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   2016| January-June  | Volume 6 | Issue 1  
    Online since January 28, 2016

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Utilitarian and deontological ethics in medicine
Jharna Mandal, Dinoop Korol Ponnambath, Subhash Chandra Parija
January-June 2016, 6(1):5-7
DOI:10.4103/2229-5070.175024  PMID:26998430
Medical ethics is a sensible branch of moral philosophy and deals with conflicts in obligations/duties and their potential outcome. Two strands of thought exist in ethics regarding decision-making: deontological and utilitarian. In deontological approach, outcomes/consequences may not just justify the means to achieve it while in utilitarian approach; outcomes determine the means and greatest benefit expected for the greatest number. In brief, deontology is patient-centered, whereas utilitarianism is society-centered. Although these approaches contradict each other, each of them has their own substantiating advantages and disadvantages in medical practice. Over years, a trend has been observed from deontological practice to utilitarian approach leading to frustration and discontentment. Health care system and practitioners need to balance both these ethical arms to bring congruity in medical practice.
  28,674 45 20
Antimalarial drug resistance: An overview
Hiasindh Ashmi Antony, Subhash Chandra Parija
January-June 2016, 6(1):30-41
DOI:10.4103/2229-5070.175081  PMID:26998432
Malaria is a major public health burden throughout the world. Resistance to the antimalarial drugs has increased the mortality and morbidity rate that is achieved so far through the malaria control program. Monitoring the drug resistance to the available antimalarial drugs helps to implement effective drug policy, through the in vivo efficacy studies, in vitro drug susceptibility tests and detection of molecular markers. It is important to understand the mechanism of the antimalarial drugs, as it is one of the key factors in the emergence and spread of drug resistance. This review summarizes the commonly used antimalarial drugs, their mechanism of action and the genetic markers validated so far for the detection of drug-resistant parasites.
  13,586 46 71
Systematic review on Endolimax nana: A less well studied intestinal ameba
Casper Sahl Poulsen, Christen Rune Stensvold
January-June 2016, 6(1):8-29
DOI:10.4103/2229-5070.175077  PMID:26998431
Of the so-called nonpathogenic intestinal protozoa, Endolimax nana belongs to the ones least well described. Most data on E. nana have emerged from general surveys of intestinal parasites in selected cohorts and mostly in the absence of any particular focus on Endolimax. Hence, the genus of Endolimax remains largely unexplored in terms of morphology, taxonomy, genetic diversity, host specificity, and epidemiology. In this review, we seek to provide an overview of the work that has been performed on the parasite since the genus Endolimax was described by Kuenen and Swellengrebel in 1917 and suggest activities that may pave the way for a better understanding of E. nana in a clinical and public health context.
  8,992 30 15
Hepatic visceral larva migrans, a resilient entity on imaging: Experience from a tertiary liver center
Shalini Thapar Laroia, Archana Rastogi, Chhagan Bihari, Ajeet Singh Bhadoria, Shiv Kumar Sarin
January-June 2016, 6(1):56-68
DOI:10.4103/2229-5070.175100  PMID:26998435
Introduction: Hepatic visceral larva migrans (VLM) is an uncommon parasitic manifestation seen in the liver. It presents as coalescing, conglomerated, or solitary abscess cavities in the liver on imaging. We conducted a retrospective clinico-radiological analysis of 24 patients with biopsy proven VLM who were reviewed and followed up at our tertiary liver institute over a period of 4 years. Materials and Methods: The study was performed to correlate the radiological features and imaging response to therapy for hepatic VLM. The disease course, imaging findings, progressive, absolute eosinophil counts (AEC), hydatid serology, and the extent of radiological regression of the liver lesions, on follow-up were analyzed. Results: Imaging showed a diagnostic accuracy of 42%. Hydatid serology was positive in 46% patients before starting treatment. The median pretreatment AEC of 507 showed a significant posttreatment AEC decline to median value of 117. The Wilcoxon signed ranks test showed significant decline in the AEC (P < 0.001). Radiological regression was present in all lesions. However, patients showed residual abscesses on imaging, up to 2 years on follow-up. Conclusion: This study reveals that AEC has a significant predictive value in diagnosis and as a marker for disease regression. Complete radiological resolution of hepatic lesions does not correlate with total clinical remission. This finding warrants the need for further studies to look into the role of prolonged medical therapy or surgery as an alternate to current therapy module in cases of hepatic visceral larva abscesses.
  5,808 31 4
A case report of an uncommon parasitic infection of human balantidiasis
Manochitra Kumar, Nonika Rajkumari, Jharna Mandal, SC Parija
January-June 2016, 6(1):82-84
DOI:10.4103/2229-5070.175118  PMID:26998438
Balantidium coli, a large, ciliated pathogen, is known to cause balantidiasis in humans. We report a case of B. coli infection in a 37-year-old male with tuberculosis and presenting with fever, anorexia, mild abdominal pain, and episodes of loose stools for 1 week.
  5,407 28 4
Detection of chloroquine and artemisinin resistance molecular markers in Plasmodium falciparum: A hospital based study
S Ramani, Subhash Chandra Parija, Jharna Mandal, Abdoul Hamide, Vishnu Bhat
January-June 2016, 6(1):69-77
DOI:10.4103/2229-5070.175110  PMID:26998436
Introduction: Emergence of chloroquine (CQ) resistance in Plasmodium falciparum has increased the morbidity and mortality of falciparum malaria worldwide. Artemisinin-based combination therapies are now recommended by the World Health Organization as the first line treatment for falciparum malaria. Numerous molecular markers have been implicated in the CQ and artemisinin resistance. Materials and Methods: A total of 26 confirmed cases of falciparum malaria (by giemsa stained thick and thin smear, quantitative buffy coat, immunochromatographic test, or polymerase chain reaction [PCR]) were included in the study. About 5 ml of ethylenediaminetetraacetic acid blood sample was collected and stored at –20°C till use. Plasmodium DNA was extracted using QIAamp whole blood DNA extraction kit. PCR was done to amplify pfcrt, pfmdr1, pfserca, and pfmrp1 genes and the amplicons obtained were sequenced by Macrogen, Inc., Korea. Single nucleotide polymorphism (SNP) analysis was done using Bio-Edit Sequence Alignment Editor. Results: Out of the four genes targeted, we noted a SNP in the pfcrt gene alone. This SNP (G > T) was noted in the 658 th position of the gene, which was seen in 13 patients. The pfmdr1 and pfserca genes were present in 9 and 14 patients respectively. But we could not find any SNPs in these genes. This SNP in pfcrt gene was not significantly associated with any adverse outcome and neither altered disease progression. Conclusion: Presence of a single SNP may not be associated with any adverse clinical outcome. As the sample size was small, we may have not been able to detect any other known or unknown polymorphisms.
  3,649 25 2
Leishmaniasis: Path toward elimination from the Indian subcontinent
Nadira D Karunaweera
January-June 2016, 6(1):2-4
DOI:10.4103/2229-5070.175023  PMID:26998429
  3,560 25 6
Polymerase chain reaction detection and inducible nitric-oxide synthase expression of Leishmania major in mice inoculated by two different routes
Abeer E Mahmoud, Rasha AH Attia, Hanan EM Eldeek, Haiam Mohammed Mahmoud Farrag, Rania Makboul
January-June 2016, 6(1):42-50
DOI:10.4103/2229-5070.175088  PMID:26998433
Introduction: Leishmania major needs a sensitive and specific method for proper diagnosis. This study aims to study the course and histopathology of L. major in certain tissues of experimentally infected BALB/c mice after subcutaneous (sc) and intraperitoneal (ip) inoculation. Materials and Methods: After infecting BALB/c mice using sc and ip inoculation, the histopathology was studied. The kinetoplastic DNA polymerase chain reaction (PCR) for its molecular detection and detect the inducible nitric-oxide synthase (iNOS) pattern during the first 3 months of infection. Result: PCR could detect the presence of L. major in all spleens, lymph nodes, and skin ulcers by both inoculation routes while (33%) and (42%) of livers were positive after sc and ip routes, respectively. Chronic inflammatory cell infiltrates with capsulitis was found in the spleen, lymph nodes, and liver. Granulomas were found in the spleen and liver. There was a statistically significant difference in iNOS expression along the experiment in the spleen and lymph nodes by both routes and in the liver by ip only. Apart from the liver, iNOS could not be detected on the 2 nd week postinfection and was high after 1 month for both routes in all samples; a moderate decrease at 2 months and the highest decrease were detected after 3 months. Conclusions: L. major inoculation by both routes produce visceral disease in mice, and kinetoplastic DNA PCR can detect its presence from the 2 nd week up to the 3 rd month postinfection. The iNOS expression was high at 1 and 2 months and remained throughout the 3 months of the experiment; which plays an important role in the disease course and control.
  3,368 24 5
Phenazopyridine as an innovative stain for permanent staining of trematodes
Mahdi Fakhar, Maryam Ghobaditara
January-June 2016, 6(1):86-88
DOI:10.4103/2229-5070.175127  PMID:26998440
  3,341 24 1
Seroprevalence of Entamoeba histolytica from a tertiary care hospital, South India
Sankaramoorthy Dhanalakshmi, Subhash Chandra Parija
January-June 2016, 6(1):78-81
DOI:10.4103/2229-5070.175116  PMID:26998437
Introduction: Amebiasis is the third leading cause of death after malaria and schistosomiasis. Diagnosis is based on microscopy, culture, isoenzyme analysis, and serology-based techniques. In resource-limited nation such as India where polymerase chain reaction cannot be employed, serology is considered to be the reliable diagnostic tool. To find the seroprevalence of Entamoeba histolytica IgG antibody by enzyme-linked immunosorbent assay (ELISA) among the liver abscess cases and healthy controls. Materials and Methods: Commercially available RIDASCREEN Entamoeba IgG ELISA kit was used to evaluate the samples as per manufacturer's instruction. Results : A total of 322 samples were evaluated by ELISA. 94/157 (59.87%) were positive for amebic liver abscess cases, 2/13 (15.38%) were positive in suspected amebiasis group, 5/15 (33.3%) were positive in nonamoebic hepatic disorder group, 5/39 (12.8%) were positive in other parasitic disorders, and 2/98 (2.04%) were positive in presumed healthy controls. The sensitivity and specificity of the assay were found to be 56% and 92%, respectively. Conclusion: In an endemic nation such as India and other developing countries, ELISA can be used as a routine surveillance test in a clinical setup to detect amoebiasis if the cases are judicially evaluated along with the other routine tests.
  3,165 25 4
Drug resistance in malaria: A predicament
Subhash Chandra Parija
January-June 2016, 6(1):1-1
DOI:10.4103/2229-5070.175022  PMID:26998428
  3,037 24 1
Topographic congruence of calcified parenchymal neurocysticercosis and other structural brain lesions with epileptiform activity
Erin K Saito, Meera Nagpal, Amanda Leon, Bijal Mehta, Aaron Matthew McMurtray
January-June 2016, 6(1):51-55
DOI:10.4103/2229-5070.175093  PMID:26998434
Introduction: Calcified parenchymal neurocysticercosis (NCC) lesions are commonly detected in many individuals with refractory epilepsy. However, the relationship between these lesions and epilepsy is not fully determined. We sought to determine if calcified parenchymal NCC demonstrated topographic congruence with epileptiform activity in refractory epilepsy patients. Additional patients with other structural brain lesions were included for comparison. Subjects and Methods: Retrospective cross-sectional analysis of all patients treated at a community-based neurology clinic for refractory epilepsy during a 3-month period and with structural brain lesions detected by neuroimaging studies. Results: A total of 105 patients were included in the study, including 63 with calcified parenchymal NCC lesions and 42 with other structural brain lesions. No significant relationship was detected between hemispheric localization of calcified parenchymal NCC lesions and epileptiform activity. For those with other structural brain lesions, the hemispheric localization was significantly related to the side of epileptiform activity (Chi-square = 11.13, P = 0.025). In addition, logistic regression models showed that those with right-sided non-NCC lesions were more likely to have right-sided epileptiform activity (odds ratio = 4.36, 95% confidence interval [CI] =1.16-16.31, P = 0.029), and those with left-sided non-NCC lesions were more likely to have left-sided epileptiform activity (odds ratio = 7.60, 95% CI = 1.89-30.49, P = 0.004). Conclusion: The lack of correlation between the side of calcified parenchymal NCC lesions and the side of the epileptiform activity suggests that these lesions may be incidental findings in many patients.
  2,989 25 2
Central nervous system infection due to Acanthamoeba: A Case Series
Shukla Das, Rumpa Saha, Mayuri Rani, Ritika Goyal, Dheeraj Shah, Jhajjar K Asish
January-June 2016, 6(1):88-91
DOI:10.4103/2229-5070.175130  PMID:26998441
  2,756 25 3
Decreased response to artemisinin combination therapy in falciparum malaria: A preliminary report from South India
T Angel Miraclin, Anu Matthew, Priscilla Rupali
January-June 2016, 6(1):85-86
DOI:10.4103/2229-5070.175125  PMID:26998439
  2,733 24 2
Parasitology: A Conceptual Approach
Subhash Chandra Parija, Shashiraja Padukone
January-June 2016, 6(1):94-95
  2,272 22 -
An E-mail interview with Prof. Shin-ichiro Kawazu

January-June 2016, 6(1):92-93
  1,956 22 -
Calendar of upcoming events for the year 2016

January-June 2016, 6(1):96-97
  1,934 22 -