487 results on '"Yatin, Mehta"'
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2. A Case Report on the Successful Management of Catastrophic Antiphospholipid Syndrome: Multidisciplinary Approach
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Pragya Silwal, Aseem Kumar Tiwari, Geet Aggarwal, Chitra Mehta, and Yatin Mehta
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antiphospholipid antibody ,catastrophic antiphospholipid syndrome ,plasma exchange ,therapeutic plasma exchange ,Diseases of the blood and blood-forming organs ,RC633-647.5 - Abstract
Catastrophic antiphospholipid syndrome (CAPS) is a multi-organ systemic thrombotic condition precipitated due to various secondary conditions such as infection, surgery, and estrogen use. The subsequent formation of various autoantibodies and various organ involvement such as the brain, heart, and kidneys cause rapid progression of the disease. The acute features of thrombosis and the predominant involvement of kidneys and the brain make the differentiation of this condition with other thrombotic microangiopathies difficult. However, early suspicion of CAPS with prompt management is key to favorable prognosis in such patients. Multidisciplinary approach to diagnosis and medical management plays an important role in the successful outcome of CAPS patients. The three pillars of management are therapeutic plasma exchange (TPE), steroids, and anticoagulants. TPE plays a major role in eliminating incriminating antibodies, cytokines, tumor necrosis factor, and complement. We present a case of 34-year-old female with definite CAPS, managed successfully with the triple regimen comprising a total of seven TPE sessions, pulse therapy with steroids, and anticoagulants.
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- 2024
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3. Evaluation of Vulnerabilities for the Spread of Carbapenem Resistant Organisms at Five Hospitals in India
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Susan Fallon, Umang Agrawal, Shaoli Basu, Valeria Fabre, Sarah Fisseha, Johns Hopkins Hospital, Arjunlal Kakrani, Rajesh Karyakarte, Mahadevan Kumar, Abhijeet Mane, Vidya Mave, Yatin Mehta, SHAHZAD MIRZA, Akaash Patel, Bharat Randive, Prachala Rathod, Matthew Robinson, Camilla Rodrigues, Smita Sarma, Jignesh Shah, Patricia Simner, SWEETY SINGH, and Melanie Curless
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Infectious and parasitic diseases ,RC109-216 ,Public aspects of medicine ,RA1-1270 - Abstract
Background: The 2022 WHO global survey on infection prevention and control (IPC) exposes significant gaps in IPC in the WHO Southeast Asia region. A better understanding of IPC vulnerabilities will inform improvement initiatives. We describe an evaluation of IPC practices known to prevent and contain carbapenem-resistant organisms (CROs) at hospitals participating in the United States Centers for Disease Control Global Action in Healthcare Network –Antimicrobial Resistance in India. Prior hospital evaluations suggest resistance to carbapenems among gram-negative isolates is up to 45%. Methods: We conducted a mixed methods evaluation including cross-sectional surveys, semi-structured interviews, and site observations at five hospitals (one government, two private tertiary care, and two private teaching) located in three cities. The number of hospital beds ranged from 362 to 2,011. Hospital and IPC program characteristics, and CRO prevention and containment activities were examined virtually. Site observations focused on hand hygiene, environmental cleaning, personal protective equipment (PPE), CRO containment practices and use of water for patient care. Results: All sites had IPC programs with established policies and qualified IPC staff. The IPC nurse-to-bed ratio ranged from 1:73 to 1:432 (mean, 1:209). Due to the integral role of microbiology staff in IPC at these hospitals, the two departments had strong communication channels associated with CRO identification. Screening for CRO colonization, if done, targeted patients from outside hospitals. Three of the five hospitals routinely implemented contact precautions for patients with identified CROs, displayed isolation signage at the bedside, and provided adequate PPE at point-of-use; however, all sites reported barriers to effective isolation and/or cohorting patients with CROs. Timely communication of CROs to clinical staff varied and no sites effectively relayed CRO status upon patient discharge to another facility. IPC teams identified gaps in environmental cleaning procedures and practices related to medical devices and equipment. All sites used alternatives to tap water for clinical care and sink etiquette was evident. Each IPC team performed audits of patient isolation and hand hygiene practices. Despite the considerable proportion of IPC resources dedicated to daily education and feedback in clinical areas, the IPC teams reported that improvement was often difficult to achieve. Conclusion: Given the high burden of CROs and limited IPC resources, detailed knowledge of IPC opportunities for improvement will help hospitals target novel interventions for CRO prevention and containment. Further investigation of colonization rates and effective performance improvement methods in these settings is needed.
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- 2024
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4. Aviptadil: A multifaceted approach to mitigating hypoxemia in acute respiratory distress syndrome
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Yatin Mehta, Chitra Mehta, and Aravind Chandrasekaran
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Aviptadil ,Acute respiratory distress syndrome ,Critical care ,Oxygenation ,Non-COVID etiologies ,Diseases of the respiratory system ,RC705-779 - Abstract
Acute Respiratory Distress Syndrome (ARDS) is a severe and potentially life-threatening lung condition that often leads to Intensive Care Unit (ICU) admissions. Treating ARDS in the ICU involves providing essential support for proper oxygenation and ventilation, often requiring mechanical ventilation using high positive end-expiratory pressure (PEEP) to recruit alveoli. Strategies like prone positioning and extracorporeal membrane oxygenation (ECMO) may be necessary for stubbornly low oxygen levels. Addressing the underlying cause, if known, and employing additional therapies to prevent complications are also integral parts of the management.Despite advances in critical care, ARDS remains a formidable challenge with considerable risks of mortality and complications. Early recognition, immediate intervention, and comprehensive ICU care are pivotal in enhancing outcomes for ARDS patients. Ongoing research and clinical trials continue to explore innovative treatments and strategies to improve the prognosis of individuals with ARDS. In this series, we share our experience regarding the safe utilization of Aviptadil for treating ARDS arising from causes other than COVID-19.
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- 2024
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5. Expert consensus statement on venovenous extracorporeal membrane oxygenation ECMO for COVID-19 severe ARDS: an international Delphi study
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Ahmed A. Rabie, Alyaa Elhazmi, Mohamed H. Azzam, Akram Abdelbary, Ahmed Labib, Alain Combes, Bishoy Zakhary, Graeme MacLaren, Ryan P. Barbaro, Giles J. Peek, Marta Velia Antonini, Kiran Shekar, Abdulrahman Al‐Fares, Pranay Oza, Yatin Mehta, Huda Alfoudri, Kollengode Ramanathan, Mark Ogino, Lakshmi Raman, Matthew Paden, Daniel Brodie, and Robert Bartlett
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ECMO ,COVID-19 ,Consensus ,Delphi ,Statement ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background The high-quality evidence on managing COVID-19 patients requiring extracorporeal membrane oxygenation (ECMO) support is insufficient. Furthermore, there is little consensus on allocating ECMO resources when scarce. The paucity of evidence and the need for guidance on controversial topics required an international expert consensus statement to understand the role of ECMO in COVID-19 better. Twenty-two international ECMO experts worldwide work together to interpret the most recent findings of the evolving published research, statement formulation, and voting to achieve consensus. Objectives To guide the next generation of ECMO practitioners during future pandemics on tackling controversial topics pertaining to using ECMO for patients with COVID-19-related severe ARDS. Methods The scientific committee was assembled of five chairpersons with more than 5 years of ECMO experience and a critical care background. Their roles were modifying and restructuring the panel’s questions and, assisting with statement formulation in addition to expert composition and literature review. Experts are identified based on their clinical experience with ECMO (minimum of 5 years) and previous academic activity on a global scale, with a focus on diversity in gender, geography, area of expertise, and level of seniority. We used the modified Delphi technique rounds and the nominal group technique (NGT) through three face-to-face meetings and the voting on the statement was conducted anonymously. The entire process was planned to be carried out in five phases: identifying the gap of knowledge, validation, statement formulation, voting, and drafting, respectively. Results In phase I, the scientific committee obtained 52 questions on controversial topics in ECMO for COVID-19, further reviewed for duplication and redundancy in phase II, resulting in nine domains with 32 questions with a validation rate exceeding 75% (Fig. 1). In phase III, 25 questions were used to formulate 14 statements, and six questions achieved no consensus on the statements. In phase IV, two voting rounds resulted in 14 statements that reached a consensus are included in four domains which are: patient selection, ECMO clinical management, operational and logistics management, and ethics. Conclusion Three years after the onset of COVID-19, our understanding of the role of ECMO has evolved. However, it is incomplete. Tota14 statements achieved consensus; included in four domains discussing patient selection, clinical ECMO management, operational and logistic ECMO management and ethics to guide next-generation ECMO providers during future pandemic situations.
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- 2023
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6. Standardized in vitro bleeding tests in a non-coated novel hybrid prosthesis for frozen elephant trunk demonstrates minimal oozing during full heparinization, supported by clinical data
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Heinz Jakob, Timo Leins, Meltem Avci-Adali, Christian Schlensak, Daniel Wendt, Yatin Mehta, Matthias Thielmann, Klaus Görlinger, Suk-Won Song, and Konstantinos Tsagakis
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dissection ,frozen elephant trunk (FET) ,in vitro ,bleeding ,aortic surgery ,hemoadsorption ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
IntroductionRecent reports have questioned the blood impermeability of the novel frozen elephant trunk (FET) device E-vita Open NEO© (EO-NEO). Therefore, standardized in vitro bleeding tests using porcine heparinized blood were performed, as well as stress testing on the blood tightness of the collar suture line, to investigate this observation.Material and methodsEO-NEO prostheses were examined in vitro for blood permeability in three test series. Initially, antegrade perfusion with heparinized porcine blood [activated clotting time (ACT) of 500 s, with a 60 min duration] was performed, followed by ante/retrograde testing via the EO-NEO side port. Testing of the collar suture line under a tension of 10 Newton (N) within a suspension device (blood pressure 120 mmHg, ACT of 560 s, 1 min duration) was carried out with the suture material force fiber white (FFWs) yarn, using standard fixation (5 stitches/cm), FFWh yarn in hemostatic fixation (15 stitches/cm), and flow weave yarn (FWYh).ResultsBlood permeability testing of EO-NEO through the prosthetic lumen or via the side port demonstrated minor leakage without statistical difference between the standard and hemostatic suture lines or suture materials used, or positioning on the crimped or tapered portion (p > 0.05). The specific collar anastomosis testing demonstrated leakage volumes of 140 ml/min for FFWs vs. 16 ml/min for FFWh (p = 0.02), vs. 9 ml/min with the FWYh (p = 0.01).ConclusionDifferent blood leakage tests showed minimal oozing and no difference in blood loss through the fabric and different collar suture lines, but unphysiological pressurized retrograde perfusion of the collar region showed significantly less leakage using FWYh and FFWh, prompting production modification of EO-NEO. Clinical results confirmed low blood loss using this novel FET device.
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- 2023
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7. Association of early mobility with the incidence of deep-vein thrombosis and mortality among critically ill patients: a post hoc analysis of PREVENT trial
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Hasan M. Al-Dorzi, Samah AlQahtani, Abdulaziz Al-Dawood, Fahad M. Al-Hameed, Karen E. A. Burns, Sangeeta Mehta, Jesna Jose, Sami J. Alsolamy, Sheryl Ann I. Abdukahil, Lara Y. Afesh, Mohammed S. Alshahrani, Yasser Mandourah, Ghaleb A. Almekhlafi, Mohammed Almaani, Ali Al Bshabshe, Simon Finfer, Zia Arshad, Imran Khalid, Yatin Mehta, Atul Gaur, Hassan Hawa, Hergen Buscher, Hani Lababidi, Abdulsalam Al Aithan, Yaseen M. Arabi, and for the Saudi Critical Care Trials Group
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Critical care ,Rehabilitation ,Outcomes ,Mobility ,Venous thromboembolism ,Deep-vein thrombosis ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background This study assessed the mobility levels among critically ill patients and the association of early mobility with incident proximal lower-limb deep-vein thrombosis and 90-day mortality. Methods This was a post hoc analysis of the multicenter PREVENT trial, which evaluated adjunctive intermittent pneumatic compression in critically ill patients receiving pharmacologic thromboprophylaxis with an expected ICU stay ≥ 72 h and found no effect on the primary outcome of incident proximal lower-limb deep-vein thrombosis. Mobility levels were documented daily up to day 28 in the ICU using a tool with an 8-point ordinal scale. We categorized patients according to mobility levels within the first 3 ICU days into three groups: early mobility level 4–7 (at least active standing), 1–3 (passive transfer from bed to chair or active sitting), and 0 (passive range of motion). We evaluated the association of early mobility and incident lower-limb deep-vein thrombosis and 90-day mortality by Cox proportional models adjusting for randomization and other co-variables. Results Of 1708 patients, only 85 (5.0%) had early mobility level 4–7 and 356 (20.8%) level 1–3, while 1267 (74.2%) had early mobility level 0. Patients with early mobility levels 4–7 and 1–3 had less illness severity, femoral central venous catheters, and organ support compared to patients with mobility level 0. Incident proximal lower-limb deep-vein thrombosis occurred in 1/85 (1.3%) patients in the early mobility 4–7 group, 7/348 (2.0%) patients in mobility 1–3 group, and 50/1230 (4.1%) patients in mobility 0 group. Compared with early mobility group 0, mobility groups 4–7 and 1–3 were not associated with differences in incident proximal lower-limb deep-vein thrombosis (adjusted hazard ratio [aHR] 1.19, 95% confidence interval [CI] 0.16, 8.90; p = 0.87 and 0.91, 95% CI 0.39, 2.12; p = 0.83, respectively). However, early mobility groups 4–7 and 1–3 had lower 90-day mortality (aHR 0.47, 95% CI 0.22, 1.01; p = 0.052, and 0.43, 95% CI 0.30, 0.62; p
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- 2023
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8. The impact of COVID-19 on health care–associated infections in intensive care units in low- and middle-income countries: International Nosocomial Infection Control Consortium (INICC) findings
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Victor D. Rosenthal, Sheila Nainan Myatra, Jigeeshu Vasishtha Divatia, Sanjay Biswas, Anjana Shrivastava, Majeda A. Al-Ruzzieh, Omar Ayaad, Ariungerel Bat-Erdene, Ider Bat-Erdene, Batsaikhan Narankhuu, Debkishore Gupta, Subhranshu Mandal, Sankar Sengupta, Hala Joudi, Ibrahim Omeis, Hala Mounir Agha, Amr Fathallala, El Hossein Mohahmed, Irem Yesiler, Mehmet Oral, Menekse Ozcelik, Yatin Mehta, Smita Sarma, Souranshu Chatterjee, Souad Belkebir, Alaa Kanaa, Rawan Jeetawi, Samantha A. Mclaughlin, James M. Shultz, Gonzalo Bearman, Zhilin Jin, and Ruijie Yin
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Surveillance ,Infection control ,Infection prevention ,Health care–associated infection ,Nosocomial infection ,Hospital infection ,Infectious and parasitic diseases ,RC109-216 - Abstract
ABSTRACT: Background: This study examines the impact of the COVID-19 pandemic on health care–associated infection (HAI) incidence in low- and middle-income countries (LMICs). Methods: Patients from 7 LMICs were followed up during hospital intensive care unit (ICU) stays from January 2019 to May 2020. HAI rates were calculated using the International Nosocomial Infection Control Consortium (INICC) Surveillance Online System applying the Centers for Disease Control and Prevention's National Healthcare Safety Network (CDC-NHSN) criteria. Pre–COVID-19 rates for 2019 were compared with COVID-19 era rates for 2020 for central line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator-associated events (VAEs), mortality, and length of stay (LOS). Results: A total of 7,775 patients were followed up for 49,506 bed days. The 2019 to 2020 rate comparisons were 2.54 and 4.73 CLABSIs per 1,000 central line days (risk ratio [RR] = 1.85, p = .0006), 9.71 and 12.58 VAEs per 1,000 mechanical ventilator days (RR = 1.29, p = .10), and 1.64 and 1.43 CAUTIs per 1,000 urinary catheter days (RR = 1.14; p = .69). Mortality rates were 15.2% and 23.2% for 2019 and 2020 (RR = 1.42; p < .0001), respectively. Mean LOS for 2019 and 2020 were 6.02 and 7.54 days (RR = 1.21, p < .0001), respectively. Discussion: This study documents an increase in HAI rates in 7 LMICs during the first 5 months of the COVID-19 pandemic and highlights the need to reprioritize and return to conventional infection prevention practices.
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- 2022
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9. The effect of intermittent pneumatic compression on deep-vein thrombosis and ventilation-free days in critically ill patients with heart failure
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Hasan M. Al-Dorzi, Abdulaziz Al-Dawood, Fahad M. Al-Hameed, Karen E. A. Burns, Sangeeta Mehta, Jesna Jose, Sami Alsolamy, Sheryl Ann I. Abdukahil, Lara Y. Afesh, Mohammed S. Alshahrani, Yasser Mandourah, Ghaleb A. Almekhlafi, Mohammed Almaani, Ali Al Bshabshe, Simon Finfer, Zia Arshad, Imran Khalid, Yatin Mehta, Atul Gaur, Hassan Hawa, Hergen Buscher, Hani Lababidi, Abdulsalam Al Aithan, and Yaseen M. Arabi
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Medicine ,Science - Abstract
Abstract There are contradictory data regarding the effect of intermittent pneumatic compression (IPC) on the incidence of deep-vein thrombosis (DVT) and heart failure (HF) decompensation in critically ill patients. This study evaluated the effect of adjunctive use of IPC on the rate of incident DVT and ventilation-free days among critically ill patients with HF. In this pre-specified secondary analysis of the PREVENT trial (N = 2003), we compared the effect of adjunctive IPC added to pharmacologic thromboprophylaxis (IPC group), with pharmacologic thromboprophylaxis alone (control group) in critically ill patients with HF. The presence of HF was determined by the treating teams according to local practices. Patients were stratified according to preserved (≥ 40%) versus reduced (
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- 2022
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10. Multinational prospective cohort study of rates and risk factors for ventilator-associated pneumonia over 24 years in 42 countries of Asia, Africa, Eastern Europe, Latin America, and the Middle East: Findings of the International Nosocomial Infection Control Consortium (INICC)
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Victor Daniel Rosenthal, Zhilin Jin, Ziad A. Memish, Camilla Rodrigues, Sheila Nainan Myatra, Mohit Kharbanda, Sandra Liliana Valderrama-Beltran, Yatin Mehta, Mohammad Abdellatif Daboor, Subhash Kumar Todi, Guadalupe Aguirre-Avalos, Ertugrul Guclu, Chin Seng Gan, Luisa Fernanda Jiménez Alvarez, Rajesh Chawla, Sona Hlinkova, Rajalakshmi Arjun, Hala Mounir Agha, Maria Adelia Zuniga Chavarria, Narangarav Davaadagva, Mat Nor Mohd Basri, Katherine Gomez, Daisy Aguilar De Moros, Chian-Wern Tai, Alejandro Sassoe Gonzalez, Lina Alejandra Aguilar Moreno, Kavita Sandhu, Jarosław Janc, Mary Cruz Aleman Bocanegra, Dincer Yildizdas, Yuliana Andrea Cano Medina, Maria Isabel Villegas Mota, Abeer Aly Omar, Wieslawa Duszynska, Souad BelKebir, Amani Ali El-Kholy, Safaa Abdulaziz Alkhawaja, George Horhat Florin, Eduardo Alexandrino Medeiros, Lili Tao, Nellie Tumu, May Gamar Elanbya, Reshma Dongol, Vesna Mioljević, Lul Raka, Lourdes Dueñas, Nilton Yhuri Carreazo, Tarek Dendane, Aamer Ikram, Souha S. Kanj, Michael M. Petrov, Asma Bouziri, Nguyen Viet Hung, Vladislav Belskiy, Naheed Elahi, María Marcela Bovera, and Ruijie Yin
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Infectious and parasitic diseases ,RC109-216 ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Objective: Rates of ventilator-associated pneumonia (VAP) in low- and middle-income countries (LMIC) are several times above those of high-income countries. The objective of this study was to identify risk factors (RFs) for VAP cases in ICUs of LMICs. Design: Prospective cohort study. Setting: This study was conducted across 743 ICUs of 282 hospitals in 144 cities in 42 Asian, African, European, Latin American, and Middle Eastern countries. Participants: The study included patients admitted to ICUs across 24 years. Results: In total, 289,643 patients were followed during 1,951,405 patient days and acquired 8,236 VAPs. We analyzed 10 independent variables. Multiple logistic regression identified the following independent VAP RFs: male sex (adjusted odds ratio [aOR], 1.22; 95% confidence interval [CI], 1.16–1.28; P < .0001); longer length of stay (LOS), which increased the risk 7% per day (aOR, 1.07; 95% CI, 1.07–1.08; P < .0001); mechanical ventilation (MV) utilization ratio (aOR, 1.27; 95% CI, 1.23–1.31; P < .0001); continuous positive airway pressure (CPAP), which was associated with the highest risk (aOR, 13.38; 95% CI, 11.57–15.48; P < .0001); tracheostomy connected to a MV, which was associated with the next-highest risk (aOR, 8.31; 95% CI, 7.21–9.58; P < .0001); endotracheal tube connected to a MV (aOR, 6.76; 95% CI, 6.34–7.21; P < .0001); surgical hospitalization (aOR, 1.23; 95% CI, 1.17–1.29; P < .0001); admission to a public hospital (aOR, 1.59; 95% CI, 1.35-1.86; P < .0001); middle-income country (aOR, 1.22; 95% CI, 15–1.29; P < .0001); admission to an adult-oncology ICU, which was associated with the highest risk (aOR, 4.05; 95% CI, 3.22–5.09; P < .0001), admission to a neurologic ICU, which was associated with the next-highest risk (aOR, 2.48; 95% CI, 1.78–3.45; P < .0001); and admission to a respiratory ICU (aOR, 2.35; 95% CI, 1.79–3.07; P < .0001). Admission to a coronary ICU showed the lowest risk (aOR, 0.63; 95% CI, 0.51–0.77; P < .0001). Conclusions: Some identified VAP RFs are unlikely to change: sex, hospitalization type, ICU type, facility ownership, and country income level. Based on our results, we recommend focusing on strategies to reduce LOS, to reduce the MV utilization ratio, to limit CPAP use and implementing a set of evidence-based VAP prevention recommendations.
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- 2023
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11. Perioperative dexmedetomidine reduces delirium after coronary artery bypass graft surgery: A prospective, single-blind, observational study
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Ajmer Singh, Vinit Garg, Yatin Mehta, Anil Bhan, and Naresh Trehan
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coronary artery bypass graft surgery ,dexmedetomidine ,postoperative delirium ,propofol ,Anesthesiology ,RD78.3-87.3 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: Delirium is a commonly seen complication of cardiac surgery. Dexmedetomidine, by its anti-inflammatory properties and other effects, can attenuate postoperative delirium. Aims: The aim of this work was to study the incidence of delirium after coronary artery bypass graft surgery, and to compare the effects of dexmedetomidine and propofol on the incidence of postoperative delirium in coronary artery bypass graft surgery patients. Materials and Methods: A prospective, observational study was conducted on 180 consecutive patients undergoing off-pump or on-pump coronary artery bypass graft surgery. The patients were administered either intravenous dexmedetomidine (n = 90) or propofol (n = 90) after hemostasis was achieved, till they were ready for weaning from the ventilator. The Confusion Assessment Method was used to assess the incidence of postoperative delirium. Measurements and Main Results: A total of 25 (13.8%) patients developed delirium after coronary artery bypass graft surgery. Sedation with dexmedetomidine was associated with a significantly reduced incidence of postoperative delirium (8.9% v 18.9% propofol, P = 0.049). Subgroup analyses showed reduced incidence of postoperative delirium in off-pump patients compared to on-pump coronary artery bypass graft patients (3.3% vs. 20%, P = 0.009 dexmedetomidine group and 11.6% vs. 33.3%, P = 0.047 propofol group respectively). The mean age of the patients who had delirium was significantly more (64.9 ± 8.1 years vs. 52.5 ± 5.8 years, P = 0.046) compared to those who did not have delirium. Conclusion: Administration of dexmedetomidine-based sedation resulted in the reduced incidence of postoperative delirium compared to propofol-based sedation in patients after coronary artery bypass graft surgery.
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- 2022
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12. Comparative study of cardiac output measurement by regional impedance cardiography and thermodilution method in patients undergoing off pump coronary artery bypass graft surgery
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Amrita Guha, Dheeraj Arora, and Yatin Mehta
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noninvasive cardiac output monitoring ,off pump coronary artery bypass graft surgery ,regional impedance cardiography ,thermodilution ,Anesthesiology ,RD78.3-87.3 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: An ideal CO monitor should be noninvasive, cost effective, reproducible, reliable during various physiological states. Limited literature is available regarding the noninvasive CO monitoring in open chest surgeries. Aim: The aim of this study was to compare the CO measurement by Regional Impedance Cardiography (RIC) and Thermodilution (TD) method in patients undergoing off pump coronary artery bypass graft surgery (OPCAB). Settings and Design: We conducted a prospective observational comparative study of CO measurement by the noninvasive RIC method using the NICaS Hemodynamic Navigator system and the gold standard TD method using pulmonary artery catheter in patients undergoing OPCAB. A total of 150 data pair from the two CO monitoring techniques were taken from 15 patients between 40-70 years at various predefined time intervals of the surgery. Patients and Methods: We have tried to find out the accuracy, precision and cost effectiveness of the newer RIC technique. Mean CO, bias and precision were compared for each pair i.e.TD-CO and RIC-CO as recommended by Bland and Altman. The Sensitivity and specificity of cutoff value to predict change in TD-CO was used to create a Receiver operating characteristic or ROC curve. Results: Mean TD-CO values were around 4.52 ± 1.09 L/min, while mean RIC- CO values were around 4.77± 1.84 L/min. The difference in CO change was found to be statistically not significant (p value 0.667). The bias was small (-0.25). The Bland Altman plot revealed a mean difference of -0.25 litres. The RIC method had a sensitivity of 55.56 % and specificity of 33.33 % in predicting 15% change in CO of TD method and the total diagnostic accuracy was 46.67%. Conclusion: A fair correlation was found between the two techniques. The RIC method may be considered as a promising noninvasive, potentially low cost alternative to the TD technique of hemodynamic measurement.
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- 2022
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13. Unexpected values of mixed venous blood analysis: Back to basics before sampling
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Ajmer Singh, Chinmaya Nanda, and Yatin Mehta
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Anesthesiology ,RD78.3-87.3 ,Pharmacy and materia medica ,RS1-441 - Published
- 2023
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14. Use of CytoSorb therapy to treat critically ill coronavirus disease 2019 patients: a case series
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Yatin Mehta, Chitra Mehta, Saurabh Nanda, Gaurav Kochar, Joby V. George, and Manish Kumar Singh
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CytoSorb ,COVID-19 ,Cytokines ,Intensive care unit (ICU) ,Critical illness ,Medicine - Abstract
Abstract Background Acute respiratory distress syndrome is an important clinical presentation of respiratory complications caused by severe acute respiratory syndrome coronavirus 2, a novel coronavirus responsible for the ongoing pandemic. The disease is poorly understood, and immunopathogenesis is constantly evolving. Cytokine release syndrome remains central to pathology of coronavirus disease 2019. Antivirals, anticytokine treatment, and other pharmacological approaches have failed to treat it. CytoSorb, an extracorporeal cytokine adsorber that reduces the cytokine storm and other inflammatory mediators in the blood, seems promising in treating severely ill patients with coronavirus disease 2019. Case presentation This article presents three cases of Asian ethnicity of severely ill adult patients with coronavirus disease 2019 admitted to intensive care unit who were treated with CytoSorb therapy. All patients used single CytoSorb device. During their clinical course, all patients were prescribed tocilizumab (an interleukin-6 receptor blocker), antivirals, hydroxychloroquine, azithromycin, and other antibiotics and general antipyretic drugs. No vasopressor treatment was required. The patients’ average duration of stay in intensive care unit was 30 days; the average duration of stay in hospital was 31 days. All three patients showed significant improvement in biochemical parameters and clinical outcomes post CytoSorb therapy. C-reactive protein levels decreased by 91.5%, 97.4%, and 55.75 %, and mean arterial pressure improved by 18%, 23%, and 17 % in patient 1, 2, and 3, respectively, on day 7 post-therapy. Conclusions All three patients improved clinically and survived.
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- 2021
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15. A career in cardiac anaesthesia in India: The heart of the matter
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Satyajeet Misra, Satyen Parida, Murali Chakravarthy, Yatin Mehta, and Goverdhan Dutt Puri
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cardiac anaesthesia ,career ,history ,stress ,Anesthesiology ,RD78.3-87.3 - Abstract
Cardiac anaesthesia is a demanding, but fulfilling speciality which challenges the skills, knowledge, professional and personal competence of cardiac anaesthesiologists on a daily basis. This article outlines the brief history of the subspecialty of cardiac anaesthesia in India, its growth and progress over the decades, reasons for choosing it as a career option, variations in practice standards and how the speciality has been affected by the coronavirus 2019 pan?demic.
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- 2021
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16. Patient blood management in India - Review of current practices and feasibility of applying appropriate standard of care guidelines. A position paper by an interdisciplinary expert group
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Ajay Gandhi, Klaus Görlinger, Sukesh C Nair, Poonam M Kapoor, Anjan Trikha, Yatin Mehta, Anil Handoo, Anil Karlekar, Jyoti Kotwal, Joseph John, Shashikant Apte, Vijay Vohra, Gajendra Gupta, Aseem K Tiwari, Anjali Rani, and Shweta A Singh
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bleeding ,blood transfusion ,coagulopathy ,hemorrhage ,hemostasis testing ,patient blood management ,patient safety ,point-of-care testing ,thromboelastometry ,Anesthesiology ,RD78.3-87.3 ,Pharmacy and materia medica ,RS1-441 - Abstract
In a developing country like India, with limited resources and access to healthcare facilities, dealing with massive hemorrhage is a major challenge. This challenge gets compounded by pre-existing anemia, hemostatic disorders, and logistic issues of timely transfer of such patients from peripheral hospitals to centers with adequate resources and management expertise. Despite the awareness amongst healthcare providers regarding management modalities of bleeding patients, no uniform Patient Blood Management (PBM) or perioperative bleeding management protocols have been implemented in India, yet. In light of this, an interdisciplinary expert group came together, comprising of experts working in transfusion medicine, hematology, obstetrics, anesthesiology and intensive care, to review current practices in management of bleeding in Indian healthcare institutions and evaluating the feasibility of implementing uniform PBM guidelines. The specific intent was to perform a gap analysis between the ideal and the current status in terms of practices and resources. The expert group identified interdisciplinary education in PBM and bleeding management, bleeding history, viscoelastic and platelet function testing, and the implementation of validated, setting-specific bleeding management protocols (algorithms) as important tools in PBM and perioperative bleeding management. Here, trauma, major surgery, postpartum hemorrhage, cardiac and liver surgery are the most common clinical settings associated with massive blood loss. Accordingly, PBM should be implemented as a multidisciplinary and practically applicable concept in India in a timely manner in order to optimize the use the precious resource blood and to increase patients' safety.
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- 2021
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17. Combined off pump coronary artery bypass graft and liver transplant
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Rajiv Juneja, Ajay Kumar, Rajeev Ranjan, P M Hemantlal, Yatin Mehta, Harpreet Wasir, Vijay Vohra, and Naresh Trehan
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living donor liver transplant ,liver transplant ,off pump coronary artery bypass graft ,coronary artery bypass graft ,combined surgery ,cabg ,Anesthesiology ,RD78.3-87.3 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: Prospective recipients of liver transplant (LT) have a high prevalence rate of coronary artery disease (CAD) requiring revascularization. In patients of Child Turcot Pugh Class B and C performing LT prior to cardiac revascularization on cardiopulmonary bypass leads to a high risk of major adverse cardiovascular events (MACE). Whereas, isolated cardiac surgery prior to LT has perioperative risk of coagulopathy, sepsis, and hepatic decompensation. We present four cases of end stage liver disease who underwent concomitant living donor liver transplant (LDLT) with off pump coronary artery bypass graft (OPCAB) in an effort to decrease the morbidity and mortality. Methods: The cases were performed in a tertiary care centre over two years. Four patients scheduled for LDLT, who were diagnosed with significant CAD, underwent single sitting OPCAB and LDLT. Cardiac surgery was performed first and once patient was stable, it was followed by LDLT. The morbidity parameters in terms of duration of intubation, blood transfusion, hospital stay, ICU stay, requirement of dialysis, atrial fibrillation and sepsis was compared with similar studies. Results: The blood transfusion requirement (median 8 units PRBC), incidence of atrial fibrillation (25%), sepsis (25%), and renal dysfunction (0%) was less than the combined surgery conducted on cardiopulmonary bypass. The rate of median intubation time, length of ICU stay, hospital stay, and one year mortality rate was comparable with other studies. Conclusions: Morbidity with combined OPCAB and LDLT is less than combined on pump coronary artery bypass surgery with LDLT. Combined CABG with LDLT may be performed with acceptable outcomes in CTP class B and C cirrhosis.
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- 2021
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18. Heterotopic caval valve implantation in severe tricuspid regurgitation
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Neeraj Kumar Sharma, Nagendra Singh Chouhan, Manish Bansal, Praveen Chandra, Ajmer Singh, Rajiv Juneja, Yatin Mehta, and Naresh Trehan
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caval valve implantation ,structural heart disease intervention ,transcatheter therapy ,tricuspid regurgitation ,Anesthesiology ,RD78.3-87.3 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Severe symptomatic tricuspid regurgitation (TR) with right heart failure is associated with significant morbidity and mortality. Medical therapy is often ineffective and surgical correction is not feasible due to prohibitive perioperative risk. Transcatheter caval valve implantation (CAVI) is an evolving therapeutic option for this condition. It refers to the heterotopic placement of a valve into the inferior vena cava alone or with a second valve in the superior vena cava to restrict the backflow from the failing tricuspid valve. We hereby describe a patient with previous mitral valve surgery with chronic severe TR who underwent successful CAVI at our institute.
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- 2021
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19. Dynamics of SARS-CoV-2 Antibody Response in a Longitudinal Cohort of Healthcare Workers from India
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Sonam Singla, Vyoma Singh, Smita Sarma, Charu Yadav, Kamini Vinayak, Teena Wadhwa, Renu Saxena, and Yatin Mehta
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coronavirus disease 2019 ,immunity ,immunogobulin g ,severe acute respiratory syndrome coronavirus 2 ,serial titres ,Medicine - Abstract
Introduction: Coronavirus Disease 2019 (COVID-19) pandemic has affected healthcare systems worldwide. Healthcare Workers (HCWs) form one of the most at-risk population groups for acquiring infection. Trend analysis of anti Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) antibody titres in vaccination naïve HCWs will give an insight into the role of natural protective immunity against reinfection. Aim: To understand the dynamics of anti SARS-CoV-2 antibody response and its protective role against reinfection in a cohort of HCWs. Materials and Methods: This observational longitudinal cohort study was conducted in a tertiary care hospital in Gurugram, Haryana, North India from June to December 2020. The study was approved by the Institutional Ethics Committee. Serum specimens from 230 HCWs were tested for anti-spike protein Immunogloublin G (IgG) antibodies by chemiluminescence immunoassay. The HCWs with positive antibody status and previous Polymerase Chain Reaction (PCR) confirmed infection (n=47) were followed-up over 180 days for serial antibody titres at four visits, each at a gap of 30-45 days. Participants were classified into asymptomatic (n=18), mild (n=17) and moderate (n=12) disease categories based on severity of previous COVID-19 illness. SPSS version 22.0 was used for statistical analysis. Intergroup comparison of means was done using Kruskal-Wallis test and Chi-square test. The p
- Published
- 2022
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20. Meeting the Unmet Need in the Management of MDR Gram-Positive Infections with Oral Bactericidal Agent Levonadifloxacin
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Yatin Mehta, K. C. Mishra, Yashesh Paliwal, Pradeep Rangappa, Sharmili Sinha, and Sandeep Bhapkar
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Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Levonadifloxacin (intravenous) and its oral prodrug alalevonadifloxacin are broad-spectrum antibacterial agents developed for the treatment of difficult-to-treat infections caused by multidrug-resistant Gram-positive bacteria, especially methicillin-resistant Staphylococcus aureus, atypical bacteria, anaerobic bacteria, and biodefence pathogens as well as Gram-negative bacteria. Levonadifloxacin has a well-defined mechanism of action involving a strong affinity for DNA gyrase as well as topoisomerase IV. Alalevonadifloxacin with widely differing solubility and oral bioavailability has pharmacokinetic profile identical to levonadifloxacin. Unlike existing MRSA drugs such as vancomycin and linezolid, which cause unfavorable side effects like nephrotoxicity, bone-marrow toxicity, and muscle toxicity, levonadifloxacin/alalevonadifloxacin has demonstrated superior safety and tolerability features with no serious adverse events. Levonadifloxacin/alalevonadifloxacin could be a useful weapon in the battle against infections caused by resistant microorganisms and could be a preferred antibiotic of choice for empirical therapy in the future.
- Published
- 2022
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21. Principles of conducting cardiac anaesthesia services in COVID-19 pandemic
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Yatin Mehta and Naveen Malhotra
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Anesthesiology ,RD78.3-87.3 - Published
- 2021
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22. A rare case of cardiac hydatid cyst
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Amrita Guha, Rajeev Ranjan, Pravin Saxena, and Yatin Mehta
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cardiac hydatid cyst ,echinococcosis ,hydatid disease ,Anesthesiology ,RD78.3-87.3 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Hydatid infection of the heart is rare and there is always the lethal hazard of cyst perforation. We present an 18-year-old male from Kashmir valley who was admitted to the emergency department of our hospital with fever and chest pain for the last 4 days. Using echocardiography and cardiac tomography (CT), cardiac Echinococcosis was diagnosed. The results of surgical treatment of cardiac Echinococcosis were better than the conservative strategy. Surgical excision was performed. The patient had an uneventful recovery.
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- 2021
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23. A rare case of double orifice mitral valve: A case report
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Shweta S Kandpal, Anil Kumar, Manisha Mishra, and Yatin Mehta
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congenital cardiac anomaly ,double-orifice mitral valve ,mitral regurgitation ,transesophageal echocardiography ,Anesthesiology ,RD78.3-87.3 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Double-orifice mitral valve is a rare congenital anomaly being associated with other cardiac defects and rarely presented in isolation. Valve function can be preserved for long and it is usually an incidental finding. We present an unusual case of double-orifice mitral valve with mitral regurgitation in a middle-aged man associated with the atrial septal defect, highlighting the role of three-dimensional transesophageal echocardiography.
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- 2021
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24. Acute perioperative hyperlactatemia in oncoplastic reconstructive surgeries: What is the significance?
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Preety M Roy, Kamal Bharti, Sudha Sinha, Sangeeta Khanna, and Yatin Mehta
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free flap surgery ,lactate ,oncoplastic surgery ,reconstructive ,Anesthesiology ,RD78.3-87.3 ,Pharmacy and materia medica ,RS1-441 - Abstract
Background and Aims: We aim to study the significance of intraoperative hyperlactatemia in reconstructive oncoplastic surgery. Material and Methods: A retrospective observational study was conducted on a cohort of patients who underwent reconstructive oncoplastic surgery with free flap for oral cancer over a 6-month period. The study population was divided into two groups based on peak lactate levels. Group N with peak lactate level less than 2 mmol/L and Group H peak lactate level more than 2 mmol/L. The various parameter studied were patient's comorbidities; intraoperative events (vasopressor requirement, blood transfusion, and duration of surgery); postoperative parameters including the need for re- exploration and duration of stay in hospital and intensive care unit. Results: The study demonstrates that intraoperative rise of lactate was not influenced by comorbidities. None of the intraoperative parameters studied influenced the lactate levels. Baseline lactate level was found to correlate with peak lactate level intraoperatively. But it was observed that there was normalization of lactate level within 24 hours postoperatively in both the groups. There was no difference in outcome parameters in the two groups. Conclusion: Intraoperative hyperlactatemia is not a significant prognostic factor for outcome in oncoplastic reconstructive surgery.
- Published
- 2021
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25. Multinational prospective study of incidence and risk factors for central-line–associated bloodstream infections in 728 intensive care units of 41 Asian, African, Eastern European, Latin American, and Middle Eastern countries over 24 years
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Victor Daniel Rosenthal, Ruijie Yin, Sheila Nainan Myatra, Ziad A. Memish, Camilla Rodrigues, Mohit Kharbanda, Sandra Liliana Valderrama-Beltran, Yatin Mehta, Majeda Afeef Al-Ruzzieh, Guadalupe Aguirre-Avalos, Ertugrul Guclu, Chin Seng Gan, Luisa Fernanda Jiménez Alvarez, Rajesh Chawla, Sona Hlinkova, Rajalakshmi Arjun, Hala Mounir Agha, Maria Adelia Zuniga Chavarria, Narangarav Davaadagva, Yin Hoong Lai, Katherine Gomez, Daisy Aguilar-de-Moros, Chian-Wern Tai, Alejandro Sassoe Gonzalez, Lina Alejandra Aguilar Moreno, Kavita Sandhu, Jarosław Janc, Mary Cruz Aleman Bocanegra, Dincer Yildizdas, Yuliana Andrea Cano Medina, Maria Isabel Villegas Mota, Abeer Aly Omar, Wieslawa Duszynska, Amani Ali El-Kholy, Safaa Abdulaziz Alkhawaja, George Horhat Florin, Eduardo Alexandrino Medeiros, Lili Tao, Nellie Tumu, May Gamar Elanbya, Reshma Dongol, Vesna Mioljević, Lul Raka, Lourdes Dueñas, Nilton Yhuri Carreazo, Tarek Dendane, Aamer Ikram, Tala Kardas, Michael M. Petrov, Asma Bouziri, Nguyen Viet-Hung, Vladislav Belskiy, Naheed Elahi, Estuardo Salgado, and Zhilin Jin
- Subjects
Microbiology (medical) ,Infectious Diseases ,Epidemiology - Abstract
Objective: To identify central-line (CL)–associated bloodstream infection (CLABSI) incidence and risk factors in low- and middle-income countries (LMICs). Design: From July 1, 1998, to February 12, 2022, we conducted a multinational multicenter prospective cohort study using online standardized surveillance system and unified forms. Setting: The study included 728 ICUs of 286 hospitals in 147 cities in 41 African, Asian, Eastern European, Latin American, and Middle Eastern countries. Patients: In total, 278,241 patients followed during 1,815,043 patient days acquired 3,537 CLABSIs. Methods: For the CLABSI rate, we used CL days as the denominator and the number of CLABSIs as the numerator. Using multiple logistic regression, outcomes are shown as adjusted odds ratios (aORs). Results: The pooled CLABSI rate was 4.82 CLABSIs per 1,000 CL days, which is significantly higher than that reported by the Centers for Disease Control and Prevention National Healthcare Safety Network (CDC NHSN). We analyzed 11 variables, and the following variables were independently and significantly associated with CLABSI: length of stay (LOS), risk increasing 3% daily (aOR, 1.03; 95% CI, 1.03–1.04; P < .0001), number of CL days, risk increasing 4% per CL day (aOR, 1.04; 95% CI, 1.03–1.04; P < .0001), surgical hospitalization (aOR, 1.12; 95% CI, 1.03–1.21; P < .0001), tracheostomy use (aOR, 1.52; 95% CI, 1.23–1.88; P < .0001), hospitalization at a publicly owned facility (aOR, 3.04; 95% CI, 2.31–4.01; P Conclusions: The following CLABSI risk factors are unlikely to change: country income level, facility ownership, hospitalization type, and ICU type. These findings suggest a focus on reducing LOS, CL days, and tracheostomy; using PICC instead of internal-jugular or femoral CL; and implementing evidence-based CLABSI prevention recommendations.
- Published
- 2023
26. Transcatheter Aortic Valve Replacement (TAVR) in thalassemic patients
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Yatin Mehta, Amrita Guha, Ravinder Sawhney, Rajiv Juneja, Praveen Chandra, Nagendra Chauhan, and Naresh Trehan
- Subjects
Anesthesiology ,RD78.3-87.3 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2022
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27. Permanent dialysis catheter-related right atrial mass: A case report
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Ajmer Singh, Battu K Shrestha, Yatin Mehta, and Naresh Trehan
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Anesthesiology ,RD78.3-87.3 ,Pharmacy and materia medica ,RS1-441 - Published
- 2020
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28. Continuation of metformin till night before surgery and lactate levels in patients undergoing coronary artery bypass graft surgery
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Tarannum Bano, Sunil Kumar Mishra, Mohammad Shafi Kuchay, Yatin Mehta, Naresh Trehan, Pooja Sharma, Manish Kumar Singh, and Ambrish Mithal
- Subjects
Coronary artery bypass graft ,lactate levels ,lactic acidosis ,metformin ,type 2 diabetes ,Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background: Lactic acidosis is a rare but serious complication associated with metformin therapy in certain high-risk patients. NICE guidelines and the British National Formulary advise the discontinuation of metformin before surgery. The drug manufacturer's datasheet advises the withdrawal of metformin 48 h before surgery. However, the data regarding perioperative use of metformin is scarce. Aims: To evaluate the effect of continuation of metformin till night before surgery on lactate levels in patients undergoing coronary artery bypass graft (CABG) surgery. Materials and Methods: In this prospective cohort study, 1,800 consecutive patients who underwent CABG between 1st November 2015 and 31st October 2016 were enrolled. Following exclusion criteria, a total of 790 subjects were included for final analysis. Three-hundred and eight seven (48.9%) patients with diabetes received metformin till night before surgery (Met group), 239 (30.3%) patients with diabetes were non-metformin users (Non-Met group), and 164 (20.8%) patients were having no diabetes (Non-Diab group). Lactate levels and arterial pH were measured using arterial blood gas machine. Postoperative morbidity outcome data were obtained by collecting clinical data, routine biochemistry, and chest imaging. Results: The mean metformin dose was 1,124.6 mg/day (SD: 509.3; range: 500–2,500 mg/day). Mean postoperative lactate levels were 1.91 ± 0.7 in Met group, 2.04 ± 0.79 in Non-Met group, and 2.07 ± 0.78 in Non-Diab group. Lactic acidosis occurred in 41 patients and there was no difference among the groups [Met group = 18 (4.7%); Non-Met group = 14 (5.9%)]. Among secondary outcome measures, acute renal failure occurred more frequently in diabetic patients [Met group = 46 (11.9%) and Non-Met group = 32 (13.4%)] as compared with non-diabetic patients. There were no differences with regard to pneumonia, length of ICU stay, and duration of ventilatory support among the three groups. Conclusions: Continuation of metformin till night before surgery is not associated with significant changes in lactate levels in patients undergoing CABG.
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- 2019
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29. A randomized study to compare palonosetron with ondansetron for prevention of postoperative nausea and vomiting following middle ear surgeries
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Shubhangi Sharma, Sangeeta Khanna, Jyotirmoy Das, Yatin Mehta, and Kumud Kumar Handa
- Subjects
Middle ear surgery ,ondansetron ,palonosetron ,postoperative nausea and vomiting ,Anesthesiology ,RD78.3-87.3 ,Pharmacy and materia medica ,RS1-441 - Abstract
Background and Aims: Postoperative nausea and vomiting (PONV) has multifactorial etiology. It is a commonly encountered morbidity after anesthesia specially following middle ear surgery. Various antiemetic medications have been tried with mixed responses. Palonosetron is a newer 5-hydroxytryptamine (5-HT3) receptor antagonist marketed for PONV prophylaxis. This study was designed to compare the efficacy of palonosetron and ondansetron in preventing PONV after middle ear surgeries. Material and Methods: One hundred patients of ASA class 1 or 2, aged 18 years and above, weighing between 40 and 90 kg scheduled for elective middle ear surgeries were randomly assigned into palonosetron group (n = 50) and ondansetron group (n = 50). Palonosetron was administered in dose of 1 mcg/kg maximum up to 75 mcg and ondansetron in dose of 0.1 mg/kg maximum up to 8 mg. Intraoperative monitoring of QTc interval was also done to see any significant change after the antiemetic administration. The incidence of nausea, vomiting, and side effects were recorded over 2, 12, and 24 hours postoperatively. All parameters were compared between the two groups as mean ± standard deviation and as count (%). Two sided P values of
- Published
- 2019
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30. Bullet in tracheobronchial tree without lung contusion removed by fibreoptic bronchoscopy in two parts
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Ashish K. Prakash, Anand Jaiswal, Ankit Aggarwal, B. Datta, Sangeeta Khanna, K.K. Handa, and Yatin Mehta
- Subjects
Diseases of the respiratory system ,RC705-779 - Abstract
A person presented with multiple gunshot injury. Chest x-ray & CT whole body trauma protocol was done which showed multiples pellets of bullet in abdomen and one bullet in elbow according to entry wound. There was an entry wound without any bullet in left maxillofacial region however there was no exit wound. A bullet was noticed in tracheobronchial tree. There was no pneumothorax any signs of chest trauma or any pneumomediastinum. It is assumed that the bullet first hit the left cheek (maxilla) and lost its momentum. As the patient lost consciousness and had a fall leading to inhalation (aspiration) of bullet in the airway. As per ballistic experts it was basically a jacketed metallic bullet. As bullet moved in airway, the outer metallic core reached the trachea near carina and the soft metallic core slipped more distally to right main bronchus and bronchus intermedius. While inspection the outer metallic capsule was seen in trachea just above carina which was hollow and was gently removed with the help of foreign body forceps. The core was removed with dormia basket without any mucosal tear. The favorable outcome can be attributed as patient had no lung contusion or chest trauma and bullet was inhaled which was not very old. The evolution of bronchoscopy started with rigid one but the fibreoptic bronchoscopy (FOB) has revolutionized the pulmonary interventions. The FOB can be used with minimal traumas under local anesthesia resulting in markedly reduced morbidity and mortality.
- Published
- 2019
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31. Sepsis Management in Southeast Asia: A Review and Clinical Experience
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Yatin Mehta, Rajib Paul, Raihan Rabbani, Subhash Prasad Acharya, and Ushira Kapilani Withanaarachchi
- Subjects
sepsis ,septic shock ,COVID-19 ,colistin resistance and chloramphenicol boon ,cytosorb ,Medicine - Abstract
Sepsis is a life-threatening condition that causes a global health burden associated with high mortality and morbidity. Often life-threatening, sepsis can be caused by bacteria, viruses, parasites or fungi. Sepsis management primarily focuses on source control and early broad-spectrum antibiotics, plus organ function support. Comprehensive changes in the way we manage sepsis patients include early identification, infective focus identification and immediate treatment with antimicrobial therapy, appropriate supportive care and hemodynamic optimization. Despite all efforts of clinical and experimental research over thirty years, the capacity to positively influence the outcome of the disease remains limited. This can be due to limited studies available on sepsis in developing countries, especially in Southeast Asia. This review summarizes the progress made in the diagnosis and time associated with sepsis, colistin resistance and chloramphenicol boon, antibiotic abuse, resource constraints and association of sepsis with COVID-19 in Southeast Asia. A personalized approach and innovative therapeutic alternatives such as CytoSorb® are highlighted as potential options for the treatment of patients with sepsis in Southeast Asia.
- Published
- 2022
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32. Extracorporeal blood purification strategies in sepsis and septic shock: An insight into recent advancements
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Yatin Mehta, Rajib Paul, Abdul Samad Ansari, Tanmay Banerjee, Serdar Gunaydin, Amir Ahmad Nassiri, Federico Pappalardo, Vedran Premužić, Prachee Sathe, Vinod Singh, and Emilio Rey Vela
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General Medicine - Published
- 2023
33. Value of new advanced hematological parameters in early prediction of severity of <scp>COVID</scp> ‐19
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Bhawna Jha, Shalini Goel, Manish K. Singh, Monisha Sethi, Vikas Deswal, Sushila Kataria, Yatin Mehta, and Renu Saxena
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Biochemistry (medical) ,Clinical Biochemistry ,Hematology ,General Medicine - Published
- 2023
34. Ulinastatin Add-on to Standard of Care in Critically Ill COVID-19 Patients: A Multicenter, Retrospective Study
- Author
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Yatin Mehta, Kapil Zirpe, Subhal Dixit, Abdul Ansari, Chitra Mehta, Abhijeet Deshmukh, Sourabh Ambapkar, Saanvi Ambapkar, Mukund Joshi, Ameya Joshi, Manish Bathija, and Mayur Shah
- Subjects
General Medicine - Abstract
Aim: To assess the impact on 30-day mortality with ulinastatin (ULI) used as add-on to standard of care (SOC) compared to SOC alone in coronavirus disease (COVID-19) patients requiring admission to the intensive care unit (ICU). Materials and methods: In this multicentric, retrospective study, we collected data on clinical, laboratory, and outcome parameters in patients with COVID-19. Thirty-day mortality outcome was compared among patients treated with SOC alone and ULI used as add-on to SOC. Odds ratio (OR) and 95% confidence intervals (CI) were determined to identify the predictors of 30-day mortality. Results: Ninety-four patients were identified and enrolled in both groups with comparable baseline parameters. On univariate analysis, 30-day mortality was significantly lower in ULI plus SOC group than SOC alone group (36.2 vs 51.1%, OR 0.54, 95% CI 0.30–0.97, p = 0.040). The effect on mortality was more pronounced in patients who did not require intubation (10.9 vs 34.0%, OR 0.24, 95% CI 0.09–0.66, p = 0.006) and with early administration (within 72 hours of admission) of ULI (30.7 vs 57.9%, OR 0.32, 95% CI 0.11–0.91, p = 0.032). On multivariate analysis, only intubation predicted mortality (adjusted OR 10.13, 95% CI 3.77–27.25, p
- Published
- 2023
35. Extracorporeal Membrane Oxygenation Carbon Dioxide Removal
- Author
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Poonam Malhotra Kapoor, Pranay Oza, Venkat Goyal, Yatin Mehta, and Muralidhar Kanchi
- Abstract
Protective lung ventilation is the mainstay ventilation strategy for patients on extracorporeal membrane oxygenation (ECMO), as prolonged mechanical ventilation increases morbidity and mortality; the technicalities of ventilation with ECMO have evolved in the last decade. ECMO on the other end of the spectrum is a complete or total extracorporeal support, which supplies complete physiological blood gas exchanges, normally performed by the native lungs and thus is capable of delivering oxygen (O2) and removing CO equal to the metabolic needs of the patient, it requires higher flows, is more complex, and uses bigger cannulas, higher dose of heparin and higher blood volume for priming. This review describes in detail carbon dioxide removal on ECMO.
- Published
- 2023
36. Extracorporeal Membrane Oxygenation in Cardiogenic shock – A Review
- Author
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Prajesh M. Nambiar, Jeetendra Sharma, and Yatin Mehta
- Abstract
Extracorporeal membrane oxygenation has been used in adult in cardiogenic shock due to myocardial infarction, myocardiopathy, myocarditis, or inability to come off cardiopulmonary bypass (CPB) after cardiac surgery.3 ECMO can provide partial or total support, but it is temporary. It is not a definitive treatment but a life support system that allows time for evaluation, diagnosis and treatment of the condition that causes heart failure. With high incidence of late stage coronary artery disease and infective myocarditis in India, the usage of ECMO for refractory cardiogenic shock is going to be a promising approach for effective management of refractory heat failure .ECMO has proven to be an effective therapeutic modality in managing cardiovascular collapse as a bridge to recovery or more definitive treatment options.
- Published
- 2023
37. Nosocomial Infections in Extracorporeal Membrane Oxygenation
- Author
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Chitra Mehta and Yatin Mehta
- Abstract
Extra corporeal membrane oxygenation (ECMO) has become an important modality in ICU for treating patients with severe hemodynamic and respiratory failure. It helps clinicians gain time for the primary disease to recover with definitive treatment, and aids in cardio pulmonary recovery of the patient. Most of the patients who require ECMO support are quite sick and fragile. Nosocomial infection is second most common complication after hemorrhage in ECMO patients.It affects about two-third of patients receiving ECMO. There is a lack of sufficient knowledge in this particular area. More focused efforts should be made in future to combat nosocomial infection in ECMO patients.
- Published
- 2023
38. India-discovered levonadifloxacin & alalevonadifloxacin: A review on susceptibility testing methods, CLSI quality control and breakpoints along with a brief account of their emerging therapeutic profile as a novel standard-of-care
- Author
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Balaji Veeraraghavan, Yamuna Devi Bakthavatchalam, Abi Manesh, Binesh Lal, Subramanian Swaminathan, Abdul Ansari, K. Subbareddy, Pradeep Rangappa, Anirban Hom Choudhuri, Vasant Nagvekar, Yatin Mehta, Boppe Appalaraju, Sujata Baveja, Shrikala Baliga, Suchitra Shenoy, Renu Bhardwaj, Vaishali Kongre, Gogi Suresh Dattatraya, Binita Verma, D.N. Mukherjee, Shalini Gupta, Priyadarshini Shanmugam, Jyoti Iravane, Sudhi Ranjan Mishra, Purabi Barman, Shimpi Chopra, Meenakshi Hariharan, Rajendra Surpam, Rana Pratap, Dilip Turbadkar, and Shripad Taklikar
- Subjects
Microbiology (medical) ,Infectious Diseases ,General Immunology and Microbiology ,Immunology and Microbiology (miscellaneous) ,Immunology ,Immunology and Allergy ,Microbiology - Abstract
Levonadifloxacin (intravenous) and alalevonadifloxacin (oral prodrug) are novel antibiotics based on benzoquinolizine subclass of fluoroquinolone, licensed for clinical use in India in 2019. The active moiety, levonadifloxacin, is a broad-spectrum antibiotic with a high potency against methicillin-resistant Staphylococcus. aureus, multi-drug resistant pneumococci and anaerobes.This review, for the first time, critically analyses the antimicrobial susceptibility testing methods, Clinical LaboratoryStandards Institute (CLSI)-quality control of susceptibility testing and breakpoints of levonadifloxacin. Further, the genesis, discovery and developmental aspects as well as therapeutic profile of levonadifloxacin and alalevonadifloxacin are briefly described.In order to aid the scientific and clinician communities with a single comprehensive overview on all the key aspects of levonadifloxacin and alalevonadifloxacin, the present article covers the reference MIC and disk diffusion methods for levonadifloxacin susceptibility testing that were approved by CLSI and the reference ranges for quality control strains published in the CLSI M100 document. The breakpoints of levonadifloxacin were derived in concordance to US FDA, European Committee on Antibiotic Susceptibility Testing (EUCAST) and CLSI approaches. Further, the article provides a brief account of challenges encountered during the discovery stages of levonadifloxacin and alalevonadifloxacin, activity spectrum and safety benefits accruing from structural novelty-linked mechanism of action. Further, the review also covers in vitro and in vivo activities, registrational clinical studies and patient-friendly features of levonadifloxacin/alalevonadifloxacin. Cumulatively, levonadifloxacin has a potential to offer a long awaited new standard-of-care treatment for the resistant Gram-positive bacterial infections.
- Published
- 2023
39. Risk factors for mortality over 18 years in 317 ICUs in 9 Asian countries: The impact of healthcare-associated infections
- Author
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Victor Daniel Rosenthal, Zhilin Jin, Camilla Rodrigues, Sheila Nainan Myatra, Jigeeshu Vasishth Divatia, Sanjay K. Biswas, Anjana Mahesh Shrivastava, Mohit Kharbanda, Bikas Nag, Yatin Mehta, Smita Sarma, Subhash Kumar Todi, Mahuya Bhattacharyya, Arpita Bhakta, Chin Seng Gan, Michelle Siu Yee Low, Marissa Bt Madzlan Kushairi, Soo Lin Chuah, Qi Yuee Wang, Rajesh Chawla, Aakanksha Chawla Jain, Sudha Kansal, Roseleen Kaur Bali, Rajalakshmi Arjun, Narangarav Davaadagva, Batsuren Bat-Erdene, Tsolmon Begzjav, Mat Nor Mohd Basri, Chian-Wern Tai, Pei-Chuen Lee, Swee-Fong Tang, Kavita Sandhu, Binesh Badyal, Ankush Arora, Deep Sengupta, and Ruijie Yin
- Subjects
Microbiology (medical) ,Infectious Diseases ,Epidemiology - Abstract
Objective: To identify risk factors for mortality in intensive care units (ICUs) in Asia. Design: Prospective cohort study. Setting: The study included 317 ICUs of 96 hospitals in 44 cities in 9 countries of Asia: China, India, Malaysia, Mongolia, Nepal, Pakistan, Philippines, Sri Lanka, Thailand, and Vietnam. Participants: Patients aged >18 years admitted to ICUs. Results: In total, 157,667 patients were followed during 957,517 patient days, and 8,157 HAIs occurred. In multiple logistic regression, the following variables were associated with an increased mortality risk: central-line–associated bloodstream infection (CLABSI; aOR, 2.36; P < .0001), ventilator-associated event (VAE; aOR, 1.51; P < .0001), catheter-associated urinary tract infection (CAUTI; aOR, 1.04; P < .0001), and female sex (aOR, 1.06; P < .0001). Older age increased mortality risk by 1% per year (aOR, 1.01; P < .0001). Length of stay (LOS) increased mortality risk by 1% per bed day (aOR, 1.01; P < .0001). Central-line days increased mortality risk by 2% per central-line day (aOR, 1.02; P < .0001). Urinary catheter days increased mortality risk by 4% per urinary catheter day (aOR, 1.04; P < .0001). The highest mortality risks were associated with mechanical ventilation utilization ratio (aOR, 12.48; P < .0001), upper middle-income country (aOR, 1.09; P = .033), surgical hospitalization (aOR, 2.17; P < .0001), pediatric oncology ICU (aOR, 9.90; P < .0001), and adult oncology ICU (aOR, 4.52; P < .0001). Patients at university hospitals had the lowest mortality risk (aOR, 0.61; P < .0001). Conclusions: Some variables associated with an increased mortality risk are unlikely to change, such as age, sex, national economy, hospitalization type, and ICU type. Some other variables can be modified, such as LOS, central-line use, urinary catheter use, and mechanical ventilation as well as and acquisition of CLABSI, VAE, or CAUTI. To reduce mortality risk, we shall focus on strategies to reduce LOS; strategies to reduce central-line, urinary catheter, and mechanical ventilation use; and HAI prevention recommendations.
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- 2022
40. Brain lesion in a recreational drug user: Isolated cerebral mucormycosis
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Ngoc-Tram Ha, Megan Lowery, Jean Woo, Yatin Mehta, and Nitin Bhanot
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Cerebral ,Mucormycosis ,Intravenous drug use ,Infectious and parasitic diseases ,RC109-216 - Abstract
Isolated cerebral mucormycosis is a relatively rare and unique variant of mucormycosis which is seen most commonly in patients with intravenous recreational drug use. While this invasive fungal infection in the brain is thought to spread from the sinuses or the lungs in other hosts such as diabetics and those with malignancy, hematogenous spread and seeding has been attributed in the pathogenesis of isolated cerebral mucormycosis. Clinical features and radiological findings may be non-specific and hence, heightened clinical suspicion for a prompt diagnosis and early medical and surgical intervention is paramount for a favorable outcome in such rare, but potentially fatal infections.
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- 2020
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41. Statistical analysis plan for the Pneumatic CompREssion for PreVENting Venous Thromboembolism (PREVENT) trial: a study protocol for a randomized controlled trial
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Yaseen Arabi, Fahad Al-Hameed, Karen E. A. Burns, Sangeeta Mehta, Sami Alsolamy, Mohammed Almaani, Yasser Mandourah, Ghaleb A. Almekhlafi, Ali Al Bshabshe, Simon Finfer, Mohammed Alshahrani, Imran Khalid, Yatin Mehta, Atul Gaur, Hassan Hawa, Hergen Buscher, Zia Arshad, Hani Lababidi, Abdulsalam Al Aithan, Jesna Jose, Sheryl Ann I. Abdukahil, Lara Y. Afesh, Maamoun Dbsawy, Abdulaziz Al-Dawood, and the PREVENT trial Group
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Deep vein thrombosis ,Pulmonary embolism ,Intermittent pneumatic compression ,Adjunct mechanical and pharmacologic DVT prophylaxis ,Critically-ill patients ,Medicine (General) ,R5-920 - Abstract
Abstract Background The Pneumatic CompREssion for Preventing VENous Thromboembolism (PREVENT) trial evaluates the effect of adjunctive intermittent pneumatic compression (IPC) with pharmacologic thromboprophylaxis compared to pharmacologic thromboprophylaxis alone on venous thromboembolism (VTE) in critically ill adults. Methods/design In this multicenter randomized trial, critically ill patients receiving pharmacologic thromboprophylaxis will be randomized to an IPC or a no IPC (control) group. The primary outcome is “incident” proximal lower-extremity deep vein thrombosis (DVT) within 28 days after randomization. Radiologists interpreting the lower-extremity ultrasonography will be blinded to intervention allocation, whereas the patients and treating team will be unblinded. The trial has 80% power to detect a 3% absolute risk reduction in the rate of proximal DVT from 7% to 4%. Discussion Consistent with international guidelines, we have developed a detailed plan to guide the analysis of the PREVENT trial. This plan specifies the statistical methods for the evaluation of primary and secondary outcomes, and defines covariates for adjusted analyses a priori. Application of this statistical analysis plan to the PREVENT trial will facilitate unbiased analyses of clinical data. Trial registration ClinicalTrials.gov, ID: NCT02040103. Registered on 3 November 2013; Current controlled trials, ID: ISRCTN44653506. Registered on 30 October 2013.
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- 2018
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42. Heart failure with preserved ejection fraction (HFpEF): Implications for the anesthesiologists
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Ajmer Singh and Yatin Mehta
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Diastolic dysfunction ,diastolic heart failure ,heart failure ,preserved ejection fraction ,Anesthesiology ,RD78.3-87.3 ,Pharmacy and materia medica ,RS1-441 - Abstract
Heart failure (HF) is a complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood. American College of Cardiology Foundation / American Heart Association 2013 guidelines have classified HF into two categories: (i) HF with reduced (≤40%) ejection fraction (HFrEF) or systolic HF, and (ii) HF with preserved (≥50%) ejection fraction (HFpEF) or diastolic HF. Risk factors for HFpEF include age more than 70 years, female gender, hypertension, wide pulse pressure, diabetes mellitus, chronic renal insufficiency, left ventricular hypertrophy, atrial fibrillation, smoking, recent weight gain, and exercise intolerance. Cardiac catheterization and echocardiography are used for the confirmation of diagnosis of HFpEF. Intraoperatively, the hemodynamic goals in patients with HFpEF are avoidance of tachycardia, maintenance of sinus rhythm, and maintenance of higher than usual filling pressure. No specific treatment for HFpEF is established, and therapeutic options include an intravenous diuretic, a beta blocker or calcium channel blocker, a venodilator, and management of co-morbidities.
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- 2018
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43. Ellis–Van Creveld syndrome and its anesthetic implications
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Rajesh Gupta, Sangeeta Khanna, Meera Luthra, and Yatin Mehta
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Anesthesia ,autosomal recessive ,chondroectodermal dysplasia ,disorders ,dwarfism ,Ellis–Van Creveld syndrome ,mesoectodermal dysplasia ,pediatric ,polydactyly ,Anesthesiology ,RD78.3-87.3 - Abstract
Ellis–Van-Creveld syndrome (EVC), otherwise known as chondroectodermal or mesoectodermal dysplasia, is an autosomal recessive disorder found in the Amish population of Pennsylvania in the USA, with the incidence of 1:244,000 for the general population. The classical syndrome encompasses a tetrad of clinical manifestations, including di sproportionate dwarfism, postaxial polydactyly, ectodermal dysplasia (mainly affecting the teeth, nails, and hair), and congenital heart disease (CHD). Additional involvement may occur in organs of endodermal origin, such as the pulmonary, renal, gastrointestinal (hepatic and pancreatic), hematologic, and central nervous systems. The perioperative care of a 2-year girl who underwent surgical correction of supernumerary digits is presented here.
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- 2018
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44. DIAGNOSTIC UTILITY OF EBUS TBNA IN TERTIARY CARE CENTER IN NORTH INDIA
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Kriti Sarin, Lalit Singh, and Yatin Mehta
- Abstract
https://www.worldwidejournals.com/international-journal-of-scientific-research-(IJSR)/fileview/diagnostic-utility-of-ebus-tbna-in-tertiary-care-center-in-north-india_February_2023_1565078025_9106817.pdf
- Published
- 2023
45. Sepsis Associated with Extracorporeal Membrane Oxygenation
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Aashish Jain and Yatin Mehta
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General Medicine - Abstract
Sepsis in patients on extracorporeal membrane oxygenation (ECMO) remains a serious complication. Its presence is a poor prognostic marker and increases overall mortality. Adult patients with prolonged duration on ECMO are at high risk of developing sepsis. Ventilator-associated pneumonia and bloodstream infections are the main sources of infection these patients. A strong early suspicion, drawing adequate volume for blood cultures, and early and timely administration of empirical antibiotics can help control the infection and decrease the morbidity and mortality. The diagnostic and the treatment are both challenging. Cardiac patients have increased risk of nosocomial infection while on ECMO, which may be in part due to longer cannulation times, as well as increased likelihood of undergoing major procedures or having an open chest.
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- 2022
46. The Potential Role of Extracorporeal Cytokine Removal in Hemodynamic Stabilization in Hyperinflammatory Shock
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Fatime Hawchar, Cristina Rao, Ali Akil, Yatin Mehta, Christopher Rugg, Joerg Scheier, Harriet Adamson, Efthymios Deliargyris, and Zsolt Molnar
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shock ,hemodynamic stabilization ,hemoadsorption ,cytosorb therapy ,hypeinflammation ,decatecholaminization ,Biology (General) ,QH301-705.5 - Abstract
Hemodynamic instability due to dysregulated host response is a life-threatening condition requiring vasopressors and vital organ support. Hemoadsorption with Cytosorb has proven to be effective in reducing cytokines and possibly in attenuating the devastating effects of the cytokine storm originating from the immune over-response to the initial insult. We reviewed the PubMed database to assess evidence of the impact of Cytosorb on norepinephrine needs in the critically ill. We further analyzed those studies including data on control cohorts in a comparative pooled analysis, defining a treatment effect as the standardized mean differences in relative reductions in vasopressor dosage at 24 h. The literature search returned 33 eligible studies. We found evidence of a significant reduction in norepinephrine requirement after treatment: median before, 0.55 (IQR: 0.39–0.90); after, 0.09 (0.00–0.25) μg/kg/min, p < 0.001. The pooled effect size at 24 h was large, though characterized by high heterogeneity. In light of the importance of a quick resolution of hemodynamic instability in the critically ill, further research is encouraged to enrich knowledge on the potentials of the therapy.
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- 2021
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47. Misdiagnosis of Tuberculosis
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Ayush Garg, Lalit Singh, Yatin Mehta, and Gauri Goswami
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General Medicine - Abstract
Introduction: High incidence of tubercular cases in developingcountries, similar clinical presentation of tuberculosis andmalignancy, lack of adequate infrastructure, and lack ofproper follow up are the most common factors associated withmisdiagnosis.Case Summary: A 72 years old male CAME with complainsof cough with expectoration for 2 month, intermittent feverassociated with chills and rigors for 1 month, loss of appetiteand weight, intermittent pain in right side of the chest for1 month. Patient was a known smoker and alcoholic. Onauscultation bilateral air entry was decreased with occasionalrhonchi. Patient’s chest x-ray was suggestive of consolidationin right upper zone of chest. His sputum was negative forAFB from outside, patient started on ATT, 2 months prior todate of admission from private clinic on empirical basis thatwas continued till the date of admission. Patient showed noimprovement, even after 2 months of ATT. His chest X-Ray wassuggestive of right upper zone consolidation, patient had noprior radiography for comparison. He was continued on ATTas he had already taken treatment for 2 months from outside.Patient was tested negative for sputum AFB 1 and 2, CBNAATand culture.Patient presented to emergency after a gap of two monthsin state of drowsiness with complains of breathlessness andsevere right side chest pain. He was intubated in emergencyand managed on ventilator support. Patient recovered and aCECT thorax was done suggestive of likely possibility of rightlung upper lobe neoplasm with metastatic lymphadenopathywith possibility of multiple liver and bilateral adrenal metastasisand changes of chronic airways disease with fibro bullouschanges in bilateral upper lobe apical segments. The FNACwas positive for malignant cells with features suggestive of nonsmallcell carcinoma – (possibly adenocarcinoma). Patient wasfurther managed in the department of Radiation Oncology bychemotherapy. We discuss the radiographical progression andsubsequent investigations required to make a proper diagnosis.Conclusion: It is imperative to form a conclusive diagnosisusing available diagnostic modalities in smear negativetubercular cases to avoid delay in management of otherpossible life-threatening diseases like lung carcinomas.
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- 2022
48. Deep vein thrombosis in medical and surgical Intensive Care Unit patients in a Tertiary Care Centre in North India: Incidence and risk factors
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Ashish Kumar, Yatin Mehta, Tariq Ali, Mukesh Kumar Gupta, and Joby V George
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Acute Physiology and Chronic Health Evaluation ,cardiothoracic vascular surgery ,central venous catheter ,computed tomography pulmonary angiogram ,deep vein thrombosis ,pulmonary embolism ,venous thromboembolism ,Anesthesiology ,RD78.3-87.3 ,Pharmacy and materia medica ,RS1-441 - Abstract
Background and Aims: Deep venous thrombosis (DVT) prophylaxis is underutilized, and there is a paucity of data reflecting the incidence of DVT in Indian Intensive Care Unit (ICU) population. We sought to evaluate the incidence and risk factors for DVT in medical and surgical ICU patients with DVT prophylaxis. Material and Methods: The ICU patients more than 18 years old, expected to be in the ICU for more than 48 h were enrolled and DVT prophylaxis were given as per risk and were observed for clinical signs of DVT along with duplex ultrasound until in ICU. The patients receiving anticoagulant for some other reasons were excluded along with those with pregnancy, congenital coagulation disorders and terminal illness. Results: The incidence of DVT was 0.8% (95% confidence interval: 0.78-0.81) in mixed populations (1.6% in medical and 0.5% in surgical). The higher DVT score (DVT (+) 10.75 ± 2.06/DVT (−) 8.75 ± 1.7 P = 0. 0264), Acute physiology and chronic health evaluation (APACHE) IV score (DVT positive patient - DVT (+) 59.25 ± 15.06/DVT negative patients - DVT (−) 44.01 ± 13.74) P = 0. 0292), length of ICU stay ([DVT (+) 26.75 ± 12.87 days/DVT (−) 5.19 ± 6.18] P < 0.010), and inotropes (DVT (+) 50%/DVT (−) 12.3% P = 0. 023) were associated with DVT. Conclusion: The incidence of DVT was 0.8% with prophylaxis. High DVT and APACHE IV score were associated with DVT. Prolonged ICU stay and vasopressors were the risk factors.
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- 2017
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49. Percutaneous tracheostomy
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Chitra Mehta and Yatin Mehta
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Critical care ,Intensive Care Unit ,percutaneous dilatational tracheostomy ,Anesthesiology ,RD78.3-87.3 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Percutaneous dilatational tracheostomy (PDT) is a commonly performed procedure in critically sick patients. It can be safely performed bedside by intensivists.This has resulted in decline in the use of surgical tracheostomy in intensive care unit (ICU) except in few selected cases. Most common indication of tracheostomy in ICU is need for prolonged ventilation. About 10% of patients requiring at least 3 days of mechanical ventilator support get tracheostomised during ICU stay. The ideal timing of PDT remains undecided at present. Contraindications and complications become fewer with increase in experience. Various methods of performing PDT have been discovered in last two decades. Preoperative work up, patient selection and post tracheostomy care form key components of a successful PDT. Bronchoscopy and ultrasound have been found to be useful procedural adjuncts, especially in presence of unfavorable anatomy. This article gives a brief overview about the use of PDT in ICU.
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- 2017
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50. ASSIST - Patient satisfaction survey in postoperative pain management from Indian subcontinent
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Balavenkata Subramanian, Naman Shastri, Lutful Aziz, Ramachandran Gopinath, Anil Karlekar, Yatin Mehta, Anand Sharma, Jitendra Suhas Bapat, Pradeep Jain, Aveek Jayant, Tanvir Samra, Ajantha Perera, Anil Agarwal, Vijay Shetty, Sushma Bhatnagar, Sunil T Pandya, and Paramanand Jain
- Subjects
Acute pain services ,epidural ,intravenous ,pain scores ,patient-controlled analgesia ,patient satisfaction ,Anesthesiology ,RD78.3-87.3 ,Pharmacy and materia medica ,RS1-441 - Abstract
Introduction: To compare pain scores at rest and ambulation and to assess patient satisfaction between the different modalities of pain management at different time points after surgery. Settings and Design: The ASSIST (Patient Satisfaction Survey: Pain Management) was an investigator-initiated, prospective, multicenter survey conducted among 1046 postoperative patients from India. Material and Methods: Pain scores, patient's and caregiver's satisfaction toward postoperative pain treatment, and overall pain management at the hospital were captured at three different time points through a specially designed questionnaire. The survey assessed if the presence of acute pain services (APSs) leads to better pain scores and patient satisfaction scores. Statistical Analysis: One-way ANOVA was used to evaluate the statistical significance between different modalities of pain management, and paired t-test was used to compare pain and patient satisfaction scores between the APS and non-APS groups. Results: The results indicated that about 88.4% of patients reported postoperative pain during the first 24 h after surgery. The mean pain score at rest on a scale of 1–10 was 2.3 ± 1.8 during the first 24 h after surgery and 1.1 ± 1.5 at 72 h; the patient satisfaction was 7.9/10. Significant pain relief from all pain treatment was reported by patients in the non-APS group (81.6%) compared with those in the APS (77.8%) group (P < 0.0016). Conclusion: This investigator-initiated survey from the Indian subcontinent demonstrates that current standards of care in postoperative pain management remain suboptimal and that APS service, wherever it exists, is yet to reach its full potential.
- Published
- 2017
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