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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.

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.

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.

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.

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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