St Johns National Academy of Health science

Bangalore, India

St Johns National Academy of Health science

Bangalore, India
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Dikshit R.,Tata Memorial Hospital | Gupta P.C.,Healis Seskaria Institute of Public Health | Ramasundarahettige C.,University of Toronto | Gajalakshmi V.,Epidemiological Research Center | And 12 more authors.
The Lancet | Year: 2012

Background: The age-specific mortality rates and total deaths from specific cancers have not been documented for the various regions and subpopulations of India. We therefore assessed the cause of death in 2001-03 in homes in small areas that were chosen to be representative of all the parts of India. Methods: At least 130 trained physicians independently assigned causes to 122 429 deaths, which occurred in 1·1 million homes in 6671 small areas that were randomly selected to be representative of all of India, based on a structured nonmedical surveyor's field report. Findings: 7137 of 122 429 study deaths were due to cancer, corresponding to 556 400 national cancer deaths in India in 2010. 395 400 (71%) cancer deaths occurred in people aged 30-69 years (200 100 men and 195 300 women). At 30-69 years, the three most common fatal cancers were oral (including lip and pharynx, 45 800 [22·9%]), stomach (25 200 [12·6%]), and lung (including trachea and larynx, 22 900 [11·4%]) in men, and cervical (33 400 [17·1%]), stomach (27 500 [14·1%]), and breast (19 900 [10·2%]) in women. Tobacco-related cancers represented 42·0% (84 000) of male and 18·3% (35 700) of female cancer deaths and there were twice as many deaths from oral cancers as lung cancers. Age-standardised cancer mortality rates per 100 000 were similar in rural (men 95·6 [99% CI 89·6-101·7] and women 96·6 [90·7-102·6]) and urban areas (men 102·4 [92·7-112·1] and women 91·2 [81·9-100·5]), but varied greatly between the states, and were two times higher in the least educated than in the most educated adults (men, illiterate 106·6 [97·4-115·7] vs most educated 45·7 [37·8- 53·6]; women, illiterate 106·7 [99·9-113·6] vs most educated 43·4 [30·7-56·1]). Cervical cancer was far less common in Muslim than in Hindu women (study deaths 24, age-standardised mortality ratio 0·68 [0·64-0·71] vs 340, 1·06 [1·05-1·08]). Interpretation: Prevention of tobacco-related and cervical cancers and earlier detection of treatable cancers would reduce cancer deaths in India, particularly in the rural areas that are underserved by cancer services. The substantial variation in cancer rates in India suggests other risk factors or causative agents that remain to be discovered.


Vallabhaneni S.,University of California at San Francisco | Chandy S.,St Johns National Academy Of Health Science | Heylen E.,University of California at San Francisco | Ekstrand M.L.,University of California at San Francisco | Ekstrand M.L.,St Johns Research Institute
Journal of the International AIDS Society | Year: 2013

Introduction: Routine HIV viral load (VL) testing is not available in India. We compared test performance characteristics of immunologic failure (IF) against the gold standard of virologic failure (VF), examined evolution of drug resistance among those who stayed on a failing regimen because they did not meet criteria for IF and assessed implications for second-line therapy. Methods: Participants on first-line highly active antiretroviral therapy (HAART) in Bangalore, India, were monitored for 24 months at six-month intervals, with CD4 count, VL and genotype, if VL > 1000 copies/ml. Standard WHO criteria were used to define IF; VF was defined as having two consecutive VL > 1000 copies/ml or one VL > 10,000 copies/ml. Resistance was assessed using standard International AIDS Society-USA (IAS-USA) recommendations. Results: Of 522 participants (67.6% male, mean age of 37.5; 85.1% on nevirapine-based and 40.4% on d4T-containing regimens), 57 (10.9%) had VF, 38 (7.3%) had IF and 13 (2.5%) had both VF and IF. The sensitivity of immunologic criteria to detect VF was 22.8%, specificity was 94.6% and positive predictive value was 34.2%. Forty-four participants with VF only continued on their failing first-line regimen; by the end of the study period, 90.9% had M184V, 63.6% had thymidine analogue mutations (TAMs), 34.1% had resistance to tenofovir, and 63.6% had resistance to etravirine. Conclusions: WHO IF criteria have low sensitivity for detecting VF, and the presence of IF poorly predicts VF. Relying on CD4 counts leads to unnecessary switches to second-line HAART and continuation of failing regimens, jeopardizing future therapeutic options. Universal access to VL monitoring would avoid costly switches to second-line HAART and preserve future treatment options. © 2013 Vallabhaneni S et al; licensee International AIDS Society.


Soares M.J.,Curtin University Australia | Murhadi L.L.,Curtin University Australia | Kurpad A.V.,St Johns National Academy of Health science | Chan She Ping-Delfos W.L.,Curtin University Australia | Piers L.S.,University of Melbourne
Obesity Reviews | Year: 2012

Low intakes of calcium and inadequate vitamin D status often cluster with higher prevalence rates of obesity. Consequently, there has been much interest in the mechanisms by which calcium and vitamin D could regulate body weight and adiposity. This review has focused on randomized controlled trials (RCTs) that have manipulated these nutrients and studied pathways of energy balance. Overall, there is consistent evidence that calcium and vitamin D increase whole body fat oxidation after single and multiple meals, and that calcium promotes a modest energy loss through increased faecal fat excretion. The evidence is equivocal for a greater diet-induced thermogenesis, increased lipolysis, suppression of key lipogenic enzymes, decreased hunger ratings or reduced energy/macronutrient intake. Emerging evidence suggests a potential improvement in insulin sensitivity following vitamin D that would impinge on food intake and substrate oxidation. However, the very few RCTs on supplemental vitamin D and energy balance have not explored postprandial avenues of the hormone's actions. Future efforts in this area need to define the threshold intake of these nutrients that would maximize metabolic and gastrointestinal outcomes. Such studies would provide a platform for endorsing the non-skeletal role of calcium and vitamin D in human pathophysiology. © 2012 The Authors. obesity reviews © 2012 International Association for the Study of Obesity.


Dwarkanath P.,National Health Research Institute | Barzilay J.R.,Cambridge College | Thomas T.,National Health Research Institute | Thomas A.,St Johns National Academy of Health science | And 2 more authors.
American Journal of Clinical Nutrition | Year: 2013

Background: Folic acid supplementation in those with a low vitamin B-12 intake or status may have adverse effects. These effects are unknown with regard to birth outcome in pregnant Indian women who are routinely supplemented with high doses of folic acid. Objective: The objective was to examine the association of unbalanced vitamin B-12 and total folate (folic acid supplement + dietary folate) intakes during pregnancy with outcomes in smallfor- gestational-age (SGA) infants. Design: This was a prospective observational cohort study of 1838 pregnant women in South India. Low intake of dietary vitamin B-12 in the presence of high total folate intake was examined as the ratio of vitamin B-12 intake to total folate intake. Results: The inadequacy of vitamin B-12 intake (<1.2 μg/d) assessed by a food-frequency questionnaire in the first, second, and third trimesters of pregnancy was 25%, 11%, and 10%, respectively. Multivariate log binomial regression showed that low vitamin B-12 and folate intakes in the first trimester were independently associated with a higher risk of SGA. In a subgroup of women with high supplemental folic acid intakes in the second trimester, those with the lowest tertile of vitamin B-12:folate ratio had a higher risk of SGA outcome than did those in the highest tertile (adjusted RR: 2.73; 95% CI: 1.17, 6.37). A similar trend was observed in the analysis of blood micronutrient status in a random subset (n = 316) of the sample. Conclusions: These findings suggest that, in addition to vitamin B-12 and folate deficiencies alone, there may be adverse birth outcomes associated with unbalanced vitamin B-12 and folate intakes or status during pregnancy. These findings have important implications for the antenatal B vitamin supplementation policy in India. This trial was registered at the Clinical Trial Registry of India as 2013/07/ 005342. Am J Clin Nutr 2013;98:1450-8. © 2013 American Society for Nutrition.


Mascarenhas J.V.,St Johns National Academy Of Health Science | Jude E.B.,Fountain
Medical Clinics of North America | Year: 2013

The Charcot foot is an acute clinical emergency that warrants immediate management in order to prevent irreversible joint destruction. Offloading remains the mainstay of treatment of Charcot foot; however, adjunctive therapy with antiresorptive agents may facilitate retardation and early recovery from the inflammatory destructive process. This article discusses the medical management of the ever-challenging complication affecting the diabetic foot. © 2013 Elsevier Inc.


Shet A.,St Johns National Academy of Health science | De Costa A.,Karolinska Institutet
Tropical Medicine and International Health | Year: 2011

The technology that has been able to straddle the digital divide most effectively in resource-constrained settings has been the mobile phone. The tremendous growth seen in Africa and Asia in mobile phone use over the last half decade has spurred plans to integrate mobile phones with healthcare delivery globally. A major challenge in HIV healthcare is sustaining good adherence to antiretroviral treatment. This report focuses on specific applications of mobile phones in the area of HIV healthcare delivery. It highlights the widespread use of mobile phones in developing areas of the world, those which have a heavy burden of HIV and infectious diseases. There is scope for exploiting existing mobile phone technology and infrastructure for healthcare enhancement in resource-constrained settings. © 2010 Blackwell Publishing Ltd.


Neogi U.,St Johns National Academy Of Health Science
AIDS research and human retroviruses | Year: 2012

The trans-activator of transcription (Tat) of HIV-1 plays an important role in viral infection and pathogenesis. We examined the genetic characteristics of exon 1 of the tat gene derived from 102 seropositive subjects from southern India. Database-derived Indian (n=105) and global (n=413) HIV-1C sequences were also used for viral epidemiological signature pattern analysis in the Tat open reading frame (ORF). We identified HIV-1C as the most predominant genetic subtype (99%) and the presence of a novel A1C recombinant strain in one study participant. After examining all the available HIV-1C Indian sequences from primary clinical isolates and database-derived sequences, we found a high level of sequence conservation (92.6 ± 12%) within Tat amino acid residues. Furthermore, signature pattern analysis identified five amino acid positions in Tat that contained signature residues unique for Indian HIV-1C consisting of 21A, 24N, 29K, 40K, and 60Q. Our data have direct relevance for subunit-based Tat HIV-1 vaccine development.


Sameer K.S.M.,Surgery Academy | Mohanty S.,St Johns National Academy Of Health Science | Correa M.M.A.,St Johns National Academy Of Health Science | Das K.,Surgery Academy
International Journal of Pediatric Otorhinolaryngology | Year: 2012

Objectives: Lingual thyroglossal duct cysts (TGDC) are rare and liable to be missed in a cursory clinical examination. This study aimed to report the details of lingual TGDC from the authors' series and review existing literature on the entity. Methods: A 12 year retrospective survey of all cases of thyroglossal duct anomalies managed at a tertiary teaching hospital was conducted to identify those with lingual TGDC. Their clinical presentation, investigations, diagnosis and management were analysed. Case series from anecdotal published English literature were critically reviewed with particular regard to diagnosis and management. Results: Of 78 cases of thyroglossal duct anomalies, 3 were lingual TGDC. All were females. One neonate presented with feeding difficulty and was clinically misdiagnosed as a ranula. The two older children presented with a cyst at the foramen caecum. The varied imaging and diagnostic dilemma are presented. The older children had cysts abutting the hyoid and were managed with transoral excision and a Sistrunk procedure; the neonate was managed with transoral excision only. This report also reviews the sparse literature and discusses specific issues in their treatment. The differential diagnoses encompass a wide array of developmental and neoplastic entities. Specific anatomic imaging with USG/CT/MRI and functional evaluation with radionuclide thyroid scan are essential investigative modalities. Besides a classical Sistrunk procedure and simple transoral excision, newer less invasive treatment options including marsupialisation and alcohol ablation have been reported. Conclusions: In conclusion, the diagnosis and management of lingual TGDC needs to be individualised depending on their presentation and anatomic location. The Sistrunk's procedure is ideal for those in close proximity to the hyoid; however complete cyst excision would suffice in the rest. © 2011 Elsevier Ireland Ltd.


Bijoor A.R.,St Johns National Academy Of Health Science | Sudha S.,St Johns National Academy Of Health Science | Venkatesh T.,St Johns National Academy Of Health Science
Indian Journal of Clinical Biochemistry | Year: 2012

Lead is found in small but appreciable quantities in air, soil drinking water and food. Exposure to such amounts of lead does not cause acute lead toxicity, but produces subtle effects, particularlyin children. The CDC advocates "safe" or "acceptable" levelsofblood leadup to 10 μg/dl, while OSHA declares blood lead levels up to 40 μg/dl as "safe" or "acceptable" in the occupationally exposed. The objective of the study was to see if blood levels considered "safe" can cause changes in the biogenic neurotransmitters in the developing brain which may cause neurobehavioral defects like hyperactivity and other cognitive disorders. Albino Wistar rats were divided into the control and lead-treated groups. The control group was given unleaded water, while the lead-treated group was fed with 50 ppm lead acetate in drinking water. On day 45 the animals were subjected to a passive avoidance test, their blood analysed for ZPP and lead. They were then sacrificed and the neurotransmitters= Norepinephrine (NE) and its metabolite/methoxyhydrox-yphenylglycol (MHPG) estimated in the brain areas associated with learning and memory/the frontal cortex, hippocampus and the striatum by HPLC-ECD. Our results showed significant increases in blood lead, NE and MHPG, while ZPP increase was insignificant. The rats showed neu-robehavioral abnormalities as assessed by the passive avoidance test. We concluded that low blood levels of lead cannot be considered "safe" or "acceptable" as it causes neurotransmitter alterations. Increased NE turnover is implicated in hyperactivity disorders such as ADHD and Tourette syndrome. © 2012 Association of Clinical Biochemists of India.


Grant
Agency: GTR | Branch: MRC | Program: | Phase: Research Grant | Award Amount: 136.37K | Year: 2015

We propose a feasibility study and a survey conducted at 6 sites - 2 in India, 2 in Srilanka, and 2 in Bangladesh. 1. The feasibility study will be conducted to understand the feasibility of peer-mentored interventions at the operational, research and policy levels to improve CVD health. At the operational level, we will identify 6 worksites in Bangladesh (2), India (2) and Sri Lanka (2), obtain acceptance from the management, identify the appropriate personnel as peers to carry out interventions and identify areas at worksites to implement interventions (café, physical exercise, stress reduction, tobacco environment). At research level, we will choose the best methods to identify individuals at risk for interventions, measure risk factor levels identify & train the peer mentors, design the most appropriate interventions, determine the training goals for the peer mentors, select the training methods, and develop the intervention tools. At policy level, we will, in discussion with the worksite management and the concerned State Government departments (health and labour departments) determine the need, methods and outcomes of the interventions. This strategy ensures that we have useful insights on the interventions as well as the agreement and investment of key stake-holders in relevant departments 2. A qualitative study will be conducted to understand the priorities for policy level changes to improve the CVD environment at worksites in each country, at the Central and Regional levels; to understand the common barriers for an optimal CVD environment at worksites; and to understannd the most acceptable peer mentor-based interventions for employees to improve CVD health. We will survey at least three levels of management staff per site on the CVD environment at the workplace. Specifically this will include tobacco policy, food at workplace, opportunities for physical activity, medical care if any provided at worksites, policy on chronic care for employees, bariers for optimal care and possible interventions to improve CV health. We will survey 5 management staff at each level or 15 per worksite for a total of 120 at 8 sites. We will conduct focussed group discussions and in-depth interviews among management staff and employees to better understand policy issues, barriers for CVD care and acceptable interventions to improve CV health. If peer mentor mediated interventions prove to be effective in reducing cardiovascular risk factors, such interventions could be scaled up globally. As adults can spend upto 60% of their time at workplaces, interventions such as these could prove to be effective in reducing cardiovascular risks and reap rich dividends by reducing cardiovascular deaths, thus helping to achieve World Hearth Federations goal of 25 by 25.

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