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Kulkarni PS, Padmapriyadarsini C, Vekemans J, Bavdekar A, Gupta M, Kulkarni P, Garg B, Gogtay NJ, Tambe M, Lalwani S, Singh K, Munshi R, Meshram S, Selvavinayagam T, Pandey K, Bhimarasetty DM, Ramakrishnan S, Bhamare C, Dharmadhikari A, Budhawant C, Bonhomme CJ, Thakar M, Kurle SN, Kelly EJ, Gautam M, Gupta N, Panda S, Bhargava B, Poonawalla CS, Shaligram U, Kapse D, Gunale B. Seropersistence of SII-ChAdOx1 nCoV-19 (COVID-19 vaccine): 6-month follow-up of a randomized, controlled, observer-blind, phase 2/3 immuno-bridging study in Indian adults. Hum Vaccin Immunother 2024; 20:2304974. [PMID: 38512394 PMCID: PMC10962622 DOI: 10.1080/21645515.2024.2304974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/10/2024] [Indexed: 03/23/2024] Open
Abstract
AZD1222 (ChAdOx1 nCoV-19) is a replication-deficient adenoviral vectored coronavirus disease-19 (COVID-19) vaccine that is manufactured as SII-ChAdOx1 nCoV-19 by the Serum Institute of India Pvt Ltd following technology transfer from Oxford University/AstraZeneca. The non-inferiority of SII-ChAdOx1 nCoV-19 with AZD1222 was previously demonstrated in an observer-blind, phase 2/3 immuno-bridging study (trial registration: CTRI/2020/08/027170). In this analysis of immunogenicity and safety data 6 months post first vaccination (Day 180), 1,601 participants were randomized 3:1 to SII-ChAdOx1 nCoV-19 or AZD1222 (immunogenicity/reactogenicity cohort n = 401) and 3:1 to SII-ChAdOx1 nCoV-19 or placebo (safety cohort n = 1,200). Immunogenicity was measured by anti-severe acute respiratory syndrome coronavirus 2 spike (anti-S) binding immunoglobulin G and neutralizing antibody (nAb) titers. A decline in anti-S titers was observed in both vaccine groups, albeit with a greater decline in SII-ChAdOx1 nCoV-19 vaccinees (geometric mean titer [GMT] ratio [95% confidence interval (CI) of SII-ChAdOx1 nCoV-19 to AZD1222]: 0.60 [0.41-0.87]). Consistent similar decreases in nAb titers were observed between vaccine groups (GMT ratio [95% CI]: 0.88 [0.44-1.73]). No cases of severe COVID-19 were reported following vaccination, while one case was observed in the placebo group. No causally related serious adverse events were reported through 180 days. No thromboembolic or autoimmune adverse events of special interest were reported. Collectively, these data illustrate that SII-ChAdOx1 nCoV-19 maintained a high level of immunogenicity 6 months post-vaccination. SII-ChAdOx1 nCoV-19 was safe and well tolerated.
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Affiliation(s)
| | | | - Johan Vekemans
- Formerly of: Clinical Development, Infection, Late-stage Development, Respiratory and Immunology (R&I), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | | | - Madhu Gupta
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Praveen Kulkarni
- Department of Community Medicine, JSS Academy of Higher Education and Research, Mysore, India
| | - B.S. Garg
- Department of Community Medicine and Dr Sushila Nayar School of Public Health, Mahatma Gandhi Institute of Medical Sciences, Wardha, India
| | - Nithya J. Gogtay
- Department of Clinical Pharmacology, Seth G S Medical College & KEM Hospital, Mumbai, India
| | - Muralidhar Tambe
- Department of Community Medicine, B J Government Medical College and Sassoon General Hospitals, Pune, India
| | - Sanjay Lalwani
- Department of Pediatrics, Bharati Vidyapeeth Deemed University Medical College and Hospital, Pune, India
| | - Kiranjit Singh
- Jehangir Clinical Development Centre Pvt Ltd, Pune, India
| | - Renuka Munshi
- Department of Clinical Pharmacology, TN Medical College & BYL Nair Hospital, Mumbai, India
| | - Sushant Meshram
- Department of Pulmonary Medicine, Government Medical College, Nagpur, India
| | | | - Krishna Pandey
- Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | | | - S.R. Ramakrishnan
- Department of Clinical Research, Sri Ramchandra Institute of Higher Education and Research, Chennai, India
| | | | | | | | - Cyrille J. Bonhomme
- Laboratory Services, Vaccines Sciences Lab, Clinical Research, PPD, Part of Thermo Fisher Scientific, Richmond, VA, USA
| | | | | | - Elizabeth J. Kelly
- Formerly of: Translational Medicine, Vaccines and Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
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Gunale B, Kapse D, Kar S, Bavdekar A, Kohli S, Lalwani S, Meshram S, Raut A, Kulkarni P, Samuel C, Munshi R, Gupta M, Plested JS, Cloney-Clark S, Zhu M, Pryor M, Hamilton S, Thakar M, Shete A, Dharmadhikari A, Bhamare C, Shaligram U, Poonawalla CS, Mallory RM, Glenn GM, Kulkarni PS. Safety and Immunogenicity of SARS-CoV-2 Recombinant Spike Protein Vaccine in Children and Adolescents in India: A Phase 2-3 Randomized Clinical Trial. JAMA Pediatr 2023; 177:2807909. [PMID: 37523166 PMCID: PMC10391359 DOI: 10.1001/jamapediatrics.2023.2552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/10/2023] [Indexed: 08/01/2023]
Abstract
Importance The recombinant COVID-19 vaccine NVX-CoV2373 has demonstrated efficacy of approximately 90% in adults; however, its safety and efficacy in children is unknown. Objective To assess the noninferiority of SII-NVX-CoV2373 in children and adolescents compared to adults and to evaluate its safety in comparison with placebo. Design, Setting, and Participants This phase 2-3 observer-blind randomized clinical trial was conducted in 2 cohorts, children (aged 2 to 11 years) and adolescents (aged 12 to 17 years) between August 2021 and August 2022. Participants were randomized 3:1 to SII-NVX-CoV2373 or placebo and monitored for 179 days. The participants, study team, and laboratory staff were blinded. This was a multicenter study conducted across 10 tertiary care hospitals in India. Exclusion criteria included previous COVID-19 infection or vaccination, immunocompromised condition, and immunosuppressive medications. Interventions Two doses of 0.5-mL SII-NVX-CoV2373 or placebo were administered intramuscularly on days 1 and 22. Main Outcomes and Measures Primary outcomes were geometric mean titer ratio of both anti-spike (anti-S) IgG and neutralizing antibodies (NAbs) between both pediatric age groups to that of adults on day 36. Noninferiority was concluded if the lower bound of 95% CI of this ratio was greater than 0.67 for each age group. Both the antibodies were assessed for the index strain and for selected variants at various time points. Solicited adverse events (AEs) were recorded for 7 days after each vaccination, unsolicited AEs were recorded for 35 days, and serious AEs and AEs of special interest were recorded for 179 days. Results A total of 460 children in each age cohort were randomized to receive vaccine or placebo. The mean (SD) age was 6.7 (2.7) years in the child cohort and 14.3 (1.6) years in the adolescent cohort; 231 participants (50.2%) in the child cohort and 218 in the adolescent cohort (47.4%) were female. Both anti-S IgG and NAb titers were markedly higher in the SII-NVX-CoV2373 group than in the placebo group on both day 36 and day 180. The geometric mean titer ratios compared to those in adults were 1.20 (95% CI, 1.08-1.34) and 1.52 (95% CI, 1.38-1.67) for anti-S IgG in adolescents and children, respectively; while for NAbs, they were 1.33 (95% CI, 1.17-1.50) and 1.93 (95% CI, 1.70-2.18) in adolescents and children, respectively, indicating noninferiority. SII-NVX-CoV2373 also showed immune responses against variants studied. Injection site reactions, fever, headache, malaise, and fatigue were common solicited AEs. There were no AEs of special interest and no causally related serious AEs. Conclusions and Relevance SII-NVX-CoV2373 was safe and well tolerated in children and adolescents in this study. The vaccine was highly immunogenic and may be used in pediatric vaccination against COVID-19. Trial Registration Clinical Trials Registry of India Identifier: CTRI/2021/02/031554.
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Affiliation(s)
| | | | - Sonali Kar
- Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Ashish Bavdekar
- King Edward Memorial Hospital Research Centre, Pune, Maharashtra, India
| | - Sunil Kohli
- Hamdard Institute of Medical Sciences and Research With Centre for Health Research and Development, New Delhi, India
| | - Sanjay Lalwani
- Bharati Vidyapeeth Deemed University Medical College and Hospital, Pune, Maharashtra, India
| | - Sushant Meshram
- Super Speciality Hospital, Government Medical College and Hospital, Nagpur, Maharashtra, India
| | - Abhishek Raut
- Sushila Nayar School of Public Health, Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Praveen Kulkarni
- JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Clarence Samuel
- Christian Medical College & Hospital, Ludhiana, Punjab, India
| | - Renuka Munshi
- Topiwala National Medical College and Bai Yamunabai Laxman Nair Hospital, Mumbai, Maharashtra, India
| | - Madhu Gupta
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | | | | | | - Madhuri Thakar
- Indian Council of Medical Research, National AIDS Research Institute, Pune, Maharashtra, India
| | - Ashwini Shete
- Indian Council of Medical Research, National AIDS Research Institute, Pune, Maharashtra, India
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Kulkarni PS, Kadam A, Godbole S, Bhatt V, Raut A, Kohli S, Tripathi S, Kulkarni P, Ludam R, Prabhu M, Bavdekar A, Gogtay NJ, Meshram S, Kadhiravan T, Kar S, Narayana DA, Samuel C, Kulkarni G, Gaidhane A, Sathyapalan D, Raut S, Hadda V, Bhalla HL, Bhamare C, Dharmadhikari A, Plested JS, Cloney-Clarke S, Zhu M, Pryor M, Hamilton S, Thakar M, Shete A, Gautam M, Gupta N, Panda S, Shaligram U, Poonawalla CS, Bhargava B, Gunale B, Kapse D, Kakrani AL, Tripathy SP, Tilak AV, Dhamne AA, Mirza SB, Athavale PV, Bhowmik M, Ratnakar PJ, Gupta S, Deotale V, Jain J, Kalantri A, Jain V, Goyal N, Arya A, Rongsen-Chandola T, Dasgupta S, Periera P, A V, Kawade A, Gondhali A, Kudyar P, Singh A, Yadav R, Alexander A, Gunasekaran V, Dineshbabu S, Samantaray P, Ravish H, Kamra D, Gaidhane S, Zahiruddin QS, Moni M, Kumar A, Dravid A, Mohan A, Suri T, Patel TK, Kishore S, Choche R, Ghatage D, Salvi S. Safety and immunogenicity of SII-NVX-CoV2373 (COVID-19 vaccine) in adults in a phase 2/3, observer-blind, randomised, controlled study. Lancet Reg Health Southeast Asia 2023; 10:100139. [PMID: 36647543 PMCID: PMC9833646 DOI: 10.1016/j.lansea.2022.100139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023]
Abstract
Background NVX-CoV2373, a Covid-19 vaccine was developed in the USA with ∼90% efficacy. The same vaccine is manufactured in India after technology transfer (called as SII-NVX-CoV2373), was evaluated in this phase 2/3 immuno-bridging study. Methods This was an observer-blind, randomised, phase 2/3 study in 1600 adults. In phase 2, 200 participants were randomized 3:1 to SII-NVX-CoV2373 or placebo. In phase 3, 1400 participants were randomized 3:1 to SII-NVX-CoV2373 or NVX-CoV2373 (940 safety cohort and 460 immunogenicity cohort). Two doses of study products (SII-NVX-CoV2373, NVX-CoV2373 or placebo) were given 3 weeks apart. Primary objectives were to demonstrate non-inferiority of SII-NVX-CoV2373 to NVX-CoV2373 in terms of geometric mean ELISA units (GMEU) ratio of anti-S IgG antibodies 14 days after the second dose (day 36) and to determine the incidence of causally related serious adverse events (SAEs) through 180 days after the first dose. Anti-S IgG response was assessed using an Enzyme-Linked Immunosorbent Assay (ELISA) and neutralizing antibodies (nAb) were assessed by a microneutralization assay using wild type SARS CoV-2 in participants from the immunogenicity cohort at baseline, day 22, day 36 and day 180. Cell mediated immune (CMI) response was assessed in a subset of 28 participants from immunogenicity cohort by ELISpot assay at baseline, day 36 and day 180. The total follow-up was for 6 months. Trial registration: CTRI/2021/02/031554. Findings Total 1596 participants (200 in Phase 2 and 1396 in Phase 3) received the first dose. SII-NVX-CoV2373 was found non-inferior to NVX-CoV2373 (anti-S IgG antibodies GMEU ratio 0.91; 95% CI: 0.79, 1.06). At day 36, there was more than 58-fold rise in anti-S IgG and nAb titers compared to baseline in both the groups. On day 180 visit, these antibody titers declined to levels slightly lower than those after the first dose (13-22 fold-rise above baseline). Incidence of unsolicited and solicited AEs was similar between the SII-NVX-CoV2373 and NVX-CoV2373 groups. No adverse event of special interest (AESI) was reported. No causally related SAE was reported. Interpretation SII-NVX-CoV2373 induced a non-inferior immune response compared to NVX-CoV2373 and has acceptable safety profile. Funding SIIPL, Indian Council of Medical Research, Novavax.
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Affiliation(s)
- Prasad S. Kulkarni
- Serum Institute of India Pvt Ltd, Pune, India,Corresponding author: Serum Institute of India Pvt Ltd, Poonawalla Biotechnology Park SEZ, Manjari (Bk), Pune, 412307, India
| | - Abhijit Kadam
- Indian Council of Medical Research-National AIDS Research Institute, Pune, India
| | - Sheela Godbole
- Indian Council of Medical Research-National AIDS Research Institute, Pune, India
| | - Varsha Bhatt
- Dr. D. Y. Patil Medical College Hospital and Research Centre, Pune, India
| | - Abhishek Raut
- Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, India
| | - Sunil Kohli
- Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | | | | | - Rakhi Ludam
- Institution of Medical Science and SUM Hospital, Bhubaneswar, India
| | - Madhav Prabhu
- KLES Dr. Prabhakar Kore Hospital and Medical Research Center, Belgavi, India
| | | | | | | | - Tamilarasu Kadhiravan
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sonali Kar
- Kalinga Institute of Medical Sciences, Bhubaneswar, India
| | | | | | | | - Abhay Gaidhane
- Acharya Vinoba Bhave Rural Hospital and Datta Meghe Institute of Medical Sciences, Sawangi (M), Wardha, India
| | | | | | - Vijay Hadda
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | | | | | - Mingzhu Zhu
- Clinical Immunology Laboratory, Novavax, Gaithersburg, MD, USA
| | - Melinda Pryor
- 360biolabs, 85 Commercial Road, Melbourne, Victoria, Australia
| | | | - Madhuri Thakar
- Indian Council of Medical Research-National AIDS Research Institute, Pune, India
| | - Ashwini Shete
- Indian Council of Medical Research-National AIDS Research Institute, Pune, India
| | | | | | - Samiran Panda
- Indian Council of Medical Research, New Delhi, India
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Meshram S, Gupta S, Alexander A, Agrawal S, Lanjewar N, Meshram K, Patel A, More A, Yadav R, Muley S, Shamkuwar C, Singh A. Sleep quality in COVID-19 patients and its association with severity of COVID. Sleep Med 2022. [PMCID: PMC9300259 DOI: 10.1016/j.sleep.2022.05.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kulkarni PS, Padmapriyadarsini C, Vekemans J, Bavdekar A, Gupta M, Kulkarni P, Garg BS, Gogtay NJ, Tambe M, Lalwani S, Singh K, Munshi R, Meshram S, Selvavinayagam TS, Pandey K, Bhimarasetty DM, Ramakrishnan SR, Bhamare C, Dharmadhikari A, Vadakkedath R, Bonhomme CJ, Thakar M, Kurle SN, Kelly EJ, Gautam M, Gupta N, Panda S, Bhargava B, Shaligram U, Kapse D, Gunale B. A phase 2/3, participant-blind, observer-blind, randomised, controlled study to assess the safety and immunogenicity of SII-ChAdOx1 nCoV-19 (COVID-19 vaccine) in adults in India. EClinicalMedicine 2021; 42:101218. [PMID: 34870133 PMCID: PMC8629682 DOI: 10.1016/j.eclinm.2021.101218] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/29/2021] [Accepted: 11/11/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND This phase 2/3 immunobridging study evaluated the safety and immunogenicity of the ChAdOx1 nCoV-19 Coronavirus Vaccine (Recombinant) (SII-ChAdOx1 nCoV-19), manufactured in India at the Serum Institute of India Pvt Ltd (SIIPL), following technology transfer from the AstraZeneca. METHODS This participant-blind, observer-blind study randomised participants 3:1 to SII-ChAdOx1 nCoV-19 or AZD1222 (ChAdOx1 nCoV-19) (immunogenicity/reactogenicity cohort) and 3:1 to SII-ChAdOx1 nCoV-19 or placebo (safety cohort). The study participants were enrolled from 14 hospitals across India between August 25 and October 31, 2020. Two doses of study products were given 4 weeks apart. The primary objectives were to demonstrate non-inferiority of SII-ChAdOx1 nCoV-19 to AZD1222 in terms of geometric mean titre (GMT) ratio of anti-SARS-CoV-2 spike IgG antibodies 28 days after the second dose (defined as lower limit of 95% CI >0·67) and to determine the incidence of serious adverse events (SAEs) causally related to SII-ChAdOx1 nCoV-19. The anti-spike IgG response was assessed using a multiplexed electrochemiluminescence-based immunoassay. Safety follow-up continued until 6 months after first dose. Trial registration: CTRI/2020/08/027170. FINDINGS 1601 participants were enrolled: 401 to the immunogenicity/reactogenicity cohort and 1200 to the safety cohort. After two doses, seroconversion rates for anti-spike IgG antibodies were more than 98·0% in both the groups. SII-ChAdOx1 nCoV-19 was non-inferior to AZD1222 (GMT ratio 0·98; 95% CI 0·78-1·23). SAEs were reported in ≤ 2·0% participants across the three groups; none were causally related. A total of 34 SARS-CoV-2 infections were reported; of which 6 occurred more than 2 weeks after the second dose; none were severe. INTERPRETATION SII-ChAdOx1 nCoV-19 has a non-inferior immune response compared to AZD1222 and an acceptable safety/reactogenicity profile. Pharmacovigilance should be maintained to detect any safety signals. FUNDING SIIPL funded the contract research organisation and laboratory costs, while the site costs were funded by the Indian Council of Medical Research. The study vaccines were supplied by SIIPL and AstraZeneca.
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Affiliation(s)
- Prasad S Kulkarni
- Serum Institute of India Pvt Ltd, Pune, India
- Correspondence to: Dr Prasad S Kulkarni, Serum Institute of India Pvt Ltd, 212/2, Off Soli Poonawalla Road, Hadapsar, Pune - 411028, India. Phone: +91 20 26602384 ; Fax: +91 20 26993945
| | | | - Johan Vekemans
- Clinical Development, Infection, Late-stage Development, Respiratory and Immunology (R&I), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | | | - Madhu Gupta
- Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | | | - B S Garg
- Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, India
| | | | - Muralidhar Tambe
- B J Government Medical College and Sassoon General Hospitals, Pune, India
| | - Sanjay Lalwani
- Bharati Vidyapeeth Deemed University Medical College and Hospital, Pune, India
| | - Kiranjit Singh
- Jehangir Clinical Development Centre Pvt Ltd, Pune, India
| | - Renuka Munshi
- TN Medical College & BYL Nair Hospital, Mumbai, India
| | | | | | - Krishna Pandey
- Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | | | - S R Ramakrishnan
- Sri Ramchandra Institute of Higher Education and Research, Chennai, India
| | | | | | | | | | | | | | - Elizabeth J Kelly
- Translational Medicine, Microbial Sciences, AstraZeneca, Gaithersburg, MD, USA
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Deokar K, Meshram S, Chawla G, Kunjir N, Meshram C, Abrol N, Gaikwad P. Obstructive sleep apnea, intermittent hypoxemia and prothrombotic biomarkers. Sleep Sci 2021; 13:230-234. [PMID: 33564369 PMCID: PMC7856672 DOI: 10.5935/1984-0063.20190147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objective To study the serum levels of fibrinogen and d-dimer in patients with obstructive sleep apnea (OSA) and its correlation with apnea hypopnea index (AHI), oxygen desaturation index (ODI), minimal oxygen saturation and arousal index. Methods It was a case control study in which 23 cases of OSA and 23 controls were enrolled. Morning fasting serum fibrinogen and d-dimer were measured in cases of OSA and controls. Results Serum fibrinogen levels among OSA patients (268.47±53.11mg/dl) were elevated as compared to the levels in controls (221.52±65.84mg/dl) (p<0.05). Serum fibrinogen co-related positively with AHI (r=0.6381, p=0.0011) and ODI (r=0.7434, p=0.0000), negatively with minimal oxygen saturation (r=-0.4461, p=0.0329). There was no statistically significant correlation of fibrinogen with arousal index (r=0.2697, p=0.2133). There was no statistically significant difference between mean fasting d-dimer level in cases (0.12mg/L, 0.06±0.18mg/L) and controls (0.12mg/L, 0.02±0.22mg/L) (p=0.8926). Conclusions The observation of elevated fibrinogen levels with the increasing severity of OSA and hypoxemic events makes OSA one of the important risk factor for cardiovascular disorders.
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Affiliation(s)
- Kunal Deokar
- Government medical college, Pulmonary Medicine - Nagpur - Maharashtra - India
| | - Sushant Meshram
- Government medical college, Pulmonary Medicine - Nagpur - Maharashtra - India
| | - Gopal Chawla
- All India Institute of Medical Sciences, Pulmonary Medicine and Sleep Disorders - New Delhi - Delhi - India
| | - Nana Kunjir
- Government medical college, Pulmonary Medicine - Nagpur - Maharashtra - India
| | - Chetna Meshram
- Government medical college, Pharmacology - Nagpur - Maharashtra - India
| | - Nupur Abrol
- All India Institute of Medical Sciences, Anaesthesia - Delhi - Delhi - India
| | - Priyanka Gaikwad
- Bhaktivedanta hospital, Paediatrics - Mumbai - Maharashtra - India
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Suryavanshi N, Murrill M, Gupta A, Hughes M, Hesseling A, Kim S, Naini L, Jones L, Smith B, Gupte N, Dawson R, Mave V, Meshram S, Mendoza-Ticona A, Sanchez J, Kumarasamy N, Comins K, Conradie F, Shenje J, Nerette Fontain S, Garcia-Prats A, Asmelash A, Nedsuwan S, Mohapi L, Lalloo U, Cristina Garcia Ferreira A, Okeyo E, Swindells S, Churchyard G, Shah NS. Willingness to Take Multidrug-resistant Tuberculosis (MDR-TB) Preventive Therapy Among Adult and Adolescent Household Contacts of MDR-TB Index Cases: An International Multisite Cross-sectional Study. Clin Infect Dis 2020; 70:436-445. [PMID: 30919881 PMCID: PMC7188234 DOI: 10.1093/cid/ciz254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 03/26/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Household contacts (HHCs) of individuals with multidrug-resistant tuberculosis (MDR-TB) are at high risk of infection and subsequent disease. There is limited evidence on the willingness of MDR-TB HHCs to take MDR-TB preventive therapy (MDR TPT) to decrease their risk of TB disease. METHODS In this cross-sectional study of HHCs of MDR-TB and rifampicin-resistant tuberculosis (RR-TB) index cases from 16 clinical research sites in 8 countries, enrollees were interviewed to assess willingness to take a hypothetical, newly developed MDR TPT if offered. To identify factors associated with willingness to take MDR TPT, a marginal logistic model was fitted using generalized estimating equations to account for household-level clustering. RESULTS From 278 MDR-TB/RR-TB index case households, 743 HHCs were enrolled; the median age of HHCs was 33 (interquartile range, 22-49) years, and 62% were women. HHC willingness to take hypothetical MDR TPT was high (79%) and remained high even with the potential for mild side effects (70%). Increased willingness was significantly associated with current employment or schooling (adjusted odds ratio [aOR], 1.83 [95% confidence interval {CI}, 1.07-3.13]), appropriate TB-related knowledge (aOR, 2.22 [95% CI, 1.23-3.99]), confidence in taking MDR TPT (aOR, 7.16 [95% CI, 3.33-15.42]), and being comfortable telling others about taking MDR TPT (aOR, 2.29 [95% CI, 1.29-4.06]). CONCLUSIONS The high percentage of HHCs of MDR-TB/RR-TB index cases willing to take hypothetical MDR TPT provides important evidence for the potential uptake of effective MDR TPT when implemented. Identified HHC-level variables associated with willingness may inform education and counseling efforts to increase HHC confidence in and uptake of MDR TPT.
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Affiliation(s)
- Nishi Suryavanshi
- Byramjee Jeejeebhoy Government Medical College Clinical Trials Unit, Pune, India
| | | | - Amita Gupta
- Byramjee Jeejeebhoy Government Medical College Clinical Trials Unit, Pune, India
- Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Michael Hughes
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Anneke Hesseling
- Desmond Tutu TB Centre, Stellenbosch University, Tygerberg, South Africa
| | - Soyeon Kim
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Linda Naini
- Social and Scientific Systems, Inc, Silver Springs, Maryland
| | - Lynne Jones
- Frontier Science and Technology Research Foundation, Amherst, New York
| | - Betsy Smith
- National Institutes of Health, Bethesda, Maryland
| | - Nikhil Gupte
- Byramjee Jeejeebhoy Government Medical College Clinical Trials Unit, Pune, India
- Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Rodney Dawson
- University of Cape Town Lung Institute, Mowbray, South Africa
| | - Vidya Mave
- Byramjee Jeejeebhoy Government Medical College Clinical Trials Unit, Pune, India
- Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Sushant Meshram
- Byramjee Jeejeebhoy Government Medical College Clinical Trials Unit, Pune, India
| | | | - Jorge Sanchez
- Asociación Civil Impacta Salud y Educación, San Miguel Clinical Research Site, Lima, Peru
| | | | - Kyla Comins
- TASK Applied Science Clinical Research Site, Bellville
| | | | - Justin Shenje
- South African Tuberculosis Vaccine Initiative, Cape Town, South Africa
| | - Sandy Nerette Fontain
- GHESKIO Centers–Institute of Infectious Diseases and Reproductive Health, Port-au-Prince, Haiti
| | | | | | - Supalert Nedsuwan
- Program for HIV Prevention and Treatment-Chiangrai Prachanukroh Hospital, Thailand
| | - Lerato Mohapi
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg
| | - Umesh Lalloo
- Durban International Clinical Research Site, South Africa
| | | | | | | | - Gavin Churchyard
- Aurum Institute
- School of Public Health, University of the Witwatersrand, Johannesburg
- Advancing Care and Treatment for TB/HIV, South African Medical Research Council, Parktown, South Africa
| | - N Sarita Shah
- Centers for Disease Control and Prevention, Atlanta, Georgia
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8
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Gupte AN, Mave V, Meshram S, Lokhande R, Kadam D, Dharmshale S, Bharadwaj R, Kagal A, Pradhan N, Deshmukh S, Atre S, Sahasrabudhe T, Barthwal M, Meshram S, Kakrani A, Kulkarni V, Raskar S, Suryavanshi N, Shivakoti R, Chon S, Selvin E, Gupte N, Gupta A, Golub JE. Trends in HbA1c levels and implications for diabetes screening in tuberculosis cases undergoing treatment in India. Int J Tuberc Lung Dis 2019; 22:800-806. [PMID: 30041729 DOI: 10.5588/ijtld.18.0026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
SETTING The optimal timing of screening for diabetes mellitus (DM) among tuberculosis (TB) cases is unclear due to the possibility of stress hyperglycemia. DESIGN We evaluated adult (18 years) pulmonary TB cases at treatment initiation as well as at 3 months, 6 months and 12 months. DM was identified by self-report (known DM) or glycated hemoglobin (HbA1c) 6.5% (new DM). Trends in HbA1c levels during treatment were assessed using non-parametric tests. RESULTS Of the 392 participants enrolled, 75 (19%) had DM, 30 (40%) of whom had new DM. Of the 45 participants with known DM, respectively 37 (82%) and 40 (89%) received medication to lower glucose levels at treatment initiation and completion; one participant with new DM initiated glucose-lowering medication during follow-up. The median HbA1c level in participants with known, new and no DM was respectively 10.1% (interquartile range [IQR] 8.3-11.6), 8.5% (IQR 6.7-11.5) and 5.6% (IQR 5.3-5.9) at treatment initiation, and 8.7% (IQR 6.8-11.3), 7.1% (IQR 5.8-9.5) and 5.3% (IQR 5.1-5.6) at treatment completion (P < 0.001). Overall, 5 (12%) with known and 13 (43%) with new DM at treatment initiation had reverted to HbA1c < 6.5% by treatment completion (P = 0.003); the majority of reversions occurred during the first 3 months, with no significant reversions beyond 6 months. CONCLUSION HbA1c levels declined with anti-tuberculosis treatment. Repeat HbA1c testing at treatment completion could reduce the risk of misdiagnosis of DM.
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Affiliation(s)
- A N Gupte
- Johns Hopkins University School of Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - V Mave
- Johns Hopkins University School of Medicine
| | - S Meshram
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals
| | - R Lokhande
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals
| | - D Kadam
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals
| | - S Dharmshale
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals
| | - R Bharadwaj
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals
| | - A Kagal
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals
| | - N Pradhan
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - S Deshmukh
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - S Atre
- Dr D Y Patil Medical College, Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pimpri, Pune, India
| | - T Sahasrabudhe
- Dr D Y Patil Medical College, Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pimpri, Pune, India
| | - M Barthwal
- Dr D Y Patil Medical College, Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pimpri, Pune, India
| | - S Meshram
- Dr D Y Patil Medical College, Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pimpri, Pune, India
| | - A Kakrani
- Dr D Y Patil Medical College, Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pimpri, Pune, India
| | - V Kulkarni
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - S Raskar
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - N Suryavanshi
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | | | - S Chon
- Johns Hopkins University School of Medicine
| | - E Selvin
- Johns Hopkins University School of Medicine
| | - N Gupte
- Johns Hopkins University School of Medicine
| | - A Gupta
- Johns Hopkins University School of Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - J E Golub
- Johns Hopkins University School of Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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9
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Shivakumar SVBY, Chandrasekaran P, Kumar AMV, Paradkar M, Dhanasekaran K, Suryavarshini N, Thomas B, Kohli R, Thiruvengadam K, Kulkarni V, Hannah LE, Sivaramakrishnan GN, Pradhan N, Dolla C, Gupte A, Ramachandran G, DeLuca A, Meshram S, Bhardawaj R, Bollinger RC, Golub J, Selvaraj K, Gupte N, Swaminathan S, Mave V, Gupta A. Diabetes and pre-diabetes among household contacts of tuberculosis patients in India: is it time to screen them all? Int J Tuberc Lung Dis 2019; 22:686-694. [PMID: 29862955 DOI: 10.5588/ijtld.17.0598] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Pre-diabetes mellitus (pre-DM) and DM increase the risk of developing tuberculosis (TB). Screening contacts of TB patients for pre-DM/DM and linking them to care may mitigate the risk of developing TB and improve DM management. OBJECTIVE To measure the prevalence of pre-DM/DM and associated factors among the adult household contacts (HHCs) of pulmonary TB patients. METHODS Between August 2014 and May 2017, adult HHCs of newly diagnosed adult PTB patients in Pune and Chennai, India, had single blood samples tested for glycosylated haemoglobin (HbA1c) at enrolment. DM was defined as previously diagnosed, self-reported DM or HbA1c 6.5%, and pre-DM as HbA1c between 5.7% and 6.4%. Latent tuberculous infection (LTBI) was defined as a positive tuberculin skin test (5 mm induration) or QuantiFERON® Gold In-Tube (0.35 international units/ml). RESULTS Of 652 adult HHCs, 175 (27%) had pre-DM and 64 (10%) had DM. Forty (64%) HHCs were newly diagnosed with DM and 48 (75%) had poor glycaemic control (HbA1c 7.0%). Sixty-eight (22%) pre-DM cases were aged 18-34 years. Age 35 years, body mass index 25 kg/m2, chronic disease and current tobacco smoking were significantly associated with DM among HHCs. CONCLUSIONS Adult HHCs of TB patients in India have a high prevalence of undiagnosed DM, pre-DM and LTBI, putting them at high risk for developing TB. Routine DM screening should be considered among all adult HHCs of TB.
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Affiliation(s)
| | - P Chandrasekaran
- National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - M Paradkar
- Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research site, Pune, Maharashtra, India
| | - K Dhanasekaran
- National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - N Suryavarshini
- Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research site, Pune, Maharashtra, India
| | - B Thomas
- National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - R Kohli
- Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research site, Pune, Maharashtra, India
| | - K Thiruvengadam
- National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - V Kulkarni
- Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research site, Pune, Maharashtra, India
| | - L E Hannah
- National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | | | - N Pradhan
- Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research site, Pune, Maharashtra, India
| | - C Dolla
- National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - A Gupte
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - G Ramachandran
- National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - A DeLuca
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - S Meshram
- Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research site, Pune, Maharashtra, India, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - R Bhardawaj
- Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research site, Pune, Maharashtra, India, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - R C Bollinger
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - J Golub
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - K Selvaraj
- Pondicherry Institute of Medical Sciences (PIMS), Puducherry
| | - N Gupte
- Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research site, Pune, Maharashtra, India, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - S Swaminathan
- Indian Council of Medical Research, New Delhi, India
| | - V Mave
- Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research site, Pune, Maharashtra, India, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - A Gupta
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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10
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Mave V, Meshram S, Lokhande R, Kadam D, Dharmshale S, Bharadwaj R, Kagal A, Pradhan N, Deshmukh S, Atre S, Sahasrabudhe T, Barthwal M, Meshram S, Kakrani A, Kulkarni V, Raskar S, Suryavanshi N, Shivakoti R, Chon S, Selvin E, Gupte A, Gupta A, Gupte N, Golub JE. Prevalence of dysglycemia and clinical presentation of pulmonary tuberculosis in Western India. Int J Tuberc Lung Dis 2019; 21:1280-1287. [PMID: 29297449 DOI: 10.5588/ijtld.17.0474] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
SETTING Pune, India. OBJECTIVES To estimate the prevalence and risk factors of pre-diabetes mellitus (DM) and DM, and its associations with the clinical presentation of tuberculosis (TB). DESIGN Screening for DM was conducted among adults (age 18 years) with confirmed TB between December 2013 and January 2017. We used multinomial regression to evaluate the risk factors for pre-DM (glycated hemoglobin [HbA1c] 5.7-6.5% or fasting glucose 100-125 mg/dl) and DM (HbA1c 6.5% or fasting glucose 126 mg/dl or random blood glucose > 200 mg/dl or self-reported DM history/treatment) and the association of dysglycemia with the severity of TB disease. RESULTS Among 1793 participants screened, 890 (50%) had microbiologically confirmed TB. Of these, 33% had pre-DM and 18% had DM; 41% were newly diagnosed. The median HbA1c level among newly diagnosed DM was 7.0% vs. 10.3% among known DM (P < 0.001). DM (adjusted OR [aOR] 4.94, 95%CI 2.33-10.48) and each per cent increase in HbA1c (aOR 1.42, 95%CI 1.01-2.01) was associated with >1+ smear grade or 9 days to TB detection. CONCLUSION Over half of newly diagnosed TB patients had DM or pre-DM. DM and increasing dysglycemia was associated with higher bacterial burden at TB diagnosis, potentially indicating a higher risk of TB transmission to close contacts.
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Affiliation(s)
- V Mave
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India; Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - S Meshram
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India; Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - R Lokhande
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India; Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - D Kadam
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India; Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - S Dharmshale
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India; Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - R Bharadwaj
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India; Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - A Kagal
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India; Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - N Pradhan
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - S Deshmukh
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - S Atre
- Dr D Y Patil Medical College, Pune, India
| | | | - M Barthwal
- Dr D Y Patil Medical College, Pune, India
| | - S Meshram
- Dr D Y Patil Medical College, Pune, India
| | - A Kakrani
- Dr D Y Patil Medical College, Pune, India
| | - V Kulkarni
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - S Raskar
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - N Suryavanshi
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - R Shivakoti
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - S Chon
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - E Selvin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - A Gupte
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - A Gupta
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India; Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - N Gupte
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India; Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - J E Golub
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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11
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Mave V, Nimkar S, Prasad H, Kadam D, Meshram S, Lokhande R, Gupte N, Jain D, Gupta A, Golub JE. Tuberculosis screening among persons with diabetes mellitus in Pune, India. BMC Infect Dis 2017; 17:388. [PMID: 28577535 PMCID: PMC5457599 DOI: 10.1186/s12879-017-2483-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Accepted: 05/22/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Diabetes mellitus (DM) increases tuberculosis (TB) risk, and there is increasing concern over the public health implications of the convergence of these two epidemics. Screening for TB among people with DM is now recommended in India. METHODS People with DM seeking care at a large public sector tertiary care hospital clinic in Pune, India, were screened for TB from June 2015 to May 2016. All consenting people with DM were screened for TB at each clinic visit using a five-item, WHO-recommended questionnaire and those with TB symptoms and/or risk factors were tested for active TB using sputum smear microscopty, Xpert® MTB/RIF and TB culture. Categorical data and continuous variables were summarized using descriptive statistics. The x 2 test or Wilcoxon rank-sum test was used to ascertain significant associations between categorical and continuous variables, respectively. RESULTS Among 630 adults approached for screening, median age was 60 (interquartile range (IQR), 57-64) years and 350 (56%) were females. Median hemoglobin A1c (HbA1c) was 8.7% (IQR, 6.7-9.9) and 444 (70.5%) were poorly controlled DM (HbA1c > 7). Forty-four (7%) had prior history of TB but the proportion with TB risk factors at screening was low (<5%). While 18% of participants reported any TB symptoms, none of these patients were diagnosed with culture confirmed TB. CONCLUSIONS Our study failed to yield any active TB cases using a WHO-recommended questionnaire among people with DM. High TB risk populations among people with DM must be identified if TB screening is to be feasible in settings such as India where the DM epidemic continues to rise.
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Affiliation(s)
- Vidya Mave
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, 1st Floor, Pathology Museum, Jai Prakash Narayan Road, Pune, Maharashtra, 411001, India. .,Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Smita Nimkar
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, 1st Floor, Pathology Museum, Jai Prakash Narayan Road, Pune, Maharashtra, 411001, India
| | - Haridas Prasad
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, 1st Floor, Pathology Museum, Jai Prakash Narayan Road, Pune, Maharashtra, 411001, India.,Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Dileep Kadam
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, 1st Floor, Pathology Museum, Jai Prakash Narayan Road, Pune, Maharashtra, 411001, India.,Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Sushant Meshram
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, 1st Floor, Pathology Museum, Jai Prakash Narayan Road, Pune, Maharashtra, 411001, India.,Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Rahul Lokhande
- Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Nikhil Gupte
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, 1st Floor, Pathology Museum, Jai Prakash Narayan Road, Pune, Maharashtra, 411001, India.,Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Divyashri Jain
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, 1st Floor, Pathology Museum, Jai Prakash Narayan Road, Pune, Maharashtra, 411001, India
| | - Amita Gupta
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, 1st Floor, Pathology Museum, Jai Prakash Narayan Road, Pune, Maharashtra, 411001, India.,Johns Hopkins University School of Medicine, Baltimore, MD, USA
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12
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Chandrasekaran P, Thiruvengadam K, Gupte N, Ns G, Pradhan N, Meshram S, Subramanyam B, Dhanasekaran K, Paradkar M, Bharadwaj R, Murali L, Shivakumar SVBY, Gupte A, Mave V, Gupta A. A Novel Tool to Detect Treatment Failures Early in the course of Antituberculosis treatment: Old Wine in New Bottle? Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.1951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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13
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Gupte A, Meshram S, Selvaraju S, Gupte N, Shivakumar SVBY, Paradkar M, Kohli R, Thiruvengadam K, Suryavanshi N, Chandrasekaran P, Mave V, Swaminathan S, Salvi S, Checkley W, Golub J, Gupta A. Host Factors Associated With Poor Respiratory Health-Related Quality of Life in Pulmonary Tuberculosis. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Akshay Gupte
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | - Nikhil Gupte
- Johns Hopkins University School of Medicine, Pune, MD
| | | | | | - Rewa Kohli
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | | | | | | | - Vidya Mave
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | | | | | - William Checkley
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jonathan Golub
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amita Gupta
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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14
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Shivakumar SVBY, Chandrasekaran P, Thiruvengadam K, Gupte N, Mave V, Hannah LE, Kulkarni V, Gupte A, Deluca A, N. S. G, P. S, Paradkar M, Kohli R, Meshram S, Kagal A, Suryavanshi N, Ramachandran G, Thomas B, K. DC, Subramanyam B, Golub J, Swaminathan S, Gupta A. Tuberculosis (TB) Infection Prevalence, Incidence and Risk Factors Among Child and Adult Household Contacts of Adult TB Cases in India. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | - Nikhil Gupte
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vidya Mave
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - Akshay Gupte
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Gomathy N. S.
- National Institute for Research in Tuberculosis, Chennai, India
| | - Sathyamurthi P.
- National Institute for Research in Tuberculosis, Chennai, India
| | | | - Rewa Kohli
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | | | - Anju Kagal
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | | | | | - Beena Thomas
- National Institute for Research in Tuberculosis, Chennai, India
| | - Dolla C. K.
- National Institute for Research in Tuberculosis, Chennai, India
| | | | - Jonathan Golub
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Amita Gupta
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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15
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Chandrasekaran P, Mave V, Thiruvengadam K, Meshram S, Gupte N, Hannah LE, Swaminathan S, Gupta A. Household Contact Tracing of Adult Pulmonary Tuberculosis (TB) Patients in India: Prevalence of TB disease and Infection. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Vidya Mave
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - Nikhil Gupte
- Johns Hopkins University School of Medicine, Pune, MD
| | | | | | - Amita Gupta
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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16
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Gupte A, Padmapriyadarsini C, Mave V, Kadam D, Suryavanshi N, Shivakumar SVBY, Kohli R, Gupte N, Thiruvengadam K, Kagal A, Meshram S, Bharadwaj R, Khadse S, Ramachandran G, Hanna LE, Pradhan N, Gomathy NS, DeLuca A, Gupta A, Swaminathan S. Cohort for Tuberculosis Research by the Indo-US Medical Partnership (CTRIUMPH): protocol for a multicentric prospective observational study. BMJ Open 2016; 6:e010542. [PMID: 26916698 PMCID: PMC4769396 DOI: 10.1136/bmjopen-2015-010542] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Tuberculosis disease (TB) remains an important global health threat. An evidence-based response, tailored to local disease epidemiology in high-burden countries, is key to controlling the global TB epidemic. Reliable surrogate biomarkers that predict key active disease and latent TB infection outcomes are vital to advancing clinical research necessary to 'End TB'. Well executed longitudinal studies strengthening local research capacity for addressing TB research priorities and advancing biomarker discovery are urgently needed. METHODS AND ANALYSIS The Cohort for Tuberculosis Research by the Indo-US Medical Partnership (CTRIUMPH) study conducted in Byramjee Jeejeebhoy Government Medical College (BJGMC), Pune and National Institute for Research in Tuberculosis (NIRT), Chennai, India, will establish and maintain three prospective cohorts: (1) an Active TB Cohort comprising 800 adults with pulmonary TB, 200 adults with extrapulmonary TB and 200 children with TB; (2) a Household Contact Cohort of 3200 adults and children at risk of developing active disease; and (3) a Control Cohort consisting of 300 adults and 200 children with no known exposure to TB. Relevant clinical, sociodemographic and psychosocial data will be collected and a strategic specimen repository established at multiple time points over 24 months of follow-up to measure host and microbial factors associated with (1) TB treatment outcomes; (2) progression from infection to active TB disease; and (3) Mycobacterium tuberculosis transmission among Indian adults and children. We anticipate CTRIUMPH to serve as a research platform necessary to characterise some relevant aspects of the TB epidemic in India, generate evidence to inform local and global TB control strategies and support novel TB biomarker discovery. ETHICS AND DISSEMINATION This study is approved by the Institutional Review Boards of NIRT, BJGMC and Johns Hopkins University, USA. Study results will be disseminated through peer-reviewed journals and research conferences. FUNDING NIH/DBT Indo-US Vaccine Action Programme and the Indian Council of Medical Research.
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Affiliation(s)
- Akshay Gupte
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Vidya Mave
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Johns Hopkins Clinical Trials Unit, Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Dileep Kadam
- Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Nishi Suryavanshi
- Johns Hopkins Clinical Trials Unit, Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | | | - Rewa Kohli
- Johns Hopkins Clinical Trials Unit, Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Nikhil Gupte
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Johns Hopkins Clinical Trials Unit, Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | | | - Anju Kagal
- Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Sushant Meshram
- Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Renu Bharadwaj
- Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Sandhya Khadse
- Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | | | | | - Neeta Pradhan
- Johns Hopkins Clinical Trials Unit, Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - N S Gomathy
- National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Andrea DeLuca
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Amita Gupta
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Taksande A, Gadekar A, Meshram S, Pathak S. Cor triatriatum sinister with situs inversus totalis in an infant. Images Paediatr Cardiol 2012; 14:6-10. [PMID: 23720687 PMCID: PMC3663153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Cor triatriatum sinister is a rare congenital cardiac malformation characterized by a membrane in the left atrium which separates the left atrium into the proximal and distal chambers. Association of cor triatriatum is extremely rare with situs inversus totalis. Here we report a rare case of cor triatriatum sinister with situs inversus totalis in a 5 month old female infant.
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Affiliation(s)
- A Taksande
- Department of Pediatrics, Jawaharlal Nehru Medical College, Sawangi Meghe, Wardha, Maharashtra -442102.,
A Taksande
| | - A Gadekar
- Department of Pediatrics, Jawaharlal Nehru Medical College, Sawangi Meghe, Wardha, Maharashtra -442102
| | - S Meshram
- Department of Pediatrics, Jawaharlal Nehru Medical College, Sawangi Meghe, Wardha, Maharashtra -442102
| | - S Pathak
- Department of Pediatrics, Jawaharlal Nehru Medical College, Sawangi Meghe, Wardha, Maharashtra -442102
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Prakash S, Meshram S, Ramtekkar U. Athletes, yogis and individuals with sedentary lifestyles; do their lung functions differ? Indian J Physiol Pharmacol 2007; 51:76-80. [PMID: 17877296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Buffalo health study concluded that pulmonary function is a long-term predictor for overall survival rates. It is essential to be involved in physical activity or sports which help in achieving better lung function. Cross sectional observation study was conducted to determine if yoga and athletic activity (running) are associated with better lung functions as compared to subjects with sedentary lifestyles and how does athletes and yogis differ in lung function. Spirometric parameters were assessed in randomly selected 60 healthy male, non-smoking; non-obese subjects-athletes, yogis and sedentary workers. The groups differed significantly in FEV1 and PEFR. The highest mean FEV1 and PEFR were observed in yogis. Both yogis and athletes had significantly better FEV1 as compared to sedentary workers. Yogis also had significantly better PEFR as compared to sedentary workers and athletes. Yogis and athletes had similar lung functions except for better PEFR amongst yogis. Involvement in daily physical activity or sport preferably yoga can help in achieving better pulmonary function.
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