Sivanthiny Sivanandamoorthy - Academia.edu (original) (raw)

Papers by Sivanthiny Sivanandamoorthy

The endocrine system ensures, through a closely regulated network, that body functions are proper... more The endocrine system ensures, through a closely regulated network, that body functions are properly coordinated. The endocrine system is comprised of endocrine glands and their messengers. The chemical mediators synthesized and secreted into the bloodstream are called hormones. The acute stress response consists in producing cortisol, catecholamines, vasopressin, glucagon, and GH aimed at maintaining tissue oxygenation as well as a readily available supply of nutrients. Prolonged critical illness is associated with low T3 syndrome, critical illness-related corticosteroid insufficiency, as well as reduced production of growth hormone and of gonadotropins. Low T3 syndrome is probably an adaptive condition, aimed at reducing energy expenditure. In conditions at risk of critical illness-related corticosteroid insufficiency such as sepsis, treatment with corticosteroids (equivalent of 200 mg hydrocortisone per day for 4 days or more) may be considered.

Frontiers in Immunology, Jul 30, 2018

EMC - Anestesia-Reanimación, Apr 1, 2018

El monoxido de carbono (CO) es la primera causa de intoxicacion accidental en Francia. Su inciden... more El monoxido de carbono (CO) es la primera causa de intoxicacion accidental en Francia. Su incidencia esta disminuyendo, en parte gracias al establecimiento de un sistema de vigilancia y prevencion asegurados respectivamente por el Institut de Veille Sanitaire (InVS) y el Institut National de Prevention et d’Education pour la Sante (INPES). Los efectos perjudiciales del CO se deben a una toxicidad inmediata por hipoxia celular con bloqueo de la cadena mitocondrial, que puede traducirse por un coma y una insuficiencia cardiovascular, y a una toxicidad retardada por peroxidacion de los componentes de la mielina a traves de la activacion plaquetaria y de los polimorfonucleares, que da lugar a lesiones cerebrales. El tratamiento se basa en una oxigenoterapia normobarica (ONB). Las indicaciones de tratamiento con oxigenoterapia hiperbarica (OHB) se reservan a casos bien definidos: perdida de conocimiento antes o en el momento del tratamiento, insuficiencia de organo (neurologica, respiratoria o cardiovascular) y mujer embarazada. Despues de una intoxicacion por CO, es necesario un seguimiento medico para detectar posibles trastornos neuropsiquicos y evaluar su impacto sobre la vida cotidiana. La gravedad potencial de las intoxicaciones, asi como las secuelas generadas, justifican el desarrollo de detectores de CO portatiles.

Critical Care Medicine, Oct 1, 2020

Coma-, delirium-, and invasive mechanical ventilationfree patients admitted to the ICU were inclu... more Coma-, delirium-, and invasive mechanical ventilationfree patients admitted to the ICU were included. Interventions: None. Measurements and Main Results: "State anxiety" was assessed using the state component of the State-Trait Anxiety Inventory State. Severity of illness was measured using Simplified Acute Physiology Score II and Sequential Organ Failure Assessment scores. Primary endpoint was a composite of occurrence of death or new organ failure in the first 7 days after admission. Three hundred ninety-one patients were included; 159 of 391 women (40.7%); median age 63 years (49-74 yr); median Simplified Acute Physiology Score II 28 (19-37). Two hundred three out of 391 patients (51.9%) reported moderate to severe anxiety (State-Trait Anxiety Inventory State ≥ 40). One hundred two out of 391 patients (26.1%) developed a new organ failure. After adjustment to Simplified Acute Physiology Score II and Sequential Organ Failure Assessment, State-Trait Anxiety Inventory State greater than or equal to 40 was associated with the primary endpoint (odds ratio, 1.94; 95% CI, 1.18-3.18; p = 0.009) and respiratory failure. In post hoc analysis, State-Trait Anxiety Inventory State greater than or equal to 40 was associated with new organ failure independently and notably of respiratory status at admission (dyspnea-Visual Analogic Scale and Paco 2 ≥ 45 mm Hg). Conclusions: Moderate to severe anxiety at ICU admission is associated with early occurrence of new organ failure in critically ill patients, independently of respiratory status and severity of critical illness. The causality link could be addressed in an interventional trial.

Research Square (Research Square), Nov 10, 2021

Rationale: Intensity of anxiety at admission in intensive care unit (ICU) is associated with subs... more Rationale: Intensity of anxiety at admission in intensive care unit (ICU) is associated with subsequent deterioration. Objective: The primary aim of this study was to assess predictive value of stressful fears and feelings to predict new organ failure within the rst seven days after ICU admission. Methods: We conducted a prospective three-center cohort study of non-comatose patients without delirium or invasive mechanical ventilation. A twelve-item questionnaire was developed to assess stressful fears and feelings. Illness severity was assessed using SAPS-II and SOFA scores. Intensity of chronic and acute anxiety was assessed with the 'Trait' and 'State' forms of the State-Trait Anxiety Inventory (STAI). Patients were followed-up for seven days. Results: From April 2014 to December 2017, 373 patients (median age, 63y.o. [49-74]; 159 [40.7%] women; SAPS-II 28 [19-37]) were included. Feeling of vulnerability and fear of dying was reported in 209 (54.4%) and 178 (46.4%) patients, respectively. STAI was equal or above 40 in 192 (51.5%) patients. Ninety-four (25.2%) patients developed a new organ failure. Feeling of vulnerability (OR=1.96, 95%CI:1.12-3.43], p=0.01) and absence of fear of dying (OR=2.38, 95%CI:1.37-4.17], p=0.002) were associated with occurrence of a new organ failure after adjustment on STAI ≥40, SAPS-II and SOFA. Conclusion: Absence of fear of dying is associated with occurrence of new organ failure within the seven post-ICU admission days. We hypothesize that fear of dying might be protective for subsequent deterioration by mobilizing patient's homeostatic resources.

Social Science Research Network, 2018

Critical Care Medicine, 2020

Objectives: Anxiety results from the anticipation of a threat and might be associated with poor o... more Objectives: Anxiety results from the anticipation of a threat and might be associated with poor outcome in the critically ill. This study aims at showing that anxiety at admission in critically ill patients is associated with new organ failure over the first 7 days of ICU hospitalization independently of baseline organ failure at admission. Design: Prospective multicenter cohort study. Setting: Three mixed ICU from April 2014 to December 2017. Patients: Coma-, delirium-, and invasive mechanical ventilation-free patients admitted to the ICU were included. Interventions: None. Measurements and Main Results: “State anxiety” was assessed using the state component of the State-Trait Anxiety Inventory State. Severity of illness was measured using Simplified Acute Physiology Score II and Sequential Organ Failure Assessment scores. Primary endpoint was a composite of occurrence of death or new organ failure in the first 7 days after admission. Three hundred ninety-one patients were included...

Medicine, 2020

Thiamine is an essential co-factor for aerobic metabolism. Both thiamine deficiency and sepsis ma... more Thiamine is an essential co-factor for aerobic metabolism. Both thiamine deficiency and sepsis may be associated with hyperlactatemia and hypotension. We assessed the relationship between thiamine compounds, lactate concentrations and clinical outcomes in septic patients. We undertook a prospective observational single-center study. Erythrocyte levels of total thiamine, free thiamine, thiamine mono, di and triphosphate (TMP, TDP, and TTP respectively), the erythrocyte transketolase activity (ETKA) and the effect of thiamine diphosphate on ETKA were measured in septic patients by high performance liquid chromatography and correlated with arterial lactate. Vital status at the end of intensive care unit stay was recorded. Overall, 28 patients suffering from sepsis were included. Median (interquartile range [IQR]) age was 60 [44–77.3] years, 15 (53.6%) patients were male, median [IQR] simplified acute physiology score II was 40 [27–50]. There was no correlation between total thiamine an...

Frontiers in Immunology, 2018

The American Journal of Human Genetics, 2007

Meckel syndrome (MKS) is a rare autosomal recessive lethal condition characterized by central ner... more Meckel syndrome (MKS) is a rare autosomal recessive lethal condition characterized by central nervous system malformations, polydactyly, multicystic kidney dysplasia, and ductal changes of the liver. Three loci have been mapped (MKS1-MKS3), and two genes have been identified (MKS1/FLJ20345 and MKS3/TMEM67), whereas the gene at the MKS2 locus remains unknown. To identify new MKS loci, a genomewide linkage scan was performed using 10-cM-resolution microsatellite markers in eight families. The highest heterogeneity LOD score was obtained for chromosome 12, in an interval containing CEP290, a gene recently identified as causative of Joubert syndrome (JS) and isolated Leber congenital amaurosis. In view of our recent findings of allelism, at the MKS3 locus, between these two disorders, CEP290 was considered a candidate, and homozygous or compound heterozygous truncating mutations were identified in four families. Sequencing of additional cases identified CEP290 mutations in two fetuses with MKS and in four families presenting a cerebro-reno-digital syndrome, with a phenotype overlapping MKS and JS, further demonstrating that MKS and JS can be variable expressions of the same ciliopathy. These data identify a fourth locus for MKS (MKS4) and the CEP290 gene as responsible for MKS.

EMC - Anestesia-Rianimazione, Apr 1, 2018

Il monossido di carbonio (CO) e la prima causa di intossicazione accidentale in Francia. La sua i... more Il monossido di carbonio (CO) e la prima causa di intossicazione accidentale in Francia. La sua incidenza e in diminuzione in parte grazie all’istituzione di un sistema di sorveglianza e prevenzione assicurato rispettivamente dall’Istituto di vigilanza sanitaria (InVS) e dall’Istituto nazionale per la prevenzione e l’educazione sanitaria (INPES). Gli effetti deleteri del CO sono legati a una tossicita immediata per ipossia cellulare con blocco della catena mitocondriale, che puo tradursi in un coma e in un’insufficienza cardiovascolare e in una tossicita ritardata per perossidazione delle componenti della mielina attraverso l’attivazione piastrinica e dei polimorfonucleati, che ha, come conseguenza, delle lesioni cerebrali. Il trattamento e basato sull’ossigenoterapia normobarica (NBOT). Le indicazioni al trattamento con ossigenoterapia iperbarica (HBOT) sono riservate a casi ben definiti: perdita di coscienza prima o al momento della presa in carico, insufficienza d’organo (neurologica, respiratoria o cardiovascolare) e donna gravida. Nei postumi di un’intossicazione da CO, e necessario un follow-up medico per individuare eventuali disturbi neuropsichici e valutarne l’impatto sulla vita quotidiana. La potenziale gravita delle intossicazioni, cosi come le sequele generate, giustificano lo sviluppo di rilevatori di CO portatili.