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Gupta Y, Kapoor D, Lakshmi JK, Praveen D, Santos JA, Billot L, Naheed A, de Silva HA, Gupta I, Farzana N, John R, Ajanthan S, Bhatla N, Desai A, Pathmeswaran A, Prabhakaran D, Teede H, Zoungas S, Patel A, Tandon N. Antenatal oral glucose tolerance test abnormalities in the prediction of future risk of postpartum diabetes in women with gestational diabetes: Results from the LIVING study. J Diabetes 2024; 16:e13559. [PMID: 38708437 PMCID: PMC11070840 DOI: 10.1111/1753-0407.13559] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/27/2024] [Accepted: 03/19/2024] [Indexed: 05/07/2024] Open
Abstract
OBJECTIVES To explore associations between type and number of abnormal glucose values on antenatal oral glucose tolerance test (OGTT) with postpartum diabetes in South Asian women diagnosed with gestational diabetes (GDM) using International Association of the Diabetes and Pregnancy Study Groups criteria. METHODS This post-hoc evaluation of the Lifestyle Intervention IN Gestational Diabetes (LIVING) study, a randomized controlled trial, was conducted among women with GDM in the index pregnancy, across 19 centers in Bangladesh, India, and Sri Lanka. Postpartum diabetes (outcome) was defined on OGTT, using American Diabetes Association (ADA) criteria. RESULTS We report data on 1468 women with GDM, aged 30.9 (5.0) years, and with median (interquartile range) follow-up period of 1.8 (1.4-2.4) years after childbirth following the index pregnancy. We found diabetes in 213 (14.5%) women with an incidence of 8.7 (7.6-10.0)/100 women-years. The lowest incidence rate was 3.8/100 women years, in those with an isolated fasting plasma glucose (FPG) abnormality, and highest was 19.0/100 women years in participants with three abnormal values. The adjusted hazard ratios for two and three abnormal values compared to one abnormal value were 1.73 (95% confidence interval [CI], 1.18-2.54; p = .005) and 3.56 (95% CI, 2.46-5.16; p < .001) respectively. The adjusted hazard ratio for the combined (combination of fasting and postglucose load) abnormalities was 2.61 (95% CI, 1.70-4.00; p < .001), compared to isolated abnormal FPG. CONCLUSIONS Risk of diabetes varied significantly depending upon the type and number of abnormal values on antenatal OGTT. These data may inform future precision medicine approaches such as risk prediction models in identifying women at higher risk and may guide future targeted interventions.
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Affiliation(s)
- Yashdeep Gupta
- Department of Endocrinology and MetabolismAll India Institute of Medical SciencesNew DelhiIndia
| | - Deksha Kapoor
- Department of Endocrinology and MetabolismAll India Institute of Medical SciencesNew DelhiIndia
| | - Josyula K. Lakshmi
- George Institute for Global HealthHyderabadIndia
- Faculty of Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
- Prasanna School of Public HealthManipal Academy of Higher EducationManipalIndia
| | - Devarsetty Praveen
- George Institute for Global HealthHyderabadIndia
- Faculty of Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
- Prasanna School of Public HealthManipal Academy of Higher EducationManipalIndia
| | | | - Laurent Billot
- Faculty of Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
- George Institute for Global HealthSydneyNew South WalesAustralia
| | - Aliya Naheed
- Initiative for Non Communicable Diseases, Nutrition Research DivisionInternational Centre for Diarrhoeal Disease Research (ICDDR, B)DhakaBangladesh
| | - H. Asita de Silva
- Clinical Trials Unit, Department of Pharmacology, Faculty of MedicineUniversity of KelaniyaKelaniyaSri Lanka
| | - Ishita Gupta
- Centre for Chronic Disease ControlNew DelhiIndia
| | - Noshin Farzana
- Initiative for Non Communicable Diseases, Nutrition Research DivisionInternational Centre for Diarrhoeal Disease Research (ICDDR, B)DhakaBangladesh
| | - Renu John
- George Institute for Global HealthHyderabadIndia
| | | | - Neerja Bhatla
- Department of Obstetrics and GynaecologyAll India Institute of Medical SciencesNew DelhiIndia
| | - Ankush Desai
- Department of EndocrinologyGoa Medical CollegeGoaIndia
| | | | - Dorairaj Prabhakaran
- Centre for Chronic Disease ControlNew DelhiIndia
- Public Health Foundation of IndiaNew DelhiIndia
- London School of Hygiene and Tropical MedicineLondonUK
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Sophia Zoungas
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Anushka Patel
- Faculty of Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
- George Institute for Global HealthSydneyNew South WalesAustralia
| | - Nikhil Tandon
- Department of Endocrinology and MetabolismAll India Institute of Medical SciencesNew DelhiIndia
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Gupta Y, Kapoor D, Lakshmi JK, Praveen D, Santos JA, Billot L, Naheed A, de Silva HA, Gupta I, Farzana N, John R, Ajanthan S, Bhatla N, Desai A, Pathmeswaran A, Prabhakaran D, Teede H, Zoungas S, Patel A, Tandon N. The incidence and risk factors of postpartum diabetes in women from Bangladesh, India and Sri Lanka (South Asia) with prior gestational diabetes mellitus: Results from the LIVING study. Diabetes Res Clin Pract 2023; 204:110893. [PMID: 37657646 DOI: 10.1016/j.diabres.2023.110893] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 08/24/2023] [Accepted: 08/30/2023] [Indexed: 09/03/2023]
Abstract
AIM To study, the incidence and risk factors for postpartum diabetes (DM), in women with gestational diabetes mellitus (GDM) from South Asia (Bangladesh, India and Sri Lanka), followed for nearly two years after delivery. METHODS Women with prior GDM diagnosed using IADPSG criteria were invited at 19 centres across Bangladesh, India and Sri Lanka for an oral glucose tolerance test (OGTT) following childbirth, and were enrolled in a randomized controlled trial. The glycaemic category (outcome) was defined from an OGTT based on American Diabetes Association criteria. RESULTS Participants (n = 1808) recruited had a mean ± SD age of 31.0 ± 5.0 years. Incident DM was identified, between childbirth and the last follow-up, in 310 (17.1 %) women [incidence 10.75/100 person years], with a median follow-up duration of 1.82 years after childbirth. Higher age, lower education status, higher prior pregnancy count, prior history of GDM, family history of DM, and postpartum overweight/obese status were significantly associated with incident DM. Women in Bangladesh had a higher cumulative incidence of DM [16.49/100 person years] than in Sri Lanka [12.74/100 person years] and India [7.21/100 person years]. CONCLUSIONS A high incidence of DM was found in women with prior GDM in South Asia, with significant variation between countries. Women from Bangladesh had a significantly higher pregnancy count, family history of DM and overweight/obese status, despite having significantly lower age, which could be responsible for their higher rates of DM. Registration of this study: The study was registered with the Clinical Trials Registry of India (CTRI/2017/06/008744), Sri Lanka Clinical Trials Registry (SLCTR/2017/001), and ClinicalTrials.gov (NCT03305939).
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Affiliation(s)
- Yashdeep Gupta
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India.
| | - Deksha Kapoor
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Josyula K Lakshmi
- George Institute for Global Health, Hyderabad, India; Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Devarsetty Praveen
- George Institute for Global Health, Hyderabad, India; Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | | | - Laurent Billot
- Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; George Institute for Global Health, Sydney, Australia
| | - Aliya Naheed
- Initiative for Non Communicable Diseases, Nutrition Research Division, International Centre for Diarrhoeal Disease Research (ICDDR, B), Dhaka, Bangladesh
| | - H Asita de Silva
- Clinical Trials Unit, Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Ishita Gupta
- Centre for Chronic Disease Control, New Delhi, India
| | - Noshin Farzana
- Initiative for Non Communicable Diseases, Nutrition Research Division, International Centre for Diarrhoeal Disease Research (ICDDR, B), Dhaka, Bangladesh
| | - Renu John
- George Institute for Global Health, Hyderabad, India
| | | | - Neerja Bhatla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Ankush Desai
- Department of Endocrinology, Goa Medical College, Goa, India
| | | | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India; Public Health Foundation of India, New Delhi, India; London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Anushka Patel
- Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; George Institute for Global Health, Sydney, Australia
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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Sidhu SS, Dusseja A, Shalimar, Nijhawan S, Kapoor D, Goyal O, Kishore H. A multicenter double-blind, placebo-controlled randomized trial to evaluate the safety and efficacy of bovine colostrum in the treatment of severe alcoholic hepatitis (SAH). Trials 2023; 24:515. [PMID: 37568158 PMCID: PMC10416362 DOI: 10.1186/s13063-023-07505-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 07/11/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Severe alcoholic hepatitis (SAH) is associated with high mortality. Numerous studies and meta-analysis have reported that corticosteroids reduce the 28-day mortality in SAH, but not the 6-month mortality. Therefore, newer treatments for SAH need to be studied. A pilot study from our group had recently treated ten patients with SAH with bovine colostrum (BC) [20 g thrice in a day for 8 weeks] and prednisolone. This therapy improved the biological functions and 3-month mortality. However, as more and more data showed the failure of corticosteroids to improve the 3- and 6-month mortality, especially in patients with high mDF and MELD scores, we planned this trial to study the safety and efficacy of BC (without corticosteroids) in the treatment of SAH. METHOD This is a multicenter, parallel, double-blind, randomized (1:1) placebo-controlled trial, which will enroll 174 patients with SAH from 5 academic centers in the India. Patients will receive freeze-dried BC or placebo by random 1:1 allocation for 4 weeks. The primary outcome measure is survival at 3 months. The secondary outcome measures are survival at 1 month, change in mDF and MELD scores, change in endotoxin and cytokines (alpha TNF, IL6, and IL8) levels, number of episodes of sepsis [pneumonia, spontaneous bacterial peritonitis (SBP), cellulitis, urinary tract infection (UTI)] from baseline to 4 weeks. DISCUSSION This study will evaluate the safety and efficacy of bovine colostrum in improving the survival of patients with SAH. TRIAL REGISTRATION ClinicalTrials.gov NCT02473341. Prospectively registered on June 16, 2015.
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Affiliation(s)
- S S Sidhu
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
| | - A Dusseja
- Department of Hepatology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Shalimar
- Department of Gastroenterology & Human Nutrition Unit, All India Institute of Medical Sciences, Delhi, India
| | - S Nijhawan
- Department of Gastroenterology, Sawai Man Singh Hospital, Jaipur, India
| | - D Kapoor
- Department of Hepatology, Global Hospital, Hyderabad, India
| | - O Goyal
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - H Kishore
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Atneriya U, Kapoor D, Sainy J, Maheshwari R. In vitro profiling of fenofibrate solid dispersion mediated tablet formulation to treat high blood cholesterol. Ann Pharm Fr 2023; 81:284-299. [PMID: 36037932 DOI: 10.1016/j.pharma.2022.08.009] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 08/02/2022] [Accepted: 08/23/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Fenofibrate (FNF), an anti-hyperlipidemic agent, suffers from poor water solubility (0.000707mg/ml) and belongs to class II drug as per BCS, shows a slow dissolution rate. The current investigation aimed to fabricate a fast-dissolving tablet of FNF (not available in the commercial market) using solid dispersion technique employing Vitamin E-D-α-Tocopheryl polyethylene glycol 1000 succinate (vitamin E TPGS) as molecular biomaterial to enhance dissolution rate and reduce the time required to reach the systemic circulation. MATERIALS AND METHODS Firstly, carrier material was selected based on the release study via preparing solid dispersion using the melting method, and prepared solid dispersion was characterized. Secondly, fast-dissolving tablets from solid dispersion were fabricated using the direct compression tool and characterized for X-ray diffraction (XRD) pattern, friability, hardness, content uniformity, weight variation and in vitro disintegration test. RESULTS The X-ray diffraction study confirmed the successful formation of solid dispersion using vitamin E TPGS by analyzing the change in physical state. The fabricated solid dispersion exhibited higher drug content than a physical mixture of FNF. An excipient interference study was also performed in methanol and 0.75% w/v sodium lauryl sulphate. It revealed no significant alterations in the absorption peak of FNF as analyzed using UV spectroscopy at 287nm. In addition, water absorption ratio phase solubility and wetting time were also assessed. In -vitro release of FNF from developed tablets was found significantly higher (93.23%±3.11; p<0.001) as compared to prepared compressed tablet of pure FNF (12.21±2.34%). The dissolution rate was also determined, and data were then kept to various kinetic models such as zero-order chemical kinetic, first-order chemical kinetic, Hixon-Crowell and Higuchi chemical kinetic. CONCLUSION A complete and sequential in vitro and physicochemical characterization of developed formulation was carried out to set-up improved and effective treatment for high blood cholesterol.
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Affiliation(s)
- U Atneriya
- School of Pharmacy Devi Ahilya Vishwavidhylaya, 452020 Indore, India
| | - D Kapoor
- Dr. Dayaram Patel Pharmacy College, SardarBaug, Station Road, 394601 Bardoli, Gujarat, India
| | - J Sainy
- School of Pharmacy Devi Ahilya Vishwavidhylaya, 452020 Indore, India
| | - R Maheshwari
- School of Pharmacy and Technology Management, SVKM'S NMIMS, Green Pharma Industrial Park, TSIIC, Jadcherla, 509301 Hyderabad, India.
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Shivashankar R, Singh K, Kondal D, Gupta R, Perel P, Kapoor D, Jindal D, Mohan S, Pradeepa R, Jarhyan P, Venkateshmurthy NS, Tandon N, Mohan V, Narayan KMV, Prabhakaran D, Ali MK. Correction: Cardiovascular Health in India - a Report Card from Three Urban and Rural Surveys of 22,144 Adults. Glob Heart 2022; 17:68. [PMID: 36199566 PMCID: PMC9504161 DOI: 10.5334/gh.1158] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 09/08/2022] [Indexed: 11/05/2022] Open
Abstract
[This corrects the article DOI: 10.5334/gh.1137.].
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Affiliation(s)
- Roopa Shivashankar
- Indian Council of Medical Research (ICMR), New Delhi, IN
- Centre for Chronic Disease Control (CCDC), New Delhi, IN
| | - Kalpana Singh
- Centre for Chronic Disease Control (CCDC), New Delhi, IN
- Hamad Medical Corporation, Doha, QA
| | - Dimple Kondal
- Centre for Chronic Disease Control (CCDC), New Delhi, IN
- Public Health Foundation of India (PHFI), New Delhi, IN
| | - Ruby Gupta
- Centre for Chronic Disease Control (CCDC), New Delhi, IN
- Public Health Foundation of India (PHFI), New Delhi, IN
| | - Pablo Perel
- London School of Hygiene and Tropical Medicine (LSHTM), London, GB
| | - Deksha Kapoor
- All India Institute of Medical Sciences (AIIMS), New Delhi, IN
- Global Academy of Agriculture and Food Systems, University of Edinburgh, Edinburgh, GB
| | - Devraj Jindal
- Centre for Chronic Disease Control (CCDC), New Delhi, IN
| | - Sailesh Mohan
- Centre for Chronic Disease Control (CCDC), New Delhi, IN
- Public Health Foundation of India (PHFI), New Delhi, IN
- Deakin University, Melbourne, AU
| | | | | | | | - Nikhil Tandon
- All India Institute of Medical Sciences (AIIMS), New Delhi, IN
| | | | - K. M. Venkat Narayan
- Rollins School of Public Health & Emory Global Diabetes Research Center, Emory University, Atlanta, US
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control (CCDC), New Delhi, IN
- Public Health Foundation of India (PHFI), New Delhi, IN
- Rollins School of Public Health, Emory University, Atlanta, US
| | - Mohammed K. Ali
- Rollins School of Public Health & Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, US
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Shivashankar R, Singh K, Kondal D, Gupta R, Perel P, Kapoor D, Jindal D, Mohan S, Pradeepa R, Jarhyan P, Srinivasapura Venkateshmurthy N, Tandon N, Mohan V, Venkat Narayan KM, Prabhakaran D, Ali MK. Cardiovascular Health in India - a Report Card from Three Urban and Rural Surveys of 22,144 Adults. Glob Heart 2022; 17:52. [PMID: 36051326 PMCID: PMC9354560 DOI: 10.5334/gh.1137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/12/2022] [Indexed: 11/20/2022] Open
Abstract
Background Markers of ideal cardiovascular health (CVH) predict cardiovascular events. We estimated the prevalence of ideal CVH markers in two levels of cities and villages in India. Methods We did pooled analysis of individual-level data from three cross sectional surveys of adults ≥ 30 years over 2010-14 (CARRS: Centre for cArdiometabolic Risk Reduction in South Asia; UDAY and Solan Surveillance Study) representing metropolitan cities; smaller cities and rural areas in diverse locations of India. We defined ideal CVH using modified American Heart Association recommendations: not smoking, ≥ 5 servings of fruits and vegetables (F&V), high physical activity (PA), body mass index (BMI) <25 Kg/m2, blood pressure (BP) <120/80 mm Hg, fasting plasma glucose (FPG) <100 mg/dl, and total cholesterol (TC) <200 mg/dL. We estimated (1) age-and sex-standardized prevalence of ideal CVH and (2) prevalence of good (≥6 markers), moderate (4-5), and poor CVH (≤3) adjusted for age, sex, education, and stratified by setting and asset tertiles. Results Of the total 22,144 participants, the prevalence of ideal CVH markers were: not smoking (76.7% [95% CI 76.1, 77.2]), consumed ≥5 F&V (4.2% [3.9, 4.5]), high PA (67.5% [66.8, 68.2]), optimum BMI (59.6% [58.9, 60.3]), ideal BP (34.5% [33.9, 35.2]), FPG (65.8% [65.1, 66.5]) and TC (65.4% [64.7, 66.1]). The mean number of ideal CVH metrics was 3.7(95% CI: 3.7, 3.8). Adjusted prevalence of good, moderate, and poor CVH, varied across settings: metropolitan (3.9%, 41.0%, and 55.1%), smaller cities (7.8%, 49.2%, and 43%), and rural (10.4%, 60.9%, and 28.7%) and across asset tertiles: Low (11.0%, 55.9%, 33.1%), Middle (6.3%, 52.2%, 41.5%), and High (5.0%, 46.4%, 48.7%), respectively. Conclusion Achievement of ideal CVH varied, with higher prevalence in rural and lower asset tertiles. Multi-sectoral and targeted policy and program actions are needed to improve CVH in diverse contexts in India.
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Affiliation(s)
- Roopa Shivashankar
- Indian Council of Medical Research (ICMR), New Delhi, IN
- Centre for Chronic Disease Control (CCDC), New Delhi, IN
| | - Kalpana Singh
- Centre for Chronic Disease Control (CCDC), New Delhi, IN
- Hamad Medical Corporation, Doha, QA
| | - Dimple Kondal
- Centre for Chronic Disease Control (CCDC), New Delhi, IN
- Public Health Foundation of India (PHFI), New Delhi, IN
| | - Ruby Gupta
- Centre for Chronic Disease Control (CCDC), New Delhi, IN
- Public Health Foundation of India (PHFI), New Delhi, IN
| | - Pablo Perel
- London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Deksha Kapoor
- All India Institute of Medical Sciences (AIIMS), New Delhi, IN
- Global Academy of Agriculture and Food Systems, University of Edinburgh, Edinburgh, UK
| | - Devraj Jindal
- Centre for Chronic Disease Control (CCDC), New Delhi, IN
| | - Sailesh Mohan
- Centre for Chronic Disease Control (CCDC), New Delhi, IN
- Public Health Foundation of India (PHFI), New Delhi, IN
- Deakin University, Melbourne, AUS
| | | | | | | | - Nikhil Tandon
- All India Institute of Medical Sciences (AIIMS), New Delhi, IN
| | | | - K. M. Venkat Narayan
- Rollins School of Public Health & Emory Global Diabetes Research Center, Emory University, Atlanta, US
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control (CCDC), New Delhi, IN
- Public Health Foundation of India (PHFI), New Delhi, IN
- Rollins School of Public Health, Emory University, Atlanta, US
| | - Mohammed K. Ali
- Rollins School of Public Health & Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, US
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Tandon N, Gupta Y, Kapoor D, Lakshmi JK, Praveen D, Bhattacharya A, Billot L, Naheed A, de Silva A, Gupta I, Farzana N, John R, Ajanthan S, Divakar H, Bhatla N, Desai A, Pathmeswaran A, Prabhakaran D, Joshi R, Jan S, Teede H, Zoungas S, Patel A. Effects of a Lifestyle Intervention to Prevent Deterioration in Glycemic Status Among South Asian Women With Recent Gestational Diabetes: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e220773. [PMID: 35234881 PMCID: PMC8892226 DOI: 10.1001/jamanetworkopen.2022.0773] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE Women with recent gestational diabetes (GDM) have increased risk of developing type 2 diabetes. OBJECTIVE To investigate whether a resource-appropriate and context-appropriate lifestyle intervention could prevent glycemic deterioration among women with recent GDM in South Asia. DESIGN, SETTING, AND PARTICIPANTS This randomized, participant-unblinded controlled trial investigated a 12-month lifestyle intervention vs usual care at 19 urban hospitals in India, Sri Lanka, and Bangladesh. Participants included women with recent diagnosis of GDM who did not have type 2 diabetes at an oral glucose tolerance test (OGTT) 3 to 18 months postpartum. They were enrolled from November 2017 to January 2020, and follow-up ended in January 2021. Data were analyzed from April to July 2021. INTERVENTIONS A 12-month lifestyle intervention focused on diet and physical activity involving group and individual sessions, as well as remote engagement, adapted to local context and resources. This was compared with usual care. MAIN OUTCOMES AND MEASURES The primary outcome was worsening category of glycemia based on OGTT using American Diabetes Association criteria: (1) normal glucose tolerance to prediabetes (ie, impaired fasting glucose or impaired glucose tolerance) or type 2 diabetes or (2) prediabetes to type 2 diabetes. The primary analysis consisted of a survival analysis of time to change in glycemic status at or prior to the final patient visit, which occurred at varying times after 12 months for each patient. Secondary outcomes included new-onset type 2 diabetes and change in body weight. RESULTS A total of 1823 women (baseline mean [SD] age, 30.9 [4.9] years and mean [SD] body mass index, 26.6 [4.6]) underwent OGTT at a median (IQR) 6.5 (4.8-8.2) months postpartum. After excluding 160 women (8.8%) with type 2 diabetes, 2 women (0.1%) who met other exclusion criteria, and 49 women (2.7%) who did not consent or were uncontactable, 1612 women were randomized. Subsequently, 11 randomized participants were identified as ineligible and excluded from the primary analysis, leaving 1601 women randomized (800 women randomized to the intervention group and 801 women randomized to usual care). These included 600 women (37.5%) with prediabetes and 1001 women (62.5%) with normoglycemia. Among participants randomized to the intervention, 644 women (80.5%) received all program content, although COVID-19 lockdowns impacted the delivery model (ie, among 644 participants who engaged in all group sessions, 476 women [73.9%] received some or all content through individual engagement, and 315 women [48.9%] received some or all content remotely). After a median (IQR) 14.1 (11.4-20.1) months of follow-up, 1308 participants (81.2%) had primary outcome data. The intervention, compared with usual care, did not reduce worsening glycemic status (204 women [25.5%] vs 217 women [27.1%]; hazard ratio, 0.92; [95% CI, 0.76-1.12]; P = .42) or improve any secondary outcome. CONCLUSIONS AND RELEVANCE This study found that a large proportion of women in South Asian urban settings developed dysglycemia soon after a GDM-affected pregnancy and that a lifestyle intervention, modified owing to the COVID-19 pandemic, did not prevent subsequent glycemic deterioration. These findings suggest that alternate or additional approaches are needed, especially among high-risk individuals. TRIAL REGISTRATION Clinical Trials Registry of India Identifier: CTRI/2017/06/008744; Sri Lanka Clinical Trials Registry Identifier: SLCTR/2017/001; and ClinicalTrials.gov Identifier: NCT03305939.
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Affiliation(s)
- Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Yashdeep Gupta
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Deksha Kapoor
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Josyula K. Lakshmi
- George Institute for Global Health, New Delhi, India
- Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Devarsetty Praveen
- Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
- George Institute for Global Health, Hyderabad, India
| | | | - Laurent Billot
- Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Aliya Naheed
- Initiative for Noncommunicable Diseases, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research (ICDDR, B), Dhaka, Bangladesh
| | - Asita de Silva
- Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Ishita Gupta
- Centre for Chronic Disease Control, New Delhi, India
| | - Noshin Farzana
- Initiative for Noncommunicable Diseases, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research (ICDDR, B), Dhaka, Bangladesh
| | - Renu John
- George Institute for Global Health, Hyderabad, India
| | | | | | - Neerja Bhatla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Ankush Desai
- Department of Medicine, Goa Medical College, Goa, India
| | | | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India
- Public Health Foundation of India, New Delhi, India
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rohina Joshi
- Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Stephen Jan
- Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Anushka Patel
- Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
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Kondal D, Patel SA, Ali MK, Mohan D, Rautela G, Gujral UP, Shivashankar R, Anjana RM, Gupta R, Kapoor D, Vamadevan AS, Mohan S, Kadir MM, Mohan V, Tandon N, Prabhakaran D, Narayan KMV. Cohort Profile: The Center for cArdiometabolic Risk Reduction in South Asia (CARRS). Int J Epidemiol 2022; 51:e358-e371. [PMID: 35138386 PMCID: PMC9749725 DOI: 10.1093/ije/dyac014] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 01/28/2022] [Indexed: 01/21/2023] Open
Affiliation(s)
- Dimple Kondal
- Public Health Foundation of India, New Delhi, India,Centre for Chronic Disease Control, New Delhi, India
| | - Shivani A Patel
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Mohammed K Ali
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Deepa Mohan
- Madras Diabetes Research Foundation, Chennai, India
| | | | - Unjali P Gujral
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | | | - Ruby Gupta
- Public Health Foundation of India, New Delhi, India
| | - Deksha Kapoor
- All India Institute of Medical Sciences, New Delhi, India
| | - Ajay S Vamadevan
- Centre for Chronic Disease Control, New Delhi, India,Healthcare management, Goa Institute of Management, Sanquelim, Goa, India
| | | | | | | | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
| | - Dorairaj Prabhakaran
- Corresponding author. Public Health Foundation of India, Plot no 47, Sector 44, Gurgaon, Haryana 122002, India. E-mail:
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Kapoor D, Ramavat AS, Mehndiratta M, Agrawal A, Arora V, Goel A. Impact of coronavirus disease 2019 on ENT clinical practice and training: the resident's perspective. J Laryngol Otol 2021; 135:1-5. [PMID: 34612181 PMCID: PMC8523968 DOI: 10.1017/s0022215121002814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The arrival of the coronavirus disease 2019 pandemic disrupted life suddenly and forcefully, and healthcare systems around the world are still struggling to come to terms with it. This paper reviews the impact of the pandemic on ENT practice and training. METHODS The present manuscript was developed as a narrative review to examine the role of otorhinolaryngologists in the management of the pandemic, and assess its impact on practice and training in the specialty. RESULTS Otorhinolaryngologists handle secretions of organs implicated in disease transmission, leaving them particularly vulnerable even while performing simple procedures. Although the pandemic increased skill expectations, it simultaneously reduced learning opportunities for trainees. In addition, attention to emergencies has been delayed. Further, the suspension of elective procedures has affected patients with malignancies. CONCLUSION While planning service resumption, provisions need to be made for protective equipment and training; improving teleconsultation services will help provide sustainable care during further waves.
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Affiliation(s)
- D Kapoor
- Department of ENT and Head and Neck Surgery, University College of Medical Sciences, Guru Teg Bahadur Hospital, Delhi, India
| | - A S Ramavat
- Department of Otorhinolaryngology, and Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - A Agrawal
- Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - V Arora
- Department of ENT and Head and Neck Surgery, University College of Medical Sciences, Guru Teg Bahadur Hospital, Delhi, India
| | - A Goel
- Department of Medicine, University College of Medical Sciences, Guru Teg Bahadur Hospital, Delhi, India
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Shanthosh J, Kapoor D, Josyula LK, Patel A, Gupta Y, Tandon N, Jan S, Teede HJ, Desai A, Joshi R, Praveen D. Lifestyle InterVention IN Gestational diabetes (LIVING) in India, Bangladesh and Sri Lanka: protocol for process evaluation of a randomised controlled trial. BMJ Open 2020; 10:e037774. [PMID: 33318108 PMCID: PMC7737084 DOI: 10.1136/bmjopen-2020-037774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 07/31/2020] [Accepted: 09/23/2020] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION The development of type 2 diabetes mellitus disproportionately affects South Asian women with prior gestational diabetes mellitus (GDM). The Lifestyle InterVention IN Gestational diabetes (LIVING) Study is a randomised controlled trial of a low-intensity lifestyle modification programme tailored to women with previous GDM, in India, Bangladesh and Sri Lanka, aimed at preventing diabetes/pre-diabetes. The aim of this process evaluation is to understand what worked, and why, during the LIVING intervention implementation, and to provide additional data that will assist in the interpretation of the LIVING Study results. The findings will also inform future scale-up efforts if the intervention is found to be effective. METHODS AND ANALYSIS The Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) methodological approach informed the evaluation framework. Michie's Behaviour Change Theory and Normalisation Process Theory were used to guide the design of our qualitative evaluation tools within the overall RE-AIM evaluation framework. Mixed methods including qualitative interviews, focus groups and quantitative analyses will be used to evaluate the intervention from the perspectives of the women receiving the intervention, facilitators, site investigators and project management staff. The evaluation will use evaluation datasets, administratively collected process data accessed during monitoring visits, check lists and logs, quantitative participant evaluation surveys, semistructured interviews and focus group discussions. Interview participants will be recruited using maximum variation purposive sampling. We will undertake thematic analysis of all qualitative data, conducted contemporaneously with data collection until thematic saturation has been achieved. To triangulate data, the analysis team will engage in constant iterative comparison among data from various stakeholders. ETHICS AND DISSEMINATION Ethics approval has been obtained from the respective human research ethics committees of the All India Institute of Medical Sciences, New Delhi, India; University of Sydney, New South Wales, Australia; and site-specific approval at each local site in the three countries: India, Bangladesh and Sri Lanka. This includes approvals from the Institutional Ethics Committee at King Edwards Memorial Hospital, Maharaja Agrasen Hospital, Centre for Disease Control New Delhi, Goa Medical College, Jawaharlal Institute of Postgraduate Medical Education and Research, Madras Diabetes Research Foundation, Christian Medical College Vellore, Fernandez Hospital Foundation, Castle Street Hospital for Women, University of Kelaniya, Topiwala National Medical College and BYL Nair Charitable Hospital, Birdem General Hospital and the International Centre for Diarrhoeal Disease Research. Findings will be documented in academic publications, presentations at scientific meetings and stakeholder workshops. TRIAL REGISTRATION NUMBERS Clinical Trials Registry of India (CTRI/2017/06/008744); Sri Lanka Clinical Trials Registry (SLCTR/2017/001) and ClinicalTrials.gov Registry (NCT03305939); Pre-results.
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Affiliation(s)
- Janani Shanthosh
- Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Deksha Kapoor
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Lakshmi K Josyula
- Division of Epidemiology, The George Institute for Global Health, Hyderabad, India
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Prasanna School of Public Health, MAHE, Manipal, India
| | - Anushka Patel
- Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Yashdeep Gupta
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Stephen Jan
- Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Victoria, Australia
| | - Ankush Desai
- Endocrine Unit, Department of Medicine, Goa Medical College, Goa, India
| | - Rohina Joshi
- Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Devarsetty Praveen
- Division of Epidemiology, The George Institute for Global Health, Hyderabad, India
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Prasanna School of Public Health, MAHE, Manipal, India
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Tewari A, Praveen D, Madhira P, Josyula LK, Joshi R, Kokku SB, Garg V, Rawal I, Chopra K, Chakma N, Ahmed S, Pathmeswaran A, Godamunne P, Lata AS, Sahay R, Patel T, Gupta Y, Tandon N, Naheed A, Patel A, Kapoor D. Feasibility of a Lifestyle Intervention Program for Prevention of Diabetes Among Women With Prior Gestational Diabetes Mellitus (LIVING Study) in South Asia: A Formative Research Study. Front Glob Womens Health 2020; 1:587607. [PMID: 34816163 PMCID: PMC8594035 DOI: 10.3389/fgwh.2020.587607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 11/03/2020] [Indexed: 12/14/2022] Open
Abstract
Aim: To refine and contextually adapt a postpartum lifestyle intervention for prevention of type 2 diabetes mellitus (T2DM) in women with prior gestational diabetes mellitus (GDM) in Bangladesh, India, and Sri Lanka. Materials and Methods: In-depth interviews (IDIs) and focus group discussions (FGDs) were conducted with women with current diagnosis of GDM, and health care professionals involved in their management, to understand relevant local contextual factors for intervention optimization and implementation. This paper describes facilitators and barriers as well as feedback from participants on how to improve the proposed intervention. These factors were grouped and interpreted along the axes of the three main determinants of behavior-capability, opportunity, and motivation. IDIs and FGDs were digitally recorded, transcribed, and translated. Data-driven inductive thematic analysis was undertaken to identify and analyze patterns and themes. Results: Two interrelated themes emerged from the IDIs and FGDs: (i) The lifestyle intervention was acceptable and considered to have the potential to improve the existing model of care for women with GDM; and (ii) Certain barriers such as reduced priority of self-care, and adverse societal influences postpartum need to be addressed for the improvement of GDM care. Based on the feedback, the intervention was optimized by including messages for family members in the content of the intervention, providing options for both text and voice messages as reminders, and finalizing the format of the intervention session delivery. Conclusion: This study highlights the importance of contextual factors in influencing postpartum care and support for women diagnosed with GDM in three South Asian countries. It indicates that although provision of postpartum care is complex, a group lifestyle intervention program is highly acceptable to women with GDM, as well as to health care professionals, at urban hospitals.
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Affiliation(s)
- Abha Tewari
- George Institute for Global Health, New Delhi, India
| | - Devarsetty Praveen
- George Institute for Global Health, New Delhi, India
- University of New South Wales, Sydney, NSW, Australia
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | | | - Lakshmi K. Josyula
- George Institute for Global Health, New Delhi, India
- University of New South Wales, Sydney, NSW, Australia
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Rohina Joshi
- George Institute for Global Health, New Delhi, India
- The George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
| | | | - Vandana Garg
- Manav Rachna International Institute of Research and Studies (MRIIRS), Faridabad, India
| | - Ishita Rawal
- Centre for Chronic Disease Control, New Delhi, India
| | - Kanika Chopra
- All India Institute of Medical Sciences, New Delhi, India
| | - Nantu Chakma
- International Center for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sabrina Ahmed
- International Center for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
- Shiga University of Medical Science, Otsu, Japan
| | | | | | - A. S. Lata
- Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, India
| | | | - Yashdeep Gupta
- All India Institute of Medical Sciences, New Delhi, India
| | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
| | - Aliya Naheed
- International Center for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Anushka Patel
- The George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
| | - Deksha Kapoor
- All India Institute of Medical Sciences, New Delhi, India
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Kapoor D, Iqbal R, Singh K, Jaacks LM, Shivashankar R, Sudha V, Anjana RM, Kadir M, Mohan V, Ali MK, Narayan KM, Tandon N, Prabhakaran D, Merchant AT. Association of dietary patterns and dietary diversity with cardiometabolic disease risk factors among adults in South Asia: The CARRS study. Asia Pac J Clin Nutr 2019; 27:1332-1343. [PMID: 30485933 DOI: 10.6133/apjcn.201811_27(6).0021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVES To investigate the association of dietary patterns and dietary diversity with cardiometabolic disease risk factors among South Asians. METHODS AND STUDY DESIGN In a population based study conducted in 2010-11, we recruited 16,287 adults aged >20 years residing in Delhi, Chennai, and Karachi. Diet was assessed using an interviewer-administered 26-item food frequency questionnaire. Principal component analysis identified three dietary patterns: Prudent, Indian, and Non-Vegetarian. We also computed a dietary diversity score. Multinomial and binary logistic regressions were used to calculate adjusted prevalence (95% confidence intervals) of cardio-metabolic disease risk factors across quartiles of dietary pattern and dietary diversity scores. RESULTS The adjusted prevalence of diagnosed diabetes was lower among participants in the highest versus lowest quartile of the Prudent Pattern (4.7% [3.8-5.6] versus 10.3% [8.5-12.0]), and the Indian Pattern (4.8% [3.7-5.9] versus 8.7% [6.7-10.6] in highest versus lowest quartile, respectively). Participants following the Indian Pattern also had lower adjusted prevalence of diagnosed hypertension (7.0% [5.4-8.5] versus 10.6% [8.6-12.5] in highest versus lowest quartile, respectively). Participants in the highest versus lowest quartile of the dietary diversity score had a lower adjusted prevalence of diagnosed diabetes (4.1% [3.0-5.2] versus 8.2% [7.1-9.3]), diagnosed hypertension (6.7% [5.3-8.1] versus 10.3% [9.1-11.5]), and undiagnosed hypertension (14.2% [12.0-16.4] versus 18.5% [16.9-20.1]). CONCLUSIONS High dietary diversity appears to be protective against cardio-metabolic disease risk factors in this urban cohort of South Asian adults. Further investigation to understand the underlying mechanism of this observation is warranted.
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Affiliation(s)
| | | | | | - Lindsay M Jaacks
- Department of Global Health and Population, Harvard University, Boston, MA, USA
| | - Roopa Shivashankar
- Public Health Foundation of India and Centre for Chronic Disease Control, Gurgaon, India
| | | | - R M Anjana
- Madras Diabetes Research Foundation, Chennai, India
| | | | | | - Mohammed K Ali
- Department of Global Health, Emory University, Atlanta, GA, USA
| | - K Mv Narayan
- Department of Global Health, Emory University, Atlanta, GA, USA
| | | | - Dorairaj Prabhakaran
- Public Health Foundation of India and Centre for Chronic Disease Control, Gurgaon, India
| | - Anwar T Merchant
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia
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Daivadanam M, Ingram M, Sidney Annerstedt K, Parker G, Bobrow K, Dolovich L, Gould G, Riddell M, Vedanthan R, Webster J, Absetz P, Mölsted Alvesson H, Androutsos O, Chavannes N, Cortez B, Devarasetty P, Fottrell E, Gonzalez-Salazar F, Goudge J, Herasme O, Jennings H, Kapoor D, Kamano J, Kasteleyn MJ, Kyriakos C, Manios Y, Mogulluru K, Owolabi M, Lazo-Porras M, Silva W, Thrift A, Uvere E, Webster R, van der Kleij R, van Olmen J, Vardavas C, Zhang P. The role of context in implementation research for non-communicable diseases: Answering the 'how-to' dilemma. PLoS One 2019; 14:e0214454. [PMID: 30958868 PMCID: PMC6453477 DOI: 10.1371/journal.pone.0214454] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 03/13/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction Understanding context and how this can be systematically assessed and incorporated is crucial to successful implementation. We describe how context has been assessed (including exploration or evaluation) in Global Alliance for Chronic Diseases (GACD) implementation research projects focused on improving health in people with or at risk of chronic disease and how contextual lessons were incorporated into the intervention or the implementation process. Methods Using a web-based semi-structured questionnaire, we conducted a cross-sectional survey to collect quantitative and qualitative data across GACD projects (n = 20) focusing on hypertension, diabetes and lung diseases. The use of context-specific data from project planning to evaluation was analyzed using mixed methods and a multi-layered context framework across five levels; 1) individual and family, 2) community, 3) healthcare setting, 4) local or district level, and 5) state or national level. Results Project teams used both qualitative and mixed methods to assess multiple levels of context (avg. = 4). Methodological approaches to assess context were identified as formal and informal assessments, engagement of stakeholders, use of locally adapted resources and materials, and use of diverse data sources. Contextual lessons were incorporated directly into the intervention by informing or adapting the intervention, improving intervention participation or improving communication with participants/stakeholders. Provision of services, equipment or information, continuous engagement with stakeholders, feedback for personnel to address gaps, and promoting institutionalization were themes identified to describe how contextual lessons are incorporated into the implementation process. Conclusions Context is regarded as critical and influenced the design and implementation of the GACD funded chronic disease interventions. There are different approaches to assess and incorporate context as demonstrated by this study and further research is required to systematically evaluate contextual approaches in terms of how they contribute to effectiveness or implementation outcomes.
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Affiliation(s)
- Meena Daivadanam
- Department of Food, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Maia Ingram
- Department of Community, Environment and Policy, University of Arizona, Tucson, Arizona, United States of America
| | | | - Gary Parker
- Global Alliance for Chronic Diseases, University College London, London, United Kingdom
| | - Kirsty Bobrow
- Department of Medicine, University of Cape Town, Rondebosch, South Africa
| | - Lisa Dolovich
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Gillian Gould
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Michaela Riddell
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Rajesh Vedanthan
- Department of Population Health, New York University School of Medicine, New York City, New York, United States of America
| | - Jacqui Webster
- The George Institute for Global Health, The University of New South Wales, Australia, Newtown New South Wales, Australia
| | - Pilvikki Absetz
- Collaborative Care Systems Finland, Helsinki, Finland
- University of Eastern Finland, Helsinki, Finland
| | | | - Odysseas Androutsos
- Department of Nutrition and Dietetics, Harokopio University, School of Health Sciences & Education, Kallithea, Athens, Greece
| | - Niels Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Briana Cortez
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, United States of America
| | - Praveen Devarasetty
- Population Health Division, The George Institute for Global Health- India, New Delhi, Delhi, India
| | - Edward Fottrell
- Global Alliance for Chronic Diseases, University College London, London, United Kingdom
| | - Francisco Gonzalez-Salazar
- Department of Basic Sciences, Universidad de Monterrey, Monterrey, Nuevo Leon, Mexico
- Centro de Investigacion Biomedica, Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon, Mexico
| | - Jane Goudge
- Faculty of Health Sciences, University of the Witwatersrand, Centre for Health Policy, School of Public Health, Braamfontein, Johannesburg, South Africa
| | - Omarys Herasme
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, United States of America
| | - Hannah Jennings
- Global Alliance for Chronic Diseases, University College London, London, United Kingdom
| | - Deksha Kapoor
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, Delhi, India
| | - Jemima Kamano
- School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Marise J. Kasteleyn
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | | | - Yannis Manios
- Department of Nutrition and Dietetics, Harokopio University, School of Health Sciences & Education, Kallithea, Athens, Greece
| | - Kishor Mogulluru
- Population Health Division, The George Institute for Global Health- India, New Delhi, Delhi, India
| | - Mayowa Owolabi
- Department of Medicine, University of Ibadan, Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Maria Lazo-Porras
- Unidad de Conocimiento y Evidencia (CONEVID), CRONICAS Center of Excellence in Chronic Disease, Universidad Peruana Cayetano Heredia, Miraflores, Lima, Peru
| | - Wnurinham Silva
- School of Public Health, Imperial College London, London, United Kingdom
| | - Amanda Thrift
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Ezinne Uvere
- Department of Medicine, University of Ibadan, Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Ruth Webster
- The George Institute for Global Health, The University of New South Wales, Australia, Newtown New South Wales, Australia
| | - Rianne van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Josefien van Olmen
- Department of Public Health, Institute of Tropical Medicine Antwerp, Antwerpen, Belgium
- University of Antwerp, Antwerpen, Belgium
| | | | - Puhong Zhang
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
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Singh S, Sarangi SS, Misra P, Kapoor D, Rani A, Rastogi N, Kumar S. EP-1484 Neoadjuvant CT followed by chemoradiation in locally advanced cancer cervix : feasibility and QOL study. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31904-8] [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: 10/26/2022]
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15
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Gupta Y, Kapoor D, Josyula LK, Praveen D, Naheed A, Desai AK, Pathmeswaran A, de Silva HA, Lombard CB, Shamsul Alam D, Prabhakaran D, Teede HJ, Billot L, Bhatla N, Joshi R, Zoungas S, Jan S, Patel A, Tandon N. A lifestyle intervention programme for the prevention of Type 2 diabetes mellitus among South Asian women with gestational diabetes mellitus [LIVING study]: protocol for a randomized trial. Diabet Med 2019; 36:243-251. [PMID: 30368898 DOI: 10.1111/dme.13850] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2018] [Indexed: 01/05/2023]
Abstract
AIM This study aims to determine whether a resource- and culturally appropriate lifestyle intervention programme in South Asian countries, provided to women with gestational diabetes (GDM) after childbirth, will reduce the incidence of worsening of glycaemic status in a manner that is affordable, acceptable and scalable. METHODS Women with GDM (diagnosed by oral glucose tolerance test using the International Association of the Diabetes and Pregnancy Study Groups criteria) will be recruited from 16 hospitals in India, Sri Lanka and Bangladesh. Participants will undergo a repeat oral glucose tolerance test at 6 ± 3 months postpartum and those without Type 2 diabetes, a total sample size of 1414, will be randomly allocated to the intervention or usual care. The intervention will consist of four group sessions, 84 SMS or voice messages and review phone calls over the first year. Participants requiring intensification of the intervention will receive two additional individual sessions over the latter half of the first year. Median follow-up will be 2 years. The primary outcome is the proportion of women with a change in glycaemic category, using the American Diabetes Association criteria: (i) normal glucose tolerance to impaired fasting glucose, or impaired glucose tolerance, or Type 2 diabetes; or (ii) impaired fasting glucose or impaired glucose tolerance to Type 2 diabetes. Process evaluation will explore barriers and facilitators of implementation of the intervention in each local context, while trial-based and modelled economic evaluations will assess cost-effectiveness. DISCUSSION The study will generate important new evidence about a potential strategy to address the long-term sequelae of GDM, a major and growing problem among women in South Asia. (Clinical Trials Registry of India No: CTRI/2017/06/008744; Sri Lanka Clinical Trials Registry No: SLCTR/2017/001; and ClinicalTrials.gov Identifier No: NCT03305939).
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Affiliation(s)
- Y Gupta
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - D Kapoor
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - L K Josyula
- The George Institute for Global Health, Hyderabad, India
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - D Praveen
- The George Institute for Global Health, Hyderabad, India
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - A Naheed
- Initiative for Noncommunicable Diseases, Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - A K Desai
- Department of Medicine, Goa Medical College and Hospital, Bambolim, Goa, India
| | - A Pathmeswaran
- Department ofPublic Health, University of Kelaniya, Ragama, Sri Lanka
| | - H A de Silva
- Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - C B Lombard
- Department of Nutrition and Dietetics, Monash University, Melbourne, Australia
| | - D Shamsul Alam
- Faculty of Health, School of Kinesiology and Health Science, York University, Toronto, Canada
| | | | - H J Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - L Billot
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - N Bhatla
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - R Joshi
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - S Zoungas
- Division of Metabolism, Ageing and Genomics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - S Jan
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - A Patel
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - N Tandon
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
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Kasturia S, Ali MK, Narayan KMV, Tandon N, Shivashankar R, Garg V, Kapoor D, Mohanasundaram A, Mohan D, Kadir MM, Prabhakaran D, Mohan V, Jaacks LM. Diets for South Asians with diabetes: recommendations, adherence, and outcomes. Asia Pac J Clin Nutr 2018; 27:823-831. [PMID: 30045427 DOI: 10.6133/apjcn.112017.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVES To determine how frequently diabetic diets are recommended to individuals with diabetes in South Asia, whether they are followed, and if they are associated with healthier dietary choices and clinical benefits. METHODS AND STUDY DESIGN Data are from the Centre for cArdiometabolic Risk Reduction in South-Asia Cohort Study. Participants with self-reported physician-diagnosed diabetes (n=1849) were divided into four groups based on whether they reported being prescribed and/or were following a diabetic diet. Linear regression was used to estimate associations between these groups and outcomes. RESULTS 53% of participants with self-reported diabetes reported not being prescribed or following a diabetic diet. Among those prescribed and following a diet, mean whole grain consumption was 1.18 times/day and refined grain consumption was 0.75 times/day compared to 0.88 times/day and 1.74 times/day, respectively, among those neither prescribed nor following a diet (both p<0.0001). Following a diet despite not being prescribed a diet was not associated with glycemic control, blood pressure, or body mass index, but was associated with a -8.54 mg/dL (95% confidence interval: -15.5, -1.58) lower low-density lipoprotein cholesterol compared to not following and not being prescribed a diet after adjustment for confounders. CONCLUSION Though participants who were prescribed diabetic diets and followed them exhibited healthier dietary choices, the majority of participants with diabetes in urban South Asia was neither prescribed nor followed such diets. Moreover, there was no statistically significant clinical benefit, thus indicating that current dietary modifications may not be large enough or consistent enough to produce meaningful changes in health outcomes in this population.
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Affiliation(s)
- Shirin Kasturia
- School of Medicine and Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Mohammed K Ali
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - K M Venkat Narayan
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, NCR, India
| | - Roopa Shivashankar
- Centre for Chronic Disease Control, Public Health Foundation of India, Gurgaon, Haryana, India
| | - Vandana Garg
- Centre for Chronic Disease Control, Public Health Foundation of India, Gurgaon, Haryana, India
| | - Deksha Kapoor
- Centre for Chronic Disease Control, Public Health Foundation of India, Gurgaon, Haryana, India
| | | | - Deepa Mohan
- Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Muhammad M Kadir
- Department of Community Health Sciences, Aga Khan University, Karachi, Sindh, Pakistan
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, Public Health Foundation of India, Gurgaon, Haryana, India
| | | | - Lindsay M Jaacks
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
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Bailey C, Garg V, Kapoor D, Wasser H, Prabhakaran D, Jaacks LM. Food Choice Drivers in the Context of the Nutrition Transition in Delhi, India. J Nutr Educ Behav 2018; 50:675-686. [PMID: 29709444 DOI: 10.1016/j.jneb.2018.03.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 03/23/2018] [Accepted: 03/29/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To understand factors that influence the process of food decision-making among urban Indian women in the context of the nutrition transition. DESIGN Mixed methods. METHODS Semistructured interviews and sorting of 12 a priori hypothesized drivers into categories of always, sometimes, and never influencing food choice. SETTING Delhi, India. PARTICIPANTS Thirty-eight women aged 20-35 years selected from the roster of a prospective cohort study. PHENOMENON OF INTEREST Drivers of food choice. ANALYSIS Interviews were transcribed verbatim and translated, then analyzed using an iterative, constant comparative process. Differences in pile sort rankings across tertiles of body mass index and wealth index were tested using Fisher exact tests. RESULT Four primary themes emerged: (1) family influence; (2) cultural perceptions, with 3 subthemes of beliefs relating to (a) outside food and less healthful food, (b) seasonality, and (c) hometown food; (3) convenience, with 3 subthemes of (a) decisions regarding procurement of food, (b) not having time to cook, resulting in eating out or purchasing premade foods, and (c) eating whatever is available at home or is left over from previous meals; and (4) habit, with 2 subthemes of (a) subconscious decisions and (b) food roots. Responses from the pile sort activity revealed perceptions that food safety and health most influence food choice whereas marketing and advertisements least influence it. CONCLUSIONS AND IMPLICATIONS Young adult women in Delhi seem to rely on preferences of their families, habits and perceptions established in childhood, convenience, and food safety and health when making choices about food. These aspects of decision-making should be targeted in future interventions aimed at improving dietary intake in this population.
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Affiliation(s)
- Claire Bailey
- Department of Nutrition, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC
| | - Vandana Garg
- Public Health Foundation of India and Centre for Chronic Disease Control, Gurgaon, Haryana, India
| | - Deksha Kapoor
- Public Health Foundation of India and Centre for Chronic Disease Control, Gurgaon, Haryana, India
| | - Heather Wasser
- Department of Nutrition, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC
| | - Dorairaj Prabhakaran
- Public Health Foundation of India and Centre for Chronic Disease Control, Gurgaon, Haryana, India
| | - Lindsay M Jaacks
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA.
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Shah SR, Chowdhury A, Mehta R, Kapoor D, Duseja A, Koshy A, Shukla A, Sood A, Madan K, Sud R, Nijhawan S, Pawan R, Prasad M, Kersey K, Jiang D, Svarovskaia E, Doehle B, Kanwar B, Subramanian M, Acharya SK, Sarin S. Sofosbuvir plus ribavirin in treatment-naïve patients with chronic hepatitis C virus genotype 1 or 3 infection in India. J Viral Hepat 2017; 24:371-379. [PMID: 27933698 DOI: 10.1111/jvh.12654] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 11/01/2016] [Indexed: 12/14/2022]
Abstract
Until 2014, pegylated interferon plus ribavirin was the recommended standard of care for the treatment of chronic hepatitis C virus (HCV) infection in India. This open-label phase 3b study, conducted across 14 sites in India between 31 March 2014 and 30 November 2015, evaluated the efficacy and safety of sofosbuvir plus ribavirin therapy among treatment-naïve patients with chronic genotype 1 or 3 HCV infection. A total of 117 patients with genotype 1 or 3 HCV infection were randomized 1:1 to receive sofosbuvir 400 mg and weight-based ribavirin (1000 or 1200 mg) daily for 16 or 24 weeks. Among those with genotype 1 infection, the primary efficacy endpoint of sustained virologic response at 12 weeks post-treatment (SVR12) was reported in 90% (95% confidence intervals [CI], 73-98) and 96% (95% CI, 82-100) of patients following 16 and 24 weeks of treatment, respectively. For patients with genotype 3 infection, SVR12 rates were 100% (95% CI, 88-100) and 93% (95% CI, 78-99) after 16 and 24 weeks of therapy, respectively. Adverse events, most of which were mild or moderate in severity, occurred in 69% and 57% of patients receiving 16 and 24 weeks of treatment, respectively. The most common treatment-emergent adverse events were asthenia, headache and cough. Only one patient in the 24-week group discontinued treatment with sofosbuvir during this study. Overall, sofosbuvir plus ribavirin therapy achieved SVR12 rates ≥90% and was well tolerated among treatment-naïve patients with chronic genotype 1 or 3 HCV infection in India.
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Affiliation(s)
- S R Shah
- Global Hospitals, Mumbai, Maharashtra, India
| | - A Chowdhury
- Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - R Mehta
- Nirmal Hospital Pvt Ltd, Surat, Gujarat, India
| | - D Kapoor
- Global Hospitals, Hyderabad, Andhra Pradesh, India
| | - A Duseja
- Postgraduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - A Koshy
- Lakeshore Hospital, Kochi, Kerala, India
| | - A Shukla
- Seth G.S. Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - A Sood
- Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - K Madan
- Artemis Hospitals, Gurgaon, Haryana, India
| | - R Sud
- Medanta - The Medicity, Gurgaon, Haryana, India
| | - S Nijhawan
- Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
| | - R Pawan
- Fortis Memorial Research Institute, Gurgaon, Haryana, India
| | - M Prasad
- VGM Hospital, Coimbatore, Tamil Nadu, India
| | - K Kersey
- Gilead Sciences, Inc., Foster City, CA, USA
| | - D Jiang
- Gilead Sciences, Inc., Foster City, CA, USA
| | | | - B Doehle
- Gilead Sciences, Inc., Foster City, CA, USA
| | - B Kanwar
- Gilead Sciences, Inc., Foster City, CA, USA
| | | | - S K Acharya
- All India Institute of Medical Science, New Delhi, Delhi, India
| | - S Sarin
- Institute of Liver and Biliary Sciences, New Delhi, Delhi, India
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Patel SA, Deepa M, Shivashankar R, Ali MK, Kapoor D, Gupta R, Lall D, Tandon N, Mohan V, Kadir MM, Fatmi Z, Prabhakaran D, Narayan KMV. Comparison of multiple obesity indices for cardiovascular disease risk classification in South Asian adults: The CARRS Study. PLoS One 2017; 12:e0174251. [PMID: 28448582 PMCID: PMC5407781 DOI: 10.1371/journal.pone.0174251] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 03/06/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND We comparatively assessed the performance of six simple obesity indices to identify adults with cardiovascular disease (CVD) risk factors in a diverse and contemporary South Asian population. METHODS 8,892 participants aged 20-60 years in 2010-2011 were analyzed. Six obesity indices were examined: body mass index (BMI), waist circumference (WC), waist-height ratio (WHtR), waist-hip ratio (WHR), log of the sum of triceps and subscapular skin fold thickness (LTS), and percent body fat derived from bioelectric impedance analysis (BIA). We estimated models with obesity indices specified as deciles and as continuous linear variables to predict prevalent hypertension, diabetes, and high cholesterol and report associations (prevalence ratios, PRs), discrimination (area-under-the-curve, AUCs), and calibration (index χ2). We also examined a composite unhealthy cardiovascular profile score summarizing glucose, lipids, and blood pressure. RESULTS No single obesity index consistently performed statistically significantly better than the others across the outcome models. Based on point estimates, WHtR trended towards best performance in classifying diabetes (PR = 1.58 [1.45-1.72], AUC = 0.77, men; PR = 1.59 [1.47-1.71], AUC = 0.80, women) and hypertension (PR = 1.34 [1.26,1.42], AUC = 0.70, men; PR = 1.41 [1.33,1.50], AUC = 0.78, women). WC (mean difference = 0.24 SD [0.21-0.27]) and WHtR (mean difference = 0.24 SD [0.21,0.28]) had the strongest associations with the composite unhealthy cardiovascular profile score in women but not in men. CONCLUSIONS WC and WHtR were the most useful indices for identifying South Asian adults with prevalent diabetes and hypertension. Collection of waist circumference data in South Asian health surveys will be informative for population-based CVD surveillance efforts.
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Affiliation(s)
- Shivani A. Patel
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Centre for Control of Chronic Conditions, Gurgaon, Haryana, India
- * E-mail:
| | - Mohan Deepa
- Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Roopa Shivashankar
- Centre for Control of Chronic Conditions, Gurgaon, Haryana, India
- Public Health Foundation of India, Gurgaon, Haryana, India
| | - Mohammed K. Ali
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Centre for Control of Chronic Conditions, Gurgaon, Haryana, India
| | - Deksha Kapoor
- All India Institute of Medical Sciences, New Delhi, India
| | - Ruby Gupta
- Centre for Control of Chronic Conditions, Gurgaon, Haryana, India
- Public Health Foundation of India, Gurgaon, Haryana, India
| | - Dorothy Lall
- Institute of Public Health Bengaluru, Bengaluru, Karnataka, India
| | - Nikhil Tandon
- Centre for Control of Chronic Conditions, Gurgaon, Haryana, India
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Zafar Fatmi
- Aga Khan University, Karachi, Sindh, Pakistan
| | - Dorairaj Prabhakaran
- Centre for Control of Chronic Conditions, Gurgaon, Haryana, India
- Public Health Foundation of India, Gurgaon, Haryana, India
| | - K. M. Venkat Narayan
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Centre for Control of Chronic Conditions, Gurgaon, Haryana, India
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20
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Patel SA, Shivashankar R, Ali MK, Anjana RM, Deepa M, Kapoor D, Kondal D, Rautela G, Mohan V, Narayan KMV, Kadir MM, Fatmi Z, Prabhakaran D, Tandon N. Is the "South Asian Phenotype" Unique to South Asians?: Comparing Cardiometabolic Risk Factors in the CARRS and NHANES Studies. Glob Heart 2017; 11:89-96.e3. [PMID: 27102026 DOI: 10.1016/j.gheart.2015.12.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 12/17/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In the context of rising obesity in South Asia, it is unclear whether the "South Asian phenotype"(described as high glucose, low high-density lipoprotein cholesterol, and high triglycerides at normal ranges of body weight) continues to be disproportionately exhibited by contemporary South Asians relative to other race/ethnic groups. OBJECTIVES We assessed the distinctiveness of the South Asian cardiometabolic profile by comparing the prevalence of combined high glucose, high triglycerides, and low high-density lipoprotein cholesterol (combined dysglycemia and dyslipidemia) in resident South Asians with 4 race/ethnic groups in the United States (Asians, black persons, Hispanics, and white persons) overall and by body mass index (BMI) category. METHODS South Asian data were from the 2010 to 2011 Center for Cardiometabolic Risk Reduction in South Asia Study, representative of Chennai and New Delhi, India and Karachi, Pakistan. U.S. data were from the 2011 to 2012 National Health and Nutrition Examination Survey, representative of the U.S. POPULATION Combined dysglycemia and dyslipidemia was defined as fasting blood glucose ≥126 mg/dl and triglyceride/high-density lipoprotein cholesterol ratio >4. Logistic regression was used to estimate the relative odds and 95% confidence intervals of combined dysglycemia and dyslipidemia associated with each race/ethnic group (referent, U.S. white persons). Models were estimated among adults aged 20 to 79 years by sex and BMI category and accounted for age, education, and tobacco use. Data from 8,448 resident South Asians, 274 U.S. Asians, 404 U.S. black persons, 308 U.S. Hispanics, and 703 U.S. white persons without previously known diabetes were analyzed. RESULTS In the normal body weight range of BMI 18.5 to 24.9 kg/m(2), the prevalence of combined dysglycemia and dyslipidemia among men and women, respectively, was 33% and 11% in resident South Asians, 15% and 1% in U.S. Asians, 5% and 2% in U.S. black persons, 11% and 2% in U.S. Hispanics, and 8% and 2% in U.S. white persons. Compared with U.S. whites persons, South Asians were more likely to present with combined dysglycemia and dyslipidemia at all categories of BMI for men and at BMI 18.5 to 29.9 for women in adjusted models. The most pronounced difference between South Asians and U.S. white persons was observed at normal weight (adjusted odds ratio: 4.98; 95% confidence interval: 2.46 to 10.07 for men) (adjusted odds ratio: 9.09; 95% confidence interval: 2.48 to 33.29 for women). CONCLUSIONS Between 8% and 15% of U.S. men and 1% and 2% of U.S. women of diverse race/ethnic backgrounds exhibited dysglycemia and dyslipidemia at levels of body weight considered "healthy," consistent with the cardiometabolic profile described as the "South Asian Phenotype." Urban South Asians, however, were 5 to 9 times more likely to exhibit dysglycemia and dyslipidemia in the "healthy" BMI range compared with any other U.S. race/ethnic group.
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Affiliation(s)
- Shivani A Patel
- Centre for Control of Chronic Conditions, New Delhi, India; Global Diabetes Research Center, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Roopa Shivashankar
- Centre for Control of Chronic Conditions, New Delhi, India; Public Health Foundation of India, New Delhi, India; Centre for Chronic Disease Control, New Delhi, India
| | - Mohammed K Ali
- Centre for Control of Chronic Conditions, New Delhi, India; Global Diabetes Research Center, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - R M Anjana
- Department of Diabetology, Madras Diabetes Research Foundation, Chennai, India
| | - M Deepa
- Department of Diabetology, Madras Diabetes Research Foundation, Chennai, India; Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, India
| | - Deksha Kapoor
- Centre for Control of Chronic Conditions, New Delhi, India; Centre for Chronic Disease Control, New Delhi, India
| | - Dimple Kondal
- Centre for Control of Chronic Conditions, New Delhi, India; Public Health Foundation of India, New Delhi, India; Centre for Chronic Disease Control, New Delhi, India
| | - Garima Rautela
- Centre for Control of Chronic Conditions, New Delhi, India; Public Health Foundation of India, New Delhi, India
| | - V Mohan
- Department of Diabetology, Madras Diabetes Research Foundation, Chennai, India
| | - K M Venkat Narayan
- Centre for Control of Chronic Conditions, New Delhi, India; Global Diabetes Research Center, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | | | - Dorairaj Prabhakaran
- Centre for Control of Chronic Conditions, New Delhi, India; Public Health Foundation of India, New Delhi, India; Centre for Chronic Disease Control, New Delhi, India
| | - Nikhil Tandon
- Centre for Control of Chronic Conditions, New Delhi, India; Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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Gupta Y, Kapoor D, Desai A, Praveen D, Joshi R, Rozati R, Bhatla N, Prabhakaran D, Reddy P, Patel A, Tandon N. Conversion of gestational diabetes mellitus to future Type 2 diabetes mellitus and the predictive value of HbA 1c in an Indian cohort. Diabet Med 2017; 34:37-43. [PMID: 26926329 DOI: 10.1111/dme.13102] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/25/2016] [Indexed: 01/18/2023]
Abstract
AIM To investigate the distribution of and risk factors for dysglycaemia (Type 2 diabetes and prediabetes) in women with previous gestational diabetes mellitus in India. METHODS All women (n = 989) from two obstetric units in New Delhi and Hyderabad with a history of gestational diabetes were invited to participate, of whom 366 (37%) agreed. Sociodemographic, medical and anthropometric data were collected and 75-g oral glucose tolerance test were carried out. RESULTS Within 5 years (median 14 months) of the pregnancy in which they were diagnosed with gestational diabetes, 263 (72%) women were dysglycaemic, including 119 (32%) and 144 (40%) with Type 2 diabetes and prediabetes, respectively. A higher BMI [odds ratio 1.16 per 1-kg/m2 greater BMI (95% CI 1.10, 1.28)], presence of acanthosis nigricans [odds ratio 3.10, 95% CI (1.64, 5.87)], postpartum screening interval [odds ratio 1.02 per 1 month greater screening interval 95% CI (1.01, 1.04)] and age [odds ratio 1.10 per 1-year older age 95% CI (1.04, 1.16)] had a higher likelihood of having dysglycaemia. The American Diabetes Association-recommended threshold HbA1c value of ≥ 48 mmol/mol (6.5%) had a sensitivity and specificity of 81.4 and 90.7%, respectively, for determining the presence of Type 2 diabetes postpartum. CONCLUSION The high post-pregnancy conversion rates of gestational diabetes to diabetes reported in the present study reinforce the need for mandatory postpartum screening and identification of strategies for preventing progression to Type 2 diabetes. Use of the American Diabetes Association-recommended HbA1c threshold for diabetes may lead to significant under-diagnosis.
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Affiliation(s)
- Y Gupta
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - D Kapoor
- Centre for Chronic Disease Control, Gurgaon, India
| | - A Desai
- Endocrine Unit-Department of Medicine, Goa Medical College, Goa, India
| | - D Praveen
- Division of Epidemiology, George Institute for Global Health, Hyderabad, India
| | - R Joshi
- George Institute for Global Health, University of Sydney, Sydney, Australia
| | - R Rozati
- Centre for Fertility Management-MHRT, Hyderabad, India
| | - N Bhatla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | | | - P Reddy
- School of Medicine and Public Health, University of Newcastle and St Vincents Health Network, Sydney, Australia
| | - A Patel
- George Institute for Global Health, University of Sydney, Sydney, Australia
| | - N Tandon
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
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Singh S, Lamin J, Kapoor D, Rani A, Rastogi N, Kumar S. EP-1318: Presence of lymph nodes and survival in cancer cervix: audit from tertiary care hospital in India. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32568-3] [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: 10/21/2022]
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Jeemon P, Narayanan G, Kondal D, Kahol K, Bharadwaj A, Purty A, Negi P, Ladhani S, Sanghvi J, Singh K, Kapoor D, Sobti N, Lall D, Manimunda S, Dwivedi S, Toteja G, Prabhakaran D. Task shifting of frontline community health workers for cardiovascular risk reduction: design and rationale of a cluster randomised controlled trial (DISHA study) in India. BMC Public Health 2016; 16:264. [PMID: 26975187 PMCID: PMC4791774 DOI: 10.1186/s12889-016-2891-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 02/18/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Effective task-shifting interventions targeted at reducing the global cardiovascular disease (CVD) epidemic in low and middle-income countries (LMICs) are urgently needed. METHODS DISHA is a cluster randomised controlled trial conducted across 10 sites (5 in phase 1 and 5 in phase 2) in India in 120 clusters. At each site, 12 clusters were randomly selected from a district. A cluster is defined as a small village with 250-300 households and well defined geographical boundaries. They were then randomly allocated to intervention and control clusters in a 1:1 allocation sequence. If any of the intervention and control clusters were <10 km apart, one was dropped and replaced with another randomly selected cluster from the same district. The study included a representative baseline cross-sectional survey, development of a structured intervention model, delivery of intervention for a minimum period of 18 months by trained frontline health workers (mainly Anganwadi workers and ASHA workers) and a post intervention survey in a representative sample. The study staff had no information on intervention allocation until the completion of the baseline survey. In order to ensure comparability of data across sites, the DISHA study follows a common protocol and manual of operation with standardized measurement techniques. DISCUSSION Our study is the largest community based cluster randomised trial in low and middle-income country settings designed to test the effectiveness of 'task shifting' interventions involving frontline health workers for cardiovascular risk reduction. TRIAL REGISTRATION CTRI/2013/10/004049 . Registered 7 October 2013.
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Affiliation(s)
- Panniyammakal Jeemon
- />Centre for Control of Chronic Conditions, Public Health Foundation of India, New Delhi, India
- />Centre for Chronic Disease Control, Sector 44, Plot 47, Gurgaon, Haryana India
| | - Gitanjali Narayanan
- />Centre for Chronic Disease Control, Sector 44, Plot 47, Gurgaon, Haryana India
| | - Dimple Kondal
- />Centre for Chronic Disease Control, Sector 44, Plot 47, Gurgaon, Haryana India
| | - Kashvi Kahol
- />Centre for Chronic Disease Control, Sector 44, Plot 47, Gurgaon, Haryana India
| | - Ashok Bharadwaj
- />Rajendra Prasad Government Medical College, Tanda, Himachal Pradesh India
| | - Anil Purty
- />Pondicherry Institute of Medical Sciences, Puducherry, India
| | | | | | - Jyoti Sanghvi
- />Sri Aurbindo Institute of Medical Sciences, Indore, India
| | - Kuldeep Singh
- />Sri Aurbindo Institute of Medical Sciences, Indore, India
| | - Deksha Kapoor
- />Centre for Chronic Disease Control, Sector 44, Plot 47, Gurgaon, Haryana India
| | - Nidhi Sobti
- />Centre for Chronic Disease Control, Sector 44, Plot 47, Gurgaon, Haryana India
| | - Dorothy Lall
- />Centre for Chronic Disease Control, Sector 44, Plot 47, Gurgaon, Haryana India
| | - Sathyaprakash Manimunda
- />Centre for Chronic Disease Control, Sector 44, Plot 47, Gurgaon, Haryana India
- />National Centre for Disease Informatics and Research, ICMR, Bangalore, India
| | | | | | - Dorairaj Prabhakaran
- />Centre for Control of Chronic Conditions, Public Health Foundation of India, New Delhi, India
- />Centre for Chronic Disease Control, Sector 44, Plot 47, Gurgaon, Haryana India
| | - On behalf of DISHA study investigators
- />Centre for Control of Chronic Conditions, Public Health Foundation of India, New Delhi, India
- />Centre for Chronic Disease Control, Sector 44, Plot 47, Gurgaon, Haryana India
- />Rajendra Prasad Government Medical College, Tanda, Himachal Pradesh India
- />Pondicherry Institute of Medical Sciences, Puducherry, India
- />Indira Gandhi Medical College, Shimla, India
- />Aga Khan Health Services, Mumbai, India
- />Sri Aurbindo Institute of Medical Sciences, Indore, India
- />National Centre for Disease Informatics and Research, ICMR, Bangalore, India
- />Indian Council of Medical Research, New Delhi, India
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Jaacks LM, Kapoor D, Singh K, Narayan KMV, Ali MK, Kadir MM, Mohan V, Tandon N, Prabhakaran D. Vegetarianism and cardiometabolic disease risk factors: Differences between South Asian and US adults. Nutrition 2016; 32:975-84. [PMID: 27155957 DOI: 10.1016/j.nut.2016.02.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 02/04/2016] [Accepted: 02/15/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Cardiometabolic diseases are increasing disproportionately in South Asia compared with other regions of the world despite high levels of vegetarianism. This unexpected discordance may be explained by differences in the healthfulness of vegetarian and non-vegetarian diets in South Asia compared with the United States. The aim of this study was to compare the food group intake of vegetarians with non-vegetarians in South Asia and the United States and to evaluate associations between vegetarianism and cardiometabolic disease risk factors (overweight/obesity, central obesity, diabetes, hypertension, high triacylglycerols, high low-density lipoprotein, low high-density lipoprotein, and high Framingham Heart Score). METHODS Using cross-sectional data from adults (age 20-69 y) in South Asia (Centre for Cardiometabolic Risk Reduction in South-Asia [CARRS] 2010-2011; N = 15 665) and the United States (National Health and Nutrition Examination Survey 2003-2006; N = 2159), adherence to a vegetarian diet was assessed using food propensity questionnaires. Multivariable logistic regression was used to estimate odds ratios and predicted margins (e.g., adjusted prevalence of the outcomes). RESULTS One-third (33%; n = 4968) of adults in the South Asian sample were vegetarian compared with only 2.4% (n = 59) in the US sample. Among South Asians, vegetarians more frequently ate dairy, legumes, vegetables, fruit, desserts, and fried foods than non-vegitarians (all P < 0.05). Among Americans, vegetarians more frequently ate legumes, fruit, and whole grains, and less frequently ate refined cereals, desserts, fried foods, fruit juice, and soft drinks than non-vegetarians (all P < 0.05). After adjustment for confounders (age, sex, education, tobacco, alcohol, and also city in CARRS), South Asian vegetarians were slightly less frequently overweight/obese compared with non-vegetarians: 49% (95% confidence interval [CI], 45%-53%) versus 53% (95% CI, 51%-56%), respectively; whereas US vegetarians were considerably less frequently overweight/obese compared with non-vegetarians: 48% (95% CI, 32%-63%) versus 68% (95% CI, 65%-70%), respectively. Furthermore, US vegetarians were less likely to exhibit central obesity than non-vegetarians: 62% (95% CI, 43%-78%) versus 78% (95% CI, 76%-80%), respectively. CONCLUSIONS There is greater divergence between vegetarian and non-vegetarian diets in the United States than in South Asia, and US vegetarians have more consistently healthier food group intakes than South Asian vegetarians. Vegetarians in both populations have a lower probability of overweight/obesity compared with non-vegetarians. The strength of this association may be stronger for US vegetarian diets, which were also protective against central obesity.
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Affiliation(s)
- Lindsay M Jaacks
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Deksha Kapoor
- Public Health Foundation of India and Centre for Chronic Disease Control, Gurgaon, Haryana, India
| | - Kalpana Singh
- Public Health Foundation of India and Centre for Chronic Disease Control, Gurgaon, Haryana, India
| | - K M Venkat Narayan
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Mohammed K Ali
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - M Masood Kadir
- Department of Community Health Sciences, Aga Khan University, Karachi, Sindh, Pakistan
| | | | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, NCR, India
| | - Dorairaj Prabhakaran
- Public Health Foundation of India and Centre for Chronic Disease Control, Gurgaon, Haryana, India
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Gopalakrishnan V, Singh R, Pradeep Y, Kapoor D, Rani AK, Pradhan S, Bhatia E, Yadav SB. Evaluation of the prevalence of gestational diabetes mellitus in North Indians using the International Association of Diabetes and Pregnancy Study groups (IADPSG) criteria. J Postgrad Med 2016; 61:155-8. [PMID: 26119433 PMCID: PMC4943402 DOI: 10.4103/0022-3859.159306] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: Currently, there is controversy regarding the diagnosis of gestational diabetes mellitus (GDM) as per the newer International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. We studied the prevalence and associations of GDM in North Indians, diagnosed by the IADPSG criteria. Patients and Methods: We conducted a cross-sectional study on 332 pregnant women, predominantly belonging to lower and middle socioeconomic strata. The women were screened for GDM between 24 weeks and 28 weeks of gestation by 75g oral glucose tolerance test (OGTT) and GDM diagnosed by the IADPSG criteria. Results: The prevalence of GDM was 41.9% [95% Confidence interval (CI) 36.6-47.2%]. Amongst the women diagnosed to have GDM, 91.4% had abnormal fasting plasma glucose (FPG), while 1-h and 2-h post-glucose (PG) levels were abnormal in 18.7% and 17.3% of women, respectively. No maternal factors were significantly associated with GDM. Birth weight of the neonates was similar in women with GDM as compared to those with normal glucose tolerance. In the entire group, fasting glucose levels were associated with the weight of the patient while 1-h PG levels were associated with weight, height, socioeconomic score, and parity. Conclusions: There is a very high prevalence rate of GDM using the IADPSG criteria in North Indian women of low and middle socioeconomic strata. Further studies are needed to assess the utility of applying these criteria in settings with limited resources.
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Affiliation(s)
| | | | | | | | | | | | | | - S B Yadav
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Krishna A, Singh R, Prasad N, Gupta A, Bhadauria D, Kaul A, Sharma RK, Kapoor D. Maternal, fetal and renal outcomes of pregnancy-associated acute kidney injury requiring dialysis. Indian J Nephrol 2015; 25:77-81. [PMID: 25838643 PMCID: PMC4379629 DOI: 10.4103/0971-4065.136890] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pregnancy-associated acute kidney injury (PAKI) is encountered frequently in developing countries. We evaluated the maternal, fetal and renal outcomes in women with PAKI who needed at least one session of dialysis. Of the total of 98 cases (mean age 28.85 ± 5.13 years; mean parity 2.65 ± 1.28) of PAKI, the most common cause of PAKI was postabortal sepsis. Eighteen patients died; those with oligoanuria, sepsis and central nervous system (CNS) involvement were at greater risk of mortality. The relative risk (RR) of neonatal mortality was lower after with full-term delivery (RR: 0.17, 95% confidence interval (CI): 0.03-0.96, P = 0.02) compared to preterm delivery. Of the 80 surviving patients, 60 (75%) patients achieved complete recovery of renal function at the end of 3 months; and of the remaining 14 had presumed (n = 4) or, biopsy-proven (n = 10) acute patchy cortical necrosis. The RR of non-recovery of renal function was high (RR: 24.7, 95% CI: 3.4- 179.5) in patients who did not recover at 6 weeks. Of the 14 patients with cortical necrosis, 3 (21.42%) became independent of dialysis at 6 months. PAKI patients should be watched for dialysis independency for 6 months.
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Affiliation(s)
- A. Krishna
- Department of Nephrology, General Hospital, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - R. Singh
- Department of Gynecology and Obstetrics, Queen Mary's Hospital, King George Medical University, Lucknow, Uttar Pradesh, India
| | - N. Prasad
- Department of Nephrology, General Hospital, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A. Gupta
- Department of Nephrology, General Hospital, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - D. Bhadauria
- Department of Nephrology, General Hospital, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A. Kaul
- Department of Nephrology, General Hospital, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - R. K. Sharma
- Department of Nephrology, General Hospital, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - D. Kapoor
- Department of Gynecology and Obstetrics, General Hospital, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Brooke JC, Walter DJ, Kapoor D, Marsh H, Muraleedharan V, Jones TH. Testosterone deficiency and severity of erectile dysfunction are independently associated with reduced quality of life in men with type 2 diabetes. Andrology 2014; 2:205-211. [PMID: 24574152 DOI: 10.1111/j.2047-2927.2013.00177.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 11/20/2013] [Accepted: 12/02/2013] [Indexed: 12/19/2022]
Abstract
Erectile dysfunction (ED) and low testosterone levels are common in men with type 2 diabetes (T2D). We have investigated the impact of testosterone on quality of life (QoL) in diabetic men with ED. Men with ED were identified within a study cohort of 355 men with T2D. All subjects completed SF-36 health and Androgen Deficiency of the Aging Male questionnaires. Total tesosterone (TT), bioavailable testosterone (BT) and sex hormone-binding globulin levels of study participants were measured and free testosterone levels were calculated (cFT). A subgroup of 126 ED patients completed the International Index of Erectile Function-5 (IIEF-5) questionnaire. Linear regression analyses were corrected for age, body mass index (BMI), glycosylated haemoglobin (HbA1c), smoking, alcohol consumption and cardiovascular disease (CVD). Total SF-36 scores significantly and positively correlated with TT levels (r = 0.219, p = 0.001), BT levels (r = 0.199, p = 0.004) and cFT levels (r = 0.185, p = 0.007) among men with ED. These trends were strengthened after adjusting for age, BMI, HbA1c, smoking, alcohol consumption and CVD (TT r = 0.359, p = 0.015; BT r = 0.354, p = 0.024 and cFT r = 0.354, p = 0.024). IIEF-5 scores significantly correlated inversely with TT (r = 0.546, p = 0.001), BT (r = 0.506, p = 0.004) and cFT levels (r = 0.532, p = 0.001). A positive linear relationship was observed between IIEF-5 scores and total SF-36 score (r = 0.491, p = 0.003). Patients who reported having ED had an average SF-36 score of 9.1% less than those without ED (p < 0.001). Lower testosterone and greater severity of ED independently correlated with poorer physical function, social function, vitality and decline in general health domains of the SF-36. This is the first study to report that testosterone deficiency and severity of ED are both independently associated with reduced QoL in men with T2D. Furthermore, ED and low testosterone are markers of poor health which impact on an individual's self-perception of their health status.
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Anand LK, Kapoor D, Goel N, Singh M. A reply. Anaesthesia 2014; 69:183-4. [DOI: 10.1111/anae.12583] [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: 11/27/2022]
Affiliation(s)
- L. K. Anand
- Government Medical College and Hospital; Chandigarh India
| | - D. Kapoor
- Government Medical College and Hospital; Chandigarh India
| | - N. Goel
- Government Medical College and Hospital; Chandigarh India
| | - M. Singh
- Government Medical College and Hospital; Chandigarh India
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Affiliation(s)
- L K Anand
- Government Medical College and Hospital, Chandigarh, India.
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Obedian E, Olsson C, Schumer M, Lieberman E, Kapoor D, Zimberg S. The Risk of Urosepsis in Patients Undergoing Fiducial Marker Placement for Image Guided Radiation Therapy (IGRT) of Prostate Cancer. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.1004] [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: 11/25/2022]
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Gupta A, Kapoor D. Comparison of two point versus one point fixation techniques in submentotracheal intubation during craniomaxillofacial surgeries—a pilot study. Int J Oral Maxillofac Surg 2013. [DOI: 10.1016/j.ijom.2013.07.548] [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: 10/26/2022]
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Abstract
Abstract
The quality of injection moulded products is determined by a complex coupling between polymer properties, mould geometry, and process dynamics. To increase the flexibility and consistency of the injection moulding process, a method was devised to simultaneously control cavity pressure at multiple locations in a mould. This control was achieved by installing multiple dynamic valve stems into the feed system of a hot runner manifold, each of which can control polymer flow. This system was used in a commercial application with four gates to deliver consistent product quality and provide manufacturing-stage flexibility. Across all eleven measured dimensions, the process capability index Cp increased between 50 and 400%. Also, multiple dimensions could be independently and simultaneously adjusted by locally controlling material shrinkage.
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Affiliation(s)
- D. Kapoor
- Department of Mechanical and Industrial Engineering, University of Massachusetts, Amherst, MA, USA
| | - D. Kazmer
- Department of Mechanical and Industrial Engineering, University of Massachusetts, Amherst, MA, USA
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André C, Kapoor D, Kaushal S, Anand LK, Dalai U. Letters to the Editor. Southern African Journal of Anaesthesia and Analgesia 2012. [DOI: 10.1080/22201173.2012.10872877] [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: 10/24/2022]
Affiliation(s)
- Coetzee André
- Department of Anaesthesiology and Critical Care Faculty of Health Sciences University of Stellenbosch Tygerberg
| | - D Kapoor
- Department of Anaesthesia and Intensive Care Government Medical College and Hospital, Chandigarh India
| | - S Kaushal
- Department of Anaesthesia and Intensive Care Government Medical College and Hospital, Chandigarh India
| | - LK Anand
- Department of Anaesthesia and Intensive Care Government Medical College and Hospital, Chandigarh India
| | - U Dalai
- Department of Surgery Government Medical College and Hospital Chandigarh, India
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Obedian E, Capece D, Kapoor D, Zimberg S. The Value of Repeat Cone Beam CT Scans in Image Guided Radiation Therapy for Prostate Cancer. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.2056] [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: 10/27/2022]
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35
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Singh M, Kapoor D. Insertion of a temperature probe into the ProSeal® laryngeal mask airway drainage tube. Southern African Journal of Anaesthesia and Analgesia 2011. [DOI: 10.1080/22201173.2011.10872790] [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: 10/24/2022]
Affiliation(s)
- M Singh
- Department of Anaesthesiology, Government Medical College and Hospital, Sec 32, Chandigarh, India
| | - D Kapoor
- Department of Anaesthesiology, Government Medical College and Hospital, Sec 32, Chandigarh, India
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36
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Stanworth RD, Kapoor D, Channer KS, Jones TH. Dyslipidaemia is associated with testosterone, oestradiol and androgen receptor CAG repeat polymorphism in men with type 2 diabetes. Clin Endocrinol (Oxf) 2011; 74:624-30. [PMID: 21470285 DOI: 10.1111/j.1365-2265.2011.03969.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE There is a high prevalence of low testosterone and dyslipidaemia in men with type 2 diabetes. The androgen receptor CAG repeat polymorphism (AR CAG) affects receptor transcriptional activity (the shorter repeats the more sensitive AR) and is associated with androgenic parameters and obesity. This study describes the relationships between testosterone, AR CAG and serum lipids in men with type 2 diabetes. DESIGN AND PATIENTS Cross-sectional study of men with type 2 diabetes in a District General Hospital Diabetes Centre. MEASUREMENTS Correlation between testosterone, AR CAG and serum lipids. RESULTS HDL cholesterol (HDL-C) correlated with total testosterone (TT) (r = 0·251, P < 0·001), bioavailable testosterone (BT) (r = 0·19, P = 0·001), free testosterone (FT) (r = 0·165, P = 0·005) and sex hormone-binding globulin (SHBG) (r = 0·147, P = 0·014). HDL-C did not correlate with oestradiol, but men with the lowest quartile of oestradiol had lower HDL-C compared to highest quartile (P = 0·046). Triglycerides correlated negatively with TT (r = -0·195, P = 0·001), BT (r = -0·148, P = 0·013) and SHBG (-0·14, P = 0·019) but not with FT or oestradiol. Total and LDL cholesterol (LDL-C) correlated negatively with oestradiol (r = -0·121, P = 0·05) but not with testosterone or SHBG. One-way anova testing across four quartiles of AR CAG showed a trend to alteration in HDL-C across groups of AR CAG (P = 0·08). HDL-C was significantly higher in men with the longest AR CAG compared with the shortest (1·19 vs 1·08 mmol/l, P = 0·02). CONCLUSIONS Lower testosterone and oestradiol levels in men with diabetes are associated with an adverse lipid profile. Shorter AR CAG is associated with low HDL-C and testosterone. The paradox that HDL-C is associated with low testosterone levels and a more active AR may suggest divergent effect of testosterone on HDL-C via genomic vs nongenomic mechanisms.
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Affiliation(s)
- R D Stanworth
- Centre for Diabetes and Endocrinology, Barnsley Hospital NHS Foundation Trust, Barnsley, South Yorkshire, UK
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Abstract
A patient with alcoholic cirrhosis of the liver, portal hypertension with hepatic encephalopathy and spontaneous bacterial peritonitis (SBP) was admitted in an obtunded condition. Attempts at delineating the aetiology of the SBP using conventional cultures as well as automated systems were not successful. The use of non-anionic surfactant agents such as Tween 80-incorporated blood agar and Triton X treatment of the specimens facilitated the growth of Klebsiella pneumoniae from the ascitic fluid, which otherwise would have been concluded to represent culture-negative neutrocytic ascites. Thus, the use of the aforementioned agents could be explored in elucidating the aetiology of body cavity infections when conventional methods fail.
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Affiliation(s)
- R N Iyer
- Global Hospitals, Lakdi-Ka-Pul, Hyderabad, India.
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Singh V, Rathore G, Kapoor D, Mishra BN, Lakra WS. Detection of aerolysin gene in Aeromonas hydrophila isolated from fish and pond water. Indian J Microbiol 2009; 48:453-8. [PMID: 23100746 DOI: 10.1007/s12088-008-0056-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2007] [Accepted: 01/24/2008] [Indexed: 11/26/2022] Open
Abstract
Aerolysin is a hemolytic toxin encoded by aerolysin gene (1482 bp) that plays a key role in the pathogenesis of Aeromonas hydrophila infection in fish. New speciesspecific primers were designed to amplify 326 bp conserved region of aerolysin gene for A. hydrophila. Twenty-five isolates of A. hydrophila recovered from fish and pond water were studied for detection of aerolysin gene. Aerolysin gene was detected in 85% of the isolates during the study. The designed primers were highly specific and showed no cross reactivity with Escherichia coli, Aeromonas veronii, Vibrio cholerae, Flavobacterium spp., Chyseobacterium spp. and Staphylococcus aureus. The sensitivity limit of primers for detection of aerolysin gene in the genomic DNA of A. hydrophila was 5 pg.
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Affiliation(s)
- Vijai Singh
- Aquatic Microbes Section, National Bureau of Fish Genetic Resources, Canal Ring Road, PO Dilkusha, Lucknow, 226 002 India
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Singh V, Somvanshi P, Rathore G, Kapoor D, Mishra BN. Gene cloning, expression and homology modeling of hemolysin gene from Aeromonas hydrophila. Protein Expr Purif 2008; 65:1-7. [PMID: 19136063 DOI: 10.1016/j.pep.2008.11.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Revised: 11/14/2008] [Accepted: 11/17/2008] [Indexed: 10/21/2022]
Abstract
Hemolysin is a significant toxin secreted by Aeromonas hydrophila, which contributes pathogenicity of fish to humans. The complete ORF of hemolysin gene (1886 bp) was amplified using PCR. It was cloned in TA and sub-cloned in pET28a vector then transformed into Escherichia coli BL21(DE3) codon plus RP cells expressed by the induction with 1.0 mM of IPTG. The expected size of expressed protein was 68.0 kDa estimated by migration in 12% SDS-PAGE. Anti-His monoclonal antibodies were used to substantiate the recombinant protein by Western blotting. The percent similarity between hemolysin of A. hydrophila with other hemolytic toxins revealed that the hemolysin/aerolysin/cytotoxin sequence varied from 99.35 to 50.40%. Homology modeling was used to construct 3-D structure of hemolysin of A. hydrophila with the known crystal 3-D structure (PDB: 1XEZ). This protein can be used for immunoassays and it is suitable for vaccine candidate against A. hydrophila infection.
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Affiliation(s)
- Vijai Singh
- National Bureau of Fish Genetic Resources, Canal ring road, P.O. Dilkusha, Lucknow 226002, India.
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Rathore G, Kumar G, Sood N, Kapoor D, Lakra WS. Development of monoclonal antibodies to rohu [Labeo rohita] immunoglobulins for use in immunoassays. Fish Shellfish Immunol 2008; 25:761-774. [PMID: 18996722 DOI: 10.1016/j.fsi.2008.02.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2007] [Revised: 02/16/2008] [Accepted: 02/26/2008] [Indexed: 05/27/2023]
Abstract
Serum immunoglobulins [Ig] of rohu [Labeo rohita] were purified by affinity chromatography using bovine serum albumin as capture ligand. The purified rohu Ig [r-Ig] had a molecular weight [MW] of 880 kDa as determined with gel filtration chromatography. The heavy chain of r-Ig had an MW of 77.8 kDa and that of light chain was 26.4 kDa in SDS-PAGE. Purified r-Ig was used for the production of two anti-rohu Ig monoclonal antibodies [D7 and H4] that belonged to subclass IgG2b and IgG1, respectively. Both the MAbs were specific to heavy chain of r-Ig as seen in Western blotting. Anti-rohu Ig MAb was used as a diagnostic reagent in ELISA and immunocytochemical assays to demonstrate its application for sero-surveillance and for immunological studies in rohu. A competitive ELISA was used to demonstrate the antigenic relatedness of r-Ig with whole serum Ig of other fish species. Cross reactivity of anti-rohu Ig MAb was observed with serum Ig of Catla catla and Cirrihinus mrigala. No reactivity to serum Ig of Ophiocephalus striatus and Clarias gariepinus was seen. Anti-rohu Ig MAb was found to be suitable for the detection of pathogen specific [Edwardsiella tarda] antibodies in serum of immunized rohu by an indirect ELISA. In flow cytometry using D7 MAb, the mean percentage [+/-SE] of Ig positive cells in spleen and blood of rohu were found to be 64.85% [+/-2.34] and 51.84% [+/-2.55] of gated lymphocytes, respectively. Similarly, D7 MAb also stained 52.84% [+/-1.30] and 10.5% of gated lymphocytes in kidney and thymus, respectively. The anti-rohu Ig MAbs also showed specific staining of Ig bearing cells in spleen sections by the indirect immunoperoxidase test.
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Affiliation(s)
- Gaurav Rathore
- National Bureau of Fish Genetic Resources, Canal Ring Road, P.O. Dilkusha, Lucknow 226 002, Uttar Pradesh, India.
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Stanworth RD, Kapoor D, Channer KS, Jones TH. Androgen receptor CAG repeat polymorphism is associated with serum testosterone levels, obesity and serum leptin in men with type 2 diabetes. Eur J Endocrinol 2008; 159:739-46. [PMID: 18805913 DOI: 10.1530/eje-08-0266] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine the relationships between androgen receptor CAG repeat polymorphism length (AR CAG), sex hormones and clinical variables in men with type 2 diabetes (DM2). Men with DM2 are known to have a high prevalence of low testosterone levels. Studies suggest that testosterone replacement therapy may improve insulin sensitivity and glycaemic control in men with DM2 and reduces central obesity and serum leptin. AR CAG is known to correlate negatively with AR sensitivity and positively with body fat, insulin levels, and leptin in healthy men. DESIGN Cross-sectional study set in a district general hospital diabetes centre. METHODS Sex hormones, AR CAG and symptoms of hypogonadism were assessed in 233 men with DM2. Associations were sought between these variables and others such as obesity, leptin, glycaemic control, and blood pressure. RESULTS Testosterone was negatively associated and AR CAG positively associated with obesity and leptin. The associations of AR CAG with leptin and obesity were independent of testosterone, estradiol, gonadotropins, and age. AR CAG was also independently associated with total, bioavailable and free testosterone, LH, waist circumference, body mass index, leptin, and systolic blood pressure. There was no association of AR CAG with sex hormone binding globulin, estradiol, HbA(1C) or the symptoms of hypogonadism. CONCLUSIONS The association of longer AR CAG with obesity and leptin suggests that shorter AR CAG may have an influence in maintaining healthy anthropomorphics and metabolism in men with DM2. Testosterone and LH levels are higher in men with longer AR CAG, probably reflecting reduced negative feedback through a less sensitive receptor.
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Affiliation(s)
- R D Stanworth
- Robert Hague Centre for Diabetes and Endocrinology, Barnsley Hospital NHS Foundation Trust, Gawber Road, Barnsley S75 2EP, South Yorkshire, UK
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Kumar G, Rathore G, Sengupta U, Kapoor D, Lakra WS. Production of monoclonal antibodies specific to major outer membrane protein of Edwardsiella tarda. Comp Immunol Microbiol Infect Dis 2008; 33:133-44. [PMID: 18804863 DOI: 10.1016/j.cimid.2008.08.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2008] [Indexed: 10/21/2022]
Abstract
Edwardsiella tarda is an important cause for hemorrhagic septicemia in fish and gastro and extra-intestinal infections in humans. Monoclonal antibodies (MAbs) were produced against outer membrane proteins (OMPs) of E. tarda ET-7, isolated from diseased snakehead (Ophiocephalus punctatus). Two stable hybridoma clones, designated as 3F10 and 2C3 MAbs were found to be potentially specific for E. tarda by indirect enzyme linked immunosorbent assay (ELISA). These MAbs recognized major immunogenic OMP band at 44kDa in Western blotting. Both MAbs belonged to the IgG1 isotype and recognized different epitopes of OMP as seen by competitive ELISA. These MAbs strongly reacted with all 17 isolates of E. tarda used in our study by indirect ELISA and Western blotting. Interestingly, no reaction was observed with the reference strain of E. tarda (MTCC 2400). The sensitivity of 3F10 MAb to detect whole cells of E. tarda was up to a level of 1x10(4)CFU/ml in indirect ELISA. No cross-reactivity of MAbs were seen with Escherichia coli, Salmonella arizonae, Pseudomonas fluorescens, Aeromonas hydrophila, Vibrio cholerae, Flavobacterium ferrugineum and Mycobacterium tuberculosis. These MAbs could be used for specific detection of E. tarda infection in fish by immunoassays.
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Affiliation(s)
- Gokhlesh Kumar
- National Bureau of Fish Genetic Resources, Lucknow, Uttar Pradesh, India
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Kapoor D, Clarke S, Channer KS, Jones TH. Erectile dysfunction is associated with low bioactive testosterone levels and visceral adiposity in men with type 2 diabetes. ACTA ACUST UNITED AC 2007; 30:500-7. [DOI: 10.1111/j.1365-2605.2007.00744.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Kapoor D, Clarke S, Stanworth R, Channer KS, Jones TH. The effect of testosterone replacement therapy on adipocytokines and C-reactive protein in hypogonadal men with type 2 diabetes. Eur J Endocrinol 2007; 156:595-602. [PMID: 17468196 DOI: 10.1530/eje-06-0737] [Citation(s) in RCA: 161] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Serum testosterone levels are known to inversely correlate with insulin sensitivity and obesity in men. Furthermore, there is evidence to suggest that testosterone replacement therapy reduces insulin resistance and visceral adiposity in type 2 diabetic men. Adipocytokines are hormones secreted by adipose tissue and contribute to insulin resistance. We examined the effects of testosterone replacement treatment on various adipocytokines and C-reactive protein (CRP) in type 2 diabetic men. DESIGN Double-blinded placebo-controlled crossover study in 20 hypogonadal type 2 diabetic men. Patients were treated with testosterone (sustanon 200 mg) or placebo intramuscularly every 2 weeks for 3 months in random order followed by a washout period of 1 month before the alternate treatment phase. METHODS Leptin, adiponectin, resistin, tumour necrosis factor-alpha (TNF-alpha), interleukin (IL)-6 and CRP levels were measured before and after each treatment phase. Body mass index (BMI) and waist circumference were also recorded. RESULTS At baseline, leptin levels significantly correlated with BMI and waist circumference. There was a significant inverse correlation between baseline IL-6 and total testosterone (r=-0.68; P=0.002) and bioavailable testosterone levels (r=-0.73; P=0.007). CRP levels also correlated significantly with total testosterone levels (r=-0.59; P=0.01). Testosterone treatment reduced leptin (-7141.9 +/- 1461.8 pg/ml; P=0.0001) and adiponectin levels (-2075.8 +/- 852.3 ng/ml; P=0.02). There was a significant reduction in waist circumference. No significant effects of testosterone therapy on resistin, TNF-alpha, IL-6 or CRP levels were observed. CONCLUSION Testosterone replacement treatment decreases leptin and adiponectin levels in type 2 diabetic men. Moreover, low levels of testosterone in men are associated with pro-inflammatory profile, though testosterone treatment over 3 months had no effect on inflammatory markers.
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Affiliation(s)
- D Kapoor
- Centre for Diabetes and Endocrinology, Barnsley NHS Foundation Trust Hospital, Barnsley, United Kingdom
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Ibebuogu UN, Kapoor D, Robinson VJ. SEVERE MYOCARDIAL ISCHEMIA DUE TO A LARGE ARTERIOVENOUS MALFORMATION OF THE LEFT ANTERIOR DESCENDING CORONARY ARTERY WITH FISTULOUS CONNECTION FROM THE RIGHT CORONARY ARTERY. J Investig Med 2007. [DOI: 10.1097/00042871-200701010-00539] [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: 11/25/2022]
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Rathore G, Swaminathan TR, Sood N, Mishra BN, Kapoor D. Affinity purification and partial characterization of IgM-like immunoglobulins of African catfish, Clarias gariepinus (Burchell, 1822). Indian J Exp Biol 2006; 44:1018-21. [PMID: 17176677] [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: 05/13/2023]
Abstract
IgM like macroglobulin from bovine serum albumin (BSA)-immunized African catfish C. gariepinus was purified by affinity chromatography and partially characterized. The molecular weight of this macroglobulin was 840 kDa, as estimated by gel filtration chromatography. Purified macroglobulin was analyzed using SDS-PAGE under reducing and non-reducing conditions. The molecular weight (MW) of heavy and light chain was 74.8 kDa and 27.2 kDa respectively, in presence of a reducing agent. In non-reducing SDS-PAGE, a single high MW band was observed representing tetrameric form.
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Affiliation(s)
- Gaurav Rathore
- National Bureau of Fish Genetic Resources, Canal Ring Road, P.O. Dilkusha, Lucknow 226 002, India.
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Kapoor D, Goodwin E, Channer KS, Jones TH. Testosterone replacement therapy improves insulin resistance, glycaemic control, visceral adiposity and hypercholesterolaemia in hypogonadal men with type 2 diabetes. Eur J Endocrinol 2006; 154:899-906. [PMID: 16728551 DOI: 10.1530/eje.1.02166] [Citation(s) in RCA: 512] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Low levels of testosterone in men have been shown to be associated with type 2 diabetes, visceral adiposity, dyslipidaemia and metabolic syndrome. We investigated the effect of testosterone treatment on insulin resistance and glycaemic control in hypogonadal men with type 2 diabetes. DESIGN This was a double-blind placebo-controlled crossover study in 24 hypogonadal men (10 treated with insulin) over the age of 30 years with type 2 diabetes. METHODS Patients were treated with i.m. testosterone 200 mg every 2 weeks or placebo for 3 months in random order, followed by a washout period of 1 month before the alternate treatment phase. The primary outcomes were changes in fasting insulin sensitivity (as measured by homeostatic model index (HOMA) in those not on insulin), fasting blood glucose and glycated haemoglobin. The secondary outcomes were changes in body composition, fasting lipids and blood pressure. Statistical analysis was performed on the delta values, with the treatment effect of placebo compared against the treatment effect of testosterone. RESULTS Testosterone therapy reduced the HOMA index (-1.73 +/- 0.67, P = 0.02, n = 14), indicating an improved fasting insulin sensitivity. Glycated haemoglobin was also reduced (-0.37 +/- 0.17%, P = 0.03), as was the fasting blood glucose (-1.58 +/- 0.68 mmol/l, P = 0.03). Testosterone treatment resulted in a reduction in visceral adiposity as assessed by waist circumference (-1.63 +/- 0.71 cm, P = 0.03) and waist/hip ratio (-0.03 +/- 0.01, P = 0.01). Total cholesterol decreased with testosterone therapy (-0.4 +/- 0.17 mmol/l, P = 0.03) but no effect on blood pressure was observed. CONCLUSIONS Testosterone replacement therapy reduces insulin resistance and improves glycaemic control in hypogonadal men with type 2 diabetes. Improvements in glycaemic control, insulin resistance, cholesterol and visceral adiposity together represent an overall reduction in cardiovascular risk.
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Affiliation(s)
- D Kapoor
- Centre for Diabetes and Endocrinology, Barnsley NHS Foundation Trust Hospital, Gawber Road, Barnsley S75 2EP, UK
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Nanda S, Grover C, Goel A, Kapoor D, Reddy BSN, Khurana N. Primary cutaneous histoplasmosis in an immunocompetent host from a non-endemic area. Indian J Dermatol 2006. [DOI: 10.4103/0019-5154.25208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kapoor D, Agrawal NK, Aggarwal R, Sahoo AK, Singh SK. Vitamin D deficiency masquerading as pseudohypoparathyoidism type 2. J Assoc Physicians India 2005; 53:999-1000; author reply 1000. [PMID: 16515248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
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