Sir: Sentinel surveillance is an important activity of the National AIDS Prevention and Control P... more Sir: Sentinel surveillance is an important activity of the National AIDS Prevention and Control Programme. It is aimed at describing the trend of HIV infection in a ® xed population over a period of time. The sexually transmitted diseases (STD) clinic attenders constitute a group of individuals who have high risk sexual behaviour and are considered as an important sentinel group for monitoring HIV trend. Since HIV and conventional STD are biologically and behaviourally linked, rapid rise of HIV prevalence is seen. The sentinel surveillance for HIV infection among STD clinic attenders was initiated in Mumbai (Bombay) in India in February 1994. This was done at the government STD clinic at Sir J J Hospital by the State AIDS Cell in technical collaboration with AIDS Research & Control Centre (ARCON). Four surveillance activities have since been completed at 6 months’ interval wherein up to 400 consecutive ® rst-time STD clinic attenders were taken into the study each time. The tests for HIV infection included ELISA HIV-1/2 and those testing positive were con® rmed using another ELISA or the Western blot. The men:women ratio of attendance varied between 6:1 (1994) and 8:1 (1995). The pattern of STD seen among 215 consecutive ® rst-time attenders was: ulcerative in 151 (70.2%), genital discharges in 26 (12.1%), growths in 22 (10.1%) and other/mixed in 16 (7.6%). The prevalence of HIV among men rose from 25.5% (81/317) in 1994 to 31.4% (60/191) in 1995. By comparison, there was rapid rise in HIV prevalence from 9.6% (8/83) to 29.2% (7/24) among female attenders during the same period (Figure 1). Within the span of 2 years, HIV is equi-prevalent among men and women. This trend is suggestive of rapid spread of HIV among women. Thus, 1995 may be considered as the beginning of Phase III of the epidemic i.e. paediatric AIDS epidemic. Strati® ed analysis of HIV prevalence showed a steep rise of infection among women< 20 years of age. By comparison, men< 20 years of age showed a declining trend (Figure 2). This ® nding may not be an artefact because number of men and women under 20 years of age who were tested did not change signi® cantly. At the same time, men and women> 20 years of age continued to have a modest upward trend. It is likely that increased public awareness about AIDS has altered attitudes such that younger men are practising safer sex while older men tend to have unprotected sex with younger women presumably due to the belief that younger women were less likely to be infected with HIV. Since most HIV/AIDS preventive strategies such as educational messages and condom promotion are directed towards men, women remain vulnerable to STD and HIV because they are underprivileged in terms of health and STD services. Also, higher prevalence of syphilis (49/244) and larger genital area make women more vulnerable to HIV. As a result, steep rise in HIV prevalence among women, especially those under 20 years of age is seen. There is an urgent need to strengthen intervention among the female population. S Salunke1 M R Jagtap1 S Hira2 P Dalal3 C Jagavkar3
Journal of the American Society of Nephrology : JASN, Jan 30, 2017
The modern immunosuppression regimen has greatly improved short-term allograft outcomes but not l... more The modern immunosuppression regimen has greatly improved short-term allograft outcomes but not long-term allograft survival. Complications associated with immunosuppression, specifically nephrotoxicity and infection risk, significantly affect graft and patient survival. Inducing and understanding pathways underlying clinical tolerance after transplantation are, therefore, necessary. We previously showed full donor chimerism and immunosuppression withdrawal in highly mismatched allograft recipients using a bioengineered stem cell product (FCRx). Here, we evaluated the gene expression and microRNA expression profiles in renal biopsy samples from tolerance-induced FCRx recipients, paired donor organs before implant, and subjects under standard immunosuppression (SIS) without rejection and with acute rejection. Unlike allograft samples showing acute rejection, samples from FCRx recipients did not show upregulation of T cell- and B cell-mediated rejection pathways. Gene expression pathw...
Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia, 2011
Rhodococcus equi (R. equi) is an uncommon cause of infection in immunocompetent individuals. We d... more Rhodococcus equi (R. equi) is an uncommon cause of infection in immunocompetent individuals. We describe a case of R. equi bacteremia associated with hemodialysis (HD) catheter in an immunocompetent patient. A 38-year-old female with end-stage renal disease (ESRD) of uncertain etiology, on HD for the past 15 months who was previously healthy otherwise, was admitted with the complaints of intermittent fever, mild nausea and occasional vomiting for two weeks. Last HD was performed four days earlier through a tunneled right internal jugular permacath. Clinically the patient was afebrile and in no acute distress. She was hemodynamically stable with no peripheral stigmata of an endovascular infection. Physical examination was essentially normal. Initially, the patient was treated with intravenous vancomycin with each HD, retaining the catheter. However, due to persistently positive blood cultures, HD catheter had to be removed. The patient became afebrile and nausea and vomiting resolved...
Since its introduction more than 3 decades ago, the use of peritoneal dialysis (PD) has increased... more Since its introduction more than 3 decades ago, the use of peritoneal dialysis (PD) has increased greatly due to its simplicity, convenience, and low cost. Advances in technique, antibiotic prophylaxis, and the introduction of newer solutions have improved survival, quality of life, and reduced rate of complications with PD. In Hong Kong, approximately 80% end-stage renal disease (ESRD) patients perform PD; in others, that is, Canada, Australia, and New Zealand, 20%–30% patients use PD. However, in the United States, the annual rate of prevalent patients receiving PD has reduced to 8% from its peak of 15% in mid-1980s. PD as the initial modality is being offered to far less patients than hemodialysis (HD), resulting in the current annual incidence rate of less than 10% in USA. There are many reasons preventing the PD first initiative including the increased numbers of in-center hemodialysis units, physician comfort with the modality, perceived superiority of HD, risk of peritonitis,...
A 70-year-old Caucasian male presented 8 months postcadaveric renal transplant with slowly progre... more A 70-year-old Caucasian male presented 8 months postcadaveric renal transplant with slowly progressive shortness of breath, abdominal distention, and cough for a duration of a few days. Thorough evaluation found him to have severe pulmonary hypertension (PH) on echocardiogram with decompensated high-output congestive heart failure. A right heart catheterization was done, which confirmed elevated right-sided pressures and high cardiac output. The mean pulmonary artery pressure, on a Swan-Ganz catheter, improved from 37 to 30 mmHg on partial manual occlusion of his still functioning hemodialysis arteriovenous fistula. Subsequently, the patient underwent ligation of the fistula and this led to gradual improvement in his symptoms. Follow-up right heart catheterization and echocardiogram showed marked improvement and normalization of right heart pressures. We recommend that patients with arteriovenous fistula should undergo close monitoring for development of early signs and symptoms of congestive heart failure and screening for PH by echocardiography post-kidney transplant. Right heart catheterization should be considered if screening is positive. Risk and benefit of fistula closure should be weighed in face of reduced survival from PH in dialysis patients and closure should be considered in post-transplant patients.
Sir: Sentinel surveillance is an important activity of the National AIDS Prevention and Control P... more Sir: Sentinel surveillance is an important activity of the National AIDS Prevention and Control Programme. It is aimed at describing the trend of HIV infection in a ® xed population over a period of time. The sexually transmitted diseases (STD) clinic attenders constitute a group of individuals who have high risk sexual behaviour and are considered as an important sentinel group for monitoring HIV trend. Since HIV and conventional STD are biologically and behaviourally linked, rapid rise of HIV prevalence is seen. The sentinel surveillance for HIV infection among STD clinic attenders was initiated in Mumbai (Bombay) in India in February 1994. This was done at the government STD clinic at Sir J J Hospital by the State AIDS Cell in technical collaboration with AIDS Research & Control Centre (ARCON). Four surveillance activities have since been completed at 6 months’ interval wherein up to 400 consecutive ® rst-time STD clinic attenders were taken into the study each time. The tests for HIV infection included ELISA HIV-1/2 and those testing positive were con® rmed using another ELISA or the Western blot. The men:women ratio of attendance varied between 6:1 (1994) and 8:1 (1995). The pattern of STD seen among 215 consecutive ® rst-time attenders was: ulcerative in 151 (70.2%), genital discharges in 26 (12.1%), growths in 22 (10.1%) and other/mixed in 16 (7.6%). The prevalence of HIV among men rose from 25.5% (81/317) in 1994 to 31.4% (60/191) in 1995. By comparison, there was rapid rise in HIV prevalence from 9.6% (8/83) to 29.2% (7/24) among female attenders during the same period (Figure 1). Within the span of 2 years, HIV is equi-prevalent among men and women. This trend is suggestive of rapid spread of HIV among women. Thus, 1995 may be considered as the beginning of Phase III of the epidemic i.e. paediatric AIDS epidemic. Strati® ed analysis of HIV prevalence showed a steep rise of infection among women< 20 years of age. By comparison, men< 20 years of age showed a declining trend (Figure 2). This ® nding may not be an artefact because number of men and women under 20 years of age who were tested did not change signi® cantly. At the same time, men and women> 20 years of age continued to have a modest upward trend. It is likely that increased public awareness about AIDS has altered attitudes such that younger men are practising safer sex while older men tend to have unprotected sex with younger women presumably due to the belief that younger women were less likely to be infected with HIV. Since most HIV/AIDS preventive strategies such as educational messages and condom promotion are directed towards men, women remain vulnerable to STD and HIV because they are underprivileged in terms of health and STD services. Also, higher prevalence of syphilis (49/244) and larger genital area make women more vulnerable to HIV. As a result, steep rise in HIV prevalence among women, especially those under 20 years of age is seen. There is an urgent need to strengthen intervention among the female population. S Salunke1 M R Jagtap1 S Hira2 P Dalal3 C Jagavkar3
Journal of the American Society of Nephrology : JASN, Jan 30, 2017
The modern immunosuppression regimen has greatly improved short-term allograft outcomes but not l... more The modern immunosuppression regimen has greatly improved short-term allograft outcomes but not long-term allograft survival. Complications associated with immunosuppression, specifically nephrotoxicity and infection risk, significantly affect graft and patient survival. Inducing and understanding pathways underlying clinical tolerance after transplantation are, therefore, necessary. We previously showed full donor chimerism and immunosuppression withdrawal in highly mismatched allograft recipients using a bioengineered stem cell product (FCRx). Here, we evaluated the gene expression and microRNA expression profiles in renal biopsy samples from tolerance-induced FCRx recipients, paired donor organs before implant, and subjects under standard immunosuppression (SIS) without rejection and with acute rejection. Unlike allograft samples showing acute rejection, samples from FCRx recipients did not show upregulation of T cell- and B cell-mediated rejection pathways. Gene expression pathw...
Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia, 2011
Rhodococcus equi (R. equi) is an uncommon cause of infection in immunocompetent individuals. We d... more Rhodococcus equi (R. equi) is an uncommon cause of infection in immunocompetent individuals. We describe a case of R. equi bacteremia associated with hemodialysis (HD) catheter in an immunocompetent patient. A 38-year-old female with end-stage renal disease (ESRD) of uncertain etiology, on HD for the past 15 months who was previously healthy otherwise, was admitted with the complaints of intermittent fever, mild nausea and occasional vomiting for two weeks. Last HD was performed four days earlier through a tunneled right internal jugular permacath. Clinically the patient was afebrile and in no acute distress. She was hemodynamically stable with no peripheral stigmata of an endovascular infection. Physical examination was essentially normal. Initially, the patient was treated with intravenous vancomycin with each HD, retaining the catheter. However, due to persistently positive blood cultures, HD catheter had to be removed. The patient became afebrile and nausea and vomiting resolved...
Since its introduction more than 3 decades ago, the use of peritoneal dialysis (PD) has increased... more Since its introduction more than 3 decades ago, the use of peritoneal dialysis (PD) has increased greatly due to its simplicity, convenience, and low cost. Advances in technique, antibiotic prophylaxis, and the introduction of newer solutions have improved survival, quality of life, and reduced rate of complications with PD. In Hong Kong, approximately 80% end-stage renal disease (ESRD) patients perform PD; in others, that is, Canada, Australia, and New Zealand, 20%–30% patients use PD. However, in the United States, the annual rate of prevalent patients receiving PD has reduced to 8% from its peak of 15% in mid-1980s. PD as the initial modality is being offered to far less patients than hemodialysis (HD), resulting in the current annual incidence rate of less than 10% in USA. There are many reasons preventing the PD first initiative including the increased numbers of in-center hemodialysis units, physician comfort with the modality, perceived superiority of HD, risk of peritonitis,...
A 70-year-old Caucasian male presented 8 months postcadaveric renal transplant with slowly progre... more A 70-year-old Caucasian male presented 8 months postcadaveric renal transplant with slowly progressive shortness of breath, abdominal distention, and cough for a duration of a few days. Thorough evaluation found him to have severe pulmonary hypertension (PH) on echocardiogram with decompensated high-output congestive heart failure. A right heart catheterization was done, which confirmed elevated right-sided pressures and high cardiac output. The mean pulmonary artery pressure, on a Swan-Ganz catheter, improved from 37 to 30 mmHg on partial manual occlusion of his still functioning hemodialysis arteriovenous fistula. Subsequently, the patient underwent ligation of the fistula and this led to gradual improvement in his symptoms. Follow-up right heart catheterization and echocardiogram showed marked improvement and normalization of right heart pressures. We recommend that patients with arteriovenous fistula should undergo close monitoring for development of early signs and symptoms of congestive heart failure and screening for PH by echocardiography post-kidney transplant. Right heart catheterization should be considered if screening is positive. Risk and benefit of fistula closure should be weighed in face of reduced survival from PH in dialysis patients and closure should be considered in post-transplant patients.
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Papers by Pranav Dalal