98 results on '"Sinha, Sanjeev"'
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2. Prevention of relapse in drug sensitive pulmonary tuberculosis patients with and without vitamin D3 supplementation: A double blinded randomized control clinical trial.
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Sinha, Sanjeev, Thukral, Himanshu, Shareef, Imtiyaz, Desai, Devashish, Singh, Binit Kumar, Das, Bimal Kumar, Dhooria, Sahajal, Sarin, Rohit, Singla, Rupak, Meena, Saroj Kumari, Pandey, Ravindra Mohan, Pandey, Shivam, Sethi, Sunil, Kajal, Ashumeet, Yadav, Rakesh, Aggarwal, Ashutosh Nath, Bhadada, Sanjay, and Behera, Digambar
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CHOLECALCIFEROL , *DIETARY supplements , *TUBERCULOSIS , *SUBSTANCE abuse relapse , *CLINICAL trials - Abstract
Background: The immunomodulatory effects of vitamin D are widely recognized and a few studies have been conducted to determine its utility in the treatment of tuberculosis, with mixed results. This study was conducted to see if vitamin D supplementation in patients with active pulmonary tuberculosis (PTB) in the Indian population contributed to sputum smear and culture conversion as well as the prevention of relapse. Methods: This randomized double-blind placebo-controlled trial was conducted in three sites in India. HIV negative participants aged 15–60 years with sputum smear positive PTB were recruited according to the Revised National Tuberculosis Control Program guidelines and were randomly assigned (1:1) to receive standard anti-tubercular treatment (ATT) with either supplemental dose of oral vitamin D3 (60,000 IU/sachet weekly for first two months, fortnightly for next four months followed by monthly for the next 18 months) or placebo with same schedule. The primary outcome was relapse of PTB and secondary outcomes were time to conversion of sputum smear and sputum culture. Results: A total of 846 participants were enrolled between February 1, 2017 to February 27, 2021, and randomly assigned to receive either 60,000 IU vitamin D3 (n = 424) or placebo (n = 422) along with standard ATT. Among the 697 who were cured of PTB, relapse occurred in 14 participants from the vitamin D group and 19 participants from the placebo group (hazard risk ratio 0.68, 95%CI 0.34 to 1.37, log rank p value 0.29). Similarly, no statistically significant difference was seen in time to sputum smear and sputum culture conversion between both groups. Five patients died each in vitamin D and placebo groups, but none of the deaths were attributable to the study intervention. Serum levels of vitamin D were significantly raised in the vitamin D group as compared to the placebo group, with other blood parameters not showing any significant difference between groups. Conclusions: The study reveals that vitamin D supplementation does not seem to have any beneficial effect in the treatment of PTB in terms to the prevention of relapse and time to sputum smear and culture conversion. Trial registration: CTRI/2021/02/030977 (ICMR, Clinical trial registry-India). [ABSTRACT FROM AUTHOR]
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- 2023
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3. Association Between Maternal HIV Stigma Among South Indian Mothers Living with HIV and the CD4 Count of Children Living with HIV.
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PhamDo, Valerie, Nyamathi, Adeline M., Ekstrand, Maria L., Sinha, Sanjeev, Yadav, Kartik, and Shin, Sanghyuk S.
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HIV-positive persons ,CONFIDENCE intervals ,PSYCHOLOGY of mothers ,CROSS-sectional method ,RURAL conditions ,DISCRIMINATION (Sociology) ,SOCIAL stigma ,HIV seroconversion ,FEAR ,CD4 lymphocyte count ,DESCRIPTIVE statistics ,PSYCHOLOGY of HIV-positive persons ,MOTHER-child relationship ,CHILDREN - Abstract
HIV stigma takes a multidimensional toll on a mother's ability to care for herself and subsequently may impact her ability to care for her child, particularly when mother and child are seroconcordant. A cross-sectional analysis was conducted to examine the association between maternal HIV stigma and child CD4 count in rural India. We assessed 108 mother–child dyads and found that a one-unit increase in community stigma fear decreased child CD4 count by 352 cells (95% CI = − 603, − 102), highlighting the need to develop a better understanding of the consequences of HIV-related stigma on the compounded burden of care in households where mother and child both live with HIV. [ABSTRACT FROM AUTHOR]
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- 2022
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4. A study on the effect of mobile phone use on sleep.
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Sinha, Sanjeev, Dhooria, Sahajal, Sasi, Archana, Tomer, Aditi, Thejeswar, N., Kumar, Sanchit, Gupta, Gaurav, Pandey, R. M., Behera, Digambar, Mohan, Alladi, and Sharma, Surendra Kumar
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CELL phones , *SLEEP quality , *SLEEP latency , *SLEEP stages , *SLEEP - Abstract
Background & objectives: Several studies have been conducted globally to assess the impact of usage of mobile phones on quality and duration of sleep as also on day time sleepiness. The objective of the present study was to assess the effect of mobile phone usage on the quality and composition of sleep in a sample from Indian population. Methods: The study was conducted at two tertiary care hospitals in north India from July 2014 to September 2019. A total of 566 participants were recruited in this study from both the centres. Sleep quality was assessed with the help of the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Subsequently, actigraphy was done in 96 participants and polysomnography in 95 participants. Results: Of the 566 participants, 128 (22.61%) had PSQI ≥5, reflecting poor sleep quality. A higher use of mobile phone was significantly associated with a poor sleep quality as a component of PSQI questionnaire (P=0.01) and higher overall PSQI score (P=0.01). The latency from sleep onset to N2 and N3 sleep stages was significantly shorter in participants having a higher mobile phone usage as compared to those with a lower usage [Median (range): 13.5 min (1.5-109) vs. 6.5 min (0-89); P=0.02] and [Median (range): 49 min (8.5-220.5) vs. 28.75 min (0-141); P=0.03], respectively. Interpretation & conclusions: This study focused on the maladaptive changes brought on by mobile phone usage on sleep. More studies with larger sample sizes need to be done that may serve to confirm the hypothesis generating findings of our study. [ABSTRACT FROM AUTHOR]
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- 2022
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5. Mental health of women living with HIV and its impact on child development in Andhra Pradesh, India.
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Satyanarayana, Veena A., Burroughs, Hadley R., Heylen, Elsa, Yadav, Kartik, Sinha, Sanjeev, Nyamathi, Adeline, and Ekstrand, Maria L.
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WOMEN'S mental health ,CHILD development ,HIV-positive women ,CHIEF ministers ,QUALITY of life ,CHILDREN'S health ,MENTAL depression ,NUTRITION education - Abstract
Global literature examining the association between mental health of women living with HIV (WLWH) and child development is scarce. In this study, we examined the relationship between mothers' mental health and their children's social development outcomes 6 months later. Data for these analyses come from several waves of interviews of 600 WLWH in the South Indian state of Andhra Pradesh, India. These women were enrolled in a 2 × 2 factorial clinical trial designed to assess the impact of food supplementation and nutrition education, both in addition to ASHA support, on adherence to ART and improved health outcomes for the women and one of their children. They were assessed on food security, stigma, social support, quality of life, depressive symptoms and child development outcomes. Results of longitudinal GEE regression analysis indicate that mother's depressive symptoms were significantly negatively associated with child's social quotient 6 months later. These findings have important implications for targeted health interventions, integrating mental health, both for WLWH and their children in India. [ABSTRACT FROM AUTHOR]
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- 2021
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6. Impact of COVID-19 on the patientsf income and work in Delhi, India.
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Chandra, Ankit, Sarda, Radhika, Kumar, Arvind, Bir, Megha, Parija, Pragyan, Pal, Aishee, Sinha, Sanjeev, Vikas, H, and Wig, Naveet
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COVID-19 ,MEDICAL history taking ,PHYSICIAN services utilization ,DIAGNOSIS ,SOCIAL stigma - Abstract
Background: Currently, there is no data on the impact of COVID-19 on patients' income and work in India. Methods: We conducted a cross-sectional study at a tertiary hospital in New Delhi. We included all the patients who were ≥18 years of age and consecutively diagnosed with COVID-19 between the 1
st of May 2020 to 31st July 2020. Patients were interviewed by a physician using a semi-structure questionnaire. Data were collected on socio-economic status, occupation, income loss, leaves taken, decrease in work efficiency (self-perceived) and about-facing any stigma/discrimination at the workplace. Results: Out of 245 patients, 190 patients were employed. A total of 126 patients (66.3%) self-reported their work was affected due to COVID-19 disease. A total of 30.5% of patients (n = 58/190) reported deduction in their salary. The median amount of salary loss was INR 10,000 (IQR 9000–25000). Decrease in income and work efficiency (self-perceived) was found to be 37.3% (n = 71) and 12.1% (n = 23), respectively. A total of 47 patients (37.3%) took personal leaves (median number – 17 days (IQR 14–25), and discrimination/stigma related to the COVID-19 at the workplace was faced by 22.6% of patients. Conclusion: Income and work of a substantial number of patients was affected due to COVID-19, as there was a decrease in income and work efficiency. Patients also had to take personal leaves and face stigma in the workplace. This will inform the policymakers to formulate strategies to mitigate the impact of COVID-19. [ABSTRACT FROM AUTHOR]- Published
- 2021
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7. The Effect of Community-Based Nutritional Interventions on Children of Women Living With Human Immunodeficiency Virus in Rural India: A 2 × 2 Factorial Intervention Trial.
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Shin, Sanghyuk S, Satyanarayana, Veena A, Ekstrand, Maria L, Carpenter, Catherine L, Wang, Qiao, Yadav, Kartik, Ramakrishnan, Padma, Pamujula, Suresh, Sinha, Sanjeev, and Nyamathi, Adeline M
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ANTHROPOMETRY ,BODY weight ,CHILDREN of people with mental illness ,COMMUNITY health services ,DIETARY supplements ,FACTOR analysis ,HIV-positive persons ,PATIENT aftercare ,MATHEMATICAL models ,NUTRITION education ,NUTRITION disorders in children ,RURAL conditions ,T cells ,TIME ,WEIGHT gain ,THEORY ,RANDOMIZED controlled trials ,TREATMENT effectiveness ,MAXIMUM likelihood statistics ,DESCRIPTIVE statistics ,CHILDREN ,EVALUATION - Abstract
Background Malnutrition is a common clinical concern among children in low-income communities affected by human immunodeficiency virus (HIV). We examined the effect of a community-based nutritional intervention on anthropometric and clinical outcomes of children of women living with HIV in rural India. Methods We assigned women living with HIV and their child (oldest 3–8 years) to 1 of 4 programs: (1) community-based HIV care program, (2) program 1 + nutrition education, (3) program 1 + food supplement, and (4) all elements of programs 1–3. Study data were collected at baseline and months 6, 12, and 18. We applied mixed-effects modeling with restricted maximum likelihood estimation to examine changes in weight (all children) and CD4
+ T-cell counts (children with HIV only). Results Overall, 600 mother–child pairs were enrolled (150/group) with 100% retention at follow-up visits. Approximately 20% of children were living with HIV. Children in program 4 had higher weight gain than those in programs 1, 2, and 3 at all time points (adjusted P <.001). We found a higher increase in CD4+ T cells across all time points among participants in programs 3 and 4 compared with program 1 (adjusted P <.001). Factorial analysis suggested a synergistic effect of combining nutrition education and food supplements for weight gain but not for increase in CD4+ T cells. Conclusions A combination of nutrition education and food supplements provided to women living with HIV significantly increased weight and CD4+ T cells, and such interventions can be integrated into HIV-care programs in low-income settings. [ABSTRACT FROM AUTHOR]- Published
- 2020
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8. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis.
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Benjafield, Adam V, Ayas, Najib T, Eastwood, Peter R, Heinzer, Raphael, Ip, Mary S M, Morrell, Mary J, Nunez, Carlos M, Patel, Sanjay R, Penzel, Thomas, Pépin, Jean-Louis D, Peppard, Paul E, Sinha, Sanjeev, Tufik, Sergio, Valentine, Kate, and Malhotra, Atul
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APNEA ,SLEEP ,DISEASE prevalence ,TREND setters ,AGE groups - Abstract
There is a scarcity of published data on the global prevalence of obstructive sleep apnoea, a disorder associated with major neurocognitive and cardiovascular sequelae. We used publicly available data and contacted key opinion leaders to estimate the global prevalence of obstructive sleep apnoea. We searched PubMed and Embase to identify published studies reporting the prevalence of obstructive sleep apnoea based on objective testing methods. A conversion algorithm was created for studies that did not use the American Academy of Sleep Medicine (AASM) 2012 scoring criteria to identify obstructive sleep apnoea, allowing determination of an equivalent apnoea-hypopnoea index (AHI) for publications that used different criteria. The presence of symptoms was not specifically analysed because of scarce information about symptoms in the reference studies and population data. Prevalence estimates for obstructive sleep apnoea across studies using different diagnostic criteria were standardised with a newly developed algorithm. Countries without obstructive sleep apnoea prevalence data were matched to a similar country with available prevalence data; population similarity was based on the population body-mass index, race, and geographical proximity. The primary outcome was prevalence of obstructive sleep apnoea based on AASM 2012 diagnostic criteria in individuals aged 30–69 years (as this age group generally had available data in the published studies and related to information from the UN for all countries). Reliable prevalence data for obstructive sleep apnoea were available for 16 countries, from 17 studies. Using AASM 2012 diagnostic criteria and AHI threshold values of five or more events per h and 15 or more events per h, we estimated that 936 million (95% CI 903–970) adults aged 30–69 years (men and women) have mild to severe obstructive sleep apnoea and 425 million (399–450) adults aged 30–69 years have moderate to severe obstructive sleep apnoea globally. The number of affected individuals was highest in China, followed by the USA, Brazil, and India. To our knowledge, this is the first study to report global prevalence of obstructive sleep apnoea; with almost 1 billion people affected, and with prevalence exceeding 50% in some countries, effective diagnostic and treatment strategies are needed to minimise the negative health impacts and to maximise cost-effectiveness. ResMed. [ABSTRACT FROM AUTHOR]
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- 2019
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9. Depression, social support, and stigma as predictors of quality of life over time: results from an Asha-based HIV/AIDS intervention in India.
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Garfin, Dana Rose, Shin, Sanghyuk S., Ekstrand, Maria L., Yadav, Kartik, Carpenter, Catherine L., Sinha, Sanjeev, and Nyamathi, Adeline M.
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AIDS patients ,CONFIDENCE intervals ,STATISTICAL correlation ,MENTAL depression ,PSYCHOLOGY of HIV-positive persons ,LATENT structure analysis ,PSYCHOLOGICAL tests ,QUALITY of life ,QUESTIONNAIRES ,RESEARCH funding ,SOCIAL stigma ,TIME ,WOMEN ,SOCIAL support ,DESCRIPTIVE statistics - Abstract
Quality of life (QOL) is associated with better outcomes in HIV/AIDS populations. We explored predictors of improved QOL over time in 600 Women Living with HIV/AIDS (WLH/A) in India [mean age = 34.31, SD = 6.97], enrolled in a nurse-led-Asha (Accredited Social Health Activist) intervention. Trained local interviewers ascertained self-report data at baseline and six-month follow-up (post-intervention). Latent Class Analysis (LCA) identified constellations of responses on psychosocial indicators (depression, social support, internalized stigma and stigma fears); their relationship with QOL over time was examined. We identified three classes: Class 1) Highest Social Resources/Lowest Depression; Class 2) Some Social Resources/Highest Depression; and Class 3) Lowest Social Resources/Higher Depression. At baseline, Class 3 reported the lowest QOL (M = 0.25, SD = 0.26); Class 1 reported the highest (M = 0.37, SD = 0.33). Class 2's QOL did not differ from Class 3's QOL, likely due to the potent effects of high depression. At six-month follow-up, all groups reported improved QOL; class membership no longer predicted variability (contrast between Class 2 and 1 = −0.05, 95% CI = −0.14, 0.04; contrast between Class 3 and 1 = 0.01, 95% CI = −0.03, 0.05; contrast between Class 3 and 2 = 0.07, 95% CI = −0.02, 0.16). Psychosocial indicators are important predictors of QOL; an Asha-supported approach may have broad applicability to improve QOL in WLH/A in India. [ABSTRACT FROM AUTHOR]
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- 2019
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10. Medical Applications of Infrared Thermography: A Narrative Review.
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Jasti, Nishitha, Bista, Suman, Bhargav, Hemant, Sinha, Sanjeev, Gupta, Sushil, Chaturvedi, S. K., and Gangadhar, B. N.
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THERMOGRAPHY ,MEDICAL thermography ,SCIENTIFIC literature ,SKIN temperature ,NEUROLOGICAL disorders ,REGENERATIVE medicine - Abstract
Medical infrared thermography (MIT) is a non-invasive, non-radiating, low cost detection tool used for analyzing physiological functions related to skin temperature. Technological advances have made medical thermography a reliable medical measurement tool. We performed a scientific literature search with an objective of exploring early diagnostic and prognostic value of MIT in areas of medicine and surgery. We found that there are potential applications in the field of vascular disorders, endocrinological disorders (especially diabetes mellitus), regenerative medicine, musculoskeletal disorders, neurological disorders, oncology and surgery. It may also help understand mechanisms of action of traditional systems of medicine such as yoga, Ayurveda and acupuncture. Future studies should focus on validation and feasibility testing of medical thermography in clinical settings in India. [ABSTRACT FROM AUTHOR]
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- 2019
11. Household Food Insecurity as Mediator of the Association Between Internalized Stigma and Opportunistic Infections.
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Shin, Sanghyuk S., Yadav, Kartik, Nyamathi, Adeline M., Carpenter, Catherine L., Shah, Saanchi V., Ekstrand, Maria L., Ramakrishnan, Padma, Sinha, Sanjeev, and Pamujula, Suresh
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DERMATOMYCOSES ,HIV infections ,PSYCHOLOGY of HIV-positive persons ,INTERVIEWING ,RURAL conditions ,SOCIAL stigma ,AIDS-related opportunistic infections ,CROSS-sectional method ,FOOD security - Abstract
Internalized HIV stigma can affect health outcomes, but the mechanism underlying this relationship is poorly understood. We investigated the potential pathways for the association between internalized stigma and opportunistic infections (OIs) among women living with HIV in rural India. We conducted a cross-sectional study involving in-person interviews with 600 participants. We modeled two outcome variables, total number of OIs and fungal dermatoses, which was the most frequently reported OI. Causal mediation analysis was performed to estimate the total effect, direct effect, and indirect effect through mediators while controlling for confounders. Food insecurity was a strong mediator of the association between internalized stigma and the number of OIs (70% of the total effect) and fungal dermatoses (83% of the total effect), while the indirect effect of stigma through adherence was minimal for both outcomes. Household food insecurity may be an important mediator of the impact of HIV-related stigma on opportunistic infections. [ABSTRACT FROM AUTHOR]
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- 2018
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12. The Role of HIV Stigma in ART Adherence and Quality of Life Among Rural Women Living with HIV in India.
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Heylen, Elsa, Mazur, Amanda, Steward, Wayne T., Ekstrand, Maria L., Carpenter, Catherine, Yadav, Kartik, Nyamathi, Adey, and Sinha, Sanjeev
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ANTIRETROVIRAL agents ,DRUGS ,HIV infections ,PSYCHOLOGY of HIV-positive persons ,LONELINESS ,EVALUATION of medical care ,PATIENT compliance ,QUALITY of life ,RURAL conditions ,SOCIAL stigma ,WOMEN'S health ,SOCIAL support - Abstract
HIV stigma continues to be a barrier to physical and mental health among people living with HIV globally, especially in vulnerable populations. We examined how stigma is associated with health outcomes and quality of life among rural women living with HIV in South India (N = 600). Interviewer-administered measures assessed multiple dimensions of stigma, as well as loneliness, social support, ART adherence, time since diagnosis, and quality of life. Internalized stigma and a lack of social support were associated with a lower quality of life, while the association between internalized stigma and adherence was mediated by the use of stigma-avoidant coping strategies, suggesting that keeping one’s diagnosis a secret may make it more difficult to take one’s medications. These findings suggest that these women constitute a vulnerable population who need additional services to optimize their health and who might benefit from peer support interventions and stigma-reduction programs for family and community members. [ABSTRACT FROM AUTHOR]
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- 2018
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13. Relationships Among Adherence and Physical and Mental Health Among Women Living with HIV in Rural India.
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Nyamathi, Adeline, Ekstrand, Maria, Heylen, Elsa, Ramakrishna, Padma, Yadav, Kartik, Sinha, Sanjeev, Hudson, Angela, Carpenter, Catherine L., and Arab, Lenore
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ANTIRETROVIRAL agents ,MENTAL depression ,HIV infections ,PSYCHOLOGY of HIV-positive persons ,MEDICAL history taking ,MENTAL health ,MULTIVARIATE analysis ,OPPORTUNISTIC infections ,PATIENT compliance ,PHYSICAL fitness ,QUALITY of life ,RURAL conditions ,SELF-evaluation ,SOCIAL stigma ,SOCIOECONOMIC factors ,CROSS-sectional method ,FOOD security ,CD4 lymphocyte count - Abstract
We conducted a cross-sectional examination of the physical and psychological factors related to ART adherence among a sample of 400 women living with HIV/AIDS in rural India. Interviewer-administered measures assessed adherence, internalized stigma, depressive symptoms, quality of life, food insecurity, health history and sociodemographic information. CD4 counts were measured using blood collected at screening. Findings revealed that adherence to ART was generally low, with 94% of women taking 50% or less of prescribed medication in past month. Multivariate analyses showed a non-linear association between numbers of self-reported opportunistic infections (OIs) in past 6 months (p = 0.016) and adherence, with adherence decreasing with each additional OI for 0–5 OIs. For those reporting more than 5 OIs, the association reversed direction, with increasing OIs beyond 5 associated with greater adherence. [ABSTRACT FROM AUTHOR]
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- 2018
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14. Nevirapine- versus Efavirenz-based antiretroviral therapy regimens in antiretroviral-naive patients with HIV and Tuberculosis infections in India: a multi-centre study.
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Sinha, Sanjeev, Gupta, Kartik, Tripathy, Srikanth, Dhooria, Sahajal, Ranjan, Sanjay, and Pandey, R. M.
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NEVIRAPINE , *EFAVIRENZ , *HIGHLY active antiretroviral therapy , *THERAPEUTICS , *HIV infections , *HIV-positive persons , *TUBERCULOSIS patients , *PUBLIC health , *TUBERCULOSIS complications , *ANTITUBERCULAR agents , *HETEROCYCLIC compounds , *HIV infection complications , *REVERSE transcriptase inhibitors , *COMPARATIVE studies , *RESEARCH methodology , *MEDICAL cooperation , *RESEARCH , *RNA , *VIRAL load , *EVALUATION research , *RANDOMIZED controlled trials , *TREATMENT effectiveness , *KAPLAN-Meier estimator , *CD4 lymphocyte count - Abstract
Background: According to World Health Organization (WHO) guidelines, which have also been adopted by the National AIDS Control Organization (NACO), India, Efavirenz-based Anti-Retroviral Therapy (ART) is better in Human-Immunodeficiency-Virus (HIV)-infected patients who are also being treated with Rifampicin-based Anti-Tuberculous Therapy (ATT). However, Efavirenz is much more expensive. We hypothesize that Nevirapine is a cheaper alternative that possesses equal efficacy as Efavirenz in HIV-Tuberculosis (TB) co-infected patients.Methods: A parallel open-label randomized clinical trial was conducted at All India Institute of Medical Sciences (AIIMS), New Delhi and National AIDS Research Institute (NARI), Pune. Those who were ART-naïve and co-infected with TB were randomized to receive either Nevirapine (Group 1)- or Efavirenz (Group 2)-based ART along with Rifampicin-based ATT. ATT was begun first in ART-naïve patients according to the NACO guidelines, with a median of 27 days between ATT and ART in both groups. The primary endpoint was a composite unfavourable outcome (death and/or ART failure) at 96 weeks, and the secondary outcome was successful TB treatment at 48 weeks.Results: A total of 284 patients (mean age 36.7 ± 8.1 years) were randomized in a 1:1 ratio to receive either Nevirapine (n = 144)- or Efavirenz (n = 140)-based ART after a median ATT-ART gap of 27 days. The median CD4 count was 105 cells/μl, with a median viral load of 820,200 copies/μl and no significant difference between the groups. Composite unfavourable outcomes were reported in 49 patients in the Nevirapine group and 51 patients in the Efavirenz group (35.3% vs. 36.9%; hazard ratio, 0.95, 95% confidence interval (CI), 0.63,1.43, adjusted). There was no difference in successful TB treatment outcome between the groups (71.5% vs. 65.6%, 95% CI -3.8,17.9, adjusted). The results were similar, showing no difference between the groups in the two centres of the study after adjusting for disease stage.Conclusions: Composite unfavourable outcome in HIV-TB co-infected patients who were ART-naïve showed no statistically significant difference in the Nevirapine or Efavirenz groups.. Therefore, Nevirapine-based ART is a reasonable alternative to Efavirenz in resource-limited settings. However, multi-centric studies with larger sample sizes are required to confirm these findings.Trial Registration: NCT01805258 (Retrospectively registered on March 6, 2013) Date of registration: March 2013. [ABSTRACT FROM AUTHOR]- Published
- 2017
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15. Women living with AIDS in rural Southern India: Perspectives on mental health and lay health care worker support.
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Srivastava, Neha, Nyamathi, Adeline M., Sinha, Sanjeev, Carpenter, Catherine, Satyanarayana, Veena, Ramakrishnan, Padma, and Ekstrand, Maria
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PSYCHOLOGICAL adaptation ,AGE distribution ,CONTENT analysis ,FOCUS groups ,HEALTH services accessibility ,MENTAL illness ,RESEARCH funding ,PSYCHOLOGY of the sick ,PSYCHOLOGICAL stress ,PSYCHOLOGY of AIDS patients ,SOCIAL support ,EDUCATIONAL attainment ,THEMATIC analysis ,ATTITUDES toward mental illness ,ATTITUDES toward illness - Abstract
In this study, focus groups were conducted with 16 rural women living with AIDS (WLA) from Andhra Pradesh, India, who had previously participated in a clinical trial wherein 68 WLA were randomized into either an Accredited Social Health Activists (ASHA)-Life (AL) intervention or a usual care program. Findings are discussed in terms of (a) mental health issues, (b) perceived stressors, (c) individual resources for coping with mental health issues, and (d) role of ASHA support in coping with mental health issues. These findings highlight the salience of mental health issues in the lives of WLA and the role played by ASHA in addressing some of these issues. The discussion section makes a case for increased emphasis on mental health care in future community-based interventions for this population. [ABSTRACT FROM AUTHOR]
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- 2017
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16. Predictors of Dengue-Related Mortality and Disease Severity in a Tertiary Care Center in North India.
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Jain, Siddharth, Mittal, Abhenil, Sharma, Surendra Kumar, Upadhyay, Ashish Datt, Pandey, Ravindra Mohan, Sinha, Sanjeev, Soneja, Manish, Biswas, Ashutosh, Jadon, Ranveer Singh, Kakade, Mahadeo B., and Dayaraj, Cecilia
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DENGUE ,MORTALITY ,TERTIARY care - Abstract
Background. There is lack of reliable predictors of disease severity and mortality in dengue. The present study was carried out to identify these predictors during the 2015 outbreak in India. Methods. This prospective observational study included confirmed adult dengue patients hospitalized between August and November 2015 in a tertiary care centre in New Delhi, India. Appropriate statistical tests were used to compare clinicolaboratory characteristics, derive predictors of severe disease and mortality, and compute a predictive score for mortality. Serotyping was done. Results. Data of 369 patients were analyzed (mean age, 30.9 years; 67% males). Of these, 198 (54%) patients had dengue fever, 125 (34%) had dengue hemorrhagic fever (grade 1 or 2), and 46 (12%) developed dengue shock syndrome (DSS). Twenty-two (6%) patients died. Late presentation to the hospital (≥5 days after onset) and dyspnea at rest were identified as independent predictors of severe disease. Age ≥24 years, dyspnea at rest and altered sensorium were identified as independent predictors of mortality. A clinical risk score was developed (12*age + 14*sensorium + 10*dyspnea), which, if ≥22, predicted mortality with a high sensitivity (81.8%) and specificity (79.2%). The predominant serotypes in Delhi (2015) were dengue virus DENV2 and DENV4. Conclusion. Age ≥24 years, dyspnea at rest, and altered sensorium were identified as independent predictors of mortality. Platelet counts did not determine outcome in dengue patients. Timely referral/access to healthcare is important. The clinical risk score for mortality prediction that was developed in this study can be used in all healthcare settings, after validation in larger cohorts. [ABSTRACT FROM AUTHOR]
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- 2017
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17. Nosocomial infection of CCHF among health care workers in Rajasthan, India.
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Yadav, Pragya D., Patil, Deepak Y., Shete, Anita M., Kokate, Prasad, Goyal, Pulkit, Jadhav, Santosh, Sinha, Sanjeev, Zawar, Divya, Sharma, Surendra K., Kapil, Arti, Sharma, D. K., Upadhyay, Kamlesh J., and Mourya, Devendra T.
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HEMORRHAGIC fever ,NOSOCOMIAL infections ,MEDICAL personnel ,TICK-borne diseases ,PUBLIC health ,DISEASES - Abstract
Background: Ever since Crimean-Congo hemorrhagic fever [CCHF] discovered in India, several outbreaks of this disease have been recorded in Gujarat State, India. During the year 2011 to 2015 several districts of Gujarat and Rajasthan state (Sirohi) found to be affected with CCHF including the positivity among ticks and livestock. During these years many infected individuals succumbed to this disease; which subsequently led to nosocomial infections. Herein, we report CCHF cases recorded from Rajasthan state during January 2015. This has affected four individuals apparently associated with one suspected CCHF case admitted in a private hospital in Jodhpur, Rajasthan. Case presentation: A 30-year-old male was hospitalized in a private hospital in Jodhpur, Rajasthan State, who subsequently had developed thrombocytopenia and showed hemorrhagic manifestations and died in the hospital. Later on, four nursing staff from the same hospital also developed the similar symptoms (Index case and Case A, B, C). Index case succumbed to the disease in the hospital at Jodhpur followed by the death of the case A that was shifted to AIIMS hospital, Delhi due to clinical deterioration. Blood samples of the index case and Case A, B, C were referred to the National institute of Virology, Pune, India for CCHF diagnosis from the different hospitals in Rajasthan, Delhi and Gujarat. However, a sample of deceased suspected CCHF case was not referred. Subsequently, blood samples of 5 nursing staff and 37 contacts (Case D was one of them) from Pokhran area, Jaisalmer district were referred to NIV, Pune. Conclusions: It clearly indicated that nursing staff acquired a nosocomial infection while attending the suspected CCHF case in an Intensive Care Unit of a private hospital in Jodhpur. However, one case was confirmed from the Pokhran area where the suspected CCHF case was residing. This case might have got the infection from suspected CCHF case or through other routes. CCHF strain associated with these nosocomial infections shares the highest identity with Afghanistan strain and its recent introduction from Afghanistan cannot be ruled out. However, lack of active surveillance, unawareness among health care workers leads to such nosocomial infections. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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18. Indian Community a Natural Leader in Global Governance.
- Author
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Sinha, Sanjeev
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INTERNATIONAL relations ,TRANSPARENCY in government ,TRUST ,NATIONAL character ,INDIANS (Asians) - Abstract
The article discusses the emergence of India as a leader in global governance according to the author. Topics covered include India as a global community, the reported diversity in India, and the transparency and trust in the Indian community. It also discusses the logical and philosophical attributes of Indians, debates relating to Indian identity, and the strong and special skills of Indians in communication and expression.
- Published
- 2016
19. ASHA-Life Intervention Perspectives Voiced by Rural Indian Women Living With AIDS.
- Author
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Nyamathi, Adeline, Ekstrand, Maria, Srivastava, Neha, Carpenter, Catherine L., Salem, Benissa E., Al-Harrasi, Shawana, Ramakrishnan, Padma, and Sinha, Sanjeev
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HIV infection transmission ,INFECTIOUS disease transmission ,ANTIRETROVIRAL agents ,RURAL population ,CONTENT analysis ,DIET therapy ,EXPERIENCE ,FOCUS groups ,HEALTH services accessibility ,HIV infections ,LONGITUDINAL method ,RESEARCH funding ,PSYCHOLOGY of women ,PSYCHOLOGY of AIDS patients ,CULTURAL awareness ,SOCIAL support ,EDUCATIONAL attainment ,THEMATIC analysis ,HEALTH literacy ,MEDICAL coding ,DESCRIPTIVE statistics ,DISEASE risk factors - Abstract
In this focus group study, we explored the experiences of 16 rural women living with AIDS (WLA) who participated in the Asha-Life (AL) intervention to gain an understanding of the environmental, psychosocial, and cultural impact of the AL on their lives. Four themes emerged among AL participants: (a) the importance of tangible support, (b) need for social support, (c) ongoing challenges to accessing antiretroviral therapy (ART), and (d) perspectives on future programs. Our research findings support the development of future programs targeting mother–child dyads which emphasize nutritional knowledge, while reducing barriers to receiving ART, and physical, emotional, and financial support. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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20. Comparative Evaluation of GenoType MTBDRplus Line Probe Assay with Solid Culture Method in Early Diagnosis of Multidrug Resistant Tuberculosis (MDR-TB) at a Tertiary Care Centre in India.
- Author
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Yadav, Raj N., Singh, Binit K., Sharma, Surendra K., Sharma, Rohini, Soneja, Manish, Sreenivas, Vishnubhatla, Myneedu, Vithal P., Hanif, Mahmud, Kumar, Ashok, Sachdeva, Kuldeep S., Paramasivan, Chinnambedu N., Vollepore, Balasangameshwra, Thakur, Rahul, Raizada, Neeraj, Arora, Suresh K., and Sinha, Sanjeev
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TUBERCULOSIS diagnosis ,EARLY diagnosis ,MULTIDRUG resistance ,GENOTYPE-environment interaction ,DRUG resistance ,GENETIC mutation - Abstract
Background: The objectives of the study were to compare the performance of line probe assay (GenoType MTBDRplus) with solid culture method for an early diagnosis of multidrug resistant tuberculosis (MDR-TB), and to study the mutation patterns associated with rpoB, katG and inhA genes at a tertiary care centre in north India. Methods: In this cross-sectional study, 269 previously treated sputum-smear acid-fast bacilli (AFB) positive MDR-TB suspects were enrolled from January to September 2012 at the All India Institute of Medical Sciences hospital, New Delhi. Line probe assay (LPA) was performed directly on the sputum specimens and the results were compared with that of conventional drug susceptibility testing (DST) on solid media [Lowenstein Jensen (LJ) method]. Results: DST results by LPA and LJ methods were compared in 242 MDR-TB suspects. The LPA detected rifampicin (RIF) resistance in 70 of 71 cases, isoniazid (INH) resistance in 86 of 93 cases, and MDR-TB in 66 of 68 cases as compared to the conventional method. Overall (rifampicin, isoniazid and MDR-TB) concordance of the LPA with the conventional DST was 96%. Sensitivity and specificity were 98% and 99% respectively for detection of RIF resistance; 92% and 99% respectively for detection of INH resistance; 97% and 100% respectively for detection of MDR-TB. Frequencies of katG gene, inhA gene and combined katG and inhA gene mutations conferring all INH resistance were 72/87 (83%), 10/87 (11%) and 5/87 (6%) respectively. The turnaround time of the LPA test was 48 hours. Conclusion: The LPA test provides an early diagnosis of monoresistance to isoniazid and rifampicin and is highly sensitive and specific for an early diagnosis of MDR-TB. Based on these findings, it is concluded that the LPA test can be useful in early diagnosis of drug resistant TB in high TB burden countries. [ABSTRACT FROM AUTHOR]
- Published
- 2013
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21. Impact of Asha Intervention on Stigma Among Rural Indian Women With AIDS.
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Nyamathi, Adeline, Ekstrand, Maria, Salem, Benissa E., Sinha, Sanjeev, Ganguly, Kalyan K., and Leake, Barbara
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PSYCHOLOGICAL adaptation ,AGE distribution ,CHI-squared test ,COMMUNITY health workers ,CONCEPTUAL structures ,MENTAL depression ,DRUGS ,EXPERIMENTAL design ,PATIENT compliance ,PSYCHOLOGICAL tests ,RELIGION ,RESEARCH funding ,RURAL conditions ,STATISTICAL hypothesis testing ,STATISTICS ,SOCIAL stigma ,T-test (Statistics) ,PSYCHOLOGY of AIDS patients ,PILOT projects ,STATISTICAL power analysis ,MULTIPLE regression analysis ,RANDOMIZED controlled trials ,CONTROL groups ,HUMAN research subjects ,PATIENT selection ,DESCRIPTIVE statistics - Published
- 2013
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22. Impact of Protein Supplementation and Care and Support on Body Composition and CD4 Count Among HIV-Infected Women Living in Rural India: Results from a Randomized Pilot Clinical Trial.
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Nyamathi, Adeline, Sinha, Sanjeev, Ganguly, Kalyan, Ramakrishna, Padma, Suresh, P., and Carpenter, Catherine
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ANALYSIS of variance ,BODY composition ,CHI-squared test ,DIETARY supplements ,HIV infections ,LONGITUDINAL method ,DIETARY proteins ,QUESTIONNAIRES ,RESEARCH funding ,RURAL conditions ,PILOT projects ,RANDOMIZED controlled trials ,REPEATED measures design ,DATA analysis software ,DESCRIPTIVE statistics ,CD4 lymphocyte count - Abstract
Body composition in HIV-infected individuals is subject to many influences. We conducted a pilot 6-month randomized trial of 68 women living with AIDS (WLA) from rural India. High protein intervention combined with education and supportive care delivered by HIV-trained village women (activated social health activist [Asha] life [AL]) was compared to standard protein with usual care delivered by village community assistants (usual care [UC]). Measurements included CD4 counts, ART adherence, socio-demographics, disease characteristics (questionnaires); and anthropometry (bioimpedance analyzer). Repeated measures analysis of variance modeled associations. AL significantly gained in BMI, muscle mass, fat mass, ART adherence, and CD4 counts compared to UC, with higher weight and muscle mass gains among ART adherent (≥66 %) participants who had healthier immunity (CD4 ≥450). BMI of WLA improved through high protein supplementation combined with education and supportive care. Future research is needed to determine which intervention aspect was most responsible. [ABSTRACT FROM AUTHOR]
- Published
- 2013
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23. Correlates of Stigma among Rural Indian Women Living with HIV/AIDS.
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Nyamathi, Adeline, Ekstrand, Maria, Zolt-Gilburne, Jessica, Ganguly, Kalyan, Sinha, Sanjeev, Ramakrishnan, Padma, Suresh, P., Marfisee, Mary, and Leake, Barbara
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HIV infections & psychology ,HIV infection epidemiology ,ANALYSIS of variance ,STATISTICAL correlation ,QUESTIONNAIRES ,RESEARCH funding ,RURAL population ,STATISTICS ,SOCIAL stigma ,DATA analysis ,MULTIPLE regression analysis ,CROSS-sectional method ,ATTITUDES toward AIDS (Disease) ,DESCRIPTIVE statistics - Abstract
AIDS-related stigma has received increasing attention in the literature; however, little is known about the devastating impact it has on rural women living with AIDS (WLA) in India. This cross-sectional study ( N = 68), analyzed from complete baseline data, identified a number of correlates of stigma among rural WLA in South India. Structured instruments were used to capture sociodemographic history, stigma, knowledge of HIV, depressive symptoms along with the recording of CD4 data. A higher level of felt stigma and more AIDS symptoms were related to avoidant coping, while fewer adherence strategies and lower support for antiretroviral therapy (ART) adherence were also associated with avoidant coping. These findings promote the need for support and resources for rural Indian WLA. [ABSTRACT FROM AUTHOR]
- Published
- 2013
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24. Correlates of Adherence Among Rural Indian Women Living With HIV/AIDS.
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Nyamathi, Adeline, Salem, Benissa, Ernst, E. J., Keenan, Colleen, Suresh, P., Sinha, Sanjeev, Ganguly, Kalyan, Ramakrishnan, Padma, and Liu, Yihang
- Subjects
ANTIRETROVIRAL agents ,PSYCHOLOGICAL adaptation ,STATISTICAL correlation ,HINDUISM ,HIV-positive persons ,LONGITUDINAL method ,PATIENT compliance ,QUALITY of life ,QUESTIONNAIRES ,RESEARCH funding ,RURAL conditions ,SCALE analysis (Psychology) ,SCALES (Weighing instruments) ,SOCIAL stigma ,T-test (Statistics) ,WOMEN'S health ,PILOT projects ,MULTIPLE regression analysis ,RANDOMIZED controlled trials ,CROSS-sectional method ,DATA analysis software ,DESCRIPTIVE statistics - Abstract
In this prospective, randomized clinical trial, correlates of adherence to antiretroviral therapy (ART) were assessed using a baseline questionnaire among 68 rural women living with AIDS (WLA) in India. Unadjusted analyses revealed positive relationships of ART adherence with Hindu religion and support from spouses and parents, whereas negative associations were found with depression, poor quality of life, and having 10 or more HIV symptoms. Multiple linear regression analysis also revealed that WLA who were Hindu, not depressed, had ART support from spouses and parents, and perceived some benefit from ART, were more adherent to ART than their respective counterparts. This study reveals the unique challenges which rural WLA experience and the need to mitigate these challenges early in ART treatment. Further, the findings enable the refinement of an intervention program that will focus on strengthening ART adherence among rural WLA. [ABSTRACT FROM AUTHOR]
- Published
- 2012
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25. Impact of an Asha Intervention on Depressive Symptoms among Rural Women Living with AIDS in India: Comparison of the Asha-Life and Usual Care Program.
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Nyamathi, Adeline, Salem, Benissa E., Meyer, Visha, Ganguly, Kalyan K., Sinha, Sanjeev, and Ramakrishnan, Padma
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MENTAL depression ,THERAPEUTICS ,RURAL population ,PSYCHOLOGICAL adaptation ,CHI-squared test ,CLINICAL trials ,COMPARATIVE studies ,PSYCHOLOGICAL tests ,REGRESSION analysis ,SCALES (Weighing instruments) ,SELF-evaluation ,STATISTICS ,T-test (Statistics) ,PSYCHOLOGY of women ,PSYCHOLOGY of AIDS patients ,PILOT projects ,DATA analysis ,RANDOMIZED controlled trials ,DESCRIPTIVE statistics ,CD4 lymphocyte count - Abstract
The purpose of this randomized pilot study is to conduct an intervention with 68 rural women living with AIDS to compare the effectiveness of two different programs on depressive symptoms. The trial was designed to assess the impact of the Asha-Life intervention engaging with an HIV-trained village woman, Asha (Accredited Social Health Activist), to participate in the care of women living with AIDS (WLA), along with other health care providers compared to a Usual Care group. Two high prevalence HIV/AIDS villages in rural Andhra Pradesh, which were demographically alike and served by distinct Public Health Centers, were selected randomly from a total of 16 villages. The findings of this study demonstrated that the Asha-Life participants significantly reduced their depressive symptom scores compared to the Usual Care participants. Moreover, women living with AIDS who demonstrated higher depressive symptom scores at baseline had greater reduction in their depressive symptoms than women with lower scores. [ABSTRACT FROM AUTHOR]
- Published
- 2012
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26. Early versus delayed initiation of antiretroviral therapy for Indian HIV-Infected individuals with tuberculosis on antituberculosis treatment.
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Sinha, Sanjeev, Shekhar, Rahul C., Singh, Gurjeet, Shah, Nipam, Ahmad, Hafiz, Kumar, Narendra, Sharma, Surendra K., Samantaray, J. C., Ranjan, Sanjai, Ekka, Meera, Sreenivas, Vishnu, and Mitsuyasu, Ronald T.
- Subjects
- *
ANTIVIRAL agents , *HIV infections , *TUBERCULOSIS , *AZIDOTHYMIDINE - Abstract
Background: For antiretroviral therapy (ART) naive human immunodeficiency virus (HIV) infected adults suffering from tuberculosis (TB), there is uncertainty about the optimal time to initiate highly active antiretroviral therapy (HAART) after starting antituberculosis treatment (ATT), in order to minimize mortality, HIV disease progression, and adverse events. Methods: In a randomized, open label trial at All India Institute of Medical Sciences, New Delhi, India, eligible HIV positive individuals with a diagnosis of TB were randomly assigned to receive HAART after 2-4 or 8-12 weeks of starting ATT, and were followed for 12 months after HAART initiation. Participants received directly observed therapy short course (DOTS) for TB, and an antiretroviral regimen comprising stavudine or zidovudine, lamivudine, and efavirenz. Primary end points were death from any cause, and progression of HIV disease marked by failure of ART. Findings: A total of 150 patients with HIV and TB were initiated on HAART: 88 received it after 2-4 weeks (early ART) and 62 after 8-12 weeks (delayed ART) of starting ATT. There was no significant difference in mortality between the groups after the introduction of HAART. However, incidence of ART failure was 31% in delayed versus 16% in early ART arm (p = 0.045). Kaplan Meier disease progression free survival at 12 months was 79% for early versus 64% for the delayed ART arm (p = 0.05). Rates of adverse events were similar. Interpretation: Early initiation of HAART for patients with HIV and TB significantly decreases incidence of HIV disease progression and has good tolerability. [ABSTRACT FROM AUTHOR]
- Published
- 2012
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27. Correlates of Depression among Rural Women Living with AIDS in Southern India.
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Nyamathi, Adeline, Heravian, Anisa, Zolt-Gilburne, Jessica, Sinha, Sanjeev, Ganguly, Kalyan, Liu, Elaine, Ramakrishnan, Padma, Marfisee, Mary, and Leake, Barbara
- Subjects
ADAPTABILITY (Personality) ,AIDS ,ANALYSIS of variance ,MENTAL depression ,PROBABILITY theory ,RURAL conditions ,STATISTICAL sampling ,SELF-evaluation ,SOCIAL stigma ,SURVEYS ,PSYCHOLOGY of women ,PILOT projects ,MULTIPLE regression analysis ,RANDOMIZED controlled trials ,CROSS-sectional method - Abstract
Although depression may be commonly experienced by persons living with AIDS, it may be challenging for health care providers to identify persons who are suffering from depression symptoms, particularly if they are living in the more isolated rural areas of India. The purpose of this study is to assess correlates of depression among women living with AIDS in rural Andhra Pradesh, India. A total of 68 rural women living with AIDS (WLA) completed baseline data and were assessed by means of structured instruments. Regression modeling revealed that disclosure avoidance and making at least six health care visits in the last six months were all associated with depression. Further, living with a spouse was associated with lower depressive symptom scores. Stigma was not found to be associated with depression. Understanding correlates of depression can lead the way toward designing culturally-tailored interventions that can mitigate disclosure avoidance and improve the health of women. A more comprehensive health focus may be needed to empower the women to seek quality care for both physical health, as well as mental health, symptomatology. [ABSTRACT FROM AUTHOR]
- Published
- 2011
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28. Challenges Experienced by Rural Women in India Living With AIDS and Implications for the Delivery of HIV/AIDS Care.
- Author
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Nyamathi, AdelineM., Sinha, Sanjeev, Ganguly, KalyanK., William, RaviRaj, Heravian, Anisa, Ramakrishnan, Padma, Greengold, Barbara, Ekstrand, Maria, and Rao, PantangiVenkata Rama
- Subjects
- *
ANTIRETROVIRAL agents , *AIDS patients , *ANALYSIS of variance , *CONTENT analysis , *DRUGS , *EXPERIENCE , *FOCUS groups , *HEALTH services accessibility , *HIV infections , *INTERVIEWING , *RESEARCH methodology , *MEDICAL care , *PATIENT compliance , *PRIMARY health care , *RURAL conditions , *STATISTICAL sampling , *SOUND recordings , *SOCIAL stigma , *QUALITATIVE research , *THEMATIC analysis - Abstract
Researchers explored the barriers to AIDS care for rural women living with AIDS, and they investigated alternative delivery models to increase the women's adherence to antiretroviral therapy (ART). Community-based participatory research focus groups were conducted by the researchers with a convenience sample of 39 women living with AIDS from a primary health center (PHC) near Chennai, India, and with nurses, physicians, and Accredited Social Health Activists (Ashas), who are lay health care workers. The most prevalent barriers expressed by the women were sickness-related, psychological, financial issues with childcare, and distance, or transportation to the site. Women living with AIDS reviewed Ashas favorably. [ABSTRACT FROM AUTHOR]
- Published
- 2011
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29. Perceptions of Women Living with AIDS in Rural India Related to the Engagement of HIV-Trained Accredited Social Health Activists for Care and Support.
- Author
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Nyamathi, Adeline M., William, Ravi Raj, Ganguly, Kalyan K., Sinha, Sanjeev, Heravian, Anisa, Albarran, Cynthia R., Thomas, Alexandra, Greengold, Barbara, Ekstrand, Maria, Ramakrishna, Padma, and Rao, Pantangi Rama
- Subjects
AIDS ,CONTENT analysis ,SENSORY perception ,POLICY sciences ,RURAL conditions ,SOCIAL change ,SOCIAL stigma ,QUALITATIVE research - Abstract
A community-based participatory research study was conducted using focus groups with 39 women living with AIDS (WLA) in the rural setting of Andhra Pradesh, India. In addition, three nurses, two physicians, and five reproductive health accredited social health activists (ASHAs) took part in focus groups. The WLA offered insight into the benefits of HIV-trained ASHAs including emotional support, assistance with travel to health care providers and antiretroviral therapy medication adherence. Health care providers also identified benefits of using HIV-trained ASHAs and suggested modalities for how to train these individuals. These findings will contribute to the design of a future program of care involving HIV-trained ASHAs. [ABSTRACT FROM AUTHOR]
- Published
- 2010
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30. Higher Frequency of HIV-1 Drug Resistance and Increased Nucleoside Reverse Transcriptase Inhibitor Mutations among the HIV-1 Positive Antiretroviral Therapy–Naïve patients Coinfected With Mycobacterium tuberculosis Compared With Only HIV Infection in India
- Author
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Sinha, Sanjeev, Gupta, Kartik, Khan, Nawaid Hussain, Mandal, Dibyakanti, Kohli, Mikashmi, Das, B. K., and Pandey, R. M.
- Subjects
HIV infection genetics ,THERAPEUTIC use of protease inhibitors ,NON-nucleoside reverse transcriptase inhibitors ,NUCLEOSIDE reverse transcriptase inhibitors ,DRUG resistance in microorganisms ,HIV infections ,GENETIC mutation ,PHYLOGENY ,TUBERCULOSIS ,VIRAL load ,CD4 lymphocyte count ,SEQUENCE analysis ,MIXED infections ,THERAPEUTICS - Abstract
Background: Emergence of human immunodeficiency virus (HIV) drug resistance mutations prior to highly active antiretroviral therapy is a serious problem in clinical management of HIV/AIDS. Risk factors for appearance of drug resistance mutations are not known. We hypothesize that Mycobacterium tuberculosis infection may contribute to rapid emergence of such mutations in antiretroviral therapy–naïve patients. Methods: A total of 115 patients were recruited in this study of which 75 were HIV+TB+ coinfected (group 1) and 40 were HIV+TB− (group 2). Blood samples from all the patients were collected and CD4+ cell counts; HIV-1 plasma viral load and sequencing of protease and two-third region of reverse transcriptase of HIV-1 was performed and analyzed for drug resistance pattern. Results: For patients with HIV+TB+, 10.6% (8/75) had mutations to non-nucleoside reverse transcriptase inhibitors (NNRTIs), 4% (3/75) to nucleoside reverse transcriptase inhibitors, and only 2.6% (2/75) patients had mutations to protease inhibitors. Interestingly, for group 2 (HIV+TB−), there were only NNRTI mutations found among these patients, and only 3 patients (7.5%) had these drug-resistant mutations. Clade typing and phylogenetic tree analysis showed HIV-1 subtype C predominance in these patients. Conclusions: Our study showed that higher percentage of HIV drug resistance mutations was found among HIV+TB+ individuals compared with tuberculosis-uninfected patients. Tuberculosis coinfection may be a risk factor for emergence of high frequency of drug resistance mutations. Studies with a larger sample size will help to confirm these findings from the Indian population. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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31. Cultural Challenges in Business Development between India & Japan.
- Author
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SINHA, Sanjeev
- Subjects
CULTURE ,BUSINESS development ,INTERNATIONAL trade - Abstract
In the article, the author discusses the cultural hindrances that adversely affect business development between India and Japan. Among the challenges that hinder business relationship between the two countries include differences in business style and the extremely poor exchange of people and information. He examines the problems encountered by Indian companies in conducting business in Japan, as well as those of Japanese firms trying to do business in India. He cites the Marunouchi India Economic Zone in Tokyo, Japan as one project to resolve the issue.
- Published
- 2010
32. Impact of a Rural Village Women (Asha) Intervention on Adherence to Antiretroviral Therapy in Southern India.
- Author
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Nyamathi, Adeline, Hanson, Alecia Y., Salem, Benissa E., Sinha, Sanjeev, Ganguly, Kalyan K., Leake, Barbara, Yadav, Kartik, and Marfisee, Mary
- Subjects
- *
CLINICAL drug trials , *AIDS , *ANTIVIRAL agents , *CHI-squared test , *CONCEPTUAL structures , *DRUGS , *HELP-seeking behavior , *EVALUATION of medical care , *PATIENT compliance , *PSYCHOLOGICAL tests , *RELIGION , *RESEARCH funding , *RURAL conditions , *STATISTICAL sampling , *SCALE analysis (Psychology) , *SCALES (Weighing instruments) , *STATISTICS , *SOCIAL stigma , *PSYCHOLOGICAL stress , *T-test (Statistics) , *PILOT projects , *THEORY , *DATA analysis , *MULTIPLE regression analysis , *RANDOMIZED controlled trials , *HUMAN research subjects , *PATIENT selection , *PATIENTS' attitudes , *CD4 lymphocyte count ,DRUG therapy for AIDS - Abstract
The article discusses a study assessing the effectiveness of an intervention (Asha-Life) by Accredited Social Health Activists (Asha) to improve antiretroviral therapy adherence of rural women living with AIDS in India compared with that of a usual care group. It focuses on continued low adherence of therapy due to several barriers facing rural women. Findings suggested significant increase in the Asha-Life intervention, which provides awareness and councelling on HIV/AIDS and its therapy.
- Published
- 2012
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33. Pattern & correlates of neurocognitive dysfunction in Asian Indian adults with severe obstructive sleep apnoea.
- Author
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Sharma, Hanish, Sharma, Surendra K., Kadhiravan, Tamilarasu, Mehta, Manju, Sreenivas, Vishnubhatla, Gulati, Vinay, and Sinha, Sanjeev
- Subjects
- *
COGNITION disorders , *SLEEP apnea syndromes , *SHORT-term memory , *PROBLEM solving - Abstract
Background & objectives: No published data are available on neurocognitive dysfunction in Asian Indians with obstructive sleep apnoea (OSA). We therefore, studied the pattern and correlates of neurocognitive dysfunction in Indian adults with severe OSA. Methods: Fifty patients aged 25-65 yr with severe OSA (apnoea-hypopnoea index > 30) and 25 age, sex, and education level-matched normal controls were studied. Both groups were administered a standardized battery of neurocognitive tests. Results: Patients with severe OSA had significantly impaired performance on tests of alertness, working memory, response inhibition, problem solving, and executive function. However, the difference in executive function between the groups disappeared after adjusting for delayed information processing. The test scores did not correlate with apnoea-hypopnoea index, arousal index, or Epworth sleepiness score. However, the percentage of time spent at < 90 per cent oxygen saturation had a weak correlation with the number of stroop errors (Spearman's rho = 0.64; P = 0.033), number of trials required (rho = 0.05; P = 0.02), and perseverative errors on Wisconsin card sorting test (rho = 0.36; P = 0.02). Interpretation & conclusions: Our results suggested that delayed information processing rather than impaired abstract thinking was probably the cause of impaired performance on composite tests of neurocognitive function in patients with severe OSA. [ABSTRACT FROM AUTHOR]
- Published
- 2010
34. Outcomes of antiretroviral therapy in a northern Indian urban clinic.
- Author
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Sharma, Surendra K., Dhooria, Sahajal, Prasad, K. T., George, Ninoo, Ranjan, Sanjay, Gupta, Deepak, Sreenivas, Vishnubhatla, Kadhiravan, Tamilarasu, Miglani, Sunita, Sinha, Sanjeev, Wig, Naveet, Biswas, Ashutosh, and Vajpayee, Madhu
- Subjects
- *
ANTIRETROVIRAL agents , *CD4 antigen , *LYMPHOCYTES , *CLINICS , *SOCIAL status , *ATTRITION in research studies - Abstract
Problem Antiretroviral therapy (ART) programmes have been successful in several countries. However, whether they would succeed as part of a national programme in a resource-constrained setting such as India is not clear. The outcomes and specific problems encountered in such a setting have not been adequately studied. Approach We assessed the efficacy and functioning of India's national ART programme in a tertiary care centre in northern India. All ART-naive patients started on ART between May 2005 and October 2006 were included in the study and were followed until 31 April 2008. Periodic clinical and laboratory evaluations were carried out in accordance with national guidelines. Changes in CD4+ lymphocyte count, body weight and body mass index were assessed at follow-up, and the operational problems analysed. Local setting The setting was a tertiary care centre in northern India with a mixed population of patients, mostly of low socioeconomic status. The centre is reasonably well resourced but faces constraints in health-care delivery, such as lack of adequate human resources and a high patient load. Relevant changes The response to ART in the cohort studied was comparable to that reported from other countries. However, the programme had a high attrition rate, possibly due to patient-related factors and operational constraints. Lessons learnt A high rate of attrition can affect the overall efficacy and functioning of an ART programme. Addressing the issues causing attrition might improve patient outcomes in India and in other resource-constrained countries. [ABSTRACT FROM AUTHOR]
- Published
- 2010
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35. Prevalence and risk factors of obstructive sleep apnea among middle-aged urban Indians: A community-based study
- Author
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Reddy, Emmadi V., Kadhiravan, Tamilarasu, Mishra, Hemant K., Sreenivas, Vishnubhatla, Handa, Kumud K., Sinha, Sanjeev, and Sharma, Surendra K.
- Subjects
- *
SLEEP apnea syndromes , *DISEASE prevalence , *MIDDLE-aged persons , *URBAN health , *COMMUNITIES , *SOCIOECONOMIC factors , *DISEASES , *DISEASE risk factors - Abstract
Abstract: Background: The epidemiology of obstructive sleep apnea (OSA) and obstructive sleep apnea syndrome (OSAS) is not well studied among Indians. We sought to determine the prevalence and risk factors of OSA in a middle-aged urban Indian population. Methods: We conducted a two-stage, cross-sectional, community-based study in four different socioeconomic zones of the South Delhi district, India, from April 2005 to June 2007. In stage 1, subjects of either gender aged 30–65yrs were administered a questionnaire by door-to-door survey using systematic random sampling. Subjects that responded were classified as habitual and non-habitual snorers. In stage 2, all the habitual and 10% of randomly selected non-habitual snorers were invited for overnight polysomnographic study. Results: Of the 2860 subjects approached, 2505 (88%) completed stage 1. Habitual snoring was present in 452 (18%) subjects. In stage 2, OSA defined as apnea–hypopnea index ⩾5 was observed in 94 (32.4%) of 290 habitual snorers and 3 (4%) of 75 non-habitual snorers. Estimated population prevalence of OSA and OSAS was 9.3% (95% CI 8.2–10.5%) and 2.8% (2.1–3.4%) respectively. On multivariable analysis, male gender (adjusted odds ratio 3.8 [1.7–4.9]), body-mass index ⩾25kg/m2 (4.1 [2.0–8.3]), and abdominal obesity (2.2 [1.9–5.3]) were independently associated with the presence of OSA. A linear trend was observed in the prevalence of OSA across the socioeconomic strata. Conclusions: OSA is a significant public health problem in the middle-aged Indian population across the socioeconomic spectrum. OSA is associated with some of the well known risk factors for cardiovascular disease. [Copyright &y& Elsevier]
- Published
- 2009
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36. Survival of Persons Living With HIV/AIDS: A Multicentric Study From India.
- Author
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Sinha S, Abdul Samad S, Bansal G, Verma S, Sangle SA, Guha SK, Rajput N, Pandey RM, Ranjan S, Salvi S, Mundhe S, More M, Modak D, Datta K, Kabra SK, Lodha R, Nischal N, and Das BK
- Subjects
- Humans, Male, Adult, HIV, India epidemiology, CD4 Lymphocyte Count, Acquired Immunodeficiency Syndrome drug therapy, Acquired Immunodeficiency Syndrome epidemiology, HIV Infections drug therapy, HIV Infections epidemiology, Anti-HIV Agents therapeutic use
- Abstract
Background: It has been more than 17 years since the introduction of free ART in India. At this point, it would be prudent to look at the factors associated with the survival of persons living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (PLHA) who are already enrolled in the ART program., Methods: PLHAs enrolled from antiretroviral therapy (ART) centers located in three different cities in India - Delhi, Pune and Kolkata, and were followed up at six monthly intervals monitoring the WHO stage, CD4 counts, complete blood counts, and liver and kidney function tests, for a duration of three years., Results and Discussion: The incidence of mortality among HIV/AIDS patients on ART was 5.0 per 1000 patient-years (21/1410, 1.4%). Age at initiation of ART, being above 35 years, was the only significant predictor of mortality (log-rank p = 0.018). Multivariable analysis showed a significant association of an unfavourable outcome (defined as mortality or development of opportunistic infection during follow-up) with male gender (adjusted odds ratio (AOR) = 5.26, p = <0.01) and being unmarried at ART initiation (AOR = 1.39, p = 0.005)., Conclusion: The survival of PLHA with good adherence to ART is independent of the WHO stage or CD4 counts at the initiation of ART. Initiation of ART after 35 years of age was a significant predictor of mortality., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)
- Published
- 2023
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37. Effectiveness of an inactivated virus-based SARS-CoV-2 vaccine, BBV152, in India: a test-negative, case-control study.
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Desai D, Khan AR, Soneja M, Mittal A, Naik S, Kodan P, Mandal A, Maher GT, Kumar R, Agarwal A, Gowda NR, H V, Kumar P, Pandey S, Pandey RM, Kumar A, Ray A, Jorwal P, Nischal N, Choudhary A, Brijwal M, Madan K, Lodha R, Sinha S, Dar L, Wig N, and Guleria R
- Subjects
- Adult, COVID-19 Nucleic Acid Testing, Case-Control Studies, Humans, India, Middle Aged, Virion immunology, COVID-19 prevention & control, COVID-19 Vaccines, SARS-CoV-2, Vaccination, Vaccines, Inactivated
- Abstract
Background: BBV152 is a whole-virion inactivated SARS-CoV-2 vaccine that has been deployed in India. The results of the phase 3 trial have shown clinical efficacy of BBV152. We aimed to evaluate the effectiveness of BBV152 against symptomatic RT-PCR-confirmed SARS-CoV-2 infection., Methods: We conducted a test-negative, case-control study among employees of the All India Institute of Medical Sciences (a tertiary care hospital in New Delhi, India), who had symptoms suggestive of COVID-19 and had an RT-PCR test for SARS-CoV-2 during the peak of the second wave of the COVID-19 pandemic in India between April 15 and May 15, 2021. Cases (test-positives) and controls (test-negatives) were matched (1:1) on the basis of age and gender. The odds of vaccination with BBV152 were compared between cases and controls and adjusted for level of occupational exposure (to COVID-19), previous SARS-CoV-2 infection, and calendar time, using conditional logistic regression. The primary outcome was effectiveness of two doses of BBV152 (with the second dose received at least 14 days before testing) in reducing the odds of symptomatic RT-PCR-confirmed SARS-CoV-2 infection, expressed as (1 - odds ratio) × 100%., Findings: Between April 15 and May 15, 2021, 3732 individuals had an RT-PCR test. Of these, 2714 symptomatic employees had data on vaccination status, and 1068 matched case-control pairs were available for analysis. The adjusted effectiveness of BBV152 against symptomatic COVID-19 after two doses administered at least 14 days before testing was 50% (95% CI 33-62; p<0·0001). The adjusted effectiveness of two doses administered at least 28 days before testing was 46% (95% CI 22-62) and administered at least 42 days before testing was 57% (21-76). After excluding participants with previous SARS-CoV-2 infections, the adjusted effectiveness of two doses administered at least 14 days before testing was 47% (95% CI 29-61)., Interpretation: This study shows the effectiveness of two doses of BBV152 against symptomatic COVID-19 in the context of a huge surge in cases, presumably dominated by the potentially immune-evasive delta (B.1.617.2) variant of SARS-CoV-2. Our findings support the ongoing roll-out of this vaccine to help control the spread of SARS-CoV-2, while continuing the emphasis on adherence to non-pharmacological measures., Funding: None., Translation: For the Hindi translation of the abstract see Supplementary Materials section., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2022 Elsevier Ltd. All rights reserved.)
- Published
- 2022
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38. Lean Mass Improvement from Nutrition Education and Protein Supplementation among Rural Indian Women Living with HIV/AIDS: Results from Cluster Randomized Factorial Trial at 18-Month Follow-Up.
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Carpenter CL, Kapur K, Ramakrishna P, Pamujula S, Yadav K, Giovanni JE, Julian O, Ekstrand ML, Sinha S, and Nyamathi AM
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- Counseling, Female, Follow-Up Studies, Humans, India, Nutritional Physiological Phenomena, Rural Population, Time Factors, Acquired Immunodeficiency Syndrome therapy, Body Composition, Dietary Proteins administration & dosage, Dietary Supplements, Health Education, Nutrition Therapy methods
- Abstract
Loss of lean muscle mass impairs immunity and increases mortality risk among individuals with HIV/AIDS. We evaluated the relative contributions of protein supplementation and nutrition education on body composition among 600 women living with HIV/AIDS in rural Andhra Pradesh, India. We conducted a cluster randomized controlled 2 × 2 factorial trial lasting six months with follow up at twelve and eighteen months. Interventions occurred in the Nellore and Prakasam regions of Andhra Pradesh by trained village women, ASHA (Accredited Social Health Activists), and included: (1) the usual supportive care from ASHA (UC); (2) UC plus nutrition education (NE); (3) UC plus nutritional protein supplementation (NS); (4) combined UC plus NE plus NS. A Bioimpedance Analyzer Model 310e measured body composition. SAS 9.4 analyzed all data. Mixed models using repeated measures evaluated lean mass change from baseline as primary and fat weight and total weight as secondary outcomes. Lean mass change was significantly associated with NS ( p = 0.0001), NE ( p = 0.0001), and combined NS plus NE ( p = 0.0001), with similar associations for secondary outcomes. Stronger associations for total weight were observed with greater ART adherence. Nutritional interventions may improve physiologic response to HIV. Significant increases in lean mass resulted from independent and combined protein supplementation and nutrition education.
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- 2021
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39. Post COVID-19 sequelae: A prospective observational study from Northern India.
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Naik S, Haldar SN, Soneja M, Mundadan NG, Garg P, Mittal A, Desai D, Trilangi PK, Chakraborty S, Begam NN, Bhattacharya B, Maher G, Mahishi N, Rajanna C, Kumar SS, Arunan B, Kirtana J, Gupta A, Patidar D, Kodan P, Sethi P, Ray A, Jorwal P, Kumar A, Nischal N, Sinha S, Biswas A, and Wig N
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, COVID-19 epidemiology, COVID-19 etiology, COVID-19 pathology, Cough epidemiology, Cough etiology, Dyspnea epidemiology, Dyspnea etiology, Fatigue epidemiology, Fatigue etiology, Female, Humans, India epidemiology, Male, Middle Aged, Myalgia epidemiology, Myalgia etiology, Prospective Studies, Risk Factors, Sleep Initiation and Maintenance Disorders epidemiology, Sleep Initiation and Maintenance Disorders etiology, Young Adult, Post-Acute COVID-19 Syndrome, COVID-19 complications
- Abstract
Post COVID-19 sequelae are a constellation of symptoms often reported after recovering from COVID-19. There is a need to better understand the clinical spectrum and long-term course of this clinical entity. The aim of this study is to describe the clinical features and risk factors of post COVID-19 sequelae in the North Indian population. This prospective observational study was conducted at a tertiary healthcare centre in Northern India between October 2020 and February 2021. Patients aged >18 years with laboratory-confirmed COVID-19 were recruited after at least two weeks of diagnosis, and details were captured. A total of 1234 patients were recruited and followed up for a median duration of 91 days (IQR: 45-181 days). Among them, 495 (40.1%) had persistent symptoms post-discharge or recovery. In 223 (18.1%) patients, the symptoms resolved within four weeks; 150 (12.1%) patients had symptoms till 12 weeks, and 122 (9.9%) patients had symptoms beyond 12 weeks of diagnosis/symptom-onset of COVID-19. Most common symptoms included myalgia (10.9%), fatigue (5.5%), shortness of breath (6.1%), cough (2.1%), insomnia (1.4%), mood disturbances (0.48%) and anxiety (0.6%). Patients who were hospitalized were more likely to report fatigue as a feature of long COVID. Hypothyroidism (OR: 4.13, 95% CI: 2.2-7.6, p-value < 0.001) and hypoxia (SpO
2 ≤ 93%) (OR: 1.7, 95% CI: 1.1-2.4, p-value 0.012) were identified as risk factors for long COVID sequelae. In conclusion, long COVID symptoms were common (22%), and 9.9% had the post COVID-19 syndrome. Myalgias, fatigue and dyspnoea were common symptoms. Patients with hypothyroidism and hypoxia during acute illness were at higher risk of long COVID.- Published
- 2021
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40. Gargle lavage as a viable alternative to swab for detection of SARS-CoV-2.
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Mittal A, Gupta A, Kumar S, Surjit M, Singh B, Soneja M, Soni KD, Khan AR, Singh K, Naik S, Kumar A, Aggarwal R, Nischal N, Sinha S, Trikha A, and Wig N
- Subjects
- Betacoronavirus pathogenicity, COVID-19, Coronavirus Infections epidemiology, Coronavirus Infections genetics, Coronavirus Infections virology, Female, Humans, India epidemiology, Male, Middle Aged, Nasopharynx virology, Oropharynx virology, Pandemics, Pneumonia, Viral epidemiology, Pneumonia, Viral genetics, Pneumonia, Viral virology, SARS-CoV-2, Specimen Handling, Betacoronavirus isolation & purification, Coronavirus Infections diagnosis, Pneumonia, Viral diagnosis, Therapeutic Irrigation
- Abstract
Background & Objectives: Nasopharyngeal and oropharyngeal swab (NPS and OPS) collection is widely accepted as the preferred method for obtaining respiratory samples. However, it has certain disadvantages which may be overcome by gargling. The primary objective of this study was to assess agreement between gargle lavage and swab as an appropriate respiratory sample for the detection of SARS-CoV-2. The secondary objective was to assess the patient acceptability of the two sampling methods., Methods: It was a cross-sectional study done at a tertiary care hospital in New Delhi, India, on 50 confirmed COVID-19 patients. Paired swab (NPS and OPS) and gargle samples were taken within 72 h of their diagnosis. Samples were processed by reverse transcription-polymerase chain reaction (RT-PCR) for detection of SARS-CoV-2. Post-sample collection, a 10-point scale was administered to assess the level of discomfort with either of the collection methods., Results: All gargle samples were positive and comparable to their corresponding swab samples irrespective of the symptoms and duration of illness. The cycle threshold (C
t ) values for gargle samples were slightly higher but comparable to those of swabs. Bland-Altman plot showed good agreement between the two methods. Majority (72%) of the patients reported moderate-to-severe discomfort with swab collection in comparison to 24 per cent reporting only mild discomfort with gargle collection., Interpretation & Conclusions: Our preliminary results show that the gargle lavage may be a viable alternative to swabs for sample collection for the detection of SARS-CoV-2. Adoption of gargle lavage for sample collection will have a significant impact as it will enable easy self-collection, relieve healthcare workers and also lead to substantial cost savings by reducing the need for swabs and personal protective equipment., Competing Interests: None- Published
- 2020
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41. High degree of fluoroquinolone resistance among extrapulmonary tuberculosis patients at a tertiary care center in North India.
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Chaubey J, Shrivastava D, Pawar S, Singh BK, Sharma R, and Sinha S
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- Adult, Antitubercular Agents therapeutic use, Female, Fluoroquinolones therapeutic use, Humans, India, Male, Microbial Sensitivity Tests, Middle Aged, Mycobacterium tuberculosis drug effects, Mycobacterium tuberculosis isolation & purification, Young Adult, Antitubercular Agents pharmacology, Fluoroquinolones pharmacology, Tertiary Care Centers statistics & numerical data, Tuberculosis, Multidrug-Resistant microbiology
- Abstract
Background: The treatment of drug-resistant tuberculosis (TB) involves various regimens. Among them, the most promising antibiotic regimens are fluoroquinolone (FQ) drugs. Drug susceptibility testing (DST) for FQs is not included as routine assessment for baseline TB diagnosis. Limited resources are available about FQ resistance among extrapulmonary TB (EPTB) cases., Methods: A total of 447 culture-positive specimens were subjected to DST for first-line anti-TB drugs (FLDs) and second-line anti-TB drugs. DST was performed using automated mycobacterium growth indicator tube-960 liquid culture techniques. The study was carried out during the period of April 2016 to March 2017. In addition, DST of FQs was also performed in FLD-sensitive strains., Results: Mycobacterium tuberculosis was isolated from 447 specimens. Of the 447 culture-positive EPTB specimens, 54 were rifampicin-resistant (RR)/multidrug-resistant TB (MDR-TB) isolates, 45 isolates were resistant to any drug, and the remaining 348 were sensitive to FLDs. Monoresistance of FQs was observed in 20.4% (11/54) among RR/MDR-TB isolates and 4.3% (15/348) among FLD-sensitive isolates., Conclusion: The high degree of FQ resistance observed in EPTB specimens among drug-sensitive and MDR-TB isolates is alarming. This study reflects the need to expand culture and DST for EPTB cases and include FQs within first-line DST in such settings. Furthermore, there should be a rational use of FQs for the treatment of other diseases., Competing Interests: None
- Published
- 2020
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42. Sustained Effect of a Community-based Behavioral and Nutrition Intervention on HIV-related Outcomes Among Women Living With HIV in Rural India: A Quasi-experimental Trial.
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Nyamathi AM, Shin SS, Sinha S, Carpenter CL, Garfin DR, Ramakrishnan P, Yadav K, and Ekstrand ML
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- Adult, Behavior Therapy, Behavioral Medicine, Body Mass Index, CD4 Lymphocyte Count, Child, Preschool, Community Health Workers, Counseling, Diet Therapy, Dietary Supplements, Female, Hemoglobins, Humans, India, Middle Aged, Non-Randomized Controlled Trials as Topic, Nutritional Status, Patient Education as Topic, Serum Albumin, Treatment Outcome, HIV Infections diet therapy, HIV Infections drug therapy, HIV Infections psychology, Nutrition Assessment, Rural Population
- Abstract
Background: Women living with HIV (WLH) in rural communities face challenges to obtaining treatment and accurate disease-related information. Nutritional deficits exacerbate disease progression., Setting: WLH were recruited from primary health centers in rural India., Method: A quasi-experimental trial of a comprehensive Accredited Social Health Activist (Asha)-supported intervention compared 4 distinct Asha-based programs [(1) standard education (SE) alone; (2) nutrition education (+NE); (3) nutrition supplements (+NS); or (4) nutrition education and nutrition supplements (+NENS)] on key disease and nutrition-related outcomes [CD4 count, body mass index (BMI), serum albumin, and hemoglobin]. Assessments occurred at baseline, and months 6 (immediately after intervention), 12, and 18. Multilevel modeling examined effects of program (group) over time., Findings: Among 600 WLH enrolled (n = 150 per arm), mean age, CD4 count, and BMI (kg/m) were 34.31, 447.42, and 20.09, respectively, at baseline. At 18-month follow-up, program 4 (+NENS) experienced greatest improvements in CD4 counts compared with program 1 (+SE) [adjusted difference = 223.81, 95% confidence interval (CI): 170.29 to 277.32]. For BMI, programs 3 (+NS; adjusted difference = 2.33, 95% CI: 1.39 to 3.26) and 4 (+NENS; adjusted difference = 2.14, 95% CI: 1.17 to 3.12) exhibited greater gains compared with program 1 (+SE). Programs 3 and 4 were not significantly different from each other (adjusted difference = -0.18, 95% CI: -1.12 to 0.76). Hemoglobin and serum albumin also improved over time; program 4 (+NENS) exhibited the greatest gains., Conclusions: A low-cost Asha-supported behavioral and nutritional intervention improved outcomes for WLH. Gains were sustained at 18-month follow-up. Similar approaches may help improve HIV and other infectious disease-related outcomes in vulnerable populations.
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- 2019
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43. Cervical cancer awareness and presence of abnormal cytology among HIV-infected women on antiretroviral therapy in rural Andhra Pradesh, India.
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Shin SS, Carpenter CL, Ekstrand ML, Wang Q, Grover S, Zetola NM, Yadav K, Sinha S, and Nyamathi AM
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- Adolescent, Adult, Carcinoma, Squamous Cell epidemiology, Carcinoma, Squamous Cell virology, Female, HIV Infections ethnology, Humans, India epidemiology, Middle Aged, Papanicolaou Test, Papillomavirus Infections epidemiology, Papillomavirus Infections virology, Prevalence, Risk Factors, Squamous Intraepithelial Lesions of the Cervix epidemiology, Squamous Intraepithelial Lesions of the Cervix virology, Surveys and Questionnaires, Uterine Cervical Neoplasms epidemiology, Uterine Cervical Neoplasms virology, Vaginal Smears, Young Adult, Uterine Cervical Dysplasia epidemiology, Uterine Cervical Dysplasia virology, Carcinoma, Squamous Cell diagnosis, HIV Infections complications, Health Knowledge, Attitudes, Practice ethnology, Papillomaviridae isolation & purification, Papillomavirus Infections diagnosis, Rural Population statistics & numerical data, Squamous Intraepithelial Lesions of the Cervix diagnosis, Uterine Cervical Neoplasms diagnosis, Uterine Cervical Dysplasia diagnosis
- Abstract
Cervical cancer is a leading cause of death among women in low- and middle-income countries, and women living with HIV are at high risk for cervical cancer. The objective of this study was to estimate the prevalence and correlates of cervical cancer and pre-cancer lesions and to examine cervical cancer knowledge among women living with HIV receiving antiretroviral therapy in rural Andhra Pradesh, India. We conducted cytology-based screening and administered a standardized questionnaire among 598 HIV-infected women. We found 5 (0.8%), 39 (6.5%), 29 (4.9%), and 4 (0.7%) had atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL), and squamous cervical carcinoma (SCC), respectively. In multivariable logistic regression analysis, ASCUS/LSIL was independently associated with age >16 years old at first sexual encounter and smokeless tobacco use. We found no factors associated with HSIL/SCC. In total, 101 women (16.9%) had heard of cervical cancer and 28 (27.7%) of them correctly identified HIV infection as a risk factor. In light of the high prevalence of pre-cancer lesions and low level of cervical cancer knowledge in our study population, focused interventions are needed to improve cervical cancer literacy and prevention among rural women living with HIV.
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- 2019
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44. Randomized controlled trial of a community-based intervention on HIV and nutritional outcomes at 6 months among women living with HIV/AIDS in rural India.
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Nyamathi AM, Carpenter CL, Ekstrand ML, Yadav K, Garfin DR, Muniz LC, Kelley M, and Sinha S
- Subjects
- Adolescent, Adult, Body Mass Index, CD4 Lymphocyte Count, Female, Humans, India, Middle Aged, Rural Population, Treatment Outcome, Young Adult, Behavior Therapy methods, Community Health Workers, Diet Therapy methods, HIV Infections pathology, HIV Infections therapy
- Abstract
Objective: To assess the impact of nurse-led Asha (Accredited Social Health Activist)-support behavioral and nutritional intervention among women living with HIV/AIDS (WLH/A) in rural India., Design: Cluster randomized controlled trial., Methods: Sixteen Primary Health Centers serving WLH/A in Andhra Pradesh were grouped into four regional clusters that were randomly allocated into one of four arms. All four groups included Asha-support and consisted of: Asha-support only (control group); nutrition education; nutrition supplementation; and the combination of supplementation and education. Differences between baseline and 6-month follow-up for key physiological outcomes (BMI, CD4 cell count) were analyzed using factorial mixed models that accounted for geographic clustering., Results: At 6 months, all groups improved CD4 cell count: Asha only [mean difference score (D) = 343.97, standard deviation (SD) = 106.94], nutrition education (D = 356.15, SD = 0.69), nutrition supplement (D = 469.66, SD = 116.0), and nutrition supplement and education (D = 530.82, SD = 128.56). In multivariable models, Asha-support and nutrition, and Asha-support and nutrition supplement interventions demonstrated independent significant improvements in CD4 cell count; the interaction term was significant [estimate = 529.9; 95% confidence interval (CI) 512.0, 547.8; P = 0.006]. BMI also increased for all groups: Asha only (D = 0.95, SD = 0.82), Asha and nutrition education (D = 1.28, SD = 0.53), Asha and nutrition supplement (D = 2.38, SD = 0.60), nutrition supplement, and nutrition supplement and education (D = 2.72, SD = 0.84). Nutrition supplementation and nutrition education demonstrated independent effects on BMI; the interaction term was not significant (estimate = 0.27; 95% CI = 2.5, 2.7; P = 0.80)., Conclusion: Interventions supported by community workers were efficacious at improving physiological outcomes and may be beneficial at meeting critical healthcare needs of vulnerable WLH/A in India.
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- 2018
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45. Effect of kidney transplantation on sleep-disordered breathing in patients with End Stage Renal Disease: a polysomnographic study.
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Mahajan S, Gupta K, Sinha S, Malhotra A, and Mahajan S
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- Adult, Female, Humans, Hypertension, India epidemiology, Male, Prevalence, Renal Dialysis methods, Kidney Failure, Chronic complications, Kidney Transplantation, Polysomnography methods, Sleep Apnea Syndromes epidemiology
- Abstract
Background: Sleep-disordered breathing (SDB) is common in patients with end-stage renal disease (ESRD). SDB is associated with comorbidities such as hypertension, diabetes mellitus, and obesity, interplaying with metabolic derangements in the form of uremia, acidosis, and hypervolemia. Renal transplant has been observed to correct most of these metabolic derangements and to control progression of comorbidities. While SDB is highly prevalent among patients in the pretransplant stage, it remains to be seen whether the beneficial aspects of transplant are extended to improvement in SDB in patients with ESRD., Methods: Eighteen patients undergoing thrice-weekly hemodialysis (HD) for ESRD at the transplant clinic of All India Institute of Medical Sciences (AIIMS), New Delhi, underwent detailed clinical, laboratory, and polysomnographic evaluation. The average number of apneas and hypopneas per hour of sleep, ie, Apnea-Hypopnea Index (AHI), was used to define the severity of sleep apnea. All patients underwent polysomnography (PSG) within 24 h of the last HD and after three months of living-donor transplant., Results: Of 18 patients, there were 14 males and four females. The median age was 28 years (range 19-50 years). They had already spent a median period of six months (range 3-31 months) on HD before inclusion. The prevalence of SDB (AHI ≥ 5/h) was 44.4% (8/18) before transplant, which decreased to 5.6% (1/18) after transplant (p = 0.016). The oxygen desaturation index had a median value of 5.8 events/h (range 0.1-35.4) in the pretransplant stage, which decreased to 0 events/h (range 0-6.6) in the post-transplant stage (p = 0.035)., Conclusion: There was a significant improvement in the prevalence and severity of SDB after transplant. Whether improvement in SDB is sustained on a long-term follow-up remains to be seen., (Copyright © 2018 Elsevier B.V. All rights reserved.)
- Published
- 2018
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46. Serum and Bronchoalveolar Lavage Fluid 25(OH)Vitamin D3 Levels in HIV-1 and Tuberculosis: A Cross-Sectional Study from a Tertiary Care Center in North India.
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Sinha S, Gupta K, Mandal D, Das BK, and Pandey RM
- Subjects
- Adult, Biomarkers, CD4 Lymphocyte Count, Calcifediol blood, Coinfection, Cross-Sectional Studies, Female, HIV Infections immunology, HIV Infections virology, Humans, India epidemiology, Male, Middle Aged, Tertiary Care Centers, Bronchoalveolar Lavage Fluid, Calcifediol metabolism, HIV Infections epidemiology, HIV Infections metabolism, Tuberculosis epidemiology
- Abstract
Background: Vitamin D is an immunomodulator, and its deficiency is associated with Tuberculosis (TB) infection. Bronchoalveolar lavage fluid (BALF) is a rich milieu of macrophages that form the first line of defense against invading TB bacilli. As there is an increased prevalence of vitamin D deficiency in TB and human immunodeficiency virus-1 (HIV-1) subjects, we intend exploring the possibility of a localized deficiency of vitamin D metabolites in BALF of these patients., Objective: The primary objective was to assess the level of 25D3 in serum and BALF of subjects and look for a significant difference among patients and controls. The secondary objective was to find a correlation between serum and BALF 25D3 levels., Methods: We performed a cross-sectional study with subjects divided into four groups: Controls (group 1), HIV positive without active TB (group 2), active TB without HIV (group 3), and HIV-TB coinfection (group 4). BALF and serum 25D3 levels were compared between the groups., Results: Among the 149 (an immunomodulator) successive subjects enrolled, there were 40 subjects in group 1 (HIV-TB-), 48 in group 2 (HIV+TB-), 37 in group 3 (HIV-TB+), and 24 in group 4 (HIV+TB+). Females constituted 31.6% of the study subjects. In groups 3 and 4, there were significantly lower serum 25D3 levels compared to group 1 (p-value group 3: 0.002; group 4: 0.012). In groups 2, 3, and 4, there were significantly lower BALF 25D3 levels compared to group 1 (p-value group 2: 0.000; group 3: 0.000; group 4: 0.001). There was a significant correlation between serum and BALF 25D3 levels (Spearman's rank correlation coefficient 0.318, p-value = 0.0001)., Conclusion: Lower levels of serum and BALF 25D3 were observed in HIV, TB, and HIV-TB coinfected patients. Localized deficiency of vitamin D metabolites might be associated with increased vulnerability to TB infection., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.)
- Published
- 2018
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47. Chronic Disease Self-Management Challenges among Rural Women Living with HIV/AIDS in Prakasam, Andhra Pradesh, India: A Qualitative Study.
- Author
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Salem BE, Bustos Y, Shalita C, Kwon J, Ramakrishnan P, Yadav K, Ekstrand ML, Sinha S, and Nyamathi AM
- Subjects
- Acquired Immunodeficiency Syndrome drug therapy, Adult, Anti-Retroviral Agents therapeutic use, Chronic Disease epidemiology, Diet, Female, HIV Infections drug therapy, Health Services Accessibility statistics & numerical data, Humans, India epidemiology, Medication Adherence, Middle Aged, Qualitative Research, Social Support, Socioeconomic Factors, Acquired Immunodeficiency Syndrome epidemiology, HIV Infections epidemiology, Rural Population, Self-Management statistics & numerical data
- Abstract
Rural women living with HIV/AIDS (WLHA) in India experience challenges self-managing HIV/AIDS in their rural communities. The purpose of this qualitative study was to explore factors influencing their care and antiretroviral treatment (ART) adherence. Themes that emerged from the qualitative focus groups among WLHA (N = 24) in rural Prakasam, Andhra Pradesh, India, included: (1) coming to know about HIV and other health conditions, (2) experiences being on ART, (3) challenges maintaining a nutritious diet, (4) factors affecting health care access and quality, and (5) seeking support for a better future. Chronic disease self-management in rural locales is challenging, given the number of barriers which rural women experience on a daily basis. These findings suggest a need for individual- and structural-level supports that will aid in assisting rural WLHA to self-manage HIV/AIDS as a chronic illness.
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- 2018
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48. Prevalence of HIV in Patients with Malignancy and of Malignancy in HIV Patients in a Tertiary Care Center from North India.
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Sinha S, Agarwal A, Gupta K, Mandal D, Jain M, Detels R, Nandy K, DeVos MA, Sharma SK, Manoharan N, Julka PK, Rath GK, Ambinder RF, and Mitsuyasu RT
- Subjects
- Adult, Aged, Cross-Sectional Studies, Female, Humans, India epidemiology, Male, Middle Aged, Prevalence, Risk Factors, Tertiary Care Centers, HIV Infections complications, HIV Infections epidemiology, Neoplasms complications, Neoplasms epidemiology
- Abstract
Background and Objectives: People living with HIV/AIDS are at an increased risk of developing cancer. The goals of this study were to obtain data on the prevalence of HIV in the cancer population and vice versa at a major tertiary cancer and HIV center in North India., Methods: This cross-sectional study was conducted over a 3-year period from July 2013 to June 2016, wherein successive HIV positive patients from an anti-retroviral therapy (ART) center were screened for malignancy. Simultaneously, successive cancer patients at the cancer center were screened for HIV. Baseline demographic details, risk factors, and laboratory investigations were obtained for all the patients., Results: Among the 999 HIV-positive patients at the ART center, the prevalence of malignancy was 2% (n=20; 95% confidence interval (CI) 1.13, 2.87). Among the 998 patients with a malignancy, the prevalence of HIV infection was 0.9% (n=9; 95% CI 0.31, 1.49). Weight loss, loss of appetite, and fever were the most common symptoms in patients with HIV and cancer. Among 29 patients with HIV and cancer, AIDS-defining cancer was found in 19 patients; non-Hodgkin's lymphoma was the most common malignancy reported (n=13)., Interpretation and Conclusion: There is a low prevalence of HIV in cancer patients as well as a low prevalence of cancer in HIV patients. AIDS-defining cancers remain much more common than non-AIDS-defining cancers. With the increased coverage of ART, it is expected that non-AIDSdefining cancers will increase, as is evident from data from more developed countries., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)
- Published
- 2018
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49. Comparative analysis of protein evolution in the genome of pre-epidemic and epidemic Zika virus.
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Ramaiah A, Dai L, Contreras D, Sinha S, Sun R, and Arumugaswami V
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- Aedes virology, Africa epidemiology, Americas epidemiology, Amino Acid Substitution, Animals, Evolution, Molecular, Haplorhini, Humans, India epidemiology, Infant, Newborn, Insect Vectors virology, Models, Molecular, Proteome metabolism, RNA-Dependent RNA Polymerase genetics, RNA-Dependent RNA Polymerase metabolism, Selection, Genetic, Viral Envelope Proteins chemistry, Viral Envelope Proteins genetics, Viral Envelope Proteins metabolism, Zika Virus classification, Zika Virus isolation & purification, Zika Virus Infection virology, Disease Outbreaks, Genome, Viral, Phylogeny, Proteome genetics, Zika Virus genetics, Zika Virus Infection epidemiology
- Abstract
Zika virus (ZIKV) causes microcephaly in congenital infection, neurological disorders, and poor pregnancy outcome and no vaccine is available for use in humans or approved. Although ZIKV was first discovered in 1947, the exact mechanism of virus replication and pathogenesis remains unknown. Recent outbreaks of Zika virus in the Americas clearly suggest a human-mosquito cycle or urban cycle of transmission. Understanding the conserved and adaptive features in the evolution of ZIKV genome will provide a hint on the mechanism of ZIKV adaptation to a new cycle of transmission. Here, we show comprehensive analysis of protein evolution of ZIKV strains including the current 2015-16 outbreak. To identify the constraints on ZIKV evolution, selection pressure at individual codons, immune epitopes and co-evolving sites were analyzed. Phylogenetic trees show that the ZIKV strains of the Asian genotype form distinct cluster and share a common ancestor with African genotype. The TMRCA (Time to the Most Recent Common Ancestor) for the Asian lineage and the subsequently evolved Asian human strains was calculated at 88 and 34years ago, respectively. The proteome of current 2015/16 epidemic ZIKV strains of Asian genotype was found to be genetically conserved due to genome-wide negative selection, with limited positive selection. We identified a total of 16 amino acid substitutions in the epidemic and pre-epidemic strains from human, mosquito, and monkey hosts. Negatively selected amino acid sites of Envelope protein (E-protein) (positions 69, 166, and 174) and NS5 (292, 345, and 587) were located in central dimerization domains and C-terminal RNA-directed RNA polymerase regions, respectively. The predicted 137 (92 CD4 TCEs; 45 CD8 TCEs) immunogenic peptide chains comprising negatively selected amino acid sites can be considered as suitable target for sub-unit vaccine development, as these sites are less likely to generate immune-escape variants due to strong functional constrains operating on them. The targeted changes at the amino acid level may contribute to better adaptation of ZIKV strains to human-mosquito cycle or urban cycle of transmission., (Copyright © 2017. Published by Elsevier B.V.)
- Published
- 2017
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50. Central venous catheter related bloodstream infections in medical intensive care unit patients in a tertiary referral centre.
- Author
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Deepti, Sinha S, Sharma SK, Aggarwal P, Biswas A, Sood S, Ragunandan P, Ekka M, Xess I, and Sreenivas V
- Subjects
- Adult, Aged, Critical Illness, Female, Humans, Incidence, India epidemiology, Intensive Care Units, Male, Middle Aged, Prospective Studies, Tertiary Care Centers, Young Adult, Central Venous Catheters adverse effects, Cross Infection epidemiology, Sepsis epidemiology
- Abstract
Aims: To determine the incidence of central line associated bloodstream infections (CLABSIs) in the medical intensive care unit (ICU) and ward setting at All India Institute of Medical Sciences (AIIMS), New Delhi., Settings and Design: The study was conducted in the medical ICU, a 9-bedded ICU at the AIIMS, a tertiary care teaching hospital. The study design was a prospective observational study., Methods: One hundred patients admitted to medical ICU and the ward at AIIMS with an indwelling, non-tunnelled central venous catheter (CVC) in place at admission and those with a hospital stay with indwelling CVC for more than 48 hours were monitored. These patients were followed daily for the development of new onset sepsis 48 hours after insertion of CVC, in which case three sets of blood samples for culture were drawn over a span of 24 hours., Statistical Methods: Incidence of CLABSIs was measured per 1000 central line days., Results: One hundred patients hospitalised for an aggregate 1119 days acquired 29 hospital-acquired infections (HAIs), a rate of 38.8% or 31.2 HAIs per 1000 hospital days. The incidence of bloodstream infections (BSIs) in this group was 6.8%. No case of laboratory confirmed CLABSIs could be demonstrated. Incidence of clinical sepsis was 27.6% or 8.2 per 1000 CVC days. There were 9 cases out of the 29 patients (39.7%) who had evidence of HAIs with no apparent focus of infection. Only one of these cases had evidence of BSI with isolation of Staphylococcus aureus in both CVC tip culture and the simultaneous blood culture; however the antibiograms were different., Conclusions: The low rate of BSIs in the present study and the absence of occurrence of a laboratory confirmed CLABSI should be interpreted in the light of the small sample size of the study and the multitude of antibiotics received before the development of HAI.
- Published
- 2014
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