R. Rajendram - Academia.edu (original) (raw)

Papers by R. Rajendram

European Journal of Surgical Oncology (EJSO), 2017

Aims: Previous research suggests that patients undergoing upper gastrointestinal surgery are at h... more Aims: Previous research suggests that patients undergoing upper gastrointestinal surgery are at high risk of poor postoperative outcomes. The aim of our study was to describe patient outcomes after elective upper gastrointestinal surgery at a global level. Methods: Prospective analysis of data collected during an international seven-day cohort study of 474 hospitals in 27 countries. Patients undergoing elective upper gastrointestinal surgery were recruited. Outcome measures were in-hospital complications and mortality at 30-days. Results are presented as n(%) and odds ratios with 95% confidence intervals. Results: 2139 patients were included, of whom 498 (23.2%) developed one or more postoperative complications, with 30 deaths (1.4%). Patients with complications had longer median hospital stay 11 (6-18) days vs. 5 (2-10) days. Infectious complications were most frequent, affecting 368 (17.2%) patients. 328 (15.3%) patients were admitted to critical care postoperatively, of whom 161 (49.1%) developed a complication with 14 deaths (4.3%). In a multivariable logistic regression model we identified age (OR 1.02 [1.01-1.03]), American Society of Anesthesiologists physical status III (OR 2.12 [1.44-3.16]) and IV (OR 3.23 [1.72-6.09]), surgery for cancer (OR 1.63 [1.27-2.11]), open procedure (OR 1.40 [1.10-1.78]), intermediate surgery (OR 1.75 [1.12-2.81]) and major surgery (OR 2.65 [1.72-4.23]) as independent risk factors for postoperative complications. Patients undergoing major surgery for upper gastrointestinal cancer experienced twice the rate of complications compared to those undergoing other procedures (224/578 patients [38.8%] versus 274/1561 patients [17.6%]). Conclusions: Complications and death are common after upper gastrointestinal surgery. Patients undergoing major surgery for cancer are at greatest risk.

Regional anaesthesia for facial plastic surgery

Using an Early Warning Score System in the acute medicine unit of a medical city in Saudi Arabia is feasible and reduces admissions to intensive care

Background: Early Warning Scoring Systems (EWSS) are based on vital signs that are intended to he... more Background: Early Warning Scoring Systems (EWSS) are based on vital signs that are intended to help in detecting and defining clinical deterioration. Several studies have demonstrated that when combined with a system of prompt and appropriate clinical responses, the use of EWSS does improve the overall outcome. However, there are very few high-quality studies and the literature is somewhat contradictory. Moreover, no study has yet been conducted on EWSS in the hospitals of Middle East. Methods: A cross-sectional study was performed on the use of the Physiological Early Warning System (PEWS) in the Acute Medicine Unit (AMU) of a large tertiary hospital (1500 bed medical city) in Saudi Arabia. Results: The study demonstrated that the use of PEWS was feasible in this setting without ward-based medical cover. PEWS did not affect the average length of stay of patient. Similarly, Critical Care Response Team (CCRT) activation was not reduced. However, admission rate to the intensive care unit (ICU) was significantly reduced. Conclusion: The studied data suggest that the use of EWSS in this clinical setting improved the responses to deteriorating patients by primary teams and thereby reduced admissions to ICU. However, CCRT involvement was not reduced because the PEWS escalation algorithm overlaps with that for CCRT activation. Further studies are required to determine whether the use of EWSS can improve outcomes whilst reducing the need for CCRT and thereby the costs of treating deteriorating medical inpatients.

— Aims: The purpose of this study was to determine the international commitment to alcohol-relate... more — Aims: The purpose of this study was to determine the international commitment to alcohol-related research relative to its global burden of disease, which is 4 % of disability adjusted life years (DALYs). Methods: The worldwide literature indexed in the Science Citation Index and the Social Sciences Citation Index during 1992–2003 was analysed using advanced bibliometric tech-niques. Results: Biomedical research and the global disease burden due to alcohol both increased during 1992–2003, whilst the number of papers from alcohol-related research remained static and declined to <0.7 % of all biomedical research literature. Nearly 58 % of all alcohol-related research papers were from Canada and the United States, 30 % from Western Europe, and 10 % from Australia, New Zealand, or Japan. However, these regions suffer only 13 % of the global burden of disease due to alcohol; meanwhile, the rest of the world contributed only 8 % of the total research whilst suffering from 87 % of the ...

Alcohol myotoxicity: A matter of NO consequence?

Alcoholism: Clinical and Experimental Research, 2000

P119 The effects of the COVID-19 lockdown on severe asthma in patients taking biologic therapy and air pollution

Introduction Whilst Coronavirus Disease 2019 (COVID-19) wreaked havoc, an expected increase in ex... more Introduction Whilst Coronavirus Disease 2019 (COVID-19) wreaked havoc, an expected increase in exacerbations of asthma did not materialize. There was significant improvement in quality of air during lockdown period due to reduced traffic and industrial activity as per local metrological data. The aim of this study was to determine the impact of enforced social distancing (i.e. lockdown) and air pollution on patients with severe asthma taking biologic therapy over 12 weeks’ period. Methods A cross-sectional survey of 60 patients with severe asthma receiving biologic therapy was performed with ethical approval. Results Fifty six (56) patients participated (F39; mean age 47.4 years; response rate 93.3%). Mean time since diagnosis was 19.6 years (SD 11.5 years). All had been on biologic therapy Omalizumab (45), Mepolizumab (7), or Dupilumab (2) for at least three months (mean 38.4 months ± SD 26.5 months). subjectively thirty, 30 (53.6%) patients reported improvement in their asthma sym...

Critical Care After Bariatric Surgery

There is an epidemic of obesity, and patients having bariatric surgery are a major subgroup of th... more There is an epidemic of obesity, and patients having bariatric surgery are a major subgroup of the morbidly obese. Despite the significant comorbidities in this cohort (see below), the 30-day mortality rate after elective bariatric surgery is low (0.3%). Most obese patients without medical comorbidities who have an uncomplicated course after bariatric surgery are managed on the standard inpatient postoperative surgical unit. Estimation of an individual patient’s risk of postoperative complications is made by the patient’s anesthetist and surgeon during their preoperative assessments. These assessments determine the need for a planned postoperative admission to the intensive care unit (ICU) after elective bariatric surgery. Common complications that occur after bariatric surgery are related to the surgical wound, deep vein thrombosis, thromboembolism, revision surgery, or prolonged length of hospital stay. Although many of these complications can be managed on the standard inpatient ...

The Diagnostic Yield and Safety of Sputum Induction in Suspected Pulmonary Tuberculosis in a Tertiary Care Hospital- A Single Centre Experience

TP95. TP095 TUBERCULOSIS CLINICAL AND BASIC STUDIES, 2021

Ethanol Metabolism and Implications for Disease

Neuropathology of Drug Addictions and Substance Misuse, 2016

Abstract Ethanol is one of the most commonly used recreational drugs worldwide, and “drinking” is... more Abstract Ethanol is one of the most commonly used recreational drugs worldwide, and “drinking” is synonymous with the consumption of beverages containing ethanol. Alcohol can damage almost every organ in the body and is responsible for 4% of the global burden of disease. On a geographical level, the burden of disease attributable to alcohol may be greater than that of either tobacco, communicable diseases, or noncommunicable diseases. The ethanol content of alcoholic beverages usually varies between 3% and 50% alcohol by volume, and in some cases can be higher. When alcoholic beverages are consumed, ethanol is absorbed from the gastrointestinal tract and rapidly distributed around the body in the blood before entering tissues, such as the brain. Acetaldehyde, which is produced by metabolism of ethanol in the stomach and liver, is toxic but is further oxidized to acetate. The metabolism of acetate and its significance are less understood, although it will be eventually oxidized in the Krebs cycle, thereby generating cellular energy. The relationships between ethanol metabolism, blood ethanol concentration, and the harmful effects of ethanol are complex and vary between individuals and with drinking habits. Many acute effects correlate with the peak blood ethanol concentrations (BEC) or peak BEC within organs during a drinking session. Other more chronic effects may be due to products of metabolism and the total dose of ethanol ingested over a period of time. The relevance of the absorption, distribution, and metabolism of ethanol to alcohol-induced disease is reviewed.

Acetaldehyde

Neuropathology of Drug Addictions and Substance Misuse, 2016

Abstract Acetaldehyde (ethanal) is an aldehyde that is highly reactive and toxic. Acetaldehyde ca... more Abstract Acetaldehyde (ethanal) is an aldehyde that is highly reactive and toxic. Acetaldehyde causes damage at the cellular and genomic levels. The sheer number of enzymes involved in the metabolism and detoxication of acetaldehyde and other aldehyde species is a testament to the impact of its reactivity. Metabolic or autoxidation pathways lead to the formation of endogenous acetaldehyde, and a large number of genes function in the metabolic detoxication of acetaldehyde. The World Health Organization considers acetaldehyde to be a Class 1 toxin (human carcinogen). The main source of acetaldehyde is the consumption of alcohol. In vivo, ethanol is predominantly metabolized to acetaldehyde. However, there are many other sources of acetaldehyde, both natural and manufactured. Understanding of the potential adverse effects and the pathogenesis of acetaldehyde is a pressing need. More toxicological studies and risk assessment on acetaldehyde are required. Acetaldehyde is ubiquitously present and increased levels are associated with neurological pathologies such as stroke, Wernike encephalopathy, and Alzheimer disease, as well as alcohol-induced impairment of brain structure and function.

Clinical Infectious Diseases, 2005

A 64-year-old woman with a mechanical mitral valve prosthesis developed late-onset Candida endoca... more A 64-year-old woman with a mechanical mitral valve prosthesis developed late-onset Candida endocarditis. Blood cultures grew Candida glabrata and Candida krusei. Transesophageal echocardiography demonstrated vegetations on the valve. The patient was not medically fit for valve replacement, but her condition was successfully treated with 6 weeks of intravenous caspofungin therapy. A 64-year-old white woman, who had been a resident of Nigeria for 120 years, had a medical history that included permanent atrial fibrillation and a mechanical mitral valve replacement (29-mm model 500DM29; ATS Medical) implanted in the United Kingdom in 1985 because of rheumatic mitral valve disease. She was given the anticoagulate warfarin and used a finger-prick home testing system to monitor the prothrombin time. In December 2003, she developed a painful swollen left calf, which was initially treated as cellulitis but was subsequently diagnosed as a spontaneous calf hematoma. The prothrombin time was markedly elevated at 176 s, and the patient had a hemoglobin level of 6.6 g/dL and a WBC count of 13.7 ϫ 10 9 cells/L. She received a transfusion of 2 units of blood and was given vitamin K. Subsequently, she developed abdominal pain, hematemesis, and acute renal failure and required transfer to the United Kingdom by air ambulance for further treatment. At admission to the hospital in the United Kingdom, the patient was hypotensive and anuric (creatinine level, 532 mmol/ L; urea level, 50 mmol/L), but her condition responded to fluid resuscitation and blood transfusion. The prothrombin time was

Burden of Disease Due to Alcohol and Alcohol Related Research

SpringerReference

Nintedanib Pirfenidone for Idiopathic Pulmonary Fibrosis (IPF) in King Abdulaziz Medical City (KAMC), Riyadh - Real Life Data

TP28. TP028 APPROACH TO THERAPY IN FIBROSING AND NON-FIBROSING ILD

Proceedings of the Nutrition Society

Anaesthesia, Pain & Intensive Care

Patients requiring advanced organ support are often malnourished. A rapid, simple and reasonably ... more Patients requiring advanced organ support are often malnourished. A rapid, simple and reasonably accurate method of identifying malnutrition is through the use of a screening tool. Indeed, a nutritional screen is required to complete a full holistic clinical assessment. Organizations such as ESPEN (the European Society for Parenteral and Enteral Nutrition) recommend standardization of nutritional screening (i.e. use of a single tool across a region). Many tools for nutritional screening have been developed. None have been fully validated for use in the intensive therapy unit (ITU). Moreover, most of these tools consider all critically ill patients to be malnourished or at high risk of malnutrition. However, not all patients in the ITU will benefit from nutritional interventions. For this reason, the Nutrition Risk in Critically ill (NUTRIC) score was developed specifically for patients in ITU. However a recent analysis of the PermiT trial failed to demonstrate any benefit on outcome...

BJA: British Journal of Anaesthesia

Brueggeney and colleagues 1 compared the performance of six videolaryngoscopes (VLs) in 720 patie... more Brueggeney and colleagues 1 compared the performance of six videolaryngoscopes (VLs) in 720 patients in a methodologically excellent multicentre study. The context for a difficult airway was simulated by application of a cervical collar, and the results, with all limitations underlined by the authors, raise serious doubts about our (maybe abused) trust in VLs for difficult airways. The most important finding, in our opinion, is that VLs do fail; the success rate was 98% after some data Correspondence | 471

Metabolism and Pathophysiology of Bariatric Surgery, 2017

Clinical Science, 2001

We have identified mutations in the TNFRSFIA gene, in some ADRF families (Cell 97; 133). As a res... more We have identified mutations in the TNFRSFIA gene, in some ADRF families (Cell 97; 133). As a result, all periodic fever families with TNFRSFIA mutations are collectively labelled with an acronym TRAPS (W o r Necrosis Receptor Associated Periodic fever syndrome). Impaired shedding of TNFRSFIA @om the cell membrane, was proposed as the disease mechanism and all affected individuals had low serum levels of soluble TNFRSFlA. Methods: We have now used ABI automated sequencing to screen a further 10 ADRF families for TNFRSFIA mutations. Enzyme linked immunoassay (ELISA) was used to determine TNFRSFIA levels. Results: Three families (Dutch, German and Scottish) had novel R92P, T50K and F60L mutations, and a TSOM mutation previously reported was found in an English family. All affected members of these families have low soluble TNFRSFlA levels. Two additional families (Northern Finnish and Irish) had low TNFRSFlA levels but I L~ mutations were found in any of the 10 TNFRSFIA exons. We therefore sequenced a further 800bp of the promoter regions, which were also negative. These latter two families are of interest because their clinical presentation is entirely compatible with TRAPS, yet they are without discernible TNFRSFIA mutations. In the remaining 5 families we did not identify any mutations in either coding or promoter regions and soluble TNFRSFIA levels were normal. Conclusion: These data indicate a degree of genetic heterogeneity in

Parkin expression varies between regions of the brain in rats in vivo but is not affected by ethanol or gender

European Journal of Surgical Oncology (EJSO), 2017

Regional anaesthesia for facial plastic surgery

Using an Early Warning Score System in the acute medicine unit of a medical city in Saudi Arabia is feasible and reduces admissions to intensive care

Alcohol myotoxicity: A matter of NO consequence?

Alcoholism: Clinical and Experimental Research, 2000

P119 The effects of the COVID-19 lockdown on severe asthma in patients taking biologic therapy and air pollution

Critical Care After Bariatric Surgery

The Diagnostic Yield and Safety of Sputum Induction in Suspected Pulmonary Tuberculosis in a Tertiary Care Hospital- A Single Centre Experience

TP95. TP095 TUBERCULOSIS CLINICAL AND BASIC STUDIES, 2021

Ethanol Metabolism and Implications for Disease

Neuropathology of Drug Addictions and Substance Misuse, 2016

Acetaldehyde

Neuropathology of Drug Addictions and Substance Misuse, 2016

Clinical Infectious Diseases, 2005

Burden of Disease Due to Alcohol and Alcohol Related Research

SpringerReference

Nintedanib Pirfenidone for Idiopathic Pulmonary Fibrosis (IPF) in King Abdulaziz Medical City (KAMC), Riyadh - Real Life Data

TP28. TP028 APPROACH TO THERAPY IN FIBROSING AND NON-FIBROSING ILD

Proceedings of the Nutrition Society

Anaesthesia, Pain & Intensive Care

BJA: British Journal of Anaesthesia

Metabolism and Pathophysiology of Bariatric Surgery, 2017

Clinical Science, 2001

Parkin expression varies between regions of the brain in rats in vivo but is not affected by ethanol or gender