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Context: While prescribing an inhaler device, it is important to take into account the usability, preference, confidence, and satisfaction of the patients. Aims: The present study assessed these parameters with Revolizer ® , a novel dry powder inhaler (DPI), in patients with obstructive airway diseases and in device-naïve healthy participants. Settings and Design: In this open-label, prospective, multicentre study with 100 participants [n = 50 healthy participants, n = 45 mild asthma patients, and n = 5 mild chronic obstructive pulmonary disease (COPD) patients], all participants were instructed and trained on the use of Revolizer and then the participants subsequently demonstrated the inhalation technique at two visits. Materials and Methods: The average time required to execute three correct consecutive attempts and the number of errors (including critical errors) were recorded. Participants were asked about the ease of use, preference, confidence, and satisfaction by means of a questionnaire at each visit. Results: The average time required by the participants to achieve three correct consecutive attempts at visit 1 was 3.75 ± 2.10 min, which significantly reduced at visit 2 (3.07 ± 1.32 min, P < 0.01). The number of errors decreased from visit 1 to visit 2. More than 85% participants found the Revolizer easy to use, and it was preferred by more than 75% participants. Revolizer scored high on the confidence and satisfaction of all participants at both visits. Conclusions: Revolizer is an easy-to-use and a preferred device in patients with mild asthma and COPD, as well as in healthy participants with no previous experience of using inhalation devices. The participants felt confident and satisfied using the Revolizer.


Zilov A.,Moscow State University | Naggar N.E.,Hai Aljamea Hospital | Shah S.,Bhatia Hospital | Shen C.,Novo Nordisk AS | Haddad J.,Prince Hamazah Hospital
Diabetes Research and Clinical Practice | Year: 2013

Aims: This subgroup analysis of the A1chieve study examined data from 15,545 people who started treatment with insulin detemir±oral glucose-lowering drugs in routine clinical care. Methods: A1chieve was a 24-week, international, prospective, non-interventional study of people with type 2 diabetes from non-Western nations starting treatment with basal insulin detemir, bolus insulin aspart or biphasic insulin aspart 30, alone or in combination, to evaluate their safety and effectiveness in routine clinical practice. Results: HbA1c for the global cohort improved after 24 weeks from 9.5±1.6% by -2.0±1.6% [80±17 by -22±17 mmol/mol] (-2.1±1.6% [-23±17 mmol/mol] for insulin-naïve participants; -1.6±1.7% [-17±19 mmol/mol] for prior insulin users). Fasting plasma glucose and postprandial plasma glucose were also significantly reduced (p<0.001), irrespective of prior therapy or geographical region. The incidence of major hypoglycaemia decreased significantly over 24 weeks in both the insulin-naïve and insulin-experienced groups (p<0.0001). Mean body weight decreased overall by -0.4±4.0kg and blood pressure, lipid profiles, and self-reported quality of life improved over 24 weeks for all people starting treatment with insulin detemir. Conclusion: People with type 2 diabetes in poor glycaemic control starting treatment with insulin detemir reported significant improvements in glycaemic control with improved treatment tolerability, irrespective of prior treatment and geographical region, after 24 weeks. © 2013 .


Gore P.P.,Bhatia Hospital
Journal International Medical Sciences Academy | Year: 2013

Anal fissure is one of the commonest pathologies of the anal canal with agony of symptoms out of proportion compared to the size of the wound. Though the etiology remails controversial, spasm of the internal anal sphincter (IAS) muscle plays a central role. Treatment is therefore aimed to relieve IAS spasm. Severe headache is the major drawback & deterrent of compliance in Chemical Sphincterolysis. LIPS (Lateral Internal Partial Sphincterotomy - a terminology used by us to precisely describe the surgical procedure) of the IAS muscle is the proven gold standard treatment for anal fissures but a permanent sphincter damage renders the patient to higher chances of incontinence especially in multiparous females. Botox relieves IAS spasm by its temporary chemical denervation action, produces symptomatic relief and induces healing of the anal fissure. The present article gives a brief description of patho-physiology, various modalities of treatment & an overview of Botulinum Toxin (BT) treatment with personal experience in Indian patients with anal fissures.


Abraham W.T.,Ohio State University | Decaux G.,Erasme University Hospital | Josiassen R.C.,Drexel University | Yagil Y.,Ben - Gurion University of the Negev | And 5 more authors.
Kidney International | Year: 2012

Hyponatremia is the most common electrolyte disorder in clinical practice. Its incidence increases with age and it is associated with increased morbidity and mortality. Recently, the vaptans, antagonists of the arginine vasopressin pathway, have shown promise for safe treatment of hyponatremia. Here we evaluated the efficacy, safety, and tolerability of oral lixivaptan, a selective vasopressin V2-receptor antagonist, for treatment of nonhospitalized individuals with euvolemic hyponatremia (sodium less than 135 mmol/l) in a multicenter, randomized, double-blind, placebo-controlled, phase III study. About half of the 206 patients were elderly in a chronic care setting. Of these patients, 52 were given a placebo and 154 were given 25-100 mg per day lixivaptan, titrated based on the daily serum sodium measurements. Compared with placebo (0.8 mmol/l), the serum sodium concentration significantly increased by 3.2 mmol/l from baseline to day 7 (primary efficacy endpoint) with lixivaptan treatment. A significantly greater proportion of patients that received lixivaptan achieved normal serum sodium (39.4%) by day 7 relative to placebo (12.2%). Overall, lixivaptan was considered safe and well-tolerated. Thus, oral lixivaptan can be safely initiated in the outpatient setting and effectively increases serum sodium concentrations in outpatients with euvolemic hyponatremia. © 2012 International Society of Nephrology.


Hussain M.,Bhatia Hospital | Balsara K.P.,Bhatia Hospital | Nagral S.,The Surgical Center
National Medical Journal of India | Year: 2012

The reuse of medical devices marked as 'single use' by manufacturers has been going on for several decades. The process has been rationalized and legislated in the West as well as in Japan. However, the practice continues in an unregulated manner in India due to a paucity of guidance from the Food and Drug Administration in India. We trace the evolution of reuse policies, look at the prevalent practices in the Indian and international contexts, analyse the available Indian literature and address the ethical and economic implications of reuse. We also suggest some guidelines which may be adopted to formulate policies. © The National Medical Journal of India 2012.


Patel R.R.,Byl Nair Hospital And Tn Medical College | Patel R.R.,Bhatia Hospital
Mens Sana Monographs | Year: 2015

The present article traces the formation of the Indian Psychiatric Society and the progress of post-graduate training in psychiatry in India in general and Mumbai in particular. It covers the standard of psychiatric education, the goals and recommendations for improvisation of residency programmes, and the future of post-graduate psychiatric training.


Iyer R.K.,Bhatia Hospital | Joshi J.M.,Byl Nair Hospital
Journal of Association of Physicians of India | Year: 2013

Cough is a commonly frequent debilitating symptom that is often viewed as an intractable problem. However, specialist cough clinics report very high success rate, in the order of 90%.6 The key to successful management is to establish a diagnosis and treat the cause. Idiopathic cough is rare and commonly misdiagnosed, because of the failure to recognize that cough is often caused from sites outside the airway. Asthma, gastric reflux and rhinitis are common causes from three different anatomical areas and the realms of different specialists.1 This problem is complicated by the frequently atypical presentation of patients with cough. Thus, patients with cough-predominant asthma may not exhibit bronchoconstriction, and patients with reflux-associated cough may have no associated reflux symptoms such as heartburn1. Hence, this warrants a detailed history and evaluation to reach a diagnosis for successful treatment. The following article aims to provide a framework for a logical approach, for patients with this highly disabling symptom.


Lakdawala P.D.,Bhatia Hospital
Mens Sana Monographs | Year: 2015

The paper discusses the issue of doctor-patient relationship in view of a changing world with special emphasis on mental health professionals. It takes into account transference and counter-transference issues in doctor-patient relationships. It deals with issues pertaining to consent and liabilities, confidentiality and patient protection. Role of a psychiatrist as a leader in the art of communication is touched upon. In the end issues about professional fees and ethics too is dealt with.


Shah P.,Bhatia Hospital | Adlakha A.,Bhatia Hospital
Journal of Minimal Access Surgery | Year: 2014

Objectives: To assess the feasibility of laparoscopic surgery in cases of moderate-severe endometriosis. Materials and Methods: A prospective study was carried out in a tertiary centre over a period of 2 years. Moderate to severe endometriosis was defined by revised American fertility society (rAFS) classification (41 patients). Various procedures were done to provide symptomatic relief. Feasibility of laparoscopic surgery and various patient parameters were analysed. Results: Various procedures like adhesiolysis in POD, excision of endometriomas, resection of endometriotic nodules in the recto-vaginal septum, ureterolysis and total laparoscopic hysterectomy with/without oophorectomy were done. Majority of patients underwent cystectomy for endometriomas (53.6%) or adhesiolysis with excision of endometriotic nodule (36.5%). Total laparoscopic hysterectomy with or without ooperectomy was done in 31.7% patients. Of the total 9 patients with primary infertility and moderate-severe endometriosis, 5 patients (55.5%) conceived after surgery. Conclusion: There is good evidence that in experienced hands laparoscopic surgery helps in long-term symptomatic relief, improves pregnancy rates and reduces recurrence of disease with largely avoiding complications.


Doctor N.,Jaslok Hospital and Research Center | Philip S.,Jaslok Hospital and Research Center | Gandhi V.,Jaslok Hospital and Research Center | Hussain M.,Bhatia Hospital | Barreto S.G.,Flinders Medical Center
World Journal of Gastroenterology | Year: 2011

AIM: To analyze outcomes of delayed single-stage necrosectomy after early conservative management of patients with infected pancreatic necrosis (IPN) associated with severe acute pancreatitis (SAP). METHODS: Between January 1998 and December 2009, data from patients with SAP who developed IPN and were managed by pancreatic necrosectomy were analyzed. RESULTS: Fifty-nine of 61 pancreatic necrosectomies were performed by open surgery and 2 laparoscopically. In 55 patients, single-stage necrosectomy could be performed (90.2%). Patients underwent surgery at a median of 29 d (range 13-46 d) after diagnosis of acute pancreatitis. Sepsis and multiple organ failure accounted for the 9.8% mortality rate. Pancreatic fstulae (50.8%) predominantly accounted for the morbidity. The median hospital stay was 23 d, and the median interval for return to regular activities was 110 d. CONCLUSION: This series supports the concept of delayed single-stage open pancreatic necrosectomy for IPN. Advances in critical care, antibiotics and interventional radiology have played complementary role in improving the outcomes. © 2011 Baishideng. All rights reserved.

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