Prathap Tharyan - Academia.edu (original) (raw)

Papers by Prathap Tharyan

Cochrane Database of Systematic Reviews, Jul 20, 2005

Meningococcal disease can lead to death or disability within hours after onset. Pre-admission ant... more Meningococcal disease can lead to death or disability within hours after onset. Pre-admission antibiotics aim to reduce the risk of serious disease and death by preventing delays in starting therapy before confirmation of the diagnosis. To study the effectiveness and safety of pre-admission antibiotics versus no pre-admission antibiotics or placebo, and different pre-admission antibiotic regimens in decreasing mortality, clinical failure and morbidity in people suspected of meningococcal disease. We updated searches of CENTRAL (2013, Issue 4), MEDLINE (1966 to April week 4, 2013), EMBASE (1980 to May 2013), Web of Science (1985 to May 2013), CAB Abstracts (1985 to May 2013), LILACS (1982 to May 2013) and prospective trials registries to May 2013. Randomised controlled trials (RCTs) or quasi-RCTs comparing antibiotics versus placebo or no intervention, in people with suspected meningococcal infection, or different antibiotics administered before admission to hospital or confirmation of the diagnosis. Two review authors independently assessed trial quality and extracted data from the search results. We calculated the risk ratio (RR) and 95% confidence interval (CI) for dichotomous data. We included only one trial so data synthesis was not performed. We assessed the overall quality of the evidence using the GRADE approach. We found no RCTs that compared pre-admission antibiotics versus no pre-admission antibiotics or placebo. One open-label, non-inferiority RCT, conducted during an epidemic in Niger, evaluated a single dose of intramuscular ceftriaxone versus a single dose of intramuscular long-acting (oily) chloramphenicol. Ceftriaxone was not inferior to chloramphenicol in reducing mortality (RR 1.2, 95% CI 0.6 to 2.6; N = 503; 308 confirmed meningococcal meningitis; 26 deaths; moderate-quality evidence), clinical failures (RR 0.8, 95% CI 0.3 to 2.2; N = 477, 18 clinical failures; moderate-quality evidence) or neurological sequelae (RR 1.3, 95% CI 0.6 to 2.6; N = 477; 29 with sequelae; low-quality evidence). No adverse effects of treatment were reported. Estimated treatment costs were similar. No data were available on disease burden due to sequelae. We found no reliable evidence to support or refute the use of pre-admission antibiotics for suspected cases of non-severe meningococcal disease. Evidence of moderate quality from one RCT indicated that single intramuscular injections of ceftriaxone and long-acting chloramphenicol were equally effective, safe and economical in reducing serious outcomes. The choice between these antibiotics would be based on affordability, availability and patterns of antibiotic resistance.Further RCTs comparing different pre-admission antibiotics, accompanied by intensive supportive measures, are ethically justifiable in participants with severe illness, and are needed to provide reliable evidence in different clinical settings.

Cochrane Database of Systematic Reviews, Aug 2, 2013

Clinical epidemiology and global health, Feb 1, 2024

Cochrane Database of Systematic Reviews, Jul 18, 2007

Metastatic spinal cord compression (MSCC), left untreated leads to pain, progressive motor and se... more Metastatic spinal cord compression (MSCC), left untreated leads to pain, progressive motor and sensory loss, including possible paraplegia and quadriplegia, bowel and bladder dysfunction, and can have a devastating impact on patients and their families (Loblaw ...

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The Cochrane library, Jul 29, 2014

Interventions for treating femoral sha fractures in children and adolescents (Review)

The Cochrane library, Apr 20, 2005

Electroconvulsive therapy (ECT) involves the induction of a seizure (fit) for therapeutic purpose... more Electroconvulsive therapy (ECT) involves the induction of a seizure (fit) for therapeutic purposes by the administration of a low frequency electrical stimulus shock via electrodes applied to the scalp. At present it is used for those with schizophrenia but its effects are unclear. To determine whether electroconvulsive therapy (ECT) results in clinically meaningful benefit with regard to global improvement, hospitalisation, changes in mental state, behaviour and functioning in those with schizophrenia. Electronic searches of Biological Abstracts (1982-1996), EMBASE (1980-1996), Medline (1966-1996), PsycLIT (1974-1996) and SCISEARCH (1996) were undertaken. The references of all identified studies were investigated. All randomised controlled trials that compared ECT with placebo, 'sham ECT', non-pharmacological interventions and antipsychotics for people with schizophrenia, schizoaffective disorder or chronic mental disorder. The reviewers extracted the data independently and analysed the data on an intention to treat basis. Less people with schizophrenia treated with ECT showed no improvement in general functioning when compared to those given placebo in the short term (OR 0.48 CI 99% 0.26-0.90). This effect, however, does not last. However, ECT is less effective than antipsychotic drug treatment for those with schizophrenia. Limited evidence exists to suggest that combining antipsychotic drugs and ECT increases the rate and extent of clinical improvement, in the short term, in one out of every five to six people. The evidence for the efficacy of ECT in the medium to long term is equivocal. Electroconvulsive therapy is also more effective than the now obsolete insulin coma treatment. There is some evidence to support the use of ECT for those with schizophrenia for short term relief of symptoms. Electroconvulsive therapy may be advocated as an adjunct to antipsychotic medication for those with schizophrenia who show a limited response to medication alone but the evidence for this is not strong. In fact in spite of more than five decades of widespread clinical use, the administration of ECT to those with schizophrenia lacks a strong research base.

PubMed, Sep 1, 1991

The clinical differentiation of epileptic seizures from hysterical pseudo-epileptic seizures is s... more The clinical differentiation of epileptic seizures from hysterical pseudo-epileptic seizures is sometimes difficult. The routine inter-ictal electroencephalogram is of limited use in such instances and prolonged electrophysiological monitoring for the detection of ictal changes may not always be feasible, especially in many centres in developing countries. This article focuses on hyperprolactinaemia as a biochemical marker of a recent ictus. It reviews studies that have explored the possibility of utilizing transient post-ictal elevations in serum prolactin as a diagnostic test in aiding the differentiation of epilepsy from hysterical pseudo-epilepticseizures, In the past decade many reports have documented post-ictal elevations in serum prolactin after tonic-clonic and complex partial seizures. Peak prolactin levels were observed 15 to 20 minutes after the ictus and values fell towards baseline within the hour. Evidence from these studies indicates that post-ictal hyperprolactinaemia is caused by involvement of medial temporal structures, especially the amygdala and hippocampus, by ictal discharges and the resultant disruption of tonic dopaminergic inhibition of prolactin release and/or stimulation of serotonin, rather than due to non-specific influences. The factors that affect the specificity, sensitivity and predictive value of post-ictal hyperprolactinaemia as a diagnostic test are discussed and a standard test procedure and definition of test result proposed that would improve its clinical utility. The test is recommended as a simple, relatively inexpensive, highly specific and fairly sensitive aid to diagnosis.

Jcpsp-journal of The College of Physicians and Surgeons Pakistan, 2005

A patient especially in the developing countries has little choice but to assume that doctor know... more A patient especially in the developing countries has little choice but to assume that doctor knows the best and has the sufficient knowledge of the best available and cost-effective interventions with minimum possible harm. However this belief may be misplaced. There were more than 14000 clinical trials with pain as an outcome published only between 1950 and 1994. This is mind boggling even for a whole time academician not to speak of a busy clinician who is faced with innumerable questions while making clinical decisions. In fact it is not easy to ask the right question as this also requires considerable expertise in itself. The natural tendency at this stage is to trust secondary sources of information and expert opinions mostly expressed in review articles and textbooks. In developing countries practitioners are often at the mercy of information provided by the pharmaceuticals. (excerpt)

PubMed, Apr 1, 1988

The usefulness of post-ictal serum prolactin changes, as an adjunct, in the differentiation of ge... more The usefulness of post-ictal serum prolactin changes, as an adjunct, in the differentiation of generalized tonic-clonic seizures and complex partial seizures from hysterical pseudoepileptic seizures, was investigated in a double blind study designed to control for variables known to alter prolactin levels. Significant post-ictal hyper-prolactinemia, with a peak at 20 minutes and a fall towards baseline by 1 hour, was found after complex partial seizures, generalized tonic-clonic seizures and after bilateral, unmodified ECT, but not after hysterical pseudoepileptic seizures or in stressed, non-epileptic controls. A proportionate increase in peak prolactin levels of at least thrice baseline values was found to best differentiate genuine seizures from pseudoepileptic seizures. Postictal hyperprolactinemia is a sensitive biochemical marker of a genuine seizure and of potential use in the differentiation of epileptic from hysterical pseudoepileptic seizures.

Clinical Epidemiology and Global Health, Aug 1, 2014

A Cochrane systematic review summarized the evidence for the effects of intermittent versus daily... more A Cochrane systematic review summarized the evidence for the effects of intermittent versus daily short-course anti-tuberculosis (TB) treatment regimens (containing rifampicin in the intensive treatment phase) on cure rates, deaths, relapses, adherence, and adverse events in children with TB not known to have drug resistance. The review included four randomized controlled trials published between 1996 and 2000 and conducted in India (two trials), South Africa and Turkey that included 563 (465 evaluable) children aged five months to 15 years. Children were recruited from the community in one trial and from hospital clinics in the others; their HIV status was not reported. All trials used a combination of clinical and radiological criteria to diagnose childhood TB. The four trials compared twice-weekly versus daily anti-TB regimens. No trials comparing thrice-weekly versus daily anti-TB regimens in children were identified. The review did not find significant differences between the intermittent twice-weekly and the daily treatment regimens in the proportions of children who were cured, who died, who relapsed over 12e30 months of follow-up, or who had treatment limiting adverse events. Adherence to the intermittent and daily treatments was also similar (87% and 84%). The trials were underpowered to detect significant differences in many of the outcomes, were at high risk of bias, and the regimens used in these trials were not the standard recommended regimens in use today. The review concluded that the evidence was in sufficient to "support or refute the use of intermittent twice-or thrice-weekly, short-course treatment regimens over daily short-course treatment in children with TB". The review called for adequately powered, well conducted and reported randomized trials comparing intermittent versus daily regimens conducted in high TB-transmission settings to provide evidence to inform policy and practice.

The Cochrane library, Feb 28, 2013

Although tubal sterilization procedures are considered to be permanent, requests for reversal of ... more Although tubal sterilization procedures are considered to be permanent, requests for reversal of the procedure (re-canalisation) are not infrequent. The reversal procedure can be done either by an open laparotomy or by minimally invasive surgery (laparoscopic or robotic approach). To compare the relative effectiveness and safety of reversal of tubal sterilization by open laparotomy, laparoscopy and robotically assisted endoscopy. On 23 October 2012 we searched the Cochrane Menstrual Disorders and Subfertility Review Group Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (Issue 10, 2012); MEDLINE; EMBASE; LILACS; clinical trials registries; regional databases; conference proceedings; and references for relevant published, unpublished and ongoing trials. Randomised trials comparing the different methods of surgical reversal of tubal sterilisation. No trials that met the selection criteria were identified. No data for evaluation were obtained Currently there is no evidence from randomised controlled trials to recommend or refute the use of a minimally invasive surgical approach (laparoscopic or robotic) or open surgery for reversal of tubal sterilization. There is a need for well conducted and reported randomised clinical trials to generate reliable evidence to inform clinical practice.

International Psychogeriatrics, Dec 13, 2006

The Cochrane library, Jun 14, 2017

Background Meningococcal disease can lead to death or disability within hours a er onset. Pre-adm... more Background Meningococcal disease can lead to death or disability within hours a er onset. Pre-admission antibiotics aim to reduce the risk of serious disease and death by preventing delays in starting therapy before confirmation of the diagnosis. Objectives To study the e ectiveness and safety of pre-admission antibiotics versus no pre-admission antibiotics or placebo, and di erent preadmission antibiotic regimens in decreasing mortality, clinical failure, and morbidity in people suspected of meningococcal disease.

Cochrane Database of Systematic Reviews, Nov 10, 2010

Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) account for one-quarter of... more Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) account for one-quarter of cases of acute respiratory failure in intensive care units (ICUs). A third to half of patients will die in the ICU, in hospital or during follow-up. Mechanical ventilation of people with ALI/ARDS allows time for the lungs to heal, but ventilation is invasive and can result in lung injury. It is uncertain whether ventilator-related injury would be reduced if pressure delivered by the ventilator with each breath is controlled, or whether the volume of air delivered by each breath is limited. To compare pressure-controlled ventilation (PCV) versus volume-controlled ventilation (VCV) in adults with ALI/ARDS to determine whether PCV reduces in-hospital mortality and morbidity in intubated and ventilated adults. In October 2014, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2014, Isssue 9), MEDLINE (1950 to 1 October 2014), EMBASE (1980 to 1 October 2014), the Latin American Caribbean Health Sciences Literature (LILACS) (1994 to 1 October 2014) and Science Citation Index-Expanded (SCI-EXPANDED) at the Institute for Scientific Information (ISI) Web of Science (1990 to 1 October 2014), as well as regional databases, clinical trials registries, conference proceedings and reference lists. Randomized controlled trials (RCTs) and quasi-RCTs (irrespective of language or publication status) of adults with a diagnosis of acute respiratory failure or acute on chronic respiratory failure and fulfilling the criteria for ALI/ARDS as defined by the American-European Consensus Conference who were admitted to an ICU for invasive mechanical ventilation, comparing pressure-controlled or pressure-controlled inverse-ratio ventilation, or an equivalent pressure-controlled mode (PCV), versus volume-controlled ventilation, or an equivalent volume-controlled mode (VCV). Two review authors independently screened and selected trials, assessed risk of bias and extracted data. We sought clarification from trial authors when needed. We pooled risk ratios (RRs) for dichotomous data and mean differences (MDs) for continuous data with their 95% confidence intervals (CIs) using a random-effects model. We assessed overall evidence quality using the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach. We included three RCTs that randomly assigned a total of 1089 participants recruited from 43 ICUs in Australia, Canada, Saudi Arabia, Spain and the USA. Risk of bias of the included studies was low. Only data for mortality and barotrauma could be combined in the meta-analysis. We downgraded the quality of evidence for the three mortality outcomes on the basis of serious imprecision around the effect estimates. For mortality in hospital, the RR with PCV compared with VCV was 0.83 (95% CI 0.67 to 1.02; three trials, 1089 participants; moderate-quality evidence), and for mortality in the ICU, the RR with PCV compared with VCV was 0.84 (95% CI 0.71 to 0.99; two trials, 1062 participants; moderate-quality evidence). One study provided no evidence of clear benefit with the ventilatory mode for mortality at 28 days (RR 0.88, 95% CI 0.73 to 1.06; 983 participants; moderate-quality evidence). The difference in effect on barotrauma between PCV and VCV was uncertain as the result of imprecision and different co-interventions used in the studies (RR 1.24, 95% CI 0.87 to 1.77; two trials, 1062 participants; low-quality evidence). Data from one trial with 983 participants for the mean duration of ventilation, and from another trial with 78 participants for the mean number of extrapulmonary organ failures that developed with PCV or VCV, were skewed. None of the trials reported on infection during ventilation or quality of life after discharge. Currently available data from RCTs are insufficient to confirm or refute whether pressure-controlled or volume-controlled ventilation offers any advantage for people with acute respiratory failure due to acute lung injury or acute respiratory distress syndrome. More studies including a larger number of people given PCV and VCV may provide reliable evidence on which more firm conclusions can be based.

The Cochrane library, Feb 4, 2016

Evidence-based Mental Health, Aug 1, 2008