Neurosciences in Rural Practice

Migraine and mood disorders: Prevalence, clinical correlations, and disability Sita Jayalakshmi, Sudhindra Vooturi Journal of Neurosciences in Rural Practice 2019 10(1):1-2

A new era in stereotactic brain biopsy: Frameless navigation-based system Murat Şakir Ekşi Journal of Neurosciences in Rural Practice 2019 10(1):3-3

Anxiety, depression, and its relationship with migraine Vimal Kumar Paliwal Journal of Neurosciences in Rural Practice 2019 10(1):4-5

Central nervous system tuberculosis – The gray area in tuberculosis treatment Joe James Journal of Neurosciences in Rural Practice 2019 10(1):6-7

Utilization of "Screening brief intervention and referral to treatment" approach for tobacco addiction in day-to-day clinical practice in India: The need of the hour Roshan Bhad Journal of Neurosciences in Rural Practice 2019 10(1):8-9

Geographical disparity and traumatic brain injury in America: Rural areas suffer poorer outcomes B Brown Joshua, Kheng Marin, A Carney Nancy, M Rubiano Andres, Puyana Juan Carlos Journal of Neurosciences in Rural Practice 2019 10(1):10-15 Introduction: Significant heterogeneity exists in traumatic brain injury (TBI) outcomes. In the United States, TBI remains a primary driver of injury-related mortality and morbidity. Prior work has suggested that disparity exists in rural areas; our objective was to evaluate potential differences in TBI mortality across urban and rural areas on a national scale. Methods: Age-adjusted TBI fatality rates were obtained at the county level across the U.S. from 2008 to 2014. To evaluate geography, urban influence codes (UIC) were also obtained at the county level. UIC codes range from 1 (most urban) to 12 (most rural). Metropolitan counties are defined as those with an UIC ≤2, while nonmetropolitan counties are defined as an UIC ≥3. County-level fatality rates and UIC classification were geospatially mapped. Linear regression was used to evaluate the change in TBI fatality rate at each category of UIC. The median TBI fatality rate was also compared between metropolitan and nonmetropolitan counties. Results: Geospatial analysis demonstrated higher fatality rates distributed among nonmetropolitan counties across the United States. The TBI fatality rate was 13.00 deaths per 100,000 persons higher in the most rural UIC category compared to the most urban UIC category (95% confidence interval 12.15, 13.86; P < 0.001). The median TBI rate for nonmetropolitan counties was significantly higher than metropolitan counties (22.32 vs. 18.22 deaths per 100,000 persons, P < 0.001). Conclusions: TBI fatality rates are higher in rural areas of the United States. Additional studies to evaluate the mechanisms and solutions to this disparity are warranted and may have implications for lower-and middle-income countries.

Vitamin D deficiency in children with psychiatric illness in a tertiary care hospital in North India Nidhi Chauhan, Susanta Kumar Padhy, Ruchita Shah, Savita Malhotra Journal of Neurosciences in Rural Practice 2019 10(1):16-20 Background: Vitamin D is increasingly recognized as important for brain health, apart from its role in endocrine and bone health. There is a growing recognition of worldwide “epidemic” of Vitamin D deficiency, and growing data from adult population illustrate the association between Vitamin D deficiency and psychiatric disorders. In children, its role is implicated in brain development, function, and psychiatric disorders. Aim: The aim of this study was to study the extent of Vitamin D deficiency in children and adolescents with psychiatric disorders. Methodology: Retrospective chart review of participants, who had attended the psychiatry outpatient department, was conducted to ascertain the extent of blood Vitamin D level requisition and its level. Results: Out of 836, 60 participants had received the requisition for blood Vitamin D level, and results were documented for 40 participants (males – 28; females – 12). No specific reason was cited for getting Vitamin D level done. The mean Vitamin D level was in the deficient range, i.e. 13.34 ng/ml with 80% of the sample having Vitamin D deficiency and 13% having insufficient Vitamin D level. More males had Vitamin D deficiency, however, the small number of females in the study limits the generalizability of the results. Among the diagnostic categories, neurodevelopmental disorders had lower mean Vitamin D level, with lowest Vitamin D for autism, i.e., 10.9 ng/ml. Conclusion: The cause-effect relationship between Vitamin D deficiency and childhood psychiatric disorders could not be derived from the study. However, it provides important initial data for the relationship between Vitamin D deficiency and childhood psychiatric disorders from India.

Role of decompressive laminectomy without instrumentation in the management of nurick Grade 4 and 5 cervical compressive myelopathy Sunil Malagi, Subhas Konar, Dhaval P Shukla, Dhananjaya I Bhat, Nishanth Sadashiva, Bhagavatula I Indira Devi Journal of Neurosciences in Rural Practice 2019 10(1):21-27 Introduction: Cervical laminectomy is a very well-known posterior decompressive procedure for cervical compressive myelopathy (CCM). Our objective is to evaluate the functional effect of posterior decompressive laminectomy for poor grade CCM. Methods: This study was an observational retrospective study carried out on patients with poor-grade CCM who underwent decompressive laminectomy from January 2010 to December 2015. Patients with Nurick Grades 4 and 5 (walking with support or bedbound) were included in the study. Clinical data and radiological information were collected from medical records, and objective scales were applied to compare the surgical outcome between preoperative score and postoperative score. Results: A total of 69 patients who underwent decompressive laminectomy for poor grade CCM were included. The mean age was 54.9 years, and the male-to-female ratio was 5.3:1. Ossified posterior longitudinal ligament comprised 52.6% cases. The follow-up data of at least 6 months' duration after surgery was available for 57 (82.6%) cases. On comparing with preoperative Nurick grade at follow-up, 40 of the 57 patients (70.2%) were found to have improvement following surgery by at least one grade. The remaining 17 (29.8%) had either remained the same or had deteriorated further. The mean preoperative modified Japanese Orthopedic Association score was 8.4 ± 2.8, and the mean follow-up score was 11.8±0.3 (P = 0.0001). On multivariate analysis, the number of levels of laminectomy, postoperative deterioration, and anesthesia grade were predictors of outcome. Conclusion: Decompressive laminectomy for poor grade myelopathy is effective in improving functional outcome.

Migraine and mood disorders: Prevalence, clinical correlations and disability K Rammohan, Shyma Manikkoth Mundayadan, Soumitra Das, C Velayudhan Shaji Journal of Neurosciences in Rural Practice 2019 10(1):28-33 Introduction: Both migraine and mood disorders are prevalent disorders with many studies demonstrating that they are comorbid with each other with increased migraine-related disability in such patients. Aim: The aim of the study is to test the hypothesis that mood disorders are comorbid with migraine with increased disability and to identify any clinical features in migraineurs which may be associated with mood disorders. Materials and Methods: Patients presenting with complaints of headache to the Neurology Outpatient Department of a Tertiary CARE Hospital from August 01, 2016 to February 28, 2017, were subjected to International Classification of Headache Disorder 3 beta criteria to satisfy a diagnosis of migraine and were assessed in detail as to headache characteristics. Mood disorders were assessed by Hospital Anxiety and Depression Scale and migraine-related disability was assessed by Migraine Disability Assessment Questionnaire. Patients with serious medical complaints, known previous psychiatric disease, other types of headaches and recent prophylactic drug intake were carefully excluded. Results: A total of 133 patients were studied. The duration and frequency of migraine headaches were found to correlate with the presence of mood disorders and the migraine-related disability in patients with comorbid mood disorders was significantly higher. Factors such as total duration of migraine, aura, vomiting, phono, and photophobia were not found to be statistically correlated with mood disorders. Conclusions: Rates of depression and anxiety in migraine vary widely in various studies due to variations in study criteria, population characteristics and various scales used. We found a prevalence of 16.54% of anxiety and 9.02% of depression in migraineurs, a rate comparable to or less than many studies in international literature and a significantly increased disability in individuals with comorbid mood disorders and migraine. Routinely including questionnaires such as HAD in screening patients with migraine to rule out comorbid mood disorders may be warranted. Because we have carefully excluded all other primary (especially tension and medication overuse headaches) and secondary headaches and selected prophylactic drug naïve patients, we contend that this study provides a clear clinical profile of migraineurs with mood disorders.

Is crush cytology of central nervous system lesions relevant in surgical practice today? Krishan Kumar Yadav, Rashmi Bhatti, Nikhil Moorchung, Deepti Mutreja, Ajay S Carvalho Journal of Neurosciences in Rural Practice 2019 10(1):34-38 Background: Intraoperative crush cytology is a useful tool for diagnosing the lesions of the central nervous system (CNS). However, because of the development of newer and better imaging techniques, it is important to evaluate if crush cytology is still relevant in neurosurgical practice. Aims: We evaluated the crush cytology smears in a series of cases where neurosurgical intervention was performed. We studied the role of crush cytology in the intraoperative diagnosis. We report a series of cases where intraoperative crush cytology helped the surgeon revise the surgery during the operation. Materials and Methods: A small portion of all CNS lesions was taken intraoperatively and the tissue was crushed between two slides. The slide was stained using the toluidine blue, Leishman stain, Pap stain and a routine H &#38; E stain. The slides were the evaluated. Results: We evaluated the 50 cases of CNS lesions. We found that intraoperative crush cytology is particularly important in differentiating between neoplastic and nonneoplastic CNS lesions. It may also help in differentiating lymphomas from high-grade gliomas. Finally, crush cytology may help the surgeon in delineating the lesions during surgery. Conclusion: We conclude that crush cytology remains relevant in neurosurgical practice today and it should be adopted in all neurosurgical centers as a routine diagnostic technique.  EDITORIALS   Migraine and mood disorders: Prevalence, clinical correlations, and disability p. 1 Sita Jayalakshmi, Sudhindra Vooturi DOI:10.4103/jnrp.jnrp_323_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta A new era in stereotactic brain biopsy: Frameless navigation-based system p. 3 Murat Şakir Ekşi DOI:10.4103/jnrp.jnrp_281_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Anxiety, depression, and its relationship with migraine p. 4 Vimal Kumar Paliwal DOI:10.4103/jnrp.jnrp_321_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Central nervous system tuberculosis – The gray area in tuberculosis treatment  p. 6 Joe James DOI:10.4103/jnrp.jnrp_229_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Utilization of "Screening brief intervention and referral to treatment" approach for tobacco addiction in day-to-day clinical practice in India: The need of the hour p. 8 Roshan Bhad DOI:10.4103/jnrp.jnrp_271_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta ORIGINAL ARTICLES Geographical disparity and traumatic brain injury in America: Rural areas suffer poorer outcomes p. 10 B Brown Joshua, Kheng Marin, A Carney Nancy, M Rubiano Andres, Puyana Juan Carlos DOI:10.4103/jnrp.jnrp_310_18   Introduction: Significant heterogeneity exists in traumatic brain injury (TBI) outcomes. In the United States, TBI remains a primary driver of injury-related mortality and morbidity. Prior work has suggested that disparity exists in rural areas; our objective was to evaluate potential differences in TBI mortality across urban and rural areas on a national scale. Methods: Age-adjusted TBI fatality rates were obtained at the county level across the U.S. from 2008 to 2014. To evaluate geography, urban influence codes (UIC) were also obtained at the county level. UIC codes range from 1 (most urban) to 12 (most rural). Metropolitan counties are defined as those with an UIC ≤2, while nonmetropolitan counties are defined as an UIC ≥3. County-level fatality rates and UIC classification were geospatially mapped. Linear regression was used to evaluate the change in TBI fatality rate at each category of UIC. The median TBI fatality rate was also compared between metropolitan and nonmetropolitan counties. Results: Geospatial analysis demonstrated higher fatality rates distributed among nonmetropolitan counties across the United States. The TBI fatality rate was 13.00 deaths per 100,000 persons higher in the most rural UIC category compared to the most urban UIC category (95% confidence interval 12.15, 13.86; P < 0.001). The median TBI rate for nonmetropolitan counties was significantly higher than metropolitan counties (22.32 vs. 18.22 deaths per 100,000 persons, P < 0.001). Conclusions: TBI fatality rates are higher in rural areas of the United States. Additional studies to evaluate the mechanisms and solutions to this disparity are warranted and may have implications for lower-and middle-income countries. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Vitamin D deficiency in children with psychiatric illness in a tertiary care hospital in North India p. 16 Nidhi Chauhan, Susanta Kumar Padhy, Ruchita Shah, Savita Malhotra DOI:10.4103/jnrp.jnrp_169_18   Background: Vitamin D is increasingly recognized as important for brain health, apart from its role in endocrine and bone health. There is a growing recognition of worldwide "epidemic" of Vitamin D deficiency, and growing data from adult population illustrate the association between Vitamin D deficiency and psychiatric disorders. In children, its role is implicated in brain development, function, and psychiatric disorders. Aim: The aim of this study was to study the extent of Vitamin D deficiency in children and adolescents with psychiatric disorders. Methodology:Retrospective chart review of participants, who had attended the psychiatry outpatient department, was conducted to ascertain the extent of blood Vitamin D level requisition and its level. Results: Out of 836, 60 participants had received the requisition for blood Vitamin D level, and results were documented for 40 participants (males – 28; females – 12). No specific reason was cited for getting Vitamin D level done. The mean Vitamin D level was in the deficient range, i.e. 13.34 ng/ml with 80% of the sample having Vitamin D deficiency and 13% having insufficient Vitamin D level. More males had Vitamin D deficiency, however, the small number of females in the study limits the generalizability of the results. Among the diagnostic categories, neurodevelopmental disorders had lower mean Vitamin D level, with lowest Vitamin D for autism, i.e., 10.9 ng/ml. Conclusion: The cause-effect relationship between Vitamin D deficiency and childhood psychiatric disorders could not be derived from the study. However, it provides important initial data for the relationship between Vitamin D deficiency and childhood psychiatric disorders from India. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Role of decompressive laminectomy without instrumentation in the management of nurick Grade 4 and 5 cervical compressive myelopathy p. 21 Sunil Malagi, Subhas Konar, Dhaval P Shukla, Dhananjaya I Bhat, Nishanth Sadashiva, Bhagavatula I Indira Devi DOI:10.4103/jnrp.jnrp_254_18   Introduction: Cervical laminectomy is a very well-known posterior decompressive procedure for cervical compressive myelopathy (CCM). Our objective is to evaluate the functional effect of posterior decompressive laminectomy for poor grade CCM. Methods: This study was an observational retrospective study carried out on patients with poor-grade CCM who underwent decompressive laminectomy from January 2010 to December 2015. Patients with Nurick Grades 4 and 5 (walking with support or bedbound) were included in the study. Clinical data and radiological information were collected from medical records, and objective scales were applied to compare the surgical outcome between preoperative score and postoperative score. Results: A total of 69 patients who underwent decompressive laminectomy for poor grade CCM were included. The mean age was 54.9 years, and the male-to-female ratio was 5.3:1. Ossified posterior longitudinal ligament comprised 52.6% cases. The follow-up data of at least 6 months' duration after surgery was available for 57 (82.6%) cases. On comparing with preoperative Nurick grade at follow-up, 40 of the 57 patients (70.2%) were found to have improvement following surgery by at least one grade. The remaining 17 (29.8%) had either remained the same or had deteriorated further. The mean preoperative modified Japanese Orthopedic Association score was 8.4 ± 2.8, and the mean follow-up score was 11.8±0.3 (P = 0.0001). On multivariate analysis, the number of levels of laminectomy, postoperative deterioration, and anesthesia grade were predictors of outcome. Conclusion: Decompressive laminectomy for poor grade myelopathy is effective in improving functional outcome. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Migraine and mood disorders: Prevalence, clinical correlations and disability p. 28 K Rammohan, Shyma Manikkoth Mundayadan, Soumitra Das, C Velayudhan Shaji DOI:10.4103/jnrp.jnrp_146_18   Introduction: Both migraine and mood disorders are prevalent disorders with many studies demonstrating that they are comorbid with each other with increased migraine-related disability in such patients. Aim: The aim of the study is to test the hypothesis that mood disorders are comorbid with migraine with increased disability and to identify any clinical features in migraineurs which may be associated with mood disorders. Materials and Methods: Patients presenting with complaints of headache to the Neurology Outpatient Department of a Tertiary CARE Hospital from August 01, 2016 to February 28, 2017, were subjected to International Classification of Headache Disorder 3 beta criteria to satisfy a diagnosis of migraine and were assessed in detail as to headache characteristics. Mood disorders were assessed by Hospital Anxiety and Depression Scale and migraine-related disability was assessed by Migraine Disability Assessment Questionnaire. Patients with serious medical complaints, known previous psychiatric disease, other types of headaches and recent prophylactic drug intake were carefully excluded. Results: A total of 133 patients were studied. The duration and frequency of migraine headaches were found to correlate with the presence of mood disorders and the migraine-related disability in patients with comorbid mood disorders was significantly higher. Factors such as total duration of migraine, aura, vomiting, phono, and photophobia were not found to be statistically correlated with mood disorders. Conclusions:Rates of depression and anxiety in migraine vary widely in various studies due to variations in study criteria, population characteristics and various scales used. We found a prevalence of 16.54% of anxiety and 9.02% of depression in migraineurs, a rate comparable to or less than many studies in international literature and a significantly increased disability in individuals with comorbid mood disorders and migraine. Routinely including questionnaires such as HAD in screening patients with migraine to rule out comorbid mood disorders may be warranted. Because we have carefully excluded all other primary (especially tension and medication overuse headaches) and secondary headaches and selected prophylactic drug naïve patients, we contend that this study provides a clear clinical profile of migraineurs with mood disorders. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Is crush cytology of central nervous system lesions relevant in surgical practice today? p. 34 Krishan Kumar Yadav, Rashmi Bhatti, Nikhil Moorchung, Deepti Mutreja, Ajay S Carvalho DOI:10.4103/jnrp.jnrp_222_18   Background: Intraoperative crush cytology is a useful tool for diagnosing the lesions of the central nervous system (CNS). However, because of the development of newer and better imaging techniques, it is important to evaluate if crush cytology is still relevant in neurosurgical practice. Aims: We evaluated the crush cytology smears in a series of cases where neurosurgical intervention was performed. We studied the role of crush cytology in the intraoperative diagnosis. We report a series of cases where intraoperative crush cytology helped the surgeon revise the surgery during the operation. Materials and Methods: A small portion of all CNS lesions was taken intraoperatively and the tissue was crushed between two slides. The slide was stained using the toluidine blue, Leishman stain, Pap stain and a routine H & E stain. The slides were the evaluated. Results: We evaluated the 50 cases of CNS lesions. We found that intraoperative crush cytology is particularly important in differentiating between neoplastic and nonneoplastic CNS lesions. It may also help in differentiating lymphomas from high-grade gliomas. Finally, crush cytology may help the surgeon in delineating the lesions during surgery. Conclusion: We conclude that crush cytology remains relevant in neurosurgical practice today and it should be adopted in all neurosurgical centers as a routine diagnostic technique. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Economic cost of schizophrenia in a Nigerian Teaching Hospital p. 39 Ibidunni Olapeju Oloniniyi, Adesanmi Akinsulore, Olutayo Olubunmi Aloba, Boladale Moyosore Mapayi, Olakunle Ayokunmi Oginni, Roger Makanjuola DOI:10.4103/jnrp.jnrp_210_18   Objective: This study evaluated the economic cost of schizophrenia in Nigerian patients and identified factors that influence cost. Methods: A total of 100 participants with schizophrenia were assessed using the modified economic cost questionnaire, the mini-international neuropsychiatric interview, the positive and negative syndrome scale, the Liverpool University Neuroleptic side-effect rating scale, and the global assessment of functioning scale. Associations between sociodemographic characteristics, illness-related variables and direct, indirect, and total costs of schizophrenia were assessed. Results: The average annual total, direct, and indirect costs of the treatment were $818.48, $349.59, and $468.89, respectively, per patient. The direct cost constituted 42.7%, while the indirect cost was 57.3% of the total costs of treatment. Hospitalization was the leading contributor to the direct cost, while productivity loss was a major component of the indirect cost. Conclusion: Schizophrenia is an expensive disease in Nigeria, measures to reduce hospitalization could significantly reduce the cost of illness to the patient and their relatives. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta To compare diagnostic ability of contrast-enhanced three-dimensional T1-SPACE with three-dimensional fluid-attenuated inversion recovery and three-dimensional T1-magnetization prepared rapid gradient echo magnetic resonance sequences in patients of meningitis p. 48 Sudesh Kumar, Suresh Kumar, Mukesh Surya, Anjali Mahajan, Sanjiv Sharma DOI:10.4103/jnrp.jnrp_157_18   Aims: The aim of this study is to compare postcontrast three-dimensional (3D) T1-Sampling perfection with application-optimized contrasts by using different flip angle evolutions, 3D fluid-attenuated inversion recovery (FLAIR), and 3D T1-magnetization prepared rapid gradient echo (MPRAGE) sequences in patients of meningitis. Settings and Design: A hospital-based cross-sectional study done in the Department of Radiodiagnosis, IGMC Shimla for a period of 1 year from June 1, 2016, to May 30, 2017. Subjects and Methods: A total of 30 patients suspected of meningitis underwent magnetic resonance imaging evaluation with postcontrast 3D T1-MPRAGE, 3D T1-SPACE, and 3D FLAIR sequences. The abnormal leptomeningeal enhancement was noted by two radiologists together on these sequences and scores were given to the abnormal leptomeningeal enhancement. Statistical Analysis Used: The sensitivity of 3D T1-SPACE, 3D T1-MPRAGE, and 3D FLAIR was calculated and compared. The level of agreement between these sequences was assessed by kappa coefficient. P < 0.05 was taken as statistically significant. Results: 3D T1-SPACE shows superiority in meningeal enhancement along basal cisterns, Sylvian fissure and along cerebral convexities. It is also found to be better in delineating parenchymal lesions. 3D FLAIR failed to demonstrate enhancement along cerebral convexities however found to be better than 3D T1-MPRAGE in delineating enhancement along basal cisterns and Sylvian fissures. 3D T1-MPRAGE has shown subtle enhancement in basal cisterns, Sylvian fissure and along cerebral convexities. 3D T1-SPACE, 3D FLAIR, and 3D T1-MPRAGE has sensitivity of 91.67%, 66.67%, and 54.17%, respectively. Conclusion: Postcontrast 3D T1-SPACE sequence is an excellent tool than postcontrast 3D T1-MPRAGE and 3D FLAIR sequences in the evaluation of meningeal enhancement and depiction of additional lesions in brain parenchyma. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Caregiver's psychosocial concerns and psychological distress in emergency and trauma care setting p. 54 TR Kanmani, Birudu Raju DOI:10.4103/jnrp.jnrp_129_18   Background: Traumatic brain injury (TBI) will be the third largest killer by the year 2020 in the world. It creates the great amount of morbidity, disability, mortality, and reduces the psychosocial well-being of the patients and their caregivers. Hence, the current paper aimed to explore the psychosocial distress and caregivers' concerns in emergency and trauma care (ETC) setting. Methodology: This study adopted qualitative research design. All caregivers of TBI survivors were considered as a universe of the study. A total of 50 caregivers were recruited, and the predesigned questionnaire was administered. Depression, anxiety, stress scale was used to identify the caregivers' depression, stress, and anxiety. The simple thematic analysis was used to derive the themes from the verbatim data. Data were analyzed using SPSS version 21.0 (SPSS South Asia Pvt.Ltd, Bengaluru, Karnataka, India). Results: In the quantitative analysis, caregivers' mean age was found to be 45 (mean = 45.00 ± 13.83) years. Caregivers had experienced mild depression (13.36 ± 3.07), moderate anxiety (13.70 ± 3.03), and minimum stress (13.66 ± 2.98) levels. Qualitative results identified the following themes: difficulty in accessing timely care, uncertainty about the prognosis and future, family concerns and financial constraints, personal feelings and personal needs, and supportive care. Chi-square test revealed that there was no significant association between gender and depression (χ2 = 2.381 P < 0.12), anxiety (χ2 = 0.01 P < 0.92), and stress (χ2 = 0.235 P < 0.61) levels of caregivers. Conclusion: To accomplish, providing psychosocial care in ETC setting, the role of psychiatric social workers is pivotal. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Patterns of illness behaviors and its correlates in patients with chronic nonorganic pain p. 60 Geetha Desai, Thennarasu Kandavel, Santosh K Chaturvedi DOI:10.4103/jnrp.jnrp_199_18   Background: Illness behaviors if abnormal can have significant influence in presentations of chronic pain. The aim of the study was to derive the patterns of illness behaviors and its correlates in subjects with chronic nonorganic pain. Methods: Illness Behavior Questionnaire (IBQ) was administered to 301 adult individuals with chronic nonorganic pain. Factor analysis was performed on the IBQ, and relationships of the dimensions of illness behavior with clinical and demographic variables were computed. Results: Majority of the sample consisted of women (n = 208; 69%) with 43% from rural background and 58% from below poverty line status. Principal axis factoring resulted in four factors, namely health concerns, affective inhibition (AI), bodily distress, and affective distress with psychosocial problems. The three factors excluding AI had significant intercorrelation among them. There was significant difference in mean scores of factors, bodily distress and affective distress in patients from urban and rural background. Conclusions: Illness behaviors in chronic nonorganic pain can be understood as three interrelated factors-health concerns, affective distress with psychosocial problems, and bodily distress. AI might be an independent factor for presentation of chronic nonorganic pain. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta The pattern of psychiatric morbidity in chronic obstructive pulmonary disease: A cross-sectional, Case–Control study from a tertiary care hospital in Kashmir, North India  p. 65 Shabir Ahmad Dar, Bilal Ahmad Bhat, Naveed Nazir Shah, Syed Bushra Imtiyaz DOI:10.4103/jnrp.jnrp_244_18   Introduction: Psychiatric morbidity has an increased prevalence in chronic obstructive pulmonary disease (COPD). Patients overall psychosocial status plays an important role in the development of depression which, when major, is said to occur in 19%–42% of cases of COPD. We aimed to study patterns of psychosocial issues in patients with COPD. Materials and Methods: This study was conducted over a period of 6 months in an Outpatient Department of Government Chest Disease Hospital Srinagar. A total of 100 COPD patients and 100 sex- and age-matched controls were included in this study and compared. The diagnosis of COPD was assessed by spirometry. Patterns of psychiatric morbidities were assessed using the Mini-International Neuropsychiatric Interview. Results: The frequency of psychiatric comorbidities was significantly higher (P < 0.001) in COPD patients (47%) as compared to controls (12%). The highest frequency of psychiatric morbidities in COPD patients was major depressive episode in 28% in comparison to 9% of controls. Other morbidities include panic disorder, dysthymia, generalized anxiety disorder, and suicidality. Conclusion: The frequency of psychiatric morbidities is increased in COPD patients as compared to controls. We recommend that all patients with COPD should be screened for psychiatric morbidity as there is enough scope for psychiatric services to be made available to these patients. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Clinical spectrum of central nervous system tuberculosis and the efficacy of revised national tuberculosis control program in its management p. 71 E Uma Maheswari, RM Bhoopathy, K Bhanu, Heber Anandan DOI:10.4103/jnrp.jnrp_163_18   Introduction: Tuberculosis (TB) is a major global problem and poses a threat which is of considerable magnitude, with an estimated one-third of the population infected with TB bacillus. Aim: The aim of this study is to study the treatment outcomes in patients with various forms of neurological TB treated with the standardized Revised National TB Control Program (RNTCP), directly observed treatment short-course (DOTS). Materials and Methods: Patients diagnosed to have TBM, tuberculoma with or without spinal arachnoiditis (central nervous system tuberculosis-TB [CNS-TB]) were categorized as per the RNTCP guidelines and received DOTS Category I or Category II thrice-weekly intermittent treatment as deemed appropriate. Results: The outcome of management with the standard RNTCP DOTS regimen was that a success rate (treatment completed) of 75%, the default rate of 6.6%, and a mortality of 3.3%. The target fixed by the RNTCP is to achieve a cure rate of 85%. We were able to document successful completion of treatment in 75% which is close to the target fixed by RNTCP. The default rate is 6.6% which quite negligible when compared to the unsupervised therapy which has a default rate of 50%. Conclusion: The most important factor in predicting the outcome of treatment in CNS-TB is early diagnosis and the timing of initiation of antituberculous treatment. Early initiation of treatment is associated with better treatment outcomes. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Diagnostic yield and complication of frameless stereotactic brain biopsy p. 78 Chin Taweesomboonyat, Thara Tunthanathip, Sakchai Sae-Heng, Thakul Oearsakul DOI:10.4103/jnrp.jnrp_166_18   Background: With the advancement of neuronavigation technologies, frameless stereotactic brain biopsy has been developed. Previous studies proved that frameless stereotactic brain biopsy was as effective and safe as frame-based stereotactic brain biopsy. The authors aimed to find the factors associated with diagnostic yield and complication rate of frameless intracranial biopsy. Materials and Methods: Frameless stereotactic brain biopsy procedures, between March 2009 and April 2017, were retrospectively reviewed from medical records including imaging studies. Using logistic regression analysis, various factors were analyzed for association with diagnostic yield and postoperative complications. Results: Eighty-nine frameless stereotactic brain biopsy procedures were performed on 85 patients. The most common pathology was primary central nervous system lymphoma (43.8%), followed by low-grade glioma (15.7%), and high-grade glioma (15%), respectively. The diagnostic yield was 87.6%. Postoperative intracerebral hematoma occurred in 19% of cases; however, it was symptomatic in only one case. The size of the lesion was associated with both diagnostic yield and postoperative intracerebral hematoma complication. Lesions, larger than 3 cm in diameter, were associated with a higher rate of positive biopsy result (P= 0.01). Lesion 3 cm or smaller than 3 cm in diameter, and intraoperative bleeding associated with a higher percentage of postoperative intracerebral hematoma complications (P = 0.01). Conclusions: For frameless stereotactic brain biopsy, the size of the lesion is the essential factor determining diagnostic yield and postoperative intracerebral hematoma complication. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Surgical experience in pediatric patients with Chiari-I malformations aged ≤18 years p. 85 Ghanshyam Das Singhal, Shakti Singhal, Gunjan Agrawal, Deepti Singhal, Vipin Arora DOI:10.4103/jnrp.jnrp_160_18   Objective: The objective of this study was to retrospectively study Chiari I malformation patients (<18 years) treated surgically. Materials and Methods: Chiari I malformation patients (<18 years) treated surgically at our institute were retrospectively studied. Results: During the study period between January 1999 and June 2011, fifty patients, aged ≤18 years with Chiari malformation, were treated surgically and formed the basis for this series. There were 21 female children (42%) and 29 male children (58%), with a female-to-male ratio of 1:1. At the last follow-up, oropharyngeal symptoms were improved in 33% (n = 3/9). Headache/neck/back pain improved in 69.56% of children (n = 16/23). Upper-extremity pain/weakness/numbness improved in 73.91% of children (n = 17/23). Ataxia improved in 66.66% of children (n = 4/6). Lower-limb weakness/hyperreflexia improved in 83.33% of children (n = 5/6). At follow-up, magnetic resonance imaging for patients with syrinx was available for 75% of patients (n = 30/50) and not available for 25% of patients (n = 10/40). Syrinx was diminished in size or resolved in 66.33% of patients (n = 19/30) and the remaining was same for 36.66% of patients (n = 11/30). Conclusions: The main goal of surgery is to arrest the progression of neurological deficits. Foramen magnum decompression with a lax duroplasty is the surgical procedure of choice. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Construct validation and reliability assessment of tamil version of epworth sleepiness scale to evaluate daytime sleepiness among adolescents in rural Puducherry, South India  p. 89 Yuvaraj Krishnamoorthy, Gokul Sarveswaran, Manikandanesan Sakthivel, A Kalaiselvy, Marie Gilbert Majella, Subitha Lakshminarayanan DOI:10.4103/jnrp.jnrp_168_18   Background: Epworth sleepiness scale (ESS) has been used widely in the assessment of daytime sleepiness for research and clinical purposes. Hence, this study was done to translate the ESS in Tamil and to assess the construct validity and reliability of the Tamil version among adolescents in rural Puducherry, South India. Materials and Methods: Translation of the ESS by native language experts and pilot tested with subsample of adolescents. Final Tamil version was administered among 789 Tamil-speaking adolescents in the selected villages of rural Puducherry (union territory in South India). Construct validity was assessed by exploratory factor analysis through principal component method. Confirmatory factor analysis was done to obtain the goodness-of-fit. Reliability of questionnaire was assessed through Cronbach's alpha coefficient. Results: Two factor structures were obtained with Eigenvalues of 3.49 and 1.09, respectively. Both factors accounted for about 57.4% of the variance. Two-factor model assessed by confirmatory factor method found Chi-square value of 215.57 (P < 0.001). Goodness-of-fit revealed acceptable comparative fit indices (0.91). The reliability coefficient (Cronbach's alpha) for complete ESS was 0.81. Factor-based analysis showed that the Cronbach's reliability coefficient was 0.83 and 0.75 for the first and second factor, respectively. Conclusion: Our study concludes that the ESS questionnaire is internally valid and consistent with good reliability coefficient for application in Tamil-speaking rural adolescents. However, further research can be done to content validate the questionnaire with standard diagnostic tool. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Serum interleukin-6 is not linked with sleep-quality, restless legs syndrome, and depression, but with 6-month survival in hematological malignancies p. 94 Smita Chandra, Vibha Gupta, Harish Chandra, Mohan Dhyani, Aarti Kotwal, Sanjiv Kumar Verma, Ravi Gupta DOI:10.4103/jnrp.jnrp_159_18   Background: Serum interleukin (IL)-6 has been found to be associated with sleep quality, mood, and survival in patients with solid tumors. Results in these studies were confounded by knowledge of diagnosis to study subjects. Moreover, such data among subjects with hematological malignancies and data regarding restless legs syndrome is limited. The present study was, therefore, conducted to assess the sleep quality, depression, and restless leg syndrome in hematological malignancies and to study if there is any role of IL6 associated with it. Methods: Sixty-six subjects having hematological malignancy were included in this study after excluding the potential confounders. Sleep quality was examined using Pittsburg Sleep Quality Index, depression by the Patient Health Questionnaire-9. Diagnosis of RLS was made through clinical examination. Serum for measurement of IL-6 was collected at baseline and after 1 month of initiation of chemotherapy. Patients were followed up for 6 months. Results: Average age of study subjects was 50.16 years with male predominance. Nearly 22.7% had clinical depression, 28.8% had poor quality sleep, and restless legs syndrome (RLS) was reported in 6.1% cases. Nearly 22.7% patients died at 6 months. Disturbed sleep at baseline was associated with depression (odds ratio [OR] =7.89) and poor 6 months survival. Serum IL-6 did not show any association with sleep quality, restless-legs-syndrome, and depression. However, baseline high level of serum IL-6 (OR = 26.06) and low level after chemotherapy (OR = 0.03) were associated with poor survival at 6 months. Conclusion: Poor quality sleep, depression, and RLS are prevalent among adult subjects with hematological malignancies. Sleep disturbance, high pretreatment inflammatory and lowering of inflammatory load after chemotherapy increase likelihood for poor prognosis. Serum IL-6 did not show any association with sleep quality, restless legs syndrome and depression. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Collaborative tele-neuropsychiatry consultation services for patients in central prisons p. 101 Preethi Pansari Agarwal, Narayana Manjunatha, Guru S Gowda, MN Girish Kumar, Neelaveni Shanthaveeranna, Channaveerachari Naveen Kumar, Suresh Bada Math DOI:10.4103/jnrp.jnrp_215_18   Background: Tele-medicine helps to provide clinical care comparable to in-person treatment in various clinical settings. It is a novel system of healthcare delivery in both low-resource settings and sites where adequate medical care continues to pose greatest challenge like in prison's in India and worldwide. Aim: To study the sociodemographic and clinical profile of patients from Central Prisons, having received collaborative Tele-Neuropsychiatric Care. Methodology: Psychiatry, neurology, and neurosurgery specialists provided tele-neuropsychiatry consultation through Specialist–Doctor–Patient model as part of the state-run program for the two central prisons from July 1, 2014, to June 30, 2016. A retrospective file review was done of the tele-neuropsychiatry case records at Tele-Medicine Centre, Located at Tertiary Neuro Psychiatric centre of South India. Results: A total of 53 patients were provided tele-neuropsychiatric consultation over 2-year period. Of these, 48 (90.6%) were male and 34 (64.1%) were aged more than 30 years. In total, 20.7% of them had severe mental illness, i.e., schizophrenia and mood disorders, 20.7% with substance use disorder (alcohol and cannabis), 17% had anxiety disorders while 17% with seizure disorder. Nearly 81.1% of patients (inmates) were advised pharmacotherapy while 18.9% were suggested further evaluation of illness and inpatient care at the higher center. Conclusion: The collaborative care was successful in delivering psychiatry, neurology, and neurosurgery consultation with a Specialist–Doctor–Patient model to prison inmates. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Nonadherence to antiepileptic medications: Still a major issue to be addressed in the management of epilepsy p. 106 Azra Zafar, Rizwana Shahid, Saima Nazish, Danah Aljaafari, Fahd Ali Alkhamis, Sadiq Alsalman, Amir H Msmar, Badaruddin Abbasi, Abdulla A Alsulaiman, Majed Alabdali DOI:10.4103/jnrp.jnrp_136_18   Context: Medication nonadherence is a significant barrier in achieving seizure freedom in patients with epilepsy. There is a deficiency of data about the reasons for nonadherence in Saudi population. Aims: The aim of this study is to prove the existence of nonadherence to antiepileptic drugs (AEDs) in patients with epilepsy and identify the responsible factors. Setting and Design: This is a prospective, cross-sectional study carried in the Department of Neurology at King Fahd Hospital of the University affiliated with Imam Abdulrahman Bin Faisal University. Subjects and Methods: Patients of all ages diagnosed to have epilepsy as mentioned in their medical record and taking antiepileptic medications were interviewed using a questionnaire. Statistical Analysis Used: Statistical analysis was performed using IBM Statistical Package for the Social Sciences version 21 (IBM Corp., Armonk, NY, USA). Statistical significance was defined as two-tailed with a P ≤ 0.05. Results: Among 152 participants, 52.6% were male and 47.4% were female. Mean age of the patients was 28 ± 14.3 (mean ± standard deviation) years. Of 152 patients, 48.7% were found to be nonadherent to their AED therapy. The most commonly identified factor was forgetfulness. Nonadherence was significantly associated with poor seizure control (P = 0.002). Conclusion:Nonadherence to the AED is common among patients with epilepsy and affects seizure control adversely. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta TECHNICAL NOTE Burr-hole evacuation of chronic subdural hematoma: Biophysically and evidence-based technique improvement p. 113 Martin Májovský, David Netuka, Vladimír Beneš, Pavel Kučera DOI:10.4103/jnrp.jnrp_167_18   Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions. Despite ongoing efforts, recurrence and reoperation rates after surgical treatment remain high. We synthesize scientific evidence on the treatment of CSDH with biophysical principles and then propose a simple and effective surgical technique aiming to reduce the recurrence rate. Under local anesthesia, one burr hole is placed in the area above the maximum hematoma thickness. One drain is inserted into the dorsal direction to the deepest point of the hematoma cavity, and a second drain is inserted frontally into the highest point. Next, saline is gently instilled to the dorsal drain to eliminate air from the hematoma cavity through the frontal drain. Once saline has filled the frontal drain, the frontal drain is removed. The dorsal drain is left in situ for 48 h, and the pressure within the cavity may be adapted hydrostatically. We implemented evidence-based conclusions of previous studies and modified the classical burr-hole technique to reduce the recurrence rate. As a result, we developed a straightforward surgical procedure that is possible to perform under local anesthesia, suitable for everyday practice in rural and remote areas while working with limited resources. The novelty of this technique is in the purposeful reduction of postoperative pneumocephalus, a known independent factor of recurrence. Subdural air is eliminated during surgery using a two-drain system. Safety and efficacy of the technique need to be evaluated in future clinical trials. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Commentary p. 118 Matteo Zoli, Alessandra Serracchioli, Diego Mazzatenta DOI:10.4103/jnrp.jnrp_316_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Commentary p. 120 Keyvan Tayebi Meybodi DOI:10.4103/jnrp.jnrp_306_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Commentary p. 120 Ryota Mashiko DOI:10.4103/jnrp.jnrp_313_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Commentary p. 121 Murat Sakir Eksi DOI:10.4103/jnrp.jnrp_301_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta IMAGES IN NEUROSCIENCES Thalamic hamartoma presenting with tremor p. 123 Niraj Kumar, Deepak Kumar DOI:10.4103/jnrp.jnrp_276_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Os Odontoideum p. 125 Arthur Robert Kurzbuch, Jean-Yves Fournier DOI:10.4103/jnrp.jnrp_252_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta CASE REPORTS Osmotic demyelination syndrome - Evolution of extrapontine before pontine myelinolysis on magnetic resonance imaging p. 126 Prerna Garg, Abhisht Aggarwal, Rajeev Malhotra, Sanjay Dhall DOI:10.4103/jnrp.jnrp_240_18   Osmotic demyelination syndrome is a rare entity characterized by noninflammatory demyelination afflicting the central pons, basal ganglia, thalami, peripheral cortex, and hippocampi. Histopathologically, there is a destruction of myelin sheaths sparing the underlying neuronal axons due to the susceptibility of oligodendrocytes to rapid osmotic shifts often encountered in chronically debilitated patients. We present the temporal progression of signal abnormalities on sequential magnetic resonance imaging (MRI) scans in a middle-aged male initially presenting with altered mental status due to severe hyponatremia and subsequently developing rigidity, diagnosed as osmotic demyelination syndrome based on typical imaging findings and supportive laboratory parameters. This case demonstrates the importance of diffusion signal abnormalities as the first indicator of osmotic demyelination, evolution of extrapontine before pontine signal changes and the relative lack of correlation between patient's clinical profile and the extent of MRI signal abnormalities. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta See-saw relationship and its reversal after immunotherapy in a case of Graves' disease with coexisting myasthenia gravis p. 136 Sathish Kumar Mallikarjuna, S Sakthi Velayutham, PR Sowmini, Malcolm K Jeyaraj, S Arunan DOI:10.4103/jnrp.jnrp_150_18   The unique association of myasthenia gravis (MG) with Graves' disease in clinical practice emphasizes that one autoimmune disease can coexist with another or many. The relationship between these two entities has remained controversial till date. Some authors have reported a see-saw relationship between these two entities, MG waning with hyperthyroidism and waxing with treatment of hyperthyroidism. Treatment of both these disorders concurrently may be challenging at times as treatment for one entity may worsen the other. The use of beta-blockers and steroids for Graves' disease may worsen myasthenic weakness. Antithyroid drugs can worsen myasthenia probably by immunomodulatory effects. We report a case of Graves' disease coexisting with MG in a reciprocal relationship which was subsequently reversed after immunotherapy. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Complete femoral nerve transection with sural nerve cable graft in a 21-month-old child p. 139 Pranati Pillutla, Evan Nix, Benjamin Wallace Elberson, Laszlo Nagy DOI:10.4103/jnrp.jnrp_235_18   Severe peripheral nerve injury occasionally requires urgent nerve grafting especially with significant separation of the proximal and distal ends of the injured nerve. Proper reinnervation to provide continued sensory and motor function is essential especially in the pediatric population. These patients would suffer lifelong disability without correction, yet have significantly improved regenerative capacity with prompt and effective management, making nerve grafts an ideal choice for complete nerve transection. This case report describes the successful sural nerve cable graft reinnervation of a transected femoral nerve in a 21-month-old male. This procedure was made difficult by severe trauma to the surrounding area with laceration of the femoral artery, significant separation of the femoral nerve ends, and the compact anatomy of such a young patient. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Regrowth of a large intracranial aneurysm after on-label use of the pipeline embolization device p. 142 Ching-Jen Chen, M Rao Patibandla, Min S Park, M Yashar Kalani DOI:10.4103/jnrp.jnrp_273_18   Despite the widespread use of the pipeline embolization device (PED), no complete aneurysm regrowth after its placement has been reported in the literature. We report the first case of aneurysm regrowth after the initial follow-up angiography demonstrating near-complete occlusion of the aneurysm and remodeling of the vessel with on-label PED use for a large 20 mm × 24 mm × 22 mm (width × depth × height) cavernous segment internal carotid artery (ICA) aneurysm. The patient was treated with two overlapping PED (4.5 mm × 20 mm and 5 mm × 20 mm). Follow-up angiogram at 4 months after treatment demonstrated remodeling of the ICA with a small residual component measuring approximately 7 mm × 8 mm × 7 mm. However, at 10 months after treatment, there was a complete regrowth of the aneurysm with interval growth, now measuring 25 mm × 28 mm × 18 mm. Despite the high aneurysm occlusion rates reported with the PED, persistent aneurysm filling and aneurysm regrowth, although rare, should not be overlooked. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Wake-up sleepyhead: Unilateral diencephalic stroke presenting with excessive sleepiness p. 145 R Pradeep, Dhananjay Gupta, Anish Mehta, R Srinivasa, Mahendra Javali, PT Acharya DOI:10.4103/jnrp.jnrp_258_18   Altered sleep architecture and stroke share a reciprocal relationship. More than half of the stroke patients display sleep abnormalities including hypersomnia, insomnia, parasomnia, periodic limb movements, or sleep-disordered breathing. Conversely, one of the major causes of severe organic hypersomnia is acute brainstem strokes, involving thalamic infarctions, which may be reversible over 6–12 months. Here, we report a patient with increased lethargy and drowsiness who was diagnosed to have a right thalamic and hypothalamic ischemic stroke. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Infratentorial epidural abscess secondary to furunculosis: Case report and a review of the literature p. 148 Ricardo Horacio Menéndez, Santiago German Erice, Emmanuel Alejandro Vázquez, Karina Breitburd DOI:10.4103/jnrp.jnrp_165_18   The authors describe a case of infratentorial epidural abscess caused by community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in a patient with a recent history of cutaneous furunculosis. This 29-year-old male presented with an occipital headache associated with fever, vomiting, and neck stiffness. Admission magnetic resonance imaging showed a retrocerebellar epidural abscess. Antimicrobial therapy was started, and the patient underwent craniectomy for evacuation of the abscess. Cultures of the surgical specimen were consistent with CA-MRSA. Postoperatively, the patient's condition improved with the resolution of symptoms, and he was discharged home with indication of 6 weeks of antibiotic therapy. Furunculosis is a very rare cause of intracranial epidural abscess but should be considered as a source of infection in an immunocompetent patient. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Chance fracture in an unbelted rear seat passenger p. 151 Abiodun Idowu Okunlola, Augustine Abiodun Adeolu DOI:10.4103/jnrp.jnrp_164_18   Chance fracture occurs from flexion-distraction injury in motor vehicle road crash usually when the patient is on a seat belt. It is often associated with intra-abdominal injuries. We managed a 22-year old female unbelted rear seat passenger of a bus which was involved in a lone accident. We highlighted the possible mechanism of chance fracture in an unbelted passenger and satisfactory spinal stability on conservative care with neither internal nor external fixation. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Clinical case presentation on absence seizures diagnosis and treatment care services and outcomes in an adult patient p. 154 MS Umashankar, A Bharath Kumar DOI:10.4103/jnrp.jnrp_191_18   Absence seizures are often associated with impaired or loss of consciousness clinically proved to have an impact on motor and cognitive abnormalities of the nerve cells of the brain. Seizure admits several etiopathophysiological events leading to several neurofunctional changes in the reticulothalamocortical circuitry zones of the central nervous system. This paves the episodes of absence seizure events. A clinical case report of absence seizure in a 25 years age adult patient came to the hospital with impaired consciousness. The brain magnetic resonance imaging scanning of the patient detected a small focal flair hypertensive area in the right parasellar region close to cavernous sinus with mild flair hypersensitivity in the left cavernous sinuses, right maxillary, and ethmoid sinusitis. The electroencephalogram of the brain showed normal waves with electrode artifacts was observed. The patient was confirmed with absence seizures, and he was treated with oxcarbazepine 150 mg twice daily. The patient was recovered from seizure and discharged with medications. He was called for follow-up examination once in 3-month period. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Rare case of sellar and suprasellar metastasis from ewing's sarcoma of tibia p. 158 Vinita Gupta, Kirti Aggarwal, Prateek Nishant, Rajnish Kumar Arora DOI:10.4103/jnrp.jnrp_139_18   We hereby report a case of metastatic Ewing's sarcoma presenting with rapid-onset total ophthalmoplegia, optic atrophy, and right temporal hemianopia. Comprehensive ophthalmic and neurological evaluation with targeted radioimaging revealed a tumor mass centered over the sella, compressing optic chiasma, extending to involve the left cavernous sinus and the left orbital apex. Whole-body imaging revealed the evidence of multifocal lung and mediastinal metastasis with focal lytic defect in the left femoral head. Histopathological evaluation of transnasal punch biopsy from the nasopharyngeal extension of the tumor revealed small round-cell tumor with strong CD99 positivity, supporting the diagnosis of Ewing's sarcoma. Rapid, aggressive extensions of the metastatic tumor into vital structures despite the initiation of chemoradiation of the extensive intracranial tumor led to unexpected demise of the patient. Our case is an unusual case of Ewing's sarcoma metastasis manifesting as a sellar mass and mimicking a pituitary adenoma radiologically, with a rapid progression within 2 weeks to cause massive extension of tumor into suprasellar, infrasellar, and left parasellar area, indicative of highly malignant nature of the tumor. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Commentary p. 162 Jonathan Douglas Santoro, Taylor Nicole Santoro DOI:10.4103/jnrp.jnrp_255_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta LETTERS TO THE EDITOR Subcutaneous cerebrospinal fluid pseudocyst: An unusual complication of ventriculoperitoneal shunt p. 164 Batuk Diyora, Bhagyashri Bhende, Gagan Dhall, Hanumant Kamble, Naren Nayak DOI:10.4103/jnrp.jnrp_142_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Commentary p. 166 Guru Dutta Satyarthee DOI:10.4103/jnrp.jnrp_262_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Commentary p. 167 Wail Mohammed DOI:10.4103/jnrp.jnrp_253_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Infected internal pulse generator of a spinal cord stimulator device treated successfully without removal: A case report p. 168 Aristedis Rovlias DOI:10.4103/jnrp.jnrp_206_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Takayasu arteritis with cerebral hypoperfusion: An unusual case p. 170 Rajeev Chauhan, Ankur Luthra, Sachin Mahajan DOI:10.4103/jnrp.jnrp_268_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Vector Borne Diseases

Geographic distribution and spatial analysis of Leishmania infantum infection in domestic and wild animal reservoir hosts of zoonotic visceral leishmaniasis in Iran: A systematic review M Mohebali, E Moradi-Asl, Y Rassi Journal of Vector Borne Diseases 2018 55(3):173-183 Visceral leishmaniasis (VL) is an important parasitic disease which is endemic in different parts of Iran; and domestic and wild canines are principal reservoir hosts of the disease. The objective of this study was to review the spatial distribution of canine VL (CVL) caused by Leishmania infantum in domestic and wild canines in different geographical areas of Iran. An extensive literature search was conducted in different international and national databases, including Cochrane, MEDLINE/PubMed, Scopus, Web of Science and Iran Medex to find articles with the words “visceral leishmaniasis in Iran” in their titles and “canine visceral leishmaniasis in Iran” or “feline visceral leishmaniasis in Iran” or “accidental reservoir hosts of visceral leishmaniasis in Iran” in their subtitles, irrespective of the type and duration of study. Screening of the irrelevant articles from total 36,342, yielded 61 eligible articles. More than 93% of the studies were carried out on domestic dogs (Canis familiaris, n = 57) and the remaining were on other carnivores such as wild canines including foxes (Vulpes vulpes, n = 4), jackals (C. aureus, n = 6) and wolves (C. lupus, n = 6); while studies on domestic cats (Felis catus, n = 3) as well as desert rodents (n = 2) were rare. The average rate of L. infantum infections reported among domestic dogs using direct agglutination test (DAT) in Iran was 12.5%. The highest prevalence rate (14%) was reported from the northwest regions of the country where VL is endemic. The review indicates that CVL is endemic in various parts of Iran and domestic dogs are the main and potential reservoir hosts of the disease. Other carnivores, such as domestic cats and some species of desert rodents (Cricetulus migratorius, Mesocricetus auratus and Meriones persicus) seem to be playing a role in the maintenance of transmission cycle of L. infantum in the endemic areas of the disease.

A laboratory simulation study on suppression of resistance genes by differential exposures to an insecticide in Anopheles stephensi Liston population Vaishali Verma, OP Agrawal, Poonam Sharma Velamuri, Kamaraju Raghavendra Journal of Vector Borne Diseases 2018 55(3):184-188 Background & objectives: Insecticide applied at optimum dosage and coverage delays the development of resistance in disease vectors. The study was aimed to test the hypothesis whether decrease in exposure to insecticide leads to decrease in selection of insecticide resistance in mosquitoes. The mosquitoes were variably exposed to insecticide in the laboratory by simulating the variations in insecticide sprays applied in the field. Methods: The study was carried out on DDT resistant adults of Anopheles stephensi. Mosquitoes were differentially exposed to impregnated papers of DDT (4%), that were differentially masked to 25, 50, and 75% area with an unimpregnated Whatman No.1 filter paper, and to a positive control without any masking, i.e. 100% exposure area. The study was conducted for five generations and at each generation mosquitoes were exposed to differentially masked impregnated papers, and percent mortality was calculated. Results: The observed survival rate in differential exposures was more with the increase in heterozygous genotype resistance-susuceptible (RS) frequency. Resistant gene frequency with differential exposures (25 to 75%) was in the range of 0.38–0.54 for the F0 generation, which increased to 0.84–0.93 for the F4 generation. In 100% exposure it was 0.18 in F0 generation, which increased to 0.58 in the F4 generation. The resistant gene frequencies in the population showed increasing trend with decrease in exposure in contrast to complete exposure. Interpretation & conclusion: Variable simulated exposures resulted in precipitation of increased resistance while complete exposure resulted in lower levels of resistance, signifying the importance of optimum dosage and coverage in the indoor residual spray in delaying/avoiding the development of insecticide resistance in the disease vectors.

Prevalence of disease vectors in Lakshadweep Islands during post-monsoon season Jayalakshmi Krishnan, L Mathiarasan Journal of Vector Borne Diseases 2018 55(3):189-196 Background & objectives: Increase of vector-borne diseases (VBDs) in India has posed a question on the situation in Lakshadweep Islands, where VBDs are reported from time-to-time. The present investigation was aimed to assess the faunastic situation of the prevailing vectors along with their breeding sites in different islands of the Lakshadweep. Methods: Extensive surveys were carried out from November 2017 to January 2018 (post-monsoon season) randomly in the nine inhabited islands of Lakshadweep for conducting faunastic studies on mosquitoes and to know the basic binomics like breeding and resting preference of mosquitoes. The study islands included, Kavaratti, Agatti, Chetlat, Bitra, Amini, Kadmath, Andrott, Kalpeni and Kiltan. Both immature and adult collections were carried out by standard/appropriate sampling techniques. The obtained data were calculated and analysed in terms of different entomological indices Results: A total of 3356 mosquitoes were collected during the study period which comprised of 16 species from nine genera. Out of the 16 species, six belonged to mosquito vectors. The collection included malaria vector, Anopheles stephensi; Japanese encephalitis vector, Culex tritaeniorhynchus; Bancroftian filariasis vector, Cx. quinquefasciatus; Brugian filariasis vector, Mansonia uniformis; and dengue and chikungunya vectors, Stegomya albopicta and St. aegypti. Stegomya albopicta was the most predominant species observed constituting 54% of the catch, followed by Cx. quinquefasciatus, An. stephensi, Cx. tritaeniorhynchus, and St. aegypti constituting 10.5, 6, 3 and 1.2%, respectively. Apart from vector species many non-vectors such as Heizmannia chandi, An. subpictus, An. varuna, Cx. sitiens, Cx. minutissimus, Cx. rubithoracis, Fredwardsius vittatus, Lutzia fuscana, Malaya genurostris and Armigeres subalbatus were also present in the study area. In Kavaratti Island, the capital of Lakshadweep, a non-vector species of sandfly, Sergentomyia (Parrotomyia) babu was observed during the indoor resting collection. The major breeding sites which supported various mosquito species included, discarded plastic containers, tree holes, open sintex tanks (water storage tanks), unused wells, discarded tyres, discarded iron pots, unused and damaged boats, cement tanks, pleated plastic sheets, coral holes, pits and irrigation canals, discarded washing machines, and Colocasia plant leaf axils. Breteau index ranged between 65.3 and 110, CI ranged between 63.64 and 72.41; and HI ranged between 38.46 and 70 among the various islands. Interpretation & conclusion: Entomological indices such as house index (HI), breteau index (BI) and pupal index (PI) were high in all the nine islands and exceeded the threshold levels specified by WHO, indicating high risk for dengue virus transmission in case of outbreaks. Occurrence of vector as well as non-vector species indicates that the global change in climate is causing notable changes in terms of breeding of vector and non-vector species in the islands. With the reported cases of VBDs and the presence of vectors species in Lakshadweep Islands, a stringent control measure needs to be implemented at the Lakshadweep Islands.

Comparison of the effectiveness of two-dose versus three-dose sulphadoxine-pyrimethamine in preventing adverse pregnancy outcomes in Nigeria Nneka U Igboeli, Maxwell O Adibe, Chinwe V Ukwe, Cletus N Aguwa Journal of Vector Borne Diseases 2018 55(3):197-202 Background & objectives: Three doses of intermittent preventive treatment with sulphadoxine-pyrimethamine (IPTp-SP) has been adopted as the new recommendation for prevention of malaria in pregnancy. This study evaluated the effectiveness of two-dose versus three-dose of SP for IPTp-SP in the prevention of low birth weight (LBW) and malaria parasitaemia. Methods: An open, randomized, controlled, longitudinal trial was conducted in a secondary level hospital in Nsukka region of Enugu State, Nigeria. A sample of 210 pregnant women within gestational ages of 16–24 wk were recruited at antenatal clinics and equally randomized to either a two-dose SP or three-dose SP group. The primary endpoints were LBWs, peripheral, and placental parasitaemia, while the secondary endpoints were maternal anaemia, pre-term birth, clinical malaria and adverse effects of SP. Results: Among 207 cases followed till delivery, the prevalence of parasitaemia was lower in three-dose group than in two-dose group for both peripheral (9.3% versus 27.8%) and placental (10.6% versus 25.6%) parasitaemia. The adjusted odds ratios (aOR) were 0.15 [95% confidence interval (CI), 0.05 – 0.45] and 0.17 (95% CI, 0.06–0.51), respectively. The prevalence of LBW was also lower in three-dose (3.5%) than in two-dose (12.2%) group (aOR, 0.15; 95% CI, 0.04–0.63); however, the prevalence of maternal anaemia, pre-term births, clinical malaria and SP adverse effects were similar between the two arms of treatment. Interpretation & conclusion: Addition of a third SP dose to the standard two-dose SP for IPTp led to improved reductions in the risk of some adverse pregnancy outcomes.

Changing paradigm in the epidemiology of Japanese encephalitis in a non-endemic region P Philip Samuel, V Thenmozhi, M Muniaraj, D Ramesh, S Victor Jerald Leo, T Balaji, K Venkatasubramani, J Nagaraj, R Paramasivan Journal of Vector Borne Diseases 2018 55(3):203-207 Background & objectives: Japanese encephalitis (JE) is a mosquito-borne zoonotic disease. The JE virus (JEV) does not cause any disease among its natural hosts and transmission continues through mosquitoes belonging to Culex vishnui subgroup. This study was aimed to investigate the prevalence of JEV in mosquitoes and humans in the Thanjavur district, a non-endemic region for JE, in Tamil Nadu, by using standard available assays. Methods : A sero-surveillance study was conducted in Thanjavur district among the normal rural school children in the 5–12 yr age group, during the JE season (October) and post-JE season (February) from 2011 to 2013 for the detection of JEV infection. Vector abundance studies were carried out from 2011 to 2014. JE seropositivity and its association between the seasons were analysed statistically. Results : The occurrence of JE infection among children aged 5–12 yr was very high in the study area. The infection rates for JE in two consecutive seasons for 2011–12 and 2012–13 were 32.2 and 65.2%, respectively. The Cx. tritaeniorhynchus sp. dominated the catch, and was majorly responsible for the transmission. There was a significant difference in the human infection rate compared to the years 1991–92 and 1992–93; and a marked decrease in the cattle to pigs ratio (123 : 1) compared to the studies in 1991–93. Interpretation & conclusion : The study unearthed the prevailing situation of JE among children, who are at higher risk of developing the disease during the transmission season. The decrease in the cattle to pigs ratio might be the one of the reasons for increase in the JEV infection among the children population compared to 20 years before. This trend requires urgent attention as it could be prevented with effective surveillance systems and vaccines.

Spatial risk analysis on occurrences and dispersal of Biomphalaria straminea in and endemic area for schistosomiasis Elainne Christine de Souza Gomes, Millena Carla da Silva Mesquitta, Leandro Batista Wanderley, Fábio Lopes de Melo, Ricardo José de Paula Souza e Guimarães, Constança Simões Barbosa Journal of Vector Borne Diseases 2018 55(3):208-214 Background & objectives : Schistosomiasis is a rural endemic disease that has been expanding to urban and coastal areas in the state of Pernambuco, Brazil. The aim of this study was to characterize the distribution of breeding sites of the causative vector, Biomphalaria straminea in an endemic municipality for schistosomiasis and to present the predictive models for occurrences and dispersal of this vector snail to new areas. Methods : A malacological survey was conducted during January to December 2015 in the municipality of São Lourenço da Mata, Pernambuco, Brazil to identify the breeding sites of Biomphalaria. Faecal contamination was determined by means of the Colitag™ diagnostic kit. Rainfall data were collected, and correlated with snail distribution data. Kernel density estimation, kriging and maximum entropy (MaxEnt) modeling were used for spatial data analysis, by means of the spatial analysis software packages. Results : Out of the 130 demarcated collection points, 64 were classified as breeding sites for B. straminea. A total of 5,250 snails were collected from these sites. Among these 64 sites, four were considered as foci of schistosomiasis transmission and 54 as potential transmission foci. An inverse relationship between rainfall and snail density was observed. Kernel spatial analysis identified three areas at higher risk of snail occurrence, which were also the areas of highest faecal contamination and included two transmission foci. Kriging and MaxEnt modeling simulated the scenarios obtained through the kernel analyses. Interpretation & conclusion : Use of geostatistical tools (Kriging and MaxEnt) is efficient for identifying areas at risk and for estimating the dispersal of Biomphalaria species across the study area. Occurrence of B. straminea in the study area is influenced by the rainy season, as it becomes more abundant during the period immediately after the rainy season, increasing the risk of dispersal and the appearance of new transmission foci.

Evaluation of epidemiological, clinical, and laboratory characteristics and mortality rate of patients with Crimean-Congo hemorrhagic fever in the northeast region of Turkey Faruk Karakecili, Aytekin Cikman, Merve Aydin, Umut Devrim Binay, Ozan Arif Kesik, Fatih Ozcicek Journal of Vector Borne Diseases 2018 55(3):215-221 Background & objectives : Crimean-Congo hemorrhagic fever (CCHF), an illness characterized by fever and hemorrhage, is caused by a CCHF virus (CCHFV). It is an important public health problem in Turkey. The objective of this study was to evaluate the demographic, clinical, and laboratory characteristics and mortality rates of CCHF patients in the northeast region of Turkey. Methods : A total of 206 patients, diagnosed with CCHF, from northeast region of Turkey were included and evaluated between 2011 and 2017. Real-time reverse transcriptase polymerase chain reaction (RT-PCR) and immunofluorescence (IFA) methods were used for the diagnoses. Results : Of the patients included in the study, 77.2% were farmers/livestockers, while 22.8% had other occupations. The incidence of tick bite or tick contact with bare hands was 52.9%. About 94.2% of the patients were living in rural areas and 5.8% in city centers. However, all the patients living in city centers had a history of visit to rural areas. The disease was more common in May, June, and July months. The most common symptoms at the time of admission included fatigue, fever, and widespread body pain, while laboratory findings were thrombocytopenia, leukopenia, and anemia. Bleeding, tachycardia, and rash were the most common findings on physical examination. Of all the patients, 95.6% were identified by RT-PCR and 4.4% by IFA methods. Severe cases constituted 22.3% (46) of the included patients. Throughout the course of this study, 7 (3.4%) patients died, and the remaining 96.6% (199) patients were discharged with a full recovery. Disease severity was significantly correlated with mortality rate and duration of hospitalization (p <0.001 and p = 0.013). Interpretation & conclusion : In this study, the mortality rate observed was lower than that reported in the literature because of accessibility of early supportive therapy. It would be beneficial in CCHF treatment to recognize the disease at an early stage, begin supportive treatment quickly, and educate the people living in high-risk areas as well as health care personnel working in these areas.

Babesiosis prevalence in malaria-endemic regions of Colombia Juliana Gonzalez, Ignacio Echaide, Adriana Pabón, J Juan Gabriel Piñeros, Silvia Blair, Alberto Tobón-Castaño Journal of Vector Borne Diseases 2018 55(3):222-229 Background & objectives : The presence of Babesia spp in humans, bovine cattle and ticks (the transmitting vector) has not been well characterized in Colombia. Babesia infection in humans can be overlooked due to similarity of the disease symptoms with malaria specially in the regions where malaria is endemic. The aim of the present work was to study the frequency of Babesia infection in humans, bovines and ticks in a malaria endemic region of Colombia, and explore the possible relationship of infection with host and the environmental factors. Methods : A cross-sectional study was carried out between August 2014 and March 2015 to determine the frequency of B. bovis and B. bigemina infection in a sample of 300 humans involved in cattle raising, in 202 bovines; and in 515 ticks obtained from these subjects, using molecular (PCR), microscopic and serological methods. In addition, the demographic, ecological and zootechnical factors associated with the presence of Babesia, were explored. Results : In the bovine population, the prevalence of infection was 14.4% (29/202); the highest risk of infection was found in cattle under nine months of age (OR = 23.9, CI 8.10–94.30, p = 0.0). In humans, a prevalence of 2% (6/300) was found; four of these six cases were positive for B. bovis. Self-report of fever in the last seven days in the positive cases was found to be associated with Babesia infection (Incidence rate ratio = 9.08; CI 1.34–61.10, p = 0.02). The frequency of B. bigemina infection in the collected ticks was 18.5% (30/162). Interpretation & conclusion : The study established the presence of Babesia spp in humans, bovines and ticks. The most prevalent species responsible for babesiosis in humans and bovines was B. bovis, while B. bigemina was the species most frequently found in the tick population. The results contribute to the knowledge of the epidemiology of babesiosis in the country and can provide guidelines for the epidemiological surveillance of this non-malarial febrile illness in humans as well as cattle.

Low susceptibility of domestic cats to experimental Leishmania infantum infection Baharak Akhtardanesh, Reza Kheirandish, Iraj Sharifi, Ali Mohammadi, Ali Mostafavi, Tohid Mahmoodi, Mohadesse Ebrahimi Journal of Vector Borne Diseases 2018 55(3):230-234 Background and objectives : The dogs are considered the main reservoir of visceral leishmaniasis (VL), but lately the disease incidence has been reported in cats also. In this study, the susceptibility of domestic cats to experimental Leishmania infantum infection was assessed by different diagnostic methods. Methods : A total of 12 healthy adult male cats were captured by double door live trap cages containing baits. Of them eight cats were intraperitoneally inoculated with 107 L. infantum promastigotes (stationary phase), and four cats were used as controls. Whole blood and serum samples were collected at weekly intervals for 16 wk after inoculation for testing by polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA) methods. Aspirates of prescapular lymph nodes and bone marrow were obtained at monthly intervals. Clinical examination was performed twice weekly and histopathological evaluation was done on necropsy samples at the termination of the study. Results: One week after inoculation, blood nested PCR was able to detect the L. infantum infection and it remained positive until 16 wk. ELISA test remained negative during the study. Amastigote phase of parasite was not observed in bone marrow aspiration and necropsy samples. Interpretation and conclusion : The feline model described in this work would be useful in further understanding of L. infantum immunopathogenensis in cats. The results of this preliminary study suggest that cats might be resistant to VL as the inoculation dose which induces pathognomonic clinical features in dogs, just creates asymptomatic parasitaemia in cats. Though, due to long-lasting parasitaemia, cats may act as appropriate reservoir for transmission of VL to human population. Further studies are needed to describe the possible role of cats in the epidemiology of VL in endemic areas.

Adaptation of Aedes aegypti to salinity: Characterized by larger anal papillae in larvae SN Surendran, K Sivabalakrishnan, T.T.P. Jayadas, S Santhirasegaram, A Laheetharan, M Senthilnanthanan, R Ramasamy Journal of Vector Borne Diseases 2018 55(3):235-238 REVIEW ARTICLE   Geographic distribution and spatial analysis of Leishmania infantum infection in domestic and wild animal reservoir hosts of zoonotic visceral leishmaniasis in Iran: A systematic review  p. 173 M Mohebali, E Moradi-Asl, Y Rassi DOI:10.4103/0972-9062.249125   Visceral leishmaniasis (VL) is an important parasitic disease which is endemic in different parts of Iran; and domestic and wild canines are principal reservoir hosts of the disease. The objective of this study was to review the spatial distribution of canine VL (CVL) caused by Leishmania infantum in domestic and wild canines in different geographical areas of Iran. An extensive literature search was conducted in different international and national databases, including Cochrane, MEDLINE/PubMed, Scopus, Web of Science and Iran Medex to find articles with the words "visceral leishmaniasis in Iran" in their titles and "canine visceral leishmaniasis in Iran" or "feline visceral leishmaniasis in Iran" or "accidental reservoir hosts of visceral leishmaniasis in Iran" in their subtitles, irrespective of the type and duration of study. Screening of the irrelevant articles from total 36,342, yielded 61 eligible articles. More than 93% of the studies were carried out on domestic dogs (Canis familiaris, n= 57) and the remaining were on other carnivores such as wild canines including foxes (Vulpes vulpes, n = 4), jackals (C. aureus, n = 6) and wolves (C. lupus, n = 6); while studies on domestic cats (Felis catus, n = 3) as well as desert rodents (n = 2) were rare. The average rate of L. infantum infections reported among domestic dogs using direct agglutination test (DAT) in Iran was 12.5%. The highest prevalence rate (14%) was reported from the northwest regions of the country where VL is endemic. The review indicates that CVL is endemic in various parts of Iran and domestic dogs are the main and potential reservoir hosts of the disease. Other carnivores, such as domestic cats and some species of desert rodents (Cricetulus migratorius, Mesocricetus auratus and Meriones persicus) seem to be playing a role in the maintenance of transmission cycle of L. infantum in the endemic areas of the disease. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta RESEARCH ARTICLES A laboratory simulation study on suppression of resistance genes by differential exposures to an insecticide in Anopheles stephensi Liston population p. 184 Vaishali Verma, OP Agrawal, Poonam Sharma Velamuri, Kamaraju Raghavendra DOI:10.4103/0972-9062.249126   Background & objectives: Insecticide applied at optimum dosage and coverage delays the development of resistance in disease vectors. The study was aimed to test the hypothesis whether decrease in exposure to insecticide leads to decrease in selection of insecticide resistance in mosquitoes. The mosquitoes were variably exposed to insecticide in the laboratory by simulating the variations in insecticide sprays applied in the field.Methods: The study was carried out on DDT resistant adults of Anopheles stephensi. Mosquitoes were differentially exposed to impregnated papers of DDT (4%), that were differentially masked to 25, 50, and 75% area with an unimpregnated Whatman No.1 filter paper, and to a positive control without any masking, i.e. 100% exposure area. The study was conducted for five generations and at each generation mosquitoes were exposed to differentially masked impregnated papers, and percent mortality was calculated. Results: The observed survival rate in differential exposures was more with the increase in heterozygous genotype resistance-susuceptible (RS) frequency. Resistant gene frequency with differential exposures (25 to 75%) was in the range of 0.38–0.54 for the F0 generation, which increased to 0.84–0.93 for the F4 generation. In 100% exposure it was 0.18 in F0 generation, which increased to 0.58 in the F4 generation. The resistant gene frequencies in the population showed increasing trend with decrease in exposure in contrast to complete exposure. Interpretation & conclusion: Variable simulated exposures resulted in precipitation of increased resistance while complete exposure resulted in lower levels of resistance, signifying the importance of optimum dosage and coverage in the indoor residual spray in delaying/avoiding the development of insecticide resistance in the disease vectors. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Prevalence of disease vectors in Lakshadweep Islands during post-monsoon season p. 189 Jayalakshmi Krishnan, L Mathiarasan DOI:10.4103/0972-9062.249127   Background & objectives: Increase of vector-borne diseases (VBDs) in India has posed a question on the situation in Lakshadweep Islands, where VBDs are reported from time-to-time. The present investigation was aimed to assess the faunastic situation of the prevailing vectors along with their breeding sites in different islands of the Lakshadweep. Methods: Extensive surveys were carried out from November 2017 to January 2018 (post-monsoon season) randomly in the nine inhabited islands of Lakshadweep for conducting faunastic studies on mosquitoes and to know the basic binomics like breeding and resting preference of mosquitoes. The study islands included, Kavaratti, Agatti, Chetlat, Bitra, Amini, Kadmath, Andrott, Kalpeni and Kiltan. Both immature and adult collections were carried out by standard/appropriate sampling techniques. The obtained data were calculated and analysed in terms of different entomological indices Results: A total of 3356 mosquitoes were collected during the study period which comprised of 16 species from nine genera. Out of the 16 species, six belonged to mosquito vectors. The collection included malaria vector, Anopheles stephensi; Japanese encephalitis vector, Culex tritaeniorhynchus; Bancroftian filariasis vector, Cx. quinquefasciatus; Brugian filariasis vector, Mansonia uniformis; and dengue and chikungunya vectors, Stegomya albopicta and St. aegypti. Stegomya albopicta was the most predominant species observed constituting 54% of the catch, followed by Cx. quinquefasciatus, An. stephensi, Cx. tritaeniorhynchus, and St. aegypti constituting 10.5, 6, 3 and 1.2%, respectively. Apart from vector species many non-vectors such as Heizmannia chandi, An. subpictus, An. varuna, Cx. sitiens, Cx. minutissimus, Cx. rubithoracis, Fredwardsius vittatus, Lutzia fuscana, Malaya genurostris and Armigeres subalbatus were also present in the study area. In Kavaratti Island, the capital of Lakshadweep, a non-vector species of sandfly, Sergentomyia (Parrotomyia) babu was observed during the indoor resting collection. The major breeding sites which supported various mosquito species included, discarded plastic containers, tree holes, open sintex tanks (water storage tanks), unused wells, discarded tyres, discarded iron pots, unused and damaged boats, cement tanks, pleated plastic sheets, coral holes, pits and irrigation canals, discarded washing machines, and Colocasia plant leaf axils. Breteau index ranged between 65.3 and 110, CI ranged between 63.64 and 72.41; and HI ranged between 38.46 and 70 among the various islands. Interpretation & conclusion: Entomological indices such as house index (HI), breteau index (BI) and pupal index (PI) were high in all the nine islands and exceeded the threshold levels specified by WHO, indicating high risk for dengue virus transmission in case of outbreaks. Occurrence of vector as well as non-vector species indicates that the global change in climate is causing notable changes in terms of breeding of vector and non-vector species in the islands. With the reported cases of VBDs and the presence of vectors species in Lakshadweep Islands, a stringent control measure needs to be implemented at the Lakshadweep Islands. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Comparison of the effectiveness of two-dose versus three-dose sulphadoxine-pyrimethamine in preventing adverse pregnancy outcomes in Nigeria p. 197 Nneka U Igboeli, Maxwell O Adibe, Chinwe V Ukwe, Cletus N Aguwa DOI:10.4103/0972-9062.249128   Background & objectives: Three doses of intermittent preventive treatment with sulphadoxine-pyrimethamine (IPTp-SP) has been adopted as the new recommendation for prevention of malaria in pregnancy. This study evaluated the effectiveness of two-dose versus three-dose of SP for IPTp-SP in the prevention of low birth weight (LBW) and malaria parasitaemia. Methods: An open, randomized, controlled, longitudinal trial was conducted in a secondary level hospital in Nsukka region of Enugu State, Nigeria. A sample of 210 pregnant women within gestational ages of 16–24 wk were recruited at antenatal clinics and equally randomized to either a two-dose SP or three-dose SP group. The primary endpoints were LBWs, peripheral, and placental parasitaemia, while the secondary endpoints were maternal anaemia, pre-term birth, clinical malaria and adverse effects of SP. Results: Among 207 cases followed till delivery, the prevalence of parasitaemia was lower in three-dose group than in two-dose group for both peripheral (9.3% versus 27.8%) and placental (10.6% versus 25.6%) parasitaemia. The adjusted odds ratios (aOR) were 0.15 [95% confidence interval (CI), 0.05 – 0.45] and 0.17 (95% CI, 0.06–0.51), respectively. The prevalence of LBW was also lower in three-dose (3.5%) than in two-dose (12.2%) group (aOR, 0.15; 95% CI, 0.04–0.63); however, the prevalence of maternal anaemia, pre-term births, clinical malaria and SP adverse effects were similar between the two arms of treatment.Interpretation & conclusion: Addition of a third SP dose to the standard two-dose SP for IPTp led to improved reductions in the risk of some adverse pregnancy outcomes. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Changing paradigm in the epidemiology of Japanese encephalitis in a non-endemic region p. 203 P Philip Samuel, V Thenmozhi, M Muniaraj, D Ramesh, S Victor Jerald Leo, T Balaji, K Venkatasubramani, J Nagaraj, R Paramasivan DOI:10.4103/0972-9062.249130   Background & objectives: Japanese encephalitis (JE) is a mosquito-borne zoonotic disease. The JE virus (JEV) does not cause any disease among its natural hosts and transmission continues through mosquitoes belonging to Culex vishnui subgroup. This study was aimed to investigate the prevalence of JEV in mosquitoes and humans in the Thanjavur district, a non-endemic region for JE, in Tamil Nadu, by using standard available assays. Methods : A sero-surveillance study was conducted in Thanjavur district among the normal rural school children in the 5–12 yr age group, during the JE season (October) and post-JE season (February) from 2011 to 2013 for the detection of JEV infection. Vector abundance studies were carried out from 2011 to 2014. JE seropositivity and its association between the seasons were analysed statistically. Results : The occurrence of JE infection among children aged 5–12 yr was very high in the study area. The infection rates for JE in two consecutive seasons for 2011–12 and 2012–13 were 32.2 and 65.2%, respectively. The Cx. tritaeniorhynchussp. dominated the catch, and was majorly responsible for the transmission. There was a significant difference in the human infection rate compared to the years 1991–92 and 1992–93; and a marked decrease in the cattle to pigs ratio (123 : 1) compared to the studies in 1991–93. Interpretation & conclusion : The study unearthed the prevailing situation of JE among children, who are at higher risk of developing the disease during the transmission season. The decrease in the cattle to pigs ratio might be the one of the reasons for increase in the JEV infection among the children population compared to 20 years before. This trend requires urgent attention as it could be prevented with effective surveillance systems and vaccines. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Spatial risk analysis on occurrences and dispersal of Biomphalaria straminea in and endemic area for schistosomiasis p. 208 Elainne Christine de Souza Gomes, Millena Carla da Silva Mesquitta, Leandro Batista Wanderley, Fábio Lopes de Melo, Ricardo José de Paula Souza e Guimarães, Constança Simões Barbosa DOI:10.4103/0972-9062.249142   Background & objectives : Schistosomiasis is a rural endemic disease that has been expanding to urban and coastal areas in the state of Pernambuco, Brazil. The aim of this study was to characterize the distribution of breeding sites of the causative vector, Biomphalaria straminea in an endemic municipality for schistosomiasis and to present the predictive models for occurrences and dispersal of this vector snail to new areas. Methods :A malacological survey was conducted during January to December 2015 in the municipality of São Lourenço da Mata, Pernambuco, Brazil to identify the breeding sites of Biomphalaria. Faecal contamination was determined by means of the Colitag™ diagnostic kit. Rainfall data were collected, and correlated with snail distribution data. Kernel density estimation, kriging and maximum entropy (MaxEnt) modeling were used for spatial data analysis, by means of the spatial analysis software packages. Results : Out of the 130 demarcated collection points, 64 were classified as breeding sites for B. straminea. A total of 5,250 snails were collected from these sites. Among these 64 sites, four were considered as foci of schistosomiasis transmission and 54 as potential transmission foci. An inverse relationship between rainfall and snail density was observed. Kernel spatial analysis identified three areas at higher risk of snail occurrence, which were also the areas of highest faecal contamination and included two transmission foci. Kriging and MaxEnt modeling simulated the scenarios obtained through the kernel analyses. Interpretation & conclusion : Use of geostatistical tools (Kriging and MaxEnt) is efficient for identifying areas at risk and for estimating the dispersal of Biomphalaria species across the study area. Occurrence of B. straminea in the study area is influenced by the rainy season, as it becomes more abundant during the period immediately after the rainy season, increasing the risk of dispersal and the appearance of new transmission foci. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Evaluation of epidemiological, clinical, and laboratory characteristics and mortality rate of patients with Crimean-Congo hemorrhagic fever in the northeast region of Turkey p. 215 Faruk Karakecili, Aytekin Cikman, Merve Aydin, Umut Devrim Binay, Ozan Arif Kesik, Fatih Ozcicek DOI:10.4103/0972-9062.249479   Background & objectives : Crimean-Congo hemorrhagic fever (CCHF), an illness characterized by fever and hemorrhage, is caused by a CCHF virus (CCHFV). It is an important public health problem in Turkey. The objective of this study was to evaluate the demographic, clinical, and laboratory characteristics and mortality rates of CCHF patients in the northeast region of Turkey. Methods : A total of 206 patients, diagnosed with CCHF, from northeast region of Turkey were included and evaluated between 2011 and 2017. Real-time reverse transcriptase polymerase chain reaction (RT-PCR) and immunofluorescence (IFA) methods were used for the diagnoses. Results : Of the patients included in the study, 77.2% were farmers/livestockers, while 22.8% had other occupations. The incidence of tick bite or tick contact with bare hands was 52.9%. About 94.2% of the patients were living in rural areas and 5.8% in city centers. However, all the patients living in city centers had a history of visit to rural areas. The disease was more common in May, June, and July months. The most common symptoms at the time of admission included fatigue, fever, and widespread body pain, while laboratory findings were thrombocytopenia, leukopenia, and anemia. Bleeding, tachycardia, and rash were the most common findings on physical examination. Of all the patients, 95.6% were identified by RT-PCR and 4.4% by IFA methods. Severe cases constituted 22.3% (46) of the included patients. Throughout the course of this study, 7 (3.4%) patients died, and the remaining 96.6% (199) patients were discharged with a full recovery. Disease severity was significantly correlated with mortality rate and duration of hospitalization (p <0.001 and p = 0.013).Interpretation & conclusion : In this study, the mortality rate observed was lower than that reported in the literature because of accessibility of early supportive therapy. It would be beneficial in CCHF treatment to recognize the disease at an early stage, begin supportive treatment quickly, and educate the people living in high-risk areas as well as health care personnel working in these areas. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Babesiosis prevalence in malaria-endemic regions of Colombia p. 222 Juliana Gonzalez, Ignacio Echaide, Adriana Pabón, J Juan Gabriel Piñeros, Silvia Blair, Alberto Tobón-Castaño DOI:10.4103/0972-9062.249480   Background & objectives : The presence of Babesia spp in humans, bovine cattle and ticks (the transmitting vector) has not been well characterized in Colombia. Babesia infection in humans can be overlooked due to similarity of the disease symptoms with malaria specially in the regions where malaria is endemic. The aim of the present work was to study the frequency of Babesia infection in humans, bovines and ticks in a malaria endemic region of Colombia, and explore the possible relationship of infection with host and the environmental factors.Methods : A cross-sectional study was carried out between August 2014 and March 2015 to determine the frequency of B. bovis and B. bigemina infection in a sample of 300 humans involved in cattle raising, in 202 bovines; and in 515 ticks obtained from these subjects, using molecular (PCR), microscopic and serological methods. In addition, the demographic, ecological and zootechnical factors associated with the presence of Babesia, were explored. Results : In the bovine population, the prevalence of infection was 14.4% (29/202); the highest risk of infection was found in cattle under nine months of age (OR = 23.9, CI 8.10–94.30, p = 0.0). In humans, a prevalence of 2% (6/300) was found; four of these six cases were positive for B. bovis. Self-report of fever in the last seven days in the positive cases was found to be associated with Babesia infection (Incidence rate ratio = 9.08; CI 1.34–61.10, p = 0.02). The frequency of B. bigemina infection in the collected ticks was 18.5% (30/162). Interpretation & conclusion : The study established the presence of Babesia spp in humans, bovines and ticks. The most prevalent species responsible for babesiosis in humans and bovines was B. bovis, while B. bigemina was the species most frequently found in the tick population. The results contribute to the knowledge of the epidemiology of babesiosis in the country and can provide guidelines for the epidemiological surveillance of this non-malarial febrile illness in humans as well as cattle. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Low susceptibility of domestic cats to experimental Leishmania infantum infection p. 230 Baharak Akhtardanesh, Reza Kheirandish, Iraj Sharifi, Ali Mohammadi, Ali Mostafavi, Tohid Mahmoodi, Mohadesse Ebrahimi DOI:10.4103/0972-9062.249481   Background and objectives : The dogs are considered the main reservoir of visceral leishmaniasis (VL), but lately the disease incidence has been reported in cats also. In this study, the susceptibility of domestic cats to experimental Leishmania infantum infection was assessed by different diagnostic methods. Methods : A total of 12 healthy adult male cats were captured by double door live trap cages containing baits. Of them eight cats were intraperitoneally inoculated with 107 L. infantum promastigotes (stationary phase), and four cats were used as controls. Whole blood and serum samples were collected at weekly intervals for 16 wk after inoculation for testing by polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA) methods. Aspirates of prescapular lymph nodes and bone marrow were obtained at monthly intervals. Clinical examination was performed twice weekly and histopathological evaluation was done on necropsy samples at the termination of the study. Results: One week after inoculation, blood nested PCR was able to detect the L. infantum infection and it remained positive until 16 wk. ELISA test remained negative during the study. Amastigote phase of parasite was not observed in bone marrow aspiration and necropsy samples. Interpretation and conclusion :The feline model described in this work would be useful in further understanding of L. infantumimmunopathogenensis in cats. The results of this preliminary study suggest that cats might be resistant to VL as the inoculation dose which induces pathognomonic clinical features in dogs, just creates asymptomatic parasitaemia in cats. Though, due to long-lasting parasitaemia, cats may act as appropriate reservoir for transmission of VL to human population. Further studies are needed to describe the possible role of cats in the epidemiology of VL in endemic areas. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta SHORT RESEARCH COMMUNICATIONS Adaptation of Aedes aegypti to salinity: Characterized by larger anal papillae in larvae p. 235 SN Surendran, K Sivabalakrishnan, T.T.P. Jayadas, S Santhirasegaram, A Laheetharan, M Senthilnanthanan, R Ramasamy DOI:10.4103/0972-9062.249482   [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Attempt to uncover reservoirs of human spotted fever rickettsiosis on the Fleurieu Peninsula, South Australia p. 239 Patrick L Taggart, Rebecca Traub, Sze Fui, Phil Weinstein DOI:10.4103/0972-9062.249483   [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta An investigation about the possible role of cattle and goats as reservoir hosts for Leishmania donovani in Bangladesh p. 242 Mohmmad Zahangir Alam, Md Mustafizur Rahman, Shirin Akter, Md Hasanuzzaman Talukder, Anita Rani Dey DOI:10.4103/0972-9062.249484   [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta LETTER TO THE EDITOR Protein tyrosine phosphatase, opisthorchiasis and dengue: A proteomics interrelationship p. 245 Sora Yasri, Viroj Wiwanitkit DOI:10.4103/0972-9062.249485   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta