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   2016| July-December  | Volume 6 | Issue 2  
    Online since September 19, 2016

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Radiological manifestations of hydatid disease and its complications
Pooja Mehta, Mahesh Prakash, Niranjan Khandelwal
July-December 2016, 6(2):103-112
DOI:10.4103/2229-5070.190812  PMID:27722098
Hydatid disease (HD) is endemic in many parts of the world. HD can affect virtually any organ system in body and should be kept as differential diagnosis of cystic lesion. HD is mostly asymptomatic; however, it demonstrates a variety of characteristic imaging findings depending on the site of involvement, stage of growth, mass effect, complications, or hematogenous spread, which helps in diagnosis. Radiography, ultrasonography (USG), computed tomography (CT), and magnetic resonance imaging (MRI) are commonly used imaging modalities. Radiography is helpful in chest and for demonstrating calcification. USG demonstrates characteristic findings such as cystic nature, daughter vesicles, membranes, septa, and hydatid sand. CT and MRI are modalities of choice for number, size, anatomic location, identification of local complications, and systemic spread. CT is, especially helpful for osseous involvement, and MRI is better for biliary and neurological involvement. Knowledge of these imaging findings helps in early diagnosis and timely initiation of appropriate therapy.
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Toxoplasmosis in HIV infection: An overview
Anuradha Basavaraju
July-December 2016, 6(2):129-135
DOI:10.4103/2229-5070.190817  PMID:27722101
Toxoplasma gondii is an obligate intracellular protozoan parasite presenting as a zoonotic infection distributed worldwide. In HIV-positive individuals, it causes severe opportunistic infections, which is of major public health concern as it results in physical and psychological disabilities. In healthy immunocompetent individuals, it causes asymptomatic chronic persistent infections, but in immunosuppressed patients, there is reactivation of the parasite if the CD4 counts fall below 200 cells/μl. The seroprevalence rates are variable in different geographic areas. The tissue cyst or oocyst is the infective form which enters by ingestion of contaminated meat and transform into tachyzoites and disseminate into blood stream. In immunocompetent persons due to cell-mediated immunity the parasite is transformed into tissue cyst resulting in life long chronic infection. In HIV-infected people opportunistic infection by T. gondii occurs due to depletion of CD4 cells, decreased production of cytokines and interferon gamma and impaired cytotoxic T-lymphocyte activity resulting in reactivation of latent infection. The diagnosis can be done by clinical, serological, radiological, histological or molecular methods, or by the combination of these. There is various treatment regimen including acute treatment, maintenance therapy should be given as the current anti T. gondii therapy cannot eradicate tissue cysts. In HIV patients, CD4 counts <100; cotrimoxazole, alternately dapsone + pyrimethamine can be given for 6 months. Hence, early diagnosis of T. gondii antibodies is important in all HIV-positive individuals to prevent complications of cerebral toxoplasmosis.
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Congenital toxoplasmosis: Clinical features, outcomes, treatment, and prevention
Sarman Singh
July-December 2016, 6(2):113-122
DOI:10.4103/2229-5070.190813  PMID:27722099
Toxoplasmosis is caused by a coccidian parasite, Toxoplasma gondii. The parasite is highly prevalent both in humans and in warm-blooded animals. Cat family animals are definitive host, and these animals excrete the infective oocysts in their feces. Humans, though not definitive host, get infection by consuming water or food contaminated with cat feces. Rarely, infection can also take place through transfusing the infected blood, through transplantation of infected organs, or transplacentally from infected mother to fetus. Transplacental infection can cause congenital infection with varied degree of clinical manifestations, which depend on the age of fetus when infection took place. Diagnosis of congenital toxoplasmosis is difficult to establish until it is suspected and laboratory investigations are carried out. In more than 75% of cases, acute infection is missed due to very mild or unnoticeable clinical symptoms and signs. In India, a prevalence rate of 22.4% (8.8-37.3%) has been reported with an overall IgM positivity of 1.43%. It is estimated that approximately between 56,737 and 176,882 children per year are born in India with a possible risk of congenital toxoplasmosis. The diagnosis of congenital toxoplasmosis can be made by serological methods which are most commonly used. The other methods are parasite isolation by culture and molecular methods. Toxoplasmosis is treatable and transplacental transmission can be prevented by spiramycin, which concentrates in the placenta. However, if infection has done any damage to the fetus or the parasite has passed the placenta, spiramycin cannot reverse the damage. Prevention remains the best remedy.
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Toxoplasmosis in organ transplant recipients: Evaluation, implication, and prevention
Sumeeta Khurana, Nitya Batra
July-December 2016, 6(2):123-128
DOI:10.4103/2229-5070.190814  PMID:27722100
Toxoplasmosis in organ transplant patients can be a result of donor-transmitted infection, or reactivation of latent infection, or de novo infection. Solid organ transplants including heart, liver, kidney, pancreas and small bowel, and hematogenous stem cell transplants have been implicated in the risk of acquiring infection. In contrast to a benign course in immunocompetent individuals, the spectrum of illness is severe in transplant recipients. Clinical manifestations usually occur within the first 3 months of transplant and may present as encephalitis, pneumonitis, chorioretinitis, meningitis, and disseminated toxoplasmosis with multi-organ involvement. The diagnosis of toxoplasmosis in organ transplant patients is often difficult and is an integration of clinical, radiological, and microbiological workup. Preventive measures include pretransplant evaluation and chemoprophylaxis in view of rapidly progressing and fatal outcome of toxoplasmosis in immunocompromised individuals.
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The role of haematological parameters in predicting malaria with special emphasis on neutrophil lymphocyte count ratio and monocyte lymphocyte ratio: A single Institutional experience
Cheryl Sarah Philipose, T Umashankar
July-December 2016, 6(2):147-150
DOI:10.4103/2229-5070.190833  PMID:27722104
Introduction: Malaria is a mosquito borne disease which is a major public health problem and a leading cause of morbidity and mortality worldwide. Various haematological parameters have been studied to help predict malaria, such as alteration in the leucocyte count, platelet counts and erythrocyte counts. The neutrophil lymphocyte count ratio (NLCR) was found to have a good predictive value in systemic inflammation, particularly in critical care setting. Aims and Objectives: The present study aims to study the various haematological parameters and acertain the predictive value of NLCR and MLR in the detection of malaria. Materials and Methods: A prospective cross sectional study was conducted at a tertiary care hospital between the period of August to December, 2014. A total of 200 smear positive malaria patients and a control group of 100 patients who were smear negative for malaria were included. Hemoglobin, Total leucocyte count, Differential leucocyte count, platelet counts and absolute counts were obtained. The NLCR and MLR were obtained from the above data. The data was analysed by statistical tools. Results: A total of 200 smear positive malaria cases were analysed of which, 180 cases were caused by the Plasmodium vivax parasite and 2 cases by Plasmodium Falciparum. Thrombocytopenia and leucopenia were found to have significant association with malaria. In the present study, the NLCR and MLR was not found to have significant association with malaria. Discussion: Although NLCR has been proven to be a useful marker for inflammation in many acute conditions5, it is albeit not of much significance in the prediction of malaria. Similarly we have found no significance of MLR in prediction of malaria.
  2,657 22 1
Ethics of scientific publication
Jharna Mandal, Dinoop Korol Ponnambath, Subhash Chandra Parija
July-December 2016, 6(2):100-102
DOI:10.4103/2229-5070.190811  PMID:27722097
Published scientific research breeds the development of clinical management guidelines and pathways. Currently, scholarly proficiency is assessed using numerous primitive metrics for incentives that can kindle publication of hoax or flawed research content. Such flawed data can lead to wastage of resources, time, and most importantly harm to the society. Authors, editors, and peer reviewers need to be genuine in conducting, analyzing, and publication of scientific research. Institutions need to be aware and utilize advanced metrics to assess the scientific reputation of researchers. This short review discusses in brief the common authorship and editorial ethical issues encountered in scientific publication and the newer metrics available for the assessment of scholarly excellence. Editors and peer reviewers need to be acquainted with the common ethical issues and follow consensus international guidelines on publication ethics to tackle them appropriately.
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Nonresponsiveness to standard treatment in cutaneous leishmaniasis: A case series from Sri Lanka
Fathima Wardha Refai, Nayani P Madarasingha, Rohini Fernandopulle, Nadira Karunaweera
July-December 2016, 6(2):155-158
DOI:10.4103/2229-5070.190835  PMID:27722106
Leishmaniasis is caused by parasitic protozoa of the genus Leishmania. Cutaneous leishmaniasis (CL) is endemic in Sri Lanka with over 3000 cases during the last decade and numbers are increasing. Treatment options available in Sri Lanka for CL include intralesional/intramuscular sodium stibogluconate and cryotherapy. Eight cases of treatment failure with standard therapy are reported from the Dermatology Clinic, Teaching Hospital Anuradhapura. Therapeutic regimes aim for clinical healing, these patients responded poorly to anti-leishmanial therapy, indicating the need for close monitoring, explore alternative treatment options and to investigate for drug resistance in parasites.
  2,312 24 2
Hematuria without chyluria: It could still be due to filarial etiology
Vijaya Lakshmi Nag, Manodeep Sen, Nihar Ranjan Dash, R Bansal, Manoj Kumar, Anand Kumar Maurya
July-December 2016, 6(2):151-154
DOI:10.4103/2229-5070.190834  PMID:27722105
There are few reports of "microfilaria in the urine." We report an elderly woman with gross hematuria who was being investigated for urinary tract tuberculosis. Three consecutive urine samples showed microfilaria of Wuchereria bancrofti. However, she did not have chyluria. Treatment with diethylcarbamazine cleared up the hematuria within 3 days. Chyluria, hematuria, and hematochyluria are problems of Bancroftian filariasis reported worldwide. The literature review was made to present a simplified way for management.
  2,311 22 1
Comparison of protein expression pattern between the Plasmodium falciparum chloroquine-resistant RKL9 and chloroquine-sensitive MRC2 strains
Hiasindh Ashmi Antony, Vrushali Pathak, Kanjaksha Ghosh, Subhash Chandra Parija
July-December 2016, 6(2):136-140
DOI:10.4103/2229-5070.190831  PMID:27722102
Objective: The objective of this study was to compare the protein expression patterns of Plasmodium falciparum extracellular and intracellular proteins separated by two-dimensional electrophoresis (2-DE) from the chloroquine-sensitive (CQS) MRC2 strain and chloroquine-resistant (CQR) RKL9 strain. Materials and Methods: Both the extracellular protein (ECP) and intracellular protein (ICP) were extracted and solubilized. The proteins were separated by 2-DE, first based on their charges using isoelectric focusing and then their sizes by electrophoresis. The separated protein spots were detected by silver staining, and further, the protein spot density was analyzed by an image analysis software. Results: 2-DE separated the proteins extracted from the CQS and CQR strains based on their differentially expressed protein patterns. Extracellular Protein Analysis: A total of 109 and 77 protein spots were detected by image analysis of ECP extracted from MRC2 and RKL9 strains, respectively. There was a marked reduction in protein expression pattern in the CQR strain when compared with the CQS strain. Interestingly, 50 and 18 protein spots were uniquely expressed in MRC2 and RKL9 strains, respectively. When MRC2 strain-expressed proteins were taken as the control, 12 upregulated and 14 downregulated protein spots were observed in the RKL9 strain-extracted proteins. Intracellular Protein Analysis: ICP extracted from MRC2 and RKL9 strains showed 187 and 199 protein spots by an image analysis software, and a small enhancement of protein expression was measured when comparing the CQR strain with CQS strain. There were 67 and 79 unique protein spots detected in MRC2 and RKL9 strains, respectively. A total of 120 protein spots were similar when MRC2 proteins were taken as the control; among these protein spots, 40 upregulated and 22 downregulated protein spots were detected in RKL9 strain-expressed protein. Conclusions: Both these unique and matched protein spots might be molecularly potent drug targets for chloroquine resistance in P. falciparum. Further identification of these proteins by mass spectrometry/peptide sequencing is essential to clearly understand the mechanism of resistance.
  2,258 23 1
Protozoans of tissue and blood: A changing paradigm
Subhash Chandra Parija
July-December 2016, 6(2):99-99
DOI:10.4103/2229-5070.190810  PMID:27722096
  2,196 25 -
Rising trends of neurocysticercosis: A serological report from tertiary-care hospital in South India
Piriyatharisini Thamilselvan, Krishna Raja Muthuraman, Jharna Mandal, Subash Chandra Parija
July-December 2016, 6(2):141-146
DOI:10.4103/2229-5070.190832  PMID:27722103
Introduction: Taenia solium is a common two-host parasitic cestode, residing in both humans (definitive) and pigs (intermediate). Invasion of this parasitic cyst into central nervous system leads to a condition known as neurocysticercosis (NCC). The World Health Organization (WHO) considers NCC as one of the "most neglected" tropical zoonotic diseases. The disease is presented with pleomorphic clinical manifestations, of which epilepsy is the most common. Diagnosis of NCC is carried out by serological tests and imaging methods. Only a few studies from Andhra Pradesh, Kerala, Tamil Nadu, and Pondicherry are available regarding the seropositive levels of NCC in South India. Materials and Methods: A descriptive analysis was carried out on NCC suspected patients attending outpatient or inpatient department of different clinics majorly from neurology, medicine, pediatrics, ophthalmology, and skin at Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, a tertiary care hospital in South India. A total of 391 patient samples (either serum or cerebrospinal fluid or urine) for 5 years from January 2011 to December 2015 were taken into the study. Serological investigations such as enzyme-linked immunosorbent assay and enzyme-linked immunoelectro transfer blot were performed for assessing the seropositivity levels of NCC. Results: The overall seropositive cases of NCC in the study population were found to be 32.5% of which positive male cases (59.1%) exceeding females (40.9%). The frequency of adult positive cases (77.2%) was more than that of pediatrics cases (22.8%) with an average of 30.9 years of age. Conclusions: NCC seropositive levels show an increasing trend with the study period. This necessitates a proper attention to the unnoticed spread of the parasitic disease, which affects the quality of life in the community. Quality screening and diagnostic strategy should be implied along with proper awareness for preventive measure practices have to be set up to reduce the impact of morbidity caused by NCC.
  2,184 27 1
An E-mail interview with Dr. Nadira Karunaweera, Senior Professor and Chair, Head of Department Parasitology, Faculty of Medicine, University of Colombo, Sri Lanka

July-December 2016, 6(2):159-162
DOI:10.4103/2229-5070.190837  PMID:27722107
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Blastocystis: Pathogen or passenger? An evaluation of 101 years of research
Subhash Chandra Parija, Shashiraja Padukone
July-December 2016, 6(2):163-164
  1,553 35 -