Publications by authors named "Saurabh Deshpande"

11 Publications

  • Page 1 of 1

Safety and Efficacy of Ibutilide for Acute Pharmacological Cardioversion of Rheumatic Atrial Fibrillation.

Cardiology 2021 Jul 15:1-9. Epub 2021 Jul 15.

Electrophysiology Unit, Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, India.

Introduction: Ibutilide is indicated for acute cardioversion of nonvalvular atrial fibrillation (AF). However, its efficacy and safety in the pharmacological cardioversion of rheumatic AF are unknown.

Methods: Patients with mild-to-moderate rheumatic mitral valve (MV) disease with symptomatic, paroxysmal, or persistent AF were included in the analysis. Intravenous ibutilide was administered at doses tailored to body weight (0.5-2.0 mg) for over 10 min. The primary end point was efficacy, assessed as the rate of conversion of AF to sinus rhythm. The secondary end point was safety, including arrhythmic events and death within 24 h of drug initiation.

Results: From June 2016 to October 2018, 165 patients (94 with mitral stenosis, 23 with mitral regurgitation, 11 with mixed MV disease, and 37 with MV replacement) received ibutilide (mean dose 0.90 ± 0.54 mg). Ibutilide successfully converted AF to sinus rhythm in 127/165 (76.9%) patients, with a conversion time of 7.9 ± 4.1 min. The QTc increased from 419.9 ± 15.8 to 487.5 ± 34 ms after ibutilide administration (p < 0.001). The mean change in QTc after ibutilide administration (∆QTc) was 72.01 ± 36.03. There were no deaths, but 3 patients (1.8%) developed torsades de pointes (TdP) requiring defibrillation 55 ± 37 min after infusion.

Conclusion: Ibutilide cardioverted 77% of rheumatic AF to sinus rhythm, indicating its potential as a clinically useful option for pharmacological cardioversion of rheumatic AF. TdP is a potentially serious adverse event that requires careful monitoring.
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http://dx.doi.org/10.1159/000516590DOI Listing
July 2021

A Network Meta-Analysis Comparing Osteoporotic Fracture among Different Direct Oral Anticoagulants and Vitamin K Antagonists in Patients with Atrial Fibrillation.

J Bone Metab 2021 May 31;28(2):139-150. Epub 2021 May 31.

Department of Cardiology, Sri Jayadeva Institute of Cardiac Sciences and Research, Bengaluru, India.

Background: There are limited studies comparing the risk of osteoporosis and fractures between different direct oral anticoagulants (DOACs) and vitamin K antagonists (VKA) in non-valvular atrial fibrillation (AF). Using a network meta-analysis (NMA), we compared osteoporotic fractures among 5 different treatment arms, viz. dabigatran, rivaroxaban, apixaban, edoxaban, and VKA.

Methods: Ten studies, including 5 randomized control trials and 5 population-based studies, with a total of 321,844 patients (148,751 and 173,093 in the VKA and DOAC group, respectively) with a median follow-up of 2 years, were included. A Bayesian random-effects NMA model comparing fractures among the treatment arms was performed using MetInsight V3. Sensitivity analysis excluded studies with the highest residual deviances from the NMA model.

Results: The mean age of the patients was 70 years. The meta-analysis favored DOACs over VKA with significantly lower osteoporotic fracture (odds ratio [OR], 0.77; 95% credible interval [CrI], 0.70-0.86). The NMA demonstrated that fractures were significantly lower with apixaban compared with dabigatran (OR, 0.64; 95% CrI, 0.44-0.95); however, fractures were statistically similar between apixaban and rivaroxaban (OR, 0.84; 95% CrI, 0.58-1.24) and dabigatran and rivaroxaban (OR, 1.32; 95% CrI, 0.90-1.87). Based on the Bayesian model of NMA, the probability of osteoporotic fracture was highest with VKA and lowest with apixaban, followed by rivaroxaban, edoxaban, and dabigatran.

Conclusions: The decision to prescribe anticoagulants in elderly patients with AF should be made not only based on thrombotic and bleeding risks but also on the risk of osteoporotic fracture; these factors should be considered and incorporated in contemporary cardiology practice.
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http://dx.doi.org/10.11005/jbm.2021.28.2.139DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8206613PMC
May 2021

Egg-shell calcification in Pick's disease (chronic constrictive pericarditis).

Radiol Case Rep 2021 Apr 29;16(4):847-849. Epub 2021 Jan 29.

Cardiology, P D Hinduja Hospital, Mumbai, India.

Egg-shell calcification is rare in cases with constrictive pericarditis. It leads to significant right heart failure and the only treatment is surgical excision of the pericardium. We present a case of a 22-year-old-male who was diagnosed to have severe pericardial calcification on the chest X-ray, which eventually led to a diagnosis of constrictive pericarditis and required an early surgical correction. This case shows that a common diagnostic test such as a chest X-ray does help to diagnose a severe systemic condition.
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http://dx.doi.org/10.1016/j.radcr.2021.01.042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7848771PMC
April 2021

MRI in patients with cardiac implantable electronic devices: A comprehensive review.

Pacing Clin Electrophysiol 2021 02 9;44(2):360-372. Epub 2021 Jan 9.

Department of Cardiac Electrophysiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India.

Magnetic resonance imaging (MRI) has become a commonly used non-ionizing radiation dependent imaging modality which has an excellent spatial resolution with the capability to provide physiological information. Cardiac implantable electronic devices (CIEDs) are used in modern cardiology with a frequency of 1:50 over 75 years of age and nearly one in three people in this population required MRI during their lifetime. Changes in the CIED structure, electronics, and algorithms paired with changes in the protocol design of MRI have created a relatively safe environment for performing MRI in patients with CIED. Despite their documentation in literature and a guideline document from a professional society, significant skepticism exists in doing MRI in patients with CIEDs. We intend to give an overview of interactions between MRI and CIEDs, including the evidence available in this regard and conclude with the suggestion of a protocol for safely carrying out an MRI in patients with CIEDs.
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http://dx.doi.org/10.1111/pace.14141DOI Listing
February 2021

Successful use of venovenous snare to fix the wire in a collateral vein for proper placement of the left ventricular lead during cardiac resynchronization therapy: a case report.

Eur Heart J Case Rep 2020 Aug 26;4(4):1-7. Epub 2020 May 26.

Department of Cardiology, P. D. Hinduja Hospital, Mumbai 400016, Maharashtra, India.

Background: In cardiac resynchronization therapy, left ventricular (LV) lead placement at the desired position may be difficult due to abnormal coronary sinus (CS) and lateral vein anatomy. We present a case with difficult anatomy in which we used 'an indigenous snare' made from hardware used for coronary angioplasty procedures, which is available in any cardiac catheterization laboratory.

Case Summary: A 52-year-old man presented with dyspnoea due to chronic heart failure was evaluated for cardiac resynchronization therapy. The LV lead was difficult to advance into the only target lateral branch of the CS due to a combination of angulation and proximal stenosis. Balloon dilation was tried first, but we failed to track the LV lead. We formed a venovenous loop, advancing the coronary guidewire 0.014″ into the posterolateral vein; subsequently into the middle cardiac vein via a collateral. The wire was advanced into the CS and then to superior vena cava. The guidewire then snared through the same left subclavian vein and exteriorized by using indigenous snare. Over this loop, the LV lead of the cardiac resynchronization therapy with defibrillator device was implanted successfully.

Discussion: We have used the snare technique, with the use of a snare prepared from a coronary guidewire. Use of such an indigenous snare has not been described before in the literature. The hardware used in this case is routinely used for coronary angioplasty procedures in all catheterization labs. The importance of our case is that no special hardware like dedicated snare was required to negotiate the LV lead at its desired location.
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http://dx.doi.org/10.1093/ehjcr/ytaa114DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7501892PMC
August 2020

Changing QRS duration and morphology with A-paced and A-sensed rhythm in postcardiac resynchronization therapy (CRT) patients.

Ann Noninvasive Electrocardiol 2020 05 26;25(3):e12703. Epub 2019 Sep 26.

Department of Cardiology, P D Hinduja Hospital, Mumbai, India.

Meticulous interpretation of the ECGs of patients with cardiac resynchronization defibrillator therapy (CRT-D) device is important to ensure optimal synchronization of both the chambers. We present the ECGs of such a patient who was noted to have different morphologies of the biventricular-paced QRS depending in atrial-sensed (A-sensed) or atrial-paced (A-paced) rhythm.
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http://dx.doi.org/10.1111/anec.12703DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7358890PMC
May 2020

Particle slip velocity influences inertial focusing of particles in curved microchannels.

Sci Rep 2018 08 7;8(1):11852. Epub 2018 Aug 7.

Department of Mechanical Engineering, Clemson University, South Carolina, USA.

Size based separation and identification of particles in microfluidics through purely hydrodynamic means has gained significant interest due to a number of possible biomedical applications. Curved micro-channels, particularly spiral micro-channels with rectangular cross-section and the dynamics of particles in such channels have been extensively researched to achieve size based separation of particles. In this paper we present evidence that sheds new light on the dynamics of particles in such curved channels; that a unique particle slip velocity is associated with the focusing positions in the cross sections, which leads to a balance of forces. Our experiments therefore imply that the forces acting on the particle lead to convergence to an attractor in both the physical space (the cross section of the channel) and the slip velocity space.
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http://dx.doi.org/10.1038/s41598-018-30171-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6081444PMC
August 2018

Computed tomographic features of abdominal tuberculosis: unmask the impersonator!

Abdom Radiol (NY) 2019 01;44(1):11-21

Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, 400022, India.

Purpose: Abdominal tuberculosis (ATB) mimics various infectious, inflammatory, and neoplastic conditions and hence requires a high index of suspicion for accurate diagnosis, especially in low prevalence areas. It is difficult to consistently establish a histopathological diagnosis of ATB which underlines the importance of supportive evidences for institution of prompt empirical therapy to prevent associated morbidity and mortality.

Methods: We retrospectively evaluated clinical and imaging features of 105 ATB cases and classified their CT findings based on peritoneal, lymph node, bowel, and solid organ involvement. Concomitant pulmonary and extra-pulmonary involvement was assessed.

Results: Abdominal pain (78.1%) followed by fever (42.9%) were the commonest presenting symptoms. Peritoneal TB (77.14%) most commonly presented with a mix of ascites (49.38%), peritoneal (28.40%), and omental involvement (27.16%). Lymphadenopathy (57.1%) most commonly presented as necrotic nodes (81.67%) at mesenteric, peripancreatic, periportal, and upper paraaortic regions. Commonest site of bowel involvement (cumulative of 62.85%) was ileocecal region, with the commonest pattern of involvement being circumferential bowel wall thickening without bowel stratification with mild luminal narrowing. Hepatic (13.33%) and splenic (16.2%) involvement predominantly presented as multiple microabscesses. Adrenal and pancreatic involvement was noted in 4.7% and 1.9% of patients, respectively. 38.1% patients showed concomitant pulmonary and extra-pulmonary TB.

Conclusion: ATB has varied radiological features; however, peritoneal involvement in the form of mild ascites, smooth peritoneal thickening, smudgy omentum, multi-focal bowel involvement, necrotic nodes, and multiple visceral microabscesses point towards a diagnosis of ATB in appropriate clinical setting.
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http://dx.doi.org/10.1007/s00261-018-1700-3DOI Listing
January 2019

Sonographic Appearance of Testicular Adrenal Rest Tumour in a Patient with Congenital Adrenal Hyperplasia.

Pol J Radiol 2017 15;82:526-529. Epub 2017 Sep 15.

Department of Radiodiagnosis, Topiwala National Medical College and B.Y.L. Nair Hospital, Mumbai, India.

Background: Testicular adrenal rest tumours (TARTs) are benign testicular masses that are found in inadequately treated patients with congenital adrenal hyperplasia (CAH). Recognizing this association and identifying characteristic ultrasound features of TARTs is important so as to avoid misdiagnosing them as malignancies, which can lead to unnecessary interventions.

Case Report: We describe a case of a 9-year-old boy, with a diagnosis of CAH and precocious puberty, who was referred to our department for an ultrasound evaluation of the abdomen and scrotum. On ultrasound, there were well-defined, heterogeneous, predominantly hypoechoic, round-to-oval masses in both testes. Taking into account the presence of CAH and a typical sonographic appearance of bilateral testicular masses, a diagnosis of testicular adrenal rest tumour was made; biopsy was deferred and hormonal treatment was modified.

Conclusions: Prompt diagnosis of testicular adrenal rest tumours is essential, as it only indicates inadequate hormonal control. Moreover, it can prevent unnecessary biopsies and orchidectomies, and can maintain fertility. TARTs have a typical imaging appearance that every radiologist must be aware of.
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http://dx.doi.org/10.12659/PJR.902013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5894002PMC
September 2017

Solvatochromic fluorescence properties of phenothiazine-based dyes involving thiazolo[4,5-b]quinoxaline and benzo[e]indole as strong acceptors.

Spectrochim Acta A Mol Biomol Spectrosc 2017 Mar 1;174:154-163. Epub 2016 Nov 1.

Department of Dyestuff Technology, Institute of Chemical Technology, Matunga, Mumbai 19, India. Electronic address:

The present work describes the photophysical properties of two newly synthesized compounds, namely (E)-10-butyl-3-(2-(thiazolo[4,5-b]quinoxalin-2-yl)vinyl)-10H-phenothiazine (PTQ) and (E)-10-butyl-3-(2-(1,1-dimethyl-1H-benzo[e]indol-2-yl)vinyl)-10H-phenothiazine (PBI). A strong intramolecular charge transfer (ICT) is observed in both dyes as indicated from absorption and emission studies on varying the solvent polarity. This can be concluded from the large Stokes shifts among these dyes as PTQ exhibits large Stokes shift with >270nm and PBI around 200nm. The effect of increasing polarity caused drastic increase in the charge transfer process leading to twisted intramolecular charge transfer (TICT) process in both the dyes PTQ and PBI. Time-resolved emission studies and non-radiative decay rate constant indicates that the excited states of both dyes behave differently with respect to solvent polarity. The non-radiative decay constant increases dramatically with the solvent polarity specifying change of ICT emissive states in non-polar solvent while TICT emitting states in highly polar solvent. On the other hand, PBI follows a general trend initially exhibiting higher non-radiative decay constant in non-polar solvent like cyclohexane, lowest in moderate polarity owing to the ICT emissive state but with increase in the polarity, the non-radiative decay constant again increases indicating TICT states.
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http://dx.doi.org/10.1016/j.saa.2016.10.045DOI Listing
March 2017
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