Publications by authors named "Thenmozhi Mani"

19 Publications

  • Page 1 of 1

A national level estimation of population need for blood in India.

Transfusion 2021 Jun 15;61(6):1809-1821. Epub 2021 May 15.

National AIDS Control Organization (NACO), New Delhi, India.

Background: The population need for blood is the total volume required to transfuse all the individuals who need transfusion in a defined population over a defined period. The clinical demand will arise when people with a disease or condition who require transfusion, access healthcare services, and subsequently the clinicians request blood. Essentially, the conversion of need to demand must be maximum to avoid preventable mortality and morbidity. The study estimated the population need for blood in India.

Methods: The methodology included a comprehensive literature review to determine the diseases and conditions requiring transfusion, the population at risk, and prevalence or incidence; and Delphi method to estimate the percentage of people requiring transfusion, and the quantum.

Results: The estimated annual population need was 26.2 million units (95% CI; 17.9-38.0) of whole blood to address the need for red cells and other components after the separation process. The need for medical conditions was 11.0 million units (95% CI:8.7-14.7), followed by surgery 6.6 million (95% CI:3.8-10.0), pediatrics 5.0 million (95% CI:3.5-7.0), and obstetrics and gynecology 3.6 million units (95% CI:1.9-6.2). The gap between need and demand which depends upon the access and efficiency of healthcare service provision was estimated at 13 million units.

Conclusion: The study brings evidence to highlight the gap between need and demand and the importance of addressing it. It cannot be just the responsibility of blood transfusion or health systems, it requires a multi-sectoral approach to address the barriers affecting the conversion of need to clinical demand for blood.
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http://dx.doi.org/10.1111/trf.16369DOI Listing
June 2021

Endoscopic Anterior Transposition of Ulnar Nerve (EATUN) for Treatment of Tardy Ulnar Nerve Palsy.

Indian J Orthop 2021 Apr 12;55(2):478-483. Epub 2021 Mar 12.

Department of Biostatistics, Christian Medical College and Hospital, Vellore, Tamil Nadu India.

Background: Tardy ulnar nerve palsy is the development of late onset ulnar nerve dysfunction and is usually treated by open anterior transposition of ulnar nerve. Open technique is done using a longitudinal incision about 6-8 inch. in length with chances of development of medial antebrachial cutaneous nerve neuromas.

Purpose: In this study, we describe the technique of Endoscopic Anterior Transposition of Ulnar Nerve (EATUN procedure) to treat tardy ulnar nerve palsy and analyze the results.

Methods: Seven patients diagnosed to have tardy ulnar nerve palsy was treated by EATUN. The humerus-elbow-wrist angle (HEW), pre- and post-operative intrinsic muscle power and sensory assessment, Dellon scores, and the was analyzed.

Results: The minimum follow-up was 12 months (Mean 27.4 months, Range 12-36 months). Improvement in Dellon and Q-DASH scores following EATUN procedure was statistically significant. There was objective improvement of intrinsic muscle power and sensation on follow-up, though not statistically significant. No instance of neuroma of the medial cutaneous nerve of forearm was noted.

Conclusions: The endoscopic anterior transposition of the ulnar nerve is a good option in surgical management of tardy ulnar nerve palsy.

Level Of Evidence: Therapeutic Level IV.

Supplementary Information: The online version contains supplementary material available at 10.1007/s43465-021-00366-w.
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http://dx.doi.org/10.1007/s43465-021-00366-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8046855PMC
April 2021

Calculated values of serum LDL-cholesterol (LDL-C) - for better or worse?

Nutr Metab Cardiovasc Dis 2021 05 29;31(5):1486-1493. Epub 2021 Jan 29.

Department of Biochemistry, Christian Medical College, Vellore, Tamil Nadu, 632002, India. Electronic address:

Background And Aims: The use of Friedewald's formula to calculate serum low-density lipoprotein cholesterol (LDL-C) is well-known to have limitations. A modification of it, in 2013, has been proposed to be superior. However, it was not known whether LDL-C values (calculated by the modified formula) meet laboratory performance criteria for their estimation. This study aimed to evaluate this.

Methods And Results: LDL-C values were calculated for 129,821 lipid profiles, using both Friedewald's formula and its modified version. Kappa statistics and intra-class correlation coefficient (ICC) were used to determine degree of agreement between directly measured and calculated values for LDL-C. Bias and total percentage error of the values were calculated. LDL-C concentrations calculated by the modified formula showed a greater degree of agreement with directly measured values (kappa = 0.713) than those calculated by Friedewald's formula (kappa = 0.595). Both the formulae produced values with negative biases (-3.47 for the modified formula and -7.62 for Friedewald's formula) and total percentage errors above the recommended limit of 12% (15.57% for the modified formula and 21.77% for Friedewald's formula). ICC showed that values calculated by the modified formula showed a greater degree of agreement with directly measured values, across a range of LDL-C values.

Conclusion: Calculated LDL-C values, using the modified formula, showed better agreement with directly measured values, and less bias and percentage total error than those obtained by use of Friedewald's formula. However, the percentage total error with use of the modified formula exceeded the recommended limit for LDL-C.
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http://dx.doi.org/10.1016/j.numecd.2021.01.016DOI Listing
May 2021

A Seroepidemiological Survey for Pertussis among Adolescents.

Indian J Pediatr 2021 05 17;88(5):509. Epub 2021 Feb 17.

Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, 632004, India.

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http://dx.doi.org/10.1007/s12098-021-03696-7DOI Listing
May 2021

Management of relapse in acute promyelocytic leukaemia treated with up-front arsenic trioxide-based regimens.

Br J Haematol 2021 01 20;192(2):292-299. Epub 2020 Nov 20.

Department of Haematology, Christian Medical College, Vellore, India.

The standard of care for patients with acute promyelocytic leukaemia (APL) relapsing after front-line treatment with arsenic trioxide (ATO)-based regimens remains to be defined. A total of 67 patients who relapsed after receiving ATO-based up-front therapy and were also salvaged using an ATO-based regimen were evaluated. The median (range) age of patients was 28 (4-54) years. While 63/67 (94%) achieved a second molecular remission (MR) after salvage therapy, three (4·5%) died during salvage therapy. An autologous stem cell transplant (auto-SCT) was offered to all patients who achieved MR, 35/63 (55·6%) opted for auto-SCT the rest were administered an ATO + all-trans retinoic acid maintenance regimen. The mean (SD) 5-year Kaplan-Meier estimate of overall survival and event-free survival of those who received auto-SCT versus those who did not was 90·3 (5·3)% versus 58·6 (10·4)% (P = 0·004), and 87·1 (6·0)% versus 47·7 (10·3)% (P = 0·001) respectively. On multivariate analysis, failure to consolidate MR with an auto-SCT was associated with a significantly increased risk of relapse [hazard ratio (HR) 4·91, 95% confidence interval (CI) 1·56-15·41; P = 0·006]. MR induction with ATO-based regimens followed by an auto-SCT in children and young adults with relapsed APL who were treated with front-line ATO-based regimens was associated with excellent long-term survival.
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http://dx.doi.org/10.1111/bjh.17221DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7894296PMC
January 2021

Myoepithelial Tumors of Salivary Gland: A Clinicopathologic and Immunohistochemical Study of 15 Patients with MIB-1 Correlation.

Head Neck Pathol 2021 Jun 21;15(2):479-490. Epub 2020 Sep 21.

Department of General Pathology, Christian Medical College, Vellore, Tamil Nadu, 632004, India.

Myoepithelial neoplasms are rare tumors of the salivary glands with predominant myoepithelial differentiation and a broad histologic spectrum. Their histological features, immunohistochemical profile and biological behavior are not well characterized and pose a diagnostic challenge. A total of 15 myoepithelial tumors, diagnosed during 2012 and 2019 were subcategorized and correlated with MIB-1 labeling index (LI) and various histological parameters. Immunohistochemical stains for MIB-1 and other antibodies were performed. Statistical analysis was done by chi-square test, Fisher's exact test and Kaplan Meier curve. Nine patients were male and six were female with the median age of 44 years (range 21-83 years). Of the 15 patients, 6 cases were classified as myoepithelioma (ME) and 9 cases as myoepithelial carcinoma (MECA). Parotid gland was the most common site (46.7%) followed by the palate. MEs showed well circumscribed tumor borders whereas MECAs exhibited focal capsular to extensive invasion into adjacent tissues. Epithelioid cell morphology was most common followed by mixed cell morphology. MIB-1 LI was significantly associated with invasive tumor borders, necrosis and high mitosis. Increased frequency of recurrence was noted with high MIB-1 LI, though it was not statistically significant. MIB-1 LI was high in nearly all MECAs with focal capsular to extensive invasion while low in MEs. Myoepithelial tumor with multinodular growth pattern and focal capsular invasion may have an indolent behavior if mitotic activity and MIB-1 LI is low. Early diagnosis and treatment of MECAs significantly improves the patient's survival and prognosis.
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http://dx.doi.org/10.1007/s12105-020-01225-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8134606PMC
June 2021

Prognostic plasma biomarkers of early complications and graft-versus-host disease in patients undergoing allogeneic hematopoietic stem cell transplantation.

EJHaem 2020 Jul 17;1(1):219-229. Epub 2020 Jun 17.

Department of Haematology, Christian Medical College, Vellore, India.

Early complications post hematopoietic stem cell transplantation (HSCT) such as sinusoidal obstruction syndrome (SOS) and graft versus host disease (GVHD) can be life threatening. Although several biomarkers have been identified to correlate with these complications and their response to treatment, these are yet to be used in clinical practice. Here, we evaluated circulating endothelial cells (CECs) (n = 26) and plasma biomarkers (ST2, REG3, VCAM1, ICAM1, TIM3) (N = 210) at early time points, to determine their association with early complications post-HSCT. Elevated CEC counts at the end of conditioning was associated with GVHD, indicating endothelial damage during HSCT. Plasma levels of REG3, VCAM1, ICAM1, and TIM3 on day 14 (D14) and D14 ICAM1 and D28 ST2 were significantly higher in patients with SOS and aGVHD, respectively. Upon sub-group analysis, D28 ST2, D14/D28 REG3, and D14ICAM1 levels were significantly higher in patients with gastrointestinal GVHD, while D28ST2 was higher in those with skin/liver GVHD. High ST2 levels on D28 was significantly associated with non-relapse mortality (NRM) and overall survival. Our results suggest that elevated ST2 levels on D28 could predict the likelihood of developing aGVHD and could influence NRM and OS.
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http://dx.doi.org/10.1002/jha2.26DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7116009PMC
July 2020

Electrocardiographic Predictors of Mortality in Acute Anterior Wall Myocardial Infarction With Right Bundle Branch Block and Right Precordial Q-Waves (qRBBB).

Can J Cardiol 2020 11 11;36(11):1764-1769. Epub 2020 Feb 11.

Department of Cardiology, Christian Medical College Vellore, Tamil Nadu, India. Electronic address:

Background: Published data on the clinical, electrocardiographic, and angiographic profile of acute anterior-wall ST-elevation myocardial infarction (STEMI) with right bundle branch block with q in leads V1, V2 (qRBBB) are scarce. The aim of this study was to estimate the incidence of short-term mortality and in-hospital complications in acute qRBBB STEMI and identify the electrocardiographic (ECG) predictors of a poor outcome.

Methods: We conducted a single-centre retrospective study among the patients with acute anterior-wall STEMI and qRBBB pattern on ECG. All relevant clinical and treatment data were collected from the electronic medical records. All the ECGs taken during the index hospitalization were subjected to detailed analysis.

Results: Among the 272 qRBBB patients included in the study, 64% had thrombolysis in myocardial infarction (TIMI) risk score of ≥6, and 41% were in Killip class III or IV at the time of presentation. The in-hospital mortality rate was 42.6%. There was a high incidence of ventricular tachyarrhythmias (12%), complete heart block (13%), heart failure (69%), and cardiogenic shock (52%). Extreme deviation of mean QRS axis to the right (180 to 269 degrees) in the baseline ECG was associated with high in-hospital mortality (odds ratio: 13.43; 95% confidence interval: 1.48-122.03; P = 0.021).

Conclusions: Acute qRBBB myocardial infarction is a sinister form of acute coronary syndrome that entails high in-hospital mortality and morbidity, necessitating early recognition and prompt institution of reperfusion therapy. Extreme deviation of QRS axis to the right (180 to 269 degrees) is a significant electrocardiographic predictor of in-hospital mortality.
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http://dx.doi.org/10.1016/j.cjca.2020.02.065DOI Listing
November 2020

The role of thymus and activation-regulated chemokine as a marker of severity of atopic dermatitis.

J Am Acad Dermatol 2021 Feb 19;84(2):545-547. Epub 2020 May 19.

Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India.

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http://dx.doi.org/10.1016/j.jaad.2020.05.052DOI Listing
February 2021

Learning Curve, Survival Curve.

JCO Glob Oncol 2020 04;6:571-574

Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India.

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http://dx.doi.org/10.1200/JGO.19.00303DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7193773PMC
April 2020

Assessing Seasonality Variation with Harmonic Regression: Accommodations for Sharp Peaks.

Int J Environ Res Public Health 2020 02 18;17(4). Epub 2020 Feb 18.

Department of Biostatistics, Christian Medical College, Vellore 632002, India.

The use of the harmonic regression model is well accepted in the epidemiological and biostatistical communities as a standard procedure to examine seasonal patterns in disease occurrence. While these models may provide good fit to periodic patterns with relatively symmetric rises and falls, for some diseases the incidence fluctuates in a more complex manner. We propose a two-step harmonic regression approach to improve the model fit for data exhibiting sharp seasonal peaks. To capture such specific behavior, we first build a basic model and estimate the seasonal peak. At the second step, we apply an extended model using sine and cosine transform functions. These newly proposed functions mimic a quadratic term in the harmonic regression models and thus allow us to better fit the seasonal spikes. We illustrate the proposed method using actual and simulated data and recommend the new approach to assess seasonality in a broad spectrum of diseases manifesting sharp seasonal peaks.
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http://dx.doi.org/10.3390/ijerph17041318DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7068504PMC
February 2020

A phase II study evaluating the role of bortezomib in the management of relapsed acute promyelocytic leukemia treated upfront with arsenic trioxide.

Cancer Med 2020 04 14;9(8):2603-2610. Epub 2020 Feb 14.

Department of Haematology, Christian Medical College, Vellore, India.

The standard-of-care for patients with acute promyelocytic leukemia (APL) relapsing after upfront arsenic trioxide (ATO) therapy is not defined. The present study was undertaken to evaluate the safety of addition of bortezomib to ATO in the treatment of relapsed APL based on our previously reported preclinical data demonstrating synergy between these agents. This was an open label, nonrandomized, phase II, single-center study. We enrolled 22 consecutive patients with relapsed APL. The median age was 26.5 years (interquartile range 17.5 to 41.5). The median time from initial diagnosis to relapse was 23.1 months (interquartile range 15.6 to 43.8). All patients achieved hematological remission at a median time of 45 days (range 40-63). Nineteen patients were in molecular remission at the end of induction. Grade 3 adverse events occurred in eight instances with one patient requiring discontinuation of therapy for grade 3 neuropathy. Twelve (54.5%) patients underwent autologous transplantation (auto-SCT) in molecular remission while the rest opted for maintenance therapy. The median follow-up was 48 months (range 28-56.3). Of the patients undergoing auto-SCT, all except one was alive and relapse free at last follow-up. Of the patients who opted for maintenance therapy, three developed a second relapse. For treatment of APL relapsing after upfront ATO therapy, addition of bortezomib to a standard ATO-based salvage regimen is safe and effective. This trial was registered at www.clinicaltrials.gov as NCT01950611.
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http://dx.doi.org/10.1002/cam4.2883DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7163093PMC
April 2020

Regular Low-Dose Oral Metronidazole Is Associated With Fewer Vesicovaginal and Rectovaginal Fistulae in Recurrent Cervical Cancer: Results From a 10-Year Retrospective Cohort.

J Glob Oncol 2019 09;5:1-10

Christian Medical College, Vellore, India.

Purpose: Anaerobic necrosis in cervical cancer can lead to malodor, fistulae, and treatment abandonment. In this retrospective cohort study, we examined the association between maintenance metronidazole and the incidence of malignant fistulae in recurrent cervical cancer.

Methods: We screened all cervical cancer records registered between 2007 and 2016 in the local palliative care database at Christian Medical College, Vellore, India. There were 208 eligible patients with post-treatment residual/recurrent pelvic disease. Among them, 76 had received oral maintenance metronidazole 200 mg once per day for 2 to 86 weeks (interquartile range, 4-16 weeks).

Results: Seventy-two patients developed at least one fistula. Forty-nine had vesicovaginal fistulae, 10 had rectovaginal fistuale, and 13 developed both types of fistulae. Patients on maintenance metronidazole had fewer fistulae (22.4% 41.7%; = .005), a longer median fistula-free survival (42.9 months 14.1 months; < .001), and a postrecurrence survival of 11.5 months versus 8.7 months ( = .112). We performed Cox multivariable proportional hazards regression analysis on the data from the subset of 146 patients observed until death. Bladder/rectal infiltration had a higher risk of fistula (HR, 5.24; = .011), whereas distant metastases (HR, 2.46; = .012) and Eastern Cooperative Oncology Group performance status greater than 1 (HR, 1.64; = .008) were associated with a higher risk of death. Maintenance metronidazole was associated with a lower risk of fistula (hazard ratio [HR], 0.33; 95% CI, 0.16 to 0.67; P = .002) and a lower risk of death (HR, 0.56; 95% CI, 0.39 to 0.81; P = .002).

Conclusion: Our data indicate that there is a significant inverse association between oral maintenance metronidazole and malignant fistulae in locally recurrent cervical cancer. The impact of this simple intervention on pelvic symptoms, fistulae, and survival should be evaluated in prospective studies.
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http://dx.doi.org/10.1200/JGO.19.00206DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6733185PMC
September 2019

The Carrico index is the parameter that guides the requirement of oxygen in the postoperative period in patients undergoing head and neck surgery under general anaesthesia: a cross-sectional study.

Rom J Anaesth Intensive Care 2018 Apr;25(1):49-54

Department of Anaesthesiology and Critical Care, AIIMS, Patrapada, Bhubaneswar-751019, Odisha, India.

Background & Aims: Altered lung function and consequent decrease in oxygenation has been linked to the duration of anaesthesia. This necessitates oxygen monitoring and supplementation in the perioperative period. But, evidence is lacking regarding the parameter that guides best the oxygen supplementation in the postoperative period and the parameter that correlates best with the duration of anaesthesia.

Methods: Adult patients scheduled for head & neck surgery under general anaesthesia were recruited. Two radial arterial blood samples one at pre-induction and the other at one hour after extubation were obtained. Primary outcome measures were partial pressure of oxygen (PaO), saturation (SpO), arterial oxygen content (CaO) and Carrico index (PaO/FiO) and their relation with duration of anaesthesia.

Results: Data from 112 patients showed a hypoxaemia incidence of 11.6%. We observed a drop in the mean CaO and haemoglobin concentration but a rise in the mean PaO at recovery. The mean PaO/FiO deteriorated by 225.65 ± 72.46 (95% CI 367.66, 83.64, p = 0.000) at recovery and there was a significant correlation (r = 0.2, p = 0.03) between duration of anaesthesia and decrease in PaO/FiO at recovery with a regression coefficient of 0.27 (95% CI 0.02, 0.50).

Conclusions: The Carrico index was proven to be the best parameter which needs to be monitored perioperatively to detect the alteration in the gaseous exchange in patients undergoing general anaesthesia for head and neck surgery. There is a positive correlation between the decrease in the Carrico index and the duration of anaesthesia especially when it is prolonged beyond 150 minutes.
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http://dx.doi.org/10.21454/rjaic.7518.251.crcDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5931183PMC
April 2018

Clinical, immunological profile and follow up of patients with pemphigus: A study from India.

Indian J Dermatol Venereol Leprol 2018 Jul-Aug;84(4):408-413

Department of Dermatology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.

Background: Pemphigus has a protracted course and multiple factors influence its prognosis. The objective of this study was to describe the epidemiology and clinical profile of pemphigus patients and to study its influence on treatment end points.

Methods: : This was a retrospective chart review done in an Indian tertiary care hospital from December 1991 to December 2013. Patients with less than 3 months' follow up and those who had paraneoplastic pemphigus were excluded.

Results: : There were 132 patients with pemphigus, of which 118 (89.4%) had pemphigus vulgaris and 14 (10.6%) had pemphigus foliaceous. The time to disease control (TDC) was available for 100 patients (n = 100, 75.7%); patients with a minimum follow up of 3 months (n = 80) were included for studying the end points like time to first disease remission (TDR) and time to first disease relapse (TDRe). The median period of follow up was 23 months (range 3-245). Out of the 100 patients, 61.9% were on oral steroids with adjuvant therapy. The steroid dose required for disease control for n = 100, ranged from 0.2 to 1.5 mg/kg body weight. Of these, 60% were treated with steroid dose of 1 mg/kg, 22% with >1 mg/kg, and 18% with <1 mg/kg. The mean time to disease control (in months) in the group which received <1 mg/kg steroid was 1.02 ± 0.68, 1 mg/kg was 0.72 ± 0.51, and >1 mg/kg was 1.02 ± 0.62 (P = 0.017); with a significant difference between the groups 2 and 3 (P = 0.007), implying a faster disease control in those who received 1 mg/kg dose. This difference was significant after adjusting for the steroid sparing drugs taken at baseline (P = 0.009, C.I. - 1.44-13.59). The mean time to first disease remission (TDR) was 11.46 ± 2.06 months. Out of the 80 patients with a minimum follow up of 3 months, 75% had achieved either partial or complete remission. None of the other epidemiological, clinical or immunological parameters had an impact on the TDC or TDR.

Conclusions: The epidemiological, clinical or immunological parameters had no impact on the treatment end points like time to disease control and time to first disease remission. The dose of steroids required for disease control higher than 1 mg/kg offered no advantage in the time to disease control as compared to 1 mg/kg.

Limitations: The study was retrospective and disease severity scores were not applied. In view of the shorter follow up period, long term prognostic end points and mortality could not be well represented. The median period of follow up was 23 months. The serum anti- desmoglein antibody titres were not available at various treatment end points for correlation at different time intervals.
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http://dx.doi.org/10.4103/ijdvl.IJDVL_323_17DOI Listing
November 2018

Cultural adaptation of the Brief COPE for persons living with HIV/AIDS in southern India.

AIDS Behav 2015 Feb;19(2):341-51

Samarth, Chennai, India.

Physical and psychological stressors of HIV infection demand adequate coping responses from persons living with HIV/AIDS (PLHA) and coping strategies may vary by cultural context. The Brief COPE is a well validated scale that has been used extensively to assess coping with cancer, depression, and HIV infection in other settings, but never in India. In this study we translated and validated the 28 item Brief COPE among 299 PLHA in South India, assessing reliability, validity, and cultural appropriateness. Although the original scale demonstrated acceptable internal consistency (alpha = 0.70) and good convergent validity with depression, the test-retest reliability was marginal (test-retest = 0.6) and the original factor structure demonstrated poor fit in a confirmatory factor analysis (CFA). An exploratory factor analysis yielded a 16 item scale with five factors (active planning, social support, avoidant emotions, substance use, religion). A second CFA demonstrated good model fit and acceptable reliability (alpha = 0.61) of the adapted scale.
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http://dx.doi.org/10.1007/s10461-014-0872-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4320041PMC
February 2015

Trends in risk behaviors among female sex workers in south India: priorities for sustaining the reversal of HIV epidemic.

AIDS Care 2013 15;25(9):1129-37. Epub 2013 Jan 15.

a AIDS Prevention and Control Project, Voluntary Health Services , Chennai , India.

HIV epidemic in India is predominantly concentrated in subgroups of population, such as female sex workers (FSWs) and their clients, whose behavior exposes them to a higher risk of acquiring HIV infection. This paper aims to present the changing patterns of socio-demographic characteristics, behaviors, reported sexually transmitted infections (STIs), and associated factors among FSWs over 11 years. Multistage cluster sampling with probability-proportional-to-size (PPS) method was used in the surveys. A sample of 400 FSWs was studied every year. The mean age and literacy at the baseline level increased significantly over the years. House-based sex increased by 40% from 43.3% in 1997 to 83% in 2008 (p<0.001). Condom use at last sex with one-time clients; consistent condom use (CCU) with one-time and regular clients indicated increasing trends. FSWs reported low levels of condom use at last sex (14.5% in 1997 to 5% in 2008; p<0.001) and CCU (12.6% in 2004 to 3.6% in 2008; p<0.01) with regular partners. FSWs who used condom with one-time clients at last sex reported significantly less STI symptoms. A two-third reduction in genital ulcers was found from 13.1% in 1997 to 4.5% in 2008 (p<0.001). Nonliterate and hotel-based sex workers were 1.6 (1.0-2.5; 95% CI) and 2.2(1.3-3.7; 95% CI) times more likely to have reported STI symptoms. The percentage of FSWs who underwent HIV testing increased (p<0.001); similarly, a 20% increase was found in FSWs who availed counseling services from 65.2% in 1997 to 85.4% in 2008 (p<0.001). Poor, illiterate, and marginalized were more likely to get involved in risky behaviors which suggest the need for structural interventions as part of HIV prevention strategy.
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http://dx.doi.org/10.1080/09540121.2012.752562DOI Listing
March 2014

Association between stigma, depression and quality of life of people living with HIV/AIDS (PLHA) in South India - a community based cross sectional study.

BMC Public Health 2012 Jun 21;12:463. Epub 2012 Jun 21.

AIDS Prevention and Control Project, Voluntary Health Services, Adyar, Chennai, 600 113, India.

Background: India has around 2.27 million adults living with HIV/AIDS who face several challenges in the medical management of their disease. Stigma, discrimination and psychosocial issues are prevalent. The objective of the study was to determine the prevalence of severe stigma and to study the association between this, depression and the quality of life (QOL) of people living with HIV/AIDS (PLHA) in Tamil Nadu.

Methods: This was a community based cross sectional study carried out in seven districts of Tamil Nadu, India, among 400 PLHA in the year 2009. The following scales were used for stigma, depression and quality of life, Berger scale, Major Depression Inventory (MDI) scale and the WHO BREF scale. Both Stigma and QOL were classified as none, moderate or severe/poor based on the tertile cut off values of the scale scores. Depression was classified as none, mild, moderate and severe. Logistic regression analyses were performed to study the risk factors.

Results: Twenty seven per cent of PLHA had experienced severe forms of stigma. These were severe forms of personalized stigma (28.8%), negative self-image (30.3%), perceived public attitude (18.2%) and disclosure concerns (26%). PLHA experiencing severe depression were 12% and those experiencing poor quality of life were 34%. Poor QOL reported in the physical, psychological, social and environmental domains was 42.5%, 40%, 51.2% and 34% respectively. PLHA who had severe personalized stigma and negative self-image had 3.4 (1.6-7.0) and 2.1 (1.0-4.1) times higher risk of severe depression respectively (p < .001). PLHA who had severe depression had experienced 2.7(1.1-7.7) times significantly poorer QOL.

Conclusions: Severe forms of stigma were equivalently prevalent among all the categories of PLHA. However, PLHA who had experienced severe depression had only developed poor QOL. A high level of social support was associated with a high level of QOL.
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http://dx.doi.org/10.1186/1471-2458-12-463DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3444349PMC
June 2012

Effects of acute and chronic inflammation on proteins involved in duodenal iron absorption in mice: a time-course study.

Br J Nutr 2012 Dec 24;108(11):1994-2001. Epub 2012 Feb 24.

Department of Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India.

In order to understand better the molecular mechanisms involved in the pathogenesis of anaemia of inflammation, we carried out a time-course study on the effects of turpentine-induced acute and chronic inflammation on duodenal proteins involved in Fe absorption in mice. Expression levels of these proteins and hepatic hepcidin and serum Fe levels were determined in inflamed mice. In acutely inflamed mice, significantly increased expression of ferritin was the earliest change observed, followed by decreased divalent metal transporter 1 expression in the duodenum and increased hepcidin expression in the liver. Ferroportin expression increased subsequently, despite high levels of hepcidin. Hypoferraemia, which developed at early time periods studied, was followed by increased serum Fe levels at later points. The present results thus show that acute inflammation induced several changes in the expression of proteins involved in duodenal Fe absorption, contributing to the development of hypoferraemia. Resolution of inflammation caused attenuation of many of these effects. Effects in chronically inflamed mice were less consistent. The present results also suggest that inflammation-induced increases in ferritin appeared to override the effects of hepcidin on the expression levels of ferroportin in enterocytes.
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http://dx.doi.org/10.1017/S0007114512000189DOI Listing
December 2012