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Search Results: 1 - 7 of 7 matches for " Thangakunam Balamugesh "
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High Annual Risk of Tuberculosis Infection among Nursing Students in South India: A Cohort Study
Devasahayam J. Christopher, Prince James, Peter Daley, Lois Armstrong, Barney T. J. Isaac, Balamugesh Thangakunam, Beulah Premkumar, Alice Zwerling, Madhukar Pai
PLOS ONE , 2011, DOI: 10.1371/journal.pone.0026199
Abstract: Background Nurses in developing countries are frequently exposed to infectious tuberculosis (TB) patients, and have a high prevalence of TB infection. To estimate the incidence of new TB infection, we recruited a cohort of young nursing trainees at the Christian Medical College in Southern India. Annual tuberculin skin testing (TST) was conducted to assess the annual risk of TB infection (ARTI) in this cohort. Methodology/Principal Findings 436 nursing students completed baseline two-step TST testing in 2007 and 217 were TST-negative and therefore eligible for repeat testing in 2008. 181 subjects completed a detailed questionnaire on exposure to tuberculosis from workplace and social contacts. A physician verified the questionnaire and clinical log book and screened the subjects for symptoms of active TB. The majority of nursing students (96.7%) were females, almost 84% were under 22 years of age, and 80% had BCG scars. Among those students who underwent repeat testing in 2008, 14 had TST conversions using the ATS/CDC/IDSA conversion definition of 10 mm or greater increase over baseline. The ARTI was therefore estimated as 7.8% (95%CI: 4.3–12.8%). This was significantly higher than the national average ARTI of 1.5%. Sputum collection and caring for pulmonary TB patients were both high risk activities that were associated with TST conversions in this young nursing cohort. Conclusions Our study showed a high ARTI among young nursing trainees, substantially higher than that seen in the general Indian population. Indian healthcare providers and the Indian Revised National TB Control Programme will need to implement internationally recommended TB infection control interventions to protect its health care workforce.
Challenges in the Development of an Immunochromatographic Interferon-Gamma Test for Diagnosis of Pleural Tuberculosis
Claudia M. Denkinger, Yatiraj Kalantri, Samuel G. Schumacher, Joy S. Michael, Deepa Shankar, Arvind Saxena, Natarajan Sriram, Thangakunam Balamugesh, Robert Luo, Nira R. Pollock, Madhukar Pai, Devasahayam J. Christopher
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0085447
Abstract: Existing diagnostic tests for pleural tuberculosis (TB) have inadequate accuracy and/or turnaround time. Interferon-gamma (IFNg) has been identified in many studies as a biomarker for pleural TB. Our objective was to develop a lateral flow, immunochromatographic test (ICT) based on this biomarker and to evaluate the test in a clinical cohort. Because IFNg is commonly present in non-TB pleural effusions in low amounts, a diagnostic IFNg-threshold was first defined with an enzyme-linked immunosorbent assay (ELISA) for IFNg in samples from 38 patients with a confirmed clinical diagnosis (cut-off of 300pg/ml; 94% sensitivity and 93% specificity). The ICT was then designed; however, its achievable limit of detection (5000pg/ml) was over 10-fold higher than that of the ELISA. After several iterations in development, the prototype ICT assay for IFNg had a sensitivity of 69% (95% confidence interval (CI): 50-83) and a specificity of 94% (95% CI: 81-99%) compared to ELISA on frozen samples. Evaluation of the prototype in a prospective clinical cohort (72 patients) on fresh pleural fluid samples, in comparison to a composite reference standard (including histopathological and microbiologic test results), showed that the prototype had 65% sensitivity (95% CI: 44-83) and 89% specificity (95% CI: 74-97). Discordant results were observed in 15% of samples if testing was repeated after one freezing and thawing step. Inter-rater variability was limited (3%; 1out of 32). In conclusion, despite an iterative development and optimization process, the performance of the IFNg ICT remained lower than what could be expected from the published literature on IFNg as a biomarker in pleural fluid. Further improvements in the limit of detection of an ICT for IFNg, and possibly combination of IFNg with other biomarkers such as adenosine deaminase, are necessary for such a test to be of value in the evaluation of pleural tuberculosis.
A young lady with vanishing lung shadows
Samuel J,Thangakunam B
Southwest Journal of Pulmonary and Critical Care , 2011,
Abstract: A previously well 20-year-old young lady who presented with nonspecific right-sided chest pain was found to have a rounded shadow on chest X-ray. Investigations to rule out malignancy revealed multiple lung masses. Initial blood tests and percutaneous image guided biopsy were inconclusive. Surgical lung biopsy revealed features suggestive of Bronchocentric Granulomatosis. Her lung shadows spontaneously resolved and there was no evidence of symptomatic or radiological recurrence on follow up for five years. Bronchocentric Granulomatosis is a rare condition particularly in non-asthmatic individuals and should be considered in the lesser-known differential diagnosis of benign lung shadows.
Endobronchial ultrasound: A new innovation in bronchoscopy
Balamugesh T,Herth F
Lung India , 2009,
Abstract: Technical development in last two decades has made it possible for pulmonologists to do endobronchial ultrasound (EBUS). With EBUS mini-probe, the multilayered structure of the tracheobronchial wall can be analyzed better than any other imaging modality. Instead of fluoroscopic guided biopsy, EBUS can be used to biopsy peripheral lesions. EBUS-transbronchial needle aspiration has proved valuable for mediastinal lymph node staging of lung cancer. Studies have shown that EBUS is cost-effective as it reduces the need for more morbid and costly invasive procedure like mediastinoscopy or thoracotomy. Prospective studies are needed in India to see how EBUS will help in populations with high prevalence of tuberculosis.
Profile of treatment failure in tuberculosis - Experience from as tertiary care hospital
Behera D,Balamugesh T
Lung India , 2006,
Endogenous excess cortisol production and diabetes mellitus as predisposing factors for pulmonary cryptococcosis: A case report and literature review
Thangakunam B,Christopher D,Kurian S,Thomas R
Lung India , 2008,
Abstract: Pulmonary cryptococcosis usually occurs as an opportunistic infection in immuno-compromised patients. Endogenous Cushing′s syndrome is associated with cortisol excess and can predispose to development of cryptococcal infections. We report a case of diabetic patient with ACTH secreting pituitary tumour who developed a cavitating lung mass. Computed tomography-guided biopsy of the lesion revealed mucicarminophilic budding forms of cryptococcus. Broncheoalveolar lavage culture grew Cryptococcus neoformans. There was radiological response to treatment with liposomal Amphotericin, but patient ultimately succumbed to septicemia and multiorgan failure. Opportunistic infections with organisms like Cryptococcus neoformans, should be considered in patients with en-dogenous Cushing′s syndrome and a pulmonary infiltrate.
Chylous ascites and chylothorax: a case study
AA Mehta, R Gupta, T Balamugesh, DJ Christopher
Libyan Journal of Medicine , 2010,
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