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Mackay CA, Rath C, Rao S, Patole S. Plant-Derived Substances for Prevention of Necrotising Enterocolitis: A Systematic Review of Animal Studies. Nutrients 2024; 16:832. [PMID: 38542743 PMCID: PMC10975714 DOI: 10.3390/nu16060832] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/06/2024] [Accepted: 03/12/2024] [Indexed: 04/05/2024] Open
Abstract
Inflammation, oxidative injury, and gut dysbiosis play an important role in the pathogenesis of necrotising enterocolitis (NEC). Plant-derived substances have historically been used as therapeutic agents due to their anti-inflammatory, antioxidant, and antimicrobial properties. We aimed to review pre-clinical evidence for plant-derived substances in the prevention and treatment of NEC. A systematic review was conducted using the following databases: PubMed, EMBASE, EMCARE, MEDLINE and Cochrane Library (PROSPERO CRD42022365477). Randomized controlled trials (RCTs) and quasi-RCTs that evaluated a plant-derived substance as an intervention for NEC in an animal model of the illness and compared pre-stated outcomes (e.g., clinical severity, severity of intestinal injury, mortality, laboratory markers of inflammation and oxidative injury) were included. Sixteen studies (n = 610) were included in the systematic review. Ten of the sixteen included RCTs (Preterm rat pups: 15, Mice: 1) reported mortality and all reported NEC-related histology. Meta-analysis showed decreased mortality [12/134 vs. 27/135; RR: 0.48 (95% CI: 0.26 to 0.87); p = 0.02, 10 RCTs] and decreased NEC in the experimental group [24/126 vs. 55/79; RR: 0.34 (95% CI: 0.22 to 0.52); p < 0.001, 6 RCTs]. Markers of inflammation (n = 11) and oxidative stress (n = 13) improved in all the studies that have reported this outcome. There was no significant publication bias for the outcome of mortality. Plant-derived substances have the potential to reduce the incidence and severity of histologically diagnosed NEC and mortality in rodent models. These findings are helpful in guiding further pre-clinical studies towards developing a food supplement for the prevention of NEC in preterm infants.
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Affiliation(s)
| | - Chandra Rath
- Neonatology, King Edward Memorial Hospita, Subiaco 6008, Australia
- Perth Children’s Hospital, Nedlands 6009, Australia
- School of Medicine, University of Western Australia, Crawley 6009, Australia
| | - Shripada Rao
- Perth Children’s Hospital, Nedlands 6009, Australia
- School of Medicine, University of Western Australia, Crawley 6009, Australia
| | - Sanjay Patole
- Neonatology, King Edward Memorial Hospita, Subiaco 6008, Australia
- School of Medicine, University of Western Australia, Crawley 6009, Australia
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Patole S, Pawale D, Rath C. Interventions for Compassion Fatigue in Healthcare Providers-A Systematic Review of Randomised Controlled Trials. Healthcare (Basel) 2024; 12:171. [PMID: 38255060 PMCID: PMC10815881 DOI: 10.3390/healthcare12020171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/04/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Compassion fatigue is a significant issue considering its consequences including negative feelings, impaired cognition, and increased risk of long-term morbidities. We aimed to assess current evidence on the effects of interventions for compassion fatigue in healthcare providers (HCP). METHODS We used the Cochrane methodology for Systematic Reviews and Meta-Analyses (PRISMA) for conducting and reporting this review. RESULTS Fifteen RCTs (n = 1740) were included. The sample size of individual studies was small ranging from 23 to 605. There was significant heterogeneity in participant, intervention, control, and outcome characteristics. The tools for assessing intervention effects on compassion fatigue included ProQOL, compassion fatigue scale, and nurses compassion fatigue inventory. Thirteen out of the fifteen included RCTs had overall high risk of bias (ROB). Meta-analysis could not be performed given the significant heterogeneity. CONCLUSIONS Current evidence on interventions for reducing compassion fatigue in HCPs is inadequate. Given the benefits reported in some of the included studies, well-designed and adequately powered RCTs are urgently needed.
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Affiliation(s)
- Sanjay Patole
- Neonatal Directorate, KEM Hospital for Women, Perth, WA 6008, Australia; (D.P.); (C.R.)
- School of Medicine, University of Western Australia, Perth, WA 6009, Australia
| | - Dinesh Pawale
- Neonatal Directorate, KEM Hospital for Women, Perth, WA 6008, Australia; (D.P.); (C.R.)
| | - Chandra Rath
- Neonatal Directorate, KEM Hospital for Women, Perth, WA 6008, Australia; (D.P.); (C.R.)
- School of Medicine, University of Western Australia, Perth, WA 6009, Australia
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Gowda BB, Rath C, Muthusamy S, Nagarajan L, Rao S. Outcomes of Neonates with Hypoxic-Ischemic Encephalopathy Treated with Magnesium Sulfate: A Systematic Review with Meta-analysis. J Pediatr 2023; 262:113610. [PMID: 37468038 DOI: 10.1016/j.jpeds.2023.113610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/01/2023] [Accepted: 07/11/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To assess magnesium sulfate (MgSO4) as a neuroprotective agent in hypoxic-ischemic encephalopathy. STUDY DESIGN For this systematic review, PubMed, EMBASE, the Cochrane Library, EMCARE, and MedNar were searched in November 2022 for randomized controlled trials (RCTs). Meta-analysis was conducted using Stata 16.0 and RevMan 5.3. RESULTS Twenty RCTs with a total sample size of 1485 were included, of which 16 were from settings where therapeutic hypothermia (TH) was not offered. Regarding MgSO4 in settings where TH was not offered, only 1 study evaluated composite outcome of death or disability at ≥18 months and reported such poor outcome in 8 of 14 control infants and 4 of 8 in the MgSO4 group. MgSO4 was not associated with mortality (RR, 0.86; 95% CI, 0.72-1.03; 13 RCTs) or hypotension (RR, 1.02; 95% CI, 0.88-1.18; 5 RCTs). Thirteen studies reported that MgSO4 improved in-hospital outcomes, such as reduced seizure burden and improved neurological status at discharge. MgSO4 reduced the risk of poor suck feeds (RR, 0.52; 95% CI, 0.40-0.68; 6RCTs) and abnormal electroencephalogram (RR, 0.64; 95% CI, 0.45-0.93; 5 RCTs). Certainty of evidence was moderate for mortality and low or very low for other outcomes. For studies with MgSO4 as an adjunct to TH, none reported on death or neurodevelopmental disability at ≥18 months. MgSO4 was not associated with mortality (RR, 0.65; 95% CI, 0.34-1.27; 3 RCTs) or hypotension (RR, 1.0; 95% CI, 0.71-1.40; 3 RCTs). CONCLUSIONS Evidence around long-term outcomes of MgSO4 when used with or without TH was scant. MgSO4 therapy may improve in-hospital neurological outcomes without affecting mortality in settings where TH is not offered. Well-designed RCTs for neuroprotection are needed, especially in low-resource settings. TRIAL REGISTRATION "Open Science Forum" (https://doi.org/10.17605/OSF.IO/FRM4D).
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Affiliation(s)
- Bhanu B Gowda
- Neurology, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Chandra Rath
- Neonatology, Joondalup Health Campus, Joondalup, Western Australia, Australia; Pediatrics, Rockingham General Hospital, Coolongup, Western Australia, Australia
| | - Saravanan Muthusamy
- Neonatology, Perth Children's Hospital, Nedlands, Western Australia, Australia; School of Medicine, University of Western Australia, Nedlands, Western Australia, Australia
| | - Lakshmi Nagarajan
- Neurology, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Shripada Rao
- Neonatology, Joondalup Health Campus, Joondalup, Western Australia, Australia; Pediatrics, Rockingham General Hospital, Coolongup, Western Australia, Australia.
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Rath C, Athalye-Jape G, Rao S, Patole S. Effect of Probiotic Dose Escalation on Gut Microbiota and Clinical Outcomes in Preterm Infants-A Systematic Review. Children (Basel) 2023; 10:1710. [PMID: 37892373 PMCID: PMC10605636 DOI: 10.3390/children10101710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/29/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023]
Abstract
Probiotics are known to decrease incidences of necrotising enterocolitis, feeding intolerance, late-onset sepsis, and mortality in preterm infants. Administering an adequate dose is important for optimizing the benefits and safety of probiotics. We conducted a systematic review to assess the effect of probiotic dose escalation on clinical outcomes and gut microbiota in preterm neonates. We searched PubMed, EMBASE, EMCARE, Medline, Cochrane Library, Google Scholar, and MedNar databases in July 2023. Three studies were included. In one of the randomized studies (n = 149, gestation 27 to 33 weeks), no significant differences in faecal Lactobacillus and Bifidobacterium counts and clinical outcomes were seen between the high- and low-dose groups. There was a trend towards increased Lactobacillus and Bifidobacterium counts in the high-dose group. In the other randomized study (n = 120, birth weight 500 to 2000 gm), smaller infants (500 to 1000 gm) required higher doses to display Lactobacillus in their faeces. The cohort study (n = 12, gestation < 33 weeks) showed a trend towards an increase in faecal abundance of bifidobacteria and bacterial diversity in the B. infantis group with increasing dose/time. Limited evidence suggests a higher dose might improve gut colonization in preterm infants. Further studies are urgently needed to address this gap in the knowledge considering the increasing use of probiotics for preterm infants.
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Affiliation(s)
- Chandra Rath
- Neonatal Directorate, King Edward Memorial Hospital for Women, Subiaco, WA 6008, Australia
- Neonatal Directorate, Perth Children's Hospital, Nedlands, WA 6009, Australia
- School of Medicine, University of Western Australia, Crawley, WA 6009, Australia
| | - Gayatri Athalye-Jape
- Neonatal Directorate, King Edward Memorial Hospital for Women, Subiaco, WA 6008, Australia
- School of Medicine, University of Western Australia, Crawley, WA 6009, Australia
| | - Shripada Rao
- Neonatal Directorate, Perth Children's Hospital, Nedlands, WA 6009, Australia
- School of Medicine, University of Western Australia, Crawley, WA 6009, Australia
| | - Sanjay Patole
- Neonatal Directorate, King Edward Memorial Hospital for Women, Subiaco, WA 6008, Australia
- School of Medicine, University of Western Australia, Crawley, WA 6009, Australia
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Rath C, Patidar N, Patole S, Rao S. Reply to insulin therapy in preterm infants: Friend or foe? Acta Paediatr 2023; 112:2245. [PMID: 37435921 DOI: 10.1111/apa.16904] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 07/05/2023] [Indexed: 07/13/2023]
Affiliation(s)
- Chandra Rath
- Department of Neonatology, King Edward Memorial Hospital, Subiaco, Western Australia, Australia
- Department of Neonatology, Perth Children's Hospital, Nedland, Western Australia, Australia
- School of Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Nital Patidar
- Department of Paediatrics, Armadale Health Service, Mounth Nasura, Western Australia, Australia
| | - Sanjay Patole
- Department of Neonatology, King Edward Memorial Hospital, Subiaco, Western Australia, Australia
- School of Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Shripada Rao
- Department of Neonatology, Perth Children's Hospital, Nedland, Western Australia, Australia
- School of Medicine, University of Western Australia, Crawley, Western Australia, Australia
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Hegde D, Rath C, Amarasekara S, Saraswati C, Patole S, Rao S. Performance of smartphone application to accurately quantify hyperbilirubinemia in neonates: a systematic review with meta-analysis. Eur J Pediatr 2023; 182:3957-3971. [PMID: 37368007 DOI: 10.1007/s00431-023-05073-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 06/28/2023]
Abstract
Neonatal jaundice is a common clinical condition that can progress to severe hyperbilirubinemia if identification and intervention are delayed. In this study, we aimed to analyze the current evidence on the accurate performance of smartphone applications to quantify bilirubin levels. PubMed, Embase, Emcare, MEDLINE, the Cochrane Library, and Google Scholar were searched from inception until July 2022. Grey literature was searched on "OpenGrey" and "MedNar" databases. We included prospective and retrospective cohort studies that recruited infants with a gestation of ≥ 35 weeks and reported paired total serum bilirubin (TSB) and smartphone app-based bilirubin (ABB) levels. We conducted the review using the guidelines of the Cochrane Collaboration Diagnostic Test Accuracy Working Group and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-diagnostic test accuracy (PRISMA-DTA) statement. The data were pooled using the random effects model. The outcome of interest was agreement between ABB and TSB measurements, provided as correlation coefficient, mean difference, and standard deviation. Certainty of evidence (COE) was assessed based on GRADE guidelines. Fourteen studies were included in the meta-analysis. The number of infants in individual studies ranged between 35 and 530. The pooled correlation coefficient (r) between ABB and TSB was 0.77 (95% CI 0.69 to 0.83; p < 0.01). Reported sensitivities for predicting a TSB of 250 µmol/L in individual studies ranged between 75 and 100% and specificities ranged from 61 to 100%. Similarly, a sensitivity of 83 to 100% and a specificity of 19.5 to 76% were reported for predicting a TSB of 205 μmol/L. Overall COE was considered moderate. Conclusion: Smartphone app-based bilirubin estimation showed a reasonable correlation to TSB levels. Well-designed studies are required to determine its utility as a screening tool for various TSB cut-off levels. What is Known: • Neonatal jaundice is a common clinical condition. Timely screening and intervention are necessary to prevent neurological morbidities • Transcutaneous bilirubinometer is a widely used non-invasive screening device but is mostly available in hospital settings and has cost limitations. Researchers have recently explored the utility of smartphone applications to estimate bilirubin levels in neonates. What is New: • This is the first systematic review and meta-analysis conducted to assess the performance of smartphone applications to detect neonatal hyperbilirubinemia. • Bilirubin estimates of newborn infants obtained through smartphone applications had a reasonable correlation with serum bilirubin levels.
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Affiliation(s)
- Deeparaj Hegde
- King Edward Memorial Hospital, Subiaco, WA, 6008, Australia
- Perth Children's Hospital, Nedlands, WA, 6008, Australia
| | - Chandra Rath
- King Edward Memorial Hospital, Subiaco, WA, 6008, Australia.
- Perth Children's Hospital, Nedlands, WA, 6008, Australia.
- School of Medicine, University of Western Australia, Crawley, WA, Australia.
| | - Sathika Amarasekara
- King Edward Memorial Hospital, Subiaco, WA, 6008, Australia
- Perth Children's Hospital, Nedlands, WA, 6008, Australia
| | | | - Sanjay Patole
- King Edward Memorial Hospital, Subiaco, WA, 6008, Australia
- School of Medicine, University of Western Australia, Crawley, WA, Australia
| | - Shripada Rao
- Perth Children's Hospital, Nedlands, WA, 6008, Australia
- School of Medicine, University of Western Australia, Crawley, WA, Australia
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Rath C, Nagpal R, Suryawanshi P. Point-of-Care Ultrasound in Neonatology in India: The Way Forward. Indian Pediatr 2023; 60:351-357. [PMID: 36814124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
The clinician-performed point-of-care ultrasound (POCUS) is a useful tool, and its scope includes bedside assessment of pulmonary (e.g., pneumothorax, pleural effusion), cardiac (e.g., pulmonary hypertension, ductus arteriosus), gastrointestinal (e.g., necrotising enterocolitis), and intracranial (e.g., intraventricular hemorrhage, cerebral blood flow velocities) pathologies, procedural guidance and rapid assessment of etiologies of acute clinical deterioration (e.g., pneumothorax, poor cardiac contractility, intraventricular hemorrhage). Despite its potential to improve patient care, a curriculum and a structured program for POCUS training is lacking in India. Homogenous approach to training and ongoing quality assurance is essential to optimize benefits of POCUS as an effective tool in clinical practice. The training needs, the legal and infrastructural barriers to successful implementation of POCUS, and strategies to implement the program at the national level are discussed.
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Affiliation(s)
- Chandra Rath
- Department of Neonatology, King Edward Memorial Hospital and Perth Children's Hospital, Western Australia 6008
| | - Rema Nagpal
- Department of Neonatology, Mount Sinai Hospital, Toronto, Ontario M5G 1X5, Canada
| | - Pradeep Suryawanshi
- Department of Neonatology, Bharati Vidyapeeth Medical College Hospital, Pune, Maharashtra, India. Correspondence to: Prof Pradeep Suryawanshi, Department of Neonatology, Bharati Vidyapeeth Medical College and Hospital, Pune, Maharashtra 411 043.
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Rath C, Rao S, Suryawanshi P, Desai S, Chetan C, Patil K, Patole S. Does abnormal Doppler on cranial ultrasound predict disability in infants with hypoxic-ischaemic encephalopathy? A systematic review. Dev Med Child Neurol 2022; 64:1202-1213. [PMID: 35390176 DOI: 10.1111/dmcn.15236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 03/16/2022] [Accepted: 03/18/2022] [Indexed: 11/30/2022]
Abstract
AIM To evaluate whether abnormal resistive index or cerebral blood flow velocity (CBFV) on cranial ultrasound predicts disability (≥1 year) in infants with hypoxic-ischaemic encephalopathy (HIE). METHOD This was a systematic review and meta-analysis of studies comparing developmental outcomes of infants with HIE with normal versus abnormal resistive index or CBFV. RESULTS Twenty-six studies were included (pre-therapeutic hypothermia era, 20; therapeutic hypothermia era, six). Data from 15 studies (pre-therapeutic hypothermia, 10; therapeutic hypothermia, five) were available for meta-analysis. Pooled sensitivity and specificity, summary area under the receiver operating characteristic curve, and diagnostic odds ratio of resistive index or CBFV for predicting 'death or severe disability' were as follows. Pre-therapeutic hypothermia era: 0.83 (95% confidence interval [CI] 0.45-0.97) and 0.92 (95% CI 0.74-0.98), 0.94 (95% CI 0.92-0.96), 54 (95% CI 7-391). Therapeutic hypothermia era (measurements before therapeutic hypothermia): 0.62 (95% CI 0.41-0.80) and 0.96 (95% CI 0.88-0.99), 0.93 (95% CI 0.89-0.94), 23 (95% CI 6-91). Therapeutic hypothermia era (measurements during/after therapeutic hypothermia): 0.51 (95% CI 0.24-0.78) and 0.83 (95% CI 0.73-0.90), 0.81 (95% CI 0.78-0.85), 5 (95% CI 2-13). Overall Grading of Recommendations Assessment, Development and Evaluation (GRADE) rating of evidence was 'low' or 'very low'. INTERPRETATION Low-level evidence suggests that abnormal resistive index or CBFV can predict death or disability with high sensitivity and specificity in infants with HIE who are not cooled. The specificity of these tests was high when performed before starting cooling in infants who received therapeutic hypothermia. WHAT THIS PAPER ADDS Cerebral doppler ultrasound may be useful in predicting death or disability in infants with hypoxic-ischaemic encephalopathy who are not cooled. Cerebral doppler ultrasound may also be useful in infants who are cooled, if done before starting cooling. Cerebral doppler ultrasound may not be useful when performed during or after completing cooling.
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Affiliation(s)
- Chandra Rath
- King Edward Memorial Hospital, Western Australia, Australia.,Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Shripada Rao
- King Edward Memorial Hospital, Western Australia, Australia.,Perth Children's Hospital, Nedlands, Western Australia, Australia.,School of Medicine, University of Western Australia, Australia
| | | | - Saumil Desai
- King Edward Memorial Hospital, Western Australia, Australia.,Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Chinmay Chetan
- Bharati Vidyapeeth Medical College Hospital, Pune, Maharashtra, India
| | - Karamchand Patil
- Bharati Vidyapeeth Medical College Hospital, Pune, Maharashtra, India
| | - Sanjay Patole
- King Edward Memorial Hospital, Western Australia, Australia.,Perth Children's Hospital, Nedlands, Western Australia, Australia.,School of Medicine, University of Western Australia, Australia
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Chetan C, Suryawanshi P, Patnaik S, Soni NB, Rath C, Pareek P, Gupta B, Garegrat R, Verma A, Singh Y. Oral versus intravenous sildenafil for pulmonary hypertension in neonates: a randomized trial. BMC Pediatr 2022; 22:311. [PMID: 35624452 PMCID: PMC9137149 DOI: 10.1186/s12887-022-03366-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/16/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Sildenafil is the drug of choice for neonatal pulmonary hypertension in developing countries where inhaled nitric oxide is not available. Available as oral and intravenous preparation - no study has been done in the past to compare the two forms. Each has its own benefits - but requires comparison in terms of efficacy and safety. This study was done to compare the efficacy of oral versus intravenous (IV) sildenafil in infants with mild to moderate pulmonary hypertension. METHODS An open labelled randomized trial was conducted in a neonatal intensive care unit of urban tertiary hospital in western India between February 2019 to December 2020. Infants born after 34 weeks of gestation with Pulmonary arterial pressure (PAP) > 25 mm Hg measured by echocardiography, within 72 h of birth, were enrolled for the study. Participants were randomly assigned to receive sildenafil either orally or by intravenous route. Primary outcome was the time taken for PAP to decrease below 25 mm Hg. Secondary outcomes were time taken for oxygenation index to decrease by 25%, duration of invasive and non-invasive mechanical ventilation, nasal oxygen, hospital stay, time to achieve full feeds, mortality, and side effects. RESULTS Forty patients were enrolled. The baseline characteristics of neonates in both groups were similar except for APGAR scores at 1 min and 5 min, with oral group having lower score [MEDIAN (IQR) 5.00 (4.00- 7.00) and 7.00 (6.00- 8.00)] compared to IV group [MEDIAN (IQR) 7.00 (6.00-8.00) and 9.00 (8.00-9.00)] respectively. Time taken for PAP to decrease below 25 mm was not statistically different between the oral and intravenous groups. Systemic hypotension occurred in 4 neonates of the intravenous group but none in the oral group. CONCLUSION Oral and intravenous sildenafil had equal efficacy at reducing PAP in neonatal pulmonary hypertension, albeit intravenous sildenafil use was associated with a greater complication rate. TRIAL REGISTRATION Trial was registered in the clinical trials registry of India [ CTRI/2019/04/018781 ][25/04/2019].
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Affiliation(s)
- Chinmay Chetan
- Department of Neonatology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand - 248140, India
- Department of Neonatology, Bharati Vidyapeeth University Medical College, Pune-Satara road, Pune, Maharashtra- 411043, India
| | - Pradeep Suryawanshi
- Department of Neonatology, Bharati Vidyapeeth University Medical College, Pune-Satara road, Pune, Maharashtra- 411043, India.
| | - Suprabha Patnaik
- Department of Neonatology, Bharati Vidyapeeth University Medical College, Pune-Satara road, Pune, Maharashtra- 411043, India
| | - Naharmal B Soni
- Department of Neonatology, Sidra Medicine, 26999, Doha, Qatar
| | - Chandra Rath
- Department of Neonatology, Perth Children's Hospital, 15 Hospital Ave, Nedlands, WA, 6009, Australia
| | - Prince Pareek
- Department of Neonatology, Bharati Vidyapeeth University Medical College, Pune-Satara road, Pune, Maharashtra- 411043, India
| | - Bhvya Gupta
- Sparsh Superspeciality Hospital, Ambala, Haryana, 134003, India
| | - Reema Garegrat
- Department of Neonatology, Bharati Vidyapeeth University Medical College, Pune-Satara road, Pune, Maharashtra- 411043, India
| | - Arjun Verma
- Department of Neonatology, Bharati Vidyapeeth University Medical College, Pune-Satara road, Pune, Maharashtra- 411043, India
| | - Yogen Singh
- Division of Neonatology, Loma Linda University School of Medicine, 11175 Anderson Street Rm 11121, Coleman Avenue, Loma Linda, 92354, USA
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Rath C, Suryawanshi P. The Fast Growth of Neonatal Lung Ultrasound: Authors Reply. Indian Pediatr 2017; 54:64. [PMID: 28141573] [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: 06/06/2023]
Affiliation(s)
- Chandra Rath
- Departments of Neonatology; #Royal North Shore Hospital, Pacific High way, St Leonards, NSW, Australia; and *Bharati Vidyapeeth University Medical college, Pune, Maharastra, India.
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Rath C, Kluckow M. Oxygen saturation profile of term equivalent extreme preterm infants at discharge - comparison with healthy term counterparts. Acta Paediatr 2016; 105:e94-8. [PMID: 26859420 DOI: 10.1111/apa.13306] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 11/30/2015] [Accepted: 12/08/2015] [Indexed: 11/27/2022]
Abstract
AIM Compare the oxygen saturation profiles before discharge of neonates born extremely preterm (<28 weeks), now at term equivalent age, with healthy term neonates and assess the impact of feeding on this profile in each group. METHODS We prospectively evaluated and compared the oxygen saturation profile in 15 very low birthweight infants at term equivalent age, ready to be discharged home without any oxygen and 15 term newborns after 48 hours of life. We also evaluated and compared the saturations of these two groups during a one-hour period during and after feeding. RESULTS Term equivalent preterm and term infants spent median 3% and 0%, respectively, of the time below 90% in a 12-hour saturation-recording period. Term infants spent a median 0.26% and 0.65% of the time in <90% saturation during feed time and no feed time, respectively. In contrast, preterm infants spent significantly more time <90% saturation (3.47% and 3.5% during feed time and no feed time, respectively). CONCLUSION Term equivalent preterm infants spent significantly more time in a saturation range <90% compared to term infants. Feeding had little effect on saturation profile overall within each group.
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Affiliation(s)
- Chandra Rath
- Department of Neonatology Royal North Shore Hospital Sydney NSW Australia
| | - Martin Kluckow
- Department of Neonatology Royal North Shore Hospital Sydney NSW Australia
- Sydney University Sydney NSWAustralia
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Abstract
Benign cardiac tumours are rare and cardiac lipomas account only for a small fraction among those. Most of these tumours differ in terms of clinical manifestation, diagnosis, morphology and size, and are therefore not diagnosed easily unless they become symptomatic. We report the case of a 71-year-old Caucasian woman with recurrent episodes of shortness of breath presenting with an acute exacerbation of dyspnoea and hypertensive crisis. Diagnosis of a right atrial lipoma with a coexisting patent foramen ovale was established on echocardiography and computed tomography, and the patient was evaluated for elective surgery. Comprising the entire free wall of the right atrium, the tumour was removed during open heart surgery on cardiopulmonary bypass. The right atrium and the orifices of both the superior and inferior vena cava were reconstructed with bovine pericardium. No evidence of tumour relapse was observed during successive follow-up visits.
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Andreas M, Wiedemann D, Seebacher G, Rath C, Aref T, Rosenhek R, Heinze G, Eigenbauer E, Simon P, Ruetzler K, Hiesmayr JM, Moritz A, Laufer G, Kocher A. The Ross procedure offers excellent survival compared with mechanical aortic valve replacement in a real-world setting. Eur J Cardiothorac Surg 2014; 46:409-13; discussion 413-4. [DOI: 10.1093/ejcts/ezt663] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Andreas M, Rath C, Pees C, Wiedemann D, Heinze G, Moritz A, Kocher A, Laufer G. The Ross Procedure - A Viable Solution for Pediatric Aortic Valve Disease. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0033-1354461] [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: 10/26/2022]
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Andreas M, Wiedemann D, Seebacher G, Rath C, Rosenhek R, Moritz A, Laufer G, Kocher A. 271 * THE ROSS PROCEDURE ENABLES SIMILAR LONG-TERM SURVIVAL COMPARED TO A MATCHED STANDARD POPULATION AND IS SUPERIOR TO MECHANICAL AORTIC VALVE REPLACEMENT. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt372.271] [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: 11/12/2022] Open
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Andreas M, Wiedemann D, Seebacher G, Aref T, Reida E, Rath C, Rosenhek R, Moritz A, Laufer G, Kocher A. The Ross Procedure has Improved Survival Compared to Mechanical Aortic Valve Replacement. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2154] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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17
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Jamitzky F, Stark RW, Bunk W, Thalhammer S, Rath C, Aschenbrenner T, Morfill GE, Heckl WM. Scaling-index method as an image processing tool in scanning-probe microscopy. Ultramicroscopy 2001; 86:241-6. [PMID: 11215629 DOI: 10.1016/s0304-3991(00)00111-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The scaling-index method (SIM) is a novel tool for image processing in scanning-probe microscopy. Originating from the theory of complex systems, the SIM can be used in order to extract structural information from arbitrary data sets. This method can readily be applied to the analysis of digital atomic-force microscopy (AFM) images. Especially for biomedical diagnostics, where genetic material is investigated by various microscopic methods, a reliable image segmentation based on the SIM algorithm is helpful. As a first application, AFM-images of GTG-banded human metaphase chromosomes (with G bands obtained by Trypsin using Giemsa) are compared with micrographs from conventional light microscopy by means of a scaling-index analysis. While the grey-level distributions of the optical and the AFM-images are largely different from each other, the scaling-index images are remarkably similar. Using this method, a fingerprint of an image can be produced which helps in the classification and interpretation of the measured data.
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Affiliation(s)
- F Jamitzky
- Institut für Kristallographie und Angewandte Mineralogie, Universität München, Germany.
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Abstract
Hematite particles of various shapes and sizes have been prepared hydrothermally at different pH values ranging from 3 to 10 from ferric chloride solution at 180°C. Particle size decreases with an increase in the pH of precipitation as observed from Transmission Electron Micrographs (TEM). A comparison of TEM and mean crystallite diameter (MCD) from XRD data reveals that the particles prepared are polycrystalline in nature. The polycrystallinity decreases with an increase in the pH of precipitation, and at pH 10 almost single crystalline nature of particles is obtained. Polycrystalline monodispersed pseudocubic particles obtained at pH 3 exhibit very high coercive force and remanent magnetization which decreases with an increase in pH, whereas Morin transition temperature, Tm, shows an opposite trend. Magnetic a.c. susceptibility increases with an increase in pH up to pH 7 and then decreases. A probable mechanism for the formation of polycrystalline particles has been suggested in order to explain the above trends in magnetic behavior.
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Affiliation(s)
- KK Sahu
- Regional Research Laboratory (Council of Scientific and Industrial Research), Bhubaneswar, 751 013, India
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Pattnaik S, Rath C, Subramanyam VR. Characterization of resistance to essential oils in a strain of Pseudomonas aeruginosa (VR-6). Microbios 1995; 81:29-31. [PMID: 7731390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
VR-6, a strain of Pseudomonas aeruginosa, harboured a plasmid and was not inhibited by 20 microliters ml-1 of essential oils (eucalyptus, lemongrass, palmarosa, and peppermint). On treatment with acridine orange, a clone VR-6-AO-1 was obtained which was susceptible to 16.6 microliters ml-1 of eucalyptus or palmarosa oil. The plasmid DNA content of this clone was similar to the parent strain.
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Affiliation(s)
- S Pattnaik
- Division of Microbiology, Indian Council of Medical Research, Chandrasekharpur, Bhubaneswar
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Charache S, Jacobson R, Brimhall B, Murphy EA, Hathaway P, Winslow R, Jones R, Rath C, Simkovich J. Hb Potomac (101 Glu replaced by Asp): speculations on placental oxygen transport in carriers of high-affinity hemoglobins. Blood 1978; 51:331-8. [PMID: 563749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Blood from a woman with unexplained erythrocytosis had increased oxygen affinity, but no abnormality could be detected by electrophoresis or chromatography of her hemolysate. Separation of the tryptic peptides of her beta chains disclosed two half-sized peaks in the regions of beta T-11. The faster of these was abnormal, with the structure beta 101 Glu replaced by Asp. The new hemoglobin was called "Potomac." Three of the proband's four surviving siblings and both of her children were carriers. Differences in the ratio of carrier: normal children born to male of female carriers of 23 other high-affinity hemoglobins were not significant. The high proportion of carriers in this kindred was probably due to chance alone, and not because high maternal oxygen affinity interfered with oxygen transport to fetuses with normal hemoglobin.
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Mai C, Rath C. Ueber Bestandteile der Früchte von Copaifera Mopane. Arch Pharm (Weinheim) 1905. [DOI: 10.1002/ardp.19052430231] [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: 11/08/2022]
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