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Khatib K, Dixit S, Telang M. Metabolic management of accidental intoxication. Curr Opin Clin Nutr Metab Care 2024; 27:147-154. [PMID: 38260945 DOI: 10.1097/mco.0000000000001013] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
PURPOSE OF REVIEW Unintentional intoxication comprises a major chunk of all intoxications. Most patients are in the pediatric age group with another set of patients being the elderly. Substances found to cause accidental intoxication vary from country to country and even within different regions of a country. Frequent reviews of current literature are needed to be abreast of trends. RECENT FINDINGS Prescription drugs and household chemicals are major culprits when it comes to accidental intoxication. Acetaminophen, digoxin and metformin are some of the prominent prescription drugs frequently associated with unintentional intoxications. Increasingly alcohol based hand sanitizers are becoming an important etiology of these events, following their increased usage during the COVID-19 pandemic. Pattern recognition to identify class of intoxicant and supportive care including prevention of further absorption and increased excretion are cornerstones of therapy. Antidote when available should be used promptly. SUMMARY Knowledge about current epidemiology of accidental intoxications, toxidrome pattern recognition and appropriate antidote usage beside adequate and timely supportive care help in successful management of the unfortunate victim of accidental intoxication.
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Affiliation(s)
| | - Subhal Dixit
- Department of Critical Care, Sanjeevan and MJM Hospitals, Pune, India
| | - Madhavi Telang
- Senior Specialist Intensive Care Unit, Rashid Hospital and Emergency Trauma Centre, Dubai, UAE
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2
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Gilbert DC, Nankivell M, Rush H, Clarke NW, Mangar S, Al-Hasso A, Rosen S, Kockelbergh R, Sundaram SK, Dixit S, Laniado M, McPhail N, Shaheen A, Brown S, Gale J, Deighan J, Marshall J, Duong T, Macnair A, Griffiths A, Amos CL, Sydes MR, James ND, Parmar MKB, Langley RE. A Repurposing Programme Evaluating Transdermal Oestradiol Patches for the Treatment of Prostate Cancer Within the PATCH and STAMPEDE Trials: Current Results and Adapting Trial Design. Clin Oncol (R Coll Radiol) 2024; 36:e11-e19. [PMID: 37973477 DOI: 10.1016/j.clon.2023.10.054] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Abstract
AIMS Androgen deprivation therapy (ADT), usually achieved with luteinising hormone releasing hormone analogues (LHRHa), is central to prostate cancer management. LHRHa reduce both testosterone and oestrogen and are associated with significant long-term toxicity. Previous use of oral oestrogens as ADT was curtailed because of cardiovascular toxicity. Transdermal oestrogen (tE2) patches are a potential alternative ADT, supressing testosterone without the associated oestrogen-depletion toxicities (osteoporosis, hot flushes, metabolic abnormalities) and avoiding cardiovascular toxicity, and we here describe their evaluation in men with prostate cancer. MATERIALS AND METHODS The PATCH (NCT00303784) adaptive trials programme (incorporating recruitment through the STAMPEDE [NCT00268476] platform) is evaluating the safety and efficacy of tE2 patches as ADT for men with prostate cancer. An initial randomised (LHRHa versus tE2) phase II study (n = 251) with cardiovascular toxicity as the primary outcome measure has expanded into a phase III evaluation. Those with locally advanced (M0) or metastatic (M1) prostate cancer are eligible. To reflect changes in both management and prognosis, the PATCH programme is now evaluating these cohorts separately. RESULTS Recruitment is complete, with 1362 and 1128 in the M0 and M1 cohorts, respectively. Rates of androgen suppression with tE2 were equivalent to LHRHa, with improved metabolic parameters, quality of life and bone health indices (mean absolute change in lumbar spine bone mineral density of -3.0% for LHRHa and +7.9% for tE2 with an estimated difference between arms of 9.3% (95% confidence interval 5.3-13.4). Importantly, rates of cardiovascular events were not significantly different between the two arms and the time to first cardiovascular event did not differ between treatment groups (hazard ratio 1.11, 95% confidence interval 0.80-1.53; P = 0.54). Oncological outcomes are awaited. FUTURE Efficacy results for the M0 cohort (primary outcome measure metastases-free survival) are expected in the final quarter of 2023. For M1 patients (primary outcome measure - overall survival), analysis using restricted mean survival time is being explored. Allied translational work on longitudinal samples is underway.
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Affiliation(s)
- D C Gilbert
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK; University Hospitals Sussex NHS Foundation Trust, Royal Sussex County Hospital, Brighton, UK.
| | - M Nankivell
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - H Rush
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - N W Clarke
- The Christie and Salford Royal Hospitals, Manchester, UK
| | - S Mangar
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - A Al-Hasso
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - S Rosen
- National Heart and Lung Institute, Imperial College, London, UK
| | - R Kockelbergh
- Department of Urology, University Hospitals of Leicester, Leicester, UK
| | - S K Sundaram
- Mid-Yorkshire Teaching NHS Trust, Pinderfields Hospital, Wakefield, UK
| | - S Dixit
- Scunthorpe General Hospital, Scunthorpe, UK
| | | | | | | | - S Brown
- Airedale General Hospital, Keighley, UK
| | - J Gale
- Queen Alexandra Hospital, Portsmouth, UK
| | - J Deighan
- Patient Representative, MRC Clinical Trials Unit at UCL, London, UK
| | - J Marshall
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - T Duong
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - A Macnair
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK; Guys and St Thomas' NHS Foundation Trust, London, UK
| | - A Griffiths
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - C L Amos
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - M R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - N D James
- Institute of Cancer Research, Sutton, UK
| | - M K B Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - R E Langley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
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3
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Gurav S, Zirpe K, Bhoyar A, Deshmukh A, Pote P, Kapse U, Tiwari A, Suryawanshi P, Malhotra R, Khan A, Dixit S. Utility of Bedside Ultrasound Measurement of Optic Nerve Sheath Diameter as a Screening Tool for raised Intracranial Pressure in Neurocritical Care Prospective Observational Study. J Assoc Physicians India 2023; 71:11-12. [PMID: 37449686 DOI: 10.59556/japi.71.0287] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Intracranial pressure (ICP) needs to be monitored in neurocritical patients. There is a need for portable bedside optic nerve ultrasound (ONUS) for early diagnosis to initiate the measures to reduce ICP Objective: To find the utility of bedside ONUS to diagnose raised ICP in neurocritical care. Materials and methods: After approval from the ethical committee, a prospective observational study was conducted. Optic nerve sheath diameter (ONSD) was measured in two groups: control group patients with neurological symptoms but computed tomography (CT)/magnetic resonance imaging (MRI) not suggestive of raised ICP, and second was study group patients with neurological symptoms and CT/MRI suggestive of elevated ICP Result: In patients with normal ICP, the mean ONSD in females was 4.47mm, and in males was 4.66mm. In patients with raised ICP, the mean ONSD in females was 6.45 ± 0.78 mm, and in males was 6.33 ± 0.70 mm. Regarding the correlation between Glasgow coma scale (GCS) and mean ONSD parameters, the coefficient of correlation (R) is 0.14; thus, there is a weak negative correlation. In our study, no difference was observed in raised mean ONSD in patients with different diagnoses. At a cut-off value of >4.8 mm, the sensitivity and specificity are 100% to diagnose raised ICP. Conclusion: Optic nerve sheath diameter (ONSD) is a reliable, rapid bedside screening tool in the Emergency Department/Critical Care/Operation Theatre to diagnose raised ICP. In order to keep a record of trends in ICP, we need to measure ONSD frequently. There was no correlation between GCS and ONSD measurement.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ria Malhotra
- Junior Consultant, Department of Neurotrauma Unit
| | - Afroz Khan
- Consultant, Neurotrauma Unit, Ruby Hall Clinic
| | - Subhal Dixit
- Director, Department of Critical Care Unit, Sanjeevan Hospital, Pune, Maharashtra, India
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Mehta Y, Zirpe K, Dixit S, Ansari A, Mehta C, Deshmukh A, Ambapkar S, Ambapkar S, Joshi M, Joshi A, Bathija M, Shah M. Ulinastatin Add-on to Standard of Care in Critically Ill COVID-19 Patients: A Multicenter, Retrospective Study. J Assoc Physicians India 2023; 71:11-12. [PMID: 37354467 DOI: 10.5005/japi-11001-0181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/26/2023]
Abstract
AIM To assess the impact on 30-day mortality with ulinastatin (ULI) used as add-on to standard of care (SOC) compared to SOC alone in coronavirus disease (COVID-19) patients requiring admission to the intensive care unit (ICU). MATERIALS AND METHODS In this multicentric, retrospective study, we collected data on clinical, laboratory, and outcome parameters in patients with COVID-19. Thirty-day mortality outcome was compared among patients treated with SOC alone and ULI used as add-on to SOC. Odds ratio (OR) and 95% confidence intervals (CI) were determined to identify the predictors of 30-day mortality. RESULTS Ninety-four patients were identified and enrolled in both groups with comparable baseline parameters. On univariate analysis, 30-day mortality was significantly lower in ULI plus SOC group than SOC alone group (36.2 vs 51.1%, OR 0.54, 95% CI 0.30-0.97, p = 0.040). The effect on mortality was more pronounced in patients who did not require intubation (10.9 vs 34.0%, OR 0.24, 95% CI 0.09-0.66, p = 0.006) and with early administration (within 72 hours of admission) of ULI (30.7 vs 57.9%, OR 0.32, 95% CI 0.11-0.91, p = 0.032). On multivariate analysis, only intubation predicted mortality (adjusted OR 10.13, 95% CI 3.77-27.25, p<0.0001) and the effect of ULI on survival was not significant (adjusted OR 0.58, 95% CI 0.22-1.52, p = 0.270). CONCLUSION Given the limited options for COVID-19 patients treated in ICU, early administration of ULI may be helpful, especially in patients not requiring intubation to improve the outcomes. Further, a large, randomized study is warranted to confirm these findings.
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Affiliation(s)
- Yatin Mehta
- Director, Department of Critical Care Medicine, Medanta Institute of Critical Care and Anaesthesiology, Medanta, The Medicity, Gurugram, Haryana
| | - Kapil Zirpe
- Head, Department of Neuro Trauma Intensive Care Unit, Ruby Hall Clinic
| | - Subhal Dixit
- Chief Consultant, Department of Critical Care Medicine, Sanjeevan Hospital and MJM Hospital, Pune; Corresponding Author
| | - Abdul Ansari
- Director, Critical Care Services, Nanavati Max Super Speciality Hospital, Mumbai
| | - Chitra Mehta
- Consultant, Department of Critical Care Medicine, Medanta Institute of Critical Care and Anaesthesiology, Medanta, The Medicity, Gurugram, Haryana
| | - Abhijeet Deshmukh
- Consultant, Department of Neuro Trauma Intensive Care Unit, Ruby Hall Clinic, Pune
| | | | - Saanvi Ambapkar
- Consultant, Department of Internal Medicine, Sanjeevan Hospital
| | | | - Ameya Joshi
- Consultant, Department of Internal Medicine, MJM Hospital, Pune
| | - Manish Bathija
- Consultant, Department of Critical Care Medicine, Nanavati Max Super Speciality Hospital, Mumbai, India
| | - Mayur Shah
- Consultant, Department of Critical Care Medicine, Nanavati Max Super Speciality Hospital, Mumbai, India
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Srinivasan S, Kumar PG, Govil D, Gupta S, Kumar V, Pichamuthu K, Clerk AM, Kothekar AT, D'Costa PM, Toraskar K, Soni KD, John JK, Patel SJ, Savio RD, Jagadeesh KN, Jose C, Pandit RA, Gopal P, Chaudhry D, Dixit S, Mishra RC, Kar A, Samavedam S. Competencies for Point-of-care Ultrasonography in ICU: An ISCCM Expert Panel Practice Recommendation. Indian J Crit Care Med 2022; 26:S7-S12. [PMID: 36896358 PMCID: PMC9989871 DOI: 10.5005/jp-journals-10071-24199] [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: 03/07/2022] [Accepted: 04/12/2022] [Indexed: 11/06/2022] Open
Abstract
How to cite this article: Srinivasan S, Kumar PG, Govil D, Gupta S, Kumar V, Pichamuthu K, et al. Competencies for Point-of-care Ultrasonography in ICU: An ISCCM Expert Panel Practice Recommendation. Indian J Crit Care Med 2022;26(S2):S7-S12.
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Affiliation(s)
| | - Praveen G Kumar
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Deepak Govil
- Institute of Critical Care and Anesthesia, Medanta - The Medicity, Gurugram, Haryana, India
| | - Sachin Gupta
- Department of Critical Care Medicine, Narayana Superspeciality Hospital, Gurugram, Haryana, India
| | - Vivek Kumar
- Department of Critical Care, Sir HN Reliance Foundation Hospital, Mumbai, Maharashtra, India
| | - Kishore Pichamuthu
- Medical Intensive Care Unit, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Anuj M Clerk
- Department of Intensive Care, Sunshine Global Hospital, Surat, Gujarat, India
| | - Amol T Kothekar
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | | | - Kedar Toraskar
- Critical Care, Wockhardt Hospitals, South Mumbai, Maharashtra, India
| | - Kapil D Soni
- Department of Critical and Intensive Care, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Jojo K John
- Medical Trust Hospital, Kochi, Kerala, India
| | - Sweta J Patel
- Department of Critical Care Medicine, Medanta - The Medicity, Gurugram, Haryana, India
| | - Raymond D Savio
- Department of Critical Care Medicine, Apollo Proton Cancer Centre, Chennai, Tamil Nadu, India
| | - K N Jagadeesh
- Department of Critical Care Medicine, Apollo Proton Cancer Centre, Chennai, Tamil Nadu, India
| | - Chacko Jose
- Department of Critical Care Medicine, Majumdar Shaw Medical Center, Bengaluru, Karnataka, India
| | - Rahul A Pandit
- Department of Critical Care, Fortis Hospital, Mumbai, Maharashtra, India
| | | | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care Medicine, University of Health Sciences, Rohtak, Haryana, India
| | - Subhal Dixit
- Department of CCM, Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Rajesh C Mishra
- Department of MICU, Shaibya Comprehensive Care Clinic, Ahmedabad, Gujarat, India
| | - Arindam Kar
- Calcutta Medical Research Institute, Kolkata, West Bengal, India
| | - Srinivas Samavedam
- Department of Critical Care, Virinchi Hospital, Hyderabad, Telangana, India
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6
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Khilnani GC, Tiwari P, Zirpe KG, Chaudhry D, Govil D, Dixit S, Kulkarni AP, Todi SK, Hadda V, Jain N, Govindagoudar MB, Samavedam S, Jha SK, Tyagi N, Jaju MR, Sharma A. Guidelines for the Use of Procalcitonin for Rational Use of Antibiotics. Indian J Crit Care Med 2022; 26:S77-S94. [PMID: 36896360 PMCID: PMC9989870 DOI: 10.5005/jp-journals-10071-24326] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 07/06/2022] [Accepted: 10/21/2022] [Indexed: 11/07/2022] Open
Abstract
How to cite this article: Khilnani GC, Tiwari P, Zirpe KG, Chaudhary D, Govil D, Dixit S, et al. Guidelines for the Use of Procalcitonin for Rational Use of Antibiotics. Indian J Crit Care Med 2022;26(S2):S77-S94.
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Affiliation(s)
- Gopi C Khilnani
- Department of Pulmonary, Critical Care and Sleep Medicine, PSRI Hospital, New Delhi, India
| | - Pawan Tiwari
- Department of Pulmonary Medicine, School of Excellence in Pulmonary Medicine, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
| | | | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care Medicine, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Deepak Govil
- Institute of Critical Care and Anesthesia, Medanta - The Medicty, Gurugram, Haryana, India
| | - Subhal Dixit
- Department of Critical Care Medicine, Sanjeevan Surgery Hospital, Pune, Maharashtra, India; Department of Critical Care Medicine, MJM Hospital, Pune, Maharashtra, India
| | - Atul Prabhakar Kulkarni
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | | | - Vijay Hadda
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Neetu Jain
- Department of Pulmonary Medicine, Critical Care and Sleep Disorders, Pushpawati Singhania Hospital & Research Institute, New Delhi, India
| | | | - Srinivas Samavedam
- Department of Critical Care Management, Virinchi Hospital, Hyderabad, Telangana, India
| | | | - Niraj Tyagi
- Department of Institute of Critical Care Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Madhusudan R Jaju
- Critical Care Medicine Sunshine Hospital, Gachibowli, Hyderabad, India
| | - Anita Sharma
- Department of Lab Medicine, Fortes Hospital, Mohali, Punjab, India
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7
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Patidar V, Dixit S, Ghandour M, Keshri A, Singh M, Kundu S. Carbohydrate and Protein Fractionations of commonly used forages and agro-industrial byproducts as per Cornell Net Carbohydrate and Protein system (CNCPS). JLS 2022. [DOI: 10.33259/jlivestsci.2022.182-187] [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: 11/11/2022]
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Jog S, Zirpe K, Dixit S, Godavarthy P, Shahane M, Kadapatti K, Shah J, Borawake K, Khan Z, Shukla U, Jahagirdar A, Dhat V, D’costa P, Shelgaonkar J, Deshmukh A, Khatib K, Prayag S. Noninvasive Respiratory Assist Devices in the Management of COVID-19-related Hypoxic Respiratory Failure: Pune ISCCM COVID-19 ARDS Study Consortium (PICASo). Indian J Crit Care Med 2022; 26:791-797. [PMID: 36864864 PMCID: PMC9973184 DOI: 10.5005/jp-journals-10071-24241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective To determine whether high-flow nasal oxygen (HFNO) or noninvasive ventilator (NIV) can avoid invasive mechanical ventilation (IMV) in COVID-19-related acute respiratory distress syndrome (ADRS), and the outcome predictors of these modalities. Design Multicenter retrospective study conducted in 12 ICUs in Pune, India. Patients Patients with COVID-19 pneumonia who had PaO2/FiO2 ratio <150 and were treated with HFNO and/or NIV. Intervention HFNO and/or NIV. Measurements The primary outcome was to assess the need of IMV. Secondary outcomes were death at Day 28 and mortality rates in different treatment groups. Main results Among 1,201 patients who met the inclusion criteria, 35.9% (431/1,201) were treated successfully with HFNO and/or NIV and did not require IMV. About 59.5% (714/1,201) patients needed IMV for the failure of HFNO and/or NIV. About 48.3, 61.6, and 63.6% of patients who were treated with HFNO, NIV, or both, respectively, needed IMV. The need of IMV was significantly lower in the HFNO group (p <0.001). The 28-day mortality was 44.9, 59.9, and 59.6% in the patients treated with HFNO, NIV, or both, respectively (p <0.001). On multivariate regression analysis, presence of any comorbidity, SpO2 <90%, and presence of nonrespiratory organ dysfunction were independent and significant determinants of mortality (p <0.05). Conclusions During COVID-19 pandemic surge, HFNO and/or NIV could successfully avoid IMV in 35.5% individuals with PO2/FiO2 ratio <150. Those who needed IMV due to failure of HFNO or NIV had high (87.5%) mortality. How to cite this article Jog S, Zirpe K, Dixit S, Godavarthy P, Shahane M, Kadapatti K, et al. Noninvasive Respiratory Assist Devices in the Management of COVID-19-related Hypoxic Respiratory Failure: Pune ISCCM COVID-19 ARDS Study Consortium (PICASo). Indian J Crit Care Med 2022;26(7):791-797.
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Affiliation(s)
- Sameer Jog
- Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India,Sameer Jog, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India, Phone: +91 9823018178, e-mail:
| | - Kapil Zirpe
- Neuro Trauma Unit, Grant Medical Foundation, Ruby Hall Clinic, Pune, Maharashtra, India
| | | | | | - Manasi Shahane
- Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | | | - Jignesh Shah
- Bharati Vidyapeeth (Deemed to be) University Medical Hospital, Pune, Maharashtra, India
| | | | - Zafer Khan
- Noble Hospital, Pune, Maharashtra, India
| | - Urvi Shukla
- Symbiosis University Hospital and Research Centre, Symbiosis International University, Pune, Maharashtra, India
| | | | - Venkatesh Dhat
- Aditya Birla Memorial Hospital, Pune, Maharashtra, India
| | | | | | | | - Khalid Khatib
- Smt Kashibai Navale Medical College, Pune, Maharashtra, India
| | - Shirish Prayag
- Department of Critical Care Medicine, Prayag Hospital, Pune, Maharashtra, India
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9
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Dixit S, Zirpe K, Suryawanshi P, Borawake K, Prasad S, Ambapkar S, Ambapkar S, Joshi A, Joshi M. Retrospective Cohort Observational Study to compare the Effect of Mycobacterium w along with Standard of Care vs Standard of Care alone in critically ill COVID-19 Patients. J Assoc Physicians India 2022; 70:11-12. [PMID: 35833395 DOI: 10.5005/japi-11001-0044] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND COVID-19 has created enormous health crisis in India due to limited available treatments. Majority of the physicians use sepsis as a prototype to understand the pathophysiology of COVID-19 as there are similarities. Heat-killed Mycobacterium w (Mw) (Inj. Mw®) is a known immunomodulator, which is approved for the treatment of gram-negative sepsis. This observational study was aimed to evaluate the role of Mw along with standard of care (SOC) in critically ill COVID-19 patients. METHODS Total 448 patients' data (intervention group: 298 in Mw plus SOC vs 150 in SOC alone) with reverse transcriptase-polymerase chain reaction (RT-PCR) confirmed critically ill COVID-19 patients who were admitted at five tertiary care centers were evaluated. They were observed for changes in laboratory [C-reactive protein (CRP), D-dimer, ferritin, lactate dehydrogenase (LDH), and interleukin-6 (IL-6)] parameters, hospital stay, intensive care unit (ICU) stay, and discharge status after giving 0.3 mL intradermal Mw for 3 consecutive days along with SOC during hospitalization. Standard of care included injectable steroids, remdesivir, and heparin. Data were analyzed using STATA 14.2 (StataCorp., College Station, Texas, USA). RESULTS In baseline characteristics, Mw plus SOC arm had more critically ill patients as seen by higher high-resolution computed tomography (HRCT) score, higher lab values [CRP, ferritin, D-dimer, LDH, creatinine, alanine aminotransferase (ALT)], and more oxygen requirement as compared to SOC alone. Mycobacterium w arm had significantly higher mortality rate in ICU and hospital. Both hospital stay and ICU stay were longer in Mw arm. However, subgroup analysis found that early initiation of Mw (<3 days vs >3 days) was associated with significantly lesser odds of mortality and lesser odds of intubation requirement. Early initiation of Mw (<3 days vs >3 days) also resulted in significantly lesser duration of stay in the ICU along with reduction of CRP, D-dimer, and LDH. Moreover, further analysis of early initiation of Mw (<3 days vs control) resulted in significant reduction in lab values (procalcitonin, CRP, ferritin, LDH, and D-dimer). CONCLUSION Mw when added to SOC was found to associate with significantly increased risk of mortality and increased length of hospital stay. However, time since admission to administration of Mw was a significant predictor of in-ICU deaths in multivariate analysis. Early initiation of Mw (<3 days) was observed to be a protective factor against ICU deaths from the multivariate logistic regression model. However, large randomized controlled trials are required to support the same.
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Affiliation(s)
- Subhal Dixit
- Director, Department of Critical Care, Sanjeevan Hospital
| | - Kapil Zirpe
- Department of Neurotrauma Unit, Ruby Hall Clinic, Grant Medical Foundation
| | - Prasad Suryawanshi
- Department of Neurotrauma Unit, Ruby Hall Clinic, Grant Medical Foundation
| | - Kapil Borawake
- Department of Critical Care and Medicine, VishwaRaj Hospital, Pune
| | - Sayi Prasad
- Department of Critical Care, Diamond Hospital, Kolhapur
| | | | | | | | - Mukund Joshi
- Medical Director and HOD, Surgery, MJM Hospital, Pune, Maharashtra, India
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10
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Granholm A, Kjær MBN, Munch MW, Myatra SN, Vijayaraghavan BKT, Cronhjort M, Wahlin RR, Jakob SM, Cioccari L, Vesterlund GK, Meyhoff TS, Helleberg M, Møller MH, Benfield T, Venkatesh B, Hammond NE, Micallef S, Bassi A, John O, Jha V, Kristiansen KT, Ulrik CS, Jørgensen VL, Smitt M, Bestle MH, Andreasen AS, Poulsen LM, Rasmussen BS, Brøchner AC, Strøm T, Møller A, Khan MS, Padmanaban A, Divatia JV, Saseedharan S, Borawake K, Kapadia F, Dixit S, Chawla R, Shukla U, Amin P, Chew MS, Wamberg CA, Bose N, Shah MS, Darfelt IS, Gluud C, Lange T, Perner A. Long-term outcomes of dexamethasone 12 mg versus 6 mg in patients with COVID-19 and severe hypoxaemia. Intensive Care Med 2022; 48:580-589. [PMID: 35359168 PMCID: PMC8970069 DOI: 10.1007/s00134-022-06677-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/10/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE We assessed long-term outcomes of dexamethasone 12 mg versus 6 mg given daily for up to 10 days in patients with coronavirus disease 2019 (COVID-19) and severe hypoxaemia. METHODS We assessed 180-day mortality and health-related quality of life (HRQoL) using EuroQoL (EQ)-5D-5L index values and EQ visual analogue scale (VAS) in the international, stratified, blinded COVID STEROID 2 trial, which randomised 1000 adults with confirmed COVID-19 receiving at least 10 L/min of oxygen or mechanical ventilation in 26 hospitals in Europe and India. In the HRQoL analyses, higher values indicated better outcomes, and deceased patients were given a score of zero. RESULTS We obtained vital status at 180 days for 963 of 982 patients (98.1%) in the intention-to-treat population, EQ-5D-5L index value data for 922 (93.9%) and EQ VAS data for 924 (94.1%). At 180 days, 164 of 486 patients (33.7%) had died in the 12 mg group versus 184 of 477 (38.6%) in the 6 mg group [adjusted risk difference - 4.3%; 99% confidence interval (CI) - 11.7-3.0; relative risk 0.89; 0.72-1.09; P = 0.13]. The adjusted mean differences between the 12 mg and the 6 mg groups in EQ-5D-5L index values were 0.06 (99% CI - 0.01 to 0.12; P = 0.10) and in EQ VAS scores 4 (- 3 to 10; P = 0.22). CONCLUSION Among patients with COVID-19 and severe hypoxaemia, dexamethasone 12 mg compared with 6 mg did not result in statistically significant improvements in mortality or HRQoL at 180 days, but the results were most compatible with benefit from the higher dose.
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Affiliation(s)
- Anders Granholm
- Department of Intensive Care 4131, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Maj-Brit Nørregaard Kjær
- Department of Intensive Care 4131, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Marie Warrer Munch
- Department of Intensive Care 4131, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Sheila Nainan Myatra
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Bharath Kumar Tirupakuzhi Vijayaraghavan
- Department of Critical Care, Apollo Hospitals, Chennai, India.,Chennai Critical Care Consultants, Chennai, India.,The George Institute for Global Health, New Delhi, India
| | - Maria Cronhjort
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Rebecka Rubenson Wahlin
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Stephan M Jakob
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luca Cioccari
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gitte Kingo Vesterlund
- Department of Intensive Care 4131, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Tine Sylvest Meyhoff
- Department of Intensive Care 4131, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Marie Helleberg
- Department of Infectious Diseases, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Morten Hylander Møller
- Department of Intensive Care 4131, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Thomas Benfield
- Center of Research and Disruption of Infectious Diseases, Department of Infectious Diseases, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | | | - Naomi E Hammond
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Sharon Micallef
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | | | - Oommen John
- Chennai Critical Care Consultants, Chennai, India.,Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Vivekanand Jha
- Chennai Critical Care Consultants, Chennai, India.,Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India.,School of Public Health, Imperial College London, London, UK
| | - Klaus Tjelle Kristiansen
- Department of Anaesthesia and Intensive Care, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Vibeke Lind Jørgensen
- Department of Thoracic Anaesthesiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Margit Smitt
- Department of Neuroanaesthesiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Morten H Bestle
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-North Zealand, Hillerød, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne Sofie Andreasen
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-Herlev, Herlev, Denmark
| | | | - Bodil Steen Rasmussen
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark.,Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Anne Craveiro Brøchner
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark.,Department of Anaesthesia and Intensive Care, Kolding Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | - Thomas Strøm
- Department of Anaesthesia and Critical Care Medicine, Odense University Hospital, Odense, Denmark.,Department of Anaesthesia and Critical Care Medicine, Hospital Sønderjylland, University Hospital of Southern, Aabenraa, Denmark
| | - Anders Møller
- Department of Anaesthesia and Intensive Care, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
| | - Mohd Saif Khan
- Department of Critical Care Medicine, Rajendra Institute of Medical Sciences, Ranchi, India
| | - Ajay Padmanaban
- Department of Critical Care, Apollo Hospitals, Chennai, India
| | - Jigeeshu Vasishtha Divatia
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Sanjith Saseedharan
- Department of Intensive Care, SL Raheja Hospital, Mumbai, Maharashtra, India
| | - Kapil Borawake
- Department of Intensive Care, Vishwaraj Hospital, Pune, India
| | - Farhad Kapadia
- Section of Critical Care, Department of Medicine, Hinduja Hospital, Mahim, Mumbai, India
| | - Subhal Dixit
- Department of Critical Care Medicine, Sanjeevan Hospital, Pune, Maharashtra, India
| | - Rajesh Chawla
- Department of Respiratory and Critical Care Medicine, Indraprastha Apollo Hospital, New Delhi, India
| | - Urvi Shukla
- Intensive Care Unit and Emergency Services, Symbiosis University Hospital and Research Centre, Lavale, Pune, India
| | - Pravin Amin
- Department of Critical Care Medicine, Bombay Hospital Institute of Medical Sciences, Mumbai, India
| | - Michelle S Chew
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | | | - Neeta Bose
- Gotri General Hospital, Vadodara, Gujarat, India
| | - Mehul S Shah
- Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Iben S Darfelt
- Department of Anaesthesia and Intensive Care, Herning Hospital, Herning, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, the Capital Region, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,Department of Regional Health Research, the Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Theis Lange
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Anders Perner
- Department of Intensive Care 4131, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. .,Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark. .,The George Institute for Global Health, University of New South Wales, Sydney, Australia.
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11
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Zirpe KG, Dixit S, Kulkarni AP, Pandit RA, Ranganathan P, Prasad S, Amanulla ZK, Kothari V, Ambapkar S, Gurav SK, Shastrabuddhe S, Gosavi V, Joshi M, Mulakavalupil B, Saldhanah C, Ambapkar S, Bapte M, Singh S, Deshmukh A, Khatib K, Zirpe A, Sayiprasad G, Joshi A. The Second- vs First-wave COVID-19: More of the Same or a Lot Worse? A Comparison of Mortality between the Two Waves in Patients Admitted to Intensive Care Units in Nine Hospitals in Western Maharashtra. Indian J Crit Care Med 2022; 25:1343-1348. [PMID: 35027792 PMCID: PMC8693103 DOI: 10.5005/jp-journals-10071-24042] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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] [Indexed: 12/15/2022] Open
Abstract
Background India, along with the rest of the world, faced the challenging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. The second wave in India lagged behind that in the Western world, due to different timing of seasons. There is scarce data about the differences between the two waves, for intensive care unit (ICU) patients. We present the data of 3,498 patients from 9 ICUs of western Maharashtra. Materials and methods We collected prospective data of hospitalized, RT-PCR confirmed, coronavirus-2019 (COVID-19) patients, from nine tertiary centers, after institutional ethics committee (IEC) approval. Then, we segregated and analyzed the data of patients admitted to the ICU, for comorbidities, high-resolution computed tomography (HRCT) score, ventilatory support, etc. The primary outcomes were ICU and hospital mortality. We also performed multivariable analysis for predictors of ICU mortality. Results Overall, there were 3,498 ICU patients. In the first wave, 1,921 patients needed ICU admission, while in the second wave, 1,577 patients. Patients in the second wave had significantly higher ICU (26.1 vs 13.4%, p <0.001) and hospital mortality (29.9 vs 18.2%, p <0.001) and need for ventilatory support of any type. More patients received steroids during the second wave. On multivariable regression, male gender, ICU admission during the second wave, increasing HRCT score, and need for intubation and mechanical ventilation were significant predictors of ICU mortality. Conclusion ICU patients admitted during the two waves were of the similar age, but there were more females, and more patients had comorbidities during the second wave. The ICU and hospital mortality were significantly higher during the second wave. How to cite this article Zirpe KG, Dixit S, Kulkarni AP, Pandit RA, Ranganathan P, Prasad S, et al. The Second- vs First-wave COVID-19: More of the Same or a Lot Worse? A Comparison of Mortality between the Two Waves in Patients Admitted to Intensive Care Units in Nine Hospitals in Western Maharashtra. Indian J Crit Care Med 2021; 25(12):1343-1348.
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Affiliation(s)
- Kapil G Zirpe
- Department of Neurotrauma Unit, Ruby Hall Clinic, Grant Medical Foundation, Pune, Maharashtra, India
| | | | - Atul P Kulkarni
- Division of Critical Care Medicine, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | | | - Priya Ranganathan
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sayi Prasad
- Department of Critical Care Medicine, Diamond Superspeciality Hospital, Kolhapur, Maharashtra, India
| | - Zafer Khan Amanulla
- Department of Medicine, Noble Hospital Pvt Ltd ICU, Pune, Maharashtra, India
| | - Vatsal Kothari
- Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | | | - Sushma K Gurav
- Department of Neurotrauma Unit, Ruby Hall Clinic, Grant Medical Foundation, Pune, Maharashtra, India
| | - Shrikant Shastrabuddhe
- Department of Pulmonology and Critical Care Medicine, Medicover Hospital, Aurangabad, Maharashtra, India
| | - Vinod Gosavi
- Marathwada Medical Research Centre and Kamalnayan Bajaj Hospital, Aurangabad, Maharashtra, India
| | | | | | - Charlotte Saldhanah
- Department of Medicine, Noble Hospital Pvt Ltd ICU, Pune, Maharashtra, India
| | | | - Madhura Bapte
- Department of Medicine, Noble Hospital Pvt Ltd ICU, Pune, Maharashtra, India
| | - Sweta Singh
- Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | - Abhijit Deshmukh
- Department of Neurotrauma Unit, Ruby Hall Clinic, Grant Medical Foundation, Pune, Maharashtra, India
| | | | - Anmol Zirpe
- SKN Medical College, Pune, Maharashtra, India
| | - Gowri Sayiprasad
- Department of Critical Care Medicine, Diamond Superspeciality Hospital, Kolhapur, Maharashtra, India
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12
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Granholm A, Munch MW, Myatra SN, Vijayaraghavan BKT, Cronhjort M, Wahlin RR, Jakob SM, Cioccari L, Kjær MBN, Vesterlund GK, Meyhoff TS, Helleberg M, Møller MH, Benfield T, Venkatesh B, Hammond NE, Micallef S, Bassi A, John O, Jha V, Kristiansen KT, Ulrik CS, Jørgensen VL, Smitt M, Bestle MH, Andreasen AS, Poulsen LM, Rasmussen BS, Brøchner AC, Strøm T, Møller A, Khan MS, Padmanaban A, Divatia JV, Saseedharan S, Borawake K, Kapadia F, Dixit S, Chawla R, Shukla U, Amin P, Chew MS, Wamberg CA, Gluud C, Lange T, Perner A. Dexamethasone 12 mg versus 6 mg for patients with COVID-19 and severe hypoxaemia: a pre-planned, secondary Bayesian analysis of the COVID STEROID 2 trial. Intensive Care Med 2022; 48:45-55. [PMID: 34757439 PMCID: PMC8579417 DOI: 10.1007/s00134-021-06573-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [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: 09/27/2021] [Accepted: 10/29/2021] [Indexed: 01/15/2023]
Abstract
PURPOSE We compared dexamethasone 12 versus 6 mg daily for up to 10 days in patients with coronavirus disease 2019 (COVID-19) and severe hypoxaemia in the international, randomised, blinded COVID STEROID 2 trial. In the primary, conventional analyses, the predefined statistical significance thresholds were not reached. We conducted a pre-planned Bayesian analysis to facilitate probabilistic interpretation. METHODS We analysed outcome data within 90 days in the intention-to-treat population (data available in 967 to 982 patients) using Bayesian models with various sensitivity analyses. Results are presented as median posterior probabilities with 95% credible intervals (CrIs) and probabilities of different effect sizes with 12 mg dexamethasone. RESULTS The adjusted mean difference on days alive without life support at day 28 (primary outcome) was 1.3 days (95% CrI -0.3 to 2.9; 94.2% probability of benefit). Adjusted relative risks and probabilities of benefit on serious adverse reactions was 0.85 (0.63 to 1.16; 84.1%) and on mortality 0.87 (0.73 to 1.03; 94.8%) at day 28 and 0.88 (0.75 to 1.02; 95.1%) at day 90. Probabilities of benefit on days alive without life support and days alive out of hospital at day 90 were 85 and 95.7%, respectively. Results were largely consistent across sensitivity analyses, with relatively low probabilities of clinically important harm with 12 mg on all outcomes in all analyses. CONCLUSION We found high probabilities of benefit and low probabilities of clinically important harm with dexamethasone 12 mg versus 6 mg daily in patients with COVID-19 and severe hypoxaemia on all outcomes up to 90 days.
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Affiliation(s)
- Anders Granholm
- Department of Intensive Care, Rigshospitalet—Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark ,Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Marie Warrer Munch
- Department of Intensive Care, Rigshospitalet—Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark ,Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Sheila Nainan Myatra
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Bharath Kumar Tirupakuzhi Vijayaraghavan
- Department of Critical Care, Apollo Hospitals, Chennai, India ,Chennai Critical Care Consultants, Chennai, India ,The George Institute for Global Health, New Delhi, India
| | - Maria Cronhjort
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Rebecka Rubenson Wahlin
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Stephan M. Jakob
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luca Cioccari
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maj-Brit Nørregaard Kjær
- Department of Intensive Care, Rigshospitalet—Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark ,Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Gitte Kingo Vesterlund
- Department of Intensive Care, Rigshospitalet—Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark ,Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Tine Sylvest Meyhoff
- Department of Intensive Care, Rigshospitalet—Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark ,Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Marie Helleberg
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Morten Hylander Møller
- Department of Intensive Care, Rigshospitalet—Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark ,Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Thomas Benfield
- Center of Research & Disruption of Infectious Diseases, Department of Infectious Diseases, Copenhagen University Hospital—Amager and Hvidovre, Hvidovre, Denmark
| | | | - Naomi E. Hammond
- The George Institute for Global Health, University of New South Wales, Sydney, Australia ,Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, St Leonards, NSW Australia
| | - Sharon Micallef
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Abhinav Bassi
- The George Institute for Global Health, New Delhi, India
| | - Oommen John
- The George Institute for Global Health, New Delhi, India ,Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Vivekanand Jha
- The George Institute for Global Health, New Delhi, India ,Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India ,School of Public Health, Imperial College London, London, UK
| | - Klaus Tjelle Kristiansen
- Department of Anaesthesia and Intensive Care, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Vibeke Lind Jørgensen
- Department of Thoracic Anaesthesiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Margit Smitt
- Department of Neuroanaesthesiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Morten H. Bestle
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital – North Zealand, Hillerød, Denmark ,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne Sofie Andreasen
- Department of Anaesthesia and Intensive Care, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | | | - Bodil Steen Rasmussen
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark ,Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Anne Craveiro Brøchner
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark ,Department of Anaesthesia and Intensive Care, Kolding Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | - Thomas Strøm
- Department of Anaesthesia and Critical Care Medicine, Odense University Hospital, Odense C, Denmark ,Department of Anaesthesia and Critical Care Medicine, Hospital Sønderjylland, University Hospital of Southern, Odense, Denmark
| | - Anders Møller
- Department of Anaesthesia and Intensive Care, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
| | - Mohd Saif Khan
- Department of Critical Care Medicine, Rajendra Institute of Medical Sciences, Ranchi, India
| | - Ajay Padmanaban
- Department of Critical Care, Apollo Hospitals, Chennai, India
| | - Jigeeshu Vasishtha Divatia
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | | | - Kapil Borawake
- Department of Intensive Care, Vishwaraj Hospital, Pune, India
| | - Farhad Kapadia
- Section of Critical Care, Department of Medicine, Hinduja Hospital, Mahim, Mumbai India
| | - Subhal Dixit
- Department of Critical Care Medicine, Sanjeevan Hospital, Pune, Maharashtra India
| | - Rajesh Chawla
- Department of Respiratory and Critical Care Medicine, Indraprastha Apollo Hospital, New Delhi, India
| | - Urvi Shukla
- Intensive Care Unit and Emergency Services, Symbiosis University Hospital and Research Centre, Lavale, Pune, India
| | - Pravin Amin
- Department of Critical Care Medicine, Bombay Hospital Institute of Medical Sciences, Mumbai, India
| | - Michelle S. Chew
- Department of Anesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | | | - Christian Gluud
- Centre for Clinical Intervention Research, Copenhagen Trial Unit, Capital Region of Denmark, Copenhagen University Hospital –Rigshospitalet, Copenhagen, Denmark ,Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Theis Lange
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Anders Perner
- Department of Intensive Care, Rigshospitalet—Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark ,Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
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13
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Munch MW, Myatra SN, Vijayaraghavan BKT, Saseedharan S, Benfield T, Wahlin RR, Rasmussen BS, Andreasen AS, Poulsen LM, Cioccari L, Khan MS, Kapadia F, Divatia JV, Brøchner AC, Bestle MH, Helleberg M, Michelsen J, Padmanaban A, Bose N, Møller A, Borawake K, Kristiansen KT, Shukla U, Chew MS, Dixit S, Ulrik CS, Amin PR, Chawla R, Wamberg CA, Shah MS, Darfelt IS, Jørgensen VL, Smitt M, Granholm A, Kjær MBN, Møller MH, Meyhoff TS, Vesterlund GK, Hammond NE, Micallef S, Bassi A, John O, Jha A, Cronhjort M, Jakob SM, Gluud C, Lange T, Kadam V, Marcussen KV, Hollenberg J, Hedman A, Nielsen H, Schjørring OL, Jensen MQ, Leistner JW, Jonassen TB, Kristensen CM, Clapp EC, Hjortsø CJS, Jensen TS, Halstad LS, Bak ERB, Zaabalawi R, Metcalf-Clausen M, Abdi S, Hatley EV, Aksnes TS, Gleipner-Andersen E, Alarcón AF, Yamin G, Heymowski A, Berggren A, La Cour K, Weihe S, Pind AH, Engstrøm J, Jha V, Venkatesh B, Perner A. Effect of 12 mg vs 6 mg of Dexamethasone on the Number of Days Alive Without Life Support in Adults With COVID-19 and Severe Hypoxemia: The COVID STEROID 2 Randomized Trial. JAMA 2021; 326:1807-1817. [PMID: 34673895 PMCID: PMC8532039 DOI: 10.1001/jama.2021.18295] [Citation(s) in RCA: 138] [Impact Index Per Article: 46.0] [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: 12/15/2022]
Abstract
IMPORTANCE A daily dose with 6 mg of dexamethasone is recommended for up to 10 days in patients with severe and critical COVID-19, but a higher dose may benefit those with more severe disease. OBJECTIVE To assess the effects of 12 mg/d vs 6 mg/d of dexamethasone in patients with COVID-19 and severe hypoxemia. DESIGN, SETTING, AND PARTICIPANTS A multicenter, randomized clinical trial was conducted between August 2020 and May 2021 at 26 hospitals in Europe and India and included 1000 adults with confirmed COVID-19 requiring at least 10 L/min of oxygen or mechanical ventilation. End of 90-day follow-up was on August 19, 2021. INTERVENTIONS Patients were randomized 1:1 to 12 mg/d of intravenous dexamethasone (n = 503) or 6 mg/d of intravenous dexamethasone (n = 497) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was the number of days alive without life support (invasive mechanical ventilation, circulatory support, or kidney replacement therapy) at 28 days and was adjusted for stratification variables. Of the 8 prespecified secondary outcomes, 5 are included in this analysis (the number of days alive without life support at 90 days, the number of days alive out of the hospital at 90 days, mortality at 28 days and at 90 days, and ≥1 serious adverse reactions at 28 days). RESULTS Of the 1000 randomized patients, 982 were included (median age, 65 [IQR, 55-73] years; 305 [31%] women) and primary outcome data were available for 971 (491 in the 12 mg of dexamethasone group and 480 in the 6 mg of dexamethasone group). The median number of days alive without life support was 22.0 days (IQR, 6.0-28.0 days) in the 12 mg of dexamethasone group and 20.5 days (IQR, 4.0-28.0 days) in the 6 mg of dexamethasone group (adjusted mean difference, 1.3 days [95% CI, 0-2.6 days]; P = .07). Mortality at 28 days was 27.1% in the 12 mg of dexamethasone group vs 32.3% in the 6 mg of dexamethasone group (adjusted relative risk, 0.86 [99% CI, 0.68-1.08]). Mortality at 90 days was 32.0% in the 12 mg of dexamethasone group vs 37.7% in the 6 mg of dexamethasone group (adjusted relative risk, 0.87 [99% CI, 0.70-1.07]). Serious adverse reactions, including septic shock and invasive fungal infections, occurred in 11.3% in the 12 mg of dexamethasone group vs 13.4% in the 6 mg of dexamethasone group (adjusted relative risk, 0.83 [99% CI, 0.54-1.29]). CONCLUSIONS AND RELEVANCE Among patients with COVID-19 and severe hypoxemia, 12 mg/d of dexamethasone compared with 6 mg/d of dexamethasone did not result in statistically significantly more days alive without life support at 28 days. However, the trial may have been underpowered to identify a significant difference. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04509973 and ctri.nic.in Identifier: CTRI/2020/10/028731.
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Affiliation(s)
| | - Marie W Munch
- Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sheila N Myatra
- Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | | | | | - Thomas Benfield
- Department of Infectious Diseases, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | - Rebecka R Wahlin
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | | | - Anne Sofie Andreasen
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital, Herlev-Gentofte Hospital, Herlev, Denmark
| | - Lone M Poulsen
- Department of Anaesthesia and Intensive Care, Zealand University Hospital, Koege, Denmark
| | - Luca Cioccari
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mohd S Khan
- Rajendra Institute of Medical Sciences, Ranchi, India
| | | | | | - Anne C Brøchner
- Department of Anaesthesia and Intensive Care, Kolding Hospital, Kolding, Denmark
| | - Morten H Bestle
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital, North Zealand, Hilleroed, Denmark
| | - Marie Helleberg
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jens Michelsen
- Department of Anaesthesia and Intensive Care, Odense University Hospital, Odense, Denmark
| | | | | | - Anders Møller
- Department of Anaesthesia and Intensive Care, Slagelse Hospital, Slagelse, Denmark
| | | | - Klaus T Kristiansen
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | - Urvi Shukla
- Symbiosis University Hospital and Research Centre, Lavale, India
| | - Michelle S Chew
- Department of Anaesthesia and Intensive Care Medicine, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | | | - Charlotte S Ulrik
- Department of Respiratory Diseases, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | - Pravin R Amin
- Bombay Hospital Institute of Medical Sciences, Mumbai, India
| | | | - Christian A Wamberg
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Mehul S Shah
- Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Iben S Darfelt
- Department of Anaesthesia and Intensive Care, Herning Hospital, Herning, Denmark
| | - Vibeke L Jørgensen
- Department of Thoracic Anaesthesia, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Margit Smitt
- Department of Neurointensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anders Granholm
- Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maj-Brit N Kjær
- Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Morten H Møller
- Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tine S Meyhoff
- Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gitte K Vesterlund
- Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Naomi E Hammond
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Sydney, Australia
| | - Sharon Micallef
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Abhinav Bassi
- The George Institute for Global Health, New Delhi, India
| | - Oommen John
- The George Institute for Global Health, New Delhi, India
- Prasanna School of Public Health, Manipal Academy of Medical Sciences, Manipal, India
| | - Anubhuti Jha
- The George Institute for Global Health, New Delhi, India
| | - Maria Cronhjort
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Stephan M Jakob
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Capital Region, Copenhagen University Hospital, Rigshospitalet, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense
| | - Theis Lange
- Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | | | - Klaus V Marcussen
- Department of Anaesthesia and Intensive Care, Slagelse Hospital, Slagelse, Denmark
| | - Jacob Hollenberg
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Anders Hedman
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Nielsen
- Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | | | - Marie Q Jensen
- Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jens W Leistner
- Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Trine B Jonassen
- Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Camilla M Kristensen
- Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Esben C Clapp
- Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Carl J S Hjortsø
- Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Thomas S Jensen
- Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Liv S Halstad
- Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Emilie R B Bak
- Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Reem Zaabalawi
- Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Matias Metcalf-Clausen
- Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Suhayb Abdi
- Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Emma V Hatley
- Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tobias S Aksnes
- Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Emil Gleipner-Andersen
- Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Arif F Alarcón
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Gabriel Yamin
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Adam Heymowski
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Anton Berggren
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Kirstine La Cour
- Department of Anaesthesia and Intensive Care, Zealand University Hospital, Koege, Denmark
| | - Sarah Weihe
- Department of Anaesthesia and Intensive Care, Zealand University Hospital, Koege, Denmark
| | - Alison H Pind
- Department of Anaesthesia and Intensive Care, Zealand University Hospital, Koege, Denmark
| | - Janus Engstrøm
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Capital Region, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Vivekanand Jha
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- The George Institute for Global Health, New Delhi, India
- Prasanna School of Public Health, Manipal Academy of Medical Sciences, Manipal, India
- School of Public Health, Imperial College, London, England
| | - Balasubramanian Venkatesh
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Department of Intensive Care, Wesley Hospital, Brisbane, Australia
| | - Anders Perner
- Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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14
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Divatia JV, Mehta Y, Govil D, Zirpe K, Amin PR, Ramakrishnan N, Kapadia FN, Sircar M, Sahu S, Bhattacharya PK, Myatra SN, Samavedam S, Dixit S, Pande RK, Mehta SN, Venkataraman R, Bajan K, Kumar V, Harne R, Thakur L, Rathod D, Sathe P, Gurav S, D'Silva C, Pasha SA, Todi SK. Intensive Care in India in 2018-2019: The Second Indian Intensive Care Case Mix and Practice Patterns Study. Indian J Crit Care Med 2021; 25:1093-1107. [PMID: 34916740 PMCID: PMC8645819 DOI: 10.5005/jp-journals-10071-23965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND We aimed to study organizational aspects, case mix, and practices in Indian intensive care units (ICUs) from 2018 to 2019, following the Indian Intensive Care Case Mix and Practice Patterns Study (INDICAPS) of 2010-2011. METHODS An observational, 4-day point prevalence study was performed between 2018 and 2019. ICU, patient characteristics, and interventions were recorded for 24 hours, and ICU outcomes till 30 days after the study day. Adherence to selected compliance measures was determined. Data were analyzed for 4,669 adult patients from 132 ICUs. RESULTS On the study day, mean age, acute physiology and chronic health evaluation (APACHE II), and sequential organ failure assessment (SOFA) scores were 56.9 ± 17.41 years, 16.7 ± 9.8, and 4.4 ± 3.6, respectively. Moreover, 24% and 22.2% of patients received mechanical ventilation (MV) and vasopressors or inotropes (VIs), respectively. On the study days, 1,195 patients (25.6%) were infected and 1,368 patients (29.3%) had sepsis during their ICU stay. ICU mortality was 1,092 out of 4,669 (23.4%), including 737 deaths and 355 terminal discharges (TDs) from ICU. Compliance for process measures related to MV ranged between 62.7 and 85.3%, 11.2 and 47.4% for monitoring delirium, sedation, and analgesia, and 7.7 and 25.3% for inappropriate transfusion of blood products. Only 34.8% of ICUs routinely used capnography. Large hospitals with ≥500 beds, closed ICUs, the APACHE II and SOFA scores, medical admissions, the presence of cancer or cirrhosis of the liver, the presence of infection on the study day, and the need for MV or VIs were independent predictors of mortality. CONCLUSIONS Hospital size and closed ICUs are independently associated with worse outcomes. The proportion of TDs remains high. There is a scope for improvements in processes of care.Registered at clinicaltrials.gov (NCT03631927). HOW TO CITE THIS ARTICLE Divatia JV, Mehta Y, Govil D, Zirpe K, Amin PR, Ramakrishnan N, et al. Intensive Care in India in 2018-2019: The Second Indian Intensive Care Case Mix and Practice Patterns Study. Indian J Crit Care Med 2021;25(10):1093-1107.
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Affiliation(s)
- Jigeeshu V Divatia
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Yatin Mehta
- Medanta Institute of Critical Care and Anaesthesia, Medanta-The Medicity, Gurugram, Haryana, India
| | - Deepak Govil
- Medanta Institute of Critical Care and Anaesthesia, Medanta-The Medicity, Gurugram, Haryana, India
| | - Kapil Zirpe
- Neurotrauma and Stroke Unit, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Pravin R Amin
- Department of Critical Care Medicine, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | | | - Farhad N Kapadia
- Department of Intensive Care Medicine, PD Hinduja Hospital and MRC, Mumbai, Maharashtra, India
| | - Mrinal Sircar
- Department of Pulmonology and Critical Care, Fortis Hospital, Noida, Uttar Pradesh, India
| | - Samir Sahu
- Department of Critical Care and Pulmonology, AMRI Hospitals, Bhubaneswar, Odisha, India
| | - Pradip Kumar Bhattacharya
- Department of Critical Care Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Sheila Nainan Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Srinivas Samavedam
- Department of Critical Care Medicine, Virinchi Hospital, Hyderabad, Telangana, India
| | - Subhal Dixit
- Department of Critical Care, Sanjeevan Hospital, Pune, Maharashtra, India
| | - Rajesh Kumar Pande
- Department of Critical Care Medicine, BLK Super Speciality Hospital, Delhi, India
| | - Sujata N Mehta
- Department of Medicine and Critical Care, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Ramesh Venkataraman
- Department of Critical Care Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Khusrav Bajan
- Department of Intensive Care Medicine, PD Hinduja Hospital and MRC, Mumbai, Maharashtra, India
| | - Vivek Kumar
- Critical Care and Emergency Medical Services, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Rahul Harne
- Medanta Institute of Critical Care and Anaesthesia, Medanta-The Medicity, Gurugram, Haryana, India
| | - Leelavati Thakur
- Department of Critical Care, IQ City Medical College and Narayana Multispecialty Hospital, Durgapur, West Bengal, India
| | - Darshana Rathod
- Department of Critical Care, Sir HN Reliance Foundation Hospital, Mumbai, Maharashtra, India
| | - Prachee Sathe
- Department of Critical Care Medicine, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Sushma Gurav
- Neurotrauma Unit, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Carol D'Silva
- Department of Critical Care Medicine, St John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Shaik Arif Pasha
- Department of Critical Care Medicine, NRI Medical College, Guntur, Andhra Pradesh, India
| | - Subhash Kumar Todi
- Department of Critical Care Medicine, AMRI Dhakuria Hospital, Kolkata, West Bengal, India
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15
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Wilcox JM, Consoli DC, Tienda AA, Dixit S, Buchanan RA, May JM, Nobis WP, Harrison FE. Altered synaptic glutamate homeostasis contributes to cognitive decline in young APP/PSEN1 mice. Neurobiol Dis 2021; 158:105486. [PMID: 34450329 PMCID: PMC8457528 DOI: 10.1016/j.nbd.2021.105486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 08/10/2021] [Accepted: 08/16/2021] [Indexed: 12/02/2022] Open
Abstract
Non-convulsive epileptiform activity is a common and under-studied comorbidity of Alzheimer’s disease that may significantly contribute to onset of clinical symptoms independently of other neuropathological features such as β-amyloid deposition. We used repeated treatment with low dose kainic acid (KA) to trigger subthreshold epileptiform activity in young (less than 6 months) wild-type (WT) and APP/PSEN1 mice to test the role of disruption to the glutamatergic system in epileptiform activity changes and the development of memory deficits. Short-term repeated low-dose KA (five daily treatments with 5 mg/kg, IP) impaired long-term potentiation in hippocampus of APP/PSEN1 but not WT mice. Long-term repeated low-dose KA (fourteen weeks of bi-weekly treatment with 7.5–10 mg/kg) led to high mortality in APP/PSEN1 mice. KA treatment also impaired memory retention in the APP/PSEN1 mice in a Morris water maze task under cognitively challenging reversal learning conditions where the platform was moved to a new location. Four weeks of bi-weekly treatment with 5 mg/kg KA also increased abnormal spike activity in APP/PSEN1 and not WT mice but did not impact sleep/wake behavioral states. These findings suggest that hyperexcitability in Alzheimer’s disease may indeed be an early contributor to cognitive decline that is independent of heavy β-amyloid-plaque load, which is absent in APP/PSEN1 mice under 6 months of age.
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Affiliation(s)
- J M Wilcox
- Program in Neuroscience, Vanderbilt University, Nashville, TN, United States of America; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - D C Consoli
- Program in Neuroscience, Vanderbilt University, Nashville, TN, United States of America
| | - A A Tienda
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - S Dixit
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - R A Buchanan
- Program in Neuroscience, Vanderbilt University, Nashville, TN, United States of America
| | - J M May
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - W P Nobis
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - F E Harrison
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America.
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16
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Munch MW, Granholm A, Myatra SN, Vijayaraghavan BKT, Cronhjort M, Wahlin RR, Jakob SM, Cioccari L, Kjær MN, Vesterlund GK, Meyhoff TS, Helleberg M, Møller MH, Benfield T, Venkatesh B, Hammond N, Micallef S, Bassi A, John O, Jha V, Kristiansen KT, Ulrik CS, Jørgensen VL, Smitt M, Bestle MH, Andreasen AS, Poulsen LM, Rasmussen BS, Brøchner AC, Strøm T, Møller A, Khan MS, Padmanaban A, Divatia JV, Saseedharan S, Borawake K, Kapadia F, Dixit S, Chawla R, Shukla U, Amin P, Chew MS, Gluud C, Lange T, Perner A. Higher vs lower doses of dexamethasone in patients with COVID-19 and severe hypoxia (COVID STEROID 2) trial: Protocol and statistical analysis plan. Acta Anaesthesiol Scand 2021; 65:834-845. [PMID: 33583034 PMCID: PMC8014264 DOI: 10.1111/aas.13795] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 01/28/2021] [Accepted: 01/31/2021] [Indexed: 12/29/2022]
Abstract
Background The coronavirus disease 2019 (COVID‐19) pandemic has resulted in millions of deaths and overburdened healthcare systems worldwide. Systemic low‐dose corticosteroids have proven clinical benefit in patients with severe COVID‐19. Higher doses of corticosteroids are used in other inflammatory lung diseases and may offer additional clinical benefits in COVID‐19. At present, the balance between benefits and harms of higher vs. lower doses of corticosteroids for patients with COVID‐19 is unclear. Methods The COVID STEROID 2 trial is an investigator‐initiated, international, parallel‐grouped, blinded, centrally randomised and stratified clinical trial assessing higher (12 mg) vs. lower (6 mg) doses of dexamethasone for adults with COVID‐19 and severe hypoxia. We plan to enrol 1,000 patients in Denmark, Sweden, Switzerland and India. The primary outcome is days alive without life support (invasive mechanical ventilation, circulatory support or renal replacement therapy) at day 28. Secondary outcomes include serious adverse reactions at day 28; all‐cause mortality at day 28, 90 and 180; days alive without life support at day 90; days alive and out of hospital at day 90; and health‐related quality of life at day 180. The primary outcome will be analysed using the Kryger Jensen and Lange test adjusted for stratification variables and reported as adjusted mean differences and median differences. The full statistical analysis plan is outlined in this protocol. Discussion The COVID STEROID 2 trial will provide evidence on the optimal dosing of systemic corticosteroids for COVID‐19 patients with severe hypoxia with important implications for patients, their relatives and society.
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Affiliation(s)
- MW Munch
- Department of Intensive Care, Rigshospitalet University of Copenhagen Copenhagen Denmark
- Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark
| | - Anders Granholm
- Department of Intensive Care, Rigshospitalet University of Copenhagen Copenhagen Denmark
- Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark
| | - SN Myatra
- Department of Anaesthesia Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute Mumbai India
| | - BKT Vijayaraghavan
- Department of Critical Care Apollo Hospitals Chennai India
- Chennai Critical Care Consultants Chennai India
- The George Institute for Global Health, University of New South Wales New Delhi India
| | - Maria Cronhjort
- Department of Clinical Science and Education, Södersjukhuset Karolinska Institutet Stockholm Sweden
| | - RR Wahlin
- Department of Clinical Science and Education, Södersjukhuset Karolinska Institutet Stockholm Sweden
| | - Stephan M. Jakob
- Department of Intensive Care Medicine Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | - Luca Cioccari
- Department of Intensive Care Medicine Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | - MN Kjær
- Department of Intensive Care, Rigshospitalet University of Copenhagen Copenhagen Denmark
- Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark
| | - GK Vesterlund
- Department of Intensive Care, Rigshospitalet University of Copenhagen Copenhagen Denmark
- Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark
| | - TS Meyhoff
- Department of Intensive Care, Rigshospitalet University of Copenhagen Copenhagen Denmark
- Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark
| | - Marie Helleberg
- Department of Infectious Diseases, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - MH Møller
- Department of Intensive Care, Rigshospitalet University of Copenhagen Copenhagen Denmark
- Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark
| | - Thomas Benfield
- Department of Infectious Diseases, Center of Research & Disruption of Infectious Diseases Copenhagen University Hospital – Amager and Hvidovre Copenhagen Denmark
| | - Balasubramanian Venkatesh
- The George Institute for Global Health, University of New South Wales Sydney New South Wales Australia
| | - Naomi Hammond
- The George Institute for Global Health, University of New South Wales Sydney New South Wales Australia
| | - Sharon Micallef
- The George Institute for Global Health, University of New South Wales Sydney New South Wales Australia
| | - Abhinav Bassi
- The George Institute for Global Health, University of New South Wales New Delhi India
| | - Oommen John
- The George Institute for Global Health, University of New South Wales New Delhi India
- Prasanna School of Public Health Manipal Academy of Higher Education Manipal India
| | - Vivekanand Jha
- The George Institute for Global Health, University of New South Wales New Delhi India
- Prasanna School of Public Health Manipal Academy of Higher Education Manipal India
- School of Public Health Imperial College London London UK
| | - KT Kristiansen
- Department of Anaesthesia and Intensive Care Hvidovre Hospital, University of Copenhagen Copenhagen Denmark
| | - CS Ulrik
- Department of Respiratory Medicine Hvidovre Hospital, University of Copenhagen Copenhagen Denmark
| | - VL Jørgensen
- Department of Thoracic Anaesthesiology, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Margit Smitt
- Department of Neuroanaesthesiology, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Morten H. Bestle
- Department of Anaesthesiology and Intensive Care Copenhagen University Hospital Nordsjælland Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - AS Andreasen
- Department of Anaesthesia and Intensive Care Herlev Hospital, University of Copenhagen Copenhagen Denmark
| | - LM Poulsen
- Department of Anaesthesiology Zealand University Hospital Copenhagen Denmark
| | - BS Rasmussen
- Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark
- Department of Anaesthesia and Intensive Care Aalborg University Hospital Aalborg Denmark
| | - AC Brøchner
- Department of Anaesthesia and Intensive Care Kolding Hospital Kolding Denmark
| | - Thomas Strøm
- Department of Anaesthesia and Critical Care Medicine Odense University Hospital Odense C Denmark
- Department of Anaesthesia and Critical Care Medicine Hospital Sønderjylland, University Hospital of Southern Denmark Odense Denmark
| | - Anders Møller
- Department of Anaesthesia and Intensive Care Næstved‐Slagelse‐Ringsted Hospital Slagelse Denmark
| | - MS Khan
- Department of Critical Care Medicine Rajendra Institute of Medical Sciences Ranchi India
| | - Ajay Padmanaban
- Department of Critical Care Apollo Hospitals Chennai India
- Chennai Critical Care Consultants Chennai India
| | - JV Divatia
- Department of Anaesthesia Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute Mumbai India
| | | | - Kapil Borawake
- Department of Intensive Care Vishwaraj Hospital Pune India
| | - Farhad Kapadia
- Section of Critical Care, Department of Medicine Hinduja Hospital Mahim, Mumbai India
| | - Subhal Dixit
- Department of Critical Care Medicine Sanjeevan Hospital Pune Maharashtra India
| | - Rajesh Chawla
- Department of Respiratory and Critical Care Medicine Indraprastha Apollo Hospital New Delhi India
| | - Urvi Shukla
- Intensive Care Unit and Emergency Services Symbiosis University Hospital and Research Centre Lavale, Pune India
| | - Pravin Amin
- Department of Critical Care Medicine Bombay Hospital Institute of Medical Sciences Mumbai India
| | - Michelle S. Chew
- Department of Anesthesiology and Intensive Care, Biomedical and Clinical Sciences Linköping University Linköping Sweden
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital Copenhagen Denmark
| | - Theis Lange
- Department of Public Health, Section of Biostatistics University of Copenhagen Copenhagen Denmark
| | - Anders Perner
- Department of Intensive Care, Rigshospitalet University of Copenhagen Copenhagen Denmark
- Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark
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17
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Singh A, Kuttippurath J, Abbhishek K, Mallick N, Raj S, Chander G, Dixit S. Biogenic link to the recent increase in atmospheric methane over India. J Environ Manage 2021; 289:112526. [PMID: 33848879 DOI: 10.1016/j.jenvman.2021.112526] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/26/2021] [Accepted: 03/30/2021] [Indexed: 05/23/2023]
Abstract
Methane (CH4) is a prominent Greenhouse Gas (GHG) and its global atmospheric concentration has increased significantly since the year 2007. Anthropogenic CH4 emissions are projected to be 9390 million metric tonnes by 2020. Here, we present the long-term changes in atmospheric methane over India and suggest possible alternatives to reduce soil emissions from paddy fields. The increase in atmospheric CH4 concentrations from 2009 to 2020 in India is significant, about 0.0765 ppm/decade. The Indo-Gangetic Plains, Peninsular India and Central India show about 0.075, 0.076 and 0.074 ppm/decade, respectively, in 2009-2020. Seasonal variations in CH4 emissions depend mostly on agricultural activities and meteorology, and contribution during the agricultural intensive period of Kharif-Rabi (i.e., June-December) is substantial in this regard. The primary reason for agricultural soil emissions is the application of chemical fertilizers to improve crop yield. However, for rice farming, soil amendments involving stable forms of carbon can reduce GHG emissions and improve soil carbon status. High crop production in pot culture experiment resulted in lower potential yield-scaled GHG emissions in rice with biochar supplement. The human impact of global warming induced by agricultural activities could be reduced by using biochar as a natural solution.
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Affiliation(s)
- A Singh
- CORAL, Indian Institute of Technology Kharagpur, Kharagpur, 721302, India; AGFE Department, Indian Institute of Technology Kharagpur, Kharagpur, 721302, India
| | - J Kuttippurath
- CORAL, Indian Institute of Technology Kharagpur, Kharagpur, 721302, India.
| | - K Abbhishek
- CORAL, Indian Institute of Technology Kharagpur, Kharagpur, 721302, India
| | - N Mallick
- AGFE Department, Indian Institute of Technology Kharagpur, Kharagpur, 721302, India
| | - S Raj
- CORAL, Indian Institute of Technology Kharagpur, Kharagpur, 721302, India
| | - G Chander
- International Crops Research Institute for the Semi-Arid Tropics (ICRISAT), Hyderabad, India
| | - S Dixit
- International Crops Research Institute for the Semi-Arid Tropics (ICRISAT), Hyderabad, India
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18
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Granholm A, Munch MW, Myatra SN, Vijayaraghavan BKT, Cronhjort M, Wahlin RR, Jakob SM, Cioccari L, Kjær MN, Vesterlund GK, Meyhoff TS, Helleberg M, Møller MH, Benfield T, Venkatesh B, Hammond N, Micallef S, Bassi A, John O, Jha V, Kristiansen KT, Ulrik CS, Jørgensen VL, Smitt M, Bestle MH, Andreasen AS, Poulsen LM, Rasmussen BS, Brøchner AC, Strøm T, Møller A, Khan MS, Padmanaban A, Divatia JV, Saseedharan S, Borawake K, Kapadia F, Dixit S, Chawla R, Shukla U, Amin P, Chew MS, Gluud C, Lange T, Perner A. Higher vs Lower Doses of Dexamethasone in Patients with COVID-19 and Severe Hypoxia (COVID STEROID 2) trial: Protocol for a secondary Bayesian analysis. Acta Anaesthesiol Scand 2021; 65:702-710. [PMID: 33583027 PMCID: PMC8014670 DOI: 10.1111/aas.13793] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 01/28/2021] [Accepted: 01/31/2021] [Indexed: 12/19/2022]
Abstract
Background Coronavirus disease 2019 (COVID‐19) can lead to severe hypoxic respiratory failure and death. Corticosteroids decrease mortality in severely or critically ill patients with COVID‐19. However, the optimal dose remains unresolved. The ongoing randomised COVID STEROID 2 trial investigates the effects of higher vs lower doses of dexamethasone (12 vs 6 mg intravenously daily for up to 10 days) in 1,000 adult patients with COVID‐19 and severe hypoxia. Methods This protocol outlines the rationale and statistical methods for a secondary, pre‐planned Bayesian analysis of the primary outcome (days alive without life support at day 28) and all secondary outcomes registered up to day 90. We will use hurdle‐negative binomial models to estimate the mean number of days alive without life support in each group and present results as mean differences and incidence rate ratios with 95% credibility intervals (CrIs). Additional count outcomes will be analysed similarly and binary outcomes will be analysed using logistic regression models with results presented as probabilities, relative risks and risk differences with 95% CrIs. We will present probabilities of any benefit/harm, clinically important benefit/harm and probabilities of effects smaller than pre‐defined clinically minimally important differences for all outcomes analysed. Analyses will be adjusted for stratification variables and conducted using weakly informative priors supplemented by sensitivity analyses using sceptic priors. Discussion This secondary, pre‐planned Bayesian analysis will supplement the primary, conventional analysis and may help clinicians, researchers and policymakers interpret the results of the COVID STEROID 2 trial while avoiding arbitrarily dichotomised interpretations of the results. Trial registration ClinicalTrials.gov: NCT04509973; EudraCT: 2020‐003363‐25.
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Affiliation(s)
- Anders Granholm
- Department of Intensive Care, Rigshospitalet University of Copenhagen Denmark
- Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark
| | - Marie Warrer Munch
- Department of Intensive Care, Rigshospitalet University of Copenhagen Denmark
- Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark
| | - Sheila Nainan Myatra
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital Homi Bhabha National Institute Mumbai India
| | - Bharath Kumar Tirupakuzhi Vijayaraghavan
- Department of Critical Care Apollo Hospitals Chennai India
- Chennai Critical Care Consultants Chennai India
- The George Institute for Global Health University of New South Wales New Delhi India
| | - Maria Cronhjort
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet Stockholm Sweden
| | - Rebecka Rubenson Wahlin
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet Stockholm Sweden
| | - Stephan M. Jakob
- Department of Intensive Care Medicine Inselspital, Bern University Hospital, University of Bern Switzerland
| | - Luca Cioccari
- Department of Intensive Care Medicine Inselspital, Bern University Hospital, University of Bern Switzerland
| | - Maj‐Brit Nørregaard Kjær
- Department of Intensive Care, Rigshospitalet University of Copenhagen Denmark
- Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark
| | - Gitte Kingo Vesterlund
- Department of Intensive Care, Rigshospitalet University of Copenhagen Denmark
- Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark
| | - Tine Sylvest Meyhoff
- Department of Intensive Care, Rigshospitalet University of Copenhagen Denmark
- Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark
| | - Marie Helleberg
- Department of Infectious Diseases, Rigshospitalet University of Copenhagen Denmark
| | - Morten Hylander Møller
- Department of Intensive Care, Rigshospitalet University of Copenhagen Denmark
- Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark
| | - Thomas Benfield
- Center of Research and Disruption of Infectious Diseases, Department of Infectious Diseases Copenhagen University Hospital – Amager and Hvidovre Denmark
| | | | - Naomi Hammond
- The George Institute for Global Health University of New South Wales Australia
| | - Sharon Micallef
- The George Institute for Global Health University of New South Wales Australia
| | - Abhinav Bassi
- The George Institute for Global Health University of New South Wales New Delhi India
| | - Oommen John
- The George Institute for Global Health University of New South Wales New Delhi India
- Prasanna School of Public Health Manipal Academy of Higher Education India
| | - Vivekanand Jha
- The George Institute for Global Health University of New South Wales New Delhi India
- Prasanna School of Public Health Manipal Academy of Higher Education India
- School of Public Health Imperial College London United Kingdom
| | - Klaus Tjelle Kristiansen
- Department of Anaesthesia and Intensive Care Hvidovre Hospital, University of Copenhagen Denmark
| | | | - Vibeke Lind Jørgensen
- Department of Thoracic Anaesthesiology, Rigshospitalet University of Copenhagen Denmark
| | - Margit Smitt
- Department of Neuroanaesthesiology, Rigshospitalet University of Copenhagen Denmark
| | - Morten H. Bestle
- Department of Anaesthesiology Intensive Care Copenhagen University Hospital Nordsjælland Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Anne Sofie Andreasen
- Department of Anaesthesia and Intensive Care Herlev Hospital, University of Copenhagen Denmark
| | | | - Bodil Steen Rasmussen
- Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark
- Department of Anaesthesia and Intensive Care Aalborg University Hospital Denmark
| | | | - Thomas Strøm
- Department of Anaesthesia and Critical Care Medicine Odense University Hospital Odense C Denmark
- Department of Anaesthesia and Critical Care Medicine Hospital Sønderjylland, University Hospital of Southern Denmark Denmark
| | - Anders Møller
- Department of Anaesthesia and Intensive Care Næstved‐Slagelse‐Ringsted Hospital Slagelse Denmark
| | - Mohd Saif Khan
- Department of Critical Care Medicine Rajendra Institute of Medical Sciences Ranchi India
| | | | - Jigeeshu Vasishtha Divatia
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital Homi Bhabha National Institute Mumbai India
| | | | - Kapil Borawake
- Department of Intensive Care Vishwaraj Hospital Pune India
| | - Farhad Kapadia
- Section of Critical Care, Department of Medicine Hinduja Hospital Mahim India
| | - Subhal Dixit
- Department of Critical Care Medicine Sanjeevan Hospital Pune India
| | - Rajesh Chawla
- Department of Respiratory and Critical Care Medicine Indraprastha Apollo Hospital New Delhi India
| | - Urvi Shukla
- Intensive Care Unit and Emergency Services Symbiosis University Hospital and Research Centre Pune India
| | - Pravin Amin
- Department of Critical Care Medicine Bombay Hospital Institute of Medical Sciences Mumbai India
| | - Michelle S. Chew
- Department of Anesthesiology and Intensive Care, Biomedical and Clinical Sciences Linköping University Linköping Sweden
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Capital Region of Denmark, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Theis Lange
- Department of Public Health, Section of Biostatistics University of Copenhagen Copenhagen Denmark
| | - Anders Perner
- Department of Intensive Care, Rigshospitalet University of Copenhagen Denmark
- Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark
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Dixit S, Thakur N, Shukla A, Upadhyay SK, C Verma P. Molecular characterization of N-methyl-d-aspartate receptor from Bemisia tabaci. Insect Mol Biol 2021; 30:231-240. [PMID: 33368750 DOI: 10.1111/imb.12690] [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] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/13/2020] [Accepted: 12/23/2020] [Indexed: 06/12/2023]
Abstract
The N-methyl-d-aspartate receptors (NMDARs) are ionotropic ligand gated channels that are highly permeable to calcium ions. In insects, NMDARs are associated with glutamatergic neurotransmission governing diverse physiological and biological processes like vitellogenesis and ovarian development. Therefore, NMDAR may act as attractive target for insect pest control. In present study, we performed structural and functional characterization of NMDARs in Bemisia tabaci, a highly invasive crop pest and potent virus vector. We identified that NMDAR consists of three subunits each encoded by single gene in whiteflies which are highly conserved among different insect orders. Expression analysis suggests that subunit 1 (BtNR1) and subunit 2 (BtNR2) are the main functional units. External supplementation of NMDAR ligand or BtNRs silencing was lethal to insects, which suggested that NMDAR function is highly balanced in whiteflies.
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Affiliation(s)
- S Dixit
- Molecular Biology and Biotechnology, CSIR-National Botanical Research Institute, (Council of Scientific and Industrial Research), Rana Pratap Marg, Lucknow, India
- Department of Biology, University of Western Ontario, London, Ontario, Canada
| | - N Thakur
- Molecular Biology and Biotechnology, CSIR-National Botanical Research Institute, (Council of Scientific and Industrial Research), Rana Pratap Marg, Lucknow, India
- DST-Centre for Policy Research, IIT-Delhi, New Delhi, India
| | - A Shukla
- Department of Biology, University of Western Ontario, London, Ontario, Canada
| | - S K Upadhyay
- Department of Botany, Panjab University, Chandigarh, India
| | - P C Verma
- Molecular Biology and Biotechnology, CSIR-National Botanical Research Institute, (Council of Scientific and Industrial Research), Rana Pratap Marg, Lucknow, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
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Abstract
PURPOSE OF REVIEW Critically ill patients who survive the ICU face issues such as reduced quality of life and increased disability and nutritional therapy during ICU stay may be used to reduce these adverse effects. Although evidence and guidelines are available to direct clinical nutrition for ICU patients, critical care practices and settings differ substantially between developed and developing countries. RECENT FINDINGS The implementation of evidence generated in well developed countries regarding critical care nutrition depends heavily on factors such as operation model, the structure of the unit, different care processes, hospital size and country income. SUMMARY Guidelines and evidence generated by various societies, agencies and trials, which are focused towards developed world may not be fully appropriate and executable in the developing world. Also, the developing world is heterogenous. Hence, 'one size fits all' approach may not be appropriate. A holistic approach to guideline and evidence generation and its appropriate utilization in the developing world is binding on caregivers in both the developing and developed world so as to benefit the critically ill patient.
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Affiliation(s)
- Subhal Dixit
- Critical Care, Sanjeevan Hospital, Pune, Maharashtra, India
| | - Mehmet Uyar
- Ege University Hospital, Dept of Anesthesiology and Intensive Care, Bornova, Izmir, Turkey
| | - Khalid Khatib
- Department of Medicine, Smt. Kashibai Navale Medical College, Pune, Maharashtra, India
| | - Kubilay Demirag
- Ege University Hospital, Dept of Anesthesiology and Intensive Care, Bornova, Izmir, Turkey
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21
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Dixit PB, Dixit S, Dahal S, Poudel P, Roy D, Manandhar N. Pattern of Dental Problems among Patients Visiting a Dental Hospital during COVID-19 Pandemic. Kathmandu Univ Med J (KUMJ) 2021; 18:58-61. [PMID: 33605240] [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: 06/12/2023]
Abstract
Background Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and Nepal is a part of this worldwide corona virus disease. In this critical situation, the patients have a sense of insecurity visiting dental hospital. Objective To assess the pattern of dental problems in patients visiting a dental college during COVID-19. Method A descriptive cross-sectional study was conducted in Dental Hospital of Kathmandu Medical College and Teaching Hospital from May to August 2020. The patients visiting the Dental hospital were assessed for dental problems. Data were analyzed in Statistical Package of Social Sciences version 20. Frequency and percentage for pattern of dental problems were calculated. Result Most of the patients of age group of 14 to 31 years 530 (36.53%) had dental problems during the survey period. Out of total patients having dental emergency, 739 (50.93%) were males and 712 (49.07%) were females. Majority 545 (37.56%) visited the dental hospital for endodontic consultation followed by emergency consultation for oral surgical procedures 298 (20.54%). Least consulted dental emergency condition was prosthodontic consultation 18 (1.24%). Conclusion The study findings showed that the major dental problems in patients causing emergency visit to dental hospital during COVID-19 pandemic period were dental pain and swelling requiring endodontic consultation and the least need felt is prosthodontic consultation.
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Affiliation(s)
- P B Dixit
- Department of Conservative Dentistry and Endodontics, Kathmandu Medical College and Teaching Hospital, Duwakot, Bhaktapur, Nepal
| | - S Dixit
- Department of Prosthodontics, Kathmandu Medical College and Teaching Hospital, Duwakot, Bhaktapur, Nepal
| | - S Dahal
- Department of Community and Public Health Dentistry, Kathmandu Medical College and Teaching Hospital, Duwakot, Bhaktapur, Nepal
| | - P Poudel
- Department of Orthodontics and Dentofacial Orthopaedics, Kathmandu Medical College and Teaching Hospital, Duwakot, Bhaktapur, Nepal
| | - D Roy
- Department of Conservative Dentistry and Endodontics, Kathmandu Medical College and Teaching Hospital, Duwakot, Bhaktapur, Nepal
| | - N Manandhar
- Department of Community Medicine, Kathmandu Medical College and Teaching Hospital, Duwakot, Bhaktapur, Nepal
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22
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Zirpe KG, Dixit S, Kulkarni AP, Sapra H, Kakkar G, Gupta R, Bansal AR, Garg A, Dash SK, Gurnani A, Khan A, Khatib KI, Mare PR. Pathophysiological Mechanisms and Neurological Manifestations in COVID-19. Indian J Crit Care Med 2020; 24:975-980. [PMID: 33281325 PMCID: PMC7689109 DOI: 10.5005/jp-journals-10071-23592] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
With increasing knowledge of the coronavirus disease-2019 (COVID-19), we now understand that COVID-19 presents with various extrapulmonary manifestations with multi-organ involvement. Involvement of the central nervous system (CNS) occurs probably via transsynaptic spread or transfer across the blood-brain barrier. Hypoxia, immune-mediated injury, and vascular damage are the potential mechanisms for the CNS manifestations. Headache, dizziness, chemosensory disturbances, such as loss of smell, taste, encephalopathy, stroke, etc., are among the commonly encountered neurological presentations. Headache is identified as one of the red flag symptoms for COVID-19. Sudden onset of loss of smell and/or taste in the absence of nasal congestion can help in COVID-19 case identification and testing prioritization. Both hemorrhagic and ischemic brain injury is common in patients developing stroke. Besides these, COVID-19-associated CNS involvement demands more careful attention toward patients with existing neurological disorders especially that are managed with immunosuppressant agents. In all, neurological involvement in COVID-19 is not uncommon and may precede, occur concomitantly or after the respiratory involvement. It may also be the sole presentation in some of the patients necessitating high vigilance for COVID-19. In this review, we briefly discussed the pathogenesis of CNS involvement and some important neurological manifestations in COVID-19. How to cite this article: Zirpe KG, Dixit S, Kulkarni AP, Sapra H, Kakkar G, Gupta R, et al. Pathophysiological Mechanisms and Neurological Manifestations in COVID-19. Indian J Crit Care Med 2020;24(10):975-980.
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Affiliation(s)
| | - Subhal Dixit
- Department of CCM, Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Atul Prabhakar Kulkarni
- Department of Anesthesia, Critical Care and Pain, Division of Critical Care Medicine, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Harsh Sapra
- Department of Neurocritical Care, Medanta: The Medicity, Gurugram, Haryana, India
| | - Gaurav Kakkar
- Department of Neuroanaesthesia and Neurocritical Care, Medanta: The Medicity, Gurugram, Haryana, India
| | - Rahul Gupta
- Department of Neuro and Spine Surgery, Fortis Hospital, Noida, Uttar Pradesh, India
| | - Atma Ram Bansal
- Department of Neuro Sciences, Medanta: The Medicity, Gurugram, Haryana, India
| | - Arun Garg
- Department of Neuro Sciences, Medanta: The Medicity, Gurugram, Haryana, India
| | - Santosh Kumar Dash
- Department of Neurology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Anil Gurnani
- Department of Critical Care, Kailash Hospital, Noida, Uttar Pradesh, India
| | - Azizullah Khan
- Department of Critical Care, Prince Ali Khan Hospital, Mumbai, Maharashtra, India
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23
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Kakkar G, Zirpe KG, Sapra H, Dixit S, Chugh C, Nagaiyan S, Kumar P. Practice Implications for Acute Ischemic Stroke during the COVID-19 Pandemic for the Indian Scenario: Realistic and Achievable Recommendations by the Society of Neurocritical Care (SNCC), India. Indian J Crit Care Med 2020; 24:757-762. [PMID: 33132556 PMCID: PMC7584840 DOI: 10.5005/jp-journals-10071-23511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
COVID-19 disease caused by the SARS coronavirus has caused significant morbidity and mortality around the world ever since it was first declared as a pandemic by the World Health Organization (WHO) in March 2020. Acute neurological manifestations of this disease have also started emerging and being recognized around the world and acute ischemic stroke (AIS) or thrombotic stroke is becoming one of the major neurological illnesses related to COVID-19. The management of AIS is time-critical and major advances in its management over the recent years, such as bridging thrombolysis and mechanical thrombectomy (MT), are multidisciplinary activities requiring robust coordination and management in the acute setting. All these advances are severely challenged in the COVID-19 pandemic where severe pressures exist on the clinical resources and logistics required to deliver an effective stroke service. This is further compromised by legal and preventive measures during this pandemic like local lockdowns. Reporting of minor or initial symptoms has also been compromised due to the fear of approaching healthcare settings which are perceived as high-risk zones to catch the infection. The purpose of this document is to highlight these challenges and provide a guiding framework for the management of AIS under three principles: (a) Delivering an effective service, (b) Preventing infections within the healthcare setting, and (c) Optimizing resource utilization. How to cite this article: Kakkar G, Zirpe KG, Sapra H, Dixit S, Chugh C, Nagaiyan S, et al. Practice Implications for Acute Ischemic Stroke during the COVID-19 Pandemic for the Indian Scenario: Realistic and Achievable Recommendations by the Society of Neurocritical Care (SNCC), India. Indian J Crit Care Med 2020;24(9):757-762.
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Affiliation(s)
- Gaurav Kakkar
- Department of Neuroanaesthesia and Neurocritical Care, Medanta–The Medicity, Gurugram, Haryana, India
| | - Kapil G Zirpe
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Harsh Sapra
- Department of Neuroanaesthesia and Neurocritical Care, Medanta–The Medicity, Gurugram, Haryana, India
| | - Subhal Dixit
- Department of CCM, Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Chandril Chugh
- Department of Interventional Neurology, Max Superspecialty Hospital, Delhi, India
| | - Sridhar Nagaiyan
- Department of Critical Care, Kauveri Hospital, Chennai, Tamil Nadu, India
| | - Prashant Kumar
- Department of Anaesthesiology and Critical Care, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
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Mehta Y, Chaudhry D, Abraham OC, Chacko J, Divatia J, Jagiasi B, Kar A, Khilnani GC, Krishna B, Kumar P, Mani RK, Rao BK, Singh PK, Singh S, Tiwary P, Wattal C, Govil D, Dixit S, Samavedam S. Critical Care for COVID-19 Affected Patients: Position Statement of the Indian Society of Critical Care Medicine. Indian J Crit Care Med 2020; 24:222-241. [PMID: 32565632 PMCID: PMC7297240 DOI: 10.5005/jp-journals-10071-23395] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The global pandemic involving severe acute respiratory syndrome-coronavirus-2 (SARS-COV-2) has stretched the limits of science. Ever since it emerged from the Wuhan province in China, it has spread across the world and has been fatal to about 4% of the victims. This position statement of the Indian Society of Critical Care Medicine represents the collective opinion of the experts chosen by the society. HOW TO CITE THIS ARTICLE Mehta Y, Chaudhry D, Abraham OC, Chacko J, Divatia J, Jagiasi B, et al. Critical Care for COVID-19 Affected Patients: Position Statement of the Indian Society of Critical Care Medicine. Indian J Crit Care Med 2020;24(4):222-241.
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Affiliation(s)
- Yatin Mehta
- Institute of Critical Care and Anesthesiology, Medanta: The Medicity, Gurugram, Haryana, India
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - OC Abraham
- Infectious Disease Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Jose Chacko
- Critical Care Medicine, Narayana Hrudyala, Bengaluru, Karnataka, India
| | - Jigeeshu Divatia
- Critical Care and Anesthesia, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Bharat Jagiasi
- Department of Critical Care, Reliance Hospital, Navi Mumbai, Maharashtra, India
| | - Arindam Kar
- CK Birla Hospitals; CMRI Institute of Critical Care; Indian Society of Critical Care Medicine; European Society of Intensive Care Medicine
| | - GC Khilnani
- Department of Pulmonary, Critical Care and Sleep Medicine, PSRI Hospital, New Delhi, India
| | - Bhuvana Krishna
- Department of Critical Care Medicine, St. John's Hospital, Bengaluru, Karnataka, India
| | - Prashant Kumar
- Department of Anesthesiology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - RK Mani
- Critical Care and Pulmonology, Batra Hospital and Medical Research Centre, New Delhi, India
| | - BK Rao
- Department of Critical care and Emergency Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Pawan K Singh
- Department of Pulmonary and Critical Care, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Sanjeev Singh
- Amrita Institute of Medical Sciences, Ernakulam, Kerala, India; Amrita Hospitals, Faridabad, Haryana, India
| | - Pavan Tiwary
- All India Institute of Medical Sciences, New Delhi, India
| | - Chand Wattal
- Clinical Microbiology and Immunology, Sir Ganga Ram Hospital, New Delhi, India
| | - Deepak Govil
- Institute of Critical Care and Anesthesiology, Medanta: The Medicity, Gurugram, Haryana, India
| | - Subhal Dixit
- Department of Critical Care Medicine, Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Srinivas Samavedam
- Department of Critical Care, Virinchi Hospital, Hyderabad, Telangana, India
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Gupta S, Tomar DS, Dixit S, Zirpe K, Choudhry D, Govil D, Mohamed Z, Chakrabortty N, Gurav S, Wanchoo J, Gupta KV. Dilatational Percutaneous vs Surgical TracheoStomy in IntEnsive Care UniT: A Practice Pattern Observational Multicenter Study (DISSECT). Indian J Crit Care Med 2020; 24:514-526. [PMID: 32963433 PMCID: PMC7482354 DOI: 10.5005/jp-journals-10071-23441] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Tracheostomy is among the common procedures performed in the intensive care unit (ICU), with percutaneous dilatational tracheostomy (PDT) being the preferred technique. We sought to understand the current practice of tracheostomy in Indian ICUs. Materials and methods A pan-India multicenter prospective observational study, endorsed and peer-reviewed by the Indian Society of Critical Care Medicine (ISCCM), on various aspects of tracheostomy performed in critically ill patients was conducted between September 1, 2019 and December 31, 2019. The SPSS software was used for the statistical analysis. Cross tables were generated and the chi-square test was used for testing of association. The p value < 0.05 was considered statistically significant. Results Out of 67 ICUs that participated, 88.1% were from private sector hospitals. A total of 923 tracheostomies were performed during the study period; out of which, 666 were PDT and 257 were surgical tracheostomy (ST). Coagulopathic patients received more platelet transfusion [p = 0.037 with platelet count (PC) < 50 × 109, p = 0.021 with PC 50–100 × 109] and fresh frozen plasma transfusion in the ST group (p = 0.0001). The performance of PDT vs ST by day 7 of admission was 28.4% vs 21% (p = 0.023). The single dilator technique (60.4%) was the preferred technique for PDT followed by the Grigg's forceps and then the multiple dilator technique. Fiberoptic bronchoscope (FOB) and ultrasonography (USG) were used in 29.3% and 16.8%, respectively, for guidance during tracheostomy. Most of the PDTs were performed by a trained intensivist (74.2%), whereas ST was mostly done by an ENT surgeon (56.8%). Percutaneous dilatational tracheostomy resulted in less hemorrhagic (2.6% vs 7%, p = 0.002) and desaturation complications (2.3% vs 6.6%, p = 0.001) as compared to ST. The duration of procedure was shorter in the PDT group (average shortening by 9.2 minutes) and the ventilator-free days (VFD) were higher in the PDT group. The cost was less in PDT by approximately Rs. 13,104. Conclusion Percutaneous dilatational tracheostomy, especially the single dilator technique, is preferred by clinicians in Indian ICUs. The incidence of minor complications like hemorrhagic episodes is lower with PDT. Percutaneous dilatational tracheostomy was found to be cheaper on cost per patient basis as compared to ST (with or without complications). How to cite this article Gupta S, Tomar DS, Dixit S, Zirpe K, Choudhry D, Govil D, et al. Dilatational Percutaneous vs Surgical TracheoStomy in IntEnsive Care UniT: A Practice Pattern Observational Multicenter Study (DISSECT). Indian J Crit Care Med 2020;24(7):514–526.
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Affiliation(s)
- Sachin Gupta
- Department of Critical Care Medicine, Narayana Superspeciality Hospital, Gurugram, Haryana, India
| | - Deeksha S Tomar
- Department of Critical Care Medicine, Narayana Superspeciality Hospital, Gurugram, Haryana, India
| | - Subhal Dixit
- Department of Critical Care Medicine, Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Kapil Zirpe
- Department of Neurocritical Care, Ruby Hall Clinic, Grant Medical Foundation, Pune, Maharashtra, India
| | - Dhruva Choudhry
- Department of Pulmonary and Critical Care Medicine, University of Health Sciences, Rohtak, Haryana, India
| | - Deepak Govil
- Department of Critical Care, Institute of Critical Care and Anesthesiology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Zubair Mohamed
- Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Nilanchal Chakrabortty
- Department of Neurointensive Care, Institute of Neurosciences, Kolkata, West Bengal, India
| | - Sushma Gurav
- Department of Neurocritical Care, Ruby Hall Clinic, Grant Medical Foundation, Pune, Maharashtra, India
| | - Jaya Wanchoo
- Department of Neuroanesthesia and Critical Care, Institute of Neurosciences, Medanta-The Medicity, Gurugram, Haryana, India
| | - Kanchi Vv Gupta
- Department of Critical Care Medicine, Manipal Hospitals, Bengaluru, Karnataka, India
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Javeri Y, Jagathkar G, Dixit S, Chaudhary D, Zirpe KG, Mehta Y, Govil D, Mishra RC, Samavedam S, Pandit RA, Savio RD, Clerk AM, Srinivasan S, Juneja D, Ray S, Sahoo TK, Jakkinaboina S, Jampala N, Jain R. Indian Society of Critical Care Medicine Position Statement for Central Venous Catheterization and Management 2020. Indian J Crit Care Med 2020; 24:S6-S30. [PMID: 32205954 PMCID: PMC7085816 DOI: 10.5005/jp-journals-10071-g23183] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background and Purpose Short-term central venous catheterization (CVC) is one of the commonly used invasive interventions in ICU and other patient-care areas. Practice and management of CVC is not standardized, varies widely, and need appropriate guidance. Purpose of this document is to provide a comprehensive, evidence-based and up-to-date, one document source for practice and management of central venous catheterization. These recommendations are intended to be used by critical care physicians and allied professionals involved in care of patients with central venous lines. Methods This position statement for central venous catheterization is framed by expert committee members under the aegis of Indian Society of Critical Care Medicine (ISCCM). Experts group exchanged and reviewed the relevant literature. During the final meeting of the experts held at the ISCCM Head Office, a consensus on all the topics was made and the recommendations for final document draft were prepared. The final document was reviewed and accepted by all expert committee members and after a process of peer-review this document is finally accepted as an official ISCCM position paper. Modified grade system was utilized to classify the quality of evidence and the strength of recommendations. The draft document thus formulated was reviewed by all committee members; further comments and suggestions were incorporated after discussion, and a final document was prepared. Results This document makes recommendations about various aspects of resource preparation, infection control, prevention of mechanical complication and surveillance related to short-term central venous catheterization. This document also provides four appendices for ready reference and use at institutional level. Conclusion In this document, committee is able to make 54 different recommendations for various aspects of care, out of which 40 are strong and 14 weak recommendations. Among all of them, 42 recommendations are backed by any level of evidence, however due to paucity of data on 12 clinical questions, a consensus was reached by working committee and practice recommendations given on these topics are based on vast clinical experience of the members of this committee, which makes a useful practice point. Committee recognizes the fact that in event of new emerging evidences this document will require update, and that shall be provided in due time. Abbreviations list ABHR: Alcohol-based hand rub; AICD: Automated implantable cardioverter defibrillator; BSI: Blood stream infection; C/SS: CHG/silver sulfadiazine; Cath Lab: Catheterization laboratory (Cardiac Cath Lab); CDC: Centers for Disease Control and Prevention; CFU: Colony forming unit; CHG: Chlorhexidine gluconate; CL: Central line; COMBUX: Comparison of Bedside Ultrasound with Chest X-ray (COMBUX study); CQI: Continuous quality improvement; CRBSI: Catheter-related blood stream infection; CUS: Chest ultrasonography; CVC: Central Venous Catheter; CXR: Chest X-ray; DTTP: Differential time to positivity; DVT: Deep venous thrombosis; ECG: Electrocardiography; ELVIS: Ethanol lock and risk of hemodialysis catheter infection in critically ill patients; ER: Emergency room; FDA: Food and Drug Administration; FV: Femoral vein; GWE: Guidewire exchange; HD catheter: Hemodialysis catheter; HTS: Hypertonic saline; ICP: Intracranial pressure; ICU: Intensive Care Unit; IDSA: Infectious Disease Society of America; IJV: Internal jugular vein; IPC: Indian penal code; IRR: Incidence rate ratio; ISCCM: Indian Society of Critical Care Medicine; IV: Intravenous; LCBI: Laboratory confirmed blood stream infection; M/R: Minocycline/rifampicin; MBI-LCBI: Mucosal barrier injury laboratory-confirmed bloodstream infection; MRSA: Methicillin-resistant Staphylococcus aureus; NHS: National Health Service (UK); NHSN: National Healthcare Safety Network (USA); OT: Operation Theater; PICC: Peripherally-inserted central catheter; PIV: Peripheral intravenous line; PL: Peripheral line; PVI: Povidone-iodine; RA: Right atrium; RCT: Randomized controlled trial; RR: Relative risk; SCV/SV: Subclavian vein; ScVO2: Central venous oxygen saturation; Sn: Sensitivity; SOP: Standard operating procedure; SVC: Superior vena cava; TEE: Transesophageal echocardiography; UPP: Useful Practice Points; USG: Ultrasonography; WHO: World Health Organization How to cite this article Javeri Y, Jagathkar G, Dixit S, Chaudhary D, Zirpe KG, Mehta Y, et al. Indian Society of Critical Care Medicine Position Statement for Central Venous Catheterization and Management 2020. Indian J Crit Care Med 2020;24(Suppl 1):S6–S30.
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Affiliation(s)
- Yash Javeri
- Department of Critical Care, Anesthesia and Emergency Medicine, Regency Health, Lucknow, Uttar Pradesh, India, , e-mail:
| | - Ganshyam Jagathkar
- Department of Critical Care Medicine, Medicover Hospital, Hyderabad, Telangana, India, e-mail:
| | - Subhal Dixit
- Department of Critical Care Medicine, Sanjeevan & MJM Hospital, Pune, Maharashtra, India, e-mail:
| | - Dhruva Chaudhary
- Department of Pulmonary and Critical Care, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India, , e-mail:
| | - Kapil Gangadhar Zirpe
- Department of Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India, , e-mail:
| | - Yatin Mehta
- Department of Critical Care and Anesthesiology, Medanta The Medicity, Sector-38, Gurgaon, Haryana, India, Extn. 3335, e-mail:
| | - Deepak Govil
- Department of Critical Care, Medanta Hospital, The Medicity, Gurugram, Haryana, India, , e-mail:
| | - Rajesh C Mishra
- Department of Critical Care, Saneejivini Hospital, Vastrapur, Ahmedabad, Gujarat, India, , e-mail:
| | - Srinivas Samavedam
- Department of Critical Care, Virinchi Hospital, Hyderabad, Telangana, India, , e-mail:
| | - Rahul Anil Pandit
- Department of Intensive Care Unit, Fortis Hospital, Mumbai, Maharashtra, India, , e-mail:
| | - Raymond Dominic Savio
- Department of Critical Care Medicine, Apollo Hospital, Chennai, Tamil Nadu, India, e-mail:
| | - Anuj M Clerk
- Department of Intensive Care, Services Sunshine Global Hospital, Surat, Gujarat, India, e-mail:
| | - Shrikanth Srinivasan
- Department of Critical Care Medicine, Manipal Hospital, New Delhi, India, , e-mail:
| | - Deven Juneja
- Department of Critical Care Medicine, Max Superspecialty Hospital, New Delhi, India, , e-mail:
| | - Sumit Ray
- Department of Critical Care, Artemis Hospital, Gurugram, Haryana, India, e-mail:
| | - Tapas Kumar Sahoo
- Department of Critical Care, Medanta Hospital, Ranchi, Jharkhand, India, , e-mail:
| | - Srinivas Jakkinaboina
- Department of Critical Care Medicine, Citizens Specialty Hospital, Hyderabad, Telangana, India, , e-mail:
| | - Nandhakishore Jampala
- Department of Critical Care, Medicover Hospital, Hyderabad, Telangana, India, , e-mail:
| | - Ravi Jain
- Department of Critical Care Medicine, Nayati Medicity, Mathura, Uttar Pradesh, India, , e-mail:
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Mehta Y, Chaudhry D, Abraham OC, Chacko J, Divatia J, Jagiasi B, Kar A, Khilnani GC, Krishna B, Kumar P, Mani RK, Rao BK, Singh PK, Singh S, Tiwary P, Wattal C, Govil D, Dixit S, Samavedam S. Critical Care for COVID-19 Affected Patients: Updated Position Statement of the Indian Society of Critical Care Medicine. Indian J Crit Care Med 2020; 24:S225-S230. [PMID: 33354047 PMCID: PMC7724933 DOI: 10.5005/jp-journals-10071-23621] [Citation(s) in RCA: 3] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The management of coronavirus disease-2019 (COVID-19) is witnessing a change as we learn more about the pathophysiology and the severity of the disease. Several randomized controlled trials (RCTs) and meta-analysis have been published over the last few months. Several interventions and therapies which showed promise in the initial days of the pandemic have subsequently failed to show benefit in well-designed trials. Understanding of the methods of oxygen delivery and ventilation have also evolved over the past few months. The Indian Society of Critical Care Medicine (ISCCM) has reviewed the evidence that has emerged since the publication of its position statement in May and has put together an addendum of updated evidence. How to cite this article: Mehta Y, Chaudhry D, Abraham OC, Chacko J, Divatia J, Jagiasi B, et al. Critical Care for COVID-19 Affected Patients: Position Statement of the Indian Society of Critical Care Medicine. Indian J Crit Care Med 2020;24(Suppl 5):S225–S230.
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Affiliation(s)
- Yatin Mehta
- Department of Critical Care and Anesthesiology, Medanta: The Medicity, Gurugram, Haryana, India
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - O C Abraham
- Infectious Disease Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Jose Chacko
- Critical Care Medicine, Narayana Hrudyala, Bengaluru, Karnataka, India
| | - Jigeeshu Divatia
- Critical Care and Anesthesia, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Bharat Jagiasi
- Department of Critical Care, Reliance Hospital, Navi Mumbai, Maharashtra, India
| | - Arindam Kar
- CK Birla Hospitals, Gurugram, Haryana, India; CMRI Institute of Critical Care, Kolkata, West Bengal, India; Indian Society of Critical Care Medicine; European Society of Intensive Care Medicine
| | - G C Khilnani
- Department of Pulmonary, Critical Care and Sleep Medicine, PSRI Hospital, New Delhi, India
| | - Bhuvana Krishna
- Department of Critical Care Medicine, St. John's Hospital, Bengaluru, Karnataka, India
| | - Prashant Kumar
- Department of Anaesthesiology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - R K Mani
- Critical Care and Pulmonology, Batra Hospital and Medical Research Centre, New Delhi, India
| | - B K Rao
- Department of Critical Care and Emergency Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Pawan K Singh
- Department of Pulmonary and Critical Care, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Sanjeev Singh
- Amrita Institute of Medical Sciences, Ernakulam, Kerala, India; Amrita Hospitals, Faridabad, Haryana, India
| | - Pavan Tiwary
- All India Institute of Medical Sciences, New Delhi, India
| | - Chand Wattal
- Clinical Microbiology and Immunology, Sir Ganga Ram Hospital, New Delhi, India
| | - Deepak Govil
- Institute of Critical Care and Anesthesiology, Medanta: The Medicity, Gurugram, Haryana, India
| | - Subhal Dixit
- Department of Critical Care Medicine, Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Srinivas Samavedam
- Department of Critical Care, Virinchi Hospital, Hyderabad, Telangana, India
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Gupta S, Dixit S, Choudhry D, Govil D, Mishra RC, Samavedam S, Zirpe K, Srinivasan S, Mohamed Z, Gupta KV, Wanchoo J, Chakrabortty N, Gurav S. Tracheostomy in Adult Intensive Care Unit: An ISCCM Expert Panel Practice Recommendations. Indian J Crit Care Med 2020; 24:S31-S42. [PMID: 32205955 PMCID: PMC7085814 DOI: 10.5005/jp-journals-10071-g23184] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND AIM Critically ill patients on mechanical ventilation undergo tracheostomy to facilitate weaning. The practice in India may be different from the rest of the world and therefore, in order to understand this, ISCCM conducted a multicentric observational study "DIlatational percutaneous vs Surgical tracheoStomy in intEnsive Care uniT: A practice pattern observational multicenter study (DISSECT Study)" followed by an ISCCM Expert Panel committee meeting to formulate Practice recommendations pertinent to Indian ICUs. MATERIALS AND METHODS All existing International guidelines on the topic, various randomized controlled trials, meta-analysis, systematic reviews, retrospective studies were taken into account to formulate the guidelines. Wherever Indian data was not available, international data was analysed. A modified Grade system was followed for grading the recommendation. RESULTS After analyzing the entire available data, the recommendations were made by the grading system agreed by the Expert Panel. The recommendations took into account the indications and contraindications of tracheostomy; effect of timing of tracheostomy on incidence of ventilator associated pneumonia, ICU length of stay, ventilator free days & Mortality; comparison of surgical and percutaneous dilatational tracheostomy (PDT) in terms of incidence of complications and cost to the patient; Comparison of various techniques of PDT; Use of fiberoptic bronchoscope and ultrasound in PDT; experience of the operator and qualification; certain special conditions like coagulopathy and morbid obesity. CONCLUSION This document presents the first Indian recommendations on tracheostomy in adult critically ill patients based on the practices of the country. These guidelines are expected to improve the safety and extend the indications of tracheostomy in critically ill patients. HOW TO CITE THIS ARTICLE Gupta S, Dixit S, Choudhry D, Govil D, Mishra RC, Samavedam S, Tracheostomy in Adult Intensive Care Unit: An ISCCM Expert Panel Practice Recommendations. Indian J Crit Care Med 2020;24(Suppl 1):S31-S42.
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Affiliation(s)
- Sachin Gupta
- Department of Critical Care Medicine, Narayana Superspeciality Hospital, Gurugram, Haryana, India, , e-mail:
| | - Subhal Dixit
- Department of Critical Care Medicine, Sanjeevan & MJM Hospital, Pune, Maharashtra, India, , e-mail:
| | - Dhruva Choudhry
- Department of Pulmonary & Critical Care Medicine, University of Health Sciences Rohtak, Haryana, India, , e-mail:
| | - Deepak Govil
- Department of Critical Care, Institute of Critical Care & Anesthesiology, Medanta The Medicity, Gurugram, Haryana, India, , e-mail:
| | | | - Srinivas Samavedam
- Department of Critical Care, Virinchi Hospital, Hyderabad, Telangana, India, , e-mail:
| | - Kapil Zirpe
- Department of Neurocritical Care, Ruby Hall Clinic, Grant Medical Foundation, Pune, Maharashtra, India, , e-mail:
| | - Shrikanth Srinivasan
- Department of Critical Care Medicine, Manipal Hospitals, New Delhi, India, , e-mail:
| | - Zubair Mohamed
- Department of Organ Transplant Anaesthesia and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India, , e-mail:
| | - Kv Venkatesha Gupta
- Department of Critical Care Medicine, Manipal Hospitals, Bengaluru, Karnataka, India, , e-mail:
| | - Jaya Wanchoo
- Department of Neuroanaesthesia and Critical Care, Institute of Neurosciences, Medanta The Medicity, Gurugram, Haryana, India, , e-mail:
| | - Nilanchal Chakrabortty
- Department of Neurointensive Care, Institute of Neurosciences, Kolkata, West Bengal, India, , e-mail:
| | - Sushma Gurav
- Department of Neurocritical Care, Ruby Hall Clinic, Grant Medical Foundation, Pune, Maharashtra, India, , e-mail:
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Pande RK, Bhalla A, Myatra SN, Yaddanpuddi LN, Gupta S, Sahoo TK, Prakash R, Sahu TA, Jain A, Gopal PB, Chaudhry D, Govil D, Dixit S, Samavedam S. Procedures in COVID-19 Patients: Part-II. Indian J Crit Care Med 2020; 24:S272-S279. [PMID: 33354051 PMCID: PMC7724929 DOI: 10.5005/jp-journals-10071-23604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Critical care in the era of novel coronavirus disease-2019 (COVID-19) infection has multiple challenges including management of the patient, underlying comorbidities, and the complications. With no end in sight to the pandemic, intensive care unit (ICU) practitioners and hospital administrators have to join hands to prepare for the long battle ahead. Critically ill COVID-19 patients need imaging or image-guided interventions in one form or the other including X-rays, ultrasonography (USG), echocardiography (ECHO), and CT scan. These patients often require renal replacement therapy (RRT) for either the preexisting chronic renal insufficiency or acutely developing kidney injury. Another important component of care is transfer of the patient to and fro from the ICU or to higher care centers. Most of the ICUs are equipped with modern facilities but with increasing number of patients a large number of makeshift arrangements are being made for managing these patients. This position paper outlines important tips to formulate protocols and procedures for critically ill patients, who are managed in the ICU. How to cite this article: Pande RK, Bhalla A, Myatra SN, Yaddanpuddi LN, Gupta S, Sahoo TK, et al. Procedures in COVID-19 Patients: Part-II. Indian J Crit Care Med 2020;24(Suppl 5):S272–S279.
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Affiliation(s)
- Rajesh K Pande
- Department of Critical Care Medicine, BLK Center for Critical Care, BLK Superspeciality Hospital, New Delhi, India
| | - Ashish Bhalla
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sheila N Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Lakshmi N Yaddanpuddi
- Department of Anaesthesiology and Critical Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sachin Gupta
- Department of Critical Care, Narayana Superspeciality Hospital, Gurugram, Haryana, India
| | - Tapas K Sahoo
- Department of Critical Care Medicine, Institute of Critical Care, Medanta Hospital, Ranchi, Jharkhand, India
| | - Ravi Prakash
- Department of Critical Care Medicine, BLK Center for Critical Care, BLK Superspeciality Hospital, New Delhi, India
| | - Tarun A Sahu
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Akansha Jain
- Department of Paediatric ICU, Bhagwan Mahavir Medica Superspecialty Hospital, Ranchi, Jharkhand, India
| | - Palepu Bn Gopal
- Department of Critical Care, Continental Hospital, Hyderabad, Telangana, India
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Deepak Govil
- Department of Critical Care Medicine, Institute of Critical Care and Anesthesia, Medanta: The Medicity, Gurugram, Haryana, India
| | - Subhal Dixit
- Department of Critical Care Medicine, Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Srinivas Samavedam
- Department of Critical Care, Virinchi Hospital, Hyderabad, Telangana, India
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Sahoo L, Sahoo S, Mohanty M, Sankar M, Dixit S, Das P, Rasal KD, Rather MA, Sundaray JK. Molecular characterization, computational analysis and expression profiling of Dmrt1 gene in Indian major carp, Labeo rohita (Hamilton 1822). Anim Biotechnol 2019; 32:413-426. [PMID: 31880491 DOI: 10.1080/10495398.2019.1707683] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Sexual dimorphism of fish morphology, physiology and behavior is diverse and complex in nature. Doublesex and mab-3 related transcription factor (Dmrt) is a large protein family whose function is sexual development and differentiation in vertebrates. Here, we report a full-length cDNA sequence of Labeo rohita (rohu) Dmrt1 of 907 bp length having 798 bp of open reading frame encoding 265 amino acids. The molecular weight of rohu DMRT1 protein was found to be 28.74 KDa and isoelectric point was 7.53. DMRT1 protein contains 23 positively and 24 negatively charged amino acids with a GRAVY score of -0.618. A characteristic DM domain was found in DMRT1 protein, which is a novel DNA-binding domain. Phylogenetic analysis showed maximum similarity with Cyprinus carpio when compared with DMRT1 of other vertebrates. Molecular docking study identified active sites to be targeted for drug designing. Rohu DMRT1 was observed to interact with other proteins such as FOXL2, CYP19a1a, AMH and SOX9a. Differential expression study revealed higher expression in testis tissue implying its role in male sex differentiation and testicular development. The information generated in the present work could facilitate further research to resolve the issues related to gonadal maturation and reproduction of commercially important aquaculture species.
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Affiliation(s)
- L Sahoo
- Fish Genetics and Biotechnology Division, ICAR-Central Institute of Freshwater Aquaculture, Bhubaneswar, Odisha, India
| | - S Sahoo
- Fish Genetics and Biotechnology Division, ICAR-Central Institute of Freshwater Aquaculture, Bhubaneswar, Odisha, India
| | - M Mohanty
- Fish Genetics and Biotechnology Division, ICAR-Central Institute of Freshwater Aquaculture, Bhubaneswar, Odisha, India
| | - M Sankar
- ICAR-Central Marine Research Institute, Mandapam Regional Centre, Tamil Nadu, India
| | - S Dixit
- Fish Genetics and Biotechnology Division, ICAR-Central Institute of Freshwater Aquaculture, Bhubaneswar, Odisha, India
| | - P Das
- Fish Genetics and Biotechnology Division, ICAR-Central Institute of Freshwater Aquaculture, Bhubaneswar, Odisha, India
| | - K D Rasal
- Fish Genetics and Biotechnology Division, ICAR-Central Institute of Freshwater Aquaculture, Bhubaneswar, Odisha, India
| | - M A Rather
- Division of Fish genetics and Biotechnology, Faculty of Fisheries, Sher-e-Kashmir University of Agricultural Sciences & Technology of Kashmir, Srinagar, Jammu and Kashmir, India
| | - J K Sundaray
- Fish Genetics and Biotechnology Division, ICAR-Central Institute of Freshwater Aquaculture, Bhubaneswar, Odisha, India
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Dwibedi B, Sabat J, Dixit S, Rathore S, Subhadra S, Panda S, Pati SS, Mandal M, Ho LM, Thakur B, Kar SK. Epidemiological and clinical profile of Influenza A(H1N1) pdm09 in Odisha, eastern India. Heliyon 2019; 5:e02639. [PMID: 31667431 PMCID: PMC6812237 DOI: 10.1016/j.heliyon.2019.e02639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 08/07/2019] [Accepted: 10/08/2019] [Indexed: 11/09/2022] Open
Abstract
Epidemic of flu is highly contagious and it spreads through air. In 2009 H1N1 influenza virus emerged after reassortment of North American TRIG and Eurasia Avian like virus of swine and started epidemic in Mexico. The first cases were reported from Hyderabad city on 16th May 2009 in India that spread rapidly within a short span of time. During this period large population of Odisha situated at the eastern side of India was also affected and incidences of H1N1 cases were recorded through state Government surveillance system. In this study real time RT-PCR based diagnosis was conducted for the throat swabs collected from suspected H1N1 cases in Odisha during 2009–2017. A total of 2872 throat swabs were received from 23 different Government and private hospitals and 21.1% positivity was confirmed. The disease affected mostly 46–60 years age group, males (50.6%) being more affected. The clinical features had shown that fever with cough (89.6%) was the most common symptom followed by shortness of breath (72.7%). Post monsoon was the peak season in which most of the cases were reported. Neurological signs, pregnancy, diabetes and hypertension were found to be risk factors for H1N1. The case fatality rate (CFR) was 15%.
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Affiliation(s)
- B Dwibedi
- Dept. of Pediatrics, AIIMS, Bhubaneswar, Odisha, India
| | - J Sabat
- Virus Research and Diagnostic Laboratory, Regional Medical Research Centre (ICMR), Bhubaneswar, Odisha, India
| | - S Dixit
- Virus Research and Diagnostic Laboratory, Regional Medical Research Centre (ICMR), Bhubaneswar, Odisha, India
| | - S Rathore
- Virus Research and Diagnostic Laboratory, Regional Medical Research Centre (ICMR), Bhubaneswar, Odisha, India
| | - S Subhadra
- Virus Research and Diagnostic Laboratory, Regional Medical Research Centre (ICMR), Bhubaneswar, Odisha, India
| | - S Panda
- Virus Research and Diagnostic Laboratory, Regional Medical Research Centre (ICMR), Bhubaneswar, Odisha, India
| | - S S Pati
- Virus Research and Diagnostic Laboratory, Regional Medical Research Centre (ICMR), Bhubaneswar, Odisha, India
| | - M Mandal
- Virus Research and Diagnostic Laboratory, Regional Medical Research Centre (ICMR), Bhubaneswar, Odisha, India
| | - L M Ho
- Virus Research and Diagnostic Laboratory, Regional Medical Research Centre (ICMR), Bhubaneswar, Odisha, India
| | - B Thakur
- Virus Research and Diagnostic Laboratory, Regional Medical Research Centre (ICMR), Bhubaneswar, Odisha, India
| | - S K Kar
- SOA University, Bhubaneswar, Odisha, India
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Sabat J, Subhadra S, Thakur B, Panda M, Panda S, Pati SS, Ho LM, Dixit S, Rathore SK, Kar SK, Dwibedi B. Molecular and phylogenetic analysis of the dengue strains circulating in Odisha, India. Virusdisease 2019; 30:380-386. [PMID: 31803805 DOI: 10.1007/s13337-019-00544-3] [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] [Received: 07/05/2019] [Accepted: 07/08/2019] [Indexed: 02/02/2023] Open
Abstract
Dengue has emerged as a major public health challenge in terms of both changing clinical pattern and epidemiological features. The state of Odisha reported first dengue epidemic in the year 2010 and this continued each year in epidemic form during post monsoon period gradually becoming an endemic phenomenon. Present study depicts the changing epidemiological and clinical pattern of dengue with reference to its serotypes and genotypes. The study included 5320 suspected dengue cases from different health facilities of the state during 2010-2017. Dengue NS1 antigen and IgM antibody was done through ELISA. Serotyping was done through RTPCR by amplifying a part of core-pre-membrane gene (CprM) followed by sequencing and phylogenetic analysis. Dengue IgM antibody in 17.7% cases and NS1 antigen in 53.20% cases was detected. Dengue serotype 2 (DEN-2) was the only serotype detected in 2010 and 2011 where as all four serotypes 1, 2, 3, 4 were detected in 2012-2017, DEN-2 being dominant but in 2017 DEN-3 was found to be dominant. Phylogenetic analysis revealed genotype IV of DEN-2 and genotype III of DEN-1 and DEN-3 circulating in this region. In 6 cases involvement of DEN-2 in clinically evident encephalitis cases is an important observation in this region and needs public health attention. High prevalence of dengue was observed without any previous reported outbreaks in the state with increased number of cases from 2010 to 2012 affecting both urban and rural areas. High incidence in 2012 was due to co-circulation of more than one serotype which continued in the following years. Severity in some cases was associated with mixed infection but in most cases it was mild indicating the endemic nature of the virus in most parts of Odisha.
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Affiliation(s)
- J Sabat
- 2ICMR- Regional Medical Research Centre, Bhubaneswar, Odisha 751023 India
| | - S Subhadra
- 2ICMR- Regional Medical Research Centre, Bhubaneswar, Odisha 751023 India
| | - B Thakur
- 2ICMR- Regional Medical Research Centre, Bhubaneswar, Odisha 751023 India
| | - M Panda
- 2ICMR- Regional Medical Research Centre, Bhubaneswar, Odisha 751023 India
| | - S Panda
- 2ICMR- Regional Medical Research Centre, Bhubaneswar, Odisha 751023 India
| | - S S Pati
- 2ICMR- Regional Medical Research Centre, Bhubaneswar, Odisha 751023 India
| | - L M Ho
- 2ICMR- Regional Medical Research Centre, Bhubaneswar, Odisha 751023 India
| | - S Dixit
- 2ICMR- Regional Medical Research Centre, Bhubaneswar, Odisha 751023 India
| | - S K Rathore
- 2ICMR- Regional Medical Research Centre, Bhubaneswar, Odisha 751023 India
| | - S K Kar
- 3Directorate of Medical research, IMS & SUM Hospital, S 'O' A University, Bhubaneswar, Odisha 751030 India
| | - B Dwibedi
- 1Department of Pediatrics, AIIMS, Bhubaneswar, Odisha 751019 India
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Koppiker C, Noor A, Dixit S, Busheri L, Sharan G, Dhar U, Allampati H, Nare S. Surgical management of multifocal/multicentric and locally advanced breast cancer with extreme oncoplasty. Breast 2019. [DOI: 10.1016/s0960-9776(19)30371-6] [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: 11/29/2022] Open
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Triolo TM, Fouts A, Pyle L, Yu L, Gottlieb PA, Steck AK, Greenbaum CJ, Atkinson M, Baidal D, Battaglia M, Becker D, Bingley P, Bosi E, Buckner J, Clements M, Colman P, DiMeglio L, Gitelman S, Goland R, Gottlieb P, Herold K, Knip M, Krischer J, Lernmark A, Moore W, Moran A, Muir A, Palmer J, Peakman M, Philipson L, Raskin P, Redondo M, Rodriguez H, Russell W, Spain L, Schatz D, Sosenko J, Wentworth J, Wherrett D, Wilson D, Winter W, Ziegler A, Anderson M, Antinozzi P, Benoist C, Blum J, Bourcier K, Chase P, Clare-Salzler M, Clynes R, Eisenbarth G, Fathman C, Grave G, Hering B, Insel R, Kaufman F, Kay T, Leschek E, Mahon J, Marks J, Nanto-Salonen K, Nepom G, Orban T, Parkman R, Pescovitz M, Peyman J, Pugliese A, Roep B, Roncarolo M, Savage P, Simell O, Sherwin R, Siegelman M, Skyler J, Steck A, Thomas J, Trucco M, Wagner J, Krischer JP, Leschek E, Rafkin L, Bourcier K, Cowie C, Foulkes M, Insel R, Krause-Steinrauf H, Lachin JM, Malozowski S, Peyman J, Ridge J, Savage P, Skyler JS, Zafonte SJ, Rafkin L, Sosenko JM, Kenyon NS, Santiago I, Krischer JP, Bundy B, Abbondondolo M, Dixit S, Pasha M, King K, Adcock H, Atterberry L, Fox K, Englert N, Mauras J, Permuy K, Sikes T, Adams T, Berhe B, Guendling L, McLennan L, Paganessi C, Murphy M, Draznin M, Kamboj S, Sheppard V, Lewis L, Coates W, Amado D, Moore G, Babar J, Bedard D, Brenson-Hughes J, Cernich M, Clements R, Duprau S, Goodman L, Hester L, Huerta-Saenz A, Asif I, Karmazin T, Letjen S, Raman D, Morin W, Bestermann E, Morawski J, White A, Brockmyer R, Bays S, Campbell A, Boonstra M, Stapleton N, Stone A, Donoho H, Everett H, Hensley M, Johnson C, Marshall N, Skirvin P, Taylor R, Williams L, Burroughs C, Ray C, Wolverton D, Nickels C, Dothard P, Speiser M, Pellizzari L, Bokor K, Izuora S, Abdelnour P, Cummings S, Cuthbertson D, Paynor M, Leahy M, Riedl S, Shockley R, Saad T, Briones S, Casella C, Herz K, Walsh J, Greening F, Deemer M, Hay S, Hunt N, Sikotra L, Simons D, Karounos R, Oremus L, Dye L, Myers D, Ballard W, Miers R, Eberhard C, Sparks K, Thraikill K, Edwards J, Fowlkes S, Kemp A, Morales L, Holland L, Johnson P, Paul A, Ghatak K, Fiske S, Phelen H, Leyland T, Henderson D, Brenner E, Oppenheimer I, Mamkin C, Moniz C, Clarson M, Lovell A, Peters V, Ford J, Ruelas D, Borut D, Burt M, Jordan S, Castilla P, Flores M, Ruiz L, Hanson J, Green-Blair R, Sheridan K, Garmeson J, Wintergerst G, Pierce A, Omoruyi M, Foster S, Kingery A, Lunsford I, Cervantes T, Parker P, Price J, Urben I, Guillette H, Doughty H, Haydock V, Parker P, Bergman S, Duncum C, Rodda A, Perelman R, Calendo C, Barrera E, Arce-Nunez Y, Geyer S, Martinez M, De la Portilla I, Cardenas L, Garrido M, Villar R, Lorini E, Calandra G, D’Annuzio K, Perri N, Minuto C, Hays B, Rebora R, Callegari O, Ali J, Kramer B, Auble S, Cabrera P, Donohoue R, Fiallo-Scharer M, Hessner P, Wolfgram A, Henderson C, Kansra N, Bettin R, McCuller A, Miller S, Accacha J, Corrigan E, Fiore R, Levine T, Mahoney C, Polychronakos V, Henry M, Gagne H, Starkman M, Fox D, Chin F, Melchionne L, Silverman I, Marshall L, Cerracchio J, Cruz A, Viswanathan J, Heyman K, Wilson S, Chalew S, Valley S, Layburn A, Lala P, Clesi M, Genet G, Uwaifo A, Charron T, Allerton W, Hsiao B, Cefalu L, Melendez-Ramirez R, Richards C, Alleyn E, Gustafson M, Lizanna J, Wahlen S, Aleiwe M, Hansen H, Wahlen C, Karges C, Levy A, Bonaccorso R, Rapaport Y, Tomer D, Chia M, Goldis L, Iazzetti M, Klein C, Levister L, Waldman E, Keaton N, Wallach M, Regelmann Z, Antal M, Aranda C, Reynholds A, Vinik P, Barlow M, Bourcier M, Nevoret J, Couper S, Kinderman A, Beresford N, Thalagne H, Roper J, Gibbons J, Hill S, Balleaut C, Brennan J, Ellis-Gage L, Fear T, Gray L, Law P, Jones C, McNerney L, Pointer N, Price K, Few D, Tomlinson N, Leech D, Wake C, Owens M, Burns J, Leinbach A, Wotherspoon A, Murray K, Short G, Curry S, Kelsey J, Lawson J, Porter S, Stevens E, Thomson S, Winship L, Liu S, Wynn E, Wiltshire J, Krebs P, Cresswell H, Faherty C, Ross L, Denvir J, Drew T, Randell P, Mansell S, Lloyd J, Bell S, Butler Y, Hooton H, Navarra A, Roper G, Babington L, Crate H, Cripps A, Ledlie C, Moulds R, Malloy J, Norton B, Petrova O, Silkstone C, Smith K, Ghai M, Murray V, Viswanathan M, Henegan O, Kawadry J, Olson L, Maddox K, Patterson T, Ahmad B, Flores D, Domek S, Domek K, Copeland M, George J, Less T, Davis M, Short A, Martin J, Dwarakanathan P, O’Donnell B, Boerner L, Larson M, Phillips M, Rendell K, Larson C, Smith K, Zebrowski L, Kuechenmeister M, Miller J, Thevarayapillai M, Daniels H, Speer N, Forghani R, Quintana C, Reh A, Bhangoo P, Desrosiers L, Ireland T, Misla C, Milliot E, Torres S, Wells J, Villar M, Yu D, Berry D, Cook J, Soder A, Powell M, Ng M, Morrison Z, Moore M, Haslam M, Lawson B, Bradley J, Courtney C, Richardson C, Watson E, Keely D, DeCurtis M, Vaccarcello-Cruz Z, Torres K, Muller S, Sandberg H, Hsiang B, Joy D, McCormick A, Powell H, Jones J, Bell S, Hargadon S, Hudson M, Kummer S, Nguyen T, Sauder E, Sutton K, Gensel R, Aguirre-Castaneda V, Benavides, Lopez D, Hemp S, Allen J, Stear E, Davis T, O’Donnell R, Jones A, Roberts J, Dart N, Paramalingam L, Levitt Katz N, Chaudhary K, Murphy S, Willi B, Schwartzman C, Kapadia D, Roberts A, Larson D, McClellan G, Shaibai L, Kelley G, Villa C, Kelley R, Diamond M, Kabbani T, Dajani F, Hoekstra M, Sadler K, Magorno J, Holst V, Chauhan N, Wilson P, Bononi M, Sperl A, Millward M, Eaton L, Dean J, Olshan H, Stavros T, Renna C, Milliard, Brodksy L, Bacon J, Quintos L, Topor S, Bialo B, Bancroft A, Soto W, Lagarde H, Tamura R, Lockemer T, Vanderploeg M, Ibrahim M, Huie V, Sanchez R, Edelen R, Marchiando J, Palmer T, Repas M, Wasson P, Wood K, Auker J, Culbertson T, Kieffer D, Voorhees T, Borgwardt L, DeRaad K, Eckert E, Isaacson H, Kuhn A, Carroll M, Xu P, Schubert G, Francis S, Hagan T, Le M, Penn E, Wickham C, Leyva K, Rivera J, Padilla I, Rodriguez N, Young K, Jospe J, Czyzyk B, Johnson U, Nadgir N, Marlen G, Prakasam C, Rieger N, Glaser E, Heiser B, Harris C, Alies P, Foster H, Slater K, Wheeler D, Donaldson M, Murray D, Hale R, Tragus D, Word J, Lynch L, Pankratz W, Badias F, Rogers R, Newfield S, Holland M, Hashiguchi M, Gottschalk A, Philis-Tsimikas R, Rosal S, Franklin S, Guardado N, Bohannon M, Baker A, Garcia T, Aguinaldo J, Phan V, Barraza D, Cohen J, Pinsker U, Khan J, Wiley L, Jovanovic P, Misra M, Bassi M, Wright D, Cohen K, Huang M, Skiles S, Maxcy C, Pihoker K, Cochrane J, Fosse S, Kearns M, Klingsheim N, Beam C, Wright L, Viles H, Smith S, Heller M, Cunningham A, Daniels L, Zeiden J, Field R, Walker K, Griffin L, Boulware D, Bartholow C, Erickson J, Howard B, Krabbenhoft C, Sandman A, Vanveldhuizen J, Wurlger A, Zimmerman K, Hanisch L, Davis-Keppen A, Bounmananh L, Cotterill J, Kirby M, Harris A, Schmidt C, Kishiyama C, Flores J, Milton W, Martin C, Whysham A, Yerka T, Bream S, Freels J, Hassing J, Webster R, Green P, Carter J, Galloway D, Hoelzer S, Roberts S, Said P, Sullivan H, Freeman D, Allen E, Reiter E, Feinberg C, Johnson L, Newhook D, Hagerty N, White L, Levandoski J, Kyllo M, Johnson C, Gough J, Benoit P, Iyer F, Diamond H, Hosono S, Jackman L, Barette P, Jones I, Sills S, Bzdick J, Bulger R, Ginem J, Weinstock I, Douek R, Andrews G, Modgill G, Gyorffy L, Robin N, Vaidya S, Crouch K, O’Brien C, Thompson N, Granger M, Thorne J, Blumer J, Kalic L, Klepek J, Paulett B, Rosolowski J, Horner M, Watkins J, Casey K, Carpenter C, Michelle Kieffer MH, Burns J, Horton C, Pritchard D, Soetaert A, Wynne C, Chin O, Molina C, Patel R, Senguttuvan M, Wheeler O, Lane P, Furet C, Steuhm D, Jelley S, Goudeau L, Chalmers D, Greer C, Panagiotopoulos D, Metzger D, Nguyen M, Horowitz M, Linton C, Christiansen E, Glades C, Morimoto M, Macarewich R, Norman K, Patin C, Vargas A, Barbanica A, Yu P, Vaidyanathan W, Nallamshetty L, Osborne R, Mehra S, Kaster S, Neace J, Horner G, Reeves C, Cordrey L, Marrs T, Miller S, Dowshen D, Oduah V, Doyle S, Walker D, Catte H, Dean M, Drury-Brown B, Hackman M, Lee S, Malkani K, Cullen K, Johnson P, Parrimon Y, Hampton M, McCarrell C, Curtis E, Paul, Zambrano Y, Paulus K, Pilger J, Ramiro J, Luvon Ritzie AQ, Sharma A, Shor A, Song X, Terry A, Weinberger J, Wootten M, Lachin JM, Foulkes M, Harding P, Krause-Steinrauf H, McDonough S, McGee PF, Owens Hess K, Phoebus D, Quinlan S, Raiden E, Batts E, Buddy C, Kirpatrick K, Ramey M, Shultz A, Webb C, Romesco M, Fradkin J, Leschek E, Spain L, Savage P, Aas S, Blumberg E, Beck G, Brillon D, Gubitosi-Klug R, Laffel L, Vigersky R, Wallace D, Braun J, Lernmark A, Lo B, Mitchell H, Naji A, Nerup J, Orchard T, Steffes M, Tsiatis A, Veatch R, Zinman B, Loechelt B, Baden L, Green M, Weinberg A, Marcovina S, Palmer JP, Weinberg A, Yu L, Babu S, Winter W, Eisenbarth GS, Bingley P, Clynes R, DiMeglio L, Eisenbarth G, Hays B, Leschek E, Marks J, Matheson D, Rafkin L, Rodriguez H, Spain L, Wilson D, Redondo M, Gomez D, McDonald A, Pena S, Pietropaolo M, Shippy K, Batts E, Brown T, Buckner J, Dove A, Hammond M, Hefty D, Klein J, Kuhns K, Letlau M, Lord S, McCulloch-Olson M, Miller L, Nepom G, Odegard J, Ramey M, Sachter E, St. Marie M, Stickney K, VanBuecken D, Vellek B, Webber C, Allen L, Bollyk J, Hilderman N, Ismail H, Lamola S, Sanda S, Vendettuoli H, Tridgell D, Monzavi R, Bock M, Fisher L, Halvorson M, Jeandron D, Kim M, Wood J, Geffner M, Kaufman F, Parkman R, Salazar C, Goland R, Clynes R, Cook S, Freeby M, Pat Gallagher M, Gandica R, Greenberg E, Kurland A, Pollak S, Wolk A, Chan M, Koplimae L, Levine E, Smith K, Trast J, DiMeglio L, Blum J, Evans-Molina C, Hufferd R, Jagielo B, Kruse C, Patrick V, Rigby M, Spall M, Swinney K, Terrell J, Christner L, Ford L, Lynch S, Menendez M, Merrill P, Pescovitz M, Rodriguez H, Alleyn C, Baidal D, Fay S, Gaglia J, Resnick B, Szubowicz S, Weir G, Benjamin R, Conboy D, deManbey A, Jackson R, Jalahej H, Orban T, Ricker A, Wolfsdorf J, Zhang HH, Wilson D, Aye T, Baker B, Barahona K, Buckingham B, Esrey K, Esrey T, Fathman G, Snyder R, Aneja B, Chatav M, Espinoza O, Frank E, Liu J, Perry J, Pyle R, Rigby A, Riley K, Soto A, Gitelman S, Adi S, Anderson M, Berhel A, Breen K, Fraser K, Gerard-Gonzalez A, Jossan P, Lustig R, Moassesfar S, Mugg A, Ng D, Prahalod P, Rangel-Lugo M, Sanda S, Tarkoff J, Torok C, Wesch R, Aslan I, Buchanan J, Cordier J, Hamilton C, Hawkins L, Ho T, Jain A, Ko K, Lee T, Phelps S, Rosenthal S, Sahakitrungruang T, Stehl L, Taylor L, Wertz M, Wong J, Philipson L, Briars R, Devine N, Littlejohn E, Grant T, Gottlieb P, Klingensmith G, Steck A, Alkanani A, Bautista K, Bedoy R, Blau A, Burke B, Cory L, Dang M, Fitzgerald-Miller L, Fouts A, Gage V, Garg S, Gesauldo P, Gutin R, Hayes C, Hoffman M, Ketchum K, Logsden-Sackett N, Maahs D, Messer L, Meyers L, Michels A, Peacock S, Rewers M, Rodriguez P, Sepulbeda F, Sippl R, Steck A, Taki I, Tran BK, Tran T, Wadwa RP, Zeitler P, Barker J, Barry S, Birks L, Bomsburger L, Bookert T, Briggs L, Burdick P, Cabrera R, Chase P, Cobry E, Conley A, Cook G, Daniels J, DiDomenico D, Eckert J, Ehler A, Eisenbarth G, Fain P, Fiallo-Scharer R, Frank N, Goettle H, Haarhues M, Harris S, Horton L, Hutton J, Jeffrrey J, Jenison R, Jones K, Kastelic W, King MA, Lehr D, Lungaro J, Mason K, Maurer H, Nguyen L, Proto A, Realsen J, Schmitt K, Schwartz M, Skovgaard S, Smith J, Vanderwel B, Voelmle M, Wagner R, Wallace A, Walravens P, Weiner L, Westerhoff B, Westfall E, Widmer K, Wright H, Schatz D, Abraham A, Atkinson M, Cintron M, Clare-Salzler M, Ferguson J, Haller M, Hosford J, Mancini D, Rohrs H, Silverstein J, Thomas J, Winter W, Cole G, Cook R, Coy R, Hicks E, Lewis N, Marks J, Pugliese A, Blaschke C, Matheson D, Pugliese A, Sanders-Branca N, Ray Arce LA, Cisneros M, Sabbag S, Moran A, Gibson C, Fife B, Hering B, Kwong C, Leschyshyn J, Nathan B, Pappenfus B, Street A, Boes MA, Peterson Eck S, Finney L, Albright Fischer T, Martin A, Jacqueline Muzamhindo C, Rhodes M, Smith J, Wagner J, Wood B, Becker D, Delallo K, Diaz A, Elnyczky B, Libman I, Pasek B, Riley K, Trucco M, Copemen B, Gwynn D, Toledo F, Rodriguez H, Bollepalli S, Diamond F, Eyth E, Henson D, Lenz A, Shulman D, Raskin P, Adhikari S, Dickson B, Dunnigan E, Lingvay I, Pruneda L, Ramos-Roman M, Raskin P, Rhee C, Richard J, Siegelman M, Sturges D, Sumpter K, White P, Alford M, Arthur J, Aviles-Santa ML, Cordova E, Davis R, Fernandez S, Fordan S, Hardin T, Jacobs A, Kaloyanova P, Lukacova-Zib I, Mirfakhraee S, Mohan A, Noto H, Smith O, Torres N, Wherrett D, Balmer D, Eisel L, Kovalakovska R, Mehan M, Sultan F, Ahenkorah B, Cevallos J, Razack N, Jo Ricci M, Rhode A, Srikandarajah M, Steger R, Russell WE, Black M, Brendle F, Brown A, Moore D, Pittel E, Robertson A, Shannon A, Thomas JW, Herold K, Feldman L, Sherwin R, Tamborlane W, Weinzimer S, Toppari J, Kallio T, Kärkkäinen M, Mäntymäki E, Niininen T, Nurmi B, Rajala P, Romo M, Suomenrinne S, Näntö-Salonen K, Simell O, Simell T, Bosi E, Battaglia M, Bianconi E, Bonfanti R, Grogan P, Laurenzi A, Martinenghi S, Meschi F, Pastore M, Falqui L, Teresa Muscato M, Viscardi M, Bingley P, Castleden H, Farthing N, Loud S, Matthews C, McGhee J, Morgan A, Pollitt J, Elliot-Jones R, Wheaton C, Knip M, Siljander H, Suomalainen H, Colman P, Healy F, Mesfin S, Redl L, Wentworth J, Willis J, Farley M, Harrison L, Perry C, Williams F, Mayo A, Paxton J, Thompson V, Volin L, Fenton C, Carr L, Lemon E, Swank M, Luidens M, Salgam M, Sharma V, Schade D, King C, Carano R, Heiden J, Means N, Holman L, Thomas I, Madrigal D, Muth T, Martin C, Plunkett C, Ramm C, Auchus R, Lane W, Avots E, Buford M, Hale C, Hoyle J, Lane B, Muir A, Shuler S, Raviele N, Ivie E, Jenkins M, Lindsley K, Hansen I, Fadoju D, Felner E, Bode B, Hosey R, Sax J, Jefferies C, Mannering S, Prentis R, She J, Stachura M, Hopkins D, Williams J, Steed L, Asatapova E, Nunez S, Knight S, Dixon P, Ching J, Donner T, Longnecker S, Abel K, Arcara K, Blackman S, Clark L, Cooke D, Plotnick L, Levin P, Bromberger L, Klein K, Sadurska K, Allen C, Michaud D, Snodgrass H, Burghen G, Chatha S, Clark C, Silverberg J, Wittmer C, Gardner J, LeBoeuf C, Bell P, McGlore O, Tennet H, Alba N, Carroll M, Baert L, Beaton H, Cordell E, Haynes A, Reed C, Lichter K, McCarthy P, McCarthy S, Monchamp T, Roach J, Manies S, Gunville F, Marosok L, Nelson T, Ackerman K, Rudolph J, Stewart M, McCormick K, May S, Falls T, Barrett T, Dale K, Makusha L, McTernana C, Penny-Thomas K, Sullivan K, Narendran P, Robbie J, Smith D, Christensen R, Koehler B, Royal C, Arthur T, Houser H, Renaldi J, Watsen S, Wu P, Lyons L, House B, Yu J, Holt H, Nation M, Vickers C, Watling R, Heptulla R, Trast J, Agarwal C, Newell D, Katikaneni R, Gardner C, Del A, Rio A, Logan H, Collier C, Rishton G, Whalley A, Ali S, Ramtoola T, Quattrin L, Mastrandea A, House M, Ecker C, Huang C, Gougeon J, Ho D, Pacuad D, Dunger J, May C, O’Brien C, Acerini B, Salgin A, Thankamony R, Williams J, Buse G, Fuller M, Duclos J, Tricome H, Brown D, Pittard D, Bowlby A, Blue T, Headley S, Bendre K, Lewis K, Sutphin C, Soloranzo J, Puskaric H, Madison M, Rincon M, Carlucci R, Shridharani B, Rusk E, Tessman D, Huffman H, Abrams B, Biederman M, Jones V, Leathers W, Brickman P, Petrie D, Zimmerman J, Howard L, Miller R, Alemzadeh D, Mihailescu R, Melgozza-Walker N, Abdulla C, Boucher-Berry D, Ize-Ludlow R, Levy C, Swenson, Brousell N, Crimmins D, Edler T, Weis C, Schultz D, Rogers D, Latham C, Mawhorter C, Switzer W, Spencer P, Konstantnopoulus S, Broder J, Klein L, Knight L, Szadek G, Welnick B, Thompson R, Hoffman A, Revell J, Cherko K, Carter E, Gilson J, Haines G, Arthur B, Bowen W, Zipf P, Graves R, Lozano D, Seiple K, Spicer A, Chang J, Fregosi J, Harbinson C, Paulson S, Stalters P, Wright D, Zlock A, Freeth J, Victory H, Maheshwari A, Maheshwari T, Holmstrom J, Bueno R, Arguello J, Ahern L, Noreika V, Watson S, Hourse P, Breyer C, Kissel Y, Nicholson M, Pfeifer S, Almazan J, Bajaj M, Quinn K, Funk J, McCance E, Moreno R, Veintimilla A, Wells J, Cook S, Trunnel J, Henske S, Desai K, Frizelis F, Khan R, Sjoberg K, Allen P, Manning G, Hendry B, Taylor S, Jones W, Strader M, Bencomo T, Bailey L, Bedolla C, Roldan C, Moudiotis B, Vaidya C, Anning S, Bunce S, Estcourt E, Folland E, Gordon C, Harrill J, Ireland J, Piper L, Scaife K, Sutton S, Wilkins M, Costelloe J, Palmer L, Casas C, Miller M, Burgard C, Erickson J, Hallanger-Johnson P, Clark W, Taylor A, Lafferty S, Gillett C, Nolan M, Pathak L, Sondrol T, Hjelle S, Hafner J, Kotrba R, Hendrickson A, Cemeroglu T, Symington M, Daniel Y, Appiagyei-Dankah D, Postellon M, Racine L, Kleis K, Barnes S, Godwin H, McCullough K, Shaheen G, Buck L, Noel M, Warren S, Weber S, Parker I, Gillespie B, Nelson C, Frost J, Amrhein E, Moreland A, Hayes J, Peggram J, Aisenberg M, Riordan J, Zasa E, Cummings K, Scott T, Pinto A, Mokashi K, McAssey E, Helden P, Hammond L, Dinning S, Rahman S, Ray C, Dimicri S, Guppy H, Nielsen C, Vogel C, Ariza L, Morales Y, Chang R, Gabbay L, Ambrocio L, Manley R, Nemery W, Charlton P, Smith L, Kerr B, Steindel-Kopp M, Alamaguer D, Liljenquist G, Browning T, Coughenour M, Sulk E, Tsalikan M, Tansey J, Cabbage N. Identical and Nonidentical Twins: Risk and Factors Involved in Development of Islet Autoimmunity and Type 1 Diabetes. Diabetes Care 2019; 42:192-199. [PMID: 30061316 PMCID: PMC6341285 DOI: 10.2337/dc18-0288] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/28/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE There are variable reports of risk of concordance for progression to islet autoantibodies and type 1 diabetes in identical twins after one twin is diagnosed. We examined development of positive autoantibodies and type 1 diabetes and the effects of genetic factors and common environment on autoantibody positivity in identical twins, nonidentical twins, and full siblings. RESEARCH DESIGN AND METHODS Subjects from the TrialNet Pathway to Prevention Study (N = 48,026) were screened from 2004 to 2015 for islet autoantibodies (GAD antibody [GADA], insulinoma-associated antigen 2 [IA-2A], and autoantibodies against insulin [IAA]). Of these subjects, 17,226 (157 identical twins, 283 nonidentical twins, and 16,786 full siblings) were followed for autoantibody positivity or type 1 diabetes for a median of 2.1 years. RESULTS At screening, identical twins were more likely to have positive GADA, IA-2A, and IAA than nonidentical twins or full siblings (all P < 0.0001). Younger age, male sex, and genetic factors were significant factors for expression of IA-2A, IAA, one or more positive autoantibodies, and two or more positive autoantibodies (all P ≤ 0.03). Initially autoantibody-positive identical twins had a 69% risk of diabetes by 3 years compared with 1.5% for initially autoantibody-negative identical twins. In nonidentical twins, type 1 diabetes risk by 3 years was 72% for initially multiple autoantibody-positive, 13% for single autoantibody-positive, and 0% for initially autoantibody-negative nonidentical twins. Full siblings had a 3-year type 1 diabetes risk of 47% for multiple autoantibody-positive, 12% for single autoantibody-positive, and 0.5% for initially autoantibody-negative subjects. CONCLUSIONS Risk of type 1 diabetes at 3 years is high for initially multiple and single autoantibody-positive identical twins and multiple autoantibody-positive nonidentical twins. Genetic predisposition, age, and male sex are significant risk factors for development of positive autoantibodies in twins.
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Affiliation(s)
- Taylor M. Triolo
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Alexandra Fouts
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Laura Pyle
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Liping Yu
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Peter A. Gottlieb
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Andrea K. Steck
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
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Mehta Y, Mithal A, Kulkarni A, Reddy BR, Sharma J, Dixit S, Zirpe K, Sivakumar MN, Bathina H, Chakravarti S, Joshi A, Rao S. Practice Guidelines for Enteral Nutrition Management in Dysglycemic Critically Ill Patients: A Relook for Indian Scenario. Indian J Crit Care Med 2019; 23:594-603. [PMID: 31988554 PMCID: PMC6970214 DOI: 10.5005/jp-journals-10071-23298] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background and aim Intensive-care practices and settings differ for India in comparison to other countries. While guidelines are available to direct the use of enteral nutrition (EN), there are no recommendations specific to nutritional management of EN in dysglycemic patients, specific to patients in Indian critical care settings. Advisory board meetings were arranged to develop the practice guidelines specific to the Indian context, for the use of EN in dysglycemic critically ill patients and to overcome challenges in this field. Materials and methods Two advisory board meetings were organized to review various existing guidelines, meta-analyses, randomized controlled trials (RCTs), controlled trials and review articles, for their contextual relevance and strength. Three rounds of Delphi voting were done to arrive at consensus on certain recommendations. A systematic grading of practice guidelines by the advisory board was done based on strength of the consensus voting and reviewed supporting evidences. Results Based on the literature review, the recommendations for developing the practice guidelines were made as per the grading criteria agreed upon by the advisory board. The recommendations were to address challenges regarding prediction and assessment of dysglycemia (DG), acceptable glycemic targets in such settings, general nutritional aspects pertaining to DG nutrition, and nutrition in various superspecialty cases in critical care settings, where DG is commonly encountered. Conclusion This paper summarizes the optimum EN practices for managing DG in critically ill patients. The practical solutions to overcome the challenges in this field are presented as practice guidelines at the end of each section. These guidelines are expected to provide guidance for EN management in dysglycemic critically ill patients. These guidelines also outline the model glycemic control task force and its roles in nutrition care as well as an intensive care unit DG nutrition protocol. How to cite this article Mehta Y, Mithal A, Kulkarni A, Reddy BR, Sharma J, Dixit S, et al. Practice Guidelines for Enteral Nutrition Management in Dysglycemic Critically Ill Patients: A Relook for Indian Scenario. Indian J Crit Care Med 2019;23(12):594–603.
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Affiliation(s)
- Yatin Mehta
- Institute of Critical Care and Anesthesiology, Medanta: The Medicity, Gurugram, Haryana, India
| | - Ambrish Mithal
- Department of Endocrinology and Diabetology, Institute of Endocrinology and Diabetology, Medanta: The Medicity, Gurugram, Haryana, India
| | - Atul Kulkarni
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - B Ravinder Reddy
- Department of Gastrointestinal Surgery, The Institute of Medical Sciences, Care Hospitals, Hyderabad, Telangana, India
| | - Jeetendra Sharma
- Department of Critical Care Medicine, Artemis Hospital, Gurugram, Haryana, India
| | - Subhal Dixit
- Department of Critical Care Medicine, Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Kapil Zirpe
- Department of Intensive Care and Neurotrauma-Stroke Unit, Ruby Hall Clinic, Pune, Maharashtra, India
| | - M N Sivakumar
- Department of Critical Care Medicine, Royal Care Super Specialty Hospital, Coimbatore, Tamil Nadu, India
| | - Harita Bathina
- Department of Dietetics, Apollo Hospitals, Hyderabad, Telangana, India
| | - Sanghamitra Chakravarti
- Department of Nutrition and Dietetics, Medica Superspecialty Hospital, Kolkata, West Bengal, India
| | - Anshu Joshi
- Department of Scientific and Medical Affairs, Abbott Nutrition International, India
| | - Sameer Rao
- Department of Scientific and Medical Affairs, Abbott Nutrition International, India
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Parikh S, Murray L, Kenning L, Bottomley D, Din O, Dixit S, Ferguson C, Handforth C, Joseph L, Mokhtar D, White L, Wright G, Henry A. Real-world Outcomes and Factors Predicting Survival and Completion of Radium 223 in Metastatic Castrate-resistant Prostate Cancer. Clin Oncol (R Coll Radiol) 2018; 30:548-555. [DOI: 10.1016/j.clon.2018.06.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/16/2018] [Accepted: 05/20/2018] [Indexed: 01/04/2023]
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Humagain M, Dixit S, Bhandari B, Khanal S, Singh PK. Self-Perception of Halitosis among Undergraduate Students of Kathmandu University School of Medical Sciences - A Questionnaire Based Study. Kathmandu Univ Med J (KUMJ) 2018; 16:89-93. [PMID: 30631025] [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]
Abstract
Background Halitosis is a frequently reported oral health problem worldwide with a prevalence rate of 10-30% in the general population. It is defined as the disagreeable or foul smelling breath originating consistently from a person's oral cavity. It not only effects the normal daily life activities of the patient but also bring humiliation, reduced self- esteem, ultimately resulting into decreased quality of life. Objective To determine the self-perception of halitosis among undergraduate students of different medical branches of Kathmandu University School of Medical Sciences (KUSMS); Kavre, Nepal. Method A descriptive cross-sectional epidemiological survey was conducted among undergraduate students of Physiotherapy, B.Sc Nursing, Bachelor of Nursing Sciences (BNS), MBBS and BDS program of Kathmandu University School of Medical Sciences, Dhulikhel. A self-administered questionnaire was developed and were distributed among 500 undergraduate students. Result Out of total 500 distributed questionnaires, 406 were completely filled and returned giving an overall response of 81.2%, in which 70 (89.7%) male and 280 (85.4%) female students from different medical branches were aware of the term halitosis. Among them 29 (7.14%) of students think that they suffer from halitosis. Similarly 178 (43.84%) students had severe impact of halitosis on their social life while 153 (37.68%) and 62 (15.27%) students had moderate and mild impact respectively. Conclusion Due to the multifactorial complexity of halitosis, further longitudinal studies including objective assessment of malodor are required to determine its prevalence and to further investigate the association of this problem with other etiological factors in the context of Nepal. Also, curriculum of different fields should be modified to include this simple but very necessary topic.
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Affiliation(s)
- M Humagain
- Department of Periodontology, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Dixit
- Department of Oral Medicine and Radiology, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - B Bhandari
- Department of Periodontology, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Khanal
- Department of Periodontology, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - P K Singh
- Department of Forensic Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
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Muser D, Liang J, Hayashi T, Castro S, Pathak R, Magnani S, Rame J, Zado E, Garcia F, Frankel D, Dixit S, Callans D, Zado E, Sinagra G, Marchlinski F, Santangeli P. 073_16945-L4 Severity of Heart Failure and Outcomes of Catheter Ablation of Ventricular Tachycardia in Nonischemic Dilated Cardiomyopathy. JACC Clin Electrophysiol 2017. [DOI: 10.1016/j.jacep.2017.09.060] [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]
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Muser D, Santangeli P, Liang J, Castro S, Hayashi T, Magnani S, Pathak R, Garcia F, Supple G, Riley M, Lin D, Schaller R, Dixit S, Zado E, Frankel D, Callans D, Marchlinski F. 073_16944-L4 Collateral Injury of the Conduction System During Interventricular Septal Substrate Modification In Non-Ischemic Cardiomyopathy: Impact on Long-term Outcomes. JACC Clin Electrophysiol 2017. [DOI: 10.1016/j.jacep.2017.09.142] [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]
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Chaurasia NK, Upadhyaya C, Dixit S. Comparative Study to Determine the efficacy of Zinc Oxide Eugenol and Alveogyl in Treatment of Dry Socket. Kathmandu Univ Med J (KUMJ) 2017; 15:203-206. [PMID: 30353893] [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: 06/08/2023]
Abstract
Background Dry socket is one of the most common complications following permanent tooth extraction, especially mandibular third molar. Management remains controversial and different authors have shown different results with the use of zinc oxide eugenol and AlveogylTM, some preferring AlveogylTM over zinc oxide eugenol. Objective To determine the incidence, possible risk factors and compare the effectiveness of two most commonly used agents (Zinc oxide eugenol and AlveogylTM) for management of dry socket. Method Dry socket patients were randomly divided into two groups. Various risk factors were recorded through proper history. After thorough irrigation with normal saline, zinc oxide eugenol paste mixed with cotton pellet was placed in one group whereas AlveogylTM was placed in another group. Intensity of pain was recorded on visual analogue scale of Zero to ten. Pain score was recorded at the time of diagnosis, thirty and sixty minutes after placement of medication and on second, fifth, seventh and tenth day. The medication was changed every day until the pain subsided. The data were collected and analyzed using SPPS software (version 20). Result Incidence of dry socket was 4.70%, more common in males (59.09%). It was more common after extraction mandibular third molar. Initial and final pain relief on visual analogue scale was better with use of zinc oxide eugenol. Conclusion Zinc oxide Eugenol paste is more effective in management of dry socket for early as well as final pain relief compared to AlveogylTM.
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Affiliation(s)
- N K Chaurasia
- Department of Oral and Maxillofacial Surgery Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - C Upadhyaya
- Department of Oral and Maxillofacial Surgery Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Dixit
- Department of Oral and Maxillofacial Surgery Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
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Ionita G, Malviya A, Rajbhandari R, Schluter WW, Sharma G, Kakchapati S, Rijal S, Dixit S. Seroprevalence of hepatitis B virus and hepatitis C virus co-infection among people living with HIV/AIDS visiting antiretroviral therapy centres in Nepal: a first nationally representative study. Int J Infect Dis 2017; 60:64-69. [PMID: 28483724 DOI: 10.1016/j.ijid.2017.04.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 10/20/2016] [Revised: 04/11/2017] [Accepted: 04/13/2017] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To assess the prevalence of human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV) co-infections among people living with HIV (PLHIV) in Nepal. METHODS A sample of 677 PLHIV representing key affected populations (KAP) in Nepal, who were undergoing antiretroviral (ART) therapy in ART clinics around the country, were voluntarily enrolled in the study. Rapid kit-based testing followed by ELISA for validation was performed, focusing on HBV surface antigen (HBsAg) and antibodies against HCV (anti-HCV). A multivariate logistic regression model was used to identify factors associated with HBV and HCV co-infection. RESULTS HCV and HBV co-infection among the 677 PLHIV was found to be 19% (95% confidence interval (CI) 16.6-22.7%) and 4.4% (95% CI 3.1-6.6%), respectively. The Eastern Region had the highest percentage of HCV infection (48%). The age group with the highest rates of co-infection was 30-39 years (58% and 70%, respectively, for HCV and HBV co-infection). After adjusting for confounding, males were more likely to have HBV co-infection than females (adjusted odds ratio (AOR) 4.61, 95% CI 1.42-14.98). Similarly, PLHIV who were male (AOR 5.7, 95% CI 2.06-15.98), had a secondary level of education (AOR 3.04, 95% CI 1.06-8.70), or who were drug users (AOR 28.7, 95% CI 14.9-55.22) were significantly more likely to have HCV co-infection. CONCLUSION This first ever national assessment of HIV, HBV, and HCV co-infection performed among PLHIV in Nepal demonstrates that HCV and HBV infections are a health threat to this population and that interventions are required to mitigate the effects of co-infection and to prevent further morbidity and mortality.
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Affiliation(s)
- G Ionita
- United Nations Development Programme, Project Management Unit, Guinea-Bissau
| | | | - R Rajbhandari
- Centre for Molecular Dynamics Nepal, Kathmandu, Nepal
| | - W William Schluter
- World Health Organization - Western Pacific Regional Office (WPRO), Manila, Philippines
| | | | - S Kakchapati
- Centre for Molecular Dynamics Nepal, Kathmandu, Nepal
| | - S Rijal
- United Nations Children's Fund, Kathmandu, Nepal
| | - S Dixit
- Centre for Molecular Dynamics Nepal, Kathmandu, Nepal
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Spaeth ML, Manes KR, Bowers M, Celliers P, Nicola JMD, Nicola PD, Dixit S, Erbert G, Heebner J, Kalantar D, Landen O, MacGowan B, Van Wonterghem B, Wegner P, Widmayer C, Yang S. National Ignition Facility Laser System Performance. Fusion Science and Technology 2017. [DOI: 10.13182/fst15-136] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Mary L. Spaeth
- Lawrence Livermore National Laboratory, 7000 East Avenue, L-466, Livermore, California 94550
| | - Kenneth R. Manes
- Lawrence Livermore National Laboratory, 7000 East Avenue, L-466, Livermore, California 94550
| | - M. Bowers
- Lawrence Livermore National Laboratory, 7000 East Avenue, L-466, Livermore, California 94550
| | - P. Celliers
- Lawrence Livermore National Laboratory, 7000 East Avenue, L-466, Livermore, California 94550
| | - J.-M. Di Nicola
- Lawrence Livermore National Laboratory, 7000 East Avenue, L-466, Livermore, California 94550
| | - P. Di Nicola
- Lawrence Livermore National Laboratory, 7000 East Avenue, L-466, Livermore, California 94550
| | - S. Dixit
- Lawrence Livermore National Laboratory, 7000 East Avenue, L-466, Livermore, California 94550
| | - G. Erbert
- Lawrence Livermore National Laboratory, 7000 East Avenue, L-466, Livermore, California 94550
| | - J. Heebner
- Lawrence Livermore National Laboratory, 7000 East Avenue, L-466, Livermore, California 94550
| | - D. Kalantar
- Lawrence Livermore National Laboratory, 7000 East Avenue, L-466, Livermore, California 94550
| | - O. Landen
- Lawrence Livermore National Laboratory, 7000 East Avenue, L-466, Livermore, California 94550
| | - B. MacGowan
- Lawrence Livermore National Laboratory, 7000 East Avenue, L-466, Livermore, California 94550
| | - B. Van Wonterghem
- Lawrence Livermore National Laboratory, 7000 East Avenue, L-466, Livermore, California 94550
| | - P. Wegner
- Lawrence Livermore National Laboratory, 7000 East Avenue, L-466, Livermore, California 94550
| | - C. Widmayer
- Lawrence Livermore National Laboratory, 7000 East Avenue, L-466, Livermore, California 94550
| | - S. Yang
- Lawrence Livermore National Laboratory, 7000 East Avenue, L-466, Livermore, California 94550
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Haan SW, Atherton J, Clark DS, Hammel BA, Callahan DA, Cerjan CJ, Dewald EL, Dixit S, Edwards MJ, Glenzer S, Hatchett SP, Hicks D, Jones OS, Landen OL, Lindl JD, Marinak MM, Macgowan BJ, Mackinnon AJ, Meezan NB, Milovich JL, Munro DH, Robey HF, Salmonson JD, Spears BK, Suter LJ, Town RP, Weber SV, Kline JL, Wilson DC. NIF Ignition Campaign Target Performance and Requirements: Status May 2012. Fusion Science and Technology 2017. [DOI: 10.13182/fst13-tfm20-31] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- S. W. Haan
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - J. Atherton
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - D. S. Clark
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - B. A. Hammel
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - D. A. Callahan
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - C. J. Cerjan
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - E. L. Dewald
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - S. Dixit
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - M. J. Edwards
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - S. Glenzer
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - S. P. Hatchett
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - D. Hicks
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - O. S. Jones
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - O. L. Landen
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - J. D. Lindl
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - M. M. Marinak
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - B. J. Macgowan
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - A. J. Mackinnon
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - N. B. Meezan
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - J. L. Milovich
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - D. H. Munro
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - H. F. Robey
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - J. D. Salmonson
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - B. K. Spears
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - L. J. Suter
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - R. P. Town
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - S. V. Weber
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - J. L. Kline
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545
| | - D. C. Wilson
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545
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Pathak R, Kochar A, Gordon J, Marchlinski F, Dixit S. Characteristics and Long-Term Outcomes of Patients with Left Ventricular Papillary Muscle Arrhythmias. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.308] [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: 11/16/2022]
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Pandit RA, Zirpe KG, Gurav SK, Kulkarni AP, Karnath S, Govil D, Abhram B, Mehta Y, Gupta A, Hegde A, Patil V, Bhatacharya P, Dixit S, Samavedan S, Todi S. Management of Potential Organ Donor: Indian Society of Critical Care Medicine: Position Statement. Indian J Crit Care Med 2017; 21:303-316. [PMID: 28584434 PMCID: PMC5455024 DOI: 10.4103/ijccm.ijccm_160_17] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Rahul Anil Pandit
- Director, Intensive Care Unit, Fortis Hospital, Mumbai, Maharashtra, India
| | - Kapil G Zirpe
- Director, Neurotrauma Unit, Grant Medical Foundation, Ruby Hall Clinic, Pune, Maharashtra, India
| | | | - Atul P Kulkarni
- Department of Anaesthesiology, Critical Care and Pain, Division of Critical Care Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sunil Karnath
- Department of Critical Care Medicine, Manipal Hospital, Bengaluru, Karnataka, India
| | - Deepak Govil
- Director, Intensive Care Unit, Medanta Institute of Critical Care and Anaesthesiology, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Babu Abhram
- Department of Critical Care, Apollo Hospital, Chennai, Tamil Nadu, India
| | - Yatin Mehta
- Chairman, Institute of Anaesthesiology and Critical Care, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Abinav Gupta
- Head, Critical Care and Emergency, Sharda Hospital, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India
| | - Ashit Hegde
- Consultant, P. D. Hinduja Hospital, Mumbai, Maharashtra, India
| | - Vijaya Patil
- Department of Anesthesia, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Pradip Bhatacharya
- Director, Emergency Services and Critical Care, Chirayu Medical College and Hospital, Bhopal, Madhya Pradesh, India
| | - Subhal Dixit
- Director, Intensive Care Unit, Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Srinivas Samavedan
- Department of Critical Care, Virinchi Hospital, Hyderabad, Telangana, India
| | - Subhash Todi
- Department of Critical Care, A.M.R.I. Hospital, Kolkata, West Bengal, India
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Saxena AK, Saxena VL, Dixit S. Mapping of protein-protein interaction network of Alexander disease. Cell Mol Biol (Noisy-le-grand) 2016; 62:17-21. [PMID: 27262796] [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] [Received: 11/07/2015] [Accepted: 04/30/2016] [Indexed: 06/05/2023]
Abstract
Alexander disease (ALXD) is slowly progressive neurodegenerative disorder which affects white matter of the central nervous system. The main cause of disorder is mutation in GFAP gene and mutation in some other genes were also reported. This study was aimed at getting a better insight into ALXD pathogenesis and identifying the important functional and highly interconnected nodes in human protein interaction network, identifying the important sub-networks in the system could be helpful in understanding the underlying molecular mechanism. The topological analysis of human protein interaction network strategy to identify highly interconnected sub-network modules from which six proteins are found i.e. GFAP, PLEC, CRYAB, NDUFV1, CASP3 and MAPK14 plays important role in disease. Further, the enrichment analysis of interaction network identifies crucial pathways in which most of the diseased proteins overlaps. Through system biology approach, the undirected human protein interaction network of ALXD is buildup with the help of Cytoscape tool and its various plugins helps to investigate network further. The systematic approach suggests the finding of previously known proteins, GFAP, PLEC, CRYAB, NDUFV1, CASP3 and MAPK14 can be used as a drug targets and potential treatment discovered also enrichment analysis will provide guidance for the future study on Alexander disease.
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Affiliation(s)
- A K Saxena
- D.A.V. College Department of Zoology Kanpur (U.P.) India
| | - V L Saxena
- Centre of DBT (Govt. of India), D.G. (P.G.) College Bioinformatics Infrastructure Facility Kanpur (U.P) India
| | - S Dixit
- Centre of DBT (Govt. of India), D.G. (P.G.) College Bioinformatics Infrastructure Facility Kanpur (U.P) India
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Crane JK, Kruschwitz B, Yang ST, Bowers M, Browning D, Budge T, Canning D, Chou J, Consentino A, Nicola JMD, Dixit S, Dorrer C, Erbert G, Hackel R, Heebner J, Hill E, Johnston M, Kelly J, Kwiatkowski J, Shaw M, Smith L, Wegner P, Zuegel J. Performance measurements on NIF beamlines for future experiments to support polar direct drive. ACTA ACUST UNITED AC 2016. [DOI: 10.1088/1742-6596/717/1/012088] [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: 11/12/2022]
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Humagain M, Rokaya D, Srii R, Dixit S, Kafle D. Gender Based Comparison of Gingival Zenith Esthetics. Kathmandu Univ Med J (KUMJ) 2016; 14:148-152. [PMID: 28166072] [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: 06/06/2023]
Abstract
Background The size, proportion and gingival zenith position of maxillary anterior teeth plays in the anterior teeth esthetics. Objective To compare the gingival zenith positions and levels between male and female in right and left side as an esthetic parameter. Method Impression of the maxillary arch was made in each participant with irreversible hydrocolloid, and dental cast was made with dental stone type IV. Two clinical parameters were evaluated: (1) the gingival zenith position (GZP) from the vertical bisected midline along the long axis of each individual maxillary anterior tooth; and (2) the gingival zenith level (GZL) of the lateral incisors in an apical-coronal direction relative to the gingival line joining the tangents of the GZP of the adjacent central incisor and canine teeth under healthy conditions. Statistical analyses were conducted using SPSS with the level of significance (α) = 0.05. Descriptive statistics was done and Independent t-test was used to compare the GZP and GZL between male and female. Result In male, the gingival zenith position for right side central, lateral and canine were 1.05 mm, 0.57 mm and 0.14 mm, and in left side were 1.02 mm, 0.53 mm, 0.15 mm. In female, the gingival zenith position for right side central, lateral and canine were 0.99 mm, 0.48 mm and 0.15 mm, and in left side were 0.94 mm, 0.44 mm and 0.14 mm. The gingival zenith position was significantly different between male and female for both lateral incisors. In addition, significantly different was found for the lateral incisor between right and left side. In male, the gingival zenith level of right and left lateral incisors 0.74 mm and 0.71 mm. In female, the gingival zenith level of right and left lateral incisors 0.76 mm and 0.72 mm. No significant difference was found between male and female for the gingival zenith level of right and left lateral incisors. Conclusion The GZP and GZL obtained from this study can be clinically applied to reestablish the GZP of the maxillary anterior teeth during periodontal surgery; crown lengthening or root coverage procedures.
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Affiliation(s)
- M Humagain
- Department of Dentistry, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - D Rokaya
- Department of Dentistry, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - R Srii
- Department of Dentistry, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Dixit
- Department of Dentistry, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - D Kafle
- Department of Dentistry, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
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Dixit S, Upadhyaya C, Humagain M, Srii R, Marla V. Clinico-histopathological Survey of Head and Neck Cancer at Tertiary Health Care Centre -Dhulikhel Hospital. Kathmandu Univ Med J (KUMJ) 2016; 14:167-171. [PMID: 28166075] [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: 06/06/2023]
Abstract
Background Head and neck is one of the most prevalent site for cancers along with lungs, cervix, breast and stomach. Hospital based cancer registries required for effective evaluation of diagnosis and management of cancer is inadequate in Nepal. Cancer registry system established by WHO is acquired by seven major hospitals in our country. However, data from tertiary health care centres like ours remain undocumented. Objective The objective of this study is to perform retrospective analysis of clinicohistopathological types of head and neck lesions which were eventually diagnosed as cancer in Dhulikel Hospital, a tertiary health care centre of Central East Nepal. Method Data regarding head and neck lesions diagnosed as cancer (January 2001- December 2014) were extracted from the archives of Department of General Pathology. These cases were categorised according to demographic profile, site of cancer and histological diagnosis. Result A total of 240 cases matched the inclusion criteria and were selected for this study. Male: Female ratio of 1.3:1 with a mean age of 52 years (52.82±1.8) was found. Two hundred and two (84.16%) patients were diagnosed with carcinoma, 31 (15%) with lymphoma, 3 (1.25%) with melanoma, 2(0.83%) with small round cell tumor and 2 (0.83%) with sarcoma. The most common histological types of carcinoma seen were Squamous cell carcinoma (138 cases; 57.5%) followed by papillary carcinoma (26 cases; 10.8%). Among the lymphomas Non-Hodgkin's lymphoma (21 cases; 8.75%) was the most predominant type. The most common site of presentation was oral cavity (60 cases; 25%) followed by skin (36 cases; 15%), thyroid (32 cases; 13.33%) and oesophagus (27 cases; 11.25%). Metastasis to cervical lymph node was found in 39 cases (16.25%). Conclusion Based on these finding, it was observed that Squamous cell carcinoma was the most common type followed by different epithelial and mesenchymal malignancies in head and neck region. The results revealed by this study will provide useful information for planning the health care policies about cancer in Nepal and will be more effective and helpful to the patients of remote areas.
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Affiliation(s)
- S Dixit
- Department of Dentistry, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - C Upadhyaya
- Department of Dentistry, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - M Humagain
- Department of Dentistry, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - R Srii
- Department of Dentistry, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - V Marla
- College of Dental Surgery, BP Koirala Institute of Health Sciences, Dharan Nepal
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Dixit S, Khatib K, Borawake K. Disorders of Calcium and Magnesium. Crit Care 2016. [DOI: 10.5005/jp/books/12670_37] [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: 11/23/2022] Open
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