 5.3 months to 5.9 months and 42% to 48%, respectively). Landmark analyses of response at two months using linear methods predicted overall survival with hazard ratios of 0.19 to 0.29 (P < 0.005). These results suggest high concordance among 1D, 2D, TV, and EV, but not 3D, methods in assessing enhancing tumor progression and in estimating mPFS and 6mPFS in adult brain tumor patients. The tumor response at two months assessed by linear methods correlated better with overall survival. Thus, linear methods are comparable to volumetric methods, but simpler to implement for routine clinical use and for designing clinical trials of brain tumors.

BackgroundVisceral leishmaniasis (VL) control in the Indian subcontinent is currently based on case detection and treatment, and on vector control using indoor residual spraying (IRS). The use of long-lasting insecticidal nets (LN) has been postulated as an alternative or complement to IRS. Here we tested the impact of comprehensive distribution of LN on the density of Phlebotomus argentipes in VL-endemic villages.MethodsA cluster-randomized controlled trial with household P. argentipes density as outcome was designed. Twelve clusters from an ongoing LN clinical trial—three intervention and three control clusters in both India and Nepal—were selected on the basis of accessibility and VL incidence. Ten houses per cluster selected on the basis of high pre-intervention P. argentipes density were monitored monthly for 12 months after distribution of LN using CDC light traps (LT) and mouth aspiration methods. Ten cattle sheds per cluster were also monitored by aspiration.FindingsA random effect linear regression model showed that the cluster-wide distribution of LNs significantly reduced the P. argentipes density/house by 24.9% (95% CI 1.80%–42.5%) as measured by means of LTs.InterpretationThe ongoing clinical trial, designed to measure the impact of LNs on VL incidence, will confirm whether LNs should be adopted as a control strategy in the regional VL elimination programs. The entomological evidence described here provides some evidence that LNs could be usefully deployed as part of the VL control program.Trial registrationClinicalTrials.gov CT-2005-015374

Abstract. A prospective study was carried out in a cohort of 355 persons in a leishmaniasis-endemic village of the Patna District in Bihar, India, to determine the prevalence of asymptomatic persons and rate of progression to symptomatic visceral leishmaniasis (VL) cases. At baseline screening, 50 persons were positive for leishmaniasis by any of the three tests (rK39 strip test, direct agglutination test, and polymerase chain reaction) used. Point prevalence of asymptomatic VL was 110 per 1,000 persons and the rate of progression to symptomatic cases was 17.85 per 1,000 person-months. The incidence rate ratio of progression to symptomatic case was 3.36 (95% confidence interval [CI] = 0.75-15.01, P = 0.09) among case-contacts of VL compared with neighbors. High prevalence of asymptomatic persons and clinical VL cases and high density of Phlebotomus argentipes sand flies can lead to transmission of VL in VL-endemic areas.

Abstract. Kala-azar, a fatal infectious disease in many Indian states, particularly in Bihar, West Bengal, Uttar Pradesh, and Jharkhand, is caused by the protozoan parasite Leishmania donovani and transmitted by the sandfly vector Phlebotomus argentipes. The vector is distributed all over the country but the disease is confined to particular zones since before the last century. In this study, parameters such as altitude, temperature, humidity, rainfall and the normalized difference vegetation index (NDVI) were investigated for correlation with the distribution of the disease in the northeastern corner of the Indian sub-continent. Data analysis on Kala-azar prevalence during the period [2005][2006][2007] in the four states showed that the highest prevalence was below 150 m of altitude with very few cases located above the 300 m level. Low NDVI value ranges (0.03-0.015) correlated with a high occurrence of the disease. The maximum temperatures in the affected sites varied between an upper level of 25-29°C and a minimum of 16-20°C. The rainfall in these areas fluctuated between 1154 and 1834 mm. As the disease showed a high correlation with the prevailing topographic conditions, an attempt was made to improve the relative strength of the approach to predict the potential for endemicity of leishmaniasis by introducing satellite imagery complemented with a geographical information system database.

BackgroundAn improved understanding in transmission variation of kala-azar is fundamental to conduct surveillance and implementing disease prevention strategies. This study investigated the spatio-temporal patterns and hotspot detection for reporting kala-azar cases in Vaishali district based on spatial statistical analysis.MethodsEpidemiological data from the study area during 2007–2011 was used to examine the dynamic space-time pattern of kala-azar outbreaks, and all cases were geocoded at a village level. Spatial smoothing was applied to reduce random noise in the data. Inverse distance weighting (IDW) is used to interpolate and predict the pattern of VL cases distribution across the district. Moran’s I Index (Moran’s I) statistics was used to evaluate autocorrelation in kala-azar spatial distribution and test how villages were clustered or dispersed in space. Getis-Ord Gi*(d) was used to identify the hotspot and cold spot areas within the study site.ResultsMapping kala-azar cases or incidences reflects the spatial heterogeneity in the incidence rate of kala-azar affected villages in Vaishali district. Kala-azar incidence rate map showed most of the highest endemic villages were located in southern, eastern and northwestern part of the district; in the middle part of the district generally show the medium occurrence of VL. There was a significant positive spatial autocorrelation of kala-azar incidences for five consecutive years, with Moran’s I statistic ranging from 0.04-0.17 (P <0.01). The results revealed spatially clustered patterns with significant differences by village. The hotspots showed the spatial trend of kala-azar diffusion (P < 0.01).ConclusionsThe results pointed to the usefulness of spatial statistical approach to improve our understanding the spatio-temporal dynamics and control of kala-azar. The study also showed the north-western and southern part of Vaishali district is most likely endemic cluster region. To employ exact and geographically suitable risk-reduction programmes, apply of such spatial analysis tools should suit a vital constituent in epidemiology research and risk evaluation of kala-azar.

Human visceral leishmaniasis (VL) or kala-azar remains a major cause of mortality, particularly in the developing world. The disease is common in the internal regions of north-eastern India, which have a tropical or sub-tropical climate. In a recent study on VL in this region, the relationship between the incidence of VL and certain physio-environmental factors was explored, using a combination of a geographical information system (GIS), satellite imagery and data collected 'on the ground'. Some eco-environmental parameters were then used to map and describe the spatial heterogeneity seen in the transmission of the parasite (Leishmania donovani) that causes VL in India, and to identify those habitats, on the Gangetic plain, where the sandfly vectors might thrive. It was found that the presence of waterbodies, woodland and urban, built-up areas, soil of the fluvisol type, air temperatures of 25.0-27.5 degrees C, relative humidities of 66%-75%, and an annual rainfall of 100-<160 cm were all positively associated with the incidence of VL. A VL map was created and stratified into areas of 'risk' and 'non-risk' for the disease, based on calculations of risk indices.

Background Visceral leishmaniasis (VL) or Kala-azar has been a major public health problem in Bihar, India, for several decades. A few VL infected districts including Vaishali have reported >600 cases annually. Hence, in 2015, the Government of India entrusted ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, to implement an integrated control strategy for achieving the VL elimination target (<1 case per 10,000 people at the block level) in the Vaishali District of Bihar. Methodology This study was conducted between January 2015 and December 2016. An integrated control strategy including the spatio-temporal mapping of VL-case distribution, active case detection, chemical-based vector control using indoor residual spraying (IRS), community awareness campaigns, the training of IRS members, the training of medical doctors for effective treatment, daily monitoring and the supervision of IRS activities, logistic management, post-IRS quality assurance, epidemiological surveillance, and entomological monitoring was performed. An insecticide quantification test was performed for evaluating the IRS quality on sprayed walls. A modern compression pump was used to maintain spray quality on different wall surfaces. The impact of IRS was assessed through sand fly collection in human dwellings and cattle sheds in pre-and post-IRS. The insecticide susceptibility of local P. argentipes was performed before each IRS round (in February and June) during 2015-2016. Statistical analysis such as the mean, percentage, and 95% CI were used to summarize the results.

Visceral leishmaniasis (VL) continues to embody as a mammoth public health problem and hurdle to the socioeconomic development of Bihar, India. Interestingly, all leishmanial infections do not lead to overt clinical disease and may stay asymptomatic for a period of time. Asymptomatic cases of VL are considered as probable potential reservoirs of VL, and thus can play a major role in transmission of the disease in highly endemic areas of Bihar, India. They outnumber the exact disease burden in endemic areas of this region, thus jeopardizing the goal of the elimination program that is due by 2015. This article discusses the potential risk factors, epidemiological markers of transmission and requirement of highly sensitive diagnostic tools for efficient recognition of the high risk groups of conversion to symptomatic for proper designing of strategies for implementation of the control programs.