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Shewade HD, Frederick A, Kalyanasundaram M, Chadwick J, Kiruthika G, Rajasekar TD, Gayathri K, Vijayaprabha R, Sabarinathan R, Shivakumar SVBY, Jeyashree K, Bhavani PK, Aarthi S, Suma KV, Pathinathan DP, Parthasarathy R, Nivetha MB, Thampi JG, Chidambaram D, Bhatnagar T, Lokesh S, Devika S, Laux TS, Viswanathan S, Sridhar R, Krishnamoorthy K, Sakthivel M, Karunakaran S, Rajkumar S, Ramachandran M, Kanagaraj KD, Kaleeswari M, Durai VP, Saravanan R, Sugantha A, Khan SZHM, Sangeetha P, Vasudevan R, Nedunchezhian R, Sankari M, Jeevanandam N, Ganapathy S, Rajasekaran V, Mathavi T, Rajaprakash AR, Murali L, Pugal U, Sundaralingam K, Savithri S, Vellasamy S, Dheenadayal D, Ashok P, Jayasree K, Sudhakar R, Rajan KP, Tharageshwari N, Chokkalingam D, Anandrajkumar SM, Selvavinayagam TS, Padmapriyadarsini C, Ramachandran R, Murhekar MV. --Eleven tips for operational researchers working with health programmes: our experience based on implementing differentiated tuberculosis care in south India. Glob Health Action 2023; 16:2161231. [PMID: 36621943 PMCID: PMC9833404 DOI: 10.1080/16549716.2022.2161231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Due to the workload and lack of a critical mass of trained operational researchers within their ranks, health systems and programmes may not be able to dedicate sufficient time to conducting operational research (OR). Hence, they may need the technical support of operational researchers from research/academic organisations. Additionally, there is a knowledge gap regarding implementing differentiated tuberculosis (TB) care in programme settings. In this 'how we did it' paper, we share our experience of implementing a differentiated TB care model along with an inbuilt OR component in Tamil Nadu, a southern state in India. This was a health system initiative through a collaboration of the State TB cell with the Indian Council of Medical Research institutes and the World Health Organisation country office in India. The learnings are in the form of eleven tips: four broad principles (OR on priority areas and make it a health system initiative, implement simple and holistic ideas, embed OR within routine programme settings, aim for long-term engagement), four related to strategic planning (big team of investigators, joint leadership, decentralised decision-making, working in advance) and three about implementation planning (conducting pilots, smart use of e-tools and operational research publications at frequent intervals). These may act as a guide for other Indian states, high TB burden countries that want to implement differentiated care, and for operational researchers in providing technical assistance for strengthening implementation and conducting OR in health systems and programmes (TB or other health programmes). Following these tips may increase the chances of i) an enriching engagement, ii) policy/practice change, and iii) sustainable implementation.
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Affiliation(s)
- Hemant Deepak Shewade
- ICMR – National Institute of Epidemiology, Chennai, India,CONTACT Hemant Deepak Shewade ; Department of Health Research, Government of India, ICMR-National Institute of Epidemiology, R-127, Second Main Road, TNHB, Ayapakkam, Chennai600077, India
| | | | | | | | - G. Kiruthika
- ICMR – National Institute of Epidemiology, Chennai, India
| | | | - K. Gayathri
- ICMR – National Institute of Epidemiology, Chennai, India
| | | | | | | | | | - P. K. Bhavani
- ICMR – National Institute for Research in Tuberculosis, Chennai, India
| | - S. Aarthi
- State TB Cell, Government of Tamil Nadu, Chennai, India
| | - K. V. Suma
- The WHO Country Office for India, New Delhi, India
| | | | | | | | | | | | | | - S. Lokesh
- ICMR – National Institute of Epidemiology, Chennai, India
| | | | | | - Stalin Viswanathan
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - R. Sridhar
- Government Hospital of Thoracic Medicine, Tambaram, India
| | - K. Krishnamoorthy
- Department of Respiratory Medicine, Tirunelveli Medical College Hospital, Tirunelveli, India
| | - M. Sakthivel
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - S. Karunakaran
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - S. Rajkumar
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - M. Ramachandran
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - K. D. Kanagaraj
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - M. Kaleeswari
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - V. P. Durai
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - R. Saravanan
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - A. Sugantha
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | | | - P. Sangeetha
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - R. Vasudevan
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - R. Nedunchezhian
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - M. Sankari
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - N. Jeevanandam
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - S. Ganapathy
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - V. Rajasekaran
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - T. Mathavi
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - A. R. Rajaprakash
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - Lakshmi Murali
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - U. Pugal
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - K. Sundaralingam
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - S. Savithri
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - S. Vellasamy
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - D. Dheenadayal
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - P. Ashok
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - K. Jayasree
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - R. Sudhakar
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - K. P. Rajan
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | | | | | | | - T. S. Selvavinayagam
- Directorate of Public Health and Preventive Medicine, Government of Tamil Nadu, Chennai, India
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Shewade HD, Frederick A, Kiruthika G, Kalyanasundaram M, Chadwick J, Rajasekar TD, Gayathri K, Vijayaprabha R, Sabarinathan R, Kathiresan J, Bhavani P, Aarthi S, Suma K, Pathinathan DP, Parthasarathy R, Nivetha MB, Thampi JG, Chidambaram D, Bhatnagar T, Lokesh S, Devika S, Laux TS, Viswanathan S, Sridhar R, Krishnamoorthy K, Sakthivel M, Karunakaran S, Rajkumar S, Ramachandran M, Kanagaraj K, Kaleeswari M, Durai V, Saravanan R, Sugantha A, Khan SZHM, Sangeetha P, Vasudevan R, Nedunchezhian R, Sankari M, Jeevanandam N, Ganapathy S, Rajasekaran V, Mathavi T, Rajaprakash A, Murali L, Pugal U, Sundaralingam K, Savithri S, Vellasamy S, Dheenadayal D, Ashok P, Jayasree K, Sudhakar R, Rajan K, Tharageshwari N, Chokkalingam D, Anandrajkumar S, Selvavinayagam T, Padmapriyadarshini C, Ramachandran R, Murhekar MV. The First Differentiated TB Care Model From India: Delays and Predictors of Losses in the Care Cascade. Glob Health Sci Pract 2023; 11:e2200505. [PMID: 37116929 PMCID: PMC10141439 DOI: 10.9745/ghsp-d-22-00505] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/07/2023] [Indexed: 04/03/2023]
Abstract
To reduce TB deaths in resource-limited settings, a differentiated care strategy can be used to triage patients with high risk of severe illness (i.e., those with very severe undernutrition, respiratory insufficiency, or inability to stand without support) at diagnosis and refer them for comprehensive assessment and inpatient care. Globally, there are few examples of implementing this type of strategy in routine program settings. Beginning in April 2022, the Indian state of Tamil Nadu implemented a differentiated care strategy called Tamil Nadu-Kasanoi Erappila Thittam (TN-KET) for all adults aged 15 years and older with drug-susceptible TB notified by public facilities. Before evaluating the impact on TB deaths, we sought to understand the retention and delays in the care cascade as well as predictors of losses. During April-June 2022, 14,961 TB patients were notified and 11,599 (78%) were triaged. Of those triaged, 1,509 (13%) were at high risk of severe illness; of these, 1,128 (75%) were comprehensively assessed at a nodal inpatient care facility. Of 993 confirmed as severely ill, 909 (92%) were admitted, with 8% unfavorable admission outcomes (4% deaths). Median admission duration was 4 days. From diagnosis, the median delay in triaging and admission of severely ill patients was 1 day each. Likelihood of triaging decreased for people with extrapulmonary TB, those diagnosed in high-notification districts or teaching hospitals, and those transferred out of district. Predictors of not being comprehensively assessed included: aged 25-34 years, able to stand without support, and diagnosis at a primary or secondary-level facility. Inability to stand without support was a predictor of unfavorable admission outcomes. To conclude, the first quarter of implementation suggests that TN-KET was feasible to implement but could be improved by addressing predictors of losses in the care cascade and increasing admission duration.
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Affiliation(s)
- Hemant Deepak Shewade
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | | | - G. Kiruthika
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | | | - Joshua Chadwick
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | - T. Daniel Rajasekar
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | - K. Gayathri
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | - R. Vijayaprabha
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | - R. Sabarinathan
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | - Jeyashree Kathiresan
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | - P.K. Bhavani
- Indian Council of Medical Research, National Institute for Research in Tuberculosis, Chennai, India
| | - S. Aarthi
- State TB Cell, Government of Tamil Nadu, Chennai, India
| | - K.V. Suma
- World Health Organization Country Office for India, New Delhi, India
| | | | | | | | - Jerome G. Thampi
- World Health Organization Country Office for India, New Delhi, India
| | | | - Tarun Bhatnagar
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | - S. Lokesh
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | | | | | - Stalin Viswanathan
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - R. Sridhar
- Government Hospital of Thoracic Medicine, Tambaram, India
| | | | - M. Sakthivel
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - S. Karunakaran
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - S. Rajkumar
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - M. Ramachandran
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - K.D. Kanagaraj
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - M. Kaleeswari
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - V.P. Durai
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - R. Saravanan
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - A. Sugantha
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | | | - P. Sangeetha
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - R. Vasudevan
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - R. Nedunchezhian
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - M. Sankari
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - N. Jeevanandam
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - S. Ganapathy
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - V. Rajasekaran
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - T. Mathavi
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - A.R. Rajaprakash
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - Lakshmi Murali
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - U. Pugal
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - K. Sundaralingam
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - S. Savithri
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - S. Vellasamy
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - D. Dheenadayal
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - P. Ashok
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - K. Jayasree
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - R. Sudhakar
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - K.P. Rajan
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | | | - D. Chokkalingam
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | | | - T.S. Selvavinayagam
- Directorate of Public Health and Preventive Medicine, Government of Tamil Nadu, Chennai, India
| | - C. Padmapriyadarshini
- Indian Council of Medical Research, National Institute for Research in Tuberculosis, Chennai, India
| | | | - Manoj V. Murhekar
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
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Shabana FS, Sudhakar R, Ravishankar P, Venugopalan V, Satheesh B, Devi R. LOW-GRADE PAPILLARY ADENOCARCINOMA: A RARE ENTITY. Oral Surg Oral Med Oral Pathol Oral Radiol 2021. [DOI: 10.1016/j.oooo.2021.03.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Thirumarai Selvi C, Amudha J, Sudhakar R. A modified salp swarm algorithm (SSA) combined with a chaotic coupled map lattices (CML) approach for the secured encryption and compression of medical images during data transmission. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102465] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Veeraiah S, Sudhakar R, Tripathy JP, Sankar D, Usharani A, Ramakrishnan S, Selvam J, Nagarajan G, Prabhakar DS, Swaminathan R. Tobacco use and quitting behaviour during COVID-19 lockdown. Int J Tuberc Lung Dis 2021; 25:247-249. [PMID: 33688818 DOI: 10.5588/ijtld.20.0728] [Citation(s) in RCA: 3] [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: 11/10/2022] Open
Affiliation(s)
| | | | - J P Tripathy
- Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, India
| | - D Sankar
- Cancer Institute (WIA), Chennai, India
| | | | | | - J Selvam
- Cancer Institute (WIA), Chennai, India
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Rajalakshmi M, Kalaiselvan G, Sudhakar R, Dhikale PT. An exploratory mixed method study on the follow up status and quality of life among recurrent tuberculosis patients in South India. Indian J Tuberc 2020; 67:515-522. [PMID: 33077053 DOI: 10.1016/j.ijtb.2020.07.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/24/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION After completion of treatment of Tuberculosis (TB), many patients can have long-term physical sequelae, which in some cases results in life-long impairment and further stigma. OBJECTIVES To determine the follow up status and quality of life of post-treatment among Category 2 TB patients under RNTCP and to explore the factors affecting the Quality of Life. MATERIAL AND METHODS The present study was done in urban area of Villupuram district of Tamil Nadu using Exploratory mixed methods study design. In the first phase case-control study was conducted with 100 post treatment category 2 TB patients (cases) and 100 non-TB patients (controls) matched for age and gender. The quality of life of the respondents was assessed by (WHOQOL-BREF) questionnaire (Quantitative), followed by five in-depth interviews among cases with extreme scores (Qualitative). RESULTS The mean scores of "perceived physical health" and "perceived psychological health" among cases after completion of treatment was significantly lower than the mean scores in controls. The determinants for perceived physical health were age, years of education and marital status. The determinants for psychological health were age, marital status and associated comorbidities. In-depth interview explored that major perspectives of cases affecting quality of life were side effects of drugs, loss of social support, loss of employment and psychological factors like anxiety, depression. CONCLUSIONS HR-QOL among post treatment TB patients was reduced. Efforts should be made to counsel TB patients, family members, relatives and their workplace regarding their care, support and challenges to have a reasonable QOL.
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Affiliation(s)
- M Rajalakshmi
- Department of Community Medicine, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry, India.
| | - G Kalaiselvan
- Department of Community Medicine, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry, India
| | - R Sudhakar
- District Tuberculosis Office, Villupuram, India
| | - P T Dhikale
- Department of Community Medicine, Hindu Hruday Samrat Balasaheb Thackarey Medical College (HBTMC) and Dr Rustom Narsi Cooper Municipal General Hospital, India
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Platter L, Urbano G, Roberto L, Sudhakar R, Tablizo M. 0902 The Use Of Auto-titrating Continuous Positive Airway Pressure (auto Cpap) For Obstructive Sleep Apnea In Children With Neurological Disorder. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Multiple studies have demonstrated the effectiveness of auto-titrating continuous positive airway pressure (auto CPAP) in the adult population, but there is limited literature on the use of auto CPAP in the pediatric population. Specifically, the use of auto CPAP in children with neurological disorder(s) has not been established. Thus, we conducted a study to review the use of auto CPAP in children ages 18 years old and younger with Obstructive Sleep Apnea Syndrome (OSAS) and associated neurological disorder to document its effectiveness, adverse events and outcomes of its use.
Methods
A retrospective chart review was performed on patients 18 yo and younger diagnosed with OSAS and associated neurological disorder(s) who have good compliance with auto CPAP use. Good compliance was defined as >4 hours/night and >20/30 days of auto CPAP use. Compliance from the most recent 30 days was downloaded.
Results
5 children met our criteria for inclusion, with a mean age of 11 years (6-18 years old). All had initial baseline sleep studies performed without PAP titration polysomnography. Associated neurological disorders were cerebral palsy, Arnold Chiari Malformation, seizure disorder and intellectual disability. The average length of use of auto CPAP was 4 months. Auto CPAP was used on average of 24/30 nights, with a mean of 7.35 hours/night. The mean baseline obstructive apnea-hypopnea (OAHI) index was 42 (8.2-94.4). The mean AHI on a 30 day download report showed a mean decrease in AHI to 2.9 (0.5-5.2) while on auto CPAP. Review of patient charts did not reveal any adverse outcomes associated with the use of auto CPAP in these patients.
Conclusion
This study showed that auto CPAP significantly improved the AHI in pediatric patients treated for OSA with associated neurological disorder. There were no reported adverse outcomes. Further research is needed to establish the effectiveness and safety of auto CPAP use in the pediatric population, specifically those with neurological disorder. The use of auto CPAP will help decrease the wait time for treatment in children with OSA. These patients can use auto CPAP while waiting for a titration study and for long term use.
Support
none
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Affiliation(s)
- L Platter
- Valley Children’s Healthcare Department of Pediatrics, Madera, CA
| | - G Urbano
- Ateneo University Medical School, Manila, PHILIPPINES
| | - L Roberto
- Valley Children’s Health Care Division of Pulmonary and Sleep, Madera, CA
| | - R Sudhakar
- Valley Children’s Health Care Division of Pulmonary and Sleep, Madera, CA
| | - M Tablizo
- Valley Children’s Health Care Division of Pulmonary and Sleep, Madera, CA
- Stanford University, Palo Alto, CA
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Tan J, Thiagarajan S, Schultz C, Sudhakar R, Hillis G, Marangou J. Assessment of Cardiac Contusion in Motor Vehicle Accident Patients. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Amudha J, Sudhakar R. A multi-resolution transform for deblurring of images in the presence of impulse noise for real-time images. IJBET 2017. [DOI: 10.1504/ijbet.2017.10003486] [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: 11/21/2022]
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Abstract
Background: The cementodentinal junction (CDJ) forms a biological and structural link between cementum and dentin. This biological link is regarded as a distinct tissue in its own right. Certain important proteins responsible for periodontal regeneration are said to be present in this tissue. Few studies have described the structure and composition of this layer by light and electron microscopy. Scanning electron microscopic studies pertaining to CDJ in health and disease are few and documentation of periodontal pathological changes of CDJ is unclear. In the first phase of our study, the collagenous architecture of CDJ of healthy teeth has been reported. Aim: The objective of this study is to observe and report periodontal pathological changes in the fibrous or collagenous architecture of CDJ of periodontitis-affected teeth and discuss the probable clinical implications of CDJ in disease. Materials and Methods: Twenty periodontitis-affected teeth were collected and processed for observing under a scanning electron microscope. Results: The results are as follows: Increased width of interface at CDJ in periodontitis samples (7.1 μ) compared to that of healthy samples; fewer areas of fiber intermingling at CDJ in periodontitis samples as compared to healthy samples; frequent detachment of cementum from dentin during sodium hydroxide maceration of samples. Conclusion: It may be inferred from results that there is a possibility of a definite weakening of CDJ in periodontally affected root surfaces and we believe that clinical procedures such as scaling and root planning may have a detrimental effect on the cementodentinal attachment of periodontally involved root surfaces.
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Affiliation(s)
- R Sudhakar
- Department of Oral Pathology, Sri Venkateshwaraa Dental College, Ariyur, Puducherry, India
| | - B Pratebha
- Department of Periodontics, Indira Gandhi Institute of Dental Sciences, SBVU, Puducherry, India
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Pratebha B, Jaikumar ND, Sudhakar R. Scanning electron microscopic observations of fibrous structure of cemento-dentinal junction in healthy teeth. Indian J Dent Res 2015; 25:758-61. [PMID: 25728109 DOI: 10.4103/0970-9290.152196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The cemento-dentinal junction (CDJ) is a structural and biologic link between cementum and dentin present in the roots of teeth. Conflicting reports about the origin, structure and composition of this layer are present in literature. The width of this junctional tissue is reported to be about 2-4 μm with adhesion of cementum and dentin by proteoglycans and by collagen fiber intermingling. AIM AND OBJECTIVE The objective of this study is to observe and report the fibrous architecture of the CDJ of healthy tooth roots. MATERIALS AND METHODS A total of 15 healthy teeth samples were collected, sectioned into halves, demineralized in 5% ethylenediaminetetraacetic acid, processed using NaOH maceration technique and observed under a scanning electron microscope. RESULTS The CDJ appeared to be a fibril poor groove with a width of 2-4 µm. Few areas of collagen fiber intermingling could be appreciated. A detailed observation of these tissues has been presented.
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Affiliation(s)
| | | | - R Sudhakar
- Department of Oral and Maxillofacial Pathology, Karpaga Vinayaga Institute of Dental Sciences, Chinna Kolambakkam, Palayanoor PO, Madhurantakam Taluk, Kanchipuram, Tamil Nadu, India
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Zirbes J, Hardy K, Sudhakar R, Salinas D, Saeed M, Kharrazi M, Milla C. 40 Longitudinal values of sweat chloride concentration among infants identified by cystic fibrosis (CF) newborn screening (NBS) in California. J Cyst Fibros 2013. [DOI: 10.1016/s1569-1993(13)60183-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Raghesh Krishnan K, Sudhakar R. Automatic Classification of Liver Diseases from Ultrasound Images Using GLRLM Texture Features. Soft Computing Applications 2013. [DOI: 10.1007/978-3-642-33941-7_54] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Abstract
Juvenile ossifying fibroma is an uncommon benign but aggressive fibroosseous lesion that affects the craniofacial skeleton. Their distinct clinical and histopathological features warrant the lesion to be considered as a separate entity from other fibro-osseous group of lesions such as fibrous dysplasia and cemento ossifying fibroma. Concomitant development of secondary aneurysmal bone cyst may rarely occur, which makes the lesion more aggressive and difficult to treat. We report a case of a 6 year old girl who was diagnosed with aneurysmal bone cyst during her earlier presentation at a private hospital and was treated for the same. The lesion recurred within 6 months. The second incisional biopsy specimen revealed features of trabecular variant of juvenile ossifying fibroma along with areas of aneurysmal bone cyst.
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Affiliation(s)
- S Sankaranarayanan
- Departments of Oral and Maxillofacial Pathology, Karpaga Vinayaga Institute of Dental Sciences, Chinna Kolambakkam, Kanchipuram Dt, India
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Abstract
Agenesis of lung is a rare congenital disorder. We are reporting varied degree of pulmonary agenesis in two adult patients.
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Affiliation(s)
- K H Kisku
- Department of Pulmonary Medicine, Pondicherry Institute of Medical Sciences, Pondicherry - 605014., India
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Vinod KN, Puttaswamy, Ninge Gowda KN, Sudhakar R. Isolation of Natural Colorants from Lagerstroemia indica: Kinetic and Adsorption Studies. CHINESE J CHEM 2010. [DOI: 10.1002/cjoc.201090191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Vinod KN, Swamy P, Gowda KN, Sudhakar R. Extraction, identification and adsorption-kinetic studies of a natural color component from G. sepium. ACTA ACUST UNITED AC 2010. [DOI: 10.4236/ns.2010.25058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Pokkali S, Rajavelu P, Sudhakar R, Das SD. Phenotypic modulation in Mycobacterium tuberculosis infected neutrophil during tuberculosis. Indian J Med Res 2009; 130:185-192. [PMID: 19797817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND & OBJECTIVE Polymorphonuclear leucocytes (PMN) or neutrophils infiltrate to the inflammatory sites and phagocytose mycobacteria thereby inhibiting the bacillary spread initially until the accumulated macrophages get activated. The present study was carried out to highlight the interaction of neutrophils with the two clinical isolates (S7 and S10) of Mycobacterium tuberculosis and the subsequent morphological changes. METHODS Dextran purified neutrophils from normal and TB patients infected with M. tuberculosis isolates were cultured for 3 and 18 h time points. At the end of termination, the cell surface expression of CD16, CD69, CXCR2 and induction of apoptosis were analyzed using flow cytometry. Cytokines and chemokines were estimated in supernatants by ELISA. RESULTS All infected PMN showed decrease in CD16 at both time points in normals while at 18 h in TB group. Interestingly, CD69 expression was significantly high at early time point in TB-PMN compared to normals. The high expression of CXCR2 was sustained in infected TB-PMN at both the time points. S7 and S10 infected neutrophils showed high phagocytic indices compared to H37Rv in both the groups. A significant increase in apoptosis was observed at both the time points in infected TB-PMN but only at 18 h in normals. Increased pro-inflammatory cytokine (TNF-alpha) and chemokine (IL-8) response was observed in infected neutrophils at 3 h in both the groups. INTERPRETATION & CONCLUSION This study demonstrates the varying degree of modulation of neutrophil functions in both the groups. TB-PMN was more competent in amplifying the innate immune response and conferring protection at the early phase of infection. However, the response was not strain specific in either of these groups.
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Affiliation(s)
- Supriya Pokkali
- Department of Immunology, Tuberculosis Research Centre (ICMR), Chennai, India
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Ramesh V, Balamurali PD, Nirima O, Premalatha B, Karthikshree V, Sudhakar R. Incidence of mast cells in oral inflammatory lesions: A pilot study. J Oral Maxillofac Pathol 2005. [DOI: 10.4103/0973-029x.39052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Wilson SR, Yamada EG, Sudhakar R, Roberto L, Mannino D, Mejia C, Huss N. A controlled trial of an environmental tobacco smoke reduction intervention in low-income children with asthma. Chest 2001; 120:1709-22. [PMID: 11713157 DOI: 10.1378/chest.120.5.1709] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
STUDY OBJECTIVES To determine the effectiveness of a cotinine-feedback, behaviorally based education intervention in reducing environmental tobacco smoke (ETS) exposure and health-care utilization of children with asthma. DESIGN Randomized controlled trial of educational intervention vs usual care. SETTING The pediatric pulmonary service of a regional pediatric hospital. PARTICIPANTS ETS-exposed, Medicaid/Medi-Cal-eligible, predominantly minority children who were 3 to 12 years old and who were seen for asthma in the hospital's emergency, inpatient, and outpatient services departments (n = 87). INTERVENTION Three nurse-led sessions employing behavior-changing strategies and basic asthma education and that incorporated repeated feedback on the child's urinary cotinine level. MEASUREMENTS The primary measurements were the urinary cotinine/creatinine ratio (CCR) and the number of acute asthma medical visits. The secondary measurements were number of hospitalizations, smoking restrictions in home, amount smoked, reported exposures of children, and asthma control. RESULTS The intervention was associated with a significantly lower odds ratio (OR) for more than one acute asthma medical visit in the follow-up year, after adjusting for baseline visits (total visits, 87; OR, 0.32; p = 0.03), and a comparably sized but nonsignificant OR for one or more hospitalization (OR, 0.34; p = 0.14). The follow-up CCR measurement and the determination of whether smoking was prohibited inside the home strongly favored the intervention group (n = 51) (mean difference in CCR adjusted for baseline, -0.38; p = 0.26; n = 51) (60; OR [for proportion of subjects prohibiting smoking], 0.24; p = 0.11; n = 60). CONCLUSIONS This intervention significantly reduced asthma health-care utilization in ETS-exposed, low-income, minority children. Effects sizes for urine cotinine and proportion prohibiting smoking were moderate to large but not statistically significant, possibly the result of reduced precision due to the loss of patients to active follow-up. Improving ETS reduction interventions and understanding their mechanism of action on asthma outcomes requires further controlled trials that measure ETS exposure and behavioral and disease outcomes concurrently.
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Affiliation(s)
- S R Wilson
- Department of Health Services Research, Palo Alto Medical Foundation Research Institute, Palo Alto, CA 94301, USA.
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Affiliation(s)
- R. Sudhakar
- Dept, of Studies in Sericulture, Bangalore University
| | | | - G. Venu
- Centre for Applied Genetics, Bangalore University
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Venugopal K, Pandya A, Sudhakar R. A recurrent neural network controller and learning algorithm for the on-line learning control of autonomous underwater vehicles. Neural Netw 1994. [DOI: 10.1016/0893-6080(94)90104-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Hanqi Zhuang, Roth Z, Sudhakar R. Simultaneous robot/world and tool/flange calibration by solving homogeneous transformation equations of the form AX=YB. ACTA ACUST UNITED AC 1994. [DOI: 10.1109/70.313105] [Citation(s) in RCA: 140] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
The stochastical aspects of noise-perturbed neuronal dynamics are studied via the Fokker-Planck equation by considering the Langevin-type relaxational, nonlinear process associated with neuronal states. On the basis of a canonical, stochastically driven, dichotomous state modeling, the equilibrium conditions in the neuronal assembly are analyzed. The markovian structure of the random occurrence of action potentials due to the disturbances (noise) in the neuronal state is considered, and the corresponding solutions relevant to the colored noise spectrum of the disturbance effects are addressed. Stochastical instability (Lyapunov) considerations in solving discrete optimization problems via neural networks are discussed. The bounded estimate(s) of the stochastical variates involved are presented, and the noise-induced perturbations on the saturated-state neuronal population are elucidated.
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Affiliation(s)
- D De Groff
- Department of Electrical Engineering, Florida Atlantic University, Boca Raton 33431
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