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Vignesh R, Pradeep P, Balakrishnan P. A Tête-à-tête with ChatGPT on the impact of artificial intelligence in medical education. Med J Malaysia 2023; 78:547-549. [PMID: 37518931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Chat Generative Pre-Trained Transformer (ChatGPT) is an artificial intelligence (AI) language model developed by OpenAI. It is trained to process vast amounts of text and engage in human-like conversational interaction with users. Being accessible by all, it is widely used and its capabilities range from language translation, summarising long texts and creative writing. This article explores the potential role of ChatGPT in medical education and the possible concerns about the misuse of this technology through a conversation with ChatGPT itself via text prompts. The implications of this technology in medical education as told by ChatGPT are interesting and seemingly helpful for both the students and the tutors. However, this could be a double-edged sword considering the risks of compromised students' integrity and concerns of over-reliance. This also calls for counter strategies and policies in place to mitigate these risks.
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Affiliation(s)
- R Vignesh
- Universiti Kuala Lumpur, Royal College of Medicine Perak, Faculty of Medicine, Preclinical Department, Ipoh, Malaysia.
| | - P Pradeep
- Universiti Kuala Lumpur, Royal College of Medicine Perak, Faculty of Medicine, Preclinical Department, Ipoh, Malaysia
| | - P Balakrishnan
- Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha Dental College and Hospitals, Centre for Infectious Diseases, Department of Microbiology, Chennai, India
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2
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Gopinath S, Balakrishnan P. A PCA‐NPOGBDT strategy‐based protection scheme to differentiate between inverter and distribution line faults plus detection and identification of faulty section in microgrid. INT J INTELL SYST 2022. [DOI: 10.1002/int.22669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Singaram Gopinath
- Department of Electrical Engineering Annasaheb Dange College of Engineering and Technology Ashta Maharashtra India
| | - P. Balakrishnan
- Department of Electrical & Electronics Engineering Malla Reddy Engineering College for Women (Autonomous) Hyderabad Telengana India
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3
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Kuo CC, Balakrishnan P, Gribble MO, Best LG, Goessler W, Umans JG, Navas-Acien A. The association of arsenic exposure and arsenic metabolism with all-cause, cardiovascular and cancer mortality in the Strong Heart Study. Environ Int 2022; 159:107029. [PMID: 34890900 PMCID: PMC9123362 DOI: 10.1016/j.envint.2021.107029] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 12/03/2021] [Accepted: 12/03/2021] [Indexed: 05/24/2023]
Abstract
The effect of low-moderate levels of arsenic exposure and of arsenic metabolism on mortality remains uncertain. We used data from a prospective cohort study in 3600 men and women aged 45 to 75 years living in Arizona, Oklahoma, and North and South Dakota. The biomarker of inorganic arsenic exposure was the sum of urine inorganic (iAs), monomethylated (MMA) and dimethylated (DMA) arsenic compounds (ƩAs) at baseline. The proportions of urine iAs, MMA and DMA over the ƩiAs, expressed as iAs%, MMA%, and DMA%, respectively, were used as biomarkers of arsenic metabolism. Arsenic exposure and arsenic metabolism were associated with all-cause, cardiovascular, and cancer mortality. For each interquartile range (IQR) increase in ƩAs (12.5 μg/L, overall range 0.7-194.1 μg/L), the adjusted hazard ratios (aHRs) were 1.28 (95% CI 1.16-1.41) for all-cause mortality, 1.28 (1.08-1.52) for cardiovascular mortality and 1.15 (0.92-1.44) for cancer mortality. The aHR for mortality for each IQR increase in MMA%, when iAs% is decreasing, was 1.52 (95% CI 1.16-1.99) for cardiovascular disease, 0.73 (0.55-0.98) for cancer, and 1.03 (0.90-1.19) for all-cause mortality. These findings at low-moderate levels of arsenic exposure highlight the need to implement public health measures to protect populations from involuntary arsenic exposure and for research to advance the biological and clinical understanding of arsenic-related health effects in general populations.
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Affiliation(s)
- Chin-Chi Kuo
- Big Data Center, China Medical University Hospital and China Medical University, Taichung, Taiwan; Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and China Medical University, Taichung, Taiwan; Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
| | - Poojitha Balakrishnan
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, NY, USA
| | - Matthew O Gribble
- Department of Environmental Health, Emory University, Atlanta, GA, USA; Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Lyle G Best
- Missouri Breaks Industries Research, Inc., Timber Lake, South Dakota
| | - Walter Goessler
- Institute of Chemistry - Analytical Chemistry, Karl-Franzens University Graz, Graz, Austria
| | - Jason G Umans
- MedStar Health Research Institute, Hyattsville, MD, USA; Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC, USA
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, NY, USA
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4
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Kavithaa G, Balakrishnan P, Yuvaraj SA. Lung Cancer Detection and Improving Accuracy Using Linear Subspace Image Classification Algorithm. Interdiscip Sci 2021; 13:779-786. [PMID: 34351570 DOI: 10.1007/s12539-021-00468-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/15/2021] [Accepted: 07/23/2021] [Indexed: 06/13/2023]
Abstract
The ability to identify lung cancer at an early stage is critical, because it can help patients live longer. However, predicting the affected area while diagnosing cancer is a huge challenge. An intelligent computer-aided diagnostic system can be utilized to detect and diagnose lung cancer by detecting the damaged region. The suggested Linear Subspace Image Classification Algorithm (LSICA) approach classifies images in a linear subspace. This methodology is used to accurately identify the damaged region, and it involves three steps: image enhancement, segmentation, and classification. The spatial image clustering technique is used to quickly segment and identify the impacted area in the image. LSICA is utilized to determine the accuracy value of the affected region for classification purposes. Therefore, a lung cancer detection system with classification-dependent image processing is used for lung cancer CT imaging. Therefore, a new method to overcome these deficiencies of the process for detection using LSICA is proposed in this work on lung cancer. MATLAB has been used in all programs. A proposed system designed to easily identify the affected region with help of the classification technique to enhance and get more accurate results.
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Affiliation(s)
- G Kavithaa
- Department of Electronics and Communication Engineering, Government College of Engineering, Salem, Tamilnadu, India.
| | - P Balakrishnan
- Malla Reddy Engineering College for Women (Autonomous), Hyderabad, 500100, India
| | - S A Yuvaraj
- Department of ECE, GRT Institute of Engineering and Technology, Tiruttani, Tamilnadu, India
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Sujatha M, Geetha K, Balakrishnan P. User-centric framework to facilitate trust worthy cloud service provider selection based on fuzzy inference system. IFS 2021. [DOI: 10.3233/jifs-189883] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The widespread adoption of cloud computing by several companies across diverse verticals of different sizes has led to an exponential growth of Cloud Service Providers (CSP). Multiple CSPs offer homogeneous services with a vast array of options and different pricing policies, making the suitable service selection process complex. Our proposed model simplifies the IaaS selection process that can be used by all users including clients from the non-IT background. In the first phase, requirements are gathered using a simple questionnaire and are mapped with the compute services among different alternatives.In the second phase, we have implemented the Sugeno Fuzzy inference system to rank the service providers based on the QoS attributes to ascertain the appropriate selection. In the third phase, we have applied the cost model to identify the optimal CSP. This framework is validated by applying it for a gaming application use case and it has outperformed the online tools thus making it an exemplary model.
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Affiliation(s)
- M. Sujatha
- School of Computing, SASTRA Deemed to be University, Thanjavur, India
| | - K. Geetha
- School of Computing, SASTRA Deemed to be University, Thanjavur, India
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Balakrishnan P, Mohan S. Treatment of triclosan through enhanced microbial biodegradation. J Hazard Mater 2021; 420:126430. [PMID: 34252677 DOI: 10.1016/j.jhazmat.2021.126430] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 06/13/2023]
Abstract
Triclosan (TCS) is extensively used in healthcare and personal care products as an antibacterial agent. Due to the persistent and toxic nature of TCS, it is not completely degraded in the biological wastewater treatment process. In this research work, identification of TCS degrading bacteria from municipal wastewater sludge and applying the same as bioaugmentation treatment for wastewater have been reported. Based on the 16S rRNA analysis of wastewater sludge, it was found that Providencia rettgeri MB-IIT strain was active and able to grow in higher TCS concentration. The identified bacterial strain was able to use TCS as carbon and energy source for its growth. The biodegradation experiment was optimized for the operational parameters viz. pH (5-10), inoculum size (1-5% (v/v)) and different initial concentration (2, 5, and 10 mg/L) of TCS. During the TCS degradation process, manganese peroxidase (MnP) and laccase (LAC) enzyme activity and specific growth rate of P. rettgeri strain were maximum at pH=7% and 2% (v/v) inoculum size, resulting in 98% of TCS removal efficiency. A total of six intermediate products were identified from the Liquid chromatography-high-resolution mass spectrometry (LC-HRMS) analysis, and the two mechanisms responsible for the degradation of TCS have been elucidated. The study highlights that P. rettgeri MB-IIT strain could be advantageously used to degrade triclosan present in the wastewater.
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Affiliation(s)
- P Balakrishnan
- Environmental and Water Resources Engineering Division, Department of Civil Engineering, Indian Institute of Technology Madras, Chennai 600036, Tamil Nadu, India.
| | - S Mohan
- Environmental and Water Resources Engineering Division, Department of Civil Engineering, Indian Institute of Technology Madras, Chennai 600036, Tamil Nadu, India.
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7
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Assudani PJ, Balakrishnan P. An efficient approach for load balancing of VMs in cloud environment. Appl Nanosci 2021. [DOI: 10.1007/s13204-021-02014-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Grau-Perez M, Voruganti VS, Balakrishnan P, Haack K, Goessler W, Franceschini N, Redón J, Cole SA, Navas-Acien A, Tellez-Plaza M. Genetic variation and urine cadmium levels: ABCC1 effects in the Strong Heart Family Study. Environ Pollut 2021; 276:116717. [PMID: 33640655 PMCID: PMC8026674 DOI: 10.1016/j.envpol.2021.116717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/03/2021] [Accepted: 02/07/2021] [Indexed: 06/12/2023]
Abstract
Genetic effects are suspected to influence cadmium internal dose. Our objective was to assess genetic determinants of urine cadmium in American Indian adults participating in the Strong Heart Family Study (SHFS). Urine cadmium levels and genotyped short tandem repeat (STR) markers were available on 1936 SHFS participants. We investigated heritability, including gene-by-sex and smoking interactions, and STR-based quantitative trait locus (QTL) linkage, using a variance-component decomposition approach, which incorporates the genetic information contained in the pedigrees. We also used available single nucleotide polymorphisms (SNPs) from Illumina's Metabochip and custom panel to assess whether promising QTLs associated regions could be attributed to SNPs annotated to specific genes. Median urine cadmium levels were 0.44 μg/g creatinine. The heritability of urine cadmium concentrations was 28%, with no evidence of gene-by-sex or -smoking interaction. We found strong statistical evidence for a genetic locus at chromosome 16 determining urine cadmium concentrations (Logarithm of odds score [LOD] = 3.8). Among the top 20 associated SNPs in this locus, 17 were annotated to ABCC1 (p-values from 0.0002 to 0.02), and attenuated the maximum linkage peak by a ∼40%. Suggestive QTL signals (LOD>1.9) in chromosomes 2, 6, 11, 14, and 19, showed associated SNPs in the genes NDUFA10, PDE10A, PLEKHA7, BAZ1A and CHAF1A, respectively. Our findings support that urinary cadmium levels are heritable and influenced by a QTL on chromosome 16, which was explained by genetic variation in ABCC1. Studies with extended sets of genome-wide markers are needed to confirm these findings and to identify additional metabolism and toxicity pathways for cadmium.
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Affiliation(s)
- Maria Grau-Perez
- Area of Cardiometabolic and Renal Risk, Institute for Biomedical Research Hospital Clinic of Valencia (INCLIVA), Valencia, Valencia, Spain; Department of Preventive Medicine and Public Health and Microbiology, Universidad Autonoma de Madrid, Madrid, Madrid, Spain; Department of Statistics and Operational Research, University of Valencia, Valencia, Spain.
| | - V Saroja Voruganti
- Department of Nutrition and Nutrition Research Institute, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Karin Haack
- Population Health Program, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Walter Goessler
- Institute of Chemistry - Analytical Chemistry, Karl-Franzens University of Graz, Graz, Austria
| | - Nora Franceschini
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Josep Redón
- Area of Cardiometabolic and Renal Risk, Institute for Biomedical Research Hospital Clinic of Valencia (INCLIVA), Valencia, Valencia, Spain; Department of Internal Medicine, Hospital Clinic of Valencia, University of Valencia, Valencia, Valencia, Spain
| | - Shelley A Cole
- Population Health Program, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia University, New York, NY, USA
| | - Maria Tellez-Plaza
- Area of Cardiometabolic and Renal Risk, Institute for Biomedical Research Hospital Clinic of Valencia (INCLIVA), Valencia, Valencia, Spain; Department of Preventive Medicine and Public Health and Microbiology, Universidad Autonoma de Madrid, Madrid, Madrid, Spain; Department of Chronic Diseases Epidemiology, National Center for Epidemiology, Instituto de Salud Carlos III, Madrid, Madrid, Spain; Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, USA
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Bhardwaj S, Geraldine Bessie Amali D, Phadke A, Umadevi K, Balakrishnan P. A new parallel galactic swarm optimization algorithm for training artificial neural networks. IFS 2020. [DOI: 10.3233/jifs-179747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | - Amrut Phadke
- School of Computer Science and Engineering, Vellore Institute of Technology, Vellore, India
| | - K.S. Umadevi
- School of Computer Science and Engineering, Vellore Institute of Technology, Vellore, India
| | - P. Balakrishnan
- School of Computer Science and Engineering, Vellore Institute of Technology, Vellore, India
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10
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Sujatha M, Geetha K, Balakrishnan P, Renugadevi T. OUTFIT - An optimal data storage hosting model using Sugeno-type fuzzy inference system for multi-cloud environments. IFS 2020. [DOI: 10.3233/jifs-179739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- M. Sujatha
- School of Computing, SASTRA Deemed to be University, Thanjavur, India
| | - K. Geetha
- School of Computing, SASTRA Deemed to be University, Thanjavur, India
| | | | - T. Renugadevi
- School of Computing, SASTRA Deemed to be University, Thanjavur, India
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11
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Solomon SS, Boon D, Saravanan S, Srikrishnan AK, Vasudevan CK, Balakrishnan P, Persaud D, Ray SC, Mehta S, Mehta SH. Diversity of hepatitis C virus infection among HIV-infected people who inject drugs in India. Virusdisease 2019; 30:490-497. [PMID: 31897414 PMCID: PMC6917681 DOI: 10.1007/s13337-019-00553-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 11/11/2019] [Indexed: 12/14/2022] Open
Abstract
The availability of generic direct acting antivirals (DAAs) for hepatitis C virus (HCV) treatment has prompted many low-and-middle-income countries to launch HCV elimination programs. Because the efficacy of some of these generic DAAs varies by HCV viral subtype, information on subtype distribution can contribute important information to these elimination programs. We conducted a cross-sectional serosurvey to characterize HCV subtype diversity among HIV positive people who inject drugs (PWID) across 14 cities in India. Of 801 HIV positive PWID sampled, 639 tested HCV antibody positive (78.9%). Among 105 samples sequenced, genotype 3 (58.1%) was the most commonly observed followed by genotype 1 (36.2%) and genotype 6 (5.7%). Of the genotype 3 infections, 65% were subtype 3a and 35% were subtype 3b. Of the genotype 1 infections, 94% were subtype 1a and 6% were subtype 1b. All genotype 6 samples were subtype 6n. There was some variability in genotype diversity depending on geographic region and PWID epidemic stage with greater diversity observed in older PWID epidemics. One sequence, HY018, did not cluster with any known reference sequences in phylogenetic analysis. Nearly 80% of HIV infected PWID across India are co-infected with HCV, and subtype prevalence and genetic diversity varied by region and PWID epidemic stage. HCV elimination programs in India will need to consider HCV subtype.
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Affiliation(s)
- S. S. Solomon
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - D. Boon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - S. Saravanan
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
| | | | - C. K. Vasudevan
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - P. Balakrishnan
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - D. Persaud
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - S. C. Ray
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - S. Mehta
- Department of Medicine, University of California at San Diego School of Medicine, La Jolla, CA USA
| | - S. H. Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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Affiliation(s)
- K.S. Umadevi
- School of Computer Science and Engineering, Vellore Institute of Technology, Vellore, Tamilnadu, India
| | - P. Balakrishnan
- School of Computer Science and Engineering, Vellore Institute of Technology, Vellore, Tamilnadu, India
| | - G. Kousalya
- Department of Computer Science Engineering, Coimbatore Institute of Technology, Coimbatore, Tamilnadu, India
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Venkatesh V, Raj P, Kannan K, Balakrishnan P. Precision centric framework for activity recognition using Dempster Shaffer theory and information fusion algorithm in smart environment. IFS 2019. [DOI: 10.3233/jifs-169923] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Veeramuthu Venkatesh
- School of Computing SASTRA Deemed University Thirumalaisamudram, Thanjavur, Tamilnadu, India
| | - Pethuru Raj
- Chief Architect, Reliance Jio Cloud Services (JCS), Bangalore, India
| | - K. Kannan
- Department of Mathematics, SASTRA Deemed University Thirumalaisamudram, Thanjavur, Tamilnadu, India
| | - P. Balakrishnan
- SCOPE, Department of Analytics, VIT University Vellore, Tamilnadu, India
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Madhawa S, Balakrishnan P, Arumugam U. Roll forward validation based decision tree classification for detecting data integrity attacks in industrial internet of things. IFS 2019. [DOI: 10.3233/jifs-169946] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Surendar Madhawa
- School of Computing, SASTRA Deemed to be University, Thirumalaisamudram, Thanjavur, Tamilnadu, India
| | - P. Balakrishnan
- SCOPE, Vellore Institute of Technology, Vellore, Tamilnadu, India
| | - Umamakeswari Arumugam
- School of Computing, SASTRA Deemed to be University, Thirumalaisamudram, Thanjavur, Tamilnadu, India
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Ezhilarasie R, Umamakeswari A, Reddy MS, Balakrishnan P. Grefenstette Bias based genetic algorithm for multi-site offloading using docker container in edge computing. IFS 2019. [DOI: 10.3233/jifs-169953] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- R. Ezhilarasie
- Embedded Systems Laboratory, School of Computing, SASTRA Deemed University, India
| | - A. Umamakeswari
- Embedded Systems Laboratory, School of Computing, SASTRA Deemed University, India
| | | | - P. Balakrishnan
- SCOPE, Vellore Institute of Technology, Vellore Campus, Tamilnadu, India
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16
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Spratlen MJ, Grau-Perez M, Umans JG, Yracheta J, Best LG, Francesconi K, Goessler W, Balakrishnan P, Cole SA, Gamble MV, Howard BV, Navas-Acien A. Arsenic, one carbon metabolism and diabetes-related outcomes in the Strong Heart Family Study. Environ Int 2018; 121:728-740. [PMID: 30321848 PMCID: PMC6221918 DOI: 10.1016/j.envint.2018.09.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 09/25/2018] [Accepted: 09/26/2018] [Indexed: 05/02/2023]
Abstract
BACKGROUND Inorganic arsenic exposure and inter-individual differences in its metabolism have been associated with cardiometabolic risk. A more efficient arsenic metabolism profile (lower MMA%, higher DMA%) has been associated with reduced risk for arsenic-related health outcomes; however, this profile has also been associated with increased risk for diabetes-related outcomes. The mechanism behind these contrasting associations is equivocal; we hypothesized one carbon metabolism (OCM) may play a role. METHODS We evaluated the association between OCM-related variables (nutrient intake and genetic variants) and both arsenic metabolism biomarkers (iAs%, MMA% and DMA%) and diabetes-related outcomes (metabolic syndrome, diabetes, HOMA2-IR and waist circumference) in 935 participants free of prevalent diabetes and metabolic syndrome from the Strong Heart Family Study, a family-based prospective cohort comprised of American Indian tribal members aged 14+ years. RESULTS Of the 935 participants free of both diabetes and metabolic syndrome at baseline, 279 (29.8%) developed metabolic syndrome over a median of 5.3 years of follow-up and of the 1458 participants free of diabetes at baseline, 167 (11.3%) developed diabetes over follow-up. OCM nutrients were not associated with arsenic metabolism, however, higher vitamin B6 was associated with diabetes-related outcomes (higher HOMA2-IR and increased risk for diabetes and metabolic syndrome). A polymorphism in an OCM-related gene, methionine synthase (MTR), was associated with both higher MMA% (β = 2.57, 95% CI: 0.22, 4.92) and lower HOMA2-IR (GMR = 0.79, 95% CI = 0.66, 0.93 per 5 years of follow-up). Adjustment for OCM variables did not affect previously reported associations between arsenic metabolism and diabetes-related outcomes; however, the association between the MTR variant and diabetes-related outcomes were attenuated after adjustment for arsenic metabolism. CONCLUSIONS Our findings suggest MMA% may be a partial mediator in the association between OCM and diabetes-related outcomes. Additional mediation analyses with longer follow-up period are needed to confirm this finding. Further research is needed to determine whether excess B vitamin intake is associated with increased risk for diabetes-related outcomes.
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Affiliation(s)
- Miranda J Spratlen
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, NY, New York, United States of America; Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
| | - Maria Grau-Perez
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, NY, New York, United States of America; Fundación Investigación Clínico de Valencia-INCLIVA, Area of Cardiometabolic and Renal Risk, Valencia, Spain; Department of Statistics and Operational Research, University of Valencia, Valencia, Spain
| | - Jason G Umans
- MedStar Health Research Institute, Hyattsville, MD, United States of America; Department of Medicine, Georgetown University School of Medicine, Washington, DC, United States of America
| | - Joseph Yracheta
- Missouri Breaks Industries Research, Inc., Eagle Butte, SD, United States of America
| | - Lyle G Best
- Missouri Breaks Industries Research, Inc., Eagle Butte, SD, United States of America
| | - Kevin Francesconi
- Institute of Chemistry - Analytical Chemistry, University of Graz, Austria
| | - Walter Goessler
- Institute of Chemistry - Analytical Chemistry, University of Graz, Austria
| | - Poojitha Balakrishnan
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, NY, New York, United States of America
| | - Shelley A Cole
- Texas Biomedical Research Institute, San Antonio, TX, United States of America
| | - Mary V Gamble
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, NY, New York, United States of America
| | - Barbara V Howard
- MedStar Health Research Institute, Hyattsville, MD, United States of America; Department of Medicine, Georgetown University School of Medicine, Washington, DC, United States of America
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, NY, New York, United States of America; Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
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Balakrishnan P, Vaidya D, Voruganti VS, Haack K, Kent JW, North KE, Laston S, Howard BV, Umans JG, Lee ET, Best LG, MacCluer JW, Cole SA, Navas-Acien A, Franceschini N. Genetic Variants Related to Cardiometabolic Traits Are Associated to B Cell Function, Insulin Resistance, and Diabetes Among AmeriCan Indians: The Strong Heart Family Study. Front Genet 2018; 9:466. [PMID: 30369944 PMCID: PMC6194194 DOI: 10.3389/fgene.2018.00466] [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] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 09/24/2018] [Indexed: 01/03/2023] Open
Abstract
Background: Genetic research may inform underlying mechanisms for disparities in the burden of type 2 diabetes mellitus among American Indians. Our objective was to assess the association of genetic variants in cardiometabolic candidate genes with B cell dysfunction via HOMA-B, insulin resistance via HOMA-IR, and type 2 diabetes mellitus in the Strong Heart Family Study (SHFS). Methods and Results: We examined the association of variants, previously associated with cardiometabolic traits (∼200,000 from Illumina Cardio MetaboChip), using mixed models of HOMA-B residuals corrected for HOMA-IR (cHOMA-B), log transformed HOMA-IR, and incident diabetes, adjusted for age, sex, population stratification, and familial relatedness. Center-specific estimates were combined using fixed effect meta-analyses. We used Bonferroni correction to account for multiple testing (P < 4.13 × 10−7). We also assessed the association between variants in candidate diabetes genes with these metabolic traits. We explored the top SNPs in an independent, replication sample from Southwestern Arizona. We identified significant associations with cHOMA-B for common variants at 26 loci of which 8 were novel (PRSS7, FCRL5, PEL1, LRP12, IGLL1, ARHGEF10, PARVA, FLJ16686). The most significant variant association with cHOMA-B was observed on chromosome 5 for an intergenic variant near PARP8 (rs2961831, P = 6.39 × 10−9). In the replication study, we found a signal at rs4607517 near GCK/YKT6 (P = 0.01). Variants near candidate diabetes genes (especially GCK and KCNQ1) were also nominally associated with HOMA-IR and cHOMA-B. Conclusion: We identified variants at novel loci and confirmed those at known candidate diabetes loci associations for cHOMA-B. This study also provided evidence for association of variants at KCNQ2, CTNAA2, and KCNQ1with cHOMA-B among American Indians. Further studies are needed to account for the high heritability of diabetes among the American Indian participants of the SHFS cohort.
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Affiliation(s)
- Poojitha Balakrishnan
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Dhananjay Vaidya
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States.,Clinical and Translational Research, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - V Saroja Voruganti
- Department of Nutrition, UNC Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, NC, United States
| | - Karin Haack
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, TX, United States
| | - Jack W Kent
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, TX, United States
| | - Kari E North
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Sandra Laston
- South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley School of Medicine, Brownsville, TX, United States
| | - Barbara V Howard
- MedStar Health Research Institute, Hyattsville, MD, United States
| | - Jason G Umans
- MedStar Health Research Institute, Hyattsville, MD, United States.,Georgetown and Howard Universities Center for Clinical and Translational Science, Washington, DC, United States
| | - Elisa T Lee
- Center for American Indian Health Research, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Lyle G Best
- Missouri Breaks Industries Research, Inc., Eagle Butte, SD, United States
| | - Jean W MacCluer
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, TX, United States
| | - Shelley A Cole
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, TX, United States
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Nora Franceschini
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Balakrishnan P. P3.16-21 Robotic Thoracic Surgery in Lung Cancer Resection – A Comprehensive Review. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1928] [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: 11/28/2022]
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19
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Balakrishnan P. P3.16-12 Standard Conventional Lobectomy vs Stereotactic Body Radiotherapy in Patients with Early Stage Non-Small Cell Lung Cancer (NSCLC) – A Review. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1919] [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: 11/28/2022]
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20
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Madhawa S, Balakrishnan P, Arumugam U. Employing invariants for anomaly detection in software defined networking based industrial internet of things. IFS 2018. [DOI: 10.3233/jifs-169670] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Surendar Madhawa
- School of Computing, SASTRA University, Thirumalaisamudram, Thanjavur, Tamilnadu, India
| | | | - Umamakeswari Arumugam
- School of Computing, SASTRA University, Thirumalaisamudram, Thanjavur, Tamilnadu, India
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21
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Spratlen MJ, Grau-Perez M, Best LG, Yracheta J, Lazo M, Vaidya D, Balakrishnan P, Gamble MV, Francesconi KA, Goessler W, Cole SA, Umans JG, Howard BV, Navas-Acien A. The Association of Arsenic Exposure and Arsenic Metabolism With the Metabolic Syndrome and Its Individual Components: Prospective Evidence From the Strong Heart Family Study. Am J Epidemiol 2018; 187:1598-1612. [PMID: 29554222 DOI: 10.1093/aje/kwy048] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 02/28/2018] [Indexed: 12/12/2022] Open
Abstract
Inorganic arsenic exposure is ubiquitous, and both exposure and interindividual differences in its metabolism have been associated with cardiometabolic risk. However, the associations of arsenic exposure and arsenic metabolism with the metabolic syndrome (MetS) and its individual components are relatively unknown. We used Poisson regression with robust variance to evaluate the associations of baseline arsenic exposure (urinary arsenic levels) and metabolism (relative percentage of arsenic species over their sum) with incident MetS and its individual components (elevated waist circumference, elevated triglycerides, reduced high-density lipoprotein cholesterol, hypertension, and elevated fasting plasma glucose) in 1,047 participants from the Strong Heart Family Study, a prospective family-based cohort study in American Indian communities (baseline visits were held in 1998-1999 and 2001-2003, follow-up visits in 2001-2003 and 2006-2009). Over the course of follow-up, 32% of participants developed MetS. An interquartile-range increase in arsenic exposure was associated with a 1.19-fold (95% confidence interval: 1.01, 1.41) greater risk of elevated fasting plasma glucose concentration but not with other individual components of the MetS or MetS overall. Arsenic metabolism, specifically lower percentage of monomethylarsonic acid and higher percentage of dimethylarsinic acid, was associated with higher risk of overall MetS and elevated waist circumference but not with any other MetS component. These findings support the hypothesis that there are contrasting and independent associations of arsenic exposure and arsenic metabolism with metabolic outcomes which may contribute to overall diabetes risk.
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Affiliation(s)
- Miranda J Spratlen
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Maria Grau-Perez
- Area of Cardiometabolic and Renal Risk, Clinical Research Foundation of Valencia, Valencia, Spain
- Department of Statistics and Operational Research, Faculty of Mathematics, University of Valencia, Valencia, Spain
| | - Lyle G Best
- Missouri Breaks Industries Research, Inc., Eagle Butte, South Dakota
| | - Joseph Yracheta
- Missouri Breaks Industries Research, Inc., Eagle Butte, South Dakota
| | - Mariana Lazo
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Dhananjay Vaidya
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Poojitha Balakrishnan
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Mary V Gamble
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Kevin A Francesconi
- Department of Analytical Chemistry, Institute of Chemistry, University of Graz, Graz, Austria
| | - Walter Goessler
- Department of Analytical Chemistry, Institute of Chemistry, University of Graz, Graz, Austria
| | | | - Jason G Umans
- MedStar Health Research Institute, Hyattsville, Maryland
- Department of Medicine, School of Medicine, Georgetown University, Washington, DC
| | - Barbara V Howard
- MedStar Health Research Institute, Hyattsville, Maryland
- Department of Medicine, School of Medicine, Georgetown University, Washington, DC
| | - Ana Navas-Acien
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York
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22
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Balakrishnan P, Jones MR, Vaidya D, Tellez-Plaza M, Post WS, Kaufman JD, Bielinski SJ, Taylor K, Francesconi K, Goessler W, Navas-Acien A. Ethnic, Geographic, and Genetic Differences in Arsenic Metabolism at Low Arsenic Exposure: A Preliminary Analysis in the Multi-Ethnic Study of Atherosclerosis (MESA). Int J Environ Res Public Health 2018; 15:E1179. [PMID: 29874848 PMCID: PMC6025014 DOI: 10.3390/ijerph15061179] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 05/25/2018] [Accepted: 05/27/2018] [Indexed: 12/31/2022]
Abstract
We investigated the effect of candidate variants in AS3MT (arsenic (III) methyltransferase) with urinary arsenic metabolites and their principal components in a subset of 264 participants in the Multi-Ethnic Study of Atherosclerosis (MESA). Urinary arsenic species, including inorganic arsenic (iAs), monomethylarsonate (MMA), dimethylarsinate (DMA), and arsenobetaine (Ab), were measured using high performance liquid chromatography-inductively coupled plasma mass spectrometry (HPLC-ICPMS) and corrected for organic sources from seafood consumption by regressing Ab on arsenic species using a validated method. Principal components of arsenic metabolism were also used as independent phenotypes. We conducted linear regression of arsenic traits with allelic dosage of candidate single nucleotide polymorphisms (SNPs) rs12768205 (G > A), rs3740394 (A > G), and rs3740393 (G > C) measured using Illumina MetaboChip. Models were stratified by non-Hispanic white vs. all other race/ethnicity and adjusted for age, sex, arsenic exposure, study site, and population stratification. Consistent with previous studies, rs12768205 showed evidence for strongest association (non-Hispanic white: iAs% -0.14 (P 0.83), MMA% -0.66 (0.49), DMA% 0.81(0.49); other race/ethnicity: 0.13 (0.71), -1.21 (0.09), 1.08 (0.20)). No association, however, passed the strict Bonferroni p-value. This was a novel study among an ethnically diverse population exposed to low arsenic levels.
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Affiliation(s)
- Poojitha Balakrishnan
- Department of Environmental Health Sciences, Columbia Mailman School of Public Health, New York, NY 10032, USA.
| | - Miranda R Jones
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Dhananjay Vaidya
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA.
| | - Maria Tellez-Plaza
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
- Fundación de Investigación Hospital Clínico de Valencia INCLIVA, Valencia 46010, Spain.
| | - Wendy S Post
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA.
| | - Joel D Kaufman
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA 98195, USA.
| | - Suzette J Bielinski
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA.
| | - Kent Taylor
- Los Angeles BioMedical Research Institute at Harbor-UCLA Medical Center, Los Angeles, CA 90502, USA.
| | | | - Walter Goessler
- Institute of Chemistry, University of Graz, 8010 Graz, Austria.
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia Mailman School of Public Health, New York, NY 10032, USA.
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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23
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Dinesha TR, Boobalan J, Sivamalar S, Subashini D, Solomon SS, Murugavel KG, Balakrishnan P, Smith DM, Saravanan S. Occult HBV infection in HIV-infected adults and evaluation of pooled NAT for HBV. J Viral Hepat 2018; 25:718-723. [PMID: 29316078 PMCID: PMC5980682 DOI: 10.1111/jvh.12858] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 12/07/2017] [Indexed: 12/31/2022]
Abstract
The study aimed to determine the prevalence of occult hepatitis B virus infection among HIV-infected persons and to evaluate the use of a pooling strategy to detect occult HBV infection in the setting of HIV infection. Five hundred and two HIV-positive individuals were tested for HBV, occult HBV and hepatitis C and D with serologic and nucleic acid testing (NAT). We also evaluated a pooled NAT strategy for screening occult HBV infection among the HIV-positive individuals. The prevalence of HBV infection among HIV-positive individuals was 32 (6.4%), and occult HBV prevalence was 10%. The pooling HBV NAT had a sensitivity of 66.7% and specificity of 100%, compared to HBV DNA NAT of individual samples. In conclusion, this study found a high prevalence of occult HBV infection among our HIV-infected population. We also demonstrated that pooled HBV NAT is highly specific, moderately sensitive and cost-effective. As conventional HBV viral load assays are expensive in resource-limited settings such as India, pooled HBV DNA NAT might be a good way for detecting occult HBV infection and will reduce HBV-associated complications.
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Affiliation(s)
- TR Dinesha
- Y.R. Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - J Boobalan
- Y.R. Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - S Sivamalar
- Y.R. Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - D Subashini
- Y.R. Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - Sunil S Solomon
- Y.R. Gaitonde Centre for AIDS Research and Education, Chennai, India,Johns Hopkins University School of Medicine, Baltimore, USA
| | - KG Murugavel
- Y.R. Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - P Balakrishnan
- Y.R. Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - Davey M Smith
- University of California San Diego, La Jolla, California, USA
| | - S Saravanan
- Y.R. Gaitonde Centre for AIDS Research and Education, Chennai, India
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24
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Balakrishnan P, Navas-Acien A, Haack K, Vaidya D, Umans JG, Best LG, Goessler W, Francesconi KA, Franceschini N, North KE, Cole SA, Voruganti VS, Gribble MO. Arsenic-gene interactions and beta-cell function in the Strong Heart Family Study. Toxicol Appl Pharmacol 2018; 348:123-129. [PMID: 29621497 DOI: 10.1016/j.taap.2018.03.034] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 03/16/2018] [Accepted: 03/31/2018] [Indexed: 12/15/2022]
Abstract
We explored arsenic-gene interactions influencing pancreatic beta-cell activity in the Strong Heart Family Study (SHFS). We considered 42 variants selected for associations with either beta-cell function (31 variants) or arsenic metabolism (11 variants) in the SHFS. Beta-cell function was calculated as homeostatic model - beta corrected for insulin resistance (cHOMA-B) by regressing homeostatic model - insulin resistance (HOMA-IR) on HOMA-B and adding mean HOMA-B. Arsenic exposure was dichotomized at the median of the sum of creatinine-corrected inorganic and organic arsenic species measured by high performance liquid chromatography-inductively coupled plasma mass spectrometry (HPLC-ICPMS). Additive GxE models for cHOMA-B were adjusted for age and ancestry, and accounted for family relationships. Models were stratified by center (Arizona, Oklahoma, North Dakota and South Dakota) and meta-analyzed. The two interactions between higher vs. lower arsenic and SNPs for cHOMA-B that were nominally significant at P < 0.05 were with rs10738708 (SNP overall effect -3.91, P = 0.56; interaction effect with arsenic -31.14, P = 0.02) and rs4607517 (SNP overall effect +16.61, P = 0.03; interaction effect with arsenic +27.02, P = 0.03). The corresponding genes GCK and TUSC1 suggest oxidative stress and apoptosis as possible mechanisms for arsenic impacts on beta-cell function. No interactions were Bonferroni-significant (1.16 × 10-3). Our findings are suggestive of oligogenic moderation of arsenic impacts on pancreatic β-cell endocrine function, but were not Bonferroni-significant.
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Affiliation(s)
- Poojitha Balakrishnan
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Karin Haack
- Texas Biomedical Research Institute, San Antonio, TX, United States
| | - Dhananjay Vaidya
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States; Clinical and Translational Research, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Jason G Umans
- MedStar Health Research Institute, Hyattsville, MD, United States
| | - Lyle G Best
- Missouri Breaks Industries Research, Inc., Eagle Butte, SD, United States
| | | | | | - Nora Franceschini
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Kari E North
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Shelley A Cole
- Texas Biomedical Research Institute, San Antonio, TX, United States
| | - V Saroja Voruganti
- Department of Nutrition and UNC Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, NC, United States
| | - Matthew O Gribble
- Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, United States; Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, United States.
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25
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Tomori C, McFall AM, Solomon SS, Srikrishnan AK, Anand S, Balakrishnan P, Mehta SH, Celentano DD. Is there synergy in syndemics? Psychosocial conditions and sexual risk among men who have sex with men in India. Soc Sci Med 2018; 206:110-116. [PMID: 29615297 DOI: 10.1016/j.socscimed.2018.03.032] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 03/16/2018] [Accepted: 03/22/2018] [Indexed: 12/24/2022]
Abstract
Syndemic theory describes the clustering and synergistic interaction of disease driven by contextual and social factors, which worsen health outcomes for a population, and has been applied to men who have sex with men (MSM) and their risk for HIV and other sexually transmitted infections. Recent reviews, however, have critiqued prevailing approaches in syndemic studies that assess only additive associations without evaluation of synergy. Following these suggestions, we compared the traditional additive approach with a test for synergistic association of 5 syndemic conditions (alcohol dependence, illicit drug use, depression, intimate partner violence (IPV), and childhood sexual abuse (CSA)) with unprotected anal intercourse (UAI) and active syphilis infection among 11,771 MSM recruited through respondent driven sampling from 12 cities in India. UAI was assessed via self-report and active syphilis infection was diagnosed by RPR and THPA tests. An additive association was explored using a condition count (range 0-5), and synergy was tested using relative excess risk due to interactions (RERIs) calculated from all 2-way and common 3-way interactions between conditions in adjusted regression models. There was a significant dose response associated with the syndemic count and UAI, and a similar pattern for syphilis, though not statistically significant. RERIs showed synergy for only one pair of conditions for UAI and syphilis, respectively: IPV + depression and alcohol dependence + illicit drug use. In this study, we found an additive association between syndemic conditions and UAI with evidence of synergistic interaction between a pair of psychosocial conditions, and no significant additive association, but a synergistic interaction between another pair of psychosocial conditions for syphilis. Our results lend further support to a critical reassessment of syndemic analyses. Closer attention to the cumulative development, underlying causal pathways, and possible synergistic interaction of co-occurring epidemics through combined qualitative and quantitative methodologies may yield more effective interventions for vulnerable, marginalized populations.
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Affiliation(s)
- Cecilia Tomori
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States.
| | - Allison M McFall
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States
| | - Sunil S Solomon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States; Department of Medicine, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, United States; YR Gaitonde Centre for AIDS Research and Education, Voluntary Health Services Campus, Taramani, Chennai, 600 113, India
| | - Aylur K Srikrishnan
- YR Gaitonde Centre for AIDS Research and Education, Voluntary Health Services Campus, Taramani, Chennai, 600 113, India
| | - Santhanam Anand
- YR Gaitonde Centre for AIDS Research and Education, Voluntary Health Services Campus, Taramani, Chennai, 600 113, India
| | - P Balakrishnan
- YR Gaitonde Centre for AIDS Research and Education, Voluntary Health Services Campus, Taramani, Chennai, 600 113, India
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States
| | - David D Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States; Department of Medicine, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, United States
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Mohanapriya N, Kousalya G, Balakrishnan P, Pethuru Raj C. Energy efficient workflow scheduling with virtual machine consolidation for green cloud computing. IFS 2018. [DOI: 10.3233/jifs-169451] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- N. Mohanapriya
- Department of Computer Science and Engineering, Coimbatore Institute of Technology, Coimbatore, India
| | - G. Kousalya
- Department of Computer Science and Engineering, Coimbatore Institute of Technology, Coimbatore, India
| | - P. Balakrishnan
- School of Computer Science and Engineering, VIT University, Vellore, India
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27
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Madhawa S, Balakrishnan P, Arumugam U. Data driven intrusion detection system for software defined networking enabled industrial internet of things. IFS 2018. [DOI: 10.3233/jifs-169425] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Surendar Madhawa
- School of Computing, SASTRA University, Thirumalaisamudram, Thanjavur, Tamilnadu, India
| | | | - Umamakeswari Arumugam
- School of Computing, SASTRA University, Thirumalaisamudram, Thanjavur, Tamilnadu, India
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28
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Grau-Perez M, Kuo CC, Gribble MO, Balakrishnan P, Jones Spratlen M, Vaidya D, Francesconi KA, Goessler W, Guallar E, Silbergeld EK, Umans JG, Best LG, Lee ET, Howard BV, Cole SA, Navas-Acien A. Association of Low-Moderate Arsenic Exposure and Arsenic Metabolism with Incident Diabetes and Insulin Resistance in the Strong Heart Family Study. Environ Health Perspect 2017; 125:127004. [PMID: 29373862 PMCID: PMC5963590 DOI: 10.1289/ehp2566] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 10/30/2017] [Accepted: 11/07/2017] [Indexed: 05/02/2023]
Abstract
BACKGROUND High arsenic exposure has been related to diabetes, but at low-moderate levels the evidence is mixed. Arsenic metabolism, which is partly genetically controlled and may rely on certain B vitamins, plays a role in arsenic toxicity. OBJECTIVE We evaluated the prospective association of arsenic exposure and metabolism with type 2 diabetes and insulin resistance. METHODS We included 1,838 American Indian men and women free of diabetes (median age, 36 y). Arsenic exposure was assessed as the sum of inorganic arsenic (iAs), monomethylarsonate (MMA), and dimethylarsinate (DMA) urine concentrations (ΣAs). Arsenic metabolism was evaluated by the proportions of iAs, MMA, and DMA over their sum (iAs%, MMA%, and DMA%). Homeostasis model assessment for insulin resistance (HOMA2-IR) was measured at baseline and follow-up visits. Incident diabetes was evaluated at follow-up. RESULTS Median ΣAs, iAs%, MMA%, and DMA% was 4.4 μg/g creatinine, 9.5%, 14.4%, and 75.6%, respectively. Over 10,327 person-years of follow-up, 252 participants developed diabetes. Median HOMA2-IR at baseline was 1.5. The fully adjusted hazard ratio [95% confidence interval (CI)] for incident diabetes per an interquartile range increase in ΣAs was 1.57 (95% CI: 1.18, 2.08) in participants without prediabetes at baseline. Arsenic metabolism was not associated with incident diabetes. ΣAs was positively associated with HOMA2-IR at baseline but negatively with HOMA2-IR at follow-up. Increased MMA% was associated with lower HOMA2-IR when either iAs% or DMA% decreased. The association of arsenic metabolism with HOMA2-IR differed by B-vitamin intake and AS3MT genetics variants. CONCLUSIONS Among participants without baseline prediabetes, arsenic exposure was associated with incident diabetes. Low MMA% was cross-sectional and prospectively associated with higher HOMA2-IR. Research is needed to confirm possible interactions of arsenic metabolism with B vitamins and AS3MT variants on diabetes risk. https://doi.org/10.1289/EHP2566.
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Affiliation(s)
- Maria Grau-Perez
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York City, New York, USA
| | - Chin-Chi Kuo
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- Big Data Center, China Medical University Hospital , China Medical University , Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Matthew O Gribble
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Poojitha Balakrishnan
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York City, New York, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Miranda Jones Spratlen
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York City, New York, USA
| | - Dhananjay Vaidya
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | | | - Eliseo Guallar
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ellen K Silbergeld
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jason G Umans
- Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC, USA
- MedStar Health Research Institute, Hyattsville, Maryland, USA
| | - Lyle G Best
- Department of Epidemiology, Missouri Breaks Industries Research, Inc., Eagle Butte, South Dakota, USA
| | - Elisa T Lee
- Center for American Indian Health Research, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Barbara V Howard
- Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC, USA
- MedStar Health Research Institute, Hyattsville, Maryland, USA
| | - Shelley A Cole
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, Texas, USA
| | - Ana Navas-Acien
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York City, New York, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Balakrishnan P, Tinawi G, Galvin S. P3.16-036 Feasibility of Lung Cancer Surgery in Septuagenarians. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1842] [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: 11/16/2022]
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Balakrishnan P, Kusel J, Galvin S, Mahon B. P3.16-035 The Unknown: Does Body Mass Index (BMI) Influence Outcomes Post Lung Cancer Resection Surgery? J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Balakrishnan P, Tinawi G, Galvin S. P2.16-028 Are We Doing the Right Thing? Overall Survival & Intermediate Outcomes Following Lung Metastasectomy. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Balakrishnan P, Beaty T, Young JH, Colantuoni E, Matsushita K. Methods to estimate underlying blood pressure: The Atherosclerosis Risk in Communities (ARIC) Study. PLoS One 2017; 12:e0179234. [PMID: 28700596 PMCID: PMC5507409 DOI: 10.1371/journal.pone.0179234] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 05/25/2017] [Indexed: 01/11/2023] Open
Abstract
Antihypertensive medications complicate studies of blood pressure (BP) natural history; BP if untreated (“underlying BP”) needs to be estimated. Our objectives were to compare validity of five missing data imputation methods to estimate underlying BP and longitudinal associations of underlying BP and age. We simulated BP treatment in untreated hypertensive participants from Atherosclerosis Risk in Communities (ARIC) in visits 1–5 (1987–2013) using matched treated hypertensive participants. The underlying BP was imputed: #1, set as missing; #2, add 10 mmHg for systolic, 5 mmHg for diastolic; #3, add medication class-specific constant; #4, truncated normal regression; and #5, truncated normal regression including prior visit data. Longitudinal associations were estimated using linear mixed models of imputed underlying BP for simulated treated and measured BP for untreated participants. Method 3 was the best-performing for systolic BP; lowest relative bias (5.3% for intercept at age 50, 0% for age coefficient) and average deviation from expected (0.04 to -1.79). Method 2 performed best for diastolic BP; lowest relative bias (0.6% intercept at age 50, 33.3% age <60, 9.1% age 60+) and average deviation (-1.25 to -1.68). Methods 4 and 5 were comparable or slightly inferior. In conclusion, constant addition methods yielded valid and precise underlying BP and longitudinal associations.
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Affiliation(s)
- Poojitha Balakrishnan
- Department of Environmental Health Sciences, Columbia University School of Public Health, New York, New York, United States of America
- * E-mail:
| | - Terri Beaty
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, United States of America
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, Maryland, United States of America
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States of America
| | - J. Hunter Young
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, United States of America
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States of America
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Elizabeth Colantuoni
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, Maryland, United States of America
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, United States of America
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States of America
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Affiliation(s)
- N.M. Dhanya
- Department of Computer Science and Engineering, Amrita School of Engineering, Amrita Vishwa Vidyapeetham, Coimbatore, Tamilnadu, India
| | - G. Kousalya
- Deparment of Computer Science and Engineering, Coimbatore Institute of Technology, Coimbatore, Tamilnadu, India
| | - P. Balakrishnan
- School of Computing, SASTRA University, Tanjore, Tamilnadu, India
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Balakrishnan P, Vaidya D, Franceschini N, Voruganti VS, Gribble MO, Haack K, Laston S, Umans JG, Francesconi KA, Goessler W, North KE, Lee E, Yracheta J, Best LG, MacCluer JW, Kent J, Cole SA, Navas-Acien A. Association of Cardiometabolic Genes with Arsenic Metabolism Biomarkers in American Indian Communities: The Strong Heart Family Study (SHFS). Environ Health Perspect 2017; 125:15-22. [PMID: 27352405 PMCID: PMC5226702 DOI: 10.1289/ehp251] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 03/27/2016] [Accepted: 05/19/2016] [Indexed: 05/18/2023]
Abstract
BACKGROUND Metabolism of inorganic arsenic (iAs) is subject to inter-individual variability, which is explained partly by genetic determinants. OBJECTIVES We investigated the association of genetic variants with arsenic species and principal components of arsenic species in the Strong Heart Family Study (SHFS). METHODS We examined variants previously associated with cardiometabolic traits (~ 200,000 from Illumina Cardio MetaboChip) or arsenic metabolism and toxicity (670) among 2,428 American Indian participants in the SHFS. Urine arsenic species were measured by high performance liquid chromatography-inductively coupled plasma mass spectrometry (HPLC-ICP-MS), and percent arsenic species [iAs, monomethylarsonate (MMA), and dimethylarsinate (DMA), divided by their sum × 100] were logit transformed. We created two orthogonal principal components that summarized iAs, MMA, and DMA and were also phenotypes for genetic analyses. Linear regression was performed for each phenotype, dependent on allele dosage of the variant. Models accounted for familial relatedness and were adjusted for age, sex, total arsenic levels, and population stratification. Single nucleotide polymorphism (SNP) associations were stratified by study site and were meta-analyzed. Bonferroni correction was used to account for multiple testing. RESULTS Variants at 10q24 were statistically significant for all percent arsenic species and principal components of arsenic species. The index SNP for iAs%, MMA%, and DMA% (rs12768205) and for the principal components (rs3740394, rs3740393) were located near AS3MT, whose gene product catalyzes methylation of iAs to MMA and DMA. Among the candidate arsenic variant associations, functional SNPs in AS3MT and 10q24 were most significant (p < 9.33 × 10-5). CONCLUSIONS This hypothesis-driven association study supports the role of common variants in arsenic metabolism, particularly AS3MT and 10q24. Citation: Balakrishnan P, Vaidya D, Franceschini N, Voruganti VS, Gribble MO, Haack K, Laston S, Umans JG, Francesconi KA, Goessler W, North KE, Lee E, Yracheta J, Best LG, MacCluer JW, Kent J Jr., Cole SA, Navas-Acien A. 2017. Association of cardiometabolic genes with arsenic metabolism biomarkers in American Indian communities: the Strong Heart Family Study (SHFS). Environ Health Perspect 125:15-22; http://dx.doi.org/10.1289/EHP251.
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Affiliation(s)
- Poojitha Balakrishnan
- Department of Environmental Health Sciences, and
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- The Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Dhananjay Vaidya
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Clinical and Translational Research, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - V. Saroja Voruganti
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- UNC Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, North Carolina, USA
| | - Matthew O. Gribble
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Karin Haack
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, Texas, USA
| | - Sandra Laston
- South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley, Brownsville, Texas, USA
| | - Jason G. Umans
- MedStar Health Research Institute, Hyattsville, Maryland, USA
- Georgetown and Howard Universities Center for Clinical and Translational Science, Washington, DC, USA
| | | | - Walter Goessler
- Institute of Chemistry - Analytical Chemistry, University of Graz, Austria
| | | | - Elisa Lee
- Center for American Indian Health Research, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Joseph Yracheta
- Missouri Breaks Industries Research, Inc., Timber Lake, South Dakota, USA
| | - Lyle G. Best
- Missouri Breaks Industries Research, Inc., Timber Lake, South Dakota, USA
| | - Jean W. MacCluer
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, Texas, USA
| | - Jack Kent
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, Texas, USA
| | - Shelley A. Cole
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, Texas, USA
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, and
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- The Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Garimella PS, Balakrishnan P, Ammakkanavar NR, Patel S, Patel A, Konstantinidis I, Annapureddy N, Nadkarni GN. Impact of dialysis requirement on outcomes in tumor lysis syndrome. Nephrology (Carlton) 2016; 22:85-88. [DOI: 10.1111/nep.12806] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 04/19/2016] [Accepted: 04/21/2016] [Indexed: 12/13/2022]
Affiliation(s)
| | - Poojitha Balakrishnan
- Department of Environmental Health Sciences, Bloomberg School of Public Health; Johns Hopkins University; Baltimore MD
| | - Natraj R. Ammakkanavar
- Division of Hematology and Oncology; Indiana University School of Medicine; Indianapolis IN
| | - Shanti Patel
- Division of Nephrology, Department of Medicine; Icahn School of Medicine at Mount Sinai; New York NY
| | - Achint Patel
- Division of Nephrology, Department of Medicine; Icahn School of Medicine at Mount Sinai; New York NY
| | - Ioannis Konstantinidis
- Division of Nephrology, Department of Medicine; Icahn School of Medicine at Mount Sinai; New York NY
| | | | - Girish N. Nadkarni
- Division of Nephrology, Department of Medicine; Icahn School of Medicine at Mount Sinai; New York NY
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Tin A, Balakrishnan P, Beaty TH, Boerwinkle E, Hoogeveen RC, Young JH, Kao WHL. GCKR and PPP1R3B identified as genome-wide significant loci for plasma lactate: the Atherosclerosis Risk in Communities (ARIC) study. Diabet Med 2016; 33:968-75. [PMID: 26433129 PMCID: PMC4819009 DOI: 10.1111/dme.12971] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2015] [Indexed: 12/22/2022]
Abstract
AIM To investigate the genetic influence of circulating lactate level, a marker of oxidative capacity associated with diabetes. METHODS We conducted a genome-wide association study of log-transformed plasma lactate levels in 6901 European-American participants in the Atherosclerosis Risk in Communities study. For regions that achieved genome-wide significance in European-American participants, we conducted candidate region analysis in African-American subjects and tested for interaction between metformin use and the index single nucleotide polymorphisms for plasma lactate in European-American subjects. RESULTS The genome-wide association study in European-American subjects identified two genome-wide significant loci, GCKR (rs1260326, T allele β=0.08; P=1.8×10(-47) ) and PPP1R3B/LOC157273 (rs9987289, A allele β=0.06; P=1.6×10(-9) ). The index single nucleotide polymorphisms in these two loci explain 3.3% of the variance in log-transformed plasma lactate levels among the European-American subjects. In the African-American subjects, based on a region-significant threshold, the index single nucleotide polymorphism at GCKR was associated with plasma lactate but that at PPP1R3B/LOC157273 was not. Metformin use appeared to strengthen the association between the index single nucleotide polymorphism at PPP1R3B/LOC157273 and plasma lactate in European-American subjects (P for interaction=0.01). CONCLUSIONS We identified GCKR and PPP1R3B/LOC157273 as two genome-wide significant loci of plasma lactate. Both loci are associated with other diabetes-related phenotypes. These findings increase our understanding of the genetic control of lactate metabolism.
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Affiliation(s)
- A Tin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - P Balakrishnan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - T H Beaty
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - E Boerwinkle
- Human Genetics Center, University of Texas School of Public Health, Houston, TX, USA
| | - R C Hoogeveen
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - J H Young
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Medicine, The Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - W H L Kao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Joyee AG, Thyagarajan SP, Rajendran P, Hari R, Balakrishnan P, Jeyaseelan L, Kurien T. Chlamydia trachomatis genital infection in apparently healthy adult population of Tamil Nadu, India: a population-based study. Int J STD AIDS 2016; 15:51-5. [PMID: 14769173 DOI: 10.1258/095646204322637272] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Since the epidemiology of Chlamydia trachomatis infection in apparently healthy population has not been studied in India, a population-based study was conducted in the state of Tamil Nadu, India in order to analyse the prevalence of genital chlamydial infections in the community and to implement control programmes. A representative sample was taken from three randomly selected districts by using the 'probability proportional to size' cluster survey method. Households were the basic units of clusters. Adults aged 15-45 years, pre-identified from the selected households were enrolled during the medical camps conducted for a major study on community prevalence of sexually transmitted diseases in Tamil Nadu. Blood and urine samples collected from the study subjects were tested by enzyme-linked immunosorbent assay (ELISA) for anti-chlamydial IgM antibodies and by the commercial Amplicor polymerase chain reaction (PCR) test for chlamydial DNA. The prevalence of anti- C. trachomatis antibodies determined by IgM-ELISA was 2.4% (95% CI 1.6%-3.2%). The prevalence of genital chlamydial infection determined by PCR was 1.1% (95% CI 0.5%-1.7%). Majority of the detected infections (68.8%) were asymptomatic. This is the first Indian report on the prevalence of genital chlamydial infections in the general population. It is concluded that this study provides evidence for a substantial burden of approximately 10 million asymptomatic genital chlamydial infection cases in the sexually active age groups in the general population of India.
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Affiliation(s)
- A G Joyee
- Department of Microbiology, Dr. ALM Post Graduate Institute of Basic Medical Sciences, University of Madras, Taramani, Chennai, India 600 113
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Garimella PS, Balakrishnan P, Annapureddy N, Patel A, Patel S, Kumar Agarwal S, Nadkarni G. TEMPORAL TRENDS AND COMPLICATIONS ASSOCIATED WITH LOWER LIMB REVASCULARIZATION IN PATIENTS ON DIALYSIS. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)32310-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Subashini D, Dinesha T, Gomathi S, Boobalan J, Swathirajan C, Samuel L, Poongulali S, Chitra D, Srirama R, Mothi S, Solomon S, Solomon S, Saravanan S, Balakrishnan P. Mitochondrial dysfunction among HIV-1 infected patients of South India and evaluation of mitochondrial DNA as a biomarker of mitochondrial toxicity. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.601] [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: 11/24/2022] Open
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Boobalan J, Dinesha T, Balakrishnan P, Sivamalar S, Murugavel K, Poongulali S, Kumarasamy N, Solomon S, Solomon S, Saravanan S. Prevalence and risk factors associated with immunological non-response in HIV-1 infected patients treated with NNRTI based first line drugs in South India. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.567] [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: 11/28/2022] Open
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Paneerselvam N, Iqbal S, Solomon S, Solomon S, Montefiori D, Balakrishnan P. Elite neutralizers among HIV-1 Subtype-C infected individuals from southern India. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.597] [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: 11/29/2022] Open
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Sivamalar S, Dinesha T, Gomathi S, Boobalan J, Pradeep A, Poongulali S, Solomon S, Solomon S, Balakrishnan P, Saravanan S. Pattern of HIV-1 drug resistance mutations among patients failing thymidine analogue and non-thymidine analogue based first-line failure in South India. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.106] [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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Dinesha T, Sivamalar S, Gomathi S, Boobalan J, Poongulali S, Kumarasamy N, Balakrishnan P, Solomon S, Solomon S, katzenstein D, Kantor R, Saravanan S. Archived drug resistance profile among suppressed HIV patients using conventional and sensitive allele specific PCR in Tenofovir experienced patients in South India. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.573] [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: 11/28/2022] Open
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Gribble MO, Voruganti VS, Cole SA, Haack K, Balakrishnan P, Laston SL, Tellez-Plaza M, Francesconi KA, Goessler W, Umans JG, Thomas DC, Gilliland F, North KE, Franceschini N, Navas-Acien A. Linkage Analysis of Urine Arsenic Species Patterns in the Strong Heart Family Study. Toxicol Sci 2015. [PMID: 26209557 DOI: 10.1093/toxsci/kfv164] [Citation(s) in RCA: 14] [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] [Indexed: 12/13/2022] Open
Abstract
Arsenic toxicokinetics are important for disease risks in exposed populations, but genetic determinants are not fully understood. We examined urine arsenic species patterns measured by HPLC-ICPMS among 2189 Strong Heart Study participants 18 years of age and older with data on ~400 genome-wide microsatellite markers spaced ~10 cM and arsenic speciation (683 participants from Arizona, 684 from Oklahoma, and 822 from North and South Dakota). We logit-transformed % arsenic species (% inorganic arsenic, %MMA, and %DMA) and also conducted principal component analyses of the logit % arsenic species. We used inverse-normalized residuals from multivariable-adjusted polygenic heritability analysis for multipoint variance components linkage analysis. We also examined the contribution of polymorphisms in the arsenic metabolism gene AS3MT via conditional linkage analysis. We localized a quantitative trait locus (QTL) on chromosome 10 (LOD 4.12 for %MMA, 4.65 for %DMA, and 4.84 for the first principal component of logit % arsenic species). This peak was partially but not fully explained by measured AS3MT variants. We also localized a QTL for the second principal component of logit % arsenic species on chromosome 5 (LOD 4.21) that was not evident from considering % arsenic species individually. Some other loci were suggestive or significant for 1 geographical area but not overall across all areas, indicating possible locus heterogeneity. This genome-wide linkage scan suggests genetic determinants of arsenic toxicokinetics to be identified by future fine-mapping, and illustrates the utility of principal component analysis as a novel approach that considers % arsenic species jointly.
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Affiliation(s)
- Matthew O Gribble
- *Department of Preventive Medicine, University of Southern California, Los Angeles, California;
| | - Venkata Saroja Voruganti
- Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina; UNC Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, North Carolina
| | - Shelley A Cole
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, Texas
| | - Karin Haack
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, Texas
| | - Poojitha Balakrishnan
- Department of Environmental Health Sciences, Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Sandra L Laston
- South Texas Diabetes and Obesity Institute, University of Texas Health Science Center, San Antonio-Regional Academic Health Center, Brownsville, Texas
| | - Maria Tellez-Plaza
- Department of Environmental Health Sciences, Johns Hopkins University, Baltimore, Maryland; Biomedical Research Institute, Hospital Clinic de Valencia-INCLIVA, Valencia, Spain
| | - Kevin A Francesconi
- Institute of Chemistry-Analytical Chemistry, University of Graz, Graz, Austria
| | - Walter Goessler
- Institute of Chemistry-Analytical Chemistry, University of Graz, Graz, Austria
| | - Jason G Umans
- Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, District of Columbia; MedStar Health Research Institute, Hyattsville, Maryland
| | - Duncan C Thomas
- *Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | - Frank Gilliland
- *Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | - Kari E North
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Nora Franceschini
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Medical Institutions, Baltimore, Maryland; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland; Department of Oncology, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Kuo CC, Balakrishnan P, Hsein YC, Wu VC, Chueh SCJ, Chen YM, Wu KD, Wang MJ. The value of losartan suppression test in the confirmatory diagnosis of primary aldosteronism in patients over 50 years old. J Renin Angiotensin Aldosterone Syst 2014; 16:587-98. [PMID: 25031295 DOI: 10.1177/1470320313498632] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 06/08/2013] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The diagnosis of primary aldosteronism (PA) among the older-aged population has posed a crucial challenge. Among patients over 50 years old, this trial assessed comparability of the performance of two PA diagnostic tests: losartan and captopril suppression tests. METHODS A post-hoc subgroup analysis from a prospective cohort was conducted by the TAIPAI (Taiwan Primary Aldosteronism Investigation) group between July 2003 and July 2006. Of the 160 patients in the cohort, 60 patients over 50 years old received captopril and losartan tests to confirm PA. RESULTS Among the 60 patients over 50 years old, 31 patients had PA confirmed by standardized protocol. The area under the receiver-operating characteristic (ROC) curve for post-captopril aldosterone was significantly less than that for post-losartan plasma aldosterone concentration (PAC) (0.87 vs 0.94, p=0.02). Using the aldosterone-renin ratio (ARR)>35 with PAC>10 ng/dl, the specificity was 82.76% vs 93.1% and the sensitivity was 77.42% vs 87.10% for the captopril and losartan tests, respectively. The equivalence between the two tests were confirmed by the exact McNemar's test (p=1.0). CONCLUSION The losartan test showed comparable accuracy to confirm PA. Verification of this "elderly-friendly" confirmatory test will be the first step to prepare a specific diagnostic model of PA for the older-aged population.
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Affiliation(s)
- Chin-Chi Kuo
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | | | - Yenh-Chen Hsein
- Division of Clinical Pathology, National Taiwan University Hospital Yun-Lin Branch, Taiwan
| | - Vin-Cent Wu
- Department of Internal Medicine, National Taiwan University Hospital, and College of Medicine, National Taiwan University, Taiwan
| | - Shih-Chieh Jeff Chueh
- Cleveland Clinic Lerner College of Medicine and Glickman Urological and Kidney Institute, Cleveland Clinic, USA
| | - Yung-Ming Chen
- Department of Internal Medicine, National Taiwan University Hospital, and College of Medicine, National Taiwan University, Taiwan
| | - Kwan-Dun Wu
- Department of Internal Medicine, National Taiwan University Hospital, and College of Medicine, National Taiwan University, Taiwan
| | - Ming-Jiuh Wang
- Department of Anesthesiology and Forensic Medicine, National Taiwan University Hospital, Taiwan
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Nandagopal P, Iqbal HS, Saravanan S, Solomon SS, Mehta S, Selvakumar M, Chandrasekhar E, Solomon S, Balakrishnan P. Evaluation of dried blood spot as an alternative specimen for the diagnosis of anti-HCV in resource-limited settings. Indian J Med Microbiol 2014; 32:208-10. [DOI: 10.4103/0255-0857.129867] [Citation(s) in RCA: 4] [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: 11/04/2022]
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Maruthur NM, Gribble MO, Bennett WL, Bolen S, Wilson LM, Balakrishnan P, Sahu A, Bass E, Kao WHL, Clark JM. The pharmacogenetics of type 2 diabetes: a systematic review. Diabetes Care 2014; 37:876-86. [PMID: 24558078 PMCID: PMC3931386 DOI: 10.2337/dc13-1276] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We performed a systematic review to identify which genetic variants predict response to diabetes medications. RESEARCH DESIGN AND METHODS We performed a search of electronic databases (PubMed, EMBASE, and Cochrane Database) and a manual search to identify original, longitudinal studies of the effect of diabetes medications on incident diabetes, HbA1c, fasting glucose, and postprandial glucose in prediabetes or type 2 diabetes by genetic variation. Two investigators reviewed titles, abstracts, and articles independently. Two investigators abstracted data sequentially and evaluated study quality independently. Quality evaluations were based on the Strengthening the Reporting of Genetic Association Studies guidelines and Human Genome Epidemiology Network guidance. RESULTS Of 7,279 citations, we included 34 articles (N = 10,407) evaluating metformin (n = 14), sulfonylureas (n = 4), repaglinide (n = 8), pioglitazone (n = 3), rosiglitazone (n = 4), and acarbose (n = 4). Studies were not standalone randomized controlled trials, and most evaluated patients with diabetes. Significant medication-gene interactions for glycemic outcomes included 1) metformin and the SLC22A1, SLC22A2, SLC47A1, PRKAB2, PRKAA2, PRKAA1, and STK11 loci; 2) sulfonylureas and the CYP2C9 and TCF7L2 loci; 3) repaglinide and the KCNJ11, SLC30A8, NEUROD1/BETA2, UCP2, and PAX4 loci; 4) pioglitazone and the PPARG2 and PTPRD loci; 5) rosiglitazone and the KCNQ1 and RBP4 loci; and 5) acarbose and the PPARA, HNF4A, LIPC, and PPARGC1A loci. Data were insufficient for meta-analysis. CONCLUSIONS We found evidence of pharmacogenetic interactions for metformin, sulfonylureas, repaglinide, thiazolidinediones, and acarbose consistent with their pharmacokinetics and pharmacodynamics. While high-quality controlled studies with prespecified analyses are still lacking, our results bring the promise of personalized medicine in diabetes one step closer to fruition.
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Schaap AP, Siddiqui S, Balakrishnan P, Lopez L, Gagnon SD. Cosensitized Electron-Transfer Photooxygenation of Epoxides. A New Synthesis of Ozonides. Isr J Chem 2013. [DOI: 10.1002/ijch.198300060] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Solomon S, Balakrishnan P, Vignesh R, Waldrop G, Solomon SS, Murugavel KG, Kumarasamy N, Yepthomi T, Poongulali S, Swathirajan CR, Sreenivasan V, Chandrasekar C, Suriakumar J, Mahilmaran A, Manoharan G, Moore DAJ. A rapid and low-cost microscopic observation drug susceptibility assay for detecting TB and MDR-TB among individuals infected by HIV in South India. Indian J Med Microbiol 2013; 31:130-7. [PMID: 23867668 DOI: 10.4103/0255-0857.115225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The converging epidemics of HIV and tuberculosis (TB) pose one of the greatest public health challenges of our time. Rapid diagnosis of TB is essential in view of its infectious nature, high burden of cases, and emergence of drug resistance. OBJECTIVE The purpose of this present study was to evaluate the feasibility of implementing the microscopic observation drug susceptibility (MODS) assay, a novel assay for the diagnosis of TB and multi-drug-resistant tuberculosis (MDR-TB) directly from sputum specimens, in the Indian setting. MATERIALS AND METHODS This study involved a cross-sectional, blinded assessment of the MODS assay on 1036 suspected cases of pulmonary TB in HIV-positive and HIV-negative patients against the radiometric method, BD-BACTEC TB 460 system. RESULTS Overall, the sensitivity, specificity, positive predictive value, and negative predictive value of the MODS assay in detecting MTB among TB suspected patients were 89.1%, 99.1%, 94.2%, 95.8%, respectively. In addition, in the diagnosis of drug-resistant TB, the MODS assay was 84.2% sensitive for those specimens reporting MDR, 87% sensitivity for those specimens reporting INH mono-resistance, and 100% sensitive for specimens reporting RIF mono-resistance. The median time to detection of TB in the MODS assay versus BACTEC was 9 versus 21 days (P<0.001). CONCLUSION Costing 5 to 10 times lesser than the automated culture methods, the MODS assay has the potential clinical utility as a simple and rapid method. It could be effectively used as an alternative method for diagnosing TB and detection of MDR-TB in a timely and affordable way in resource-limited settings.
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Affiliation(s)
- S Solomon
- Infectious Diseases Laboratory, YRG Centre for AIDS Research and Education (YRG CARE), Chennai, India
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