Digumarti R.,Nizam's Institute of Medical Sciences |
Bapsy P.P.,Apollo Hospitals |
Suresh A.V.,Yashoda Hospital |
Bhattacharyya G.S.,Orchid Nursing Home |
And 3 more authors.
Lung Cancer | Year: 2014
Objective: Bavituximab is a phosphatidylserine (PS)-targeting monoclonal antibody with immune-modulating and tumor-specific vascular targeting properties. Preclinical studies have shown activity against numerous solid tumors and at least an additive effect in combination with chemotherapy. This study evaluated bavituximab in combination with paclitaxel and carboplatin in patients with previously untreated, locally advanced or metastatic non-small-cell lung cancer (NSCLC). Patients and methods: This phase II, open-label study (NCT00687817) was conducted in 49 patients with stage IIIB/IV NSCLC utilizing a Simon two-stage design. Patients were treated with up to six cycles of carboplatin area under the concentration-time curve (AUC) 5 plus paclitaxel 175mg/m2 every 21 days with weekly bavituximab 3mg/kg followed by bavituximab monotherapy until progression or unacceptable toxicity. Results: The primary efficacy endpoint of overall response rate (ORR) was 40.8% (complete response [CR] 2.0%, partial response [PR] was 38.8%). Median progression-free survival (PFS) and overall survival (OS) were 6.0 and 12.4 months, respectively. Treatment-related adverse events (AEs) occurred in 40.8% of patients. The most common treatment-related AEs were anemia (10.2%), asthenia, vomiting, paresthesia, anorexia, and fatigue (6.1% each). One patient with a central, cavitating squamous tumor developed fatal hemoptysis and aspiration. Conclusion: Bavituximab in combination with paclitaxel-carboplatin as first-line therapy demonstrated a tolerable safety profile and potential efficacy in this single-arm phase II trial in patients with advanced local or metastatic NSCLC. Randomized trials with this regimen are in progress. ClinicalTrials.gov identifier: NCT00687817. © 2014 Elsevier Ireland Ltd.
Amte R.,Yashoda Hospital |
Munta K.,Yashoda Hospital |
Gopal P.B.,Care Hospital
Indian Journal of Critical Care Medicine | Year: 2015
Background: Doctors working in critical care units are prone to higher stress due to various factors such as higher mortality and morbidity, demanding service conditions and need for higher knowledge and technical skill. Aim: The aim was to evaluate the stress level and the causative stressors in doctors working in critical care units in India. Materials and Methods: A two modality questionnaire-based cross-sectional survey was conducted. In manual mode, randomly selected delegates attending the annual congress of Indian Society of Critical Care Medicine filled the questionnaire. In the electronic mode, the questionnaires were E-mailed to critical care doctors. These questionnaires were based on General Health Questionnaire-12 (GHQ-12). Completely filled 242 responses were utilized for comparative and correlation analysis. Results: Prevalence of moderate to severe stress level was 40% with a mean score of 2 on GHQ-12 scale. Too much responsibility at times and managing VIP patients ranked as the top two stressors studied, while the difficult relationship with colleagues and sexual harassment were the least. Intensivists were spending longest hours in the Intensive Care Unit (ICU) followed by pulmonologists and anesthetists. The mean number of ICU bed critical care doctors entrusted with was 13.2 ± 6.3. Substance abuse to relieve stress was reported as alcohol (21%), anxiolytic or antidepressants (18%) and smoking (14%). Conclusion: Despite the higher workload, stress levels measured in our survey in Indian critical care doctors were lower compared to International data. Substantiation of this data through a wider study and broad-based measures to improve the quality of critical care units and quality of the lives of these doctors is the need of the hour. © 2015, Medical Knowledge. All rights reserved.
Wadhwa V.,Yashoda Hospital |
Rai S.,Yashoda Hospital |
Thukral T.,UCMS and GTB Hospital |
Chopra M.,Yashoda Hospital
Indian Journal of Medical Microbiology | Year: 2012
This review attempts to clarify the concepts of Laboratory Quality Management System (Lab QMS) for a medical testing and diagnostic laboratory in a holistic way and hopes to expand the horizon beyond quality control (QC) and quality assurance. It provides an insight on accreditation bodies and highlights a glimpse of existing laboratory practices but essentially it takes the reader through the journey of accreditation and during the course of reading and understanding this document, prepares the laboratory for the same. Some of the areas which have not been highlighted previously include: requirement for accreditation consultants, laboratory infructure and scope, applying for accreditation, document preparation. This section is well supported with practical illustrations and necessary tables and exhaustive details like preparation of a standard operating procedure and a quality manual. Concept of training and privileging of staff has been clarified and a few of the QC exercises have been dealt with in a novel way. Finally, a practical advice for facing an actual third party assessment and caution needed to prevent post-assessment pitfalls has been dealt with.
Deenadayal D.S.,Yashoda Hospital |
kumar M.N.,Yashoda Hospital |
Sudhakshin P.,Yashoda Hospital |
Hameed S.,Yashoda Hospital
Indian Journal of Otolaryngology and Head and Neck Surgery | Year: 2014
To evaluate the treatment of hypertrophy of inferior turbinates in patients diagnosed with allergic/non allergic rhinitis with the use of radiofrequency ablation technique. Ablation with radiofrequency was used in this study on the inferior turbinates of 200 patients diagnosed as allergic/non allergic rhinitis at our institution between January 2006 and December 2009. The results were evaluated subjectively by changes in pre and post operative symptoms, size of inferior turbinate, postoperative pain and assessment of ciliary function. Four patients (2%) at the end of 6 months and 4 patients (2%) at the end of 12 months reported persistent symptom of nasal obstruction. No patient reported nasal discharge, 28 patients (14%) at 6 months, 20 patients (10%) at 24 months reported persistence of sneezing. 8 patients (4%) at 6 months, 4 patients (2%) at 24 months reported persistence of snoring, no patient complained of persistence of hyposmia. 4 patients (2%) at 6 months, no patient at 24 months complained of crusting, no patient complained of bleeding at 6, 24 months. No alteration of ciliary function and anatomy of the inferior turbinate mucosa was noticed. These results suggests that ablation with radiofrequency is an easily applied, efficient and reliable technique in the treatment of hypertrophied inferior turbinate in allergic/non allergic rhinitis patients with no changes in the ciliary function and necrosis/atrophy of inferior turbinate. © 2012 Association of Otolaryngologists of India.
Manimala Rao S.,Yashoda Hospital |
Munta K.,Yashoda Hospital
Current Respiratory Medicine Reviews | Year: 2015
For the past three to four decades, the onset of acute respiratory distress syndrome (ARDS) has brought substantial insight into its epidemiology and pathophysiology. It is characterised by an acute lung injury resulting in widespread pulmonary oedema due to increased alveolar capillary permeability. Acute lung injury arises from the damaging effects of inflammatory mediators. Treatment of ARDS involves various modalities of supportive care categorised as ventilator and nonventilator measures. Berlin’s conference consensus definition of ARDS has been widely accepted in defining and categorising ARDS. The promising therapies for future include use of statins, aspirin, nebulised heparin, AdrenoMedulin, Interferon beta, Tumour necrosis factor (TNF alpha) receptor blockade, Angiotensin converting enzyme and keratinocytes growth factors. © 2015 Bentham Science Publishers.
Kujur R.,Yashoda Hospital |
Rao S.M.,Yashoda Hospital |
Badwaik G.,Yashoda Hospital |
Paraswani R.,Yashoda Hospital
Indian Journal of Critical Care Medicine | Year: 2012
Background and Aims: Central venous catheters (CVC) are essential in a critical care setting. Thrombosis is one of the very important associated complications that can lead to increased morbidity and mortality. The aim of this study was to find out the incidence of thrombosis in right-sided internal jugular vein (IJV) CVC with the help of color Doppler duplex sonography, its extent, risk factors and clinical impact. Materials and Methods: One hundred consecutive patients having right-sided IJV CVC were included in the study. Color Doppler sonography was performed on the 3 rd and 6 th days after CVC insertion. The size of the thrombus was noted. Presence of diabetes mellitus, hypertension or smoking was noted. Presence of any hypertonic solution and thromboprophylaxis for Deep vein thrombosis (DVT) were also noted. Results: Thrombus was detected in 33 of 100 (33.0%) patients. The incidence in males was 32.86% and in females was 33.33%. Males had a significantly higher incidence of small thrombus (P = 0.05), whereas females had a significantly higher incidence of large thrombus (P = 0.05). DVT thromboprophylaxis was not effective for CVC-related thrombosis. Hypertonic solution, presence of diabetes, hypertension or history of smoking did not increase the risk of thrombosis. Conclusion: CVC-related thrombosis is common and has the potential for serious complications. Females appear to be at a higher risk for larger thrombus formation. DVT thromboprophylaxis does not confer protection for CVC-related thrombosis. Color Doppler duplex sonography provides with an easily available, noninvasive means of detecting a thrombus. More studies are needed to establish a consensus for prophylaxis and treatment of asymptomatic CVC-related thrombosis.
Bhambhani A.,Yashoda Hospital |
Somanath H.S.,Yashoda Hospital
Journal of Invasive Cardiology | Year: 2012
Most cases of combination congenital cardiac anomalies are treated with open-heart surgeries because the coexisting anomalies change the cardiac anatomy in an adverse way, making catheter manipulations complex. Lutembacher syndrome is a combination of acquired mitral stenosis and congenital ostium secundum atrial septal defect. The large defect in the septum makes an Inoue balloon catheter unstable, which provides excessive space for free floatation of the catheter, making its passage into the left ventricle difficult by Inoue technique. We present a case of elective definitive percutaneous treatment of Lutembacher syndrome, discussing the technical difficulties faced in mitral valve crossing and reviewing the possible strategies to improve chances of success.
Kalidass B.,Yashoda Hospital |
Sunnathkal R.,Yashoda Hospital |
Rangashamanna V.,Yashoda Hospital |
Paraswani R.,Yashoda Hospital
Journal of Neuroimaging | Year: 2012
Case History: Wernicke's encephalopathy is a metabolic disorder caused by deficiency of thiamine (vitamin B1) seen in alcoholics and even in nonalcoholic patients, classically presenting with a triad of ataxia, ophthalmoplegia, and altered mental status. Typical findings in magnetic resonance imaging are represented by symmetric signal alterations in medial thalami, mamillary bodies, tectal plate, and periaqueductal area and atypical findings involve lesions in cerebellum, midline vermis, red nuclei, dentate, caudate, cranial nerve nuclei, splenium and cerebral cortex. We report here a case of nonalcoholic starvation induced atypical WE showing symmetrical lesions in substantia nigra in addition to the classical neuroradiological findings. © 2010 by the American Society of Neuroimaging.
Venkategowda P.M.,Yashoda Hospital |
Rao S.M.,Yashoda Hospital |
Mutkule D.P.,Yashoda Hospital |
Taggu A.N.,Yashoda Hospital
Indian Journal of Critical Care Medicine | Year: 2014
Background: Intra-hospital transport of critically ill patients is a challenging task. However, despite the improvements in intra-hospital transport practices, adverse event incidents remain high and constitute a significant risk for the transport of the critically ill ICU patients. Objectives: To observe the number and types of unexpected-events (UEs) occurring during intra-hospital transport of critically ill ICU patients. Interventions provided along with outcome. Materials and Methods: This was a prospective observational study of 254 intra-hospital critically-ill ICU patients of our hospital transported for diagnostic purposes during April 2012 - March 2013. The escorting intensivist completed the data of unexpected events during transport. Results: A total of 254 patients were observed prospectively for UEs during intra-hospital transfer of critically ill patients. The overall UEs observed were 139 among 64 patients. Among the UEs which occurred, the maximum were miscellaneous causes [89 (64.00%)] like oxygen probe [38 (27.33%)] or ECG lead displacement [27 (19.42%)]. Major events like fall in spo2 >5% observed in 15 (10.79%) patients, BP variation > 20% from baseline in 22 (15.82%) patients, altered mental status in 5 (3.59%), and arrhythmias in 6 (4.31%) patients. Among 64 (100%) patients with UEs, 3 (2.15%) patients with serious adverse events have been aborted from transport. Conclusion: Unexpected-events (UEs) are common during transport of critically ill ICU patients and these adverse events can be reduced when critically ill patients are accompanied by intensivist/medically qualified person during transport and following strict transport guidelines.
Nair A.S.,Yashoda Hospital
Anaesthesia, Pain and Intensive Care | Year: 2013
Patients with pulmonary hypertension often have adverse outcomes after anesthesia. Tachycardia, hypertension, hypervolemia, increased intrathoracic pressure, acidosis, painful stimuli and hyperthermia are triggering factors for adverse perioperative events. Dexmedetomidine is a centrally acting α2 agonist which, due to its desirable properties like sympatholysis, bradycardia and μ agonism, can be a useful agent for patients with pulmonary hypertension. Dexmedetomidine also has the ability to potentiate inhalational, intravenous and regional anesthetics when it is used as an adjunct.