Liepe K.,GH Hospital Frankfurt Oder |
Shinto A.,Kovai Medical Center and Hospital
Therapeutic Advances in Medical Oncology | Year: 2016
Patients with hormone-refractory prostate cancer often have multiple bone metastases. The resulting bone pain is associated with reduced life quality, increased cost of therapy and impairment of overall survival. Trials with bone-targeting β-emitters have mostly showed an effect on alleviation of bone pain along with prolongation in survival, documented in only a limited number of patients. A randomized phase III trial (ALSYMPCA) using the α-emitter 223RaCl2 (Xofigo®) showed for the first time, a longer overall survival of 3.6 months in treated patients as a sign of an antitumor effect. The time to first skeletal-related events was also significantly longer in the therapy group compared with placebo. Because of the short range of α-emitter, the bone marrow toxicity of radium therapy is low, and so this radionuclide could also be a candidate for combination with chemotherapy. The elimination of 223RaCl2 is mainly through the gastrointestinal tract and side effects are mainly in this area. The procedure is similar to treatment with other bone-seeking agents and consists of six administrations of 50 kBq/kg bodyweight Xofigo®, repeated every 4 weeks. At present Xofigo® is only approved for hormone-refractory prostate cancer. © SAGE Publications.
Alexander T.,Kovai Medical Center and Hospital |
Victor S.M.,Madras Medical Mission Hospital |
Mullasari A.S.,Madras Medical Mission Hospital |
Veerasekar G.,Kovai Medical Center and Hospital |
And 2 more authors.
BMJ Open | Year: 2013
Introduction: Over the past two decades, India has witnessed a staggering increase in the incidence and mortality of ST-elevation myocardial infarction (STEMI). Indians have higher rates of STEMI and younger populations that suffer from it when compared with developed countries. Yet, the recommended reperfusion therapy with fibrinolysis and percutaneous coronary intervention is available only to a minority of patients. This gap in care is a result of financial barriers, limited healthcare infrastructure and poor knowledge and accessibility of acute medical services for a majority of its population. Methods and analysis: This is a prospective, multicentre, 'pretest/post-test' quasi-experimental, community-based study. This programme will use a 'hub-and-spoke' model of an integrated healthcare network based on clusters of primary-care health clinics, small hospitals and large tertiary-care facilities. It is an 'all-comers' study which will enrol consecutive patients presenting with STEMI to the participating hospitals. The primary objectives of the study is to improve the use of reperfusion therapy and reduce the time from first medical contact to device or drug in STEMI patients; and to increase the rates of early invasive risk stratification with coronary angiography within 3-24 h of fibrinolytic therapy in eligible patients through changes in process of care. Outcomes will be measured with statistical comparison made before and after implementing the TN-STEMI programme. The estimated sample size is based on the Kovai Erode Pilot study, which provided an initial work on establishing this type of programme in South India. It will be adequately powered at 80% with a superiority margin of 10% if 36 patients are enrolled per cluster or 108 patients in three clusters. Thus, the enrolment period of 9 months will result in a sample size of 1500 patients. Ethics: This study will be conducted in accordance with the ethical principles that have their origin in the current Declaration of Helsinki and 'ethical guidelines for biomedical research on human participants' as laid down by the Indian Council for Medical Research. All participating hospitals will still obtain local ethics committee approval of the study protocol and written informed consent will be obtained from all participants. Dissemination and results: Our findings will be reported through scientific publications, research conferences and public policy venues aimed at state and local governments in India. If successful, this model can be extended to other areas of India as well as serve as a model of STEMI systems of care for low-income and middle-income countries across the world. Registration: Trial is registered with Clinical trial registry of India, No: CTRI/2012/09/003002.
Singh D.,Kovai Medical Center and Hospital |
Darbari A.,All India Institute of Medical Sciences
Interactive Cardiovascular and Thoracic Surgery | Year: 2014
The entrapment, fracture and dislodgement of diagnostic or therapeutic devices within the coronary circulation during a procedure are a rare complication occurring in 0.2-0.8% of cases. Despite technological improvements, this complication is still occurring because coronary angioplasty is often undertaken for complex anatomical situations. The complication of device fracture during the intervention procedure occurs due to entrapment, overcoiling and excessive traction of the guide wire. There has been no agreement as to whether and by which technique the immediate removal of the broken fragment of guide wire should be done. Here, we report a case of anterolateral myocardial infarction who underwent primary percutaneous coronary intervention. During the procedure, the guide wire was entrapped within the left anterior descending coronary artery. Despite many attempts, the wire could not be removed and even became fractured at the femoral insertion site; thus, urgent surgical removal of the wire with vessel grafting was done with a successful outcome. This gives a clear message about the importance of the ready availability of surgical backup and, particularly, the necessity for complex percutaneous interventions. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
Swaminathan K.,Kovai Medical Center and Hospital
British Journal of Diabetes and Vascular Disease | Year: 2015
Aim: To assess prescribing practices and patient awareness of issues relating to hypoglycaemia in a South Indian population. Methods: A standard questionnaire was administered to one hundred consecutive patients with diabetes attending the Diabetes Clinic at Apollo Specialty Hospital, Madurai, India. All data were tabulated and analysed using Microsoft Excel 2007. Results: There was a predominance of sulphonylurea use, in combination with oral agents and insulin. Nearly 60% of patients reported that their doctor never talked about hypoglycaemia during clinic visits. At least 20% of patients had at least one hospital admission related to a hypoglycaemic event since the diagnosis of diabetes. More than a third of patients were not aware of symptoms of hypoglycaemia nor did they know how to manage the symptoms. Conclusions: Medical professionals in India need to do more to educate patients about issues relating to hypoglycaemia, its importance, awareness and appropriate management.
Dhiwakar M.,Kovai Medical Center and Hospital |
Nambi G.I.,Kovai Medical Center and Hospital |
Ramanikanth T.V.,Kovai Medical Center and Hospital
European Archives of Oto-Rhino-Laryngology | Year: 2014
Chylous fistula following neck dissection is difficult to treat. We hypothesized that timely removal of the suction drain followed by daily aspiration might aid in resolution of the condition. The study model is prospective cohort study. Out of 170 consecutive neck dissections, 7 (4 %) developed chylous fistula postoperatively. Retaining the suction drain was associated with resolution of the fistula in only one case. The remaining six had peak 24 h outputs between 85 and 675 ml that showed no significant fall despite maximal conservative treatment. Suction drain removal followed by daily needle aspiration however led to cessation of the fistula in all six cases. No patient required surgical re-exploration. Drain removal was associated with a significant fall in the volume of chylous output (p = 0.002). In selected cases of low output chylous fistula, suction drain removal and daily needle aspiration is an effective treatment option. © 2013 Springer-Verlag Berlin Heidelberg.
Dhiwakar M.,Kovai Medical Center and Hospital
Cochrane database of systematic reviews (Online) | Year: 2012
This is an update of a Cochrane Review first published in The Cochrane Library in Issue 2, 2008 and previously updated in 2010.Tonsillectomy continues to be one of the most common surgical procedures performed in children and adults. Despite improvements in surgical and anaesthetic techniques, postoperative morbidity, mainly in the form of pain, remains a significant clinical problem. Postoperative bacterial infection of the tonsillar fossa has been proposed as an important factor causing pain and associated morbidity, and some studies have found a reduction in morbid outcomes following the administration of perioperative antibiotics. To determine whether perioperative antibiotics reduce pain and other morbid outcomes following tonsillectomy. We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 20 March 2012. All randomised controlled trials examining the impact of perioperative administration of systemic antibiotics on post-tonsillectomy morbidity in children or adults. Two authors independently collected data. Primary outcomes were pain, consumption of analgesia and secondary haemorrhage (defined as significant if patient re-admitted, transfused blood products or returned to theatre, and total (any documented) haemorrhage). Secondary outcomes were fever, time taken to resume normal diet and activities and adverse events. Where possible, we generated summary measures using random-effects models. Ten trials, comprising a pooled total of 1035 participants, met the eligibility criteria. Most did not find a significant reduction in pain with antibiotics. Similarly, antibiotics were mostly not shown to be effective in reducing the need for analgesics. Antibiotics were not associated with a reduction in significant secondary haemorrhage rates (risk ratio (RR) 0.49, 95% CI 0.08 to 3.11, P = 0.45) or total secondary haemorrhage rates (RR 0.90, 95% CI 0.56 to 1.44, P = 0.66). With regard to secondary outcomes, antibiotics reduced the proportion of patients with fever (RR 0.63, 95% CI 0.46 to 0.85, P = 0.002). The present systematic review, including meta-analyses for select outcomes, suggests that although individual studies vary in their findings, there is no evidence to support a consistent, clinically important impact of antibiotics in reducing the main morbid outcomes following tonsillectomy (i.e. pain, need for analgesia and secondary haemorrhage rates). The limited benefit apparent with antibiotics may be a result of positive bias introduced by several important methodological shortcomings in the included trials. Based on existing evidence, therefore, we would advocate against the routine prescription of antibiotics to patients undergoing tonsillectomy. Whether a subgroup of patients who might benefit from selective administration of antibiotics exists is unknown and needs to be explored in future trials.
Kamaleshwaran K.K.,Kovai Medical Center and Hospital
Clinical nuclear medicine | Year: 2013
Limbic encephalitis (LE) can be associated with cancer, viral infection, or be idiopathic. One such rare but treatable form is associated with voltage-gated potassium channel (VGKC) antibodies. Typical abnormalities are seen in FDG PET/CT. We report a 39-year-old female patient who presented with 3 months of progressive faciobrachial dystonic seizures and limbic encephalitis. Her serum and cerebrospinal fluid Lgi1 antibody titers were elevated. FDG PET/CT showed basal ganglial hypermetabolism and associated abnormalities. Serial MRI demonstrated atrophic changes predominantly involving the temporal lobes. She is on immunosuppressive therapy and shows clinical improvement with lowering of antibody titers.
Swaminathan K.,Kovai Medical Center and Hospital
Indian Journal of Pharmacology | Year: 2015
Proton pump inhibitors are the one of the most widely used drugs in the world. Hypomagnesemic hypoparathyroidism has been reported with different proton pump inhibitors with prolonged oral use. We report the first reported case of possible such effect with intravenous preparation of proton pump inhibitor. This case report raises awareness among physicians worldwide of this often unknown association, as life-threatening cardiac and neuromuscular complications can arise with unrecognized hypocalcemia and hypomagnesemia with proton pump inhibitors.
Alexander T.,Kovai Medical Center and Hospital |
Mehta S.,University of Miami |
Mullasari A.,Madras Medical Mission |
Nallamothu B.K.,University of Michigan
Heart | Year: 2012
The prevalence of coronary artery disease and ST-elevation myocardial infarction (STEMI) are increasing in India. Although recent publications have focused on improving preventive measures in developing countries, less attention has been placed on the acute management of STEMI. Recent policy changes in India have provided new opportunities to address existing barriers but require greater investment and support in the coming years.
Anagha P.P.,Kovai Medical Center and Hospital |
Sen S.,Kovai Medical Center and Hospital
Journal of Oncology | Year: 2014
Objectives. We aim to determine the efficacy of bisphosphonates in preventing aromatase inhibitor induced bone loss (AIBL) in postmenopausal women with early breast cancer. The secondary objective was to determine the safety of bisphosphonates. Materials and Methods. We searched electronic databases in a time period of 1995 January to 2013 June. Random effects meta-analytical models were used; between study heterogeneity and publication bias was assessed. Results. A total of six eligible studies reported the BMD T score of LS at 12 months and from that 3 trials of Zoledronic acid compared the change in BMD in immediate ZOL versus delayed ZOL done with subgroups like patients with normal BMD at baseline (OR = 5.402, 95% CI = 1.329-21.959, P value = 0.018) and osteopenic BMD at baseline (OR = 4.008, 95% CI = 2.249-7.143, P value = 0.0002). Both had a significant decrease in BMD that favoured the delayed ZOL; 3 trials of risedronate and ibandronate also had a significant decrease in BMD in AIs alone group. Immediate ZOL versus delayed ZOL also showed increased risk of getting an ADR in immediate group. Conclusion. Third generation bisphosphonates has an effect on BMD of patients who are on treatment of AIs in breast cancer. Furthermore, the patients treated with immediate ZOL had a significantly high risk of musculoskeletal ADR's than patients with delayed ZOL. © 2014 Pooleriveetil Padikkal Anagha and Suchandra Sen.