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Bergaoui K, Fraj MB, Fragaszy S, Ghanim A, Hamadin O, Al-Karablieh E, Al-Bakri J, Fakih M, Fayad A, Comair F, Yessef M, Mansour HB, Belgrissi H, Arsenault K, Peters-Lidard C, Kumar S, Hazra A, Nie W, Hayes M, Svoboda M, McDonnell R. Development of a composite drought indicator for operational drought monitoring in the MENA region. Sci Rep 2024; 14:5414. [PMID: 38443431 PMCID: PMC10914844 DOI: 10.1038/s41598-024-55626-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 02/26/2024] [Indexed: 03/07/2024] Open
Abstract
This paper presents the composite drought indicator (CDI) that Jordanian, Lebanese, Moroccan, and Tunisian government agencies now produce monthly to support operational drought management decision making, and it describes their iterative co-development processes. The CDI is primarily intended to monitor agricultural and ecological drought on a seasonal time scale. It uses remote sensing and modelled data inputs, and it reflects anomalies in precipitation, vegetation, soil moisture, and evapotranspiration. Following quantitative and qualitative validation assessments, engagements with policymakers, and consideration of agencies' technical and institutional capabilities and constraints, we made changes to CDI input data, modelling procedures, and integration to tailor the system for each national context. We summarize validation results, drought modelling challenges and how we overcame them through CDI improvements, and we describe the monthly CDI production process and outputs. Finally, we synthesize procedural and technical aspects of CDI development and reflect on the constraints we faced as well as trade-offs made to optimize the CDI for operational monitoring to support policy decision-making-including aspects of salience, credibility, and legitimacy-within each national context.
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Affiliation(s)
- Karim Bergaoui
- International Water Management Institute (IWMI), Colombo, Sri Lanka.
- Dubai Technology Entrepreneur Campus, ACQUATEC Solutions, Dubai, UAE.
| | - Makram Belhaj Fraj
- International Water Management Institute (IWMI), Colombo, Sri Lanka
- Dubai Technology Entrepreneur Campus, ACQUATEC Solutions, Dubai, UAE
| | - Stephen Fragaszy
- International Water Management Institute (IWMI), Colombo, Sri Lanka.
| | - Ali Ghanim
- Drought Management Unit, Ministry of Water and Irrigation, Amman, Jordan
| | - Omar Hamadin
- Jordanian Meteorological Department, Ministry of Transportation, Amman, Jordan
| | - Emad Al-Karablieh
- Department of Agricultural Economics and Agribusiness, The University of Jordan, Amman, Jordan
| | - Jawad Al-Bakri
- Department of Land, Water and Environment, The University of Jordan, Amman, Jordan
| | - Mona Fakih
- Water Resources, General Directorate of Hydraulic and Electrical Resources, Ministry of Energy and Water, Beirut, Lebanon
| | - Abbas Fayad
- Water Resources, General Directorate of Hydraulic and Electrical Resources, Ministry of Energy and Water, Beirut, Lebanon
- Centre for Hydrology, University of Saskatchewan, Canmore, Alberta, T1W 3G1, Canada
| | - Fadi Comair
- Water Resources, General Directorate of Hydraulic and Electrical Resources, Ministry of Energy and Water, Beirut, Lebanon
- Energy, Environment, and Water Research Centre in the Cyprus Institute, Nicosia, Cyprus
| | - Mohamed Yessef
- Institut Hassan II of Agronomy and Veterinary Medicine, Rabat, Morocco
| | | | | | - Kristi Arsenault
- Hydrological Science Laboratory, NASA Goddard Space Flight Center, Greenbelt, MD, USA
- Earth System Science Interdisciplinary Center, University of Maryland, Maryland, USA
- NASA Goddard Space Flight Center, Maryland, USA
| | | | - Sujay Kumar
- Hydrological Science Laboratory, NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - Abheera Hazra
- Earth System Science Interdisciplinary Center, University of Maryland, Maryland, USA
- NASA Goddard Space Flight Center, Maryland, USA
| | - Wanshu Nie
- Hydrological Science Laboratory, NASA Goddard Space Flight Center, Greenbelt, MD, USA
- Science Applications International Corporation, McLean, VA, USA
| | - Michael Hayes
- School of Natural Resources, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Mark Svoboda
- National Drought Mitigation Center, University of Nebraska-Lincoln, Lincoln, NE, USA
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Ray A, Pandithurai G, Mukherjee S, Kumar VA, Hazra A, Patil RD, Waghmare V. Seasonal variability in size-resolved hygroscopicity of sub-micron aerosols over the Western Ghats, India: Closure and parameterization. Sci Total Environ 2023; 869:161753. [PMID: 36690110 DOI: 10.1016/j.scitotenv.2023.161753] [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] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 06/17/2023]
Abstract
Hygroscopicity of atmospheric aerosol primarily depends on the size and chemical composition of the particle and is important for estimating anthropogenic aerosol radiative forcing. There is limited information exists over the Indian region on size segregated aerosol hygroscopicity (κ) in different seasons. This study presents 'κ' as derived from a Humidified Tandem Differential Mobility Analyzer (HTDMA) over a High Altitude Cloud Physics Laboratory (HACPL) in the Western Ghats, India for more than a year (from May 2019 to May 2020). The average hygroscopicity values of aerosol particles of diameters 32, 50, 75, 110, 150, 210 and 260 nm at 90 % RH condition are 0.19, 0.18, 0.16, 0.17, 0.18, 0.20, 0.21 respectively during the entire observation period. κ was observed to decrease with an increase in size in the Aitken mode regime (32-75 nm) and an increase in the accumulation mode (110-260 nm). Seasonal variation of hygroscopicity for a wide range of particle diameters is reported which is highly demanding as there is a change in the air mass flow pattern in each of the seasons. The diurnal cycle of hygroscopicity showed a prominent peak during the midnight to early morning hours followed by a decrease in the forenoon hours and a secondary peak in the afternoon hours. κ is found to be higher in pre-monsoon compared to winter season as Chl is approximately 3 % higher in pre-monsoon and NH4Cl is highly hygroscopic among the assumed chemical composition. Hygroscopicity derived through chemical speciation observations assuming internal and external mixing of aerosols i.e. κinter and κexter are overestimating as compared to κHTDMA. However, the bias between kexter and kHTDMA is relatively lower as external mixing type of aerosol is evident through the growth factor data sets measured by HTDMA. Utilizing the hygroscopicity measurements available for discrete diameters by HTDMA, a parameterization of hygroscopicity with the dry diameter of sub-micron particles is developed.
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Affiliation(s)
- Avishek Ray
- Indian Institute of Tropical Meteorology, Pune, Ministry of Earth Sciences, India; Savitribai Phule Pune University, Pune, India
| | - G Pandithurai
- Indian Institute of Tropical Meteorology, Pune, Ministry of Earth Sciences, India.
| | - S Mukherjee
- Indian Institute of Tropical Meteorology, Pune, Ministry of Earth Sciences, India
| | - V Anil Kumar
- Indian Institute of Tropical Meteorology, Pune, Ministry of Earth Sciences, India
| | - A Hazra
- Indian Institute of Tropical Meteorology, Pune, Ministry of Earth Sciences, India
| | - Rohit D Patil
- Indian Institute of Tropical Meteorology, Pune, Ministry of Earth Sciences, India
| | - V Waghmare
- Indian Institute of Tropical Meteorology, Pune, Ministry of Earth Sciences, India
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Zaaimi B, Turnbull M, Hazra A, Wang Y, Gandara C, McLeod F, McDermott EE, Escobedo-Cousin E, Idil AS, Bailey RG, Tardio S, Patel A, Ponon N, Gausden J, Walsh D, Hutchings F, Kaiser M, Cunningham MO, Clowry GJ, LeBeau FEN, Constandinou TG, Baker SN, Donaldson N, Degenaar P, O'Neill A, Trevelyan AJ, Jackson A. Closed-loop optogenetic control of the dynamics of neural activity in non-human primates. Nat Biomed Eng 2023; 7:559-575. [PMID: 36266536 PMCID: PMC7614485 DOI: 10.1038/s41551-022-00945-8] [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: 09/15/2020] [Accepted: 08/14/2022] [Indexed: 11/08/2022]
Abstract
Electrical neurostimulation is effective in the treatment of neurological disorders, but associated recording artefacts generally limit its applications to open-loop stimuli. Real-time and continuous closed-loop control of brain activity can, however, be achieved by pairing concurrent electrical recordings and optogenetics. Here we show that closed-loop optogenetic stimulation with excitatory opsins enables the precise manipulation of neural dynamics in brain slices from transgenic mice and in anaesthetized non-human primates. The approach generates oscillations in quiescent tissue, enhances or suppresses endogenous patterns in active tissue and modulates seizure-like bursts elicited by the convulsant 4-aminopyridine. A nonlinear model of the phase-dependent effects of optical stimulation reproduced the modulation of cycles of local-field potentials associated with seizure oscillations, as evidenced by the systematic changes in the variability and entropy of the phase-space trajectories of seizures, which correlated with changes in their duration and intensity. We also show that closed-loop optogenetic neurostimulation could be delivered using intracortical optrodes incorporating light-emitting diodes. Closed-loop optogenetic approaches may be translatable to therapeutic applications in humans.
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Affiliation(s)
- B Zaaimi
- Biosciences Institute, Newcastle University, Newcastle, UK
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - M Turnbull
- Biosciences Institute, Newcastle University, Newcastle, UK
| | - A Hazra
- Biosciences Institute, Newcastle University, Newcastle, UK
| | - Y Wang
- School of Computing, Newcastle University, Newcastle, UK
| | - C Gandara
- Biosciences Institute, Newcastle University, Newcastle, UK
| | - F McLeod
- Biosciences Institute, Newcastle University, Newcastle, UK
| | - E E McDermott
- Biosciences Institute, Newcastle University, Newcastle, UK
| | | | - A Shah Idil
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - R G Bailey
- School of Engineering, Newcastle University, Newcastle, UK
| | - S Tardio
- School of Engineering, Newcastle University, Newcastle, UK
| | - A Patel
- School of Engineering, Newcastle University, Newcastle, UK
| | - N Ponon
- School of Engineering, Newcastle University, Newcastle, UK
| | - J Gausden
- School of Engineering, Newcastle University, Newcastle, UK
| | - D Walsh
- Biosciences Institute, Newcastle University, Newcastle, UK
| | - F Hutchings
- School of Computing, Newcastle University, Newcastle, UK
| | - M Kaiser
- School of Computing, Newcastle University, Newcastle, UK
- NIHR, Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
- Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, UK
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - M O Cunningham
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - G J Clowry
- Biosciences Institute, Newcastle University, Newcastle, UK
| | - F E N LeBeau
- Biosciences Institute, Newcastle University, Newcastle, UK
| | - T G Constandinou
- Department of Electrical and Electronic Engineering, Imperial College, London, UK
| | - S N Baker
- Biosciences Institute, Newcastle University, Newcastle, UK
| | - N Donaldson
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - P Degenaar
- School of Engineering, Newcastle University, Newcastle, UK
| | - A O'Neill
- School of Engineering, Newcastle University, Newcastle, UK
| | - A J Trevelyan
- Biosciences Institute, Newcastle University, Newcastle, UK
| | - A Jackson
- Biosciences Institute, Newcastle University, Newcastle, UK.
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Sharma S, Sahu R, Taneja N, Hazra A. Epidemiological investigation of viral hepatitis E outbreak in two colocated training centers. Med J Armed Forces India 2022; 78:S116-S122. [PMID: 36147417 PMCID: PMC9485744 DOI: 10.1016/j.mjafi.2018.09.001] [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: 02/27/2018] [Accepted: 09/02/2018] [Indexed: 10/27/2022] Open
Abstract
Background A high number of jaundice cases were reported from two colocated training centers in North India. This outbreak was investigated to describe the epidemiology, identify risk factors, and recommend preventive and control measures. Methods Initial line list was prepared, and case definition was defined as "the presence of icterus or passage of yellow-colored urine with fever/anorexia/vomiting/abdominal pain in a resident of Military Station A between 03/04/2016 to 06/06/2016". Case search was conducted through surveillance. An unmatched 1:1 case-control study was conducted to evaluate the associated risk factors. All cases were tested for hepatitis markers. Environmental investigation of food and water sources was conducted to identify the source of infection. Results Of 172 cases, all were males from two co-located military training centers (attack rate, 4.7%). Clinical features included icterus (100%), yellowish discoloration of urine (98.9%), anorexia (97.22%), fever (80%), nausea/vomiting (56%), and abdominal pain (52.77%). Only one case (0.6%) had complication of fulminant hepatitis, and there were no deaths (CFR = 0%). Consumption of juice with ice from juice shops was significantly associated with illness (Odds Ratio-14.3 [95%CI 7.4-27.6]). Of 172 cases, 167 (97.1%) tested anti-HEV-IgM positive. Juice shops in training centers were using ice made from contaminated water with positive coliform test. All other water samples tested satisfactory. No cross-contamination of water pipelines with sewage was observed. Conclusion Epidemiological evidence concludes that a large viral hepatitis E outbreak was likely caused by consumption of juice with contaminated ice. Early stoppage of contaminated ice usage led to timely control of the outbreak.
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Affiliation(s)
- Seema Sharma
- Assistant Director (Health), Head Quarters (DB Area), Chennai 600 009, India
| | - Rajesh Sahu
- Classified Specialist (Community Medicine), Command Hospital (Central Command), Lucknow 226010, India
| | - N.S. Taneja
- Classified Specialist (Pathology), Military Hospital Ramgarh Cantt, Jharkhand, India
| | - A. Hazra
- Senior Advisor (Community Medicine), Headquarters Southern Command, Pune, India
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Hazra A, Mandal S, Chakraborty J. W040 Relationship of neutrophil-lymphocyte-ratio and platelet counts with parathormone, and how they are affected by gender, age and sugar levels in maintenance hemodialysis patients in India. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.171] [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: 11/03/2022]
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Joshi R, Medhi B, Prakash A, Chandy S, Ranjalkar J, Bright HR, Basker J, Govindraj L, Chugh PK, Tripathi CD, Badyal DK, Balakrishnan S, Jhaj R, Shukla AK, Atal S, Najmi A, Banerjee A, Kamat S, Tripathi RK, Shetty YC, Parmar U, Rege N, Dikshit H, Mishra H, Roy SS, Chatterjee S, Hazra A, Bhattacharya M, Das D, Trivedi N, Shah P, Chauhan J, Desai C, Gandhi AM, Patel PP, Shah S, Sheth S, Raveendran R, Mathaiyan J, Manikandan S, Jeevitha G, Gupta P, Sarangi SC, Yadav HN, Singh S, Kaushal S, Arora S, Gupta K, Jain S, Cherian JJ, Chatterjee NS, Kaul R, Kshirsagar NA. Assessment of prescribing pattern of drugs and completeness of prescriptions as per the World Health Organization prescribing indicators in various Indian tertiary care centers: A multicentric study by Rational Use of Medicines Centers-Indian Council of Medical Research network under National Virtual Centre Clinical Pharmacology activity. Indian J Pharmacol 2022; 54:321-328. [PMID: 36537400 PMCID: PMC9846909 DOI: 10.4103/ijp.ijp_976_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE The rational use of medicines as per the World Health Organization (WHO) should be practiced globally. However, data regarding the completeness of the prescriptions and their rational use is lacking from developing countries like India. Thus, the aim of this study was to assess the prescribing patterns of drugs and completeness of prescriptions as per WHO core drug use and complementary indicators to provide real-life examples for the Indian Council of Medical Research (ICMR) online prescribing skill course for medical graduates. METHODS Prescriptions of the patients, fulfilling inclusion criteria, attending Outpatient Departments of various specialties of tertiary care hospitals, were collected by thirteen ICMR Rational use of medicines centers located in tertiary care hospitals, throughout India. Prescriptions were evaluated for rational use of medicines according to the WHO guidelines and for appropriateness as per standard treatment guidelines using a common protocol approved by local Ethics committees. RESULTS Among 4838 prescriptions, an average of about three drugs (3.34) was prescribed to the patients per prescription. Polypharmacy was noted in 83.05% of prescriptions. Generic drugs were prescribed in 47.58% of the prescriptions. Further, antimicrobials were prescribed in 17.63% of the prescriptions and only 4.98% of prescriptions were with injectables. During the prescription evaluation, 38.65% of the prescriptions were incomplete due to multiple omissions such as dose, duration, and formulation. CONCLUSION Most of the parameters in the present study were out of the range of WHO-recommended prescribing indicators. Therefore, effective intervention program, like training, for the promotion of rational drug use practice was recommended to improve the prescribing pattern of drugs and the quality of prescriptions all over the country.
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Affiliation(s)
- R Joshi
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - B Medhi
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India,Address for correspondence: Dr. Medhi B, Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India. E-mail:
| | - A Prakash
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S Chandy
- Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore, Tamil Nadu, India
| | - J Ranjalkar
- Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore, Tamil Nadu, India
| | - HR Bright
- Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore, Tamil Nadu, India
| | - J Basker
- Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore, Tamil Nadu, India
| | - L Govindraj
- Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore, Tamil Nadu, India
| | - PK Chugh
- Vardhman Mahavir Medical College, New Delhi, India
| | - CD Tripathi
- Vardhman Mahavir Medical College, New Delhi, India
| | - DK Badyal
- Department of Pharmacology, Christian Medical College, Ludhiana, Punjab, India
| | - S Balakrishnan
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | - R Jhaj
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | - AK Shukla
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | - S Atal
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | - A Najmi
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | - A Banerjee
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | - S Kamat
- Department of Pharmacology and Therapeutics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - RK Tripathi
- Department of Pharmacology and Therapeutics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - YC Shetty
- Department of Pharmacology and Therapeutics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - U Parmar
- Department of Pharmacology and Therapeutics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - N Rege
- Department of Pharmacology and Therapeutics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - H Dikshit
- Department of Pharmacology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - H Mishra
- Department of Pharmacology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - SS Roy
- Department of Pharmacology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - S Chatterjee
- Department of Pharmacology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - A Hazra
- Department of Pharmacology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - M Bhattacharya
- Department of Pharmacology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - D Das
- Department of Pharmacology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - N Trivedi
- Department of Pharmacology, Government Medical College, Baroda, Gujarat, India
| | - P Shah
- Department of Pharmacology, Government Medical College, Baroda, Gujarat, India
| | - J Chauhan
- Department of Pharmacology, Government Medical College, Baroda, Gujarat, India
| | - C Desai
- Department of Pharmacology, B.J. Medical College, Ahmedabad, Gujarat, India
| | - AM Gandhi
- Department of Pharmacology, B.J. Medical College, Ahmedabad, Gujarat, India
| | - PP Patel
- Department of Pharmacology, B.J. Medical College, Ahmedabad, Gujarat, India
| | - S Shah
- Department of Pharmacology, B.J. Medical College, Ahmedabad, Gujarat, India
| | - S Sheth
- Department of Pharmacology, B.J. Medical College, Ahmedabad, Gujarat, India
| | - R Raveendran
- Department of Pharmacology, Jawaharlal Institute of Post Medical Education and Research, Puducherry, India
| | - J Mathaiyan
- Department of Pharmacology, Jawaharlal Institute of Post Medical Education and Research, Puducherry, India
| | - S Manikandan
- Department of Pharmacology, Jawaharlal Institute of Post Medical Education and Research, Puducherry, India
| | - G Jeevitha
- Department of Pharmacology, Jawaharlal Institute of Post Medical Education and Research, Puducherry, India
| | - P Gupta
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - SC Sarangi
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - HN Yadav
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - S Singh
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - S Kaushal
- Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - S Arora
- Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - K Gupta
- Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - S Jain
- Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - JJ Cherian
- Indian Council of Medical Research, New Delhi, India
| | - NS Chatterjee
- Indian Council of Medical Research, New Delhi, India
| | - R Kaul
- Indian Council of Medical Research, New Delhi, India
| | - NA Kshirsagar
- Indian Council of Medical Research, New Delhi, India
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Vong C, Wang X, Hazra A, Mukherjee A, Nicholas T, Chang C. FRI0465 TOFACITINIB POPULATION PHARMACOKINETICS IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS: A POOLED ANALYSIS OF DATA FROM THREE CLINICAL STUDIES. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Tofacitinib is an oral JAK inhibitor that is being investigated for juvenile idiopathic arthritis (JIA).Objectives:To describe tofacitinib pharmacokinetics (PK) in patients with JIA, identify potential covariates accounting for variability in exposure, assess the formulation effect of oral solution vs tablet and propose a simplified dosing regimen.Methods:This was a pooled analysis of data from 3 tofacitinib clinical studies in patients with JIA aged 2−<18 years: a Phase 1, open-label (OL), non-randomised study (NCT01513902); a Phase 3, randomised, double-blind, placebo-controlled, withdrawal study (NCT02592434); and an OL long-term extension study (NCT01500551). Tofacitinib was dosed at 5 mg twice daily (BID) in patients ≥40 kg or at body weight (BW)-based lower doses BID in patients <40 kg, to achieve average concentrations (Cavg) comparable with those in patients receiving 5 mg BID. A sparse PK sampling scheme was applied, and the plasma samples were assayed using a validated, sensitive and specific high-performance liquid chromatography tandem mass spectrometric method (lower limit of quantification = 0.100 ng/mL). A nonlinear mixed-effects modelling approach was used for the population PK model, and population parameter variability was assumed to be log-normally distributed. Covariates relating to patient demographics, disease characteristics, concomitant medications and formulation (oral solution vs tablet) were selected using a stepwise covariate modelling approach, and parameter-covariate relationships were evaluated using stepwise forward-inclusion (p<0.05) backward-deletion (p<0.001) procedures. The effect of time-varying BW on oral clearance (CL/F) and apparent volume of distribution (V/F) was characterised using an allometric model. Final model quality was assessed by Visual Predictive Checks (VPCs).Results:Of 246 patients in the analysis, 74.0% were female; 87.8% were white, 2% were black, 10.2% were ‘other’ races and no patients were Asian. Median (range) BW was 46.3 (11.1−121.8) kg. Initially, 100 patients received oral solution and 146 patients received tablets; 11 patients switched formulations during the studies. A one compartment disposition model with first-order absorption and a lag time sufficiently described the data. Final estimates for CL/F, V/F and the first-order absorption rate constant (ka) for tablets were 26.1 L/hr, 89.2 L and 2.78 hr-1, respectively. The only statistically significant covariate was a formulation effect on ka. All parameters were estimated adequately. Estimated allometric exponents were 0.310 for CL/F and 0.537 for V/F. Absorption was described with an estimated lag time of 0.186 hr, and the oral solution had a 1.64-fold faster absorption rate vs the tablet. VPCs sufficiently described the observed data over time, across BWs and ages. Given the PK characterisation and variability in patients with JIA, a simplified dosing scheme was proposed, targeting Cavgvalues equivalent to those in patients receiving 5 mg BID: 3.2 mg BID solution in patients 10−<20 kg; 4 mg BID solution in patients 20−<40 kg; and 5 mg BID tablet or solution in patients ≥40 kg.Conclusion:Tofacitinib population PK in patients with JIA were adequately described by a one compartment model parameterised in terms of CL/F, V/F and first-order absorption with a lag time. Drug absorption from the oral solution was faster than from the tablet. Tofacitinib does not require dose modification or restrictions for any covariates, except BW, to account for differences in Cavg. Based on the results of this analysis, a simplified BW-based dosing regimen was proposed.Acknowledgments:Study sponsored by Pfizer Inc. Medical writing support was provided by Sarah Piggott of CMC Connect and funded by Pfizer Inc.Disclosure of Interests:Camille Vong Shareholder of: Pfizer Inc, at time of analysis, Employee of: Pfizer Inc, at time of analysis, Xiaoxing Wang Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Anasuya Hazra Shareholder of: Pfizer Inc, at time of analysis, Employee of: Pfizer Inc, at time of analysis, Arnab Mukherjee Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Timothy Nicholas Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Cheng Chang Shareholder of: Pfizer Inc, Employee of: Pfizer Inc
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Banerjee TK, Saha M, Ghosh E, Hazra A, Das A, Choudhury D, Ojha S, Haldar A, Mukherjee A, Nandi SS, Ghosh A, Mukherjee A, Chatterjee A, Datta A, Purakayastha S. Conversion of clinically isolated syndrome to multiple sclerosis: a prospective multi-center study in Eastern India. Mult Scler J Exp Transl Clin 2019; 5:2055217319849721. [PMID: 31236283 PMCID: PMC6572895 DOI: 10.1177/2055217319849721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Received: 12/24/2018] [Revised: 04/05/2019] [Accepted: 04/16/2019] [Indexed: 11/17/2022] Open
Abstract
Background In White populations more than 60% of clinically isolated syndrome (CIS) convert to multiple sclerosis (MS) on a long-term follow-up; several predictors for conversion have been identified. Objective This study aimed to determine the conversion rate and the predictors of conversion from CIS to MS (McDonald 2010) among Indians. The other objective was to evaluate the diagnostic accuracy of the new McDonald 2017 criteria in prediction of a second clinical attack. Methods Clinical and demographic data of CIS cohorts were collected. Baseline investigations included cerebrospinal magnetic resonance imaging (MRI) with contrast and cerebrospinal fluid (CSF) testing for oligoclonal band (OCB). Follow-up clinical and MRI examinations were performed annually for at least 24 months. Results Of the 82 subjects (age range 15-58 years), 36 (43.9%) converted to MS; 31/82 (37.8%) converted in 24 months. The predictors for conversion were earlier age of onset, CSF-OCB, cerebral MRI T2 lesion count, and periventricular and juxtacortical location of lesions. Twenty-two (26.83%) CIS fulfilled the McDonald MS 2017 criteria at baseline. Conclusion In this first prospective study of CIS in India, the risk factors for conversion are similar but the conversion rate to MS is lower than that in the western nations.
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Affiliation(s)
- T K Banerjee
- National Neurosciences Centre Calcutta, Kolkata, India
| | - M Saha
- Apollo Gleneagles Hospital, Kolkata, India
| | - E Ghosh
- National Neurosciences Centre Calcutta, Kolkata, India
| | - A Hazra
- Institute of Postgraduate Medical Education & Research, Kolkata, India
| | - A Das
- National Neurosciences Centre Calcutta, Kolkata, India
| | - D Choudhury
- National Neurosciences Centre Calcutta, Kolkata, India
| | - S Ojha
- National Neurosciences Centre Calcutta, Kolkata, India
| | | | - A Mukherjee
- Vivekananda Institute of Medical Sciences, Kolkata, India
| | - S S Nandi
- Calcutta Medical Research Institute, Kolkata, India
| | - A Ghosh
- Apollo Gleneagles Hospital, Kolkata, India
| | - A Mukherjee
- Calcutta Medical Research Institute, Kolkata, India
| | - A Chatterjee
- Calcutta Medical Research Institute, Kolkata, India
| | - A Datta
- Institute of Neuroscience Kolkata, Kolkata, India
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Chandrashekar S, Saha S, Varghese B, Mohan L, Shetty G, Porwal A, Hazra A, Mondal S, Das R. Cost and cost-effectiveness of health behavior change interventions implemented with self-help groups in Bihar, India. PLoS One 2019; 14:e0213723. [PMID: 30921334 PMCID: PMC6438566 DOI: 10.1371/journal.pone.0213723] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 11/07/2017] [Accepted: 02/27/2019] [Indexed: 01/09/2023] Open
Abstract
Introduction Health interventions implemented with self-help groups (SHGs) enhance the relevance and acceptability of the health services. The Parivartan program was implemented in eight districts of Bihar with women’s self-help groups to increase adoption of maternal and newborn health behaviors through layering health behavior change communication. This study estimates the cost and cost-effectiveness of a health behavior change program with SHGs in Bihar. Methods Cost analysis was conducted from a provider’s perspective. All costs have been presented in US dollars for the purpose of international comparisons and converted to constant values. The effectiveness estimate was based on the reported changes in select newborn care practices. A decision model approach was used to estimate the potential number of neonatal deaths averted based on adoption of key newborn care practices. Using India’s life expectancy of 65 years, cost per life year saved was calculated. A one-way sensitivity analysis was conducted using the upper and lower estimates for various variables in the model, and functionality of SHGs. Results The cost of forming an SHG group was US$254 and that of reaching a woman within the group was US$19. The unit cost for delivering health interventions through the Parivartan program was US$148 per group and US$11 per woman reached. During an 18 months period, Parivartan program reached around 17,120 SHGs and an estimated 20,544 pregnant women resulting in an estimated prevention of 23 neonatal deaths at a cost of US$3,825 per life year saved. Conclusion SHGs can be an effective platform to increase uptake of women’s health interventions and follow-up care, and also to broaden their utility beyond microfinance, particularly when they operate at a larger scale.
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Affiliation(s)
| | - S. Saha
- Public Health Foundation of India, New Delhi, India
- Indian Institute of Public Health, Gandhinagar, India
| | - B. Varghese
- Public Health Foundation of India, New Delhi, India
| | - L. Mohan
- Karnataka Health Promotion Trust, Bangalore, India
| | - G. Shetty
- Karnataka Health Promotion Trust, Bangalore, India
| | - A. Porwal
- Population Council, New Delhi, India
| | - A. Hazra
- Population Council, New Delhi, India
| | - S. Mondal
- Project Concern International, New Delhi, India
| | - R. Das
- Project Concern International, New Delhi, India
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Okereke O, Ogata S, Mischoulon D, Chang G, Hazra A, Manson J, Reynolds C, De Vivo I. VARIATIONS BY RACE, ETHNICITY AND SEX IN RELATIONS OF BEHAVIORAL FACTORS TO BIOLOGICAL AGING. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- O Okereke
- Massachusetts General Hospital, Department of Psychiatry
| | - S Ogata
- Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center
| | - D Mischoulon
- Massachusetts General Hospital, Department of Psychiatry
| | | | - A Hazra
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital
| | - J Manson
- Brigham and Women’s Hospital and Harvard Medical School
| | - C Reynolds
- University of Pittsburgh School of Medicine
| | - I De Vivo
- Brigham and Women’s Hospital and Harvard Medical School
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Ghude SD, Bhat GS, Prabhakaran T, Jenamani RK, Chate DM, Safai PD, Karipot AK, Konwar M, Pithani P, Sinha V, Rao PSP, Dixit SA, Tiwari S, Todekar K, Varpe S, Srivastava AK, Bisht DS, Murugavel P, Ali K, Mina U, Dharua M, Rao J, Padmakumari B, Hazra A, Nigam N, Shende U, Lal DM, Chandra BP, Mishra AK, Kumar A, Hakkim H, Pawar H, Acharja P, Kulkarni R, Subharthi C, Balaji B, Varghese M, Bera S, Rajeevan M. Winter Fog Experiment Over the Indo-Gangetic Plains of India. CURR SCI INDIA 2017. [DOI: 10.18520/cs/v112/i04/767-784] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
Medication nonadherence is a known problem after renal transplantation and can vary from one setting to another. Since it can lead to negative outcomes, it is important to develop intervention strategies to enhance adherence in a given setting using determinants identified through exploratory studies. We explored nonadherence in renal transplant recipients. A longitudinal survey was done with adult renal transplant recipients at a tertiary care public and two private hospitals of Kolkata. Subjects were followed-up for 1 year. After screening for medication adherence status by the four-item Morisky Medication Adherence Scale, those admitting to potential nonadherence were probed further. A patient was deemed to be nonadherent if failing to take medicines on appointed time (doses missed or delayed by more than 2 h) more than three times in any month during the observation period. A pretested questionnaire was used to explore potential determinants of nonadherence. Data of 153 patients recruited over a 2-year were analyzed. The extent of nonadherence with immunosuppressant regimens was about 31% overall; 44% in the public sector and 19% in the private sector (P < 0.001). Nonadherence with other medication was around 19% in both the sectors. Several potential demographic, socioeconomic and psychosocial determinants of nonadherence were identified on univariate analysis. However, logistic regression analysis singled out only the economic status. This study had updated the issue of nonadherence in renal transplant recipients in the Indian setting. Strategies to improve medication adherence can be planned by relevant stakeholders on the basis of these findings.
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Affiliation(s)
| | - A Taraphder
- Department of Nephrology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - A Hazra
- Department of Pharmacology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - T Das
- Department of Medicine, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
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Roy R, Kundu R, Sengupta M, Hazra A. Assessment of 2nd and 4th digit length ratio as an anatomical marker for predicting the risk of developing polycystic ovarian syndrome. J ANAT SOC INDIA 2016. [DOI: 10.1016/j.jasi.2016.08.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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van Vollenhoven R, Choy E, Lee E, Hazra A, Anisfeld A, Lazariciu I, Biswas P, Lamba M, Menon S, Hodge J, Clark J, Wang L, Krishnaswami S. THU0199 Tofacitinib, An Oral Janus Kinase Inhibitor, in The Treatment of Rheumatoid Arthritis: Changes in Lymphocytes and Lymphocyte Subset Counts and Reversibility after Up To 8 Years of Tofacitinib Treatment. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ruperto N, Brunner H, Hazra A, Wang R, Mebus C, Alvey C, Lamba M, Krishnaswami S, Conte U, Wang M, Tzaribachev N, Foeldvari I, Horneff G, Kingsbury D, Koskova E, Smolewska E, Vehe R, Zuber Z, Martini A, Lovell D. AB0879 Pharmacokinetics, Safety, and Tolerability of Tofacitinib in Paediatric Patients from Two To Less than Eighteen Years of Age with Juvenile Idiopathic Arthritis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2640] [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: 11/04/2022]
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16
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Bhadra R, Choudhuri AR, Hazra A, Mukhopadhyay JD. Serum vitamin D level and its relation with carotid intima-media thickness in type 2 diabetic patients: a cross-sectional observational study. Diabetes Metab Syndr 2016; 10:S55-S59. [PMID: 26818693 DOI: 10.1016/j.dsx.2016.01.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 01/09/2016] [Indexed: 12/29/2022]
Affiliation(s)
- R Bhadra
- Department of Pharmacology, IPGMER & SSKM Hospital, Kolkata.
| | - A R Choudhuri
- Department of Biochemistry, IPGME&R & SSKM Hospital, Kolkata
| | - A Hazra
- Department of Pharmacology, IPGMER & SSKM Hospital, Kolkata
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Hazra A, Warren L, Nakhlis F, Bellon JR, Hirshfield-Bartek J, Jacene H, Yeh ED, Dominici L, Schlosnagle E, Hirko K, Overmoyer B. Abstract P6-18-03: Tumor profiling of inflammatory breast cancer: Advancing the tools needed for precision medicine. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p6-18-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Inflammatory breast cancer (IBC) is a rare and highly lethal form of breast cancer, accounting for approximately 10% of breast cancer mortality in the US. The clinical presentation of IBC includes rapid onset of symptoms, erythema > 1/3 of the breast, and edema. The genomic changes underlying the clincopathologic manifestations of IBC are yet unknown. Identification of a unique molecular signature in de novo IBC may provide insight into the biology of this disease, allowing further investigation into the etiology and treatment of this aggressive disease. In previous studies, supervised analysis of gene expression data from surgical tissue specimens identified a molecular-subtype independent 79-gene signature associated with IBC compared to locally-advanced non-IBC. In this study, we propose to identify a gene expression signature associated with IBC using breast specimens collected from patients with non-metastatic IBC prior to initiating preoperative systemic treatment.
Methods: Formalin fixed paraffin embedded (FFPE) core biopsy specimens were collected from patients with inflammatory breast cancer prior to initiating systemic therapy. All specimens underwent centralized pathology review at Brigham and Women's Hospital, and the clinical diagnosis was confirmed through evaluation by the Dana Farber Cancer Institute Inflammatory Breast Cancer Program. Sufficient RNA and DNA were simultaneously extracted from 14 biopsy specimens using the Qiagen AllPrep Kit. The RNA was amplified using the Sensation kit and profiled using the Affymetrix Human Transcriptome Array (HTA) 2.0. DNA was profiled for druggable somatic mutations and genome-wide copy number variations using the Affymetrix OncoScan Array.
Results: Pearson correlation coefficients for overall gene expression for 4 technical replicates included in the HTA ranged from r=0.993 - 0.994 and suggest excellent reproducibility in archival biopsy tissue. In preliminary analyses, 765 mRNA transcripts and 335 non-coding transcripts were differentially expressed based on clinical presentation features. The strongest differential association for rapid onset of disease was observed for alternately spliced variants in the TSPAN1 gene. Somatic mutations in PIK3CA were detected in 3 of the IBC patients. Additional paired assays as well as single-gene and pathway analyses, and integrated analyses of the genome and transcriptome using the R/Bioconductor packages are ongoing.
Conclusion: An understanding of the genomic changes that contribute to the unique presentation and biologic features associated with IBC should lead to a significant impact on identifying etiologic risk factors and in optimizing treatment strategies. Our findings to date suggest a robust and reproducible method for genomic investigation using standard diagnostic breast core biopsies among IBC patients, and may inform profiling of biopsy specimens for other cancer types. The completion of this study will provide biological insights into the molecular mechanisms driving IBC and may identify clinically actionable targets for novel IBC therapies that warrant further exploration.
Citation Format: Hazra A, Warren L, Nakhlis F, Bellon JR, Hirshfield-Bartek J, Jacene H, Yeh ED, Dominici L, Schlosnagle E, Hirko K, Overmoyer B. Tumor profiling of inflammatory breast cancer: Advancing the tools needed for precision medicine. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-18-03.
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Affiliation(s)
- A Hazra
- Brigham and Women's Hospital, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; Dana Farber Cancer Institute, Boston, MA
| | - L Warren
- Brigham and Women's Hospital, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; Dana Farber Cancer Institute, Boston, MA
| | - F Nakhlis
- Brigham and Women's Hospital, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; Dana Farber Cancer Institute, Boston, MA
| | - JR Bellon
- Brigham and Women's Hospital, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; Dana Farber Cancer Institute, Boston, MA
| | - J Hirshfield-Bartek
- Brigham and Women's Hospital, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; Dana Farber Cancer Institute, Boston, MA
| | - H Jacene
- Brigham and Women's Hospital, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; Dana Farber Cancer Institute, Boston, MA
| | - ED Yeh
- Brigham and Women's Hospital, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; Dana Farber Cancer Institute, Boston, MA
| | - L Dominici
- Brigham and Women's Hospital, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; Dana Farber Cancer Institute, Boston, MA
| | - E Schlosnagle
- Brigham and Women's Hospital, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; Dana Farber Cancer Institute, Boston, MA
| | - K Hirko
- Brigham and Women's Hospital, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; Dana Farber Cancer Institute, Boston, MA
| | - B Overmoyer
- Brigham and Women's Hospital, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; Dana Farber Cancer Institute, Boston, MA
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Banerjee TK, Dutta S, Ray BK, Ghosal M, Hazra A, Chaudhuri A, Das SK. Epidemiology of epilepsy and its burden in Kolkata, India. Acta Neurol Scand 2015; 132:203-11. [PMID: 25689886 DOI: 10.1111/ane.12384] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Disability-adjusted life year (DALY) is a time-based measure of disease burden incorporating both disability and mortality. Our study aimed to determine the DALY lost from epilepsy in an Indian metropolis. METHODS A population-based prospective study on epilepsy was conducted over 5 years (2003-8) in Kolkata, India, on randomly selected 100,802 subjects (males 53,209, females 47,593) to assess prevalence as well as to capture incident cases of epilepsy and those incident cases that died. Standard case definitions were used. The data were used to estimate years of life lost (YLL) due to premature mortality, years of life lived with disability (YLD), and DALY, utilizing the prevalence-based Global Burden of Disease (GBD) 2010 approach. Age- and gender-specific figures were computed. RESULTS During 2003-2004, a total of 476 subjects with active epilepsy were detected and the age-adjusted prevalence rate was 4.71 per 1000. Over 5 years, there were 197 incident cases of epilepsy of whom 26 died. The age-adjusted annual incidence rate of epilepsy was 38.3 per 100,000. The all-cause standardized mortality rate (SMR) of epilepsy was 2.4. The burden of epilepsy in the year 2007-8 revealed the overall YLL was 755 per 100,000, and the overall YLD ranged from 14.45 to 31.0 per 100,000 persons depending on the clinical severity of the epilepsy. Both YLL and YLD values were higher in males than in females. The overall DALY lost due to epilepsy in 2007-8 was found to be 846.96 (males 1183.04, females 463.81) per 100,000. CONCLUSIONS This is the first study in India to determine the DALY of epilepsy using GBD 2010. The results reveal a substantial burden of epilepsy in our setting. Similar such studies are needed in other parts of India in both urban and rural settings.
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Affiliation(s)
- T. K. Banerjee
- Department of Neurology; National Neuroscience Centre; Kolkata India
| | - S. Dutta
- Department of Statistics; Ballygunje Science College; University of Calcutta; Kolkata India
| | - B. K. Ray
- Department of Neurology; BIN and IPGME&R; Kolkata India
| | - M. Ghosal
- Department of Psychiatry; Medical College Kolkata; Kolkata India
| | - A. Hazra
- Department of Pharmacology; IPGME&R; Kolkata India
| | - A. Chaudhuri
- Sampling Unit; Indian Statistical Institute; Kolkata India
| | - S. K. Das
- Department of Neurology; BIN and IPGME&R; Kolkata India
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van Vollenhoven R, Tanaka Y, Lamba M, Collinge M, Hendrikx T, Hirose T, Toyoizumi S, Hazra A, Krishnaswami S. THU0178 Relationship Between NK Cell Count and Important Safety Events in Rheumatoid Arthritis Patients Treated with Tofacitinib. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hazra A, Bhowmik B, Dutta K, Chattopadhyay PP, Bhattacharyya P. Stoichiometry, Length, and Wall Thickness Optimization of TiO2 Nanotube Array for Efficient Alcohol Sensing. ACS Appl Mater Interfaces 2015; 7:9336-9348. [PMID: 25918822 DOI: 10.1021/acsami.5b01785] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The present study concerns development of an efficient alcohol sensor by controlling the stoichiometry, length, and wall thickness of electrochemically grown TiO2 nanotube array for its use as the sensing layer. Judicious variation of H2O content (0, 2, 10 and 100% by volume) in the mixed electrolyte comprising ethylene glycol and NH4F resulted into the desired variation of stoichiometry. The sensor study was performed within the temperature range of 27 to 250 °C for detecting the alcohols in the concentration range of 10-1000 ppm. The nanotubes grown with the electrolyte containing 2 vol % H2O offered the maximum response magnitude. For this stoichiometry, variation of corresponding length (1.25-2.4 μm) and wall thickness (19.8-9 nm) of the nanotubes was achieved by varying the anodization time (4-16 h) and temperatures (42-87 °C), respectively. While the variation of length influenced the sensing parameters insignificantly, the best response magnitude was achieved for ∼13 nm wall thickness. The underlying sensing mechanism was correlated with the experimental findings on the basis of structural parameters of the nanotubes.
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Affiliation(s)
- A Hazra
- †Nano-Thin Films and Solid State Gas sensor Devices Laboratory, Department of Electronics and Telecommunication Engineering and ‡Department of Metallurgy and Materials Engineering, Indian Institute of Engineering Science and Technology (IIEST), Shibpur, Howrah-711103, India
| | - B Bhowmik
- †Nano-Thin Films and Solid State Gas sensor Devices Laboratory, Department of Electronics and Telecommunication Engineering and ‡Department of Metallurgy and Materials Engineering, Indian Institute of Engineering Science and Technology (IIEST), Shibpur, Howrah-711103, India
| | - K Dutta
- †Nano-Thin Films and Solid State Gas sensor Devices Laboratory, Department of Electronics and Telecommunication Engineering and ‡Department of Metallurgy and Materials Engineering, Indian Institute of Engineering Science and Technology (IIEST), Shibpur, Howrah-711103, India
| | - P P Chattopadhyay
- †Nano-Thin Films and Solid State Gas sensor Devices Laboratory, Department of Electronics and Telecommunication Engineering and ‡Department of Metallurgy and Materials Engineering, Indian Institute of Engineering Science and Technology (IIEST), Shibpur, Howrah-711103, India
| | - P Bhattacharyya
- †Nano-Thin Films and Solid State Gas sensor Devices Laboratory, Department of Electronics and Telecommunication Engineering and ‡Department of Metallurgy and Materials Engineering, Indian Institute of Engineering Science and Technology (IIEST), Shibpur, Howrah-711103, India
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Choudhary K, Manjuladevi V, Gupta RK, Bhattacharyya P, Hazra A, Kumar S. Ultrathin films of TiO2 nanoparticles at interfaces. Langmuir 2015; 31:1385-1392. [PMID: 25557246 DOI: 10.1021/la503514p] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The properties of a material change remarkably as a result of the scaling dimensions. The Langmuir-Blodgett (LB) film deposition technique is known to offer precise control over the film thickness and the interparticle separation. To form a well-ordered LB film, it is essential to form a stable Langmuir film at the air-water interface. Here, we report our studies on ultrathin films of TiO2 nanoparticles at air-water and air-solid interfaces. The Langmuir film of TiO2 nanoparticles at the air-water interface was found to be very stable, and it exhibits loose-packing and close-packing phases. The LB films were transferred onto solid substrates for characterization and application. The surface morphology of the LB film was obtained by a field emission scanning electron microscope. The optical and electronic properties of the LB films of TiO2 nanoparticles were studied using UV-vis spectroscopy and current-voltage measurements, respectively. The LB film of TiO2 nanoparticles was employed for ethanol gas sensing, and the sensing performance was compared to that of bulk material. Because of the enormous gain in the surface to volume ratio and the increase in crystalline defect density in the ultrathin LB film of TiO2 nanoparticles, the LB film is found to be a potential functional layer for ethanol sensing as compared to the bulk material.
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Affiliation(s)
- Keerti Choudhary
- Department of Physics, Birla Institute of Technology and Science (BITS) , Pilani, Rajasthan 333031, India
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Chowdhury IH, Choudhuri S, Sen A, Bhattacharya B, Ahmed AM, Hazra A, Pal NK, Bahar B. Serum interleukin 6 (IL-6) as a potential biomarker of disease progression in active pulmonary tuberculosis following anti-tuberculosis drug therapy. Mol Immunol 2014; 63:601-2. [PMID: 25287812 DOI: 10.1016/j.molimm.2014.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 09/12/2014] [Indexed: 10/24/2022]
Affiliation(s)
- I H Chowdhury
- Department of Biochemistry, Institute of Postgraduate Medical Education and Research (IPGME&R), 244B, AJC Bose Road, Kolkata 700020, India
| | - S Choudhuri
- Department of Biochemistry, Institute of Postgraduate Medical Education and Research (IPGME&R), 244B, AJC Bose Road, Kolkata 700020, India
| | - A Sen
- Department of Biochemistry, Institute of Postgraduate Medical Education and Research (IPGME&R), 244B, AJC Bose Road, Kolkata 700020, India
| | - B Bhattacharya
- Department of Biochemistry, Institute of Postgraduate Medical Education and Research (IPGME&R), 244B, AJC Bose Road, Kolkata 700020, India
| | - A M Ahmed
- School of Veterinary Medicine, University College Dublin, Belfield, Dublin 4, Dublin, Ireland
| | - A Hazra
- Department of Pharmacology, Institute of Postgraduate Medical Education and Research (IPGME&R), 244B, AJC Bose Road, Kolkata 700020, India
| | - N K Pal
- Department of Microbiology, Institute of Postgraduate Medical Education and Research (IPGME&R), 244B, AJC Bose Road, Kolkata 700020, India
| | - B Bahar
- School of Agriculture and Food Science, University College Dublin, Belfield, Dublin 4, Dublin, Ireland.
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Lamba M, Wang R, Fletcher T, Alvey C, Hazra A, Kushner J, Larmann J, Stock T. THU0143 Pharmacokinetics, Bioavailability and Safety of A Modified Release Once Daily Formulation of Tofacitinib in Healthy Volunteers. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
Background: This is the largest prospective cohort analysis to assess how dietary factors involved in one-carbon metabolism are associated with endometrial cancer incidence, using 26 years of follow-up data from the Nurses’ Health Study. Methods: The prospective cohort analysis of one-carbon metabolism dietary factors used the Cox proportional hazards model, and incorporated 788 incident endometrial cancer events from 1980 to 2006. Genotyping and unconditional logistic regression were performed on 572 endometrial cancer cases and their matched controls to examine 29 mostly non-synonymous single-nucleotide polymorphisms involved in one-carbon metabolism. Results: There were no significant dose–response relationships between intake of any of the one-carbon metabolism dietary factors and endometrial cancer incidence, but alcohol consumption of <1 drink a day was significantly protective (hazard ratio: 0.80; 95% CI: 0.68, 0.94). Those with the MTHFR 677 TT or MTHFR 1298 CC genotype had more protective associations for many of the dietary factors and endometrial cancer, but statistical power was limited in this analysis. Conclusion: Dietary levels of folate, choline, methionine, vitamin B2, vitamin B6 or vitamin B12 do not appear to influence endometrial cancer incidence. Moderate alcohol intake may protect against developing endometrial cancer.
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Affiliation(s)
- J J Liu
- Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA.
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Sahoo T, SenDasgupta C, Goswami A, Hazra A. In reply. Int J Obstet Anesth 2012. [DOI: 10.1016/j.ijoa.2012.08.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Mondal R, Sarkar S, Nandi M, Hazra A. Comparative analysis between objective structured clinical examination (OSCE) and conventional examination (CE) as a formative evaluation tool in Pediatrics in semester examination for final MBBS students. Kathmandu Univ Med J (KUMJ) 2012; 10:62-5. [PMID: 22971865 DOI: 10.3126/kumj.v10i1.6917] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The use of objective structured clinical examination in pediatrics is not common in undergraduate evaluation process. OBJECTIVE To evaluate the effectiveness of objective structured clinical examination as compare to conventional examination as formative assessment tool in Pediatrics. METHODS We conducted a cross sectional comparative study in defined population of 9th semester MBBS students to evaluate the effectiveness of objective structured clinical examination as comparison to conventional examination as formative assessment tool in Pediatrics. We analyzed the perception of objective structured clinical examination among the students. RESULTS Fifty-two students appeared for the objective structured clinical examination evaluation on the first day and 42 turned up for conventional examination on the next day. The 42 students who turned up for both examinations were asked to respond to the perception evaluation questionnaire. Comparison of the two examination styles showed that students fared better in objective structured clinical examination than in conventional examination both with respect to mean total score (p less than 0.001) as well as mean percentage score. Out of the 42 subjects who appeared in both examinations, all passed in objective structured clinical examination and 35 passed in conventional examination, this difference was significant by McNemar chi-square test (p = 0.016). 73.8% of the students opined in favor of objective structured clinical examination as a better formative assessment tool whereas 9.5% students preferred conventional examination. CONCLUSIONS Objective structured clinical examination a statistically significant better evaluation tool with comparison to conventional examination.
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Affiliation(s)
- R Mondal
- Department of Pediatrics, NBMCH, Darjeeling.
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Sahoo T, SenDasgupta C, Goswami A, Hazra A. Reduction in spinal-induced hypotension with ondansetron in parturients undergoing caesarean section: A double-blind randomised, placebo-controlled study. Int J Obstet Anesth 2012; 21:24-8. [DOI: 10.1016/j.ijoa.2011.08.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2009] [Revised: 07/28/2011] [Accepted: 08/28/2011] [Indexed: 11/28/2022]
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Das SK, Misra AK, Ray BK, Hazra A, Ghosal MK, Chaudhuri A, Roy T, Banerjee TK, Raut DK. Epidemiology of Parkinson disease in the city of Kolkata, India: a community-based study. Neurology 2010; 75:1362-9. [PMID: 20938028 DOI: 10.1212/wnl.0b013e3181f735a7] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE No well-designed longitudinal study on Parkinson disease (PD) has been conducted in India. Therefore, we planned to determine the prevalence, incidence, and mortality rates of PD in the city of Kolkata, India, on a stratified random sample through a door-to-door survey. METHOD This study was undertaken between 2003 to 2007 with a validated questionnaire by a team consisting of 4 trained field workers in 3 stages. Field workers screened the cases, later confirmed by a specialist doctor. In the third stage, a movement disorders specialist undertook home visits and reviewed all surviving cases after 1 year from last screening. Information on death was collected through verbal autopsy. A nested case-control study (1:3) was also undertaken to determine putative risk factors. The rates were age adjusted to the World Standard Population. RESULT A total population of 100,802 was screened. The age-adjusted prevalence rate (PR) and average annual incidence rate were 52.85/100,000 and 5.71/100,000 per year, respectively. The slum population showed significantly decreased PR with age compared with the nonslum population. The adjusted average annual mortality rate was 2.89/100,000 per year. The relative risk of death was 8.98. The case-control study showed that tobacco chewing protected and hypertension increased PD occurrence. CONCLUSION This study documented lower prevalence and incidence of PD as compared with Caucasian and a few Oriental populations. The mortality rates were comparable. The decreased age-specific PR among slum populations and higher relative risk of death need further probing.
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Affiliation(s)
- S K Das
- Department of Neurology, Bangur Institute of Neuroscience, Kolkata, India.
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Chowdhury AN, Banerjee S, Brahma A, Das S, Sarker P, Biswas MK, Sanyal D, Hazra A. A prospective study of suicidal behaviour in Sundarban Delta, West Bengal, India. Natl Med J India 2010; 23:201-205. [PMID: 21192512] [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: 05/30/2023]
Abstract
BACKGROUND Deliberate self-harm is a challenging public health issue but there is a paucity of data on non-fatal deliberate self-harm in the literature. We aimed to understand the behaviour of deliberate self-harm, both fatal and nonfatal, in a primary care setting. METHODS A year-long prospective study of all admitted patients of deliberate self-harm at 13 block primary health centres of the Sundarban region was done to examine the sociodemographic profile and clinical outcome of suicidal behaviour. Data were collected by using an especially devised deliberate self-harm register. Each subject was administered a 20-item case history sheet by trained medical officers and nursing staff. RESULTS A total of 1614 deliberate self-harm subjects (619 men, 995 women) were admitted during the year, of whom 143 (62 men, 81 women) died. Although women, especially in the younger age groups, constituted the majority of subjects (61.6%), the fatality trend was higher among men than among women (10% v. 8.1%). Poisoning was the commonest (98.4%) method of self-harm, particularly using pesticide. Easy availability of pesticides was a risk factor. Psychosocial stressors, such as conflict with spouse, guardian or in-laws, failed love affairs and economic distress, were the common underlying reasons. The majority of acts of deliberate self-harm (92.6%) were committed inside the home, especially by women. Only a small proportion of subjects had a past or family history of attempt at deliberate self-harm. The overall incidence of fatal and non-fatal deliberate self-harm was 5.98 and 61.51 per 100 000 population, respectively. CONCLUSION Both fatal and non-fatal pesticide-related deliberate self-harm is a major public health issue in the Sundarban region. An intersectoral approach involving primary health, administration and agriculture may help in developing an effective preventive programme to reduce the morbidity and mortality from deliberate self-harm.
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Affiliation(s)
- A N Chowdhury
- Institute of Psychiatry, Kolkata, West Bengal, India.
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Abstract
BACKGROUND AND PURPOSE Prevalence of essential tremor (ET), one of the most common movement disorders, has not been properly evaluated amongst heterogeneous population in India. METHODS We conducted a cross-sectional epidemiological study on the prevalence of ET in a randomly stratified population in the metropolitan city of Kolkata (erstwhile Calcutta), India, by a field team headed by a specialist doctor. A two-stage house-to-house survey was carried out with a validated screening instrument. RESULTS A population of 52377 was screened and a total of 184 cases of ET were identified as per pre-defined criteria and the prevalence rate adjusted to World Standard Population was 3.95 per 1000 (95% CI: 3.40-4.56). Age-specific prevalence showed increasing prevalence with aging. Sex-specific prevalence did not show significant difference between men and women. Socio-economic factors appeared to influence the prevalence and risk of ET was higher amongst slum dwellers versus non-slum population (odd ratio-2.29). Family history was positive in about one-fifth of the cases. CONCLUSION This study has documented that the prevalence of ET above 40 years in India is similar to that of many countries globally and common amongst slum dwellers and there are fewer familial cases.
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Affiliation(s)
- S K Das
- Bangur Institute of Neuroscience and Psychiatry, Kolkata, India.
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Das SK, Biswas A, Roy J, Bose P, Roy T, Banerjee TK, Mukherjee C, Raut DK, Chowdhury A, Hazra A. Prevalence of major neurological disorders among geriatric population in the metropolitan city of Kolkata. J Assoc Physicians India 2008; 56:175-181. [PMID: 18697633] [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: 05/26/2023]
Abstract
Well-conducted neuroepidemiological studies for the geriatric population are rare in India. In view of the growing aging population, we planned to determine the prevalence of common neurological disorders among the elderly population in the city of Kolkata. This was a cross-sectional study of a stratified random sample of the city population and carried in two stages through house to house survey. Initially, trained non-medical workers screened the cases with a validated family questionnaire and then a neurologist examined all the screened positive cases. A validated neuropsychological screening test was also applied among the elderly population with cognitive complaints. Results showed prevalence rates (per 1000 elderly population--> or = 60 years) of following disorders in decreasing order: stroke--33.93, essential tremor--13.76, dementia--7.89, Parkinsonism--3.30 and epilepsy--2.57. Sex-specific prevalence showed that stroke was commoner among men and that of other disorders among women. Age-specific prevalence recorded progressive increase in the rates of all disorders among both genders, though not uniformly among women. Overall the crude prevalence of neurological disorders was 60.9 per 1000. The present study shows higher rate of stroke as compared to other neurological disorders among elderly population in India, which needs urgent attention.
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Affiliation(s)
- S K Das
- Department of Neuromedicine, Bangur Institute of Neurology, Kolkata
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Banerjee T, Mukherjee C, Dutt A, Shekhar A, Hazra A. Cognitive Dysfunction in an Urban Indian Population – Some Observations. Neuroepidemiology 2008; 31:109-14. [DOI: 10.1159/000146252] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2008] [Accepted: 05/03/2008] [Indexed: 11/19/2022] Open
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Hazra A, Tripathi SK, Alam MS. Prescribing and dispensing activities at the health facilities of a non-governmental organization. Natl Med J India 2000; 13:177-82. [PMID: 11002683] [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: 02/17/2023]
Abstract
BACKGROUND Prescribing and dispensing surveys are pre-requisites to achieving rational drug use. There is a dearth of such studies in India, particularly in the non-governmental organization sector. METHODS We carried out a survey at the outpatient facilities maintained by the Southern Health Improvement Samity, a non-governmental organization in the South 24 Parganas district of West Bengal. Data were collected prospectively by interviewing patients immediately after patient-physician and patient-dispenser encounters. Pre-designed forms were used to collect data pertaining to World Health Organization drug-use indicators and some additional indices. The calculations of cost of therapy involved some approximation. RESULTS Of the 312 prescriptions analysed, the majority were signed, legible and complete with respect to age/gender data; 95.5% used Latin abbreviations and 7.7% mentioned neither signs and symptoms nor diagnosis. The average number of drugs per encounter was 3.2; only 2 patients were treated without drugs; 46.2% of drugs were prescribed by generic name. Use of antibiotics (72.8% of encounters) and irrational fixed dose combinations (45.6% of prescribed drugs) were frequent, but injection use (3.9% of prescriptions) was low. The average drug cost per encounter was Rs 74.19, of which antibiotics comprised 37.1%. The availability of first-line antitubercular drugs was adequate but other key drugs were in limited supply. Essential drugs lists and formularies were not followed. Only 45.7% of prescribed drugs conformed to the World Health Organization model list of essential drugs. Only 12 preparations accounted for 70.9% of the prescribed drugs, including therapeutically doubtful ones such as cough syrups, multivitamins and carminative syrups. For the dispensing survey, 301 prescriptions were analysed separately. All the prescribed drugs were supplied for only 11.6% of prescriptions. There were no serious errors in dispensing but 43.8% of dispensed products were inadequately labelled. Patients knew the correct mode of use for 64.5% of dispensed drugs. The average consultation and dispensing times were 3.7 and 3.1 minutes, respectively. CONCLUSION Frequent use of antibiotics, irrational fixed dose combinations and preparations of uncertain efficacy, inadequate labelling of dispensed drugs and lack of access to standard tools for rational drug use such as locally adapted essential drugs list, formularies and standard treatment guidelines were some of the problematic prescribing and dispensing trends identified through this survey. Educational interventions are required to rectify these problems.
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Affiliation(s)
- A Hazra
- Community Development Medicinal, Unit Documentation Centre, Calcutta, West Bengal, India.
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