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Kamath D, Abdullakutty J, Granger B, Kulkarni S, Bhuvana K, Salazar L, Shifra S, Idiculla J, Narendra J, Varghese K, Xavier D. A randomized controlled trial evaluating a theory driven, complex intervention centered on task sharing and mobile health to improve selfcare and outcomes in heart failure - The PANACEA-HF RCT: Design and rationale. Am Heart J Plus 2023; 34:100310. [PMID: 38510948 PMCID: PMC10945930 DOI: 10.1016/j.ahjo.2023.100310] [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] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/15/2023] [Accepted: 07/15/2023] [Indexed: 03/22/2024]
Abstract
Background We developed a three-pronged complex intervention to improve selfcare and deliver whole person care for patients with heart failure, underpinned by the 'extant cycle' theory - a theory based on our formative work. Methods This is a 3 centre, 2-arm, 1:1, open, adaptive stratified, randomized controlled trial. We included patients aged ≥ 18 years with heart failure, taking any of the key guideline directed medical treatments, with a history of or currently on a high ceiling diuretic. We excluded end stage renal disease, clinically diagnosed severe mental illness or cognitive dysfunction and having no caregivers. Interventions included, (i) trained hospital based lay health worker mediated assessment of patients' current selfcare behaviour, documenting barriers and facilitators and implementing a plan to 'transition' the patient toward optimal selfcare. (ii) m-health mediated remote monitoring and (iii) dose optimization through a 'physician supervisor'. Results We recruited 301 patients between Jan 2021 and Jan 2022. Mean age was 59.8 (±11.7) years, with 195 (64.8 %) from rural or semi-urban areas and 67.1 % having intermediate to low health literacy. 190 (63.1 %) had an underlying ischemic cardiomyopathy. In the intervention arm, 142 (94.1 %) had a Selfcare in Heart Failure Index (SCHFI) score of ≤70, with significant barriers being 'lack of knowledge' 105 (34.5 %) and 'behavioural passivity' 23 (7.5 %). Conclusion This is the first South Asian trial evaluating a complex intervention underpinned by behaviour change theory for whole person heart failure care. These learnings can be applied to heart failure patient care in other resource constrained health systems.
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Affiliation(s)
- D.Y. Kamath
- Pharmacology, St. John's Medical College, Bengaluru, India
| | | | - B.B. Granger
- Duke University School of Nursing, Durham, NC, USA
| | - S. Kulkarni
- Medicine, St. John's Medical College, Bengaluru, India
| | - K.B. Bhuvana
- Pharmacology, St. John's Medical College, Bengaluru, India
| | - L.J. Salazar
- Psychiatry, St. John's Medical College, Bengaluru, India
| | - S. Shifra
- Pharmacology, St. John's Medical College, Bengaluru, India
| | - J. Idiculla
- Internal Medicine, St. John's Medical College, Bengaluru, India
| | - J. Narendra
- Cardiology, Nanjappa Hospital, Shivamogga, Karnataka, India
| | - K. Varghese
- Cardiology, St. John's Medical College, Bengaluru, India
| | - D. Xavier
- Pharmacology, St. John's Medical College, Bengaluru, India
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Varghese K, Sharma P, Sahu S, Kumar A, Wadhwa G. Emergency Lifesaving Management of a Homicidal Cut-Throat Injury: A Case Report. Cureus 2023; 15:e47789. [PMID: 38021825 PMCID: PMC10676562 DOI: 10.7759/cureus.47789] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Patients with cut-throat injuries presenting to the emergency department pose a serious challenge and often require a multidisciplinary mode of management. The role of an anesthesiologist is primarily airway management, either by endotracheal intubation or tracheostomy. Securing a definitive airway before wound exploration and repair of transected tissues is difficult as such injuries are often accompanied by distortion of the airway anatomy complicated by vascular or tissue bleed. Here, we report a case of a homicidal cut-throat injury in a 55-year-old female who was bleeding profusely from the neck, along with airway compromise in the form of a transected trachea. Timely intervention by a multidisciplinary team consisting of anesthesiologists and otorhinolaryngologists resulted in a favorable outcome.
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Affiliation(s)
- Koshy Varghese
- Department of Anaesthesiology, Tata Main Hospital, Jamshedpur, IND
| | - Prashant Sharma
- Department of Anaesthesiology, Tata Main Hospital, Jamshedpur, IND
- Department of Anaesthesiology, Manipal Tata Medical College, Jamshedpur, IND
| | - Seelora Sahu
- Department of Anaesthesiology, Tata Main Hospital, Jamshedpur, IND
- Department of Anaesthesiology, Manipal Tata Medical College, Jamshedpur, IND
| | - Abhijit Kumar
- Department of Otolaryngology, Raj Hospital, Ranchi, IND
| | - Gunjan Wadhwa
- Department of Anaesthesiology, Tata Main Hospital, Jamshedpur, IND
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3
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Abdou NEMI, Al-Batel MK, Henedi AA, Al-Mutairi LZ, Varghese K, Samy A. Cross-sectional and histopathological studies of Feline Coronavirus infections in stray cats in Kuwait. Vet Ital 2023; 59. [PMID: 38376836 DOI: 10.12834/vetit.2646.17310.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 05/23/2022] [Indexed: 02/21/2024]
Abstract
Feline Coronavirus (FCoV) is a worldwide viral infection of felids. The disease is usually asymptomatic, but it can cause mild diarrhoea; however, few numbers of cases may develop a severe systemic disease known as feline infectious peritonitis (FIP). This study aims to determine the prevalence of FCoV shedding in the faeces of stray cats in Kuwait and detect antibodies against FCoV in their serum. Histopathological analyses and RT‑PCR were used to prove cases of FIP. A total of 178 cats were examined for the presence of FCoV in their faeces using a rapid immunochromatography (IC) test. Anti‑FCoV Antibody (Anti‑FCoV Ab) was detected in their serum using ELISA. Eleven samples were tested using RT‑PCR to confirm positive cases. The prevalence of FCoV faecal antigen in stray cats was 32.6%. The overall detection rate of Anti‑FCoV Ab in stray cats was 44.9%. Nine cats tested positive using the RT‑PCR test. Six out of those nine were confirmed to be FIP positive through gross and histopathological examination. The characteristic uveitis and discoloration of the irises were seen. The present study is the first report confirming FCoV infection in stray cats in Kuwait. Postmortem and histopathological lesions in cases of FIP were recorded.
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Affiliation(s)
- Nadra-Elwgoud M I Abdou
- Department of Medicine and Infectious Diseases, Faculty of Veterinary Medicine, Cairo University.
| | - Maha K Al-Batel
- Veterinary Laboratories, Public Authority for Agriculture Affairs and Fish Resources, Rabyia-1307, Kuwait
| | - Adawia A Henedi
- Parasitology laboratory, Veterinary Laboratories, Public Authority for Agriculture Affairs and Fish Resources, Rabyia-1307, Kuwait
| | - Laila Z Al-Mutairi
- Early Warning Center for Transboundary Animal Diseases-Gulf Cooperation Council, Public Authority for Agriculture Affairs and Fish Resources, Rabyia-1307, Kuwait / Virology laboratory, Veterinary Laboratories, Public Authority for Agriculture Affairs and Fish Resources, Rabyia-1307, Kuwait
| | - Koshy Varghese
- Veterinary Laboratories, Public Authority for Agriculture Affairs and Fish Resources, Rabyia-1307, Kuwait
| | - Attia Samy
- Virology laboratory, Veterinary Laboratories, Public Authority for Agriculture Affairs and Fish Resources, Rabyia-1307, Kuwait
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4
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Varghese K, Swain A, Sahu S, Mohanty P, Shukla R. Combined Spinal-Epidural Anaesthesia for Caesarean Delivery in Takayasu's Arteritis: A Viable Alternative. Cureus 2021; 13:e12459. [PMID: 33552777 PMCID: PMC7854924 DOI: 10.7759/cureus.12459] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Takayasu's arteritis (TA), also known as “pulseless disease”, is a nonspecific inflammatory arteritis of large and medium caliber arteries of unknown aetiology with a predilection for young women of childbearing age. Although the evolution of the disease is not affected during pregnancy, it can result in uncontrolled hypertension, multiple organ dysfunction, and stenosis that hinder regional blood flow. Associated pregnancy, therefore, poses an increased risk to the mother and foetus due to the many cardiovascular complications that can occur in the course of the disease, making anaesthesia for caesarean delivery especially challenging to the anaesthesiologist. We report the successful anaesthetic management of a case of TA undergoing caesarean section in view of a previous caesarean delivery. We also engage in a brief review of the related literature.
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Affiliation(s)
| | - Amlan Swain
- Anaesthesiology, Tata Main Hospital, Jamshedpur, IND
| | - Seelora Sahu
- Anaesthesiology, Tata Main Hospital, Jamshedpur, IND
| | | | - Rajiv Shukla
- Anaesthesiology, Tata Main Hospital, Jamshedpur, IND
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Laroucau K, Aaziz R, Vorimore F, Varghese K, Deshayes T, Bertin C, Delannoy S, Sami AM, Al Batel M, El Shorbagy M, Almutawaa KAW, Alanezi SJ, Alazemi YSN, Guernier-Cambert V, Wernery U. A genetic variant of Burkholderia mallei detected in Kuwait: Consequences for the PCR diagnosis of glanders. Transbound Emerg Dis 2020; 68:960-963. [PMID: 33245616 DOI: 10.1111/tbed.13777] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/02/2020] [Accepted: 08/04/2020] [Indexed: 11/26/2022]
Abstract
Glanders is a contagious zoonotic disease caused by Burkholderia mallei. Following the detection of glanders positive horses using the OIE complement fixation test, the tissues of two horses were analysed by PCR. While PCR systems targeting the Burkholderia pseudomallei complex gave positive signals, the species-specific PCR systems targeting B. mallei (fliP-IS407A) and B. pseudomallei (orf11)-the OIE recommended targets-resulted in negative signals. However, the presence of B. mallei in these tissues was confirmed with a recently described B. mallei-specific real-time PCR system and genotyping with MLST- and SNP-based methods, performed on the most positive tissue, identified a genotype closely related to B. mallei strains recently isolated in the Middle East. This study leads to recommendations regarding the use of PCR systems for the molecular diagnosis of glanders, especially in regions where the circulating B. mallei strains have not yet been fully genetically characterized.
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Affiliation(s)
- Karine Laroucau
- Laboratory for Animal Health, Bacterial Zoonosis Unit, European and OIE Reference Laboratory for Glanders, Paris-Est University, ANSES, Maisons-Alfort, France
| | - Rachid Aaziz
- Laboratory for Animal Health, Bacterial Zoonosis Unit, European and OIE Reference Laboratory for Glanders, Paris-Est University, ANSES, Maisons-Alfort, France
| | - Fabien Vorimore
- Laboratory for Animal Health, Bacterial Zoonosis Unit, European and OIE Reference Laboratory for Glanders, Paris-Est University, ANSES, Maisons-Alfort, France
| | - Koshy Varghese
- Veterinary Diagnostic Laboratory Centre & Animal Health Department, Agriculture Affairs & Fish Resources Authority (PAAF), Kuwait
| | - Thomas Deshayes
- Laboratory for Animal Health, Bacterial Zoonosis Unit, European and OIE Reference Laboratory for Glanders, Paris-Est University, ANSES, Maisons-Alfort, France
| | - Claire Bertin
- Laboratory for Animal Health, Bacterial Zoonosis Unit, European and OIE Reference Laboratory for Glanders, Paris-Est University, ANSES, Maisons-Alfort, France
| | - Sabine Delannoy
- Food Research Laboratory, IdentyPath Platform, University Paris-Est, ANSES, Maisons-Alfort, France
| | - Attia M Sami
- Veterinary Diagnostic Laboratory Centre & Animal Health Department, Agriculture Affairs & Fish Resources Authority (PAAF), Kuwait
| | - Maha Al Batel
- Veterinary Diagnostic Laboratory Centre & Animal Health Department, Agriculture Affairs & Fish Resources Authority (PAAF), Kuwait
| | - Mamdouh El Shorbagy
- Veterinary Diagnostic Laboratory Centre & Animal Health Department, Agriculture Affairs & Fish Resources Authority (PAAF), Kuwait
| | - Khaled A W Almutawaa
- Veterinary Diagnostic Laboratory Centre & Animal Health Department, Agriculture Affairs & Fish Resources Authority (PAAF), Kuwait
| | - Saad J Alanezi
- Veterinary Diagnostic Laboratory Centre & Animal Health Department, Agriculture Affairs & Fish Resources Authority (PAAF), Kuwait
| | - Yousef S N Alazemi
- Veterinary Diagnostic Laboratory Centre & Animal Health Department, Agriculture Affairs & Fish Resources Authority (PAAF), Kuwait
| | - Vanina Guernier-Cambert
- Agricultural Research Service, National Animal Disease Center, United States Department of Agriculture, Ames, IA, USA
| | - Ulrich Wernery
- Central Veterinary Research Laboratory, OIE Reference Laboratory for Glanders, Dubai, United Arab Emirates
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Kamath DY, Bhuvana KB, Dhiraj RS, Xavier D, Varghese K, Salazar LJ, Granger CB, Pais P, Granger BB. Patient and caregiver reported facilitators of self-care among patients with chronic heart failure: report from a formative qualitative study. Wellcome Open Res 2020; 5:10. [PMID: 32266322 PMCID: PMC7101008 DOI: 10.12688/wellcomeopenres.15485.2] [Citation(s) in RCA: 4] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2020] [Indexed: 12/13/2022] Open
Abstract
Background: Adherence to a complex, yet effective medication regimen improves clinical outcomes in patients with chronic heart failure (CHF). However, patient adherence to an agreed upon plan for medication-taking is sub-optimal and continues to hover at 50% in developed countries. Studies to improve medication-taking have focused on interventions to improve adherence to guideline-directed medication therapy, yet few of these studies have integrated patients’ perceptions of what constitutes effective strategies for improved medication-taking and self-care in everyday life. The purpose of this formative study was to explore patient perceived facilitators of selfcare and medication-taking in South Asian CHF patients. Methods: We conducted in-depth interviews of patients with long standing heart failure admitted to the cardiology and internal medicine wards of a South Indian tertiary care hospital. We purposively sampled using the following criteria: sex, socio-economic status, health literacy and patient reported medication adherence in the month prior to hospitalization. We employed inductive coding to identify facilitators. At the end of 15 interviews (eight patients and seven caregivers; seven patient-caregiver dyads), we arrived at theoretical saturation for facilitators. Results: Facilitators could be classified into intrinsic (patient traits – situational awareness, self-efficacy, gratitude, resilience, spiritual invocation and support seeking behavior) and extrinsic (shaped by the environment – financial security and caregiver support, company of children, ease of healthcare access, trust in provider/hospital, supportive environment and recognizing the importance of knowledge). Conclusions: We identified and classified a set of key patient and caregiver reported self-care facilitators among Indian CHF patients. The learnings from this study will be incorporated into an intervention package to improve patient engagement, overall self-care and patient-caregiver-provider dynamics.
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Affiliation(s)
- D Y Kamath
- Department of Pharmacology, St. John's National Academy of Health Sciences, Bangalore, 560034, India.,Division of Clinical Research and Training, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, 560034, India
| | - K B Bhuvana
- Department of Pharmacology, St. John's National Academy of Health Sciences, Bangalore, 560034, India.,Division of Clinical Research and Training, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, 560034, India
| | - R S Dhiraj
- Division of Clinical Research and Training, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, 560034, India
| | - D Xavier
- Department of Pharmacology, St. John's National Academy of Health Sciences, Bangalore, 560034, India.,Division of Clinical Research and Training, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, 560034, India
| | - K Varghese
- Department of Cardiology, St. John's Hospital, Koramangala, Bangalore, 560034, India
| | - L J Salazar
- Department of Psychiatry, St. John's Hospital, Bangalore, Karnataka, 560034, India
| | - C B Granger
- Department of Cardiology, Duke University Health System, Durham, NC, 27710, USA
| | - P Pais
- Division of Clinical Research and Training, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, 560034, India
| | - B B Granger
- Duke University School of Nursing, Durham, NC, 27710, USA
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7
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Kamath DY, Bhuvana KB, Dhiraj RS, Xavier D, Varghese K, Salazar LJ, Granger CB, Pais P, Granger BB. Patient and caregiver reported facilitators of self-care among patients with chronic heart failure: report from a formative qualitative study. Wellcome Open Res 2020; 5:10. [DOI: 10.12688/wellcomeopenres.15485.1] [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] [Accepted: 01/06/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Adherence to a complex, yet effective medication regimen improves clinical outcomes in patients with chronic heart failure (CHF). However, patient adherence to an agreed upon plan for medication-taking is sub-optimal and continues to hover at 50% in developed countries. Studies to improve medication-taking have focused on interventions to improve adherence to guideline-directed medication therapy, yet few of these studies have integrated patients’ perceptions of what constitutes effective strategies for improved medication-taking and self-care in everyday life. The purpose of this formative study was to explore patient perceived facilitators of selfcare and medication-taking. Methods: We conducted in-depth interviews of patients with long standing heart failure admitted to the cardiology and internal medicine wards of a South Indian tertiary care hospital. We purposively sampled using the following criteria: sex, socio-economic status, health literacy and patient reported medication adherence in the month prior to hospitalization. We employed inductive coding to identify facilitators. At the end of 15 interviews (eight patients and seven caregivers; seven patient-caregiver dyads), we arrived at theoretical saturation for facilitators. Results: Facilitators could be classified into intrinsic (patient traits – situational awareness, self-efficacy, gratitude, resilience, spiritual invocation and support seeking behavior) and extrinsic (shaped by the environment – financial security and caregiver support, company of children, ease of healthcare access, trust in provider/hospital, supportive environment and recognizing the importance of knowledge). Conclusions: We identified and classified a set of key patient and caregiver reported self-care facilitators among Indian CHF patients. The learnings from this study will be incorporated into an intervention package to improve patient engagement, overall self-care and patient-caregiver-provider dynamics.
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8
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Kamath D, Bhuvana KB, Salazar L, Varghese K, Umesh S, Immaculate SJ, Kulkarni S, Xavier D, Granger CB, Granger BB. P4396Patients explanations of self-care in chronic heart failure: a grounded theory analysis of qualitative data from PANACEA-HF Phase 1. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Sub-optimal self-care and non-adherence to treatments are important predictors of poor clinical outcomes in patients with heart failure. Task-sharing and technology have each contributed modest improvements, but the combined effect on outcomes is unknown. We aim to develop a complex intervention package to improve self-care predicated on task sharing and smartphone based remote monitoring among heart failure patients.
Purpose
As a formative step, we conducted a qualitative study among heart failure patients and their caregivers to explore self-care and to inform the development of a contextualized intervention package.
Methods
We conducted in-depth interviews among 22 patients admitted to in-patient wards with a clinical diagnosis of chronic heart failure (diagnosis made at least 1 month prior to index hospitalization) and 18 caregivers (n=40), sampled from 4 states in southern India. Patients were purposively sampled based on sex, socioeconomic status, health literacy and past one month's history of adherence to heart failure medications. The middle range theory of self-care informed the drafting of the interview guide. We recorded and transcribed interviews translated from 5 regional languages. We inductively coded the data from a social constructionist viewpoint, created categories, prepared memos, compared extreme cases, identified key emergent themes and their inter-relationships.
Results
Patients' mean age was 60.5 (±13.4), with representation from socioeconomic strata, urban and rural areas. Patients had a high pill burden [median 10; IQR (6, 31)] and 8 (44%) reported irregular adherence to prescribed medications in the last month. Key categories associated with sub-optimal self-care included “Passivity”, “Entrenched Belief systems”, “Negative Emotions/Affect”, “Ageing causes disease”, and “inability to control situations” across all socioeconomic strata. These themes appear to impair self-actualization that negatively impacts self efficacy/confidence and in turn self-care reciprocally (Refer Figure). Key facilitators of self-care were: Intrinsic patient distinctive facilitators (situational awareness, resilience) and extraneous facilitators (insurance/financial protection, positive caregiver relationships and ease of healthcare access). Patients and caregivers generally expressed their readiness to use mobile technology for remote monitoring and to be counseled by trained lay workers to address beliefs and be trained on self-care.
Framework explaining self-care in HF
Conclusions
Findings from this formative study show opportunities for providers and community-based care workers to address task-sharing of beliefs by educating patients on self-care, including through the use of technology-based solutions. These findings regarding a self-care framework identify opportunities to improve self-care among heart failure patients using task-sharing and technology to support the patient-caregiver-provider triad.
Acknowledgement/Funding
India Alliance - Wellcome Trust and Department of Biotechnology
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Affiliation(s)
- D Kamath
- St John's Medical College Hospital, Pharmacology, Bangalore, India
| | - K B Bhuvana
- St John's Medical College Hospital, Pharmacology, Bangalore, India
| | - L Salazar
- St John's Medical College Hospital, Psychiatry, Bangalore, India
| | - K Varghese
- St John's Medical College Hospital, Cardiology, Bangalore, India
| | - S Umesh
- St John's Medical College Hospital, Internal Medicine, Bangalore, India
| | - S J Immaculate
- St John's Medical College Hospital, Clinical Research & Training, Bangalore, India
| | - S Kulkarni
- St John's Medical College Hospital, Internal Medicine, Bangalore, India
| | - D Xavier
- St John's Medical College Hospital, Pharmacology, Bangalore, India
| | - C B Granger
- Duke University Medical Center, Cardiology, Durham, United States of America
| | - B B Granger
- Duke University School of Nursing, Durham, United States of America
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Lohitashwa S, Srilakshmi M, Varghese K, Santhosh M, Raghavan S. Echocardiographic assessment of right ventricular function in acute myocardial infarction. Indian Heart J 2014. [DOI: 10.1016/j.ihj.2014.10.181] [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: 10/24/2022] Open
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10
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Anilkumar PP, Varghese K, Ganesh LS. Formulating a coastal zone health metric for landuse impact management in urban coastal zones. J Environ Manage 2010; 91:2172-2185. [PMID: 20576347 DOI: 10.1016/j.jenvman.2010.05.021] [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] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Revised: 05/01/2010] [Accepted: 05/28/2010] [Indexed: 05/29/2023]
Abstract
The need for ICZM arises often due to inadequate or inappropriate landuse planning practices and policies, especially in urban coastal zones which are more complex due to the larger number of components, their critical dimensions, attributes and interactions. A survey of literature shows that there is no holistic metric for assessing the impacts of landuse planning on the health of a coastal zone. Thus there is a need to define such a metric. The proposed metric, CHI (Coastal zone Health Indicator), developed on the basis of coastal system sustainability, attempts to gauge the health status of any coastal zone. It is formulated and modeled through an expert survey and pertains to the characteristic components of coastal zones, their critical dimensions, and relevant attributes. The proposed metric is applied to two urban coastal zones and validated. It can be used for more coast friendly and sustainable landuse planning/masterplan preparation and thereby for the better management of landuse impacts on coastal zones.
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Affiliation(s)
- P P Anilkumar
- Dept. of Architecture, National Institute of Technology, NIT Calicut P.O, Kozhikode District, Calicut 673601, Kerala, India.
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Abstract
BACKGROUND Critically ill patients undergoing bypass surgery experience a higher mortality and morbidity. HYPOTHESIS The study was undertaken to evaluate the efficacy and value of percutaneous transluminal coronary angioplasty (PTCA) as a bridge to coronary artery bypass graft surgery (CABG) in high-risk patients with refractory unstable angina or cardiogenic shock. METHODS We present 11 seriously unstable patients with severe multivessel coronary artery disease undergoing culprit vessel PTCA. Angioplasty was performed not as a definitive procedure but rather as a bridge to surgical revascularization. All the patients had sustained at least one myocardial infarction prior to catheterization, all had refractory unstable angina, eight patients had only a single patent coronary artery, and five patients were in cardiogenic shock. RESULTS Following PTCA, all patients enjoyed a stable in-hospital period. One patient died 12 weeks after successful PTCA while awaiting second CABG. Seven patients subsequently underwent CABG and are doing well. The remaining three patients were also advised to undergo CABG, but elected to continue medical management. CONCLUSIONS Coronary angioplasty of the culprit vessel may play a role as a bridge to surgery in critically ill patients.
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Affiliation(s)
- N J Hayat
- Chest Diseases Hospital, Safat, Kuwait
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13
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Shenoy AR, Isaac BC, Naik GD, Varghese K, Shetty GG, Iyengar SS. Gross left ventricular voltage with preexcitation in isolated left ventricular non-compaction. J Assoc Physicians India 2003; 51:1017-20. [PMID: 14719598] [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: 04/28/2023]
Abstract
A 30 years man presented with symptoms of heart failure with prior history of pulmonary tuberculosis, on routine investigation he was found to have gross left ventricular voltage on the electrocardiogram and evidence of ventricular pre-excitation. His echocardiogram confirmed the diagnosis of left ventricular non-compaction. The aetiopathogenesis, clinical features, diagnostic criteria and review of literature of this rare entity is discussed here.
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Affiliation(s)
- A R Shenoy
- Department of Cardiology, St. John's Medical College Hospital, Bangalore 560034
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14
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Abstract
Patients with end stage renal disease have a high prevalence of cardiovascular disease and coronary arteriography is often routinely performed prior to kidney transplantation. However, the value of the conventional risk factors and non-invasive markers of coronary artery disease (CAD) in triaging patients for coronary arteriography has not been fully examined. 116 patients with end stage renal disease were evaluated. Coronary arteriography was performed in all patients either for a suspicion of CAD or as part of a routine pre-transplant evaluation. Lesions causing > or = 50% luminal diameter stenosis in any of the three major coronary artery systems were considered significant. The mean age was 53.3 +/- 9.3 years. Significant CAD was present in 69 patients (60%). Increasing age, family history of premature ischemic heart disease, the presence of angina, abnormal Q waves on the ECG or abnormal ST segment depression and the presence of coronary calcification were significant markers of coronary artery disease. However male gender, diabetes mellitus and obesity did not correlate with coronary disease. Even though hypertension, hypercholesterolemia and smoking were also not useful predictors these could have been modified by the renal failure. In conclusion increasing age, a family history of premature ischemic heart disease and some non-invasive markers were useful predictors of coronary disease.
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Affiliation(s)
- K Varghese
- Department of Cardiology, Chest Diseases Hospital, Safat, Kuwait
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15
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Varghese K, Cherian G, Abraham MT, Hayat NJ, Johny KV. Coronary artery disease among diabetic and non-diabetic patients with end stage renal disease. Ren Fail 2001; 23:669-77. [PMID: 11725913 DOI: 10.1081/jdi-100107363] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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: 11/03/2022] Open
Abstract
Cardiovascular disease is the major cause of death among patients with end stage renal disease and accounts for about half the deaths among the dialysis population. Several researchers have reported a high prevalence of coronary artery disease among diabetic patients with renal failure and coronary arteriography is often considered an integral part of the pre-transplant evaluation of diabetic patients with end stage renal disease. However, very few reports have addressed the question of coronary disease in non-diabetic patients, and the pattern and prevalence of coronary artery disease in non-diabetic patients with end stage renal disease are not well defined. We evaluated the clinical and coronary angiographic findings in 158 consecutive patients (84 diabetic and 74 non-diabetic) with end stage renal disease. The coronary arteries were divided into 16 segments and each segment was analyzed for the presence of coronary disease, which was defined as the presence of > or = 50% luminal diameter stenosis. Diabetic patients had more adverse risk factors for coronary artery disease, yet there was no significant difference in the prevalence of coronary artery disease between the diabetic and non-diabetic patients (67% vs. 55%, p = 0.15), or in the number of affected coronary artery segments (2.0 vs. 1.4, p = 0.05). Triple vessel coronary artery disease was however, significantly more common among the diabetic subjects (27% vs. 12%, p = 0.005). Non-diabetic patients with end stage renal disease also have a high prevalence of coronary artery disease and may merit as careful investigation of their coronary status as their diabetic counterparts.
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Affiliation(s)
- K Varghese
- Department of Cardiology, Chest Diseases Hospital, Safat, Kuwait
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Zubaid M, Thomas CS, Salman H, Al-Rashdan I, Hayat N, Habashi A, Abraham MT, Varghese K, Thalib L. A randomized study of the safety and efficacy of reused angioplasty balloon catheters. Indian Heart J 2001; 53:167-71. [PMID: 11428471] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND To lower costs, many centers around the world utilize previously used, resterilized balloon catheters to perform coronary angioplasty There are no controlled trials regarding their safety and efficacy. METHODS AND RESULTS We performed the first randomized, double-blind, controlled, single-center clinical trial comparing the safety (clinical success) and efficacy (angiographic success) of reused versus new coronary angioplasty balloon catheters. A total of 377 procedures were included, 178 in the reused catheter arm and 199 in the new catheter arm. There were no significant differences in clinical or lesion characteristics among the two arms. The incidence of first balloon failure in the reused catheter arm was similar to that of the new catheter arm (12 cases [7%] v. 10 cases [5%], respectively). The angiographic success rate was also similar-176 cases (98.9%) in the reused catheter arm and 196 cases (98.5%) in the new catheter arm. The number of balloon catheters used per lesion, amount of contrast, and procedural and fluoroscopy time were similar in the two arms. At 30 days, the incidence of major adverse cardiac events was similar in both arms, 8 cases (4.5%) in the reused catheter arm and 10 cases (5%) in the new catheter arm. The incidence of fever was also similar. CONCLUSIONS When performing coronary angioplasty, reused catheters are as effective (similar angiographic success) and safe (similar clinical success) as new catheters.
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Affiliation(s)
- M Zubaid
- Department of Cardiology, Chest Diseases Hospital, Kuwait.
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Hayat NJ, Varghese K, Salman H, Elghoul S, Abraham MT. Angioplasty in the stent era: results of a consecutive series of patients undergoing coronary angioplasty without surgical backup. Int J Cardiol 1998; 64:241-6. [PMID: 9672403 DOI: 10.1016/s0167-5273(98)00076-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [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] [Indexed: 11/16/2022]
Abstract
UNLABELLED We prospectively studied the angiographic and clinical outcome in a group of 117 consecutive patients (140 vessels) undergoing coronary angioplasty in the stent ERA without surgical backup. There were no exclusion criteria. Intracoronary stents were deployed in 36 vessels (26%) either as a bailout procedure or for a suboptimal result following balloon angioplasty. Procedural success was achieved in 126 vessels in 108 patients (90%). Two patients developed Q-wave myocardial infarction and another two developed nonQ myocardial infarction. One patient died suddenly 2 days following an initially successful procedure. No patient was referred for emergency coronary artery bypass grafting and there were no vascular complications. Clinical or angiographic follow up was available in 87% of the patients and an angiographic follow up in 50% of the patients. At a median angiographic follow up of 210 days restenosis was seen in 34% of the vessels. Restenosis occurred in three of the 21 (14%) stented vessels and in 18 of the 41 (44%) nonstented vessels (P<0.02). CONCLUSION In the stent era, coronary angioplasty can be safely performed without surgical backup. A satisfactory immediate and long-term result could be achieved by stenting 26% of the vessels.
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Affiliation(s)
- N J Hayat
- Chest Diseases Hospital, Safat, Kuwait
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Hayat N, Shafie MZ, Varghese K. "Interim angioplasty": a novel approach aimed at stabilising the critically ill patient for coronary artery bypass surgery. Int J Cardiol 1997; 62:283-4. [PMID: 9476692 DOI: 10.1016/s0167-5273(97)00266-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Mishra SK, Asthana OP, Mohanty S, Patnaik JK, Das BS, Srivastava JS, Satpathy SK, Dash S, Rath PK, Varghese K. Effectiveness of alpha,beta-arteether in acute falciparum malaria. Trans R Soc Trop Med Hyg 1995; 89:299-301. [PMID: 7660441 DOI: 10.1016/0035-9203(95)90550-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [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: 01/26/2023] Open
Abstract
With the emergence of widespread chloroquine resistance and a world-wide scarcity of quinine, a search for newer antimalarial drugs has become imperative. Different derivatives of qinghaosu have been successfully tried. alpha,beta-Arteether, an ethyl derivative of qinghaosu, was administered to 51 patients with Plasmodium falciparum malaria, in a dose of 150 mg intramuscularly once a day on 3 consecutive days. Complete parasite clearance from the peripheral blood was observed in 80% of the patients at 48 h and in 98% at 72 h. The median parasite clearance time was 2 d (range 1-4 d). 65% of the patients became afebrile within 48 h and 81% by 72 h. The mean fever clearance time was 52.04 h (standard deviation 27.09). No side effect was seen. Patients were followed-up for 4 weeks; 7 were readmitted with P. falciparum infection but it could not be ascertained definitely whether these cases were reinfections or recrudescences. alpha-beta Arteether was a safe, effective and convenient drug for treating P. falciparum malaria. This is the first clinical study with arteether in falciparum malaria.
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Affiliation(s)
- S K Mishra
- Department of Internal Medicine, Ispat General Hospital, Rourkela, Orissa, India
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