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Satish SP, Narayanasamy K, Sambandam MT, Raghunanthan S, Johnson J, Mangaiyarkarasi A, Paranthakan C, Narayanan S, Chandrasekar S, Sureshkanna S, Dhus U, Venkatraman J, Alexander V, Kumar SE, David V, Varughese S, Daniel D, Goel A, Zachariah U, Eapen CE. The "Hub and Spoke" model: a pathway for urgent plasma exchange to treat patients with rodenticide ingestion induced acute liver failure in Tamil Nadu, India. Lancet Reg Health Southeast Asia 2024; 25:100405. [PMID: 38638507 PMCID: PMC11024643 DOI: 10.1016/j.lansea.2024.100405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/20/2024]
Affiliation(s)
- Shilpa Prabhakar Satish
- Tamil Nadu Accident and Emergency Care Initiative - National Health Mission (TAEI-NHM) Working Group on Rodenticide Poison, Chennai, India
| | - Krishnasamy Narayanasamy
- Tamil Nadu Accident and Emergency Care Initiative - National Health Mission (TAEI-NHM) Working Group on Rodenticide Poison, Chennai, India
- The Tamil Nadu Dr. M.G.R. Medical University, Chennai, India
- Tamil Nadu Chapter - Indian Society of Gastroenterology (TN-ISG), Chennai, India
| | - Maruthu Thurai Sambandam
- Tamil Nadu Accident and Emergency Care Initiative - National Health Mission (TAEI-NHM) Working Group on Rodenticide Poison, Chennai, India
| | - Srinivasan Raghunanthan
- Tamil Nadu Accident and Emergency Care Initiative - National Health Mission (TAEI-NHM) Working Group on Rodenticide Poison, Chennai, India
| | - Jeyalydia Johnson
- Tamil Nadu Accident and Emergency Care Initiative - National Health Mission (TAEI-NHM) Working Group on Rodenticide Poison, Chennai, India
| | - Amirthalingam Mangaiyarkarasi
- Tamil Nadu Accident and Emergency Care Initiative - National Health Mission (TAEI-NHM) Working Group on Rodenticide Poison, Chennai, India
| | - Chellian Paranthakan
- Tamil Nadu Accident and Emergency Care Initiative - National Health Mission (TAEI-NHM) Working Group on Rodenticide Poison, Chennai, India
| | - Suresh Narayanan
- Tamil Nadu Accident and Emergency Care Initiative - National Health Mission (TAEI-NHM) Working Group on Rodenticide Poison, Chennai, India
| | - Selvaraj Chandrasekar
- Tamil Nadu Accident and Emergency Care Initiative - National Health Mission (TAEI-NHM) Working Group on Rodenticide Poison, Chennai, India
| | - Singaram Sureshkanna
- Tamil Nadu Accident and Emergency Care Initiative - National Health Mission (TAEI-NHM) Working Group on Rodenticide Poison, Chennai, India
| | - Ubal Dhus
- Tamil Nadu Chapter - Indian Society of Gastroenterology (TN-ISG), Chennai, India
| | - Jayanthi Venkatraman
- Tamil Nadu Accident and Emergency Care Initiative - National Health Mission (TAEI-NHM) Working Group on Rodenticide Poison, Chennai, India
- Tamil Nadu Chapter - Indian Society of Gastroenterology (TN-ISG), Chennai, India
| | - Vijay Alexander
- Christian Medical College (CMC) Vellore Collaborative Group for PLEX to Treat Liver Failure, Vellore, India
| | - Santhosh E. Kumar
- Christian Medical College (CMC) Vellore Collaborative Group for PLEX to Treat Liver Failure, Vellore, India
| | - Vinoi David
- Christian Medical College (CMC) Vellore Collaborative Group for PLEX to Treat Liver Failure, Vellore, India
| | - Santosh Varughese
- Christian Medical College (CMC) Vellore Collaborative Group for PLEX to Treat Liver Failure, Vellore, India
| | - Dolly Daniel
- Christian Medical College (CMC) Vellore Collaborative Group for PLEX to Treat Liver Failure, Vellore, India
| | - Ashish Goel
- Christian Medical College (CMC) Vellore Collaborative Group for PLEX to Treat Liver Failure, Vellore, India
| | - Uday Zachariah
- Christian Medical College (CMC) Vellore Collaborative Group for PLEX to Treat Liver Failure, Vellore, India
| | - Chundamannil Eapen Eapen
- Tamil Nadu Accident and Emergency Care Initiative - National Health Mission (TAEI-NHM) Working Group on Rodenticide Poison, Chennai, India
- Tamil Nadu Chapter - Indian Society of Gastroenterology (TN-ISG), Chennai, India
- Christian Medical College (CMC) Vellore Collaborative Group for PLEX to Treat Liver Failure, Vellore, India
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Simon EG, Dhus U, Rao AS, M K, Yedupati KR, George JT, K P, Swarna A, Somasundaram A, Ramakrishnan A, L V, Thomas D, V A, S P AM, M S R, Jha R, S J, Devakumar S, Pl A, Gade SV, Manickavasagam K, Agarwal D, V G MP, Prasad M, B M, Abirami D, T S C, B J G, Natrayan R, Sampathkumar HM, B S R, Chand N, S JJB, Ashokan S, S A, Srinivasan K, A A, N L, R S A, Kumar AEP, A R, N A R, A C A, Balaji G, P P, Verma S, V J. Clinical profile of 1208 newly diagnosed colorectal cancer patients in Tamil Nadu-A multi-centric survey. Indian J Gastroenterol 2024:10.1007/s12664-023-01496-9. [PMID: 38372944 DOI: 10.1007/s12664-023-01496-9] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/28/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND An increasing incidence of colorectal cancer (CRC) is being reported in developing countries, including India. Most Indian studies on CRC are retrospective and single-centered. The present study is an attempt to understand the current clinical profile and stage of newly diagnosed CRCs across multiple centers in Tamil Nadu, India. METHODS A multi-centric observational survey was conducted between September 1, 2021, and August 31, 2022, under the aegis of the Indian Society of Gastroenterology - Tamil Nadu chapter. Patients 18 years of age and older with a recent diagnosis of CRC fulfilling the inclusion criteria were prospectively recruited at the participating centers. Their demographic, clinical, biochemical, endoscopic, histopathologic, radiologic and risk factor details were systematically collected and analyzed. RESULTS Across 23 centers in Tamil Nadu, 1208 patients were recruited. The male:female ratio was 1.49:1, while mean (SD) age was 57.7 (13.5) years. A majority (81.9%) were Tamils and 78.5% belonged to lower socioeconomic classes. The predominant symptoms were hematochezia (30.2%) and a change in bowel habits (27.5%). The most common locations were the rectum (34.3%) and rectosigmoid (15.1%). Synchronous CRCs were seen in 3.3% and synchronous colorectal polyps in 12.8%. Predisposing factors for CRC were seen in 2%. A past history of any cancer among CRC patients was obtained in 3.1% and a family history of any cancer was found in 7.6%. Patients who were either overweight or obese constituted 46.4% of the study population. At presentation, the predominant stages were stage III (44.7%) and stage IV (20.8%). CONCLUSIONS A majority of patients with newly diagnosed CRC in Tamil Nadu belonged to the lower socioeconomic classes. About 60% had CRCs located within the reach of the flexible sigmoidoscope. Two-thirds of the patients exceeded stage II disease at presentation. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Ebby George Simon
- Department of Medical Gastroenterology, Christian Medical College, Vellore, 632 004, India.
| | - Ubal Dhus
- Department of Medical Gastroenterology, Apollo Hospitals, Chennai, 600 006, India
| | - Amara Sadguna Rao
- Department of Medical Gastroenterology, Apollo Hospitals, Chennai, 600 006, India
| | - Kannan M
- Department of Medical Gastroenterology, Madurai Medical College, Madurai, 625 020, India
| | - Kondala Rao Yedupati
- Department of Medical Gastroenterology, Madurai Medical College, Madurai, 625 020, India
| | - John Titus George
- Department of Medical Gastroenterology, Christian Medical College, Vellore, 632 004, India
| | - Premkumar K
- Institute of Medical Gastroenterology, Madras Medical College, Chennai, 600 003, India
| | - Anupama Swarna
- Institute of Medical Gastroenterology, Madras Medical College, Chennai, 600 003, India
| | | | - Arulraj Ramakrishnan
- GI and Liver Unit, Kovai Medical Center and Hospital, Coimbatore, 641 014, India
| | - Venkatakrishnan L
- Department of Gastroenterology, PSG Institute of Medical Sciences and Research, Coimbatore, 641 004, India
| | - Dhanush Thomas
- Department of Gastroenterology, PSG Institute of Medical Sciences and Research, Coimbatore, 641 004, India
| | - Arulselvan V
- Department of Medical Gastroenterology, Coimbatore Medical College, Coimbatore, 641 018, India
| | - Arshiya Mubin S P
- Department of Medical Gastroenterology, Coimbatore Medical College, Coimbatore, 641 018, India
| | - Revathy M S
- Department of Medical Gastroenterology, Stanley Medical College, Chennai, 600 001, India
| | - Rakesh Jha
- Department of Medical Gastroenterology, Stanley Medical College, Chennai, 600 001, India
| | - Jeswanth S
- Department of Surgical Gastroenterology, Stanley Medical College, Chennai, 600 001, India
| | - Satish Devakumar
- Department of Surgical Gastroenterology, Stanley Medical College, Chennai, 600 001, India
| | - Alagammai Pl
- Department of Gastroenterology, Meenakshi Mission Hospital and Research Centre, Madurai, 625 107, India
| | - Sujata V Gade
- Department of Gastroenterology, Meenakshi Mission Hospital and Research Centre, Madurai, 625 107, India
| | - Kanagavel Manickavasagam
- Department of General, GI and Minimal Access Surgery, St. Isabel's Hospital, Chennai, 600 004, India
| | - Deepak Agarwal
- Department of General, GI and Minimal Access Surgery, St. Isabel's Hospital, Chennai, 600 004, India
| | - Mohan Prasad V G
- Department of Medical Gastroenterology, VGM Hospital, Coimbatore, 641 005, India
| | - Madhura Prasad
- Department of Medical Gastroenterology, VGM Hospital, Coimbatore, 641 005, India
| | - Mahadevan B
- Department of Medical Gastroenterology, Gleneagles Global Health City, Chennai, 600 100, India
| | - Dinu Abirami
- Department of Medical Gastroenterology, Gleneagles Global Health City, Chennai, 600 100, India
| | - Chandrasekar T S
- Department of Medical Gastroenterology, MedIndia Hospitals, Chennai, 600 034, India
| | - Gokul B J
- Department of Medical Gastroenterology, MedIndia Hospitals, Chennai, 600 034, India
| | - Rajesh Natrayan
- Department of Medical Gastroenterology, Sri Gokulam Hospital, Salem, 636 004, India
| | | | - Ramakrishna B S
- Department of Medical Gastroenterology, SRM Institutes for Medical Science, Chennai, 600 083, India
| | - Naveen Chand
- Department of Medical Gastroenterology, SRM Institutes for Medical Science, Chennai, 600 083, India
| | | | - Sindhu Ashokan
- Department of Gastroenterology, Annai Arul Hospital, Chennai, 600 063, India
| | - Arulprakash S
- Department of Gastroenterology and Hepatology, MGM Healthcare, Chennai, 560 070, India
| | - Karishma Srinivasan
- Department of Gastroenterology and Hepatology, MGM Healthcare, Chennai, 560 070, India
| | - Aravind A
- Department of Digestive Health and Diseases, Govt. Kilpauk Medical College, Chennai, 600 010, India
| | - Lavanya N
- Department of Digestive Health and Diseases, Govt. Kilpauk Medical College, Chennai, 600 010, India
| | - Arun R S
- Department of Medical Gastroenterology, Madras Medical Mission, Chennai, 600 037, India
| | | | - Rathnaswami A
- Department of Surgical Gastroenterology, SRM Medical College Hospital and Research Centre, Chennai, 603 211, India
| | - Rajesh N A
- Department of Medical Gastroenterology, SRM Medical College Hospital and Research Centre, Chennai, 603 211, India
| | - Arun A C
- Department of Medical Gastroenterology, Velammal Medical College Hospital and Research Institute, Madurai, 625 009, India
| | - Ganga Balaji
- Department of Medical Gastroenterology, Velammal Medical College Hospital and Research Institute, Madurai, 625 009, India
| | - Padmanabhan P
- Department of Medical Gastroenterology, Meenakshi Medical College Hospital and Research Institute, Kancheepuram, 631 552, India
| | - Somnath Verma
- Department of Medical Gastroenterology, Meenakshi Medical College Hospital and Research Institute, Kancheepuram, 631 552, India
| | - Jayanthi V
- Department of Hepatology, Gleneagles Global Health City, Chennai, 600 100, India
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Vyas VD, Parameswaran SA, Paramasivan P, Sankaranarayanan K, Palaniswamy KR, Mohan AT, Srinivas U, Dhus U, Muthuswamy H, Revathy MS, Natarajan M, Karunakaran P, Venkatesh S, Mahalingam P, Patel A. Etiological profile of diarrhea in solid organ transplant recipients at a tertiary care center in Southern India. Transpl Infect Dis 2021; 23:e13584. [PMID: 33594745 DOI: 10.1111/tid.13584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 01/11/2021] [Accepted: 02/01/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Diarrhea is one of the common gastrointestinal (GI) adverse events after solid organ transplantation. Diarrhea may be caused by infectious or non-infectious etiology. The infectious etiology of diarrhea varies according to the location and duration of diarrhea. Non-infectious etiologies include drugs, inflammatory bowel disease, neoplasia. The objective of this study was to evaluate the etiological profile of diarrhea in solid organ transplant recipients presenting to a tertiary care center in Southern India. METHODS This was a retrospective analysis of prospectively collected data of all solid organ transplantation recipients referred to the Department of Medical Gastroenterology for evaluation of diarrhea from April 2012 till May 2014. All patients had stool evaluated by wet mount examination, modified acid fast (AFB) stain, trichrome stain, culture, and Clostridium difficile toxin assay. EDTA plasma was collected for quantitative Cytomegalovirus (CMV) detection by real-time PCR. If the diarrhea was acute (<2 wk), and no etiological agent was identified, empirical antibiotic therapy was instituted and followed up. If persistent or chronic diarrhea (>2-4 wk), endoscopic evaluation (upper GI endoscopy and/or colonoscopy with biopsies), depending on the clinical type of diarrhea was done. If no specific etiological diagnosis was established after endoscopic evaluation, breath test for SIBO and celiac serology were done. If no specific etiology was identified after the above investigations, dose of immunosuppressive drugs was reduced. If diarrhea responded to dose reduction, it was considered to be drug related. RESULTS Fifty-eight episodes of diarrhea occurred in 55 solid organ transplant recipients during the study period. Renal transplant recipients constituted the majority (70%). Most (79%) of patients included in the study had their transplant > 6 mo ago. Infective diarrhea was the etiology in 46%, drug-related diarrhea in 29.3%. No specific etiology was identified in 22.4% of patients. Parasites accounted for 69% of all infective diarrhea. Stool evaluation was the main investigation in establishing diagnosis in acute diarrhea. Endoscopic evaluation was required in two thirds of patients to establish diagnosis in chronic diarrhea. CONCLUSION GI infections and drug-related diarrhea were the common causes of diarrhea in solid organ transplant recipients. Parasites were the most common infectious etiology of diarrhea. Step-wise evaluation was able to identify the etiology in ~ 77% of patients. Overall, 98% of diarrheal episodes resolved.
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Affiliation(s)
| | | | | | | | | | - Arumugam T Mohan
- Department of Medical Gastroenterology, Apollo Hospitals, Chennai-600006, India
| | - Usha Srinivas
- Department of Medical Gastroenterology, Apollo Hospitals, Chennai-600006, India
| | - Ubal Dhus
- Department of Medical Gastroenterology, Apollo Hospitals, Chennai-600006, India
| | | | - Marimuthu S Revathy
- Department of Medical Gastroenterology, Apollo Hospitals, Chennai-600006, India
| | - Murugan Natarajan
- Department of Medical Gastroenterology, Apollo Hospitals, Chennai-600006, India
| | | | - Seshadri Venkatesh
- Department of Medical Gastroenterology, Apollo Hospitals, Chennai-600006, India
| | - Preethi Mahalingam
- Department of Medical Gastroenterology, Apollo Hospitals, Chennai-600006, India
| | - Ankit Patel
- Department of Medical Gastroenterology, Apollo Hospitals, Chennai-600006, India
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