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   2019| April  | Volume 149 | Issue 4  
    Online since July 16, 2019

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Emerging/re-emerging viral diseases & new viruses on the Indian horizon
Devendra T Mourya, Pragya D Yadav, PT Ullas, Sumit D Bhardwaj, Rima R Sahay, Mandeep S Chadha, Anita M Shete, Santosh Jadhav, Nivedita Gupta, Raman R Gangakhedkar, Pradeep Khasnobis, Sujeet K Singh
April 2019, 149(4):447-467
DOI:10.4103/ijmr.IJMR_1239_18  PMID:31411169
Infectious diseases remain as the major causes of human and animal morbidity and mortality leading to significant healthcare expenditure in India. The country has experienced the outbreaks and epidemics of many infectious diseases. However, enormous successes have been obtained against the control of major epidemic diseases, such as malaria, plague, leprosy and cholera, in the past. The country's vast terrains of extreme geo-climatic differences and uneven population distribution present unique patterns of distribution of viral diseases. Dynamic interplays of biological, socio-cultural and ecological factors, together with novel aspects of human-animal interphase, pose additional challenges with respect to the emergence of infectious diseases. The important challenges faced in the control and prevention of emerging and re-emerging infectious diseases range from understanding the impact of factors that are necessary for the emergence, to development of strengthened surveillance systems that can mitigate human suffering and death. In this article, the major emerging and re-emerging viral infections of public health importance have been reviewed that have already been included in the Integrated Disease Surveillance Programme.
  12,433 1,372 2
Prevalence of substance use disorders in Punjab: Findings from National Mental Health Survey
BS Chavan, Rohit Garg, Subhash Das, Sonia Puri, Arvind Anniappan Banavaram
April 2019, 149(4):489-496
DOI:10.4103/ijmr.IJMR_1267_17  PMID:31411172
Background & objectives: Substance use disorders are a major public health concern in Punjab. However, reliable estimates of prevalence of substance use disorders are not available for the State. The present study reports estimates of prevalence of substance use disorders in Punjab, conducted as part of National Mental Health Survey, India. Methods: Using multistage stratified random cluster sampling, 2895 individuals from 719 households of 60 clusters (from 4 districts of Punjab) were interviewed. Mini International Neuropsychiatric Interview and Fagerstrom nicotine dependence scale were used to assess substance use disorders. Results: The sample comprised almost equal numbers of males and females. Nearly 80 per cent had less than or equal to high school education, and 70 per cent were married. The weighted prevalence of alcohol and other substance use disorders was 7.9 and 2.48 per cent, respectively. The prevalence of tobacco dependence was 5.5 per cent; 35 per cent households had one person with substance use disorder. The prevalence was highest in the productive age group (30-39 yr), urban metro and less educated persons. The prevalence of alcohol and other substance use disorders was much higher in Punjab as compared to other States where survey was done. Tobacco dependence was lowest in Punjab. Majority (87%) of the persons with substance use disorders did not suffer from any other mental disorder. Treatment gap was 80 per cent. Interpretation & conclusions: Punjab has a high burden of substance use disorders. The estimates will help clinicians and policymakers to plan the strategies against the menace of substance use disorders effectively.
  2,043 274 -
Young-onset diabetes: An Indian perspective
Deep Dutta, Soumitra Ghosh
April 2019, 149(4):441-442
DOI:10.4103/ijmr.IJMR_1938_18  PMID:31411167
  1,748 467 -
Geographical distribution of primary & secondary dengue cases in India – 2017: A cross-sectional multicentric study
Chaitra Rao, Harmanmeet Kaur, Nivedita Gupta, Sasidharan Pillai Sabeena, R Ambica, Amita Jain, Ashvini Yadav, Bhagirathi Dwibedi, Bharti Malhotra, Dalip K Kakru, Debasis Biswas, Deepali Savargaonkar, M Ganesan, Jyotsnamayee Sabat, Kanwardeep Dhingra, S Lalitha, Neena Valecha, Pamireddy Madhavilatha, Pradip V Barde, Piyush D Joshi, Pratibha Sharma, Rajarshi Gupta, RK Ratho, Shailpreet Sidhu, Shakti Saumnam Shrivastava, Shanta Dutta, GB Shantala, Sheikh Imtiaz, Shveta Sethi, Usha Kalawat, P Vijayachari, Vimal Raj, Neetu Vijay, Biswajyoti Borkakoty, Purnima Barua, Tapan Majumdar, Govindakarnavar Arunkumar
April 2019, 149(4):548-553
DOI:10.4103/ijmr.IJMR_916_18  PMID:31411180
Background & objectives: Dengue virus infection is endemic in India with all the four serotypes of dengue virus in circulation. This study was aimed to determine the geographic distribution of the primary and secondary dengue cases in India. Methods: A multicentre cross-sectional study was conducted at Department of Health Research / Indian Council of Medical Research (DHR)/(ICMR) viral research and diagnostic laboratories (VRDLs) and selected ICMR institutes located in India. Only laboratory-confirmed dengue cases with date of onset of illness less than or equal to seven days were included between September and October 2017. Dengue NS1 antigen ELISA and anti-dengue IgM capture ELISA were used to diagnose dengue cases while anti-dengue IgG capture ELISA was used for identifying the secondary dengue cases. Results: Of the 1372 dengue cases, 897 (65%) were classified as primary dengue and 475 (35%) as secondary dengue cases. However, the proportion varied widely geographically, with Theni, Tamil Nadu; Tirupati, Andhra Pradesh and Udupi-Manipal, Karnataka reporting more than 65 per cent secondary dengue cases while Srinagar, Jammu and Kashmir reporting as low as 10 per cent of the same. The median age of primary dengue cases was 25 yr [interquartile range (IQR 17-35] while that of secondary dengue cases was 23 yr (IQR 13.5-34). Secondary dengue was around 50 per cent among the children belonging to the age group 6-10 yr while it ranged between 20-43 per cent among other age groups. Interpretation & conclusions: Our findings showed a wide geographical variation in the distribution of primary and secondary dengue cases in India. It would prove beneficial to include primary and secondary dengue differentiation protocol in the national dengue surveillance programme.
  1,143 299 -
‘More, better, faster & sustained’: Strengthen primary health care to advance universal health coverage
Chandrakant Lahariya
April 2019, 149(4):433-436
DOI:10.4103/ijmr.IJMR_753_19  PMID:31411165
  1,023 405 -
Strategies for ending tuberculosis in the South-East Asian Region: A modelling approach
Nimalan Arinaminpathy, Sandip Mandal, Vineet Bhatia, Ross McLeod, Mukta Sharma, Soumya Swaminathan, Khurshid Alam Hyder, Partha Pratim Mandal, Swarup Kumar Sarkar, Poonam Khetrapal Singh
April 2019, 149(4):517-527
DOI:10.4103/ijmr.IJMR_1901_18  PMID:31411176
Background & objectives: To support recent political commitments to end tuberculosis (TB) in the World Health Organization South-East Asian Region (SEAR), there is a need to understand by what measures, and with what investment, these goals could be reached. These questions were addressed by using mathematical models of TB transmission by doing the analysis on a country-by-country basis in SEAR. Methods: A dynamical model of TB transmission was developed, in consultation with each of the 11 countries in the SEAR. Three intervention scenarios were examined: (i) strengthening basic TB services (including private sector engagement), (ii) accelerating TB case-finding and notification, and (iii) deployment of a prognostic biomarker test by 2025, to guide mass preventive therapy of latent TB infection. Each scenario was built on the preceding ones, in successive combination. Results: Comprehensive improvements in basic TB services by 2020, in combination with accelerated case-finding to increase TB detection by at least two-fold by 2020, could lead to a reduction in TB incidence rates in SEAR by 67.3 per cent [95% credible intervals (CrI) 65.3-69.8] and TB deaths by 80.9 per cent (95% CrI 77.9-84.7) in 2035, relative to 2015. These interventions alone would require an additional investment of at least US$ 25 billion. However, their combined effect is insufficient to reach the end TB targets of 80 per cent by 2030 and 90 per cent by 2035. Model projections show how additionally, deployment of a biomarker test by 2025 could end TB in the region by 2035. Targeting specific risk groups, such as slum dwellers, could mitigate the coverage needed in the general population, to end TB in the Region. Interpretation & conclusions: While the scale-up of currently available strategies may play an important role in averting TB cases and deaths in the Region, there will ultimately be a need for novel, mass preventive measures, to meet the end TB goals. Achieving these impacts will require a substantial escalation in funding for TB control in the Region.
  1,082 292 1
Emerging evidence that irritable bowel syndrome & functional dyspepsia are microbial diseases
Nicholas J Talley, Marjorie M Walker
April 2019, 149(4):437-440
DOI:10.4103/ijmr.IJMR_84_19  PMID:31411166
  950 403 -
What makes non-cirrhotic portal hypertension a common disease in India? Analysis for environmental factors
Ashish Goel, Banumathi Ramakrishna, Uday Zachariah, KG Sajith, Deepak K Burad, Thomas A Kodiatte, Shyamkumar N Keshava, KA Balasubramanian, Elwyn Elias, CE Eapen
April 2019, 149(4):468-478
DOI:10.4103/ijmr.IJMR_1405_17  PMID:31411170
In India, an unexplained enteropathy is present in a majority of non-cirrhotic intrahepatic portal hypertension (NCIPH) patients. Small intestinal bacterial contamination and tropical enteropathy could trigger inflammatory stimuli and activate the endothelium in the portal venous system. Groundwater contaminated with arsenic is an environmental factor of epidemic proportions in large areas of India which has similar consequences. Von Willebrand factor (a sticky protein) expressed by activated endothelium may promote formation of platelet microthrombi and occlusion of intrahepatic portal vein branches leading to NCIPH. Environmental factors linked to suboptimal hygiene and sanitation, which enter through the gastrointestinal (GI) tract, predispose to platelet plugging onto activated endothelium in portal microcirculation. Thus, NCIPH, an example of poverty linked thrombophilia, is a disease mainly affecting the lower socio-economic strata of Indian population. Public health measures to improve sanitation, provide clean drinking water and eliminate arsenic contamination of drinking water are urgently needed. Till such time as these environmental factors are addressed, NCIPH is likely to remain 'an Indian disease'.
  1,135 215 -
Heterogeneity in the aetiology of diabetes mellitus in young adults: A prospective study from north India
Saroj Kumar Sahoo, Ghazala Zaidi, Valam Puthussery Vipin, Aaron Chapla, Nihal Thomas, Liping Yu, Pranjul Asthana, Eesh Bhatia
April 2019, 149(4):479-488
DOI:10.4103/ijmr.IJMR_1004_17  PMID:31411171
Background & objectives: In contrast to Caucasians of European origin, the aetiology of diabetes mellitus (DM) in young adults in other ethnic groups, including Indians is likely to be heterogeneous and difficult to determine. This study was undertaken to determine the aetiology of diabetes in young Indian adults using a protocol-based set of simple clinical and investigation tools. Methods: In this prospective study, 105 Indian young adults with diabetes (age at onset 18-35 yr; duration <2 yr) were studied for a period of 1-3 years. Pancreatic imaging, fasting C-peptide, islet antibodies (against glutamic acid decarboxylase, tyrosine phosphatase and zinc transporter-8) and mitochondrial A3243G mutational analysis were performed in all patients. Four patients were screened for maturity-onset diabetes of the young (MODY) using next-generation sequencing. Results: Type 1 and type 2 diabetes mellitus (T1DM and T2DM) were equally frequent (40% each), followed by fibrocalculous pancreatic diabetes (FCPD, 15%). Less common aetiologies included MODY (2%), mitochondrial diabetes (1%) and Flatbush diabetes (2%). There was considerable phenotypic overlap between the main aetiological subtypes. Elevated islet antibodies were noted in 62 per cent of T1DM patients [positive predictive value (PPV) 84%; negative predictive value (NPV) 78%] while low plasma C-peptide (<250 pmol/l) was present in 56 per cent of T1DM patients [PPV 96% (after excluding FCPD), NPV 72%]. Using these tests and observing the clinical course over one year, a final diagnosis was made in 103 (99%) patients, while the diagnosis at recruitment changed in 23 per cent of patients. Interpretation & conclusions: The aetiology of diabetes in young adults was heterogeneous, with T1DM and T2DM being equally common. FCPD was also frequent, warranting its screening in Indian patients. Testing for islet antibodies and C-peptide in this age group had good PPV for diagnosis of T1DM.
  952 334 1
Pattern of cognitive deficits in vascular dementia
Prasenjit Sengupta, Jacky Ganguly, Sandip Pal, Malay Ghosal
April 2019, 149(4):503-507
DOI:10.4103/ijmr.IJMR_1336_17  PMID:31411174
Background & objectives: There is a paucity of literature on the cognitive profiles of vascular dementia (VaD) in India. The current study was undertaken to investigate the pattern of cognitive deficits in patients with VaD. Methods: Fifty patients fulfilling the Diagnostic and Statistical Manual of Mental Disorders-IV criteria of dementia and National Institute of Neurological Disorders and Stroke - Association Internationale pour la Recherche et l'Enseignement en Neurosciences criteria for VaD were assessed using Mini Mental State Examination, Kolkata Cognitive Screening Battery and other relevant tests including magnetic resonance imaging of brain. Results: Twenty patients had small vessel dementia, whereas the least common was haemorrhagic dementia in four patients. In patients with small vessel dementia, apart from memory, all patients had problem in attention and executive function, whereas 12 patients had visuoconstructional deficit and eight patients had language problem. In a total of 12 patients with large vessel dementia, apart from memory, executive dysfunction and visuoconstructional deficit were noted in 10 patients, whereas attention deficit was noted in eight patients. Attention was found to be more involved in small-vessel dementia than large-vessel dementia though all had memory impairment (P<0.01). Interpretation & conclusions: Small vessel dementia was the commonest subtype of VaD in our study. Memory, attention and executive functions were predominantly affected in patients with VaD. Attention was significantly more involved in small vessel dementia than large vessel dementia. Further studies with large sample size need to be done in different regions of the country.
  834 208 -
Clinical epidemiology of substance use disorders: Understanding patterns, sharing knowledge, planning interventions
Paolo Mannelli, Li-Tzy Wu
April 2019, 149(4):443-445
DOI:10.4103/ijmr.IJMR_3_19  PMID:31411168
  596 225 -
Contribution of acrB upregulation & OmpC/Ompk36 loss over the presence of blaNDM towards carbapenem resistance development among pathogenic Escherichia coli & Klebsiella spp.
Arijit Pal, Lena Dhara, Anusri Tripathi
April 2019, 149(4):528-538
DOI:10.4103/ijmr.IJMR_716_17  PMID:31411177
Background & objectives: The global spread of carbapenem-resistant Enterobacteriaceae (CRE) is an emerging clinical problem. Hence, in this study, the plausible role of extended-spectrum beta-lactamases (ESBLs)/carbapenemases, OmpC/Ompk36, acrB and their combinations was explored among CRE. Methods: The minimum inhibitory concentration (MIC) of meropenem, enzyme-phenotypes (ESBLs/IR and metallo-beta-lactamase (MBL)/non-MBL carbapenemase), genotypes (blaTEM, blaSHV and blaCTX-M; blaNDM and blaVIM; blaKPC and blaOXA-48-like variants), acrB and outer membrane protein (OMP) expressions were analyzed with a total of 101 non-duplicate clinical isolates, obtained from various samples of patients visiting two tertiary care units of Eastern India during May 2013 - October 2016. This included Escherichia coli (n=36) and Klebsiella pneumoniae (n=65), categorized into two groups, namely Group I (resistant to all carbapenems; n=93; E. coli=34 and Klebsiella spp.=59) and Group II (non-resistant to all the carbapenems; n=8; E. coli=2 and Klebsiella spp.=6). Results: Though 88.17 per cent of Group I isolates exhibited ESBL property, the presence of carbapenemase activity (70.96%) and that of blaNDM gene (42/66: 63.63%) indicated their contributions towards the emergence of CRE. Further, porin loss and/or efflux pump activation among ESBL/carbapenemase-producing isolates heightened the MIC of meropenem from 64 to 256 mg/l (range exhibited by only ESBL/carbapenemase-producing isolates) to >256 mg/l. Interpretation & conclusions: These findings implied the major contribution of porin loss and/or efflux pump activation over the presence of ESBLs/carbapenemases in imparting carbapenem resistance in pathogenic bacteria.
  526 163 2
Plasma ghrelin levels after laparoscopic sleeve gastrectomy in obese individuals
Garima Sharma, Prabhdeep S Nain, Pulkit Sethi, Ashish Ahuja, Sarit Sharma
April 2019, 149(4):544-547
DOI:10.4103/ijmr.IJMR_984_18  PMID:31411179
Background & objectives: Ghrelin is an orexigenic gut hormone expressed by the gastric fundus. Laparoscopic sleeve gastrectomy (LSG) procedure involves resection of the gastric fundus leading to a decreased appetite and weight loss. This study was undertaken to determine the levels of plasma ghrelin after sleeve gastrectomy in obese patients. Methods: The study was conducted on 90 morbidly obese patients [body mass index (BMI) >40 kg/m[2]] and severely obese patients (BMI >35/kg/m[2]) who underwent sleeve gastrectomy. The patients were followed up for six months. Weight loss parameters and plasma ghrelin levels were assessed pre- and postoperatively. Results: A significant weight loss and decrease in BMI were observed at three and six months postoperatively. A significant decrease in plasma ghrelin levels over six months of follow up postoperatively was also seen. Interpretation & conclusions: These preliminary findings indicated inhibition of ghrelin production after LSG leading to a decrease in the plasma ghrelin levels within a few days of surgery and sustainable weight loss in obese patients.
  526 144 -
Elevated levels of glutathionyl haemoglobin as an oxidative stress marker in patients with major depressive disorder
Boby Mathew, Krishnamachari Srinivasan, Pradeep Johnson, Tinku Thomas, Amit Kumar Mandal
April 2019, 149(4):497-502
DOI:10.4103/ijmr.IJMR_586_17  PMID:31411173
Background & objectives: Oxidative stress has been implicated in the pathophysiology of major depressive disorder (MDD), but biomarkers to assess oxidative stress in patients with MDD have yielded ambiguous results. Glutathionyl haemoglobin (GS-Hb) has been reported as a stable and potential biomarker for oxidative stress in various clinical conditions. The objective of the study was to evaluate GS-Hb as a potential biomarker of oxidative stress in patients with MDD through its quantification and to compare the levels of GS-Hb in age- and gender-matched healthy controls. Methods: The levels of GS-Hb were estimated using liquid chromatography coupled to electrospray ionization mass spectrometry in patients diagnosed with MDD and in a subset of patients after six weeks of treatment with selective serotonin reuptake inhibitors (SSRIs). Results: GS-Hb levels in drug-naïve patients with MDD (n=26) were significantly elevated compared to matched healthy controls (n=17). GS-Hb levels were not significantly different between MDD patients with and without co-morbid anxiety disorders. There were no significant differences in GS-Hb levels following six weeks of treatment with SSRIs compared to baseline. Interpretation & conclusions: Compared to controls, GS-Hb level in patients with MDD was significantly elevated, suggestive of increased oxidative stress associated with MDD. However, six weeks of antidepressant treatment was not sufficient to modify the alterations in antioxidant/oxidant system. Further studies need to be done with a large sample of MDD patients with a longer duration of antidepressant treatment.
  498 166 1
Anand K Annamalai, Kothandaramaraju Padmini
April 2019, 149(4):561-562
DOI:10.4103/ijmr.IJMR_2018_17  PMID:31411183
  412 223 -
Influence of hepatocyte growth factor-transfected bone marrow-derived mesenchymal stem cells towards renal fibrosis in rats
Mingbu Xie, Jianxin Wan, Fengxia Zhang, Ruifang Zhang, Zhenhuan Zhou, Danyou You
April 2019, 149(4):508-516
DOI:10.4103/ijmr.IJMR_1527_16  PMID:31411175
Background & objectives: Hepatocyte growth factor (HGF) produced by endothelial cells, fibroblasts, fat cells and other interstitial cells, can promote angiogenesis, repair damaged tissues and resist fibrosis. Mesenchymal stem cells (MSCs) are located in bone marrow and secrete a variety of cytokines and are often used in the repair and regeneration of damaged tissues. This study was aimed to investigate the influence of HGF-transfected bone marrow-derived MSCs towards renal fibrosis in rats. Methods: The HGF gene-carrying adenoviral vector (Ad-HGF) was transfected into MSCs, and the Ad-HGF-modified MSCs were transplanted into rats with unilateral ureteral obstruction (UUO). The localization of renal transplanted cells in the frozen section was observed with fluorescence microscope. The Masson's trichrome staining was performed to observe the renal collagen deposition, and the immunohistochemistry was performed to detect the expressions of α-smooth muscle actin (α-SMA) and HGF in renal tissues. Reverse transcription (RT)-PCR was used to detect the mRNA expressions of α-SMA, HGF and fibronectin (FN). Results: Ad-HGF-modified MSCs could highly express HGF in vitro. On the post-transplantation 3rd, 7th and 14th day, the 4',6-diamidino-2-phenylindole (DAP)-labelled transplanted cells were seen inside renal tissues. Compared with UUO group, the renal collagen deposition in transplantation group was significantly reduced, and the expressions of α-SMA mRNA and protein were significantly decreased, while the expressions of HGF mRNA and protein were significantly increased, and the expression of FN mRNA was significantly decreased (P<0.001). Interpretation & conclusions: Trans-renal artery injection of HGF-modified MSCs can effectively reduce the renal interstitial fibrosis in UUO rat model.
  469 150 1
Evaluation of various culture techniques for identification of hookworm species from stool samples of children
Onila Nongmaithem, T Shantikumar, Sudip Dutta
April 2019, 149(4):539-543
DOI:10.4103/ijmr.IJMR_938_17  PMID:31411178
  380 177 1
Synergist piperonyl butoxide enhances the efficacy of deltamethrin in deltamethrin-resistant Anopheles culicifacies sensu lato in malaria endemic districts of Odisha State, India
Sudhansu Sekhar Sahu, Smrutidhara Dash, Thankachy Sonia, Kasinathan Gunasekaran
April 2019, 149(4):554-557
DOI:10.4103/ijmr.IJMR_144_18  PMID:31411181
  422 119 2
Detection of Haitian ctxB7 & tcpA alleles in Vibrio cholerae O1 El Tor biotype in Puri, Odisha, India
Anna Salomi Kerketta, Shantanu Kumar Kar, Hemant Kumar Khuntia
April 2019, 149(4):558-560
DOI:10.4103/ijmr.IJMR_1130_17  PMID:31411182
  408 113 -
Antibody therapy: Substitution-immunomodulation -monoclonal immunotherapy
Narinder K Mehra
April 2019, 149(4):563-565
  237 116 -