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Ekstrand M.L.,University of California at San Francisco | Ekstrand M.L.,St Johns Research Institute | Bharat S.,Tata Institute of Social Sciences | Ramakrishna J.,National Institute of Mental Health and Neuro Sciences | Heylen E.,University of California at San Francisco
AIDS and Behavior | Year: 2012

This study was designed to examine the prevalence of stigma and its underlying factors in two large Indian cities. Cross-sectional interview data were collected from 1, 076 non-HIV patients in multiple healthcare settings in Mumbai and Bengaluru, India. The vast majority of participants supported mandatory testing for marginalized groups and coercive family policies for PLHA, stating that they "deserved" their infections and "didn't care" about infecting others. Most participants did not want to be treated at the same clinic or use the same utensils as PLHA and transmission misconceptions were common. Multiple linear regression showed that blame, transmission misconceptions, symbolic stigma and negative feelings toward PLHA were significantly associated with both stigma and discrimination. The results indicate an urgent need for continued stigma reduction efforts to reduce the suffering of PLHA and barriers to prevention and treatment. Given the high levels of blame and endorsement of coercive policies, it is crucial that such programs are shaped within a human rights framework. © 2011 Springer Science+Business Media, LLC.


Varadharajan K.S.,St Johns Medical College | Thomas T.,St Johns Research Institute | Kurpad A.V.,St Johns Research Institute
Asia Pacific Journal of Clinical Nutrition | Year: 2013

India is often thought of as a development paradox with relatively high economic growth rates in the past few years, but with lower progress in areas of life expectancy, education and standard of living. While serious inequalities in growth, development and opportunity explain the illusion of the paradox at the country level, still, a significant proportion of the world's poor live in India, as do a significant proportion of the world's malnourished children. Poverty and undernutrition coexist, and poor dietary quality is associated with poor childhood growth, as well as significant micronutrient deficiencies. Food security is particularly vulnerable to changes in the economic scenario and to inequities in wealth distribution. Migration from rural to urban settings with a large informal employment sector also ensures that migrants continue to live in food insecure situations. While food production has for the most part kept pace with the increasing population, it has been with regard to cereal rather than of pulses and millet production. Oil seeds, sugar cane and horticultural crops, along with non-food crops are also being promoted, which do not address nutrition security, and, coupled with the increase in the consumption of preprepared food, may indeed predispose towards the double burden of malnutrition. Access to food is also particularly susceptible to poverty and inequality. Many strategies and policies have been proposed to counter undernutrition in India, but their implementation has not been uniform, and it is still too early to assess their lasting impact at scale.


Chandra P.S.,National Institute of Mental Health and Neuro Sciences | Satyanarayana V.A.,St Johns Research Institute
International Review of Psychiatry | Year: 2010

Research in the area of gender and mental health indicates that women are disproportionately affected by common mental disorders (CMDs) as well as co-morbid mental disorders. However, the concept of gender disadvantage, its correlates, and mental health outcomes has received relatively less research attention. In addition, there are no known systematic reviews in the area of gender disadvantage and common mental disorders in recent years. In this review we have therefore attempted to deconstruct the concept of gender disadvantage, identify important correlates of gender disadvantage and illustrate their influence on common mental disorders. Since gender is a social construct and is greatly influenced by one's culture and ethnicity, we have made an attempt to integrate international literature on the subject and highlight cultural and ethnic relevance of topics as they emerge. Finally, we have provided take home messages from existing literature, identified gaps in literature, and formulated directions for future research in this area. © 2010 Informa UK Ltd All rights reserved.


Maddu N.,Sri Krishnadevaraya University | Raghavendra P.B.,St Johns Research Institute
Immunopharmacology and Immunotoxicology | Year: 2015

One of the remarkable discoveries in the field of psychopharmacology from late 1940s is Lithium (Li) that reminds of old but still gold. It continues to be a distinctive mood stabilizer that matches various standards recommended for mood stabilizers. Apart from this Li is also known to affect immune cell functions. Lithium response and regulations of different immune cells in bipolar patients, related immune disorders are not well defined. Here, we provide an overview of literature with regard to Li's effects on different immune cells. However, the use of Li is currently limited to bipolar disorders and there is no empirical evidence for immune cell disorders. The objective of this article is to provide the evaluations of Li responses towards the different immune cells based on the existing studies. Further, more studies are needed to understand the mechanistic basis and heterogeneous responses of Li's effect in bipolar, also unravel relative immune disorders. © 2014 Informa Healthcare USA, Inc. All rights reserved.


Swaminathan S.,St Johns Research Institute
Indian journal of pediatrics | Year: 2013

Establishing the relationship between childhood physical inactivity and noncommunicable disease (NCD) is difficult, since chronic disease and mortality are not direct health outcomes of physical inactivity in children. Published literature explores the relationship of physical inactivity with appearance of early childhood disease risk markers, the adverse impact of which may take some time to appear. Promoting childhood physical activity has multiple benefits including delay in evolution of risk factors contributing to adult degenerative disease. It is clear from available literature that physical inactivity or its surrogates constitute an important independent risk factor for NCD. This is likely to be underestimated not only because of measurement issues, but also because physical inactivity may act through other risk factors for NCD. To recognize and intervene on the issue of physical inactivity in children is important not only for the benefit of the child but in the context of NCD in later life. Studies on physical inactivity and its functional correlates are limited in India and this would be an important area for future research.


Vaz M.,St Johns Research Institute
Indian journal of medical ethics | Year: 2014

There is no agreement on the typology and definition of biobanks.The present regulations across countries, including India, focus ongenomic and genetic databases and DNA and cell line biobanking.It is unclear how the range of the holdings of biological samples in diagnostic and research laboratories fall under these regulatory frameworks. Biobank-related research has become very attractive because of advances in sample storage and data processing, a better understanding of the human genome, and high throughput laboratory assays. There is extensive literature and much debate on the subject, especially on the ethical and regulatory dilemmas, in the developed countries, but this is hardly the casein developing countries. This paper is based on a review of the published documents and data, and aims at evaluating the ethical frameworks for biobanking in the Indian context. The issues of"'broad consent; commercialisation of samples, and extended sample use are discussed. The governance of biobanks emerges as an integral part of the ethical responsibilities of institutions. It also makes the implementation of national guidelines possible, and helps to enhance the trust and confidence of local contributors in biobank research.


Pillai R.R.,St Johns Research Institute | Kurpad A.V.,St Johns Research Institute
British Journal of Nutrition | Year: 2012

The factorial approach is used to measure the dietary indispensable amino acid (IAA) requirements in children, although recent measurements based on the indicator amino acid oxidation (IAAO) method have begun to generate more direct evidence. Difficulties with the factorial method are that it depends on accurate estimates of the maintenance protein requirement, as well as of protein deposition during growth. Also, a value for the efficiency of utilizing dietary protein for deposition has to be selected, based on published Nitrogen (N) balance studies. In the recent 2007 WHO/FAO/UNU report, the amino acid requirement pattern for infants was taken to be similar to the amino acid composition of breast milk. For pre-school and older children, the factorial method gave values for the scoring pattern of protein that were fairly close to the earlier 1985 WHO/FAO/UNU report for children, since growth progressively became a smaller component of the factorial calculation as age progressed. However, given that there are several assumptions in the derivation of factorial estimates, direct experimental measurements of the amino acid requirement are desirable. The IAAO method, as it is non-invasive, as made it possible to measure the IAA requirements in children. Over the last decade, some of the IAA requirements have been determined by using the IAAO method in healthy school age children; however, the data on IAA requirements in developing country populations are still being conducted. In the elderly, there are not enough data to make a separate recommendation for IAA requirements from that of adults. © 2012 The Authors.


Geojith G.,St Johns Research Institute | Dhanasekaran S.,St Johns Research Institute | Chandran S.P.,St Johns Research Institute | Kenneth J.,St Johns Research Institute
Journal of Microbiological Methods | Year: 2011

Current methods of TB diagnosis are time consuming and less suited for developing countries. The LAMP (loop mediated isothermal amplification) is a rapid method more suitable for diagnosis in resource limited settings and has been proposed as a viable test requiring further evaluation for use as a laboratory method as well. We evaluated two LAMP assays, using culture lysates of clinical sputum samples (from Southern India) and compared it to a proprietary multiplex PCR reverse-hybridization line probe assay ('GenoType MTBC' from HAIN Lifescience GmbH, Germany). The LAMP procedure was modified to suit the local conditions. The Mycobacterium tuberculosis specific LAMP assay ('MTB LAMP') showed sensitivity and specificity, of 44.7% and 94.4% respectively in a 60 min format, 85.7% and 93.9% respectively in a 90. min format and 91.7%, and 90.9% respectively in a 120. min format. The Mycobacteria universal LAMP assay ('Muniv LAMP') showed a sensitivity of 99.1%. The LAMP was shown to be a rapid and accessible assay for the laboratory identification of M. tuberculosis isolates. Initial denaturation of template was shown to be essential for amplification in unpurified/dilute samples and longer incubation was shown to increase the sensitivity. The need for modification of protocols to yield better efficacy in this scenario needs to be addressed in subsequent studies. © 2010 Elsevier B.V.


John S.H.,St Johns Research Institute | Kenneth J.,St Johns Research Institute | Gandhe A.S.,St Johns Research Institute
Biomarkers | Year: 2012

Context: Identification of clinically relevant biomarkers is required for better diagnosis, prevention and treatment of tuberculosis. Objective: In this review, potential host biomarkers in blood or blood cells in tuberculosis were identified by a systematic approach. Methods: A total of 55 articles were selected from PubMed and Google Scholar that analyzed gene and or protein expression in humans in active and or latent TB. Articles were scored according to certain criteria and categorized as strong or weak studies. Biomarkers reported by more than one article or by a single strong article were identified as potential biomarkers. Results: Six most promising markers (IP-10, IL-6, IL-10, IL-4, FOXP3 and IL-12) were identified based on their presence in both mycobacterial antigen-stimulated and -unstimulated samples. Conclusions: With this review we hope to provide a reliable guideline for biomarker studies in tuberculosis. © 2012 Informa UK, Ltd.


George G.,St Johns Research Institute | Mony P.,St Johns Research Institute | Kenneth J.,St Johns Research Institute
PLoS ONE | Year: 2011

Background: Despite the advent of novel diagnostic techniques, smear microscopy remains as the most practical test available in resource-limited settings for tuberculosis (TB) diagnosis. Due to the low sensitivity of microscopy and the long time required for culture, feasible and accessible rapid diagnostic methods are urgently needed. Loop-mediated Isothermal Amplification (LAMP) is a promising nucleic-acid amplification assay, which could be accessible, cost-effective and more suited for use with unpurified samples. Methodology/Principal Findings: In the current study, the objective was to assess the efficacy of a LAMP assay for tuberculosis compared with fluorescence smear microscopy as well as Löwenstein-Jensen (LJ) and Mycobacteria Growth Indicator Tube (MGIT) cultures for the diagnosis of pulmonary tuberculosis using sputum samples. Smear microscopy and culture were performed for decontaminated and concentrated sputum from TB suspects and the LAMP was also performed on these specimens. The LAMP and smear microscopy were compared, in series and in parallel, to culture. LAMP and smear microscopy showed sensitivities of 79.5% and 82.1% respectively and specificities of 93.8% and 96.9% respectively, compared to culture. LAMP and smear in series had sensitivity and specificity of 79.5% and 100.0% respectively. LAMP and smear in parallel had sensitivity and specificity of 82.1% and 90.6% respectively. Conclusions/Significance: The overall efficacies of LAMP and fluorescence smear microscopy in the current study were high and broadly similar. LAMP and smear in series had high specificity (100.0%) and can be used as a rule-in test combination. However, the performance of LAMP in smear negative samples was found to be insufficient. © 2011 George et al.

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