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Sedhai Y, Bhat P, Spalitto D, Singh K, Waheed I, Khan T, Ahmed M, Kazimuddin N, Steff R. Iron pill aspiration syndrome: A case report and literature review. Respir Med Case Rep 2023; 45:101908. [PMID: 37609001 PMCID: PMC10440560 DOI: 10.1016/j.rmcr.2023.101908] [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: 07/17/2023] [Revised: 08/02/2023] [Accepted: 08/05/2023] [Indexed: 08/24/2023] Open
Abstract
Aspiration of iron pill containing ferrous sulfate into the airway can induce fulminant chemical burn and necrosis of the airway mucosa. Acute chemical burn and inflammatory response can result in life-threatening airway compromise. It can also result in long-term sequelae including but not limited to fibrosis and airway stenosis. Considering the common use of iron supplements, and the potential severity of aspiration related airway injury, clinicians should be fully cognizant of the interaction between aspirated iron and airway passages. Herein, we present a case report with pertinent review of the literature.
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Affiliation(s)
- Y.R. Sedhai
- Division of Pulmonary Disease, and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY, USA
| | - P. Bhat
- Division of Pulmonary Disease, and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY, USA
| | - D. Spalitto
- Division of Internal Medicine, University of Kentucky College of Medicine, Bowling Green, KY, USA
| | - K. Singh
- Division of Pulmonary Disease, and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY, USA
| | - I. Waheed
- Division of Pulmonary Disease, and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY, USA
| | - T.M.A. Khan
- Division of Pulmonary Disease, and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY, USA
| | - M.A. Ahmed
- Division of Pulmonary Disease, and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY, USA
| | - N. Kazimuddin
- Division of Pulmonary Disease, and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY, USA
| | - R.T. Steff
- Division of Pulmonary Disease, and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY, USA
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Peer S, Jabbal HS, Singh P, M PS, Kakkera S, Bhat P. A case report of successful percutaneous aspiration, injection, and re-aspiration (PAIR) technique for treatment of retrovesical pelvic hydatid cyst. Radiol Case Rep 2023; 18:331-334. [DOI: 10.1016/j.radcr.2022.10.056] [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] [Received: 10/07/2022] [Accepted: 10/16/2022] [Indexed: 11/17/2022] Open
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Backes ER, Afonso NS, Guffey D, Tweddell JS, Tabbutt S, Rudd NA, O'Harrow G, Molossi S, Hoffman GM, Hill G, Heinle JS, Bhat P, Anderson JB, Ghanayem NS. Cumulative comorbid conditions influence mortality risk after staged palliation for hypoplastic left heart syndrome and variants. J Thorac Cardiovasc Surg 2023; 165:287-298.e4. [PMID: 35599210 DOI: 10.1016/j.jtcvs.2022.01.056] [Citation(s) in RCA: 1] [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: 05/10/2021] [Revised: 12/29/2021] [Accepted: 01/27/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Prematurity, low birth weight, genetic syndromes, extracardiac conditions, and secondary cardiac lesions are considered high-risk conditions associated with mortality after stage 1 palliation. We report the impact of these conditions on outcomes from a prospective multicenter improvement collaborative. METHODS The National Pediatric Cardiology Quality Improvement Collaborative Phase II registry was queried. Comorbid conditions were categorized and quantified to determine the cumulative burden of high-risk diagnoses on survival to the first birthday. Logistic regression was applied to evaluate factors associated with mortality. RESULTS Of the 1421 participants, 40% (575) had at least 1 high-risk condition. The aggregate high-risk group had lower survival to the first birthday compared with standard risk (76.2% vs 88.1%, P < .001). Presence of a single high-risk diagnosis was not associated with reduced survival to the first birthday (odds ratio, 0.71; confidence interval, 0.49-1.02, P = .066). Incremental increases in high-risk diagnoses were associated with reduced survival to first birthday (odds ratio, 0.23; confidence interval, 0.15-0.36, P < .001) for 2 and 0.17 (confidence interval, 0.10-0.30, P < .001) for 3 to 5 high-risk diagnoses. Additional analysis that included prestage 1 palliation characteristics and stage 1 palliation perioperative variables identified multiple high-risk diagnoses, poststage 1 palliation extracorporeal membrane oxygenation support (odds ratio, 0.14; confidence interval, 0.10-0.22, P < .001), and cardiac reoperation (odds ratio, 0.66; confidence interval, 0.45-0.98, P = .037) to be associated with reduced survival odds to the first birthday. CONCLUSIONS The presence of 1 high-risk diagnostic category was not associated with decreased survival at 1 year. Cumulative diagnoses across multiple high-risk diagnostic categories were associated with decreased odds of survival. Further patient accrual is needed to evaluate the impact of specific comorbid conditions within the broader high-risk categories.
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Affiliation(s)
- Emily R Backes
- Divisions of Cardiology and Critical Care, Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Tex, Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Tex.
| | - Natasha S Afonso
- Divisions of Cardiology and Critical Care, Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Tex, Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Tex
| | - Danielle Guffey
- Divisions of Cardiology and Critical Care, Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Tex, Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Tex
| | - James S Tweddell
- Division of Cardiology, Department of Surgery, Department of Pediatrics, University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Sarah Tabbutt
- Divisions of Critical Care and Cardiology, Department of Pediatrics, University of California San Francisco and Benioff Children's Hospital, San Francisco, Calif
| | - Nancy A Rudd
- Division of Cardiology, Department of Pediatrics, Department of Anesthesia, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, Wis
| | - Ginny O'Harrow
- Division of Critical Care, Department of Pediatrics, University of Chicago Medicine and Comer Children's Hospital, Chicago, Ill
| | - Silvana Molossi
- Divisions of Cardiology and Critical Care, Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Tex, Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Tex
| | - George M Hoffman
- Division of Cardiology, Department of Pediatrics, Department of Anesthesia, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, Wis
| | - Garick Hill
- Division of Cardiology, Department of Surgery, Department of Pediatrics, University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jeffrey S Heinle
- Divisions of Cardiology and Critical Care, Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Tex, Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Tex
| | - Priya Bhat
- Divisions of Cardiology and Critical Care, Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Tex, Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Tex
| | - Jeffrey B Anderson
- Division of Cardiology, Department of Surgery, Department of Pediatrics, University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Nancy S Ghanayem
- Division of Critical Care, Department of Pediatrics, University of Chicago Medicine and Comer Children's Hospital, Chicago, Ill; Advocate Children's Hospital, Oak Lawn, Ill
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Waters AM, Patterson J, Bhat P, Phillips AW. Investigating dysphagia in adults: symptoms and tests. BMJ 2022; 379:e067347. [PMID: 36252961 DOI: 10.1136/bmj-2021-067347] [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] [Indexed: 11/04/2022]
Affiliation(s)
- A M Waters
- Department of Otolaryngology, Freeman Hospital, Newcastle upon Tyne, UK
| | - J Patterson
- School of Health Sciences, Institute of Population Heath, University of Liverpool, UK
| | | | - A W Phillips
- Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK
- School of Medical Education, Newcastle University, Newcastle upon Tyne, UK
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Abadie B, Chan N, Sharalaya Z, Bhat P, Harb S, Jacob M, Tang WH, Cremer P, Jaber W. Positron emission tomography/computed tomography perfusion imaging with myocardial blood flow has diagnostic and prognostic value for cardiac allograft vasculopathy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.305] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardiac allograft vasculopathy (CAV) is a leading cause of morbidity and mortality in patients with orthotopic heart transplantation (OHT). Invasive coronary angiography is the traditional method of screening for and diagnosing CAV. Alternative non-invasive modalities have been sought to screen for CAV. A small, single-center study utilizing Positron Emission Tomography/Computed Tomography Perfusion Imaging (PET/CT) with stress myocardial blood flow (MBF) demonstrated good diagnostic and prognostic value for CAV.
Purpose
The purpose of this study was to validate the proposed algorithm for diagnosing and prognosticating CAV by PET/CT with stress MBF in a large and contemporary series.
Methods
Patients with a history of OHT with no prior revascularization in the transplanted heart who underwent PET/CT with MBF were included in the prognostic portion of the study. For the diagnostic value of PET/CT with MBF, only patients who had a PET/CT within 12 months of coronary angiography were included. The diagnostic accuracy of PET/CT was compared to the most recent coronary angiogram. A composite outcome of death, heart failure hospitalization, acute coronary syndrome, revascularization, and re-transplantation was used to validate the prognostic ability of PET/CT with MBF.
Results
450 PET/CT scans with MBF were performed and included in the prognostic portion of the study. 78 patients had PET/CT within 12 months of coronary angiography and were included in the diagnostic portion. Normal perfusion with normal myocardial blood flow had a 100% negative predictive value for moderate-severe CAV by angiography. PET/CT CAV 2/3 had a positive predictive value of 69% for moderate-severe CAV. Over 24 months, there were 20 events in the 39 patients with a PET CAV grade of 2/3 versus 21 events in the 411 patients with a PET CAV grade of 0/1 with a hazard ratio 13.3 (p<0.001).
Conclusions
The current proposed algorithm for diagnosing CAV by PET/CT with stress MBF has excellent negative predictive value along with good positive predictive value for detecting moderate-severe CAV by coronary angiography. A PET/CT with stress MBF with CAV classification of 2/3 is associated with a poor prognosis.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- B Abadie
- Cleveland Clinic Foundation , Cleveland , United States of America
| | - N Chan
- Cleveland Clinic Foundation , Cleveland , United States of America
| | - Z Sharalaya
- Cleveland Clinic Foundation , Cleveland , United States of America
| | - P Bhat
- Cleveland Clinic Foundation , Cleveland , United States of America
| | - S Harb
- Cleveland Clinic Foundation , Cleveland , United States of America
| | - M Jacob
- Cleveland Clinic Foundation , Cleveland , United States of America
| | - W H Tang
- Cleveland Clinic Foundation , Cleveland , United States of America
| | - P Cremer
- Cleveland Clinic Foundation , Cleveland , United States of America
| | - W Jaber
- Cleveland Clinic Foundation , Cleveland , United States of America
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Affiliation(s)
- N Arora
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, 4th Floor, F block, PGIMER, Chandigarh 160012, India
| | - P Bhat
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, 4th Floor, F block, PGIMER, Chandigarh 160012, India
| | - R Goel
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, 4th Floor, F block, PGIMER, Chandigarh 160012, India
| | - A K Pannu
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, 4th Floor, F block, PGIMER, Chandigarh 160012, India
| | - P Malhotra
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, 4th Floor, F block, PGIMER, Chandigarh 160012, India
| | - V Suri
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, 4th Floor, F block, PGIMER, Chandigarh 160012, India
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Abstract
Purpose To describe a paradigm of care for patients with ocular inflammatory diseases aimed at induction of durable remission. Methods Retrospective cohort study. The records of 399 patients with ocular inflammatory diseases treated with systemic immunomodulatory therapy (IMT) at the Massachusetts Eye Research and Surgery Institution were reviewed. Durable remission was defined as control of inflammation in the absence of systemic IMT for at least 1 year. Fifty patients met the inclusion criteria. Results Mean age was 46±22.5 years (range 18–88). All the patients had corticosteroid therapy and failed this therapy before having IMT. Fifty-two percent of the patients had used methotrexate alone or in combination with other medications. Thirty percent of the patients required at least 2 years of therapy with systemic IMT to obtain durable remission, while 44% required 2 to 5 years of therapy to achieve the same. Twenty percent continued to stay in remission, off immunomodulatory drugs, between 2 and 5 years and 18% were in remission for more than 5 years after therapy discontinuation. Conclusions IMT can be sight saving in patients. It can be tapered and discontinued successfully without the return of ocular inflammation. Durable drug-free remission is an achievable goal, and should be pursued by ocular inflammatory disease specialists.
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Affiliation(s)
| | - P. Bhat
- Massachusetts Eye Research and Surgery Institution, Cambridge
| | - E. Fortuna
- Massachusetts Eye Research and Surgery Institution, Cambridge
| | - S. Acevedo
- Massachusetts Eye Research and Surgery Institution, Cambridge
| | - C.S. Foster
- Massachusetts Eye Research and Surgery Institution, Cambridge
- Harvard Medical School and Ocular Immunology and Uveitis Foundation, Cambridge, MA - USA
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Affiliation(s)
- M.J. Gallagher
- Massachusetts Eye Research and Surgery Institute, Cambridge - USA
| | | | - P. Bhat
- Massachusetts Eye Research and Surgery Institute, Cambridge - USA
| | - T. Yilmaz
- Massachusetts Eye Research and Surgery Institute, Cambridge - USA
| | - C.S. Foster
- Massachusetts Eye Research and Surgery Institute, Cambridge - USA
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Bhat P, Goyal V, Srivastava A, Behari M. Effects of repetetive transcranial magnetic stimulation at three cortical sites in parkinson’s disease: a randomized study. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.319] [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: 11/29/2022]
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10
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Jacobs GP, Bhat P, Owiti P, Edwards JK, Tweya H, Najjemba R. Did the 2014 Ebola outbreak in Liberia affect HIV testing, linkage to care and ART initiation? Public Health Action 2017; 7:S70-S75. [PMID: 28744442 DOI: 10.5588/pha.16.0101] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 10/25/2016] [Accepted: 03/13/2017] [Indexed: 01/09/2023] Open
Abstract
Setting: Health facilities providing human immunodeficiency virus (HIV) testing, care and treatment in Liberia. Objective: To evaluate individuals aged ⩾15 years who were tested, diagnosed and enrolled into HIV care before (2013), during (2014) and after the Ebola outbreak (2015). Design: A cross-sectional descriptive study. Results: A median of 6930 individuals aged ⩾15 years per county were tested for HIV before the Ebola outbreak; this number declined by 35% (2444/6930) during the outbreak. HIV positivity remained similar before (7028/207 314, 3.4%) and during the outbreak (4146/121 592, 3.5%). During Ebola, HIV testing declined more in highly affected counties (68 035/127 468, 47%) than in counties that were less affected (16 444/23 955, 31%, P < 0.001). Compared to the pre-Ebola period, HIV testing in less-affected counties recovered more quickly during the post-outbreak period, with a 19% increase in testing, while medium and highly affected counties remained at respectively 38% and 48% below pre-outbreak levels. Enrolment for HIV care increased during and after the outbreak compared to the pre-Ebola period. Conclusion: HIV testing and diagnosis were significantly limited during the Ebola outbreak, with the most severe effects occurring in highly affected counties. However, enrolment for HIV care and treatment were resilient throughout the outbreak. Pro-active measures are needed to sustain HIV testing rates in future epidemics.
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Affiliation(s)
| | - P Bhat
- Ministry of Health, Government of Karnataka, Bangalore, India
| | - P Owiti
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,International Union Against Tuberculosis and Lung Disease, Paris, France
| | - J K Edwards
- Médecins Sans Frontières, Brussels, Belgium.,Johns Hopkins University, School of Public Health, Baltimore, Maryland, USA
| | - H Tweya
- International Union Against Tuberculosis and Lung Disease, Paris, France.,The Lighthouse Trust, Lilongwe, Malawi
| | - R Najjemba
- Makerere University College of Health Sciences, Kampala, Uganda
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Mussah VG, Mapleh L, Ade S, Harries AD, Bhat P, Kateh F, Dahn B. Performance-based financing contributes to the resilience of health services affected by the Liberian Ebola outbreak. Public Health Action 2017; 7:S100-S105. [PMID: 28744447 PMCID: PMC5515557 DOI: 10.5588/pha.16.0096] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 12/23/2016] [Indexed: 11/10/2022] Open
Abstract
Setting: The Liberian counties of Bong, with performance-based financing (PBF) for all 36 public primary-care facilities, and Margibi, with no PBF for its 24 public primary-care facilities. Objective: To compare whether specific maternal and child health indicators changed in the two counties during the pre-Ebola (2013), Ebola (2014) and post-Ebola (2015) disease outbreak periods from July to September each year. Design: This was a cross-sectional study. Results: For pregnant women, the numbers of antenatal visits, intermittent preventive malaria treatments, human immunodeficiency virus (HIV) tests and facility-based births with skilled attendants all fell during the Ebola period, with decreases being significantly more marked in Margibi County. Apart from HIV testing, which remained low in both counties, these indicators increased in the post-Ebola period, with increases significantly more marked in Bong than in Margibi. The number of childhood immunisations decreased significantly in Bong in the Ebola period compared with the pre-Ebola period, but increased to above pre-Ebola levels in the post-Ebola period. There were markedly larger decreases in childhood immunisations in Margibi County during the Ebola period, which remained significantly lower in the post-Ebola period compared with Bong County. Conclusion: In a PBF-supported county, selected maternal and childhood health indicators showed less deterioration during Ebola and better recovery post-Ebola than in a non-PBF-supported county.
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Affiliation(s)
- V G Mussah
- Performance-based Financing Unit, Department of Health Services (DHS), Ministry of Health (MoH), Monrovia, Liberia
| | - L Mapleh
- Fixed Amount Reimbursement Agreement Unit, DHS, MoH, Monrovia, Liberia
| | - S Ade
- International Union Against Tuberculosis and Lung Disease, Paris, France
- National Tuberculosis Control Programme, Cotonou, Benin
- Faculty of Medicine, University of Parakou, Parakou, Benin
| | - A D Harries
- London School of Hygiene & Tropical Medicine, London, UK
| | - P Bhat
- Ministry of Health, Government of Karnataka, Karnataka, India
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Samba T, Bhat P, Owiti P, Samuels L, Kanneh PJ, Paul R, Kargbo B, Harries AD. Non-communicable diseases in the Western Area District, Sierra Leone, before and during the Ebola outbreak. Public Health Action 2017; 7:S16-S21. [PMID: 28744434 PMCID: PMC5515558 DOI: 10.5588/pha.16.0086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 09/29/2016] [Accepted: 11/26/2016] [Indexed: 12/22/2022] Open
Abstract
Setting: Twenty-seven peripheral health units, five secondary hospitals and one tertiary hospital, Western Area District, Sierra Leone. Objectives: To describe reporting systems, monthly attendances and facility-based patterns of six non-communicable diseases (NCDs) in the pre-Ebola and Ebola virus disease outbreak periods. Design: A cross-sectional study using programme data. Results: Reporting was 89% complete on the six selected NCDs pre-Ebola and 86% during the Ebola outbreak (P < 0.01). Overall, marked declining trends in NCDs were reported during the Ebola period, with a monthly mean of 342 cases pre-Ebola and 164 during the Ebola outbreak. The monthly mean number of cases per disease in the pre-Ebola and Ebola outbreak periods was respectively 228 vs. 85 for hypertension, 43 vs. 27 for cardiovascular diseases, 36 vs. 18 for diabetes and 25 vs. 29 for peptic ulcer disease; this last condition increased during the outbreak. There were higher proportions of NCDs among females during the Ebola outbreak compared with the pre-Ebola period. Except for peptic ulcer disease, the number of patients with NCDs declined by 25% in peripheral health units, 91% in the secondary hospitals and 70% in the tertiary hospital between the pre-Ebola and the Ebola outbreak periods. Conclusion: Comprehensive reporting of NCDs was suboptimal, and declined during the Ebola epidemic. There were decreases in reported attendances for NCDs between the pre-Ebola and the Ebola outbreak periods, which were even more marked in the hospitals. This study has important policy implications.
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Affiliation(s)
- T Samba
- Western Area District Health Management Team, Ministry of Health and Sanitation (MoHS), Freetown, Sierra Leone
| | - P Bhat
- Ministry of Health, Government of Karnataka, Bengaluru, India
| | - P Owiti
- Academic Model Providing Access to Health Care (AMPATH), Eldoret, Kenya
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - L Samuels
- Western Area District Health Management Team, Ministry of Health and Sanitation (MoHS), Freetown, Sierra Leone
| | - P J Kanneh
- Western Area District Health Management Team, Ministry of Health and Sanitation (MoHS), Freetown, Sierra Leone
| | - R Paul
- Western Area District Health Management Team, Ministry of Health and Sanitation (MoHS), Freetown, Sierra Leone
| | | | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France
- London School of Hygiene & Tropical Medicine, London, UK
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13
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Gamanga AH, Owiti P, Bhat P, Harries AD, Kargbo-Labour I, Koroma M. The Ebola outbreak: effects on HIV reporting, testing and care in Bonthe district, rural Sierra Leone. Public Health Action 2017; 7:S10-S15. [PMID: 28744433 PMCID: PMC5515556 DOI: 10.5588/pha.16.0087] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 02/20/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: All public health facilities in Bonthe District, rural Sierra Leone. Objective: To compare, in the periods before and during the Ebola virus disease outbreak, 1) the submission and completeness of monthly human immunodeficiency virus (HIV) reports, and 2) the uptake of HIV testing and care for pregnant women and the general population. Design: A cross-sectional study using routine programme data. Results: Of the 627 HIV reports expected in each period, 406 (65%) were submitted in the pre-Ebola period and 376 (60%) during the Ebola outbreak (P = 0.08), of which respectively 318 (78%) and 335 (89%) had complete information (P < 0.001). In the pre-Ebola period, 5012 pregnant women underwent testing for HIV, of whom 25 were HIV-positive, compared to 4254 during the Ebola period, of whom 21 were HIV-positive (P < 0.001). Of those who were HIV-positive, respectively 14 (56%) and 21 (100%) received antiretroviral prophylaxis or antiretroviral therapy (ART) (P < 0.001). In the general population, 5770 persons underwent HIV testing pre-Ebola vs. 3095 in the Ebola period (P < 0.001); of those who tested positive for HIV, respectively 62% (33/53) and 81% (33/41) were started on ART (P = 0.06). Conclusion: There was suboptimal reporting on HIV/acquired immune-deficiency disease syndrome activities before and during the Ebola virus disease outbreak. HIV testing decreased during the Ebola outbreak, while the uptake of prevention of mother-to-child transmission and ART increased. Pre-emptive actions are needed to maintain the levels of HIV testing in any future outbreak.
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Affiliation(s)
- A H Gamanga
- Bonthe Government Hospital, Ministry of Health and Sanitation (MoHS), Bonthe Sherbro Island, Bonthe District, Sierra Leone
| | - P Owiti
- Academic Model Providing Access to Health Care (AMPATH), Eldoret, Kenya
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - P Bhat
- Ministry of Health, Government of Karnataka, Mangalore, India
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - M Koroma
- MoHS, Mattru Jong, Bonthe District, Sierra Leone
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14
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Wesseh CS, Najjemba R, Edwards JK, Owiti P, Tweya H, Bhat P. Did the Ebola outbreak disrupt immunisation services? A case study from Liberia. Public Health Action 2017; 7:S82-S87. [PMID: 28744444 DOI: 10.5588/pha.16.0104] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 10/26/2016] [Accepted: 01/25/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: All health facilities providing routine immunisation services in Liberia. Objective: To compare the number of routine facility-based and outreach immunisations and measles cases before, during and after the Ebola outbreak. Design: A descriptive cross-sectional study. Results: Immunisation coverage for fully immunised children before the Ebola outbreak was 73%. Immunisation coverage for all antigens declined by half compared to baseline during the outbreak. These findings were similar in facility-based and outreach immunisations. During the outbreak, the proportion of fully immunised children dropped by respectively 58%, 33% and 39% in the most, moderately and least Ebola-affected counties. Immunisation rate of recovery in the post-Ebola period was respectively 82%, 21% and 9% in the most, moderately and least affected counties compared to the Ebola-outbreak period. Outreach immunisation recovered slowly compared to facility-based immunisation. The mean number of measles cases reported per month was 12 pre-Ebola, 16 Ebola and 60 post-Ebola. Conclusion: This study provides insights into the possible impact of an Ebola outbreak on countrywide immunisation. The outbreak weakened a struggling national immunisation programme, and post-outbreak recovery took significant time, which likely contributed to the measles epidemic. Recommendations for the improvement of immunisation services that could limit further preventable epidemics in Liberia and similar contexts at risk for Ebola are provided.
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Affiliation(s)
- C S Wesseh
- Ministry of Health, Republic of Liberia, Monrovia, Liberia
| | - R Najjemba
- Makerere University College of Health Sciences, Kampala, Uganda
| | - J K Edwards
- Médecins Sans Frontières, Brussels, Belgium.,Johns Hopkins University, School of Public Health, Baltimore, Maryland, USA
| | - P Owiti
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,The International Union Against Tuberculosis and Lung Disease, Paris, France
| | - H Tweya
- The International Union Against Tuberculosis and Lung Disease, Paris, France.,The Lighthouse Trust, Lilongwe, Malawi
| | - P Bhat
- Ministry of Health, Government of Karnataka, Bangalore, India
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15
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Bah OM, Kamara HB, Bhat P, Harries AD, Owiti P, Katta J, Foray L, Kamara MI, Kamara BO. The influence of the Ebola outbreak on presumptive and active tuberculosis in Bombali District, Sierra Leone. Public Health Action 2017; 7:S3-S9. [PMID: 28744432 DOI: 10.5588/pha.16.0093] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 12/12/2016] [Indexed: 11/10/2022] Open
Abstract
Setting: Bombali District, rural Sierra Leone. Objective: To compare the number of patients with presumptive tuberculosis (TB), the number of patients registered with TB (including testing for the human immunodeficiency virus [HIV] and initiation on antiretroviral therapy [ART]) and treatment outcomes during the pre-Ebola, Ebola and post-Ebola disease outbreak periods between 2013 and 2016. Design: This was a cross-sectional study and retrospective cohort analysis of treatment outcomes. Results: The mean monthly number of patients with presumptive TB before, during and post-Ebola was respectively 169, 145 and 210. The mean monthly number of registered TB cases was respectively 57, 57 and 96. Smear-positive TB was the most frequent type of TB, at 75%, 66% and 77%. The proportion of TB patients tested for HIV was 82% pre-Ebola, 74% Ebola and 99% post-Ebola. The proportion of HIV-positive patients with TB initiated on ART was respectively 46%, 85% and 100%. Treatment success among TB patients was 71% in the pre-Ebola period and 89% in the Ebola period (P < 0.001). Conclusion: During the Ebola outbreak, there were decreases in the number of presumptive TB patients and in the proportions of patients diagnosed with smear-positive TB and tested for HIV. The initiation of ART in HIV-infected TB patients and treatment outcomes remained acceptable. Pre-emptive actions are needed to maintain adequate control activities in future outbreaks.
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Affiliation(s)
- O M Bah
- Makeni Regional Hospital, Makeni, Bombali District, Sierra Leone
| | - H B Kamara
- Makeni Regional Hospital, Makeni, Bombali District, Sierra Leone
| | - P Bhat
- Ministry of Health, Government of Karnataka, Bengaluru, India
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France.,London School of Hygiene & Tropical Medicine, London, UK
| | - P Owiti
- International Union Against Tuberculosis and Lung Disease, Paris, France.,Academic Model Providing Access to Health Care (AMPATH), Eldoret, Kenya
| | - J Katta
- National Tuberculosis Control Programme, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - L Foray
- National Tuberculosis Control Programme, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - M I Kamara
- Makeni Regional Hospital, Makeni, Bombali District, Sierra Leone
| | - B O Kamara
- Makeni Regional Hospital, Makeni, Bombali District, Sierra Leone
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16
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Konwloh PK, Cambell CL, Ade S, Bhat P, Harries AD, Wilkinson E, Cooper CT. Influence of Ebola on tuberculosis case finding and treatment outcomes in Liberia. Public Health Action 2017; 7:S62-S69. [PMID: 28744441 PMCID: PMC5515566 DOI: 10.5588/pha.16.0097] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 10/21/2016] [Accepted: 01/09/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: National Leprosy and Tuberculosis (TB) Control Programme, Liberia. Objectives: To assess TB case finding, including human immunodeficiency virus (HIV) associated interventions and treatment outcomes, before (January 2013-March 2014), during (April 2014-June 2015) and after (July-December 2015) the Ebola virus disease outbreak. Design: A cross-sectional study and retrospective cohort analysis of outcomes. Results: The mean quarterly numbers of individuals with presumptive TB and the proportion diagnosed as smear-positive were: pre-Ebola (n = 7032, 12%), Ebola (n = 6147, 10%) and post-Ebola (n = 6795, 8%). For all forms of TB, stratified by category and age group, there was a non-significant decrease in the number of cases from the pre-Ebola to the Ebola and post-Ebola periods. There were significant decreases in numbers of cases with smear-positive pulmonary TB (PTB) from the pre-Ebola period (n = 855), to the Ebola (n = 640, P < 0.001) and post-Ebola (n = 568, P < 0.001) periods. The proportions of patients tested for HIV, found to be HIV-positive and started on antiretroviral therapy decreased as follows: pre-Ebola (respectively 72%, 15% and 34%), Ebola (69%, 14% and 30%) and post-Ebola (68%, 12% and 26%). Treatment success rates among TB patients were: 80% pre-Ebola, 69% Ebola (P < 0.001) and 73% post-Ebola (P < 0.001). Loss to follow-up was the main contributing adverse outcome. Conclusion: The principal negative effects of Ebola were the significant decreases in diagnoses of smear-positive PTB, the declines in HIV testing and antiretroviral therapy uptake and poor treatment success. Ways to prevent these adverse effects from recurring in the event of another Ebola outbreak need to be found.
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Affiliation(s)
- P K Konwloh
- National Leprosy & Tuberculosis Control Programme, Ministry of Health, Monrovia, Liberia
| | - C L Cambell
- National Leprosy & Tuberculosis Control Programme, Ministry of Health, Monrovia, Liberia
| | - S Ade
- International Union Against Tuberculosis and Lung Disease, Paris, France
- National Tuberculosis Control Programme, Cotonou, Benin
- Faculty of Medicine, University of Parakou, Parakou, Benin
| | - P Bhat
- Ministry of Health, Government of Karnataka, Bangalore, India
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France
- London School of Hygiene & Tropical Medicine, London, UK
| | - E Wilkinson
- Institute of Medicine, University of Chester, Chester, UK
| | - C T Cooper
- National Leprosy & Tuberculosis Control Programme, Ministry of Health, Monrovia, Liberia
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Shannon FQ, Horace-Kwemi E, Najjemba R, Owiti P, Edwards J, Shringarpure K, Bhat P, Kateh FN. Effects of the 2014 Ebola outbreak on antenatal care and delivery outcomes in Liberia: a nationwide analysis. Public Health Action 2017; 7:S88-S93. [PMID: 28744445 DOI: 10.5588/pha.16.0099] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 10/24/2016] [Accepted: 01/31/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: All health facilities, public and private, in Liberia, West Africa. Objectives: To determine access to antenatal care (ANC), deliveries and their outcomes before, during and after the 2014-2015 Ebola outbreak. Design: This was a descriptive cross-sectional study. Result: During the Ebola outbreak in Liberia, overall monthly reporting from health facilities plunged by 43%. Access to ANC declined by 50% and reported deliveries fell by one third during the outbreak. Reported deliveries by skilled attendants and Caesarian section declined by respectively 32% and 60%. Facility-based deliveries dropped by 35% and reported community deliveries fell by 47%. There was an overall decline in reported stillbirths, maternal and neonatal deaths, by 50%, during the outbreak. ANC, reported deliveries and related outcomes returned to pre-outbreak levels within one year following the outbreak. Conclusion: The Liberian health system was considerably weakened during the Ebola outbreak and had difficulties providing basic maternal health services. In the light of the major reporting gaps during the Ebola period, and the reduced use of health facilities for maternal care, these findings highlight the need for measures to avoid such disruptions during future outbreaks.
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Affiliation(s)
| | | | - R Najjemba
- Makerere University College of Health Sciences, Kampala, Uganda
| | - P Owiti
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,International Union Against Tuberculosis and Lung Disease, Paris, France
| | - J Edwards
- Operational Research Unit (LUXOR), Médecins Sans Frontières, Brussels Operational Centre, Brussels, Belgium.,Johns Hopkins University, School of Public Health, Baltimore, Maryland, USA
| | | | - P Bhat
- Ministry of Health, Government of Karnataka, India
| | - F N Kateh
- Ministry of Health, Monrovia, Liberia
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18
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Hancock H, Pituch K, Uzark K, Bhat P, Fifer C, Silveira M, Yu S, Donohue J, Lowery R, Aiyagari R. IMPACT OF EARLY PALLIATIVE CARE INTERVENTION ON MATERNAL STRESS IN MOTHERS OF INFANTS PRENATALLY DIAGNOSED WITH SINGLE VENTRICLE HEART DISEASE: A RANDOMIZED CLINICAL TRIAL. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30921-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Tellapragada C, Kalwaje Eshwara V, Bhat P, Kamath A, Mukhopadhyay C. Vaginal colonization by microbes during early pregnancy and their association with adverse pregnancy outcomes. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.738] [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: 10/22/2022] Open
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20
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Bhat P, Savitri V, Laxmi P, Jenitta E. A Study on the Phytochemical Analysis, Silver Nanoparticle Synthesis and Antibacterial Activity from Seed Extract of Areca catechu L. ACTA ACUST UNITED AC 2016. [DOI: 10.9734/ijbcrr/2016/21864] [Citation(s) in RCA: 1] [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: 11/09/2022]
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21
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Singh N, Mahajan V, Kaur A, Bhat P, Leishangthem G, Banga H, Brar R. Localization of classical swine fever virus antigen in young piglets by immunohistochemistry. ACTA ACUST UNITED AC 2016. [DOI: 10.5958/0973-970x.2016.00084.5] [Citation(s) in RCA: 1] [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: 10/20/2022]
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22
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Kumar AMV, Naik B, Guddemane DK, Bhat P, Wilson N, Sreenivas AN, Lauritsen JM, Rieder HL. Efficient, quality-assured data capture in operational research through innovative use of open-access technology. Public Health Action 2015; 3:60-2. [PMID: 26392997 DOI: 10.5588/pha.13.0004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 01/11/2013] [Accepted: 01/14/2013] [Indexed: 11/10/2022] Open
Abstract
Ensuring quality of data during electronic data capture has been one of the most neglected components of operational research. Multicentre studies are also challenged with issues about logistics of travel, training, supervision, monitoring and troubleshooting support. Allocating resources to these issues can pose a significant bottleneck for operational research in resource-limited settings. In this article, we describe an innovative and efficient way of coordinating data capture in multicentre operational research using a combination of three open access technologies-EpiData for data capture, Dropbox for sharing files and TeamViewer for providing remote support.
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Affiliation(s)
- A M V Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India
| | - B Naik
- World Health Organization Country Office for India, New Delhi, India
| | - D K Guddemane
- World Health Organization Country Office for India, New Delhi, India
| | - P Bhat
- World Health Organization Country Office for India, New Delhi, India
| | - N Wilson
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India
| | - A N Sreenivas
- World Health Organization Country Office for India, New Delhi, India
| | - J M Lauritsen
- Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark ; EpiData Association, Odense, Denmark
| | - H L Rieder
- The Union, Paris, France ; Institute of Social and Preventive Medicine, University of Zurich, Switzerland
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23
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Vishnu PH, Bhat P, Bansal A, Satyanarayana S, Alavadi U, Ohri BS, Shrinivas MSR, Desikan P, Jaju J, Rao VG, Moonan PK. Is bleach-sedimented smear microscopy an alternative to direct microscopy under programme conditions in India? Public Health Action 2015; 3:23-5. [PMID: 26392991 DOI: 10.5588/pha.12.0100] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Accepted: 02/14/2013] [Indexed: 11/10/2022] Open
Abstract
This cross-sectional multi-centric study compared the yield of and potential benefit for detecting smear-positive pulmonary tuberculosis (PTB) by bleach sedimentation (2% sodium-hypochlorite) versus direct microscopy under programme conditions in India. Among 3168 PTB suspects, 684 (21.6%) were detected by bleach sedimentation vs. 625 (19.7%) by direct microscopy, with a proportional overall agreement of 96% (κ = 0.88). While 594 patients were smear-positive with both methods, 31 patients detected by direct microscopy were missed and an additional 90 patients were detected by bleach sedimentation. Overall, bleach sedimentation increased the yield of smear-positive TB detection; however; it also increased the time to results.
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Affiliation(s)
- P H Vishnu
- State Tuberculosis Training and Demonstration Centre, Hyderabad, Andra Pradesh, India
| | - P Bhat
- World Health Organization Revised National Tuberculosis Control Programme (RNTCP) Technical Assistance Project, New Delhi, India
| | - A Bansal
- World Health Organization Revised National Tuberculosis Control Programme (RNTCP) Technical Assistance Project, New Delhi, India
| | - S Satyanarayana
- Regional Office for South-East Asia, International Union Against Tuberculosis and Lung Disease, New Delhi, India
| | - U Alavadi
- World Health Organization Revised National Tuberculosis Control Programme (RNTCP) Technical Assistance Project, New Delhi, India
| | - B S Ohri
- RNTCP State Tuberculosis Office, Bhopal, Madhya Pradesh, India
| | | | - P Desikan
- Bhopal Memorial Hospital and Research Centre, Bhopal, Madhya Pradesh, India
| | - J Jaju
- World Health Organization Revised National Tuberculosis Control Programme (RNTCP) Technical Assistance Project, New Delhi, India
| | - V G Rao
- Regional Medical Research Center for Tribals, Jabalpur, Madhya Pradesh, India
| | - P K Moonan
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Kodan P, Chakrapani M, Shetty M, Pavan R, Bhat P. Hemophagocytic lymphohistiocytosis secondary to infections: a tropical experience! J Postgrad Med 2015; 61:112-5. [PMID: 25766345 PMCID: PMC4943449 DOI: 10.4103/0022-3859.150904] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Revised: 06/09/2014] [Accepted: 11/06/2014] [Indexed: 11/04/2022] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a potentially fatal hyper inflammatory condition, if not recognized and treated in time. A high index of suspicion can help identify the condition early. This condition can occur in the primary or secondary form. Secondary HLH or hemophagocytic syndrome (HPS) secondary to infections is an important clinical entity especially in tropical world. In this article, we share our experience with this entity and make an attempt to explore literature about ravenous macrophages which occurs secondary to infections. It is a series of six cases of HLH secondary to infectious disease in our center in a coastal city in South India over last one year with follow up.
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Affiliation(s)
| | - M Chakrapani
- Department of Medicine, Kasturba Medical College, Manipal University, Mangalore, India
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Moza A, Ali A, Moukarbel G, Bhat P, Tian J, Khouri S. Endothelin-1 Levels in Patients With Heart Failure With Normal Ejection Fraction and Pulmonary Venous Hypertension. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.841] [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: 11/24/2022] Open
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26
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Bhat P, Nassif M, Vader J, Sparrow C, Novak E, Ewald G, LaRue S. Epistaxis in Patients with Left Ventricular Assist Devices - Incidence, Risk Factors, and Implications. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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27
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Mahla H, Bhat P, Bhairappa S, Manjunath CN. Ring-shaped thrombus in left atrial appendage: a contraindication for valvotomy. Case Reports 2013; 2013:bcr-2013-201108. [DOI: 10.1136/bcr-2013-201108] [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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28
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Mahla H, Bhairappa S, Bhat P, Manjunath CN. Rheumatic mitral stenosis simulating double-orifice mitral valve. Case Reports 2013; 2013:bcr-2013-200090. [DOI: 10.1136/bcr-2013-200090] [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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29
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Morris MD, Quezada L, Bhat P, Moser K, Smith J, Perez H, Laniado-Laborin R, Estrada-Guzman J, Rodwell TC. Social, economic, and psychological impacts of MDR-TB treatment in Tijuana, Mexico: a patient's perspective. Int J Tuberc Lung Dis 2013; 17:954-60. [PMID: 23743315 PMCID: PMC3769163 DOI: 10.5588/ijtld.12.0480] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING The State of Baja California, Mexico, had the highest prevalence of multidrug-resistant tuberculosis (MDR-TB) in Mexico in 2009. OBJECTIVE To understand the socio-economic burden of MDR-TB disease and its treatment on patients in Tijuana and Mexicali, Mexico. DESIGN From July to November 2009, qualitative interviews were conducted with 12 patients enrolled in a US-Mexico binational MDR-TB treatment program, Puentes de Esperanza (Bridges of Hope), which was designed to support MDR-TB patients. In-depth interviews were coded to identify major themes in patient experiences of MDR-TB diagnosis and care. RESULTS While some patients were able to maintain their pre-MDR-TB lives to a limited extent, most patients reported losing their sense of identity due to their inability to work, social isolation, and stigmatization from family and friends. The majority of participants expressed appreciation for Puentes' role in 'saving their lives'. CONCLUSION Being diagnosed with MDR-TB and undergoing treatment imposes significant psychological, social and economic stress on patients. Strong social support elements within Puentes helped alleviate these burdens. Improvements to the program might include peer-support groups for patients undergoing treatment and transitioning back into the community after treatment.
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Affiliation(s)
- Meghan D. Morris
- Division of Global Public Health, Department of Medicine, University of California San Diego
| | - Liliana Quezada
- Division of Global Public Health, Department of Medicine, University of California San Diego
| | - Priya Bhat
- Division of Global Public Health, Department of Medicine, University of California San Diego
| | - Kathleen Moser
- San Diego County Tuberculosis Control Program, San Diego, CA USA
| | - Jennifer Smith
- Border Infectious Disease Surveillance Program, California Department of Public Health, San Diego, CA
| | - Hector Perez
- San Diego County Tuberculosis Control Program, San Diego, CA USA
| | | | | | - Timothy C. Rodwell
- Division of Global Public Health, Department of Medicine, University of California San Diego
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Panneerselvam A, Krishnamurthy AH, Bhat P, Nanjappa MC. Delayed contrast enhancement in MRI in takotsubo cardiomyopathy. Case Reports 2011; 2011:bcr.06.2011.4324. [DOI: 10.1136/bcr.06.2011.4324] [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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31
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Girisha KM, Bhat P, Adiga PK, Pai AH, Rai L. Unusual facial cleft in Fryns syndrome: defect of stomodeum? Genet Couns 2010; 21:233-236. [PMID: 20681225] [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: 05/29/2023]
Abstract
Unusual facial cleft in Fryns syndrome: defect of stomodeum?: We report on a fetus with Fryns syndrome. The facial cleft was unusual. There was bilateral cleft lip with cleft palate. The intermaxillary segment was connected through the base of a mound in the midline to the lower lip. We believe this is an atypical facial cleft in Fryns syndrome and likely represents a defective stomodeum.
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Affiliation(s)
- K M Girisha
- Genetics Clinic, Department of Pediatrics, Kasturba Medical College, Manipal University, Manipal, India.
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Verma A, Wulffhart Z, Lakkireddy D, Khaykin Y, Kaplan A, Sarak B, Biria M, Pillarisetti J, Bhat P, Di Biase L, Constantini O, Quan K, Natale A. Incidence of left ventricular function improvement after primary prevention ICD implantation for non-ischaemic dilated cardiomyopathy: a multicentre experience. Heart 2009; 96:510-5. [DOI: 10.1136/hrt.2009.178061] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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33
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Dalal P, Bhattacharjee M, Vairale J, Bhat P. International Stroke Society - WHO Global Stroke Initiative: a report on population-based Mumbai stroke registry (2005-2006), India. Int J Stroke 2009; 4:239-40. [PMID: 19689748 DOI: 10.1111/j.1747-4949.2009.00313.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bhat P, Sisler I, Collier AB. Exchange transfusion as treatment for rasburicase induced methemoglobinemia in a glucose-6-phosphate dehydrogenase deficient patient. Pediatr Blood Cancer 2008; 51:568. [PMID: 18561168 DOI: 10.1002/pbc.21582] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [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: 11/06/2022]
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Dalal PM, Bhattacharjee M, Vairale J, Bhat P. Mumbai stroke registry (2005-2006)--surveillance using WHO steps stroke instrument--challenges and opportunities. J Assoc Physicians India 2008; 56:675-680. [PMID: 19086353] [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: 05/27/2023]
Abstract
BACKGROUND India will face enormous socioeconomic burden because life expectancy is increasing placing larger numbers of older people at risk of stroke and other chronic diseases. In order to plan prevention strategies, reliable information on stroke epidemiology is required. For uniform data collection (population based), WHO recommends use of STEPS Stroke instrument. STUDY A well-defined community (H-ward) with verifiable census data, and representative of population structure of Mumbai (Bombay), was selected. The manual on WHO STEPwise approach to stroke surveillance (STEPS; http://www.who.int/chp/steps/Manual.pdf) was the operational protocol. RESULTS During the two year study period (Jan 2005 to Dec 2006), 521 new stroke (CVD) cases (males--275 and females--246) were identified; of which 456 (238 males and 218 females) had "first ever stroke"(FES) indicating an annual incidence of 145 per 100,000 persons (CI 95%: 120-170); age adjusted Segi rate: 152/100,000/year (CI 95% 132-172). Two thirds of the FES cases were admitted to health care facilities (Step I: "in-hospital" cases), the remaining 150 (32.8%) either died outside of hospital or were treated at home or nursing homes (Step II: Fatal events in community and Step III: Non-fatal events in community). CVD Diagnosis was supported by CT (Computed Tomography) in 407 (89%) of 456 FES cases: 366 (80.2%) had Ischaemic CVD, 81 (17.7%) had hemorrhagic CVD and 9 (1%) were of unspecified category. The mean age was 66 yrs SD +/- 13.60 and women were older compared with men (mean age 68.9 yrs SD +/- 13.12 versus 63.4 yrs SD +/- 13.53). Hypertension (BP more than 140/90 mm Hg) alone or in various combinations was present in 378 ( 82.8%) cases. Case fatality at 28 days after the FES stroke was 29.8%. Of 320 surviving patients 38.5% had moderate to severe disability. CONCLUSIONS WHO STEPs stroke surveillance Instrument is simple to use and, practical for community surveys. The data are useful for planning stroke prevention campaigns on public awareness and education with regard to diet, exercise, blood pressure control and early symptoms of minor strokes.
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Affiliation(s)
- P M Dalal
- Lilavati Hospital and L. K. M. M. Trust Research Centre, A-791, Bandra Reclamation, Mumbai-400 050, India
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Dalal P, Malik S, Bhattacharjee M, Trivedi N, Vairale J, Bhat P, Deshmukh S, Khandelwal K, Mathur V. Population-Based Stroke Survey in Mumbai, India: Incidence and 28-Day Case Fatality. Neuroepidemiology 2008; 31:254-61. [DOI: 10.1159/000165364] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2008] [Accepted: 07/19/2008] [Indexed: 11/19/2022] Open
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Dalal P, Bhattacharjee M, Vairale J, Bhat P. UN millennium development goals: Can we halt the stroke epidemic in India? Ann Indian Acad Neurol 2007. [DOI: 10.4103/0972-2327.34791] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [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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Dalal PM, Mishra NK, Bhattacharjee M, Bhat P. Antithrombotic agents in cerebral ischaemia. J Assoc Physicians India 2006; 54:555-61. [PMID: 17089906] [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: 05/12/2023]
Abstract
The current evidence suggests that aspirin is treatment of choice when compared to anticoagulants for patients with non-cardioembolic stroke. The usefulness of combination therapy (aspirin vs. with or without warfarin) is still debated. Likewise the combination of Aspirin with clopidogrel has no added advantage (MATCH Trial). However anticoagulant therapy significantly benefits high-risk patients with atrial fibrillation in the elderly subjects whereas aspirin may still be the drug of choice in stroke prevention in low risk group in the younger age. There is dire need for well planned randomized double blind controlled studies to define the role of Antithrombotic agents in "cryptogenic stroke" (PFO/ASD related) antiphospholipid antibody syndrome, arterial dissections and intraluminal clot syndromes. Evaluation and treatment of associated risk factors in all categories needs greater emphasis.
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Affiliation(s)
- P M Dalal
- LKMM Trust Research Centre at Lilavati Hospital, Bandra Reclamation, Mumbai
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Bhat P, Anderson D. P.013 Vectorial export of hepatitis B virus. J Clin Virol 2006. [DOI: 10.1016/s1386-6532(06)80197-6] [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]
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Bhat P, Anderson D. O.136 HBV translocates across placental trophoblasts. J Clin Virol 2006. [DOI: 10.1016/s1386-6532(06)80130-7] [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]
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Abstract
OBJECTIVES To study the clinical profile of snake envenomation in a tertiary referral north Indian hospital. METHODS Retrospective case note analysis of all cases of snakebite admitted to the medical emergency from January 1997 to December 2001. RESULTS Of a total of 142 cases of snakebite there were 86 elapid bites presenting with neuroparalytic symptoms and 52 viper bites having haemostatic abnormalities. Some 60.6% of the cases of snakebite occurred when the patient was asleep. Urban to rural ratio was 1:4.7 and male to female ratio was 4.25:1. Median time to arrival at our hospital after the bite was nine hours and mean duration of hospital stay was eight days. Twenty seven cases had acute renal failure and 75% of all elapid bites required assisted ventilation. Seventeen of 119 patients who received antivenom had an adverse event. The average dose of antivenom was 51.2 vials for elapid bites and 31 vials for viper bites. Overall mortality rate was 3.5%. CONCLUSION Snakebites are common in the rural population of developing countries. There is a need to educate the public about the hazards of snakebite, early hospital referral, and treatment.
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Affiliation(s)
- N Sharma
- Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
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King J, Hamil T, Creighton J, Wu S, Bhat P, McDonald F, Stevens T. Structural and functional characteristics of lung macro- and microvascular endothelial cell phenotypes. Microvasc Res 2004; 67:139-51. [PMID: 15020205 DOI: 10.1016/j.mvr.2003.11.006] [Citation(s) in RCA: 175] [Impact Index Per Article: 8.8] [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: 09/11/2003] [Indexed: 01/04/2023]
Abstract
Lung macro- and microvascular endothelial cells exhibit unique functional attributes, including signal transduction and barrier properties. We therefore sought to identify structural and functional features of endothelial cells that discriminate their phenotypes in the fully differentiated lung. Rat lung macro- (PAEC) and microvascular (PMVEC) endothelial cells each exhibited expression of typical markers. Screening for reactivity with nine different lectins revealed that Glycine max and Griffonia (Bandeiraea) simplicifolia preferentially bound microvascular endothelia whereas Helix pomatia preferentially bound macrovascular endothelia. Apposition between the apical plasmalemma and endoplasmic reticulum was closer in PAECs (8 nm) than in PMVECs (87 nm), implicating this coupling distance in the larger store operated calcium entry responses observed in macrovascular cells. PMVECs exhibited a faster growth rate than did PAECs and, once a growth program was initiated by serum, PMVECs sustained growth in the absence of serum. Thus, PAECs and PMVECs differ in their structure and function, even under similar environmental conditions.
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Affiliation(s)
- Judy King
- Department of Pathology, Center for Lung Biology, The University of South Alabama College of Medicine, Mobile, AL 36617, USA
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Bhat P. Nocardia asteroides keratitis in south India. Indian J Med Microbiol 2003; 21:219-20; author reply 220. [PMID: 17643029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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Chowta KN, Chowta MN, Bhat P, Adhikari PMR. An open comparative clinical trial to assess the efficacy and safety of losartan versus enalapril in mild to moderate hypertension. J Assoc Physicians India 2002; 50:1236-9. [PMID: 12568205] [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: 02/28/2023]
Abstract
OBJECTIVES To compare the efficacy and safety of losartan with enalapril, in mild to moderate hypertension. METHODS An open, enalapril controlled study was conducted in 30 patients with mild to moderate hypertension. Losartan 50 mg was administered to patients for eights weeks. Throughout the study blood pressure was measured every two weeks. Routine laboratory investigations were performed before entering the trial, fourth week and at the end of the study. Adverse effects were recorded. After eight weeks losartan was stopped and enalapril 10 mg daily was administered to the same patients after two weeks washout period. The same methodology that was followed for losartan trial was repeated for enalapril trial also. RESULTS Losartan treatment resulted in a highly significant reduction in the mean sitting diastolic blood pressure. Comparison with enalapril showed that both drugs are equally efficacious in reducing blood pressure in mild to moderate hypertension. The percentage of responders was slightly more with losartan than enalapril (86.7% vs 76.7%). Adverse events reported with losartan were mild. Enalapril also was well tolerated like losartan but there was high incidence of dry cough, which was reported in nine patients (30%). CONCLUSIONS Losartan is an effective antihypertensive drug with an excellent safety and tolerability profile. It shows similar blood pressure lowering efficacy to that of enalapril. In contrast to enalapril, losartan does not cause dry cough.
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Affiliation(s)
- K N Chowta
- Department of Medicine, Kasturba Medical College, Mangalore
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Bhat P. Isolation and identification of Aeromonas from patients with acute diarrhoea in Kolkata, India. Indian J Med Microbiol 2002; 20:229-30; author reply 230. [PMID: 17657081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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Bhat P. Isolation and Identification of Aeromonas from Patients with Acute Diarrhoea in Kolkata, India. Indian J Med Microbiol 2002. [DOI: 10.1016/s0255-0857(21)03201-1] [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: 11/26/2022]
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