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   Table of Contents - Current issue
Coverpage
July-December 2019
Volume 9 | Issue 2
Page Nos. 69-138

Online since Wednesday, September 18, 2019

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EDITORIAL  

Microbial links to noninfectious diseases: The way forward p. 69
Subhash Chandra Parija
DOI:10.4103/tp.TP_57_19  
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REVIEW ARTICLES Top

Schizophrenia and bipolar disorders: The Toxoplasma connection Highly accessed article p. 71
Abhijit Chaudhury, BV Ramana
DOI:10.4103/tp.TP_28_19  
The infectious etiology of psychiatric illnesses has remained an unexplored area till recently. During the past two decades, numerous studies from multiple angles have tried to link chronic toxoplasmosis with schizophrenia and bipolar disorders, among others. Most of the evidence has come from serological studies in the patient population, but other facets have also been explored. This review examines the various areas from which a causal link has been deduced and includes: (a) serological studies, (b) effect of maternal toxoplasmosis on children, (c) neurotransmitter studies, (d) parasite localization in the brain, (e) role of cytokines, and (f) psychotherapy and its effect on Toxoplasma. However, multiple factors may play a role in the etiopathogenesis of psychiatric illnesses, and chronic Toxoplasma infection may be considered an important risk factor for the genesis and symptomatology of schizophrenia and bipolar disorders.
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Applying systems approach for bridging education, research, and patient care in a health sciences university p. 77
BV Adkoli, SC Parija
DOI:10.4103/tp.TP_49_19  
Systems approach provides a logical and scientific basis for explaining the functioning of a system in a holistic manner. The health sciences university is a system with its three major operations – education, research, and patient care, which can be conceived as inputs, process, and output, respectively. The system is aided by a feedback loop to inform and correct the system. Systems thinking enable us to identify the deficiencies existing in each of the components so that appropriate remedial action can be taken. In this article, we have identified deficiencies in the health sciences system. Further, we have suggested a five-point formula to achieve connection among education, research, and patient care. We need to Form consortia and networks to create a mass movement, Uniform regulations to remove bottlenecks, Reform curricula to make them credit linked and competency based, Inform all through a faculty development initiative, and finally, Transform the system by setting examples and demonstrating success. The initiative taken by the Medical Council of India in introducing a competency-based curriculum for MBBS, and the revised accreditation manual introduced by the National Assessment and Accreditation Council can provide a lot of opportunities to explore the potentiality educational research to answer many questions that can help us in connecting research with education and patient care.
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ORIGINAL ARTICLES Top

Echinococcus contamination ratio and its related risk factors in Moghan plain, northwest of Iran p. 83
Hafez Mirzanejad-Asl
DOI:10.4103/tp.TP_6_18  
Background and Objectives: Alveolar and cystic echinococcosis (AE and CE) are caused by the larval stages of Echinococcus multilocularis and Echinococcus granulosus, respectively. This study aimed to determine the prevalence of human AE and CE diseases among the tribes, livestock breeders, and farmers in Moghan plain, northwest of Iran. Materials and Methods: Screening of hydatid cystic fluid antigen (HCF-Ag) was done by enzyme-linked immunosorbent (ELISA) kit. Briefly, HCF-Ag was collected, and the prevalence of the disease was evaluated using specific antigens for AE and CE (Ag-5, Ag-B, and Em2+) and questionnaires. A total of 2453 serum samples were randomly collected from normal populations of five different areas of Moghan plain. The serology was evaluated using ELISA kit and specific antigens for AE and CE. Results: Of the 2453 serum samples, 36 were positive for AE (1.46%). The infection rate was higher in males than females (1.94% vs. 0.94%). The age group of 4–19 years had the lowest and 40–59 years had the highest infection rate (0.2% vs. 2.5%). Among CE-positive serum samples, 178 samples were positive to Ag-5 (7.3%) and 167 samples were positive to Ag-B (6.8%). Conclusion: Our findings showed that the highest infection rates were in the Borran and Eivazlou regions, and the lowest level of infection was for Parsabad area of Moghan plain. In areas with higher contamination, the risk factors associated with CE and AE were the water quality, the method of washing vegetables, and occupational and hydatid disease knowledge of the inhabitants.
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Clinical spectrum of Plasmodium vivax infection, from benign to severe malaria: A tertiary care prospective study in adults from Delhi, India p. 88
Sujata Elizabeth Mathews, Mohit M Bhagwati, Vinod Agnihotri
DOI:10.4103/tp.TP_2_19  
Objective: Plasmodium vivax infection has been recognized to be a cause of severe malaria in recent time. We report findings from a prospective observational study aimed at analyzing the clinical spectrum, complications, and outcome of patients infected with P. vivax malaria. Materials and Methods: The study was conducted in a tertiary care hospital of Delhi over a period of 2 years. All adults hospitalized with P. vivax malaria, confirmed on peripheral smear and/or rapid diagnostic test, were included in the study. The cases were categorized into uncomplicated and severe malaria groups according to WHO criteria. The clinical and biochemical profile of cases in each group were compared for determining the predictors of severe malaria. Results: One hundred and fifty consecutive cases of P. vivax monoinfection were included in the study. All patients had fever, and 63 (42%) developed severe malaria, while 87 (58%) were uncomplicated. Vomiting, abdominal pain, headache, altered consciousness, cough with breathlessness, icterus, and hepatosplenomegaly were more frequent in severe malaria. Severe malaria was associated with severe thrombocytopenia, leucopenia, raised serum bilirubin, elevated serum creatinine, and prolonged prothrombin time. Jaundice (54 patients) was the most common complication, followed by acute respiratory distress syndrome, spontaneous bleeding, metabolic acidosis, shock, renal failure, and cerebral malaria. Multiple complications were observed in 17 (26.9%) cases of severe malaria. Overall mortality of 1.33% was recorded. However, case fatality of 40% was observed in cases with evidence of multiorgan dysfunction. Conclusion: P. vivax malaria has a varying clinical profile, from a relatively benign uncomplicated form to severe, even fatal disease. Certain clinical and laboratory parameters may serve as predictors of severe disease.
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Utility of cytology in the diagnosis of parasitic infestation: A retrospective study p. 93
Pramod Kumar Pamu, Navatha Vangala, Padmasree Sabbavarapu, Ashwani Tandon
DOI:10.4103/tp.TP_3_19  
Background: Parasitic infestation is one of the serious health problems in developing countries. Parasitic infestation is usually asymptomatic and does not cause disease as it may eventually lead to the death of both organism and host. Materials and Methods: This was a retrospective study done over a period of 5 years from 2013 to 2018. The study included 26 cases of parasitic infestations diagnosed on fine-needle aspiration cytology (FNAC) as well as fluid cytology. Results: Hydatidosis, cysticercosis, and filariasis were the parasitic infestations observed in this study, of which hydatidosis was the most common infestation. The predominant age group was 20–85 years old, with a mean age of presentation being 55 years. There was male predominance with a male–female of 9:1. Conclusion: FNAC and fluid cytology are rapid diagnostic tools that aid in the early diagnosis of parasitic infestations. In parasitic infestations presenting as visceral cystic lesions, thorough examination with proper clinical correlation aid in early management. In cases with coexistent malignancy, cytology plays a major role in the diagnosis of silent carriers of infection.
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Association between inflammatory cytokine levels and anemia during Plasmodium falciparum and Plasmodium vivax infections in Mangaluru: A Southwestern Coastal Region of India p. 98
Kishore Punnath, Kiran K Dayanand, Valleesha N Chandrashekhar, Rajeshwara N Achur, Srinivasa B Kakkilaya, Susanta K Ghosh, Suchetha N Kumari, D Channe Gowda
DOI:10.4103/tp.TP_66_18  
Background and Objectives: Dysregulated production of inflammatory cytokines might play important role in anemia during malaria infection. The objective of this study was to assess the extent of anemia due to malaria, associated complications, and inflammatory cytokines (tumor necrosis factor alpha [TNF-α], interleukin [IL]-6, and IL-10) across varying anemic intensity during malaria infections. Materials and Methods: A hospital-based cross-sectional study was conducted at District Wenlock hospital in Mangaluru city. Samples from 627 patients and 168 healthy controls (HC) were analyzed for level of hemoglobin (Hb), red blood cells (RBCs), and inflammatory cytokines. The blood cell parameters and inflammatory cytokines levels across varying intensity of anemia were analyzed using Kruskal–Wallis test and pair-wise comparison between two groups were by Mann–Whitney U-test. Correlations were calculated by Pearson's and Spearman rank correlations. Results: Compared to HC, Hb, and RBC levels were significantly lower in infected patients. On comparison with mild anemia patients (Hb 8–10.9 g/dL), the levels of TNF-α and IL-6 were significantly elevated, whereas IL-10 levels were lower during severe anemia (SA) (Hb <5 g/dL). In this endemic setting, we found a strong negative association between Hb levels and parasitemia, Hb and TNF-α, and positive relationship with IL-10; anemic patients also had significantly high TNF-α/IL-10 ratios. SA was associated with complications such as acute renal failure (16.0%), jaundice (16.0%), metabolic acidosis (24.0%), hypoglycemia (12.0%), hyperparasitemia (4.0%), and hepatic dysfunction (16.0%). Conclusions: Contrary to its benign reputation, Plasmodium vivax(Pv) infections can also result in severe malarial anemia (SMA) and its associated severe complications similar to Plasmodium falciparum infections. Dysregulated inflammatory cytokine responses play an important role in the pathogenesis of SMA, especially during Pv infections.
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Genetic diversity of Indian Plasmodium vivax isolates based on the analysis of PvMSP3β polymorphic marker p. 108
VM Anantabotla, Hiasindh Ashmi Antony, Noyal Maria Joseph, Subhash Chandra Parija, Nonika Rajkumari, Jyoti R Kini, Radhakrishna Manipura, Vijaya Lakshmi Nag, RS Gadepalli, Nirupama Chayani, Somi Patro
DOI:10.4103/tp.TP_11_19  
Background: Malaria is one of the major communicable diseases in India and worldwide. PvMSP3β is a highly polymorphic gene due to its large insertions and deletions in the central alanine-rich region, which, in turn, makes it a valuable marker for population genetic analysis. Very few studies are available from India about the genetic diversity of Plasmodium vivax based on PvMSP3β gene, and hence, this study was designed to understand the molecular diversity of the P. vivax malaria parasite. The accumulating epidemiological data provide insights into the circulating genetic variants of P. vivax in India, and ultimately benefits the vaccine development. Materials and Methods: A total of 268 samples confirmed to be positive by microscopy, rapid diagnostic test, and quantitative buffy coat test were collected from four different regions of India (Puducherry, Mangaluru, Jodhpur, and Cuttack) in the present study. Polymerase chain reaction (PCR)-based diagnosis was carried out to confirm the P. vivax monoinfection, and only the mono-infected samples were subjected to PvMSP3β gene amplification and further restriction fragment length polymorphism (RFLP) to determine suballeles. Results: Based on the size of the amplified fragment, the PvMSP3β gene was apportioned into two major types, namely Type A genotype (1.6–2 Kb) was predominantly present in 148 isolates and Type B (1–1.5 Kb) was observed in 110 isolates. The percentage of mixed infections by PCR was 3.73%. All the PCR products were subjected to RFLP to categorize into suballeles and we detected 39 suballeles (A1–A39) in Type A, and 23 suballeles (B1–B23) in Type B genotype. A high degree of diversity was observed among the isolates collected from Mangaluru region when compared to isolates collected from other regions. Conclusion: The present study showed a high degree of genetic diversity of PvMSP3β gene among the isolates collected from various parts of India. High polymorphism in PvMSP3β gene makes it a promising marker for epidemiological and vaccine development studies.
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Cutaneous leishmaniasis in Bikaner, India: Clinicoepidemiological profile; parasite identification using conventional, molecular methods and CL Detect™ rapid test, a new Food and Drug Administration-approved test p. 115
Ekadashi Rajni, BC Ghiya, Sarman Singh, Prem Shankar, Taruna Swami, Deepika Singh Jadon, SR Negi, Manisha Malik, PK Khatri
DOI:10.4103/tp.TP_1_19  
Background and Objective: Cutaneous Leishmaniasis (CL) is a dermal manifestation caused by various species of Leishmania. This is the most common Leishmanial syndrome seen worldwide and is emerging as and threatens to become an uncontrollable disease. The present study was planned to understand the current epidemiology of CL in the conventionally endemic area of Bikaner, Rajasthan. Species characterization was also done. Material and Methods: The diagnostic modalities used in the study were microscopy, histopathologic examination, antigen testing and confirmation and species characterization by PCR. Field evaluation of the new antigen detection kit approved by FDA in 2016 CL Detect™ IC-RDT was done and its results compared with other available diagnostic tests. Results: A total of 14 cases with 25 skin lesions presented to the Skin OPD during the six month study period (January to June 2018). Out of these, 5 were males and 9 were females, average age being 32 yrs. Students and housewives of poor socio economic group were the most frequently affected groups. Lesions were found on the exposed areas of the body, mainly on the upper limbs and facial region. Majority of them were ulcerated plaques. Out of 14 cases under study, antigen test confirmed 7 positives; thereby yielding a positive rate of 50% against 71.4% for microscopy, 72.7% for PCR and a mere 38.5% for histopathology. Species characterization revealed Leishmania tropica as the causative organism. Interpretation and Conclusion: The study indicates that the number of cases have declined substantially over the past decade in Bikaner. Despite being the oldest technique used, microscopy still is a good option for diagnosis. Combined with PCR, diagnostic accuracy and hence utility is increased multifold. In its current form, IC-RDT may not be very useful.
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DISPATCHES Top

Filariasis presenting as a solitary testicular mass p. 124
Sushil Kumar Shukla, Anuradha Kusum, Siddharth Sharma, Deepika Kandari
DOI:10.4103/tp.TP_15_19  
In an endemic country like India, the occurrence of filariasis is very common, especially in the states of Uttar Pradesh, Bihar, Jharkhand, Odisha, Andhra Pradesh, and Tamil Nadu. The present study describes the case of a male from a nonendemic state who presented with a testicular lump. Fine-needle aspiration cytology (FNAC) of the lump revealed many adult filarial worms. The appearance of adult filarial worms in different sites, other than lymph nodes and lymphatic vessels, are relatively rarer and should always be reported. Filariasis remains asymptomatic for a long time and responds very well to treatment if diagnosed early. Despite the availability of multiple diagnostic options, FNAC holds a great importance in diagnosing filariasis, especially in cases where there are normal eosinophil counts and no peripheral filarial parasite. Finally, careful examination of cytological smear for the parasite in high-risk groups is helpful in labeling the disease in early asymptomatic states.
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Lymphatic filariasis presenting as a soft tissue swelling in midarm: A histopathological diagnosis at unusual site p. 127
Nibedita Sahoo, Pranita Mohanty, Sandip Mohanty, Sujata Naik
DOI:10.4103/tp.TP_67_18  
Filariasis is a major social health problem in tropical countries like India. Wuchereria bancrofti accounts for 95% cases of lymphatic filariasis. The adult worm resides in the lymphatics and lymph nodes and causes little inflammatory response as long as it is alive, but granulomatous reaction is noted once the death of parasite occurs. In the present case, spectrum of inflammatory response is noted to the adult and larval form, which forms a soft tissue mass, masquerading as a soft tissue tumor clinically.
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LETTERS TO EDITOR Top

Sparganum in frog meat: A warning for the occurrence of human sparganosis p. 130
R Heru Prasetyo, Erma Safitri
DOI:10.4103/tp.TP_64_18  
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The endosymbiotic role of intestinal helminths in multiple sclerosis: Promising probiotic hypothesis p. 131
Narges Karimi, Mahdi Fakhar, Masoud Keighobadi
DOI:10.4103/tp.TP_4_15  
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FACE TO FACE Top

Face to face: Leishmaniasis and its changing patterns p. 133

DOI:10.4103/tp.TP_48_19  
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CALENDAR OF UPCOMING EVENTS Top

Upcoming Events (October 2019 to July 2020) p. 138

DOI:10.4103/2229-5070.267137  
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