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   Table of Contents - Current issue
Coverpage
July-December 2021
Volume 11 | Issue 2
Page Nos. 69-134

Online since Wednesday, October 20, 2021

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EDITORIAL  

Publication Trends in the COVID Era Highly accessed article p. 69
Subhash Chandra Parija
DOI:10.4103/tp.tp_84_21  
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DR SC PARIJA ORATION Top

My experience on taeniasis and neurocysticercosis p. 71
Kashi Nath Prasad
DOI:10.4103/tp.tp_6_21  
Taeniasis and neurocysticercosis (NCC) are major public health problems in developing countries. NCC is the leading cause of community-acquired active epilepsy. NCC may present as a medical emergency, especially when there is cysticercotic encephalitis or raised intracranial hypertension. Systematic community-based studies on taeniasis and NCC are lacking. We studied taeniasis and NCC-related active epilepsy disease burden in the pig farming community of Lucknow district, Uttar Pradesh, India. Based on the 30 cluster sampling approach as recommended by the World Health Organization, we estimated the prevalence of taeniasis, NCC-related active epilepsy, and silent NCC in the community. We also estimated the prevalence of swine cysticercosis. Taeniasis was detected in 18.6% of populations. Expulsions of tapeworm segments in stool, consumption of undercooked pork, age above 15 years, and handwash with clay or plain water after defecation were associated with taeniasis. On molecular analyses of positive stool samples, T. solium was identified in 40% and Taenia asiatica in 60% of cases. Active epilepsy was identified in 5.8% of subjects; 48% of them had NCC. On neuroimaging, NCC was detected in 15% of asymptomatic individuals. We observed that host genetic factors such as toll-like receptor-4, matrix metalloproteinase-9, intercellular adhesion molecule-1, and glutathione-S transferase gene polymorphisms were associated with seizure in NCC. When peripheral blood mononuclear cells (PBMCs) from NCC subjects were exposed to cysticerci fluid antigens in-vitro, PBMCs from symptomatic and asymptomatic subjects showed significantly higher Th 1 and Th 2 cytokines response respectively, symptomatic patients had significant Th-1 cytokines response, while asymptomatic individuals showed Th-2 response. Porcine cysticercosis was detected in 26% of swine; 38% of them had cysticerci in the brain. Swine with brain involvement showed clinical signs such as excessive salivation, excessive blinking and tearing, and subconjunctival nodule. On molecular analysis, 15% of cysticerci in swine were identified as T. asiatica. Infected swine when treated with albendazole plus/minus steroid, the response rate of cysticerci (either dead or resolved lesion) was 100% in albendazole-treated group and 71% in albendazole plus steroid-treated group. The above studies suggest that taeniasis and NCC are alarmingly high in the pig farming community of North India. Taeniasis in human and cysticercosis in swine due to T. asiatica call for further studies on this parasite.
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REVIEW ARTICLE Top

Balamuthia mandrillaris: An opportunistic, free-living ameba – An updated review p. 78
Namrata K Bhosale, Subhash Chandra Parija
DOI:10.4103/tp.tp_36_21  
Balamuthia mandrillaris is an opportunistic, free-living ameba that is pathogenic to humans. It has a worldwide distribution but is mainly detected in warmer regions. Balamuthia infections are rare but have been reported in both immunocompetent and immunocompromised individuals of all ages. B. mandrillaris can enter through wounds on the skin or the nose and cause cutaneous lesions and the usually fatal Balamuthia amebic encephalitis (BAE). Infection usually spreads from the lungs or through nerve fibers, and attacks the central nervous system, forming granulomatous lesions and necrosis in the brain. Balamuthia infection is usually chronic, and patients initially present with nonspecific symptoms, including headache, nausea, myalgia, and low-grade fever. As the disease progresses, the patient becomes paralyzed and comatose, often leading to death. Lack of knowledge of predisposing factors, specific treatment, and standardized detection tools have resulted in a nearly cent percent fatality rate. Although only about 200 cases have been reported worldwide since its characterization in the 1990s, the number of reported cases has increased over the years. BAE is an emerging disease and a major health concern. Few patients have survived Balamuthia infections with antimicrobial treatment that has largely been empirical. Early diagnosis is the key and requires familiarity with the disease and a high degree of suspicion on the part of the diagnostician. There are currently no specific treatment and prevention recommendations. This review highlights our current understanding of B. mandrillaris in terms of its pathogenicity, genomics, and novel diagnostic and therapeutic approaches against BAE infections.
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BRIEF BIOGRAPHY Top

Sir U.N. Brahmachari and his battle against Kala-Azar p. 89
Pabitra Saha, Abhijit Chaudhury, Ardhendu Kumar Maji
DOI:10.4103/tp.tp_48_21  
Kala-azar or visceral leishmaniasis was at one time a scourge in the Bengal Presidency of British India comprising the present Indian states of Bengal, Bihar, Assam, and Odisha. The disease was rampant along the Ganga and Brahmaputra River adjoining areas. In the early 1900s, the treatment initiated was by the intravenous injection of tartar emetic, which had a narrow safety level and long-term use was marked with multiple side effects. In 1920, Upendranath Brahmachari discovered urea stibamine, which is the urea salt of para-amino phenyl stibnic acid and it revolutionized the treatment of Kala-azar with >90% cure rate and with minimal side effects. He is also credited with the description of post-kala-azar dermal leishmaniasis. He was conferred the knighthood of the British Empire as recognition of his important contribution. Although his name was twice nominated for Nobel Prize, unfortunately, he never received it.
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ORIGINAL ARTICLES Top

Correlation between CD 34 and CD 68 expression in placental malaria with maternal anemia p. 92
Primariadewi Rustamadji, Muhammad Takbir, Puspita Eka Wuyung, Kusmardi Kusmardi, Elvan Wiyarta
DOI:10.4103/tp.TP_108_20  
Background: Malaria is the second most life-threatening infectious disease in Indonesia, causing approximately 1–3 million deaths annually. Histopathologic studies assessing CD 68 and CD 34 protein expression in placental malaria and its association with maternal anemia are essential to determine the prognosis of malaria in pregnancy. Materials and Methods: This cross-sectional study was carried out in 2017. Thirty biopsy samples of human placental tissue were obtained from Timika and Sumba, and ten normal biopsy samples were taken from the Pathological Anatomy Department of Cipto Mangunkusumo General Hospital as comparisons. CD 34 and CD 68 protein expressions were determined using immunohistochemistry, and the resulting data were analyzed using SPSS. Results: Average hemoglobin (Hb) level was 9.5 mg/dL, 11.5 mg/dL, and 9.9 mg/dL in acute infection, chronic infection, and latent infection, respectively. A positive correlation was found between CD 68 protein expression and maternal Hb level. No correlation was found between CD34 expression and maternal anemia. Conclusions: CD 68 expression in placental tissue biopsy from Timika and Sumba residents with placental malaria was shown to be positively correlated with maternal anemia. Immunohistochemical examination of CD 68 may play a role in the early diagnosis of malaria.
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High susceptibility to severe malaria among patients with A blood group versus those with O blood group: A cross-sectional study in the Democratic Republic of the Congo p. 97
Serge Tonen-Wolyec, Salomon Batina-Agasa
DOI:10.4103/tp.TP_87_20  
This study aimed to assess the association of severe malaria infection with the ABO blood groups among acute febrile patients at the General Hospital of Rungu, in the Democratic Republic of the Congo. This cross-sectional study was conducted between August and October 2018. Plasmodium falciparum-infected individuals were categorized as severe malaria and uncomplicated malaria. A total of 400 febrile patients were enrolled. The majority (n = 251; 62.8%) was positive P. falciparum in microscopy test, of whom 180 (71.7%) had uncomplicated malaria and 71 (28.3%) severe malaria; 32.3%, 18.3%, 2.8%, and 46.6% were found to be blood group of A, B, AB, and O, respectively. In the multivariate analysis using the logistic regression models, severe malaria was high among patients with A blood group compared to those with O blood group (45.8% vs. 13.7%; adjusted odds ratio: 5.3 [95% confidence interval: 2.7–10.5]; P < 0.001). This survey demonstrates that patients with A blood group had a high susceptibility to severe malaria compared to those with O blood group.
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Utilization of the castor seed cake (biowaste) for mosquito vector control p. 102
Nisha Sogan, Smriti Kala, Neera Kapoor, PK Patanjali, BN Nagpal
DOI:10.4103/tp.TP_36_19  
The present work is related to the utilization of castor (Ricinus communis) seed cake, biowaste produced during the oil extraction of castor seeds, as efficient mosquitocidal composition against Aedes aegypti and Anopheles culicifacies. The efficacy of coil formulations was evaluated in the Peet Grady chamber and resulted in 90% and 100% knocked down and mortality against A. aegypti and A. Culicifacies, respectively. Further heavy metals' (Cr, Pb, Co, As, Cd, Cu, Mn, and Zn) analysis of the coil was performed using Inductively Coupled Plasma mass spectrometry and was compared with commercially available mosquito repellent coil. Heavy metal analysis revealed that commercial repellent coil had a higher content of heavy metals than the castor seed cake coil. Finding of the present research study indicates that castor seed cake coil has the potential to be used in mosquito vector control. Castor seed cake coil formulation will also open up avenues in future for sustainable utilization of the biowaste.
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A study on neurcognitive disorders and demographic profile of neurocysticercosis patients p. 108
Gunjan Goyal, Upninder Kaur, Vivek Lal, Karthik Vinay Mahesh, Rakesh Sehgal
DOI:10.4103/tp.TP_88_20  
Background: Neurocysticercosis is a common cerebral parasitic infestation, caused due to pork tapeworm infection the infestations risks parallels the socio-economic status, personal hygiene and education. The effect of NCC was assessed in neurocognition. Objective: To study demographic characteristics and neurocognitive domains of patients with Neurocysticercosis Methods: Neurocysticercosis diagnosed patients by CT, MRI and LAMP tests. MMSE score was measured for assessment. Results: MMSE score were reduced in majority of the patients. In attention was the most common deficit found. Repeat MMSE assessment done in 6 patients showed an improvement of scores post therapy Conclusion: Cognitive involvement is common in NCC and is a major cause of morbidity.
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Blastocystis spp. infection in cases of diarrhea: A pilot study from a tertiary care teaching hospital in Rishikesh, Uttarakhand, with a brief review of literature p. 113
Sweta Jha, Pratima Gupta, Mohit Bhatia
DOI:10.4103/tp.TP_90_20  
Context: Intestinal parasitic infections (IPI) are among the most common infections throughout the world. Blastocystis spp. is a mysterious parasite which is commonly encountered in tropical countries. Its pathogenic status is unknown and there is a paucity of literature about this organism from the state of Uttarakhand, India. Aims: The aim was to estimate the prevalence of Blastocystis spp. in diarrheal stools. Settings and Design: This was a cross-sectional study conducted from January 2018 to July 2019. Subjects and Methods: Nonrepetitive stool samples of 187 consecutive patients of diarrhea attending the inpatient department and outpatient department of a tertiary care teaching hospital located in Rishikesh, Uttarakhand, were collected after obtaining informed written consent. These samples were subjected to wet mount microscopy and permanent staining. Statistical Analysis Used: Fisher's exact test and Kappa coefficient were used in this study. Results: The mean age ± standard deviation of the patients was 36.04 ± 11.31 years with a male-to-female ratio of 1.49:1. The prevalence of IPI was 36.09%. Giardia intestinalis was the most common parasite. Blastocystis spp. was observed in 6.42% of the stool samples, majority of which were obtained from cases of chronic diarrhea. Moderate agreement (0.48) was observed between wet mount microscopy and permanent staining in the identification of Blastocystis spp. Conclusions: This is the first study to assess the burden and role of different epidemiological and clinical profiles of Blastocystis spp. in Uttarakhand. More studies are required to know its pathogenesis and its role as opportunistic pathogen.
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DISPATCHES Top

Molecular characterization of Entamoeba, Blastocystis and Cryptosporidium species in stool samples collected from Jordanian patients suffering from gastroenteritis p. 122
Nawal Hijjawi, Alireza Zahedi, Una Ryan
DOI:10.4103/tp.TP_106_20  
Little is known about the prevalence of intestinal protozoa in patients suffering from diarrhea in Jordan. The present study aimed to detect and speciate Entamoeba, Blastocystis, and Cryptosporidium species in a total of 159 human patients with diarrhea from November 2014 to October 2016. The overall prevalence for the three parasites was 19.5% (31/159). Entamoeba spp. (Entamoeba. dispar and/or Entamoeba histolytica), Blastocystis hominis, and Cryptosporidium parvum subtype IIaA15G2R1 were detected in 12.6%, 6%, and 0.6 of samples, respectively. This is the first molecular study in Jordan to confirm the diagnosis of Entamoeba species and to discriminate between E. histolytica and E. dispar.
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The first case report of subcutaneous dirofilariasis caused by Dirofilaria repens in Thailand p. 125
Jerapas Thongpiya, Suchada Kreetitamrong, Theerasak Thongsit, Tanaporn Toothong, Sunsanee Rojanapanus, Patsharaporn Techasintana Sarasombath
DOI:10.4103/tp.TP_113_20  
Dirofilariasis is a rare zoonotic disease which is commonly caused by two Dirofilaria species; Dirofilaria immitis and Dirofilaria repens. Humans are accidental dead-end hosts of the parasites, and the infection is mainly asymptomatic. Here, we report the case of a 54-year-old Thai woman who experienced a painful left shoulder nodule and eosinophilia for 1 month. An excisional biopsy of the nodule revealed a degenerated filarial nematode compatible with adult females of the Dirofilaria species. Molecular identification of the partial 12 mt rRNA gene of the worm confirmed that the causative species was D. repens, a zoonotic filariasis that causes subcutaneous dirofilariasis in dogs and cats. To the best of our knowledge, this was the first reported case of subcutaneous dirofilariasis caused by D. repens in Thailand. This increased concerns about zoonotic filariasis from natural animal reservoirs in Thailand.
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FACE TO FACE Top

Face-to-Face: Virtual interview with Dr. Nirmal Kumar Ganguly p. 128

DOI:10.4103/tp.tp_61_21  
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OBITUARY Top

Dr. Utpala Devi p. 132
Abhijit Chaudhury
DOI:10.4103/tp.tp_59_21  
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BOOK REVIEW Top

Effective Medical Communication – The A, B, C, D, E of it. p. 133
PV Vijayaraghavan
DOI:10.4103/tp.tp_64_21  
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