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   2018| March  | Volume 147 | Issue 3  
    Online since June 18, 2018

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Circulation of Nipah virus in Pteropus giganteus bats in northeast region of India, 2015
Pragya Yadav, Anakkathil Sudeep, Mangesh Gokhale, Shailesh Pawar, Anita Shete, Deepak Patil, Vimal Kumar, Rajen Lakra, Prasad Sarkale, Stuart Nichol, Devendra Mourya
March 2018, 147(3):318-320
DOI:10.4103/ijmr.IJMR_1488_16  PMID:29923524
  6 1,665 407
Creation of monosodium iodoacetate-induced model of osteoarthritis in rabbit knee joint
Elizabeth Vinod, P. R. J. V. C. Boopalan, Sabareeswaran Arumugam, Solomon Sathishkumar
March 2018, 147(3):312-314
DOI:10.4103/ijmr.IJMR_2004_16  PMID:29923522
  4 809 211
Time trends in prevalence of anaemia in pregnancy
K Kalaivani, Prema Ramachandran
March 2018, 147(3):268-277
DOI:10.4103/ijmr.IJMR_1730_16  PMID:29923516
Background & objectives: The prevalence of anaemia in pregnancy in India is among the highest in the world. In the last two decades, several national surveys have estimated haemoglobin levels in pregnant women. In this study, data from these surveys were analyzed to find out changes, if any, in prevalence of anaemia in pregnancy. Methods: National and State-level estimates on the prevalence of anaemia were tabulated from the reports of the National Family Health Survey (NFHS) 2, NFHS 3, Fact Sheets of NFHS 4 and District Level Household Survey (DLHS) 2. Unit level data from DLHS 4 and Annual Health Survey Clinical Anthropometric and Biochemical component (AHS CAB) were obtained and State level prevalence of different grades of anaemia was estimated. Time trends in the prevalence of anaemia and different grades of anaemia were assessed from these surveys. Results: NFHS 2, 3 and 4 reported relatively lower prevalence of anaemia as compared to DLHS and AHS CAB. There was not much change in the prevalence or severity of anaemia between NFHS 2, 3 and 4. There was substantial reduction in the prevalence and severity of anaemia in all States except Uttarakhand between DLHS 2 and 4 and DLHS 2 and AHS CAB. Interpretation & conclusions: There was a reduction in the prevalence and severity of anaemia in the last 15 years. The two-pronged strategy of increasing iron intake (dietary diversification and use of iron-fortified iodized salt) in all the population and testing, and detecting and treating pregnant women with anaemia will accelerate the pace of reduction in anaemia.
  4 2,200 520
Ending tuberculosis in India: A political challenge & an opportunity
Hannah Monica Yesudian Dias, Madhukar Pai, Mario C Raviglione
March 2018, 147(3):217-220
DOI:10.4103/ijmr.IJMR_660_18  PMID:29923507
  3 2,431 570
Intrapatient variability in plasma rifampicin & isoniazid in tuberculosis patients
A. K. Hemanth Kumar, V Chandrasekaran, T Kannan, J Lavanya, Soumya Swaminathan, Geetha Ramachandran
March 2018, 147(3):287-292
DOI:10.4103/ijmr.IJMR_1961_16  PMID:29923518
Background & objectives: Large variability in anti-tuberculosis (TB) drug concentrations between patients is known to exist. However, limited information is available on intrapatient drug levels during the course of anti-TB treatment (ATT). This study was conducted to evaluate intrapatient variability in plasma rifampicin (RMP) and isoniazid (INH) concentrations during ATT at start of the treatment, at the end of intensive phase (IP) of ATT and at the end of ATT in adult TB patients being treated in the Revised National TB Control Programme (RNTCP). Methods: Adult TB patients (n=485), receiving thrice-weekly ATT in the RNTCP, were studied. Two-hour post-dosing concentrations of RMP and INH were determined at month 1, end of IP and end of ATT, after directly observed drug administration. Drug concentrations were estimated by high-performance liquid chromatography. Results: The median (inter-quartile range) RMP concentrations during the first month, at end of IP and end of ATT were 2.1 (0.4-5.0), 2.4 (0.6-5.5) and 2.2 (0.5-5.3) μg/ml, respectively. The corresponding INH concentrations were 7.1 (4.2-9.9), 7.2 (3.9-10.9) and 6.7 (3.9-9.5) μg/ml. None of the differences in drug concentrations obtained at different time points during ATT were significant. RMP and INH concentrations at different time points were significantly correlated. Age and body mass index caused significant variability in drug concentrations. Interpretation & conclusions: Plasma RMP and INH estimations in adult TB patients at two hours after drug administration remained unaltered during ATT. Clinicians can consider testing drug concentrations at any time point during ATT. These findings may assume significance in the context of therapeutic drug monitoring of anti-TB drug concentrations.
  2 855 229
Evaluation of real-time reverse-transcription loop-mediated isothermal amplification assay for clinical diagnosis of West Nile virus in patients
Jyoti S Kumar, Divyasha Saxena, Manmohan Parida, Sivakumar Rathinam
March 2018, 147(3):293-298
DOI:10.4103/0971-5916.234607  PMID:29923519
Background & objectives: West Nile virus (WNV) is a mosquito-borne flavivirus. The disease can be diagnosed by isolation followed by fluorescent antibody tests, enzyme-linked immunosorbent assay and polymerase chain reaction (PCR) assay. These diagnostic methods are laborious and time-consuming. The present study was aimed to evaluate the real-time reverse-transcription loop-mediated isothermal amplification (RT-LAMP) method for rapid, early and accurate diagnosis of WNV. Methods: A one-step single tube accelerated quantitative RT-LAMP assay was evaluated by targeting the Env gene of WNV. The gene amplification was accomplished by incubating the reaction mixture at 63°C for 60 min in both real time turbidimeter as well as routine laboratory water bath/dry heating bath. To rule out contamination issues, proper negative controls, including no template, no primer; and no enzyme, were always kept alongside each run. The RT-LAMP assay was evaluated on 105 clinical samples from individuals having ocular infection. Results: Of the 105 samples tested, 27 were positive for WNV by RT-LAMP assay. The comparative evaluation with conventional RT-PCR revealed 100 per cent accordance with sensitivity and specificity of 100 and 95 per cent, respectively. The specificity of this assay was confirmed with serum samples obtained from patients with dengue and chikungunya. Interpretation & conclusions: The RT-LAMP test seemed to be a sensitive and specific method for rapid detection of WNV infection and would be useful for rapid screening of a large number of clinical samples in endemic areas during outbreaks.
  2 1,238 325
Host-targeted therapy for tuberculosis: Time to revisit the concept
Prabha Desikan, Aseem Rangnekar
March 2018, 147(3):233-238
DOI:10.4103/ijmr.IJMR_652_17  PMID:29923511
Tuberculosis (TB) is an important cause of morbidity and mortality worldwide. Every year millions of people die due to TB. Drug resistance has been a major factor that has obstructed successful control and treatment of TB. As the rate of spread of drug-resistant TB outpaces the rate of discovery of new anti-tubercular drugs, targeted therapy may provide a new approach to TB cure. In a scenario where drug resistance is spreading rapidly, and existing drugs regimens seem to be dwindling away, this review summarizes the concept of host-targeted therapy which may be the ray of hope for the effective management and control of the rapidly spreading drug-resistant TB (multidrug resistant and extensively drug resistant).
  2 1,075 448
Pandemic Flu, 1918: After hundred years, India is as vulnerable
Lalit Kant, Randeep Guleria
March 2018, 147(3):221-224
DOI:10.4103/ijmr.IJMR_407_18  PMID:29923508
  1 1,740 395
Genetic diversity of Mycobacterium tuberculosis in south coastal Karnataka, India, using spoligotyping
Kiran Chawla, Ajay Kumar, Vishnu Prasad Shenoy, Devendra Singh Chauhan, Pragya Sharma
March 2018, 147(3):278-286
DOI:10.4103/ijmr.IJMR_2026_16  PMID:29923517
Background & objectives: Despite high occurrence of tuberculosis in India very little information is available about the genetic diversity of Mycobacterium tuberculosis isolates prevailing in coastal Karnataka, India. Thus, the present study was undertaken to explore the genetic biodiversity of M. tuberculosis isolates prevailing in south coastal region of Karnataka (Udupi District), India. Methods: A total of 111 Mycobacterial isolates were cultured in Lowenstein Jensen (LJ) medium and after obtaining growth, DNA was extracted and spoligotyping was performed. SITVIT WEB database was used to locate families of spoligotypes. Results: On analyzing the hybridization results of all 111 isolates on SITVIT WEB database 57 (51.35%) isolates were clustered into 11 Spoligotype International Types (SIT). The largest cluster of 14 (12.61%) isolates was SIT-48 (EAI1-SOM), followed by SIT-1942 (CAS1-Delhi) with 11 isolates (9.9%) and SIT-11 with seven (6.30%). Moreover, 23 isolates (20.72%) had unique spoligotypes and 31 (27.92%) were orphans. Spotclust analysis revealed that majority (67%) of orphan isolates were variants of CAS (37%) and EAI-5 (34%). Interpretation & conclusions: The present study revealed high biodiversity among the circulating isolates of M. tuberculosis in this region with the presence of mixed genotypes earlier reported from north and south India along with certain new genotypes with unique SITs. The study highlights the need for further longitudinal studies to explore the genetic diversity and to understand the transmission dynamics of prevailing isolates.
  1 913 278
Whole-body 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT) for staging locally advanced breast cancer: A prospective study from a tertiary cancer centre in south India
Sivanath Reddy Gajjala, Narendra Hulikal, Silpa Kadiyala, Radhika Kottu, Tekchand Kalawat
March 2018, 147(3):256-262
DOI:10.4103/ijmr.IJMR_1368_16  PMID:29923514
Background & objectives: Locally advanced breast cancer (LABC) is associated with substantial risk of occult metastases. The patients with LABC have high rate of systemic relapse, suggesting inadequacy of the current conventional staging in detecting the occult metastatic spread. 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) is a new modality in the staging of breast cancer patients. Hence, this study was conducted to evaluate the role of 18F-FDG PET/CT in initial staging of LABC and to compare it with conventional methods. Methods: This prospective study included biopsy-confirmed female patients diagnosed with LABC meeting the selection criteria and attending surgical, medical and radiation oncology departments of a tertiary care centre in south India, from April 2013 to December 2014. Conventional workup included serum chemistry, mammogram, bone scan, contrast-enhanced CT (CECT) chest and upper abdomen and ultrasound abdomen and pelvis. All patients following conventional workup underwent 18F-FDG PET/CT. Results: In this study, 61 women with LABC underwent both conventional workup and 18F-FGD PET/CT. The 18F-FDG PET/CT, in comparison to conventional workup, revealed unsuspected N3 nodal disease in 11 more patients, revealed distant metastasis in seven more patients and also detected extra sites of metastasis in five patients. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of PET/CT to detect distant metastasis were 95, 98, 95, 98 and 97 per cent, respectively, whereas the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of conventional imaging to detect distant metastasis were 65, 93, 81, 84 and 84 per cent, respectively. Interpretation & conclusions: The 18F-FDG PET/CT was found to be more accurate than conventional imaging for staging and modified stage and treatment in 30 and 38 per cent of patients, respectively. It was particularly useful in detecting occult distant metastasis and N3 nodal disease with an added advantage of examining whole body in single session. However, CECT chest was superior over 18F-FDG PET/CT for detecting pulmonary metastasis.
  1 1,110 253
Universal health coverage framework to combat antimicrobial resistance
Rajesh Bhatia
March 2018, 147(3):228-232
DOI:10.4103/ijmr.IJMR_1462_17  PMID:29923510
  1 855 340
Genotypes of erythrovirus B19, their geographical distribution & circulation in cases with various clinical manifestations
Amita Jain, Ravi Kant
March 2018, 147(3):239-247
DOI:10.4103/ijmr.IJMR_1816_16  PMID:29923512
Erythrovirus B19 (B19V) is one of the erythroviruses known to be pathogenic in humans. B19V is classified into three distinct genotypes; 1, 2 and 3, differing from each other by 2-13 per cent. Genotype 1 consists of the prototype B19V isolates, genotype 2 comprises the A6, LaLi and their related isolates while genotype 3 includes the V9- and V9-related isolates. The classification of genotype 1 into two subtypes (1A and 1B) and genotype 3 into two subtypes (3a and 3b) with an estimated nucleotide difference of about 5 per cent has been done. Predominance of genotype 1 across all the continents is seen followed by genotypes 2 and 3. There are no disease-specific genotypes. All the three genotypes have been found in symptomatic as well as asymptomatic individuals and have been reported from several countries across the world. The prevalence of genotype 2 in older populations and its absence from current circulation in Northern Europe has also been reported. The present review focuses on geographic distribution and association of genotypes of B19V with different clinical manifestations.
  1 911 294
Imaging in endocrine disorders
AK Gupta, D Kandasamy
March 2018, 147(3):323-324
  - 270 113
Practical use of biostatistics: For medical, allied sciences & research professional
DK Subbakrishna
March 2018, 147(3):324-324
  - 310 192
The right therapy for neurological disorders: From randomized trials to clinical practice
M.V. Padma Srivastava
March 2018, 147(3):324-326
  - 379 119
An unusual cause of dysphagia in a child: Gastrointestinal manifestations of epidermolysis bullosa
Raghu Prakash, Archana Puri
March 2018, 147(3):321-321
DOI:10.4103/ijmr.IJMR_793_16  PMID:29923525
  - 553 178
Dermatitis neglecta
Sonali Langar, Sidharth Sonthalia
March 2018, 147(3):322-322
DOI:10.4103/ijmr.IJMR_43_17  PMID:29923526
  - 916 166
Role of apoptotic markers in paediatric acute lymphoblastic leukaemia
Gauri Kapoor, Neha Singh
March 2018, 147(3):225-227
DOI:10.4103/ijmr.IJMR_906_17  PMID:29923509
  - 832 303
A possible need for routine screening for Strongyloides stercoralis infection in Indian haemophilia patients
Rucha K Patil, Kanjaksha K Ghosh, S Chandrakala, Shrimati Shetty
March 2018, 147(3):315-317
DOI:10.4103/ijmr.IJMR_1236_16  PMID:29923523
  - 788 156
Years of potential life lost due to cancer in Kamrup Urban District of Assam, northeast India
Jagannath Dev Sharma, Amal Chandra Kataki, Manoj Kalita
March 2018, 147(3):308-311
DOI:10.4103/ijmr.IJMR_1505_16  PMID:29923521
  - 844 194
Field testing & evaluation of the efficacy & duration of effectiveness of a biolarvicide, Bactivec® SC (Bacillus thuringiensis var. israelensis SH-14) in Bengaluru, India
Sreehari Uragayala, Raghavendra Kamaraju, Satyanarayan Tiwari, Susanta Kumar Ghosh, Neena Valecha
March 2018, 147(3):299-307
DOI:10.4103/ijmr.IJMR_1631_16  PMID:29923520
Background & objectives: Different formulations of Bacillus thuringiensis var. israelensis (Bti) have been tested against different mosquito vectors and other insects for their residual activity. In the present study, the efficacy and residual activity of a new formulation of Bti (Bactivec Suspension Concentrate) were evaluated against immature stages of Anopheles stephensi Liston (Diptera: Culicidae), Aedes aegypti Linnaeus (Diptera: Culicidae) and Culex quinquefasciatus Say (Diptera: Culicidae), in natural habitats in Phase II and Phase III in Bengaluru, India. Methods: Preferential breeding habitats of the mosquito species were selected and four dosages (0.25, 0.5, 1 and 2 ml/50 l) were tested in Phase II trial. Two most effective dosages, 0.5 and 1 ml/50 l were selected for Phase III trial. The evaluation was carried out essentially following the guidelines of the World Health Organization Pesticide Evaluation Scheme. Pre-treatment and post-treatment densities were recorded at regular intervals, and >80 per cent reduction in pupae was taken as the duration of effectiveness. Results: Bactivec SC treated at the dosage of 1 ml/50 l could produce 10-17 days efficacy (>80% reduction in pupae) in clean water habitats tested, whereas 0.5 ml/50 l dosage showed residual activity from 7 to 14 days against Ae. aegypti and An. stephensi in Phase III studies. In polluted water habitats, 4-7 days efficacy could be recorded against Cx. quinquefasciatus in Phase III. Interpretation & conclusions: The Bactivec SC formulation was operationally feasible and easy to handle. For the control of Anopheles and Aedes mosquitoes in freshwater habitats, 1 ml/50 l dosage was found effective, whereas in polluted water habitats against Cx. quinquefasciatus 5 ml/m2 was found effective.
  - 818 220
Low spontaneous apoptosis index at diagnosis predicts a high-risk phenotype in paediatric acute lymphoblastic leukaemia
Ankita Singh, Prateek Bhatia, Amita Trehan, Deepak Bansal, Ajit Singh, Alka Bhatia
March 2018, 147(3):248-255
DOI:10.4103/ijmr.IJMR_303_16  PMID:29923513
Background & objectives: Significance of apoptosis as a prognostic marker is less well studied in paediatric acute lymphoblastic leukaemia (ALL) cases. Hence, a prospective study, involving 30 paediatric ALL cases, was done to assess the clinical relevance of in vivo apoptosis. Methods: Peripheral blood mononuclear cells from all patients were subjected to annexin V/propidium iodide staining to detect the degree of apoptosis [apoptotic index (AI)] at day 0 and day 35 post-induction chemotherapy. In addition, Bax and Bcl2 apoptotic protein expressions were studied at day 0 and their relative fluorescence mean intensity (RFMI) ratios were calculated. Results: Mean age of patients was 5.1 years. Of the 30 cases, 21 (70%) were at standard-risk, five (17%) at intermediate and four (13%) at high risk. Majority (83%) were B-ALL. Day 8 absolute blast count was >1000/μl in seven (23%) and <1000/μl in 23 of 30 (77%) cases. Day 35 marrow was M1 in 23 (92%) and M2 in two of 25 (8%) cases. AI at day 0 and day 35 ranged from 0.9 to16.6 per cent and 1.4 to 62.8 per cent with a mean of 5.90 and 19.64 per cent, respectively. The Bax/Bcl2 ratio ranged from 0.2 to 3.5 with a mean of 0.83. The ratio was predominantly anti-apoptotic, i.e. <1 (77%). A significant association was noted between low AI at day 0 and high total leucocyte count (P=0.02), T-cell phenotype (P=0.043) and high-risk as per NCI category (P=0.025). Significant increase (>30%) in day 35 AI was seen in only six cases. Interpretation & conclusions: Our study showed that low AI at day 0 was associated with a high-risk clinical phenotype in paediatric ALL. However, studies on larger group, especially with longer follow up or study of relapse cases, will help draw conclusions regarding apoptosis assessment in paediatric ALL.
  - 677 254
Comparative study between liquid-based cytology & conventional Pap smear for cytological follow up of treated patients of cancer cervix
Uma Singh, Anjum, Sabuhi Qureshi, Neha Negi, Nisha Singh, Madhumati Goel, Kirti Srivastava
March 2018, 147(3):263-267
DOI:10.4103/ijmr.IJMR_854_16  PMID:29923515
Background & objectives: Cancer cervix is one of the most common forms of genital malignancy among Indian women. Recurrence is seen in a significant number of cases. The conventional cervical smear technique has inherent problems and screening and interpretation errors. This study was undertaken to assess the efficacy of liquid-based cytology (LBC) as a method for cytological follow up and detection of recurrence in treated cases of cancer cervix and to compare it with conventional Pap smear technique to find the best screening method for detection of recurrence in these patients. Methods: This cross-sectional study was conducted over a period of one year. Patients attending Gynecology and Radiotherapy outpatient departments for follow up after treatment of cancer cervix were included. Pap smear and LBC were taken in all cases. Colposcopy and biopsy were done for those having epithelial cell abnormality in cytology report. Colposcopy and biopsy were taken as gold standard for diagnosis of cancer cervix recurrence. Results: Ninety four treated patients of carcinoma cervix were studied. The diagnostic accuracy for detection of recurrence of conventional Pap smear was 79.16 per cent, and that of LBC was 97.6 per cent. The difference between the two methods was significant (P<0.001). Interpretation & conclusions: Our findings showed that LBC performed better than the conventional method of cytology to detect recurrence of squamous cell carcinoma. Its sensitivity, specificity as well as accuracy were much higher than conventional method. LBC can be a better method of cytological follow up of post-treated patients of cancer cervix.
  - 2,886 445