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Krishna P, Rammohan A, Rajalingam R, Narasimhan G, Cherukuru R, Sachan D, Rajakumar A, Kaliamoorthy I, Reddy MS, Rela M. Propensity score matched analysis and risk stratification of donors with G6PD deficiency in living donor liver transplantation. Hepatol Int 2024; 18:265-272. [PMID: 37700142 DOI: 10.1007/s12072-023-10583-0] [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: 06/26/2023] [Accepted: 08/16/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION Glucose 6 phosphate dehydrogenase (G6PD) deficiency (G6PDd) can trigger hemolysis following surgical stress. Differentiating G6PDd-related post-operative hemolytic episodes (PHE) and post-hepatectomy liver failure may be challenging especially in living donors where donor safety is paramount. We analysed outcomes of our cohort of G6PDd liver donors. METHODS G6PDd individuals with no evidence of hemolysis were considered as living donors if there was no alternative family donor. Outcomes of G6PDd donors undergoing left lateral/left lobe donation (Group LL) and right lobe donation (Group RL) were compared with non-G6PDd donors matched in a 1:3 ratio using propensity score matching. RESULTS 59 G6PDd donors (5.8% of 1011) underwent living donor hepatectomy (LiDH) during the study period. LL-G6PDd donors (22.37%) had higher post-operative peak bilirubin level compared to matched controls, but no difference in morbidity or need for post-operative blood transfusion.RL-G6PDd donors (37.63%) had higher peak bilirubin level, morbidity (16.2% vs. 3.6%, p = 0.017) and more post-operative blood transfusion (21.6% vs. 6.4%, p = 0.023) as compared to matched non-G6PDd cohort. Four RL-G6PDd donors (10.8%) developed PHE. Low G6PD activity (15% vs. 40%, p = 0.034) and lower future liver remnant (FLR) (34.3% vs. 37.8%, p = 0.05) were identified as risk factors for PHE. CONCLUSION We report the largest to-date series of G6PDd individuals undergoing LiDH and confirm the safety of LL donation in G6PDd. Our analysis identifies specific risk factors for PHE and suggests that right lobe LiDH be avoided in individuals with less than 25% G6PD activity when the FLR is less than 36%.
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Affiliation(s)
- P Krishna
- Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chennai, Bharath Institute of Higher Education and Research, CLC Works Road, Chennai, India
| | - A Rammohan
- Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chennai, Bharath Institute of Higher Education and Research, CLC Works Road, Chennai, India.
| | - R Rajalingam
- Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chennai, Bharath Institute of Higher Education and Research, CLC Works Road, Chennai, India
| | - G Narasimhan
- Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chennai, Bharath Institute of Higher Education and Research, CLC Works Road, Chennai, India
| | - R Cherukuru
- Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chennai, Bharath Institute of Higher Education and Research, CLC Works Road, Chennai, India
| | - D Sachan
- Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chennai, Bharath Institute of Higher Education and Research, CLC Works Road, Chennai, India
| | - A Rajakumar
- Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chennai, Bharath Institute of Higher Education and Research, CLC Works Road, Chennai, India
| | - I Kaliamoorthy
- Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chennai, Bharath Institute of Higher Education and Research, CLC Works Road, Chennai, India
| | - M S Reddy
- Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chennai, Bharath Institute of Higher Education and Research, CLC Works Road, Chennai, India
| | - M Rela
- Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chennai, Bharath Institute of Higher Education and Research, CLC Works Road, Chennai, India
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Sachan D, Shukla SK, Bajpai PK, Srivastava DK, Kumar S, Jain PK, Pathak P. Validation of satisfaction questionnaire for services provided in the labour rooms of government health facilities. J Healthc Qual Res 2023; 38:76-83. [PMID: 36163149 DOI: 10.1016/j.jhqr.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 06/20/2022] [Accepted: 08/21/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION AND OBJECTIVES Using the assessment of satisfaction of patients of labour room services, the caregiver or policymakers can identify the gaps in the implemented programmes and health policies. This study was aimed to design a valid and reliable satisfaction questionnaire that will help in identifying the aspects of gaps that need improvement. METHODS A facility and community-based observational cross-sectional study was conducted in the district of western Uttar Pradesh (India) between January 2019 and August 2020. Validation of the structured questionnaire with 34 dichotomous questions categorized under five subscales was performed by evaluating its validity and reliability. A total of 380 beneficiaries were selected from 48 government health facilities. RESULTS The calculated Content validity index was calculated to be 9.5 which was adequate as per the guidelines. The reliability analysis of the questionnaire showed that the internal consistency was high with an overall Cronbach's alpha of 0.710. The variation in Cronbach's alpha on the elimination of any question from the questionnaire ranged from 0.676 to 0.767. The mean patient satisfaction score in the total surveyed population was 24.39±4.684 (total score=34) and there was a greater variation in the satisfaction score of infrastructure when compared with other subscales. CONCLUSION The findings from this study support the reliability and validity of the patient satisfaction questionnaire as it is capable of evaluating the satisfaction in terms of delivery services provided in labour rooms as a whole.
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Affiliation(s)
- D Sachan
- Department of Community Medicine, Uttar Pradesh University of Medical Sciences, Saifai, India
| | - S K Shukla
- Department of Community Medicine, Uttar Pradesh University of Medical Sciences, Saifai, India.
| | - P K Bajpai
- Department of Community Medicine, Uttar Pradesh University of Medical Sciences, Saifai, India
| | - D K Srivastava
- Department of Community Medicine, Uttar Pradesh University of Medical Sciences, Saifai, India
| | - S Kumar
- Department of Community Medicine, Uttar Pradesh University of Medical Sciences, Saifai, India
| | - P K Jain
- Department of Community Medicine, Uttar Pradesh University of Medical Sciences, Saifai, India
| | - P Pathak
- Department of Community Medicine, Uttar Pradesh University of Medical Sciences, Saifai, India
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Sachan D, Yadav A, Yadav D. PLA2G6-Associated Dystonia Parkinsonism. Indian Pediatr 2021; 58:77-78. [PMID: 33452780] [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: 06/12/2023]
Affiliation(s)
- Deepak Sachan
- Department of Pediatrics, PGIMER, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India.
| | - Amit Yadav
- Department of Pediatrics, PGIMER, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Dinesh Yadav
- Department of Pediatrics, PGIMER, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
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Sarswat S, Sachan D. Intraventricular tuberculoma: An unusual presentation of brain tuberculosis. Indian J Tuberc 2018; 65:180-181. [PMID: 29579437 DOI: 10.1016/j.ijtb.2017.08.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 08/02/2017] [Indexed: 06/08/2023]
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Abstract
Introduction: Febrile seizure is a benign condition in children. Susceptibility genes associated with febrile convulsions have been identified, but the precise pathophysiologic mechanism that triggers febrile seizure is unclear. Using animal models, it has been demonstrated that hyperthermia causes respiratory alkalosis with consequent brain alkalosis and seizures. This study was conducted to find out any association of febrile seizures with fever induced hypocapnia. Methods: We conducted a cross sectional observational study and enrolled 45 children presenting with febrile seizures. Axillary temperature was measured and venous blood gas analysis was done soon after admission and within 24 hour of seizure onset. Mean pH and pCO2 from venous blood gas analysis was measured and compared with standard normal values. Data was analyzed using SPSS software version 17.0 software. Results: The mean pCO2 (27.95 ± 5.31mmHg) was much below normal range, and 91% of children had hypocapnia (pCO2 <35) after the febrile seizures. However alkalosis (pH > 7.45) was demonstrated in only 20% of children. Also pCO2 levels in samples drawn before 2 hours were significantly less than those taken after 2 hours (23.24 ± 3.44 vs 29.29 ± 4.99 respectively; p = 0.001). Conclusion: Our data indicates that febrile seizures may be associated with fever induced hyperventilation and ensuing hypocapnia may be one of the precipitating factor in inducing seizures. However, well-structured human trials are needed to demonstrate the same.
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Affiliation(s)
- Deepak Sachan
- Department of Paediatrics, Dr. Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India
| | - Samridhi Goyal
- Department of Paediatrics, Dr. Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India
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Affiliation(s)
- Sawan Kumar
- Department of Pathology, Postgraduate Institute of Medical Education and Research; Dr. R.M.L. Hospital, New Delhi, India
| | - Prajwala Gupta
- Department of Pathology, Postgraduate Institute of Medical Education and Research; Dr. R.M.L. Hospital, New Delhi, India
| | - Minakshi Bhardwaj
- Department of Pathology, Postgraduate Institute of Medical Education and Research; Dr. R.M.L. Hospital, New Delhi, India
| | - Deepak Sachan
- Department of Paediatrics, Postgraduate Institute of Medical Education and Research; Dr. R.M.L. Hospital, New Delhi, India
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Abstract
Background: Weight gain is a common adverse effect of sodium valproic acid (VPA) in children with epilepsy. Several mechanisms of VPA-induced obesity have been suggested such as increased appetite, facultative thermogenesis, and elevated insulin and leptin levels. In this study, we aimed to investigate the role of Insulin and Leptin in the pathogenesis of weight gain caused by VPA. Materials and Methods: Body mass index (BMI) was calculated, and serum insulin and leptin levels were measured in 45 consecutive patients and 45 controls. Results: The mean BMI of the cases and control group was 22.97 kg/m2 and 19.4 kg/m2, respectively, and it was significantly higher in cases (P < 0.001). Fasting serum insulin levels were higher in VPA group (26.3 μU/ml) than in controls (15.83 μU/ml), which was statistically significant (P < 0.001). Serum leptin levels were also found to be elevated significantly in VPA group (7.9 ng/ml) than in controls (1.6 ng/ml). Conclusion: Sodium VPA is associated with significant rise of BMI, hyperinsulinemia, raised insulin resistance, and increased leptin levels in children with epilepsy.
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Affiliation(s)
- Talha Rehman
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Deepak Sachan
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Anubhuti Chitkara
- Department of Biochemistry, Postgraduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Alam A, Sachan D, Bijarnia R, Choudhary S. Late infantile metachromatic leukodystrophy presenting with extrapyramidal sign. J Pediatr Neurol 2015. [DOI: 10.3233/jpn-130620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Anwer Alam
- Department of Pediatrics, Postgraduate Institute of medical Education and Research and Dr. Ram Manohar Lohiya Hospital, New Delhi, India
| | - Deepak Sachan
- Department of Pediatrics, Postgraduate Institute of medical Education and Research and Dr. Ram Manohar Lohiya Hospital, New Delhi, India
| | - Ritu Bijarnia
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College, New Delhi, India
| | - Sandeep Choudhary
- Department of Pediatrics, Postgraduate Institute of medical Education and Research and Dr. Ram Manohar Lohiya Hospital, New Delhi, India
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Sachan D, Shukla A. Klebsiella brain abscess in an infant with hereditary spherocytosis. Indian Pediatr 2015; 52:169-170. [PMID: 25691204] [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: 06/04/2023]
Affiliation(s)
- Deepak Sachan
- Department of Pediatrics, PGIMER, Dr RML Hospital, New Delhi.
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Gulati S, Jain P, Sachan D, Chakrabarty B, Kumar A, Pandey R, Gupta AK. Seizure and radiological outcomes in children with solitary cysticercous granulomas with and without albendazole therapy: A retrospective case record analysis. Epilepsy Res 2014; 108:1212-20. [DOI: 10.1016/j.eplepsyres.2014.04.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 03/14/2014] [Accepted: 04/27/2014] [Indexed: 11/16/2022]
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Affiliation(s)
- Deepak Sachan
- Associate Professor, Department of Pediatrics, PGIMER and Associate DR RML hospital, New Delhi 110 001, India.
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Upadhyay P, Tripathi VN, Singh RP, Sachan D. Role of hypertonic saline and mannitol in the management of raised intracranial pressure in children: A randomized comparative study. J Pediatr Neurosci 2011; 5:18-21. [PMID: 21042500 PMCID: PMC2964805 DOI: 10.4103/1817-1745.66673] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To compare the efficacy and side effects of 3% hypertonic saline and mannitol in the management of raised intracranial pressure in children. DESIGN Prospective randomized study. SETTING Pediatric intensive care unit (PICU) in a tertiary care hospital. SUBJECT 200 patients with raised intracranial pressure. MATERIALS AND METHODS Patients were randomized into two statistically comparable groups; Group A (n = 98) was treated with mannitol while Group B (n = 100) was treated with 3% hypertonic saline. Group C (n = 2) included those members of Group A in whom serum osmolality ≥320 mosmol/kg and were then treated with 3% hypertonic saline. Both Drugs were given at a loading dose of 5 ml/kg stat followed by 2 ml/kg in every 6 h(both have same osmolarity) for two days in their respective groups. Besides monitoring, blood pressure (NIBP), mean arterial pressure (pre and post 30 min of drug), serum sodium, chloride and osmolality were measured. Intracranial pressure was assessed indirectly by measuring mean arterial ressure "MAP". Student paired 't' test was applied. RESULTS Decrease in MAP was highly significant (P<0.001) at 0 h in males 0,6 h in females, and moderately significant at 12,36 h in females and significant(P<0.05) at 6,24,42 h in males of Group B. Decrease in coma hours was a highly significant finding (P<0.001) in Group B. In Group B, serum sodium and chloride increased significantly but remained within acceptable limits. There was no difference in osmolality and mortality (fisher Z). CONCLUSION Mannitol has several side effects, 3% hypertonic saline is a safe and effective alternative in managing cerebral edema.
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Affiliation(s)
- Piyush Upadhyay
- Pediatric Intensive Care Unit, Department of Pediatrics, GSVM Medical College, Kanpur (U.P.), India
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Sachan D. Erythema infectiosum rash. Indian Pediatr 2011; 48:338. [PMID: 21532111] [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: 05/30/2023]
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Sachan D, Gupta N, Agarwal P, Chaudhary R. The utility of pre-test clinical scoring for clinical diagnosis of heparin-induced thrombocytopenia in cardiac surgery patients of a tertiary care centre in North India. Transfus Med 2011; 21:231-5. [DOI: 10.1111/j.1365-3148.2010.01068.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Agarwal N, Sachan D, Verma A. Reply to: Prevalence of immediate vasovagal reaction in blood donors visiting two blood banks of Karachi. Transfus Med 2011; 21:63-4. [PMID: 21199534 DOI: 10.1111/j.1365-3148.2010.01038.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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