Publications by authors named "Jeyaseelan Lakshmanan"

70 Publications

The prevalence, severity, and risk factors for dry eye disease in Dubai - a cross sectional study.

BMC Ophthalmol 2021 May 17;21(1):219. Epub 2021 May 17.

College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE.

Background: The prevalence of dry eye disease is increasing globally and requires the attention of healthcare professionals as it worsens patients' quality of life. No published studies on the epidemiology of dry eyes have been found in Dubai.

Purpose: To describe the epidemiology, prevalence, severity, and associated factors of dry eyes in Dubai, United Arab Emirates, in 2019.

Methods: This was an analytical, cross-sectional, survey-based study. An online survey was distributed by email to Mohammed Bin Rashid University students, staff, and faculty and to the staff at Mediclinic City and Parkview Hospitals in Dubai, United Arab Emirates, from April-June 2019. The survey included demographic questions and the Ocular Surface Disease Index (OSDI).

Results: The survey was completed by 452 participants; the majority were females (288/452; 63.7 %). The prevalence of dry eyes in Dubai was estimated to be 62.6 % (283/452), with severely dry eyes being the most prevalent (119/283; 42 %). Females, high daily screen time (> 6 h), and the use of contact lenses were found to be associated with dry eyes (P-value < 0.05, 95 % confidence interval). Age was found to be negatively correlated with prevalence of dry eyes. Exposure to smoking/shisha, history of eye injury/surgery, and nationality were not associated with dry eyes.

Conclusions: This is the first cross-sectional study to investigate the prevalence of dry eyes in Dubai (62.6 %). The majority of participants had severe dry eyes symptoms. Severely dry eyes were more common among females and users of contact lenses.
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http://dx.doi.org/10.1186/s12886-021-01978-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8127306PMC
May 2021

A national level estimation of population need for blood in India.

Transfusion 2021 May 15. Epub 2021 May 15.

National AIDS Control Organization (NACO), New Delhi, India.

Background: The population need for blood is the total volume required to transfuse all the individuals who need transfusion in a defined population over a defined period. The clinical demand will arise when people with a disease or condition who require transfusion, access healthcare services, and subsequently the clinicians request blood. Essentially, the conversion of need to demand must be maximum to avoid preventable mortality and morbidity. The study estimated the population need for blood in India.

Methods: The methodology included a comprehensive literature review to determine the diseases and conditions requiring transfusion, the population at risk, and prevalence or incidence; and Delphi method to estimate the percentage of people requiring transfusion, and the quantum.

Results: The estimated annual population need was 26.2 million units (95% CI; 17.9-38.0) of whole blood to address the need for red cells and other components after the separation process. The need for medical conditions was 11.0 million units (95% CI:8.7-14.7), followed by surgery 6.6 million (95% CI:3.8-10.0), pediatrics 5.0 million (95% CI:3.5-7.0), and obstetrics and gynecology 3.6 million units (95% CI:1.9-6.2). The gap between need and demand which depends upon the access and efficiency of healthcare service provision was estimated at 13 million units.

Conclusion: The study brings evidence to highlight the gap between need and demand and the importance of addressing it. It cannot be just the responsibility of blood transfusion or health systems, it requires a multi-sectoral approach to address the barriers affecting the conversion of need to clinical demand for blood.
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http://dx.doi.org/10.1111/trf.16369DOI Listing
May 2021

Diagnostic accuracy of urinary aquaporin-1 as a biomarker for renal cell carcinoma.

Indian J Urol 2021 Jan-Mar;37(1):59-64. Epub 2021 Jan 1.

Department of Urology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.

Introduction: Optimal patient selection plays a vital role in management of renal tumors with the introduction of nephron-sparing approaches and active surveillance. A reliable and accurate diagnostic biomarker will be a useful adjunct to decision-making. We studied the diagnostic accuracy of urinary aquaporin-1 (uAQP-1), an upcoming urinary biomarker, for renal cell carcinoma.

Materials And Methods: In this prospective biomarker study, urine samples were obtained preoperatively from 36 patients with an imaged renal mass suggestive of RCC and 24 healthy age-matched controls, chosen from among voluntary kidney donors. uAQP-1 concentrations were estimated with a sensitive and specific enzyme-linked immunosorbent assay (ELISA) and normalized by estimation of urinary creatinine. The Mann-Whitney U-test was used to compare differences between any two groups. A receiver operator characteristic (ROC) curve was plotted to analyze the diagnostic accuracy of uAQP-1 for RCC.

Results: The median uAQP-1 concentration among the cases and controls was 8.78 ng/mg creatinine (interquartile range [IQR]: 5.56-12.67) and 9.52 ng/mg creatinine (IQR: 5.55-12.45), respectively. There was no significant difference in uAQP-1 concentrations between the two groups. ROC analysis showed that, for a cutoff value of 8 ng/mg creatinine, the sensitivity and specificity of uAQP-1 as a diagnostic test were 47.2% and 66.7%, respectively, and area under the curve was 0.52 (95% confidence interval: 0.42-0.62).

Conclusions: uAQP-1 concentrations did not discriminate between healthy individuals and patients with RCC. The results of this study suggest that uAQP-1 may not be a suitable diagnostic biomarker for RCC in the study population.
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http://dx.doi.org/10.4103/iju.IJU_330_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8033244PMC
January 2021

The Role of Frozen Section in the Rapid Diagnosis of Severe Cutaneous Adverse Drug Reactions.

Indian Dermatol Online J 2021 Jan-Feb;12(1):78-83. Epub 2021 Jan 16.

Department of Dermatology, Venereology and Leprosy, Christian Medical College, Vellore, Tamil Nadu, India.

Context: Early diagnosis is the mainstay in the management of severe cutaneous adverse reactions (SCARs) to drugs.

Aims: To study the role of frozen section in the rapid diagnosis of SCARs and the impact on outcome of the affected patients.

Settings And Design: A single-blind, hospital-based study was conducted from December 2014-July 2016.

Methods And Material: We biopsied 32 adults with SCARs diagnosed by clinical features and standard criteria. The histopathological features seen on frozen sections were compared to that of paraffin blocks. The impact of rapid diagnosis on the clinical outcome was studied in toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome (SJS), drug rash with eosinophilia and systemic symptoms (DRESS) and acute generalized exanthematous pustulosis (AGEP).

Statistical Analysis: Z test was used to compare two proportions. Kappa statistic, sensitivity, specificity, positive predictive value, and negative predictive value of the frozen section diagnosis were calculated in TEN/SJS and DRESS using MedCalc software.

Results: Frozen and paraffin sections were done in TEN/SJS spectrum (13), DRESS (17), and AGEP (2). The sensitivity, specificity and kappa values for frozen section diagnosis in SJS/TEN and DRESS were 91.7%, 95%, 0.867 and 94.4%, 100%, 0.937 respectively. The concordance between frozen and paraffin section diagnosis was 100% in TEN, SJS, DRESS and AGEP. All the 6 patients with TEN and 2 with AGEP survived. Taking the worst-case scenario, the mortality in SJS was 28.6%. The mortality among patients with DRESS was 11.8%.

Conclusions: Frozen section helps in the rapid diagnosis and early treatment of SCARs and differentiates it from diseases that mimic it.
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http://dx.doi.org/10.4103/idoj.IDOJ_397_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7982049PMC
January 2021

Combination of obesity and co-morbidities leads to unfavorable outcomes in COVID-19 patients.

Saudi J Biol Sci 2021 Feb 3;28(2):1445-1450. Epub 2020 Dec 3.

Ministry of Health and Prevention (MOHAP), Dubai, United Arab Emirates.

Objective: Obesity has been described as a significant independent risk factors of COVID-19. We aimed to study the association between obesity, co-morbidities and clinical outcomes of COVID-19.

Methods: Clinical data from 417 patients were collected retrospectively from the Al Kuwait Hospital, Ministry of Health and Prevention (MOHAP), Dubai, United Arab Emirates, who were admitted between March and June 2020. Patients were divided according to their body mass index (BMI). Various clinical outcomes were examined: presenting symptoms, severity, major co-morbidities, ICU admission, death, ventilation, ARDS, septic shock and laboratory parameters.

Results: The average BMI was 29 ± 6.2 kg/m. BMI alone was not associated with the outcomes examined. However, class II obese patients had more co-morbidities compared to other groups. Hypertension was the most significant co-morbidity associated with obesity. Patients with BMI above the average BMI (29 kg/m) and presence of underlying co-morbidities showed significant increase in admission to ICU compared to patients below 29 kg/m and underlying co-morbidities (21.7% Vs. 9.2%), ARDS development (21.7% Vs. 10.53%), need for ventilation (8.3% Vs. 1.3%), and mortality (10% Vs. 1.3%).

Conclusions: Our data suggests that presence of underlying co-morbidities and high BMI work synergistically to affect the clinical outcomes of COVID-19.
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http://dx.doi.org/10.1016/j.sjbs.2020.11.081DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7713568PMC
February 2021

Cerebral Venous Thrombosis, Seasonal Trends, and Climatic Influence: A Region-SpecificStudy.

Ann Indian Acad Neurol 2020 Jul-Aug;23(4):522-527. Epub 2019 Jul 11.

Department of Neurology, Christian Medical College Hospital, Vellore, Tamil Nadu, India.

Background And Purpose: Studies looking at seasonal variation on cerebral venous thrombosis (CVT) are few with conflicting conclusions. In this region-specific study, we looked for climatic influence and seasonal trends on the incidence of CVT.

Methods: Imaging proven adult CVT cases treated over a period of 18 years from a specific geographical location with similar seasons and climatic conditions were studied. Metrological parameters prepared using 30 years of data was used. Quantum geographical information system (QGIS software) and SPSS v 22 were used for patient plotting and analysis.

Results: Total of 970 cases were studied. The incidence was significantly higher in summer 411 (42.3%) compared with autumn 317 (32.7%) and winter 242 (25.05); = 0.038. This trend was consistent across all the 18 years in time series analysis. Mean age was 33.5 years (range 18-88 years). A significant majority 673 (69.4%) were below 40 years of age; = 0.012. Females constituted 394 (40.6%) of cases. Postpartum CVT cases constituted 237 (30%). Interaction analysis showed younger age (<40 years) were more vulnerable for CVT in summer; = 0.009. There was no seasonal influence on postpartum CVT. Apart for a weak positive correlation between rain fall ( = 0.18, < 0.01); humidity and cloud cover was not influencing the incidence.

Conclusions: Higher ambient temperatures were consistently associated with higher incidence of CVT. This is the largest region-specific study on CVT in the world. These results may be applicable to other regions with similar climatic conditions.
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http://dx.doi.org/10.4103/aian.AIAN_409_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7657288PMC
July 2019

Management of relapse in acute promyelocytic leukaemia treated with up-front arsenic trioxide-based regimens.

Br J Haematol 2021 01 20;192(2):292-299. Epub 2020 Nov 20.

Department of Haematology, Christian Medical College, Vellore, India.

The standard of care for patients with acute promyelocytic leukaemia (APL) relapsing after front-line treatment with arsenic trioxide (ATO)-based regimens remains to be defined. A total of 67 patients who relapsed after receiving ATO-based up-front therapy and were also salvaged using an ATO-based regimen were evaluated. The median (range) age of patients was 28 (4-54) years. While 63/67 (94%) achieved a second molecular remission (MR) after salvage therapy, three (4·5%) died during salvage therapy. An autologous stem cell transplant (auto-SCT) was offered to all patients who achieved MR, 35/63 (55·6%) opted for auto-SCT the rest were administered an ATO + all-trans retinoic acid maintenance regimen. The mean (SD) 5-year Kaplan-Meier estimate of overall survival and event-free survival of those who received auto-SCT versus those who did not was 90·3 (5·3)% versus 58·6 (10·4)% (P = 0·004), and 87·1 (6·0)% versus 47·7 (10·3)% (P = 0·001) respectively. On multivariate analysis, failure to consolidate MR with an auto-SCT was associated with a significantly increased risk of relapse [hazard ratio (HR) 4·91, 95% confidence interval (CI) 1·56-15·41; P = 0·006]. MR induction with ATO-based regimens followed by an auto-SCT in children and young adults with relapsed APL who were treated with front-line ATO-based regimens was associated with excellent long-term survival.
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http://dx.doi.org/10.1111/bjh.17221DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7894296PMC
January 2021

Demystifying the varying case fatality rates (CFR) of COVID-19 in India: Lessons learned and future directions.

J Infect Dev Ctries 2020 Oct 31;14(10):1128-1135. Epub 2020 Oct 31.

Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India.

Introduction: At the end of the second week of June 2020, the SARS-CoV-2 responsible for COVID-19 infected above 7.5 million people and killed over 400,000 worldwide. Estimation of case fatality rate (CFR) and determining the associated factors are critical for developing targeted interventions.

Methodology: The state-level adjusted case fatality rate (aCFR) was estimated by dividing the cumulative number of deaths on a given day by the cumulative number confirmed cases 8 days before, which is the average time-lag between diagnosis and death. We conducted fractional regression analysis to determine the predictors of aCFR.

Results: As of 13 June 2020, India reported 225 COVID-19 cases per million population (95% CI:224-226); 6.48 deaths per million population (95% CI:6.34-6.61) and an aCFR of 3.88% (95% CI:3.81-3.97) with wide variation between states. High proportion of urban population and population above 60 years were significantly associated with increased aCFR (p=0.08, p=0.05), whereas, high literacy rate and high proportion of women were associated with reduced aCFR (p<0.001, p=0.03). The higher number of cases per million population (p=0.001), prevalence of diabetes and hypertension (p=0.012), cardiovascular diseases (p=0.05), and any cancer (p<0.001) were significantly associated with increased aCFR. The performance of state health systems and proportion of public health expenditure were not associated with aCFR.

Conclusions: Socio-demographic factors and burden of non-communicable diseases (NCDs) were found to be the predictors of aCFR. Focused strategies that would ensure early identification, testing and effective targeting of non-literate, elderly, urban population and people with comorbidities are critical to control the pandemic and fatalities.
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http://dx.doi.org/10.3855/jidc.13340DOI Listing
October 2020

Defining IL-6 levels in healthy individuals: A meta-analysis.

J Med Virol 2021 06 22;93(6):3915-3924. Epub 2020 Nov 22.

Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India.

Background: Interleukin-6 (IL-6) is produced by and impacts different cell types in human. IL-6 is associated with different diseases and viral infections, including COVID-19. To our knowledge, no normal values were reported for IL-6 in the blood of healthy individuals. We have reviewed and performed a meta-analysis on a total of 140 studies, including 12,421 values for IL-6 in the blood of healthy adult donors. Among these studies, 83 did not report a mean value and the standard deviation. Therefore, for the statistical analysis, we used the values reported in 57 studies, which included 3166 values for IL-6.

Results: The reported values for IL-6 in the blood of healthy donors varied between 0 and 43.5 pg/ml. The pooled estimate of IL-6 was 5.186 pg/ml (95% confidence interval [CI]: 4.631, 5.740). As the age increased by 1 year, IL-6 values increased by 0.05 pg/ml (95% CI: 0.02, 0.09; p < .01). Though the heterogenicity, as determined by I statistics, was high in our study, the differences in IL-6 values are still at the level of a few pg/ml, which might be related to the differences in the conditions that influence IL-6 production in the healthy population.

Conclusions: This is the first meta-analysis reporting the levels of IL-6 in the blood of healthy donors based on a large number of studies and donors. Therefore the 95% CI values determined in our study could well serve as a reference range for quick decision-making in clinical interventions, particularly those aiming to inhibit IL-6, especially urgent interventions, for example, COVID-19.
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http://dx.doi.org/10.1002/jmv.26654DOI Listing
June 2021

Who is dying from COVID-19 and when? An Analysis of fatalities in Tamil Nadu, India.

Clin Epidemiol Glob Health 2021 Jan-Mar;9:275-279. Epub 2020 Oct 3.

Professor, Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, 632 002, India.

Background: As the number of COVID-19 cases continues to rise, public health efforts must focus on preventing avoidable fatalities. Understanding the demographic and clinical characteristics of deceased COVID-19 patients; and estimation of time-interval between symptom onset, hospital admission and death could inform public health interventions focusing on preventing mortality due to COVID-19.

Methods: We obtained COVID-19 death summaries from the official dashboard of the Government of Tamil Nadu, between 10th May and July 10, 2020. Of the 1783 deaths, we included 1761 cases for analysis.

Results: The mean age of the deceased was 62.5 years (SD: 13.7). The crude death rate was 2.44 per 100,000 population; the age-specific death rate was 22.72 among above 75 years and 0.02 among less than 14 years, and it was higher among men (3.5 vs 1.4 per 100,000 population). Around 85% reported having any one or more comorbidities; Diabetes (62%), hypertension (49.2%) and CAD (17.5%) were the commonly reported comorbidities. The median time interval between symptom onset and hospital admission was 4 days (IQR: 2, 7); admission and death was 4 days (IQR: 2, 7) with a significant difference between the type of admitting hospital. One-fourth of (24.2%) deaths occurred within a day of hospital admission.

Conclusion: Elderly, male, people living in densely populated areas and people with underlying comorbidities die disproportionately due to COVID-19. While shorter time-interval between symptom onset and admission is essential, the relatively short time interval between admission and death is a concern and the possible reasons must be evaluated and addressed to reduce avoidable mortality.
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http://dx.doi.org/10.1016/j.cegh.2020.09.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7532809PMC
October 2020

The impact of demonetisation on the utilisation of hospital services, patient outcomes and finances: a multicentre observational study from India.

BMJ Glob Health 2020 09;5(9)

Division of Critical Care, George Institute for Global Health, Sydney, New South Wales, Australia.

Background: This study assessed trends in healthcare utilisation in relation to the implementation of an economic policy in India wherein 500 and 1000 rupee notes were demonetised.

Methods: In this ambidirectional observational study of private not-for-profit hospitals, data on hospital outpatient and inpatient numbers, surgeries, emergency department (ED) visits, obstetric admissions and mortality were obtained for pre-demonetisation (September/October 2016), early (November/December 2016) and late demonetisation (January/February 2017), and post-demonetisation periods (March/April 2017) and compared with the control period (2015-2016) from 11 centres (three tertiary hospitals; eight secondary). A Bayesian regression analysis was performed to adjust for seasonal (winter) effect. Monthly financial data, including the proportion of cash versus non-cash transactions, were collected.

Findings: Overall, at the pooled all-hospital level, Bayesian analysis showed non-significant increase in outpatients (535.4, 95% CI -7097 to 8116) and decrease in deaths (-6.3 per 1000 inpatients, 95% CI -15.45 to 2.75) and a significant decrease in inpatients (-145.6, 95% CI -286.4 to -10.63) during demonetisation. Analysis at the level of secondary and tertiary hospitals showed a variable effect. For individual hospitals, after adjusting for the seasonal effect, some hospitals observed a significant reduction in outpatient (n=2) and inpatient (n=3) numbers, ED visits (n=4) and mortality (n=2) during demonetisation, while others reported significantly increased outpatient numbers (n=3) and ED visits (n=2). Deliveries remained unchanged during demonetisation in the hospitals that provided the service. There was no significant reduction in hospital incomes during demonetisation. In tertiary hospitals, there was a significant increase in non-cash component of transactions from 35% to 60% (p=0.02) that persisted beyond the demonetisation period.

Conclusions: The effect of demonetisation on healthcare utilisation was variable. Some hospitals witnessed a significant reduction in utilisation in some areas, while others reported increased utilisation. There was an increase in non-cash transactions that persisted beyond the period of demonetisation.
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http://dx.doi.org/10.1136/bmjgh-2020-002509DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7493109PMC
September 2020

Measurement of non-invasive blood pressure in lateral decubitus position under general anaesthesia - Which arm gives more accurate BP in relation to invasive BP - dependent or non-dependent arm?

Indian J Anaesth 2020 Jul 1;64(7):631-636. Epub 2020 Jul 1.

Department of Anaesthesia, Christian Medical College, Vellore, Tamil Nadu, India.

Background And Aims: Non-invasive blood pressure (NiBP) varies with the arm and body position. In the lateral decubitus position (LDP), the non-dependent arm reads lower, and the dependent arm reads higher pressure. We aimed to study the correlation between the NiBP and invasive arterial blood pressure (ABP) as anaesthesia progressed and its correlation in different BP ranges.

Methods: American Society of Anesthesiologists (ASA I-III) patients, between 18-70 years undergoing neurosurgical procedures in the LDP were studied. All were anaesthetised using a standard protocol, positioned in the LDP. NiBP was measured every 15 min in both dependent and non-dependent arms and correlated with the ABP.

Results: Intra-class correlation (ICC) done between the dependent arm NiBP and ABP showed good correlation for mean and systolic BP and moderate correlation for diastolic BP. ICC was 0.800, 0.846 and 0.818 for mean and 0.771, 0.782, 0.792 for systolic BP at 15 min, 1 h, and 2 h, respectively. The ICC between the non-dependent arm NiBP and the invasive ABP showed poor correlation for all BP (systolic, diastolic and mean). As anaesthesia progressed, the mean difference between the NiBP and the ABP decreased in the dependent arm and increased in the non-dependent arm. The strength of agreement between the NiBP and the ABP in various BP ranges showed moderate correlation for the dependent arm NiBP (0.45-0.54) and poor correlation (0.21-0.38) for the non-dependent arm.

Conclusion: The NiBP of the dependent arm correlated well with ABP in LDP under general anaesthesia (GA). It is better to defer measuring NiBP in the non-dependent arm as the correlation with ABP is poor.
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http://dx.doi.org/10.4103/ija.IJA_125_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7413357PMC
July 2020

Feasibility of computer-generated telephonic message-based follow-up system among healthcare workers with diabetes: a randomized controlled trial.

BMJ Open Diabetes Res Care 2020 07;8(1)

Internal Medicine, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India.

Introduction: To assess the feasibility of computer-generated educational messaging system in healthcare workers of a tertiary care hospital. The secondary objectives were glycemic control, patient satisfaction and adherence to lifestyle modifications.

Research Design And Methods: Single-center parallel-group open-labeled randomized controlled trial with computer generated block randomization.

Setting: Healthcare workers with diabetes working in Christian Medical College Vellore, Tamil Nadu.

Participants: 431 assessed, 341 met the selection criteria, 320 participants were randomized and 161 were taken into intervention arm and 159 in the control arm.

Intervention: Computer-generated short message service (SMS) based on transtheoretical model of behavioral change, 2 messages per week for 3 months, along with standard of care diabetic care. Messages had educational material regarding healthy eating habits and exercise and these messages were sent twice weekly. The messages were scheduled via an automatic calendar in a way that each subject in the intervention arm received 15 educational messages per month.Control group received only standard of care diabetic care which included dietary advice, exercise regimen and diabetic medications under supervision of their physician every 3 months.

Follow-up: 6 months.

Results: 95.65% of people in the intervention arm (n=154) received regular messages, out of which 93.17% read the messages regularly. 80.12% acted on the messages. 93.17% felt more satisfied with their healthcare.While both groups showed improvement in body mass index (BMI) and hemoglobin A1c (HbA1c), the difference was greater in the intervention with regard to both decrease in BMI (-0.6, p<0.001) and HBA1c (-0.48, p<0.001).

Conclusions: SMS-based education system is feasible in improving healthcare among healthcare workers with diabetes. It improves patient satisfaction, adherence and improves healthcare among individuals with diabetes by decreasing their BMI and decreasing HbA1c.
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http://dx.doi.org/10.1136/bmjdrc-2020-001237DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7359061PMC
July 2020

The role of thymus and activation-regulated chemokine as a marker of severity of atopic dermatitis.

J Am Acad Dermatol 2021 Feb 19;84(2):545-547. Epub 2020 May 19.

Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India.

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http://dx.doi.org/10.1016/j.jaad.2020.05.052DOI Listing
February 2021

Interaction of human immunodeficiency virus-1 and human immunodeficiency virus-2 capsid amino acid variants with human tripartite motif 5α protein SPRY domain and its association with pathogenesis.

Indian J Med Microbiol 2019 Oct-Dec;37(4):574-583

Department of Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, India.

Purpose: The sequence variation of human immunodeficiency virus (HIV) capsid region may influence and alter the susceptibility to human tripartite motif 5α protein (huTRIM5α).

Materials And Methods: Molecular docking was carried out with huTRIM5α SPRY domain by the use of ClusPro and Hex docking program for HIV-1 and HIV-2 capsid sequences.

Results: The sequence analysis on HIV-1 and HIV-2 capsid gag gene identified 35 (19.7%) single-nucleotide polymorphisms (SNPs) in HIV-1 and 8 (4.5%) SNPs in HIV-2. The variations observed in the HIV-2 capsid region were significantly lower than HIV-1 (P < 0.001). The molecular docking analysis showed that HIV-1 wild type used V1 loop, while HIV-2 used V3 loop of huTRIM5α for interaction. HIV-1 with A116T SNP and HIV-2 with V81A SNP use V3 and V1 loop of huTRIM5α for interaction respectively. The reduced huTRIM5α inhibition may lead to a faster progression of disease among HIV-1-infected individuals. However, in case of HIV-2, increased inhibition by huTRIM5α slows down the disease progression.

Conclusion: Polymorphisms in the capsid protein with both HIV-1- and HIV-2-monoinfected individuals showed the difference in the docking energy from the wild type. This is the first study which documents the difference in the usage of loop between the two HIV types for interaction with huTRIM5α. Variations in the capsid protein result in alteration in the binding to the restriction factor huTRIM5α.
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http://dx.doi.org/10.4103/ijmm.IJMM_20_109DOI Listing
July 2020

Burden of diabetes among patients with tuberculosis: 10-year experience from a tertiary care referral teaching hospital in South India.

Lung India 2020 May-Jun;37(3):232-237

Department of Biosatatistics, Christian Medical College, Vellore, Tamil Nadu, India.

Context: Tuberculosis (TB) and diabetes mellitus (DM) are converging epidemics, each worsening the morbidity of the other. A study of the prevalence of DM in TB patients assumes great importance.

Aims: The study aims to evaluate the association between DM and TB over a 10-year period in a tertiary care hospital.

Settings And Design: A retrospective observational study in a southern Indian tertiary care teaching hospital was conducted.

Materials And Methods: All patients with TB diagnosed and treated during the 10-year study period were identified from the hospital database. All relevant clinical, microbiological, and laboratory results pertaining to diagnosis of DM were collected. The diagnosis of TB and DM was made as per the standard criteria.

Statistical Analysis: Categorical variables were analyzed using Chi-square test while continuous variables using independent sample t-test.

Results: From 2001 to 2012, we studied 1979 TB patients among whom data on DM were available. The prevalence of DM was 29%, 21%, and 14%, in smear positive, smear negative and extrapulmonary TB respectively (overall 24%). Diabetics were more likely to be men (77.3% vs. 61%;P = 0.001); >40 years of age (81.7% vs. 38.9%;P < 0.001); heavier (59.96 vs. 50.37;P = 0.004); tobacco smokers (16.1% vs. 8.1%;P < 0.001); and alcohol consumers (6.8% vs. 4%;P = 0.02). They were less likely to be HIV coinfected (1.8% vs. 6.1%;P < 0.001). HIV coinfection was seen in 5% of patients and was substantially higher in extrapulmonary TB group (19.4%). Multidrug-resistant TB was lower in DM (11.7%) compared to non-DM (15.9%) (P = 0.02). Overall, 48% of the DM patients were diagnosed at the time of TB diagnosis. Over 10 years, no obvious changes in the trend were evident.

Conclusions: Over a 10-year study period, 24% of the TB patients were diabetic, nearly half were detected at the time of TB diagnosis. There may be a good case for screening all TB patients for DM.
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http://dx.doi.org/10.4103/lungindia.lungindia_111_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7353927PMC
May 2020

Delayed Hyponatremia Following Surgery for Pituitary Adenomas: An Under-recognized Complication.

Neurol India 2020 Mar-Apr;68(2):340-345

Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India.

Background: Delayed hyponatremia is a serious complication seen after pituitary surgery. We document the incidence, presentation, outcome and risk factors for this condition.

Materials And Methods: This was a retrospective study involving 222 patients operated for nonfunctioning pituitary macroadenomas between 2007-2016. Delayed hyponatremia was defined as serum sodium <135 mmol/L, occurring after the third post-operative day. Hyponatremia was categorized as mild (134-130 mmol/L), moderate (129-125 mmol/L) and severe (<125 mmol/L). All patients received intravenous (0.9%) saline, intravenous hydrocortisone and 12g oral salt over 24 hours. Patients with severe hyponatremia were given 3% saline.

Results: Fifty eight patients (26%) developed delayed hyponatremia; thirty (13.5%) had severe hyponatremia. Delayed hyponatremia usually (43.1%) occurred on the seventh post-operative day (range, 3-15 days). Most patients (81%) remained asymptomatic; 11 patients developed vomiting (5), seizures (3), lethargy (1), fever (1) and paralytic ileus (1). One patient developed status epilepticus. Patients who manifest symptoms had lower sodium levels as compared to those who did not have symptoms (mean 117.7 mmol/L vs. 123 mmol/L; P < 0.01). Male gender (P = 0.002) and intra-operative CSF leak (P = 0.003) were risk factors for developing delayed hyponatremia. Other factors like, age, pre-operative cortisol levels, extent of resection and post-operative diabetes insipidus did not correlate with the occurrence of delayed hyponatremia. Patients who maintained their mean serum sodium levels >138 mmol/L (day 1-day 3) were unlikely to develop delayed hyponatremia (sensitivity, 55.2% and specificity, 83.9%), positive predictive value, 63.2% [confidence interval (CI) 48, 76.7%] and negative predictive value, 78.8% (CI 70.6, 85.5%). In most patients (57%) hyponatremia was corrected within 48 hours (h).

Conclusions: We recommend routine serum sodium testing on the seventh post-operative day for all patients undergoing pituitary surgery. Most patients remain asymptomatic and unless they are detected early they can go on to develop serious complications.
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http://dx.doi.org/10.4103/0028-3886.280637DOI Listing
March 2021

Systematic Analysis of the Application and Inappropriate Use/Misuse of Statistics in Cholangiocarcinoma Research in Southeast Asia.

Asian Pac J Cancer Prev 2020 Feb 1;21(2):275-280. Epub 2020 Feb 1.

Chulabhorn International College of Medicine, Thammasat University, Paholyothin Road, Klongluang, Pathumthani Thailand.

Objective: The aim of the study was to perform a systematic review of research articles related to cholangiocarcinoma (CCA), the bile duct cancer in Southeast Asian (SEA) countries published during 2010-2015 including analysis of inappropriate use/misuse of statistics.

Methods: Research articles were retrieved from the PubMed database using different 'keywords' for seven research disciplines/categories in biomedical sciences (medicine/physiology, epidemiology, immunology, pharmacology and toxicology, diagnosis/diagnostics, drug resistance, and biochemistry).

Results: A total of 353 articles were finally included in the analysis based on the pre-defined eligibility criteria. Most were articles of which the studies were conducted in Thailand (335 articles, 94.90%). Disease diagnosis/diagnostics (n=266, 75.35%), biochemistry (n =223, 63.17%), and pharmacology and toxicology (n =218, 61.76%) were the three main research disciplines/categories for CAA conducted in SEA countries during 2010-2015. Thailand was the country which most published CCA-related research articles in all disciplines/categories. Drug resistance was the research category that most applied both descriptive and inferential statistics (100%). The student's t-test was the most applied test (35.13%). Inappropriate use/misuse of statistics in all types was highest in diagnosis/diagnostics (73.59%) and pharmacology and toxicology (73.06%) research disciplines/categories and was lowest in medicine/pathophysiology (0.26%). Inappropriate use/misuse in almost all types (seven types) was found in the diagnosis/diagnostics category.

Conclusion: Results of the systematic analysis of CCA-related research articles published from the ten SEA countries during 2010-2015 reveal high rates of inappropriate use/misuse of statistics. The readers should be aware of the reliability of the articles and the possibility of wrong interpretation and conclusion of these articles.
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http://dx.doi.org/10.31557/APJCP.2020.21.2.275DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7332113PMC
February 2020

Assessing Seasonality Variation with Harmonic Regression: Accommodations for Sharp Peaks.

Int J Environ Res Public Health 2020 02 18;17(4). Epub 2020 Feb 18.

Department of Biostatistics, Christian Medical College, Vellore 632002, India.

The use of the harmonic regression model is well accepted in the epidemiological and biostatistical communities as a standard procedure to examine seasonal patterns in disease occurrence. While these models may provide good fit to periodic patterns with relatively symmetric rises and falls, for some diseases the incidence fluctuates in a more complex manner. We propose a two-step harmonic regression approach to improve the model fit for data exhibiting sharp seasonal peaks. To capture such specific behavior, we first build a basic model and estimate the seasonal peak. At the second step, we apply an extended model using sine and cosine transform functions. These newly proposed functions mimic a quadratic term in the harmonic regression models and thus allow us to better fit the seasonal spikes. We illustrate the proposed method using actual and simulated data and recommend the new approach to assess seasonality in a broad spectrum of diseases manifesting sharp seasonal peaks.
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http://dx.doi.org/10.3390/ijerph17041318DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7068504PMC
February 2020

A phase II study evaluating the role of bortezomib in the management of relapsed acute promyelocytic leukemia treated upfront with arsenic trioxide.

Cancer Med 2020 04 14;9(8):2603-2610. Epub 2020 Feb 14.

Department of Haematology, Christian Medical College, Vellore, India.

The standard-of-care for patients with acute promyelocytic leukemia (APL) relapsing after upfront arsenic trioxide (ATO) therapy is not defined. The present study was undertaken to evaluate the safety of addition of bortezomib to ATO in the treatment of relapsed APL based on our previously reported preclinical data demonstrating synergy between these agents. This was an open label, nonrandomized, phase II, single-center study. We enrolled 22 consecutive patients with relapsed APL. The median age was 26.5 years (interquartile range 17.5 to 41.5). The median time from initial diagnosis to relapse was 23.1 months (interquartile range 15.6 to 43.8). All patients achieved hematological remission at a median time of 45 days (range 40-63). Nineteen patients were in molecular remission at the end of induction. Grade 3 adverse events occurred in eight instances with one patient requiring discontinuation of therapy for grade 3 neuropathy. Twelve (54.5%) patients underwent autologous transplantation (auto-SCT) in molecular remission while the rest opted for maintenance therapy. The median follow-up was 48 months (range 28-56.3). Of the patients undergoing auto-SCT, all except one was alive and relapse free at last follow-up. Of the patients who opted for maintenance therapy, three developed a second relapse. For treatment of APL relapsing after upfront ATO therapy, addition of bortezomib to a standard ATO-based salvage regimen is safe and effective. This trial was registered at www.clinicaltrials.gov as NCT01950611.
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http://dx.doi.org/10.1002/cam4.2883DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7163093PMC
April 2020

Urinary tract infections in renal transplant recipients at a quaternary care centre in Australia.

BMC Nephrol 2019 12 27;20(1):479. Epub 2019 Dec 27.

Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.

Background: Urinary tract infections (UTI) are the most common of infections after renal transplantation. The consequences of UTIs in this population are serious, with increased morbidity and hospitalisation rates as well as acute allograft dysfunction. UTIs may impair overall graft and patient survival. We aimed to identify the prevalence and risk factors for post-transplant UTIs and assess UTIs' effect on renal function during a UTI episode and if they result in declining allograft function at 2 years post-transplant. Additionally, the causative organism, the class of antibacterial drug employed for each UTI episode and utilisation rates of trimethoprim/sulfamethoxazole (TMP/SMX) prophylaxis were also quantified.

Methods: This was a retrospective study of 72 renal transplant patients over a 5-year period who were managed at the Royal Brisbane and Women's Hospital. Patient charts, pathology records and dispensing histories were reviewed as part of this study and all UTIs from 2 years post transplantation were captured.

Results: Of these patients, 20 (27.8%) had at least one UTI. Older age (p = 0.015), female gender (p < 0.001), hyperglycaemia (p = 0.037) and acute rejection episodes (p = 0.046) were risk factors for developing a UTI on unadjusted analysis. Female gender (OR 4.93) and age (OR 1.03) were statistically significant risk factors for a UTI on adjusted analysis. On average, there was a 14.4% (SEM 5.20) increase in serum creatinine during a UTI episode, which was statistically significant (p = 0.027), and a 9.1% (SEM 6.23) reduction in serum creatinine after the UTI episode trending toward statistical significance. (p = 0.076). Common organisms (Escherichia coli and Klebsiella pneumoniae) accounted for 82% of UTI episodes with 70% of UTI cases requiring only a single course of antibiotic treatment. Furthermore, the antibiotic class used was either a penicillin (49%) or cephalosporin (36%) in the majority of UTIs. The use of TMP/SMX prophylaxis for Pneumocystis carinii pneumonia prophylaxis did not influence the rate of UTI, with > 90% of the cohort using this treatment.

Conclusions: There was no significant change in serum creatinine and estimated glomerular filtrate rate from baseline to 2 years post-transplant between those with and without a UTI.
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http://dx.doi.org/10.1186/s12882-019-1666-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6935183PMC
December 2019

Characteristics of treatment-naïve HBV-infected individuals with HIV-1 coinfection: A cross-sectional study from South India.

Indian J Med Microbiol 2019 Apr-Jun;37(2):219-224

Department of Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, India.

Purpose: Human immunodeficiency virus-1 (HIV-1) and hepatitis B virus (HBV) coinfection has become a major health problem across the globe. The increased life expectancy of HIV-1 patients due to antiretroviral therapy has led to the emergence of liver disease as a major mortality factor among them. The purpose of the study was to examine the baseline characteristics of HBV in treatment-naïve HBV/HIV coinfection from southern India compared to monoinfected individuals.

Materials And Methods: The study was cross sectional in design, and samples were examined from 80 HIV-1, 70 HBV and 35 HBV/HIV-coinfected individuals using chemiluminescent microparticle immunoassay, real-time polymerase chain reaction and flow cytometry assays.

Results: There was a significant increase in HBV DNA (P = 0.0001), higher hepatitis B e antigen percentage difference (P = 0.027) and lower CD4 counts (P = 0.01) among the HBV/HIV-coinfected individuals, but no difference in the HIV-1 viral load compared to HIV-1-monoinfected individuals. Also, the aspartate aminotransferase levels, prothrombin time and the international normalised ratio were significantly high among coinfected individuals.

Conclusion: These findings conclude that HIV-1 coinfection can have serious implications on the outcome of HBV-related liver disease. To the contrary, HBV infection had no consequence on the progression of HIV-1 disease but distinctly lowered CD4+ T-cells.
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http://dx.doi.org/10.4103/ijmm.IJMM_19_16DOI Listing
April 2020

Coverage, quality, and correlates of childhood immunization in slums under national immunization program of India: A cross-sectional study.

Heliyon 2019 Sep 6;5(9):e02403. Epub 2019 Sep 6.

National Polio Surveillance Project, Mumbai, Maharashtra, India.

Adequate and quality immunization coverage plays a key role in controlling the outbreaks of vaccine preventable diseases. Places where immunization coverage is low, vaccine preventable diseases contribute to worse health outcomes. This is especially true in Indian slum dwellings where 33.0% of the urban population live. The aim of the study was to explore the coverage, quality, and correlates of primary immunization under national immunization program among children aged 12-23 months, living in slums of Mumbai. A community based cross-sectional survey was conducted. Parents or caretakers of 550 eligible children aged 12-23 months were interviewed using a structured interview schedule. Regression analysis was used to detect correlates of full immunization coverage (children who received one dose each of BCG, measles, and three doses each of DPT, OPV, and HBV by his/her first birthday) and of quality immunization coverage (children who received primary vaccines at appropriate age and intervals as mentioned above and had filled immunization card). Out of total 550 children, 402 (73.1%), 131 (23.8%), and 17 (3.1%) were fully, partially, and unimmunized, respectively. Almost 86.0% children received quality immunization coverage. In the regression analysis, reminder for immunization services was found to be the single most significant correlate of full and quality immunization coverage. In this study, full immunization coverage was found to be below the expected level. This study also revealed that the awareness regarding the importance of adequate immunization was still lacking in the slum population. Emphasizing on reminders for immunization services, encouraging institutional deliveries, and scaling up use of postnatal care services may act as keys to improving the immunization coverage in Indian slums.
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http://dx.doi.org/10.1016/j.heliyon.2019.e02403DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6734516PMC
September 2019

Study of familial aggregation of autoimmune rheumatic diseases in Asian Indian patients with systemic lupus erythematosus.

Rheumatol Int 2019 Dec 1;39(12):2053-2060. Epub 2019 Jul 1.

Department of Clinical Immunology and Rheumatology, Christian Medical College Hospital, Vellore, India.

Systemic lupus erythematosus (SLE) and other autoimmune rheumatic diseases (AIRD) tend to co-aggregate in families, making positive familial history a risk factor. We aimed to estimate familial aggregation of AIRD in SLE patients and to compare between ones having a positive and negative family history of autoimmunity in our cohort. We included families of 157 consecutive SLE patients in a hospital-based, cross-sectional design for a three-generation pedigree study. Clinical and laboratory parameters of these patients were recorded. AIRD was seen in families of 39 SLE patients amounting to a familial prevalence of 24.8% [95% confidence interval (CI) 18.1, 31.6] with a relative risk (λ) of 4.3 for first-degree relatives (FDRs) and 1.1 for second-degree relatives (SDRs). SLE was the commonest AIRD seen in families of 19 patients with a familial prevalence of 12.1% (95% CI 7.0, 17.2) and λ of 78.2 for FDRs and 18.1 for SDRs. AIRD as a whole and SLE alone were seen more commonly with parental consanguinity (p < 0.05). Familial aggregation in SLE patients also showed a relatively higher percentage of affected males and lesser presentation with constitutional features (p < 0.05) than sporadic SLE patients. Rheumatoid arthritis (RA) was the second most common AIRD seen in 16/39 (41%) families with a RR of 3.1 in FDRs of SLE patients. In conclusion, Asian Indian SLE patients seem to have a high familial aggregation of AIRD, which is more pronounced in the background of parental consanguinity. SLE is the commonest AIRD seen amongst FDRs and SDRs of SLE patients, followed by RA, with FDRs being at highest risk.
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http://dx.doi.org/10.1007/s00296-019-04355-zDOI Listing
December 2019

Multiple Mini-interview Consistency and Satisfactoriness for Residency Program Recruitment: Oman Evidence.

Oman Med J 2019 May;34(3):218-223

Department of Biostatistics, Christian Medical College, Vellore, India.

Objectives: Standard interviews are used by most residency programs to assess non-cognitive skills, but variability in the interviewer's skills, interviewer bias, and context specificity limit reliability. We sought to investigate the consistency and satisfactoriness of the multiple mini-interview (MMI) model for resident selection into an otorhinolaryngology head and neck surgery residency program.

Methods: This pilot study was done in an independent academic residency training center for 15 applicants, in seven eight-minute MMI stations with eight raters for the 2015-2016 academic year. The raters included the chief resident and education committee chairman in one of the stations. Candidates were assessed on two items: medical knowledge (two standardized case scenarios) and behavioral knowledge (personality and attitude, professionalism, communication, enthusiasm to the specialty, and English proficiency).

Results: Of 15 candidates, 10 (66.7%) were female and five (33.3%) were male; five were recommended for selection, and five were kept on the waiting list. The reliability, intraclass correlation coefficient (ICC), of the scores obtained from seven items of MMI was 0.36 (95% confidence interval (CI): -0.31-0.75; 0.110). However, the ICC of the medical interview was 0.54 (95% CI: 0.45-0.84; 0.090). The correlation between behavioral items score and MMI total score was r = 0.135 ( 0.150).

Conclusions: The interview evaluation/survey form given to candidates and interviewers has shown that MMI is a fair and effective tool to evaluate non-cognitive traits. Both candidates and interviewers prefer MMI to standard interviews. The MMI process for residency interviews can generate reliable interview results using only seven stations and is acceptable and preferred over standard interview modalities by residency program applicants and faculty members.
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http://dx.doi.org/10.5001/omj.2019.42DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6505339PMC
May 2019

Postoperative intraventricular blood: a new modifiable risk factor for early postoperative symptomatic hydrocephalus in children with posterior fossa tumors.

Childs Nerv Syst 2019 07 18;35(7):1137-1146. Epub 2019 May 18.

Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India.

Objective: To analyze factors associated with the development of early symptomatic hydrocephalus following posterior fossa tumor (PFT) surgery in children.

Methods: In this retrospective study, data from 148 children (age < 18 years) who underwent primary resection of their PFTs without preoperative permanent CSF diversion procedures were collected. The incidence of symptomatic hydrocephalus within 30 days of tumor resection was studied and its association with various demographic, tumor-related, and surgery-related risk factors was analyzed.

Results: At presentation, 131 (89%) of the 148 patients had symptomatic hydrocephalus. There were 99 males and 49 females (mean age 8.7 years; range 1 to 17 years). Postoperatively, 14 (9.4%) patients required shunt placement for symptomatic hydrocephalus. The indications for shunt surgery were persistent symptoms of raised intracranial pressure (n = 6, 43%), CSF leak from the wound (n = 7, 50%), and tense pseudomeningocele (n = 1, 7%). On multivariate analysis, age < 6 years (OR 5.9, 95% CI 1.6-22.6, p = 0.009) and the presence of intraventricular blood (IVB) on postoperative CT (OR 6.4, 95% CI 1.7-23.7, p = 0.006) were independent risk factors for developing symptomatic hydrocephalus.

Conclusions: The incidence of postoperative symptomatic hydrocephalus in our series (9.4%) is lower than that reported in most previous studies. Age < 6 years and the presence of postoperative IVB were independent risk factors for developing symptomatic hydrocephalus. Of these, postoperative IVB is probably the only modifiable risk factor.
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http://dx.doi.org/10.1007/s00381-019-04195-zDOI Listing
July 2019

Effects of an Adenotonsillectomy on the Cognitive and Behavioural Function of Children Who Snore: A naturalistic observational study.

Sultan Qaboos Univ Med J 2018 Nov 28;18(4):e455-e460. Epub 2019 Mar 28.

Department of Surgery, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman.

Objectives: This study aimed to evaluate cognitive and behavioural changes among 9-14-year-old Omani children with obstructive sleep apnoea (OSA) after an adenotonsillectomy (AT).

Methods: This naturalistic observational study was conducted at the Sultan Qaboos University Hospital, Muscat, Oman, between January 2012 and December 2014. Omani children with adenotonsillar hypertrophy (ATH) underwent overnight polysomnography and those with confirmed OSA were scheduled for an AT. Cognitive and behavioural evaluations were performed using standardised instruments at baseline prior to the procedure and three months afterwards.

Results: A total of 37 children were included in the study, of which 24 (65%) were male and 13 (35%) were female. The mean age of the males was 11.4 ± 1.9 years, while that of the females was 11.1 ± 1.5 years. Following the AT, there was a significant reduction of 56% in mean apnoea-hypopnoea index (AHI) score (2.36 ± 4.88 versus 5.37 ± 7.17; <0.01). There was also a significant positive reduction in OSA indices, including oxygen desaturation index (78%), number of desaturations (68%) and number of obstructive apnoea incidents (74%; <0.01 each). Significant improvements were noted in neurocognitive function, including attention/concentration (42%), verbal fluency (92%), learning/recall (38%), executive function (52%) and general intellectual ability (33%; <0.01 each). There was a significant decrease of 21% in both mean inattention and hyperactivity scores ( <0.01 each).

Conclusion: These results demonstrate the effectiveness of an AT in improving cognitive function and attention deficit hyperactivity disorder-like symptoms among children with ATH-caused OSA. Such changes can be observed as early as three months after the procedure.
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http://dx.doi.org/10.18295/squmj.2018.18.04.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6443270PMC
November 2018

The Impact of Narrow Band Imaging in the Detection and Resection of Bladder Tumor in Transitional Cell Carcinoma of the Bladder: A Prospective, Blinded, Sequential Intervention Randomized Controlled Trial.

Urology 2019 06 26;128:55-61. Epub 2019 Feb 26.

Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India.

Objective: To determine the impact of Narrow Band Imaging (NBI) in detection and resection of tumors during transurethral resection of bladder cancer.

Materials And Methods: This was a single center randomized prospective interventional study with a sequential intervention design. Patients with bladder tumors were randomized into 2 arms where they were resected under white light (WL) first followed by NBI in arm A, or NBI followed by WL in arm B. The number of patients in whom additional lesions were detected by the second light source, in both arms, was analyzed. The feasibility of initial resection of tumor under NBI was also studied.

Results: A total of 110 patients were randomized. Of 54 patients in arm A (WL first) additional lesions were identified at the second look in 20 patients (37%). In contrast, of 56 patients in arm B (NBI first), additional lesions were identified in 5(9%) patients. This difference of 28% was statistically significant (P value <.001). In arm B (NBI first), there were 7 breaches in protocol, and all these patients had high risk (more than or equal to 3 in number or 3 cm in size) tumors (P value <.002).

Conclusion: Narrowband imaging is superior to WL in the detection of tumors, thus allowing a more complete resection. However, initial resection under NBI is difficult due to poor visibility, especially for high-risk tumors.
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http://dx.doi.org/10.1016/j.urology.2019.01.039DOI Listing
June 2019

Randomized open-label trial of docosahexaenoic acid-enriched fish oil and fish meal on cognitive and behavioral functioning in Omani children.

Nutrition 2019 01 17;57:167-172. Epub 2018 May 17.

Ministry of Agriculture and Fisheries Wealth, Muscat, Oman.

Objective: This study aimed to examine the effect of docosahexaenoic acid (DHA)-enriched fish oil supplement and meal of grilled fish on cognitive and behavioral functioning manifested as attention-deficit/hyperactivity disorder in primary school students 9 to 10 y of age in Muscat, Oman.

Methods: This randomized open-label trial involved two types of interventions: fish oil supplement or one serving (100 g) of grilled fish per day (Sunday through Friday) for 12 weeks. Red cell total lipid DHA levels were assessed. The Verbal Fluency Test, Buschke Selective Reminding Test, and Trail Making Test were used to measure cognitive functioning. Behavioral functioning was assessed using a standardized Arabic version of the National Initiative for Children's Health Quality Vanderbilt Assessment Scales. All measurements were carried out before and after intervention.

Results: DHA levels increased by 72% and 64% in the fish oil (mean, 3.6%-6.2%) and fish-meal (mean, 3.4%-5.6%) groups, respectively (P = 0.000). The Trail Making Test was the only cognitive test that demonstrated marked differences between groups: Median interquartile range difference between pre- and postintervention in the Trail Making Part B score was 61.5 (SE, 19.3, 103.2) in the fish oil versus fish-meal group, 24.5 (SE, -15.2, 74.7, P = 0.005). The Vanderbilt Assessment Scales also showed significant differences between groups (P < 0.001).

Conclusion: This study contributed to available evidence on the cognitive and behavioral benefits of DHA in healthy school children. Expanding the food fortification program with DHA-enriched fish oil should be considered as part of broader policy to improve child health.
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http://dx.doi.org/10.1016/j.nut.2018.04.008DOI Listing
January 2019