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Article ; Online: Feasibility and acceptability pilot of video-based direct observed treatment (vDOT) for supporting antitubercular treatment in South India

Rashmi Rodrigues / George D'Souza / Suman Sarah Varghese / Mohammed Mahrous / Anil Ananthaneni Kumar / Mohammed Naseer Ahmed

BMJ Open, Vol 13, Iss

a cohort study

2023 Volume 5

Abstract: Objectives The objective of this study was to assess the feasibility and acceptability of video-based anti-tuberculosis (TB) treatment adherence support in patients with TB (PwTB) in South India.Design An exploratory cohort.Setting Participants were ... ...

Abstract	Objectives The objective of this study was to assess the feasibility and acceptability of video-based anti-tuberculosis (TB) treatment adherence support in patients with TB (PwTB) in South India.Design An exploratory cohort.Setting Participants were recruited at the TB treatment centre (direct observed treatment short centre) of a tertiary-level teaching facility in Bangalore, Karnataka, South India.Participants The study enrolled 25 PwTB, with replacement. Adult PwTB who were on drug-sensitive treatment regimens were included, while those who had drug resistant TB were excluded from the study.Intervention Participants received scheduled adherence reminders and were trained to videorecord themselves swallowing their medication via a mobile application. The application was automated to submit these videos for evaluation. Participants were followed up monthly till treatment completion or withdrawal.Outcome measures Adherence rate and acceptability of video-based directly observed treatment (vDOT).Results The mean±SD age of the participants was 33±14 years, majority were females (16, 64%), residing in urban areas (24,96%), married (17, 68%) and had access to smart phones (23,92%). A total of 3193 person days of follow-up was completed; of the videos submitted within the first 6 months of enrollment (2501), 94% (2354/2501) were considered ‘acceptable’ and 16 (64%) participants were optimally adherent (ie, ≥80%). Participant videos improved in quality and a higher proportion met acceptability criteria over time. Twenty-one (84%) participants stated that they found the application easy to learn; 13 (52%) preferred vDOT over DOT. Mixed model logistic regression showed that those who are married are more likely have daily adherence to anti-TB treatment.Conclusion Video-based mobile phone interventions are acceptable to PwTB and the ease of using the application increases with time. To provide patient-centred care, vDOT is a promising option that can be offered to patients for treatment support and adherence monitoring.
Keywords	Medicine ; R
Subject code	150
Language	English
Publishing date	2023-05-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Role of ultrasound in the assessment of diaphragm function in patients with chronic obstructive pulmonary disease

Priya Ramachandran / Uma Devaraj / Louis Varghese / Kavitha Venkatanarayana / Uma Maheshwari Krishnaswamy / George D'Souza

Eurasian Journal of Pulmonology, Vol 23, Iss 1, Pp 1-

2021 Volume 9

Abstract: Chronic obstructive pulmonary disease (COPD) characterized by irreversible airway obstruction, has numerous systemic complications including skeletal muscle dysfunction. Diaphragm, an important muscle of respiration, is also affected and it has far- ... ...

Abstract	Chronic obstructive pulmonary disease (COPD) characterized by irreversible airway obstruction, has numerous systemic complications including skeletal muscle dysfunction. Diaphragm, an important muscle of respiration, is also affected and it has far-reaching impact on morbidity. The study of diaphragm in individuals with COPD is challenging. Although the use of ultrasonography to study the function of diaphragm is in its nascent stage, it seems to be a promising tool for a comprehensive evaluation of diaphragm in COPD patients. This article reviews the available literature on the use of US in study of diaphragm on individuals with stable COPD.
Keywords	chronic obstructive pulmonary disease ; diaphragm ; ultrasound ; Internal medicine ; RC31-1245
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	Wolters Kluwer Medknow Publications
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Insulin resistance in moderate to severe obstructive sleep apnea in nondiabetics and its response to continuous positive airway pressure treatment

Archana Baburao / George D Souza

North American Journal of Medical Sciences, Vol 6, Iss 10, Pp 500-

2014 Volume 504

Abstract: Background: The effects of nasal continuous positive airway pressure (CPAP) on insulin resistance (IR) in obstructive sleep apnea (OSA) are still under discussion especially in nondiabetics. Trials have found conflicting results in this regard. Aims: The ...

Abstract	Background: The effects of nasal continuous positive airway pressure (CPAP) on insulin resistance (IR) in obstructive sleep apnea (OSA) are still under discussion especially in nondiabetics. Trials have found conflicting results in this regard. Aims: The study was to measure IR in nondiabetic patients with moderate to severe OSA and to evaluate the effect of nasal CPAP on IR in these patients. Materials and Methods: A total of 30 consecutively newly diagnosed patients with moderate to severe OSA was enrolled in the study. OSA was diagnosed by doing an overnight polysomnography. Plasma glucose and insulin levels were measured at baseline and after 1 month of CPAP treatment. IR was calculated by homeostasis model assessment (HOMA) method. Results: Of 30 OSA patients, 21 were males, and 9 were females. The mean age of the subjects was 49.9 years, and mean body mass index (BMI) was 29.33. All 30 patients had moderate to severe OSA with a mean apnea and hypopnea index (AHI) of 80.46/h. The Epworth sleepiness score (ESS) showed a significant change with 1 month of treatment with CPAP from baseline of 13 to 9.7 (P ≤ 0.0001). There was a significant reduction in fasting insulin levels from 21.75 to 19.39 (P = 0.009). There was a small fall in fasting glucose, but it was not significant. The HOMA IR also reduced from 5.78 to 4.82 which was significant (P = 0.024) without any significant change in BMI (P = 0.916). The HOMA IR did not showed any positive correlation with different variables of OSA severity, ESS (r = 0.156) (P = 0.410), AHI (r = 0.177) (P = 0.349), and percentage of test time <90% saturation (r = −0.296) (P = 0.112). Conclusion: Moderate to severe OSA is associated with an increase in IR and effective treatment with CPAP rapidly improves the insulin sensitivity in nondiabetic patients with OSA without any change in BMI.
Keywords	Continuous positive airway pressure ; Insulin resistance ; Obstructive sleep apnea ; Medicine ; R ; Medicine (General) ; R5-920
Subject code	616
Publishing date	2014-01-01T00:00:00Z
Publisher	North American Journal of Medical Sciences
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Adrenal reserve in acute exacerbation of non-cystic fibrosis bronchiectasis

Srinivas Rajagopala / Anantharaman Ramakrishnan / Anushree Chakraborty / Ganapathi Bantwal / Uma Devaraj / George D′Souza

Indian Journal of Medical Research, Vol 142, Iss 6, Pp 763-

2015 Volume 767

Keywords	Medicine ; R
Language	English
Publishing date	2015-01-01T00:00:00Z
Publisher	Wolters Kluwer Medknow Publications
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Pulmonary involvement in systemic sclerosis

A S Deepa / Roopa Premanand Rachel / Priya Ramchandran / Uma Devaraj / S Abhilash Arnold / Vineeta Shobha / George D′souza

Lung India, Vol 33, Iss 2, Pp 144-

A clinical profile

2016 Volume 147

Abstract: Background: Systemic sclerosis is a generalized disorder of connective tissue affecting skin and internal organs. Lung involvement accounts for significant morbidity and is a leading cause of mortality in patients. Objectives: This study intends to study ...

Abstract	Background: Systemic sclerosis is a generalized disorder of connective tissue affecting skin and internal organs. Lung involvement accounts for significant morbidity and is a leading cause of mortality in patients. Objectives: This study intends to study the frequency of occurrence of pulmonary involvement in progressive systemic sclerosis (PSS) and to describe the clinical and radiological picture of pulmonary involvement in PSS. Materials and Methods: This was a descriptive cross-sectional study. A detailed history, modified Rodnan score, clinical examination, routine investigation, antinuclear antibody, immuno biot, chest X-ray (CXR), pulmonary function test (PFT), and 6 min walk test (6MWT) were performed on all patients. High resolution computed tomography was done on those who consented. Results: Hundred subjects with PSS were included in the study; 90 were females and 10 were males. Common presenting complaints were skin thickening in 98% and Raynaud's phenomenon in 98%. Skin thickening of digits beyond metacarpo phalangeal was seen in 98%, face and neck in 92%, and hands in 92%. Chest wall thickening was seen in 40 subjects (40%). 90 (90%) of the studied subjects had pulmonary involvement, longer duration of disease was significantly associated with pulmonary involvement (P < 0.05). Dyspnea, cough, bilateral crepitations, CXR, Borg score, and Rodnan score was found to be significantly associated with severe pulmonary involvement (P < 0.05). Conclusion: The prevalence of pulmonary involvement in this cohort study was 90%. Almost 1/3rd of patients, that is 29 (29%) were detected to have pulmonary involvement despite being asymptomatic for respiratory complaints, hence early screening and evaluation is recommended. PFT and 6MWT are noninvasive, cost-effective, and easily available screening tests which can be used in resource-limited settings.
Keywords	Diffusing capacity of the lungs for carbon monoxide (DLCO) ; forced expiratory volume at 1 s ; forced vital capacity ; metacarpo phalangeal ; mixed connective tissue disorder ; systemic sclerosis ; Diseases of the respiratory system ; RC705-779 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R
Subject code	610 ; 616
Language	English
Publishing date	2016-01-01T00:00:00Z
Publisher	Medknow Publications
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Circulating HLA-DR+CD4+ effector memory T cells resistant to CCR5 and PD-L1 mediated suppression compromise regulatory T cell function in tuberculosis.

Asma Ahmed / Vasista Adiga / Soumya Nayak / J Anto Jesuraj Uday Kumar / Chirag Dhar / Pravat Nalini Sahoo / Bharath K Sundararaj / George D Souza / Annapurna Vyakarnam

PLoS Pathogens, Vol 14, Iss 9, p e

2018 Volume 1007289

Abstract: Chronic T cell activation is a hallmark of pulmonary tuberculosis (PTB). The mechanisms underpinning this important phenomenon are however, poorly elucidated, though known to rely on control of T effector cells (Teff) by regulatory T cells (Treg). Our ... ...

Abstract	Chronic T cell activation is a hallmark of pulmonary tuberculosis (PTB). The mechanisms underpinning this important phenomenon are however, poorly elucidated, though known to rely on control of T effector cells (Teff) by regulatory T cells (Treg). Our studies show that circulating natural Treg cells in adults with PTB preserve their suppressive potential but Teff cells from such subjects are resistant to Treg-mediated suppression. We found this to be due to expansion of an activated Teff subset identified by Human Leukocyte Antigen (HLA)-DR expression. Sensitivity to suppression was restored to control levels by depletion of this subset. Comparative transcriptome analysis of Teff cells that contain HLA-DR+ cells versus the fraction depleted of this population identified putative resistance mechanisms linked to IFNG, IL17A, IL22, PD-L1 and β-chemokines CCL3L3, CCL4 expression. Antibody blocking experiments confirmed HLA-DR+ Teff cells, but not the fraction depleted of HLA-DR+ effectors, to be resistant to Treg suppression mediated via CCR5 and PD-L1 associated pathways. In the presence of HLA-DR+ Teff cells, activation of NFκB downstream of CCR5 and PD-L1 was perturbed. In addition, HLA-DR+ Teff cells expressed significantly higher levels of Th1/Th17 cytokines that may regulate Treg function through a reciprocal counter-balancing relationship. Taken together, our study provides novel insight on how activated HLA-DR+CD4+ T cells may contribute to disease associated inflammation by compromising Treg-mediated suppression in PTB.
Keywords	Immunologic diseases. Allergy ; RC581-607 ; Biology (General) ; QH301-705.5
Subject code	570
Language	English
Publishing date	2018-09-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Clinico-epidemiological profile of tobacco users attending a tobacco cessation clinic in a teaching hospital in Bangalore city

George D′Souza / Dorothy P Rekha / Priya Sreedaran / K Srinivasan / Prem K Mony

Lung India, Vol 29, Iss 2, Pp 137-

2012 Volume 142

Abstract: Background: Tobacco-attributable mortality in India is estimated to be at least 10%. Tobacco cessation is more likely to avert millions of deaths before 2050 than prevention of tobacco use initiation. Objective: To describe the clinico-epidemiological ... ...

Abstract	Background: Tobacco-attributable mortality in India is estimated to be at least 10%. Tobacco cessation is more likely to avert millions of deaths before 2050 than prevention of tobacco use initiation. Objective: To describe the clinico-epidemiological profile of attendees of a tobacco cessation clinic in a teaching hospital in Bangalore city. Materials and Methods: A descriptive study of 189 attendees seen over 2 years in the Tobacco Cessation Clinic of a tertiary-care teaching hospital in Bangalore, with information on socio demographic characteristics, tobacco-use details, nicotine dependence, family/medical history, past quit attempts, baseline stage-of-change, and treatment initiated. Results: Only 5% were ′walk-in′ patients; 98% of attendees were smokers; 97% were males. The mean (±SD) age of attendees was 48.0 (±14.0) years. Most participants were married (88%), and predominantly urban (69%). About 62% had completed at least 8 years of schooling. Two-thirds of smokers reported high levels of nicotine dependence (Fagerström score >5/10). About 43% of patients had attempted quitting earlier. Four-fifths (79%) of tobacco-users reported a family member using tobacco. Commonly documented comorbidities included: Chronic respiratory disease (44%), hypertension (23%), diabetes (12%), tuberculosis (9%), myocardial infarction (2%), stroke (1%), sexual dysfunction (1%) and cancer (0.5%). About 52% reported concomitant alcohol use. At baseline, patients′ motivational stage was: Precontemplation (14%), contemplation (48%), preparation/action (37%) and maintenance (1%). Treatment modalities started were: Counseling alone (41%), nicotine replacement therapy alone (NRT) (34%), medication alone (13%), and NRT+medication (12%). Conclusions: This is the first study of the baseline profile of patients attending a tobacco cessation clinic located within a chest medicine department in India. Important determinants of outcome have been captured for follow-up and prospective documentation of outcomes.
Keywords	Cessation ; clinic ; smoking ; smokeless tobacco ; tobacco ; Diseases of the respiratory system ; RC705-779 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R
Language	English
Publishing date	2012-01-01T00:00:00Z
Publisher	Medknow Publications
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Adrenal insufficiency in patients with stable non-cystic fibrosis bronchiectasis

Srinivas Rajagopala / Anantharaman Ramakrishnan / Ganapathi Bantwal / Uma Devaraj / Smrita Swamy / S Vageesh Ayyar / George D′Souza

Indian Journal of Medical Research, Vol 139, Iss 3, Pp 393-

2014 Volume 401

Abstract: Background & objectives: Suppressed adrenal responses associated with inhaled steroid use have been reported in patients with bronchiectasis and have been shown to be associated with poor quality of life. This study was undertaken to examine the ... ...

Abstract	Background & objectives: Suppressed adrenal responses associated with inhaled steroid use have been reported in patients with bronchiectasis and have been shown to be associated with poor quality of life. This study was undertaken to examine the prevalence of suppressed cortisol responses in stable bronchiectasis and determine their correlation with the use of inhaled corticosteroids, radiologic severity of bronchiectasis and quality of life (QOL) scores. Methods: In this case-control study, cases were patients with bronchiectasis and suppressed cortisol responses and controls were healthy volunteers, and patients with bronchiectasis without suppressed cortisol responses. Symptoms, lung function test values, exercise capacity, HRCT severity scores for bronchiectasis, exacerbations, inhaled corticosteroid use and quality of life scores were compared between patients with and without suppressed cortisol values. Results: Forty consecutive patients with bronchiectasis and 40 matched controls underwent 1-μg cosyntropin testing. Baseline cortisol (mean difference -2.0 μg/dl, P=0.04) and 30-minute stimulated cortisol (mean difference -3.73 μg/dl, P=0.001) were significantly lower in patients with bronchiectasis. One patient had absolute adrenal insufficiency and 39.5 per cent (15/38) patients with bronchiectasis had impaired stimulated responses. Baseline and stimulated cortisol responses were unaffected by inhaled steroids (O.R 1.03, P=0.96). SGRQ scores were negatively correlated with body mass (r= -0.51, P=0.001) and bronchiectasis severity (r=0.37, P=0.019), but not related to baseline or stimulated cortisol responses. Interpretation & conclusions: Our results showed that the impaired adrenal responses to 1-μg cosyntropin were common in patients with bronchiectasis. This was not associated with the use of inhaled steroids or severity of bronchiectasis. Poor health status was associated with advanced disease and not with cortisol responses to the 1-μg cosyntropin test.
Keywords	Adrenal insufficiency - bronchiectasis - fatigue - St. George Respiratory Questionnaire - Synacten test ; Medicine ; R
Subject code	616
Language	English
Publishing date	2014-01-01T00:00:00Z
Publisher	Wolters Kluwer Medknow Publications
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: HIV Skews a Balanced Mtb-Specific Th17 Response in Latent Tuberculosis Subjects to a Pro-inflammatory Profile Independent of Viral Load

Srabanti Rakshit / Nitin Hingankar / Shuba Varshini Alampalli / Vasista Adiga / Bharath K. Sundararaj / Pravat Nalini Sahoo / Greg Finak / Anto Jesuraj Uday Kumar J / Chirag Dhar / George D’Souza / Rashmi Govind Virkar / Manisha Ghate / Madhuri R. Thakar / Ramesh S. Paranjape / Stephen C. De Rosa / Tom H.M. Ottenhoff / Annapurna Vyakarnam

Cell Reports, Vol 33, Iss 9, Pp 108451- (2020)

2020

Abstract: Summary: HIV infection predisposes latent tuberculosis-infected (LTBI) subjects to active TB. This study is designed to determine whether HIV infection of LTBI subjects compromises the balanced Mycobacterium tuberculosis (Mtb)-specific T helper 17 (Th17) ...

Abstract	Summary: HIV infection predisposes latent tuberculosis-infected (LTBI) subjects to active TB. This study is designed to determine whether HIV infection of LTBI subjects compromises the balanced Mycobacterium tuberculosis (Mtb)-specific T helper 17 (Th17) response of recognized importance in anti-TB immunity. Comparative analysis of Mtb- and cytomegalovirus (CMV)-specific CD4+ T cell responses demonstrates a marked dampening of the Mtb-specific CD4+ T cell effectors and polyfunctional cells while preserving CMV-specific response. Additionally, HIV skews the Mtb-specific Th17 response in chronic HIV-infected LTBI progressors, but not long-term non-progressors (LTNPs), with preservation of pro-inflammatory interferon (IFN)-γ+/interleukin-17+ (IL-17+) and significant loss of anti-inflammatory IL-10+/IL-17+ effectors that is restored by anti-retroviral therapy (ART). HIV-driven impairment of Mtb-specific response cannot be attributed to preferential infection as cell-associated HIV DNA and HIV RNA reveal equivalent viral burden in CD4+ T cells from different antigen specificities. We therefore propose that beyond HIV-induced loss of Mtb-specific CD4+ T cells, the associated dysregulation of Mtb-specific T cell homeostasis can potentially enhance the onset of TB in LTBI subjects.
Keywords	HIV ; tuberculosis ; CD4+ T cells ; CD8+ T cells ; Th17 ; ART ; Biology (General) ; QH301-705.5
Language	English
Publishing date	2020-12-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
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Article ; Online: Deep sequencing of near full-length HIV-1 genomes from plasma identifies circulating subtype C and infrequent occurrence of AC recombinant form in Southern India.

Shuba Varshini Alampalli / Michael M Thomson / Raghavan Sampathkumar / Karthi Sivaraman / Anto Jesuraj U K J / Chirag Dhar / George D Souza / Neil Berry / Annapurna Vyakarnam

PLoS ONE, Vol 12, Iss 12, p e

2017 Volume 0188603

Abstract: India has the third largest number of HIV-1-infected individuals accounting for approximately 2.1 million people, with a predominance of circulating subtype C strains and a low prevalence of subtype A and A1C and BC recombinant forms, identified over the ...

Abstract	India has the third largest number of HIV-1-infected individuals accounting for approximately 2.1 million people, with a predominance of circulating subtype C strains and a low prevalence of subtype A and A1C and BC recombinant forms, identified over the past two decades. Recovery of near full-length HIV-1 genomes from a plasma source coupled with advances in next generation sequencing (NGS) technologies and development of universal methods for amplifying whole genomes of HIV-1 circulating in a target geography or population provides the opportunity for a detailed analysis of HIV-1 strain identification, evolution and dynamics. Here we describe the development and implementation of approaches for HIV-1 NGS analysis in a southern Indian cohort. Plasma samples (n = 20) were obtained from HIV-1-confirmed individuals living in and around the city of Bengaluru. Near full-length genome recovery was obtained for 9 Indian HIV-1 patients, with recovery of full-length gag and env genes for 10 and 2 additional subjects, respectively. Phylogenetic analyses indicate the majority of sequences to be represented by subtype C viruses branching within a monophyletic clade, comprising viruses from India, Nepal, Myanmar and China and closely related to a southern African cluster, with a low prevalence of the A1C recombinant form also present. Development of algorithms for bespoke recovery and analysis at a local level will further aid clinical management of HIV-1 infected Indian subjects and delineate the progress of the HIV-1 pandemic in this and other geographical regions.
Keywords	Medicine ; R ; Science ; Q
Language	English
Publishing date	2017-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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