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Bandyopadhyay A, Yaddanapudi LN, Saini V, Sahni N, Grover S, Puri S, Ashok V. Efficacy of melatonin in decreasing the incidence of delirium in critically ill adults: a randomized controlled trial. Crit Care Sci 2024; 36:e20240144en. [PMID: 38656078 DOI: 10.62675/2965-2774.20240144-en] [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] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 11/16/2023] [Indexed: 04/26/2024]
Abstract
OBJECTIVE To determine whether enteral melatonin decreases the incidence of delirium in critically ill adults. METHODS In this randomized controlled trial, adults were admitted to the intensive care unit and received either usual standard care alone (Control Group) or in combination with 3mg of enteral melatonin once a day at 9 PM (Melatonin Group). Concealment of allocation was done by serially numbered opaque sealed envelopes. The intensivist assessing delirium and the investigator performing the data analysis were blinded to the group allocation. The primary outcome was the incidence of delirium within 24 hours of the intensive care unit stay. The secondary outcomes were the incidence of delirium on Days 3 and 7, intensive care unit mortality, length of intensive care unit stay, duration of mechanical ventilation and Glasgow outcome score (at discharge). RESULTS We included 108 patients in the final analysis, with 54 patients in each group. At 24 hours of intensive care unit stay, there was no difference in the incidence of delirium between Melatonin and Control Groups (29.6 versus 46.2%; RR = 0.6; 95%CI 0.38 - 1.05; p = 0.11). No secondary outcome showed a statistically significant difference. CONCLUSION Enteral melatonin 3mg is not more effective at decreasing the incidence of delirium than standard care is in critically ill adults.
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Affiliation(s)
- Anjishnujit Bandyopadhyay
- Department of Anaesthesiology, Pain Medicine and Critical Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences - New Delhi, India
| | - Lakshmi Narayana Yaddanapudi
- Department of Anaesthesia and Intensive Care, Level 4, Nehru Hospital, Postgraduate Institute of Medical Education and Research, Sector 12 - Chandigarh, India
| | - Vikas Saini
- Department of Anaesthesia and Intensive Care, Level 4, Nehru Hospital, Postgraduate Institute of Medical Education and Research, Sector 12 - Chandigarh, India
| | - Neeru Sahni
- Department of Anaesthesia and Intensive Care, Level 4, Nehru Hospital, Postgraduate Institute of Medical Education and Research, Sector 12 - Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Nehru Hospital, Postgraduate Institute of Medical Education and Research, Sector 12 - Chandigarh, India
| | - Sunaakshi Puri
- Department of Anaesthesia and Intensive Care, Level 4, Nehru Hospital, Postgraduate Institute of Medical Education and Research, Sector 12 - Chandigarh, India
| | - Vighnesh Ashok
- Department of Anaesthesia and Intensive Care, Level 4, Nehru Hospital, Postgraduate Institute of Medical Education and Research, Sector 12 - Chandigarh, India
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Xess PA, Sarna R, Sethi S, Chauhan R, Meena SC, Saini V, Luthra A, Singh N. Effect of CoolSense and EMLA Cream on Pain During Intravenous Cannulation in Pediatric Population: A Randomized, Controlled Trial. Indian J Pediatr 2024; 91:119-124. [PMID: 35767175 DOI: 10.1007/s12098-022-04233-w] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/29/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To compare the efficacy of CoolSense and EMLA cream on pain reduction during intravenous cannulation in the pediatric population. METHODS A total of 140 American Society of Anesthesiologist I/II children of 6-12 y requiring intravenous cannulation before induction of anesthesia were randomized into two groups of 70 each. Before intravenous cannulation, group I received CoolSense pretreatment while group II received EMLA cream pretreatment. The primary outcome was to assess the efficacy of CoolSense and EMLA cream on pain reduction during intravenous cannulation. The secondary outcomes included the anxiety level of children, successful first attempt at cannulation, technical difficulties faced, adverse reactions, and parents' satisfaction score. RESULTS There was a significant reduction in pain scores during intravenous cannulation in the CoolSense group compared to the EMLA cream group (mean pain score 7.14 ± 4.322 versus 29.32 ± 8.95, p value 0.001). Comparison of pre- and postprocedural anxiety levels showed a decrease in the anxiety level in the CoolSense group (p value = 0.003) as compared to the EMLA group. The duration of application of CoolSense was significantly less than EMLA cream. CONCLUSION CoolSense was more efficacious in reducing the pain of intravenous cannulation than the EMLA cream. In the pediatric population, CoolSense appears to be a simple and rapid means of providing adequate analgesia for venous cannulation.
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Affiliation(s)
- Pratibha Alice Xess
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Rashi Sarna
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Sameer Sethi
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Rajeev Chauhan
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Shyam Charan Meena
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Vikas Saini
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Ankur Luthra
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Nidhi Singh
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
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Moar K, Pant A, Saini V, Pandey M, Maurya PK. Potential diagnostic and prognostic biomarkers for breast cancer: A compiled review. Pathol Res Pract 2023; 251:154893. [PMID: 37918101 DOI: 10.1016/j.prp.2023.154893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 11/04/2023]
Abstract
Breast cancer is one of the major reason for death of women worldwide. As per the International Agency for Research on Cancer (IARC) statistics, the number of cases of breast cancer is increasing year by year in many parts of the world. As per the recent global cancer burden figures, in 2020, there were 2.26 million incidences of breast cancer cases and it is one of the main causes of mortality due to cancer in women in the world. Biomarkers of breast cancer would prove to be very beneficial to screen women who are at higher risk and for detection of disease recurrence. Here, studies carried out on biomarkers of breast cancer and susceptibility to the disease have been reviewed. Various databases like Google Scholar, ScienceDirect and PubMed have been used for searching and majorly literature from the last 10 years have been considered. Potential biomarkers of breast cancer including blood based angiogenic factors, glycoprotein-based biomarkers, hormone receptor biomarkers and other biomarkers that were identified from various studies have been summarized.
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Affiliation(s)
- Kareena Moar
- Department of Biochemistry, Central University of Haryana, Mahendergarh 123031, India
| | - Anuja Pant
- Department of Biochemistry, Central University of Haryana, Mahendergarh 123031, India
| | - Vikas Saini
- Department of Vocational Studies & Skill Development, Central University of Haryana, Mahendergarh 123031, India
| | - Manisha Pandey
- Department of Pharmaceutical Sciences, Central University of Haryana, Mahendergarh 123031, India
| | - Pawan Kumar Maurya
- Department of Biochemistry, Central University of Haryana, Mahendergarh 123031, India.
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Goyal N, Saini V, Gangar S, Mohapatra S, Singh NP, Saha R. Are we missing the silver lining of COVID-19 pandemic: An analytical study to determine effects of three COVID-19 peaks on antimicrobial susceptibility of Staphylococcus aureus isolates. J Family Med Prim Care 2023; 12:1424-1429. [PMID: 37649748 PMCID: PMC10465057 DOI: 10.4103/jfmpc.jfmpc_2420_22] [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: 12/13/2022] [Revised: 05/09/2023] [Accepted: 05/24/2023] [Indexed: 09/01/2023] Open
Abstract
Background Given the evolving nature of COVID-19, for better understanding of its effect on antimicrobial resistance of Staphylococcus aureus (S. aureus), it becomes crucial that we follow the resistance patterns across different surges of COVID-19 cases. Methods This prospective surveillance study extended over two years from January 2020-March 2022 and was conducted in a healthcare center of North India. Susceptibility patterns of Staphylococcus aureus during January-March 2020 were considered as prepandemic patterns. Processing of clinical specimens, identification of S. aureus, and in-vitro antibiotic susceptibility testing were performed in accordance with standard microbiological testing procedures and Clinical Laboratory Standard Institute guidelines. Results Lowest prevalence (38.9%) of Methicillinresistant S. aureus was reported during January-March 2021 and July-September 2021. More than 50% S. aureus isolates were susceptible to linezolid, cotrimoxazole, tetracycline, and gentamicin in January-March 2020. In January-March 2021, ≥50% of S. aureus isolates from clinical specimens were additionally susceptible to clindamycin and erythromycin. Antibiotic agents of linezolid, tetracycline, clindamycin, and cotrimoxazole were susceptible in ≥50% of S. aureus isolates in January-March 2022. Conclusions This study reveals a sharp decline in overall resistance to commonly prescribed antibiotic agents for S. aureus isolates after first peak of COVID-19 cases. However, same trend was not observed in subsequent peaks and probably we are approaching the same resistance levels that were seen prior to COVID-19 pandemic.
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Affiliation(s)
- Nisha Goyal
- Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Vikas Saini
- Department of Microbiology, National Cancer Institute- All India Institute of Medical Sciences, BADSA Jhajjar, Haryana, India
| | - Seema Gangar
- Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Subhashree Mohapatra
- Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Narendra Pal Singh
- Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Rumpa Saha
- Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
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Varshney N, Kashyap D, Behra SK, Saini V, Chaurasia A, Kumar S, Jha HC. Predictive profiling of gram-negative antibiotics in CagA oncoprotein inactivation: a molecular dynamics simulation approach. SAR QSAR Environ Res 2023; 34:501-521. [PMID: 37462112 DOI: 10.1080/1062936x.2023.2230876] [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: 04/20/2023] [Accepted: 06/24/2023] [Indexed: 07/20/2023]
Abstract
Gastric cancer (GC) is the fifth most prevalent form of cancer worldwide. CagA - positive Helicobacter pylori infects more than 60% of the human population. Moreover, chronic infection of CagA-positive H. pylori can directly affect GC incidence. In the current study, we have repurposed FDA-approved antibiotics that are viable alternatives to current regimens and can potentially be used as combination therapy against the CagA of H. pylori. The 100 FDA-approved gram negative antibiotics were screened against CagA protein using the AutoDock 4.2 tool. Further, top nine compounds were selected based on higher binding affinity with CagA. The trajectory analysis of MD simulations reflected that binding of these drugs with CagA stabilizes the system. Nonetheless, atomic density map and principal component analysis also support the notion of stable binding of antibiotics to the protein. The residues ASP96, GLN100, PRO184, and THR185 of compound cefpiramide, doxycycline, delafloxacin, metacycline, oxytetracycline, and ertapenem were involved in the binding with CagA protein. These residues are crucial for the CagA that aids in entry or pathogenesis of the bacterium. The screened FDA-approved antibiotics have a potential druggability to inhibit CagA and reduce the progression of H. pylori borne diseases.
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Affiliation(s)
- N Varshney
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Indore, India
| | - D Kashyap
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Indore, India
| | - S K Behra
- Department of Biotechnology, National Institute of Pharmaceutical Education and Research, Ahmedabad, Gandhinagar, India
| | - V Saini
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Indore, India
| | - A Chaurasia
- Division of Crop Protection, ICAR -Indian Institute of Vegetable Research, Varanasi, India
| | - S Kumar
- Division of Agricultural Bioinformatics (CABIN), ICAR-Indian Agricultural Statistics Research Institute (IASRI), Delhi, India
| | - H C Jha
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Indore, India
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Chalmers K, Brownlee S, Saini V. How can routine colorectal cancer screening in the USA be considered low value in other countries? BMJ Qual Saf 2023:bmjqs-2022-015576. [PMID: 36914279 DOI: 10.1136/bmjqs-2022-015576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2023] [Indexed: 03/14/2023]
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Singh A, Kayina CA, Naik N, Ganesh V, Kumar S, Pandey VK, Bora GS, Saini K, Soni SL, Kaloria N, Samra T, Saini V. Transurethral lidocaine (100 mg) bladder irrigation (TULI100) reduces the incidence of catheter related bladder discomfort in transurethral resection of bladder tumors: A randomized, double blind, controlled trial. Int J Urol 2023; 30:264-270. [PMID: 36375083 DOI: 10.1111/iju.15100] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/03/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Transurethral resection of bladder tumors (TURBT) surgeries requires post-resection catheterization for continuous irrigation of the bladder. This indwelling catheter is associated with distressing catheter-related bladder discomfort (CRBD) and increases postoperative pain and agitation. OBJECTIVES To prove the hypothesis that transurethral 100 mg lidocaine irrigation at the end of TURBT can reduce the frequency of moderate-to-severe postoperative CRBD. METHODS 116 patients scheduled for TURBT were screened, 94 were recruited and completed the study. American Society of Anesthesiologists Physical Status I-II adult patients, 20-75 years of age undergoing elective TURBT surgery under general anesthesia were included. Transurethral normal saline with 0.01% lidocaine (100 mg in 1 L NS) was used for irrigation 30 min before the completion of surgery in group L, while only normal saline was used for transurethral irrigation in group N. The main outcomes were frequency of CRBD, pain and patient satisfaction at 0, 1, 2, and 6 h postoperatively. RESULTS A total of 94 patients were analyzed in the study. The incidence of moderate-severe CRBD was significantly lower in group L as compared to group C at 0, 1, and 2 h (65.9% vs. 31.9%, p = 0.01; 31.9% vs. 10.6%, p = 0.012; 21.3% vs. 2.1%, p = 0.004, respectively). At the 6-h mark, the incidence of CRBD was lower in group L, although this did not achieve statistical significance (6.38% vs. 2.1%; p = 0.613). CONCLUSION Irrigation with 0.01% lidocaine (100 mg) towards the end of TURBT reduces the incidence of moderate-severe CRBD by 52% and increases patient satisfaction.
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Affiliation(s)
- Ajay Singh
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | | | - Naveen Naik
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Venkata Ganesh
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Sumit Kumar
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | | | | | - Kulbhushan Saini
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Shiv Lal Soni
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Narender Kaloria
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Tanvir Samra
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Vikas Saini
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
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Moar K, Pant A, Saini V, Maurya PK. Potential biomarkers in endometrial cancer: a narrative review. Biomarkers 2023:1-14. [PMID: 36755526 DOI: 10.1080/1354750x.2023.2179114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
CONTEXT Every year, approximately 0.4 million women suffer from endometrial cancer (EC) worldwide and it has become the most common gynecological malignancy. Almost 66% of EC cases are diagnosed at an early stage and can be cured by performing surgery while those at an advanced stage turns out to be fatal. Biomarkers of endometrial cancer would be very valuable for screening of women who are at high risk and in detecting the chance of recurrence of disease. OBJECTIVE The current article has reviewed studies published on expression of biomarkers and susceptibility to EC. METHODS Google Scholar and PubMed were used as searching platforms and we have majorly considered the literature from last 10 years. RESULTS Potential biomarkers of EC identified from various studies were summarised.
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Affiliation(s)
- Kareena Moar
- Department of Biochemistry, Central University of Haryana, Mahendragarh, India
| | - Anuja Pant
- Department of Biochemistry, Central University of Haryana, Mahendragarh, India
| | - Vikas Saini
- Biomedical Sciences, Department of Vocational Studies and Skill Development, Central University of Haryana, Mahendragarh, India
| | - Pawan Kumar Maurya
- Department of Biochemistry, Central University of Haryana, Mahendragarh, India
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Cleveland Manchanda E, Sivashanker K, Kinglake S, Laflamme E, Saini V, Maybank A. Training to Build Antiracist, Equitable Health Care Systems. AMA J Ethics 2023; 25:E37-47. [PMID: 36623303 DOI: 10.1001/amajethics.2023.37] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
All clinicians should provide high-quality, safe, and equitable care to every patient and community. Yet, in practice, health care delivery systems are designed and organized to exacerbate inequity in access and outcomes, and clinicians are incentivized to deliver unequal and inequitable care in deeply segregated academic health centers that are structured to reify white supremacy. This article investigates the nature and scope of health professions educators' obligations to acknowledge harms of segregation in health care as widespread, unjust, iatrogenic, and preventable.
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Affiliation(s)
- Emily Cleveland Manchanda
- Assistant professor of emergency medicine at the Boston University School of Medicine in Massachusetts
| | - Karthik Sivashanker
- Vice president of equitable health systems innovation in the Center for Health Equity at the American Medical Association in Chicago, Illinois
| | - Steffie Kinglake
- Health equity communication and narrative strategist and senior content manager at the American Medical Association Center for Health Equity in Chicago, Illinois
| | - Emily Laflamme
- Senior research analyst at the American Medical Association Center for Health Equity in Chicago, Illinois
| | - Vikas Saini
- President of the Lown Institute in Needham, Massachusetts
| | - Aletha Maybank
- Chief health equity officer and senior vice president at the American Medical Association in Chicago, Illinois
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Saini V, Goyal N, Singh NP, Goswami M. Evaluation of errors during susceptibility reporting of glycopeptide antibiotics for enterococcal isolates on sole basis of widely used disk diffusion test. HEALTHC LOW-RESOUR S 2022. [DOI: 10.4081/hls.2022.10806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
In resource limited settings, very often susceptibility reports glycopeptide antibiotics are released only on the basis of disk diffusion test. Determination of MIC by either E-strips or microbroth dilution tests can be of paramount importance in checking the errors that may have incurred with the singular use of disk diffusion tests. Distribution of errors in Vancomycin and Teicoplanin susceptibility reporting by disk diffusion test was evaluated in comparison with MIC determination with reference method of E-strip. A total of 40 isolates of Enterococcus species were obtained during the study period. In vancomycin susceptibility reporting, very major errors, major errors and minor errors were observed in 33.3%, 5.4% and 5% instances respectively. For teicoplanin, major errors were observed in 5.3% of instances. E test can be used in conjunction with disk diffusion where resources are limited. We have observed that by using a combination of both disk diffusion and MIC determination by E-strip methods for glycopeptide antibiotics, a majority of reporting errors can be addressed.
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Saini V, Rai G, Singh P, Das S, Singh NP. P374 Fungal coinfection in patients with SARS-CoV-2: Atertiary care hospital study. Med Mycol 2022. [PMCID: PMC9509878 DOI: 10.1093/mmy/myac072.p374] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM Background There is a high risk of developing fungal co-infections in patients infected with SARS-CoV-2, few studies have been conducted on the incidence and risk of these secondary infections. The incidence of Candida infection due to different Candida species is increasing in COVID patients. Methods This retrospective study comprised a total of 23 patients with upper respiratory infection investigated in the Department of Microbiology of University College of Medical Sciences (UCMS) and Guru Teg Bahadur Hospital (GTBH), Delhi from April 2021 to June 2021. Identification was done using DNA sequencing. Results Of the 23 cases, identification by DNA sequencing, C. albicans was present in 34.78%, C. tropicalis in 30.43%, Pichia kudriavzevii in 26.08%, C. parapsilosis in 4.3%%, and C. auris in 4.3%. Conclusion C. albicans is the leading pathogen in our patients, along with the rise in the incidence of P. kudriavzevii which is usually an environmental contaminant. Regular surveillance and infection control practices are future ventures to reduce the burden of infection.
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Joshi KK, Bhatt DC, Arya AK, Saini V. Population status of house sparrow (Passer domesticus L.) and its association with native bird species in and around Dehradun City of Uttarakhand, India. Proc Indian Natl Sci Acad 2022. [DOI: 10.1007/s43538-022-00112-2] [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: 10/14/2022]
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Sasmal S, Dwari G, Baran Maity B, Saini V, Thamizhavel A, Mondal R. Shubnikov-de Haas and de Haas-van Alphen oscillations in Czochralski grown CoSi single crystal. J Phys Condens Matter 2022; 34:425702. [PMID: 35961292 DOI: 10.1088/1361-648x/ac8960] [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] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
Anisotropic transport, Shubnikov-de Haas (SdH), and de Haas-van Alphen (dHvA) quantum oscillations studies are reported on a high-quality CoSi single crystal grown by the Czochralski method. Temperature-dependent resistivities indicate the dominating electron-electron scattering. Magnetoresistance (MR) at 2 K reaches 610% forI ∥ [111]andB ∥ [011-], whereas it is 500% forI ∥ [011-] andB ∥ [111]. A negative slope in field-dependent Hall resistivity suggests electrons are the majority carriers. The carrier concentration extracted from Hall conductivity indicates no electron-hole compensation. In 3D CoSi, the electron transport lifetime is found to be approximately in the same order as the quantum lifetime, whereas in 2Delectron gas the long-range scattering drives the transport life much larger than the quantum lifetime. From MR and Hall SdH oscillations, the effective masses and Dingle temperatures have been calculated. The dHvA oscillation reveals three frequencies at 18 T (γ), 558 T (α) and 663 T (β), whereas, SdH oscillation results in only two frequenciesαandβ. Theγfrequency observed in dHvA oscillation is a tiny hole pocket at the Γ point.
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Affiliation(s)
- Souvik Sasmal
- Department of Condensed Matter Physics and Materials Science, Tata Institute of Fundamental Research, Homi Bhabha Road, Colaba, Mumbai 400 005, India
| | - Gourav Dwari
- Department of Condensed Matter Physics and Materials Science, Tata Institute of Fundamental Research, Homi Bhabha Road, Colaba, Mumbai 400 005, India
| | - Bishal Baran Maity
- Department of Condensed Matter Physics and Materials Science, Tata Institute of Fundamental Research, Homi Bhabha Road, Colaba, Mumbai 400 005, India
| | - Vikas Saini
- Department of Condensed Matter Physics and Materials Science, Tata Institute of Fundamental Research, Homi Bhabha Road, Colaba, Mumbai 400 005, India
| | - A Thamizhavel
- Department of Condensed Matter Physics and Materials Science, Tata Institute of Fundamental Research, Homi Bhabha Road, Colaba, Mumbai 400 005, India
| | - Rajib Mondal
- UGC-DAE Consortium for Scientific Research, Kolkata Centre, Bidhannagar, Kolkata 700 106, India
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Kashyap B, Saha R, Saini V, Singh NP. Conventional versus reverse testing algorithm for syphilis in high-risk population: A diagnostic dilemma. Indian J Sex Transm Dis AIDS 2022; 43:233-234. [PMID: 36743102 PMCID: PMC9890993 DOI: 10.4103/ijstd.ijstd_23_21] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 02/03/2022] [Accepted: 02/07/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Bineeta Kashyap
- Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Rituparna Saha
- Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Vikas Saini
- Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Narendra Pal Singh
- Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
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Abstract
U.S. Food and Drug Administration–s (FDA) approval of aducanumab (Aduhelm® in the US) as a treatment for mild cognitive impairment of the Alzheimer type and Alzheimer–s disease has raised such major concerns about efficacy, safety, FDA processes, and regulatory capture that Biogen–s license to market this biologic should be immediately withdrawn. Aducanumab has not demonstrated benefit to patients, failed to meet regulatory guidelines, and is likely to cause both individual and societal harm.
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Affiliation(s)
- Peter J. Whitehouse
- Case Western Reserve University, Cleveland, OH, USA
- University of Toronto, Toronto, Ontario, Canada
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Whitehouse P, Gandy S, Saini V, George DR, Larson EB, Alexander GC, Avorn J, Brownlee S, Camp C, Chertkow H, Fugh-Berman A, Howard R, Kesselheim A, Langa K, Perry G, Richard E, Schneider L. Making the Case for Accelerated Withdrawal of Aducanumab. J Alzheimers Dis 2022; 87:1003-1007. [DOI: 10.3233/jad-220262] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The controversial approval in June 2021 by the Food and Drug Administration (FDA) of aducanumab (marketed as Aduhelm), Biogen’s monoclonal antibody for patients with Alzheimer’s disease, raises significant concerns for the dementia field and drug approval process, considering its lack of adequate evidence for clinical efficacy, safety issues, and cost. On 15 December 2021, an international group of clinicians, basic science experts, psychological and social science researchers, lay people with lived experience of dementia, and advocates for public health met to discuss making a recommendation for whether aducanumab’s approval should be withdrawn. Attendees considered arguments both in favor of and in opposition to withdrawal and voted unanimously to recommend that the FDA withdraw its approval for aducanumab and to support the Right Care Alliance’s filing of a formal Citizen Petition to this effect.
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Affiliation(s)
- Peter Whitehouse
- Departments of Neurology, Psychiatry, Neuroscience, Cognitive Science, Organizational Behavior, and Design and Innovation, Case Western Reserve University, Cleveland, OH, USA
- Professor of Medicine (Neurology), University of Toronto, Toronto, Ontario, Canada
| | - Sam Gandy
- Departments of Neurology and Psychiatry, and The Mount Sinai Alzheimer’s Disease Research Center, Icahn School of Medicine at Mount Sinai, New York NY, USA
- Research Administration and Division of Neurology, James J Peters VA Medical Center, Bronx, NY, USA
| | | | - Daniel R. George
- Department of Humanities, Penn State College of Medicine, Hershey, PA, USA
| | - Eric B. Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Medicine and Health Services, University of Washington, Seattle, WA, USA
| | - G. Caleb Alexander
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jerry Avorn
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Shannon Brownlee
- Department of Policy and Management, George Washington University School of Public Health, Washington, DC, USA
| | - Cameron Camp
- Director of Research and Development, Center for Applied Research in Dementia, Solon, OH, USA
| | - Howard Chertkow
- Cognitive Neurology and Innovation and Senior Scientist, Baycrest Academy for Research & Education at Baycrest Centre for Geriatric Care, Toronto, Ontario, Canada
- Kimel Centre for Brain Health and Wellness and Anne & Allan Bank Centre for Clinical ResearchTrials, Baycrest, Toronto, Ontario, Canada
- Canadian Consortium on Neurodegeneration in Aging, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
- Neurology (Medicine), University of Toronto, Toronto, Ontario, Canada
| | - Adriane Fugh-Berman
- PharmedOut, Georgetown University Medical Center, Department of Pharmacology and Physiology, Washington, DC, USA
| | - Rob Howard
- Old Age Psychiatry, Division of Psychiatry, University College London, UK
| | - Aaron Kesselheim
- Medicine, Harvard Medical School, Boston, MA, USA
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Boston, MA, USA
| | - Ken Langa
- Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, MI, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
- Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - George Perry
- Department of Biology, University of Texas at San Antonio, San Antonio, TX, USA
| | - Edo Richard
- Department of Neurology, Donders Institute for Brain, Behaviour and Cognition, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Public and Occupational Health, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Lon Schneider
- Psychiatry and Neuroscience, Keck School of Medicine of USC, Psychiatry and The Behavioral Sciences, Los Angeles, CA, USA
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Singh NP, Goyal N, Saini V, Kapoor A, Gangar S. Are we adequately prepared to handle the anticipated 3rd peak of COVID-19: A KAP survey among HCWs. Healthc Low Resour Settings 2022. [DOI: 10.4081/hls.2022.10298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Experts in the field are predicting a third COVID-19 peak very soon in coming times, it is important to assess recent knowledge, attitude in view of prolonged exhaustion and adherence to preventive practices of HCWs. This cross-sectional study involved 168 HCWs (42 doctors, 42 nurses, 42 paramedical staff and 42 ANMs). Data was collected through online survey tool Google forms in July and August 2021. First section included sociodemographic information and infection with SARS-CoV- 2, section 2 assessed recent knowledge, section 3 practices of COVID-19 appropriate behavior and section 4 assessed attitude of HCWs. Shapiro Wilk test was used to determine normality of distribution of variables. Kruskal-Wallis and Mann-Whitney U tests were used to determine the association between two variables. Pairwise comparison was done following a significant Kruskal-Wallis test using Bonferroni’s correction. 42.9% of the HCWs and family members of 44.6% HCWs were infected with SARS-CoV-2. 54.1% of infected HCWs were infected during the March- May 2021 peak. 85.1% HCWs had taken COVID-19 vaccine. Mean knowledge, attitude, practice scores were 7.88±3.03(maximum score: 12), 20.35±3.2 (maximum score: 25), 69.89±9.39 (maximum score: 85) respectively. Only 48.8% HCWs had good knowledge about more recent COVID-19 information. A significant association was observed between profession and knowledge scores (p<0.001). Over 85% HCWs had good scores for attitude towards COVID-19 and 88.7% HCWs scored good in COVID-19 appropriate behavior practices. Our HCWs need to be better equipped with the more recently available knowledge about COVID-19 to improve our preparedness for the next anticipated peak.
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Challa AS, Luther E, Burks J, Saini V, Abecassis J, Silva M, Jamshidi A, Yavagal D, Peterson E, Starke RM. Radial Long Sheath Angioplasty for Proximal Severe Flow Limiting Radial Artery Spasm Utilizing the Dotter Technique. World Neurosurg 2022; 160:16-21. [PMID: 35032711 DOI: 10.1016/j.wneu.2022.01.025] [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: 10/26/2021] [Accepted: 01/06/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although studies continue to demonstrate the advantages of transradial access (TRA) for neurointerventions, radial artery spasm (RAS) remains a frequent cause of TRA failure. Dotter initially described a technique to dilate areas of peripheral vascular stenosis by advancing sequentially larger catheters across the lesion over a wire. We present our institutional experience performing a modified Dotter technique utilizing long radial sheaths to dilate areas of proximal flow limiting RAS. OBJECTIVE To review the use of the Dotter technique for alleviating RAS in patients undergoing TRA for neurointerventions. METHODS A retrospective review of all patients undergoing TRA for neurointerventions at our institution from 2018-2020 was performed to identify patients with proximal flow limiting RAS. In identified patients, a modified Dotter technique was employed to dilate the stenosis. Demographic and periprocedural data were assessed to identify any adverse outcomes. RESULTS Four patients with severe proximal flow limiting RAS were identified. In each case, a hydrophilic long radial sheath and vascular dilator were sequentially advanced through the stenosis. In all cases, repeat angiography demonstrated improvement of the spasm and final radial angiograms demonstrated persistent improvement in caliber and regularity of the vessel. Each procedure was also completed via TRA with no periprocedural complications. CONCLUSIONS Our modified Dotter technique is effective in bypassing areas of severe proximal flow limiting RAS thus obviating the need for access site conversion. Additional studies are warranted to understand the implication of the angioplasty-like effects seen within the radial artery following removal of the long radial sheaths.
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Affiliation(s)
- A S Challa
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - E Luther
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA.
| | - J Burks
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - V Saini
- Department of Neurology, University of Miami School of Medicine, Miami, Florida, USA
| | - J Abecassis
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - M Silva
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - A Jamshidi
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - D Yavagal
- Department of Neurology, University of Miami School of Medicine, Miami, Florida, USA
| | - E Peterson
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - R M Starke
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
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Kumar S, Saini V. Portable BiPAP machines in Covid: A saviour in second pandemic wave. J Anaesthesiol Clin Pharmacol 2022; 38:S144-S145. [PMID: 36060173 PMCID: PMC9438845 DOI: 10.4103/joacp.joacp_373_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/08/2021] [Indexed: 11/12/2022] Open
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20
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Nirmal K, Saini V, Ahmad N, Das S, Singh N. Microbiological profile and their antibiogram of bloodstream infections amongst first and second surge of the COVID-19 patients in a tertiary care hospital. J Family Med Prim Care 2022; 11:7367-7371. [PMID: 36993004 PMCID: PMC10041244 DOI: 10.4103/jfmpc.jfmpc_770_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction The world is experiencing a pandemic of coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2. The prescription of a superfluity of unnecessary antibiotics without regard for the potential for increased antimicrobial resistances is extensive and unimpeded during the COVID-19 pandemic. Aims To compare the microorganisms and the pattern of antimicrobial resistance of bacteremia during the first and second waves of the COVID-19 pandemic in a tertiary care hospital. Methods and Material This retrospective observational study, to compared the blood culture of the COVID-19 pandemic during the first wave (April 2020 to September 2020) and the second wave (April 2021 to September 2021). All the blood culture isolates were identified and the antimicrobial susceptibility testing was done according to standard guidelines. Results Out of 1470 blood culture samples, 259 (17.6%) blood bacterial isolates were grown in the first wave and, out of 4200 blood culture samples, 711 (16.9%) bacterial isolated during the second wave of the COVID-19 pandemic. Coagulase-negative staphylococcus (CONS) was 32.8% followed by Staphylococcus aureus 29.7% in COVID first wave and staphylococcus aureus (48.9%) followed by Klebsiella pneumoniae (11.6%) during COVID second wave were the most prevalent isolates. Conclusions This study shows that coagulase-negative staphylococcus aureus and multidrug-resistant Klebsiella spp. are the leading causes of bloodstream coagulase-negative infections during both the first and second wave in the bloodstream COVID-19 pandemic.
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S. Bhogal R, Sachdeva M, Suri V, Saini V, Kumar A, Mohindra R, Rohilla K, Kumar M, Soni R, Singh H, Sharma P, Kumar S, Jain A, K Naidu GSRSN, Rastogi A, Prasad K. Clinical profile of COVID-19 patients and their length of stay: Tertiary care hospital experience. J Family Med Prim Care 2022; 11:3100-3103. [PMID: 36119302 PMCID: PMC9480766 DOI: 10.4103/jfmpc.jfmpc_2107_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background: SARSCoV-2, a coronavirus that causes COVID-19, is spreading rapidly. By the middle of August-2021, it has affected over 3 million confirmed cases in India. The main aim of this study was to examine the clinical profile of COVID-19 patients and their length of stay during treatment in a hospital. Materials and Methods: It was a hospital-based retrospective study conducted by using a total enumeration technique in July–August 2021 at Nehru Hospital, Postgraduate Institute of Medical Education and Research (PGIMER) in India. The present study was conducted on 72 COVID-19 patients who took treatment in 4C and 5C wards. Structured questionnaires were used to collect data, which included bio-demographic factors and questions about their treatment and length of stay. Results: The majority of the 72 COVID-19 positive patients were men (62%), belonged to the age group of 41–60 years (35%), had SpO2 levels ranging from 91%–95% (45%), and received room air O2 therapy (63%) during their treatment in the hospital. Female patients had a longer length of stay (7.33 days), patients under the age of 20 years had the longest hospital stay (11.5 days), patients with SpO2 less than 70% had the longest hospital stay (8 days), and patients who received oxygen using a non-rebreathing mask had the longest hospital stay (11 days). Conclusion: To avoid panic situations, regular admission and discharge of patients was essential due to the considerable increase in cases during the second wave. Patient length of stay was reduced as a consequence of collaboration and cooperation among all physicians, residents, staff nurses, and paramedics, with the goal of discharging the patient after a room air trial and follow up if needed.
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22
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Saini V, Duggal N. Comparison of rapid tests (antigen vs. antibody) for the diagnosis of typhoid in the first and second weeks of fever. J Family Med Prim Care 2022; 11:3730-3734. [DOI: 10.4103/jfmpc.jfmpc_2329_21] [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] [Received: 11/30/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/04/2022] Open
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23
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Saini V, Vamsidhar A, Samra T, Sethi S, Naik BN. Comparative evaluation of ultrasound guided supraclavicular and infraclavicular subclavian venous catheterizations in adult patients. J Anaesthesiol Clin Pharmacol 2022; 38:411-416. [PMID: 36505187 PMCID: PMC9728414 DOI: 10.4103/joacp.joacp_400_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 01/04/2021] [Accepted: 04/07/2021] [Indexed: 12/15/2022] Open
Abstract
Background and Aims Ultrasound-guided subclavian vein cannulation has two approaches: supraclavicular and infraclavicular. The aim of this study was to compare the ease of cannulation by recording the puncture time of the subclavian vein with the two approaches in adult patients. Material and Methods This study was approved by our institutional ethics committee, and a written informed consent was obtained from the patients. This prospective randomized trial recruited patients aged 18 to 80 years with definite indications of subclavian vein cannulation. Real-time in-plane ultrasound-guided technique was used, and the subclavian vein was punctured at the junction of the brachiocephalic and IJV in supraclavicular approach (SC) and in oblique axis below the border of the clavicle in infraclavicular approach (IC). Results A total of 96 patients were randomly allocated equally into two groups of 48 each, but only 45 patients in each group could be successfully cannulated. Median puncture times were comparable; 15 (9-39) s in SC and 21 (5-80) s in IC group. The first attempt success rate was 82.2% and 62.2%, and the mean total access time was 99.11 ± 34.66 s and 103.44 ± 50.27 s in SC and IC approaches, respectively and were comparable. The attempts of needle puncture were significantly higher in IC approach (1.40 ± 0.54 vs 1.20 ± 0.46 in SC approach; P = 0.04). The complication rates were comparable and less than 5%. Conclusion Ease of cannulation of the subclavian vein using ultrasound-guided supraclavicular and infraclavicular approach is comparable as no statistically significant difference is noted in the puncture time and first-attempt success rate. The increased number of needle punctures reported in our study with the IC approach did not translate to an increased complication rate.
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Affiliation(s)
- Vikas Saini
- Department of Anesthesia, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Amburu Vamsidhar
- Department of Anesthesia, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Tanvir Samra
- Department of Anesthesia, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India,Address for correspondence: Dr. Tanvir Samra, Department of Anesthesia, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh - 160 012, India. E-mail:
| | - Sameer Sethi
- Department of Anesthesia, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - B. N. Naik
- Department of Anesthesia, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
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Saini V, Kalra P, Sharma M, Rai C, Saini V, Gautam K, Bhattacharya S, Mani S, Saini K, Kumar S. A Cold Chain-Independent Specimen Collection and Transport Medium Improves Diagnostic Sensitivity and Minimizes Biosafety Challenges of COVID-19 Molecular Diagnosis. Microbiol Spectr 2021; 9:e0110821. [PMID: 34878310 PMCID: PMC8653843 DOI: 10.1128/spectrum.01108-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/21/2021] [Indexed: 01/10/2023] Open
Abstract
Equitable and timely access to COVID-19-related care has emerged as a major challenge, especially in developing and low-income countries. In India, ∼65% of the population lives in villages where infrastructural constraints limit the access to molecular diagnostics of COVID-19 infection. Especially, the requirement of a cold chain transport for sustained sample integrity and associated biosafety challenges pose major bottlenecks to the equitable access. Here, we developed an innovative clinical specimen collection medium, named SupraSens microbial transport medium (SSTM). SSTM allowed a cold chain-independent transport at a wide temperature range (15°C to 40°C) and directly inactivated SARS-CoV-2 (<15 min). Evaluation of SSTM compared to commercial viral transport medium (VTM) in field studies (n = 181 patients) highlighted that, for the samples from same patients, SSTM could capture more symptomatic (∼26.67%, 4/15) and asymptomatic (52.63%, 10/19) COVID-19 patients. Compared to VTM, SSTM yielded significantly lower quantitative PCR (qPCR) threshold cycle (Ct) values (mean ΔCt > -3.50), thereby improving diagnostic sensitivity of SSTM (18.79% [34/181]) versus that of VTM (11.05% [20/181]). Overall, SSTM had detection of COVID-19 patients 70% higher than that of VTM. Since the logistical and infrastructural constraints are not unique to India, our study highlights the invaluable global utility of SSTM as a key to accurately identify those infected and control COVID-19 transmission. Taken together, our data provide a strong justification to the adoption of SSTM for sample collection and transport during the pandemic. IMPORTANCE Approximately forty-four percent of the global population lives in villages, including 59% in Africa (https://unhabitat.org/World%20Cities%20Report%202020). The fast-evolving nature of SARS-CoV-2 and its extremely contagious nature warrant early and accurate COVID-19 diagnostics across rural and urban population as a key to prevent viral transmission. Unfortunately, lack of adequate infrastructure, including the availability of biosafety-compliant facilities and an end-to-end cold chain availability for COVID-19 molecular diagnosis, limits the accessibility of testing in these countries. Here, we fulfill this urgent unmet need by developing a sample collection and transport medium, SSTM, that does not require cold chain, neutralizes the virus quickly, and maintains the sample integrity at broad temperature range without compromising sensitivity. Further, we observed that use of SSTM in field studies during pandemic improved the diagnostic sensitivity, thereby establishing the feasibility of molecular testing even in the infrastructural constraints of remote, hilly, or rural communities in India and elsewhere.
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Affiliation(s)
- Vikram Saini
- Laboratory of Infection Biology and Translational Research, Department of Biotechnology, All India Institute of Medical Sciences, New Delhi, India
- Biosafety Laboratory-3, Centralized Core Research Facility (CCRF), All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Priya Kalra
- Laboratory of Infection Biology and Translational Research, Department of Biotechnology, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Sharma
- Defence Institute of Physiology and Allied Sciences (DIPAS), Defence Research and Development Organization (DRDO), Ministry of Defense, Delhi, India
| | - Chhavi Rai
- Defence Institute of Physiology and Allied Sciences (DIPAS), Defence Research and Development Organization (DRDO), Ministry of Defense, Delhi, India
| | - Vikas Saini
- University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - Kamini Gautam
- Laboratory of Infection Biology and Translational Research, Department of Biotechnology, All India Institute of Medical Sciences, New Delhi, India
| | - Sankar Bhattacharya
- Translational Health Science and Technology Institute (THSTI), Faridabad, Haryana, India
| | - Shailendra Mani
- Translational Health Science and Technology Institute (THSTI), Faridabad, Haryana, India
| | - Kanchan Saini
- Laboratory of Infection Biology and Translational Research, Department of Biotechnology, All India Institute of Medical Sciences, New Delhi, India
| | - Sunil Kumar
- Laboratory of Infection Biology and Translational Research, Department of Biotechnology, All India Institute of Medical Sciences, New Delhi, India
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Kashyap B, Saha R, Saini V, Grover C, Singh NP. Utility of a rapid point of care test for screening of syphilis among high-risk and low-risk population at a tertiary care hospital. Indian J Sex Transm Dis AIDS 2021; 42:83-85. [PMID: 34765947 PMCID: PMC8579593 DOI: 10.4103/ijstd.ijstd_8_20] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/18/2020] [Accepted: 10/23/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Bineeta Kashyap
- Department of Microbiology, University College of Medical Sciences, Guru Teg Bahadur Hospital, Delhi, India
| | - Rituparna Saha
- Department of Microbiology, University College of Medical Sciences, Guru Teg Bahadur Hospital, Delhi, India
| | - Vikas Saini
- Department of Microbiology, University College of Medical Sciences, Guru Teg Bahadur Hospital, Delhi, India
| | - Chander Grover
- Department of Dermatology, University College of Medical Sciences, Guru Teg Bahadur Hospital, Delhi, India
| | - Narendra Pal Singh
- Department of Microbiology, University College of Medical Sciences, Guru Teg Bahadur Hospital, Delhi, India
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Saini V, Samra T, Naik B N, Ganesh V, Garg K, Sethi S, Kanwar DB, Singh S, Rawat N, Gorla D. Normal Saline Versus Balanced Crystalloids in Renal Transplant Surgery: A Double-Blind Randomized Controlled Study. Cureus 2021; 13:e18247. [PMID: 34722040 PMCID: PMC8544908 DOI: 10.7759/cureus.18247] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 11/21/2022] Open
Abstract
Background The importance of optimal acid-base balance during renal transplant surgeries cannot be stressed enough. Optimal preload and electrolyte balance is important in maintaining this. There has been a debate on the choice of perioperative crystalloids in renal transplant surgeries over the past decades. Normal saline (0.9% saline) is more likely to cause hyperchloremic acidosis when compared to balanced salt solutions (BSS) with low chloride content whereas BSS may cause hyperkalemia. We aim to compare the safety and efficacy of normal saline (NS), Ringer’s lactate (RL) and Plasmalyte (PL) on acid-base balance and electrolytes during living donor kidney transplantation. Materials and methods Patients were randomized to NS group (n = 60), RL group (n = 60) and Plasmalyte group (n = 60). Arterial blood samples were collected for acid-base analysis after induction of anaesthesia (T0), prior to clamping the iliac vein (T1), 10 minutes after reperfusion of the donated kidney (T2) and at the end of surgery (T3). In addition, serum creatinine and 24-hour urine output were recorded on postoperative days one, two and seven. Results There was a statistically significant difference (p < 0.001) in the pH at the end of surgery between the three groups with the NS group being more acidotic (pH 7.29 ± 0.06, 95% CI 7.27-7.32), although this was not clinically relevant. This was explainable by the parallel increase in chloride in the NS group. Early postoperative graft functions in terms of serum creatinine, urine output and graft failure requiring dialysis were not significantly different between the groups. Conclusion Balanced salt solutions such as Plasmalyte and Ringer’s lactate are associated with better pH and chloride levels compared to normal saline when used intraoperatively in renal transplant patients. This difference, however, does not appear to have any bearing on graft function. Plasmalyte seems to maintain a better acid-base and electrolyte balance, especially during the postreperfusion period.
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Affiliation(s)
- Vikas Saini
- Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Tanvir Samra
- Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Naveen Naik B
- Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Venkata Ganesh
- Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Kashish Garg
- Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Sameer Sethi
- Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Deepesh B Kanwar
- Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Sarbpreet Singh
- Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Neha Rawat
- Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Deepkanth Gorla
- Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
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Saini V, Samra T, Sethi S, Naik BN. Comparative evaluation of optic nerve sheath diameter in patients undergoing laparoscopic cholecystectomy using low and standard pressures of gas insufflations. J Anaesthesiol Clin Pharmacol 2021; 37:616-621. [PMID: 35340969 PMCID: PMC8944363 DOI: 10.4103/joacp.joacp_370_18] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/07/2019] [Accepted: 02/24/2020] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Intra-abdominal insufflation of CO2 is associated with an increase of intracranial pressure (ICP). We conducted this randomized control trial to compare the impact of low vs standard pressure pneumoperitoneum on ICP through the ultrasonographic estimation of the optic nerve sheath diameter (ONSD). Material and Methods Patients of age group 18-80 years planned for laparoscopic cholecystectomy were randomly allocated into two groups; group S (standard pressure of 12-16 mmHg) and group L (low pressure of 8-10 mmHg) on the basis of intra-abdominal pressures used for the surgery. All were administered general anesthesia and end-tidal carbon dioxide (ETCO2) was maintained between 35 and 40 mmHg and peak airway pressures less than 35 cmH2O. ONSD was measured in either eye at a point 3 mm posterior to the globe at following time intervals; baseline, 5 min after induction, 10 min after insufflation, 10 min after reverse Trendelenburg, intraoperatively during surgery and after exsufflation in the supine position. Results The demographic profile and operative times were comparable. ONSD was measured in 100 patients in each group for both the eyes and no patient had values above the cutoff value of 5.0 mm. No significant difference in the ONSD was observed at the above mentioned time intervals between the groups. There was a statistically significant lower value of the heart rate and mean arterial pressure in the low-pressure group. Conclusion Intra-abdominal insufflation of CO2 at standard and low pressures does not increase ICP in short duration surgeries and thus both the pressures can be safely used in adult patients operated in reverse Trendelenburg position. Advantages of low pressure were limited to better hemodynamic control.
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Affiliation(s)
- Vikas Saini
- Department of Anesthesia, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Tanvir Samra
- Department of Anesthesia, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Sameer Sethi
- Department of Anesthesia, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - B Naveen Naik
- Department of Anesthesia, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
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Li L, Chamoun GF, Chamoun NG, Sessler D, Gopinath V, Saini V. Elucidating the association between regional variation in diagnostic frequency with risk-adjusted mortality through analysis of claims data of medicare inpatients: a cross-sectional study. BMJ Open 2021; 11:e054632. [PMID: 34588267 PMCID: PMC8479990 DOI: 10.1136/bmjopen-2021-054632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The validity of risk-adjustment methods based on administrative data has been questioned because hospital referral regions with higher diagnosis frequencies report lower case-fatality rates, implying that diagnoses do not track the underlying health risk. The objective of this study is to test the hypothesis that regional variation of diagnostic frequency in inpatient records is not associated with different coding practices but a reflection of the underlying health risks. DESIGN We applied two stratification methods to Medicare Analysis and Provider Review data from 2009 through 2014: (1) the number of chronic conditions; and, (2) quartiles of Risk Stratification Index (RSI)-defined risk. After sorting hospital referral regions into quintiles of diagnostic frequency, we examined all-cause mortality. SETTING Medicare Analysis and Provider Review administrative database. PARTICIPANTS 18 126 301 hospitalised Medicare fee-for-service beneficiaries aged 65 or older who had at least one hospital-based procedure between 2009 and 2014. EXPOSURE Coding frequency and baseline regional population risk factors by hospital referral region. PRIMARY AND SECONDARY OUTCOMES AND MEASURES One year all-cause mortality in patients having the same number of chronic conditions or within the same RSI score quartile across US health referral regions, grouped by diagnostic frequency. RESULTS No consistent relationship between diagnostic frequency and mortality in the risk stratum defined by number of chronic conditions was detected. In the strata defined by RSI quartile, there was no decrease in mortality as a function of diagnostic frequency. Instead, adjusted mortality was positively correlated with socioeconomic risk factors. CONCLUSIONS Using present-on-admission codes only, diagnostic frequency among inpatients with at least one hospital-based procedure appears to be consequent to differences in baseline population health status, rather than diagnostic coding practices. In this population, claims-based risk-adjustment using RSI appears to be useful for assessing hospital outcomes and performance.
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Affiliation(s)
- Linyan Li
- School of Data Science, City University of Hong Kong, Hong Kong, China
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | | | - Daniel Sessler
- Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA
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Saini V, Gopinath V. Application of the Risk Stratification Index to Multilevel Models of All-condition 30-Day Mortality in Hospitalized Populations Over the Age of 65. Med Care 2021; 59:836-842. [PMID: 33989249 PMCID: PMC8360662 DOI: 10.1097/mlr.0000000000001570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Risk Stratification Index (RSI) is superior to Hierarchical Conditions Categories (HCC) in patient-level regressions but has not been applied to assess hospital effects. OBJECTIVE The objective of this study was to measure the accuracy of RSI in modeling 30-day hospital mortality across all conditions using multilevel logistic regression. SUBJECTS AND DATA SOURCES A 100% sample of Medicare inpatient stays from 2009 to 2014, restricted to patients greater than 65 years of age in general hospitals, resulting in 64 million stays at 3504 hospitals. RESEARCH DESIGN We calculated RSI and HCC scores for patient stays using multilevel logistic regression in 3 populations: all inpatients, surgical, and nonsurgical. Correlations of risk-standardized mortality rates with rates of specific case types assessed case-mix balance. Patient stay volume was included to assess smaller hospitals. RESULTS We found a negligible correlation of all-conditions risk-standardized mortality rates with hospitals' proportions of orthopedic, cardiac, or pneumonia cases. RSI outperformed HCC in multilevel regressions containing both patient and hospital-level effects. C-statistics using RSI were 0.87 for the all-inpatients group, 0.87 for surgical, and 0.86 for nonsurgical stays. With HCC they were 0.82, 0.82, and 0.81. Akaike Information Criteria and Bayesian Information Criteria values were higher with HCC. RSI shifted 41% of hospitals' rankings by >1 decile. Hospitals with smaller volumes had higher 30-day observed and standardized mortality: 11.2% in the lowest volume quintile versus 8.5% in the highest volume quintile. CONCLUSION RSI has superior accuracy and results in a significant shift in rankings compared with HCC in multilevel models of 30-day hospital mortality across all conditions.
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Saini V, Jain C, Singh NP, Alsulimani A, Gupta C, Dar SA, Haque S, Das S. Paradigm Shift in Antimicrobial Resistance Pattern of Bacterial Isolates during the COVID-19 Pandemic. Antibiotics (Basel) 2021; 10:antibiotics10080954. [PMID: 34439004 PMCID: PMC8388877 DOI: 10.3390/antibiotics10080954] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/24/2021] [Accepted: 07/26/2021] [Indexed: 12/22/2022] Open
Abstract
Antimicrobial resistance (AMR) is an emerging public health problem in modern times and the current COVID-19 pandemic has further exaggerated this problem. Due to bacterial co-infection in COVID-19 cases, an irrational consumption of antibiotics has occurred during the pandemic. This study aimed to observe the COVID-19 patients hospitalized from 1 March 2019 to 31 December 2020 and to evaluate the AMR pattern of bacterial agents isolated. This was a single-center study comprising 494 bacterial isolates (blood and urine) that were obtained from patients with SARS-CoV-2 admitted to the ICU and investigated in the Department of Microbiology of a tertiary care hospital in Delhi, India. Out of the total bacterial isolates, 55.46% were gram negative and 44.53% were gram positive pathogens. Of the blood samples processed, the most common isolates were CoNS (Coagulase Negative Staphylococcus) and Staphylococcus aureus. Amongst the urinary isolates, most common pathogens were Escherichia coli and Staphylococcus aureus. A total of 60% MRSA was observed in urine and blood isolates. Up to 40% increase in AMR was observed amongst these isolates obtained during COVID-19 period compared to pre-COVID-19 times. The overuse of antibiotics gave abundant opportunity for the bacterial pathogens to gradually develop mechanisms and to acquire resistance. Since the dynamics of SARS-COV-2 are unpredictable, a compromise on hospital antibiotic policy may ultimately escalate the burden of drug resistant pathogens in hospitals. A shortage of trained staff during COVID-19 pandemic renders it impossible to maintain these records in places where the entire hospital staff is struggling to save lives. This study highlights the extensive rise in the use of antibiotics for respiratory illness due to COVID-19 compared to antibiotic use prior to COVID-19 in ICUs. The regular prescription audit followed by a constant surveillance of hospital infection control practices by the dedicated teams and training of clinicians can improve the quality of medications in the long run and help to fight the menace of AMR.
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Affiliation(s)
- Vikas Saini
- Department of Microbiology, University College of Medical Sciences & GTB Hospital, Delhi 110095, India; (V.S.); (C.J.); (N.P.S.); (S.A.D.)
| | - Charu Jain
- Department of Microbiology, University College of Medical Sciences & GTB Hospital, Delhi 110095, India; (V.S.); (C.J.); (N.P.S.); (S.A.D.)
| | - Narendra Pal Singh
- Department of Microbiology, University College of Medical Sciences & GTB Hospital, Delhi 110095, India; (V.S.); (C.J.); (N.P.S.); (S.A.D.)
| | - Ahmad Alsulimani
- Medical Laboratory Technology Department, College of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia;
| | - Chhavi Gupta
- Northern Railways Central Hospital, New Delhi 110055, India;
| | - Sajad Ahmad Dar
- Department of Microbiology, University College of Medical Sciences & GTB Hospital, Delhi 110095, India; (V.S.); (C.J.); (N.P.S.); (S.A.D.)
- Research and Scientific Studies Unit, College of Nursing, Jazan University, Jazan 45142, Saudi Arabia
| | - Shafiul Haque
- Research and Scientific Studies Unit, College of Nursing, Jazan University, Jazan 45142, Saudi Arabia
- Faculty of Medicine, Görükle Campus, Bursa Uludağ University, Nilüfer 16059, Turkey
- Correspondence: (S.H.); (S.D.)
| | - Shukla Das
- Department of Microbiology, University College of Medical Sciences & GTB Hospital, Delhi 110095, India; (V.S.); (C.J.); (N.P.S.); (S.A.D.)
- Correspondence: (S.H.); (S.D.)
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Chalmers K, Gopinath V, Brownlee S, Saini V, Elshaug AG. Adverse Events and Hospital-Acquired Conditions Associated With Potential Low-Value Care in Medicare Beneficiaries. JAMA Health Forum 2021; 2:e211719. [PMID: 35977201 PMCID: PMC8796970 DOI: 10.1001/jamahealthforum.2021.1719] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/29/2021] [Indexed: 12/19/2022] Open
Abstract
Question What is the prevalence and cost of hospital-acquired conditions (HACs) and patient safety events (PSIs) associated with procedures that may be low value? Findings In this retrospective claims analysis of a cohort of Medicare fee-for-service beneficiaries, there were 231 HACs and 1764 PSIs in 197 755 claims for 7 inpatient procedures from 2016 to 2018. Meaning Patients with flagged, potential low-value procedures were harmed while in hospital, resulting in an extended length of stay and additional costs. Importance There has been insufficient research on the patient harms and costs associated with potential low-value procedures in the US Medicare population. Objective To report the prevalence of adverse events associated with potential low-value procedures and the additional hospital length of stay (LOS) and costs. Design, Setting, and Participants This is a retrospective cohort study using Medicare fee-for-service claims between January 2016 to December 2018. Participants were aged 65 years or older. Procedures were selected if they had previously published indicators of low-value care, including knee arthroscopy, spinal fusion, vertebroplasty, percutaneous coronary intervention (PCI), carotid endarterectomy, renal stenting, and hysterectomy for benign conditions. Analysis was conducted from July to December, 2020. Main Outcomes and Measures For inpatient procedures, the number and rate of admissions with a hospital-acquired condition (HAC) or patient safety indicator event (PSIs), as well as the unadjusted and adjusted difference in mean LOS and Medicare costs between admissions with and without a HAC/PSI. For outpatient procedures, we report the number of claims where the beneficiary had an unplanned hospital admission within seven days and the number of these admissions with a HAC/PSI. Results There were 573 351 patients included in the study, with 617 264 procedures; the mean (SD) age was 74.2 (6.7) years, with 320 637 women (55.9%), and mostly White patients (520 735; 90.8%). Among the 197 755 claims for the inpatient procedures, 231 had an HAC and 1764 had a PSI. Spinal fusion was associated with the most HACs (123 admissions) and PSIs (1015 admissions). Overall, HACs during a PCI admission were associated with the highest adjusted additional mean LOS (17.5 days; 95% CI, 10.3-23.6), with also the highest adjusted additional mean cost ($22 000; 95% CI, $9100-$32 600). There were 419 509 included outpatient procedures, and 7514 (1.8%) had an unplanned admission within 7 days. A total of 17 HACs and PSIs occurred in these admissions. Conclusions and Relevance In this cross-sectional cohort study of Medicare fee-for-service claims, patients receiving potential low-value care were exposed to risk of unnecessary harm associated with higher cost and LOS.
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Affiliation(s)
- Kelsey Chalmers
- Lown Institute, Needham, Massachusetts
- Menzies Centre for Health Policy, Sydney School of Public Health, University of Sydney, Australia, NSW
| | | | | | | | - Adam G. Elshaug
- Menzies Centre for Health Policy, Sydney School of Public Health, University of Sydney, Australia, NSW
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Australia, VIC
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Singla K, Kajal K, Chauhan N, Kajal S, Saini V. A rare case of tracheoesophageal fistula and pneumothorax occurring simultaneously in a patient following percutaneous dilatational tracheostomy. J Anaesthesiol Clin Pharmacol 2021; 37:127-129. [PMID: 34103838 PMCID: PMC8174443 DOI: 10.4103/joacp.joacp_98_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 10/30/2019] [Accepted: 12/20/2019] [Indexed: 11/23/2022] Open
Affiliation(s)
- Karan Singla
- Department of Anesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Kamal Kajal
- Department of Anesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Neha Chauhan
- Department of Anesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Sunita Kajal
- Sri Guru Harkrishan Sahib Hospital, Sohana, Punjab, India
| | - Vikas Saini
- Department of Anesthesia and Intensive Care, PGIMER, Chandigarh, India
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Chalmers K, Smith P, Garber J, Gopinath V, Brownlee S, Schwartz AL, Elshaug AG, Saini V. Assessment of Overuse of Medical Tests and Treatments at US Hospitals Using Medicare Claims. JAMA Netw Open 2021; 4:e218075. [PMID: 33904912 PMCID: PMC8080218 DOI: 10.1001/jamanetworkopen.2021.8075] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/09/2021] [Indexed: 11/27/2022] Open
Abstract
Importance Overuse of health care services exposes patients to unnecessary risk of harm and costs. Distinguishing patterns of overuse among hospitals requires hospital-level measures across multiple services. Objective To describe characteristics of hospitals associated with overuse of health care services in the US. Design, Setting, and Participants This retrospective cross-sectional analysis used Medicare fee-for-service claims data for beneficiaries older than 65 years from January 1, 2015, to December 31, 2017, with a lookback of 1 year. Inpatient and outpatient services were included, and services offered at specialty and federal hospitals were excluded. Patients were from hospitals with the capacity (based on a claims filter developed for this study) to perform at least 7 of 12 investigated services. Statistical analyses were performed from July 1, 2020, to December 20, 2020. Main Outcomes and Measures Outcomes of interest were a composite overuse score ranging from 0 (no overuse of services) to 1 (relatively high overuse of services) and characteristics of hospitals clustered by overuse rates. Twelve published low-value service algorithms were applied to the data to find overuse rates for each hospital, normalized and aggregated to a composite score and then compared across 6 hospital characteristics using multivariable regression. A k-means cluster analysis was used on normalized overuse rates to identify hospital clusters. Results The primary analysis was performed on 2415 cohort A hospitals (ie, hospitals with capacity for 7 or more services), which included 1 263 592 patients (mean [SD] age, 72.4 [14] years; 678 549 women [53.7%]; 101 017 191 White patients [80.5%]). Head imaging for syncope was the highest-volume low-value service (377 745 patients [29.9%]), followed by coronary artery stenting for stable coronary disease (199 579 [15.8%]). The mean (SD) composite overuse score was 0.40 (0.10) points. Southern hospitals had a higher mean score than midwestern (difference in means: 0.06 [95% CI, 0.05-0.07] points; P < .001), northeast (0.08 [95% CI, 0.06-0.09] points; P < .001), and western hospitals (0.08 [95% CI, 0.07-0.10] points; P < .001). Nonprofit hospitals had a lower adjusted mean score than for-profit hospitals (-0.03 [95% CI, -0.04 to -0.02] points; P < .001). Major teaching hospitals had significantly lower adjusted mean overuse scores vs minor teaching hospitals (difference in means, -0.07 [95% CI, -0.08 to -0.06] points; P < .001) and nonteaching hospitals (-0.10 [95% CI, -0.12 to -0.09] points; P < .001). Of the 4 clusters identified, 1 was characterized by its low counts of overuse in all services except for spinal fusion; the majority of major teaching hospitals were in this cluster (164 of 223 major teaching hospitals [73.5%]). Conclusions and Relevance This cross-sectional study used a novel measurement of hospital-associated overuse; results showed that the highest scores in this Medicare population were associated with nonteaching and for-profit hospitals, particularly in the South.
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Affiliation(s)
- Kelsey Chalmers
- Lown Institute, Brookline, Massachusetts
- Menzies Centre for Health Policy, Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | | | | | | | | | - Aaron L. Schwartz
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, The University of Pennsylvania, Philadelphia
- Division of General Internal Medicine, Perelman School of Medicine, The University of Pennsylvania, Philadelphia
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, Pennsylvania
| | - Adam G. Elshaug
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- University of Southern California, Brookings Schaeffer Initiative for Health Policy, The Brookings Institution, Washington, DC
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Prajesh R, Jha RK, Saini V, Nahid M, Goyal V, Chaudhury P, Bhargava J, Sharma AK, Agarwal A. Assessing simultaneous effect of Ar/O2 ratio and process pressure on ammonia sensing properties of reactive DC magnetron sputtered SnO2 thin films. Materials Letters 2021; 286:129239. [DOI: 10.1016/j.matlet.2020.129239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2023]
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Mohanty CR, Saini V, Sethi S, Bellapukonda S. Point-of-care nasal ultrasonography: A novel technique using "hockey stick" probe. Saudi J Anaesth 2020; 14:544-545. [PMID: 33447205 PMCID: PMC7796734 DOI: 10.4103/sja.sja_152_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 11/10/2022] Open
Affiliation(s)
- Chitta R Mohanty
- Department of Truma and Emergency, All India Institute of Medical Science, Bhubaneswar, Odisha, India
| | - Vikas Saini
- Department of Anaesthesia and Critical Care, PGIMER, Chandigarh, India
| | - Sameer Sethi
- Department of Anaesthesia and Critical Care, PGIMER, Chandigarh, India
| | - Snigdha Bellapukonda
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Science, Bhubaneswar, Odisha, India
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Parveez MQ, Yaddanapudi LN, Saini V, Kajal K, Sharma A. Critical events during intra-hospital transport of critically ill patients to and from intensive care unit. Turk J Emerg Med 2020; 20:135-141. [PMID: 32832732 PMCID: PMC7416857 DOI: 10.4103/2452-2473.290067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/23/2020] [Accepted: 07/06/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Intensive care unit (ICU) patients are at an increased risk of many catastrophic events during intrahospital transport (IHT) for various procedures. This study was planned to determine the incidence and types of adverse events occurring during the transport of critically ill patients in a tertiary care hospital. METHODS This prospective observational study was conducted in the ICU of a tertiary care hospital for 8 months after ethical clearance from the institute ethics committee. All patients transported out of the ICU during the audit period for diagnostic or therapeutic procedures were included in the study. Vitals and several study parameters were recorded before, during, and after shifting patients to and from the ICU. Various critical events were noted during transport and classified into major and minor critical events based on the presence and absence of potential consequences that lead to a change of therapy during transport. RESULTS One hundred and sixty patients were studied for consecutive IHT to and from the ICU. The patients were transported for imaging studies (58.1%), minor surgery (31.8%), major surgery (2.5%), and other procedures (7.5%). A total of 248 critical events were observed in 104 IHTs (65%; 95% confidence interval [95% CI]: 57.4%-72.1%). Hence, an average of 2.38 critical events occurred per IHT. There were 31 major events among the 248 critical events (12.5%; 95% CI: 8.8%-17.1%). CONCLUSIONS Standard guidelines about the accompanying personnel and monitoring need to be followed during IHT. Conduct of minor surgical procedures in the ICU and better bedside diagnostic procedures may be considered for the future.
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Affiliation(s)
- Mohd Qurram Parveez
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Lakshmi Narayana Yaddanapudi
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Saini
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kamal Kajal
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankur Sharma
- Department of Trauma and Emergency (Anaesthesiology), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Jain A, Mehta A, Singh U, Saini V. Oculocardiac reflex in an anophthalmic eye. Indian J Anaesth 2020; 64:163-165. [PMID: 32139942 PMCID: PMC7017660 DOI: 10.4103/ija.ija_713_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 10/19/2019] [Accepted: 11/05/2019] [Indexed: 11/23/2022] Open
Affiliation(s)
- Aditi Jain
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Aditi Mehta
- Department of Ophthalmology, PGIMER, Chandigarh, India
| | - Usha Singh
- Department of Ophthalmology, PGIMER, Chandigarh, India
| | - Vikas Saini
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
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Affiliation(s)
- Vikas Saini
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, Punjab, India
| | - Shiraz M Assu
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, Punjab, India
| | - Nidhi Bhatia
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, Punjab, India
| | - Sameer Sethi
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, Punjab, India
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Singh SR, Saini V, Singh A, Dogra M. Commentary: Role of alpha-2 agonists in regional ophthalmic anesthesia. Indian J Ophthalmol 2019; 67:1247-1248. [PMID: 31238484 PMCID: PMC6611292 DOI: 10.4103/ijo.ijo_170_19] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Simar R Singh
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Saini
- Department of Anaesthesiology and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Avneet Singh
- Department of Anaesthesiology and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mohit Dogra
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Saini V, Samra T, Ahuja N, Sethi S. A prospective randomized study to evaluate safety and efficacy of heparin topical solution (1000 IU/ml) compared to heparin topical gel (200 IU/g) in prevention of infusion-associated phlebitis. Indian J Pharmacol 2019; 50:344-349. [PMID: 30783328 PMCID: PMC6364337 DOI: 10.4103/ijp.ijp_201_17] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Thrombosis and thrombophlebitis of the superficial venous system are common in hospitalized patients. Efficacy and safety of topical quick penetrating solution (QPS) of heparin were compared to heparin sodium topical gel for the prevention of infusion-associated phlebitis. MATERIALS AND METHODS Patients aged 18-65 years undergoing intravenous cannulation for at least 72 h were enrolled and randomized to receive 6-8 drops of topical solution of heparin (Group sodium topical solution [QPS]) or1 g of topical gel (Group GEL) over the cannulated vein every 8 hourly for a total of 10 doses. Enrolled patients were monitored every 8 ± 1 h for phlebitis using visual infusion phlebitis scale. The primary aim was to compare the proportion of patients with Grade 0, I, and II phlebitis at the end of 72 h of treatment period. RESULTS Number of patients assessed for eligibility was 110; 26 excluded and 84 randomized. Analysis was done for 41 administered heparin QPS and 33 administered heparin gel as the rest were lost to follow-up. No phlebitis was reported in 32% of patients in QPS group and 9% in GEL group (P =0.0019). Proportion of patients with Grade I and Grade II phlebitis was 22.9% and 13.5% with QPS and 35.13% and 22.97% with gel, respectively, and the difference was statistically significant. Mean time to develop Grade I (Group QPS = 59.7 h; Group GEL = 58.46 h; P = 0.949) and Grade II (Group QPS = 62.4 h; Group GEL = 61.17 h; P = 0.732) phlebitis was comparable no adverse effects were reported in either group. CONCLUSION Heparin QPS was more effective in he prevention of infusion-associated phlebitis with similar safety profile as heparin gel.
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Affiliation(s)
- Vikas Saini
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Tanvir Samra
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nitin Ahuja
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sameer Sethi
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Kumari K, Samra T, Saini V, Sethi S, Banerjee N, Sharma S. Comparison of Haemodynamic Response to Inhalational Bolus with Desflurane in Normotensive and Hypertensive Patients Undergoing Laparoscopic Cholecystectomy. Turk J Anaesthesiol Reanim 2019; 47:165-172. [PMID: 31183461 DOI: 10.5152/tjar.2018.93457] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 09/05/2017] [Indexed: 11/22/2022] Open
Abstract
Objective Desflurane causes sympathetic stimulation at high end-tidal concentrations. We conducted this study to compare the haemodynamic response to inhalational bolus with desflurane in normotensive and hypertensive patients undergoing laparoscopic cholecystectomy. Methods In this prospective, clinical trial, 40 patients aged 18-60 years and undergoing laparoscopic cholecystectomy were divided into normotensives (Group N; n=20) and hypertensives (Group H; n=20). Heart rate (HR), mean arterial pressure (MAP) and bispectral index (BIS) were measured at baseline and every 60 s for 5 min after induction, intubation, initiation and inhalational bolus of desflurane. The primary objective was to compare haemodynamic response, and the secondary objective was to assess the need for inhalational boluses and to compare the number of overcorrections and undercorrections in BIS value after each inhalational bolus. An independent t-test was used to compare the means of the study parameters between the groups, and a dependent t-test was used to compare the percentage change in the means of the study parameters within the same group. Statistical significance was defined as p<0.05. Results No statistically significant difference in the percentage of patients responding with a decrease, increase or no change of HR or MAP were seen between the two groups after inhalational bolus of desflurane. An overcorrection of BIS (value <45) was seen in 60% of the patients in Group H and 15% of the patients in Group N (p=0.003). None of the patients in either group had an undercorrection (BIS>55). Conclusion BIS-guided desflurane administration and BIS-triggered inhalational boluses of desflurane is safe, feasible and does not cause sympathetic stimulation in either normotensive or hypertensive patients.
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Affiliation(s)
- Kamlesh Kumari
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tanvir Samra
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Saini
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sameer Sethi
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neerja Banerjee
- Department of Anaesthesia and Intensive Care, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Sujata Sharma
- Department of Anaesthesia and Intensive Care, Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Gaddam M, Sethi S, Jain A, Saini V. Comparison of Air-QⓇ insertion techniques in pediatric patients with fiber-optic bronchoscopic assessment: a prospective randomized control trial. Korean J Anesthesiol 2019; 72:570-575. [PMID: 31159533 PMCID: PMC6900414 DOI: 10.4097/kja.d.18.00367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 05/28/2019] [Indexed: 11/13/2022] Open
Abstract
Background Air-QⓇ laryngeal mask airway (LMA) is a second-generation supraglottic airway device (SAD) providing adequate airway control despite the unfavorable airway anatomy in children. Several studies have assessed it as a conduit for tracheal intubation and compared its efficacy with that of other SADs, but there are no studies comparing the laryngeal view with midline and rotational insertion techniques of Air-Q. Therefore, this study compared the fiber-optic bronchoscopic (FOB) assessment of the Air-Q position using these two insertion techniques. Methods This randomized controlled trial included 80 patients of the American Society of Anesthesiologists physical status I/II of either sex (age group 5–12 years, weight 10–30 kg), who were scheduled for elective surgery in the supine position under general anesthesia. The patients were randomly subjected to rotational and midline technique groups (n = 40, each), and appropriate sized Air-Q, based on the weight of the patient, was inserted using the technique allocated to each patient. Time taken and number of attempts for successful insertion of the devices and any complications after removal of device were studied. Results FOB grade 1 (ideal position) was seen in 29/40 (72.5%) and 19/40 (47.5%) children subjected to the rotational and classic midline techniques, respectively (P = 0.045). The time taken to successfully insert the Air-Q was significantly lesser in the rotational technique group (7.2 ± 1.5 s) than in the classic midline technique group (10.2 ± 2.1 s) (P < 0.001), whereas complications were similar in both groups. Conclusions The rotational technique was associated with better FOB view, and was faster than the classic midline technique of Air-Q insertion in pediatric patients.
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Affiliation(s)
- Manasa Gaddam
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
| | - Sameer Sethi
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
| | - Aditi Jain
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
| | - Vikas Saini
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
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Singh SR, Saini V, Singh A, Dogra M. Commentary: Role of alpha-2 agonists in regional ophthalmic anaesthesia. Indian J Ophthalmol 2019; 67:641-642. [PMID: 31007227 PMCID: PMC6498905 DOI: 10.4103/ijo.ijo_635_19] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Simar Rajan Singh
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Saini
- Department of Anaesthesiology and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Avneet Singh
- Department of Anaesthesiology and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mohit Dogra
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
Background:
Polymeric micelles are being used as successful nanocarriers for
the delivery of diverse drug molecules due to properties like solubilization, selective targeting,
P-glycoprotein inhibition, altered drug internalization route and subcellular localization
etc.
Objective:
The present investigation was planned to prepare and characterize novel polymeric
micelles derived from self assembly of amphiphilic chitosan-bile salt derivative
(CS-mPEG-DA) as nanocarrier and evaluate their potential in delivery of an anticancer
drug, paclitaxel.
Method:
Paclitaxel, a diterpenoid compound, useful in clinical treatment of several solid
tumors such as ovarian cancer, breast cancer and lung cancer suffers from limitations like
low aqueous solubility and bioavailability and subsequently was used as the model drug.
Results:
Paclitaxel was successfully incorporated into polymeric micelles using dialysis
and emulsion method with encapsulation efficiency up to 95% having particle size in
nanometer range (<200 nm). Paclitaxel loaded micelles were found to release the drug in
a sustained manner up to 96 h in PBS containing 0.1% (w/v) tween 80 at 37°C. The micelles
powders subjected to stability studies for a period of 90 days were found to be stable
at 4 ± 2°C with respect to particle size and drug content. In vivo cytotoxicity assay
confirmed that paclitaxel encapsulated in polymeric micelles showed higher cytotoxicity
against cultured MCF-7 breast cancer cells than paclitaxel alone.
Conclusion:
Polymeric micellar systems derived from copolymerization of chitosan exhibit
a great potential in successful delivery of poorly water soluble or low bioavailable
drugs like paclitaxel.
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Affiliation(s)
- V. Lather
- Department of Pharmaceutical Chemistry, JCDM College of Pharmacy, Sirsa-125055, Haryana, India
| | - V. Saini
- Department of Pharmaceutics, JCDM College of Pharmacy, Sirsa-125055, Haryana, India
| | - D. Pandita
- Department of Pharmaceutics, JCDM College of Pharmacy, Sirsa-125055, Haryana, India
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Affiliation(s)
- B Naveen Naik
- Department of Anaesthesia and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Venkata Ganesh
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Saini
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tanvir Samra
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Samra T, Deepak R, Jayant A, Saini V. The utility of limited trans-thoracic echocardiography in the stratification of pulse pressure variation: A feasibility study in major open abdominal surgery. Saudi J Anaesth 2018; 12:584-592. [PMID: 30429741 PMCID: PMC6180698 DOI: 10.4103/sja.sja_686_17] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background and Aim: Limitation in use of pulse pressure variation (PPV) in predicting fluid responsiveness (FR) in hypotensive patients is encountered when values are in the “gray zone” (8–13%). Dynamic arterial elastance (Eadyn= PPV/SVV) can be used in such situations to predict arterial pressure response to volume expansion (VE). In our study, we used respiratory variation of ascending aorta velocity time integral (AoVTI) calculated from suprasternal window as a surrogate of stroke volume variation (SVV). Fluids/vasopressors were administered to hypotensive patients intraoperatively based on value of Eadyn. Aim was to assess feasibility and utility of suprasternal echocardiography in the above-mentioned subset of patients. Materials and Methods: Hemodynamic data were monitored and respiratory variation in AoVTI was recorded using suprasternal echocardiography at all time points when patients developed hypotension (systolic blood pressure <90 mm Hg/<20% of baseline for 5 min) and at randomly selected time intervals when hemodynamic stability was maintained. VE with 250 ml of Ringer lactate (RL) was done in hypotensive patients with PPV value of 8–13% and Eadyn>0.9. Increase of >15% in AoVTI after VE defined “fluid responsiveness.” Results: Twenty-eight patients were enrolled, but three were excluded in view of left ventricular systolic dysfunction detected during preinduction echocardiography. Hemodynamic and echocardiographic data were recorded at 538 observation points in 25 adults. Hypotension occurred in 247 data sets, and in 168 data sets, value of PPV was 8–13%. VE was carried out in only those 131 data sets in which the value of Eadyn was >0.9. Area under the curve (AUC) for VE as an intervention in the indeterminate (PPV 8–13%) group was 0.574 (0.49–0.68, 95% CI, P < 0.049), and in the observation set with PPV >13, the AUC value was 0.7 (0.59–0.98, 95% CI, P < 0.01). Conclusions: Echocardiography using the suprasternal window in the operating room during abdominal surgery is feasible, but the utility of Eadyn in stratification of patients with PPV 8–13% is inconclusive.
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Affiliation(s)
- Tanvir Samra
- Department of Anesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - R Deepak
- Department of Anesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Aveek Jayant
- Amrita Institute of Medical Sciences and Research Center, Kochi, Kerala, India
| | - Vikas Saini
- Department of Anesthesia and Intensive Care, PGIMER, Chandigarh, India
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Saini V, Lin KW. Introducing Lown Right Care: Reducing Overuse and Underuse. Am Fam Physician 2018; 98:560. [PMID: 30365295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
| | - Kenneth W Lin
- Georgetown University Medical Center, Washington, DC, USA
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Dhiman D, Saini V, Sethi S, Samra T. Targeting the Venous Confluence of Pirogoff for Central Venous Cannulation Insertion, When Internal Jugular Vein Cannulation is Difficult: A Three-Step Approach. Indian J Crit Care Med 2018; 22:760-761. [PMID: 30405293 PMCID: PMC6201643 DOI: 10.4103/ijccm.ijccm_331_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/12/2022] Open
Affiliation(s)
- Deepanshu Dhiman
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Saini
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sameer Sethi
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Tanvir Samra
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Garg K, Binji S, Saini V, Jaswal S, Handa U, Kaur J. P2.11-07 Lung Cancer in a Tertiary Care Setting: So Near, Yet So Far. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1353] [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: 10/28/2022]
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Saini V, Samra T, Kaur G. Perioperative use of transthoracic echocardiography in a patient with congenitally corrected transposition of great arteries, atrial septal defect and severe pulmonary stenosis for lower segment cesarean section. J Anaesthesiol Clin Pharmacol 2018; 33:544-546. [PMID: 29416252 PMCID: PMC5791273 DOI: 10.4103/0970-9185.173342] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 25-year-old female with congenitally corrected transposition of great arteries (CCTGAs), atrial septal defect, and severe pulmonary stenosis underwent lower segment cesarean section at 34 weeks of gestation using combined spinal epidural anesthesia (CSEA). We used transthoracic echocardiography (TTE) for intraoperative monitoring of the cardiovascular system because these patients are reported to have a high prevalence of myocardial perfusion defects, regional wall motion abnormalities, and impaired ventricular contractility. Scanning was done at four different time intervals; preoperatively, after initiation of CSEA, after delivery of child and postoperatively (6 and 24 h postdelivery) to detect regional wall motion and valvular abnormalities, calculate ejection fractions and optimize fluid administration. In this case report, we thus discuss the anatomical defects of CCTGA, physiologic concerns and emphasize on the use of TTE for perioperative management of such cases.
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Affiliation(s)
- Vikas Saini
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Tanvir Samra
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gurpreet Kaur
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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