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Banerjee AA, Bhanarkar SR, Keshwani R, Pande S, Modi DN, Mehta A, Bombe S, Pathak BR, Joshi B, Tandon D, Patil A, Begum S, Chauhan S, Mahale SD, Rao S, Surve SV. Relevance of augmented kisspeptin signaling through H 364 KISS1R in central precocious puberty. Gene 2024; 895:148016. [PMID: 37981083 DOI: 10.1016/j.gene.2023.148016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/28/2023] [Accepted: 11/16/2023] [Indexed: 11/21/2023]
Abstract
Understanding the pathophysiology of idiopathic central precocious puberty (ICPP) is essential, in view of its consequences on reproductive health and metabolic disorders in later life. Towards this, estimation of circulating levels of the neuropeptides, viz; Kisspeptin (Kp-10), Neurokinin B (NKB) and Neuropeptide Y (NPY), acting upstream to Gonadotropin-Releasing Hormone (GnRH), has shown promise. Insights can also be gained from functional studies on genetic variations implicated in ICPP. This study investigated the pathophysiology of ICPP in a girl by exploring the therapeutic relevance of the circulating levels of Kp-10, NKB, NPY and characterizing the nonsynonymous KISS1R variant, L364H, that she harbours, in a homozygous condition. Plasma levels of Kp-10, NKB and NPY before and after GnRH analog (GnRHa) treatment, were determined by ELISA. It was observed that GnRHa treatment resulted in suppression of circulating levels of Kp-10, NKB and NPY. Further, the H364 variant in KISS1R was generated by site directed mutagenesis. Post transient transfection of either L364 or H364 KISS1R variant in CHO cells, receptor expression was ascertained by western blotting, indirect immunofluorescence and flow cytometry. Kp-10 stimulated signalling response was also determined by phospho-ERK and inositol phosphate production. Structure-function studies revealed that, although the receptor expression in H364 KISS1R was comparable to L364 KISS1R, there was an enhanced signalling response through this variant at high doses of Kp-10. Thus, elevated levels of Kp-10, acting through H364 KISS1R, contributed to the manifestation of ICPP, providing further evidence that dysregulation of Kp-10/KISS1R axis impacts the onset of puberty.
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Affiliation(s)
- Antara A Banerjee
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Shital R Bhanarkar
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Rachna Keshwani
- Bai Jerbai Wadia Hospital For Children, Acharya Donde Marg, Parel, Mumbai 400 012, India
| | - Shailesh Pande
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Deepak N Modi
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Amrita Mehta
- Bai Jerbai Wadia Hospital For Children, Acharya Donde Marg, Parel, Mumbai 400 012, India
| | - Shweta Bombe
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Bhakti R Pathak
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Beena Joshi
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Deepti Tandon
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Anushree Patil
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Shahina Begum
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Sanjay Chauhan
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Smita D Mahale
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Sudha Rao
- Bai Jerbai Wadia Hospital For Children, Acharya Donde Marg, Parel, Mumbai 400 012, India.
| | - Suchitra V Surve
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India.
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Srimathi G, Revathy R, Bagepally BS, Joshi B. Clinical effectiveness of ferric carboxymaltose (iv) versus iron sucrose (iv) in treatment of iron deficiency anaemia in pregnancy: A systematic review and meta-analysis. Indian J Med Res 2024; 159:62-70. [PMID: 38439125 PMCID: PMC10954109 DOI: 10.4103/ijmr.ijmr_246_23] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND OBJECTIVES Iron deficiency anaemia (IDA) during pregnancy is treated with oral and parenteral iron. The objective of this review was to compare the clinical effectiveness, safety, pregnancy and neonatal outcomes of intravenous (iv) ferric carboxymaltose (FCM) and iv iron sucrose (IS) in treating IDA in pregnancy. METHODS The Department of Health Research funded this study. PubMed, Cochrane Library, EMBASE and Scopus were searched to include studies published till November 2022. The protocol was registered in PROSPERO (CRD42022306092). Pregnant women (15-49 yr) in second and third trimesters, diagnosed with moderate-to-severe iron deficiency anaemia, treated with either of the drugs were included. The included studies were critically assessed using appropriate tools. We conducted a qualitative synthesis of the studies and meta-analysis for improvement in haematological parameters and incidence of adverse events. RESULTS A total of 18 studies were included. The risk of bias was low to moderate. A rise in haemoglobin up to four weeks was higher with FCM than IS by 0.57 (0.24, 0.9) g/dl. Intravenous FCM is associated with fewer adverse events than IS [pooled odds ratio: 0.5 (0.32, 0.79)]. The included studies had limited evidence on pregnancy and neonatal outcomes after iv iron treatment. INTERPRETATION CONCLUSIONS Intravenous FCM is effective and safer than intravenous IS in terms of haematological parameters, in treating IDA in pregnancy. Further research is required on the effects of iv FCM and iv IS on the pregnancy and neonatal outcomes when used for treating IDA in pregnancy.
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Affiliation(s)
- G. Srimathi
- Department of Operational & Implementation Research, Mumbai, Maharashtra, India
| | - R. Revathy
- Department of Regional Resource Hub-Health Technology Assessment, ICMR - National Institute for Research in Reproductive & Child Health, Mumbai, Maharashtra, India
| | - Bhavani Shankara Bagepally
- Division of Non Communicable Diseases, ICMR - National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Beena Joshi
- Department of Operational & Implementation Research, Mumbai, Maharashtra, India
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Revathy R, Chaurasia H, Shetty S, Joshi B. Health facility-based interventions and the uptake of contraception among people living with HIV: A systematic review & meta-analysis. Indian J Med Res 2023; 158:483-493. [PMID: 38143434 PMCID: PMC10878490 DOI: 10.4103/ijmr.ijmr_2471_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Indexed: 12/26/2023] Open
Abstract
BACKGROUND OBJECTIVES The prong 2 of 4 prong strategy introduced by the World Health Organization aims at averting unintended pregnancies among people living with HIV (PLHIV). This systematic review aimed to generate evidence on the effectuality of facility-based interventions in improving uptake of modern and dual contraception, for reducing unmet family planning (FP) needs and unintended pregnancies among PLHIV. METHODS Articles evaluating facility-based interventions to integrate human immunodeficiency virus (HIV) and FP published in English language were included. Eligible studies were identified from electronic and lateral search from three databases (PubMed, Cochrane Library and Web of Science) and grey literature. HIV care with no/minimal focus on FP was considered a comparator. Quality was assessed using design-appropriate tools. Descriptive analysis was presented in tables. Uptake of dual methods, unmet FP needs and unintended pregnancies were included in the meta-analysis to estimate pooled odds ratio (OR) with random effect model, P and I2 values. RESULTS The search yielded 2112 results. After excluding duplicates and unfit articles, 17 were found eligible for review and nine for meta-analysis. The pooled OR for uptake of dual contraception was 1.69 (1.14, 2.5) ( P =0.008; I2 =90%), for unmet FP needs was 0.58 (0487, 0.69) ( P <0.00001; I2 =0%) and for unintended pregnancies was 0.6 (0.32, 1.1) ( P =0.1, I2 =38%). INTERPRETATION CONCLUSIONS The results of this meta-analysis suggest that health facility-based interventions to integrate HIV and FP services do result in improved uptake of dual methods and reduce unmet need for contraception along with a protective trend on incidence of unintended pregnancies. Such facility-based integration would ensure universal access to effective contraception and facilitate in achieving Sustainable Development Goals that aim at ending epidemics like HIV.
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Affiliation(s)
- R Revathy
- Department of Operational and Implementation Research, Regional Resource Hub-Health Technology Assessment, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Himanshu Chaurasia
- Department of Operational and Implementation Research, Regional Resource Hub-Health Technology Assessment, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Siddesh Shetty
- Department of Operational and Implementation Research, Regional Resource Hub-Health Technology Assessment, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Beena Joshi
- Department of Operational and Implementation Research, Regional Resource Hub-Health Technology Assessment, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
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Sharma N, Khandelwal V, Kumar S, Joshi B, Mohanty KK. Immunological depiction of synthetic B-cell epitopes of Mycobacterium tuberculosis. Int J Mycobacteriol 2023; 12:380-387. [PMID: 38149531 DOI: 10.4103/ijmy.ijmy_187_23] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
Abstract
Background To combat the tuberculosis (TB) epidemic, the development of a better and faster diagnosis or more effective vaccine is essential. Pulmonary TB (PTB) is one of the major causes of morbidity and mortality. Early diagnosis of TB is difficult. Serological assays have been performed with several antigens of laboratory strains such as Mycobacterium tuberculosis H37Rv which have not been found to be highly sensitive. In the present study, various peptides were synthesized which were predicted on the basis of immunoreactivity and differential expression in clinical isolates of M. tuberculosis compared to their expression in a laboratory strain of M. tuberculosis. Therefore, the aim of this study was to compare the antibody levels in PTB and healthy controls against these peptides. Methods An effort was made to evaluate antibody response to peptides derived from proteins Rv2588c, Rv0512, Rv0148, Rv0896, and Rv0635 of M. tuberculosis in PTB patients and healthy individuals through enzyme-linked immunosorbent assay. Five milliliters of venous blood samples was collected from each participant, and serum was separated and stored until use. Results Antibody levels against these peptides, Rv2588c, Rv0512, Rv0148, Rv0896. and Rv0635 in 139 PTB patients and 52 healthy controls were evaluated. Higher immune response was observed in PTB patients when compared with healthy individuals. Strong immunoglobulin G responses with high percentage, considerable difference among patients and healthy controls was observed with P < 0.0001. Conclusion In our study, we found significant statistical differences in antibody levels in PTB patients and healthy individuals against these peptides. These peptides are suggestive of being a potential new candidate (s) for early diagnosis of TB.
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Affiliation(s)
- Niharika Sharma
- Department of Immunology, Indian Council of Medical Research, National JALMA Institute for Leprosy and Other Mycobacterial Diseases, Agra; Department of Biotechnology and Microbiology, GLA University, Mathura, Uttar Pradesh, India
| | - Vishal Khandelwal
- Department of Biotechnology and Microbiology, GLA University, Mathura, Uttar Pradesh, India
| | - S Kumar
- Department of Tuberculosis, Sarojini Naidu Medical College, Agra, India
| | - B Joshi
- Department of Tuberculosis, Sarojini Naidu Medical College, Agra, India
| | - Keshar Kunja Mohanty
- Department of Immunology, Indian Council of Medical Research, National JALMA Institute for Leprosy and Other Mycobacterial Diseases, Agra, India
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Ganie MA, Chowdhury S, Suri V, Joshi B, Bhattacharya PK, Agrawal S, Malhotra N, Sahay R, Jabbar PK, Rozati R, Wani IA, Shukla A, Arora T, Rashid H. Prevalence, Regional Variations, and Predictors of Overweight, Obesity, and Hypertension Among Healthy Reproductive-Age Indian Women: Nationwide Cross-Sectional Polycystic Ovary Syndrome Task Force Study. JMIR Public Health Surveill 2023; 9:e43199. [PMID: 37672315 PMCID: PMC10512112 DOI: 10.2196/43199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/05/2023] [Accepted: 05/16/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND A clear understanding of the anthropometric and sociodemographic risk factors related to BMI and hypertension categories is essential for more effective disease prevention, particularly in India. There is a paucity of nationally representative data on the dynamics of these risk factors, which have not been assessed among healthy reproductive-age Indian women. OBJECTIVE This cross-sectional polycystic ovary syndrome (PCOS) task force study aimed to assess the anthropometric and sociodemographic characteristics of healthy reproductive-age Indian women and explore the association of these characteristics with various noncommunicable diseases. METHODS We conducted a nationwide cross-sectional survey from 2018 to 2022 as part of the Indian Council of Medical Research-PCOS National Task Force study, with the primary aim of estimating the national prevalence of PCOS and regional phenotypic variations among women with PCOS. A multistage random sampling technique was adopted, and 7107 healthy women (aged 18-40 years) from 6 representative geographical zones of India were included in the study. The anthropometric indices and sociodemographic characteristics of these women were analyzed. Statistical analysis was performed to assess the association between exposure and outcome variables. RESULTS Of the 7107 study participants, 3585 (50.44%) were from rural areas and 3522 (49.56%) were from urban areas. The prevalence of obesity increased from 8.1% using World Health Organization criteria to 40% using the revised consensus guidelines for Asian Indian populations. Women from urban areas showed higher proportions of overweight (524/1908, 27.46%), obesity (775/1908, 40.62%), and prehypertension (1008/1908, 52.83%) categories. A rising trend of obesity was observed with an increase in age. Women aged 18 to 23 years were healthy (314/724, 43.4%) and overweight (140/724, 19.3%) compared with women aged 36 to 40 years with obesity (448/911, 49.2%) and overweight (216/911, 23.7%). The proportion of obesity was high among South Indian women, with 49.53% (531/1072) and 66.14% (709/1072), using both World Health Organization criteria and the revised Indian guidelines for BMI, respectively. BMI with waist circumference and waist-to-height ratio had a statistically significant linear relationship (r=0.417; P<.001 and r=0.422; P<.001, respectively). However, the magnitude, or strength, of the association was relatively weak (0.3<|r|<0.5). Statistical analysis showed that the strongest predictors of being overweight or obese were older age, level of education, wealth quintile, and area of residence. CONCLUSIONS Anthropometric and sociodemographic characteristics are useful predictors of overweight- and obesity-related syndromes, including prehypertension, among healthy Indian women. Increased attention to the health of Indian women from public health experts and policy makers is warranted. The findings of this study can be leveraged to offer valuable insights, informing health decision-making and targeted interventions that mitigate risk factors of overweight, obesity, and hypertension. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/23437.
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Affiliation(s)
- Mohd Ashraf Ganie
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Subhankar Chowdhury
- Department of Endocrinology, Institute of Postgraduate Medical Education & Research, Kolkata, India
| | - Vanita Suri
- Department of Obstetrics & Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Beena Joshi
- Department of Operational Research, National Institute for Research in Reproductive Health, Indian Council of Medical Research (ICMR), Mumbai, India
| | - Prasanta Kumar Bhattacharya
- Department of General Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Meghalaya, India
| | - Sarita Agrawal
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, Chatisgarh, India
| | - Neena Malhotra
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, India
| | | | - Roya Rozati
- Department of Obstetrics & Gynaecology, Maternal Health & Research Trust, Hyderabad, India
| | - Imtiyaz Ahmad Wani
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Amlin Shukla
- Reproductive Biology and Maternal Health, Indian Council of Medical Research (ICMR), New Delhi, India
| | - Taruna Arora
- Reproductive Biology and Maternal Health, Indian Council of Medical Research (ICMR), New Delhi, India
| | - Haroon Rashid
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
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Kharat N, Ramachandra R, Chaurasia H, Shetty S, Begum S, Joshi B. Assessment of Health-Related Quality of Life Using EQ-5D-5L Tool With Indian Tariffs Among Reproductive Age Group Women Living With HIV in India. Value Health Reg Issues 2023; 37:113-120. [PMID: 37481902 DOI: 10.1016/j.vhri.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/07/2023] [Accepted: 04/19/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE India is witnessing declining HIV prevalence because of dedicated efforts by the government. The highly active antiretroviral therapy has improved life span of people living with HIV but bearing many side effects. Women living with HIV (WLHIV) in reproductive age group have additional burden of pregnancy-related issues. This study aimed to estimate the health utility score among WLHIV in India, particularly in context of their contraceptive use, during pregnancy and postpartum period. METHODS A primary cross-sectional study was conducted among 195 WLHIV availing antiretroviral treatment services at public health facilities of Mumbai. The EQ-5D-5L interview-based questionnaire in local language and Indian value set was used to estimate health-related quality of life (QOL) reported as mean (± SD) utility and visual analog scale (VAS) scores. The relationship between utility values and VAS scores was assessed. RESULTS The WLHIV with mean age of 31.6 (6.4) years were on antiretroviral medication for nearly 7 years, and 63% had CD4+ cell count > 500 cells/mm3. Response of "11111," that is, in full health state, was reported by 66.7%. The mean utility and VAS scores were 0.976 (± 0.0519) and 82.21 (± 15.77). Reduced health-related QOL scores were associated with pain and discomfort dimension. Utility scores among contraceptive users (0.986 [± 0.029]) was higher than nonusers (0.976 [± 0.028]). Currently pregnant WLHIV had least utility score (0.959 [± 0.088]). CONCLUSIONS WLHIV had better QOL while using contraceptives more so when they were sterilized. Pregnancy reduces the QOL. This emphasizes the need to promote effective contraceptive methods among WLHIV and prevent unintended pregnancies.
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Affiliation(s)
- Namrata Kharat
- HTA Regional Resource Hub, Department of Operational and Implementation Research, Indian Council of Medical Research - National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Revathy Ramachandra
- HTA Regional Resource Hub, Department of Operational and Implementation Research, Indian Council of Medical Research - National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Himanshu Chaurasia
- HTA Regional Resource Hub, Department of Operational and Implementation Research, Indian Council of Medical Research - National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Siddesh Shetty
- HTA Regional Resource Hub, Department of Operational and Implementation Research, Indian Council of Medical Research - National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Shahina Begum
- Department of Biostatistics, Indian Council of Medical Research - National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Beena Joshi
- HTA Regional Resource Hub, Department of Operational and Implementation Research, Indian Council of Medical Research - National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India.
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Ganie MA, Chowdhury S, Suri V, Joshi B, Bhattacharya PK, Agrawal S, Malhotra N, Sahay R, Jabbar PK, Nair A, Rozati R, Shukla A, Rashid R, Shah IA, Rashid H, Wani IA, Arora T, Kulkarni B. Normative range of various serum hormonal parameters among Indian women of reproductive age: ICMR-PCOS task force study outcome. Lancet Reg Health Southeast Asia 2023; 15:100226. [PMID: 37614351 PMCID: PMC10442974 DOI: 10.1016/j.lansea.2023.100226] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 04/04/2023] [Accepted: 05/17/2023] [Indexed: 08/25/2023]
Abstract
Background The hormonal profile varies considerably with age, gender, ethnicity, diet or physiological state of an individual. Limited population-specific studies have studied the variations in hormonal parameters among apparently healthy women. We aimed to analyse the biological reference interval for various hormonal parameters in the reproductive-aged healthy Indian women. Methods Out of 3877 participants that were clinically evaluated, 1441 subjects were subjected to laboratory investigations. All participants underwent a detailed clinical, biochemical and hormonal profiling. The hormone analysis was carried out at a single centre using a uniform methodology. Among the participants evaluated for biochemical and hormonal parameters, subjects that presented any abnormal profile or had incomplete investigations (n = 593) were excluded for further analysis. Findings The mean age (±SD) of the subjects retained in the final analysis (n = 848) was 29.9 (±6.3) years. In the present study, the biological reference interval (2.5th-97.5th centile) observed were: serum T4: μg/dL (5.23-12.31), TSH: μg/mL (0.52-4.16) and serum prolactin: ng/mL (5.13-37.35), LH: mIU/mL (2.75-20.68), FSH: mIU/mL 2.59-15.12), serum total testosterone: ng/mL (0.06-0.68), fasting insulin: mIU/mL (1.92-39.72), morning cortisol: μg/dL (4.71-19.64), DHEAS:μg/dL (50.61-342.6) and SHBG: nmol/L (21.37-117.54). Unlike T4, TSH, LH, and E2, the biological reference interval for prolactin, FSH, testosterone, C-peptide insulin and DHEAS varied when the subjects were stratified by age (p < 0.05). The comparative analysis showed marginal differences in the normative ranges for the hormones analysed among different populations. Interpretation Our first large composite data on hormonal measures will benefit future endeavours to define biological reference intervals in reproductive-aged Indian women. Funding The study was financially supported by the grant-in-aid from ICMR vide file No:5/7/13337/2015-RBMH.
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Affiliation(s)
- Mohd Ashraf Ganie
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
- Multidisciplinary Research Unit, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Subhankar Chowdhury
- Department of Endocrinology Metabolism, Institute of Postgraduate Medical Education Research, Kolkata, India
| | - Vanita Suri
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Beena Joshi
- Department of Operational Research, National Institute for Research in Reproductive Health, Indian Council of Medical Research, Mumbai, India
| | - Prasanta Kumar Bhattacharya
- Department of General Medicine, North-Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, India
| | - Sarita Agrawal
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, Raipur, India
| | - Neena Malhotra
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, India
| | | | - Abilash Nair
- Department of Endocrinology, Government Medical College, Thiruvananthapuram, India
| | - Roya Rozati
- Department of Obstetrics and Gynaecology, Maternal Health, Research Trust, Hyderabad, India
| | - Amlin Shukla
- Reproductive Biology and Maternal Health, Child Health, Indian Council of Medical Research, New Delhi, India
| | - Rabiya Rashid
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Idrees A. Shah
- Multidisciplinary Research Unit, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Haroon Rashid
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Imtiyaz Ahmad Wani
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Taruna Arora
- Reproductive Biology and Maternal Health, Child Health, Indian Council of Medical Research, New Delhi, India
| | - Bharati Kulkarni
- Reproductive Biology and Maternal Health, Child Health, Indian Council of Medical Research, New Delhi, India
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Revathy R, Kharat N, Chaurasia H, Shetty S, Begum S, Joshi B. Health system cost for providing antiretroviral therapy, family planning, and pregnancy-related services to women living with HIV in public health settings, Mumbai, India. Indian J Public Health 2023; 67:428-434. [PMID: 37929386 DOI: 10.4103/ijph.ijph_1639_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Background Integration of HIV care into family planning (FP) services would help in reducing unintended pregnancies among women living with HIV. Objectives This study focuses on determining the health system cost for providing the linked HIV-FP services per beneficiary for the year 2019-2020. Materials and Methods Using mixed micro-costing approach costs were collected from two tertiary hospitals in Maharashtra, India. The economic costs collected from gynaecology department and anti-retroviral treatment center were combined and added with package, program, and intervention costs to obtain health-system costs. We conducted probabilistic sensitivity analysis. Results The unit cost and annual per-capita cost for providing HIV care (without considering cost of drugs and investigations) per beneficiary were INR 1033.8 (USD 13.6) and INR 9304.2 (USD 122.7), respectively. The unit cost was least for the outpatient services INR 197.5 (USD 2.6), followed by inpatient services INR 2735.92 (USD 36.21) and operation theater INR 4410 (USD 58.2). Cost was highest for dual-permanent (INR 13866.8 [USD 182.9]) followed by dual-reversible user (INR 2104.8 [USD 24.8]). It was the least for a person who only used condoms at INR 1674.1 (USD 22.1). In pregnancy-related services, cost for ante-natal services was least (INR 2043.6 [USD 27.96]), followed by vaginal delivery (INR 7120.5 [USD 93.93]), abortion (INR 11530.5 [USD 152.097]), and C-section (INR 18703.8 [USD 246.7]). Conclusion We found no staggeringly additional costs for providing FP and pregnancy-related services to HIV-affected population, in comparison to general population. The findings could improve programs and insurance with a focus on this vulnerable population.
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Affiliation(s)
- R Revathy
- Scientist B, HTA Regional Resource Hub, Department of Operational and Implementation Research, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Namrata Kharat
- Ex-Senior Research Fellow, HTA Regional Resource Hub, Department of Operational and Implementation Research, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Himanshu Chaurasia
- Ex-Scientist, HTA Regional Resource Hub, Department of Operational and Implementation Research, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Siddesh Shetty
- Ex-Scientist D, HTA Regional Resource Hub, Department of Operational and Implementation Research, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Shahina Begum
- Scientist E, Department of Biostatistics, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Beena Joshi
- Scientist F, HTA Regional Resource Hub, Department of Operational and Implementation Research, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
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9
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Joshi B, Patil A, Kokate PP, Akula AJ, Shaikh SA, Tandon D, Nayak AS. Assessment of Health-Related Quality of Life Using PCOSQ Tool, Its Determinants and Coping Mechanisms Used by Women with Polycystic Ovarian Syndrome Attending Multidisciplinary Clinic in Mumbai, India. J Obstet Gynaecol India 2023; 73:172-179. [PMID: 37073232 PMCID: PMC10105802 DOI: 10.1007/s13224-022-01723-x] [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: 02/21/2022] [Accepted: 10/23/2022] [Indexed: 11/27/2022] Open
Abstract
Background Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorder having most impact on women of reproductive age group, affecting their quality of life (HRQOL) and psychological well-being. Objective This paper aims to determine QOL among women affected with PCOS attending a multidisciplinary clinic using PCOSQ tool and its association with socio-economic status, phenotypes, anxiety, depression and metabolic comorbidities and evaluate the coping strategies adapted by these women. Design Retrospective study. Setting Integrated multidisciplinary PCOS clinic. Patients Two hundred and nine women diagnosed with PCOS as per Rotterdam criteria. Results Infertility was an important condition for reduced HRQOL and psychological morbidity across all socio-economic status and phenotypes. The poor psychological status and obesity were identified as determinants of HRQOL among women affected with PCOS. Those who suffered from anxiety, depression and showed lower HRQOL used emotional maladaptive coping strategies. Conclusion Results reveal that HRQOL of PCOS women is worsened in the presence of comorbidities. Maladaptive and disengagement coping strategies used by women may worsen their psychological status. Holistic assessment of comorbidities and its management can help improve HROL of affected women. Personalised counselling based on the assessment of coping strategies used by women could empower women to cope better with PCOS.
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Affiliation(s)
- Beena Joshi
- Department of Operational Research, ICMR-National Institute for Research in Reproductive and Child Health, Jahangir Merwanji Street, Parel, Mumbai, 400012 India
| | - Anushree Patil
- Department of Clinical Research, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, 400012 India
| | - Pratibha P. Kokate
- Department of Clinical Research, National Institute for Research in Reproductive and Child Health, Mumbai, 400012 India
| | - Anamika J. Akula
- Department of Clinical Research, National Institute for Research in Reproductive and Child Health, Mumbai, 400012 India
| | - Sharmeen A. Shaikh
- Department of Operational Research, ICMR-National Institute for Research in Reproductive and Child Health, Jahangir Merwanji Street, Parel, Mumbai, 400012 India
- Ex -Dept of Operational Research, ICMR National Institute for Research in Reproductive and Child Health, Parel, Mumbai, India
| | - Deepti Tandon
- Department of Clinical Research, National Institute for Research in Reproductive and Child Health, Mumbai, 400012 India
| | - Ajita S. Nayak
- Department of Psychiatry, Grant Medical College and KEM Hospital, Parel, Mumbai, 400012 India
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Shukla P, Mukherjee S, Patil A, Joshi B. Molecular characterization of variants in mitochondrial DNA encoded genes using next generation sequencing analysis and mitochondrial dysfunction in women with PCOS. Gene 2023; 855:147126. [PMID: 36563715 DOI: 10.1016/j.gene.2022.147126] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 12/07/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
Emerging studies indicates mitochondrial dysfunction and involvement of mitochondrial DNA (mtDNA) variants in the pathogenesis of polycystic ovary syndrome (PCOS). Cumulative effect of mtDNA rare variants are now gaining considerable interest apart from common variants in the pathogenesis of complex diseases. Rare variants may modify the effect of polymorphism or in combination with the common variants may affect the risk of disease. With the evolution of high throughput sequencing techniques, which can be utilized to identify common as well as rare variants along with heteroplasmy levels, comprehensive characterization of the mtDNA variants is possible. Till date, few studies reported common mtDNA variants using traditional sequencing techniques but rare variants in mtDNA encoding genes remain unexplored in women with PCOS. These mtDNA variants may be responsible for mitochondrial dysfunction and may contribute in PCOS pathogenesis. In this study we determined mtDNA copy number, a biomarker of mitochondrial dysfunction and first time analysed variants in mtDNA encoded genes in women with PCOS using mitochondrial Next Generation sequencing (NGS) approach and compared allele frequency from mitochondrial 1000 genome dataset. Variant annotation and prioritization was done using highly automated pipeline, MToolBox that excludes reads mapped from nuclear mitochondrial DNA sequences (NumtS) to identify unique mtDNA reads. The present study identified significant reduction in mtDNA copy number in women with PCOS compared to non-PCOS women. A total of unique 214 prioritized common to rare variants were identified in mtDNA encoded genes, 183 variants in OXPHOS complexes, 14 variants in MT-tRNA and 17 variants in MT-rRNA genes that may be involved in mitochondrial dysfunction in PCOS. Numerous variants were heteroplasmic, pathogenic in nature and occurred in evolutionary conserved region. Heteroplasmic variants were more frequently occurred in MT-CO3 gene. Non-synonymous variants were more than synonymous variants and mainly occurred in OXPHOS complex I and IV. Few variants were found to be associated with diseases in MITOMAP database. The study provides a better understanding towards pathogenesis of PCOS from novel aspects focusing on mitochondrial genetic defects as underlying cause for contributing mitochondrial dysfunction in women with PCOS.
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Affiliation(s)
- Pallavi Shukla
- Department of Molecular Endocrinology, Indian Council of Medical Research-National Institute for Research in Reproductive and Child Health (ICMR-NIRRCH), J.M. Street, Parel, Mumbai 400012, India.
| | - Srabani Mukherjee
- Department of Molecular Endocrinology, Indian Council of Medical Research-National Institute for Research in Reproductive and Child Health (ICMR-NIRRCH), J.M. Street, Parel, Mumbai 400012, India
| | - Anushree Patil
- Department of Clinical Research, Indian Council of Medical Research-National Institute for Research in Reproductive and Child Health (ICMR-NIRRCH), J.M. Street, Parel, Mumbai 400012, India
| | - Beena Joshi
- Department of Operational Research, Indian Council of Medical Research-National Institute for Research in Reproductive and Child Health (ICMR-NIRRCH), J.M. Street, Parel, Mumbai 400012, India
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11
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Kabra R, Joshi B, Elisaria E, Akande TM, Allagh KP, Olumide A, Tandon D, Prusty R, Ramesh M, Shamba D, Kiarie J. Mixed methods study to determine the impact of the COVID-19 pandemic on availability, utilization, and readiness of family planning and contraceptive services at selected primary health care facilities in Africa and Asia: A study protocol. JMIR Res Protoc 2023; 12:e43329. [PMID: 36927830 PMCID: PMC10173704 DOI: 10.2196/43329] [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] [Received: 10/08/2022] [Revised: 01/26/2023] [Accepted: 01/26/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic and the associated social restrictions may have disrupted the provision of essential services, including family planning and contraceptive services. This protocol is adapted from a generic study protocol titled 'Health systems analysis and evaluations of the barriers to availability and readiness of sexual and reproductive health services in COVID-19 affected areas', conducted by the WHO Department of Reproductive Health and Research. OBJECTIVE This study aims to assess the availability and utilization of family planning and contraceptive services in primary health facilities during and after the COVID-19 pandemic, assess the risk perceptions of COVID-19 stigma, barriers to access, and quality of services from clients' and providers' perspectives in the COVID-19 affected areas and to assess the post-pandemic recovery of the facilities in the provision of family planning and contraceptive services. METHODS The study will be conducted in India, Nigeria and Tanzania by the Indian Council of Medical Research -National Institute of Research in Reproductive and Child Health, the University of Ilorin Teaching hospital and the Ifakara Health Institute, respectively. In each country, study sites will be selected based on geographical location, organization of family planning and contraceptive services and epidemic status where the COVID-19 pandemic is likely to have significantly affected service delivery. This study uses a mix of quantitative and qualitative methods. In-depth interviews will be conducted with clients (women in the reproductive age group and their male partners who visit the selected health facilities for FP and contraceptive services) and health providers (the most knowledgeable person on FP and contraceptive service provision) at the selected health facilities. Focus group discussions with be conducted with clients at the selected health facilities and in the community. The in-depth interviews and focus group discussions will help to understand clients' and health service providers' perspectives of FP and contraceptive service availability and readiness in COVID-19 affected areas. A cross-sectional health facility assessment will be conducted in all the selected health facilities to determine the health facility infrastructure's ability and readiness to provide FP and contraceptive services and to capture the trends in FP and contraceptive services available during the COVID-19 pandemic. Scientific approval for this study is obtained from the WHO Research Project Review Panel, and the WHO Ethics Review Committee has given ethical approval in the three countries. RESULTS Using a standardized research protocol will ensure that the results from this study can be compared across regions and countries. CONCLUSIONS The findings from this study will provide a better understanding of the impact of the COVID-19 pandemic on family planning and contraceptive services at the facility level, which will help policymakers and health managers develop and strengthen FP policies and services to be more responsive to community needs by strengthening FP service delivery in the health facilities. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/43329.
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Affiliation(s)
- Rita Kabra
- World Health Organization, avenue appia-20, Geneva, CH
| | - Beena Joshi
- ICMR National Institute for Research in Reproductive and Child Health, Mumbai, IN
| | | | | | | | | | - Deepti Tandon
- ICMR National Institute for Research in Reproductive and Child Health, Mumbai, IN
| | - Ranjan Prusty
- ICMR National Institute for Research in Reproductive and Child Health, Mumbai, IN
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12
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Hasan G, Shaikh S, Joshi B, Ganie MA, Shukla A, Vadhan H, Parab R, Sanap P, Mashal I. Addressing Challenges During Community based Screening of Women for Polycystic Ovary Syndrome (PCOS): A Research Experience from Maharashtra, India before and During COVID Pandemic. Indian J Community Med 2023; 48:167-171. [PMID: 37082412 PMCID: PMC10112744 DOI: 10.4103/ijcm.ijcm_181_22] [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: 02/21/2022] [Accepted: 11/30/2022] [Indexed: 02/11/2023] Open
Abstract
Introduction A multicentric community-based screening to determine prevalence of Polycystic Ovary Syndrome was undertaken in India. This article aims to describe the challenges faced at one site and strategies adopted to mitigate them. Material and Methods Eligible women were enrolled at household-level and investigated for Polycystic Ovary Syndrome diagnosis as per Rotterdam criteria. Challenges faced were documented and alternate strategies were adopted. Results Challenges ranged from identifying women as per the polling booth list, enrolling them, and getting them investigated. COVID-19 pandemic added to the challenges. Involving health system workforce, gaining community support, flexible timings, and alternate strategies for investigation including COVID-19 appropriate safety measures helped mitigate some of the challenges. Conclusion Unforeseen challenges may crop up in community-based studies, like the ones faced during the COVID-19 pandemic. Planning, strategizing, using technology to keep communications on, and finding out of the box and amicable solutions for bottlenecks may help mitigate challenges.
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Affiliation(s)
- Gazala Hasan
- Senior Research Fellow, PCOS Taskforce Study, Mumbai, Maharashtra, India
| | - Sharmeen Shaikh
- Junior Medical Officer, ICMR, PCOS Taskforce Study, Mumbai, Maharashtra, India
| | - Beena Joshi
- Scientist F, Department of Operational Research, ICMR - National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Mohd A. Ganie
- Department of Endocrinology and Clinical Research, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Amlin Shukla
- Scientist D, Division of Reproductive Biology, Maternal & Child Health, Indian Council of Medical Research, New Delhi, India
| | - Himali Vadhan
- Field Officer, ICMR, PCOS Taskforce Study, Mumbai, Maharashtra, India
| | - Rita Parab
- Data Entry Operator, ICMR, PCOS Taskforce Study, Mumbai, Maharashtra, India
| | - Pravin Sanap
- Technician A, Department of Operational Research, ICMR - National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Iranna Mashal
- Technician 2, Department of Operational Research, ICMR - National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
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13
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Tandon D, Joshi B, Begum S, Surve S, Kokate P, Patil AD. Effect of vitamin D deficiency on the metabolic profile of women with polycystic ovary syndrome. Indian J Med Res 2022; 156:693-695. [PMID: 36926792 DOI: 10.4103/ijmr.ijmr_1345_21] [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: 02/28/2023] Open
Affiliation(s)
- Deepti Tandon
- Department of Clinical Research, ICMR-National Institute for Research in Reproductive & Child Health, Mumbai 400 012, Maharashtra, India
| | - Beena Joshi
- Department of Operational Research, ICMR-National Institute for Research in Reproductive & Child Health, Mumbai 400 012, Maharashtra, India
| | - Shahina Begum
- Department of Biostastistics, ICMR-National Institute for Research in Reproductive & Child Health, Mumbai 400 012, Maharashtra, India
| | - Suchitra Surve
- Department of Clinical Research, ICMR-National Institute for Research in Reproductive & Child Health, Mumbai 400 012, Maharashtra, India
| | - Pratibha Kokate
- Department of Clinical Research, ICMR-National Institute for Research in Reproductive & Child Health, Mumbai 400 012, Maharashtra, India
| | - Anushree Devashish Patil
- Department of Clinical Research, ICMR-National Institute for Research in Reproductive & Child Health, Mumbai 400 012, Maharashtra, India
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14
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Kulkarni R, Chauhan S, Joshi B, Balsaraf K, Chaudhari R, Donde G, Juneja K. Assessing the potential of self-help group women for improving reproductive health of women in a tribal block of Maharashtra, India. Indian J Med Res 2022; 156:191-197. [PMID: 36629179 PMCID: PMC10057364 DOI: 10.4103/ijmr.ijmr_1827_20] [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] [Indexed: 01/11/2023] Open
Abstract
Background & objectives In the current health system, cash incentives are given to accredited social health activists for referring women to public health facilities for specific maternal and child health services, however many reproductive health problems are not included in these services. The objective of this study was to assess the impact of involvement of self-help groups (SHGs) in improving reproductive health seeking behaviour and service utilization by tribal women. Methods An experimental study was conducted in two tribal blocks of Nasik district (Kalvan and Surgana) in Maharashtra, India, over a period of 18 months. Interventions included training of SHG women and providing incentives to them for conducting health education sessions for reproductive age group women in the community and referring those with the requisite problems, to the health facilities. Pre- and post-intervention focus group discussions and in-depth interviews among SHG women were conducted. Training of service providers on diagnosis and treatment of reproductive morbidities was done, and health service utilization was assessed. Results Sixty five per cent of the referred women with reproductive morbidities availed services at the public health facilities. A review of records of women seeking services for reproductive health problems showed that there was a significant improvement in the intent for seeking services in the study block as compared to the control block (χ[2]-9.06, P<0.002). Interpretation & conclusions This study demonstrates the feasibility of utilizing the potential of SHGs for improving reproductive health seeking behaviour of the tribal women. The results suggest that this model could be scaled up to address the neglected reproductive health needs of women without burdening the existing human resources.
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Affiliation(s)
- Ragini Kulkarni
- Department of Operational Research, Indian Council of Medical Research-National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Sanjay Chauhan
- Department of Operational Research, Indian Council of Medical Research-National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Beena Joshi
- Department of Operational Research, Indian Council of Medical Research-National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Kusum Balsaraf
- Mahila Arthik Vikas Mahamandal, Women and Child Development Department, Griha Nirman Bhavan, India
| | - Ravindra Chaudhari
- Public Health Department, Government of Maharashtra, Mumbai, Maharashtra, India
| | - Gauri Donde
- Mahila Arthik Vikas Mahamandal, Women and Child Development Department, Griha Nirman Bhavan, India
| | - Kavita Juneja
- Department of Operational Research, Indian Council of Medical Research-National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
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15
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Nair S, Bhadricha H, Patil A, Surve S, Joshi B, Balasinor N, Desai M. Association of OPG and RANKL gene polymorphisms with bone mineral density in Indian women. Gene 2022; 840:146746. [PMID: 35868414 DOI: 10.1016/j.gene.2022.146746] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/01/2022] [Accepted: 07/14/2022] [Indexed: 11/18/2022]
Abstract
Osteoprotegerin (OPG) and receptor activator of the NF-kB ligand (RANKL) are key players in bone remodelling. Reports show that OPG and RANKL gene polymorphisms are associated with osteoporosis and fracture risk. The aim of this study was to examine the influence of 5 single nucleotide polymorphisms (SNPs) in OPG and RANKL gene on bone mineral density (BMD) in Indian women. The study included 374 healthy Indian women. Kompetitive Allele Specific PCR (KASP) was used for genotyping. There was a significant difference in the BMD at spine between genotypes of OPG rs2073618 (CC: 0.988 ± 0.167 CG: 1.023 ± 0.17 GG: 1.053 ± 0.155; p = 0.039) which was lost upon adjustment for age and BMI (p = 0.087). Multiple linear regression revealed that genotypes of OPG rs2073618 (β = 0.098; p = 0.027) and rs3102735 (β = 0.092; p = 0.038) are predictors of BMD at spine in Indian women. We did not observe any association of SNPs in RANKL gene with BMD. Thus, SNPs rs2073618 and rs3102735 in OPG gene may influence BMD at spine in Indian women.
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Affiliation(s)
- Sandhya Nair
- Molecular Immunodiagnostics Division, ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Hetal Bhadricha
- Molecular Immunodiagnostics Division, ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Anushree Patil
- Department of Clinical Research, ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Suchitra Surve
- Department of Clinical Research, ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Beena Joshi
- Department of Operational Research, ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Nafisa Balasinor
- Neuroendocrinology Division, ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India
| | - Meena Desai
- Molecular Immunodiagnostics Division, ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai 400 012, India.
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Pyakurel M, Bhattarai S, Joshi B, Koju RP, Shrestha A. Burden of Stroke in Nepal: Findings from Global Burden of Disease Dataset 2017. Kathmandu Univ Med J (KUMJ) 2022; 19:11-17. [PMID: 35526132] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background Stroke is the second leading cause of death and disability worldwide including Asian countries, surpassing ischemic heart disease. Stroke accounts for 10% of global death, of which more than three fourth occur in low- and middle-income countries. An exact estimate of the burden of stroke in Nepal is not available. Objective To assess the burden of stroke including disability and death over time in Nepal and compare it with other South Asian countries. Method We retrieved data from the Institute of Health Metrics and Evaluation's Global Burden of Diseases database of 2017 on stroke deaths, disability-adjusted life years, incidence, and prevalence rates, for both genders from Nepal, Bangladesh, Pakistan, Bhutan, and India by year. We assessed the trend of deaths and Disability-Adjusted Life Years (DALYs) due to stroke from 1990 to 2017; and the contribution of major risk factors to stroke burden in 2017. Result Stroke contributed 7.6% of total deaths and 3.5% of total DALYs in Nepal, with a higher burden among the male and old age population. Intracerebral hemorrhage was the dominant type of stroke in Nepal with the highest proportion of deaths and DALYs. Among the South Asian countries, incidence, prevalence, and burden of stroke were highest in Bangladesh. Intracerebral hemorrhage contributed the highest DALYs in South Asian countries. High systolic blood pressure was contributing the maximum DALYs due to stroke in Nepal. Conclusion Hemorrhagic stroke causes high mortality and DALYs in Nepal. Most of the burden of stroke is attributed to high blood pressure in Nepal.
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Affiliation(s)
- M Pyakurel
- Inclusive Partnership Against Violence (InPAV)Project, Green Tara Nepal, Baluwatar, Nepal. and Fellow, CVD Translational Research Program, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Bhattarai
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - B Joshi
- University of Bordeaux, Inserm, Research Institute for development (IRD), France. and Center for Research Innovation and Development (CRID), Lalitpur, Nepal
| | - R P Koju
- Dean, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. and Department of Internal Medicine, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - A Shrestha
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal. Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, USA. and Institute for Implementation Science and Health, Kathmandu, Nepal
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Joshi B, Font H, Wobudeya E, Nanfuka M, Kobusingye A, Mwanga-Amumpaire J, Natukunda N, Turyahabwe S, Borand L, Mao TE, Dim B, Ferhi R, Moh R, Kouakou J, Aka Bony R, Breton G, Mustapha A, Matata L, Foray L, Detjen A, Verkuijl S, Sekadde M, Khosa C, Mbassa V, Taguebue JV, Kwedi Nolna S, Bonnet M, Marcy O, Orne-Gliemann J. Knowledge, attitudes and practices on childhood TB among healthcare workers. Int J Tuberc Lung Dis 2022; 26:243-251. [PMID: 35197164 PMCID: PMC9121838 DOI: 10.5588/ijtld.21.0317] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Increasing childhood TB case detection requires the deployment of diagnostic services at peripheral healthcare level. Capacity and readiness of healthcare workers (HCWs) are key to the delivery of innovative approaches.METHODS: In 2019, HCWs from five district hospitals (DHs) and 20 primary healthcare centres (PHCs) in Cambodia, Cameroon, Cote d´Ivoire, Sierra Leone and Uganda completed a self-administered knowledge-attitudes-practices (KAP) questionnaire on childhood TB. We computed knowledge and attitudes as scores and identified HCW characteristics associated with knowledge scores using linear regression.RESULT: Of 636 eligible HCWs, 497 (78%) participated. Median knowledge scores per country ranged between 7.4 and 12.1 (/18). Median attitude scores ranged between 2.8 and 3.3 (/4). Between 13.3% and 34.4% of HCWs reported diagnosing childhood with (presumptive) TB few times a week. Practising at PHC level, being female, being involved in indirect TB care, having a non-permanent position, having no previous research experience and working in Cambodia, Cameroon, Cote d´Ivoire and Sierra Leone as compared to Uganda were associated with a lower knowledge score.CONCLUSION: HCWs had overall limited knowledge, favourable attitudes and little practice of childhood TB diagnosis. Increasing HCW awareness, capacity and skills, and improving access to effective diagnosis are urgently needed.
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Affiliation(s)
- B Joshi
- Unité mixte de recherche 1219, University of Bordeaux, Institut national de la santé et de la recherche médicale (INSERM), Institut de Recherche pour le Développement (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France
| | - H Font
- Unité mixte de recherche 1219, University of Bordeaux, Institut national de la santé et de la recherche médicale (INSERM), Institut de Recherche pour le Développement (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France
| | - E Wobudeya
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, MU-JHU Care Limited, Kampala, Uganda
| | - M Nanfuka
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, MU-JHU Care Limited, Kampala, Uganda
| | - A Kobusingye
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, MU-JHU Care Limited, Kampala, Uganda
| | | | - N Natukunda
- Epicentre Mbarara Research Centre, Mbarara, Uganda
| | - S Turyahabwe
- National Tuberculosis and Leprosy Program, Kampala, Uganda
| | - L Borand
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - T E Mao
- Centre national de Lutte contre la Tuberculose et la Lèpre (CENAT), Phnom Penh, Cambodia
| | - B Dim
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - R Ferhi
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - R Moh
- Programme ANRS Coopération Côte d´Ivoire (PAC-CI) Abidjan, Côte d´Ivoire
| | - J Kouakou
- Programme National de Lutte contre la Tuberculose (PNLT), Abidjan, Côte d´Ivoire
| | - R Aka Bony
- Programme ANRS Coopération Côte d´Ivoire (PAC-CI) Abidjan, Côte d´Ivoire
| | | | - A Mustapha
- Ola During Children´s Hospital, Freetown, Sierra Leone
| | | | - L Foray
- National Leprosy and TB Control Programme, Freetown, Sierra Leone
| | - A Detjen
- Child and Community Health Unit, United Nations Children´s Fund (UNICEF), New York, NY, USA
| | - S Verkuijl
- Global Tuberculosis Programme, WHO, Geneva, Switzerland
| | - M Sekadde
- National Tuberculosis and Leprosy Program, Kampala, Uganda
| | - C Khosa
- Instituto Nacional de Saúde, Maputo, Mozambique
| | | | - J-V Taguebue
- Mother and Child Centre, Chantal Biya Foundation, Yaoundé, Cameroon
| | | | - M Bonnet
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses), University of Montpellier, IRD, INSERM, Montpellier, France
| | - O Marcy
- Unité mixte de recherche 1219, University of Bordeaux, Institut national de la santé et de la recherche médicale (INSERM), Institut de Recherche pour le Développement (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France
| | - J Orne-Gliemann
- Unité mixte de recherche 1219, University of Bordeaux, Institut national de la santé et de la recherche médicale (INSERM), Institut de Recherche pour le Développement (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France
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Joshi B, Moray K, Sachin O, Chaurasia H. Cost of providing family planning services & management of pregnancy outcomes at public health facilities in India. Indian J Med Res 2022; 155:34-42. [PMID: 35859426 PMCID: PMC9552369 DOI: 10.4103/ijmr.ijmr_146_20] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background & objectives: Lack of costing data is a critical gap that exists in the field of family planning (FP) in India. The aim of this study was to estimate health system costs of FP in India for existing modern methods, and potential newer methods (etonorgestrel implant and levonorgestrel intrauterine device) and pregnancy-related services in India. Methods: A bottom-up micro-costing study was conducted in five public health facilities of an Indian State. Data of last one year were collected from existing hospital records and hospital staff was interviewed. Collected data were analyzed using standard costing methods. Results: Package costs of delivering FP services ranged from ₹ 807 (95% CI 685, 931) for condoms and ₹ 10,539 (8796, 12269) for tubal ligation. Estimates of etonorgestrel implant and levonorgestrel intrauterine system were ₹ 3,200 (2800, 3625) and 3,426 (3232, 3623). Cost of antenatal care along with vaginal delivery, caesarean and abortion were ₹ 10,916 (8744, 13078), 22,136 (17570, 26910) and 8,574 (6791, 10379), respectively. One way sensitivity analysis showed that the three most influential factors on the costs of FP services were prices of drugs and consumables, number of beneficiaries and health personnel cost. Interpretation & conclusions: The present study has generated package costs for FP and pregnancy-related services in India which could be used by publicly-funded insurance schemes, for budgeting, economic evaluations and improve resource allocation of services. The cost estimates from this study add to the limited literature in India on costs of FP.
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Surve S, Begum S, Chauhan S, Khatkhatay MI, Joshi B. Determinants of Vitamin D Deficiency Among Under-five Children in Urban Slums of Mumbai, India. Indian Pediatr 2021; 58:888-889. [PMID: 34047721] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A community-based study was undertaken in an urban slum in Mumbai, between October, 2015 and September, 2017 among 426 healthy children (aged 1-5 years) to assess prevalence of vitamin D deficiency (VDD) and its determinants. VDD was classified as 25(OH)D <20 ng/mL. The prevalence of VDD was 76.8% (n=327), and sun-exposure, male sex, and calcium and vitamin D supplementations during infancy were important determinants. Routine supplementation with vitamin D in infancy is likely to reduce the occurrence of VDD in children.
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Affiliation(s)
- Suchitra Surve
- Department of Clinical Research, Indian Council of Medical Research-National Institute of Research in Reproductive Health, Parel, Mumbai, Maharashtra
| | - Shahina Begum
- Department of Biostatistics, Indian Council of Medical Research-National Institute of Research in Reproductive Health, Parel, Mumbai, Maharashtra
| | - Sanjay Chauhan
- Department of Clinical and Operational Research, Indian Council of Medical Research-National Institute of Research in Reproductive Health, Parel, Mumbai, Maharashtra
| | - M I Khatkhatay
- Department of Molecular Immunodiagnostics, Indian Council of Medical Research-National Institute of Research in Reproductive Health, Parel, Mumbai, Maharashtra
| | - Beena Joshi
- Department of Operational Research, Indian Council of Medical Research-National Institute of Research in Reproductive Health, Parel, Mumbai, Maharashtra.
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Ganie MA, Chowdhury S, Suri V, Joshi B, Bhattacharya PK, Agrawal S, Malhotra N, Sahay R, Rozati R, Jabbar PK, Sreenivas V, Sriwastva M, Wani IA, Singh S, Sharma RS. Evaluation of the Prevalence, Regional Phenotypic Variation, Comorbidities, Risk Factors, and Variations in Response to Different Therapeutic Modalities Among Indian Women: Proposal for the Indian Council of Medical Research-Polycystic Ovary Syndrome (ICMR-PCOS) Study. JMIR Res Protoc 2021; 10:e23437. [PMID: 34448720 PMCID: PMC8433859 DOI: 10.2196/23437] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/30/2020] [Accepted: 01/06/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND There is scanty data in India on polycystic ovary syndrome (PCOS) from several small, undersized, convenience-based studies employing differing diagnostic criteria and reporting varied regional prevalence. It is difficult to draw clear-cut conclusions from these studies; therefore, the present multicentric, well-designed, large-scale representative countrywide epidemiological study on PCOS across India was conceived with the aim to generate the actual prevalence rates of PCOS in India with a total sample size of approximately 9000 individuals. OBJECTIVE The primary objectives of the study are to estimate the national prevalence of PCOS in India and the burden of comorbidities and to compare the variation in efficacy of standard therapeutic modalities for metabolic dysfunction in women with PCOS. METHODS This multicentric umbrella study consists of three different substudies. Substudy 1 will involve recruitment of women aged 18-40 years using a multistage sampling technique from randomly selected polling booths across urban and rural areas to estimate national prevalence, phenotypic variation, and risk factors among regions. Substudy 2 involves recruitment of subjects from the community pool of substudy 1 and the institutional pool for quantitation of comorbidities among women with PCOS. Substudy 3, an interventional part of the study, aims for comparison of variation in efficacies of common treatment modalities and will be conducted only at 2 centers. The eligible consenting women will be randomized in a 1:1 ratio into 2 arms through a blinding procedure. All these women will undergo clinical, biochemical, and hormonal assessment at baseline and at 3 and 6 months. The data generated will be analyzed using the reliable statistical software SPSS (version 26). RESULTS The study is ongoing and is likely to be completed by April 2022. The data will be compiled and analyzed, and the results of the study will be disseminated through publications. CONCLUSIONS The Indian Council of Medical Research-PCOS study is the first of its kind attempting to provide accurate and comprehensive data on prevalence of PCOS in India. TRIAL REGISTRATION Clinical Trials Registry-India CTRI/2018/11/016252; ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=26366. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/23437.
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Affiliation(s)
- Mohd Ashraf Ganie
- Department of Endocrinology & Clinical Research, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Subhankar Chowdhury
- Department of Endocrinology & Metabolism, Institute of Postgraduate Medical Education & Research, Kolkata, India
| | - Vanita Suri
- Department of Obstetrics & Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Beena Joshi
- Department of Operational Research, National Institute for Research in Reproductive Health, Indian Council of Medical Research, Mumbai, India
| | - Prasanta Kumar Bhattacharya
- Department of Community Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, India
| | - Sarita Agrawal
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, Raipur, India
| | - Neena Malhotra
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, India
| | - Roya Rozati
- Department of Obstetrics & Gynaecology, Maternal Health & Research Trust, Hyderabad, India
| | | | | | - Mukesh Sriwastva
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Imtiyaz Ahmad Wani
- Department of Endocrinology & Clinical Research, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Shalini Singh
- Reproductive Biology and Maternal Health, Child Health, Indian Council of Medical Research, New Delhi, India
| | - Radhey Shyam Sharma
- Reproductive Biology and Maternal Health, Child Health, Indian Council of Medical Research, New Delhi, India
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Joshi B, Girase B, Shetty S, Verma V, Acharya S, Deoraj P, Kulkarni R, Begum S. Improving public health service delivery response to address contraceptive needs of socio-economically disadvantaged HIV positive people in Maharashtra, India. Contracept Reprod Med 2021; 6:14. [PMID: 33934712 PMCID: PMC8091514 DOI: 10.1186/s40834-021-00159-4] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 03/23/2021] [Indexed: 11/21/2022] Open
Abstract
Background People living with HIV (PLHIV) receive free antiretroviral treatment (ART) in public health facilities of India. With improved life expectancy, unmet sexual and reproductive health needs of PLHIV have to be addressed through a converged programmatic response strategy. Evidence shows that socioeconomically disadvantaged women are most vulnerable to high reproductive morbidities, especially HIV positive women with an unmet need of contraception. Methods Programmatic convergence by linking ART and family planning services were strengthened at two public health facilities (district hospitals) generally accessed by disadvantaged socio-economic sections of the society. Barriers to linking services including stigma and discrimination were addressed through analysis of existing linkage situation, sensitization and training of healthcare providers and system-level interventions. This facilitated provider-initiated assessment of contraceptive needs of PLHIV, counseling about dual contraception using a couple approach, linkage to family planning centers and maintaining data about these indicators. Six hundred eligible PLHIV seeking care at ART centers were enrolled and followed up for a duration of 6 months. Acceptance of family planning services as a result of the intervention, use of dual contraception methods and their determinants were assessed. Results Eighty-seven percent HIV couples reached FP centers and 44.6% accepted dual methods at the end of the study period. Dual methods such as oral contraceptive pills (56.2%), IUCDs (19.4%), female sterilization (11.6%), injectable contraception (9.9%) and vasectomy (2.9%) in addition to condoms were the most commonly accepted methods. Condom use remained regular and consistently high throughout. The study witnessed seven unintended pregnancies, all among exclusive condom users. These women availed medical abortion services and accepted dual methods after counseling. Female index participants, concordant couples, counseling by doctors and women with CD4 count above 741 had higher odds of accepting dual contraception methods. Standard operating procedures (SOP) were developed in consultation with key stakeholders to address operational linkage of HIV and family programs. Conclusion The study saw significant improvement in acceptance of dual contraception by PLHIV couples as a result of the intervention. Implementation of SOPs with supportive supervision can ensure efficient linkage of programs and provide holistic sexual and reproductive healthcare for PLHIV in India.
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Affiliation(s)
- Beena Joshi
- Indian Council of Medical Research- National Institute for Research in Reproductive Health (NIRRH), Mumbai, Maharashtra, India.
| | - Bhushan Girase
- Indian Council of Medical Research- National Institute for Research in Reproductive Health (NIRRH), Mumbai, Maharashtra, India.,Family Health Department, PATH India, New Delhi, India
| | - Siddesh Shetty
- Indian Council of Medical Research- National Institute for Research in Reproductive Health (NIRRH), Mumbai, Maharashtra, India
| | - Vinita Verma
- National AIDS Control Organization, New Delhi, India
| | - Shrikala Acharya
- Mumbai District AIDS Control Society, Mumbai, Maharashtra, India
| | - Pramod Deoraj
- Maharashtra State AIDS Control Society, Mumbai, Maharashtra, India
| | - Ragini Kulkarni
- Indian Council of Medical Research- National Institute for Research in Reproductive Health (NIRRH), Mumbai, Maharashtra, India
| | - Shahina Begum
- Indian Council of Medical Research- National Institute for Research in Reproductive Health (NIRRH), Mumbai, Maharashtra, India
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Joshi B, Moray KV, Sachin O, Chaurasia H, Begum S. Correction to: Cost Effectiveness of Introducing Etonorgestrel Contraceptive Implant into India's Current Family Welfare Programme. Appl Health Econ Health Policy 2021; 19:279. [PMID: 33106948 DOI: 10.1007/s40258-020-00617-1] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Beena Joshi
- Health Technology Assessment Resource Hub, Indian Council of Medical Research, National Institute for Research in Reproductive Health, Jehangir Merwanji Street, Parel, Mumbai, 400012, India.
| | - Kusum V Moray
- Health Technology Assessment Resource Hub, Indian Council of Medical Research, National Institute for Research in Reproductive Health, Jehangir Merwanji Street, Parel, Mumbai, 400012, India
| | - Oshima Sachin
- Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | - Himanshu Chaurasia
- Health Technology Assessment Resource Hub, Indian Council of Medical Research, National Institute for Research in Reproductive Health, Jehangir Merwanji Street, Parel, Mumbai, 400012, India
| | - Shahina Begum
- Biostatistics Department, Indian Council of Medical Research, National Institute for Research in Reproductive Health, Jehangir Merwanji Street, Parel, Mumbai, 400012, India
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Joshi B, Moray KV, Sachin O, Chaurasia H, Begum S. Cost Effectiveness of Introducing Etonorgestrel Contraceptive Implant into India's Current Family Welfare Programme. Appl Health Econ Health Policy 2021; 19:267-277. [PMID: 32776166 DOI: 10.1007/s40258-020-00605-5] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The aim of this study was to provide evidence to policy makers on cost effectiveness and budget impact for the introduction of the etonorgestrel implant into the Indian public health system. METHODS An economic evaluation was conducted to ascertain the potential costs and outcomes of adding the etonorgestrel implant to the public health system of India as compared to the current scenario. A decision analytical model (Markov cohort) was conceptualized from a societal perspective, where a hypothetical population of 15-year-old females was followed until menopause. The primary outcome was incremental cost-utility ratio (ICUR). Sources for model inputs included country-level secondary data analysis, government reports, an observational primary costing study, a systematic review of etonorgestrel implant and targeted literature reviews. One-way and probabilistic sensitivity analyses (OWSA and PSA) were performed to account for uncertainty. The impact of etonorgestrel implant introduction on the annual Indian health budget was also analysed. RESULTS The base-case ICUR was 16,475 Indian rupees (INR) (USD 232) per quality-adjusted life-year gained, which showed the etonorgestrel implant to be very cost effective (ICUR below willingness-to-pay threshold of INR 137,945 [USD 1943]). OWSA showed that discount rate, percentage of people who do not use contraceptives and costs of managing side effects were the important parameters that affected ICUR. PSA showed that ICUR values of all 1000 Monte Carlo simulations were cost effective. Budget impact analysis showed that introduction of the implant would account for < 1% of the total annual health budget of India, even if acceptance of the implant varied between 0.2 and 4%. CONCLUSION Adding the etonorgestrel implant to the public health system would be cost effective for India, with a feasible budgetary allocation.
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Affiliation(s)
- Beena Joshi
- Health Technology Assessment Resource Hub, Indian Council of Medical Research, National Institute for Research in Reproductive Health, Jehangir Merwanji Street, Parel, Mumbai, 400012, India.
| | - Kusum V Moray
- Health Technology Assessment Resource Hub, Indian Council of Medical Research, National Institute for Research in Reproductive Health, Jehangir Merwanji Street, Parel, Mumbai, 400012, India
| | - Oshima Sachin
- Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | - Himanshu Chaurasia
- Health Technology Assessment Resource Hub, Indian Council of Medical Research, National Institute for Research in Reproductive Health, Jehangir Merwanji Street, Parel, Mumbai, 400012, India
| | - Shahina Begum
- Biostatistics Department, Indian Council of Medical Research, National Institute for Research in Reproductive Health, Jehangir Merwanji Street, Parel, Mumbai, 400012, India
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Dadachanji R, Patil A, Joshi B, Mukherjee S. Elucidating the impact of obesity on hormonal and metabolic perturbations in polycystic ovary syndrome phenotypes in Indian women. PLoS One 2021; 16:e0246862. [PMID: 33635862 PMCID: PMC7909663 DOI: 10.1371/journal.pone.0246862] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 01/27/2021] [Indexed: 12/23/2022] Open
Abstract
Polycystic ovary syndrome is a complex endocrinopathy with heterogeneous presentation and multifactorial etiology. We have undertaken this case-control study to compare metabolic and endocrine characteristics in different phenotypic subgroups of women with PCOS and the impact of obesity on them. Women with PCOS (n = 489) were classified into 4 phenotypes according to Rotterdam criteria. Comparisons of clinical, biochemical and hormonal parameters were performed across all phenotypic groups of PCOS and with controls (n = 270) by Welch’s ANOVA with subsequent Games-Howell post-hoc test. We found maximum prevalence of normoandrogenic phenotype D, which is milder form of PCOS in terms of insulin resistance, gonadotropin levels and dyslipidemia, followed by phenotype A, in our total study population. After classification of the study group into lean and obese groups, only few insulin and lipid-related traits showed marked differences between phenotypes. Further, we noted that obese women showed adverse metabolic but not androgenic traits compared to lean counterparts in the same phenotype. Metabolic syndrome frequency is increased in hyperandrogenic phenotypes with HDL-C and waist circumference being most predominant contributing factors in total, lean and obese groups. We demonstrate that in our study population there is greater occurrence of phenotype D of PCOS. Our study highlights the importance of clinicians concurrently employing Rotterdam criteria along with obesity status for ascertaining accurate PCOS status and formulating suitable therapeutic intervention.
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Affiliation(s)
- Roshan Dadachanji
- Department of Molecular Endocrinology, ICMR-National Institute for Research in Reproductive Health, Parel, Mumbai, India
| | - Anushree Patil
- Department of Clinical Research, ICMR-National Institute for Research in Reproductive Health, Parel, Mumbai, India
| | - Beena Joshi
- Department of Operational Research, ICMR-National Institute for Research in Reproductive Health, Parel, Mumbai, India
| | - Srabani Mukherjee
- Department of Molecular Endocrinology, ICMR-National Institute for Research in Reproductive Health, Parel, Mumbai, India
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Moray KV, Chaurasia H, Sachin O, Joshi B. A systematic review on clinical effectiveness, side-effect profile and meta-analysis on continuation rate of etonogestrel contraceptive implant. Reprod Health 2021; 18:4. [PMID: 33407632 PMCID: PMC7788930 DOI: 10.1186/s12978-020-01054-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 08/18/2020] [Accepted: 12/06/2020] [Indexed: 01/16/2023] Open
Abstract
Background Unintended pregnancies (UIP) have a significant impact on health of women and the health budget of countries. Contraception is an effective way to prevent UIPs. The study objective was to collate evidence on clinical effectiveness of etonogestrel subdermal implant (ESI), continuation rate and side effect profile among eligible women of reproductive age group, as compared to levonorgestrel intrauterine system (LNG-IUS), copper intrauterine device (Cu-IUD) and depot medroxy progesterone acetate injections; other types of contraceptive implants were excluded as comparators. Methods The protocol of the systematic review was registered in Prospero (registration number: CRD42018116580). MEDLINE via PubMed, Cochrane library and web of science were the electronic databases searched. A search strategy was formulated and studies from 1998 to 2019 were included. Clinical trial registries and grey literature search was done. Critical assessment of included studies was done using appropriate tools. A qualitative synthesis of included studies was done and a meta-analysis was conducted in RevMan software for continuation rates of ESI as compared to other long acting reversible contraceptives (LARC) e.g. LNG IUS and Cu-IUD. Results The search yielded 23,545 studies. After excluding 467 duplicates, 23,078 titles were screened and 51 studies were included for the review. Eight of the 15 studies reporting clinical effectiveness reported 100% effectiveness and overall pearl index ranged from 0 to 1.4. One-year continuation rates ranged from 57–97%; 44–95% at the end of second year and 25–78% by 3 years of use. Abnormal menstruation was the most commonly reported side effect. There was no significant difference in bone mineral density at 1 year follow-up. The meta-analyses showed that odds ratio (OR) of 1-year continuation rate was 1.55 (1.36, 1.76) for LNG-IUS vs. ESI and 1.34 (1.13, 1.58) for copper-IUD vs. ESI; showing that continuation rates at the end of one-year were higher in LNG-IUS and copper-IUD as compared to ESI. Conclusion ESI is clinically effective and safe contraceptive method to use, yet 1-year continuation rates are lower as compared to LNG-IUS and copper-IUD, mostly attributed to the disturbances in the menstruation.
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Affiliation(s)
- Kusum V Moray
- Regional Resource Hub for Health Technology Assessment, Indian Council of Medical Research, National Institute for Research in Reproductive Health, Jehangir Merwanji Street, Parel, Mumbai, 400012, India
| | - Himanshu Chaurasia
- Regional Resource Hub for Health Technology Assessment, Indian Council of Medical Research, National Institute for Research in Reproductive Health, Jehangir Merwanji Street, Parel, Mumbai, 400012, India
| | - Oshima Sachin
- Health Technology Assessment Secretariat, Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | - Beena Joshi
- Regional Resource Hub for Health Technology Assessment, Indian Council of Medical Research, National Institute for Research in Reproductive Health, Jehangir Merwanji Street, Parel, Mumbai, 400012, India.
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Begum S, Chaurasia H, Moray KV, Joshi B. Predictors of Discontinuation of Modern Spacing Contraceptives in India. Asia Pac J Public Health 2020; 33:121-125. [PMID: 33356436 DOI: 10.1177/1010539520983149] [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] [Indexed: 11/16/2022]
Abstract
Data from National Family Health Survey (2015-2016) was analyzed to examine the contraceptive acceptance, discontinuation rates, and associated factors among reproductive age women in India over one year. Findings revealed that 11.7% accepted modern methods of which 68% were for spacing. Only 5% switched to other methods. Discontinuation rate was high among condom (56.8%) and oral contraceptive pill users (34.5%), among women aged less than 25 years, with parity less than 2, belonging to rural area, and having no education. Health concerns/side effects, husband's disapproval, or method failure were most common reasons cited for discontinuation. The data show high discontinuation rates among some subgroups of women and for certain methods. Hence, women need to be provided options to switch methods to meet changing contraceptive needs and health priorities. Continuum of care with follow-up and counselling can facilitate sustained contraceptive use to avert unintended pregnancies.
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Affiliation(s)
- Shahina Begum
- Indian Council of Medical Research, National Institute for Research in Reproductive Health, Mumbai, India
| | - Himanshu Chaurasia
- Indian Council of Medical Research, National Institute for Research in Reproductive Health, Mumbai, India
| | - Kusum V Moray
- Indian Council of Medical Research, National Institute for Research in Reproductive Health, Mumbai, India
| | - Beena Joshi
- Indian Council of Medical Research, National Institute for Research in Reproductive Health, Mumbai, India
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Nair S, Bhadricha H, Hatkar S, Kadam SS, Patil A, Surve S, Joshi B, Khatkhatay MI, Desai M. Effect of Vitamin D Levels on Bone Remodeling in Healthy Women. Int J Endocrinol Metab 2020; 18:e100656. [PMID: 32636886 PMCID: PMC7322670 DOI: 10.5812/ijem.100656] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/26/2020] [Accepted: 03/30/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Vitamin D deficiency is prevalent among Indian women. Subclinical vitamin D deficiency is a significant risk factor for osteopenia and fractures. However, its effect on bone metabolism and bone mineral density (BMD) is still debatable. OBJECTIVES This study aimed to determine relationships of the vitamin D status with bone turnover markers, carboxy-terminal telopeptide of type-I collagen (CTX), N-terminal propeptide of type I procollagen (PINP), and BMD in healthy Indian women. METHODS In this cross-sectional study, we determined serum levels of 25-hydroxy vitamin D (25(OH)D), parathyroid hormone, serum CTX, and PINP using commercial ELISA kits in 310 healthy Indian women aged 25 - 65 years who underwent BMD measurements with DXA scan. RESULTS The prevalence of vitamin D deficiency was 53.87% and vitamin D insufficiency 31.29%. A direct correlation of BMD with vitamin D levels was not observed. PINP negatively correlated with vitamin D in both premenopausal (Spearman's r = -0.169, P < 0.05) and postmenopausal (Spearman's r = -0.241, P < 0.05) women. However, CTX positively correlated with vitamin D in both premenopausal (Spearman's r = 0.228, P < 0.01) and postmenopausal (Spearman's r = 0.244, P < 0.05) women. CONCLUSIONS Vitamin D deficiency is more prevalent in premenopausal women than in postmenopausal ones. Although vitamin D does not show any association with BMD, it affects bone remodeling, which is reflected by changes in the bone formation marker PINP and the bone resorption marker CTX.
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Affiliation(s)
- Sandhya Nair
- Molecular Immunodiagnostics Division, ICMR-National Institute for Research in Reproductive Health, Mumbai, India
| | - Hetal Bhadricha
- Molecular Immunodiagnostics Division, ICMR-National Institute for Research in Reproductive Health, Mumbai, India
| | - Sonam Hatkar
- Molecular Immunodiagnostics Division, ICMR-National Institute for Research in Reproductive Health, Mumbai, India
| | - Seema S Kadam
- Molecular Immunodiagnostics Division, ICMR-National Institute for Research in Reproductive Health, Mumbai, India
| | - Anushree Patil
- Department of Clincal Research, ICMR-National Institute for Research in Reproductive Health, Mumbai, India
| | - Suchitra Surve
- Department of Clincal Research, ICMR-National Institute for Research in Reproductive Health, Mumbai, India
| | - Beena Joshi
- Department of Operational Research, ICMR-National Institute for Research in Reproductive Health, Mumbai, India
| | - M. Ikram Khatkhatay
- Molecular Immunodiagnostics Division, ICMR-National Institute for Research in Reproductive Health, Mumbai, India
| | - Meena Desai
- Molecular Immunodiagnostics Division, ICMR-National Institute for Research in Reproductive Health, Mumbai, India
- Corresponding Author: Molecular Immunodiagnostics Division, ICMR-National Institute for Research in Reproductive Health, J. M. Street, Mumbai, India. Tel: +91-2224192141,
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Surve S, Begum S, Joshi B, Khatkhatay MI, Kadam S, Chauhan S. Significance of Vitamin D Binding Protein in Assessing Vitamin D Status Among Under-Five Children. Indian J Clin Biochem 2020; 36:167-174. [PMID: 33867707 DOI: 10.1007/s12291-020-00873-x] [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: 08/20/2019] [Accepted: 01/22/2020] [Indexed: 10/25/2022]
Abstract
Despite ample sunshine, 50-90% Indian children have Vitamin D deficiency (VDD). This enigma of widespread VDD needs exploration especially among under-fives as physiological variations in Vitamin D Binding Protein (VDBP) levels could be potential confounders in the interpretation of total 25-hydroxyvitamin D [25(OH)D]. However, there is scarce information about relevance of VDBP levels in under-five age group. We therefore, explored association of VDBP levels among 1-5 year old children with VDD. Serum levels of 25(OH)D, VDBP, calcium, parathyroid hormone (PTH) and alkaline phosphatase were estimated in 210 apparently healthy children in the age group of 1-5 years. VDD was defined as serum 25(OH)D levels < 20 ng/ml as per the IOM classification. VDBP levels were classified as low if levels were < 168 μg/ml as per the kit. The prevalence of VDD was 79.5% (n = 167) and VDBP levels were low in 48.6% (n = 102) of children. 25(OH)D levels correlated positively with VDBP (r = 0.298, p = 0.0001). A significant number of children (52.7%) with VDD had low VDBP (p = 0.015). and despite adequate sun exposure, 43% of children showed VDD and 56.6% had low VDPB levels. The low VDBP levels largely explain low 25OHD levels without necessarily implying VDD. It may add a new dimension for better understanding of widespread VDD among under-five children. It thus, points towards the need for redefining cut offs and complete evaluation of vitamin D status among under-fives including VDBP.
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Affiliation(s)
- Suchitra Surve
- Department of Clinical Research, ICMR-National Institute for Research in Reproductive Health, Parel, Mumbai, Maharashtra 400012 India
| | - Shahina Begum
- Department of Bio-statistics, ICMR-National Institute for Research in Reproductive Health, Parel, Mumbai, India
| | - Beena Joshi
- Department of Operational Research, ICMR-National Institute for Research in Reproductive Health, Parel, India
| | - M Ikram Khatkhatay
- Department of Molecular Immunodiagnostics, ICMR-National Institute for Research in Reproductive Health, Parel, India
| | - Seema Kadam
- Department of Molecular Immunodiagnostics, ICMR-National Institute for Research in Reproductive Health, Parel, India
| | - Sanjay Chauhan
- Department of Clinical and Operational Research, ICMR-National Institute for Research in Reproductive Health, Parel, India
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Wasan H, Singh D, Joshi B, Sharma U, Jagannathan N, Reeta K. Evaluation of neuroprotective effects of safinamide in experimental model of ischemic stroke. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Joshi B, Chauhan S, Das H, Luaia R, Sunil N. Changes in sexual behavior and contraceptive use after HIV acquisition and factors associated with risky sexual practices among people living with HIV in selected Indian cities. Indian J Public Health 2019; 60:251-259. [PMID: 27976645 DOI: 10.4103/0019-557x.195854] [Citation(s) in RCA: 2] [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] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Sexual behavior and contraceptive use among HIV-infected persons are a neglected issue in public health programs. OBJECTIVES To understand sexual practices and contraceptive use of people living with HIV (PLHIV) before and after being diagnosed with the infection and assess the providers' perspectives on provision of contraceptives to PLHIV, the quality of services provided and linkages between reproductive health and HIV services. METHODS A mix method design study using a purposive sampling was undertaken enrolling PLHIV from ART centers and PLHIV networks across three cities in India. Doctors and counselors providing HIV services at public hospitals were also interviewed. RESULTS Use of condoms increased from 35% to 81% after being diagnosed with HIV. Consistent condom use was 69% compared to only 8.7% before being diagnosed with HIV. Nearly 41% (297) of participants indulged in one or more forms of risky sexual behaviors. Significant correlates of risky sexual practices were: participants who were middle-aged (25-33 years), formerly married, currently not on antiretroviral therapy, and received negligible information on contraception from service providers leading to poor knowledge on safe sex and dual protection. Information from service providers reveals a lack of specific program guidelines to comprehensively address family planning (FP) issues through HIV programs. CONCLUSION The study throws light on missed opportunities to address contraceptive needs of PLHIV and recommends training service providers and operationalizing a strategy to link HIV and FP services.
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Affiliation(s)
- Beena Joshi
- Scientist E, Department of Operational Research, National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
| | - Sanjay Chauhan
- Scientist - F and Head, Department of Operational Research, National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
| | - Hiranya Das
- Scientist - D, Regional Medical Research Center, Dibrugarh, Assam, India
| | - Rosangluaia Luaia
- Head, Department of Medicine, Incharge ART Center, Civil Hospital, Aizawl, Mizoram, India
| | - Nitya Sunil
- Project Research Officer, Department of Operational Research, National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
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Surve S, Begum S, Chauhan S, Khatkhatay I, Joshi B. Discrepancy between the Recommended and Functional Cut Offs of Vitamin D among Under-five Children: Experiences from a Pilot Study. Indian J Endocrinol Metab 2018; 22:473-478. [PMID: 30148092 PMCID: PMC6085962 DOI: 10.4103/ijem.ijem_574_17] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Vitamin D is a key determinant of bone health and calcium homeostasis in children. Vitamin D deficiency (VDD) in early years may have an effect on total bone mass and risk of osteoporosis. Despite widespread prevalence of VDD among children, there is limited information in under-five age group. The objectives of the current study were to estimate the community-based prevalence of VDD and to identify the factors associated with children aged 1-5 years. MATERIALS AND METHODS A community-based cross-sectional study was conducted among 201 apparently healthy children (aged 1-5 years) in an urban slum of the selected geographical area in Mumbai. VDD was defined as serum 25-hydroxy Vitamin D (25[OH]D) levels <20 ng/ml as per the US Endocrine society classification. RESULTS The prevalence of VDD was found to be 74.6% (95% of confidence interval [68.6-80.6]). It was significantly higher (P = 0.04) among children staying indoors (44.8%). 25(OH)D was negatively correlated with parathyroid hormone (PTH) ([r = -0.199, P = 0.005]) and Alkaline phosphatase ([r = -0.140, P = 0.05]). However, the increase in PTH was observed when 25(OH)D levels were <10 ng/ml unlike anticipated increase at <20 ng/ml. CONCLUSION The study revealed a high prevalence of VDD in 1-5 years age group. It was observed that the outdoor activities and sun exposure have a significant association with Vitamin D status. Majority of children had normal PTH levels despite VDD. The study endorses the importance of sun exposure and throws light on that fact that functional cutoffs for VDD may be lower in under-five children and also highlights the need of redefining cutoffs of Vitamin D among the Indian children.
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Affiliation(s)
- Suchitra Surve
- Department of Clinical Research, ICMR-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
| | - Shahina Begum
- Department of Statistics, ICMR-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
| | - Sanjay Chauhan
- Department of Clinical and Operational Research, ICMR-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
| | - Ikram Khatkhatay
- Department of Molecular Immunodiagnostics, ICMR-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
| | - Beena Joshi
- Department of Operational Research, ICMR-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
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Chauhan S, Unisa S, Joshi B, Kulkarni R, Singh A, Subramanian T, Chaudhuri RN, Baishya AC, Bharat S, Patil A, Pasi A, Agarwal D. Capacity Assessment of District Health System in India on Services for Prevention and Management of Infertility. Indian J Community Med 2018; 43:19-23. [PMID: 29531433 PMCID: PMC5842468 DOI: 10.4103/ijcm.ijcm_306_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 08/30/2016] [Accepted: 01/04/2018] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Infertility is a neglected service component in the public health-care system in India. OBJECTIVES This study aims to assess the availability and practices on prevention and management services for infertility in the district health system. METHODOLOGY A cross-sectional survey of selected health facilities and the staff from 12 district hospitals (DHs), 24 community health centers (CHCs), 48 primary health centers (PHCs), and 48 subcenters was conducted using qualitative and quantitative methods. Interviewed staff included 26 gynecologists; 91 medical officers; 91 auxiliary nurse midwife; 67 laboratory technicians; and 84 accredited social health activist workers. RESULTS The findings indicate that adequate staff was in place at more than 70% of health facilities, but none of the staff had received any in-service training on infertility management. Most of the DHs had basic infrastructural and diagnostic facilities. However, the majority of the CHCs and PHCs had inadequate physical and diagnostic facilities related to infertility management. Semen examination service was not available at 94% of PHCs and 79% of CHCs. Advanced laboratory services were available in <42% at DHs and 8% at CHCs. Diagnostic laparoscopy and hysteroscopy were available in 25% and 8% of DHs, respectively. Ovulation induction with clomiphene was practiced at 83% and with gonadotropins at 33% of DHs. CONCLUSION The district health infrastructure in India has a potential to provide basic services for infertility. With some policy decisions, resource inputs and capacity strengthening, it is possible to provide advanced services for infertility in the district health system.
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Affiliation(s)
- Sanjay Chauhan
- Department of Operational Research, ICMR-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
| | - Sayeed Unisa
- Department of Demography and Statistics, International Institute of Population Sciences, Mumbai, Maharashtra, India
| | - Beena Joshi
- Department of Operational Research, ICMR-NIRRH, Chandigarh, India
| | - Ragini Kulkarni
- Department of Operational Research, ICMR-NIRRH, Chandigarh, India
| | - Amarjeet Singh
- Department of Community Medicine, School of Public Health, PGIMER, Chandigarh, India
| | | | | | - A. C. Baishya
- Department of Community Medicine, Guwahati Medical College, Guwahati, Assam, India
| | - Shalini Bharat
- Centre for Health and Social Sciences, Tata Institute of Social Sciences, Mumbai, Maharashtra, India
| | - Anushree Patil
- Department of Clinical Research, ICMR-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
| | - Achhelal Pasi
- Department of Clinical Research, ICMR-NIRRH, Delhi, India
| | - Dinesh Agarwal
- Department of Health & Nutrition, IPE Global Ltd, Delhi, India
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Joshi B, Velhal G, Chauhan S, Kulkarni R, Begum S. Linking HIV & family planning services to improve dual methods of contraception among women infected with HIV in Mumbai, Maharashtra, India. Indian J Med Res 2017; 143:464-73. [PMID: 27377503 PMCID: PMC4928553 DOI: 10.4103/0971-5916.184286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background & objectives: Preventing unintended pregnancies among people living with HIV (PLHIV) is one of the strategies of WHO for preventing parent-to-child transmission (PPTCT). Given the limitation of only condom use, the objective of this study was to improve use of dual contraceptive methods among HIV infected women. Methods: An experimental study among HIV positive women was conducted at two tertiary care level hospitals in Mumbai. Linking HIV with family planning services was the focus of intervention at one site and standard level of care was maintained at the control site. At each site, 150 HIV+ve women attending counselling and testing centres, who did not intend to get pregnant in the next one year and were eligible to use dual methods, were enrolled and followed up to one year. Results: At the end of one year, 60 per cent women in the intervention group reached Family Planning Centres compared to eight per cent in the control group. There was three times more acceptance and continuation of use of dual methods along with increase in consistent use of condoms and less number of unplanned pregnancies in the intervention group than the control group. Interpretation & conclusions: The study findings demonstrate that linking HIV and family planning services may facilitate the uptake of dual methods of contraception without reducing consistent condom use among HIV infected women. The PPTCT programmes need to focus on the component of Prong 2 of PPTCT which aims to prevent unintended pregnancies among HIV positive women.
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Affiliation(s)
- Beena Joshi
- Department of Operational Research, National Institute for Research in Reproductive Health, (ICMR), Mumbai, India
| | - Gajanan Velhal
- Department of Preventive & Social Medicine, T.N. Medical College & BYL Nair Hospital, Mumbai, India
| | - Sanjay Chauhan
- Department of Operational Research, National Institute for Research in Reproductive Health, (ICMR), Mumbai, India
| | - Ragini Kulkarni
- Department of Operational Research, National Institute for Research in Reproductive Health, (ICMR), Mumbai, India
| | - Shahina Begum
- Department of Operational Research, National Institute for Research in Reproductive Health, (ICMR), Mumbai, India
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Talati K, Joshi B, Prajapati K, Mishra S, Phatak A, Nimbalkar S, Murphy H, Dongre A. Summarizing Factors Contributing to Partial or Non-utilization of
Individual Household Latrine (IHHL) in Charutar Region of Gujarat,
India. Ann Glob Health 2017. [DOI: 10.1016/j.aogh.2017.03.399] [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] Open
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Jung K, Everson RJC, Joshi B, Bulsara PA, Upasani R, Clarke MJ. Structure-function relationship of phenolic antioxidants in topical skin health products. Int J Cosmet Sci 2016; 39:217-223. [DOI: 10.1111/ics.12367] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 09/15/2016] [Indexed: 12/21/2022]
Affiliation(s)
- K. Jung
- Gematria Test Lab GmbH; Parkstraße 23 Berlin D-13187 Germany
| | - R. J. C. Everson
- Skin Health; GlaxoSmithKline Consumer Healthcare; 184 Liberty Corner Road Warren NJ 07059 USA
| | - B. Joshi
- Skin Health; GlaxoSmithKline Consumer Healthcare; 184 Liberty Corner Road Warren NJ 07059 USA
| | - P. A. Bulsara
- Skin Health; GlaxoSmithKline Consumer Healthcare; 184 Liberty Corner Road Warren NJ 07059 USA
| | - R. Upasani
- Skin Health; GlaxoSmithKline Consumer Healthcare; 184 Liberty Corner Road Warren NJ 07059 USA
| | - M. J. Clarke
- Skin Health; GlaxoSmithKline Consumer Healthcare; 184 Liberty Corner Road Warren NJ 07059 USA
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Neurath AR, Haberfield P, Joshi B, Hewlett IK, Strick N, Jiang S. Rapid Prescreening for Antiviral Agents against HIV-1 Based on Their Inhibitory Activity in Site-Directed Immunoassays. I. The V3 Loop of gp 120 as Target. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/095632029100200505] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The anionic triphenylmethane derivative aurintricarboxylic acid (ATA) was reported to inhibit the replication and cytopathogenicity of human immunodeficiency virus type 1 (HIV-1). This antiviral effect, ascribed to the inhibitory activity of ATA on the virus reverse transcriptase, was subsequently also explained by binding of ATA to the HIV-1 envelope glycoprotein gp120 and/or to the CD4 receptor for the virus. Results presented here show: (1) the effectiveness of ATA as a potential antiviral drug by demonstrating that HIV-1 replication in vitro can be completely aborted in the presence of ATA as measured by the polymerase chain reaction; (2) that ATA inhibited the reaction between gp120 and antibodies specific for the V3 hypervariable loop of gp120; (3) that additional compounds with anti-HIV-1 activity can be rapidly identified based on their inhibitory effects measured by radioimmunoassays and/or enzyme-linked immunoadsorbent assays; and (4) that ATA also bound to synthetic peptides representing V3 loops of several HIV-1 isolates, suggesting the possibility that selected chemicals would interfere with the biological function of V3 loops of most HIV-1 isolates and would be effective for chemotherapy, and possibly for prophylaxis, of HIV-1 infections.
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Affiliation(s)
- A. R. Neurath
- The Lindsley F. Kimball Research Institute of the New York Blood Center, New York, NY, USA
| | - P. Haberfield
- Department of Chemistry, Brooklyn College of the City University of New York, Brooklyn, NY, USA
| | - B. Joshi
- Laboratory of Retrovirology, Division of Transfusion Science, Center for Biologics Evaluation and Research, Food and Drug Administration, Bethesda, MD, USA
| | - I. K. Hewlett
- Laboratory of Retrovirology, Division of Transfusion Science, Center for Biologics Evaluation and Research, Food and Drug Administration, Bethesda, MD, USA
| | - N. Strick
- The Lindsley F. Kimball Research Institute of the New York Blood Center, New York, NY, USA
| | - S. Jiang
- The Lindsley F. Kimball Research Institute of the New York Blood Center, New York, NY, USA
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Nava-Guerra L, Tran WH, Chalacheva P, Loloyan S, Joshi B, Keens TG, Nayak KS, Davidson Ward SL, Khoo MCK. Model-based stability assessment of ventilatory control in overweight adolescents with obstructive sleep apnea during NREM sleep. J Appl Physiol (1985) 2016; 121:185-97. [PMID: 27174926 DOI: 10.1152/japplphysiol.01081.2015] [Citation(s) in RCA: 13] [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] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 05/05/2016] [Indexed: 11/22/2022] Open
Abstract
Obstructive sleep apnea (OSA) involves the interplay of several different factors such as an unfavorable upper airway anatomy, deficiencies in pharyngeal muscle responsiveness, a low arousal threshold, and ventilatory control instability. Although the stability of ventilatory control has been extensively studied in adults, little is known about its characteristics in the pediatric population. In this study, we developed a novel experimental setup that allowed us to perturb the respiratory system during natural non-rapid eye movement (NREM) sleep conditions by manipulating the inspiratory pressure, provided by a bilevel pressure ventilator, to induce sighs after upper airway stabilization. Furthermore, we present a modeling framework that utilizes the noninvasively measured ventilatory responses to the induced sighs and spontaneous breathing data to obtain representations of the processes involved in the chemical regulation of respiration and extract their stability characteristics. After validation with simulated data, the modeling technique was applied to data collected experimentally from 11 OSA and 15 non-OSA overweight adolescents. Statistical analysis of the model-derived stability parameters revealed a significantly higher plant gain and lower controller gain in the OSA group (P = 0.046 and P = 0.007, respectively); however, no differences were found in loop gain (LG) and circulatory time delay between the groups. OSA severity and LG, within the 0.03-0.04-Hz frequency band, were significantly negatively associated (r = -0.434, P = 0.026). Contrary to what has been found in adults, our results suggest that in overweight adolescents, OSA is unlikely to be initiated through ventilatory instability resulting from elevated chemical loop gain.
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Affiliation(s)
- L Nava-Guerra
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California;
| | - W H Tran
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California
| | - P Chalacheva
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California
| | - S Loloyan
- Division of Pediatric Pulmonology and Sleep Medicine, Children's Hospital Los Angeles, Los Angeles, California; Keck School of Medicine, University of Southern California, Los Angeles, California; and
| | - B Joshi
- Division of Pediatric Pulmonology and Sleep Medicine, Children's Hospital Los Angeles, Los Angeles, California; Keck School of Medicine, University of Southern California, Los Angeles, California; and
| | - T G Keens
- Division of Pediatric Pulmonology and Sleep Medicine, Children's Hospital Los Angeles, Los Angeles, California; Keck School of Medicine, University of Southern California, Los Angeles, California; and
| | - K S Nayak
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California; Ming Hsieh Department of Electrical Engineering, University of Southern California, Los Angeles, California
| | - S L Davidson Ward
- Division of Pediatric Pulmonology and Sleep Medicine, Children's Hospital Los Angeles, Los Angeles, California; Keck School of Medicine, University of Southern California, Los Angeles, California; and
| | - M C K Khoo
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California
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Desai H, Patel D, Joshi B. Screening and Characterization of Heavy Metal Resistant Fungi for its Prospects in Bioremediation of Contaminated Soil. ACTA ACUST UNITED AC 2016. [DOI: 10.20546/ijcmas.2016.504.074] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Joshi B, Chinnakali P, Shrestha A, Das M, Kumar AMV, Pant R, Lama R, Sarraf RR, Dumre SP, Harries AD. Impact of intensified case-finding strategies on childhood TB case registration in Nepal. Public Health Action 2015; 5:93-8. [PMID: 26400376 DOI: 10.5588/pha.15.0004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 01/12/2015] [Accepted: 04/08/2015] [Indexed: 11/10/2022] Open
Abstract
SETTING Seven intervention districts with intensified childhood tuberculosis (TB) case-finding strategies implemented by a non-governmental organisation and seven control districts under the National Tuberculosis Programme, Nepal. OBJECTIVES To assess the differences in childhood TB case registrations and case registration rates per 100 000 population between two time periods (Year 1 = March 2012-March 2013 and Year 2 = March 2013-March 2014) in intervention and control districts. DESIGN Retrospective record review using routinely collected data. RESULTS Childhood TB cases increased from 271 to 360 between Years 1 and 2 in the intervention districts (case registration rate from 18.2 to 24.2/100 000) and from 97 to 113 in the control districts (13.4 to 15.6/100 000): the increases were significantly higher in the intervention districts compared with the control districts. The increases were also significantly higher in children aged 0-4 years and in those with smear-negative pulmonary TB and extra-pulmonary TB. Of the various case-finding strategies, household contact screening, private-public mix services and mobile health chest camps produced the highest yield of TB. CONCLUSION A package of intensified case-finding strategies in children was associated with an increase in childhood TB case registrations in Nepal. Additional diagnostic approaches to increase case registrations also need to be considered.
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Affiliation(s)
- B Joshi
- Friends Affected and Infected Together In Hand (FAITH), Kathmandu, Nepal
| | - P Chinnakali
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - A Shrestha
- National Tuberculosis Centre, Thimi, Bhaktapur, Nepal
| | - M Das
- Médecins Sans Frontières Operational Centre Brussels, New Delhi, India
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asian Regional Office, New Delhi, India
| | - R Pant
- National Tuberculosis Centre, Thimi, Bhaktapur, Nepal
| | - R Lama
- Friends Affected and Infected Together In Hand (FAITH), Kathmandu, Nepal
| | - R R Sarraf
- Sano Paila ( A little step ), Lalitpur, Nepal
| | - S P Dumre
- World Health Organization Country Office for Nepal, Lalitpur, Nepal
| | - A D Harries
- The Union, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
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Joshi B, Velhal G, Chauhan S, Kulkarni R, Begum S, Nandanwar YS, Fonseca M, Baweja S, Turbadkar D, Ramchandran A, Dalal A, Shastri J, Agrawal S, Panhale M, More V, Sanap P, Panchal R, Kanougiya S. Contraceptive Use and Unintended Pregnancies Among HIV-Infected Women in Mumbai. Indian J Community Med 2015; 40:168-73. [PMID: 26170540 PMCID: PMC4478657 DOI: 10.4103/0970-0218.158855] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 07/17/2014] [Accepted: 11/04/2014] [Indexed: 11/14/2022] Open
Abstract
Background: Access to reproductive health services in Human Immunodeficiency Virus (HIV) programs can greatly enhance program's potential to limit the spread of disease, reduce unintended pregnancies and safeguard the health of infected people. Objectives: To assess (i) knowledge, attitude, and use regarding contraceptives; safe sex and dual protection; (ii) fertility desires and unintended pregnancies post HIV and (iii) symptoms of reproductive tract infection/sexually transmitted infection (RTI/STI) among women infected with HIV. Materials and Methods: A cross-sectional study among 300 currently married HIV-positive women who had not undergone permanent sterilization with no immediate desire for pregnancy. Study site was Integrated Counseling and Testing Centers (ICTC) in tertiary hospitals of Mumbai and women were interviewed using a semistructured questionnaire. Results: In spite of good awareness about modern methods, 42.7 felt that contraceptives other than condoms were harmful to use due to their HIV status. Knowledge on dual protection was limited to condom (75%). Condom use increased from 5.7% pre-HIV to 71.7% post-HIV, with 89.6% reporting regular use. Future fertility desire was expressed by 8.7% women. Induced abortions post-HIV was reported by16.6% women, as pregnancies were unintended. About 69% wished to use dual contraceptive methods for effective protection if it was not harmful to be used by people living with HIV (PLHIV). Conclusion: Data reveals a need to promote modern contraceptive methods along with regular condom use to prevent unintended pregnancies and improve health-seeking behavior for contraception. Health system models that converge or link HIV services with other reproductive health services need to be tested to provide comprehensive reproductive healthcare to infected women in India.
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Affiliation(s)
- Beena Joshi
- Department of Operational Research, National Institute for Research in Reproductive Health, Indian Council of Medical Research, Parel, Mumbai, India
| | - Gajanan Velhal
- Department of Community Medicine, Topiwala National Medical College and Bai Yamunabai Laxman Nair Charitable Hospital, Mumbai, India
| | - Sanjay Chauhan
- Department of Operational Research, National Institute for Research in Reproductive Health, Indian Council of Medical Research, Parel, Mumbai, India
| | - Ragini Kulkarni
- Department of Operational Research, National Institute for Research in Reproductive Health, Indian Council of Medical Research, Parel, Mumbai, India
| | - Shahina Begum
- Department of Operational Research, National Institute for Research in Reproductive Health, Indian Council of Medical Research, Parel, Mumbai, India
| | - Y S Nandanwar
- Department of Obstetrics and Gynaecology, Lokmanya Tilak Municipal Medical College and Sion Hospital, Mumbai, Maharashtra, India
| | - Michelle Fonseca
- Department of Obstetrics and Gynaecology, Lokmanya Tilak Municipal Medical College and Sion Hospital, Mumbai, Maharashtra, India
| | - Sujata Baweja
- Department of Microbiology, Lokmanya Tilak Municipal Medical College and Sion Hospital, Mumbai, Maharashtra, India
| | - Dilip Turbadkar
- Department of Microbiology, Lokmanya Tilak Municipal Medical College and Sion Hospital, Mumbai, Maharashtra, India
| | - Anita Ramchandran
- Department of Microbiology, Lokmanya Tilak Municipal Medical College and Sion Hospital, Mumbai, Maharashtra, India
| | - Asha Dalal
- Department of Obstetrics and Gynaecology, Topiwala National Medical College and Bai Yamunabai Laxman Nair Charitable Hospital, Mumbai, India
| | - Jayanti Shastri
- Department of Microbiology, Topiwala National Medical College and Bai Yamunabai Laxman Nair Charitable Hospital, Mumbai, India
| | - Sachee Agrawal
- Department of Microbiology, Topiwala National Medical College and Bai Yamunabai Laxman Nair Charitable Hospital, Mumbai, India
| | - Manisha Panhale
- Department of Operational Research, National Institute for Research in Reproductive Health, Indian Council of Medical Research, Parel, Mumbai, India
| | - Vasundhara More
- Department of Operational Research, National Institute for Research in Reproductive Health, Indian Council of Medical Research, Parel, Mumbai, India
| | - Pravin Sanap
- Department of Operational Research, National Institute for Research in Reproductive Health, Indian Council of Medical Research, Parel, Mumbai, India
| | - Renuka Panchal
- Department of Operational Research, National Institute for Research in Reproductive Health, Indian Council of Medical Research, Parel, Mumbai, India
| | - Suman Kanougiya
- Department of Operational Research, National Institute for Research in Reproductive Health, Indian Council of Medical Research, Parel, Mumbai, India
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Jha A, Joshi B, Pradhan S. Fetal Transcerebellar Diameter/ Abdominal Circumference Ratio as a Gestational Age Independent Parameter for Fetal Growth. Nepal j obstet gynaecol 2014. [DOI: 10.3126/njog.v9i2.11770] [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: 11/18/2022] Open
Abstract
Aims: The purpose of this study was to evaluate accuracy of trans-cerebellar diameter / abdominal circumference (TCD/AC) ratio to assess fetal growth. The ratio of TCD with head circumference (HC) and biparietal diameter (BPD) was also determined. Methods: This was a prospective cross-sectional study involving 442 women with uncomplicated singleton gestation between 15-40 weeks. Protocol included obtaining the BPD, HC, TCD and AC in conventional planes and obtaining ratio of TCD with other biometric parameters.Results: We were able to visualize the cerebellum in about 93% of scans. The TCD/ AC ratio remained nearly constant throughout gestational age and was 0.138. The mean TCD/HC ratio was 0.124 and mean TCD/BPD ratio was 0.476.Conclusions: TCD/HC and TCD/BPD ratio showed a small increase towards the completion of gestation while TCD/AC ratio remained nearly constant throughout gestational age. TCD/AC ratio is reliable as a gestational age independent parameter of fetal growth.DOI: http://dx.doi.org/10.3126/njog.v9i2.11770
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Joshi B, Chauhan S, Pasi A, Kulkarni R, Sunil N, Bachani D, Mankeshwar R. Level of suboptimal adherence to first line antiretroviral treatment & its determinants among HIV positive people in India. Indian J Med Res 2014; 140:84-95. [PMID: 25222782 PMCID: PMC4181166] [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] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND & OBJECTIVES National Anti-retroviral treatment (ART) programme in India was launched in 2004. Since then, there has been no published country representative estimate of suboptimal adherence among people living with HIV (PLHIV) on first line ART in public settings. Hence a multicentric study was undertaken in 15 States of India to assess the level of suboptimal adherence and its determinants among PLHIV. METHODS Using a prospective observational study design, 3285 PLHIV were enrolled and followed up to six months across 30 ART centres in India. Adherence was assessed using pill count and self-reported recall method and determinants of suboptimal adherence were explored based on the responses to various issues as perceived by them. RESULTS Suboptimal adherence was found in 24.5 per cent PLHIV. Determinants of suboptimal adherence were illiteracy (OR--1.341, CI--1.080-1.665), on ART for less than 6 months (OR--1.540, CI--1.280-1.853), male gender (OR for females--0.807, CI--0.662-0.982), tribals (OR--2.246, CI--1.134-4.447), on efavirenz (EFA) regimen (OR--1.479, CI--1.190-1.837), presence of anxiety (OR--1.375, CI--1.117-1.692), non-disclosure of HIV status to family (OR--1.549, CI--1.176-2.039), not motivated for treatment (OR--1.389, CI--1.093-1.756), neglect from friends (OR--1.368, CI--1.069-1.751), frequent change of residence (OR--3.373, CI--2.659-4.278), travel expenses (OR--1.364, CI--1.138-1.649), not meeting the PLHIV volunteer/community care coordinator at the ART center (OR--1.639, CI--1.330-2.019). INTERPRETATION & CONCLUSIONS To enhance identification of PLHIV vulnerable to suboptimal adherence, the existing checklist to identify the barriers to adherence in the National ART Guidelines needs to be updated based on the study findings. Quality of comprehensive adherence support services needs to be improved coupled with vigilant monitoring of adherence measurement.
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Affiliation(s)
- Beena Joshi
- National Institute for Research in Reproductive Health (ICMR), Mumbai, India,Reprint requests: Dr Beena Nitin Joshi, National Institute for Research in Reproductive Health (ICMR) J.M. Street, Parel, Mumbai 400 012, India e-mail:
| | - Sanjay Chauhan
- National Institute for Research in Reproductive Health (ICMR), Mumbai, India
| | - Achhelal Pasi
- National Institute for Research in Reproductive Health (ICMR), Mumbai, India
| | - Ragini Kulkarni
- National Institute for Research in Reproductive Health (ICMR), Mumbai, India
| | - Nithya Sunil
- National Institute for Research in Reproductive Health (ICMR), Mumbai, India
| | - Damodar Bachani
- Lady Hardinge Medical College & Smt. S.K. Hospital, New Delhi, India
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Joshi B, Mukherjee S, Patil A, Purandare A, Chauhan S, Vaidya R. A cross-sectional study of polycystic ovarian syndrome among adolescent and young girls in Mumbai, India. Indian J Endocrinol Metab 2014; 18:317-324. [PMID: 24944925 PMCID: PMC4056129 DOI: 10.4103/2230-8210.131162] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Polycystic ovary disease is a common endocrine condition which is rapidly gaining epidemic proportions. No community based prevalence data is available for this syndrome in India. MATERIALS AND METHODS A cross-sectional community-based study was undertaken in a sampled census block of Mumbai to assess the prevalence of polycystic ovarian syndrome (PCOS) among 778 adolescents and young girls aged 15-24 years. Among them, 600 completed all clinical, ultrasonography (USG), and biochemical investigations. RESULTS The prevalence of PCOS among them was 22.5% by Rotterdam and 10.7% by Androgen Excess Society criteria. Nonobese comprised 71.8% of PCOS diagnosed by Rotterdam criteria. Mild PCOS (oligomenorrhea and polycystic ovaries on USG) was the most common phenotype (52.6%). History of oligomenorrhea had a positive predictive value of 93.3% and negative predictive value of 86.7% to detect a possible case of PCOS. Hyperinsulinemia (serum insulin >15 μlU/mL) was present among 19.2% of diagnosed PCOS cases. Obese girls with PCOS were more hirsute, hypertensive, and had significantly higher mean insulin and 2 h post 75 g glucose levels compared with nonobese PCOS. CONCLUSION To our knowledge, this is the first urban community-based study diagnosing PCOS and phenotypes among adolescent and young girls in India. This study demonstrates that PCOS is an emerging disorder during adolescence and screening could provide opportunity to target the group for promoting healthy lifestyles and early interventions to prevent future morbidities.
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Affiliation(s)
- Beena Joshi
- Department of Operational Research, National Institute for Research in Reproductive Health, Indian Council of Medical Research, Mumbai, India
| | - Srabani Mukherjee
- Department of Molecular Endocrinology, National Institute for Research in Reproductive Health, Indian Council of Medical Research, Mumbai, India
| | - Anushree Patil
- Department of Operational Research, National Institute for Research in Reproductive Health, Indian Council of Medical Research, Mumbai, India
| | | | - Sanjay Chauhan
- Department of Operational Research, National Institute for Research in Reproductive Health, Indian Council of Medical Research, Mumbai, India
| | - Rama Vaidya
- Director, Unit of Endocrine and Metabolic Disorders, Medical Research Center-Kasturba Health Society, Vile Parle, Mumbai, Maharashtra, India
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Joshi B, Velhal G, Chauhan S, Kulkarni R, Begum S, Nandanwar YS, Fonseca M, Baweja S, Turbadkar D, Ramachandran A, Dalal A, Shastri J, Agrawal S, Panhale M, More V, Sanap P, Panchal R, Kanoujiya S. Improving dual protection among women infected with HIV. BMC Infect Dis 2014. [PMCID: PMC4080187 DOI: 10.1186/1471-2334-14-s3-e40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Shakya P, Aryal S, Aryal R, Mazgaeen L, Shah A, Joshi B. Occurrence of amino acid mutation (Ala98Val) of HNF1α in association with type II diabetes. J Nepal Health Res Counc 2014; 12:116-118. [PMID: 25575005] [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: 06/04/2023]
Abstract
BACKGROUND Maturity onset diabetes of the young type 3 is a monogenic form of diabetes. Gene defects in the Hepatocyte Nuclear Factor -1 alpha (HNF1a) causes MODY3. HNF1a gene located in the chromosome (12q24.2) codes for a transcription factor which helps in signalling of insulin exocytosis in pancreatic Beta cells. A prevalent amino acid polymorphism at codon 98-Ala98Val (exon 1) of the HNF1a was shown to be associated with diabetes in the South Indian population. Since Nepal shares the ancestral origin with India and people have been sharing similar lifestyles for a long period of life it was relevant to check the occurrence of same mutation in diabetic population of Nepal as well. The study was carried out to identify the occurrence of amino acid mutation (Ala98Val) of HNF 1 alpha in association with type 2 diabetes in diabetic population of Kathmandu. METHODS DNA samples were randomly collected from 12 non-diabetic and 56 diabetic patients. The DNA samples were amplified using Polymerase Chain Reaction (PCR). Restriction Fragment Length Polymorphism (RFLP) was carried out to identify the occurrence of the mutation. RESULTS During the study, out of 12 non-diabetic samples, nine were normal while three samples showed heterozygous Ala98Val mutation. Whereas, eight diabetic patients were found to have Ala98Val mutation and rest 48 had normal genotype. The study thus showed 16.17% occurence of Ala98Val mutation among 68 samples. CONCLUSIONS The study showed the occurrence of Ala98Val amino acid mutation in diabetic samples that were taken under study.
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Affiliation(s)
- P Shakya
- SANN International College, Kathmandu, Nepal
| | - S Aryal
- SANN International College, Kathmandu, Nepal
| | - R Aryal
- SANN International College, Kathmandu, Nepal
| | - L Mazgaeen
- SANN International College, Kathmandu, Nepal
| | - A Shah
- SANN International College, Kathmandu, Nepal
| | - B Joshi
- Annapurna Neurological Institute and Allied Sciences, Kathmandu, Nepal
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Ono M, Joshi B, Brady K, Easley RB, Zheng Y, Brown C, Baumgartner W, Hogue CW. Risks for impaired cerebral autoregulation during cardiopulmonary bypass and postoperative stroke. Br J Anaesth 2012; 109:391-8. [PMID: 22661748 DOI: 10.1093/bja/aes148] [Citation(s) in RCA: 135] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Impaired cerebral autoregulation may predispose patients to cerebral hypoperfusion during cardiopulmonary bypass (CPB). The purpose of this study was to identify risk factors for impaired autoregulation during coronary artery bypass graft, valve surgery with CPB, or both and to evaluate whether near-infrared spectroscopy (NIRS) autoregulation monitoring could be used to identify this condition. METHODS Two hundred and thirty-four patients were monitored with transcranial Doppler and NIRS. A continuous, moving Pearson's correlation coefficient was calculated between mean arterial pressure (MAP) and cerebral blood flow (CBF) velocity, and between MAP and NIRS data, to generate the mean velocity index (Mx) and cerebral oximetry index (COx), respectively. Functional autoregulation is indicated by an Mx and COx that approach zero (no correlation between CBF and MAP); impaired autoregulation is indicated by an Mx and COx approaching 1. Impaired autoregulation was defined as an Mx ≥0.40 at all MAPs during CPB. RESULTS Twenty per cent of patients demonstrated impaired autoregulation during CPB. Based on multivariate logistic regression analysis, time-averaged COx during CPB, male gender, Pa(CO(2)), CBF velocity, and preoperative aspirin use were independently associated with impaired CBF autoregulation. Perioperative stroke occurred in six of 47 (12.8%) patients with impaired autoregulation compared with five of 187 (2.7%) patients with preserved autoregulation (P=0.011). CONCLUSIONS Impaired CBF autoregulation occurs in 20% of patients during CPB. Patients with impaired autoregulation are more likely than those with functional autoregulation to have perioperative stroke. Non-invasive monitoring autoregulation may provide an accurate means to predict impaired autoregulation. Clinical trials registration. www.clinicaltrials.gov (NCT00769691).
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Affiliation(s)
- M Ono
- Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Joshi B, Tyagi V. Potential of Coriaria nepalensis for establishment of tree seedlings: Implication for restoration of degraded hill slopes of Central Himalaya. RUSS J ECOL+ 2009. [DOI: 10.1134/s1067413609070042] [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: 11/23/2022]
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Joshi B, Tewari A. Irregularity in frequency of mast seed years in Quercus floribunda a late successional species of Central Himalaya. RUSS J ECOL+ 2009. [DOI: 10.1134/s1067413609070054] [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: 11/23/2022]
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