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Joy M, Mani T, Jeyaseelan L, Babu M, S M, Kumar S, Mohanraj R, Viswanathan S, Bangdiwala SI. Reduction in prevalence of spousal physical violence against women in India: evidence from three national surveys. Int J Inj Contr Saf Promot 2023; 30:352-361. [PMID: 36905635 DOI: 10.1080/17457300.2023.2188468] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 02/18/2023] [Accepted: 03/03/2023] [Indexed: 03/12/2023]
Abstract
Spousal physical violence (PV) against women is considered to be major health issue in developing countries. Lifetime physical violence is a composite outcome consists of hit, kick, beat, slap and threatened with weapon, perpetrated by the husband. The study aims to examine changes in prevalence and specific risk factors for PV from 1998 to 2016 in India. This study analyzed data from a cross sectional epidemiological survey in 1998-1999, NFHS-3 (2005-2006) and NFHS-4 (2015-2016) data. There was a significant decline of about 10% (95% CI: 8.8%-11.1%) in PV. Major risk factors for change in PV were husband's use of alcohol, illiteracy and socio-economic status of the household. The Protection of Women from Domestic Violence Act may have played a role in reducing the PV. Even though there was a decline in PV, actions have to be implemented from the root level to ensure women empowerment.
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Affiliation(s)
- Melvin Joy
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Thenmozhi Mani
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - L Jeyaseelan
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
| | - Malavika Babu
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Marimuthu S
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | | | | | - Shankar Viswanathan
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Shrikant I Bangdiwala
- Population Health Research Institute and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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Ramachandran R, Bhargava V, Jasuja S, Gallieni M, Jha V, Sahay M, Alexender S, Mostafi M, Pisharam JK, Wai TSC, Jacob C, Gunawan A, Leong GB, Thwin KT, Agrawal RK, Vareesangthip K, Tanchanco R, Choong L, Herath C, Lin CC, Cuong NT, Akhtar SF, Alsahow A, Rana DS, Kher V, Rajapurkar MM, Jeyaseelan L, Puri S, Sagar G, Bahl A, Verma S, Sethi A, Vachharajani T. Interventional nephrology and vascular access practice: A perspective from South and Southeast Asia. J Vasc Access 2022; 23:849-860. [PMID: 33934667 PMCID: PMC7615897 DOI: 10.1177/11297298211011375] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
South and Southeast Asia is the most populated, heterogeneous part of the world. The Association of Vascular Access and InTerventionAl Renal physicians (AVATAR Foundation), India, gathered trends on epidemiology and Interventional Nephrology (IN) for this region. The countries were divided as upper-middle- and higher-income countries as Group-1 and lower and lower-middle-income countries as Group-2. Forty-three percent and 70% patients in the Group 1 and 2 countries had unplanned hemodialysis (HD) initiation. Among the incident HD patients, the dominant Vascular Access (VA) was non-tunneled central catheter (non-TCC) in 70% of Group 2 and tunneled central catheter (TCC) in 32.5% in Group 1 countries. Arterio-Venous Fistula (AVF) in the incident HD patients was observed in 24.5% and 35% of patients in Group-2 and Group-1, respectively. Eight percent and 68.7% of the prevalent HD patients in Group-2 and Group-1 received HD through an AVF respectively. Nephrologists performing any IN procedure were 90% and 60% in Group-2 and Group 1, respectively. The common procedures performed by nephrologists include renal biopsy (93.3%), peritoneal dialysis (PD) catheter insertion (80%), TCC (66.7%) and non-TCC (100%). Constraints for IN include lack of time (73.3%), lack of back-up (40%), lack of training (73.3%), economic issues (33.3%), medico-legal problems (46.6%), no incentive (20%), other interests (46.6%) and institution not supportive (26%). Routine VA surveillance is performed in 12.5% and 83.3% of Group-2 and Group-1, respectively. To conclude, non-TCC and TCC are the most common vascular access in incident HD patients in Group-2 and Group-1, respectively. Lack of training, back-up support and economic constraints were main constraints for IN growth in Group-2 countries.
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Affiliation(s)
| | | | | | | | - Vivekanand Jha
- Executive Director, George Institute of Global Health, India
| | | | | | - Mamun Mostafi
- Department of Nephrology, Armed Forces Medical College, Bangladesh
| | | | | | | | | | | | | | | | | | | | | | | | | | - Nguyen The Cuong
- Department of Kidney diseases and Dialysis, Viet Duc University Hospital, Vietnam
| | | | | | | | | | | | | | - Sonika Puri
- Rutgers Robert Wood Johnson Medical School, USA
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Bhattacharya R, Pearse M, Bates P, Tahmassebi R, El-Daly I, Jeyaseelan L, Sedgwick P, Trompeter A. The impact of COVID-19 on major trauma (ISS>15) in London, across its four Level 1 centres. Ann R Coll Surg Engl 2022; 104:437-442. [PMID: 34845936 PMCID: PMC9158040 DOI: 10.1308/rcsann.2021.0218] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has led to reconfiguration of healthcare resources to manage increased demand for acute hospital beds and intensive care places. Concerns were raised regarding continuing provision of critical care for non-COVID patients during the pandemic. The aim of this study was to assess the impact of the COVID-19 pandemic on patients admitted with major trauma (Injury Severity Score >15) across the four Level 1 trauma centres in London. METHODS Data were collected from all four major trauma centres (MTCs) in London using the Trauma Audit and Research Network database and from local databases at each centre. A 2-month period from 5 March to 5 May 2020 was selected and the same period during 2019 was used to compare changes due to the pandemic. RESULTS There was a 31% decrease in overall number of patients presenting to the four MTCs during the COVID-19 period compared with 2019. There was no difference in patient demographics or mechanism of injury between the two periods. Sports-related injuries and proportion of self-presentation to hospital were reduced slightly during the pandemic, although the differences were not statistically significant. The mortality rate and association between mortality and injury severity were similar. Proportion of patients requiring intensive care unit facilities also did not change. CONCLUSION Despite diversion of critical care resources to deal with COVID-related admissions, we did not observe a change in mortality rate or proportion of severely injured patients requiring critical care. Our results suggest London MTCs were able to provide their usual standard of care for critically injured major trauma (Injury Severity Score >15) patients during the pandemic.
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Affiliation(s)
| | - M Pearse
- Imperial College Healthcare NHS Trust, UK
| | | | - R Tahmassebi
- King’s College Hospital NHS Foundation Trust, UK
| | - I El-Daly
- King’s College Hospital NHS Foundation Trust, UK
| | | | - P Sedgwick
- St George’s University Hospitals NHS Foundation Trust, UK
| | - A Trompeter
- St George’s University Hospitals NHS Foundation Trust, UK
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Marimuthu S, Mani T, Sudarsanam TD, George S, Jeyaseelan L. Preferring Box-Cox transformation, instead of log transformation to convert skewed distribution of outcomes to normal in medical research. Clinical Epidemiology and Global Health 2022. [DOI: 10.1016/j.cegh.2022.101043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Rupa V, Sara K, Jeyaseelan L. Changes in olfaction & quality of life following standard medical therapy in patients with intermittent & persistent allergic rhinitis. Indian J Med Res 2022; 155:373-379. [DOI: 10.4103/ijmr.ijmr_1517_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Joselyn AS, Suhag K, Joy M, Jeyaseelan L. Development and validation of Daycare Anesthesia Satisfaction (DAS) questionnaire to assess patient's satisfaction with daycare anesthesia. J Anaesthesiol Clin Pharmacol 2022; 38:474-479. [PMID: 36505188 PMCID: PMC9728453 DOI: 10.4103/joacp.joacp_563_20] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 04/14/2021] [Accepted: 06/09/2021] [Indexed: 11/06/2022] Open
Abstract
Background and Aims The patient's satisfaction can be considered as a unique indicator of the quality of healthcare provided. The advantages of patient satisfaction surveys rely heavily on using standardized, psychometrically tested data collection approaches. There is a lack of a proper, psychometrically robust instrument to evaluate the patient's perioperative satisfaction following all types of anesthesia in daycare facility. Hence, this study aimed to develop a Daycare Anesthesia Satisfaction (DAS) questionnaire to measure the patient's satisfaction with the experience of daycare anesthesia services. Material and Methods A preliminary pool of questions was generated from research literature, expert consultations, and pilot tested on patients. The internal consistency and reliability of the preliminary questionnaire was evaluated by calculating Cronbach's alpha, intraclass correlation coefficient (ICC), and feasibility with the formation of a final 27-item questionnaire. In the next step, the questionnaire was distributed to a larger group of patients in the phase 2 of postanesthesia care unit (PACU). The results were subjected to confirmatory factor analysis to determine the goodness of fit of the questions under each domain. Results The internal consistency of the preliminary questionnaire as measured by Cronbach's alpha was 0.929. Intraclass correlation coefficient measured for test-retest reliability was 0.97 (95% confidence interval [CI]). Feasibility was confirmed, as 75% of the patients could fill the questionnaire within 15 min. In the second step of confirmatory factor analysis (CFA), questionnaire has been shown to have goodness of fit with Bentler's comparative fit index (CFI) of 0.99 that is greater than the suggested cutoff of 0.90. The root mean square error of approximation (RMSEA) of 0.09 is also close to the suggested cutoff of 0.06. Conclusion This systematically developed and validated, 27-item DAS questionnaire can be tentatively recommended to be used to measure patient's satisfaction with day care anesthesia services following all types of surgical procedures, under various types of anesthesia.
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Affiliation(s)
- Anita Shirley Joselyn
- Department of Anaesthesia, Christian Medical College, Vellore, Tamil Nadu, India,Address for correspondence: Dr. Anita Shirley Joselyn, Department of Anaesthesia, Christian Medical College and Hospital, Vellore, Tamil Nadu - 632 004, India. E-mail:
| | - Kanika Suhag
- Department of Trauma Anaesthesia, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Melvin Joy
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - L Jeyaseelan
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
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Danda D, Goel R, Joseph G, Kumar ST, Nair A, Ravindran R, Jeyaseelan L, Merkel PA, Grayson PC. Clinical course of 602 patients with Takayasu's arteritis: comparison between Childhood-onset versus adult onset disease. Rheumatology (Oxford) 2021; 60:2246-2255. [PMID: 33179052 DOI: 10.1093/rheumatology/keaa569] [Citation(s) in RCA: 31] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 07/18/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To describe the clinical profile of Asian Indian patients with Takayasu's arteritis (TAK) and to compare clinical features and outcome of childhood-onset Takayasu's arteritis (cTAK) with adult-onset TAK (aTAK). METHODS Data related to clinical features and response to treatment of patients with cTAK (age of onset <16 years) and aTAK from a large observational cohort in our tertiary care teaching hospital were noted and compared. RESULTS Altogether, 602 patients (cTAK = 119; aTAK = 483) were studied. Patients with cTAK had a blunted female: male ratio; but fever, elevated acute phase reactants, involvement of abdominal aorta or its branches, hypertension, abdominal pain, elevated serum creatinine and cardiomyopathy were more common in cTAK as compared with aTAK. Patients with aTAK were more likely to have aortic-arch disease and claudication than cTAK. During follow-up, complete remission was more common in cTAK (87% vs 66%; P < 0.01), but subsequent relapses were equally common (30% vs 27%; P = 0.63). Independent associations of disease duration at presentation with disease extent [Disease Extent Index in TAK (DEI.Tak)] and damage [TAK Damage Score (TADS)] were observed (P ≤ 0.01). Moreover, 54% of patients with symptom duration of >5 years at presentation still continued to have elevated CRP suggesting continued and active inflammation warranting escalation or inititation of immunosuppression. CONCLUSION Patients with cTAK are more likely to have arterial disease below the diaphragm, systemic inflammation and achieve remission. Disease of the aortic arch is more common in patients with aTAK. Longer duration of symptoms prior to initiation of immunosuppression, thereby leading to extensive disease and damage, reflects ongoing disease activity as the rule rather than exception in untreated TAK.
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Affiliation(s)
| | - Ruchika Goel
- Department of Clinical Immunology and Rheumatology
| | | | - Sathish T Kumar
- Department of Child Health, Christian Medical College, Vellore, India
| | - Aswin Nair
- Department of Clinical Immunology and Rheumatology
| | | | - L Jeyaseelan
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - Peter A Merkel
- Division of Rheumatology, Department of Medicine, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Peter C Grayson
- Systemic Autoimmunity Branch/NIAMS, National Institutes of Health, Bethesda, MD, USA
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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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George L, Mahabal G, Mohanan E, Balasubramanian P, Peter D, Pulimood S, Lakshmi K, Jeyaseelan L, Abraham A, Srivastava A, Mathews V, George B. Limited utility of plasma elafin as a biomarker for skin graft-versus-host disease following allogeneic stem cell transplantation. Clin Exp Dermatol 2021; 46:1482-1487. [PMID: 34081805 DOI: 10.1111/ced.14785] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Acute cutaneous graft-versus-host disease (acGVHD) following haematopoietic stem cell transplant (HSCT) is common but difficult to distinguish from other causes of rash. Plasma elafin has been proposed as a diagnostic and prognostic biomarker of skin GVHD. AIM To evaluate the role of plasma elafin as a biomarker in acGVHD in an Indian population. METHODS Plasma elafin was evaluated in a prospective study of HSCT recipients, conducted over 2 years, taking measurements at baseline and at onset of skin rash after HSCT. Patients were categorized into those with GVHD rash, those with non-GVHD rash and those with no rash and the three groups were compared. RESULTS Two hundred and sixty-one patients with a median age of 16 years (range 1-61 years) and a male predominance (175 : 86 M/F) underwent HSCT during the study period: 56 patients in the GVHD group, 49 in the non-GVHD group and 156 in the no-rash group. The median baseline elafin was similar in all three groups. At the onset of rash, median elafin level was similar between GVHD and non-GVHD rash (34 549 vs. 32 077 pg/mL; P = 0.58) and between GVHD and no rash (34 549 vs. 26 197 pg/mL; P = 0.08). A rise in elafin from baseline was significantly different between GVHD and no rash (P < 0.001) but not between GVHD and non-GVHD rash (P = 0.44). CONCLUSION The utility of plasma elafin as a biomarker of skin GVHD is very limited. Plasma elafin, although elevated in cutaneous GVHD, is not helpful in distinguishing between GVHD rash and other causes of rash following HSCT.
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Affiliation(s)
- L George
- Department of, Dermatology, Venereology and Leprosy, Christian Medical College, Vellore, Tamil Nadu, India
| | - G Mahabal
- Department of, Dermatology, Venereology and Leprosy, Christian Medical College, Vellore, Tamil Nadu, India
| | - E Mohanan
- Department of, Haematology, Christian Medical College, Vellore, Tamil Nadu, India
| | - P Balasubramanian
- Department of, Haematology, Christian Medical College, Vellore, Tamil Nadu, India
| | - D Peter
- Department of, Dermatology, Venereology and Leprosy, Christian Medical College, Vellore, Tamil Nadu, India
| | - S Pulimood
- Department of, Dermatology, Venereology and Leprosy, Christian Medical College, Vellore, Tamil Nadu, India
| | - K Lakshmi
- Department of, Haematology, Christian Medical College, Vellore, Tamil Nadu, India
| | - L Jeyaseelan
- Department of, Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - A Abraham
- Department of, Haematology, Christian Medical College, Vellore, Tamil Nadu, India
| | - A Srivastava
- Department of, Haematology, Christian Medical College, Vellore, Tamil Nadu, India
| | - V Mathews
- Department of, Haematology, Christian Medical College, Vellore, Tamil Nadu, India
| | - B George
- Department of, Haematology, Christian Medical College, Vellore, Tamil Nadu, India
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Varala S, George R, Mathew L, Russell P, Koshy B, Oommen SP, Thomas M, Muthusamy K, Yoganathan S, Jeyaseelan L, Muliyil J. The Diagnostic Value of Congenital and Nevoid Cutaneous Lesions Associated with Autism Spectrum Disorders in Indian Children- A Case-Control Study. Indian Dermatol Online J 2021; 12:84-89. [PMID: 33768027 PMCID: PMC7982006 DOI: 10.4103/idoj.idoj_275_20] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 07/22/2020] [Accepted: 09/05/2020] [Indexed: 11/26/2022] Open
Abstract
Background and Aims: Cutaneous lesions are the defining features of several neurocutaneous syndromes like neurofibromatosis1(NF1), tuberous sclerosis complex (TSC), and Sturge Weber syndrome to name a few. With this background, we explored the possibility of identifying congenital and nevoid cutaneous markers that may help in the early recognition of autism spectrum disorders (ASD) in Indian children. The objective of this study was to measure the strength of association between congenital and nevoid cutaneous lesions and ASD among Indian children. Methods: A case-control study was conducted from January 2018 to June 2018. 132 children (18 months-16 years of age) with ASD and equal number of age and sex-matched children without autism were studied. Diagnosis of ASD was based on DSM-5 criteria. All the children were examined for cutaneous lesions with special attention to nevoid and congenital conditions. The strength of association was measured using the diagnostic odds ratio (OR). Results: The prevalence of congenital and nevoid lesions were higher in ASD group (OR = 3.12, P = 0.0001). Among them, pigmentary mosaicism of hyperpigmented type (OR = 2.76, P = 0.02) and café-au-lait macules (CALMs) (OR = 2.40, P = 0.001) were the most prevalent with hyperpigmented pigmentary mosaicism showing a higher association with autism. Atypical CALMs (OR = 2, P = 0.09) were also more prevalent in the ASD group though not statistically significant. Conclusion: The presence of hyperpigmented pigmentary mosaicism and CALMs warrant closer surveillance by the caregivers and physicians for evolving features of autism. Larger multicentric studies are required to validate these findings.
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Affiliation(s)
- Sirisha Varala
- Department of Dermatology, Venereology and Leprosy, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Renu George
- Department of Dermatology, Venereology and Leprosy, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Lydia Mathew
- Department of Dermatology, Venereology and Leprosy, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Paul Russell
- Department of Child and Adolescent Psychiatry, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Beena Koshy
- Department of Developmental Pediatrics, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Samuel P Oommen
- Department of Developmental Pediatrics, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Maya Thomas
- Department of Pediatric Neurology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Karthik Muthusamy
- Department of Pediatric Neurology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Sangeetha Yoganathan
- Department of Pediatric Neurology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - L Jeyaseelan
- Department of Biostatistics, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Jayaprakash Muliyil
- Division of Gastrointestinal Sciences, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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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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Shah PB, Jeyaseelan L, Soundararajan P, Sathiyasekaran BWC. Comparative Assessment of Glomerular Filtration Rate (GFR) Google APPs and CKD Prepare GFR India Google App. JPRI 2021. [DOI: 10.9734/jpri/2021/v33i231148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Aim: Glomerular filtration rate (GFR) estimation is an important parameter for assessment of kidney function and management of the patient with suspected kidney function. These mobile applications hence change the way better patient care is managed. In the research project, there is an attempt to perform comparative assessment of GFR Google APPs and CKD PREPARE GFR India Google APP.
Methods: Google app store was searched to identify all the applications which may help in estimation of GFR. All the application were compared except general medical calculators and non-English applications. All important parameters were identified with the guidance of delphi group and comparison chart was made.
Results: The search of Google play store led to 35 mobile applications related to GFR estimation. The majority of the applications were by IT company developers and few were by associations or individuals. There are few companies who have developed multiple mobile applications with different formulas. Many of these aspects of the mobile applications which are considered had important parameters. Few of the applications have multiple page interfaces which may lead to multiple clicks before reaching to GFR estimation which may be at times may be difficult in case of large amounts of use.
Conclusion: All the GFR estimation applications are comparable. Single user interface applications have advantages over others where all the data can be entered and results are available in a single view. The disclaimer of using calculators under medical guidance of a qualified physicians is always required.
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13
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Abraham K, Abraham A, Regi A, Lionel J, Thomas E, Vijayaselvi R, Jeyaseelan L, Abraham AM, Santhanam S, Kuruvilla KA, Steinhoff MC. Maternal and Perinatal Outcomes of Influenza in Pregnancy after Treatment with Oseltamivir. J Glob Infect Dis 2021; 13:20-26. [PMID: 33911448 PMCID: PMC8054794 DOI: 10.4103/jgid.jgid_157_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] [Received: 05/31/2020] [Revised: 07/15/2020] [Accepted: 08/18/2020] [Indexed: 11/05/2022] Open
Abstract
Context: Influenza infection in pregnancy causes 4%–8% case fatality and five times more perinatal mortality. Influenza is a major contributor to mortality in developing countries; however, the morbidity has largely been underestimated. Public health interventions for prevention are also lacking. Aims: This study aimed to determine the seasonality of influenza in pregnant Indian women and to estimate the maternal and perinatal morbidity after treatment with oseltamivir. Settings and Design: This was a prospective observational cohort study, conducted in a tertiary hospital. Subjects and Methods: Pregnant women with ILI (influenza-like illness) were recruited into Cohort 1 (polymerase chain reaction [PCR] positive) and Cohort 2 (PCR negative). Gestational age-matched asymptomatic controls formed Cohort 3. Women in Cohort 1 received oseltamivir for 5 days. The incidence of small-for-gestational age (SGA) and preterm birth were the primary outcomes. Maternal and neonatal morbidity formed the secondary outcomes. Statistical Analysis: Unmatched (Cohort 1 and 2) and matched analysis (Cohort 1 and 3) were done. Student's t-test and Chi-square test were used to compare between variables. Results: Year-round incidence of influenza was recorded. Severe illness was more in Cohort 1 compared to Cohort 2 (36.2% vs. 6.3%; P < 0.001). SGA was comparable in all the cohorts (13%). Preterm birth (7.8% vs. 3.3%; P < 0.08; relative risk-2.75) was considerably high in Cohort 1. Secondary maternal and neonatal outcomes were similar between the groups. Conclusion: Influenza in pregnancy showed year-round incidence and increased maternal and neonatal morbidity despite treatment with oseltamivir. We suggest the need for newer interventions to curtail the illness in pregnancy.
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Affiliation(s)
- Kavitha Abraham
- Department of Obstetrics and Gynaecology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Anuja Abraham
- Department of Obstetrics and Gynaecology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Annie Regi
- Department of Obstetrics and Gynaecology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Jessie Lionel
- Department of Obstetrics and Gynaecology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Elsy Thomas
- Department of Obstetrics and Gynaecology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Reeta Vijayaselvi
- Department of Obstetrics and Gynaecology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - L Jeyaseelan
- Department of Biostatistics, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Asha Mary Abraham
- Department of Virology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Sridhar Santhanam
- Department of Neonatology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Kurian Anil Kuruvilla
- Department of Neonatology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Mark C Steinhoff
- Global Health Center, Cincinnati Children's Hospital, Cincinnati, OH, USA
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Balasubramanya B, Isaac R, Philip S, Prashanth HR, Abraham P, Poobalan A, Thomas N, Jeyaseelan L, Mammen J, Devarasetty P, John O. Task shifting to frontline community health workers for improved diabetes care in low-resource settings in India: a phase II non-randomized controlled clinical trial. Journal of Global Health Reports 2020. [DOI: 10.29392/001c.17609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
| | - Rita Isaac
- RUHSA Department, Christian Medical College, Vellore, India
| | - Sam Philip
- Centre for Diabetes & Endocrinology, University of Aberdeen, Aberdeen, UK
| | - H R Prashanth
- RUHSA Department, Christian Medical College, Vellore, India
| | - Prakash Abraham
- Centre for Diabetes & Endocrinology, University of Aberdeen, Aberdeen, UK
| | - Amudha Poobalan
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Nihal Thomas
- Department of Endocrinology, Christian Medical College, Vellore, India
| | - L Jeyaseelan
- Department of Endocrinology, Christian Medical College, Vellore, India
| | - Joy Mammen
- Department of Transfusion Medicine, Christian Medical College, Vellore, India
| | | | - Oomen John
- The George Institute for Global Health, India, Telengana, India
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Kumar S, Doss SA, Stephen S, Pratheeba M, Jeyaseelan L, Daniel D. The challenge of using the virtual crossmatch as a singular tool for the detection of Anti-HLA antibodies- A study from a tertiary care institute from South India. Transpl Immunol 2020; 65:101349. [PMID: 33127497 DOI: 10.1016/j.trim.2020.101349] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 10/24/2020] [Accepted: 10/25/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Detection of donor specific antibodies (DSA) is critical in both solid organ and mismatched haematopoietic stem cell transplants. The single antigen bead assay (SAB) is widely used as a virtual crossmatch in these settings. However, HLA allele variation across ethnicities and differing genetic backgrounds is a well-known and acknowledged fact and representation of alleles prevalent in a population is key while using a virtual crossmatch as a sole decision making tool. Against this background, this study was performed to assess the feasibility of using the SAB as a single tool to identify DSA in our population. MATERIALS AND METHODS The HLA alleles identified in the study population were analysed to assess their representation on SAB panels from two different vendors. RESULTS The study population comprised of a total of 966 subjects for whom 6 loci high resolution HLA typing was done. A total of 241 different alleles were assigned in the population. Among the 241 alleles identified in our study population, 48.55% (n = 117) alleles were represented in the SAB A panel and 48.13% (n = 116) represented in the SAB B panel. Unrepresented alleles were 51.45% (n = 124) in panel A and 51.87% (n = 125) in panel B. All the twelve alleles were represented for 16.05% (n = 155) and 16.25% (n = 157) of study population in panel A and in panel B respectively. The remaining individuals (83.95%, (n = 811) in panel A and 83.75%, (n = 809) in panel B) had at least one allele unrepresented. CONCLUSION Our study addresses an important limitation in utilizing the SAB as a single tool to identify DSA, owing to non-representation of locally prevalent / unique alleles in our population. More than 50% of alleles were unrepresented in both the SAB assays we studied, which included alleles from both Class I and Class II. We recommend therefore that, until a comprehensive coverage of alleles is provided, or epitope matching becomes robust, that the SAB be combined with a physical crossmatch when mismatched alleles are not represented.
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Affiliation(s)
- Snehil Kumar
- Department of Transfusion Medicine and Immunohaematology, Christian Medical College, Vellore 632004, Tamil Nadu, India.
| | - Sam Arul Doss
- Department of Transfusion Medicine and Immunohaematology, Christian Medical College, Vellore 632004, Tamil Nadu, India
| | - S Stephen
- Department of Transfusion Medicine and Immunohaematology, Christian Medical College, Vellore 632004, Tamil Nadu, India
| | - M Pratheeba
- Department of Transfusion Medicine and Immunohaematology, Christian Medical College, Vellore 632004, Tamil Nadu, India
| | - L Jeyaseelan
- Department of Biostatistics, Christian Medical College, Vellore 632004, Tamil Nadu, India
| | - Dolly Daniel
- Department of Transfusion Medicine and Immunohaematology, Christian Medical College, Vellore 632004, Tamil Nadu, India.
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16
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Joy M, Malavika B, Asirvatham ES, Sudarsanam TD, Jeyaseelan L. Is BCG associated with reduced incidence of COVID-19? A meta-regression of global data from 160 countries. Clin Epidemiol Glob Health 2020; 9:202-203. [PMID: 33163696 PMCID: PMC7597766 DOI: 10.1016/j.cegh.2020.08.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/14/2020] [Accepted: 08/21/2020] [Indexed: 11/18/2022] Open
Abstract
Background Global research is running towards to find a vaccine to stop the threat of the COVID-19. The Bacillus Calmette–Guérin (BCG) vaccine that prevents severe forms of tuberculosis is getting more attention in this scenario. The objective of our study was to determine the association between BCG vaccine coverage and incidence of COVID-19 at a national-level across the Globe. Methods The data of 160 countries were included in the study. Meta-regression was done to estimate the difference in the incidence of COVID-19 cases between countries with BCG vaccination coverage. BCG coverage was categorized as ≤70%, >70% and no vaccination. The analyses were carried out by adjusting for factors such as population density, income group, latitude, and percentage of the total population under age groups 15–64 and above 65 years of each country. Results The countries that had ≤70% coverage of BCG vaccine reported 6.5 (95% CI: −8.4 to −4.5) less COVID-19 infections per 10,000 population as compared to countries that reported no coverage. Those that had >70% coverage reported 10.1 (95% CI: −11.4 to −8.7) less infections per 10,000 population compared to those with no BCG countries. Conclusion Our analysis suggests that BCG is associated with reduced COVID-19 infections if the BCG vaccine coverage is over 70%. The region-wise analyses also suggested similar findings, except the Middle East and North African region.
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Affiliation(s)
- 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
| | - Edwin Sam Asirvatham
- Health Systems Research India Initiative (HSRII), Thiruvananthapuram, Kerala, India
| | - Thambu David Sudarsanam
- Department of Medicine, and Clinical Epidemiology Unit, Christian Medical College, Vellore, Tamil Nadu, 632 004, India
| | - L Jeyaseelan
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, 632 002, India
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Bondu JD, Nellickal AJ, Jeyaseelan L, Geethanjali FS. Assessing Diagnostic Accuracy of Serum Holotranscobalamin (Active-B12) in Comparison with Other Markers of Vitamin B12 Deficiency. Indian J Clin Biochem 2020; 35:367-372. [PMID: 32647416 DOI: 10.1007/s12291-019-00835-y] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 06/04/2019] [Indexed: 11/28/2022]
Abstract
About 15-40% India is Vitamin B12 deficient (commonly diagnosed by total Vitamin B12) but, as only holoTC (active form) is taken up by body cells, thus measuring holoTC is more reflective of Vitamin B12 status than the former. We aimed to assess diagnostic accuracy of serum holoTC in comparison with total Vitamin B12 and total Homocysteine (HCY) as indicator of serum Vitamin B12 status. 217 human subjects (99 males and 118 females) ranging from 17 to 83 years were divided into Vitamin B12 deficient (n = 70), borderline (n = 100) and sufficient groups (n = 47) who were further assessed for markers of Vitamin B12 deficiency-holoTC, HCY, Mean Corpuscular Volume (MCV), Folate, heamoglobin and creatinine. Samples were analysed using Siemens Advia Centaur Xpi. Total Vitamin B12 deficient group had - 84.3% holoTC deficient; 15.7% holoTC sufficient; 72.9% with elevated HCY; 27.1% with normal HCY; 11.4% with megaloblastic anaemia. Borderline group had - 34% holoTC deficient; 28% elevated HCY. A strong positive correlation was found between Total Vitamin B12 and holoTC (r = 0.754, p = <0.001) but strong negative correlation existed between holoTC and HCY (r = - 0.471, p = <0.001). Concordance between Total Vit B12 and HCY (Kappa index = 0.51, p < 0.001); between holoTC and HCY (Kappa index = 0.52, p = <0.001) were statically significant but the latter had a better sensitivity and specificity. Also, statically significant association exists between Total Vitamin B12 and holoTC with HCY (p = <0.001). Therefore, it is ascertained that Active Vitamin B12 assay is a better test and can be considered as an early marker of vitamin B12 deficiency.
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Affiliation(s)
- Joseph Dian Bondu
- Department of Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Arun Jose Nellickal
- Department of Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - L Jeyaseelan
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu India
| | - F S Geethanjali
- Department of Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu 632004 India
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18
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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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19
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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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20
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Jeyaseelan L, Malagelada F, Parker L, Panagopoulos A, Heidari N, Vris A. Intra-Operative 3-Dimensional Imaging (O-arm) in Foot and Ankle Trauma Surgery: Report of 2 Cases and Review of the Literature. Open Orthop J 2019. [DOI: 10.2174/1874325001913010189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Background:
Intraoperative two-dimensional (2D) fluoroscopy is the standard imaging modality available to orthopaedic surgeons worldwide. It is well-accepted, however, multiplanar 3 dimensional (3D) CT scanning is superior to 2D imaging for visualising joint surfaces and is now a fundamental feature of the pre-operative planning of intra-articular fractures.
Objective:
We present two cases in which the use of 3D intraoperative imaging and the O-arm® (Medtronic, Minneapolis, USA) led to immediate intraoperative revision to optimise fixation and articular congruity. A review of the current literature is also provided.
Methods:
During the trial period of the O-arm at our major trauma centre, intra-operative imaging was used in the lower limb trauma setting. The O-arm was used intra-operatively in a comminuted pilon fracture and a displaced talus fracture. We recorded all the intra-operative events, including quality of reduction, implant positioning and operation time. Each patient was followed-up for 12 months post-operation and was finally assessed with x-rays and the AOFAS score.
Results:
In both the cases, either fracture reduction or the implant position/usage that was observed with 2D fluoroscopy was revised following a 3D intra-operative scan. No postoperative complications were noted and the healing process was uneventful. X-rays at the final follow-up were excellent and acceptable for the talus and pilon fracture, respectively, with corresponding clinical results and AOFAS score.
Conclusion:
Although frequently used in spinal surgery, to the best of our knowledge, the use of intra-operative 3D techniques in lower limb trauma is sparse and sporadically reported. We present our cases in which the most current innovative imaging techniques influenced intra-operative outcomes without compromising patient safety. We feel that this is a real example of how innovation can positively influence patient care.
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Ebenezer ED, Londhe V, Rathore S, Benjamin S, Ross B, Jeyaseelan L, Mathews JE. Peripartum interventions resulting in reduced perinatal mortality rates, and birth asphyxia rates, over 18 years in a tertiary centre in South India: a retrospective study. BJOG 2019; 126 Suppl 4:21-26. [PMID: 31257695 DOI: 10.1111/1471-0528.15848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To study the changes in the rates of perinatal mortality, birth asphyxia, and caesarean sections in relation to interventions implemented over the past 18 years, in a tertiary centre in South India. DESIGN Retrospective study. SETTING Labour and maternity unit of a tertiary centre in South India. POPULATION OR SAMPLE Women who gave birth between 2000 and 2018. METHODS Information from perinatal audits, chart reviews, and data retrieved from the electronic database were used. Interventions implemented during this time period were audits and training, obstetric re-organisation, and minor changes in staffing and infrastructure. MAIN OUTCOME MEASURES Main outcome measures were perinatal mortality rate, birth asphyxia rate, and caesarean section rate. RESULTS Perinatal mortality rate decreased from 44 per 1000 births in 2000 to 16.4 per 1000 births in 2018 (P < 0.001). The rates of babies born with birth asphyxia requiring admission to the neonatal unit decreased from 24 per 1000 births in 2001 to 0.7 per 1000 births in 2018 (P < 0.00001). The overall caesarean section rate was maintained close to 30%. CONCLUSION In a large tertiary hospital in South India, with 14 000 deliveries per year, a policy of rigorous audits of stillbirths and birth asphyxia, electronic fetal monitoring, and the introduction of standardised criteria for trial of scar, reduced the perinatal mortality and the rate of babies born with birth asphyxia over the past 18 years, without an increase in the caesarean section rate. TWEETABLE ABSTRACT Rigorous perinatal audits with training in fetal cardiotocography, decreased birth asphyxia, without a major increase in caesarean rates.
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Affiliation(s)
- E D Ebenezer
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamilnadu, India
| | - V Londhe
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamilnadu, India
| | - S Rathore
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamilnadu, India
| | - S Benjamin
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamilnadu, India
| | - B Ross
- Department of Neonatology, Christian Medical College, Vellore, Tamilnadu, India
| | - L Jeyaseelan
- Department of Biostatistics, Christian Medical College, Vellore, Tamilnadu, India
| | - J E Mathews
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamilnadu, India
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Pillai R, Kumaran S, Jeyaseelan L, George SP, Sahajanandan R. Usefulness of ultrasound-guided measurement of minimal transverse diameter of subglottic airway in determining the endotracheal tube size in children with congenital heart disease: A prospective observational study. Ann Card Anaesth 2019; 21:382-387. [PMID: 30333331 PMCID: PMC6206798 DOI: 10.4103/aca.aca_220_17] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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
Introduction The search for an accurate and predictable method to estimate the endotracheal tube (ETT) size in pediatric population had led to derivation of many formulae. Of this, age-based formulae are the most commonly used. Studies have shown that minimal transverse diameter of subglottic airway (MTDSA) measurements using a high-frequency probe improves the success rate of predicting the airway diameter to about 90%. We did a prospective observational study using MTDSA as the criteria to select the size of ETT in children with congenital heart disease. Methods In this prospective observational study, 51 children aged from 1 day to 5 years, scheduled for cardiac surgery, were enrolled for this study. The ETT size was guided solely based on the MTDSA. Leak test was used to determine the best-fit ETT size. Results Data from 49 patients were analyzed. Agreement between the ETT determined by MTDSA and that predicted by Cole's age-based formulas with the best-fit ETT size was analyzed using a Bland-Altman plot. Conclusion Age-based formula showed poor correlation (27.5%) compared to MTDSA (87.8%) in predicting the best-fit ETT. We observed that pediatric patients with congenital heart disease need a larger sized ETT as compared to what was predicted by age-based formula. Using ultrasound MTDSA measurements to guide selection of ETT size is a safe and accurate method in pediatric cardiac population.
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Affiliation(s)
- Rahul Pillai
- Department of Anesthesia, Christian Medical College, Vellore, Tamil Nadu, India
| | - Suresh Kumaran
- Department of Anesthesia, Christian Medical College, Vellore, Tamil Nadu, India
| | - L Jeyaseelan
- Department of Anesthesia, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sajan P George
- Department of Anesthesia, Christian Medical College, Vellore, Tamil Nadu, India
| | - Raj Sahajanandan
- Department of Anesthesia, Christian Medical College, Vellore, Tamil Nadu, India
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Manda P, Srinivasa Rao PVLN, Bitla AR, Vinapamula KS, Jeyaseelan L, Rajasekhar D, Vishnubhotla S. Study of contrast-induced oxidative stress in nondiabetic patients undergoing coronary angiography. Saudi J Kidney Dis Transpl 2019; 30:45-52. [PMID: 30804266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
Administration of iodinated contrast media is associated with serious complications such as acute kidney injury (AKI). Oxidative stress is implicated as a major mechanism underlying the production of contrast-induced AKI (CI-AKI). There are very few human studies on oxidative stress occurring after contrast administration. Twenty-seven patients scheduled for coronary angiography were recruited. An average of 22.2 mL low-osmolal nonionic contrast was administered. Plasma conjugated dienes (CD), lipid hydroperoxides (LOOH), malondialdehyde (MDA), protein carbonyl (PC), protein thiols (PTs), ferric reducing ability of plasma (FRAP), erythrocyte super oxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), and glutathione reductase were estimated before, 30 min, 2 and 4 h after contrast administration. CD, LOOH, MDA, and PC increased (P <0.001), whereas PTs, FRAP, SOD, CAT (P <0.001), and GPx (P = 0.013) decreased in the first 4 h. Estimated glomerular filtration rate (eGFR) showed inverse association with MDA and positive association with GPx. The study provides evidence for oxidative stress following contrast administration even in the absence of predisposing factors. Association of eGFR with MDA and GPx indicate kidney as the source of oxidative stress. Hence, antioxidant therapy before contrast administration helps to prevent the development of oxidative stress, thereby reducing the risk of CI-AKI.
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Affiliation(s)
- Prasanth Manda
- Department of Biochemistry, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - P V L N Srinivasa Rao
- Department of Biochemistry, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Aparna R Bitla
- Department of Biochemistry, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Kiranmayi S Vinapamula
- Department of Biochemistry, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - L Jeyaseelan
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - D Rajasekhar
- Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Sivakumar Vishnubhotla
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
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Srinivasa Rao PVLN, Manda P, Bitla A, Vinapamula K, Jeyaseelan L, Rajasekhar D, Vishnubhotla S. Study of contrast-induced oxidative stress in nondiabetic patients undergoing coronary angiography. Saudi J Kidney Dis Transpl 2019. [DOI: 10.4103/1319-2442.252932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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25
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Jeyaseelan L. Interpreting the meta-analysis of efficacy of vitamin D supplementation in major depression. J Postgrad Med 2019; 65:70-71. [PMID: 31036776 PMCID: PMC6515788 DOI: 10.4103/jpgm.jpgm_267_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- L Jeyaseelan
- Department of Biostatistics, Christian Medical College, Vellore - 632 002, Tamil Nadu, India,Address for correspondence: Prof. Jeyaseelan L, E-mail:
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Alexander S, John GT, Korula A, Vijayakumar TS, David VG, Mohapatra A, Valson AT, Jacob S, Koshy PM, Rajan G, John EE, Matthai SM, Jeyaseelan L, Ponnusamy B, Cook T, Pusey C, Daha MR, Feehally J, Barratt J, Varughese S. Protocol and rationale for the first South Asian 5-year prospective longitudinal observational cohort study and biomarker evaluation investigating the clinical course and risk profile of IgA nephropathy: GRACE IgANI cohort. Wellcome Open Res 2018; 3:91. [PMID: 30345379 PMCID: PMC6148466 DOI: 10.12688/wellcomeopenres.14644.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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] [Accepted: 07/18/2018] [Indexed: 12/18/2022] Open
Abstract
Background: IgA nephropathy (IgAN) is the most common primary glomerulonephritis and an important cause of end-stage kidney disease. Unlike the slowly progressive course seen among Caucasian and East Asian subjects (actuarial survival 80-85% over 10 years), in India about 30-40% of patients have nephrotic syndrome and renal dysfunction at presentation and a 10-year renal survival of 35%, as reported from a retrospective registry. These observations cannot be entirely attributed to a lack of uniform screening protocols or late referral and attest to the probability that IgAN may not be the same disease in different parts of the world. Methods: We will prospectively recruit 200 patients with IgAN (the GRACE IgANI- Glomerular Research And Clinical Experiments- Ig A Nephropathy in Indians-cohort) and stratify them into low and high risk of progression based on published absolute renal risk scores. We will test the validity of this risk score in an unselected Indian IgAN population over a 5-year follow-up period. In parallel, we will undertake extensive exploratory serum, urine, renal and microbiome biomarker studies, firstly, to determine if the underlying pathogenic pathways are the same in Indian IgAN compared to those reported in Caucasian and East Asian IgAN. Secondly, we will systematically assess the value of measuring selected biomarkers and adding this data to traditional measures of risk in IgAN to predict kidney failure. We ultimately hope to generate a composite IgAN risk score specific for the Indian population. Ethics and data dissemination: Approval was obtained from the Institutional Review Board (Silver, Research and Ethics Committee) of the Christian Medical College, Vellore, India (Ref. No. IRB Min. No. 8962 [Other] dated 23.07.2014 and IRB Min. No. 9481 [Other] dated 24.06.2015). It is anticipated that results of this study will be presented at national and international meetings, with reports being published from late 2018.
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Affiliation(s)
- Suceena Alexander
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - George T John
- Department of Renal Medicine, Royal Brisbane and Women's Hospital, Queensland, 4029, Australia
| | - Anila Korula
- Department of General Pathology, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - T S Vijayakumar
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Vinoi George David
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Anjali Mohapatra
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Anna T Valson
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Shibu Jacob
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Pradeep Mathew Koshy
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Gautam Rajan
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Elenjickal Elias John
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Smita Mary Matthai
- Central Electron Microscope Unit, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - L Jeyaseelan
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Babu Ponnusamy
- Centre for Cellular and Molecular Platforms, Bengaluru, Karnataka, 560065, India
| | - Terence Cook
- Centre for Complement and Inflammation Research, Imperial College, London, UK
| | - Charles Pusey
- Department of Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Mohamed R Daha
- Rijksuniversiteit Groningen Faculteit Biologie, Groningen, Netherlands
| | - John Feehally
- University of Leicester, College of Medicine Biological Sciences and Psychology, Leicester, UK
| | - Jonathan Barratt
- University of Leicester, College of Medicine Biological Sciences and Psychology, Leicester, UK
| | - Santosh Varughese
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, 632004, India
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Jha UM, Dhingra N, Raj Y, Rewari BB, Jeyaseelan L, Harvey P, Chavan L, Saggurti N, S Reddy DC. Survival of Children Living with Human Immunodeficiency Virus on Antiretroviral Therapy in Andhra Pradesh, India. Indian Pediatr 2018; 55:301-305. [PMID: 29428912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To assess the survival probability and associated factors among children living with human immunodeficiency virus (CLHIV) receiving antiretroviral therapy (ART) in India. METHODS The data on 5874 children (55% boys) from one of the high HIV burden states of India from the cohort were analyzed. Data were extracted from the computerized management information system of the National AIDS Control Organization (NACO). Children were eligible for inclusion if they had started ART during 2007-2013, and had at least one potential follow-up. Kaplan Meier survival and Cox proportional hazards models were used to measure survival probability. RESULTS The baseline median (IQR) CD4 count at the start of antiretroviral therapy was 244 (153, 398). Overall, the mortality was 30 per 1000 child years; 39 in the <5 year age group and 25 in 5-9 year age group. Mortality was highest among infants (86 per 1000 child years). Those with CD4 count ≤ 200 were six times more likely to die (adjusted HR: 6.3, 95% CI 3.5, 11.4) as compared to those with a CD4 count of ≥350/mm3. CONCLUSION Mortality rates among CLHIV is significantly higher among children less than five years when the CD4 count at the start of ART is above 200. Additionally, lower CD4 count, HIV clinical staging IV, and lack of functional status seems to be associated with high mortality in children who are on ART.
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Affiliation(s)
- Ugra Mohan Jha
- National AIDS Control Organization, New Delhi,India. Correspondence to: Ugra Mohan Jha, National AIDS Control Organization, New Delhi, India.
| | | | - Yujwal Raj
- Independent consultants, New Delhi, India
| | | | | | - Pauline Harvey
- Center for Disease Control and Prevention, Global Health-India, New Delhi, India
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Jha UM, Dhingra N, Raj Y, Rewari BB, Jeyaseelan L, Harvey P, Chavan L, Saggurti N, Reddy DCS. Survival of Children Living with Human Immunodeficiency Virus on Antiretroviral Therapy in Andhra Pradesh, India. Indian Pediatr 2018. [DOI: 10.1007/s13312-018-1272-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Harikrishnan S, Sarma S, Sanjay G, Jeemon P, Krishnan MN, Venugopal K, Mohanan PP, Jeyaseelan L, Thankappan KR, Zachariah G. Prevalence of metabolic syndrome and its risk factors in Kerala, South India: Analysis of a community based cross-sectional study. PLoS One 2018; 13:e0192372. [PMID: 29584725 PMCID: PMC5870937 DOI: 10.1371/journal.pone.0192372] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 01/21/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Coronary Artery Disease (CAD) is a leading cause of death and disability in Kerala, India. Metabolic syndrome (MS) is a constellation of established risk factors for CAD. We aimed to estimate the prevalence of MS and evaluate the association between MS and CAD using a community-based sample population. METHODS A cross-sectional community based survey was conducted in urban and rural areas of Kerala in 2011. We included 5063 individuals for analysis. Age standardized prevalence of MS, associated diagnoses (hypertension, diabetes and hypercholesterolemia) and other potential risk factors were assessed for men and women in both urban and rural locations. Univariate and multivariate logistic regression models were developed to identify participant characteristics that are associated with MS. RESULTS After standardization for age and adjustment for sex and urban-rural distribution, the prevalence of metabolic syndrome in Kerala was 24%, 29% and 33% for the NCEP ATP III, IDF and AHA/NHLBI Harmonization definitions, respectively. The mean (SD) age of the participants was 51 (14) years, and 60% were women. Women had a higher prevalence of MS than men (28% versus 20% for ATP III, p<0.001). Similarly, participants living in urban areas had higher prevalence of MS than their rural counterparts (26% versus 22%, p<0.001). Elevated body mass index, older age, and female sex were associated with MS in an adjusted multivariate model. The propensity for definite CAD was 1.7 times higher in individuals with MS defined based on ATP III criteria compared to those without MS (Adjusted OR = 1.69; 95% CI: 1.3-2.2, p<0.001). CONCLUSIONS One of four to one of three adult individuals in Kerala have MS based on different criteria. Higher propensity for CAD in individuals with MS in Kerala calls for urgent steps to prevent and control the burden of metabolic conditions.
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Affiliation(s)
- S. Harikrishnan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Smitha Sarma
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - G. Sanjay
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - P. Jeemon
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - M. N. Krishnan
- Department of Cardiology, Government Medical College, Kozhikode, Kerala, India
| | - K. Venugopal
- Department of Cardiology, Pushpagiri Hospital, Tiruvalla, Kottayam, Kerala, India
| | - P. P. Mohanan
- Department of Cardiology, Westfort High-tech Hospital, Thrissur, Kerala, India
| | - L. Jeyaseelan
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - K. R. Thankappan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - G. Zachariah
- Department of Cardiology, Mother Hospital, Thrissur, Kerala, India
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Ganapati A, Ravindran R, David T, Yadav B, Jeyaseelan V, Jeyaseelan L, Danda D. Head to head comparison of adverse effects and efficacy between high dose deflazacort and high dose prednisolone in systemic lupus erythematosus: a prospective cohort study. Lupus 2018; 27:890-898. [PMID: 29320974 DOI: 10.1177/0961203317751854] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 11/16/2022]
Abstract
BACKGROUND Deflazacort (DFZ), an oxazoline derivative of prednisolone (PDN), has a dose equivalence of 1.2:1 (mg) to PDN. No study to date has compared adverse effects and efficacy of high doses of DFZ as against high-dose PDN in systemic lupus erythematosus (SLE). OBJECTIVES To compare adverse effects of high dose DFZ and PDN in SLE patients, especially in terms of cushingoid features and gain in body weight, 3 and 6 months after initiation of these agents. METHODS In both the steroid arms, the following outcome parameters were assessed at 3 and 6 months: (a) cushingoid features by Cushing's Severity Index (CSI) (b) hirsutism by modified Ferriman Gallwey score (c) weight gain by difference (Δ, delta) of weight (in kilograms). RESULTS Patients on PDN had 1.6 kg (3.2%) and 2 kg (5.1%) higher median weight gain as compared to those on DFZ at 3 and 6 months respectively ( p = 0.012 and 0.001). PDN caused 10% and 22.2% higher increment in median hirsutism scores as compared to DFZ at 3 months and 6 months follow-up, respectively ( p = 0.004 and 0.002). PDN caused 100% higher increase in median CSI scores than DFZ at 6 months ( p = 0.03). There was no significant difference by generalized estimation equation between the groups with respect to changes in SLEDAI, renal SLEDAI, anti-dsDNA titres and C3/C4 levels. There were two serious infections (requiring hospitalization/intravenous antibiotics) in the PDN group, while none in the DFZ group. CONCLUSION Comparable intake and tapering of high dose DFZ and PDN in active SLE revealed 2-fold less weight gain, 2.5-fold less hirsutism and 1.5-fold lower cushingoid severity index as well as lower glycaemic elevation in the DFZ group as compared to PDN group. Both had similar efficacy.
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Affiliation(s)
- A Ganapati
- Department of Clinical Immunology and Rheumatology, 30025 Christian Medical College, Vellore , India
| | - R Ravindran
- Department of Clinical Immunology and Rheumatology, 30025 Christian Medical College, Vellore , India
| | - T David
- Department of Medicine II, 30025 Christian Medical College, Vellore , India
| | - B Yadav
- Department of Biostatistics, 30025 Christian Medical College, Vellore , India
| | - V Jeyaseelan
- Department of Biostatistics, 30025 Christian Medical College, Vellore , India
| | - L Jeyaseelan
- Department of Biostatistics, 30025 Christian Medical College, Vellore , India
| | - D Danda
- Department of Clinical Immunology and Rheumatology, 30025 Christian Medical College, Vellore , India
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Al-Busafi SA, Al-Shuaili H, Omar H, Al-Zuhaibi H, Jeyaseelan L, Al-Naamani K. Epidemiology of Chronic Hepatitis C Infections at a Tertiary Care Centre in Oman. Sultan Qaboos Univ Med J 2018; 17:e404-e410. [PMID: 29372081 DOI: 10.18295/squmj.2017.17.04.005] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 08/26/2017] [Accepted: 09/28/2017] [Indexed: 12/24/2022] Open
Abstract
Objectives Chronic hepatitis C (CHC) is a leading cause of liver cirrhosis and hepatocellular carcinoma (HCC) worldwide. However, there is a lack of data regarding the epidemiology of CHC in Oman. This study aimed to describe the clinicopathological characteristics and outcomes of CHC-infected patients at a tertiary care hospital in Oman. Methods This retrospective descriptive hospital-based study included all CHC-infected patients who presented to the Sultan Qaboos University Hospital (SQUH) in Muscat, Oman, between January 2010 and December 2015. The baseline demographic, clinical, laboratory and radiological data of the patients were analysed. Results A total of 603 CHC-infected patients were identified during the study period; of these, 65.8% were male and the mean age was 44.8 ± 16.5 years. The main risk factors associated with CHC infection were intravenous drug abuse (23.9%) and a history of blood transfusions (20.7%). The most prevalent virus genotypes were 1 and 3 (44.0% and 35.1%, respectively). Upon initial presentation, 33.0% of the cohort had liver cirrhosis; of these, 48.7% had decompensated cirrhosis and 23.1% had HCCs. Liver transplantation was only performed for 7.5% of the cirrhosis patients, mostly as a curative treatment for HCC. Conclusion The implementation of national policies to prevent hepatitis C transmission and encourage the early screening of at-risk patients is recommended to reduce the burden and consequences of this disease in Oman.
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Affiliation(s)
- Said A Al-Busafi
- Department of Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Halima Al-Shuaili
- Internal Medicine Residency Programme, Oman Medical Specialty Board, Muscat, Oman
| | - Heba Omar
- Department of Medicine, Armed Forces Hospital, Muscat, Oman
| | - Haifa Al-Zuhaibi
- Department of Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - L Jeyaseelan
- Department of Statistics & Health Information, Sultan Qaboos University Hospital, Muscat, Oman.,Department of Biostatics, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
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Sabharwal S, Jeyaseelan L, Panda A, Gnanaraj L, Kekre NS, Devasia A. A prospective randomised double-blind placebo-controlled trial to assess the effect of diuretics on shockwave lithotripsy of calculi. Arab J Urol 2017; 15:289-293. [PMID: 29234530 PMCID: PMC5717457 DOI: 10.1016/j.aju.2017.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 12/19/2016] [Revised: 04/16/2017] [Accepted: 04/22/2017] [Indexed: 10/24/2022] Open
Abstract
Objective To assess the effect of diuretics with shockwave lithotripsy (SWL) on the treatment of renal and upper ureteric calculi. Patients and methods Adult patients with a solitary non-obstructive radio-opaque renal or upper ureteric calculus with normal renal function were included. They were prospectively randomised to receive either SWL with placebo or SWL with diuretics (40 mg parenteral furosemide) in a double-blind manner with a sample size of 48 patients in each arm. The primary outcomes were the SWL success and failure rates. The secondary outcomes were the number of shocks and sessions. Results Complete fragmentation was achieved in 89.6% of the patients in the furosemide arm as compared to 81.3% in the placebo arm. Clearance was achieved in 77.1% of the patients in the furosemide arm as compared to 70.8% in the placebo arm. The number of shocks and the number of sessions were higher in the placebo arm. These differences were not statistically significant. Conclusion The use of diuretics along with SWL treatment of renal and upper ureteric calculi does not show a statistically significant improvement in fragmentation or clearance.
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Affiliation(s)
- Sagar Sabharwal
- Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India
| | - L Jeyaseelan
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Arabind Panda
- Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Lionel Gnanaraj
- Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nitin S Kekre
- Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Antony Devasia
- Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India
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Atsali E, Kassara D, Katsimbri P, Boiu S, Boumpas DT, Papaevangelou V, Oshlyanska OA, Omelchenko LI, Ljudvik TA, Bouchalova K, Schüller M, Franova J, Skotakova J, Macku M, Fellas A, Hawke F, Santos D, Coda A, Kelempisioti A, Keskitalo P, Glumoff V, Kulmala P, Vahasalo P, Mozaffar MA, Turkistani AK, Sangoof SO, Sevostyanov V, Zholobova E, Bountouvi E, Theodoropoulos K, Atsali E, Moutsiou R, Tsalapaki C, Katsimbri P, Boiu S, Boumpas DT, Papaevangelou V, Diaz T, Osorio S, Braña MT, Ramirez Y, Aparicio L, Rodriguez A, Faugier E, Maldonado R, Gicchino MF, Granato C, Macchini G, Capalbo D, Olivieri AN, Hasson N, Marino A, Narula S, Lerman M, Calonge MAM, Loza SMM, Alcobendas RM, Remesal A, Núñez-Cuadros E, Zavala RG, Rego GDC, Fernández CA, Molina YG, Cardona ALU, Sahin N, Durmus HS, Pinarbasi AS, Gunduz Z, Poyrazoglu MH, Karaman ZF, Oktem T, Oner M, Dusunsel R, Susic G, Krstajic T, Vujovic D, Radlovic N, Lekovic Z, Novakovic D, Lomic GM, Mördrup K, Hesselstrand G, Sorić I, Lamot L, Vidovic M, Lamot M, Harjacek M, Adank E, Schneider EC, Abdalla E, Ullah I, Jeyaseelan L, Abdwani R, Abdwani R, Shaqsi LAL, Zakwani IAL, Atsali E, Katsimbri P, Fanouriakis A, Boiu S, Papaevangelou V, Boumpas DT, Janarthanan M, Vetrichelvan D, Ramachandran P, Geminiganesan S, Kumar D, Rao S, Papatesta EM, Maritsi D, Eleftheriou I, Tsolia M, Vougiouka O, Çakan M, Ayaz NA, Karadağ ŞG, Keskindemirci G, Keltsev V, Grebenkina L, Kim KN, Ahn JG, Kim YD, Maggio MC, Cimaz R, Failla MC, Dones P, Collura M, Corsello G, Rhim JW, Kim KH, Lee SY, Han SB, Kang JH, Chung JH, Lee SJ, Jeong DC, Santimov A, Rupp R, Alekseev I, Plutova N, Moskvina E, Kruchina M, Tarasenko A, Sokolova N, Saveleva E, Bogdanov I, Ivanov D, Kandrina T, Kopanevich O, Grafskaia A, Ignateva N, Pulukchu D, Pavlova N, Kalashnikova O, Kornishina T, Dubko M, Chasnyk V, Kostik M, Sowdagar S, Sankar J, Ramesh V, Janarthanan M, Szabo IE, Sirbe C, Pamfil C, Damian L, Rednic S, Deac M, Pamfil C, Sparchez M, Filipescu I, Parvu M, Balint D, Nicoara A, Rednic S, Damian L. Proceedings of the 24th Paediatric Rheumatology European Society Congress: Part three. Pediatr Rheumatol Online J 2017. [PMCID: PMC5592440 DOI: 10.1186/s12969-017-0187-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Lindley RI, Anderson CS, Billot L, Forster A, Hackett ML, Harvey LA, Jan S, Li Q, Liu H, Langhorne P, Maulik PK, Murthy GVS, Walker MF, Pandian JD, Alim M, Felix C, Syrigapu A, Tugnawat DK, Verma SJ, Shamanna BR, Hankey G, Thrift A, Bernhardt J, Mehndiratta MM, Jeyaseelan L, Donnelly P, Byrne D, Steley S, Santhosh V, Chilappagari S, Mysore J, Roy J, Padma MV, John L, Aaron S, Borah NC, Vijaya P, Kaul S, Khurana D, Sylaja PN, Halprashanth DS, Madhusudhan BK, Nambiar V, Sureshbabu S, Khanna MC, Narang GS, Chakraborty D, Chakraborty SS, Biswas B, Kaura S, Koundal H, Singh P, Andrias A, Thambu DS, Ramya I, George J, Prabhakar AT, Kirubakaran P, Anbalagan P, Ghose M, Bordoloi K, Gohain P, Reddy NM, Reddy KV, Rao TNM, Alladi S, Jalapu VRR, Manchireddy K, Rajan A, Mehta S, Katoch C, Das B, Jangir A, Kaur T, Sreedharan S, Sivasambath S, Dinesh S, Shibi BS, Thangaraj A, Karunanithi A, Sulaiman SMS, Dehingia K, Das K, Nandini C, Thomas NJ, Dhanya TS, Thomas N, Krishna R, Aneesh V, Krishna R, Khullar S, Thouman S, Sebastian I. Family-led rehabilitation after stroke in India (ATTEND): a randomised controlled trial. Lancet 2017; 390:588-599. [PMID: 28666682 DOI: 10.1016/s0140-6736(17)31447-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/17/2017] [Accepted: 04/04/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Most people with stroke in India have no access to organised rehabilitation services. The effectiveness of training family members to provide stroke rehabilitation is uncertain. Our primary objective was to determine whether family-led stroke rehabilitation, initiated in hospital and continued at home, would be superior to usual care in a low-resource setting. METHODS The Family-led Rehabilitation after Stroke in India (ATTEND) trial was a prospectively randomised open trial with blinded endpoint done across 14 hospitals in India. Patients aged 18 years or older who had had a stroke within the past month, had residual disability and reasonable expectation of survival, and who had an informal family-nominated caregiver were randomly assigned to intervention or usual care by site coordinators using a secure web-based system with minimisation by site and stroke severity. The family members of participants in the intervention group received additional structured rehabilitation training-including information provision, joint goal setting, carer training, and task-specific training-that was started in hospital and continued at home for up to 2 months. The primary outcome was death or dependency at 6 months, defined by scores 3-6 on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]) as assessed by masked observers. Analyses were by intention to treat. This trial is registered with Clinical Trials Registry-India (CTRI/2013/04/003557), Australian New Zealand Clinical Trials Registry (ACTRN12613000078752), and Universal Trial Number (U1111-1138-6707). FINDINGS Between Jan 13, 2014, and Feb 12, 2016, 1250 patients were randomly assigned to intervention (n=623) or control (n=627) groups. 33 patients were lost to follow-up (14 intervention, 19 control) and five patients withdrew (two intervention, three control). At 6 months, 285 (47%) of 607 patients in the intervention group and 287 (47%) of 605 controls were dead or dependent (odds ratio 0·98, 95% CI 0·78-1·23, p=0·87). 72 (12%) patients in the intervention group and 86 (14%) in the control group died (p=0·27), and we observed no difference in rehospitalisation (89 [14%]patients in the intervention group vs 82 [13%] in the control group; p=0·56). We also found no difference in total non-fatal events (112 events in 82 [13%] intervention patients vs 110 events in 79 [13%] control patients; p=0·80). INTERPRETATION Although task shifting is an attractive solution for health-care sustainability, our results do not support investment in new stroke rehabilitation services that shift tasks to family caregivers, unless new evidence emerges. A future avenue of research should be to investigate the effects of task shifting to health-care assistants or team-based community care. FUNDING The National Health and Medical Research Council of Australia.
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Alawi MA, Sinawi HA, AL-Adawi S, Jeyaseelan L, MurthiP S. Public perception of mental illness in Oman: A cross-sectional study. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
IntroductionStigma toward mental illness is an international phenomena and it has negative consequences on the patients and their families. Studies on public attitudes toward people with mental illness (PWMI) in the Arab world initially reported less prevalence of stigma compared to other societies; however, follow up studies showed that stigma was influenced by specific socio-cultural factors.AimsThis study aims to examine public attitudes toward people with mental illness in Oman and the impact of socio-demographic factors.MethodsThis is a cross-sectional survey conducted among the general public in Oman. The attitude was measured via the Attitude toward Mental Illness (AMI) questionnaire. Various demographic factors were examined including age, place of residence, occupation and previous encounter with PWMI. The data were collected using online research methods.ResultsA total of 601 subjects participated in this study, (M: 41.4%, F: 58.6%). 48% of the participants were aged 15–30 years while 46% were aged 31–45 years. The majority of the participants were employed and 10% were students. After adjusting for all other variables, subjects aged (15–30years) had less positive attitude compared to those aged (46–60 years) (P = 0.06). Socio-demographic factors such as gender, occupation and previous contact were correlated with the endorsement of positive attitudes toward PWMI.ConclusionThis study illustrated that public attitudes toward PWMI in Oman is generally sub-optimal. The observed attitudes were strongly influenced by age, gender, occupation and previous exposure to PWMI. Future studies with robust methodology are recommended to scrutinize the present findings.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Doddabelavangala Mruthyunjaya M, Chapla A, Hesarghatta Shyamasunder A, Varghese D, Varshney M, Paul J, Inbakumari M, Christina F, Varghese RT, Kuruvilla KA, V. Paul T, Jose R, Regi A, Lionel J, Jeyaseelan L, Mathew J, Thomas N. Comprehensive Maturity Onset Diabetes of the Young (MODY) Gene Screening in Pregnant Women with Diabetes in India. PLoS One 2017; 12:e0168656. [PMID: 28095440 PMCID: PMC5240948 DOI: 10.1371/journal.pone.0168656] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 12/05/2016] [Indexed: 02/03/2023] Open
Abstract
Pregnant women with diabetes may have underlying beta cell dysfunction due to mutations/rare variants in genes associated with Maturity Onset Diabetes of the Young (MODY). MODY gene screening would reveal those women genetically predisposed and previously unrecognized with a monogenic form of diabetes for further clinical management, family screening and genetic counselling. However, there are minimal data available on MODY gene variants in pregnant women with diabetes from India. In this study, utilizing the Next generation sequencing (NGS) based protocol fifty subjects were screened for variants in a panel of thirteen MODY genes. Of these subjects 18% (9/50) were positive for definite or likely pathogenic or uncertain MODY variants. The majority of these variants was identified in subjects with autosomal dominant family history, of whom five were in women with pre-GDM and four with overt-GDM. The identified variants included one patient with HNF1A Ser3Cys, two PDX1 Glu224Lys, His94Gln, two NEUROD1 Glu59Gln, Phe318Ser, one INS Gly44Arg, one GCK, one ABCC8 Arg620Cys and one BLK Val418Met variants. In addition, three of the seven offspring screened were positive for the identified variant. These identified variants were further confirmed by Sanger sequencing. In conclusion, these findings in pregnant women with diabetes, imply that a proportion of GDM patients with autosomal dominant family history may have MODY. Further NGS based comprehensive studies with larger samples are required to confirm these finding.
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Affiliation(s)
| | - Aaron Chapla
- Department of Endocrinology, Diabetes & Metabolism, Christian Medical College, Vellore, India
| | | | - Deny Varghese
- Department of Endocrinology, Diabetes & Metabolism, Christian Medical College, Vellore, India
| | - Manika Varshney
- Department of Endocrinology, Diabetes & Metabolism, Christian Medical College, Vellore, India
| | - Johan Paul
- Department of Endocrinology, Diabetes & Metabolism, Christian Medical College, Vellore, India
| | - Mercy Inbakumari
- Department of Endocrinology, Diabetes & Metabolism, Christian Medical College, Vellore, India
| | - Flory Christina
- Department of Endocrinology, Diabetes & Metabolism, Christian Medical College, Vellore, India
| | - Ron Thomas Varghese
- Department of Endocrinology, Diabetes & Metabolism, Christian Medical College, Vellore, India
| | | | - Thomas V. Paul
- Department of Endocrinology, Diabetes & Metabolism, Christian Medical College, Vellore, India
| | - Ruby Jose
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India
| | - Annie Regi
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India
| | - Jessie Lionel
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India
| | - L. Jeyaseelan
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - Jiji Mathew
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India
| | - Nihal Thomas
- Department of Endocrinology, Diabetes & Metabolism, Christian Medical College, Vellore, India
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Jeyaseelan L, Chandrashekar S, Mulligan A, Bosman HA, Watson AJS. Correction of moderate to severe hallux valgus with combined proximal opening wedge and distal chevron osteotomies: a reliable technique. Bone Joint J 2016; 98-B:1202-7. [PMID: 27587521 DOI: 10.1302/0301-620x.98b9.35984] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 02/15/2015] [Accepted: 04/19/2016] [Indexed: 11/05/2022]
Abstract
AIMS The mainstay of surgical correction of hallux valgus is first metatarsal osteotomy, either proximally or distally. We present a technique of combining a distal chevron osteotomy with a proximal opening wedge osteotomy, for the correction of moderate to severe hallux valgus. PATIENTS AND METHODS We reviewed 45 patients (49 feet) who had undergone double osteotomy. Outcome was assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) and the Short Form (SF) -36 Health Survey scores. Radiological measurements were undertaken to assess the correction. The mean age of the patients was 60.8 years (44.2 to 75.3). The mean follow-up was 35.4 months (24 to 51). RESULTS The mean AOFAS score improved from 54.7 to 92.3 (p < 0.001) and the mean SF-36 score from 59 to 86 (p < 0.001). The mean hallux valgus and intermetatarsal angles were improved from 41.6(o) to 12.8(o) (p < 0.001) and from 22.1(o) to 7.1(o), respectively (p < 0.001). The mean distal metatarsal articular angle improved from 23(o) to 9.7(o). The mean sesamoid position, as described by Hardy and Clapham, improved from 6.8 to 3.5. The mean length of the first metatarsal was unchanged. The overall rate of complications was 4.1% (two patients). CONCLUSION These results suggest that a double osteotomy of the first metatarsal is a reliable, safe technique which, when compared with other metatarsal osteotomies, provides strong angular correction and excellent outcomes with a low rate of complications. Cite this article: Bone Joint J 2016;98-B:1202-7.
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Affiliation(s)
- L Jeyaseelan
- Princess Alexandra Hospital, Hamstel Rd, Harlow CM20 1QX, UK
| | - S Chandrashekar
- Princess Alexandra Hospital, Hamstel Rd, Harlow CM20 1QX, UK
| | - A Mulligan
- Barts and the London NHS Trust, Whitechapel Rd, London, Whitechapel E1 1BB, UK
| | - H A Bosman
- Homerton NHS Trust, Homerton Row, London E9, UK
| | - A J S Watson
- Princess Alexandra Hospital, Hamstel Rd, Harlow CM20 1QX, UK
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George R, Thomas K, Thyagarajan SP, Jeyaseelan L, Peedicayil A, Jeyaseelan V, George S. Genital syndromes and syndromic management of vaginal discharge in a community setting. Int J STD AIDS 2016; 15:367-70. [PMID: 15186579 DOI: 10.1258/095646204774195191] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The objective of the study was to determine the community prevalence of genital syndromes in women and evaluate the syndromic management of vaginal discharge in this setting. A representative sample for the state of Tamilnadu was chosen using probability proportional to size cluster technique. Thirty clusters were selected from three districts. Demographic, sexual behaviour, risk factors, clinical and laboratory data were collected from the selected population using a structured questionnaire. Direct smear examination for Trichomonas vaginalis, culture for Neisseria gonorrhoeae and Haemophilus ducreyi, serological tests for syphilis (RPR and TPHA), hepatitis B (Hbs Ag ELISA), IgM and IgG antibodies to HSV2 (Novum diagnostics, Germany) and PCR test for detection of C. trachomatis from urine were done. There were 1157 women in the selected population. On examination, vaginal discharge was the most common genital syndrome (38.4%). The sensitivity, specificity, positive and negative predictive value of vaginal discharge as a marker for STD in women was found to be 43.3%, 61.6%, 10.7% and 91.1%, respectively. We concluded that treatment on the basis of syndromic management would result in over-treatment of 90% of women with vaginal discharge.
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Affiliation(s)
- R George
- Christian Medical College & Hospital, Vellore, Tamilnadu, India.
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Joyee AG, Thyagarajan SP, Rajendran P, Hari R, Balakrishnan P, Jeyaseelan L, Kurien T. Chlamydia trachomatis genital infection in apparently healthy adult population of Tamil Nadu, India: a population-based study. Int J STD AIDS 2016; 15:51-5. [PMID: 14769173 DOI: 10.1258/095646204322637272] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Since the epidemiology of Chlamydia trachomatis infection in apparently healthy population has not been studied in India, a population-based study was conducted in the state of Tamil Nadu, India in order to analyse the prevalence of genital chlamydial infections in the community and to implement control programmes. A representative sample was taken from three randomly selected districts by using the 'probability proportional to size' cluster survey method. Households were the basic units of clusters. Adults aged 15-45 years, pre-identified from the selected households were enrolled during the medical camps conducted for a major study on community prevalence of sexually transmitted diseases in Tamil Nadu. Blood and urine samples collected from the study subjects were tested by enzyme-linked immunosorbent assay (ELISA) for anti-chlamydial IgM antibodies and by the commercial Amplicor polymerase chain reaction (PCR) test for chlamydial DNA. The prevalence of anti- C. trachomatis antibodies determined by IgM-ELISA was 2.4% (95% CI 1.6%-3.2%). The prevalence of genital chlamydial infection determined by PCR was 1.1% (95% CI 0.5%-1.7%). Majority of the detected infections (68.8%) were asymptomatic. This is the first Indian report on the prevalence of genital chlamydial infections in the general population. It is concluded that this study provides evidence for a substantial burden of approximately 10 million asymptomatic genital chlamydial infection cases in the sexually active age groups in the general population of India.
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Affiliation(s)
- A G Joyee
- Department of Microbiology, Dr. ALM Post Graduate Institute of Basic Medical Sciences, University of Madras, Taramani, Chennai, India 600 113
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Abstract
How many of us are in breach of basic governance requirements?
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Affiliation(s)
| | | | | | - S Heaton
- Princess Alexandra Hospital NHS Trust
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Abstract
BACKGROUND AND OBJECTIVE In the analysis of dichotomous type response variable, logistic regression is usually used. However, the performance of logistic regression in the presence of sparse data is questionable. In such a situation, a common problem is the presence of high odds ratios (ORs) with very wide 95% confidence interval (CI) (OR: >999.999, 95% CI: <0.001, >999.999). In this paper, we addressed this issue by using penalized logistic regression (PLR) method. MATERIALS AND METHODS Data from case-control study on hyponatremia and hiccups conducted in Christian Medical College, Vellore, Tamil Nadu, India was used. The outcome variable was the presence/absence of hiccups and the main exposure variable was the status of hyponatremia. Simulation dataset was created with different sample sizes and with a different number of covariates. RESULTS A total of 23 cases and 50 controls were used for the analysis of ordinary and PLR methods. The main exposure variable hyponatremia was present in nine (39.13%) of the cases and in four (8.0%) of the controls. Of the 23 hiccup cases, all were males and among the controls, 46 (92.0%) were males. Thus, the complete separation between gender and the disease group led into an infinite OR with 95% CI (OR: >999.999, 95% CI: <0.001, >999.999) whereas there was a finite and consistent regression coefficient for gender (OR: 5.35; 95% CI: 0.42, 816.48) using PLR. After adjusting for all the confounding variables, hyponatremia entailed 7.9 (95% CI: 2.06, 38.86) times higher risk for the development of hiccups as was found using PLR whereas there was an overestimation of risk OR: 10.76 (95% CI: 2.17, 53.41) using the conventional method. Simulation experiment shows that the estimated coverage probability of this method is near the nominal level of 95% even for small sample sizes and for a large number of covariates. CONCLUSIONS PLR is almost equal to the ordinary logistic regression when the sample size is large and is superior in small cell values.
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Affiliation(s)
| | - L Jeyaseelan
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
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Peedicayil A, Abraham P, Prasad J, Jeyaseelan L, Abraham S, Kurian S, Gravitt P, Shah KV. Community Prevalence of Human Papillomavirus by Self-Collected Samples in South India. Indian J Gynecol Oncolog 2016. [DOI: 10.1007/s40944-016-0045-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Krishnan MN, Zachariah G, Venugopal K, Mohanan PP, Harikrishnan S, Sanjay G, Jeyaseelan L, Thankappan KR. Prevalence of coronary artery disease and its risk factors in Kerala, South India: a community-based cross-sectional study. BMC Cardiovasc Disord 2016; 16:12. [PMID: 26769341 PMCID: PMC4712491 DOI: 10.1186/s12872-016-0189-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 01/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are no recent data on prevalence of coronary artery disease (CAD) in Indians. The last community based study from Kerala, the most advanced Indian state in epidemiological transition, was in 1993 that reported 1.4% definite CAD prevalence. We studied the prevalence of CAD and its risk factors among adults in Kerala. METHODS In a community-based cross sectional study, we selected 5167 adults (mean age 51 years, men 40.1%) using a multistage cluster sampling method. Information on socio-demographics, smoking, alcohol use, physical activity, dietary habits and personal history of hypertension, diabetes, and CAD was collected using a structured interview schedule. Anthropometry, blood pressure, electrocardiogram, and biochemical investigations were done using standard protocols. CAD and its risk factors were defined using standard criteria. Comparisons of age adjusted prevalence were done using two tailed proportion tests. RESULTS The overall age-adjusted prevalence of definite CAD was 3.5%: men 4.8%, women 2.6% (p < 0.001). Prevalence of any CAD was 12.5%: men 9.8%, women 14.3% (p < 0.001). There was no difference in definite CAD between urban and rural population. Physical inactivity was reported by 17.5 and 18% reported family history of CAD. Other CAD risk factors detected in the study were: overweight or obese 59%, abdominal obesity 57%, hypertension 28%, diabetes 15%, high total cholesterol 52% and low level of high density lipoprotein cholesterol 39%. Current smoking was reported only be men (28%). CONCLUSION The prevalence of definite CAD in Kerala increased nearly three times since 1993 without any difference in urban and rural areas. Most risk factors of CAD were highly prevalent in the state. Both population and individual level approaches are warranted to address the high level of CAD risk factors to reduce the increasing prevalence of CAD in this population.
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Affiliation(s)
- M N Krishnan
- Govt. Medical College, Kozhikode, Kerala, India.
| | | | - K Venugopal
- Pushpagiri Hospital, Tiruvalla, Kottayam, Kerala, India.
| | - P P Mohanan
- Westfort High-tech Hospital, Thrissur, Kerala, India.
| | - S Harikrishnan
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
| | - G Sanjay
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
| | - L Jeyaseelan
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India.
| | - K R Thankappan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum Medical College, P.O. 695011, Thiruvananthapuram, Kerala, India.
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Pai R, Ebenazer A, Paul MJ, Thomas N, Nair A, Seshadri MS, Oommen R, Shanthly N, Devasia A, Rebekah G, Jeyaseelan L, Rajaratnam S. Mutations seen among patients with pheochromocytoma and paraganglioma at a referral center from India. Horm Metab Res 2015; 47:133-7. [PMID: 24977658 DOI: 10.1055/s-0034-1376989] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Determining the mutational status of susceptibility genes including RET, VHL, SDHx (SDHB, SDHC, SDHD) among patients with pheochromocytoma/paraganglioma (PCC/PGL) is gaining importance. These genes have not been systematically characterized among patients with PCC/PGL from India. The aim of the work was to screen the most frequently mutated genes among patients with PCC/PGL to determine the frequency and spectrum of mutations seen in this region. Fifty patients with PCC/PGL treated at our tertiary care hospital between January 2010 and June 2012 were screened for mutations in susceptibility genes using an algorithmic approach. Thirty-two percent (16/50) of patients were found to be positive for mutations including mutations among RET (n=4), VHL (n=6), SDHB (n=3), and SDHD (n=3) genes. None of these patients were positive for SDHC mutations. A significant association was found between young patients with bilateral tumors and VHL mutations (p=0.002). Two of the 3 patients with extra-adrenal SDHB associated tumors, had unique mutations, viz., c.436delT (exon 5) and c.788_857del (exon 8), one of which was malignant. High frequency of mutations seen among patients in this study emphasizes the need to consider mutational analysis among Indian patients with PCC/PGL.
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Affiliation(s)
- R Pai
- Department of Pathology, Christian Medical College, Vellore, India
| | - A Ebenazer
- Department of Pathology, Christian Medical College, Vellore, India
| | - M J Paul
- Department of Endocrine Surgery, Christian Medical College, Vellore, India
| | - N Thomas
- Department of Endocrinology and Metabolism, Christian Medical College, Vellore, India
| | - A Nair
- Department of Endocrine Surgery, Christian Medical College, Vellore, India
| | - M S Seshadri
- Department of Endocrinology and Metabolism, Christian Medical College, Vellore, India
| | - R Oommen
- Department of Nuclear Medicine, Christian Medical College, Vellore, India
| | - N Shanthly
- Department of Nuclear Medicine, Christian Medical College, Vellore, India
| | - A Devasia
- Department of Urology, Christian Medical College, Vellore, India
| | - G Rebekah
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - L Jeyaseelan
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - S Rajaratnam
- Department of Endocrinology and Metabolism, Christian Medical College, Vellore, India
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Danda D, Hindhumathi M, Ruchika G, Jayakanthan K, Jeyaseelan L, Jeyaseelan V, Joseph G, Danda S. Cytokine gene polymorphisms in Asian Indian patients with Takayasu’s Arteritis (TA) – a single center study. Indian Journal of Rheumatology 2014. [DOI: 10.1016/j.injr.2014.10.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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David VG, Yadav B, Jeyaseelan L, Deborah MN, Jacob S, Alexander S, Varughese S, John GT. Prospective blood pressure measurement in renal transplant recipients. Indian J Nephrol 2014; 24:154-60. [PMID: 25120292 PMCID: PMC4127834 DOI: 10.4103/0971-4065.132006] [Citation(s) in RCA: 3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Blood pressure (BP) control at home is difficult when managed only with office blood pressure monitoring (OBPM). In this prospective study, the reliability of BP measurements in renal transplant patients with OBPM and home blood pressure monitoring (HBPM) was compared with ambulatory blood pressure monitoring (ABPM) as the gold standard. Adult patients who had living-related renal transplantation from March 2007 to February 2008 had BP measured by two methods; OBPM and ABPM at pretransplantation, 2nd, 4th, 6th, and 9th months and all the three methods: OBPM, ABPM, and HBPM at 6 months after transplantation. A total of 49 patients, age 35 ± 11 years, on prednisolone, tacrolimus, and mycophenolate were evaluated. A total of 39 were males (79.6%). Systolic BP (SBP) and diastolic BP (DBP) measured by OBPM were higher than HBPM when compared with ABPM. When assessed using OBPM and awake ABPM, both SBP and DBP were significantly overestimated by OBPM with mean difference of 3-12 mm Hg by office SBP and 6-8 mm Hg for office DBP. When HBPM was compared with mean ABPM at 6 months both the SBP and DBP were overestimated by and 7 mm Hg respectively. At 6 months post transplantation, when compared with ABPM, OBPM was more specific than HBPM in diagnosing hypertension (98% specificity, Kappa: 0.88 vs. 89% specificity, Kappa: 0.71). HBPM was superior to OBPM in identifying patients achieving goal BP (89% specificity, Kappa: 0.71 vs. 50% specificity Kappa: 0.54). In the absence of a gold standard for comparison the latent class model analysis still showed that ABPM was the best tool for diagnosing hypertension and monitoring patients reaching targeted control. OBPM remains an important tool for the diagnosis and management of hypertension in renal transplant recipients. HBPM and ABPM could be used to achieve BP control.
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Affiliation(s)
- V G David
- Department of Nephrology, Christian Medical College/Hospital, Vellore, Tamil Nadu, India
| | - B Yadav
- Department of Biostatics, Christian Medical College/Hospital, Vellore, Tamil Nadu, India
| | - L Jeyaseelan
- Department of Biostatics, Christian Medical College/Hospital, Vellore, Tamil Nadu, India
| | - M N Deborah
- Department of Nephrology, Christian Medical College/Hospital, Vellore, Tamil Nadu, India
| | - S Jacob
- Department of Nephrology, Christian Medical College/Hospital, Vellore, Tamil Nadu, India
| | - S Alexander
- Department of Nephrology, Christian Medical College/Hospital, Vellore, Tamil Nadu, India
| | - S Varughese
- Department of Nephrology, Christian Medical College/Hospital, Vellore, Tamil Nadu, India
| | - G T John
- Department of Renal Unit, Royal Brisbane and Women's Hospital, QLD, Australia
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Abstract
Peri-prosthetic infection is amongst the most common causes of failure following total knee replacement (TKR). In the presence of established infection, thorough joint debridement and removal of all components is necessary following which new components may be implanted. This can be performed in one or two stages; two-stage revision with placement of an interim antibiotic-loaded spacer is regarded by many to be the standard procedure for eradication of peri-prosthetic joint infection. We present our experience of a consecutive series of 50 single-stage revision TKRs for established deep infection performed between 1979 and 2010. There were 33 women and 17 men with a mean age at revision of 66.8 years (42 to 84) and a mean follow-up of 10.5 years (2 to 24). The mean time between the primary TKR and the revision procedure was 2.05 years (1 to 8). Only one patient required a further revision for recurrent infection, representing a success rate of 98%. Nine patients required further revision for aseptic loosening, according to microbiological testing of biopsies taken at the subsequent surgery. Three other patients developed a further septic episode but none required another revision. These results suggest that a single-stage revision can produce comparable results to a two-stage revision. Single-stage revision offers a reduction in costs as well as less morbidity and inconvenience for patients.
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Affiliation(s)
- S Tibrewal
- The Royal London Hospital, Department of Orthopaedics, Whitechapel, London E1 1BB, UK
| | - F Malagelada
- The Royal London Hospital, Department of Orthopaedics, Whitechapel, London E1 1BB, UK
| | - L Jeyaseelan
- The Royal London Hospital, Department of Orthopaedics, Whitechapel, London E1 1BB, UK
| | - F Posch
- Vienna General Hospital Medical University of Vienna, Clinical Division of Haematology & Haemostaseology, Department of Medicine I, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - G Scott
- The Royal London Hospital, Department of Orthopaedics, Whitechapel, London E1 1BB, UK
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Ishi SV, Lakshmi M, Kakde ST, Sabnis KC, Jagannati M, Girish TS, Jeyaseelan L, Cherian AM. Randomised controlled trial for efficacy of unfractionated heparin (UFH) versus low molecular weight heparin (LMWH) in thrombo-prophylaxis. J Assoc Physicians India 2013; 61:882-886. [PMID: 24968543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To study if low dose Unfractionated heparin (UFH) is as effective and safe as Low-molecular weight heparin (LMWH) and also economical as a prophylactic agent for venous thromboembolism in medically ill patients. METHODOLOGY A prospective double blind randomised controlled trial consisting of 92 patients fulfilling the inclusion criteria who were admitted to Bangalore Baptist Hospital, Bengaluru, between March 2008 and July 2009 were randomised to receive Unfractionated heparin (UFH) or Low-molecular weight heparin (LMWH). RESULTS The result based on intention to treat (ITT)analysis with best outcome scenario: in the UFH arm there were 47 (97.9%) patients who had not developed DVT/PE as compared to 42 (95.5%) in the LMWH arm. The difference in proportion of patients who had not developed DVT/PE between UFH and LMWH was 2.4% (-5.0, 9.8). The results based on per protocol analysis: In the UFH arm there were 44 (97.8%) patients who had not developed DVT/PE as compared to 39 (95.1%) in the LMWH arm. The difference in proportion of patients who had not developed DVT/PE between the UFH and LMWH arm was 2.7% (-5.2, 10.5). Patients on UFH had higher major bleeding complications 4 (8.9%) as compared to 0 in LMWH arm. But with respect to other complications like thrombocytopenia (HIT) and mild or minimal bleeding both arms were comparable. CONCLUSION This study has demonstrated that low dose UFH is as effective as LMWH as a prophylactic agent for venous thromboembolism in medically ill patients and economical also.
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Ghosh S, Singh VK, Jeyaseelan L, Sinisi M, Fox M. Isolated latissimus dorsi transfer to restore shoulder external rotation in adults with brachial plexus injury. Bone Joint J 2013; 95-B:660-3. [PMID: 23632677 DOI: 10.1302/0301-620x.95b5.29776] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In adults with brachial plexus injuries, lack of active external rotation at the shoulder is one of the most common residual deficits, significantly compromising upper limb function. There is a paucity of evidence to address this complex issue. We present our experience of isolated latissimus dorsi (LD) muscle transfer to achieve active external rotation. This is a retrospective review of 24 adult post-traumatic plexopathy patients who underwent isolated latissimus dorsi muscle transfer to restore external rotation of the shoulder between 1997 and 2010. All patients were male with a mean age of 34 years (21 to 57). All the patients underwent isolated LD muscle transfer using a standard technique to correct external rotational deficit. Outcome was assessed for improvement in active external rotation, arc of movement, muscle strength and return to work. The mean improvement in active external rotation from neutral was 24° (10° to 50°). The mean increase in arc of rotation was 52° (38° to 55°). Mean power of the external rotators was 3.5 Medical Research Council (MRC) grades (2 to 5). A total of 21 patients (88%) were back in work by the time of last follow up. Of these, 13 had returned to their pre-injury occupation. Isolated latissimus dorsi muscle transfer provides a simple and reliable method of restoring useful active external rotation in adults with brachial plexus injuries with internal rotational deformity.
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Affiliation(s)
- S Ghosh
- Peripheral Nerve Injury Unit, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
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Abstract
We present our experience of managing patients with iatropathic brachial plexus injury after delayed fixation of a fracture of the clavicle. It is a retrospective cohort study of patients treated at our peripheral nerve injury unit and a single illustrative case report. We identified 21 patients in whom a brachial plexus injury occurred as a direct consequence of fixation of a fracture of the clavicle between September 2000 and September 2011. The predominant injury involved the C5/C6 nerves, upper trunk, lateral cord and the suprascapular nerve. In all patients, the injured nerve was found to be tethered to the under surface of the clavicle by scar tissue at the site of the fracture and was usually associated with pathognomonic neuropathic pain and paralysis. Delayed fixation of a fracture of the clavicle, especially between two and four weeks after injury, can result in iatropathic brachial plexus injury. The risk can be reduced by thorough release of the tissues from the inferior surface of the clavicle before mobilisation of the fracture fragments. If features of nerve damage appear post-operatively urgent specialist referral is recommended. Cite this article: Bone Joint J 2013;95-B:106–10.
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Affiliation(s)
- L. Jeyaseelan
- Peripheral Nerve Injury Unit, Royal National
Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex
HA7 4LP, UK
| | - V. K. Singh
- Peripheral Nerve Injury Unit, Royal National
Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex
HA7 4LP, UK
| | - S. Ghosh
- Peripheral Nerve Injury Unit, Royal National
Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex
HA7 4LP, UK
| | - M. Sinisi
- Peripheral Nerve Injury Unit, Royal National
Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex
HA7 4LP, UK
| | - M. Fox
- Peripheral Nerve Injury Unit, Royal National
Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex
HA7 4LP, UK
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