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Search Results: 1 - 10 of 78 matches for " Nagalingeswaran Kumarasamy "
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Blepharitis and lid ulcer as initial ocular manifestation in acquired immunodeficiency syndome patients
Biswas Jyotirmay,Madhavan Hajib,Kumarasamy Nagalingeswaran,Solomon Suniti
Indian Journal of Ophthalmology , 1997,
Bilateral frosted branch angiitis and cytomegalovirus retinitis in acquired immunodeficiency syndrome
Biswas Jyotirmay,Raizada Seemant,Gopal Lingam,Kumarasamy Nagalingeswaran
Indian Journal of Ophthalmology , 1999,
Lid abscess with extensive molluscum contagiosum in a patient with acquired immunodeficiency syndrome
Biswas Jyotirmay,Therese Lily,Kumarasamy Nagalingeswaran,Solomon Suniti
Indian Journal of Ophthalmology , 1997,
Cancers in the TREAT Asia HIV Observational Database (TAHOD): a retrospective analysis of risk factors
Petoumenos Kathy,Hui Eugenie,Kumarasamy Nagalingeswaran,Kerr Stephen J
Journal of the International AIDS Society , 2010, DOI: 10.1186/1758-2652-13-51
Abstract: Background This retrospective survey describes types of cancers diagnosed in HIV-infected subjects in Asia, and assesses risk factors for cancer in HIV-infected subjects using contemporaneous HIV-infected controls without cancer. Methods TREAT Asia HIV Observational Database (TAHOD) sites retrospectively reviewed clinic medical records to determine cancer diagnoses since 2000. For each diagnosis, the following data were recorded: date, type, stage, method of diagnosis, demographic data, medical history, and HIV-related information. For risk factor analyses, two HIV-infected control subjects without cancer diagnoses were also selected. Cancers were grouped as AIDS-defining cancers (ADCs), and non-ADCs. Non-ADCs were further categorized as being infection related (NADC-IR) and unrelated (NADC-IUR). Results A total of 617 patients were included in this study: 215 cancer cases and 402 controls from 13 sites. The majority of cancer cases were male (71%). The mean age (SD) for cases was 39 (10.6), 46 (11.5) and 44 (13.7) for ADCs, NADC-IURs and NADCs-IR, respectively. The majority (66%) of cancers were ADCs (16% Kaposi sarcoma, 40% non-Hodgkin's lymphoma, and 9% cervical cancer). The most common NADCs were lung (6%), breast (5%) and hepatocellular carcinoma and Hodgkin's lymphoma (2% each). There were also three (1.4%) cases of leiomyosarcoma reported in this study. In multivariate analyses, individuals with CD4 counts above 200 cells/mm3 were approximately 80% less likely to be diagnosed with an ADC (p < 0.001). Older age (OR: 1.39, p = 0.001) and currently not receiving antiretroviral treatment (OR: 0.29, p = 0.006) were independent predictors of NADCs overall, and similarly for NADCs-IUR. Lower CD4 cell count and higher CDC stage (p = 0.041) were the only independent predictors of NADCs-IR. Conclusions The spectrum of cancer diagnoses in the Asia region currently does not appear dissimilar to that observed in non-Asian HIV populations. One interesting finding was the cases of leiomyosarcoma, a smooth-muscle tumour, usually seen in children and young adults with AIDS, yet overall quite rare. Further detailed studies are required to better describe the range of cancers in this region, and to help guide the development of screening programmes.
Atypically distributed cutaneous lesions of Norwegian scabies in an HIV-positive man in South India: a case report
Ramachandran Vignesh, Esaki Shankar, Bella Devaleenal, Pachamuthu Balakrishnan, Shieh Thousen, Ramalingam Sekar, Suniti Solomon, Nagalingeswaran Kumarasamy
Journal of Medical Case Reports , 2008, DOI: 10.1186/1752-1947-2-82
Abstract: We report the case of an HIV-positive 16-year-old man with severe crusted Norwegian scabies initially misdiagnosed as a dermal fungal infection. The patient had extensive, generalized, thick, hyperkeratotic, crusting, yellowish papule lesions distributed on the entire body from his scalp to his toes.The patient was started with Ivermectin and topical Permethrin, which eventually resulted in complete resolution. Interestingly, despite quarantining efforts, one of the patient's acquaintances and a healthcare worker acquired the symptoms of itching.This atypical presentation of Norwegian scabies emphasizes the need to include scabies in the differential diagnosis when HIV-infected patients present with crusted, generalized cutaneous lesions.Norwegian (crusted) scabies is an opportunistic dermatological manifestation which is seen in HIV-infected individuals and which is probably acquired as a consequence of the immune system's inability to control the mites, thereby facilitating overwhelming reproduction [1]. There is a wide range of presentations of Norwegian scabies in people with HIV with lesions ranging from thick, crusted plaques to red papules to psoriasiform plaques to hyperkeratotic yellow papules [2,3]. The lesions in Norwegian scabies are classically distributed on the extremities, but are frequently found on the back, face, scalp and around the nail folds [4]. As Norwegian scabies is extremely infectious, early diagnosis is paramount to allow prompt therapeutic interventions and infection control. We report a case of a man being treated at a tertiary AIDS care centre in Chennai, India, who presented with severe Norwegian scabies infection with lesions distributed all over the body and which was initially misdiagnosed as a fungal skin infection.A 16-year-old man with HIV infection was admitted to the inpatient department of the YRG Centre for AIDS Research and Education (YRG CARE) with severe crusted cutaneous lesions all over the body. He had a history of sk
Impact of drug classes and treatment availability on the rate of antiretroviral treatment change in the TREAT Asia HIV Observational Database (TAHOD)
Preeyaporn Srasuebkul, Alexandra Calmy, Jialun Zhou, Nagalingeswaran Kumarasamy, Matthew Law, Poh Lim, The TREAT Asia HIV Observational Database
AIDS Research and Therapy , 2007, DOI: 10.1186/1742-6405-4-18
Abstract: Rates of ART changes were examined in patients who started first line triple or more ART combination in TAHOD, and had at least one follow-up visit. Rates of ART changes were summarised per follow-up year, and factors associated with changes assessed using random-effect Poisson regression. The Kaplan-Meier method was used to determine durations of patients in their first, second and third regimen.A total of 1846 patients initiated an ART combination with at least three drugs. Median follow up time for the first treatment was 3.2 years. The overall rate of ART change was 29 per 100-person-year.In univariate analyses, rate of treatment change was significantly associated with exposure category, the country income category, the drug class combination, calendar year and the number of combinations. In multivariate analysis, compared to d4T/3TC/NVP, starting ART with another NNRTI-containing regimen, with PI only or with a triple NRTI regimen was associated with a higher risk of combination change (relative risk (RR) 1.6 (95% CI 1.64 – 1.96), p < 0.001, RR 3.39 (2.76 – 4.16) p < 0.001, RR 6.37 (4.51 – 9.00), p < 0.001). Being on a second or a third combination regimen was also associated with a decreased rate of ART change, compared with first ART combination (RR 0.82 (0.68 – 0.99), p = 0.035, RR 0.77 (0.61 – 0.97), p = 0.024). Sites with fewer than 12 drugs used had an increased rate of treatment changes (1.31 (1.13 – 1.51), p < 0.001). Injecting drug users, and other/unknown exposure was found to increase rate of treatment change (1.24 (1.00 – 1.54), p = 0.055). Percentages of patients who stopped treatment due to adverse events were 31, 27 and 32 in 1st, 2nd and 3rd treatment combinations, respectively.Our study suggests that drug availability impacts on ART prescription patterns. Our data, reflecting real clinic use in Asia, suggest that around half of all patients require second combination ART by 3 years after treatment initiation.In South and South-East Asia the nu
Immune reconstitution inflammatory syndrome in association with HIV/AIDS and tuberculosis: Views over hidden possibilities
Esaki Shankar, Ramachandran Vignesh, Kailapuri G Murugavel, Pachamuthu Balakrishnan, Ramalingam Sekar, Charmaine AC Lloyd, Suniti Solomon, Nagalingeswaran Kumarasamy
AIDS Research and Therapy , 2007, DOI: 10.1186/1742-6405-4-29
Abstract: IRIS is an adverse consequence of the restoration of pathogen-specific immune responses in HIV-infected patients during the initial months of highly active antiretroviral treatment (HAART) [1]. Even though IRIS is also closely associated with certain other infectious (mycobacteria, varicella zoster, herpesviruses, and cytomegalovirus) and non-infectious (autoimmune) conditions [2-10], the morbidity associated with HIV/tuberculosis (TB) is more important [1,11] as the crisis seem to be alarming in third-world nations, where the proportion of HIV/TB IRIS is reportedly high, ranging from 11% to 43% [12-15]. This could be due to differences in cohort characteristics, case definitions and differences in the mean time interval between TB diagnosis and antiretroviral therapy (ART) initiation. Data from resource-limited countries on TB-IRIS is scarce; a rate of 8% was reported from India [1]. Immunology of IRIS in HIV/TB is deficient and HIV-specific T lymphocyte responses have repeatedly shown to be defective [16]. To understand the immunopathogenesis of IRIS it will be crucial to elucidate the intrinsic dynamics of immune cells after initiation of HAART [17]. Preliminary investigations have shown that an acute exacerbation of mycobacteria-specific Th1 response after HIV infection control by HAART causes IRIS in HIV/TB [17,18].In the context of an HIV infected subject with latent pulmonary TB, progressing to AIDS stage of HIV disease, the acute stage of the infection is characterized by eventual depletion in the number of CD4+ T-cells, the key orchestrator of all immune mechanisms in the body. Recent research has re-examined the rate of immunopathologic events in HIV disease, where the first few weeks is characterized by massive viremia and depletion of ~50% memory CD4+ T-cell (CCR5+) population especially in the gut [19-26]. Since the gut associated lymphoid tissue (GALT) comprises ~60% of entire lymphoid organ system, rich in memory cells, its depletion has a strong cons
Design of a randomized trial to evaluate the influence of mobile phone reminders on adherence to first line antiretroviral treatment in South India - the HIVIND study protocol
Ayesha De Costa, Anita Shet, Nagalingeswaran Kumarasamy, Per Ashorn, Bo Eriksson, Lennart Bogg, Vinod K Diwan, the HIVIND study team
BMC Medical Research Methodology , 2010, DOI: 10.1186/1471-2288-10-25
Abstract: 600 treatment na?ve patients eligible for first-line treatment as per the national antiretroviral treatment guidelines will be recruited into the trial at two clinics in South India. Patients will be randomized into control and intervention arms. The control arm will receive the standard of care; the intervention arm will receive the standard of care plus mobile phone reminders. Each reminder will take the form of an automated call and a picture message. Reminders will be delivered once a week, at a time chosen by the patient. Patients will be followed up for 24 months or till the primary outcome i.e. virological failure, is reached, whichever is earlier. Self-reported adherence is a secondary outcome. Analysis is by intention-to-treat. A cost-effectiveness study of the intervention will also be carried out.Stepping up telecommunications technology in resource-limited healthcare settings is a priority of the World Health Organization. The trial will evaluate if the use of mobile phone reminders can influence adherence to first-line antiretrovirals in an Indian context.Trial registration: ISRCTN79261738.In the current era of enhanced access to antiretroviral treatment (ART) globally, the number of people on ART in low and middle income countries by the end of 2008 has crossed the 4 million mark, with an increase of 1 million from the end of 2007[1]. However, one of the greatest challenges associated with the management of HIV is suboptimal adherence to antiretroviral therapy [2]. Good adherence to ART is beneficial to patients, as it minimizes treatment failure and prolongs survival. In addition, it has public health benefits. This is because poor adherence gives rise to the potential for development of drug-resistant strains [3], necessitating administration of expensive second-line therapy, and the possibility of transmission of drug-resistant HIV by non-adherent patients [4,5].Adherence is known to be influenced by diverse characteristics of individuals, by their
The Cost-Effectiveness of Tuberculosis Preventive Therapy for HIV-Infected Individuals in Southern India: A Trial-Based Analysis
Mai T. Pho, Soumya Swaminathan, Nagalingeswaran Kumarasamy, Elena Losina, C. Ponnuraja, Lauren M. Uhler, Callie A. Scott, Kenneth H. Mayer, Kenneth A. Freedberg, Rochelle P. Walensky
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0036001
Abstract: Background Regimens for isoniazid-based preventive therapy (IPT) for tuberculosis (TB) in HIV-infected individuals have not been widely adopted given concerns regarding efficacy, adherence and drug resistance. Further, the cost-effectiveness of IPT has not been studied in India. Methods We used an HIV/TB model to project TB incidence, life expectancy, cost and incremental cost-effectiveness of six months of isoniazid plus ethambutol (6EH), thirty-six months of isoniazid (36H) and no IPT for HIV-infected patients in India. Model input parameters included a median CD4 count of 324 cells/mm3, and a rate ratio of developing TB of 0.35 for 6EH and 0.22 for 36H at three years as compared to no IPT. Results of 6EH and 36H were also compared to six months of isoniazid (6H), three months of isoniazid plus rifampin (3RH) and three months of isoniazid plus rifapentine (3RPTH). Results Projected TB incidence decreased in the 6EH and 36H regimens by 51% and 62% respectively at three-year follow-up compared to no IPT. Without IPT, projected life expectancy was 136.1 months at a lifetime per person cost of $5,630. 6EH increased life expectancy by 0.8 months at an additional per person cost of $100 (incremental cost-effectiveness ratio (ICER) of $1,490/year of life saved (YLS)). 36H further increased life expectancy by 0.2 months with an additional per person cost of $55 (ICER of $3,120/YLS). The projected clinical impact of 6EH was comparable to 6H and 3RH; however when compared to these other options, 6EH was no longer cost-effective given the high cost of ethambutol. Results were sensitive to baseline CD4 count and adherence. Conclusions Three, six and thirty-six-month regimens of isoniazid-based therapy are effective in preventing TB. Three months of isoniazid plus rifampin and six-months of isoniazid are similarly cost-effective in India, and should be considered part of HIV care.
Does CD4+CD25+foxp3+ cell (Treg) and IL-10 profile determine susceptibility to immune reconstitution inflammatory syndrome (IRIS) in HIV disease?
Esaki Shankar, Ramachandran Vignesh, Vijayakumar Velu, Kailapuri G Murugavel, Ramalingam Sekar, Pachamuthu Balakrishnan, Charmaine AC Lloyd, Shanmugam Saravanan, Suniti Solomon, Nagalingeswaran Kumarasamy
Journal of Inflammation , 2008, DOI: 10.1186/1476-9255-5-2
Abstract: The immune reconstitution inflammatory syndrome (IRIS) in HIV-infected patients initiating highly active antiretroviral therapy (HAART) leading to 'paradoxical clinical worsening' [1] results from restored immunity to specific infectious or non-infectious antigens [2-10]. Possible mechanisms include a partial recovery of the host immune system or exuberant immunological responses to antigenic stimuli. The overall frequency of IRIS is undefined, but is believed to be dependent on underlying opportunistic infectious (mycobacteria, varicella zoster, herpesviruses, and cytomegalovirus) and non-infectious (autoimmune) burdens [2-10]. Of the subjects that are initiated on HAART, only a proportion progress to develop IRIS and the remaining never develop IRIS despite an exuberant immune restoration from poor baseline CD4+ T-cell levels. Recently, we proposed that subjects that develop IRIS generate a high burden of proinflammatory cytokines in response to enormous levels of systemic bacterial LPS as compared with less LPS in IRIS non-developers [11]. Although several other mechanisms have been proposed, HIV-specific T-cell responses underlying IRIS are incomplete [12]. To investigate the inflammatory intermediaries of IRIS it will be crucial to explain the intrinsic dynamics of immune cells after initiating HAART [13]. Furthermore, factors that confers resistance to development of IRIS among IRIS non-developers needs to be described.The majority of individuals with HIV infection in resource-constrained settings attend HIV testing centres only after progression to terminal stage of HIV disease (i.e. when their CD4+ T-cell counts are very low) [1,14]. Therefore, these subjects with the most severe immunosuppression (CD4+ T-cell nadirs, 100 cells/μL), initiating antiretroviral regimens may be at the highest risk for the development of IRIS [15]. Conceptually, any individual harboring microbial antigens should mount an over-exuberant immune response against any pre-existing ant
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