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   Table of Contents - Current issue
Coverpage
January-June 2019
Volume 9 | Issue 1
Page Nos. 1-68

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EDITORIAL  

New technologies and new horizons p. 1
Subhash Chandra Parija
DOI:10.4103/tp.TP_23_19  PMID:31161084
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REVIEW ARTICLE Top

Systems approach in medical education: The thesis, antithesis, and synthesis p. 3
BV Adkoli, SC Parija
DOI:10.4103/tp.TP_7_19  PMID:31161085
Systems approach is a time tested, method of trying to understand the reality holistically, and resolving the issues by problem-solving method. It has resulted in enormous applications in almost every field of knowledge, science, technology, industries, agriculture, and health or education. The main essence of systems thinking lies in minimizing the inputs, optimizing the process to maximize the outputs through continuous feedback, and monitoring. Medical education has been greatly benefitted as the systems approach has influenced all aspects, from delineating the competencies of doctors, designing curriculum that includes comprehensive assessment. However, of late, there has been a debate as to whether the systems approach can really contribute to resolve complex issues such as bringing curricular reforms, or promote policy changes in patient care, education, or research. This involves a paradigm shift from problem-solving approach to “pattern recognition” and adaptive action to correct the system. This review based on critical appreciation, begins with a thesis that systems approach is a great tool. It then exposes its inadequacy to address complex systems. This is antithesis. In the end, a synthesis of both the contradictory views has been proposed as a take home.
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ORIGINAL ARTICLES Top

Neem oil-loaded cross-linked biodegradable polymeric capsules: Its larvicidal activity against Culex quinquefasciatuss larvae p. 7
Sonia Ninan, B Dineshkumar, K Krishnakumar
DOI:10.4103/tp.TP_44_18  PMID:31161086
Background: Pesticide delivery system has been formulated in the form of emulsifiable concentrates, water solutions, aerosols, or spray formulations. However, such formulations showed health hazards. Encapsulation technique is the more suitable method to reduce health hazard and to deliver and release the pesticides. Natural biopolymers have been widely studied for encapsulation of pesticide compounds, as they are biodegradable, biocompatible, and low toxic to mammalian. Neem oil has been reported for controlling of the mosquitoes and more eco-friendly insecticide than synthetic insecticides. The present study was designed to prepare a cross-linked polymeric network capsules loaded with neem oil as effective controlled release formulation against Culex quinquefasciatus larvae. Materials and Methods: Neem oil-loaded chitosan/alginate/gelatin capsules were prepared by cross-linking method. Neem oil-loaded capsules were characterized with respect to their capsule size, scanning electron microscopy (SEM) analysis, and swelling property. In vitro larvicidal activity of neem oil-loaded polymeric capsules was studied against C. quinquefasciatus larvae. Results: The cross-linking method produced spherical shape of neem oil-loaded capsules. Ultraviolet spectroscopy analysis indicated that 10% of neem oil was loaded with capsule. A swelling study indicated that swelling of the loaded capsules tends to be more stable. SEM analysis showed that loading of the neem oil with the capsules fills all pores and capsules were found with good compatibility between chitosan, alginate, and gelatin due to the uniform shape of the capsule. Formulated neem oil-loaded capsules showed potential larvicidal activity (100% of mortality) against C. quinquefasciatus larvae in an in vitro model. Conclusion: Formulated neem oil-loaded capsules showed a simple method of preparation and eco-friendly. These polymeric capsule containing neem oil exhibited potential larvicidal activity against C. quinquefasciatus larvae.
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Utilizing larvicidal and pupicidal efficacy of Eucalyptus and neem oil against Aedes mosquito: An approach for mosquito control Highly accessed article p. 12
Taruna Kaura, Abhishek Mewara, Kamran Zaman, Amit Sharma, Sonu Kumari Agrawal, Vandana Thakur, Anil Garg, Rakesh Sehgal
DOI:10.4103/tp.TP_35_18  PMID:31161087
Background and Objectives: Plant-based products can provide safe and biodegradable mosquito control agents. The essential oils have a strong odor due to complex secondary metabolites and exhibit lower density than that of water, which renders them suitable to form a thin layer above the water surface. The present study was designed to evaluate the larvicidal, pupicidal activity of Eucalyptus and neem oils against Aedes aegypti and Aedes albopictus. Materials and Methods: We evaluated the activity of commercially available Eucalyptus (Eucalyptus globulus) and neem (Azadirachta indica) oils against larvae and pupae of A. aegypti and A. albopictus for their larvicidal and pupicidal activity, stability in different water types, dependence on volume and surface area of the water body, and residual efficacy. Results: Eucalyptus oil was found to be more effective against larvae and pupae at lower concentrations, i.e., concentration at which 50% is observed (LC50) for larvae and pupae was 93.3 and 144.5 parts per million (ppm) and concentration at which 90% is observed (LC90) was 707.9 and 741.3 ppm, respectively, while for neem oil, LC50 for larvae and pupae was 7852 and 19,054 ppm and LC90 was 10,092 and 19,952 ppm, respectively. The efficacy of Eucalyptus oil depended on surface area rather than volume of water, and the residual efficacy of Eucalyptus oil was up to 8 days. Conclusions: Eucalyptus oil was more effective against mosquito larvae at lower concentration as compared to neem oil. It can, therefore, be utilized in the community in artificial and small temporary water bodies as an eco-friendly vector control measure in the era of increasing resistance to chemical insecticides.
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Prevalence of cryptosporidiosis in symptomatic immunocompetent children and comparative evaluation of its diagnosis by Ziehl–Neelsen staining and antigen detection techniques p. 18
Rumpa Saha, Bhoomika Saxena, Sungtila T Jamir, Shwetank Shekhar
DOI:10.4103/tp.TP_59_18  PMID:31161088
Background: Cryptosporidia is a major pathogen causing diarrhoea and with increasing morbidity and mortality. As persistent diarrhoea from intestinal cryptosporidiosis leads to increased susceptibility to recurrent diarrheal episodes further leading to chronic nutritional and cognitive sequelae or even death, diagnosis is important. Most of the studies done on Cryptosporidium worldwide have focused on immunocompromised patients which have led to a paucity of data on its prevalence among immunocompetent people. Aims and Objectives: Keeping these facts in mind the present study was aimed to estimate prevalence of cryptosporidiosis in immunocompetent children, and do a comparative evaluation of its detection by microscopy with antigen detection methods. Material and Methods: 80 immunocompetent children (40 OPD children presenting with diarrhea and 40 children hospitalized for diarrhea) upto age of 5 years were studies and their stool samples were compared by microscopy by mZN with copro-antigen detection methods (using rapid ICT and ELISA) for the diagnosis of Cryptosporidiosis. Results: A Cryptosporidium prevalence rate of 22.5% was detected in the immunocompetent children upto 5 years of age. Microscopy remained the preferred method of diagnosis for Cryptosporidium being a more sensitive test and considering it's low cost in resource poor settings. Moderate agreement between mZN and ELISA in Cohen's kappa test shows that either of the tests can be used for diagnosis of Cryptosporidium from fecal sample. ELISA is time-saving method but ELISA and rapid antigen tests should not be used as the sole method of diagnosis. Keeping in view the ICT kit used in this study is species specific, and the species identification was not carried out in the present study, hence genus specific kits may be useful for diagnosis in such settings. Conclusion: Microscopy remains the preferred method of diagnosis for Cryptosporidium having good sensitivity and specificity and considering it's low cost in resource poor settings. ELISA is time-saving method but ELISA and rapid antigen tests should not be used as the sole method of diagnosis.
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Prevalence of soil-transmitted helminth infestations among children attending Integrated Child Development Service centers in a tea garden area in Darjeeling p. 23
Sony Das, Abhijit Mukherjee, Sanjay Mallick, Sharmistha Bhattacherjee, Sumanta Chakraborty, Samir Dasgupta
DOI:10.4103/tp.TP_55_17  PMID:31161089
Introduction: Helminths infestations are common in children in the tea garden areas of Darjeeling, which present unique social, cultural, and environmental conditions. The present study was conducted to determine the proportion of soil-transmitted helminth (STH) infestations and association of STH to sociodemographic variables among children attending Integrated Child Development Services centers of a tea garden area in Darjeeling. Methodology: A cross-sectional descriptive study was conducted at Kiran Chandra Tea Estate, a tea garden in Naxalbari, Darjeeling, between August and September 2016. Stool samples were collected from children attending ICDS centers in the area and examined using the direct and concentration methods. A pretested and predesigned questionnaire was used to collect data on the sociodemographic profile of the children's families. Results: Stool samples could be collected from 52 (45%) of the 115 eligible children. The children were predominantly male (61.5%), from families with an income between Rs. 2000 and 4000 per month, had mothers with no formal education (75.0%) and came from households with no sanitary toilets (33.5). The proportion of children with STHs was 9.6%; with Ascaris found in 7.7% and Trichuris in 1.9%. No statistically significant differences were found in selected variables between the worm-positive and worm-negative children. Conclusions: The proportion of STH infestation is low among children <6 years of age attending ICDS in the study area probably because of the mass de-worming strategy of the government of India. Some differences in infestations among groups might suggest a clustering effect.
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Prophylactic interferon-γ and interleukin-17 facilitate parasite clearance in experimental visceral leishmaniasis p. 30
Prabin Kumar, Pragya Misra, Narendra Kumar Yadav, Sumit Joshi, Amogh A Sahasrabuddhe, Anuradha Dube, Narayan Rishi, Dipendra Kumar Mitra
DOI:10.4103/tp.TP_32_18  PMID:31161090
Background and Objective: The synergy of interleukin (IL)-17 along with other pro-inflammatory cytokines is well known in various autoimmune and infectious diseases. A longitudinal study in the Sudanese population showed an association of IL-17 with the protection of kala-azar outbreak. The protective role of IL-17 is also known in terms of expansion of IL-17-producing cells in vaccine-induced immunity. However, the prophylactic role of IL-17 in visceral leishmaniasis has still not been validated. In the present study, we evaluated the prophylactic efficacy of IL-17A and interferon (IFN)-γ in Leishmania donovani-challenged Balb/c mice. Materials and Methods: Two doses of recombinant IL (rIL)-17A and/or IFN-γ were administered intraperitoneally after/at 1 week interval and then the mice were challenged with amastigote form of L. donovani. At 45 days of postchallenge, mice were sacrificed and evaluated for change in the body and organ weight, parasitic load in visceral organs, and fold change in gene expression of cytokines. Results: We observed that the prophylactic use of rIL-17A and IFN-γ alone or in combination significantly inhibited the parasitic load in visceral organs. Furthermore, pro-inflammatory cytokine gene expression increased up to 2–4-folds in mice treated with recombinant cytokines. Conclusion: Our results suggest that prophylactic use of recombinant IFN-γ and IL-17A inhibits parasitic growth in visceral organs of L. donovani-challenged experimental mice model, especially through upregulation of pro-inflammatory cytokines' gene expression.
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Impact of training of mothers, drug shop attendants and voluntary health workers on effective diagnosis and treatment of malaria in Lagos, Nigeria p. 36
Olusola Ajibaye, Emmanuel O Balogun, Yetunde A Olukosi, Bassey A Orok, Kolapo M Oyebola, Bamidele A Iwalokun, Olugbenga O Aina, Olalere Shittu, Adeniyi K Adeneye, Oyesola O Ojewunmi, K Kita, Samson T Awolola
DOI:10.4103/tp.TP_36_18  PMID:31161091
Background: The National Malaria Eradication Program and international agencies are keen on scaling up the use of malaria rapid diagnostic tests (mRDTs) and artemisinin-based combination therapies (ACTs) for effective diagnosis and treatment of the disease. However, poor diagnostic skills and inappropriate treatment are limiting the efforts. In Nigeria, a large proportion of infected patients self-diagnose and treat while many others seek care from informal drug attendants and voluntary health workers. Aims: This study describes the impact of training voluntary health workers, drug shop attendants, and mothers on effective case detection and treatment of malaria in Lagos, Nigeria. METHODS: We trained mothers accessing antenatal care, drug shop attendants, and voluntary health workers selected from the three districts of Lagos, on the use of histidine-rich protein-2-based mRDTs and ACTs. Pre- and post-training assessments, focus group discussions (FGDs), and in-depth interviews (IDIs) were carried out. Results: The knowledge, attitude, and skill of the participants to achieve the goal of “test, treat, and track” using mRDT and ACTs were low (11%–55%). There was a low awareness of other non-malaria fevers among mothers. Self-medication was widely practiced (31.3%). FGDs and IDIs revealed that health-care providers administered antimalarials without diagnosis. Training significantly improved participants' knowledge and expertise on the use of mRDTs and ACTs (P = 0.02). The participants' field performance on mRDT use was significantly correlated with their category (bivariate r = 0.51, P = 0.001). There was no statistically significant association between the participants' level of education or previous field experience and their field performance on mRDT (r = 0.12, P = 0.9; χ2 = 38, df = 2 and P = 0.49). Conclusion: These findings suggest that training of stakeholders in malaria control improves diagnosis and treatment of malaria. However, a broader scope of training in other settings may be required for an effective malaria control in Nigeria.
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Trichomonas vaginalis and Mycoplasma infections among women with vaginal discharge at Fann teaching hospital in Senegal p. 45
Roger C Tine, Lamine Dia, Khadime Sylla, Doudou Sow, Souleye Lelo, Cheikh T Ndour
DOI:10.4103/tp.TP_50_18  PMID:31161092
Background: Trichomonas vaginalis and genital Mycoplasmas are two synergistic pathogens, but in many settings, limited data on the co-infection by Trichomonas and Mycoplasma are available. Objective: This study aimed at assessing Mycoplasma prevalence and its association with Trichomonas vaginalis among women with vaginal discharge. Materials and Methods: A retrospective analysis of laboratory records (2012 and 2013) from patients referred at the Fann teaching hospital in Dakar Senegal for vaginal discharge was carried out. Detection of genital mycoplasmas was based on the commercial Kit Mycoplasma Duo Bio-Rad™ using endo-cervical swabs. Vaginal swabs were collected and examined using optic microscopy with 40x magnification to detect T. vaginalis. Results: Overall, data from 1257 women were analysed. Prevalence of Mycoplasma hominis represented 57.4%, 95%CI(54.6-60.1), versus 54.9%, 95%CI(52.1-57.5) for Ureaplasma urealyticum. Trichomonas vaginalis infection was observed with a frequency of 3%. Out of the 50 patients with trichomoniasis, 76% of them were co-infected by Mycoplasma hominis and patients with Trichomonas vaginalis had an increased risk of acquiring Mycoplasma infection (adjusted OR:2.5, 95%CI(1.2-5.2);p=0.02)). Conclusion: Trichomonas vaginalis and Mycoplasmas are two closely associated pathogens in the urogenital tract of women. This clinically significant symbiotic action may require systematic screening of Mycoplasma among patients with trichomoniasis for optimal management of sexually transmitted infections.
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DISPATCHES Top

Echinostomiasis in a child with severe anemia p. 54
Vinay Khanna, Asem Ali Ashraf, Ruchee Khanna
DOI:10.4103/tp.TP_68_18  PMID:31161093
A child had presented with complaints of dark green-colored loose stools, nonbilious vomiting, and fever for a day. Blood investigations revealed low hemoglobin levels. Abdominal ultrasonography showed features suggestive of worms. Wet mount examination of stool showed eggs of Echinostoma species and Trichuris trichiura and fertilized and unfertilized eggs of Ascaris lumbricoides. High incidences of intestinal parasitic infections in children can lead to anemia, consequently disturbing the development of these children. Such intestinal parasitic infections seem to be associated directly due to the unclean living settings linked with lack of awareness regarding the communicable disease and diversity of influences that need to be further elucidated. In humans, Echinostoma species have seldom been detected perhaps for the reason of its complexity in diagnosis by fecal examination as the eggs generated per worm are relatively less in contrast to other helminthic parasites.
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Ocular filariasis: “Dancing sensation in the anterior chamber” p. 57
Ashish Mitra, Alok Sen, Tina Agrawal, Gaurav Kohli
DOI:10.4103/tp.TP_69_18  PMID:31161094
We report a case of ocular filariasis in a 28–year-old male who presented with a 2-month history of irritated acute red eye. Examination revealed a living and active large worm dancing in the anterior chamber of the left eye causing acute iridocyclitis, leading to drop in vision to 6/36. The worm whose size was approximately 33 mm in length was extracted under local anesthesia in toto using viscoelastics without damaging the ocular structures. Microscopic examination confirmed adult Wuchereria bancrofti.
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CASE REPORT Top

Cysticercosis masquerading as tuberculous lymphadenitis in supraclavicular region p. 59
Sonam Jain, Saumya Nanda, Divya Sethi, Sangeeta Lamba
DOI:10.4103/tp.TP_22_18  PMID:31161095
Cysticercosis is a parasitic infestation caused by the larvae of the tapeworm Taenia solium. In humans, cysticercosis spreads through fecal–oral route by ingesting food contaminated with eggs of pork tapeworm. The most frequent sites affected are central nervous system, eye, subcutaneous tissue, and skeletal muscle. We report a case of cysticercosis presenting as left supraclavicular swelling which is a rare site, diagnosed on fine-needle aspiration.
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LETTERS TO EDITOR Top

Isolation of Acanthamoeba from pond water in Dibrugarh district of Assam: A report p. 62
Utpala Devi, Jagadish Mahanta
DOI:10.4103/tp.TP_34_15  PMID:31161096
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FACE TO FACE Top

An email interview with Dr. Christen Rune Stensvold p. 64

DOI:10.4103/tp.TP_14_19  PMID:31161097
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