279 results on '"Srinath A"'
Search Results
2. Sensitive detection of multiple islet autoantibodies in type 1 diabetes using small sample volumes by agglutination-PCR.
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Cortez, Felipe de Jesus, Gebhart, David, Robinson, Peter V, Seftel, David, Pourmandi, Narges, Owyoung, Jordan, Bertozzi, Carolyn R, Wilson, Darrell M, Maahs, David M, Buckingham, Bruce A, Mills, John R, Roforth, Matthew M, Pittock, Sean J, McKeon, Andrew, Page, Kara, Wolf, Wendy A, Sanda, Srinath, Speake, Cate, Greenbaum, Carla J, and Tsai, Cheng-Ting more...
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Islets of Langerhans ,Humans ,Diabetes Mellitus ,Type 1 ,Glutamate Decarboxylase ,Autoantibodies ,Insulin Antibodies ,Mass Screening ,Sensitivity and Specificity ,Polymerase Chain Reaction ,Agglutination ,Adolescent ,Adult ,Female ,Male ,Young Adult ,Diabetes Mellitus ,Type 1 ,General Science & Technology - Abstract
Islet autoantibodies are predominantly measured by radioassay to facilitate risk assessment and diagnosis of type 1 diabetes. However, the reliance on radioactive components, large sample volumes and limited throughput renders radioassay testing costly and challenging. We developed a multiplex analysis platform based on antibody detection by agglutination-PCR (ADAP) for the sample-sparing measurement of GAD, IA-2 and insulin autoantibodies/antibodies in 1 μL serum. The assay was developed and validated in 7 distinct cohorts (n = 858) with the majority of the cohorts blinded prior to analysis. Measurements from the ADAP assay were compared to radioassay to determine correlation, concordance, agreement, clinical sensitivity and specificity. The average overall agreement between ADAP and radioassay was above 91%. The average clinical sensitivity and specificity were 96% and 97%. In the IASP 2018 workshop, ADAP achieved the highest sensitivity of all assays tested at 95% specificity (AS95) rating for GAD and IA-2 autoantibodies and top-tier performance for insulin autoantibodies. Furthermore, ADAP correctly identified 95% high-risk individuals with two or more autoantibodies by radioassay amongst 39 relatives of T1D patients tested. In conclusion, the new ADAP assay can reliably detect the three cardinal islet autoantibodies/antibodies in 1μL serum with high sensitivity. This novel assay may improve pediatric testing compliance and facilitate easier community-wide screening for islet autoantibodies. more...
- Published
- 2020
Catalog
3. Sensitive detection of multiple islet autoantibodies in type 1 diabetes using small sample volumes by agglutination-PCR
- Author
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de Jesus Cortez, Felipe, Gebhart, David, Robinson, Peter V, Seftel, David, Pourmandi, Narges, Owyoung, Jordan, Bertozzi, Carolyn R, Wilson, Darrell M, Maahs, David M, Buckingham, Bruce A, Mills, John R, Roforth, Matthew M, Pittock, Sean J, McKeon, Andrew, Page, Kara, Wolf, Wendy A, Sanda, Srinath, Speake, Cate, Greenbaum, Carla J, and Tsai, Cheng-ting more...
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Diabetes ,Autoimmune Disease ,Pediatric ,4.2 Evaluation of markers and technologies ,4.1 Discovery and preclinical testing of markers and technologies ,Detection ,screening and diagnosis ,Metabolic and endocrine ,Adolescent ,Adult ,Agglutination ,Autoantibodies ,Diabetes Mellitus ,Type 1 ,Female ,Glutamate Decarboxylase ,Humans ,Insulin Antibodies ,Islets of Langerhans ,Male ,Mass Screening ,Polymerase Chain Reaction ,Sensitivity and Specificity ,Young Adult ,General Science & Technology - Abstract
Islet autoantibodies are predominantly measured by radioassay to facilitate risk assessment and diagnosis of type 1 diabetes. However, the reliance on radioactive components, large sample volumes and limited throughput renders radioassay testing costly and challenging. We developed a multiplex analysis platform based on antibody detection by agglutination-PCR (ADAP) for the sample-sparing measurement of GAD, IA-2 and insulin autoantibodies/antibodies in 1 μL serum. The assay was developed and validated in 7 distinct cohorts (n = 858) with the majority of the cohorts blinded prior to analysis. Measurements from the ADAP assay were compared to radioassay to determine correlation, concordance, agreement, clinical sensitivity and specificity. The average overall agreement between ADAP and radioassay was above 91%. The average clinical sensitivity and specificity were 96% and 97%. In the IASP 2018 workshop, ADAP achieved the highest sensitivity of all assays tested at 95% specificity (AS95) rating for GAD and IA-2 autoantibodies and top-tier performance for insulin autoantibodies. Furthermore, ADAP correctly identified 95% high-risk individuals with two or more autoantibodies by radioassay amongst 39 relatives of T1D patients tested. In conclusion, the new ADAP assay can reliably detect the three cardinal islet autoantibodies/antibodies in 1μL serum with high sensitivity. This novel assay may improve pediatric testing compliance and facilitate easier community-wide screening for islet autoantibodies. more...
- Published
- 2020
4. Avidity-dependent programming of autoreactive T cells in T1D.
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Durinovic-Belló, Ivana, Gersuk, Vivian H, Ni, Chester, Wu, Rebecca, Thorpe, Jerill, Jospe, Nicholas, Sanda, Srinath, Greenbaum, Carla J, and Nepom, Gerald T
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T-Lymphocyte Subsets ,Humans ,Diabetes Mellitus ,Type 1 ,Insulin ,Proinsulin ,Receptors ,Antigen ,T-Cell ,Autoantigens ,Case-Control Studies ,Gene Expression Profiling ,Autoimmunity ,T-Cell Antigen Receptor Specificity ,Protein Binding ,Genotype ,Adult ,Middle Aged ,Female ,Male ,Young Adult ,Diabetes ,Autoimmune Disease ,Genetics ,Underpinning research ,1.1 Normal biological development and functioning ,Metabolic and endocrine ,General Science & Technology - Abstract
Fate determination for autoreactive T cells relies on a series of avidity-dependent interactions during T cell selection, represented by two general types of signals, one based on antigen expression and density during T cell development, and one based on genes that interpret the avidity of TCR interaction to guide developmental outcome. We used proinsulin-specific HLA class II tetramers to purify and determine transcriptional signatures for autoreactive T cells under differential selection in type 1 diabetes (T1D), in which insulin (INS) genotypes consist of protective and susceptible alleles that regulate the level of proinsulin expression in the thymus. Upregulation of steroid nuclear receptor family 4A (NR4A) and early growth response family genes in proinsulin-specific T cells was observed in individuals with susceptible INS-VNTR genotypes, suggesting a mechanism for avidity-dependent fate determination of the T cell repertoire in T1D. The NR4A genes act as translators of TCR signal strength that guide central and peripheral T cell fate decisions through transcriptional modification. We propose that maintenance of an NR4A-guided program in low avidity autoreactive T cells in T1D reflects their prior developmental experience influenced by proinsulin expression, identifying a pathway permissive for autoimmunity. more...
- Published
- 2014
5. Improved sleep, cognitive processing and enhanced learning and memory task accuracy with Yoga nidra practice in novices
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Datta, Karuna, primary, Bhutambare, Anna, additional, V. L., Mamatha, additional, Narawa, Yogita, additional, Srinath, Rajagopal, additional, and Kanitkar, Madhuri, additional
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- 2023
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6. Feasibility, enablers and challenges of using timeliness metrics for household contact tracing and TB preventive therapy in Pakistan
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Jamil, Bushra, primary, Nair, Divya, additional, Thekkur, Pruthu, additional, Laeeq, Neelofar, additional, Adil, Anum, additional, Khogali, Mohammed, additional, Zachariah, Rony, additional, Dar Berger, Selma, additional, Satyanarayana, Srinath, additional, Kumar, Ajay M. V., additional, Bochner, Aaron, additional, McClelland, Amanda, additional, Fatima, Razia, additional, and Harries, Anthony D., additional more...
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- 2023
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7. Face mask use in the city of Chennai, India: Results from three serial cross-sectional surveys, 2021.
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Sharan, Murali, Sakthivel, Manikandanesan, Rubeshkumar, Polani, Nagarajan, Ramya, Venkatasamy, Vettrichelvan, Muthappan, Sendhilkumar, Raju, Mohankumar, Chadwick, Joshua, S., Kalyani, Krishna, Navaneeth S., Kaviprawin, Mogan, Gollapalli, Pavan Kumar, Ramamurthy, Srinath, Ganeshkumar, Parasuraman, Jagadeesan, Murugesan, and Kaur, Prabhdeep more...
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MEDICAL masks ,MIDDLE-aged persons ,COVID-19 pandemic ,PUBLIC spaces ,YOUNG adults ,AGE groups - Abstract
Introduction: The Government of Tamil Nadu, India, mandated wearing face masks in public places to combat the COVID-19 pandemic. We established face mask surveillance and estimated the prevalence of appropriate mask use (covering the nose, mouth, and chin) in the slums and non-slums of Chennai at different time points in 2021. Methods: We conducted three serial cross-sectional surveys in the outdoors and indoors of Chennai in March, July, and October 2021. We observed the mask wearing among 3200 individuals in the outdoors and 1280 in the indoors. We divided the outdoor and indoor locations into slums and non-slums. In October 2021, we also surveyed 150 individuals from each of the 11 shopping malls in the city. We calculated the proportions and 95% confidence interval (95%CI) for the appropriate mask use in the outdoor, indoor, and malls by age, gender, region, and setting (slum and non-slum). Results: We observed 3200 individuals in the outdoor and 1280 individuals in the indoor setting, each from a slum and non-slum, during the three rounds of the study. In outdoor and indoors, males comprised three-fourths and middle-aged individuals were half the study population. Mask compliance changed significantly with time (p-value <0.001). Males consistently demonstrated better compliance in all rounds. The south region had the highest mask compliance in slums indoors and outdoors in rounds 4 and 5. Young adults had the highest mask compliance in both outdoor slums and non-slums in all rounds. Overall mask compliance in shopping malls was 57% (95% CI: 48–65). Conclusion: The mask compliance in Chennai outdoors during the COVID-19 pandemic was less than 50%, with variations across time points by gender, age groups, and geographical locations. We must develop more effective communication strategies for older age groups and crowded indoor settings. [ABSTRACT FROM AUTHOR] more...
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- 2024
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8. Predictors of telemedicine use during the COVID-19 pandemic in the United States–an analysis of a national electronic medical record database
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Khatana, Sameed Ahmed M., primary, Yang, Lin, additional, Eberly, Lauren A., additional, Julien, Howard M., additional, Adusumalli, Srinath, additional, and Groeneveld, Peter W., additional
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- 2022
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9. Antitubercular activity assessment of fluorinated chalcones, 2-aminopyridine-3-carbonitrile and 2-amino-4H-pyran-3-carbonitrile derivatives: In vitro, molecular docking and in-silico drug likeliness studies
- Author
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Lagu, Surendra Babu, primary, Yejella, Rajendra Prasad, additional, Nissankararao, Srinath, additional, Bhandare, Richie R., additional, Golla, Venu Sampath, additional, Subrahmanya Lokesh, Bontha Venkata, additional, Rahman, M. Mukhlesur, additional, and Shaik, Afzal Basha, additional more...
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- 2022
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10. Comparative assessment of cognitive impairment and oxidative stress markers among vitamin D insufficient elderly patients with and without type 2 diabetes mellitus (T2DM)
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R., Rajalakshmi, primary, Uthaiah, Chinnappa A., additional, C. M., Ramya, additional, Madhunapantula, SubbaRao V., additional, Salimath, Paramahans V., additional, K., Praveen, additional, M., Srinath K., additional, and M. R., Kishor, additional more...
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- 2022
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11. Predictors of telemedicine use during the COVID-19 pandemic in the United States-an analysis of a national electronic medical record database
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Sameed Ahmed M. Khatana, Lin Yang, Lauren A. Eberly, Howard M. Julien, Srinath Adusumalli, and Peter W. Groeneveld
- Subjects
Adult ,Multidisciplinary ,Adolescent ,SARS-CoV-2 ,COVID-19 ,Electronic Health Records ,Humans ,Female ,Pandemics ,Telemedicine ,United States ,Retrospective Studies - Abstract
Telemedicine utilization increased significantly in the United States during the COVID-19 pandemic. However, there is concern that disadvantaged groups face barriers to access based on single-center studies. Whether there has been equitable access to telemedicine services across the US and during later parts of the pandemic is unclear. This study retrospectively analyzes outpatient medical encounters for patients 18 years of age and older using Healthjump–a national electronic medical record database–from March 1 to December 31, 2020. A mixed effects multivariable logistic regression model was used to assess the association between telemedicine utilization and patient and area-level factors and the odds of having at least one telemedicine encounter during the study period. Among 1,999,534 unique patients 21.6% had a telemedicine encounter during the study period. In the multivariable model, age [OR = 0.995 (95% CI 0.993, 0.997); p more...
- Published
- 2021
12. Antitubercular activity assessment of fluorinated chalcones, 2-aminopyridine-3-carbonitrile and 2-amino-4H-pyran-3-carbonitrile derivatives: In vitro, molecular docking and in-silico drug likeliness studies
- Author
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Surendra Babu Lagu, Rajendra Prasad Yejella, Srinath Nissankararao, Richie R. Bhandare, Venu Sampath Golla, Bontha Venkata Subrahmanya Lokesh, M. Mukhlesur Rahman, and Afzal Basha Shaik
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Molecular Docking Simulation ,Structure-Activity Relationship ,Multidisciplinary ,Chalcone ,Chalcones ,Molecular Structure ,Antitubercular Agents ,Streptomycin ,Aminopyridines ,Humans ,Prospective Studies ,Pyrans - Abstract
A series of newer previously synthesized fluorinated chalcones and their 2-amino-pyridine-3-carbonitrile and 2-amino-4H-pyran-3-carbonitrile derivatives were screened for their in vitro antitubercular activity and in silico methods. Compound 40 (MIC~ 8 μM) was the most potent among all 60 compounds, whose potency is comparable with broad spectrum antibiotics like ciprofloxacin and streptomycin and three times more potent than pyrazinamide. Additionally, compound 40 was also less selective and hence non-toxic towards the human live cell lines-LO2 in its MTT assay. Compounds 30, 27, 50, 41, 51, and 60 have exhibited streptomycin like activity (MIC~16–18 μM). Fluorinated chalcones, pyridine and pyran derivatives were found to occupy prime position in thymidylate kinase enzymatic pockets in molecular docking studies. The molecule 40 being most potent had shown a binding energy of -9.67 Kcal/mol, while docking against thymidylate kinase, which was compared with its in vitro MIC value (~8 μM). These findings suggest that 2-aminopyridine-3-carbonitrile and 2-amino-4H-pyran-3-carbonitrile derivatives are prospective lead molecules for the development of novel antitubercular drugs. more...
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- 2021
13. Sensitive detection of multiple islet autoantibodies in type 1 diabetes using small sample volumes by agglutination-PCR
- Author
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Jordan Owyoung, Andrew McKeon, Cheng-ting Tsai, Darrell M. Wilson, Bruce A. Buckingham, Srinath Sanda, Cate Speake, David M. Maahs, Peter V. Robinson, Matthew M. Roforth, Narges Pourmandi, Kara Page, Felipe de Jesus Cortez, David Gebhart, Carla J. Greenbaum, Sean J. Pittock, Wendy A. Wolf, John Mills, David Seftel, Carolyn R. Bertozzi, and Chatenoud, Lucienne more...
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0301 basic medicine ,Male ,Physiology ,Epidemiology ,medicine.medical_treatment ,Insulin Antibodies ,Artificial Gene Amplification and Extension ,Polymerase Chain Reaction ,Biochemistry ,0302 clinical medicine ,Endocrinology ,Medical Conditions ,Immune Physiology ,Medicine and Health Sciences ,Medicine ,Mass Screening ,Insulin ,Bile ,Multiplex ,Pediatric ,Multidisciplinary ,geography.geographical_feature_category ,Immune System Proteins ,biology ,Glutamate Decarboxylase ,Diabetes ,Islet ,Body Fluids ,Female ,Antibody ,Anatomy ,4.2 Evaluation of markers and technologies ,Type 1 ,Research Article ,Adult ,Agglutination ,Adolescent ,General Science & Technology ,Endocrine Disorders ,Science ,Concordance ,Immunology ,030209 endocrinology & metabolism ,Research and Analysis Methods ,Autoimmune Disease ,Sensitivity and Specificity ,Antibodies ,03 medical and health sciences ,Islets of Langerhans ,Young Adult ,Diabetes Mellitus ,Humans ,Molecular Biology Techniques ,Molecular Biology ,Metabolic and endocrine ,Autoantibodies ,Diabetic Endocrinology ,Type 1 diabetes ,geography ,Endocrine Physiology ,business.industry ,Insulin Signaling ,Autoantibody ,Biology and Life Sciences ,Proteins ,Bilirubin ,medicine.disease ,Hormones ,4.1 Discovery and preclinical testing of markers and technologies ,Agglutination (biology) ,030104 developmental biology ,Diabetes Mellitus, Type 1 ,Metabolic Disorders ,Medical Risk Factors ,biology.protein ,business - Abstract
Islet autoantibodies are predominantly measured by radioassay to facilitate risk assessment and diagnosis of type 1 diabetes. However, the reliance on radioactive components, large sample volumes and limited throughput renders radioassay testing costly and challenging. We developed a multiplex analysis platform based on antibody detection by agglutination-PCR (ADAP) for the sample-sparing measurement of GAD, IA-2 and insulin autoantibodies/antibodies in 1 μL serum. The assay was developed and validated in 7 distinct cohorts (n = 858) with the majority of the cohorts blinded prior to analysis. Measurements from the ADAP assay were compared to radioassay to determine correlation, concordance, agreement, clinical sensitivity and specificity. The average overall agreement between ADAP and radioassay was above 91%. The average clinical sensitivity and specificity were 96% and 97%. In the IASP 2018 workshop, ADAP achieved the highest sensitivity of all assays tested at 95% specificity (AS95) rating for GAD and IA-2 autoantibodies and top-tier performance for insulin autoantibodies. Furthermore, ADAP correctly identified 95% high-risk individuals with two or more autoantibodies by radioassay amongst 39 relatives of T1D patients tested. In conclusion, the new ADAP assay can reliably detect the three cardinal islet autoantibodies/antibodies in 1μL serum with high sensitivity. This novel assay may improve pediatric testing compliance and facilitate easier community-wide screening for islet autoantibodies. more...
- Published
- 2020
14. Comparative assessment of cognitive impairment and oxidative stress markers among vitamin D insufficient elderly patients with and without type 2 diabetes mellitus (T2DM)
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Rajalakshmi R., Chinnappa A. Uthaiah, Ramya C. M., SubbaRao V. Madhunapantula, Paramahans V. Salimath, Praveen K., Srinath K. M., and Kishor M. R.
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Male ,Glutathione Peroxidase ,Multidisciplinary ,Vitamins ,Middle Aged ,Vitamin D Deficiency ,Oxidative Stress ,Cross-Sectional Studies ,Diabetes Mellitus, Type 2 ,Humans ,Cognitive Dysfunction ,Female ,Vitamin D ,Biomarkers ,Aged - Abstract
Background Disorders of mental health are known to affect cognitive functions, hence called as cognitive disorders. Impaired glucose metabolism, insulin resistance, vitamin-D deficiency and oxidative stress are some of the key early events reported to be involved in the pathogenesis of most common cognitive disorders, which include Alzheimer’s disease. Type-2 diabetes mellitus (T2DM) is one of the known contributing factors of cognitive impairment and dementia. Methods A cross sectional study was carried out in 145 subjects, who were assessed for cognitive function by modified mini mental status examination (3MS). In addition, measurement of fasting blood sugar (FBS), fasting insulin, HbA1c, lipid profile, vitamin D and oxidative markers was performed. Participants were divided into different groups based on (a) vitamin D insufficiency and sufficiency; (b) diabetic and non-diabetic with and without cognitive impairment. Results The study included a total of 145 subjects; 51 males and 94 females and the mean age was 68.24±9.70 years. Among diabetics with vitamin D insufficiency, 35 subjects (71.43%) had cognitive impairment, but, among non-diabetics with vitamin D insufficiency, 27 subjects (62.79%) had cognitive impairment. Chi square test showed no significant association between diabetes, vitamin D insufficiency and cognitive impairment. Glutathione peroxidase (GPx) and superoxide dismutase (SOD) levels were non-significantly lower in cognition-impaired subjects, when compared to cognition normal subjects in diabetics with vitamin D insufficiency. Conclusion Our study showed that cognitive impairment is more predominant in individuals with diabetes. However, our study did not find any significant relationship between T2DM, vitamin D deficiency, cognitive impairment, and oxidative stress. A significant association was found only with GPx and 3MSE score in vitamin D insufficient non-diabetics. more...
- Published
- 2022
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- View/download PDF
15. HIV testing uptake and HIV positivity among presumptive tuberculosis patients in Mandalay, Myanmar, 2014-2017
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Kyaw, Khine Wut Yee, primary, Kyaw, Nang Thu Thu, additional, Kyi, Myo Su, additional, Aye, Sandar, additional, Harries, Anthony D., additional, Kumar, Ajay M. V., additional, Oo, Nay Lynn, additional, Satyanarayana, Srinath, additional, and Aung, Si Thu, additional more...
- Published
- 2020
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16. Causal relationships between lipid and glycemic levels in an Indian population: A bidirectional Mendelian randomization approach
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Gagandeep Kaur Walia, Vipin Gupta, Shah Ebrahim, Tanica Lyngdoh, Tripti Agarwal, Sanjay Kinra, Dorairaj Prabhakaran, K. Srinath Reddy, George Davey Smith, Giriraj R. Chandak, Caroline L Relton, and Frank Dudbridge more...
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0301 basic medicine ,Blood Glucose ,Male ,Genotyping Techniques ,Physiology ,Type 2 diabetes ,030204 cardiovascular system & hematology ,Biochemistry ,Fats ,0302 clinical medicine ,Endocrinology ,Glucose Metabolism ,Medicine and Health Sciences ,Insulin ,Multidisciplinary ,Alcohol Consumption ,Mendelian Randomization Analysis ,Lipids ,3. Good health ,Type 2 Diabetes ,Cholesterol ,Medicine ,Carbohydrate Metabolism ,Female ,Research Article ,Adult ,medicine.medical_specialty ,Endocrine Disorders ,Science ,India ,Single-nucleotide polymorphism ,Biology ,Quantitative trait locus ,Polymorphism, Single Nucleotide ,03 medical and health sciences ,Insulin resistance ,Quantitative Trait, Heritable ,Internal medicine ,Mendelian randomization ,medicine ,Diabetes Mellitus ,Humans ,Least-Squares Analysis ,Triglycerides ,Glycemic ,Nutrition ,Diabetic Endocrinology ,Endocrine Physiology ,Cholesterol, HDL ,Biology and Life Sciences ,Cholesterol, LDL ,medicine.disease ,Hormones ,Diet ,030104 developmental biology ,Metabolism ,Cross-Sectional Studies ,Metabolic Disorders ,Insulin Resistance ,Dyslipidemia - Abstract
BackgroundDyslipidemia and abnormal glycemic traits are leading causes of morbidity and mortality. Although the association between the two traits is well established, there still exists a gap in the evidence for the direction of causality.ObjectiveThis study aimed to examine the direction of the causal relationship between lipids and glycemic traits in an Indian population using bidirectional Mendelian randomization (BMR).MethodsThe BMR analysis was conducted on 4900 individuals (2450 sib-pairs) from the Indian Migration Study. Instrument variables were generated for each lipid and glycemic trait (fasting insulin, fasting glucose, HOMA-IR, HOMA-β, LDL-cholesterol, HDL-cholesterol, total cholesterol and triglycerides) to examine the causal relationship by applying two-stage least squares (2SLS) regression in both directions.ResultsLipid and glycemic traits were found to be associated observationally, however, results from 2SLS showed that only triglycerides, defined by weighted genetic risk score (wGRS) of 3 SNPs (rs662799 at APOAV, rs780094 at GCKR and rs4420638 at APOE/C1/C4), were observed to be causally effecting 1.15% variation in HOMA-IR (SE = 0.22, P = 0.010), 1.53% in HOMA- β (SE = 0.21, P = 0.001) and 1.18% in fasting insulin (SE = 0.23, P = 0.009). No evidence for a causal effect was observed in the reverse direction or between any other lipid and glycemic traits.ConclusionThe study findings suggest that triglycerides may causally impact various glycemic traits. However, the findings need to be replicated in larger studies. more...
- Published
- 2020
17. HIV testing uptake and HIV positivity among presumptive tuberculosis patients in Mandalay, Myanmar, 2014-2017
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Srinath Satyanarayana, Anthony D. Harries, Nay Lynn Oo, Sandar Aye, Si Thu Aung, Khine Wut Yee Kyaw, Nang Thu Thu Kyaw, Myo Su Kyi, and Ajay M. V. Kumar
- Subjects
Bacterial Diseases ,RNA viruses ,Counseling ,Male ,0301 basic medicine ,Human immunodeficiency virus (HIV) ,HIV Infections ,Myanmar ,Pathology and Laboratory Medicine ,medicine.disease_cause ,Geographical Locations ,Endocrinology ,0302 clinical medicine ,Immunodeficiency Viruses ,Outpatients ,Medicine and Health Sciences ,Prevalence ,Mass Screening ,030212 general & internal medicine ,Multidisciplinary ,Coinfection ,HIV diagnosis and management ,Middle Aged ,Infectious Diseases ,Medical Microbiology ,Viral Pathogens ,Viruses ,Medicine ,Tuberculosis Diagnosis and Management ,HIV clinical manifestations ,Female ,Pathogens ,Research Article ,Adult ,medicine.medical_specialty ,Asia ,Tuberculosis ,Patients ,Adolescent ,HIV Positivity ,Endocrine Disorders ,Science ,Hiv testing ,Microbiology ,World health ,Young Adult ,03 medical and health sciences ,Internal medicine ,Retroviruses ,Diabetes Mellitus ,medicine ,Humans ,Microbial Pathogens ,Aged ,business.industry ,Lentivirus ,Organisms ,Biology and Life Sciences ,HIV ,Patient Acceptance of Health Care ,Tropical Diseases ,medicine.disease ,030112 virology ,Diagnostic medicine ,Number needed to screen ,Health Care ,TB Outpatient ,Cross-Sectional Studies ,Metabolic Disorders ,People and Places ,Hiv status ,business - Abstract
IntroductionThe World Health Organization's framework for TB/HIV collaborative activities recommends provider-initiated HIV testing and counselling (PITC) of patients with presumptive TB. In Myanmar, PITC among presumptive TB patients was started at the TB outpatient department (TB OPD) in Mandalay in 2014. In this study, we assessed the uptake of PITC among presumptive TB patients and the number needed to screen to find one additional HIV positive case, stratified by demographic and clinical characteristics.MethodThis was a cross-sectional study using routinely collected data of presumptive TB patients who registered for PITC services at the TB OPD between August 2014 and December 2017 in Mandalay.ResultAmong 21,989 presumptive TB patients registered, 9,796 (44.5%) had known HIV status at registration and 2,763 (28.2%) were people already living with HIV (PLHIV). Of the remainder, 85.3% (10,401/12,193) were newly tested for HIV. Patients ConclusionUptake of HIV testing among eligible presumptive TB patients was high with four out of five presumptive TB patients being tested for HIV. This strategy detected many additional HIV-positive persons, and this included those who were not diagnosed with TB. We strongly recommend that this strategy be implemented nationwide in Myanmar. more...
- Published
- 2020
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18. Identifying high or low risk of mother to child transmission of HIV: How Harare City, Zimbabwe is doing?
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Brian Komtenza, Prosper Chonzi, Angela Mushavi, Ngwarai Sithole, Srinath Satyanarayana, Solomon Mukungunugwa, Owen Mugurungi, Kudakwashe C. Takarinda, and Talent Bvochora
- Subjects
RNA viruses ,0301 basic medicine ,Cross-sectional study ,Maternal Health ,HIV Infections ,Pathology and Laboratory Medicine ,Families ,Labor and Delivery ,0302 clinical medicine ,Immunodeficiency Viruses ,Pregnancy ,immune system diseases ,Medicine and Health Sciences ,Mass Screening ,030212 general & internal medicine ,Pregnancy Complications, Infectious ,Antibiotic prophylaxis ,Young adult ,Children ,Multidisciplinary ,Obstetrics ,Transmission (medicine) ,Obstetrics and Gynecology ,virus diseases ,HIV diagnosis and management ,Viral Load ,Anti-Retroviral Agents ,Medical Microbiology ,Viral Pathogens ,Viruses ,Infectious diseases ,Medicine ,Female ,Pathogens ,Infants ,Viral load ,Research Article ,medicine.drug ,Adult ,Zimbabwe ,medicine.medical_specialty ,Nevirapine ,Adolescent ,Science ,Viral diseases ,Microbiology ,Young Adult ,03 medical and health sciences ,Zidovudine ,Virology ,Trimethoprim, Sulfamethoxazole Drug Combination ,Retroviruses ,medicine ,Humans ,Management of High-Risk Pregnancies ,Microbial Pathogens ,business.industry ,Lentivirus ,Infant, Newborn ,Organisms ,Biology and Life Sciences ,HIV ,Antibiotic Prophylaxis ,medicine.disease ,030112 virology ,Infectious Disease Transmission, Vertical ,Diagnostic medicine ,Cross-Sectional Studies ,Age Groups ,People and Places ,Birth ,Women's Health ,Population Groupings ,business ,Viral Transmission and Infection - Abstract
BackgroundDespite high antiretroviral (ARV) treatment coverage among pregnant women for prevention of mother-to-child transmission (PMTCT) of Human Immunodeficiency Virus (HIV) in Zimbabwe, the MTCT rate is still high. Therefore in 2016, the country adopted World Health Organization recommendations of stratifying pregnant women into "High" or"Low" MTCT risk for subsequent provision of HIV exposed infant (HEI) with appropriate follow-up care according to risk status.ObjectiveThe study sought to ascertain, among pregnant women who delivered in clinics of Harare in August 2017: the extent to which high risk MTCT pregnancies were identified at time of delivery; and whether their newborns were initiated on appropriate ARV prophylaxis, cotrimoxazole prophylaxis, subjected to early HIV diagnostic testing and initiated on ARV treatment.MethodsCross-sectional study using review of records of routinely collected program data.ResultsOf the 1,786 pregnant women who delivered in the selected clinics, HIV status at the time of delivery was known for 1,756 (98%) of whom 197 (11%) were HIV seropositive. Only 19 (10%) could be classified as "high risk" for MTCT and the remaining 90% lacked adequate information to classify them into high or low risk for MTCT due to missing data. Of the 197 live births, only two (1%) infants had a nucleic-acid test (NAT) at birth and 32 (16%) infants had NAT at 6 weeks. Of all 197 infants, 183 (93%) were initiated on single ARV prophylaxis (Nevirapine), 15 (7%) infants' ARV prophylaxis status was not documented and one infant got dual ARV prophylaxis (Nevirapine+Zidovudine).ConclusionThere was paucity of data requisite for MTCT risk stratification due to poor recording of data; "high risk" women were missed in the few circumstances where sufficient data were available. Thus "high risk" HEI are deprived of dual ARV prophylaxis and priority HIV NAT at birth and onwards which they require for PMTCT. Health workers need urgent training, mentorship and supportive supervision to master data management and perform MTCT risk stratification satisfactorily. more...
- Published
- 2019
19. Isoniazid preventive therapy: Uptake, incidence of tuberculosis and survival among people living with HIV in Bulawayo, Zimbabwe
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Ronnie Matambo, Winnie Mandewo, Khulamuzi Nyathi, Hannock Tweya, Srinath Satyanarayana, Kudakwashe C. Takarinda, Edwin Sibanda, Riitta A Dlodlo, Sithokozile Hove, Saziso Nyathi, and Anthony D. Harries more...
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Male ,Bacterial Diseases ,RNA viruses ,Pediatrics ,Antitubercular Agents ,Prevalence ,HIV Infections ,Pathology and Laboratory Medicine ,Geographical Locations ,0302 clinical medicine ,Immunodeficiency Viruses ,Antiretroviral Therapy, Highly Active ,Health care ,Medicine and Health Sciences ,Public and Occupational Health ,030212 general & internal medicine ,Young adult ,Multidisciplinary ,Incidence ,Incidence (epidemiology) ,Drugs ,Middle Aged ,Vaccination and Immunization ,Infectious Diseases ,Medical Microbiology ,Viral Pathogens ,Viruses ,Tuberculosis Diagnosis and Management ,Medicine ,Female ,Pathogens ,Research Article ,Cohort study ,Adult ,Zimbabwe ,medicine.medical_specialty ,Tuberculosis ,Science ,Immunology ,HIV prevention ,030231 tropical medicine ,Antiretroviral Therapy ,Microbiology ,Young Adult ,03 medical and health sciences ,Pharmacotherapy ,Antiviral Therapy ,Diagnostic Medicine ,Retroviruses ,parasitic diseases ,Isoniazid ,medicine ,Humans ,Microbial Pathogens ,Pharmacology ,business.industry ,Lentivirus ,Organisms ,Biology and Life Sciences ,HIV ,Tropical Diseases ,medicine.disease ,Regimen ,Age Groups ,People and Places ,Africa ,Population Groupings ,Preventive Medicine ,business - Abstract
SettingFour primary health care clinics providing tuberculosis (TB) and Human Immunodeficiency Virus care services in Bulawayo, Zimbabwe.ObjectivesTo assess isoniazid preventive therapy (IPT) initiation and completion, factors associated with IPT uptake and incidence of TB, and TB and antiretroviral treatment (ART) outcomes among people living with HIV (PLHIV).DesignThis was a cohort study using routine data in the records for PLHIV initiated on ART from October 2013 to March 2014 with 31 December 2017 as the end of the follow-up period.ResultsA total of 408 PLHIV were eligible for IPT, 214 (52%) were initiated on IPT and 201 (94%) completed IPT. No person in the IPT-initiated group developed Tuberculosis (TB). Six persons with TB were reported among the non-IPT-initiated group leading to an incidence of 9 cases/1,000 person-years of follow-up. About 70% of those who developed and were treated for TB had a successful TB treatment outcome. The survival on ART at four years of follow-up was 88% among the IPT-initiated PLHIV that was significantly higher than the 75% survival in the group not- initiated on IPT.ConclusionThe study revealed low IPT initiation among eligible PLHIV who, if started on IPT, completed the six month regimen. TB was reported only among the PLHIV not-initiated on IPT and the four year ART survival was higher in the IPT-initiated group than in the non-initiated group. These findings reinforce the need to strengthen IPT uptake among PLHIV in Bulawayo. more...
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- 2019
20. Enhanced adherence counselling and viral load suppression in HIV seropositive patients with an initial high viral load in Harare, Zimbabwe: Operational issues
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Brian Komtenza, Tsitsi Apollo, Srinath Satyanarayana, Kudakwashe C. Takarinda, Hilda Bara, Talent Bvochora, Clemence Duri, and Prosper Chonzi
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Bacterial Diseases ,RNA viruses ,Counseling ,Male ,0301 basic medicine ,Epidemiology ,Physiology ,Hiv seropositive ,Human immunodeficiency virus (HIV) ,HIV Infections ,Pathology and Laboratory Medicine ,Global Health ,medicine.disease_cause ,0302 clinical medicine ,Immunodeficiency Viruses ,Medicine and Health Sciences ,Public and Occupational Health ,030212 general & internal medicine ,Viral suppression ,Young adult ,Child ,Multidisciplinary ,HIV diagnosis and management ,Viral Load ,Middle Aged ,Vaccination and Immunization ,Body Fluids ,Infectious Diseases ,Blood ,Anti-Retroviral Agents ,HIV epidemiology ,Medical Microbiology ,Viral Pathogens ,Viruses ,Medicine ,Female ,Pathogens ,Anatomy ,Viral load ,Research Article ,Adult ,Zimbabwe ,medicine.medical_specialty ,Tuberculosis ,Adolescent ,Science ,Immunology ,Antiretroviral Therapy ,Microbiology ,Medication Adherence ,Young Adult ,03 medical and health sciences ,Antiviral Therapy ,Virology ,Internal medicine ,Retroviruses ,medicine ,Humans ,Microbial Pathogens ,Retrospective Studies ,business.industry ,Lentivirus ,Organisms ,Biology and Life Sciences ,HIV ,Retrospective cohort study ,Tropical Diseases ,medicine.disease ,030112 virology ,Diagnostic medicine ,Research studies ,Preventive Medicine ,business ,Viral Transmission and Infection - Abstract
Background In people living with HIV (PLHIV) who are on anti-retroviral therapy (ART), it is essential to identify persons with high blood viral loads (VLs) (≥1000 copies/ml), provide enhanced adherence counselling (EAC) for 3 months and assess for VL suppression (5,000 copies/ml were associated with lower probability of viral suppression. Conclusion The routine VL testing levels were high, but there were major programmatic gaps in enrolling PLHIV with high VLs into EAC and achieving VL suppression. The full potential of EAC on achieving viral load suppression has not been achieved in this setting. The reasons for these gaps need to be assessed in future research studies and addressed by suitable changes in policies/practices. more...
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- 2019
21. Causal relationships between lipid and glycemic levels in an Indian population: A bidirectional Mendelian randomization approach
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Agarwal, Tripti, primary, Lyngdoh, Tanica, additional, Dudbridge, Frank, additional, Chandak, Giriraj Ratan, additional, Kinra, Sanjay, additional, Prabhakaran, Dorairaj, additional, Reddy, K. Srinath, additional, Relton, Caroline L., additional, Davey Smith, George, additional, Ebrahim, Shah, additional, Gupta, Vipin, additional, and Walia, Gagandeep Kaur, additional more...
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- 2020
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22. Isoniazid preventive therapy: Uptake, incidence of tuberculosis and survival among people living with HIV in Bulawayo, Zimbabwe
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Nyathi, Saziso, primary, Dlodlo, Riitta A., additional, Satyanarayana, Srinath, additional, Takarinda, Kudakwashe C., additional, Tweya, Hannock, additional, Hove, Sithokozile, additional, Matambo, Ronnie, additional, Mandewo, Winnie, additional, Nyathi, Khulamuzi, additional, Sibanda, Edwin, additional, and Harries, Anthony D., additional more...
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- 2019
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23. Factors associated with death and loss to follow-up in children on antiretroviral care in Mingalardon Specialist Hospital, Myanmar, 2006-2016
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Kay Khaing Kaung Nyunt, Htun Nyunt Oo, Petros Isaakidis, Srinath Satyanarayana, Hoa Nguyen Binh, San Hone, Wai Wai Han, and Aye Aye Khaing
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Male ,RNA viruses ,Bacterial Diseases ,Human immunodeficiency virus (HIV) ,lcsh:Medicine ,HIV Infections ,Kaplan-Meier Estimate ,Myanmar ,medicine.disease_cause ,Pathology and Laboratory Medicine ,Pediatrics ,Geographical Locations ,Families ,0302 clinical medicine ,Immunodeficiency Viruses ,Antiretroviral Therapy, Highly Active ,Medicine and Health Sciences ,Medicine ,Public and Occupational Health ,030212 general & internal medicine ,Child ,lcsh:Science ,Children ,Multidisciplinary ,Vaccination and Immunization ,Medical Microbiology ,Child, Preschool ,Viral Pathogens ,Viruses ,Infectious diseases ,Female ,Pathogens ,Pediatric Infections ,Cohort study ,Research Article ,medicine.medical_specialty ,Tuberculosis ,Asia ,Adolescent ,Anti-HIV Agents ,Immunology ,Antiretroviral Therapy ,Viral diseases ,Microbiology ,03 medical and health sciences ,Acquired immunodeficiency syndrome (AIDS) ,Antiviral Therapy ,030225 pediatrics ,Retroviruses ,Humans ,Protease Inhibitors ,Lost to follow-up ,Microbial Pathogens ,Retrospective Studies ,business.industry ,Lentivirus ,lcsh:R ,Organisms ,Infant ,Biology and Life Sciences ,HIV ,Retrospective cohort study ,medicine.disease ,Tropical Diseases ,CD4 Lymphocyte Count ,Regimen ,Age Groups ,Emergency medicine ,People and Places ,Lost to Follow-Up ,Population Groupings ,lcsh:Q ,Preventive Medicine ,Rural area ,business ,Follow-Up Studies - Abstract
Background Myanmar National AIDS programme’s priority is to improve the survival of all people living with HIV by providing anti-retroviral therapy (ART) care. More than 7200 children (aged
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- 2018
24. Cost-effectiveness of GeneXpert and LED-FM for diagnosis of pulmonary tuberculosis: A systematic review
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M Muniyandi, Srinath Satyanarayana, Kalpita Shringarpure, Kayzad Nilgiriwala, Richard Kirubakaran, Sarabjit Chadha, Karuna D. Sagili, and Prathap Tharyan
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Bacterial Diseases ,Statistical methods ,Cost effectiveness ,Economics ,Cost-Benefit Analysis ,lcsh:Medicine ,Social Sciences ,Geographical locations ,South Africa ,Database and Informatics Methods ,0302 clinical medicine ,Medicine and Health Sciences ,030212 general & internal medicine ,Database Searching ,lcsh:Science ,education.field_of_study ,Multidisciplinary ,GeneXpert MTB/RIF ,Statistics ,Health services research ,Cost-effectiveness analysis ,Monte Carlo method ,Physical sciences ,Infectious Diseases ,Tuberculosis Diagnosis and Management ,Health Services Research ,Research Article ,DNA, Bacterial ,medicine.medical_specialty ,Tuberculosis ,030231 tropical medicine ,Population ,Cost-Effectiveness Analysis ,Context (language use) ,Real-Time Polymerase Chain Reaction ,03 medical and health sciences ,Diagnostic Medicine ,medicine ,Humans ,education ,Intensive care medicine ,Tuberculosis, Pulmonary ,Cost–utility analysis ,business.industry ,lcsh:R ,Sputum ,Mycobacterium tuberculosis ,medicine.disease ,Tropical Diseases ,Economic Analysis ,Research and analysis methods ,Health Care ,Microscopy, Fluorescence ,Africa ,Mathematical and statistical techniques ,lcsh:Q ,People and places ,business ,Mathematics - Abstract
Background Early and accurate diagnosis of tuberculosis is a priority for TB programs globally to initiate treatment early and improve treatment outcomes. Currently, Ziehl–Neelsen (ZN) stain-based microscopy, GeneXpert and Light Emitting Diode-Fluorescence Microscopy (LED-FM) are used for diagnosing pulmonary drug sensitive tuberculosis. Published evidence synthesising the cost-effectiveness of these diagnostic tools is scarce. Methodology PubMed, EMBASE and Cost-effectiveness analysis registry were searched for studies that reported on the cost-effectiveness of GeneXpert and LED-FM, compared to ZN microscopy for diagnosing pulmonary TB. Risk of bias was assessed independently by four authors using the Consensus Health Economic Criteria (CHEC) extended checklist. The data variables included the study settings, population, type of intervention, type of comparator, year of study, duration of study, type of study design, costs for the test and the comparator and effectiveness indicators. Incremental cost-effectiveness ratio (ICER) was used for assessing the relative cost-effectiveness in this review. Results Of the 496 studies identified by the search, thirteen studies were included after removing duplicates and studies that did not fulfil inclusion criteria. Four studies compared LED-FM with ZN and nine studies compared GeneXpert with ZN. Three studies used patient cohorts and eight were modelling studies with hypothetical cohorts used to evaluate cost-effectiveness. All these studies were conducted from a health system perspective, with four studies utilising cost utility analysis. There were considerable variations in costing parameters and effectiveness indicators that precluded meta-analysis. The key findings from the included studies suggest that LED-FM and GeneXpert may be cost effective for pulmonary TB diagnosis from a health system perspective. Conclusion Our review identifies a consistent trend of the cost effectiveness of LED-FM and GeneXpert for pulmonary TB diagnosis in different countries with diverse context of socio-economic condition, HIV burden and geographical distribution. However, all the studies used different parameters to estimate the impact of these tools and this underscores the need for improving the methodological issues related to the conduct and reporting of cost-effectiveness studies. more...
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- 2017
25. Patient characteristics, health seeking and delays among new sputum smear positive TB patients identified through active case finding when compared to passive case finding in India
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Shewade, Hemant Deepak, primary, Gupta, Vivek, additional, Satyanarayana, Srinath, additional, Pandey, Prabhat, additional, Bajpai, U. N., additional, Tripathy, Jaya Prasad, additional, Kathirvel, Soundappan, additional, Pandurangan, Sripriya, additional, Mohanty, Subrat, additional, Ghule, Vaibhav Haribhau, additional, Sagili, Karuna D., additional, Prasad, Banuru Muralidhara, additional, Nath, Sudhi, additional, Singh, Priyanka, additional, Singh, Kamlesh, additional, Singh, Ramesh, additional, Jayaraman, Gurukartick, additional, Rajeswaran, P., additional, Srivastava, Binod Kumar, additional, Biswas, Moumita, additional, Mallick, Gayadhar, additional, Bera, Om Prakash, additional, Sahai, K. N., additional, Murali, Lakshmi, additional, Kamble, Sanjeev, additional, Deshpande, Madhav, additional, Kumar, Naresh, additional, Kumar, Sunil, additional, Jaisingh, A. James Jeyakumar, additional, Naqvi, Ali Jafar, additional, Verma, Prafulla, additional, Ansari, Mohammed Salauddin, additional, Mishra, Prafulla C., additional, Sumesh, G, additional, Barik, Sanjeeb, additional, Mathew, Vijesh, additional, Lohar, Manas Ranjan Singh, additional, Gaurkhede, Chandrashekhar S., additional, Parate, Ganesh, additional, Bale, Sharifa Yasin, additional, Koli, Ishwar, additional, Bharadwaj, Ashwin Kumar, additional, Venkatraman, G., additional, Sathiyanarayanan, K., additional, Lal, Jinesh, additional, Sharma, Ashwini Kumar, additional, Rao, Raghuram, additional, Kumar, Ajay M. V., additional, and Chadha, Sarabjit Singh, additional more...
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- 2019
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26. Identifying high or low risk of mother to child transmission of HIV: How Harare City, Zimbabwe is doing?
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Komtenza, Brian, primary, Satyanarayana, Srinath, additional, Takarinda, Kudakwashe C., additional, Mukungunugwa, Solomon H., additional, Mugurungi, Owen, additional, Chonzi, Prosper, additional, Sithole, Ngwarai, additional, Bvochora, Talent, additional, and Mushavi, Angela, additional more...
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- 2019
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27. Enhanced adherence counselling and viral load suppression in HIV seropositive patients with an initial high viral load in Harare, Zimbabwe: Operational issues
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Bvochora, Talent, primary, Satyanarayana, Srinath, additional, Takarinda, Kudakwashe C., additional, Bara, Hilda, additional, Chonzi, Prosper, additional, Komtenza, Brian, additional, Duri, Clemence, additional, and Apollo, Tsitsi, additional more...
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- 2019
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28. Cost-effectiveness of GeneXpert and LED-FM for diagnosis of pulmonary tuberculosis: A systematic review
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Sagili, Karuna D., primary, Muniyandi, Malaisamy, additional, Nilgiriwala, Kayzad Soli, additional, Shringarpure, Kalpita S., additional, Satyanarayana, Srinath, additional, Kirubakaran, Richard, additional, Chadha, Sarabjit S., additional, and Tharyan, Prathap, additional more...
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- 2018
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29. Developing a model to predict unfavourable treatment outcomes in patients with tuberculosis and human immunodeficiency virus co-infection in Delhi, India
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Madan, Chandravali, primary, Chopra, Kamal Kishore, additional, Satyanarayana, Srinath, additional, Surie, Diya, additional, Chadha, Vineet, additional, Sachdeva, Kuldeep Singh, additional, Khanna, Ashwani, additional, Deshmukh, Rajesh, additional, Dutta, Lopamudra, additional, Namdeo, Amit, additional, Shukla, Ajay, additional, Sagili, Karuna, additional, and Chauhan, Lakhbir Singh, additional more...
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- 2018
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30. Factors associated with death and loss to follow-up in children on antiretroviral care in Mingalardon Specialist Hospital, Myanmar, 2006–2016
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Kaung Nyunt, Kay Khaing, primary, Han, Wai Wai, additional, Satyanarayana, Srinath, additional, Isaakidis, Petros, additional, Hone, San, additional, Khaing, Aye Aye, additional, Nguyen Binh, Hoa, additional, and Oo, Htun Nyunt, additional more...
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- 2018
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31. Patient characteristics, health seeking and delays among new sputum smear positive TB patients identified through active case finding when compared to passive case finding in India
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Ajay M. V. Kumar, Gayadhar Mallick, Kamlesh Singh, Hemant Deepak Shewade, A. James Jeyakumar Jaisingh, Vaibhav Haribhau Ghule, Lakshmi Murali, Binod Kumar Srivastava, Sanjeeb Barik, Ramesh Singh, Srinath Satyanarayana, Manas Ranjan Singh Lohar, Prafulla Verma, Banuru Muralidhara Prasad, Ganesh Venkatraman, Kavita Sahai, Gurukartick Jayaraman, Karuna D. Sagili, Naresh Kumar, Vivek Gupta, Soundappan Kathirvel, Om Prakash Bera, Ali Jafar Naqvi, Jinesh Lal, Subrat Mohanty, Ashwini Kumar Sharma, Chandrashekhar S. Gaurkhede, Raghuram Rao, Prabhat Pandey, Sharifa Yasin Bale, Ishwar Koli, Sripriya Pandurangan, U N Bajpai, Sudhi Nath, Ashwin Kumar Bharadwaj, Mohammed Salauddin Ansari, Madhav Deshpande, Sanjeev Kamble, Sunil Kumar, Moumita Biswas, Priyanka Singh, P. Rajeswaran, Kulathu Iyer Sathiyanarayanan, Ganesh Parate, Vijesh Mathew, G Sumesh, Jaya Prasad Tripathy, Sarabjit Chadha, and Prafulla C. Mishra more...
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Bacterial Diseases ,Male ,0301 basic medicine ,Delayed Diagnosis ,Medical Doctors ,National Health Programs ,Physiology ,Health Care Providers ,Patient advocacy ,Geographical Locations ,0302 clinical medicine ,Weight loss ,Medicine and Health Sciences ,Mass Screening ,Medical Personnel ,030212 general & internal medicine ,Young adult ,Multidisciplinary ,Confounding ,Middle Aged ,Body Fluids ,Professions ,Infectious Diseases ,Tuberculosis Diagnosis and Management ,Medicine ,Female ,Anatomy ,medicine.symptom ,Research Article ,Adult ,medicine.medical_specialty ,Asia ,Tuberculosis ,Adolescent ,Science ,030106 microbiology ,India ,Patient Advocacy ,Vulnerable Populations ,Time-to-Treatment ,Young Adult ,03 medical and health sciences ,Diagnostic Medicine ,Internal medicine ,medicine ,Humans ,Tuberculosis, Pulmonary ,Mass screening ,Aged ,business.industry ,Sputum ,Biology and Life Sciences ,Patient Acceptance of Health Care ,Tropical Diseases ,medicine.disease ,Health Care ,Mucus ,People and Places ,Population Groupings ,Observational study ,business - Abstract
BackgroundAxshya SAMVAD is an active tuberculosis (TB) case finding (ACF) strategy under project Axshya (Axshya meaning 'free of TB' and SAMVAD meaning 'conversation') among marginalized and vulnerable populations in 285 districts of India.ObjectivesTo compare patient characteristics, health seeking, delays in diagnosis and treatment initiation among new sputum smear positive TB patients detected through ACF and passive case finding (PCF) under the national TB programme in marginalized and vulnerable populations between March 2016 and February 2017.MethodsThis observational analytic study was conducted in 18 randomly sampled Axshya districts. We enrolled all TB patients detected through ACF and an equal number of randomly selected patients detected through PCF in the same settings. Data on patient characteristics, health seeking and delays were collected through record review and patient interviews (at their residence). Delays included patient level delay (from eligibility for sputum examination to first contact with any health care provider (HCP)), health system level diagnosis delay (from contact with first HCP to TB diagnosis) and treatment initiation delays (from diagnosis to treatment initiation). Total delay was the sum of patient level, health system level diagnosis delay and treatment initiation delays.ResultsWe included 234 ACF-diagnosed and 231 PCF-diagnosed patients. When compared to PCF, ACF patients were relatively older (≥65 years, 14% versus 8%, p = 0.041), had no formal education (57% versus 36%, pConclusionAxshya SAMVAD linked the most impoverished communities to TB care and resulted in reduction of health system level diagnosis delay. more...
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- 2019
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32. Developing a model to predict unfavourable treatment outcomes in patients with tuberculosis and human immunodeficiency virus co-infection in Delhi, India
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K K Chopra, Rajesh Deshmukh, Lakhbir Singh Chauhan, Diya Surie, Amit Namdeo, Lopamudra Dutta, Ajay Shukla, Karuna D. Sagili, Kuldeep Singh Sachdeva, Srinath Satyanarayana, Chandravali Madan, Vineet K. Chadha, and Ashwani Khanna more...
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Male ,Bacterial Diseases ,RNA viruses ,Physiology ,Antitubercular Agents ,lcsh:Medicine ,HIV Infections ,Pathology and Laboratory Medicine ,Diagnostic Radiology ,Cohort Studies ,Mathematical and Statistical Techniques ,0302 clinical medicine ,Immunodeficiency Viruses ,Medicine and Health Sciences ,Treatment Failure ,030212 general & internal medicine ,Young adult ,lcsh:Science ,Tomography ,Multidisciplinary ,Coinfection ,Pharmaceutics ,Radiology and Imaging ,HIV diagnosis and management ,Middle Aged ,Body Fluids ,Infectious Diseases ,Medical Microbiology ,Viral Pathogens ,Viruses ,Physical Sciences ,Cohort ,Tuberculosis Diagnosis and Management ,Female ,Pathogens ,Anatomy ,medicine.symptom ,Statistics (Mathematics) ,Research Article ,Cohort study ,Adult ,medicine.medical_specialty ,Tuberculosis ,Adolescent ,Imaging Techniques ,India ,Neuroimaging ,030209 endocrinology & metabolism ,Research and Analysis Methods ,Microbiology ,Young Adult ,03 medical and health sciences ,Drug Therapy ,Acquired immunodeficiency syndrome (AIDS) ,Internal medicine ,Retroviruses ,medicine ,Humans ,Statistical Methods ,Microbial Pathogens ,Retrospective Studies ,Models, Statistical ,business.industry ,Lentivirus ,lcsh:R ,Organisms ,Sputum ,Biology and Life Sciences ,HIV ,Retrospective cohort study ,Tropical Diseases ,medicine.disease ,Diagnostic medicine ,Computed Axial Tomography ,Mucus ,Regimen ,lcsh:Q ,business ,Mathematics ,Neuroscience ,Forecasting - Abstract
Background Tuberculosis (TB) patients with human immunodeficiency virus (HIV) co-infection have worse TB treatment outcomes compared to patients with TB alone. The distribution of unfavourable treatment outcomes differs by socio-demographic and clinical characteristics, allowing for early identification of patients at risk. Objective To develop a statistical model that can provide individual probabilities of unfavourable outcomes based on demographic and clinical characteristics of TB-HIV co-infected patients. Methodology We used data from all TB patients with known HIV-positive test results (aged ≥15 years) registered for first-line anti-TB treatment (ATT) in 2015 under the Revised National TB Control Programme (RNTCP) in Delhi, India. We included variables on demographics and pre-treatment clinical characteristics routinely recorded and reported to RNTCP and the National AIDS Control Organization. Binomial logistic regression was used to develop a statistical model to estimate probabilities of unfavourable TB treatment outcomes (i.e., death, loss to follow-up, treatment failure, transfer out of program, and a switch to drug-resistant regimen). Results Of 55,260 TB patients registered for ATT in 2015 in Delhi, 928 (2%) had known HIV-positive test results. Of these, 816 (88%) had drug-sensitive TB and were ≥15 years. Among 816 TB-HIV patients included, 157 (19%) had unfavourable TB treatment outcomes. We developed a model for predicting unfavourable outcomes using age, sex, disease classification (pulmonary versus extra-pulmonary), TB treatment category (new or previously treated case), sputum smear grade, known HIV status at TB diagnosis, antiretroviral treatment at TB diagnosis, and CD4 cell count at ATT initiation. The chi-square p-value for model calibration assessed using the Hosmer-Lemeshow test was 0.15. The model discrimination, measured as the area under the receiver operator characteristic (ROC) curve, was 0.78. Conclusion The model had good internal validity, but should be validated with an independent cohort of TB-HIV co-infected patients to assess its performance before clinical or programmatic use. more...
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- 2018
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33. Is Knowledge Regarding Tuberculosis Associated with Stigmatising and Discriminating Attitudes of General Population towards Tuberculosis Patients? Findings from a Community Based Survey in 30 Districts of India
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Srinath Satyanarayana, Karuna D. Sagili, and Sarabjit Chadha
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Bacterial Diseases ,Male ,0301 basic medicine ,Health Knowledge, Attitudes, Practice ,Disease status ,Social stigma ,Physiology ,Culture ,Social Stigma ,Social Sciences ,lcsh:Medicine ,Academic Skills ,Community based survey ,Pathology and Laboratory Medicine ,Medical care ,Literacy ,Geographical Locations ,Families ,Discrimination, Psychological ,0302 clinical medicine ,Sociology ,Surveys and Questionnaires ,Medicine and Health Sciences ,Coughing ,Psychology ,030212 general & internal medicine ,lcsh:Science ,Children ,media_common ,education.field_of_study ,Multidisciplinary ,Social Discrimination ,Middle Aged ,Infectious Diseases ,Health Education and Awareness ,Female ,Research Article ,Adult ,medicine.medical_specialty ,Asia ,Tuberculosis ,media_common.quotation_subject ,030106 microbiology ,Population ,MEDLINE ,India ,03 medical and health sciences ,Signs and Symptoms ,medicine ,Humans ,Psychiatry ,education ,business.industry ,lcsh:R ,Cognitive Psychology ,Biology and Life Sciences ,Tropical Diseases ,medicine.disease ,Health Care ,Age Groups ,Family medicine ,People and Places ,Cognitive Science ,Population Groupings ,lcsh:Q ,Physiological Processes ,business ,Neuroscience - Abstract
Background Stigmatising and discriminating attitudes may discourage tuberculosis (TB) patients from actively seeking medical care, hide their disease status, and discontinue treatment. It is expected that appropriate knowledge regarding TB should remove stigmatising and discriminating attitudes. In this study we assessed the prevalence of stigmatising and discriminating attitudes towards TB patients among general population and their association with knowledge regarding TB. Method A cross-sectional knowledge, attitude and practice survey was conducted in 30 districts of India in January-March 2011. A total of 4562 respondents from general population were interviewed using semi-structured questionnaires which contained items to measure stigma, discrimination and knowledge on TB. Result Of the 4562 interviewed, 3823 were eligible for the current analysis. Of these, 73% (95% CI 71.4–74.2) had stigmatising and 98% (95% CI 97.4–98.3) had discriminating attitude towards TB patients. Only 17% (95% CI 15.6–18.0) of the respondents had appropriate knowledge regarding TB with even lower levels observed amongst females, rural areas and respondents from low income groups. Surprisingly stigmatising (adjusted OR 1.31 (0.78–2.18) and discriminating (adjusted OR 0.79 (0.43–1.44) attitudes were independent of knowledge regarding TB. Conclusion Stigmatising and discriminating attitudes towards TB patients remain high among the general population in India. Since these attitudes were independent of the knowledge regarding TB, it is possible that the current disseminated knowledge regarding TB which is mainly from a medical perspective may not be adequately addressing the factors that lead to stigma and discrimination towards TB patients. Therefore, there is an urgent need to review the messages and strategies currently used for disseminating knowledge regarding TB among general population and revise them appropriately. The disseminated knowledge should include medical, psycho-social and economic aspects of TB that not only informs people about medical aspects of TB disease, but also removes stigma and discrimination. more...
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- 2016
34. Patient and Provider Reported Reasons for Lost to Follow Up in MDRTB Treatment: A Qualitative Study from a Drug Resistant TB Centre in India
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Patrick K. Moonan, Malik Parmar, Ajay M. V. Kumar, Achuthan Sreenivas, D. J. Dhande, Srinath Satyanarayana, Kuldeep Singh Sachdeva, Terrence Q. Lo, and Rajesh Deshmukh
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Adult ,Male ,medicine.medical_specialty ,Tuberculosis ,Drug-Related Side Effects and Adverse Reactions ,lcsh:Medicine ,India ,Pharmacology ,Pharmacotherapy ,Tuberculosis, Multidrug-Resistant ,medicine ,Humans ,Lost to follow-up ,lcsh:Science ,Qualitative Research ,Related factors ,Multidisciplinary ,business.industry ,Public health ,Multi-drug-resistant tuberculosis ,Drug resistant tuberculosis ,lcsh:R ,Middle Aged ,medicine.disease ,Family medicine ,Patient Compliance ,lcsh:Q ,Female ,Lost to Follow-Up ,Public Health ,business ,Qualitative research ,Research Article - Abstract
INTRODUCTION:Multidrug-resistant Tuberculosis (MDR TB) is emerging public health concern globally. Lost to follow-up (LTFU) is one of the key challenge in MDRTB treatment. In 2013, 18% of MDR TB patients were reported LTFU in India. A qualitative study was conducted to obtain better understanding of both patient and provider related factors for LTFU among MDR TB treatment. METHODS:Qualitative semi-structured personal interviews were conducted with 20 MDRTB patients reported as LTFU and 10 treatment providers in seven districts linked to Nagpur Drug resistant TB Centre (DRTBC) during August 2012-February 2013. Interviews were transcribed and inductive content analysis was performed to derive emergent themes. RESULTS:We found multiple factors influencing MDR TB treatment adherence. Barriers to treatment adherence included drug side effects, a perceived lack of provider support, patient financial constraints, conflicts with the timing of treatment services, alcoholism and social stigma. CONCLUSIONS:Patient adherence to treatment is multi-factorial and involves individual patient factors, provider factors, and community factors. Addressing issue of LTFU during MDRTB treatment requires enhanced efforts towards resolving medical problems like adverse drug effects, developing short duration treatment regimens, reducing pill burden, motivational counselling, flexible timings for DOT services, social, family support for patients & improving awareness about disease. more...
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- 2015
35. Predictors and Timing of ATT Initiation among HIV-TB Patients at ART Centers of Karnataka, India: Two Year Follow-Up
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Sharath Burugina Nagaraja, B B Rewari, Jaya Prasad Tripathy, Suresh Shastri, and Srinath Satyanarayana
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Adult ,Male ,Program evaluation ,Pediatrics ,medicine.medical_specialty ,Time Factors ,Tuberculosis ,Adolescent ,Antitubercular Agents ,India ,lcsh:Medicine ,HIV Infections ,Kaplan-Meier Estimate ,Antiviral Agents ,Pharmacotherapy ,Acquired immunodeficiency syndrome (AIDS) ,Outcome Assessment, Health Care ,Humans ,Medicine ,Child ,lcsh:Science ,Proportional Hazards Models ,Multidisciplinary ,Coinfection ,business.industry ,Proportional hazards model ,Public health ,lcsh:R ,Infant, Newborn ,Infant ,Middle Aged ,Prognosis ,medicine.disease ,Child, Preschool ,Cohort ,Drug Therapy, Combination ,Female ,lcsh:Q ,business ,Follow-Up Studies ,Research Article - Abstract
Background In India, TB and HIV co-infection remains as a serious public health problem. From 2006 onwards, the intensified TB-HIV collaborative activities are being jointly implemented by National AIDS Control Programme (NACP) and Revised National TB Control programme (RNTCP) at high HIV burden states. Objectives To determine (a) the predictors of outcome among a cohort of HIV-TB co-infected patients after two years after initiation of ART treatment. (b) prognostic significance of time difference between the initiation of ATT and ART in HIV-TB co-infected patients. Methods Patients registered at sixteen ART centres in Karnataka, from October through December 2009 formed the study cohort and were followed till December 2011. Results A total of 604 HIV-TB patients were registered. Follow-up (a) at the end of one year had shown 63.6% (377)patients with unfavorable TB treatment outcomes (b) at the end of second year, 55.6% (336)patients were alive on ART treatment. The variables male, smear negative TB, CD4 count less than 50cells per cumm and unfavorable TB outcome were significantly associated with unfavorable ART treatment outcome. Conclusions The programmes need to review the existing strategies and strengthen HIV-TB collaborative activities for timely treatment initiation with intensive monitoring of HIV-TB patients on treatment. more...
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- 2015
36. Access to CD4 Testing for Rural HIV Patients: Findings from a Cohort Study in Zimbabwe
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Anthony Reid, Eliphas Makondo, Srinath Satyanarayana, Liberty Havazvidi, Marcel Manzi, Andrea Bernasconi, Buhlebenkosi Moyo, Mohammed Khogali, Florian Vogt, Katie Tayler-Smith, and Fabian Taziwa
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Adult ,Male ,Rural Population ,Zimbabwe ,medicine.medical_specialty ,Adolescent ,Anti-HIV Agents ,Science ,Population ,HIV Infections ,Health Services Accessibility ,Cohort Studies ,Young Adult ,medicine ,Humans ,Young adult ,education ,Retrospective Studies ,education.field_of_study ,Multidisciplinary ,business.industry ,Public health ,Retrospective cohort study ,CD4 Lymphocyte Count ,Relative risk ,Immunology ,Emergency medicine ,Medicine ,Female ,Rural area ,business ,Viral load ,Cohort study ,Research Article - Abstract
BackgroundCD4 cell count measurement remains an important diagnostic tool for HIV care in developing countries. Insufficient laboratory capacity in rural Sub-Saharan Africa is frequently mentioned but data on the impact at an individual patient level are lacking. Urban-rural discrepancies in CD4 testing have not been quantified to date. Such evidence is crucial for public health planning and to justify new yet more expensive diagnostic procedures that could circumvent access constraints in rural areas.ObjectiveTo compare CD4 testing among rural and urban HIV patients during the first year of treatment.MethodsRecords from 2,145 HIV positive adult patients from a Médecins sans Frontières (Doctors without Borders) HIV project in Beitbridge, Zimbabwe, during 2011 and 2012 were used for a retrospective cohort analysis. Covariate-adjusted risk ratios were calculated to estimate the effects of area of residence on CD4 testing at treatment initiation, six and 12 months among rural and urban patients.FindingsWhile the proportion of HIV patients returning for medical consultations at six and 12 months decreased at a similar rate in both patient groups, CD4 testing during consultations dropped to 21% and 8% for urban, and 2% and 1% for rural patients at six and 12 months, respectively. Risk ratios for missing CD4 testing were 0.8 (95% CI 0.7-0.9), 9.2 (95% CI 5.5-15.3), and 7.6 (95% 3.7-17.1) comparing rural versus urban patients at treatment initiation, six and 12 months, respectively.ConclusionsCD4 testing was low overall, and particularly poor in rural patients. Difficulties with specimen transportation were probably a major factor underlying this difference and requires new diagnostic approaches. Our findings point to severe health system constraints in providing CD4 testing overall that need to be addressed if effective monitoring of HIV patients is to be achieved, whether by alternative CD4 diagnostics or newly-recommended routine viral load testing. more...
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- 2014
37. Identification of BRCA1 Deficiency Using Multi-Analyte Estimation of BRCA1 and Its Repressors in FFPE Tumor Samples from Patients with Triple Negative Breast Cancer
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Korlimarla, Aruna, primary, Prabhu, Jyothi S., additional, Remacle, Jose, additional, Rajarajan, Savitha, additional, Raja, Uma, additional, C. E., Anupama, additional, Srinath, B. S., additional, Manjunath, Suraj, additional, K. S., Gopinath, additional, Correa, Marjorrie, additional, M. S. N., Prasad, additional, and Sridhar, T. S., additional more...
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- 2016
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38. Deceased-Donor Apolipoprotein L1 Renal-Risk Variants Have Minimal Effects on Liver Transplant Outcomes
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Dorr, Casey R., primary, Freedman, Barry I., additional, Hicks, Pamela J., additional, Brown, W. Mark, additional, Russell, Gregory B., additional, Julian, Bruce A., additional, Pastan, Stephen O., additional, Gautreaux, Michael D., additional, Muthusamy, Amutha, additional, Chinnakotla, Srinath, additional, Hauptfeld, Vera, additional, Bray, Robert A., additional, Kirk, Allan D., additional, Divers, Jasmin, additional, and Israni, Ajay K., additional more...
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- 2016
- Full Text
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39. Avidity-dependent programming of autoreactive T cells in T1D
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Chester Ni, Carla J. Greenbaum, Jerill Thorpe, Vivian H. Gersuk, Srinath Sanda, Ivana Durinovic-Belló, Nicholas Jospe, Rebecca P. Wu, and Gerald T. Nepom
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Male ,lcsh:Medicine ,Autoimmunity ,T-Cell Antigen Receptor Specificity ,Autoantigens ,Major Histocompatibility Complex ,White Blood Cells ,T-Lymphocyte Subsets ,Animal Cells ,Genetics of the Immune System ,Cytotoxic T cell ,Insulin ,IL-2 receptor ,lcsh:Science ,Immune Response ,Proinsulin ,Multidisciplinary ,T Cells ,Middle Aged ,medicine.anatomical_structure ,T cell selection ,Female ,Cellular Types ,Protein Binding ,Research Article ,Adult ,Genotype ,T cell ,Immune Cells ,Immunology ,Receptors, Antigen, T-Cell ,Antigen-Presenting Cells ,Biology ,Young Adult ,Antigen ,medicine ,Humans ,Avidity ,Blood Cells ,Gene Expression Profiling ,lcsh:R ,T-cell receptor ,Biology and Life Sciences ,Cell Biology ,Diabetes Mellitus, Type 1 ,Case-Control Studies ,lcsh:Q ,Clinical Immunology - Abstract
Fate determination for autoreactive T cells relies on a series of avidity-dependent interactions during T cell selection, represented by two general types of signals, one based on antigen expression and density during T cell development, and one based on genes that interpret the avidity of TCR interaction to guide developmental outcome. We used proinsulin-specific HLA class II tetramers to purify and determine transcriptional signatures for autoreactive T cells under differential selection in type 1 diabetes (T1D), in which insulin (INS) genotypes consist of protective and susceptible alleles that regulate the level of proinsulin expression in the thymus. Upregulation of steroid nuclear receptor family 4A (NR4A) and early growth response family genes in proinsulin-specific T cells was observed in individuals with susceptible INS-VNTR genotypes, suggesting a mechanism for avidity-dependent fate determination of the T cell repertoire in T1D. The NR4A genes act as translators of TCR signal strength that guide central and peripheral T cell fate decisions through transcriptional modification. We propose that maintenance of an NR4A-guided program in low avidity autoreactive T cells in T1D reflects their prior developmental experience influenced by proinsulin expression, identifying a pathway permissive for autoimmunity. more...
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- 2014
40. The association between a vegetarian diet and cardiovascular disease (CVD) risk factors in India: the Indian Migration Study
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Shridhar, Krithiga, Dhillon, Preet Kaur, Bowen, Liza, Kinra, Sanjay, Bharathi, Ankalmadugu Venkatsubbareddy, Prabhakaran, Dorairaj, Reddy, Kolli Srinath, Ebrahim, Shah, and Indian Migration Study Group more...
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lcsh:R ,lcsh:Medicine ,lcsh:Q ,lcsh:Science - Abstract
BACKGROUND: Studies in the West have shown lower cardiovascular disease (CVD) risk among people taking a vegetarian diet, but these findings may be confounded and only a minority selects these diets. We evaluated the association between vegetarian diets (chosen by 35%) and CVD risk factors across four regions of India. METHODS: Study participants included urban migrants, their rural siblings and urban residents, of the Indian Migration Study from Lucknow, Nagpur, Hyderabad and Bangalore (n = 6555, mean age-40.9 yrs). Information on diet (validated interviewer-administered semi-quantitative food frequency questionnaire), tobacco, alcohol, physical history, medical history, as well as blood pressure, fasting blood and anthropometric measurements were collected. Vegetarians ate no eggs, fish, poultry or meat. Using robust standard error multivariate linear regression models, we investigated the association of vegetarian diets with blood cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL), triglycerides, fasting blood glucose (FBG), systolic (SBP) and diastolic blood pressure (DBP). RESULTS: Vegetarians (32.8% of the study population) did not differ from non-vegetarians with respect to age, use of smokeless tobacco, body mass index, and prevalence of diabetes or hypertension. Vegetarians had a higher standard of living and were less likely to smoke, drink alcohol (p more...
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- 2014
41. Impact of introducing the line probe assay on time to treatment initiation of MDR-TB in Delhi, India
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Neeta Singla, Srinath Satyanarayana, Tony Reid, Rohit Sarin, Katherine Tayler-Smith, Engy Ali, Kuldeep Singh Sachdeva, V.P. Myneedu, Rafael Van den Bergh, Digamber Behera, and Donald A. Enarson
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Male ,Bacterial Diseases ,Pulmonology ,Epidemiology ,Antitubercular Agents ,lcsh:Medicine ,Global Health ,Drug Resistance, Multiple, Bacterial ,Tuberculosis, Multidrug-Resistant ,Medicine and Health Sciences ,Medicine ,Public and Occupational Health ,lcsh:Science ,Socioeconomics ,Health Systems Strengthening ,Setting national ,Multidisciplinary ,biology ,Multi-drug-resistant tuberculosis ,Multi-Drug-Resistant Tuberculosis ,Bacterial Pathogens ,Lower Respiratory Tract Infections ,Infectious Diseases ,Medical Microbiology ,Biological Assay ,Female ,geographic locations ,Research Article ,Adult ,medicine.medical_specialty ,Tuberculosis ,Time to treatment ,India ,Microbiology ,Infectious Disease Epidemiology ,Time-to-Treatment ,Mycobacterium tuberculosis ,Diagnostic Medicine ,Humans ,Tuberculosis, Pulmonary ,Microbial Pathogens ,Retrospective Studies ,Health Care Policy ,business.industry ,lcsh:R ,Biology and Life Sciences ,Mycobacteria ,biology.organism_classification ,medicine.disease ,Surgery ,Health Care ,Respiratory Infections ,lcsh:Q ,Lost to Follow-Up ,business - Abstract
SETTING: National Institute of Tuberculosis and Respiratory Diseases (erstwhile Lala Ram Sarup Institute) in Delhi, India. OBJECTIVES: To evaluate before and after the introduction of the line Probe Assay (LPA) a) the overall time to MDR-TB diagnosis and treatment initiation; b) the step-by-step time lapse at each stage of patient management; and c) the lost to follow-up rates. METHODS: A retrospective cohort analysis was done using data on MDR-TB patients diagnosed during 2009-2012 under Revised National Tuberculosis Control Programme at the institute. RESULTS: Following the introduction of the LPA in 2011, the overall median time from identification of patients suspected for MDR-TB to the initiation of treatment was reduced from 157 days (IQR 127-200) to 38 days (IQR 30-79). This reduction was attributed mainly to a lower diagnosis time at the laboratory. Lost to follow-up rates were also significantly reduced after introduction of the LPA (12% versus 39% pre-PLA). CONCLUSION: Introduction of the LPA was associated with a major reduction in the delay between identification of patients suspected for MDR-TB and initiation of treatment, attributed mainly to a reduction in diagnostic time in the laboratory. more...
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- 2013
42. Intensified tuberculosis case finding among malnourished children in nutritional rehabilitation centres of Karnataka, India: missed opportunities
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Suryakanth, Srinath Satyanarayana, Balaji Naik, Donald A. Enarson, K. G. Deepak, Sreenivas Achuthan Nair, Anthony Reid, P. Bhat, Ajay M. V. Kumar, and Einar Heldal
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Male ,Pediatrics ,medicine.medical_specialty ,Tuberculosis ,Cross-sectional study ,Science ,Population ,Severe Acute Malnutrition ,Tuberculin ,India ,Child Nutrition Disorders ,Tuberculosis diagnosis ,medicine ,Humans ,Mass Screening ,education ,Mass screening ,Retrospective Studies ,education.field_of_study ,Multidisciplinary ,business.industry ,Infant, Newborn ,Infant ,medicine.disease ,Malnutrition ,Cross-Sectional Studies ,Child, Preschool ,Population Surveillance ,Medicine ,Female ,business ,Algorithms ,Research Article - Abstract
BackgroundSevere acute malnutrition (SAM) is the most serious form of malnutrition affecting children under-five and is associated with many infectious diseases including Tuberculosis (TB). In India, nutritional rehabilitation centres (NRCs) have been recently established for the management of SAM including TB. The National TB Programme (NTP) in India has introduced a revised algorithm for diagnosing paediatric TB. We aimed to examine whether NRCs adhered to these guidelines in diagnosing TB among SAM children.MethodsA cross-sectional study involving review of records of all SAM children identified by health workers during 2012 in six tehsils (sub-districts) with NRCs (population: 1.8 million) of Karnataka, India.ResultsOf 1927 identified SAM children, 1632 (85%) reached NRCs. Of them, 1173 (72%) were evaluated for TB and 19(2%) were diagnosed as TB. Of 1173, diagnostic algorithm was followed in 460 (37%). Among remaining 763 not evaluated as per algorithm, tuberculin skin test alone was conducted in 307 (41%), chest radiography alone in 99 (13%) and no investigations in 337 (45%). The yield of TB was higher among children evaluated as per algorithm (4%) as compared to those who were not (0.3%) (OR: 15.3 [95%CI: 3.5-66.3]). Several operational challenges including non-availability of a full-time paediatrician, non-functioning X-ray machine due to frequent power cuts, use of tuberculin with suboptimal strength and difficulties in adhering to a complex diagnostic algorithm were observed.ConclusionThis study showed that TB screening in NRCs was sub-optimal in Karnataka. Some children did not reach the NRC, while many of those who did were either not or sub-optimally evaluated for TB. This study pointed to a number of operational issues that need to be addressed if this collaborative strategy is to identify more TB cases amongst malnourished children in India. more...
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- 2013
43. Comparing same day sputum microscopy with conventional sputum microscopy for the diagnosis of tuberculosis--Chhattisgarh, India
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Sreenivas Achuthan Nair, Kshitij Khaparde, Srinath Satyanarayana, Shankar Dapkekar, M. M. Claassens, Debashish Kundu, Sachin Chandraker, Ajay M. V. Kumar, Donald A. Enarson, Priyakanta Nayak, and Tarun K. Agrawal more...
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Male ,medicine.medical_specialty ,Pathology ,Tuberculosis ,Science ,India ,Specimen Handling ,fluids and secretions ,Tuberculosis diagnosis ,Microscopy ,medicine ,Humans ,Multidisciplinary ,business.industry ,Sputum ,Middle Aged ,medicine.disease ,Dermatology ,humanities ,respiratory tract diseases ,Medicine ,Female ,medicine.symptom ,business ,Research Article - Abstract
BackgroundThe World Health Organization (WHO) recommends same day sputum microscopy (spot-spot) in preference to conventional strategy (spot-morning) for the diagnosis of smear positive tuberculosis with the view that completing diagnosis on a single day may be more convenient to the patients and reduce pre-treatment losses to follow-up.MethodsWe conducted a cross-sectional study in seven selected district level hospitals of Chhattisgarh State, India. During October 2012 - March 2013, two sputum specimens (spot-early morning) were collected from consecutively enrolled adult (≥ 18 years) presumptive TB patients as per current national guidelines. In addition, a second sample was collected (one hour after the collection of first spot sample) from the same patients. All the samples were examined by ziehl-Neelsen (ZN) microscopy. McNemar's test was used to compare statistical differences in the proportion smear positive between the two approaches (spot-spot versus spot-morning).ResultsOf 2551 presumptive TB patients, 69% were male. All patients provided the first spot specimen, 2361 (93%) provided the second spot specimen, and 2435 (96%) provided an early morning specimen. 72% of specimens were mucopurulent in conventional strategy as compared to 60% in same day strategy. The proportion of smear-positive patients diagnosed by same day microscopy was 14%, as compared to 17% by the conventional method (pConclusionSame-day microscopy method missed 17% of smear-positive cases and contrary to prior perception, did not increase the proportion of suspects providing the second sample. These findings call for an urgent need to revisit the WHO recommendation of switching to same-day diagnosis over the current policy. more...
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- 2013
44. Deceased-Donor Apolipoprotein L1 Renal-Risk Variants Have Minimal Effects on Liver Transplant Outcomes
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Ajay K. Israni, Casey R. Dorr, Allan D. Kirk, Pamela J. Hicks, W. Mark Brown, Gregory B. Russell, Vera Hauptfeld, Barry I. Freedman, Bruce A. Julian, Srinath Chinnakotla, Jasmin Divers, Stephen O. Pastan, Michael D. Gautreaux, Amutha Muthusamy, and Robert A. Bray more...
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Male ,Heredity ,Apolipoprotein L1 ,medicine.medical_treatment ,030232 urology & nephrology ,lcsh:Medicine ,030230 surgery ,Liver transplantation ,Pathology and Laboratory Medicine ,Gastroenterology ,0302 clinical medicine ,Risk Factors ,Genotype ,Medicine and Health Sciences ,Ethnicities ,lcsh:Science ,Kidney transplantation ,African Americans ,Mammalian Genomics ,Multidisciplinary ,biology ,Genomics ,Animal Models ,Population groupings ,Middle Aged ,Allografts ,Tissue Donors ,3. Good health ,Survival Rate ,Genetic Mapping ,Treatment Outcome ,Female ,Anatomy ,Lipoproteins, HDL ,Research Article ,Adult ,medicine.medical_specialty ,Surgical and Invasive Medical Procedures ,Variant Genotypes ,Mouse Models ,Research and Analysis Methods ,Polymorphism, Single Nucleotide ,Nephropathy ,Digestive System Procedures ,Necrosis ,03 medical and health sciences ,Signs and Symptoms ,Model Organisms ,Diagnostic Medicine ,Internal medicine ,Genetics ,medicine ,Humans ,Allele ,Survival rate ,Alleles ,Transplantation ,lcsh:R ,Biology and Life Sciences ,Kidneys ,Organ Transplantation ,Renal System ,medicine.disease ,Liver Transplantation ,Black or African American ,Apolipoproteins ,Genetic Loci ,Animal Genomics ,Immunology ,biology.protein ,lcsh:Q ,People and places ,Kidney disease - Abstract
Background Apolipoprotein L1 gene (APOL1) G1 and G2 renal-risk variants, common in populations with recent African ancestry, are strongly associated with non-diabetic nephropathy, end-stage kidney disease, and shorter allograft survival in deceased-donor kidneys (autosomal recessive inheritance). Circulating APOL1 protein is synthesized primarily in the liver and hydrodynamic gene delivery of APOL1 G1 and G2 risk variants has caused hepatic necrosis in a murine model. Methods To evaluate the impact of these variants in liver transplantation, this multicenter study investigated the association of APOL1 G1 and G2 alleles in deceased African American liver donors with allograft survival. Transplant recipients were followed for liver allograft survival using data from the Scientific Registry of Transplant Recipients. Results Of the 639 liver donors evaluated, 247 had no APOL1 risk allele, 300 had 1 risk allele, and 92 had 2 risk alleles. Graft failure assessed at 15 days, 6 months, 1 year and total was not significantly associated with donor APOL1 genotype (p-values = 0.25, 0.19, 0.67 and 0.89, respectively). Conclusions In contrast to kidney transplantation, deceased-donor APOL1 G1 and G2 risk variants do not significantly impact outcomes in liver transplantation. more...
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- 2016
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45. Linkage of presumptive multidrug resistant tuberculosis (MDR-TB) patients to diagnostic and treatment services in Cambodia
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Ajay M. V. Kumar, Srinath Satyanarayana, Yadav Prasad Rajendra, Sokhan Khann, Sharath Burugina Nagaraja, and Eang Tan Mao
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Male ,Bacterial Diseases ,medicine.medical_specialty ,Pathology ,Tuberculosis ,Cross-sectional study ,Clinical Research Design ,lcsh:Medicine ,Mycobacterium ,Diagnostic Medicine ,Internal medicine ,Culture Techniques ,Medicine ,Humans ,lcsh:Science ,Setting national ,Tuberculosis, Pulmonary ,Multidisciplinary ,biology ,business.industry ,Multi-Drug-Resistant Tuberculosis ,lcsh:R ,Sputum ,Tropical Diseases (Non-Neglected) ,Drug susceptibility ,Middle Aged ,biology.organism_classification ,medicine.disease ,Diagnostic Services ,Drug Resistance, Multiple ,Multiple drug resistance ,Cross-Sectional Studies ,Infectious Diseases ,Mycobacterium tuberculosis complex ,Cohort ,lcsh:Q ,Female ,medicine.symptom ,business ,Cambodia ,Research Article ,Test Evaluation - Abstract
SETTING: National Tuberculosis Programme, Cambodia. OBJECTIVE: In a cohort of TB patients, to ascertain the proportion of patients who fulfil the criteria for presumptive MDR-TB, assess whether they underwent investigation for MDR-TB, and the results of the culture and drug susceptibility testing (DST). METHODS: A cross sectional record review of TB patients registered for treatment between July-December 2011. RESULTS: Of 19,236 TB patients registered, 409 (2%) fulfilled the criteria of presumptive MDR-TB; of these, 187 (46%) were examined for culture. This proportion was higher among relapse, failure, return after default (RAD) and non-converters at 3 months of new smear positive TB patients (>60%) as compared to non-converters at 2 months of new TB cases ( more...
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- 2012
46. High Diabetes Prevalence among Tuberculosis Cases in Kerala, India
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Puneet Dewan, Shibu Balakrishnan, Matthew Willis, Anthony D. Harries, Srinath Satyanarayana, Durai Karthickeyan, Sunilkumar Mrithyunjayan, Nevin Wilson, Ajay M. V. Kumar, Jayasankar Subramoniapillai, Shibu Vijayan, Sreenivas Achuthan Nair, and Sanjeev Nair more...
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Bacterial Diseases ,Male ,Pediatrics ,medicine.medical_specialty ,Tuberculosis ,Epidemiology ,lcsh:Medicine ,India ,Disease Informatics ,Infectious Disease Epidemiology ,Endocrinology ,Disease Screening ,Diabetes mellitus ,medicine ,Diabetes Mellitus ,Prevalence ,Humans ,Risk factor ,lcsh:Science ,History of tuberculosis ,Diabetic Endocrinology ,Glycated Hemoglobin ,Multidisciplinary ,business.industry ,Poor glycemic control ,lcsh:R ,Diabetes prevalence ,Tropical Diseases (Non-Neglected) ,Diabetes Mellitus Type 2 ,Middle Aged ,medicine.disease ,Number needed to screen ,Survey Methods ,Infectious Diseases ,Medicine ,lcsh:Q ,Female ,Public Health ,Preventive Medicine ,business ,Research Article - Abstract
BACKGROUND: While diabetes mellitus (DM) is a known risk factor for tuberculosis, the prevalence among TB patients in India is unknown. Routine screening of TB patients for DM may be an opportunity for its early diagnosis and improved management and might improve TB treatment outcomes. We conducted a cross-sectional survey of TB patients registered from June-July 2011 in the state of Kerala, India, to determine the prevalence of DM. METHODOLOGY/PRINCIPAL FINDINGS: A state-wide representative sample of TB patients in Kerala was interviewed and screened for DM using glycosylated hemoglobin (HbA1c); patients self-reporting a history of DM or those with HbA1c ≥6.5% were defined as diabetic. Among 552 TB patients screened, 243(44%) had DM - 128(23%) had previously known DM and 115(21%) were newly diagnosed - with higher prevalence among males and those aged >50 years. The number needed to screen(NNS) to find one newly diagnosed case of DM was just four. Of 128 TB patients with previously known DM, 107(84%) had HbA1c ≥7% indicating poor glycemic control. CONCLUSIONS/SIGNIFICANCE: Nearly half of TB patients in Kerala have DM, and approximately half of these patients were newly-diagnosed during this survey. Routine screening of TB patients for DM using HbA1c yielded a large number of DM cases and offered earlier management opportunities which may improve TB and DM outcomes. However, the most cost-effective ways of DM screening need to be established by futher operational research. more...
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- 2012
47. Is One Sputum Specimen as Good as Two during Follow-Up Cultures for Monitoring Multi Drug Resistant Tuberculosis Patients in India?
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Ashok Kumar, M. E. Edginton, Ajay M. V. Kumar, Malik Parmar, Puneet Dewan, Sven Gudmund Hinderaker, Kuldeep Singh Sachdeva, Sreenivas Achuthan Nair, Avi Kumar Bansal, Ranjani Ramachandran, Sarabjit Chadha, Sharath Burugina Nagaraja, and Srinath Satyanarayana more...
- Subjects
Bacterial Diseases ,medicine.medical_specialty ,Treatment response ,Tuberculosis ,Clinical Research Design ,Epidemiology ,Antitubercular Agents ,lcsh:Medicine ,India ,Microbial Sensitivity Tests ,Global Health ,Mycobacterium tuberculosis ,Pharmacotherapy ,Diagnostic Medicine ,Internal medicine ,Tuberculosis, Multidrug-Resistant ,medicine ,Humans ,Sputum specimen ,lcsh:Science ,Multidisciplinary ,biology ,business.industry ,Multi-drug-resistant tuberculosis ,Multi-Drug-Resistant Tuberculosis ,lcsh:R ,Sputum ,Tropical Diseases (Non-Neglected) ,medicine.disease ,biology.organism_classification ,Surgery ,Cross-Sectional Studies ,Infectious Diseases ,Treatment Outcome ,Neglected tropical diseases ,Medicine ,lcsh:Q ,medicine.symptom ,business ,Case Management ,Research Article ,Test Evaluation ,Follow-Up Studies - Abstract
Background: In India, the Revised National Tuberculosis Control Programme (RNTCP) has adopted the strategy of examining two specimens during follow-up culture examinations to monitor the treatment response of multi-drug resistant tuberculosis (MDR-TB) patients. Objectives: To determine the incremental yield of the second sputum specimen during follow-up culture examinations among patients with MDR-TB and the effect on case management on changing from two to one specimen follow-up strategy. Methods: A cross sectional record review of MDR-TB patients registered during 2008–09 under RNTCP was undertaken in three MDR-TB treatment sites of India. Results: Of 1721 pairs of follow-up sputum culture examinations done among 220 MDR-TB patients, 451(26%) were positive with either of the two specimens; 29(1.7%) were culture positive only on the second specimen indicating the incremental yield. To detect one additional culture positive result on the second specimen, 59 specimens needed to be processed. If we had examined only one specimen, we would have missed 29 culture-positive results. By current RNTCP guidelines, however, a single specimen policy would have altered case management in only 3(0.2%) instances, where patients would have missed a one month extension of the intensive phase of MDR-TB treatment. There is no meaningful advantage in using two specimens for the monitoring of MDR-TB patients. A single specimen policy could be safely implemented with negligible clinical effect on MDR-TB patients and favourable resource implications for RNTCP. publishedVersion more...
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- 2012
48. How Did the TB Patients Reach DOTS Services in Delhi? A Study of Patient Treatment Seeking Behavior
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Sunil K. Kapoor, Srinath Satyanarayana, Kuldeep Singh Sachdeva, and A. Venkat Raman
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Bacterial Diseases ,Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Health Screening ,Tuberculosis ,Infectious Disease Control ,Adolescent ,MEDLINE ,lcsh:Medicine ,India ,Global Health ,Health Services Accessibility ,Young Adult ,Tuberculosis diagnosis ,Health care ,medicine ,Humans ,Patient treatment ,Young adult ,lcsh:Science ,Child ,Directly Observed Therapy ,Primary Care ,Demography ,Multidisciplinary ,business.industry ,lcsh:R ,Tropical Diseases (Non-Neglected) ,Middle Aged ,Patient Acceptance of Health Care ,medicine.disease ,Infectious Diseases ,Family medicine ,Medicine ,lcsh:Q ,Female ,Public Health ,business ,Behavioral and Social Aspects of Health ,Qualitative research ,Research Article - Abstract
Setting Revised National Tuberculosis Control Programme (RNTCP), Delhi, India. Objective To ascertain the number and sequence of providers visited by TB patients before availing treatment services from DOTS; to describe the duration between onset of symptoms to treatment. Study design A cross sectional, qualitative study. Information was gathered through in-depth interviews of TB patients registered during the month of Oct, 2012 for availing TB treatment under the Revised National TB Control Programme from four tuberculosis diagnosis and treatment centers in Delhi. Results Out of the 114 patients who registered, 108 participated in the study. The study showed that informal providers and retail chemists were the first point of contact and source of clinical advice for two-third of the patients, while the rest sought medical care from qualified providers directly. Most patients sought medical care from more than two providers, before being diagnosed as TB. Female TB patients and patients with extra-pulmonary TB had long mean duration between onset of symptoms to initiation of treatment (6.3 months and 8.4 months respectively). Conclusion The pathways followed by TB patients, illustrated in this study, provide valuable lessons on the importance of different types of providers (both formal and informal) in the health system in a society like India and the delays in the diagnosis and treatment of tuberculosis. more...
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- 2012
49. Should sputum smear examination be carried out at the end of the intensive phase and end of treatment in sputum smear negative pulmonary TB patients?
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R. P. Vashist, Sanjay Zodpey, Sumit Malhotra, Srinath Satyanaryana, Rony Zachariah, Anthony D. Harries, and Shivani Chandra
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Bacterial Diseases ,medicine.medical_specialty ,Health Screening ,Tuberculosis ,Infectious Disease Control ,Non-Clinical Medicine ,Epidemiology ,Science ,Cytodiagnosis ,Antitubercular Agents ,India ,Context (language use) ,Sensitivity and Specificity ,Infectious Disease Epidemiology ,Mycobacterium tuberculosis ,Pharmacotherapy ,Intensive Phase ,Diagnostic Medicine ,Internal medicine ,medicine ,Humans ,Tuberculosis, Pulmonary ,Biology ,Multidisciplinary ,Health Care Policy ,biology ,Population Biology ,business.industry ,Multi-drug-resistant tuberculosis ,Sputum ,medicine.disease ,biology.organism_classification ,Surgery ,Regimen ,Biomarker Epidemiology ,Treatment Outcome ,Infectious Diseases ,Costs and Cost Analysis ,Medicine ,Public Health ,medicine.symptom ,business ,Research Article - Abstract
BackgroundThe Indian guidelines on following up sputum smear-negative Pulmonary tuberculosis (PTB) patients differ from the current World Health Organization (WHO) guidelines in that the former recommends two follow up sputum examinations (once at the end of intensive phase and the other at the end of treatment) while the latter recommends only one follow up sputum smear microscopy examination, which is done at the end of the intensive phase. This study was conducted to examine if there was any added value in performing an additional sputum smear examination at the end of treatment within the context of a national TB program.MethodsThis study was a descriptive record based review conducted in nine tuberculosis (TB) units in Delhi, India. All consecutive new sputum smear-negative PTB patients registered in these nine TB units from 1(st) January 2009 to 31(st) December 2009 were included in the study.ResultsOf 2567 new sputum smear-negative TB patients, 1973 (90%) had sputum specimens examined at the end of the intensive phase, of whom 36 (2%) were smear-positive: the majority (n = 28) successfully completed treatment with either the same or a re-treatment regimen. At treatment completion, 1766 (85%) patients had sputum specimens examined, of whom 16 (0.9%) were smear-positive: all these were changed to a re-treatment regimen. Amongst the sputum-positive patients identified as a result of follow up (n = 52), four were diagnosed with multi-drug resistant TB (MDR-TB), three of whom were detected after smear examination at the end of treatment.ConclusionsGiven the high burden of TB in India, a 0.9% additional yield of smear-positive sputum smears at the end of treatment translates to 3,297 cases of smear-positive PTB. End-of-treatment smear is a low-yield strategy for detection of smear-positive TB cases, although further studies are needed to determine its population-level impact and cost, particularly in relation to other TB control interventions. more...
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- 2012
50. Sputum smear microscopy at two months into continuation-phase: should it be done in all patients with sputum smear-positive tuberculosis?
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Sreenivas Achuthan Nair, Raveendra H. R. Reddy, Srinath Satyanarayana, Manoj Nandkishor Toshniwal, Shamim Mannan, Ajay M. V. Kumar, John E. Oeltmann, Mohit Padamchand Gandhi, and Puneet Dewan
- Subjects
Bacterial Diseases ,Health Screening ,medicine.medical_specialty ,Time Factors ,Tuberculosis ,Non-Clinical Medicine ,Extensively Drug-Resistant Tuberculosis ,Revised National Tuberculosis Control Program ,Antitubercular Agents ,India ,lcsh:Medicine ,History of Tuberculosis ,Global Health ,Pharmacotherapy ,Disease Screening ,Internal medicine ,medicine ,Humans ,Registries ,Treatment Failure ,Health Systems Strengthening ,lcsh:Science ,Disease surveillance ,Health Care Policy ,Multidisciplinary ,business.industry ,Multi-Drug-Resistant Tuberculosis ,lcsh:R ,Sputum ,Tropical Diseases (Non-Neglected) ,Health Risk Analysis ,Workload ,medicine.disease ,Discontinuation ,Surgery ,Treatment Outcome ,Infectious Diseases ,Medicine ,lcsh:Q ,Public Health ,Health Statistics ,medicine.symptom ,business ,Algorithms ,Follow-Up Studies ,Research Article - Abstract
BACKGROUND: The Revised National Tuberculosis Control Program (RNTCP) of India recommends follow-up sputum smear examination at two months into the continuation phase of treatment. The main intent of this (mid-CP) follow-up is to detect patients not responding to treatment around two-three months earlier than at the end of the treatment. However, the utility of mid-CP follow-up under programmatic conditions has been questioned. We undertook a multi-district study to determine if mid-CP follow-up is able to detect cases of treatment failures early among all types of patients with sputum smear-positive TB. METHODOLOGY: We reviewed existing records of patients with sputum smear-positive TB registered under the RNTCP in 43 districts across three states of India during a three month period in 2009. We estimated proportions of patients that could be detected as a case of treatment failure early, and assessed the impact of various policy options on laboratory workload and number needed to test to detect one case of treatment failure early. RESULTS: Of 10055 cases, mid-CP follow-up was done in 6944 (69%) cases. Mid-CP follow-up could benefit 117/8015 (1.5%) new and 206/2040 (10%) previously-treated sputum smear-positive cases by detecting their treatment failure early. Under the current policy, 31 patients had to be tested to detect one case of treatment failure early. All cases of treatment failure would still be detected early if mid-CP follow-up were discontinued for new sputum smear-positive cases who become sputum smear-negative after the intensive-phase of treatment. This would reduce the related laboratory workload by 69% and only 10 patients would need to be tested to detect one case of treatment failure early. CONCLUSION: Discontinuation of mid-CP follow-up among new sputum smear-positive cases who become sputum smear-negative after completing the intensive-phase of treatment will reduce the laboratory workload without impacting overall early detection of cases of treatment failure. more...
- Published
- 2012
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