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Arumugam R, Thomas S, Jacob NSM, Nadaraj A, George SP, Singh G. Relationship between pulse pressure variation and stroke volume variation with changes in cardiac index during hypotension in patients undergoing major spine surgeries in prone position - A prospective observational study. J Anaesthesiol Clin Pharmacol 2022; 38:553-559. [PMID: 36778833 PMCID: PMC9912902 DOI: 10.4103/joacp.joacp_594_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/04/2021] [Accepted: 07/06/2021] [Indexed: 12/30/2022] Open
Abstract
Background and Aims Dynamic indices such as pulse pressure variation (PPV) and stroke volume variation (SVV) are better predictors of fluid responsiveness than static indices. There is a strong correlation between PPV and SVV in the prone position when assessed with the fluid challenge. However, this correlation has not been established during intraoperative hypotension. Our study aimed to assess the correlation between PPV and SVV during hypotension in the prone position and its relationship with cardiac index (CI). Material and Methods Thirty patients aged 18-70 years of ASA class I-III, undergoing spine procedures in the prone position were recruited for this prospective observational study. Hemodynamic variables such as heart rate (HR), mean arterial pressure (MAP), PPV, SVV, and CI were measured at baseline (after induction of anesthesia and positioning in the prone position). This set of variables were collected at the time of hypotension (T-before) and after correction (T-after) with either fluids or vasopressors. HR and MAP are presented as median with inter quartile range and compared by Mann-Whitney U test. Reliability was measured by intraclass correlation coefficients (ICC). Generalized estimating equations were performed to assess the change of CI with changes in PPV and SVV. Results A statistically significant linear relationship between PPV and SVV was observed. The ICC between change in PPV and SVV during hypotension was 0.9143, and after the intervention was 0.9091 (P < 0.001). Regression of changes in PPV and SVV on changes in CI depicted the reciprocal change in CI which was not statistically significant. Conclusion PPV is a reliable surrogate of SVV during intraoperative hypotension in the prone position.
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Affiliation(s)
- Rajasekar Arumugam
- Department of Cardiothoracic Anaesthesia, Critical Care and ECMO, Manchester University Hospital NHS Foundation Trust, United Kingdom
| | - Susan Thomas
- Department of Anaesthesiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nisha Sara M Jacob
- Department of Anaesthesia, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ambily Nadaraj
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sajan P. George
- Department of Anaesthesiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Georgene Singh
- Department of Anaesthesiology, Christian Medical College, Vellore, Tamil Nadu, India
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Devakumar D, Sunny G, Sasidharan BK, Bowen SR, Nadaraj A, Jeyseelan L, Mathew M, Irodi A, Isiah R, Pavamani S, John S, T Thomas HM. Framework for Machine Learning of CT and PET Radiomics to Predict Local Failure after Radiotherapy in Locally Advanced Head and Neck Cancers. J Med Phys 2021; 46:181-188. [PMID: 34703102 PMCID: PMC8491314 DOI: 10.4103/jmp.jmp_6_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 06/07/2021] [Accepted: 06/07/2021] [Indexed: 01/06/2023] Open
Abstract
Context: Cancer Radiomics is an emerging field in medical imaging and refers to the process of converting routine radiological images that are typically qualitatively interpreted to quantifiable descriptions of the tumor phenotypes and when combined with statistical analytics can improve the accuracy of clinical outcome prediction models. However, to understand the radiomic features and their correlation to molecular changes in the tumor, first, there is a need for the development of robust image analysis methods, software tools and statistical prediction models which is often limited in low- and middle-income countries (LMIC). Aims: The aim is to build a framework for machine learning of radiomic features of planning computed tomography (CT) and positron emission tomography (PET) using open source radiomics and data analytics platforms to make it widely accessible to clinical groups. The framework is tested in a small cohort to predict local disease failure following radiation treatment for head-and-neck cancer (HNC). The predictors were also compared with the existing Aerts HNC radiomics signature. Settings and Design: Retrospective analysis of patients with locally advanced HNC between 2017 and 2018 and 31 patients with both pre- and post-radiation CT and evaluation PET were selected. Subjects and Methods: Tumor volumes were delineated on baseline PET using the semi-automatic adaptive-threshold algorithm and propagated to CT; PyRadiomics features (total of 110 under shape/intensity/texture classes) were extracted. Two feature-selection methods were tested for model stability. Models were built based on least absolute shrinkage and selection operator-logistic and Ridge regression of the top pretreatment radiomic features and compared to Aerts' HNC-signature. Average model performance across all internal validation test folds was summarized by the area under the receiver operator curve (ROC). Results: Both feature selection methods selected CT features MCC (GLCM), SumEntropy (GLCM) and Sphericity (Shape) that could predict the binary failure status in the cross-validated group and achieved an AUC >0.7. However, models using Aerts' signature features (Energy, Compactness, GLRLM-GrayLevelNonUniformity and GrayLevelNonUniformity-HLH wavelet) could not achieve a clear separation between outcomes (AUC = 0.51–0.54). Conclusions: Radiomics pipeline included open-source workflows which makes it adoptable in LMIC countries. Additional independent validation of data is crucial for the implementation of radiomic models for clinical risk stratification.
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Affiliation(s)
- Devadhas Devakumar
- Department of Nuclear Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Goutham Sunny
- Department of Radiation Oncology, Christian Medical College, Vellore, Tamil Nadu, India.,Department of Radiation Oncology, Baptist Cancer Centre, Bangalore Baptist Hospital, Bengaluru, Karnataka, India
| | | | - Stephen R Bowen
- Department of Radiation Oncology, School of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Ambily Nadaraj
- Department of Clinical Epidemiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - L Jeyseelan
- Department of Clinical Epidemiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Manu Mathew
- Department of Radiation Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Aparna Irodi
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rajesh Isiah
- Department of Radiation Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Simon Pavamani
- Department of Radiation Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Subhashini John
- Department of Radiation Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Hannah Mary T Thomas
- Department of Radiation Oncology, Christian Medical College, Vellore, Tamil Nadu, India
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3
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Edakhlon S, Mohan P, Pillai GS, Verma L, Honavar SG, Sharma N, Nadaraj A. Impact of COVID-19 pandemic on income and opportunities of ophthalmologists in India: Ophthalmologists' Workplace Expectations and Satisfaction Survey (OWESS) Report 1. Indian J Ophthalmol 2021; 69:2189-2194. [PMID: 34304208 PMCID: PMC8482938 DOI: 10.4103/ijo.ijo_1491_21] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/28/2021] [Accepted: 07/05/2021] [Indexed: 11/06/2022] Open
Abstract
Purpose To evaluate the impact of COVID-19 pandemic on the income and surgical training opportunities among the ophthalmologists in India and their opinion on salary reduction during this period. Methods A questionnaire in the form of a Google survey was sent to ophthalmologists across India on May 1, 2021. The data collected until May 11, 2021 was analyzed. Results A total of 1057 ophthalmologists all over India participated in the survey. Of the respondents, 559 (52.9%) were women and 730 (69.1%) were young ophthalmologists (below the age of 40 years). Salary reduction was reported by 569 (53.8%) of the respondents. The categories suffering the maximum salary reduction were - young ophthalmologists (407, 55.8%) (P < 0.001), women (304, 54.4%) (P < 0.001), and private sector employees (457, 67%) (P < 0.001). More women ophthalmologists (438, 78.4%) felt it was unfair to reduce the salary during the pandemic, as compared to men (330, 66.3%) (P < 0.001). A reduction in surgical training opportunities was reported by 689 (65.2%) of ophthalmologists. The categories who suffered the maximum loss of surgical training opportunities were young ophthalmologists (565, 77.4%) (P < 0.001), women ophthalmologists (415, 74.2%) (P < 0.001), and ophthalmologists in the government sector (147, 82.6%) (P < 0.001). Conclusion Ophthalmologists in India, especially women and the younger professionals, had to face salary reduction and loss of surgical training opportunities during the COVID-19 pandemic. Most ophthalmologists in India do not favor a reduction in salary. There is a need to formulate policies to safeguard ophthalmologists, especially women and younger generation from future crises in training, employment, and income.
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Affiliation(s)
- Sreeni Edakhlon
- Comtrust Charitable Trust Eye Hospital, Thalassery, Kerala, India
| | - Prashob Mohan
- Chaithanya Eye Hospital and Research Institute, Thiruvananthapuram, Kerala, India
| | - Gopal S Pillai
- Department of Ophthalmology, Amrita Institute of Medical Science, Kochi, Kerala, India
| | | | | | - Namrata Sharma
- Dr RP Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Ambily Nadaraj
- Department of Ophthalmology, Amrita Institute of Medical Science, Kochi, Kerala, India
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Govindarajan R, Ramamoorthy G, Shanmugam RM, Bavanandam S, Murugesan M, Shanmugam C, Arumugam A, Chellamuthu VP, Venkatraj RK, Sampathkumar K, Rejoice P, Kumar KA, Adamali S, Mariappan K, Rathnavel R, Manivasagam VSC, Velusamy A, Arumugam S, Elikkottil TT, Dev AV, Sen M, Palaniappan A, Dorairaj AJ, Kedarisetty CK, Venkataraman J, Karthikeyan M, Somasundaram A, Ramakrishnan A, Madesh VP, Varghese J, Anupa DK, Leelakrishnan V, Swaminathan M, Kantamaneni R, Dhus JU, Murugan N, Natarajan K, Selvi C, Saithanyamurthi HV, Nadaraj A, Jeyaseelan L, Eapen CE. Rodenticide ingestion is an important cause of acute hepatotoxicity in Tamil Nadu, southern India. Indian J Gastroenterol 2021; 40:373-379. [PMID: 34189713 DOI: 10.1007/s12664-021-01178-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 03/29/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM Though rodenticidal hepatotoxicity is reported from India, there is no systematic study to assess its magnitude. This study aimed to assess exposure to rodenticide as a risk factor for acute hepatotoxicity in Tamil Nadu, India. METHODS We retrospectively analyzed acute hepatotoxicity caused by ingestion of hepatotoxin or potentially hepatotoxic drug overdose across 15 hospitals in 6 districts of Tamil Nadu from 1 January 2019 to 30 June 2019. Study exclusion criteria were idiosyncratic drug-induced liver injury and chronic liver diseases. RESULTS Of the 702 patients, 685 gave history of consuming rodenticide; hepatotoxicity in the other patients resulted from paracetamol overdose (n=10) and due to other drugs (n=7); 97% patients had a suicidal intent. Of 671 patients with complete data, ratio of number of patients with hepatotoxicity due to rodenticide to paracetamol overdose was 450:6 (i.e. 75:1). The 451 rodenticidal hepatotoxicity patients (255 males, 75% were 15-34 years old) underwent conservative management (n=396), plasma exchange (n=54) and plasma exchange followed by liver transplant (n=1); 159 patients (35%) had poor outcome (131 died, 28 discharged in moribund state). Based on our observations, we estimate a case burden of 1584 rodenticidal hepatotoxicity patients (95% CI: 265-6119) with poor outcome in 554 patients in Tamil Nadu from January 2019 to June 2019. Population attributable risk for rodenticide as cause of hepatotoxicity was 22.7%. CONCLUSION Rodenticide ingestion was an important cause of acute hepatotoxicity in Tamil Nadu. Most patients were young and one-third had poor outcome. Public health interventions are needed to address this.
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Affiliation(s)
- Ramkumar Govindarajan
- Department of Medical Gastroenterology, Thanjavur Medical College, Thanjavur, 613 004, India
| | - Ganesan Ramamoorthy
- Department of Medical Gastroenterology, Thanjavur Medical College, Thanjavur, 613 004, India
| | | | - Sumathi Bavanandam
- Department of Medical Gastroenterology, Stanley Medical College, Chennai, 600 001, India
| | - Manimaran Murugesan
- Department of Medical Gastroenterology, Stanley Medical College, Chennai, 600 001, India
| | - Chitra Shanmugam
- Department of Medical Gastroenterology, Stanley Medical College, Chennai, 600 001, India
| | - Aravind Arumugam
- Department of Medical Gastroenterology, Government Kilpauk Medical College, Chennai, 600 010, India.,Department of Digestive Health and Diseases, Government Kilpauk Medical College, Chennai, 600 010, India
| | - Vaishnavi Priyaa Chellamuthu
- Department of Medical Gastroenterology, Government Kilpauk Medical College, Chennai, 600 010, India.,Department of Digestive Health and Diseases, Government Kilpauk Medical College, Chennai, 600 010, India
| | | | - Kavitha Sampathkumar
- Department of Medical Gastroenterology, Government Kilpauk Medical College, Chennai, 600 010, India.,Department of Digestive Health and Diseases, Government Kilpauk Medical College, Chennai, 600 010, India
| | - Poppy Rejoice
- Department of Medical Gastroenterology, Tirunelveli Medical College, Tirunelveli, 627 011, India
| | - Kandasamy Alias Kumar
- Department of Medical Gastroenterology, Tirunelveli Medical College, Tirunelveli, 627 011, India
| | - Shafique Adamali
- Department of Medical Gastroenterology, Tirunelveli Medical College, Tirunelveli, 627 011, India
| | - Kannan Mariappan
- Department of Medical Gastroenterology, Government Rajaji Hospital, Madurai Medical College, Madurai, 625 020, India
| | - Ramani Rathnavel
- Department of Medical Gastroenterology, Government Rajaji Hospital, Madurai Medical College, Madurai, 625 020, India
| | | | - Arulselvan Velusamy
- Department of Medical Gastroenterology, Government Medical College, Coimbatore, 641 018, India
| | - Senthilvadivu Arumugam
- Department of Medical Gastroenterology, Government Medical College, Coimbatore, 641 018, India
| | - Thasneem Taj Elikkottil
- Department of Medical Gastroenterology, Government Medical College, Coimbatore, 641 018, India
| | - Anand Vimal Dev
- Department of Hepatology, Christian Medical College, Vellore, 632 004, India
| | - Mousumi Sen
- Department of Forensic Medicine, Christian Medical College, Vellore, 632 004, India
| | - Alagammai Palaniappan
- Department of Gastroenterology, Meenakshi Mission Hospital and Research Centre, Madurai, 625 107, India
| | - Allwin James Dorairaj
- Department of Gastroenterology, Meenakshi Mission Hospital and Research Centre, Madurai, 625 107, India
| | - Chandan Kumar Kedarisetty
- Department of Hepatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, 600 116, India
| | - Jayanthi Venkataraman
- Department of Hepatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, 600 116, India
| | - Mugilan Karthikeyan
- Department of Hepatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, 600 116, India
| | - Aravindh Somasundaram
- Department of Gastroenterology, Kovai Medical Center Hospital, Coimbatore, 641 014, India
| | - Arulraj Ramakrishnan
- Department of Gastroenterology, Kovai Medical Center Hospital, Coimbatore, 641 014, India
| | - Vijaya Prakash Madesh
- Department of Gastroenterology, Kovai Medical Center Hospital, Coimbatore, 641 014, India
| | - Joy Varghese
- Department of Hepatology and Transplant Hepatology, Gleneagles Global Health City Hospital, Chennai, 600 100, India
| | - Dheeraj Kumar Anupa
- Department of Hepatology and Transplant Hepatology, Gleneagles Global Health City Hospital, Chennai, 600 100, India
| | - Venkatakrishnan Leelakrishnan
- Department of Gastroenterology and Hepatology, PSG Institute of Medical Sciences and Research, Coimbatore, 641 004, India
| | - Mukundan Swaminathan
- Department of Gastroenterology and Hepatology, PSG Institute of Medical Sciences and Research, Coimbatore, 641 004, India
| | - Ravindra Kantamaneni
- Department of Gastroenterology and Hepatology, PSG Institute of Medical Sciences and Research, Coimbatore, 641 004, India
| | - Jeyaraj Ubal Dhus
- Department of Medical Gastroenterology and Hepatology, Apollo Hospitals, Chennai, 600 006, India
| | - Natarajan Murugan
- Department of Medical Gastroenterology and Hepatology, Apollo Hospitals, Chennai, 600 006, India
| | - Kartik Natarajan
- Department of Medical Gastroenterology and Hepatology, Apollo Hospitals, Chennai, 600 006, India
| | - Caroline Selvi
- Department of Medical Gastroenterology, Government Royapettah Hospital, Kilpauk Medical College, Chennai, 600 010, India
| | | | - Ambily Nadaraj
- Clinical Epidemiology Unit, Christian Medical College, Vellore, 632 004, India
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Thomas VV, Kumar SE, Alexander V, Nadaraj A, Vijayalekshmi B, Prabhu S, Kumar S, Murugabharathy K, Thomas SM, Hansdak S, Carey R, Iyyadurai R, Pichamuthu K, Abhilash KPP, Varghese GM, Nair S, Goel A, Jeyaseelan L, Zachariah U, Zachariah A, Eapen CE. Plasma Von Willebrand Factor Levels Predict Survival in COVID-19 Patients Across the Entire Spectrum of Disease Severity. Indian J Hematol Blood Transfus 2021; 38:333-340. [PMID: 34177141 PMCID: PMC8214842 DOI: 10.1007/s12288-021-01459-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 06/10/2021] [Indexed: 12/20/2022] Open
Abstract
Background: Characterization of reticulo-endothelial activation in COVID-19 may guide treatment. Objectives: To assess reticulo-endothelial activation and its correlation with disease severity and death in patients across the entire spectrum of COVID-19 severity. Methods: Consecutive hospitalized COVID-19 patients were studied, with similar number of patients in each disease severity category. Baseline serum ferritin, sCD163 (macrophage activation markers) and plasma von Willebrand factor (VWF) antigen (endothelial activation marker) levels were studied. Clinical parameters and plasma D-dimer levels were also studied. The study parameters were correlated with COVID-19 severity and survival. Results: The 143 patients (104 males [80%], age 54 [42 – 65] years, median [inter-quartile range]) presented 4 (3—7) days after symptom onset. Thirty-four patients had mild disease, 36 had moderate disease, 36 had severe disease and 37 had critical disease at baseline. With increasing COVID-19 severity, ferritin, sCD163, VWF and D-dimer levels significantly increased at baseline, however, 139 patients had normal sCD163 levels. Of the reticulo-endothelial markers, VWF level independently correlated with COVID-19 severity and with survival. VWF level > 332.6 units/dl correlated with COVID-19 severity (odds ratio [OR]: 2.77 [95% confidence interval (C.I): 1.1 – 6.99], p value: 0.031) and in-hospital death (OR [95% CI]: 29.28 [5.2 – 165], p value < 0.001). Conclusions: Reticulo-endothelial activation markers increased incrementally with worsening COVID-19 severity. Baseline endothelial activation marker (VWF), and not macrophage activation markers, independently correlated with COVID-19 severity and death.
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Affiliation(s)
| | - Santhosh E Kumar
- Hepatology, Christian Medical College, Vellore, Tamil Nadu India
| | - Vijay Alexander
- Hepatology, Christian Medical College, Vellore, Tamil Nadu India
| | - Ambily Nadaraj
- Bio-statistics, Christian Medical College, Vellore, Tamil Nadu India
| | - B Vijayalekshmi
- Wellcome Trust Research labs - Division of GI Sciences, Christian Medical College, Vellore, Tamil Nadu India
| | - Savit Prabhu
- Wellcome Trust Research labs - Division of GI Sciences, Christian Medical College, Vellore, Tamil Nadu India
| | - Snehil Kumar
- Transfusion Medicine & Immunohaematology, Christian Medical College, Vellore, Tamil Nadu India
| | - K Murugabharathy
- Departments of Medicine, Christian Medical College, Vellore, Tamil Nadu India
| | - Sheba Meriam Thomas
- Departments of Medicine, Christian Medical College, Vellore, Tamil Nadu India
| | - Samuel Hansdak
- Departments of Medicine, Christian Medical College, Vellore, Tamil Nadu India
| | - Ronald Carey
- Departments of Medicine, Christian Medical College, Vellore, Tamil Nadu India
| | - Ramya Iyyadurai
- Departments of Medicine, Christian Medical College, Vellore, Tamil Nadu India
| | - Kishore Pichamuthu
- Critical Care division, Christian Medical College, Vellore, Tamil Nadu India
| | - K P P Abhilash
- Emergency Medicine, Christian Medical College, Vellore, Tamil Nadu India
| | - George M Varghese
- Infectious diseases, Christian Medical College, Vellore, Tamil Nadu India
| | - Sukesh Nair
- Transfusion Medicine & Immunohaematology, Christian Medical College, Vellore, Tamil Nadu India
| | - Ashish Goel
- Hepatology, Christian Medical College, Vellore, Tamil Nadu India
| | - L Jeyaseelan
- Bio-statistics, Christian Medical College, Vellore, Tamil Nadu India
| | - Uday Zachariah
- Hepatology, Christian Medical College, Vellore, Tamil Nadu India
| | - Anand Zachariah
- Departments of Medicine, Christian Medical College, Vellore, Tamil Nadu India
| | - C E Eapen
- Hepatology, Christian Medical College, Vellore, Tamil Nadu India
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Ganesan P, Jain H, Bagal B, Subramanian PG, George B, Korula A, Mehra N, Kalaiyarasi JP, Bhurani D, Agrawal N, Ahmed R, Kayal S, Bhattacharyya J, Yanamandra U, Kumar S, Philip CC, John MJ, Nadaraj A, Karunamurthy O, Lakshmanan J, Mathews V, Sengar M. Outcomes in adolescent and young adult acute lymphoblastic leukaemia: a report from the Indian Acute Leukaemia Research Database (INwARD) of the Hematology Cancer Consortium (HCC). Br J Haematol 2021; 193:e1-e4. [PMID: 33656752 DOI: 10.1111/bjh.17268] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Prasanth Ganesan
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Hasmukh Jain
- Department of Medical Oncology, Adult Hematolymphoid Disease Management Group, Tata Memorial Centre, Mumbai, India
| | - Bhausaheb Bagal
- Department of Medical Oncology, Adult Hematolymphoid Disease Management Group, Tata Memorial Centre, Mumbai, India
| | | | - Biju George
- Department of Haematology, Christian Medical College, Vellore, India
| | - Anu Korula
- Department of Haematology, Christian Medical College, Vellore, India
| | - Nikita Mehra
- Department of Medical Oncology, Cancer Institute (WIA), Chennai, India
| | | | - Dinesh Bhurani
- Department of Hemato-Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Narendra Agrawal
- Department of Hemato-Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Rayaz Ahmed
- Department of Hemato-Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Smita Kayal
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Jina Bhattacharyya
- Department of Clinical Hematology, Gauhati Medical College and Hospital, Gauhati, India
| | - Uday Yanamandra
- Department of Hematology, Army Hospital (Research and Referral), New Delhi, India
| | - Suman Kumar
- Department of Hematology, Army Hospital (Research and Referral), New Delhi, India
| | - Chepsy C Philip
- Department of Clinical Haematology, Christian Medical College and Hospital, Ludhiana, India
| | - M Joseph John
- Department of Clinical Haematology, Christian Medical College and Hospital, Ludhiana, India
| | - Ambily Nadaraj
- Department of Biostatistics, Christian Medical College, Vellore, India
| | | | | | - Vikram Mathews
- Department of Haematology, Christian Medical College, Vellore, India
| | - Manju Sengar
- Department of Medical Oncology, Adult Hematolymphoid Disease Management Group, Tata Memorial Centre, Mumbai, India
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7
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Ganu SA, Mathew AJ, Nadaraj A, Jeyaseelan L, Danda D. Cotrimoxazole prophylaxis prevents major infective episodes in patients with systemic lupus erythematosus on immunosuppressants: A non-concurrent cohort study. Lupus 2021; 30:893-900. [PMID: 33626971 DOI: 10.1177/0961203321995238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Prophylactic trimethoprim-sulfamethoxazole (TMP-SMX) prevents pneumocystis jirovecii infection in SLE on immunosuppression. Its role in preventing other major infections in immuno suppressed SLE patients is unknown. METHODS A non-concurrent cohort study was conducted on patients of SLE fulfilling SLICC and/or ACR 1997 criteria, who received tapering dose of steroid starting with ≥0.5 mg/kg/day of prednisolone or equivalent dose of deflazacort and mycophenolate mofetil ≥1 g/day (or equivalent dose of mycophenolate sodium) at least for the preceding 1 year. Interviewing patients & documenting relevant data from hospital electronic Medical records (EMR), followed by comparison of Incidence densities of major infections between those on prophylactic Trimethoprim 160 mg + Sulfamethoxazole 800 mg and those not on it, was done by student 't' test. Multivariate logistic regression was performed for independent risk of any major infection between the two groups. RESULTS Of 228 patients, 162 did not receive TMP-SMX prophylaxis, and 66 had received. The incidence density of major infection was found to be significantly lower in TMP-SMX group (1.25 per 100 person year) as compared to those not on TMP-SMX group (11.201 per 100 person year); P < 0.001 (95% CI 0.027 - 0.449) and odds ratio of 0.03 (CI 0 - 0.24). CONCLUSION Cotrimoxazole prophylaxis in SLE patients on immunosuppression prevents major infections.
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Affiliation(s)
- Salil A Ganu
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India.,Department of Clinical Immunology and Rheumatology, Amrita Institute of Medical sciences, Kochi, India
| | - Ashish J Mathew
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
| | - Ambily Nadaraj
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - L Jeyaseelan
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - Debashish Danda
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
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Rose JS, Lalgudi S, Joshua RA, Paul J, Susanne MA, Phillips AC, Jeyaraj C, Abraham G, Joshua R, Vinay S, Paul P, Amritanand A, Nadaraj A. A validated audio-visual educational module on examination skills in ophthalmology for undergraduate medical students in the COVID-19 season - An observational longitudinal study. Indian J Ophthalmol 2021; 69:400-405. [PMID: 33380618 PMCID: PMC7933836 DOI: 10.4103/ijo.ijo_2054_20] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose The aim of this study was to assess the impact of an audio visual (AV) teaching module on basic torchlight examination of the eye and direct ophthalmoscopy for undergraduate medical students. Methods This observational longitudinal study was done on 33 consecutive medical interns during their Ophthalmology posting from December 2019 to March 2020 at a medical college in South-India. An AV-module was created using animation graphics, narratives, demonstrations on normal individuals and on patients with positive signs. All interns had a pretest consisting of Multiple-choice questions, (MCQs) and an Objective Structured Clinical Examination (OSCE) on torchlight examination and direct ophthalmoscopy (DO). They were then shown the 20-minute AV-module. A posttest was performed immediately and after one week. Results The mean pretest MCQ score was 5.84 ± 1.98. It improved to 8.81 ± 1.15 in the immediate posttest and 8.87 ± 1.66 in the one-week posttest. The mean pretest OSCE score was 12.21 ± 3.39. It improved to 23.21 ± 3.39 in the immediate posttest and 23.90 ± 3.7 in the one-week posttest. Using Generalized Estimating Equation, MCQ score improved by 2.97 units and 3.03 units and the OSCE score improved by 11 units and 11.69 units in the immediate posttest and one-week posttest respectively when compared to the pretest corresponding to the MCQ score and OSCE score (p < 0.001). Conclusion AV teaching modules-for torchlight examination and DO has a significant benefit in improving knowledge and skill in undergraduate medical students. These significant results have the great translatory capacity in the current COVID-19 pandemic, where physical demonstrations involving close proximity and groups of students are highly risk prone.
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Affiliation(s)
- Jeyanth S Rose
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sharmili Lalgudi
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - R Aarwin Joshua
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Joshua Paul
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - M Aishwarya Susanne
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ashna C Phillips
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Chriset Jeyaraj
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Greeni Abraham
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - R Joshua
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Samuel Vinay
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Padma Paul
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anika Amritanand
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ambily Nadaraj
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
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Marimuthu S, Joy M, Malavika B, Nadaraj A, Asirvatham ES, Jeyaseelan L. Modelling of reproduction number for COVID-19 in India and high incidence states. Clin Epidemiol Glob Health 2020; 9:57-61. [PMID: 32838059 PMCID: PMC7324346 DOI: 10.1016/j.cegh.2020.06.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/08/2020] [Accepted: 06/26/2020] [Indexed: 01/24/2023] Open
Abstract
Background Since the onset of the COVID-19 in China, forecasting and projections of the epidemic based on epidemiological models have been in the centre stage. Researchers have used various models to predict the maximum extent of the number of cases and the time of peak. This yielded varying numbers. This paper aims to estimate the effective reproduction number (R) for COVID-19 over time using incident number of cases that are reported by the government. Methods Exponential Growth method to estimate basic reproduction rate R0, and Time dependent method to calculate the effective reproduction number (dynamic) were used. "R0" package in R software was used to estimate these statistics. Results The basic reproduction number (R0) for India was estimated at 1.379 (95% CI: 1.375, 1.384). This was 1.450 (1.441, 1.460) for Maharashtra, 1.444 (1.430, 1.460) for Gujarat, 1.297 (1.284, 1.310) for Delhi and 1.405 (1.389, 1.421) for Tamil Nadu. In India, the R at the first week from March 2-8, 2020 was 3.2. It remained around 2 units for three weeks, from March 9-29, 2020. After March 2020, it started declining and reached around 1.3 in the following week suggesting a stabilisation of the transmissibility rate. Conclusion The study estimated a baseline R0 of 1.379 for India. It also showed that the R was getting stabilised from first week of April (with an average R of 1.29), despite the increase in March. This suggested that in due course there will be a reversal of epidemic. However, these analyses should be revised periodically.
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Affiliation(s)
- S Marimuthu
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, 632 002, India
| | - Melvin Joy
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, 632 002, India
| | - B Malavika
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, 632 002, India
| | - Ambily Nadaraj
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, 632 002, India
| | - Edwin Sam Asirvatham
- Health Systems and Policy, Health Systems Research India Initiative (HSRII), Trivandrum, India
| | - L Jeyaseelan
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, 632 002, India
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Malavika B, Marimuthu S, Joy M, Nadaraj A, Asirvatham ES, Jeyaseelan L. Forecasting COVID-19 epidemic in India and high incidence states using SIR and logistic growth models. Clin Epidemiol Glob Health 2020; 9:26-33. [PMID: 32838058 PMCID: PMC7319934 DOI: 10.1016/j.cegh.2020.06.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/02/2020] [Accepted: 06/22/2020] [Indexed: 11/06/2022] Open
Abstract
Background Ever since the Coronavirus disease (COVID-19) outbreak emerged in China, there has been several attempts to predict the epidemic across the world with varying degrees of accuracy and reliability. This paper aims to carry out a short-term projection of new cases; forecast the maximum number of active cases for India and selected high-incidence states; and evaluate the impact of three weeks lock down period using different models. Methods We used Logistic growth curve model for short term prediction; SIR models to forecast the maximum number of active cases and peak time; and Time Interrupted Regression model to evaluate the impact of lockdown and other interventions. Results The predicted cumulative number of cases for India was 58,912 (95% CI: 57,960, 59,853) by May 08, 2020 and the observed number of cases was 59,695. The model predicts a cumulative number of 1,02,974 (95% CI: 1,01,987, 1,03,904) cases by May 22, 2020. As per SIR model, the maximum number of active cases is projected to be 57,449 on May 18, 2020. The time interrupted regression model indicates a decrease of about 149 daily new cases after the lock down period, which is statistically not significant. Conclusion The Logistic growth curve model predicts accurately the short-term scenario for India and high incidence states. The prediction through SIR model may be used for planning and prepare the health systems. The study also suggests that there is no evidence to conclude that there is a positive impact of lockdown in terms of reduction in new cases.
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Affiliation(s)
- B Malavika
- Associate Research Officer, Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, 632 002, India
| | - S Marimuthu
- Associate Research Officer, Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, 632 002, India
| | - Melvin Joy
- Associate Research Officer, Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, 632 002, India
| | - Ambily Nadaraj
- Associate Research Officer, Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, 632 002, India
| | - Edwin Sam Asirvatham
- Technical Adviser (Health Systems and Policy), Health Systems Research India Initiative (HSRII), Trivandrum, India
| | - L Jeyaseelan
- Professor, Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, 632 002, India
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John KJ, Turaka VP, Muruga Bharathy K, Vignesh Kumar C, Jayaseelan L, Visalakshi J, Nadaraj A, Mathew A, Mariam F, Nellimala NJ, Joy A, Punitha JV, Koshy M, Chandy G, Gunasekaran K, Sudarsanam TD. Predictors of mortality, strategies to reduce readmission, and economic impact of acute decompensated heart failure: Results of the Vellore Heart Failure Registry. Indian Heart J 2020; 72:20-26. [PMID: 32423556 PMCID: PMC7231859 DOI: 10.1016/j.ihj.2020.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 01/22/2020] [Accepted: 03/12/2020] [Indexed: 01/14/2023] Open
Abstract
AIM Heart failure is a global problem that is increasing in prevalence. We undertook the initiative to compile the Vellore Heart Failure Registry (VHFR) to assess the clinical profile, mortality, risk factors and economic burden of heart failure by conducting a prospective, observational, hospital-based cohort study in Vellore, Tamil Nadu. METHODS AND RESULTS This study was a prospective observational cohort study conducted at the Christian Medical College and Hospital, Vellore, between January 2014 and December 2016. A total of 572 patients who satisfied the Boston criteria for "definite heart failure" were included and the primary outcome was all-cause mortality. The median duration of hospital stay was eight days and the in-hospital, one, three and six month mortalities were 13.25%, 27.3%, 32.53% and 38.15%, respectively. The median duration of survival was 921 days. Readmission for heart failure constituted 42%, and the most common cause of decompensation was an infection(31.5%). The presence of cyanosis at admission, history of previous stroke or transient ischemic attack, and American College of Cardiology (ACC)/American Heart Association (AHA) stage D at the time of discharge were independently associated with mortality at six months. The median total direct cost of admission was INR 84,881.00 ($ 1232.34) CONCLUSION: The VHFR cohort had younger, more diabetic, and fewer hypertensive subjects than most cohorts. Admission for heart failure is a catastrophic health expenditure. Attempts should be made to ensure a reduction in readmission rates by targeting goal-directed therapy. As the most common cause of acute decompensation is pneumonia, vaccinating all patients before discharge may also help in this regard.
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Affiliation(s)
- Kevin John John
- Department of Medicine, Christian Medical College, Vellore, India
| | | | | | - C Vignesh Kumar
- Department of Medicine, Christian Medical College, Vellore, India
| | - L Jayaseelan
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - J Visalakshi
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - Ambily Nadaraj
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - Anoop Mathew
- Interventional Cardiology, Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Canada
| | | | | | - Anisha Joy
- Christian Medical College, Vellore, India
| | - J V Punitha
- Department of Medicine, Christian Medical College, Vellore, India
| | - Maria Koshy
- Department of Medicine, Christian Medical College, Vellore, India
| | - Gina Chandy
- Department of Medicine, Christian Medical College, Vellore, India
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Singh S, Sahu D, Agrawal A, Jeyaseelan L, Nadaraj A, Vashi MD. Coverage, quality, and correlates of childhood immunization in slums under national immunization program of India: A cross-sectional study. Heliyon 2019; 5:e02403. [PMID: 31517125 PMCID: PMC6734516 DOI: 10.1016/j.heliyon.2019.e02403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 06/02/2019] [Accepted: 08/29/2019] [Indexed: 11/29/2022] Open
Abstract
Adequate and quality immunization coverage plays a key role in controlling the outbreaks of vaccine preventable diseases. Places where immunization coverage is low, vaccine preventable diseases contribute to worse health outcomes. This is especially true in Indian slum dwellings where 33.0% of the urban population live. The aim of the study was to explore the coverage, quality, and correlates of primary immunization under national immunization program among children aged 12–23 months, living in slums of Mumbai. A community based cross-sectional survey was conducted. Parents or caretakers of 550 eligible children aged 12–23 months were interviewed using a structured interview schedule. Regression analysis was used to detect correlates of full immunization coverage (children who received one dose each of BCG, measles, and three doses each of DPT, OPV, and HBV by his/her first birthday) and of quality immunization coverage (children who received primary vaccines at appropriate age and intervals as mentioned above and had filled immunization card). Out of total 550 children, 402 (73.1%), 131 (23.8%), and 17 (3.1%) were fully, partially, and unimmunized, respectively. Almost 86.0% children received quality immunization coverage. In the regression analysis, reminder for immunization services was found to be the single most significant correlate of full and quality immunization coverage. In this study, full immunization coverage was found to be below the expected level. This study also revealed that the awareness regarding the importance of adequate immunization was still lacking in the slum population. Emphasizing on reminders for immunization services, encouraging institutional deliveries, and scaling up use of postnatal care services may act as keys to improving the immunization coverage in Indian slums.
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Affiliation(s)
- Sanjeev Singh
- University School of Medicine & Paramedical Health Sciences, Guru Gobind Singh Indraprastha University, Delhi, India.,GlaxoSmithKline Pharmaceuticals Ltd., India
| | - Damodar Sahu
- Indian Council of Medical Research-National Institute of Medical Statistics, New Delhi, India
| | | | | | - Ambily Nadaraj
- Department of Biostatistics, Christian Medical College, Vellore, India
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