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Venkitakrishnan R, Vijay A, Augustine J, Ramachandran D, Cleetus M, Nirmal AS, John S. Hospitalisation Outcomes in Pneumococcal Vaccinated VersusUnvaccinated Patients with Exacerbation of COPD – Results From The HOPE COPD Study. ERJ Open Res 2023; 9:00476-2022. [PMID: 37143841 PMCID: PMC10152243 DOI: 10.1183/23120541.00476-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/04/2023] [Indexed: 01/27/2023] Open
Abstract
BackgroundInfectious exacerbations are crucial events that dictate the natural course of COPD patients. Pneumococcal vaccination has shown to decrease incidence of community acquired pneumonia in COPD patients. There is paucity of data on outcomes of hospitalisation in pneumococcal vaccinated COPD patients in comparison with unvaccinated subjects.ObjectivesTo evaluate the difference in hospitalisation outcomes in pneumococcal vaccinatedversusunvaccinated COPD subjects hospitalized with Acute Exacerbation.MethodsThis was a prospective analytical study on 120 subjects hospitalised with acute COPD exacerbation. 60 patients with prior pneumococcal vaccination and 60 unvaccinated patients were recruited. Outcomes of hospitalisation like mortality rate, need for assisted ventilation, length of hospital stay, need for ICU care, and length of ICU stay were collected and compared between two groups with appropriate statistical tools.Results60% of unvaccinated patients (36/60) required assisted ventilation whereas only 43.3% of vaccinated subjects (26/60) needed assisted ventilation (p value 0.04). Most of the secondary outcomes were better in the vaccinated group. The mean length of ICU stay in the vaccinated group was 0.67 days (±1.11) compared to 1.77 (± 1.89) in the unvaccinated group. The mean length of hospital stay was 4.50 days (±1.64) and 5.47 days (±2.03) days in vaccinated and unvaccinated group respectively (p value 0.005).ConclusionsCOPD patients who have received prior pneumococcal vaccination have better outcomes when they are hospitalised for an acute exacerbation. Pneumococcal vaccination may be recommended for all patients with COPD who are at risk of hospitalisation with acute exacerbation.
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Gwilym BL, Pallmann P, Waldron CA, Thomas-Jones E, Milosevic S, Brookes-Howell L, Harris D, Massey I, Burton J, Stewart P, Samuel K, Jones S, Cox D, Clothier A, Edwards A, Twine CP, Bosanquet DC, Benson R, Birmpili P, Blair R, Bosanquet DC, Dattani N, Dovell G, Forsythe R, Gwilym BL, Hitchman L, Machin M, Nandhra S, Onida S, Preece R, Saratzis A, Shalhoub J, Singh A, Forget P, Gannon M, Celnik A, Duguid M, Campbell A, Duncan K, Renwick B, Moore J, Maresch M, Kamal D, Kabis M, Hatem M, Juszczak M, Dattani N, Travers H, Shalan A, Elsabbagh M, Rocha-Neves J, Pereira-Neves A, Teixeira J, Lyons O, Lim E, Hamdulay K, Makar R, Zaki S, Francis CT, Azer A, Ghatwary-Tantawy T, Elsayed K, Mittapalli D, Melvin R, Barakat H, Taylor J, Veal S, Hamid HKS, Baili E, Kastrisios G, Maltezos C, Maltezos K, Anastasiadou C, Pachi A, Skotsimara A, Saratzis A, Vijaynagar B, Lau S, Velineni R, Bright E, Montague-Johnstone E, Stewart K, King W, Karkos C, Mitka M, Papadimitriou C, Smith G, Chan E, Shalhoub J, Machin M, Agbeko AE, Amoako J, Vijay A, Roditis K, Papaioannou V, Antoniou A, Tsiantoula P, Bessias N, Papas T, Dovell G, Goodchild F, Nandhra S, Rammell J, Dawkins C, Lapolla P, Sapienza P, Brachini G, Mingoli A, Hussey K, Meldrum A, Dearie L, Nair M, Duncan A, Webb B, Klimach S, Hardy T, Guest F, Hopkins L, Contractor U, Clothier A, McBride O, Hallatt M, Forsythe R, Pang D, Tan LE, Altaf N, Wong J, Thurston B, Ash O, Popplewell M, Grewal A, Jones S, Wardle B, Twine C, Ambler G, Condie N, Lam K, Heigberg-Gibbons F, Saha P, Hayes T, Patel S, Black S, Musajee M, Choudhry A, Hammond E, Costanza M, Shaw P, Feghali A, Chawla A, Surowiec S, Encalada RZ, Benson R, Cadwallader C, Clayton P, Van Herzeele I, Geenens M, Vermeir L, Moreels N, Geers S, Jawien A, Arentewicz T, Kontopodis N, Lioudaki S, Tavlas E, Nyktari V, Oberhuber A, Ibrahim A, Neu J, Nierhoff T, Moulakakis K, Kakkos S, Nikolakopoulos K, Papadoulas S, D'Oria M, Lepidi S, Lowry D, Ooi S, Patterson B, Williams S, Elrefaey GH, Gaba KA, Williams GF, Rodriguez DU, Khashram M, Gormley S, Hart O, Suthers E, French S. Short-term risk prediction after major lower limb amputation: PERCEIVE study. Br J Surg 2022; 109:1300-1311. [PMID: 36065602 DOI: 10.1093/bjs/znac309] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/06/2022] [Accepted: 07/31/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND The accuracy with which healthcare professionals (HCPs) and risk prediction tools predict outcomes after major lower limb amputation (MLLA) is uncertain. The aim of this study was to evaluate the accuracy of predicting short-term (30 days after MLLA) mortality, morbidity, and revisional surgery. METHODS The PERCEIVE (PrEdiction of Risk and Communication of outcomE following major lower limb amputation: a collaboratIVE) study was launched on 1 October 2020. It was an international multicentre study, including adults undergoing MLLA for complications of peripheral arterial disease and/or diabetes. Preoperative predictions of 30-day mortality, morbidity, and MLLA revision by surgeons and anaesthetists were recorded. Probabilities from relevant risk prediction tools were calculated. Evaluation of accuracy included measures of discrimination, calibration, and overall performance. RESULTS Some 537 patients were included. HCPs had acceptable discrimination in predicting mortality (931 predictions; C-statistic 0.758) and MLLA revision (565 predictions; C-statistic 0.756), but were poor at predicting morbidity (980 predictions; C-statistic 0.616). They overpredicted the risk of all outcomes. All except three risk prediction tools had worse discrimination than HCPs for predicting mortality (C-statistics 0.789, 0.774, and 0.773); two of these significantly overestimated the risk compared with HCPs. SORT version 2 (the only tool incorporating HCP predictions) demonstrated better calibration and overall performance (Brier score 0.082) than HCPs. Tools predicting morbidity and MLLA revision had poor discrimination (C-statistics 0.520 and 0.679). CONCLUSION Clinicians predicted mortality and MLLA revision well, but predicted morbidity poorly. They overestimated the risk of mortality, morbidity, and MLLA revision. Most short-term risk prediction tools had poorer discrimination or calibration than HCPs. The best method of predicting mortality was a statistical tool that incorporated HCP estimation.
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Affiliation(s)
- Brenig L Gwilym
- South East Wales Vascular Network, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK
| | | | | | | | | | | | - Debbie Harris
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Ian Massey
- Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK
| | - Jo Burton
- Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK
| | - Phillippa Stewart
- Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK
| | - Katie Samuel
- Department of Anaesthesia, North Bristol NHS Trust, Bristol, UK
| | - Sian Jones
- c/o INVOLVE Health and Care Research Wales, Cardiff, UK
| | - David Cox
- c/o INVOLVE Health and Care Research Wales, Cardiff, UK
| | - Annie Clothier
- South East Wales Vascular Network, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Christopher P Twine
- Bristol, Bath and Weston Vascular Network, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - David C Bosanquet
- South East Wales Vascular Network, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK
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Moliner L, Woodhouse L, Ahmed S, Bhagani S, Sevak P, Vijay A, Steele N, Gray HL, Robinson S, Davidson M, O'Brien M, Cox S, Powell C, Khalid T, T.R. Geldart, Hennah L, Newsom-Davis T, A. Denton, Blackhall F, Califano R. 1541P Real-world data of atezolizumab plus carboplatin-etoposide for patients with extensive stage SCLC: The UK experience. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Wijayaratne P, Vijay A, Shah A, Ene M. 763 QUALITY IMPROVEMENT PROJECT (QIP) ON IMPROVING THE USE OF THE CLINICAL FRAILTY SCALE (CFS) DURING THE COVID-19 PANDEMIC. Age Ageing 2022. [PMCID: PMC9383576 DOI: 10.1093/ageing/afac034.763] [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: 11/14/2022] Open
Abstract
Abstract
Introduction
Older people were disproportionally affected by the COVID-19 pandemic resulting in a surge in the demand for healthcare resources. The aim of this QIP was to assess and improve the compliance of using the CFS in patients over the age of 65 with COVID-19 to aid in establishing appropriate Treatment Escalation Plans (TEPs) during admission.
Method
Prospectively, clinical notes of 80 patients were reviewed to calculate the compliance of documenting the CFS on admission. Multiple Plan-Do-Study-Act (PDSA) cycles were implemented. As the first intervention, a trust-wide email message was sent to all medical doctors highlighting the importance of assessing CFS in all patients during admission. Also, reminder emails and text messages were sent to all medical doctors’ WhatsApp groups. As the second intervention, we designed an e-poster and displayed it as a screensaver on all trust computers for 2 weeks. Data was collected and analysed after each intervention.
Results
The baseline audit showed that only 42% of patients had a CFS documented during admission. The majority (55%) had a CFS above 5 and 93% of the patients had a ‘Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) order in place. Compliance in assessing CFS after the two interventions was 65% and 68% respectively. In both cycles, all patients who had a CFS of 5 and above had DNACPR decisions in place. Moreover, significant variability in escalation plans was noted when the CFS was 4.
Conclusion
The compliance in assessing CFS progressively improved with each intervention. Although the CFS is a valuable tool in assisting TEPs, it should be treated as a spectrum that is independent of age, rather than a binary phenomenon. We hope to further improve compliance by arranging teaching sessions for doctors in our hospital and thereby ensure appropriate TEPs are in place.
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Affiliation(s)
- P Wijayaratne
- Department of Elderly Care Medicine, Northampton General Hospital
| | - A Vijay
- Department of Elderly Care Medicine, Northampton General Hospital
| | - A Shah
- Department of Elderly Care Medicine, Northampton General Hospital
| | - M Ene
- Department of Elderly Care Medicine, Northampton General Hospital
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Venkitakrishnan R, Nirmal A, Augustine J, Divya R, Cleetus M, Vijay A, John S. Delayed lung function testing after COVID-19 to detect persistent lung function abnormalities – The DELTA – COVID-19 lung function study. J Family Med Prim Care 2022; 11:7351-7356. [PMID: 36993117 PMCID: PMC10041253 DOI: 10.4103/jfmpc.jfmpc_703_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: 03/25/2022] [Revised: 08/09/2022] [Accepted: 08/18/2022] [Indexed: 12/24/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) has made its presence felt as the worst pandemic witnessed till date in the 21st century. The mortality and morbidity associated with COVID-19 does not end with the acute pneumonia and respiratory failure and consequences extend well into the subsequent weeks to months in a minority. After recovery from severe disease, symptoms, lung function abnormalities and radiological changes are known to persist for varying length of time in a small proportion of patients. Various studies report different incidences of lung function abnormalities post-COVID-19. The present study describes the occurrence, severity, pattern and risk factors for persistent lung function abnormalities post-COVID-19 patients. Aim The present study was aimed to find out the occurrence of persistent lung function abnormalities in patients hospitalised with COVID-19 at three months of discharge who had normal previous lung function prior to COVID-19. In those with persisting abnormal lung function, the severity, pattern and risk factors for persistent lung function abnormalities were also studied. Methods The present study was a retrospective study in patients hospitalised with COVID-19 who had radiological evidence of pneumonia at admission. Patients with prior abnormal lung function were excluded from the study. Lung function was analysed with spirometry, 6-min walk test and diffusion capacity between day 85 and 95 of hospital discharge and the occurrence, severity and pattern of impairment was described. Lung function impairment was correlated with baseline characteristics and univariate regression analysis was done to identify risk factors for persisting functional impairment. Results 39 patients were included in the study. Spirometry at follow up showed a restrictive ventilatory defect in 26 out of 39 patients (64%) and a normal study was noted in 12 patients. One patient had an obstructive ventilatory defect. Diffusion impairment was present in 27 patients and normal transfer factor was seen in 12 patients. The degree of diffusion impairment was mild in 16 patients and moderate in 11 patients. Univariate regression analysis revealed that age, history of systemic hypertension, severe hypoxia at presentation, and extent of lung involvement by CT chest were associated with lung function impairment. Conclusion Almost two-thirds of patients hospitalised with COVID-19 pneumonia have persistent lung function abnormalities at three months post-discharge. Advanced age, severe disease and medical comorbidities increase the risk of persistent functional abnormalities.
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Narayanan M, Vijay A, Kandasamy S, Nasif O, Alharbi SA, Srinivasan R, Kavitha R. Phytochemical profile and larvicidal activity of aqueous extract of Ocimum americanum against mosquito vectors. Appl Nanosci 2021. [DOI: 10.1007/s13204-021-02087-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Venkitakrishnan R, Cleetus M, Augustine J, Ramachandran D, John S, Vijay A, Nirmal AS, Sasi A, Kuriachen E. Acceptance and Results of Therapy with Omalizumab in Real world Kerala setting - Reports from the ARTWORK study, Kerala, South India. J Asthma 2021; 59:1831-1838. [PMID: 34388058 DOI: 10.1080/02770903.2021.1968425] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Despite the availability of effective medications, only a minority of asthma patients achieve guideline defined asthma control. Treatment success depends on patient concurrence to the prescribed drug and adherence to treatment. It is therefore crucial to identify the patient preferences as well as attitudes towards asthma medications. Omalizumab is recommended as a preferred option in step five of asthma therapy. There have been few studies to address patient perspectives on omalizumab therapy in India. METHODS This was a retrospective study. Patients with inadequate asthma control were considered for the study. Systematic evaluation was done to identify and correct modifiable factors that can worsen asthma control. Patients with persisting poor asthma control who were deemed suitable to receive this agent were evaluated with their attitudes towards acceptance or refusal and the reasons for opting out were noted. The patients who received omalizumab were followed up to determine the results of treatment and duration of adherence to therapy. RESULTS 35 patients out of 51 patients chose to avoid this drug. The reasons for opting out included erroneous perception of optimal asthma control, cost of therapy, and concern about adverse effects. Patients took omalizumab for a median duration of 6 months. Improved asthma control and decreased frequency of exacerbation was noted in all patients which persisted during the six month follow up. CONCLUSIONS Majority of patients needing step five therapy opt out of omalizumab. Cost of drug, duration of therapy and erroneous perception of good asthma control account for refusing treatment. Omalizumab affords excellent clinical benefits to patients who receive it, and the benefits extend beyond the duration of therapy.
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Affiliation(s)
| | - Melcy Cleetus
- Rajagiri Hospital, Pulmonary medicine, Aluva, 683112 India
| | | | | | - Susan John
- Rajagiri Hospital, Clinical Epidemiology, Aluva, 683112 India
| | - Anand Vijay
- Rajagiri Hospital, Pulmonary medicine, Aluva, 683112 India
| | | | - Anju Sasi
- Rajagiri Hospital, Pulmonary medicine, Aluva, 683112 India
| | - Elda Kuriachen
- Rajagiri Hospital, Pulmonary medicine, Aluva, 683112 India
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Venkitakrishnan R, Paul M, Sleeba T, Abraham L, Joshi M, Augustine J, Ramachandran D, Cleetus M, Vijay A. Expecting the unexpected - Primary mediastinal large B cell lymphoma presenting as huge lung parenchymal mass. Respir Med Case Rep 2021; 32:101370. [PMID: 33717867 PMCID: PMC7921618 DOI: 10.1016/j.rmcr.2021.101370] [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: 12/15/2020] [Revised: 02/02/2021] [Accepted: 02/13/2021] [Indexed: 11/17/2022] Open
Abstract
The first possibility considered in the etiology of large lung masses is neoplastic lesions. The differential diagnoses of these masses include bronchogenic carcinoma, pulmonary sarcoma, primitive neuroectodermal tumor etc. Primary or secondary pulmonary parenchymal lymphomas presenting as large mass is distinctly rare. We share the case of a young lady who presented with a large left lung mass almost entirely replacing the left lung parenchyma, with associated intrathoracic lymphadenopathy. On evaluation she was proved to have primary mediastinal large B-cell lymphoma. Treatment with an aggressive chemotherapy regimen led to complete remission of the parenchymal and nodal disease. The uncommon radiological presentation and the excellent therapeutic response despite huge tumor load merit clinical attention.
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Affiliation(s)
| | - Mobin Paul
- Pulmonary Medicine, Rajagiri hospital, Aluva, Kochi, Kerala
| | - Teena Sleeba
- Pulmonary Medicine, Rajagiri hospital, Aluva, Kochi, Kerala
| | - Latha Abraham
- Pulmonary Medicine, Rajagiri hospital, Aluva, Kochi, Kerala
| | - Manisha Joshi
- Pulmonary Medicine, Rajagiri hospital, Aluva, Kochi, Kerala
| | | | | | - Melcy Cleetus
- Pulmonary Medicine, Rajagiri hospital, Aluva, Kochi, Kerala
| | - Anand Vijay
- Pulmonary Medicine, Rajagiri hospital, Aluva, Kochi, Kerala
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Venkitakrishnan R, Augustine J, Vijay A, Ramachandran D, Cleetus M, Nirmal A, John S, Thomas S. Improving the yield of diagnostic medical thoracoscopy for undiagnosed exudative pleural effusions using a rigid diagnostic algorithm. Int J Mycobacteriol 2021; 10:405-410. [DOI: 10.4103/ijmy.ijmy_214_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] [Indexed: 11/04/2022] Open
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Radhika T, Vijay A, Harinadha BV, Madhavareddy B. Design, Synthesis, Molecular Docking Studies, and Biological Evaluation of Pyrazoline Incorporated Isoxazole Derivatives. Russ J Bioorg Chem 2020. [DOI: 10.1134/s1068162020030152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Gurunathan U, Vijay A, Grover A, Coulson T, Myles P. The Impact of Nature of Surgery on the Relevance of Outcome Measures. Anaesth Intensive Care 2016. [DOI: 10.1177/0310057x1604400627] [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: 11/16/2022]
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Vijay A, Grover A, Coulson TG, Myles PS. Perioperative Management of Patients Treated with Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers: A Quality Improvement Audit. Anaesth Intensive Care 2016; 44:346-52. [DOI: 10.1177/0310057x1604400305] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Previous studies have shown that patients continuing angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers on the day of surgery are more likely to have significant intraoperative hypotension, higher rates of postoperative acute kidney injury and lower incidences of postoperative atrial fibrillation. However, many of these studies were prone to bias and confounding, and questions remain over the validity of these outcomes. This observational, before-and-after quality mprovement audit aimed to assess the effect of withholding these medications on the morning of surgery. We recruited 323 participants, with 83 (26%) having their preoperative angiotensin-converting enzyme inhibitor (ACEi) or angiotensin II receptor blocker (ARB) withheld on the day of surgery. There were only very small Spearman rank-order correlations between time since last dose of these medications (rho −0.12, P=0.057) and intraoperative and recovery room intravenous fluid administration (rho −0.11, P=0.042). There was no statistically significant difference between the continued or withheld groups in vasopressor (metaraminol use 3.5 [1.5–8.3] mg versus 3.5 [1.5–8.5] mg, P=0.67) or intravenous fluid administration (1000 ml [800–1500] ml versus 1000 [800–1500] ml, P=0.096), nor rates of postoperative acute kidney injury (13% vs 18%, P=0.25) or atrial fibrillation (15% versus 18%, P=0.71). This audit found no significant differences in measured outcomes between the continued or withheld ACEi/ARB groups. This finding should be interpreted with caution due to the possibility of confounding and an insufficient sample size. However, as the finding is in contrast to many previous studies, future prospective randomised clinical trials are required to answer this important question.
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Affiliation(s)
- A. Vijay
- Alfred Hospital, Melbourne, Victoria
| | - A. Grover
- Department of Anaesthesia and Perioperative Medicine, The Alfred Hospital and Monash University, Melbourne, Victoria
| | - T. G. Coulson
- Department of Anaesthesia and Perioperative Medicine, The Alfred Hospital, Melbourne, Victoria
| | - P. S. Myles
- Department of Anaesthesia and Perioperative Medicine, The Alfred Hospital and Monash University, Melbourne, Victoria
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Barthwal MS, Marwah V, Chopra M, Garg Y, Tyagi R, Kishore K, Vijay A, Dutta V, Katoch CDS, Singh S, Bhattacharya D. A Five-Year Study of Intrapleural Fibrinolytic Therapy in Loculated Pleural Collections. Indian J Chest Dis Allied Sci 2016; 58:17-20. [PMID: 28368566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Pleural fluid loculations due to complicated parapneumonic effusion (CPE), empyema, tubercular effusion and traumatic hemothorax can be managed either by video-assisted thoracoscopic surgery (VATS) or intrapleural ibrinolytic therapy (IPFT). The former is more invasive, not easily available and is also more expensive. On the other hand, IPFT is less invasive, cheaper, easily accessible and if used early, in loculated pleural collections, break loculations and early pleural peel, thereby facilitating pleural space drainage. OBJECTIVE To study the efficacy of IPFT in facilitating pleural space drainage in loculated pleural collections of diverse aetiologies. METHODS A five-year retrospective, observational study of 200 patients, with loculated pleural collections and failed tube drainage and managed with IPFT was carried out. Responders were defined as those with significant volume of fluid drained and significant radiological resolution. RESULTS There were 106 (53%) cases of CPE, 59 (29.5%) cases of tubercular effusion, 23 (11.5%) cases of empyema and 12 (6%) cases of hemothorax. Responders were 148 (74%) in number. The distribution of responders as per type of loculated pleural collection was as follows: CPE 88 (83%), tubercular 37 (62.7%), empyema 14 (60.8%) and traumatic hemothorax 11 (91.6%). The adverse effects were mild and included chest pain in six patients and low-grade transient fewer in three cases. CONCLUSIONS Intrapleural fibrinolytic therapy is a safe and cost-effective option in the management of selected patients with loculated pleural effusions.
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Palanisamy S, Patel ND, Sabnis SC, Palanisamy N, Vijay A, Chinnusamy P. Laparoscopic hysterectomy with bilateral orchidectomy for Persistent Mullerian duct syndrome with seminoma testes: Case report. J Minim Access Surg 2015; 11:273-5. [PMID: 26622120 PMCID: PMC4640029 DOI: 10.4103/0972-9941.158160] [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] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Persistent Mullerian duct syndrome (PMDS) is one of the three rare intersex disorders caused by defective anti-mullerian hormone or its receptor, characterized by undescended testes with presence of underdeveloped derivatives of mullerian duct in genetically male infant or adult with normal external genitals and virilization. This population will essentially have normal, 46(XY), phenotype. We hereby present a case of PMDS, presented with incarcerated left inguinal hernia associated with cryptorchidism and seminoma of right testes. Patient underwent laparoscopic hernia repair with bilateral orchidectomy and hysterectomy with uneventful postoperative recovery. Here we highlight the importance of minimal access approach for this scenario in terms of better visualization, less blood loss, combining multiple procedures along with early return to work and excellent cosmetic outcome.
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Affiliation(s)
- Senthilnathan Palanisamy
- Department of Minimal Access Surgery, Gem Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Nikunj D Patel
- Department of Minimal Access Surgery, Gem Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Sandeep C Sabnis
- Department of Minimal Access Surgery, Gem Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Nalankilli Palanisamy
- Department of Minimal Access Surgery, Gem Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Anand Vijay
- Department of Minimal Access Surgery, Gem Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Palanivelu Chinnusamy
- Department of Minimal Access Surgery, Gem Hospital and Research Centre, Coimbatore, Tamil Nadu, India
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Palanisamy S, Patel N, Sabnis S, Palanisamy N, Vijay A, Palanivelu P, Parthasarthi R, Chinnusamy P. Laparoscopic radical cholecystectomy for suspected early gall bladder carcinoma: thinking beyond convention. Surg Endosc 2015; 30:2442-8. [PMID: 26416372 DOI: 10.1007/s00464-015-4495-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [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: 04/14/2015] [Accepted: 08/03/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Gall bladder cancer (GBC) is the most common and aggressive malignancy of the biliary tract with extremely poor prognosis. Radical resection remains the only potential curative treatment for operable lesions. Although laparoscopic approach is now considered as standard of care for many gastrointestinal malignancies, surgical community is still reluctant to use this approach for GBC probably because of fear of tumor dissemination, inadequate lymphadenectomy and overall nihilistic approach. Aim of this study was to share our initial experience of laparoscopic radical cholecystectomy (LRC) for suspected early GBC. METHODS From 2008 to 2013, 91 patients were evaluated for suspected GBC, of which, 14 patients had early disease and underwent LRC. RESULTS Mean age of the cohort was 61.14 ± 4.20 years with male/female ratio of 1:1.33. Mean operating time was 212.9 ± 26.73 min with mean blood loss of 196.4 ± 63.44 ml. Mean hospital stay was 5.14 ± 0.86 days without any 30-day mortality. Bile leak occurred in two patients. Out of 14 patients, 12 had adenocarcinoma, one had xanthogranulomatous cholecystitis and another had adenomyomatosis of gall bladder as final pathology. Resected margins were free in all (>1 cm). Median number of lymph nodes resected was 8 (4-14). Pathological stage of disease was pT2N0 in eight, pT2N1 in three and pT3N0 in one patient. Median follow-up was 51 (14-70) months with 5-year survival 68.75 %. CONCLUSIONS Laparoscopic radical cholecystectomy with lymphadenectomy can be a viable alternative for management of early GBC in terms of technical feasibility and oncological clearance along with offering the conventional advantages of minimal access approach.
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Affiliation(s)
- Senthilnathan Palanisamy
- Department of HPB Surgery, Gem Hospital and Research Centre, 45, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu, 641045, India.
| | - Nikunj Patel
- Department of HPB Surgery, Gem Hospital and Research Centre, 45, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu, 641045, India
| | - Sandeep Sabnis
- Department of HPB Surgery, Gem Hospital and Research Centre, 45, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu, 641045, India
| | - Nalankilli Palanisamy
- Department of HPB Surgery, Gem Hospital and Research Centre, 45, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu, 641045, India
| | - Anand Vijay
- Department of HPB Surgery, Gem Hospital and Research Centre, 45, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu, 641045, India
| | - Praveenraj Palanivelu
- Department of HPB Surgery, Gem Hospital and Research Centre, 45, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu, 641045, India
| | - R Parthasarthi
- Department of HPB Surgery, Gem Hospital and Research Centre, 45, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu, 641045, India
| | - Palanivelu Chinnusamy
- Department of HPB Surgery, Gem Hospital and Research Centre, 45, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu, 641045, India
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Mahalingashetti PB, Subramanian RA, Jayker SS, Vijay A. Lymphatic filariasis: A view at pathological diversity. Trop Parasitol 2014; 4:128-32. [PMID: 25250237 PMCID: PMC4166800 DOI: 10.4103/2229-5070.138544] [Citation(s) in RCA: 3] [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] [Received: 01/01/2014] [Accepted: 08/12/2014] [Indexed: 11/04/2022] Open
Abstract
Filariasis is traditionally diagnosed following screening of peripheral smear for microfilaria. Clinically lymphatic filariasis mimics the common local diseases. Thus, it is plausible to observe this parasitic infection in histological sections. We encountered three such cases, which displayed diverse patterns of immune response. Presence of both dead and viable worm at the same foci suggests that such immune response could be the result of parasitic death. Histological features such as endothelial injury and granulomatous response attests to the role of Wolbachia bacteria in influencing tissue response.
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Affiliation(s)
| | | | - Sushan Shweta Jayker
- Department of Pathology, P E S Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh, India
| | - A Vijay
- Department of Pathology, P E S Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh, India
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Senthilnathan P, Inamdar S, Nalankilli VP, Vijay A, Rajapandian S, Parthsarathi R, Raj P, Palanivelu C. Long-term results of hepatic hydatid disease managed using palanivelu hydatid system: Indian experience in tertiary center. Surg Endosc 2014; 28:2832-9. [PMID: 24902813 DOI: 10.1007/s00464-014-3570-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 04/24/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Incidence of hepatic hydatid disease is increasing due to globalization. Surgery is the gold standard treatment. Laparoscopy has gained enough evidence regarding its safety and efficacy. Complete evacuation of hydatid contents without spillage remains a challenge. We aimed to determine long-term results of hepatic hydatid disease managed laparoscopically using palanivelu hydatid system (PHS) at our institution. METHODS One hundred and five patients underwent laparoscopic surgical management using the PHS at our institute from May 1997 to May 2013. Clinical presentations, surgical strategy, postoperative morbidity, and long-term recurrence rate were evaluated. RESULTS Of the 105 patients, 76 were male and 29 female with a mean age of 32 years (range 14-71 years). The most common presentation was abdominal pain in 61 patients (58%). Sixteen patients had multiple cysts of which nine had involvement of both lobes. Seventy-seven (73.3%) cysts were uncomplicated. Nineteen (18.09%) had a cyst-biliary communication, two were ruptured cysts, and seven were recurrent cysts. All patients underwent successful laparoscopic management where conservative surgery was performed in 94 patients and radical surgery in 11 patients. Post-operative morbidity was seen in 18 (17.14 %) patients, which included deep cavity infection in two cases, post-operative bile leak in 13 cases, and duodenal injury in one case without any mortality. Mean long-term follow-up was 36 months (range 6 months-5 years) with recurrence in two cases. CONCLUSION Our long-term results with PHS showed good outcomes in the laparoscopic management of hepatic hydatid disease with conservative surgery as the preferred approach reserving radical surgery only in selected cases.
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Affiliation(s)
- P Senthilnathan
- HPB Department, GEM Hospital and Research Center, Pankaja Mill Road, Ramnathpuram, Coimbatore, 641045, Tamil Nadu, India,
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Vijay A, Wyatt RE. Spectral filters in quantum mechanics: A measurement theory perspective. Phys Rev E Stat Phys Plasmas Fluids Relat Interdiscip Topics 2000; 62:4351-4364. [PMID: 11088965 DOI: 10.1103/physreve.62.4351] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2000] [Indexed: 05/23/2023]
Abstract
We present the time-domain theory of spectral filters, starting with the basic propositions of the theory of measurement in quantum mechanics, and develop its parameter-free implementation in the traditional correlation function as well as the filter diagonalization (FD) form. The present study unifies all the time-domain spectral filter algorithms in the literature, under a single theme which is based on the notion of selective measurements. For specific numerical purposes, we have selected Chebyshev polynomials for developing the time propagator and this permits us to carry out the relevent time integrals fully analytically and obtain FD equations in a numerically convenient form. We also argue that the FD method is a particular realization of the general spectral filter goal and it is constrained, in general, by the time-energy uncertainty regime at least as much as the correlation-function-based method. To contrast the performance of the correlation function and the FD methods, we have carried out the detailed numerical experiments on a model system, which suggest that the FD method needs almost as much time propagation as the correlation function method, in order to identify the correct spectrum. The difference lies in the procedure for the exact location of eigenvalue positions, for which the FD method employs a diagonalization step while the correlation function method involves the location of zeros.
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Affiliation(s)
- A Vijay
- Institute for Theoretical Chemistry, Department of Chemistry and Biochemistry, The University of Texas at Austin, Austin, Texas 78712-1167, USA
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Subhash C, Agarwal AK, Rewari BB, Sangla KS, Vijay A. Disease modifying anti-rheumatic drugs (DMARDs) in rheumatoid disease. J Assoc Physicians India 1995; 43:232-3. [PMID: 11256928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Vijay A, Sathyanarayana D. Use of L matrix to obtain reliable ab initio force constants of polyatomic molecules: ethylene as a test system. J Mol Struct 1994. [DOI: 10.1016/0022-2860(94)08390-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Vijay A, Sathyanarayana D. Ab initio study of molecular conformations, ground state force field and vibrational spectra of S-methyl dithiocarbamate. J Mol Struct 1994. [DOI: 10.1016/0022-2860(94)08157-3] [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: 10/17/2022]
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