Hisham Moosan - Academia.edu (original) (raw)
Papers by Hisham Moosan
Cureus, Dec 6, 2021
Kyasanur forest disease (KFD), also known as monkey fever, was first recognized in the Shimoga di... more Kyasanur forest disease (KFD), also known as monkey fever, was first recognized in the Shimoga district of Karnataka, India, in 1957. This study was conceived to address the paucity of medical literature on KFD, to describe the clinical and laboratory features of real-time reverse-transcriptase-polymerase chain reaction (rRT-PCR) confirmed cases of KFD, and to detect any change in the clinical picture and presentation of the disease over the last 30 years. The study sought to document the clinical and laboratory features of Kyasanur forest disease (KFD), a tickborne arboviral disease, now emerging in many parts of southern India. This was a retrospective study using secondary data of patients with real-time reverse transcriptionpolymerase chain reaction (rRT-PCR)-confirmed KFD in a secondary care hospital in Wayanad, Kerala, India. Sixty rRT-PCR-proven KFD patients were included in the study. Commonly noted clinical symptoms were fever (98%), headache (80%), body ache (86%), vomiting (61%), and prostration (83%). Relative bradycardia, hypotension (45%), and oral lesions (23%) were the frequent physical signs. The median total leukocyte count and median platelet count at admission were 2600 per μL and 1.62 per μL, respectively. The median erythrocyte sedimentation rate was 10 mm/hr. Urinary sediments and albuminuria were seen in 66% and 60% respectively. The major complications observed were neurological complications (23%), bleeding manifestations (20%), and persistent shock (20%). The common neurological complications were seizures, altered sensorium, aseptic meningitis, and focal neurological deficits. The case fatality rate in the study was 6.7%. The clinical picture of a prostrating viral syndrome in an epidemiological setting of KFD with marked leucopenia, moderate thrombocytopenia, low erythrocyte sedimentation rate (ESR), albuminuria, urinary sediments, and moderately elevated transaminases help in making an early diagnosis of KFD. Neurological complications in the initial two weeks are associated with poor outcomes.
Assessing health-seeking behavior among Asthma and COPD patients in urban South India
Journal of family medicine and primary care, 2019
Context: Health-seeking behavior of patients with chronic obstructive pulmonary disease (COPD) an... more Context: Health-seeking behavior of patients with chronic obstructive pulmonary disease (COPD) and asthma and the diagnosis told to them by doctors before they reach tertiary care is not well documented. Aims: This study aimed at describing the health-seeking behavior of asthma and COPD patients before they present to a tertiary care hospital in Trivandrum in South India. Methods and Materials: The hospital-based cross-sectional study was done at one government and one private tertiary care hospital in Trivandrum, Kerala, including diagnosed COPD and asthma patients. Data were collected using a pretested semistructured questionnaire paired with the results of clinical evaluation and spirometry. Results: Among the studied population, about half (53%) of the patients in this study sought initial treatment from government facilities and most patients continued the same pattern of government care or private providers till the final level. Most of them (91%) were likely to have a history of first care from modern medicine system. High proportion of patients (89%) did not have a diagnosis known after the initial consultations, among patients with asthma only 3.4% were given a correct diagnosis and only one person was given a correct diagnosis of COPD out of 129 patients with COPD as the final diagnosis. Out of 739 patients, only 135 patients had done pulmonary functtion test as investigation. Conclusions: High proportions of patients do not know the diagnosis of their disease when they reached tertiary care. Patients tended to follow the same sector of health care (private/government) where they sought initial care.
Implementation research on diabetes in India: A systematic review
Clinical Epidemiology and Global Health
F1000Research
Introduction: The burden of non-communicable diseases (NCDs) is a major public health concern acr... more Introduction: The burden of non-communicable diseases (NCDs) is a major public health concern across the world. Various initiatives have tried to address these with varying degrees of success. Objective: The objective is to assess and collate existing evidence in implementation research done in India on three broad domains of NCDs namely, cardiovascular diseases (CVD), diabetes mellitus (DM), and mental health (MH) in India. Materials and methods: Three systematic review protocols have been drafted to explore and collate extant evidence of implementation research on cardiovascular diseases, diabetes mellitus, and mental health in India, in accordance with the PRISMA-P statement. Academic databases including PubMed, Embase and Science Direct will be searched. Search strategies will be formulated in iterative processes and in accordance with the formats that are specific to the databases that will be searched. In addition, grey literature and non-academic databases will also be explor...
PLOS Global Public Health
Recently, two Phase 2B tuberculosis vaccine trials reported positive efficacy results in adolesce... more Recently, two Phase 2B tuberculosis vaccine trials reported positive efficacy results in adolescents and adults. However, experience in vaccinating these age groups is limited. We identified potential implementation strategies for the M72/AS01E vaccination and BCG-revaccination-like candidates and explored their acceptability and feasibility. We conducted in-depth semi-structured interviews among key decision makers to identify implementation strategies and target groups in South Africa, India, and China. Thematic and deductive analysis using a coding framework were used to identify themes across and within settings. In all three countries there was interest in novel TB vaccines, with school-attending adolescents named as a likely target group. In China and India, older people were also identified as a target group. Routine vaccination was preferred in all countries due to stigma and logistical issues with targeted mass campaigns. Perceived benefits for implementation of M72/AS01E w...
Knowledge, Attitude, and Practice of epilepsy in Wayanad, Kerala
Epilepsy & Behavior
Historical exclusion, conflict and health systems : health among tribal communities in India : a synthesis of three studies
Biomedical and Biotechnology Research Journal (BBRJ), 2017
Chinua Achebe has made a creative Africanization of the English language in all his literary work... more Chinua Achebe has made a creative Africanization of the English language in all his literary works. In the process of writing counter-narratives to Euro-centric misrepresentations of Africa, Achebe has successfully harnessed the colonizer's language to make it bear the burden of his native experience. The present paper proposes to take up the third novel by Achebe, namely Arrow of God (1964) to introspect the different kinds of narrative strategies involved in it. This includes a study of the kind of narrator used, and a survey of the various ways in which the language is maneuvred-through the usage of standard and pidgin English, through linguistic devices like humour, satire and irony, through symbols, proverbs, images, metaphors and songs-in order to capture a vivid picture of Nigeria of the late 1920s, in which the novel is set. In a nutshell, this stylistic criticism aims to illustrate in effect how Achebe creatively extends the frontiers of English language to accommodate the various shades of Nigerian reality within it.
Role of line probe assay in detection of extra-pulmonary tuberculosis/multidrug-resistant tuberculosis: The experience from Kerala state, India
Journal of The Academy of Clinical Microbiologists, 2017
Background: There are limited data on use of line probe assay (LPA) for detection of TB and Rifam... more Background: There are limited data on use of line probe assay (LPA) for detection of TB and Rifampicin resistance among extra-pulmonary tuberculosis (EPTB) patients under specific TB control programme settings. Our aim was to compare the positivity of LPA with Lowenstein–Jensen (LJ) and Bactec MGIT and to test its utility in faster testing and in patients on treatment. Methodology: The data of all 387 EPTB samples processed in two years by the state-level accredited laboratory in 2013–2014 were selected for the study. The laboratory used standard N-acetyl-L-cysteine – sodium hydroxide processing method for all samples except for cerebrospinal fluid and urine samples before conducting Ziehl-Neelsen smear microscopy, LPA and culture on both LJ and MGIT. Those samples with a negative LPA result if culture positive was subjected to a second LPA as per laboratory protocol. Doubtful Rifampicin resistant (RR) results were cleared by phenotypic testing by MGIT. Anti-TB treatment (ATT) durat...
The International Journal of Mycobacteriology, 2017
Introduction: Regulatory T cell (Treg) therapy is a promising strategy to promote transplant tole... more Introduction: Regulatory T cell (Treg) therapy is a promising strategy to promote transplant tolerance and aid in the reduction of immunosuppression . This study aims to identify new strategies to increase potency, stability and specificity of human Tregs to produce an effective clinical therapy. Ligation of CD70 to CD27, a costimulatory molecule member of the tumour necrosis factor superfamily, is known to be sufficient and indispensable for the generation of effective and long-term antigen-specific Tcell immunity . In human
Assessing health-seeking behavior among Asthma and COPD patients in urban South India
Journal of Family Medicine and Primary Care
Context: Health-seeking behavior of patients with chronic obstructive pulmonary disease (COPD) an... more Context: Health-seeking behavior of patients with chronic obstructive pulmonary disease (COPD) and asthma and the diagnosis told to them by doctors before they reach tertiary care is not well documented. Aims: This study aimed at describing the health-seeking behavior of asthma and COPD patients before they present to a tertiary care hospital in Trivandrum in South India. Methods and Materials: The hospital-based cross-sectional study was done at one government and one private tertiary care hospital in Trivandrum, Kerala, including diagnosed COPD and asthma patients. Data were collected using a pretested semistructured questionnaire paired with the results of clinical evaluation and spirometry. Results: Among the studied population, about half (53%) of the patients in this study sought initial treatment from government facilities and most patients continued the same pattern of government care or private providers till the final level. Most of them (91%) were likely to have a history of first care from modern medicine system. High proportion of patients (89%) did not have a diagnosis known after the initial consultations, among patients with asthma only 3.4% were given a correct diagnosis and only one person was given a correct diagnosis of COPD out of 129 patients with COPD as the final diagnosis. Out of 739 patients, only 135 patients had done pulmonary functtion test as investigation. Conclusions: High proportions of patients do not know the diagnosis of their disease when they reached tertiary care. Patients tended to follow the same sector of health care (private/government) where they sought initial care.
Purpose: The Kudumbashree mission, an initiative of the Government of Kerala state in India, has ... more Purpose: The Kudumbashree mission, an initiative of the Government of Kerala state in India, has collaborated with Local Self Governments to set up ‘Buds’, a special school system for individuals with intellectual disability. The objectives of this study were to evaluate the structure and functioning of ‘Buds ’ schools, to identify the healthcare needs of the students, and to conceptualise a framework for healthcare provision. Method: A cross-sectional survey was conducted among 202 children at 11 registered ‘Buds ’ schools in Kerala. A multidisciplinary team consisting of a psychiatrist, public health personnel and a social worker from the Medical Colleges of Kerala, visited the institutions. Data collection consisted of abstraction from medical records, interviews with parents, and clinical assessment and prescription of intervention by the specialists concerned. A pre-tested semi-structured questionnaire was used for every child. Using both quantitative and qualitative techniques...
Predictable repeatability issues with GeneXpert-Xpert MTB/RIF (version 4) derived rifampicin resistant tuberculosis results from South India: Appreciating the limits of a technological marvel!
Biomedical and Biotechnology Research Journal (BBRJ), 2017
Background: GeneXpert MTB/RIF (Xpert), the fully automated cartridge-based nucleic acid amplifica... more Background: GeneXpert MTB/RIF (Xpert), the fully automated cartridge-based nucleic acid amplification test for simultaneous identification of Mycobacterium tuberculosis complex and rifampicin resistance (RR), directly from samples is considered as a game changer for tuberculosis (TB) control programs worldwide. Methods: We are reporting serious issues with repeatability among a subgroup of Xpert (Version 4) identified RR results from South Indian state recently switched to Xpert by the National TB control program. Results: We have demonstrated that poor repeatability is frequently associated with those Xpert derived RR results, identified by detection of delayed amplification of any probe in the presence of positive analyte results for all probes. Another significant contributing factor was found to be lower bacterial loads in samples. The repeat tests were done by Xpert and/or by line probe assay depending on smear positivity. The finding is worrying as Xpert is recommended over ot...
Clinical and Laboratory Diagnostic Features of Kyasanur Forest Disease: A Study From Wayanad, South India
Cureus
Comparison of Prevalence of Anemia and Associated Factors among Adolescent Girls under WIFS with Non-WIFS Group in a School in North Kerala
Role of line probe assay in detection of extra-pulmonary tuberculosis/multidrug-resistant tuberculosis: The experience from Kerala state, India
Journal of The Academy of Clinical Microbiologists, 2017
Background: There are limited data on use of line probe assay (LPA) for detection of TB and Rifam... more Background: There are limited data on use of line probe assay (LPA) for detection of TB and Rifampicin resistance among extra-pulmonary tuberculosis (EPTB) patients under specific TB control programme settings. Our aim was to compare the positivity of LPA with Lowenstein–Jensen (LJ) and Bactec MGIT and to test its utility in faster testing and in patients on treatment. Methodology: The data of all 387 EPTB samples processed in two years by the state-level accredited laboratory in 2013–2014 were selected for the study. The laboratory used standard N-acetyl-L-cysteine – sodium hydroxide processing method for all samples except for cerebrospinal fluid and urine samples before conducting Ziehl-Neelsen smear microscopy, LPA and culture on both LJ and MGIT. Those samples with a negative LPA result if culture positive was subjected to a second LPA as per laboratory protocol. Doubtful Rifampicin resistant (RR) results were cleared by phenotypic testing by MGIT. Anti-TB treatment (ATT) durat...
International Journal of Medical Research and Review
Introduction: Pneumonia Severity Index (PSI) and CURB-65 rule for community acquired pneumonia (C... more Introduction: Pneumonia Severity Index (PSI) and CURB-65 rule for community acquired pneumonia (CAP) have been developed to stratify patients based on mortality. Lack of a risk stratifying score like PSI or CURB-65 can lead to significant delay in starting treatment. This study was conducted to find out the ability of CURB-65 score and PSI to predict clinically relevant outcomes. Methods: 78 patients diagnosed as CAP admitted to a tertiary care hospital were enrolled into the study. Detailed clinical history was noted and CURB-65 and PSI scores were given with the help of a structured questionnaire in <24 hours of admission. The patients were revisited at day 3 and at discharge and data collected. Results:Out of 78 patients included in the study, 60 were males and 18 were females. Of the 78 patients, 14 died accounting for aninhospital mortality of 17.94%. Mortality in the mild, moderate and severe groups of CURB-65 were 0%, 16.7% and 47.8% respectively. Mortality in the mild, moderate and severe groups of PSI were 1.8%, 50% and 80% respectively. Area under the curve (AUC) for CURB-65 and PSI in terms of in hospital mortality were 0.935 and 0.920 respectively. Conclusion: The CURB-65 and PSI scores correlated well with mortality and other severity indicators. The CURB-65 has a better discriminatory power than PSI inour study. Because of its simplicity in addition to its better discriminatory power than PSI, CURB-65 may be better suited as a severity scoring system in CAP.
Comparison of health-care utilization pattern and its correlates among the tribal and nontribal population of Kerala
Indian Journal of Community Medicine
A Framework for Healthcare Provision to Children with Intellectual Disability
Disability, CBR & Inclusive Development, 2013
Cureus, Dec 6, 2021
Kyasanur forest disease (KFD), also known as monkey fever, was first recognized in the Shimoga di... more Kyasanur forest disease (KFD), also known as monkey fever, was first recognized in the Shimoga district of Karnataka, India, in 1957. This study was conceived to address the paucity of medical literature on KFD, to describe the clinical and laboratory features of real-time reverse-transcriptase-polymerase chain reaction (rRT-PCR) confirmed cases of KFD, and to detect any change in the clinical picture and presentation of the disease over the last 30 years. The study sought to document the clinical and laboratory features of Kyasanur forest disease (KFD), a tickborne arboviral disease, now emerging in many parts of southern India. This was a retrospective study using secondary data of patients with real-time reverse transcriptionpolymerase chain reaction (rRT-PCR)-confirmed KFD in a secondary care hospital in Wayanad, Kerala, India. Sixty rRT-PCR-proven KFD patients were included in the study. Commonly noted clinical symptoms were fever (98%), headache (80%), body ache (86%), vomiting (61%), and prostration (83%). Relative bradycardia, hypotension (45%), and oral lesions (23%) were the frequent physical signs. The median total leukocyte count and median platelet count at admission were 2600 per μL and 1.62 per μL, respectively. The median erythrocyte sedimentation rate was 10 mm/hr. Urinary sediments and albuminuria were seen in 66% and 60% respectively. The major complications observed were neurological complications (23%), bleeding manifestations (20%), and persistent shock (20%). The common neurological complications were seizures, altered sensorium, aseptic meningitis, and focal neurological deficits. The case fatality rate in the study was 6.7%. The clinical picture of a prostrating viral syndrome in an epidemiological setting of KFD with marked leucopenia, moderate thrombocytopenia, low erythrocyte sedimentation rate (ESR), albuminuria, urinary sediments, and moderately elevated transaminases help in making an early diagnosis of KFD. Neurological complications in the initial two weeks are associated with poor outcomes.
Assessing health-seeking behavior among Asthma and COPD patients in urban South India
Journal of family medicine and primary care, 2019
Context: Health-seeking behavior of patients with chronic obstructive pulmonary disease (COPD) an... more Context: Health-seeking behavior of patients with chronic obstructive pulmonary disease (COPD) and asthma and the diagnosis told to them by doctors before they reach tertiary care is not well documented. Aims: This study aimed at describing the health-seeking behavior of asthma and COPD patients before they present to a tertiary care hospital in Trivandrum in South India. Methods and Materials: The hospital-based cross-sectional study was done at one government and one private tertiary care hospital in Trivandrum, Kerala, including diagnosed COPD and asthma patients. Data were collected using a pretested semistructured questionnaire paired with the results of clinical evaluation and spirometry. Results: Among the studied population, about half (53%) of the patients in this study sought initial treatment from government facilities and most patients continued the same pattern of government care or private providers till the final level. Most of them (91%) were likely to have a history of first care from modern medicine system. High proportion of patients (89%) did not have a diagnosis known after the initial consultations, among patients with asthma only 3.4% were given a correct diagnosis and only one person was given a correct diagnosis of COPD out of 129 patients with COPD as the final diagnosis. Out of 739 patients, only 135 patients had done pulmonary functtion test as investigation. Conclusions: High proportions of patients do not know the diagnosis of their disease when they reached tertiary care. Patients tended to follow the same sector of health care (private/government) where they sought initial care.
Implementation research on diabetes in India: A systematic review
Clinical Epidemiology and Global Health
F1000Research
Introduction: The burden of non-communicable diseases (NCDs) is a major public health concern acr... more Introduction: The burden of non-communicable diseases (NCDs) is a major public health concern across the world. Various initiatives have tried to address these with varying degrees of success. Objective: The objective is to assess and collate existing evidence in implementation research done in India on three broad domains of NCDs namely, cardiovascular diseases (CVD), diabetes mellitus (DM), and mental health (MH) in India. Materials and methods: Three systematic review protocols have been drafted to explore and collate extant evidence of implementation research on cardiovascular diseases, diabetes mellitus, and mental health in India, in accordance with the PRISMA-P statement. Academic databases including PubMed, Embase and Science Direct will be searched. Search strategies will be formulated in iterative processes and in accordance with the formats that are specific to the databases that will be searched. In addition, grey literature and non-academic databases will also be explor...
PLOS Global Public Health
Recently, two Phase 2B tuberculosis vaccine trials reported positive efficacy results in adolesce... more Recently, two Phase 2B tuberculosis vaccine trials reported positive efficacy results in adolescents and adults. However, experience in vaccinating these age groups is limited. We identified potential implementation strategies for the M72/AS01E vaccination and BCG-revaccination-like candidates and explored their acceptability and feasibility. We conducted in-depth semi-structured interviews among key decision makers to identify implementation strategies and target groups in South Africa, India, and China. Thematic and deductive analysis using a coding framework were used to identify themes across and within settings. In all three countries there was interest in novel TB vaccines, with school-attending adolescents named as a likely target group. In China and India, older people were also identified as a target group. Routine vaccination was preferred in all countries due to stigma and logistical issues with targeted mass campaigns. Perceived benefits for implementation of M72/AS01E w...
Knowledge, Attitude, and Practice of epilepsy in Wayanad, Kerala
Epilepsy & Behavior
Historical exclusion, conflict and health systems : health among tribal communities in India : a synthesis of three studies
Biomedical and Biotechnology Research Journal (BBRJ), 2017
Chinua Achebe has made a creative Africanization of the English language in all his literary work... more Chinua Achebe has made a creative Africanization of the English language in all his literary works. In the process of writing counter-narratives to Euro-centric misrepresentations of Africa, Achebe has successfully harnessed the colonizer's language to make it bear the burden of his native experience. The present paper proposes to take up the third novel by Achebe, namely Arrow of God (1964) to introspect the different kinds of narrative strategies involved in it. This includes a study of the kind of narrator used, and a survey of the various ways in which the language is maneuvred-through the usage of standard and pidgin English, through linguistic devices like humour, satire and irony, through symbols, proverbs, images, metaphors and songs-in order to capture a vivid picture of Nigeria of the late 1920s, in which the novel is set. In a nutshell, this stylistic criticism aims to illustrate in effect how Achebe creatively extends the frontiers of English language to accommodate the various shades of Nigerian reality within it.
Role of line probe assay in detection of extra-pulmonary tuberculosis/multidrug-resistant tuberculosis: The experience from Kerala state, India
Journal of The Academy of Clinical Microbiologists, 2017
Background: There are limited data on use of line probe assay (LPA) for detection of TB and Rifam... more Background: There are limited data on use of line probe assay (LPA) for detection of TB and Rifampicin resistance among extra-pulmonary tuberculosis (EPTB) patients under specific TB control programme settings. Our aim was to compare the positivity of LPA with Lowenstein–Jensen (LJ) and Bactec MGIT and to test its utility in faster testing and in patients on treatment. Methodology: The data of all 387 EPTB samples processed in two years by the state-level accredited laboratory in 2013–2014 were selected for the study. The laboratory used standard N-acetyl-L-cysteine – sodium hydroxide processing method for all samples except for cerebrospinal fluid and urine samples before conducting Ziehl-Neelsen smear microscopy, LPA and culture on both LJ and MGIT. Those samples with a negative LPA result if culture positive was subjected to a second LPA as per laboratory protocol. Doubtful Rifampicin resistant (RR) results were cleared by phenotypic testing by MGIT. Anti-TB treatment (ATT) durat...
The International Journal of Mycobacteriology, 2017
Introduction: Regulatory T cell (Treg) therapy is a promising strategy to promote transplant tole... more Introduction: Regulatory T cell (Treg) therapy is a promising strategy to promote transplant tolerance and aid in the reduction of immunosuppression . This study aims to identify new strategies to increase potency, stability and specificity of human Tregs to produce an effective clinical therapy. Ligation of CD70 to CD27, a costimulatory molecule member of the tumour necrosis factor superfamily, is known to be sufficient and indispensable for the generation of effective and long-term antigen-specific Tcell immunity . In human
Assessing health-seeking behavior among Asthma and COPD patients in urban South India
Journal of Family Medicine and Primary Care
Context: Health-seeking behavior of patients with chronic obstructive pulmonary disease (COPD) an... more Context: Health-seeking behavior of patients with chronic obstructive pulmonary disease (COPD) and asthma and the diagnosis told to them by doctors before they reach tertiary care is not well documented. Aims: This study aimed at describing the health-seeking behavior of asthma and COPD patients before they present to a tertiary care hospital in Trivandrum in South India. Methods and Materials: The hospital-based cross-sectional study was done at one government and one private tertiary care hospital in Trivandrum, Kerala, including diagnosed COPD and asthma patients. Data were collected using a pretested semistructured questionnaire paired with the results of clinical evaluation and spirometry. Results: Among the studied population, about half (53%) of the patients in this study sought initial treatment from government facilities and most patients continued the same pattern of government care or private providers till the final level. Most of them (91%) were likely to have a history of first care from modern medicine system. High proportion of patients (89%) did not have a diagnosis known after the initial consultations, among patients with asthma only 3.4% were given a correct diagnosis and only one person was given a correct diagnosis of COPD out of 129 patients with COPD as the final diagnosis. Out of 739 patients, only 135 patients had done pulmonary functtion test as investigation. Conclusions: High proportions of patients do not know the diagnosis of their disease when they reached tertiary care. Patients tended to follow the same sector of health care (private/government) where they sought initial care.
Purpose: The Kudumbashree mission, an initiative of the Government of Kerala state in India, has ... more Purpose: The Kudumbashree mission, an initiative of the Government of Kerala state in India, has collaborated with Local Self Governments to set up ‘Buds’, a special school system for individuals with intellectual disability. The objectives of this study were to evaluate the structure and functioning of ‘Buds ’ schools, to identify the healthcare needs of the students, and to conceptualise a framework for healthcare provision. Method: A cross-sectional survey was conducted among 202 children at 11 registered ‘Buds ’ schools in Kerala. A multidisciplinary team consisting of a psychiatrist, public health personnel and a social worker from the Medical Colleges of Kerala, visited the institutions. Data collection consisted of abstraction from medical records, interviews with parents, and clinical assessment and prescription of intervention by the specialists concerned. A pre-tested semi-structured questionnaire was used for every child. Using both quantitative and qualitative techniques...
Predictable repeatability issues with GeneXpert-Xpert MTB/RIF (version 4) derived rifampicin resistant tuberculosis results from South India: Appreciating the limits of a technological marvel!
Biomedical and Biotechnology Research Journal (BBRJ), 2017
Background: GeneXpert MTB/RIF (Xpert), the fully automated cartridge-based nucleic acid amplifica... more Background: GeneXpert MTB/RIF (Xpert), the fully automated cartridge-based nucleic acid amplification test for simultaneous identification of Mycobacterium tuberculosis complex and rifampicin resistance (RR), directly from samples is considered as a game changer for tuberculosis (TB) control programs worldwide. Methods: We are reporting serious issues with repeatability among a subgroup of Xpert (Version 4) identified RR results from South Indian state recently switched to Xpert by the National TB control program. Results: We have demonstrated that poor repeatability is frequently associated with those Xpert derived RR results, identified by detection of delayed amplification of any probe in the presence of positive analyte results for all probes. Another significant contributing factor was found to be lower bacterial loads in samples. The repeat tests were done by Xpert and/or by line probe assay depending on smear positivity. The finding is worrying as Xpert is recommended over ot...
Clinical and Laboratory Diagnostic Features of Kyasanur Forest Disease: A Study From Wayanad, South India
Cureus
Comparison of Prevalence of Anemia and Associated Factors among Adolescent Girls under WIFS with Non-WIFS Group in a School in North Kerala
Role of line probe assay in detection of extra-pulmonary tuberculosis/multidrug-resistant tuberculosis: The experience from Kerala state, India
Journal of The Academy of Clinical Microbiologists, 2017
Background: There are limited data on use of line probe assay (LPA) for detection of TB and Rifam... more Background: There are limited data on use of line probe assay (LPA) for detection of TB and Rifampicin resistance among extra-pulmonary tuberculosis (EPTB) patients under specific TB control programme settings. Our aim was to compare the positivity of LPA with Lowenstein–Jensen (LJ) and Bactec MGIT and to test its utility in faster testing and in patients on treatment. Methodology: The data of all 387 EPTB samples processed in two years by the state-level accredited laboratory in 2013–2014 were selected for the study. The laboratory used standard N-acetyl-L-cysteine – sodium hydroxide processing method for all samples except for cerebrospinal fluid and urine samples before conducting Ziehl-Neelsen smear microscopy, LPA and culture on both LJ and MGIT. Those samples with a negative LPA result if culture positive was subjected to a second LPA as per laboratory protocol. Doubtful Rifampicin resistant (RR) results were cleared by phenotypic testing by MGIT. Anti-TB treatment (ATT) durat...
International Journal of Medical Research and Review
Introduction: Pneumonia Severity Index (PSI) and CURB-65 rule for community acquired pneumonia (C... more Introduction: Pneumonia Severity Index (PSI) and CURB-65 rule for community acquired pneumonia (CAP) have been developed to stratify patients based on mortality. Lack of a risk stratifying score like PSI or CURB-65 can lead to significant delay in starting treatment. This study was conducted to find out the ability of CURB-65 score and PSI to predict clinically relevant outcomes. Methods: 78 patients diagnosed as CAP admitted to a tertiary care hospital were enrolled into the study. Detailed clinical history was noted and CURB-65 and PSI scores were given with the help of a structured questionnaire in <24 hours of admission. The patients were revisited at day 3 and at discharge and data collected. Results:Out of 78 patients included in the study, 60 were males and 18 were females. Of the 78 patients, 14 died accounting for aninhospital mortality of 17.94%. Mortality in the mild, moderate and severe groups of CURB-65 were 0%, 16.7% and 47.8% respectively. Mortality in the mild, moderate and severe groups of PSI were 1.8%, 50% and 80% respectively. Area under the curve (AUC) for CURB-65 and PSI in terms of in hospital mortality were 0.935 and 0.920 respectively. Conclusion: The CURB-65 and PSI scores correlated well with mortality and other severity indicators. The CURB-65 has a better discriminatory power than PSI inour study. Because of its simplicity in addition to its better discriminatory power than PSI, CURB-65 may be better suited as a severity scoring system in CAP.
Comparison of health-care utilization pattern and its correlates among the tribal and nontribal population of Kerala
Indian Journal of Community Medicine
A Framework for Healthcare Provision to Children with Intellectual Disability
Disability, CBR & Inclusive Development, 2013