|FACE TO FACE
|Year : 2012 | Volume
| Issue : 2 | Page : 86-88
An e-mail interview with Dr. J. Mahanta
|Date of Web Publication||28-Dec-2012|
|How to cite this article:|
. An e-mail interview with Dr. J. Mahanta. Trop Parasitol 2012;2:86-8
Dr. Jagadish Mahanta obtained his MBBS degree from Guwahati Medical College, Assam in 1974 in first class and MD Microbiology from PGI Chandigarh bagging the medal for merit of first order. He has a vast teaching, clinical and research experience. He served reputed institutes of the state and the country namely Guwahati Medical College, PGI Chandigarh etc. He joined the Regional Medical Research Centre, Dibrugarh as a deputy director in the year 1993 and became the Director of this institute in 1996. He has to his credit more than 300 publications in peer reviewed national and international journals. He has authored chapters of several books, and proceedings. He has received a number of prestigious awards for his contribution to the health related research of this part of the country. The ICMR award for 2007 has been conferred upon him for his outstanding epidemiological research in communicable and non-communicable diseases. He is also the recipient of the prestigious SC Parija Oration award 2010 of the Indian Academy of Tropical Parasitology, for his immense contribution to the research on parasitic diseases of this region.
a. Dear Sir, could you shed some light on the salient changes related to policy matters and research activities of the RMRC, Dibrugarh over the years?
Ans: Regional Medical Research Centre (RMRC) for Northeast was established in 1982 as one of the regional centers of Indian Council of Medical Research for biomedical research in seven northeastern states of India, but later on, with inclusion of Sikkim in Northeast Council, the geographic span of the center was extended to Sikkim. Research at RMRC for Northeast started with estimating burden of cancer in this part of the country and malaria epidemiology. But gradually over the years, to keep pace with the development across the globe, research policy of the center took a turn to carry out research in modern biology in areas relevant to northeast, both communicable and noncommunicable diseases. For this, concerted effort was made to-
- develop infrastructure for research in modern biology,
- develop human resource to do cutting-edge research,
- develop collaboration with advance institutes in the country and across the globe,
- develop experimental animal facility, and
- explore traditional knowledge for treatment and prevention of diseases.
b. How would you assess the present scenario of parasitic diseases in the northeastern Indian states?
Ans : Parasitic diseases are major public health problem in this region. All four known human malaria parasites are found in this region. Out of them, drug-resistant Plasmodium falciparum infection is a major concern. Kala-azar has re-emerged after a long gap in one district of Assam and it may cause havoc in the near future if not contained aggressively. Soil-transmitted helminthes, filariasis among a large section of agro industry workers (tea garden population), neurocysticercosis causing epilepsy, and food-borne trematode infections like paragonimiasis and fascioliasis (due to exotic food behavior) are becoming the major public health challenges in this region.
c. How have the research activities in parasitic diseases in the northeastern states changed in the past years in terms of technicality and quality?
Ans: Research activity in parasitic diseases in the northeast region over the years has witnessed a quantum change. Earlier, estimation of parasitic disease burden, in vivo antimalarial resistance study, and epidemiology of some parasitic diseases were the areas more often chosen by the scientists. But gradually, facilities for continuous culture of malaria parasite, in vivo maintenance for bioassay of new molecules, molecular characterization of parasite for speciation, and drug resistance have been added in the laboratory. More focused etiologic diagnosis, molecular taxonomy, vector biology and transmission dynamics, and newer methods of vector and parasite control could be planned with improvement of technology. Etiology of hitherto unknown parasitic diseases could be established. Today availability of modern tools has made investigation much more accessible to people. Quality of studies has improved with better study design, sampling procedure, and analysis tools.
d. How do you prioritize research in parasitic diseases in the northeastern states?
Ans: Keeping mission-oriented theme of RMRC NE in mind, research agenda has been prioritized in basic, applied, and translational medicine on the line of the following:
- National health program relevant to northeast India
- Diseases common to two or more states of the region
- Diseases unique to this region
- Exploration of traditional knowledge available across the region
e. How many laboratories in the northeast, in your opinion, are well equipped in performing newer molecular, genomic, and proteomic studies?
Ans: As on date, besides the RMRC laboratory, many laboratories across the region under CSIR, DBT, DST, ICAR, universities, and medical institutes have the infrastructure and human resource to carry out molecular biology work. But barring RMRC, very few have facilities for sequencing (especially deep sequencing) and proteomic studies.
f. Which parasitic diseases in India do you think would benefit the most from research and which of the diseases need more attention on research?
Ans: India as a whole and the northeastern region in particular will get maximum benefit from our research in malaria, food-borne trematode infections, neurocysticercosis, filariasis, and kala-azar out of all parasitic diseases. Perhaps soil-transmitted helminthes and intestinal protozoan infections need more attention.
g. As regards to Plasmodium knowlesi, what is the current epidemiological status and research activity in our country?
Ans: In fact, all four species causing human infection have been reported from this region and now having the threat of entering Plasmodium knowlesi in the country through northeast, because Myanmar, which borders India, has already reported confirmed human infection with P. knowlesi. Northeastern region has susceptible monkey population as well as the capable vector for transmission of P. knowlesi. In India, RMRC NE is making frequent survey to detect any such case across the border.
h. What are the locally active arthropod vectors significant in parasitic disease transmission and are they different from those in other parts of the country?
Ans: Out of many vectors transmitting parasitic diseases in this region, three mosquitoes and a sand fly are worth mentioning. Anopheles baimaii (earlier known as A. dirus), A. minimus, Culex quinquefasciatus, and Phlebotomus argentipes are the common and locally active arthropod vectors transmitting malaria, filariasis, and kala-azar in the northeastern region of India. Arthropod vectors for filariasis and kala-azar are similar to those in other parts of the country. However, the vectors of malaria, viz. A. baimaii and A. minimus, are unique for this region, as against A. culicifacies and A. stephensi spreading malaria in the rest of the country. A. baimaii plays a major role in transmitting malaria in deep forest and forest fringe areas, and A. minimus is responsible for transmitting malaria in forest fringe and plain areas. A. baimaii is exophillic (breeds and rests outside the dwelling house) and both exo and endophagic (bites outdoors and indoors), but A. minimus is mostly endophillic and endophagic. Therefore, though indoor residual spray (IRS) is effective against A. minimus, IRS is not effective for A. baimaii due to its exophillic behavior.
i. What initiatives are the RMRC taking in expanding/improving research in the northeastern region?
Ans: Modern biology research in the northeastern region was not very encouraging earlier. Therefore, ICMR with active involvement of RMRC has taken up many innovative steps for creating research environment and generating research interest among young scientists. Special packages for research have been proposed for the northeastern region.
- For empowering medical college, a multidisciplinary research unit in government medical colleges has been initiated. These units will contain modern equipments, manpower, and consumable for the initial years so that researchers can do different investigations in these units. A proposal has also been considered to establish such facility in major state hospitals where no government medical college exists.
- Separate research review committee has been constituted for proposed projects to be carried out either alone by scientists from the northeast region or in collaboration with any advance institute outside the region. A provision of technology transfer has also been kept in these projects.
- Research methodology workshops relevant for biomedical research have been conducted in different medical colleges of the region for capacity building in scientific project writing.
- To encourage young researchers of the northeastern region, provision for seed grant has been made for good concepts.
- State-of-the-art infrastructure facilities at RMRC have been created to facilitate researchers of the region to do research in modern biology. Further, for monitoring emergence of viral diseases, a network of virology laboratories of different grades has been planned.
j. What are the long-term goals of ICMR in parasitological research?
Ans: Besides epidemiological and clinical research in different parasitic diseases, ICMR has been emphasizing on carrying the research benefit to the community. It has built state-of-the-art facilities for research on parasitic diseases in several ICMR institutes spread across the country to carry out basic and applied research. Through its translational research agenda, control of malaria, and elimination of filariasis and kala-azar have been taken up. Development of antimalarial drug, and mosquitocidal and repellent formulas has been worked out. At RMRC, monitoring of drug resistance in malaria at molecular level, emergence of new species across the border, and control of malaria in forest and forest fringe have been taken as the priority. Transmission dynamics and vector biology, and evolution of vector and drug resistance in Southeast Asia have been taken the as the long-term goals. Development of diagnostics, and control and prevention of food-borne parasitic infections are some of the goals in the long-term agenda of RMRC NE.
k. Since you have a vast experience on paragonimiasis, please tell us the advancements in respect to the epidemiology and laboratory diagnosis and treatment.
Ans: To start with, we started looking into the burden of paragonimiasis across different northeastern states to find out its priority as a public health problem. Initially we thought that human paragonimiasis is a problem in Manipur and Arunachal Pradesh, but later on, cases were seen in all the states of the region. History revealed that animal and human paragonimiasis was reported from many states of India. As type species of paragonimiasis originated from India, we started looking for the molecular homologies with the prevalent species across Southeast Asia and Far East. In our search, we could establish that human paragonimiasis in India is caused both by Paragonimus westermani and Paragonimus heterotremus. Detailed molecular and morphological studies suggested the existence of few more P. westermani like species in the region. This established the higher diversity of Paragonimus species in India. Of course, their clinical implication is yet to be established. Clinical and radiological findings of human cases in these infections could be described for diagnostic algorithms. Looking into the paucity of diagnostic tests in India, we could develop a very sensitive and specific ELISA-based diagnostic kit. Till date, all these cases are easily treated with Praziquintal with a high success rate. We also tried to translate our research findings for diagnosis, treatment, and control of the disease in Arunachal Pradesh. Results were very encouraging.
l. Paragonimiasis, being a differential diagnosis of pulmonary tuberculosis, what is your opinion regarding the treatment guidelines and do you suggest any policy decisions as regards to the RNTCP?
Ans: Human paragonimiasis, besides being endemic to northeastern states, has also been reported from many parts of India. Pulmonary paragonimiasis causes endemic hemoptysis, and X-ray/CT chest finding is often confusing with pulmonary tuberculosis, leading to misdiagnosis and wrong treatment. This sends wrong message to the patients attending DOTS center for treatment under RNTCP of India. Therefore, I feel in endemic states, cases with chronic cough with or without hemoptysis (especially smear negatives) should be investigated for paragonimiasis along with tuberculosis. Simple history taking of exotic food behavior can help the clinician to suspect the cases.
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