A bstract Background Fluid overload is deleterious in critically ill patients. It can lead to venous congestion, thereby increasing venous pressure, theoretically increasing the backpressure, and thereby reducing renal blood flow. Venous congestion thus can be an important contributor to acute kidney injury (AKI), with no validated tools to objectively identify venous congestion bedside. Materials and methods Patients above 18 years admitted in ICU with a provisional diagnosis of cardiorenal syndrome were included in the study. Those with inadequate window, inferior vena cava (IVC) thrombus, and known case of cirrhosis with portal hypertension were excluded from the study. Patients underwent ultrasound examination with serial determination till AKI resolved or patient is initiated on dialysis. Venous excess ultrasound score (VEXUS) comprising inferior vena cava, hepatic vein waveform, and portal vein pulsatility was assessed. Results Thirty patients were enrolled for the study. The mean age was 59.53 ± 16.47 with 21 (70%) males. Mean sequential organ failure assessment (SOFA) score was 5.03 ± 1.97. Fourteen patients (46.7%) were in AKI stage 1, while eight patients (26.7%) were in AKI stage 2 and stage 3 each. Twenty patients (66.7%) had VEXUS grade III. Resolution of AKI injury showed significant correlation with improvement in VEXUS grade ( p value 0.003). Similarly, there was significant association between changes in VEXUS grade and fluid balance ( p value 0.006). There was no correlation between central venous pressure (CVP), left ventricular function, and right ventricular function with change in VEXUS grade. Conclusion The study shows that a combined grading of IVC, hepatic vein, and portal vein might reliably demonstrate venous congestion and aid in the clinical decision to perform fluid removal. How to cite this article Bhardwaj V, Vikneswaran G, Rola P, Raju S, Bhat RS, Jayakumar A, et al. Combination of Inferior Vena Cava Diameter, Hepatic Venous Flow, and Portal Vein Pulsatility Index: Venous Excess Ultrasound Score (VEXUS Score) in Predicting Acute Kidney Injury in Patients with Cardiorenal Syndrome: A Prospective Cohort Study. Indian J Crit Care Med 2020;24(9):783–789.
Background:Vitamin D which is involved in the maintenance of bone mineral homeostasis has been found to portray various pleiotropic effects. Although it has been widely accepted that serum 25-hydroxy Vitamin D level above 30 ng/ml is considered optimal for the biological actions of Vitamin D, there is a need to explore the levels of Vitamin D reported among Indians from various regions of the country. Hence, this systematic review aims to appraise the status of Vitamin D levels reported from apparently healthy Indians across various parts of India.Methodology:A comprehensive literature search was carried out to identify the range of Vitamin D levels among apparently healthy individuals from various parts of India, with the search term “Vitamin D and India” in the search portals of PubMed, Google Scholar, Indmed, and ScienceDirect. A total of 2998 articles were retrieved by the above search strategy, of which only forty studies fulfilled the criteria to be included in the systematic review. Studies done in various states were compiled under the respective zones based on the classification of Indian zones as specified in Zonal maps of India.Results:The level of Vitamin D from all the forty included studies ranged from 3.15 ± 1.4 to 52.9 ± 33.7 ng/ml. The effect size of Vitamin D level was higher in the South Zone compared to other zones.Conclusion:The present study shows that Vitamin D deficiency is prevalent among apparently healthy Indians living in different regions of India, irrespective of their exposure to sunlight.
Background: Spontaneous reporting of adverse drug reaction is globally practiced it under pharmacovigilance programme. But the major drawback of this system is underreporting. In this context the present survey was conducted, to assess the knowledge, attitude and practice of spontaneous ADR reporting among doctors and nurses in a tertiary care teaching hospital in South India. Methods: A cross-sectional questionnaire-based survey was conducted among doctors and nurses in a tertiary care teaching hospital in South India. A pre-designed and structured multiple choice questionnaire containing 19 questions was used to assess knowledge (1-9), attitude (10-14) and practice (15)(16)(17)(18)(19). The data obtained were analyzed using appropriate statistical analysis through SPPS version 19.0. Results: A total of 318 healthcare professionals participated in the study. Among them 46.2% were doctors, and 53.8% were nurses. The participants had good knowledge regarding the purpose of monitoring ADRs, type of ADRs to report, who can report, etc. They also felt reporting of ADRs is a professional obligation and all ADRs should be reported. There was no significant difference in the knowledge and attitude between doctors and nurses. The practice of ADR reporting was significantly higher in doctors compared to nurses. Conclusion:The present study indicates that majority of participants have good knowledge about local hospital based ADR monitoring. However, the transition from knowledge to practice was not adequate. ADR reporting can be further increased by improving access to ADR reporting forms, using user-friendly methods such as electronic reporting and by educational interventions targeting especially the junior healthcare professionals.Key words: Adverse drug reactions, Knowledge, Attitude and practice, Survey questionnaire. hospital in South India, involving doctors and nurses working in departments of General Medicine, Pulmonary Medicine, Pediatrics, Psychiatry, Cardiology, Neurology, Dermatology & Sexually Transmitted Disease, Endocrinology, Medical Oncology, Clinical Immunology and Nephrology. Study Instruments: The survey tool used was based on pre-designed questionnaires adopted from previous studies [14][15][16] with minor modification done according to our hospital environment. The modified questionnaire was pretested in each five participants of doctors, nurses,and suitable modifications were done before initiation of the survey. The questionnaire survey consists of demographic characteristics of participants, their knowledge of pharmacovigilance (Q no. 1-9), attitude towards ADR reporting (Q. no. 10-14), and practice of pharmacovigilance (Q. no. 15-19). After explaining the purpose of the survey, the final version of the questionnaire was distributed to the doctors and nurses during their departmental activities. The participants were given 30 mins to provide the necessary information. The response format included multiple choice questions in which the participants were asked to choose the correct answer ...
Objective: To evaluate the pattern of adverse drug reactions (ADRs) reported in cancer patients receiving anticancer drugs in an adverse drug reaction monitoring centre (AMC). Methods: The anticancer drug related ADRs received in AMC through spontaneous reporting and active surveillance methods from January 2014 to June 2016 were analyzed for demographic profile, organ system and department wise distribution of ADRs, common ADRs encountered, drugs responsible for causing ADRs, ADRs reported by healthcare professionals, number of ADR/ ADRs developed per patient and causality assessment of reported ADRs. Descriptive statistics were used for analysis and the values were expressed in numbers and percentages. Results: 2209 ADRs were reported from 1869 patients comprising of 764 males (40.88%) and 1105 females (59.12%). In our study, the most common ADRs observed were anemia (12.68%), neuropathy (11.18%) and neutropenia (6.07%). Causality assessment of ADRs by WHO-UMC causality scale revealed that 90.9% of ADRs were possible followed by 4.48% probable and 2.39% possible. The most common organ system wise classified ADRs were blood (24.22%) related reactions followed by gastrointestinal system (14.17%) related adverse effects. The most common drugs associated with ADRs were imatinib (13.94%) followed by docetaxel (9.55%), gemcitabine (8.56%) and paclitaxel (7.38%). Amidst 1869 patients, 301(13.63%) patients had developed two ADRs while 39 (1.76%) patients experienced three ADRs. Conclusion: The average ADR encountered per patient due to anticancer drug was about 1.18 in this study. Anemia, neuropathy and neutropenia were the most common ADRs reported.
BackgroundAYUSH formulations have a potential role in symptomatic treatment, preventing disease progression and improving quality of life in COVID-19 patients.ObjectiveTo study the effect of AYUSH formulation (Kabasura Kudineer tablets, Shakti drops and Turmeric plus) as an add-on treatment in patients with mild COVID - 19MethodologySingle centre, two arms, open labelled randomized controlled trial with a total of 30 patients (15 in the intervention arm and 15 in the standard care arm). Intervention arm received a combination of 3 AYUSH formulation along with the standard of care treatment for 21 days. All patients were followed for 28 days. Symptom severity (using Modified Jackson scale), negative conversion of SARS-CoV-2 RNA (using RTPCR) and quality of life (WHOWOL BREF questionnaire) was assessed.ResultsFifteen patients (93.8%) in the intervention group and twelve patients (92.3%) in the standard care arm had complete resolution of symptoms (P value= 0.36). Negative conversion for SARS-CoV-2 was seen in thirteen patients (92.9%) in intervention arm and eleven patients (100%) in standard care arm at day 28 (P value = 0.56). There was no difference in the quality of life scores between the 2 groups.ConclusionThe use of Ayush interventions as add-on therapy did not negatively impact the clinical outcomes in COVID-19. This trial confirmed the safety and tolerability of Kabasura Kudineer tablets, Shakti drops and Turmeric plus tablets when used use among mild to moderate symptom category, of COVID-19. There were no serious adverse events in the treated group. There was no clinical progression of disease from baseline status and all trial participants recovered fully by day 28. A longer follow up and a larger sample size is recommended for future definitive trials with this alternative medicine (AYUSH) combination.
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