1
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KJ Adhikari N, Beane A, Devaprasad D, Fowler R, Haniffa R, James A, Jayakumar D, Kodippily C, Aravindakshan Kooloth R, Laxmappa R, Mangal K, Mani A, Mathew M, Pari V, Patodia S, Pattnaik R, Priyadarshini D, Pulicken M, Rabindrarajan E, Ramachandran P, Ramesh K, Rani U, Ramaiyan A, Ramakrishnan N, Ranganathan L, Rashan A, Dominic Savio R, Selva J, Tirupakuzhi Vijayaraghavan BK, Tripathy S, Udayanga I, Venkataraman R. Impact of COVID-19 on non-COVID intensive care unit service utilization, case mix and outcomes: A registry-based analysis from India. Wellcome Open Res 2021; 6:159. [PMID: 34957335 PMCID: PMC8666986 DOI: 10.12688/wellcomeopenres.16953.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Coronavirus disease 2019 (COVID-19) has been responsible for over 3.4 million deaths globally and over 25 million cases in India. As part of the response, India imposed a nation-wide lockdown and prioritized COVID-19 care in hospitals and intensive care units (ICUs). Leveraging data from the Indian Registry of IntenSive care, we sought to understand the impact of the COVID-19 pandemic on critical care service utilization, case-mix, and clinical outcomes in non-COVID ICUs. Methods: We included all consecutive patients admitted between 1 st October 2019 and 27 th September 2020. Data were extracted from the registry database and included patients admitted to the non-COVID or general ICUs at each of the sites. Outcomes included measures of resource-availability, utilisation, case-mix, acuity, and demand for ICU beds. We used a Mann-Whitney test to compare the pre-pandemic period (October 2019 - February 2020) to the pandemic period (March-September 2020). In addition, we also compared the period of intense lockdown (March-May 31 st 2020) with the pre-pandemic period. Results: There were 3424 patient encounters in the pre-pandemic period and 3524 encounters in the pandemic period. Comparing these periods, weekly admissions declined (median [Q1 Q3] 160 [145,168] to 113 [98.5,134]; p<0.001); unit turnover declined (median [Q1 Q3] 12.1 [11.32,13] to 8.58 [7.24,10], p<0.001), and APACHE II score increased (median [Q1 Q3] 19 [19,20] to 21 [20,22] ; p<0.001). Unadjusted ICU mortality increased (9.3% to 11.7%, p=0.015) and the length of ICU stay was similar (median [Q1 Q3] 2.11 [2, 2] vs. 2.24 [2, 3] days; p=0.151). Conclusion: Our registry-based analysis of the impact of COVID-19 on non-COVID critical care demonstrates significant disruptions to healthcare utilization during the pandemic and an increase in the severity of illness.
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Affiliation(s)
- Indian Registry of IntenSive care (IRIS)
- Intedepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand
- Department of Critical Care Medicine, Apollo Specialty Hospital, Chennai, India
- Department of Critical Care Medicine, Apollo Main Hospital, Chennai, India
- Network for Improving Critical care Systems and Training, Colombo, Sri Lanka
- Department of Critical Care Medicine, Nanjappa Hospital, Shimoga, India
- Department of Critical Care Medicine, Eternal Hospital, Jaipur, India
- Department of Critical Care Medicine, Apollo First Med Hospital, Chennai, India
- Chennai Critical Care Consultants Private Limited, Chennai, India
- Department of Critical Care Medicine, Apollo Proton Cancer Centre, Chennai, India
- Department of Critical Care Medicine, Ispat General Hospital, Rourkela, India
- Department of Critical Care Medicine, Pushpagiri Medical College, Tiruvalla, India
- Department of Critical Care Medicine, ABC Hospital, Vishakapatnam, India
- Department of Critical Care Medicine, Mehta Hospital, Chennai, India
- Department of Anaesthesia and Intensive Care Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Neill KJ Adhikari
- Intedepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Abi Beane
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand
| | | | - Robert Fowler
- Intedepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Rashan Haniffa
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand
| | - Augustian James
- Department of Critical Care Medicine, Apollo Main Hospital, Chennai, India
| | | | - Chamira Kodippily
- Network for Improving Critical care Systems and Training, Colombo, Sri Lanka
| | | | - Rakesh Laxmappa
- Department of Critical Care Medicine, Nanjappa Hospital, Shimoga, India
| | - Kishore Mangal
- Department of Critical Care Medicine, Eternal Hospital, Jaipur, India
| | - Ashwin Mani
- Department of Critical Care Medicine, Apollo First Med Hospital, Chennai, India
| | - Meghena Mathew
- Department of Critical Care Medicine, Apollo First Med Hospital, Chennai, India
| | - Vrindha Pari
- Chennai Critical Care Consultants Private Limited, Chennai, India
| | - Sristi Patodia
- Department of Critical Care Medicine, Apollo Proton Cancer Centre, Chennai, India
| | | | | | - Mathew Pulicken
- Department of Critical Care Medicine, Pushpagiri Medical College, Tiruvalla, India
| | | | | | - Kavita Ramesh
- Department of Critical Care Medicine, ABC Hospital, Vishakapatnam, India
| | - Usha Rani
- Department of Critical Care Medicine, Apollo Specialty Hospital, Chennai, India
| | - Ananth Ramaiyan
- Chennai Critical Care Consultants Private Limited, Chennai, India
| | | | | | - Aasiyah Rashan
- Network for Improving Critical care Systems and Training, Colombo, Sri Lanka
| | | | - Jaganathan Selva
- Department of Critical Care Medicine, Mehta Hospital, Chennai, India
| | | | - Swagata Tripathy
- Department of Anaesthesia and Intensive Care Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Ishara Udayanga
- Network for Improving Critical care Systems and Training, Colombo, Sri Lanka
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2
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KJ Adhikari N, Beane A, Devaprasad D, Fowler R, Haniffa R, James A, Jayakumar D, Kodippily C, Aravindakshan Kooloth R, Laxmappa R, Mangal K, Mani A, Mathew M, Pari V, Patodia S, Pattnaik R, Priyadarshini D, Pulicken M, Rabindrarajan E, Ramachandran P, Ramesh K, Rani U, Ramaiyan A, Ramakrishnan N, Ranganathan L, Rashan A, Dominic Savio R, Selva J, Tirupakuzhi Vijayaraghavan BK, Tripathy S, Udayanga I, Venkataraman R. Impact of COVID-19 on non-COVID intensive care unit service utilization, case mix and outcomes: A registry-based analysis from India. Wellcome Open Res 2021; 6:159. [PMID: 34957335 PMCID: PMC8666986 DOI: 10.12688/wellcomeopenres.16953.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 09/17/2023] Open
Abstract
Background: Coronavirus disease 2019 (COVID-19) has been responsible for over 3.4 million deaths globally and over 25 million cases in India. As part of the response, India imposed a nation-wide lockdown and prioritized COVID-19 care in hospitals and intensive care units (ICUs). Leveraging data from the Indian Registry of IntenSive care, we sought to understand the impact of the COVID-19 pandemic on critical care service utilization, case-mix, and clinical outcomes in non-COVID ICUs. Methods: We included all consecutive patients admitted between 1 st October 2019 and 27 th September 2020. Data were extracted from the registry database and included patients admitted to the non-COVID or general ICUs at each of the sites. Outcomes included measures of resource-availability, utilisation, case-mix, acuity, and demand for ICU beds. We used a Mann-Whitney test to compare the pre-pandemic period (October 2019 - February 2020) to the pandemic period (March-September 2020). In addition, we also compared the period of intense lockdown (March-May 31 st 2020) with the pre-pandemic period. Results: There were 3424 patient encounters in the pre-pandemic period and 3524 encounters in the pandemic period. Comparing these periods, weekly admissions declined (median [Q1 Q3] 160 [145,168] to 113 [98.5,134]; p=0.00002); unit turnover declined (median [Q1 Q3] 12.1 [11.32,13] to 8.58 [7.24,10], p<0.00001), and APACHE II score increased (median [Q1 Q3] 19 [19,20] to 21 [20,22] ; p<0.00001). Unadjusted ICU mortality increased (9.3% to 11.7%, p=0.01519) and the length of ICU stay was similar (median [Q1 Q3] 2.11 [2, 2] vs. 2.24 [2, 3] days; p=0.15096). Conclusion: Our registry-based analysis of the impact of COVID-19 on non-COVID critical care demonstrates significant disruptions to healthcare utilization during the pandemic and an increase in the severity of illness.
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Affiliation(s)
- Indian Registry of IntenSive care (IRIS)
- Intedepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand
- Department of Critical Care Medicine, Apollo Specialty Hospital, Chennai, India
- Department of Critical Care Medicine, Apollo Main Hospital, Chennai, India
- Network for Improving Critical care Systems and Training, Colombo, Sri Lanka
- Department of Critical Care Medicine, Nanjappa Hospital, Shimoga, India
- Department of Critical Care Medicine, Eternal Hospital, Jaipur, India
- Department of Critical Care Medicine, Apollo First Med Hospital, Chennai, India
- Chennai Critical Care Consultants Private Limited, Chennai, India
- Department of Critical Care Medicine, Apollo Proton Cancer Centre, Chennai, India
- Department of Critical Care Medicine, Ispat General Hospital, Rourkela, India
- Department of Critical Care Medicine, Pushpagiri Medical College, Tiruvalla, India
- Department of Critical Care Medicine, ABC Hospital, Vishakapatnam, India
- Department of Critical Care Medicine, Mehta Hospital, Chennai, India
- Department of Anaesthesia and Intensive Care Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Neill KJ Adhikari
- Intedepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Abi Beane
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand
| | | | - Robert Fowler
- Intedepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Rashan Haniffa
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand
| | - Augustian James
- Department of Critical Care Medicine, Apollo Main Hospital, Chennai, India
| | | | - Chamira Kodippily
- Network for Improving Critical care Systems and Training, Colombo, Sri Lanka
| | | | - Rakesh Laxmappa
- Department of Critical Care Medicine, Nanjappa Hospital, Shimoga, India
| | - Kishore Mangal
- Department of Critical Care Medicine, Eternal Hospital, Jaipur, India
| | - Ashwin Mani
- Department of Critical Care Medicine, Apollo First Med Hospital, Chennai, India
| | - Meghena Mathew
- Department of Critical Care Medicine, Apollo First Med Hospital, Chennai, India
| | - Vrindha Pari
- Chennai Critical Care Consultants Private Limited, Chennai, India
| | - Sristi Patodia
- Department of Critical Care Medicine, Apollo Proton Cancer Centre, Chennai, India
| | | | | | - Mathew Pulicken
- Department of Critical Care Medicine, Pushpagiri Medical College, Tiruvalla, India
| | | | | | - Kavita Ramesh
- Department of Critical Care Medicine, ABC Hospital, Vishakapatnam, India
| | - Usha Rani
- Department of Critical Care Medicine, Apollo Specialty Hospital, Chennai, India
| | - Ananth Ramaiyan
- Chennai Critical Care Consultants Private Limited, Chennai, India
| | | | | | - Aasiyah Rashan
- Network for Improving Critical care Systems and Training, Colombo, Sri Lanka
| | | | - Jaganathan Selva
- Department of Critical Care Medicine, Mehta Hospital, Chennai, India
| | | | - Swagata Tripathy
- Department of Anaesthesia and Intensive Care Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Ishara Udayanga
- Network for Improving Critical care Systems and Training, Colombo, Sri Lanka
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3
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Tirupakuzhi Vijayaraghavan BK, Priyadarshini D, Rashan A, Beane A, Venkataraman R, Ramakrishnan N, Haniffa R. Validation of a simplified risk prediction model using a cloud based critical care registry in a lower-middle income country. PLoS One 2020; 15:e0244989. [PMID: 33382834 PMCID: PMC7775074 DOI: 10.1371/journal.pone.0244989] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 12/20/2020] [Indexed: 11/18/2022] Open
Abstract
Background The use of severity of illness scoring systems such as the Acute Physiology and Chronic Health Evaluation in lower-middle income settings comes with important limitations, primarily due to data burden, missingness of key variables and lack of resources. To overcome these challenges, in Asia, a simplified model, designated as e-TropICS was previously developed. We sought to externally validate this model using data from a multi-centre critical care registry in India. Methods Seven ICUs from the Indian Registry of IntenSive care(IRIS) contributed data to this study. Patients > 18 years of age with an ICU length of stay > 6 hours were included. Data including age, gender, co-morbidity, diagnostic category, type of admission, vital signs, laboratory measurements and outcomes were collected for all admissions. e-TropICS was calculated as per original methods. The area under the receiver operator characteristic curve was used to express the model’s power to discriminate between survivors and non-survivors. For all tests of significance, a 2-sided P less than or equal to 0.05 was considered to be significant. AUROC values were considered poor when ≤ to 0.70, adequate between 0.71 to 0.80, good between 0.81 to 0.90, and excellent at 0.91 or higher. Calibration was assessed using Hosmer-Lemeshow C -statistic. Results We included data from 2062 consecutive patient episodes. The median age of the cohort was 60 and predominantly male (n = 1350, 65.47%). Mechanical Ventilation and vasopressors were administered at admission in 504 (24.44%) and 423 (20.51%) patients respectively. Overall, mortality at ICU discharge was 10.28% (n = 212). Discrimination (AUC) for the e-TropICS model was 0.83 (95% CI 0.812–0.839) with an HL C statistic p value of < 0.05. The best sensitivity and specificity (84% and 72% respectively) were achieved with the model at an optimal cut-off for probability of 0.29. Conclusion e-TropICS has utility in the care of critically unwell patients in the South Asia region with good discriminative capacity. Further refinement of calibration in larger datasets from India and across the South-East Asia region will help in improving model performance.
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Affiliation(s)
| | | | - Aasiyah Rashan
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka
| | - Abi Beane
- Mahidol Oxford Tropical Research Unit, Thailand, Bangkok
| | - Ramesh Venkataraman
- Department of Critical Care Medicine, Apollo Hospitals, India and Chennai Critical Care Consultants, Chennai, India
| | - Nagarajan Ramakrishnan
- Department of Critical Care Medicine, Apollo Hospitals, India and Chennai Critical Care Consultants, Chennai, India
| | - Rashan Haniffa
- Mahidol Oxford Tropical Research Unit, Thailand, Bangkok
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4
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Adhikari NKJ, Arali R, Attanayake U, Balasundaram S, Beane A, Chakravarthy V, Channanath Ashraf N, Darshana S, Devaprasad D, Dondorp AM, Fowler R, Haniffa R, Ishani P, James A, Jawad I, Jayakumar D, Kodipilly C, Laxmappa R, Mangal K, Mani A, Mathew M, Patodia S, Pattnaik R, Priyadarshini D, Pulicken M, Rabindrarajan E, Ramachandran P, Ramesh K, Rani U, Ranjit S, Ramaiyan A, Ramakrishnan N, Ranganathan L, Rashan T, Dominic Savio R, Selva J, Tirupakuzhi Vijayaraghavan BK, Tripathy S, Tolppa T, Udayanga I, Venkataraman R, Vijayan D. Implementing an intensive care registry in India: preliminary results of the case-mix program and an opportunity for quality improvement and research. Wellcome Open Res 2020; 5:182. [PMID: 33195819 PMCID: PMC7642994 DOI: 10.12688/wellcomeopenres.16152.2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 12/19/2022] Open
Abstract
Background: The epidemiology of critical illness in India is distinct from high-income countries. However, limited data exist on resource availability, staffing patterns, case-mix and outcomes from critical illness. Critical care registries, by enabling a continual evaluation of service provision, epidemiology, resource availability and quality, can bridge these gaps in information. In January 2019, we established the Indian Registry of IntenSive care to map capacity and describe case-mix and outcomes. In this report, we describe the implementation process, preliminary results, opportunities for improvement, challenges and future directions. Methods: All adult and paediatric ICUs in India were eligible to join if they committed to entering data for ICU admissions. Data are collected by a designated representative through the electronic data collection platform of the registry. IRIS hosts data on a secure cloud-based server and access to the data is restricted to designated personnel and is protected with standard firewall and a valid secure socket layer (SSL) certificate. Each participating ICU owns and has access to its own data. All participating units have access to de-identified network-wide aggregate data which enables benchmarking and comparison. Results: The registry currently includes 14 adult and 1 paediatric ICU in the network (232 adult ICU beds and 9 paediatric ICU beds). There have been 8721 patient encounters with a mean age of 56.9 (SD 18.9); 61.4% of patients were male and admissions to participating ICUs were predominantly unplanned (87.5%). At admission, most patients (61.5%) received antibiotics, 17.3% needed vasopressors, and 23.7% were mechanically ventilated. Mortality for the entire cohort was 9%. Data availability for demographics, clinical parameters, and indicators of admission severity was greater than 95%. Conclusions: IRIS represents a successful model for the continual evaluation of critical illness epidemiology in India and provides a framework for the deployment of multi-centre quality improvement and context-relevant clinical research.
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Affiliation(s)
- Neill K J Adhikari
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Rajeshwari Arali
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, Apollo Children's Hospital, Chennai, India
| | - Udara Attanayake
- Network for Improving Critical care Systems and Training, NICST, Colombo, Sri Lanka
| | | | - Abi Beane
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Network for Improving Critical care Systems and Training, NICST, Colombo, Sri Lanka.,Critical Care, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Vijay Chakravarthy
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, Apollo Hospitals, Chennai, India
| | | | - Sri Darshana
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Network for Improving Critical care Systems and Training, NICST, Colombo, Sri Lanka
| | - Dedeepiya Devaprasad
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, Apollo Hospitals, Chennai, India
| | - Arjen M Dondorp
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Robert Fowler
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Rashan Haniffa
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Network for Improving Critical care Systems and Training, NICST, Colombo, Sri Lanka.,Critical Care, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Pramodya Ishani
- Network for Improving Critical care Systems and Training, NICST, Colombo, Sri Lanka
| | - Augustian James
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, Apollo Hospitals, Chennai, India
| | - Issrah Jawad
- Network for Improving Critical care Systems and Training, NICST, Colombo, Sri Lanka
| | - Devachandran Jayakumar
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Chennai Critical Care Consultants, Chennai, India.,Critical Care Medicine, Apollo Hospitals, Chennai, India
| | - Chamira Kodipilly
- Network for Improving Critical care Systems and Training, NICST, Colombo, Sri Lanka
| | - Rakesh Laxmappa
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, Nanjappa Hospital, Shimoga, India
| | - Kishore Mangal
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, Eternal Hospitals, Jaipur, India
| | - Ashwin Mani
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, Apollo Hospitals, Chennai, India
| | - Meghena Mathew
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, Apollo Hospitals, Chennai, India
| | - Sristi Patodia
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, Apollo Hospitals, Chennai, India
| | - Rajyabardhan Pattnaik
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, Ispat General Hospital, Rourkela, India
| | | | - Mathew Pulicken
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, Pushpagiri Hospital, Tiruvalla, India
| | - Ebenezer Rabindrarajan
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, Apollo Hospitals, Chennai, India
| | - Pratheema Ramachandran
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, Apollo Hospitals, Chennai, India
| | - Kavita Ramesh
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, ABC Hospitals, Vishakapatnam, India
| | - Usha Rani
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, Apollo Hospitals, Chennai, India
| | - Suchitra Ranjit
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, Apollo Children's Hospital, Chennai, India
| | - Ananth Ramaiyan
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Chennai Critical Care Consultants, Chennai, India
| | - Nagarajan Ramakrishnan
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Chennai Critical Care Consultants, Chennai, India.,Critical Care Medicine, Apollo Hospitals, Chennai, India
| | - Lakshmi Ranganathan
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Chennai Critical Care Consultants, Chennai, India.,Critical Care Medicine, Apollo Hospitals, Chennai, India
| | - Thalha Rashan
- Network for Improving Critical care Systems and Training, NICST, Colombo, Sri Lanka
| | - Raymond Dominic Savio
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, Apollo Hospitals, Chennai, India
| | - Jaganathan Selva
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, Mehta Hospitals, Chennai, India
| | - Bharath Kumar Tirupakuzhi Vijayaraghavan
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Chennai Critical Care Consultants, Chennai, India.,Critical Care Medicine, Apollo Hospitals, Chennai, India
| | - Swagata Tripathy
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Anaesthesia and Intensive Care Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Timo Tolppa
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Network for Improving Critical care Systems and Training, NICST, Colombo, Sri Lanka
| | - Ishara Udayanga
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Network for Improving Critical care Systems and Training, NICST, Colombo, Sri Lanka
| | - Ramesh Venkataraman
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Chennai Critical Care Consultants, Chennai, India.,Critical Care Medicine, Apollo Hospitals, Chennai, India
| | - Deepak Vijayan
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, Kerala Institute of Medical Sciences, Thiruvananthapuram, India
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5
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Adhikari NKJ, Arali R, Attanayake U, Balasundaram S, Beane A, Chakravarthy V, Channanath Ashraf N, Darshana S, Devaprasad D, Dondorp AM, Fowler R, Haniffa R, Ishani P, James A, Jawad I, Jayakumar D, Kodipilly C, Laxmappa R, Mangal K, Mani A, Mathew M, Patodia S, Pattnaik R, Priyadarshini D, Pulicken M, Rabindrarajan E, Ramachandran P, Ramesh K, Rani U, Ranjit S, Ramaiyan A, Ramakrishnan N, Ranganathan L, Rashan T, Dominic Savio R, Selva J, Tirupakuzhi Vijayaraghavan BK, Tripathy S, Tolppa T, Udayanga I, Venkataraman R, Vijayan D. Implementing an intensive care registry in India: preliminary results of the case-mix program and an opportunity for quality improvement and research. Wellcome Open Res 2020; 5:182. [DOI: 10.12688/wellcomeopenres.16152.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2020] [Indexed: 11/20/2022] Open
Abstract
Background: The epidemiology of critical illness in India is distinct from high-income countries. However, limited data exist on resource availability, staffing patterns, case-mix and outcomes from critical illness. Critical care registries, by enabling a continual evaluation of service provision, epidemiology, resource availability and quality, can bridge these gaps in information. In January 2019, we established the Indian Registry of IntenSive care to map capacity and describe case-mix and outcomes. In this report, we describe the implementation process, preliminary results, opportunities for improvement, challenges and future directions. Methods: All adult and paediatric ICUs in India were eligible to join if they committed to entering data for ICU admissions. Data are collected by a designated representative through the electronic data collection platform of the registry. IRIS hosts data on a secure cloud-based server and access to the data is restricted to designated personnel and is protected with standard firewall and a valid secure socket layer (SSL) certificate. Each participating ICU owns and has access to its own data. All participating units have access to de-identified network-wide aggregate data which enables benchmarking and comparison. Results: The registry currently includes 14 adult and 1 paediatric ICU in the network (232 adult ICU beds and 9 paediatric ICU beds). There have been 8721 patient encounters with a mean age of 56.9 (SD 18.9); 61.4% of patients were male and admissions to participating ICUs were predominantly unplanned (87.5%). At admission, most patients (61.5%) received antibiotics, 17.3% needed vasopressors, and 23.7% were mechanically ventilated. Mortality for the entire cohort was 9%. Data availability for demographics, clinical parameters, and indicators of admission severity was greater than 95%. Conclusions: IRIS represents a successful model for the continual evaluation of critical illness epidemiology in India and provides a framework for the deployment of multi-centre quality improvement and context-relevant clinical research.
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6
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Sahoo SK, Sahoo HB, Priyadarshini D, Soundarya G, Kumar CK, Rani KU. Antiulcer Activity of Ethanolic Extract of Salvadora indica (W.) Leaves on Albino Rats. J Clin Diagn Res 2016; 10:FF07-FF10. [PMID: 27790462 PMCID: PMC5071962 DOI: 10.7860/jcdr/2016/20384.8470] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 07/21/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Ulcer can be developed inside the inner lining of the stomach (gastric ulcer) or the small intestine (duodenal ulcer). Both the ulcers are also cumulatively referred as peptic ulcers. It affects nearly 10% of world population. AIM To investigate the antiulcer activity of ethanolic extract of Salvadora indica W. leaves (ESIL) on albino rats. MATERIALS AND METHODS The present study was carried by pylorus ligation, ethanol and cysteamine induced ulcer models in albino rats. The antiulcer activity of ESIL (150, 300 and 600 mg/kg p.o. for 7 days) was compared with standard drugs (Ranitidine). In pyloric ligation induced ulcer model, the studied parameters were gastric volume, pH, total acidity, free acidity, and ulcer index whereas in ethanol and cysteamine induced ulcer model, the ulcer index was determined for severity of ulcers. The parameters studied were ulcer index, gastric juice volume, pH, free acidity and total acidity. RESULTS In pyloric ligation model; the volume of gastric content, total/free acidity and pepsin activity was significantly decreased at p<0.05 and p<0.01 and pH of the gastric juice was significantly increased at p<0.05 and p<0.01 in ESIL treated groups as compared to control group. All the doses of ESIL showed dose dependent antiulcer effect as well as significant (p<0.05 and p<0.01) reduction in the ulcer index as compared to control group in all the experimental models. CONCLUSION The results of the study indicate that the ESIL have better potential against ulcer which supports the traditional claims in folklore medicine.
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Affiliation(s)
- Saroj Kumar Sahoo
- Assistant Professor, Department of Pharmaceutical Chemistry, Sri Sivani College of Pharmacy, Srikakulam, Andhra Pradesh, India
| | - Himanshu Bhusan Sahoo
- Assistant Professor, Department of Pharmacology, MKCG Medical College & Hospital, Berhampur, Odisha, India
| | - D. Priyadarshini
- Assistant Professor, Department of Pharmacology, Sri Sivani College of Pharmacy, Srikakulam, Andhra Pradesh, India
| | - G. Soundarya
- Assistant Professor, Department of Pharmaceutical Analysis, Sri Sivani College of Pharmacy, Srikakulam, Andhra Pradesh, India
| | - Ch. Kishore Kumar
- Assistant Professor, Department of Pharmaceutics, Sri Sivani College of Pharmacy, Srikakulam, Andhra Pradesh, India
| | - K. Usha Rani
- Assistant Professor, Department of Pharmacology, Sri Sivani College of Pharmacy, Srikakulam, Andhra Pradesh, India
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Sahoo HB, Sagar R, Patro G, Panda M, Sahoo SK, Priyadarshini D. Pharmacological evaluation of Apium leptophyllum (Pers.) on bronchial asthma. J Pharm Bioallied Sci 2016; 8:341-345. [PMID: 28216960 PMCID: PMC5314835 DOI: 10.4103/0975-7406.199343] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective: The present study was to investigate the antiasthmatic potential from the flavonoid fraction of Apium leptophyllum fruit (FFALF) to validate its traditional claim. Materials and Methods: The antiasthmatic activity of FFALF was evaluated by histamine or acetylcholine-induced bronchospasm model in guinea pigs, compound 48/80 induced mast cell degranulation in albino rats and histamine-induced tracheal contraction in guinea pig. The preconvulsion dyspnea time at 0th and 7th day at the dose of 100 and 200 mg/kg in guinea pig's bronchospasm model, the percentage of granulated and degranulated mast cell at the dose of 500, 750, and 1000 μg/ml in rats and tracheal contraction at the dose of 500, 750, and 1000 μg/ml in guinea pig were measured and compared with respective control groups. Results: The treatments of FFALF were significantly (P < 0.001) decreased the histamine/acetylcholine-induced bronchospasm, mast cell degranulation, and histamine-induced tracheal contraction as compared to inducer group. In addition, FFALF showed dose-dependent antiasthmatic activity in all the animals. Conclusion: Hence, this study suggested that the FFALF showed antiasthmatic activity probably by membrane stabilizing property as well as suppressing antibody production and inhibiting of antigen induced by histamine and acetylcholine.
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Affiliation(s)
- Himanshu Bhusan Sahoo
- Department of Pharmacology and Experimental Biology, Vedica College of Pharmacy, RKDF University, Bhopal, Madhya Pradesh, India
| | - Rakesh Sagar
- Department of Pharmacology and Experimental Biology, Vedica College of Pharmacy, RKDF University, Bhopal, Madhya Pradesh, India
| | - Ganesh Patro
- Department of Pharmacology, College of Pharmaceutical Sciences, Mohuda, Berhampur, Odisha, India
| | - Madhulita Panda
- Department of Pharmacology, College of Pharmaceutical Sciences, Mohuda, Berhampur, Odisha, India
| | - Saroj Kumar Sahoo
- Department of Pharmaceutical Chemistry, Sri Sivani College of Pharmacy, Srikakulam, Andhra Pradesh, India
| | - D Priyadarshini
- Department of Pharmaceutical Chemistry, Sri Sivani College of Pharmacy, Srikakulam, Andhra Pradesh, India
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Priyadarshini D, Nadig P, Deshpande N, Deshpande A. Role of psychotherapy in managing a case of generalised aggressive periodontitis. BMJ Case Rep 2014; 2014:bcr-2013-200851. [PMID: 25035440 DOI: 10.1136/bcr-2013-200851] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Generalised aggressive periodontitis is characterised by "generalized interproximal attachment loss affecting at least three permanent teeth other than first molars and incisors." The management of generalised aggressive periodontitis is challenging as it involves an interdisciplinary approach. When the patient presents himself late to the clinician, the tooth and bone loss can be up to 60%. Natural teeth and alveolar bone contribute to the contour and aesthetics of the face. Loss of teeth in younger age may lead to attitude, behaviour changes and may cause psychological depression and withdrawal from society. The main distinguishing feature of this case report is the psychological counselling provided along with periodontal and prosthetic treatment.
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Affiliation(s)
- D Priyadarshini
- Department of Periodontics, Manubhai Patel Dental College and Hospital, ORI, Vadodara, Gujarat, India
| | - Prasad Nadig
- Department of Periodontics, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
| | - Neeraj Deshpande
- Department of Periodontics, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
| | - Anshula Deshpande
- Department of Pedodontics and Preventive Dentistry, K. M. Shah Dental College, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
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Priyadarshini D, Gadia RR, Tripathy A, Gurukumar KR, Bhagat A, Patwardhan S, Mokashi N, Vaidya D, Shah PS, Cecilia D. Clinical findings and pro-inflammatory cytokines in dengue patients in Western India: a facility-based study. PLoS One 2010; 5:e8709. [PMID: 20090849 PMCID: PMC2806829 DOI: 10.1371/journal.pone.0008709] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Accepted: 12/21/2009] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Descriptions of dengue immunopathogenesis have largely relied on data from South-east Asia and America, while India is poorly represented. This study characterizes dengue cases from Pune, Western India, with respect to clinical profile and pro-inflammatory cytokines. METHODOLOGY/PRINCIPAL FINDINGS In 2005, 372 clinically suspected dengue cases were tested by MAC-ELISA and RT-PCR for dengue virus (DENV) aetiology. The clinical profile was recorded at the hospital. Circulating levels of IFN-gamma, TNF-alpha, IL-6, and IL-8 were assessed by ELISA and secondary infections were defined by IgM to IgG ratio. Statistical analysis was carried out using the SPSS 11.0 version. Of the 372 individuals, 221 were confirmed to be dengue cases. Three serotypes, DENV-1, 2 and 3 were co-circulating and one case of dual infection was identified. Of 221 cases, 159 presented with Dengue fever (DF) and 62 with Dengue hemorrhagic fever (DHF) of which six had severe DHF and one died of shock. There was a strong association of rash, abdominal pain and conjunctival congestion with DHF. Levels of IFN-gamma were higher in DF whereas IL-6 and IL-8 were higher in DHF cases (p<0.05). The mean levels of the three cytokines were higher in secondary compared to primary infections. Levels of IFN-gamma and IL-8 were higher in early samples collected 2-5 days after onset than late samples collected 6-15 days after onset. IFN-gamma showed significant decreasing time trend (p = 0.005) and IL-8 levels showed increasing trend towards significance in DHF cases (interaction p = 0.059). There was a significant association of IL-8 levels with thrombocytopenia and both IFN-gamma and IL-8 were positively associated with alanine transaminase levels. CONCLUSIONS/SIGNIFICANCE Rash, abdominal pain and conjunctival congestion could be prognostic symptoms for DHF. High levels of IL-6 and IL-8 were shown to associate with DHF. The time trend of IFN-gamma and IL-8 levels had greater significance than absolute values in DHF pathogenesis.
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Affiliation(s)
| | - Rajesh R. Gadia
- Department of General Medicine, King Edward Memorial Hospital, Pune, India
| | | | | | | | - Sampada Patwardhan
- Department of Microbiology, Deenanath Mangeshkar Hospital, Erandwane, Pune, India
| | - Nitin Mokashi
- Department of Microbiology, Yashwant Rao Chauhan Memorial Hospital, Pune, India
| | - Dhananjay Vaidya
- John Hopkins Medical Institutions, Baltimore, Maryland, United States of America
| | | | - D. Cecilia
- National Institute of Virology, Pune, India
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